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DUPLICATE COVERAGE PROHIBITION IN SUPPLEMENTAL UNINSURED UNDERINSURED MOTORIST (SUM) ENDORSEMENT NOT VIOLATED WHERE OVERALL DAMAGES EXCEED AMOUNT WHICH CAN BE RECOVERED FROM SEVERAL TORTFEASORS.

The Second Department determined the “duplicate coverage” prohibition in the supplemental uninsured/underinsured motorist (SUM) endorsement of the GEICO policy did not prevent plaintiff's widow, Maria Sherlock, from proceeding to arbitration seeking coverage under the endorsement. The driver, Maldonado, who struck and killed plaintiff's decedent had a policy with $50,000 coverage. Maldonado's insurer settled for its $50,000 limit. Because the accident occurred during a police chase and the municipality was sued, the municipality's insurer settled for $425,000.  Geico argued any recovery under the SUM endorsement would constitute prohibited duplicate coverage. Maria Sherlock argued the overall damages were in the millions and recovery of difference between the $250,000 SUM limit and the $50,000 paid out under defendant's policy would therefore not be duplicative, even taking into account the $425,000 recovery from the municipality:

The key to a proper understanding of [the duplicate coverage prohibition] is the recognition that “shall not duplicate” is not aimed at preventing an insured from seeking full compensation by combining partial recoveries from several tortfeasors, but at preventing double recoveries for their bodily injuries.

… Sherlock alleged in her request for arbitration that the bodily injury damages are in the millions of dollars. Presumably, if the Maldonado defendants' policy had contained the same $250,000 liability limit that the GEICO policy provided, … Sherlock would have been able to obtain $250,000 from the Maldonado defendants' insurer as well as the $425,000 from the [municipal] defendants' insurer. … Sherlock seeks only, through her claim under the SUM endorsement—for which she paid a premium—to be in the same position she would have been in had the Maldonado defendants not been underinsured relative to the GEICO policy. Matter of Government Empls. Ins. Co. v Sherlock, 2016 NY Slip Op 04414, 2nd Dept 6-8-16

INSURANCE LAW (DUPLICATE COVERAGE PROHIBITION IN SUPPLEMENTAL UNINSURED UNDERINSURED MOTORIST (SUM) ENDORSEMENT NOT VIOLATED WHERE OVERALL DAMAGES EXCEED AMOUNT WHICH CAN BE RECOVERED FROM SEVERAL TORTFEASORS)/SUPPLEMENTAL UNINSURED UNDERINSURED MOTORIST (SUM) ENDORSEMENT (DUPLICATE COVERAGE PROHIBITION IN SUPPLEMENTAL UNINSURED UNDERINSURED MOTORIST (SUM) ENDORSEMENT NOT VIOLATED WHERE OVERALL DAMAGES EXCEED AMOUNT WHICH CAN BE RECOVERED FROM SEVERAL TORTFEASORS)/NON-DUPLICATION PROVISION (DUPLICATE COVERAGE PROHIBITION IN SUPPLEMENTAL UNINSURED UNDERINSURED MOTORIST (SUM) ENDORSEMENT NOT VIOLATED WHERE OVERALL DAMAGES EXCEED AMOUNT WHICH CAN BE RECOVERED FROM SEVERAL TORTFEASORS)

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INSURER’S DUTY TO DEFEND MUST BE DETERMINED SOLELY UPON THE INFORMATION WITHIN THE COMPLAINT, MATTERS OUTSIDE THE COMPLAINT MUST BE RAISED IN A SUMMARY JUDGMENT MOTION OR AT TRIAL.

The First Department determined, in this declaratory judgment action, the insurer has the duty to defend the city in this slip and fall case. The fact that information which is outside the four corners of the complaint may indicate the insurer does not have the duty to defend must be raised in a summary judgment motion or at trial:

Under the circumstances presented, the City’s cross motion is granted to the extent of declaring that plaintiff is obligated to defend it in the underlying litigation. The duty of an insurer to provide a defense for its insured is “exceedingly broad,” arising “whenever the allegations of the complaint suggest. . . a reasonable possibility of coverage” … . Accordingly, “a liability insurer has a duty to defend its insured in a pending lawsuit if the pleadings allege a covered occurrence,” even if “facts outside the four corners of those pleadings indicate that the claim may be meritless or not covered” … . Thus, an insurer may be contractually bound to defend “even though it may not ultimately be bound to pay, either because its insured is not factually or legally liable or because the occurrence is later proven to be outside the policy’s coverage” … .

