Lead Opinion
The Superior Court of Athens-Clarke County granted the motion for summary judgment filed by the insured, University of Georgia Athletic Association, Inc. (“the Association”), in this insurance coverage dispute. The insurer, Fireman’s Fund Insurance Company, appeals, contending that it has no duty to defend because the claims at issue come within the ambit of both a “failure to effect or maintain insurance” exclusion and a “bodily injury” exclusion. For the reasons that follow, we affirm.
*356 Summary judgment is proper when there is no genuine issue of material fact and the movant is entitled to judgment as a matter of law. OCGA § 9-11-56 (c). A de novo standard of review applies to an appeal from a grant of summary judgment, and we view the evidence, and all reasonable conclusions and inferences drawn from it, in the light most favorable to the nonmovant.
(Citations and footnotes omitted.) BBL-McCarthy, LLC v. Baldwin Paving Co., 285 Ga. App. 494-495 (
the allegations of the complaint against the insured are ambiguous or incomplete with respect to the issue of insurance coverage. To excuse the duty to defend[,] the petition must unambiguously exclude coverage under the policy, and thus, the duty to defend exists if the claim potentially comes within the policy. Where the claim is one of potential coverage, doubt as to liability and insurer’s duty to defend should be resolved in favor of the insured.
(Citations and punctuation omitted.) Id. at 565-566.
Under Georgia law,
contracts of insurance are interpreted by ordinary rules of contract construction. . . . Where the terms are clear and unambiguous, and capable of only one reasonable interpretation, the court is to look to the contract alone to ascertain the parties’ intent. The contract is to be considered as a whole and each provision is to be given effect and interpreted so as to harmonize with the others.
(Citations omitted.) Boardman Petroleum v. Federated Mut. Ins. Co.,
[a]ny ambiguities in the contract are strictly construed against the insurer as drafter of the document; any exclusion from coverage sought to be invoked by the insurer is likewise strictly construed; and [the] insurance contract [is] to be read in accordance with the reasonable expectations of the insured where possible.
(Citations omitted.) Richards v. Hanover Ins. Co.,
The underlying complaint filed by Decory Bryant against Hoke Wilder and the Association, which triggered the Association’s claim to Fireman’s Fund, alleges the following facts. In the fall of 2003, the Association employed Wilder as its Assistant Athletic Director for Standards and New Sports Programs. In that capacity, Wilder was responsible for coordinating the Association’s Exceptional Student-Athlete Disability Insurance program. His duties included explaining the insurance program to eligible athletes, requesting disability insurance quotes for athletes interested in the insurance program, and submitting signed “Request to Place Coverage” forms to a designated insurance broker. The broker’s receipt of a signed coverage request form would bind the coverage described in the quote, subject to termination if the broker did not receive timely payment of the premium or the required medical examination report.
That fall, junior Bryant, who played football for the University of Georgia, became eligible for the disability insurance. On Tuesday, October 21, 2003, Bryant told Wilder that he wanted the disability policy. Wilder told Bryant that the papers for him to sign would be at his locker by the end of the next day. At Wilder’s request, ESIX
On Saturday, October 25, Bryant suffered a serious spinal injury while playing for his team and, as a result, is disabled for life from playing any contact sports. Representatives of the Association presented Bryant with a coverage request form to sign for the first time on October 29, 2003. After receiving the form, ESIX informed Wilder that, in the absence of proof that Bryant had reviewed the quote and signed a coverage request form prior to his injury, Lloyd’s of London refused to backdate the coverage to October 23.
On December 17,2004, Bryant filed an action against Wilder and the Association asserting claims based on theories of breach of fiduciary duties, breach of contract, and negligence for damages attributable to his lack of the disability insurance he requested. Bryant seeks compensatory damages for the amount of coverage that would have been available to him had he been insured under the Lloyd’s of London policy he requested, as well as punitive damages and attorney fees. The Association notified its liability carrier, Fireman’s Fund, of the claim and requested defense and indemnification.
