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Bits & Pieces

General Motors Corp. v. Nationwide Ins. Co.

Court of Appeals of New York.

GENERAL MOTORS ACCEPTANCE CORPORATION, et al., Respondents,

v.

NATIONWIDE INSURANCE COMPANY, Appellant.

March 31, 2005.

 

CIPARICK, J.

We are called upon to determine whether an allocation of defense costs between a primary and excess insurer is warranted. We conclude that where, as here, two coincidental primary policies exist–one excess to the other by reason of competing “other insurance” provisions–and where the excess carrier has voluntarily assumed and marshaled the insured’s defense, an allocation of defense costs based on primary policy limits is appropriate. Here the primary policy limits are identical, warranting a 50-50 split.

In 1994, John C. Sabin, not a party to this action, leased an SUV from plaintiff General Motors Acceptance Corporation (GMAC). The lease agreement required Sabin to obtain an automobile insurance policy and include GMAC as an additional insured under the policy. Sabin procured a suitable primary insurance policy through defendant Nationwide Insurance Company. This policy limited liability to $100,000 per person and $300,000 per occurrence. Nationwide’s policy made explicit that it would “defend at [its] expense, with attorneys of [its] choice, any suit against the insured.”

In order to cover its potential liability in the event the lessee failed to fulfill its obligation to obtain insurance, and to obtain excess coverage in the event of catastrophic injury, GMAC purchased two distinct policies from plaintiff Fireman’s Fund Insurance Company. Fireman’s issued both a primary “Business Auto Policy,” with liability limits comparable to Nationwide’s policy, and an “Excess Liability Policy,” or an “umbrella” policy, with a substantially greater limit of $9,000,000 per occurrence. The primary business auto policy stated that Fireman’s had “the right and duty to defend any suit asking for [ ] damages.” As to other insurance, the policy stated that the primary policy’s insurance coverage was “excess over any other collectible insurance, whether primary, excess, or contingent.” There was no similar limitation on Fireman’s duty to defend. Fireman’s true excess or umbrella policy, by contrast, specifically limited the duty to defend to instances where no primary policy or other insurance applied, stating that it would “assume charge of the settlement or defense of any claim or suit against the Insured seeking damages to which this policy applies and to which no Primary Insurance or Other Insurance applies …” (emphasis in original).

On April 5, 1995, Sabin drove his leased vehicle through an intersection, colliding with a dump truck and another passenger vehicle. Two individuals were seriously injured and a third died in the accident. The injured parties, and decedent’s estate, commenced three separate lawsuits against, among others, GMAC as owner of the offending vehicle. Jeanette Mammano, whose injuries left her in a permanent vegetative state, commenced the action that exposed GMAC to the greatest potential liability. Nationwide’s primary policy and both Fireman’s policies were in effect on the date of the accident. Prior to commencement of this action, Nationwide–reasonably expecting any award to exceed policy limits–tendered its entire policy to Mammano’s attorney in exchange for a general release. Counsel refused the tender and the case proceeded.

Nationwide originally undertook GMAC’s defense of the Mammano action. In a letter dated October 24, 1997, however, Nationwide wrote that it was tendering the defense to Fireman’s. “As our available liability limit is only $100,000 it represents only 1% of the total indemnification potential considering [Fireman’s] limits of nine million.” Nationwide further wrote that “[i]t only makes sense therefore that [Fireman’s] designate counsel that should continue with the defense of the matter, under your direction.” In a letter dated November 25, 1997, Fireman’s voluntarily agreed that it would “assume the defense of … GMAC, but it [would] do so while reserving its rights to pursue collection of all defense costs from Nationwide expended in Fireman’s Fund’s defense of these actions.” Thereafter Fireman’s retained counsel vigorously defended the action in an effort to reduce the enormous exposure of GMAC and Fireman’s.

In January 1999, the parties settled the Mammano action. The settlement agreement provided for a one-time payment of $4.5 million, of which Fireman’s paid $3.3 million and provided an annuity of $10,000 a month for life with guaranteed payments for ten years. The settlement nearly exhausted the $9.1 million limit provided under both Fireman’s policies. Nationwide contributed its entire $100,000 policy to the settlement. Prior to settling, Fireman’s amassed over $200,000 in legal fees defending the action.

