Lead Opinion
delivered the opinion of the Court,
In this case, we must decide whether an insured’s failure to timely notify its insurer of a claim defeats coverage under the policy if the insurer was not prejudiced by the delay. We hold, as we did in Hernandez v. Gulf Group Lloyds, that an immaterial breach does not deprive the insurer of the benefit of the bargain and thus cannot relieve the insurer of the contractual coverage obligation.
I.
PAJ, Inc., a jewelry manufacturer and distributor, purchased a commercial general liability (“CGL”) policy from Hanover Insurance Company that covered, among other things, liability for advertising injury. The policy required PAJ to notify Hanover of any claim or suit brought against PAJ “as soon as practicable.” In 1998, Yurman Designs, Inc. demanded that PAJ cease marketing a particular jewelry line, and a month later sued PAJ for copyright infringement. Initially unaware that the CGL policy covered the dispute, PAJ did not notify Hanover of the suit until four to six months after litigation commenced.
PAJ brought this suit against Hanover seeking a declaration that Hanover was contractually obligated to defend and indemnify PAJ in the copyright suit, and asserting several extracontractual claims. The parties stipulated that PAJ failed to notify Hanover of the Yurman claim “as soon as practicable” and that Hanover was not prejudiced by the untimely notice. Both parties moved for summary judgment on the notice issue based on these undisputed facts. The trial court granted Hanover’s motion and denied PAJ’s, holding that Hanover was not required to dem
II.
The Hanover policies issued to PAJ provide coverage for “advertising injury,” which the policy defines to include injury arising out of copyright infringement. The policy contains a prompt-notice provision that requires PAJ to notify Hanover of an occurrence or an offense that may result in a claim “as soon as practicable.” The parties dispute whether the policy’s prompt-notice requirement constitutes a condition precedent or merely a covenant. Hanover contends the policy language creates a condition precedent, the failure of which defeats coverage under the policy irrespective of prejudice to the insurer. See Hohenberg Bros. Co. v. George E. Gibbons & Co.,
III.
Hanover pins its analysis on our decision in Members Mutual Insurance Co. v. Cutaia,
The State Board of Insurance responded the very next year by issuing Board Order 23080, which requires a mandatory endorsement to all Texas CGL policies that precludes forfeiture of coverage for an insured’s failure to comply with notice or forwarding conditions unless the insurer is prejudiced thereby. See State Board of Insurance, Revision of Texas Standard Provision For General Liability Policies — Amendatory Endorsement-Notice, Order No. 23080 (Mar. 13,1973).
The endorsement provides:
As respects bodily injury liability coverage and property damage liability coverage, unless the company is prejudiced by the insured’s failure to comply with the requirement, any provision of this policy requiring the insured to give notice of action, occurrence or loss, or requiring the insured to forward demands, notices, summons or other legal process, shall not bar liability under this policy.
Two decades after Board Order 2B080 became effective, we decided Hernandez.
Since our decision in Hernandez, courts and several major treatises have acknowledged Texas as a state that has adopted a notice-prejudice rule. See, e.g., Ridglea Estate Condo. Ass’n v. Lexington Ins. Co.,
If anything, we believe that the failure to give notice of a claim poses a smaller risk of prejudice than failure to obtain consent to a settlement. In many instances of untimely notice of a claim, the insurer is not prejudiced at all, and ultimately may not face any coverage obligation. Conversely, in many if not most cases where an insured settles a case without the insurer’s consent, the insurer faces at least some liability. If the Texas Supreme Court does not presume prejudice in a settlement-without-consent case, we are persuaded that it would not presume prejudice in a failure- of-notice case.
Id. at 631. The Fifth Circuit noted “a modern trend in favor of requiring proof of prejudice” in this context and emphasized that in Hernandez, our Court considered the law of other jurisdictions and that our analysis “is entirely consistent with [this modern trend].” Id.; see St. Paul Guardian Ins. Co. v. Centrum G.S. Ltd.,
This insurance does not apply: a) to bodily injury or property damage with respect to which the insured, ... without written consent of the company, makes any settlement with any person ... who may be legally liable therefor.
