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Language of Exclusion from Coverage, Including the Phrase “Arising Out Of” Was Not Ambiguous—Insurer Was Not Obligated to Defend or Indemnify Defendants

The Second Department determined the insurance policy unambiguously excluded coverage for actions stemming from the taking of property (eminent domain) and, therefore, the insurer was not obligated to defend or indemnify the defendants:

The plaintiff is an insurance carrier that insured the Village and its officials for claims arising from public officials’ wrongful acts. However, the relevant insurance policy contained an exclusion for “[a]ny injury or damage arising out of or resulting from a taking that involves or is in any way related to the principles of eminent domain, inverse condemnation . . . or dedication by adverse use or by whatever name used.”  * * *

An insurer’s contractual duty to defend is liberally construed, and is broader than the duty to indemnify … . The duty to defend ” arises whenever the allegations in a complaint state a cause of action that gives rise to the reasonable possibility of recovery under the policy'” … . “The duty to defend is not triggered, however, when the only interpretation of the allegations against the insured is that the factual predicate for the claim falls wholly within a policy exclusion” … .

Policy exclusions “are subject to strict construction and must be read narrowly” …, and any ambiguities in the insurance policy are to be construed against the insurer … . However, unambiguous provisions of insurance contracts will be given their “plain and ordinary” meaning … .

In the context of a policy exclusion, the phrase “arising out of” is unambiguous, and is interpreted broadly to mean “originating from, incident to, or having connection with” … . A “but-for” test applies to determine the applicability of an “arising out of” exclusion … . In other words, if the plaintiff in an underlying action or proceeding alleges the existence of facts clearly falling within such an exclusion, and none of the causes of action that he or she asserts could exist but for the existence of the excluded activity or state of affairs, the insurer is under no obligation to defend the action … .

Here, the plaintiff established its prima facie entitlement to judgment as a matter of law by demonstrating that the remaining claims asserted by the … defendants in the underlying federal and state-court matters all arose out of “a taking that involves or is in any way related to the principles of eminent domain, inverse condemnation . . . or dedication,” a situation that is specifically excluded from coverage by the clear and unambiguous language of the policy … . Scottsdale Indem Co v Beckerman, 2014 NY Slip Op 06071, 2nd Dept 9-10-14

 

“Temporary Substitute Vehicle” Not Excluded from Supplemental Uninsured/Underinsured Motorist Policy

The Second Department determined that the language of the policy did not exclude the driver (O’Brien) of a “temporary substitute” vehicle from coverage under the supplemental uninsured/underinsured motorist (SUM) policy.  O’Brien, an auto mechanic, was injured when returning a customer’s “loaner” car to the dealer (at the customer’s request). O’Brien was named as an additional driver on the loaner vehicle agreement:

“Generally, it is for the insured to establish coverage and for the insurer to prove that an exclusion in the policy applies to defeat coverage” … . Whether the burden of proof rests on the insured to establish coverage, or on the insurer to establish an exclusion, rests on the language of the policy (see id. ). “Where the provisions of the policy are clear and unambiguous, they must be given their plain and ordinary meaning, and courts should refrain from rewriting the agreement. The policy must, of course, be construed in favor of the insured, and ambiguities, if any, are to be resolved in the insured’s favor and against the insurer” … .

Here, State Farm bears the burden of establishing that O’Brien’s use of a “substitute temporary car” was excluded from SUM benefits. The opening language of the SUM endorsement states: “This endorsement is a part of the policy. Except for the changes it makes, all other provisions of the policy remain the same and apply to this endorsement.” Moreover, the opening language of the policy states: “We define certain words and phrases below for use throughout the policy. Each coverage includes additional definitions only for use with that coverage.” The general definition section includes a definition of “temporary substitute car,” which is to be applied throughout the policy: “Temporary Substitute Car means a car that is in the lawful possession of the person operating it and that: 1. replaces your car for a short time while your car is out of use due to its: a. breakdown; b. servicing; c. repair; d. loss; or e. destruction; and 2. neither you nor the person operating it own or have registered.”

This Court has held that the purpose of a provision relating to a “temporary substitute” vehicle “is to afford continuous coverage to the insured during the period that a vehicle scheduled under the policy is out of commission, and at the same time limit the risk to the insurer to one operating vehicle at a time for a single, fair premium. Coverage for a substitute vehicle ceases when the insured vehicle is repaired and returned to its owner” … . Here, the SUM endorsement fails to articulate any exclusion for a “temporary substitute car.” Matter of State Farm Mut Auto Ins Co v O’Brien, 2014 NY Slip Op 06096, 2nd Dept 9-10-14

 

Insurer Estopped (pursuant to Insurance Law 3420) from Disclaiming Coverage Re: Previously Incurred Defense Costs in a Personal Injury Action