Following settlement, Fireman’s sought to recover all its legal expenses from Nationwide. When Nationwide refused to contribute, Fireman’s and GMAC commenced the underlying action to recover the defense costs. Supreme Court granted plaintiffs Fireman’s and GMAC summary judgment and awarded them full reimbursement of defense costs, and the Appellate Division affirmed.. We granted defendant Nationwide leave to appeal and now reverse.

FN Supreme Court approved a total award to Fireman’s of $289,052.18, representing reasonable attorneys’ fees and costs, with statutory interest from January 1999.

A primary insurer “has the primary duty to defend on behalf of [its] insureds” (General Accident Fire & Life Assurance Corp., Ltd. v. Piazza, 4 N.Y.2d 659, 669 [1958]; see also Ostrager and Newman, Handbook on Insurance Coverage Disputes § 6.03[a] [12th Ed.] ). Moreover, a primary insurer has a duty to defend “without any entitlement to contribution from an excess insurer” (Fireman’s Ins. Co. of Washington v. Federal Ins. Co., 233 A.D.2d 193, 193 [1st Dept 1996] ). An excess carrier may, in its discretion, “protect its interest … by participating in the defense” (General Accident Fire & Life, 4 N.Y.2d at 669). Unlike a primary insurer, however, there is no obligation to do so.

We have liberally construed an insurer’s general duty to defend in order to ensure the adequate and timely investigation of a claim and defense of an insured, regardless of the insured’s ultimate likelihood of success on the merits. Consequently, an insurer’s duty to defend is broader than its duty to indemnify (see Fitzpatrick v. American Honda Motor Co., Inc., 78 N.Y.2d 61, 65-66 [1991] ).

Here, Fireman’s issued two distinct policies–a primary policy deemed excess by the competing “other insurance” provisions and a true excess, or “umbrella,” policy where the duty to defend and the duty to indemnify came into effect only after the limits of the underlying primary coverage were exhausted. Furthermore, Fireman’s accepted the defense of the action and conducted it in a most thorough manner suitable to protect its own interests and that of its insured. The circumstances of this case thus allowed both Nationwide and Fireman’s to defend the action on behalf of GMAC. Moreover, insofar as both Nationwide and Fireman’s shared this obligation, and each participated in the defense, they are both liable for the defense costs, here in equal shares as the policy limits of the coincidental primary auto liability policies are identical.

Both primary insurance policies contain specific language reaffirming their duties, as primary insurers, to defend the insured. While Fireman’s primary policy coverage is deemed “excess” by virtue of other collectible insurance, the limiting language is directed to its obligation to contribute to a settlement or judgment, not to its duty to defend. Moreover, when Nationwide tendered the defense, Fireman’s accepted and proceeded to defend the action in a manner that it deemed most appropriate–albeit reserving its rights to collect defense costs from Nationwide. In essence, Fireman’s, in accepting the defense here, embraced the specific language of its primary policy requiring it to “defend any suit asking for [ ] damages.” In assuming the defense, Fireman’s triggered its own duty to defend the action, a duty that overlapped with Nationwide’s same obligation.

Fireman’s reservation of rights put Nationwide on notice that Fireman’s acceptance did not relieve Nationwide of its policy obligations. At a minimum, Nationwide knew that it would be liable for a share of the defense costs. Consequently, insofar as the primary insurers’ respective policy limits were identical, an allocation in this case requires that the total defense costs be shared equally.

We are mindful of the fact that these policies were both coincidental primary policies. Primary insurance premiums are based, at least in part, on the insurers’ consideration that it may be liable to defend an action. In this sense, “primary” policy premiums are higher, relatively speaking, than “excess” premiums, because the primary insurer contemplates defending a potential lawsuit when it contracts with the insured. A primary insurer’s duty to defend is not diminished, however, nor is it entitled to defend an action less vigorously, simply because its policy limits are more easily exceeded in any given case. Relieving primary insurers of this duty to defend would provide a windfall to the carrier insofar as the costs of defense–litigation insurance– are contemplated by, and reflected in, the premiums charged for primary coverage. This is in contrast to a true excess, or “umbrella,” policy, where the duty to defend is not as readily triggered.