The fact that Hernandez involved a policy exclusion rather than a policy provision does not supply a valid ground for distinguishing its application here. Exclusions and conditions are in effect two sides of the same coin; exclusions avoid coverage if the insured does something, and conditions avoid coverage unless an insured does something. The dissent’s construction would have the absurd consequence that identical policy language creates a condition precedent as to one type of coverage (advertising injury) but a covenant as to the other (bodily injury and property damage). We have said unequivocally that
Moreover, we question the dissent’s fundamental premise that the timely notice provision before us creates a condition precedent rather than a covenant. The policy language in Cutaia specifically provided that “no action shall lie against the company unless, as a condition precedent thereto, the insured shall have fully complied with all the terms of this policy.”
In addition, the timely notice provision was not an essential part of the bargained-for exchange under PAJ’s occurrence-based policy. The Fifth Circuit, applying Texas insurance law, aptly describes the critical distinction between “occurrence” polices and “claims-made” policies as follows:
In the case of an “occurrence” policy, any notice requirement is subsidiary to the event that triggers coverage. Courts have not permitted insurance companies to deny coverage on the basis of untimely notice under an “occurrence” policy unless the company shows actual prejudice from the delay.
Matador Petroleum Corp. v. St. Paul Surplus Lines Ins. Co.,
Finally, and perhaps most disturbingly, the dissent’s analysis of the policy language would impose draconian consequences for even de minimis deviations from the duties the policy places on insureds. The policy in this case requires, in the same section at issue, not only notice of suit “as soon as practicable,” but also that PAJ “immediately send ... copies of any demands, summonses or legal papers.” Thus, under the dissent’s construction, an insured’s failure to promptly forward a deposition notice or a certificate of conference would work a forfeiture of coverage, even when the insurer is not at all harmed. This is precisely the result that Board Order 23080 attempted to avoid and we rejected in Hernandez.
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We hold that an insured’s failure to timely notify its insurer of a claim or suit does not defeat coverage if the insurer was
Notes
. The Insurance Services Office, Inc. ("ISO”) is the industry organization responsible for issuing nearly all standard CGL forms. See Ernest Martin, Jr., et al., Insurance Coverage for the New Breed of Internet-Related Trademark Infringement Claims, 54 SMU L. REV. 1973, 1984 (2001). The standard 1973 ISO form provided coverage for only "bodily injury” and "property damage,” and did not itself cover "advertising injury.” Id. at 1988. Not until 1981 did the ISO issue an “advertising injury” Broad Form Comprehensive General Liability Endorsement that could be purchased as a supplemental endorsement to the 1973 form. Id. at 1988. In 1986, sweeping changes were made to the ISO CGL policy form, and "advertising injury” coverage was incorporated into the body of the form. Id. at 1992. Since October 2000, the ISO version of the mandatory Texas Department of Insurance endorsement has included a provision that requires a showing of prejudice for notice defects in personal and advertising injury cases to avoid liability under the policy.
. Like our treatment of the exclusion in Hernandez, the courts in many of the cases we cited made no attempt to classify the policy provisions as either covenants or conditions, nor did they even employ those terms. See Hernandez,
. See generally Barry R. Ostrager & Thomas R. Newman, Handbook on Insurance Coverage Disputes § 4.02(c)(2), (3d ed.2006), (citing cases). See, e.g., Tush v. Pharr,
Dissenting Opinion
joined by Justice HECHT, Justice WAINWRIGHT, and Justice JOHNSON, dissenting.
I respectfully dissent. I would follow Members Mutual Insurance Co. v. Cutaia
I. Discussion
PAJ argues that under Hernandez v. Gulf Group Lloyds
A. The Timely Notice Provision Is a Condition Precedent, Not a Covenant
The parties dispute whether the policy’s prompt-notice language constitutes a condition precedent (as Hanover argues), the failure of which defeats coverage,
This Court has indeed repeatedly described insurance policy notice provisions as conditions precedent to coverage.
PAJ insists the notice requirement in Hanover’s CGL policy is necessarily a covenant because it omits the “as a condition precedent thereto” clause present in the Cutaia policy. I disagree. “Magic words” are not controlling; labeling something a “condition precedent” does not make it so, and the absence of such a label does not make it not so. Whether a notice provision constitutes a condition precedent turns on what the provision actually does, its nature and purpose, not merely on what it is called or because it appears under a heading, as here, that includes the word “Conditions.” “A condition precedent may be either a condition to the formation of a contract or to an obligation to perform an existing agreement.”