Here, the four corners of the complaint in the underlying action place the allegations squarely within the responsibilities of plaintiff’s insured, triggering the duty to defend. Plaintiff’s primary argument, that the accident was not within its insured’s area of responsibility, is properly made to Supreme Court in a motion for summary judgment dismissing Bari’s complaint or at trial and cannot be resolved by this Court on a motion seeking declaratory relief… . Axis Surplus Ins. Co. v GTJ Co., Inc., 2016 NY Slip Op 04106, 1st Dept 5-26-16

INSURANCE LAW (INSURER’S DUTY TO DEFEND MUST BE DETERMINED SOLELY UPON THE INFORMATION WITHIN THE COMPLAINT, MATTERS OUTSIDE THE COMPLAINT MUST BE RAISED IN A SUMMARY JUDGMENT MOTION OR AT TRIAL)/NEGLIGENCE (INSURER’S DUTY TO DEFEND MUST BE DETERMINED SOLELY UPON THE INFORMATION WITHIN THE COMPLAINT, MATTERS OUTSIDE THE COMPLAINT MUST BE RAISED IN A SUMMARY JUDGMENT MOTION OR AT TRIAL)

INSURER NOT OBLIGATED TO SATISFY JUDGMENT AGAINST ITS INSURED; INJURED PARTY FAILED TO TIMELY NOTIFY INSURER OF THE FIRE WHICH CAUSED THE DAMAGE.

The Second Department, reversing Supreme Court, determined plaintiff insurer was not required to satisfy the injured party's (Seville's) judgment against its insured because Seville did not timely notify plaintiff insurer of the fire which damaged Seville's property:

“Insurance Law § 3420(a)(2) expressly permits an injured party to recover any unsatisfied judgment against an insured, directly from the insurer” … . Insurance Law § 3420(a)(3) requires the injured party to demonstrate that he or she acted diligently in attempting to ascertain the identity of the insurer, and thereafter expeditiously notified the insurer … . “In determining the reasonableness of an injured party's notice, the notice required is measured less rigidly than that required of the insured[ ]” … . “The injured person's rights must be judged by the prospects for giving notice that were afforded him, not by those available to the insured” … . “What is reasonably possible for the insured may not be reasonably possible for the person he has injured. The passage of time does not of itself make delay unreasonable” … .

Here, the plaintiff made a prima facie showing that Seville failed to act diligently in attempting to ascertain the plaintiff's identity and in expeditiously notifying it. In opposition, Seville failed to raise a triable issue of fact … . Mt. Hawley Ins. Co. v Seville Electronics Trading Corp., 2016 NY Slip Op 03862, 2nd Dept 5-18-16

INSURANCE LAW (INSURER NOT OBLIGATED TO SATISFY JUDGMENT AGAINST ITS INSURED; INJURED PARTY FAILED TO TIMELY NOTIFY INSURER OF THE FIRE WHICH CAUSED THE DAMAGE)

UNDER OHIO LAW, CLAIMS ASSERTED IN DEMAND FOR ARBITRATION FELL WITHIN THE SCOPE OF EXCLUSIONS FOR KNOWLEDGE OF FALSITY OF STATEMENTS BY THE INSURED AND BREACH OF CONTRACT BY THE INSURED.

The First Department, in a full-fledged opinion by Justice Moskowitz, applying Ohio law, determined claims asserted in a demand for arbitration fell within the scope of exclusions for “knowledge of falsity of statements” by the insured and “breach of contract” by the insured. The insurer was therefore not obligated to pay for the arbitration defense. Allied World Natl. Assur. Co. v Great Divide Ins. Co., 2016 NY Slip Op 03603, 1st Dept 5-5-16

INSURANCE LAW (UNDER OHIO LAW, CLAIMS ASSERTED IN DEMAND FOR ARBITRATION FELL WITHIN THE SCOPE OF EXCLUSIONS FOR KNOWLEDGE OF FALSITY OF STATEMENTS BY THE INSURED AND BREACH OF CONTRACT BY THE INSURED)/EXCLUSIONS FROM COVERAGE (INSURANCE LAW, UNDER OHIO LAW, CLAIMS ASSERTED IN DEMAND FOR ARBITRATION FELL WITHIN THE SCOPE OF EXCLUSIONS FOR KNOWLEDGE OF FALSITY OF STATEMENTS BY THE INSURED AND BREACH OF CONTRACT BY THE INSURED)

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ANTISUBROGATION RULE DOES NOT APPLY TO A PARTY NOT COVERED BY THE RELEVANT POLICY.

