GEORGE CAMPBELL PAINTING et al., Respondents-Appellants, v NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA, Appellant-Respondent.
First Department
January 17, 2012
[937 NYS2d 164]
APPEARANCES OF COUNSEL
Sedgwick, Detert, Moran & Arnold LLP, New York City (Jeffrey M. Winn and Lawrence Klein of counsel), for appellant-respondent.
Traub Lieberman Straus & Shrewsberry LLP, Hawthorne (Lisa J. Black, Meryl R. Lieberman and Robert S. Nobel of counsel), for respondents-appellants.
OPINION OF THE COURT
FRIEDMAN, J.
Accordingly, we now hold, in agreement with the Second Department‘s decision in City of New York v Northern Ins. Co. of N.Y. (284 AD2d 291 [2001], lv dismissed 97 NY2d 638 [2001]), that
This insurance dispute arises from an occurrence during renovation work on the Henry Hudson Bridge, a structure owned by plaintiff Triborough Bridge and Tunnel Authority (TBTA). Plaintiff George Campbell Painting (Campbell) was the general contractor for the project in question, and nonparty Safespan Platform Systems, Inc. (Safespan) was a subcontractor on the project. On August 11, 2003, nonparty James Conklin, a Safespan employee, was injured when he lost his footing and fell
Under its subcontract with Campbell, Safespan was required to obtain liability insurance covering both Campbell and TBTA as additional insureds. At the time of Conklin‘s accident, Safespan had primary liability coverage, with a per-occurrence limit of $1 million, under a policy issued by Gulf Insurance Company (Gulf). Safespan also had excess liability coverage under an umbrella policy issued by defendant NUFIC, with a per-occurrence limit of $10 million excess of the $1 million limit of the underlying Gulf policy. The “Additional Insured” endorsement to the Gulf policy provided that the policy would cover “any person or organization for whom you [Safespan] are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy.” The NUFIC umbrella policy provided that it would provide excess coverage to “[a]ny person or organization . . . included as an additional insured” in the underlying Gulf policy.
In December 2003, Conklin commenced a lawsuit against Campbell and TBTA in Supreme Court, Bronx County (the Conklin action), in which he sought recovery for his injuries under the common law and
During the course of the Conklin action, Campbell/TBTA‘s counsel periodically sent status reports on the litigation to Gulf. In a status report dated August 23, 2004, counsel discussed potential damages in the case in light of the bill of particulars that Conklin had served. As pertinent to this appeal, the August 2004 status report stated:
“The plaintiff is alleging that due [to] the incident he sustained three herniated discs at L3-L4 with nerve impingement at L4-L5 and L5-S1, a bulging disc at L1-L2 as well as an internal derangement of
the shoulder. The herniation at the L3-L4 space required a spinal fusion, indicating a severe injury. “Although the plaintiff continued to work for almost a month following the incident, he claims he was confined to bed due to his injuries from September 2003 through February 2004. The plaintiff apparently is still primarily confined to home.
“Based on the plaintiffs claim that he was earning approximately $3,200 a week, his lost earnings total is currently $130,000. The future lost wage claim is $9,000,000, which seems quite inflated. It assumes that this relatively young 38 year old plaintiff will never return to any work.”
Notwithstanding that, as of August 2004, Campbell/TBTA knew from Conklin‘s bill of particulars that he was alleging “a severe injury” and was asserting a multimillion-dollar lost wages claim—which, if successful, would far exceed Safespan‘s primary insurance—NUFIC, the excess insurer, was not given notice of the claim until November 2005, more than a year later. By letter to NUFIC dated November 16, 2005, Campbell/TBTA‘s counsel advised NUFIC of the pendency of the Conklin action and brought to NUFIC‘s attention that “[Conklin‘s] attorney has recently represented that [his] damages may substantially exceed the $1,000,000 limit of liability of the [Gulf] policy.”3 Noting that NUFIC was Safespan‘s excess carrier, the November 16 letter requested that “[NUFIC], as the excess insurer of [TBTA] and [Campbell] with regard to the captioned action, participate with [Gulf] in the handling and resolution of the Conklin Action.” A copy of the Conklin complaint was enclosed with the letter.