The notice provision at issue is a condition precedent, as coverage is expressly conditioned on compliance with the notice requirement. Section IV of the policy, entitled “Commercial General Liability Conditions,” contains a list of “Duties In The Event Of Occurrence, Offense, Claim Or Suit,” one of which states: “If a claim is made or ‘suit’ is brought against any insured, you must .... [njotify us as soon as practicable.” Section IV also specifies that “[n]o person or organization has a right under this Coverage Part ... to sue us on this Coverage Part unless all of its terms have been fully complied with ” (emphasis added). The prompt-notice requirement, expressly identified in the policy as a condition and, more importantly, providing that no suit may take place absent full compliance, is plainly a condition that precedes the insurer’s obligations to perform under the policy.
PAJ’s reliance on Hernandez is misplaced. Hernandez involved an insured’s breach of a settlement-without-consent exclusion in an automobile policy, which said that the insurance did not apply to “bodily injury or property damage with respect to which the insured ... shall, without written consent of the company, make any settlement with any person or organization
Hernandez’s materiality-of-breaeh analysis is inapposite here because PAJ did not breach a covenant. Rather, it failed to comply with a condition precedent, a strict requirement that precedes any obligation on the part of Hanover under the policy. As noted above, and as PAJ concedes, the Court has long and consistently treated notice requirements as conditions precedent to coverage rather than covenants.
B. A Late-Notice Defense Should Require No Showing of Prejudice Unless the Policy or Positive Law Specifically Provides Otherwise
PAJ’s reliance on our 1995 decision in Harwell likewise falls short. In Harwell, prejudice was expressly required by the policy itself: “If we show that your failure to provide notice prejudices our defense, there is no liability coverage under the policy.”
In Cutaia, we held that a late-notice defense requires no showing of prejudice, refusing to “insert a provision that violations of conditions precedent will be excused if no harm results from their violation.”
As respects bodily injury liability coverage and property damage liability coverage, unless the company is prejudiced by the insured’s failure to comply with the requirement, any provision of this policy requiring the insured to give notice of action, occurrence or loss, or requiring the insured to forward demands, notices, summons or other legal process, shall not bar liability under this policy.26
PAJ casts this 1973 Board action as a “regulatory rejection” of Cutaia’s no-prejudice rule. As concerns the dispositive issue before us, I disagree. This Board-mandated policy language, while clearly applicable to the automobile policy in Har-well, was not an across-the-board abrogation of Cutaia’s no-prejudice rule; by its terms, the Board’s endorsement reaches only certain lines of insurance and a defined subset of claims for bodily injury and property damage.
PAJ’s policy provided for three kinds of coverage: Coverage A, for bodily injury and property damage; Coverage B, for personal and advertising injury; and Coverage C, for medical payments. The agency’s required endorsement is targeted solely at Coverage A. The endorsement imposes no prejudice requirement for any other types of coverages.
My text-based construction of the policy is consistent with the principle of expressio unius est exclusio alterius, meaning that the naming of one implies the exclusion of others.
I would reaffirm Cutaia’s recognition that the Legislature and the state agency overseeing the insurance industry are better suited to decide whether an insurer must show prejudice to deny coverage based on late notice. TDI and legislators are free to supplant Cutaia’s no-prejudice rule with a more liberal notice-prejudice rule if they believe, on public policy grounds, that the latter is preferable. I would not fault them for doing so. But when interpreting text — whether a contract, regulatory edict, statute, or constitution — formalism matters, and key to formalism is consistency in entrusting policy matters to policymakers.
In any event, I find it understandable that an insurer would insist on a strict notice requirement. An insured’s failure to provide prompt notice of a suit or claim to an insurer, who has the resources and experience to handle such claims, can obviously work a substantial hardship on both the insurer and the insured. The insurer understandably -wishes to discourage late notice and to avoid ancillary litigation devoted to whether or not it was prejudiced by a failure to provide prompt notice; litigation could have the effect of raising premiums on all insured parties, thus forcing punctual insured parties to subsidize those who flout the policy’s notice requirements.
Regardless of which side makes the superior public policy argument as to what an insurance policy should provide, I would decline to insert nonexistent language into the parties’ agreement. The Court is construing a contract, not editing it, and just six months ago, in Fortis Benefits v. Cantu, this Court unanimously stressed that “contract rights generally arise from contract language; they do not derive their validity from principles of equity but directly from the parties’ agreement.”