The Court of Appeals, in a full-fledged opinion by Judge Abdus-Salaam, reversing the Appellate Division, re: claims stemming from lead paint exposure, determined the antisubrogation rule did not apply to a party, ANP, which was not covered by the relevant policy:

… [T]he antisubrogation rule is an exception to the right of subrogation … . Under that rule, “an 'insurer has no right of subrogation against its own insured for a claim arising from the very risk for which the insured was covered . . . even where the insured has expressly agreed to indemnify the party from whom the insurer's rights are derived'” … . In effect, “an insurer may not step into the shoes of its insured to sue a third-party tortfeasor . . . for damages arising from the same risk covered by the policy” … , even where there is an express subrogation agreement … . The two primary purposes of the antisubrogation rule are to avoid “a conflict of interest that would undercut the insurer's incentive to provide an insured with a vigorous defense” and “to prohibit an insurer from passing its loss to its own insured” … .  * * *

The antisubrogation rule … requires a showing that the party the insurer is seeking to enforce its right of subrogation against is its insured, an additional insured, or a party who is intended to be covered by the insurance policy in some other way … . Here, as recognized by the courts below, ANP and its predecessor were not insured under the relevant insurance policies. … Thus, the principal element for application of the antisubrogation rule — that the insurer seeks to enforce its right of subrogation against its own insured, additional insured, or a party intended to be covered by the insurance policy — is absent. Millennium Holdings LLC v Glidden Co., 2016 NY Slip Op 03543, CtApp 5-5-16

INSURANCE LAW (INSURANCE LAW, ANTISUBROGATION RULE DOES NOT APPLY TO A PARTY NOT COVERED BY THE RELEVANT POLICY)/SUBROGATION (INSURANCE LAW, ANTISUBROGATION RULE DOES NOT APPLY TO A PARTY NOT COVERED BY THE RELEVANT POLICY)/ANITSUBROGATION RULE  (INSURANCE LAW,  ANTISUBROGATION RULE DOES NOT APPLY TO A PARTY NOT COVERED BY THE RELEVANT POLICY)

NO-FAULT CARRIER DID NOT DEMONSTRATE LETTERS TO DEFENDANT SCHEDULING AN EXAMINATION UNDER OATH WERE TIMELY AND PROPERLY MAILED, CARRIER’S MOTION FOR SUMMARY JUDGMENT SHOULD HAVE BEEN DENIED.

The Second Department determined plaintiff insurance company's motion for summary judgment under the no-fault insurance law should have been denied. Plaintiff alleged defendant failed to comply with the requirement that defendant submit to an examination under oath (EUO). The Second Department determined plaintiff did not demonstrate the letters to defendant scheduling the EUO were timely and properly mailed:

Generally, “proof that an item was properly mailed gives rise to a rebuttable presumption that the item was received by the addressee” … . ” The presumption may be created by either proof of actual mailing or proof of a standard office practice or procedure designed to ensure that items are properly addressed and mailed'” … . However, for the presumption to arise, the office practice must be geared so as to ensure the likelihood that the item is always properly addressed and mailed … . “Denial of receipt by the insured[ ], standing alone, is insufficient to rebut the presumption” … .