Both Fireman’s and Nationwide issued primary policies commensurate with their respective expectations and bargained-for rights and obligations. Therefore, requiring both Fireman’s and Nationwide, as coincidental primary insurers having the same policy limits, to contribute equally to defense costs is consistent with the requirement that insurance contracts be interpreted “according to the reasonable expectation and purpose of the ordinary businessman when making an ordinary business contract” (Atl. Cement Co., Inc. v Fidelity & Cas. Co. of New York, 91 A.D.2d 412, 418 [1st Dept 1983], affd 63 N.Y.2d 798 [1984] ). It is also consistent with our general reluctance to relieve a primary insurer of its duty to defend (see generally Fitzpatrick, 78 N.Y.2d 61). In this instance, it is apparent that both Fireman’s and Nationwide, by virtue of their status as primary insurers, and additionally through their course of conduct, could reasonably have expected to share the expense of the defense.

Thus, we reject Nationwide’s position, followed in only a minority of jurisdictions, that an equitable allocation between a primary and excess insurer must be realized and hold only that, under the circumstances of this case, both insurers should be required to share defense costs. Here, the policy limits of the coincidental policies lead to a 50-50 split (cf. Fed. Ins. Co. v. Atl. Natl. Ins. Co., 25 N.Y.2d 71 [1969] ).

Accordingly, the order of the Appellate Division should be reversed, with costs, and the case remitted to Supreme Court for further proceedings in accordance with this Opinion.

R.S. SMITH, J. (Concurring):

I agree with the result reached by the majority, and I agree in part with its reasoning. I think the majority is correct in rejecting a general doctrine of “equitable allocation” between primary and excess insurers. I also agree that, since Fireman’s chose to take over the defense in this case, it is liable under its policy for a fair portion of defense costs. Indeed, I think the facts here would support allocating to Fireman’s more than 50 percent of the burden, but allocations like this are not an exact science, and the majority’s 50-50 division is not unreasonable.

I differ with the majority, however, in its reliance on the existence of two “coincidental” defense policies. As the majority notes, the terms of Nationwide’s policy and Fireman’s “Business Auto Policy” render the latter “excess” with respect to the former. The relevant language in the Fireman’s Business Auto Policy–“The insurance provided by this policy is excess over any other collectible insurance, whether primary, excess, or contingent”–is on its face equally applicable to defense costs and damages. The majority seems to suggest that, as to defense costs, the Nationwide policy and the Fireman’s Business Auto Policy were both primary, but I see no valid reason for reaching that conclusion.

I believe the Fireman’s “true excess” policy, the “Excess Liability Policy”, provides a sounder basis for compelling Fireman’s to share defense costs. That policy provided nine million dollars in coverage–many times the amount provided by the other two policies. This large exposure obviously furnished the motivation for Fireman’s to assume, as it did, control of the defense of the case.

The Excess Liability Policy also gave Fireman’s the right to defend the case– at its own expense. The policy provided that Fireman’s “will have the right and opportunity, although not the obligation, to associate with the Primary Insurer in the defense and control of any claim or Suit….” The policy also provided that “[w]ith respect to any claim or Suit of which We [Fireman’s] assume charge of the settlement or defense, We will pay … All expenses We incur.”

Fireman’s did assume charge of the defense of the Mammano case, and thus it became obligated to pay the expenses it incurred. That did not release Nationwide from its own obligation under the primary policy. Nationwide’s policy excused it from defending claims only “[a]fter the limits of this coverage have been paid,” and I agree with the majority that that never occurred.

Thus, the terms of the Fireman’s Excess Liability Policy and the terms of the Nationwide policy both rendered the insurers liable for defense costs on the facts of this case. It is only these policy clauses that, in my view, make an allocation between the two insurers appropriate.

 

Order reversed, with costs, and case remitted to Supreme Court, New York County, for further proceedings in accordance with the opinion herein.

Chief Judge KAYE and Judges G.B. SMITH, GRAFFEO and READ concur. Judge R.S. SMITH concurs in result in a separate opinion in which Judge ROSENBLATT concurs.

Argo Corp. v. Greater New York Mutual

==================================================================================================================================

This opinion is uncorrected and subject to revision before

publication in the New York Reports.

—————————————————————–

The Argo Corporation, et al.,

Appellants,

v.

Greater New York Mutual Insurance

Company,

Respondent.

 

G.B. SMITH, J.:

 

The issue in this case is whether a primary insurer can disclaim coverage based

solely upon a late notice of lawsuit or must show prejudice. We hold that,

under the circumstances of this case, plaintiffs’ late notice was unreasonable

as a matter of law, that the Appellate Division correctly applied Matter of

Brandon v Nationwide Mut. Ins. Co. (97 NY2d 491 [2002]) and that the insurer

need not show prejudice.