After Fireman’s Fund refused to provide Wilder and the Association a defense in Bryant’s action, the Association filed this third-party action, seeking a determination that Bryant’s claim is covered by the Association’s “Non-Profit Organization Liability Insurance Policy” issued by Fireman’s Fund for the policy period of March 17, 2004 to March 17, 2005.
Among other exclusions, the policy excludes coverage for any claim “[alleging, based upon or attributable to, arising out of, in consequence of or in any way related to the Insured’s failure to effect or maintain insurance.” In addition, the policy excludes coverage for any claim “[alleging, based upon or attributable to, arising out of, in consequence of or in any way related to any Bodily Injury, provided, however, this exclusion shall not apply to an Employment Practices Claim for emotional distress, mental anguish or humiliation.” “Bodily Injury” is defined to include “sickness, injury, disease or death of any person.”
Under the policy, Fireman’s Fund has the right and duty to defend the insured, “even if any of the allegations are groundless, false or fraudulent.”
Fireman’s Fund filed a motion to dismiss the Association’s action for failure to state a claim, and the Association filed a motion for summary judgment. The trial court concluded that neither the “failure to effect or maintain insurance” exclusion nor the “bodily injury” exclusion unambiguously excluded coverage for Bryant’s claim under the Association’s liability policy, granted the Association’s motion for summary judgment and denied Fireman’s Fund’s motion to dismiss.
Bearing the applicable rules of contract interpretation in mind, we first consider whether, as Fireman’s Fund contends, the failure to effect and maintain insurance exclusion is capable of only one reasonable interpretation and is, therefore, unambiguous. The American Heritage Dictionary,
derivative action might be brought against directors and officers alleging that they had failed to maintain adequate insurance coverage — e.g., on a major plant that was destroyed by fire. Such a claim would be excluded by [the failure to maintain insurance] clause. The intention of this exclusion is to avoid making the D&O policy a substitute for the corporation’s normal liability and property insurance coverage.
Joseph F. Johnston, Jr., Corporate Indemnification and Liability Insurance for Directors and Officers, 33 Bus. Law. 1993, 2020 (1978).
In this case, taking the averments of Bryant’s complaint as true, the Association, acting through Wilder, voluntarily undertook to help student athletes like Bryant obtain disability insurance, by informing an eligible student about the coverage, communicating on the student’s behalf with an insurance broker who would solicit quotes and place the coverage, and generally facilitating the transaction by acting as a conduit between the student and the insurance broker. We are not aware of, and Fireman’s Fund has not identified, any other type of policy that a nonprofit organization would normally have which would provide coverage for this type of claim. Thus, the nonprofit organization liability policy is not being made to substitute for another kind of insurance. As a result, one could reasonably conclude that the failure to maintain insurance exclusion is limited to
Because the failure to maintain insurance exclusion is susceptible of more than one reasonable construction, it is ambiguous under Georgia law, and we must apply the applicable rules of interpretation. Hurst v. Grange Mut. Cas. Co.,
2. Fireman’s Fund contends that Bryant’s claim against the Association is “entirely predicated on his bodily injury. In other words, ‘but for’ [Bryant’s] bodily injury, his claim against [the Association] would have been unsustainable.” As a result, Fireman’s Fund contends, Bryant’s claim arises out of bodily injury to him, and, therefore, the bodily injury exclusion precludes coverage under the policy. The Association contends, on the other hand, that Bryant’s claim does not arise from bodily injury because he is not suing the
We conclude that the nexus between Bryant’s bodily injury and his claims against Wilder and the Association is too attenuated to bring his claims within the ambit of the bodily injury exclusion. No conduct of the insureds is causally related to Bryant’s bodily injury, in contrast to the cases cited in the dissent’s “but-for” analysis.
3. Because the Association’s nonprofit organization liability policy does not unambiguously exclude coverage for Bryant’s claim,
As noted above, we resolve the issue of the duty to defend by comparing Bryant’s amended complaint and the terms of the policy. We note that the issue of whether Fireman’s Fund will ultimately be liable to indemnify the Association is a separate issue from the duty to defend. Penn-America Ins. Co. v. Disabled American Veterans, Inc.,
Judgment affirmed.