According to NUFIC, it received the November 16 letter from Campbell/TBTA‘s counsel on November 23, 2005. A NUFIC claims adjuster responded by letter dated December 23, 2005. While the December 23 letter acknowledged the existence of “potential excess coverage for Safespan” in connection with the Conklin action, NUFIC purported to reserve all of its rights under the policy. In that regard, NUFIC raised, inter alia, the possibility that Campbell/TBTA‘s notice to NUFIC may have been untimely under the terms of Safespan‘s policy. As noted in the December 23 letter, one of the “Conditions” of the NUFIC
“[T]he policy conditions require timely notice. We note that your tender request is our first notice of this loss. It further appears [that] this matter has been in suit for approximately 2 years. However, first notice to NUFIC was not [received] until November 23, 2005. This notice may have breached the foregoing policy conditions.”
The December 23 letter requested that Campbell/TBTA provide NUFIC with the Gulf policy, “all contracts between the defendants [in the Conklin action] and our insured,” “all of counsel‘s evaluations of liability and/or damages,” and “your explanation as to why notice to us was delayed.”
By letter to Campbell/TBTA‘s counsel dated January 17, 2006, the NUFIC claims adjuster noted that NUFIC had not yet received any response to its December 23 letter. Counsel to Campbell/TBTA responded to NUFIC by letter dated January 19, 2006, enclosing (1) Safespan‘s certificate of insurance under the Gulf policy (the policy itself, the letter stated, would be “forwarded under a separate cover“), (2) the contract between TBTA and Campbell, (3) the subcontract between Campbell and Safespan, and (4) “[a] copy of our previous status reports to [Gulf] which reflect our evaluations of liability and damages.”
Among the documents transmitted to NUFIC with the January 19, 2006 letter from Campbell/TBTA‘s counsel was the aforementioned August 2004 status report. However, rather than promptly disclaim on the ground of late notice, NUFIC sent counsel for Campbell/TBTA letters dated March 20 and April 5, 2006, repeating its requests for the Gulf policy. NUFIC finally received a copy of the policy on or about May 1, 2006.
Based on the Gulf policy, NUFIC‘s claims adjuster concluded that Campbell and TBTA were, in fact, additional insureds under the NUFIC umbrella policy, which “followed form” to the Gulf policy. Nonetheless, by letter dated May 17, 2006, NUFIC rejected the claim on the ground of late notice. NUFIC‘s May 17 letter stated in pertinent part:
“In his bill of particulars, Conklin alleges a future lost wage claim of $9 million, which substantially exceeds the limits of the Gulf Policy. Conklin fur-
ther alleges severe and serious spinal injuries that required, among other things, spinal fusion surgery. This is information that was available to you no later than August 2004. However, we received first notice of the suit when we received the tender letter on November 23, 2005, almost two years after the complaint was filed on January 9, 2004. Moreover, the tender letter enclosed only the complaint, and we did not receive the August 2004 report on plaintiff‘s first bill of particulars until January 2006, more than sixteen months after you received the first bill of particulars indicating that coverage under the NUFIC Policy may be implicated. “By letter dated December 23, 2005, we responded to your tender, noting potential coverage under the NUFIC Policy and reserving rights on the basis of, among other things, late notice. We requested a copy of the Gulf Policy and an explanation as to the delay in notifying us of the lawsuit. Following our third request for the Gulf Policy, we finally received a copy on or about May 1, 2006. To date, you have not provided us with any explanation for the delay in providing notice to NUFIC.
“An insured‘s duty to notify its excess insurer arises when the insured has reason to believe that an occurrence is likely to involve excess coverage. Based on our review of the information provided to us, we conclude that NUFIC did not receive timely notice of the lawsuit; therefore, there is no coverage under the NUFIC Policy.”