The Second Department determined Insurance Law 3420(d)(2) applied and the insurer, Rutgers Casualty, was estopped from disclaiming coverage for previously incurred defense costs in connection with an underlying personal injury action:

Pursuant to Insurance Law § 3420(d), an insurance carrier is required to provide its insured and any other claimant with timely notice of its disclaimer or denial of coverage on the basis of a policy exclusion, and will be estopped from disclaiming liability or denying coverage if it fails to do so … . Although Insurance Law § 3420(d)(2) does not apply if the underlying claim does not involve death or bodily injury …, contrary to Rutgers Casualty’s contention, this provision is applicable where, as here, the coverage the defendant seeks to disclaim is for defense costs incurred in connection with an underlying personal injury action. Accordingly, the plaintiffs made a prima facie showing of their entitlement to judgment as a matter of law, inter alia, declaring that Rutgers Casualty was estopped from disclaiming insurance coverage under the Policy by submitting evidence that it failed to provide a timely written notice of this disclaimer to Key Fat, a claimant in this litigation … . In opposition, Rutgers Casualty failed to raise a triable issue of fact.  Key Fat Corp vs Rutgers Cas Ins Co, 2014 NY Slip Op 06060, 2nd Dept 9-10-14

 

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Law of Contracts, Not Law of Torts, Applied to Conflict of Laws Analysis Concerning Motor Vehicle Insurance Policy

The Second Department determined the law of contracts, as opposed to the law of torts, controlled which state law applied.  The case involved a car accident in Florida and an insurance policy issued in New York:

It is undisputed that this conflict of law question, although arising in the context of a motor vehicle accident, must be resolved by the conflict of law rules relevant to contracts, not torts … . Generally, “the courts apply the more flexible center of gravity’ or grouping of contacts’ inquiry, which permits consideration of the spectrum of significant contacts’ in order to determine which State has the most significant contacts to the particular contract dispute” … . “In general, significant contacts in a case involving contracts, in addition to the place of contracting, are the place of negotiation and performance, the location of the subject matter of the contract, and the domicile or place of business of the contracting parties” … . As to insurance contracts specifically, significance has been attached to the ” local law of the state which the parties understood was to be the principal location of the insured risk . . . unless with respect to the particular issue, some other state has a more significant relationship under the principles stated in § 6 [of the Restatement] to the transaction and the parties'” … . In the case of a noncommercial vehicle, which is by its nature mobile, the principal location of the insured risk is the place where the vehicle is to be principally garaged … .

Here, as the Supreme Court correctly noted, the insurance contract at issue was written to conform to the laws, rules and regulations of New York State, and was obtained in New York by Brand, a New York resident, from an insurance company doing business in New York. Furthermore, Brand served the demand for SUM [supplemental uninsured/underinsured motorist] arbitration upon the American Arbitration Association in New York. Applying the grouping of contacts inquiry to these facts, New York has the most significant contacts with the parties and the contract. Indeed, such a conclusion would be in conformity with the reasonable expectations of the contracting parties. Matter of Unitrin Direct/Warner Ins co v Brand, 2014 NY Slip Op 05887, 2nd Dept 8-20-14

 

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Term “Entrustment” in a Policy Exclusion (In the Context of Entrustment of Property to Another) Interpreted to Encompass Entire Leased Premises

The First Department determined that preclusion of coverage for “dishonest or criminal acts” committed by persons to whom the subject property was “entrusted” encompassed the removal of fixtures from premises leased by the insured:

Plaintiffs leased the insured premises to a tenant, which converted the premises into a youth hostel, removed the kitchen cabinets and appliances to turn the kitchens into additional dormitory areas, and, when the hostel closed, did not return the cabinets or appliances … . Plaintiffs argue that the term “entrustment” in the policy pertains solely to chattels and not to fixtures … . However, in Abrams v Great Am. Ins. Co. (269 NY 90, 92 [1935]), the Court of Appeals explained that an insurance contract’s language “must be given its ordinary meaning,” and “common words” in a policy such as entrusted are not “used as words of art with legalistic implications” (id.). Accordingly, Abrams taught, when a contract indicates that the property is entrusted, it can be understood that the parties mean that possession of property is willingly “surrender[ed] or deliver[ed] or transfer[red],” to be “used for the purpose intended by the owner . . . . The controlling element is the design of the owner rather than the motive of the one who obtained possession” (id.). Here, we find that the terms of the policy at issue do not limit what can be entrusted, that property may be entrusted to another under a triple net lease agreement, and that the entrustment refers to the entirety of the premises unless otherwise specified.  Lexington Park Realty LLC v National Union Fire Ins Co of Pittsburgh PA, 2014 NY Slip Op 05817, 8-14-14

 

Denial of “Defective” No-Fault Claim (on Form UB-40) Was of No Effect—Failure to Respond Within 30 Days to a Subsequent “Correct” Claim (on Form NF-5) Precluded Insurer from Raising Defenses to the Claim

The Second Department determined the insurer’s denial of a defective claim was of no effect and the insurer’s failure to respond to the valid claim within 30 days precluded raising defenses to the claim:

[The insurer] contends that the 30-day period commenced when it received the Form UB-04 in December 2011, that it timely requested verification of the claim, and that, after it received the medical records, it timely denied the claim in January 2012. [the hospital] could not commence the 30-day clock anew by submitting the same claim several months later … .