In a post-submission brief, Hanover points out that since October 2000 a “Texas Changes” endorsement, designated endorsement “CG 01 03” and published by the Insurance Services Office (ISO), has included a prejudice requirement for personal and advertising injury claims as well as bodily injury and property damage claims. Hanover alternatively describes this endorsement as “approved” or “required” by TDI. Under current and prior law, TDI has been authorized to approve standardized policy forms.
Today the Court treats Cutaia as a dead letter, overruled by Hernandez, reasoning that the Court in Hernandez declined to draw any distinction between covenants and conditions and “apparently rejected” Cutaia’s holding that failure to comply with a coverage condition precluded liability irrespective of harm.
Put simply, Hernandez concerned a policy exclusion — not a policy condition — and this Court has restated the distinction repeatedly since Hernandez was decided.
The Court finds my reading of the policy unreasonable because “identical policy language creates a condition precedent as to one type of coverage (advertising injury), but a covenant as to the other (bodily injury and property damage).”
Finally, the Court views my approach as imposing “draconian consequences for even de minimis deviations from the duties the policy places on insureds.”
II. Conclusion
Courts should enforce unambiguous policy terms in accordance with their plain meaning.
.
. Id. at 281.
.
.
. Klein v. Century Lloyds,
. See Hernandez,
. Harwell,
. Cutaia,
. Cutaia,
. Hohenberg Bros. Co. v. George E. Gibbons & Co.,
. Id.
. See, e.g., Cutaia,
. Landscape Design & Constr., Inc. v. Harold Thomas Excavating, Inc.,
. Hernandez v. Gulf Group Lloyds,
. Criswell v. European Crossroads Shopping Ctr., Ltd.,
. Hohenberg Bros.,
.
. Id. at 692-93.
. Id. at 692.
. See id.
. See supra note 7 and accompanying text.
.
. Harwell v. State Farm Mut. Auto. Ins. Co.,
. Id. at 174 (citing Liberty Mut. Ins. Co. v. Cruz,
. Members Mut. Ins. Co. v. Cutaia,
. State Bd. of Ins., Revision of Texas Standard Provision for Automobile Policies Editions of April 1, 1955 and October 1, 1966—Amendatory Endorsement — Notice, Order No. 22582 (Jan. 26, 1973), available at http:// www.tdi.state.tx.us/commercial/pcck22582. html; State Bd. of Ins., Revision of Texas Standard Provision for General Liability Policies — Amendatory Endorsement-Notice, Order No. 23080 (Mar. 13, 1973), available at http:// www.tdi.state.tx.us/commercial/pcck23080. html.
. CKB & Assocs., Inc. v. Moore McCormack Petroleum, Inc.,
.
. Id. at 749-50.
. Id. at 750.
.
. Id. at 649.
. Id. at 649-50.
. Fiess, 202 S.W.3d at 753.
. Members Mut. Ins. Co. v. Cutaia,
. Under current law, an insurer offering a CGL policy must use forms filed with and approved by TDI, Tex. Ins.Code §§ 2301.003(b)(3), 2301.006, subject to an exemption for certain large risks, § 2301.004. TDI "may adopt standard insurance policy forms ... that an insurer may use instead of the insurer’s own forms.” § 2301.008. "The Commissioner may approve the use of policy forms and endorsements adopted by a national organization of insurance companies or a similar organization, if such forms or endorsements are filed with and are approved by the commissioner in accordance with this article.” Tex. Ins.Code art. 5.35(c) (Vernon Supp.1997). Similarly, under prior law applicable to CGL policies, insurers were required to file and obtain approval of policy forms with TDI, which was also authorized to "promulgate standard insurance policy forms.” See id. art. 5.13-2, § § 2(a)(1), 8(a), 8(e), repealed by Act of May 24, 2005, 79th Leg., R.S., ch. 727, § 18(d), 2005 Tex. Gen. Laws 1752, 2186-87.
. Progressive County Mut. Ins. Co. v. Sink,
.
.Harwell v. State Farm Mut. Auto. Ins. Co.,
. In Maldonado,
. See supra Part I.A.
. Fortis Benefits v. Cantu,
.
.
. See Bituminous Cas. Corp. v. Vacuum Tanks, Inc.,
.Blaylock v. Am. