Lead Opinion
Whether or not the plaintiff’s petition presented an issue as to the defendant insurance company’s obligation, under its insurance contract, to defend the claim and suits brought against the plaintiff is the only question before us. The contract provision in question is the following: “With respect to such insurance as is afforded by this policy for bodily injury liability and for property damage liability, the company shall (a) defend any suit against the insured alleging such injury, sickness, disease or destruction and seeking damages on account thereof, even if such suit is groundless, false or fraudulent, but the company may make such investigation, negotiation and settlement of any claim or suit as it deems expedient.” Similar or identical provisions are contained in most liability insurance policies. 7A Appleman, Insurance Law & Practice, 428, § 4682; 50 ALR2d 458, 461, 463.
In the usual case the facts alleged in the complaint brought against the insured and the trae facts relating to coverage or non-coverage will be the same, so that there will be no dispute Whether the insured’s liability is covered by the policy and whether the insurer has a duty to defend. Dispute has often arisen, however, when a complaint against the insured shows false facts within the coverage of the policy, but the true facts, of which the insurer has knowledge from information furnished by the insured or from its own investigation, are not within coverage. The insurer must defend these suits for the reason that it has expressly obligated itself to do so by the insurance contract containing the common provision that the insurer will defend even groundless, false or fraudulent suits. McGettrick v. Fidelity &c. Co. of N. Y., 264 F2d 883, 886 (2d Cir. 1959); Bloom-Rosenblum-Kline Co. v. Union Indem. Co.,
Webster’s New International Dictionary defines “groundless” as “without ground or foundation, wanting cause or reason for support.” The groundless suit which the insurer undertakes to defend is a suit containing unsupportable allegations which on their face show coverage by the policy of the liability asserted against the insured for “damages because of bodily injury, sickness or disease, including death at any time resulting therefrom, sustained by any person,” or “because of injury or destruction of property, including the loss of use thereof, caused by accident and arising out of the ownership, maintenance and use of the automobile.” Whether or not the insured could be liable to the injured claim'ant under the true facts is not determinative of the groundlessness of the suit. For example, a suit is brought alleging injury and damage arising out of the use of the insured automobile. In truth the automobile involved was another automobile owned by the insured and not covered by the policy. This is a groundless suit because the allegations show coverage, even though the insured may, or may not, be personally liable under the trae facts. Another example: The injured plaintiff alleges that the insured automobile was being driven by the wife of the insured, thus showing that the insured’s liability is covered by the policy. In truth the automobile was being driven by an employee in the insured’s business, under which facts the insured’s liability is excluded. This is a groundless suit in contemplation of the insurance contract. “But a distinction must be drawn between groundless suits and actions which, even if successful would not be within the policy coverage.” 7A Apple-man, Op. cit. 448, '§ 4684. A claim based on true facts not within coverage is not groundless within the meaning of the policy, but simply one for which liability insurance is not afforded and which the insurer did not undertake to defend (though the insured may be liable.)
Much rarer than actions involving “groundless” suits are the cases in which the insured seeks recovery for the expenses of defending a suit on the ground that the known or ascertainable
As to the defense of a suit alleging untrue facts showing non-coverage, when the known or ascertainable facts are within coverage, the contract is ambiguous as to the rights and duties between the insured and the insurer. In such a case, “the rights of the parties must be determined by fairly construing the insurance contract in such a way as to carry out its intended purpose.” McGettrick v. Fidelity &c. Co. of N. Y., 264 F2d 883, 886, supra. The dubiousness of asserting the non-ambiguity of the contract provision in issue is well illustrated by the lack of agreement among the decisions throughout the country on this problem. 7A Appleman, Op. cit. 442-443, § 4683; 29A Am. Jur. 567, § 1454; 50 ALR2d 458, 497. Fairly construing the provision in question in light of the objects of the policy, We do not believe that the intent of the parties was to allow the insurer to ignore the true facts and to place the burden on the insured to enter into the defense of the suit to prove coverage already known to the insurer.