About two years after NUFIC‘s May 2006 disclaimer, Conklin, Campbell/TBTA and three of Campbell/TBTA‘s insurers entered into a settlement agreement, dated July 21, 2008, resolving the Conklin action for total consideration of $5,500,000. The settlement was funded as follows: Gulf contributed its full $1 million policy limit; Campbell‘s primary insurer, American Home Insurance Company (American Home), contributed its full $1 million limit; and Campbell‘s excess insurer, Westchester Fire Insurance Company (Westchester), contributed $3.5 million. The settlement agreement provided that payment of $1 million of Westchester‘s share would not become due until July 1, 2009, and that Campbell/TBTA reserved the right to bring a declara-
Campbell/TBTA commenced this action against NUFIC in December 2008. The complaint seeks, inter alia, (1) a declaration that NUFIC‘s late-notice disclaimer was untimely under
In determining whether NUFIC‘s disclaimer was timely under
Notably, the possible basis for denial of coverage that NUFIC was investigating while withholding its late-notice disclaimer until May 17—the possibility that Campbell and TBTA were not additional insureds under Safespan‘s NUFIC policy and therefore not covered at all—would not even have been subject to
To follow the DiGuglielmo rule would be in effect to permit an insurer to delay deciding whether to disclaim on grounds known to it while pursuing an investigation of other potential grounds for disclaiming liability or denying coverage. More than 40 years ago, however, the Court of Appeals specifically rejected an insurer‘s argument that the statute (then codified as
Further, the Court of Appeals has made it abundantly clear that the determination of whether the disclaimer was issued “as soon as [was] reasonably possible” (
In view of the foregoing, adhering to the DiGuglielmo rule would be tantamount to deliberately setting aside the rule promulgated by the Court of Appeals (and flowing naturally from the language of the statute) that “once the insurer has sufficient knowledge of facts entitling it to disclaim, . . . it must notify the policyholder in writing as soon as is reasonably possible” (Jetco, 1 NY3d at 66 [emphasis added]). We decline to replace the Court of Appeals’ rule with a rule that measures the timeliness of a notice of disclaimer from the point in time when the insurer has completed its investigation of any and all possible grounds for rejecting the claim, regardless of when the insurer had sufficient knowledge to disclaim on the particular grounds relied upon.
Not surprisingly, the policy behind
“While the Legislature specified no particular pe-
riod of time, its words ‘as soon as is reasonably possible’ leave no doubt that it intended to expedite the disclaimer process, thus enabling a policyholder to pursue other avenues expeditiously. As the Legislature‘s 1975 Budget Report on the bill that ultimately became section 3420 (d) noted, the purpose ‘is to assist a consumer or claimant in obtaining an expeditious resolution to liability claims by requiring insurance companies to give prompt notification when a claim is being denied’ (30-Day Budget Report on Bills, Bill Jacket, L 1975, ch 775)” (Jetco, 1 NY3d at 68).
The Court of Appeals then rejected the argument of the insurer in Jetco that it was entitled to delay disclaiming on late-notice grounds because it had been investigating other possible sources of insurance for the policyholder. The Court explained that the insurer‘s inquiries, even if of some potential benefit to the insured, “may detrimentally delay the policyholder‘s own search for alternative coverage. When the insurer promptly disclaims coverage, the policyholder—perhaps with the aid of its own broker or insurance agent—is best motivated by its own interest to explore alternative avenues of protection” (id. at 69). The Court of Appeals’ reasoning in Jetco applies even more strongly here, where the investigation that delayed the disclaimer was NUFIC‘s exploration of other possible grounds for rejecting the claim—an inquiry manifestly undertaken by NUFIC for its own benefit, not that of the parties seeking coverage.
Moreover, just as we would not permit the insured to delay giving the insurer notice of claim while investigating other possible sources of coverage, we should not permit the insurer to delay issuing a disclaimer on a known ground while investigating other possible grounds for avoiding liability. Any uncertainty as to the existence of coverage is irrelevant to the insurer‘s ability to issue a timely disclaimer based on the insured‘s breach of a condition precedent to coverage, such as late notice of claim, that is known to the insurer. As previously discussed, such a disclaimer will not prejudice the insurer‘s ability later to take the position that no coverage exists, should that prove to be the case.
In the final analysis, NUFIC has no answer to the argument that the DiGuglielmo rule is inconsistent with the statute and relevant Court of Appeals precedent. Nor can NUFIC convincingly demonstrate any reason to allow an insurance company that knows it has grounds to reject a claim to delay giving the
Having established that NUFIC‘s disclaimer on the ground of late notice is ineffective as against Campbell and TBTA under
NUFIC contends that the excess share of the settlement is actually less than $3.5 million because, in NUFIC‘s view, coverage is available from TBTA‘s primary carrier, which has not yet made any payment in connection with the Conklin action. Specifically, NUFIC states that, during discussions aimed at resolving this matter in June 2008 (before the commencement of this action), Campbell/TBTA‘s defense counsel in the Conklin action, in response to NUFIC‘s request, produced a document referring to an insurance policy issued to TBTA by nonparty First Mutual Transportation Assurance Company (First Mutual). In his e-mail transmitting the document to NUFIC, Campbell/TBTA‘s counsel described the document as “the TBTA primary policy.” Based on this representation, NUFIC argues
Notwithstanding what their counsel told NUFIC in June 2008, Campbell and TBTA now argue that the document counsel transmitted to NUFIC at that time is not an insurance policy at all, but a reinsurance policy covering First Mutual with respect to its coverage of TBTA. In support of this position, Campbell and TBTA submitted to Supreme Court the affidavit of the Director of Risk and Insurance Management of the Metropolitan Transportation Authority (MTA) (with which TBTA is affiliated), who asserted that the document in question “is not a true and correct copy of a policy issued by [First Mutual] to TBTA. Nor does that policy provide coverage to TBTA.”