On January 2, 1997, Igo Maidenek slipped and fell on ice on the sidewalk

adjacent to 137-01, 83rd Avenue in Kew Gardens, New York. Maidenek was a tenant

of the premises. The property was owned by Henry Moskowitz and managed by two

companies owned by Moskowitz, Argo Corporation and Martinique Realty Associates

(Argo).

On February 23, 2000, Maidenek brought suit for personal injuries against Argo

by serving a summons and complaint on the New York Secretary of State. Argo

acknowledged receipt of the summons and complaint by signing a return-receipt

dated February 28, 2000. On November 10, 2000, Argo was served with a default

judgment. On February 13, 2001, Argo received a notice of entry of the default

judgment and of the scheduling of a hearing on that judgment. On February 21,

2001, Argo received service of a note of issue for trial readiness.

Argo notified Greater New York Mutual Insurance Company (GNY), its commercial

liability insurance carrier,[1] on May 2, 2001. On June 4, 2001, GNY disclaimed

coverage because of the late notice of the lawsuit, and occurrence, which,

according to GNY, was a “condition precedent” to coverage under the insurance

policy.[2]

In January, 2003, Argo brought a declaratory judgment action against GNY

challenging GNY’s disclaimer. GNY responded with a motion to dismiss for

failure to comply with the contract provision which required timely notice to

the carrier of the occurrence and of the lawsuit against the insured. The

contract required notice “as soon as practicable.”[3]

Supreme Court agreed that defendant failed to comply with a condition precedent

to coverage under the contract, stating, “Plaintiff’s policy required them to

Asee to it that we [the insurer] are notified as soon as practicable of an

‘occurrence’ or an offense which may result in a claim. Plaintiffs did not

notify defendant of Maidenek’s suit until 14 months after service of the

complaint upon the Secretary of State as their agent, until 6 months after

service of the default motion upon plaintiffs, until more than 3 months after

default was entered and until almost 3 months after service of the Note of Issue

upon plaintiffs.” As a result, Supreme Court granted defendant’s motion to

dismiss for failure to timely notify the insurer.

The Appellate Division affirmed, stating:

“[T]he insureds are unable to provide an excuse for their failure to comply with

the policy’s notice provisions. Unlike in Matter of Brandon v Nationwide Mut.

Ins. Co., (97 NY2d 491), this is not a case where the carrier had prior notice

of the claim before the action was commenced (citations omitted).”

We granted leave to appeal and now affirm.

For years the rule in New York has been that where a contract of primary

insurance requires notice “as soon as practicable” after an occurrence, the

absence of timely notice of an occurrence is a failure to comply with a

condition precedent which, as a matter of law, vitiates the contract (see

Security Mut. Ins. Co. of NY v Acker-Fitzsimons Corp., 31 NY2d 436, 440-43

[1972]) [failure to notify in a timely manner allowed insurer to disclaim

coverage]). No showing of prejudice is required (id.). Strict compliance with

the contract protects the carrier against fraud or collusion (id.); gives the

carrier an opportunity to investigate claims while evidence is fresh; allows the

carrier to make an early estimate of potential exposure and establish adequate

reserves and gives the carrier an opportunity to exercise early control of

claims, which aids settlement (Unigard Sec. Ins. Co. v North River Ins. Co., 79

NY2d 576, 582 [1992]).

We have applied the no-prejudice rule in various contexts in recent years:

supplementary underinsured motorist insurance (SUM)(Matter of Metropolitan Prop.

& Cas. Ins. Co. v. Mancuso, 93 NY2d 487, 495-96 [1999]; cf. Matter of Brandon

and Rekemeyer v State Farm Mutual Automobile Ins. Co. _____NY_____ [decided

today]); and excess insurance (American Home Assur. Co. v International Ins.

Co., 90 NY2d 433, 442-47 [1997]). We have held, however, that the rule

enunciated in Security Mutual does not apply to reinsurance and a reinsurer must

show prejudice before it can be relieved of its obligations to perform under a

contract (Unigard Sec. Ins. Co. v North River Ins. Co., 79 NY2d 576, 582-84

[1992]).