As the defendant correctly contends, the plaintiffs failed to establish, prima facie, that they timely and properly mailed the EUO letters to the defendant. The affirmation of the plaintiffs' counsel contained conclusory allegations regarding his office practice and procedure, and failed to establish that the practice and procedure was designed to ensure that the EUO letters were addressed to the proper party and properly mailed … . Progressive Cas. Ins. Co. v Metro Psychological Servs., P.C., 2016 NY Slip Op 03485, 2nd Dept 5-4-16

INSURANCE LAW (NO-FAULT CARRIER DID NOT DEMONSTRATE LETTERS TO DEFENDANT SCHEDULING AN EXAMINATION UNDER OATH WERE TIMELY AND PROPERLY MAILED, CARRIER'S MOTION FOR SUMMARY JUDGMENT SHOULD HAVE BEEN DENIED)/NO-FAULT INSURANCE (NO-FAULT CARRIER DID NOT DEMONSTRATE LETTERS TO DEFENDANT SCHEDULING AN EXAMINATION UNDER OATH WERE TIMELY AND PROPERLY MAILED, CARRIER'S MOTION FOR SUMMARY JUDGMENT SHOULD HAVE BEEN DENIED)

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BASED UPON THE POLICY LANGUAGE, AN ALL SUMS ALLOCATION AND VERTICAL EXHAUSTION APPLY TO EXCESS INSURANCE POLICIES IN THIS ASBESTOS INJURY ACTION.

The Court of Appeals, in a full-fledged opinion by Judge Stein, determined, pursuant to the language and provisions of the relevant excess insurance policies, (1) an “all sums,” as opposed to a “pro-rata,” allocation applies, and (2) vertical, as opposed to horizontal, exhaustion of available policies applies. The underlying claims relate to asbestos exposure over a period of years in the manufacture of pumps:

[The “all sums”] theory of allocation “permits the insured to ‘collect its total liability . . . under any policy in effect during’ the periods that the damage occurred,” up to the policy limits … . The burden is then on the insurer against whom the insured recovers to seek contribution from the insurers that issued the other triggered policies … . * * *

… [V]ertical exhaustion is more consistent than horizontal exhaustion with … language tying attachment of the excess policies specifically to identified policies that span the same policy period. Further, vertical exhaustion is conceptually consistent with an all sums allocation, permitting the Insured to seek coverage through the layers of insurance available for a specific year … . Matter of Viking Pump, Inc., 2016 NY Slip Op 03413, CtApp 5-3-16

 

INSURANCE LAW (BASED UPON THE POLICY LANGUAGE, AN ALL SUMS ALLOCATION AND VERTICAL EXHAUSTION APPLY TO EXCESS INSURANCE POLICIES IN THIS ASBESTOS INJURY ACTION)/CONTRACT LAW (INSURANCE POLICIES, BASED UPON THE POLICY LANGUAGE, AN ALL SUMS ALLOCATION AND VERTICAL EXHAUSTION APPLY TO EXCESS INSURANCE POLICIES IN THIS ASBESTOS INJURY ACTION)/ALL SUMS ALLOCATION (INSURANCE POLICIES, BASED UPON THE POLICY LANGUAGE, AN ALL SUMS ALLOCATION AND VERTICAL EXHAUSTION APPLY TO EXCESS INSURANCE POLICIES IN THIS ASBESTOS INJURY ACTION)/VERTICAL EXHAUSTION  (INSURANCE POLICIES, BASED UPON THE POLICY LANGUAGE, AN ALL SUMS ALLOCATION AND VERTICAL EXHAUSTION APPLY TO EXCESS INSURANCE POLICIES IN THIS ASBESTOS INJURY ACTION)/EXCESS INSURANCE (ASBESTOS INJURY, BASED UPON THE POLICY LANGUAGE, AN ALL SUMS ALLOCATION AND VERTICAL EXHAUSTION APPLY TO EXCESS INSURANCE POLICIES IN THIS ASBESTOS INJURY ACTION)

INSURED’S EXCUSES FOR DELAY IN NOTIFYING INSURANCE BROKERS OF PENDING ACTION NOT SUPPORTED BY SUFFICIENT EVIDENCE, SUMMARY JUDGMENT IN FAVOR OF DEFENDANT BROKERS PROPERLY GRANTED.