We conclude that the Supreme Court erred in denying [the hospital’s] motion for summary judgment on the complaint and in granting [the insurer’s] cross motion for summary judgment dismissing the complaint. Under our decision in Sound Shore [106 AD3d 157], the 30-day period for [the insurer] to pay or deny the claim did not begin to run until March 26, 2012, when [the hospital] submitted the Form NF-5, which contained the information needed. Because [the insurer] did not pay or deny the claim within 30 days thereafter, it was precluded from raising defenses. In other words, the defective “claim” submitted in December 2011 did not start the 30-day clock, so [the insurer’s] denial in January 2012 was of no effect … . Mount Sinai Hosp v New York Cent Mut Fire Ins Co, 2014 NY Slip Op 05779, 2nd Dept 8-13-14

 

Supplemental Uninsured/Underinsured Motorist (SUM) Provision Triggered When an Individual Would Be Afforded More Coverage by the Policy with the SUM Provision

The Second Department determined that the supplementary uninsured/underinsured motorist (SUM) provision was triggered when the policy with the provision (the GEICO policy) had a $300,000 single limit liability and the policy which paid out the claim (the Allstate policy) was a “split limit” policy with a $300,000 per accident limit and a $100,000 per person limit. The injured party was paid the $100,000 limit under the Allstate policy:

Benefits under a SUM policy, when SUM coverage is purchased at the option of the insured, are available “if the limits of liability under all bodily injury liability bonds and insurance policies of another motor vehicle liable for damages are in a lesser amount than the bodily injury liability insurance limits of coverage” provided by the insured’s policy (Insurance Law § 3420[f][2][A]…). “The necessary analytical step, then, is to place the insured in the shoes of the tortfeasor and ask whether the insured would have greater bodily injury coverage under the circumstances than the tortfeasor actually has” … . The determination of whether SUM benefits are available “requires a comparison of each policy’s bodily injury liability coverage as it in fact operates under the policy terms applicable to that particular coverage” … . “Only by doing that comparison is it possible to make the required determination: whether the tortfeasor has less bodily injury liability coverage than the insured” … .

Here, a comparison of the two policies at issue, in light of the particular circumstances of this case, demonstrates that an individual … would be afforded greater per-person bodily liability injury coverage under the GEICO policy than under the Allstate policy. Matter of Government Empls Ins Co v Lee, 2014 NY Slip Op 05642, 2nd Dept 8-6-14

 

Disclaimer of Coverage Unreasonably Untimely as a Matter of Law

The Second Department determined the defendant insurer’s disclaimer of coverage was unreasonably untimely as a matter of law:

An insurance company has an affirmative obligation to provide written notice of a disclaimer of coverage as soon as is reasonably possible, even where the policyholder’s own notice of the claim to the insurer is untimely … . Here, the defendant learned by January 6, 2012, at the latest, about the underlying personal injury action. The defendant was aware by that date of the grounds for disclaimer of coverage … . Nevertheless, it did not disclaim coverage until March 28, 2012, almost three months later, a delay that, under the circumstances of this case, is unreasonable as a matter of law … . Darling Ferreira v Global Liberty Ins Co of NY, 2014 NY Slip Op 05409, 2nd Dept 7-23-14

 

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Action Against Broker for Failure to Procure Correct Coverage Should Not Have Been Dismissed/Question of Injured Worker’s Employment Status Must First Be Determined by the Workers’ Compensation Board

The Second Department determined that a cause of action alleging the insurance broker (Crystal) failed to purchase adequate insurance in response to a request from the insured (Mariani) should not have been dismissed.  The insured’s worker was injured on the job and the insurer disclaimed coverage because the policy did not cover subcontractors.  The Second Department also determined that it was up to the Workers’ Compensation Board to first determine the injured worker’s employment status and Supreme Court should not inject itself into that question until the Board acts:

“An insurance agent or broker . . . may be held liable under theories of breach of contract or negligence for failing to procure insurance . . . An insured must show that the agent or broker failed to discharge the duties imposed by the agreement to obtain insurance, either by proof that it breached the agreement or because it failed to exercise due care in the transaction” … . Crystal was not entitled to judgment as a matter of law because it failed to establish, prima facie, that it procured the adequate coverage that Mariani had engaged it to procure … . Siekkeli v Mark Mariani Inc, 2014 Slip Op 05319, 2nd Dept 7-16-14

 

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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