Liability insurance policies are usually prepared, as was the one in the present case, on a form contract which describes several coverages, each designated by a letter and descriptive words and each limited by a stated maximum amount of liability. Each individual policy is issued on the printed form for the coverages for which a premium is written in. Thus an individual policy will effect one or more coverages to the insured. The language “With respect to such insurance as is afforded by this policy for bodily injury liability and for property damage liability, the company shall (a) defend any suit against the insured alleging such injury, sickness, disease or destruction and seeking damages on account thereof, . . .” is a part of the form of contract upon which the coverages to the individual insured are to be filled in. It must be considered in this light to mean, “If this policy is issued for, or affords in
We must assume that the insurer’s undertaking to defend was intended to afford benefits to the insured. The undertaking to defend suits alleging facts within coverage, even though groundless, will benefit the insured only if he is sued for a sum in excess of the policy limits. Without such an express undertaking the insurer will defend suits, groundless or not, up to the limits of the policy to protect itself from an excessive or default judgment against the insured, which it would be liable to pay. But when untrue facts are alleged in the complaint showing an exclusion from coverage, the insurer need not defend in its own interest, as it would not be liable for a judgment based upon these untrue facts. Hence its undertaking to defend will be of definite benefit to the insured sued by such a complaint when the true facts are within coverage. We may reasonably presume that the undertaking to defend “with respect to the insurance afforded by this policy” was intended to give the insured this benefit—to defend suits when the policy affords insurance according to the true facts.
If the insurer intended otherwise, it could have made its intent clear and unmistakable by undertaking to defend “unless the complaint alleges facts which show the claim to be excluded from coverage,” or by using other unambiguous language, for example: “The company shall defend claims and suits, groundless or otherwise, for which it may become liable only when the allegations thereof show injury covered by the policy and do not show the claim to be excluded by the policy.”
The rule of thumb that has been enunciated in cases where the complaint against the insured alleges untrue facts showing the insured’s liability or coverage by the policy—that the insurer’s obligation to defend is to be determined by the allegations of the complaint (See 50 ALR2d 458, 463)—upholds the insurer’s explicit undertaking to defend groundless, false or fraudulent suits. McGettrick v. Fidelity &c. Co. of N. Y., 264 F2d 883,
We cannot accept the contention that the allegations of the complaint alone determine the duty to defend in this class of cases.
The burden is on the insurer to show that a loss or claim comes within an exception to coverage. Pilgrim Health &c. Ins. Co. v. Gormley,
An insurance policy is a “contract of adhesion,” prepared by legal draftsmen to be accepted by daymen. Patterson, The Delivery of a Life Insurance Policy, 33 Harv. L. Rev. 198, 222 (1919); See Schultz, The Special Nature of the Insurance Contract, 15 Law & Contemporary Prob. 376 (1950). Such a contract should be construed as reasonably understood by the insured. Royal Indem. Co. v. McClatchey,
The Pennsylvania court in Wilson v. Maryland Cas. Co.,
The defendant contends in effect that its obligation must depend uniformly on either the true facts or the allegations of the complaint, and that because the insurer is bound to defend a suit falsely alleging a claim covered by the policy, therefore it is excused from defending a suit alleging facts not covered, whether false or not. “The conclusion ... is a non sequitur.” McGettrick v. Fidelity &c. Co. of N. Y., 264 F2d 883, 886, supra. The duty 'to defend in the former instance is
We recognize that some courts in other jurisdictions have taken the opposite view (Wilson v. Maryland Cas. Co.,
Our decision is not out of line with Morgan v. New York Cas. Co.,
In many cases, where the facts alleged in the complaint and the true facts are not in conflict, and where the complaint falsely alleges facts within coverage, but the insurer, with the duty to defend groundless suits, has knowledge of the true facts not within coverage, a correct result has been reached by holding that the allegations of the complaint determine the duty to defend. 50 ALR2d 458, 463. These cases are compatible with this decision.
The facts alleged by the plaintiff do not as a matter of law show that the defendant had no obligation to defend the alleged claim. The trial court erred in sustaining the defendant’s general demurrer.
Judgment reversed.