The Second Department determined Supreme Court properly granted summary judgment in favor of the defendant-insurance-brokers who procured the policy on the plaintiff-insured's behalf. The insured did not notify the brokers of the action against the insured for 52 days. The excuses offered by the insured for the delay (complicated policy language, good-faith belief insured was not liable) were not supported by sufficient evidence:

Where an insurance policy requires an insured to provide notice ” as soon as practicable,' such notice must be accorded the carrier within a reasonable period of time. The insured's failure to satisfy the notice requirement constitutes a failure to comply with a condition precedent which, as a matter of law, vitiates the contract” … . “[T]here may be circumstances that excuse a failure to give timely notice, such as where the insured has a good-faith belief of nonliability,' provided that belief is reasonable” … . It is the insured's burden to demonstrate the reasonableness of the excuse … . “Ordinarily, the question of whether the insured had a good-faith belief in nonliability, and whether that belief was reasonable, presents an issue of fact and not one of law” … . “Nevertheless, the issue of whether an insured's excuse for the delay is reasonable may be determined as a matter of law where the evidence, construing all inferences in favor of the insured, establishes that the belief was unreasonable or in bad faith'” … . Rockland Exposition, Inc. v Marshall & Sterling Enters., Inc., 2016 NY Slip Op 03157, 2nd Dept 4-27-16


ORDINANCE OR LAW ENDORSEMENT DID NOT REQUIRE INSURER TO PAY FOR REMEDIATION OF CODE VIOLATIONS NOT RELATED TO THE COVERED DAMAGE.

The First Department, in a full-fledged opinion by Justice Saxe, determined a “Blanket Ordinance or Law Coverage Endorsement” did not cover remediation of below-code construction which was not related to the covered damage. Below-code structural concrete was discovered when covered water-related damage was being repaired. Because the below-code concrete was unrelated to the water damage, the “Law Coverage Endorsement” did not obligate the insurer to pay for remedtion of the concrete-work:

Here … the latent problem that was uncovered by inspection necessitated by the covered damage was not a problem related to the covered damage; rather, the inspection discovered a latent, unrelated problem with the building's infrastructure. The condition of the concrete slabs in plaintiff's building, which had to be repaired to bring the building into compliance with the Building Code, bore no relationship to the covered loss — the water damage … .

… The Ordinance or Law endorsement cannot be triggered simply by the discovery, in the course of an inspection necessitated by a covered event, of structural problems that amount to code violations. That is so whether the discovered condition could have been discerned earlier … or where, as here, it could not have been discovered absent the covered damage. St. George Tower v Insurance Co. of Greater N.Y., 2016 NY Slip Op 03100, 1st Dept 4-21-16


FAILURE TO DISCLAIM BASED UPON AN EXCLUSION DOES NOT GIVE RISE TO COVERAGE WHICH DOES NOT EXIST.

The Second Department noted that the loss at issue, the collapse of a retaining wall caused by run-off water, was the subject of a policy exclusion, an issue about which there was no dispute. Plaintiff argued the insurer’s disclaimer letter was ineffective because it did not identify the precise ground upon which the disclaimer was ultimately based. The Second Department, applying common law waiver and estoppel principles, rejected the argument because the failure to disclaim based upon an exclusion will not give rise to coverage which does not exist:

… [T]he defendants’ failure to specifically identify the flood and surface water exclusions in its disclaimer letter must be considered under common-law waiver and/or estoppel principles … .

Waiver, which is a voluntary and intentional relinquishment of a known right, does not apply here because “the failure to disclaim based on an exclusion will not give rise to coverage that does not exist” … . Under the principles of estoppel, an insurer, though in fact not obligated to provide coverage, may be precluded from denying coverage upon proof that the insurer “by its conduct, otherwise lulled [the insured] into sleeping on its rights under the insurance contract” … . Estoppel requires proof that the insured has suffered prejudice by virtue of the insurer’s conduct … . Because the plaintiff failed to make the requisite showing of prejudice, there was no basis to estop the defendants from relying on policy exclusions not detailed in their letter disclaiming coverage. Provencal, LLC v Tower Ins. Co. of N.Y., 2016 NY Slip Op 02644, 2nd Dept 4-6-16

INSURANCE LAW (FAILURE TO DISCLAIM BASED UPON AN EXCLUSION DOES NOT GIVE RISE TO COVERAGE WHICH DOES NOT EXIST)/DISCLAIMER (INSURANCE LAW, FAILURE TO DISCLAIM BASED UPON AN EXCLUSION DOES NOT GIVE RISE TO COVERAGE WHICH DOES NOT EXIST)EXCLUSIONS FROM INSURANCE COVERAGE (FAILURE TO DISCLAIM BASED UPON AN EXCLUSION DOES NOT GIVE RISE TO COVERAGE WHICH DOES NOT EXIST)

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