In Matter of Brandon (Nationwide Mut. Ins. Co.)(97 NY2d 491 [2002]), we again

departed from the general “no prejudice” rule and held that the carrier must

show prejudice before disclaiming based on late notice of a lawsuit in the SUM

context (see 97 NY2d 491, 498, supra). Under the facts of Brandon, the carrier

received timely notice of claim but late notice of a lawsuit (see id. at

494-95). We were unwilling to extend the no prejudice exception in regard to

late notice of a lawsuit because “unlike most notices of claim — which must be

submitted promptly after the accident, while an insurer’s investigation has the

greatest potential to curb fraud — notices of legal action become due at a

moment that cannot be fixed relative to any other key event, such as the injury,

the discovery of the tortfeasor’s insurance limits or the resolution of the

underlying tort claim” (see id. at 498).

Brandon did not abrogate the no-prejudice rule and should not be extended to

cases where the carrier received unreasonably late notice of a claim. The facts

here, where no notice of claim was filed and the first notice filed was a notice

of law suit, are distinguishable from Brandon where a timely notice of claim was

filed, followed by a late notice of law suit, and distinguishable from

Rekemeyer, where an insured gave timely notice of the accident, but late notice

of a SUM claim. Argo was notified of the lawsuit against it in February, 2000

but did not notify GNY until May, 2001. The burden of establishing that the

delay was not unreasonable falls on the insured (see U.S. Underwriters Ins. Co.

v A&D Maja Const. Inc., 160 F Supp2d 565, 569, [SDNY 2001]).

Argo admits that Maidenek filed the lawsuit against it in late 1999, and that

it received notice of the claim in early 2000. Argo further admits that its

notice to GNY was late but argues that GNY has not shown prejudice as a result

of this late notice. Argo notified GNY 14 months after it was first served with

the lawsuit, and six months after a default judgment was entered against it.

Argo asks this court to extend the Brandon “prejudice analysis to notice of suit

in commercial policies where the notice was admittedly late.”

The rationale of the no-prejudice rule is clearly applicable to a late notice of

lawsuit under a liability insurance policy. A liability insurer, which has a

duty to indemnify and often also to defend, requires timely notice of lawsuit in

order to be able to take an active, early role in the litigation process and in

any settlement discussions and to set adequate reserves. Late notice of lawsuit

in the liability insurance context is so likely to be prejudicial to these

concerns as to justify the application of the no prejudice rule. Argo=s delay

was unreasonable as a matter of law and thus, its failure to timely notify GNY

vitiates the contract. GNY was not required to show prejudice before declining

coverage for late notice of law suit.

Accordingly, the order of the Appellate Division should be affirmed, with costs.

* * * * * * * * * * * * * * * * *

 

Order affirmed, with costs. Opinion by Judge G.B. Smith. Judges Ciparick,

Rosenblatt, Graffeo, Read and R.S. Smith concur. Chief Judge Kaye took no part.

 

 

 

Decided April 5, 2005

 

[1]Previously, “GNY issued a commercial-package insurance policy to Henry

Moskowitz that included commercial-liability insurance coverage for some 35

buildings in New York City.”

[2]”A condition precedent is >an act or event, other than a lapse of time,

which, unless the condition is excused, must occur before a duty to perform a

promise in the agreement arises=” (Oppenheimer & Co. v Oppenheimer, Appel, Dixon

& Co., 86 NY2d 685, 690 [1995][citations omitted]).

[3]Section IV–Commercial General–Liability Conditions

2.Duties in The Event of Occurrence, Offense, Claim or Suit

a. You must see to it that we are notified as soon as practicable of an

“occurrence” or an offense which may result in a claim (emphasis added). To the

extent possible, notice should include:

(1) How, when and where the “occurrence” or offense took place:

(2) The names and addresses of any injured person and witnesses; and

(3) The nature and location of any injury or damage arising out of the

“occurrence” or offense.

 

b. If a claim is made or “suit” is brought against any insured, you must:

1. Immediately record the specifics of the claim of “suit” and the date

received; and

2. Notify us as soon as practicable.

 

c. You and any other involved insured must:

1. Immediately send us copies of any demands, notices, summonses or

legal papers received in connection with the claim or “suit”;

2. Authorize us to obtain records and other information;

3. Cooperate with us in the investigation or settlement of the claim or

defense against the “suit” and;

4. Assist us, upon our request, in the enforcement of any right against

any person or organization which may be liable to the insured because of injury

or damage to which this insurance may also apply.

 

d. No insured will, except at that insured’s own cost, voluntarily make

a payment, assume any obligation, or incur any expense, other than for first

aid, without our consent.

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