Notes
See also Prudential Ins. Co. of America v. South,
Under Georgia law, “insureds ... have the same opportunity as insurers to determine in advance the scope of policy provisions.” Atlantic Wood Indus. v. Argonaut Ins. Co.,
The American Heritage Dictionary of the English Language, Fourth Edition (retrieved from www.dictionary.com).
See Mgmt. Specialists v. Northfield Ins. Co.,
See Elaine L. Johnston et al., Nuts and Bolts of Insurance: Directors’ and Officers’ Liability Media Liability, SF12 American Law Institute - American Bar Association Continuing Legal Education 363, 365 (2001).
Id. at 367.
In reaching the conclusion that the exclusion is not ambiguous, the dissent simply ignores the recognized purpose of the exclusion in D&O insurance policies.
See Stewart v. Boykin,
See Novak v. Ins. Administration Unlimited,
Jefferson Ins. Co. &c. v. Dunn,
Cf. Cotton States Mut. Ins. Co. v. Crosby,
See also Philadelphia Indem. Ins. Co. v. Maryland Yacht Club,
See Divisions 1 and 2, supra.
Dissenting Opinion
dissenting.
The University of Georgia Athletic Association, Inc. (UGAA) filed a declaratory judgment action seeking a ruling that a liability insurance policy issued to UGAA by Fireman’s Fund Insurance Company provided coverage on a claim brought against the UGAA by a former University of Georgia football player, Decory Bryant. Bryant sued the
Fireman’s Fund refused to provide coverage or a defense on this claim on the basis of two exclusions from coverage contained in its policy. The first policy provision excluded coverage “for loss in connection with any claim . . . [alleging, based upon or attributable to, arising out of, in consequence of, or in any way related to any [bjodily [i]njury....” The policy defines “Bodily Injury” as including “sickness, injury, disease or death of any person.” The second policy provision excluded coverage “for loss in connection with any claim... [a]lleging, based upon or attributable to, arising out of, in consequence of or in any way related to the Insured’s failure to effect or maintain insurance.” Because both provisions unambiguously excluded coverage, the trial court erred by granting the UGAA’s motion for summary judgment and declaring that the Fireman’s Fund policy provided coverage on the claim.
Insurance coverage is a matter of contract between the insurer and the insured, and this Court “will not strain to extend coverage where none was contracted or intended.” (Citation omitted.) Jefferson Ins. Co. &c. v. Dunn,
The decision in Cotton States,
The Fireman’s Fund policy also excluded coverage “for loss in connection with any claim . . . [ajlleging, based upon or attributable to, arising out of, in consequence of or in any way related to the Insured’s failure to effect or maintain insurance.” Bryant’s complaint against the UGAA seeking recovery for loss of the disability insurance benefits alleged that the UGAA breached a legal duty to submit the “Request to Place Coverage” form in order to “procure” the $500,000 disability insurance coverage binder for his benefit. An insurer can carry its burden of proving the applicability of a coverage exclusion by reference to the allegations in the underlying complaint against the insured, and thereby shift the burden to the insured to produce evidence creating a factual issue over whether the exclusion is applicable. First Specialty Ins. Corp. v. Flowers,
The Fireman’s Fund policy excluded coverage for loss based on the UGAA’s “failure to effect or maintain insurance,” not a failure to “effect and maintain” insurance. At issue is whether the provision excluded coverage for the UGAA’s alleged breach of a duty to “effect” insurance that would have provided Bryant with insurance benefits. Bryant does not claim that the UGAA failed to maintain or pay for disability insurance on his behalf. Rather, the allegation in his complaint was that the UGAA failed to “procure” a disability insurance binder providing coverage for him prior to his bodily injury
The existence or nonexistence of an ambiguity in the insurance contract is a question of law for the courts. Avion Systems v. Thompson,
For these reasons, I respectfully dissent.
I am authorized to state that Presiding Judge Blackburn and Judge Mikell join in this dissent.
The trial court also erred by denying the motion by Fireman’s Fund seeking dismissal of the declaratory judgment action on the basis that the claim was expressly excluded from coverage under the policy.
