Bouton v. USAA Casualty InsuranceBouton v. USAA Casualty Insurance
Opinion
Insurance Code section 11580.2 requires insurers to provide coverage for bodily injury or wrongful death caused by uninsured motorists. Subdivision (f) of this statute provides that if the insurer and the insured cannot agree whether the insured is legally entitled to recover damages from an uninsured motorist and the amount of such damages, those issues shall be determined by arbitration. (
We granted review in these consolidated cases to decide two related issues. The insurer in Bouton v. USAA Casualty Insurance Company opposed a demand for arbitration on the ground that the claimant was not covered by the insurance policy. We held in Van Tassel v. Superior Court (1974)
We conclude that our holding in Van Tassel cannot be reconciled with our subsequent holding in Freeman and must be overruled. Determining whether a claimant is insured under an uninsured motorist provision is not a question of the underinsured tortfeasor’s liability or damages owed to the insured, and is therefore not subject to arbitration under Insurance Code
Background
Bouton v. USAA Casualty Insurance Company
Plaintiff Lloyd Bouton was injured in an automobile accident, and settled his claim against Kevin Daniels, the driver of the other vehicle, for Daniels’s automobile insurance policy limit of $15,000. Bouton formally demanded arbitration with defendant USAA Casualty Insurance Company, his sister’s insurer, seeking damages exceeding the $15,000 policy limit payment he received from Daniels’s insurer. USAA denied coverage, claiming that Bouton was not a resident of his sister’s household, and was therefore not covered under her insurance policy.
Consistent with Insurance Code
USAA opposed Bouton’s demand for arbitration, arguing that Bouton was not covered under his sister’s policy, The trial court denied Bouton’s motion to compel arbitration, finding that because the arbitration provision of the insurance policy was no broader than
O’Hanesian v. State Farm Mutual Automobile Insurance Company
Plaintiff Charles Michael O’Hanesian was insured by defendant State Farm Mutual Automobile Insurance Company under a general insurance policy with a $100,000 limit for bodily injury, and under an umbrella policy with a $1 million limit for bodily injury. The underinsured motorist provision of the policies covered “damages for bodily injury an insured is legally entitled to collect from the owner or driver of an uninsured motor vehicle.” Following an accident, the policies required that the insured provide “all the details about the death, injury, treatment and other information” necessary to “determine the amount payable,” and “be examined by physicians chosen and paid by” the insurer.
The policies contained an arbitration provision as required by
Consistent with
O’Hanesian was injured when his car was rear-ended by Curtis Gray Thurlow’s car. O’Hanesian filed an action against Thurlow, who failed to appear after being properly served by publication. O’Hanesian submitted evidence at a bench trial regarding the extent of his injuries, and the court awarded him $2,751,000 in compensatory damages and $1 million in punitive damages. O’Hanesian made a demand on Thurlow’s insurer, and received the policy limit of $100,000.
O’Hanesian demanded payment of $900,000 from State Farm, the maximum benefit available under his underinsured motorist coverage. O’Hanesian asserted that the default judgment entered against Thurlow conclusively established damages. State Farm refused to tender the requested payment, seeking instead to informally evaluate O’Hanesian’s damages prior to tendering any money under the policy.
O’Hanesian sued State Farm for declaratory relief, breach of contract, and breach of the covenant of good faith and fair dealing, arguing that the default judgment obtained against Thurlow established his damages and he was not required to submit to State Farm’s evaluation of the dispute. State Farm demurred to O’Hanesian’s complaint, arguing that it was not bound by the declaratory judgment against Thurlow, and that O’Hanesian’s action was premature because no arbitration had occurred as required by the policies and by
The Court of Appeal held that O’Hanesian must arbitrate the issues of liability and damages with State Farm, and that the arbitrator is free to consider whether O’Hanesian’s default judgment against Thurlow conclusively established his damages. O’Hanesian sought review in this court.
We have interpreted the scope of
In Orpustan, we held that whether the plaintiff had been injured by an uninsured vehicle within the meaning of
Relying on this rationale, we held in Van Tassel that “[u]nder the statute and the provisions for arbitration contained in an uninsured motorist provision such as that in the present case, . . . jurisdictional facts, including the status of the claimant as an insured, are subject to determination by the arbitrator.” (Van Tassel, supra,
Less than one year later, we were again called upon to consider the appropriate forum for the resolution of “jurisdictional facts.” (Freeman, supra,
We held that “[t]he issue of whether the right to compel arbitration has been waived by failure to comply with the [former] one-year [statute of] limitation is clearly one for the determination of the court pursuant to the provisions of section 1281.2 of the Code of Civil Procedure.” (Freeman, supra,
We distinguished our earlier holding in Orpustan, concluding that the holding permitting arbitration in that case was “based upon the language of the insurance policy” and was consistent with prior Court of Appeal decisions regarding the physical contact rule. (Freeman, supra,
Freeman clarified the concept of “jurisdictional facts,” reasoning that the statute of limitations issue, “as opposed to others which we loosely and unfortunately termed ‘jurisdictional’ in Orpustan and in our later Van Tassel decision, is logically and legally prior to any consideration by the arbitrator of those other issues which, in the circumstances of the particular case, are a part of ‘the entirety of the controversy’ and whose determination may have the effect of precluding him from reaching the merits of the dispute. It was in this latter sense that we used the term ‘jurisdictional’ in describing those other issues—i.e., in the sense that the arbitrator’s consideration of the merits of the controversy must await his determination of them. In using this terminology, however, we in no way intended to indicate that the prior issue of waiver of the right to compel arbitration, which under the relevant statutes and the long line of decisions we have adverted to is a matter for the determination of the court upon a motion to compel arbitration, was to be swept along with those other issues into the area of arbitrative determination. While as we indicated in Orpustan and Van Tassel we favor full and complete determination by the arbitrator of matters properly submitted to him, we cannot allow our enthusiasm for the expeditious and economical disposition of such matters to intrude upon our responsibility to determine whether the right to compel arbitration has been waived through failure to seek it in a timely manner.” (Freeman, supra, 14 Cal.3d at pp. 485-486.)