Dissenting Opinion
dissenting. The policy provision as to duty to defend is plain and unambiguous. It is: “With respect to such insurance as is afforded by this policy for bodily injury liability and for property damage liability, the company shall (a) defend any suit against the
The decisions are overwhelming to the effect that under such a policy the company is bound to defend if the allegations of the suit against the insured show policy coverage, and it makes no difference whether the company knows true facts which make the case groundless or fraudulent. The agreement to defend groundless or fraudulent actions where the suit shows coverage is superfluous as there would be a duty to defend even groundless suits if the suits showed coverage. If knowledge of the true facts does not relieve the insurance company of the duty to defend in such a case we cannot see why it would obligate the insurance company to defend where the suit did not show coverage. It did not agree to do so and the contract cannot be so construed. In McGettrick v. Fidelity &c. Co. of N. Y., 264 F2d 883, 886, it is stated that in cases alleging facts not covered by the policy there is no express agreement as to the duty to defend and that the rights of the parties must be determined by fairly construing the insurance contract in such a way as to carry out its intended purpose. This is the primary fallacious rationale in the majority opinion. The court stated in McGettrick v. Fidelity &c. Co. of N. Y.: “The conclusion that because the insurance company is bound to defend a suit alleging a claim covered by its policy, when in fact the incident giving rise to the claim was outside the scope of, or was expressly excluded from coverage, therefore the company is excused from defending a suit
The above hypothetical case may have some relevancy under the policy terms involved in the Hilderbrandt case because there the insurance company did not confine its duty to defend to cases where policy coverage was alleged in the suit. There the policy provided (p. 293): “The Company . . . agrees ... to defend in his name and behalf any suit against the assured seeking damages on account of such injury, even if such suit is groundless, false or fraudulent. . .” “Such injury” refers to the obligation to insure the insured against liability imposed by law for damages for death or bodily injuries accidentally sustained on the hotel premises by any person or persons other than employees of the insured. So the hypothetical asked by the court in the Hilderbrandt case is not relevant in this case (and it was not relevant in the McGettrick case) because in that case the insurance company did not agree exclusively to defend suits which alleged coverage, as the company did in the
Another unfounded statement in the McGettrick case is as follows: “The language of the policy says nothing about state
In Liberty Mutual Ins. Co. v. Atlantic C. L. R. Co.,
In Comunale v. Traders & Gen. Ins. Co.,
Morgan v. New York Cas. Co.,
In Marshall’s U. S. Auto Supply v. Maryland Cas. Co.,
In Wilson v. Maryland Cas. Co.,
We construe the ruling in University Club v. American Mutual Life Ins. Co. of Boston,
The duty of defending groundless suits does not extend obligation to suits outside coverage. Wilson v. Maryland Cas. Co.,
The second of the principal fallacies in the majority opinion is the erroneous conception of what is a groundless suit. In our opinion a groundless suit is one that affects the liability of a defendant and not one which merely alleges some false facts which apply to the coverage of an insurance policy. False facts pertaining to coverage might not cut any figure at all insofar as the liability of a defendant to a plaintiff is concerned. For example, a defendant may have injured a plaintiff by the negligent operation of a Ford automobile which was not covered by an insurance policy, whereas the facts in the case may have shown that the defendant injured the plaintiff in the negligent operation of a Chevrolet automobile which was not covered by an insurance policy. The divergent facts in the case would not affect the liability of the defendant for negligence. A groundless suit is one which states false facts upon which the liability of a defendant is based. Whether.the facts show coverage or not has nothing to do with the liability of the defendant. The majority opinion in its beginning makes the following statement: “The insurer must defend these suits for the reason that it has expressly obligated itself to do so by the insurance contract containing the common provision that the insurer will defend even groundless, false or fraudulent suits,” and the opinion cites five cases to support its statement. We do not agree that any one of the cases cited in support of the statement actually supports it. The first citation does not support it for the reason that the duty of the insurance company to defend is based on an erroneous interpretation of the provisions of the policy and is not based on the agreement to defend groundless suits. The cases cited either do not have the same provision involved in the instant policy or they are cases which allege coverage. The majority gives as an example of a groundless suit one which alleges injury and damages arising out of the use of an insured automobile, when in truth the automobile involved was another automobile owned by the insured and not covered by the policy. This is not a groundless suit under the true meaning of the words “groundless suit.” Another example given by the ma
The following cases are in accord with the above opinion, that where there is a conflict between the allegations in a suit against the insured and the true facts as known to or ascertainable by the insurer the allegations in the complaint determine the insurer’s- duty to defend: Equity Mut. Ins. Co. v. Southern Ice Co.,
We think the provision in the insurance policy is clearly un
