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Policy Language Interpreted to Support Plaintiff’s Allegation the Insurer Was Timely Notified of Injured Worker’s Claim

The Fourth Department, over a two-justice dissent, reversed Supreme Court finding that the documentary evidence did not demonstrate the insurer had not been timely notified of the claim (within the meaning of the policy language) as a matter of law.  In the course of the decision, the court interpreted the policy terms “occurrence,” “claim” and “suit” as well as the phrase “see to it that defendant was notified:”

Initially, we conclude that the December 2009 letter was a notice of an “occurrence . . . which may result in a claim” and not a “claim” under the policy. The terms “occurrence,” “claim,” and “suit” are separately used in the policy, and thus each term must be ” deemed to have some meaning’ ” … . The policy defines “[o]ccurrence” as “an accident.” The term “[c]laim” is not defined in the policy, but such term has been interpreted to mean ” an assertion of legally cognizable damage,’ ” i.e., ” a type of demand that can be defended, settled and paid by the insurer’ ” … . Here, the December 2009 letter “neither makes any demand for payment nor advises that legal action will be forthcoming” … . Rather, the letter advised plaintiff that [the injured worker] had retained an attorney in connection with personal injuries he had sustained during the course of his work on the construction project, requested that plaintiff forward the letter to its insurance carrier, and warned plaintiff that failure to notify its carrier could result in a denial of coverage and “personal responsibility for any obligations that may arise” from [the] accident.

We further conclude that the January 2010 letter and form … sent to defendant at plaintiff’s request satisfied the insured’s duty under the policy to “see to it” that defendant was notified of the occurrence “as soon as practicable” …. Contrary to the court’s conclusion, the policy did not require that written notice of an occurrence come directly from plaintiff; it simply required that plaintiff “see to it” that defendant was “notified” … . Moreover, to the extent that the phrase “see to it that we are notified” is ambiguous, that ambiguity must be construed in plaintiff’s favor … .   Inasmuch as the January 2010 letter constituted notice of an “occurrence,” we conclude that the May 2010 letter constituted notice of a “claim” or “suit” based upon [the injured worker’s] April 15, 2010 commencement of the underlying action. We therefore agree with plaintiff that the court erred in dismissing the complaint against defendant inasmuch as the documentary evidence does not conclusively establish a defense to plaintiff’s claim as a matter of law… . Spoleta Constr LLC v Aspen Ins UK Ltd, 2014 NY Slip Op 05250, 4th Dept 7-11-14

 

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