Supreme Court resolved the dispute over the alleged First Mutual policy by giving effect to the “Other Insurance” provision therein, which, in summary, states that the coverage afforded thereby is excess to any “other insurance protecting the named insured . . . [that] exists,” not including other insurance actually purchased by the named insured. Since there is no evidence that TBTA itself purchased other insurance covering its liability in the Conklin action, Supreme Court concluded that the First Mutual policy was excess to all other available coverage, meaning that First Mutual was not obligated to contribute to the settlement so long as the NUFIC and Westchester policies had not been exhausted.
On its appeal, NUFIC argues that Supreme Court‘s treatment of the First Mutual policy contravenes the rules of priority of coverage established in this Court‘s precedents (see e.g. Tishman Constr. Corp. of N.Y. v Great Am. Ins. Co., 53 AD3d 416 [2008]; Bovis Lend Lease LMB, Inc. v Great Am. Ins. Co., 53 AD3d 140 [2008]). Campbell and TBTA, while not objecting to the court‘s conclusion that First Mutual need not contribute to the settlement, have cross-appealed on the ground that the court should not have considered the alleged First Mutual policy at all.
In our view, the record is not sufficiently developed for us to render definitive rulings on the nature of the First Mutual policy (if that is what it is) and First Mutual‘s obligation, if any, to contribute to the settlement. On its face, the document in question does appear to be a reinsurance policy, although it sets forth the terms of an underlying insurance policy issued by First Mutual to the MTA and its affiliates, including TBTA. No-
Finally, NUFIC argues that Campbell and TBTA (the insureds) are no longer the real parties in interest in this matter because the agreement settling the Conklin action required Westchester to pay the final $1 million of the settlement consideration on or before July 1, 2009. In this regard, NUFIC interprets a statement in Campbell/TBTA‘s brief to the effect that Westchester “contributed $3.5 million” to the settlement as an admission that the full amount of the settlement has been paid. If the settlement has been fully paid by insurers—leaving the insureds with no actual interest in the case and making Westchester, the other excess insurer, the real party in interest—the argument that NUFIC‘s disclaimer was invalid under
An appeal is decided based on the record on which the order appealed from was rendered. There is no indication in the record on this appeal that Westchester paid the final $1 million of the settlement of the Conklin action at any time before Supreme Court entered its order granting summary judgment to Campbell/TBTA on May 21, 2009 (more than a month before the due date of the final payment under the settlement agree-
Accordingly, the order of the Supreme Court, New York County (Walter A. Tolub, J.), entered May 21, 2009, which granted plaintiffs’ motion for summary judgment and denied defendant‘s cross motion for summary judgment, should be modified, on the law, to deny plaintiffs summary judgment on the issues of defendant‘s pro rata share of the settlement of the underlying personal injury action and the dollar amount of such pro rata share, and otherwise affirmed, without costs.
SAXE, J.P., ABDUS-SALAAM and ROMÁN, JJ., concur with FRIEDMAN, J.
Order, Supreme Court, New York County, entered May 21, 2009, modified, on the law, to deny plaintiffs summary judgment on the issues of defendant‘s pro rata share of the settlement of the underlying personal injury action and the dollar amount of such pro rata share, and otherwise affirmed, without costs.
Notes
“If under a liability policy delivered or issued for delivery in this state, an insurer shall disclaim liability or deny coverage for death or bodily injury arising out of a motor vehicle accident or any other type of accident occurring within this state, it shall give written notice as soon as is reasonably possible of such disclaimer of liability or denial of coverage to the insured and the injured person or any other claimant” (emphasis added).
The 2008 amendment, in addition to redesignating the provision as section 3420 (d) (2), revised the statutory language slightly (the words “delivered or issued for delivery” were changed to “issued or delivered“).