Our holding in Freeman cannot be harmonized with our earlier holding in Van Tassel. In Van Tassel, we relied on the broad language in Orpustan to conclude that whether an individual was covered under her stepfather’s insurance policy constituted a “jurisdictional fact” to be arbitrated despite the parties’ agreement to arbitrate only whether an uninsured motorist was liable to the insured, and the extent of the damages, if any. (Van Tassel, supra, 12 Cal.3d at pp. 625, 627.) We indicated in Freeman that our holding in Orpustan “was an invitation to misinterpretation,” but we did not expressly overrule Van Tassel’s overly broad interpretation of the Orpustan decision. (Freeman, supra,
Applying this rule to the Bouton controversy, we hold that a court, not an arbitrator, must determine whether Bouton is insured under his sister’s policy. Whether Bouton is a covered person under the insurance policy is not a question regarding the underinsured tortfeasor’s liability to the insured, or the amount of damages. Questions of coverage—that is, whether the claimant is insured and therefore entitled to take advantage of the protection provided by the policy at issue—must be resolved before an arbitrator reaches the two arbitrable questions pursuant to
Applying this rule to the O’Hanesian controversy, we hold that it is for an arbitrator, and not a court, to decide whether the default judgment O’Hanesian obtained against the underinsured tortfeasor binds State Farm. As previously explained, O’Hanesian submitted evidence regarding the extent of his injuries arising out of his accident with an underinsured motorist at a bench trial, and the court awarded him $2,751,000 in compensatory damages and $1 million in punitive damages. The judgment pertains directly to the underinsured tortfeasor’s liability to the insured, and the amount of damages owed to the insured. The parties agreed to arbitrate, consistent with
The parties do not and cannot dispute that the policy and
An unusual feature of the O’Hanesian controversy is that both State Farm and O’Hanesian disagree with the Court of Appeal’s holding that arbitration is appropriate to determine whether State Farm is bound by the default judgment obtained against the underinsured tortfeasor. O’Hanesian argues that a court should interpret an insurance contract and
It is certainly true, as O’Hanesian and State Farm argue, that parties cannot be compelled to arbitrate a dispute if they have not agreed to do so, and no statute compels them to arbitrate. (Freeman, supra,
State Farm and O’Hanesian both also argue that permitting an arbitrator to determine whether the default judgment obtained against the underinsured motorist binds State Farm does not promote uniformity of decisions because arbitrators are free to “ ‘base their decision upon broad principles of justice and equity, and in doing so may expressly or impliedly reject a claim that a party might successfully have asserted in a judicial action.’ ” (Moncharsh v. Heily & Blase (1992)
Concerns about uniformity must also be balanced against the strong public policy favoring arbitration of disputes when the parties so agree. The “Legislature has expressed a ‘strong public policy in favor of arbitration as a speedy and relatively inexpensive means of dispute resolution.’ [Citations.] . . . Indeed, more than 70 years ago this court explained: ‘The policy of the law in recognizing arbitration agreements and in providing by statute for their enforcement is to encourage persons who wish to avoid delays incident to a civil action to obtain an adjustment of their differences by a tribunal of their own choosing.’ [Citation.] ‘Typically, those who enter into arbitration agreements expect that their dispute will be resolved without necessity for any contact with the courts.’ [Citation.]” (Moncharsh v. Heily & Blase, supra,
Finally, O’Hanesian argues that the default judgment obtained against the underinsured tortfeasor binds State Farm at least with respect to O’Hanesian’s umbrella policy, if not his general liability policy. O’Hanesian’s argument is unavailing. The umbrella policy stated that “[t]his coverage will apply in accordance with the terms and conditions of [O’Hanesian’s] underlying Uninsured Motorist Coverage.” The uninsured motorist policy included an arbitration section pursuant to 11580.2, subdivision (f). Thus, under both policies, O’Hanesian and State Farm must arbitrate all disputes concerning liability and damages arising out of an accident between O’Hanesian and an underinsured motorist.
We reverse the judgment of the Court of Appeal in Bouton v. USAA Casualty Insurance Company, and remand for further proceedings consistent with this decision. We affirm the judgment of the Court of Appeal in O’Hanesian v. State Farm Mutual Insurance Company.
George, C. J., Kennard, J., Baxter, J., Werdegar, J., Chin, J., and Corrigan, J., concurred.
The petition of respondents State Farm Mutual Automobile Insurance Company et al. for a rehearing was denied August 20, 2008.
Notes
All further statutory references are to the Insurance Code, unless otherwise indicated.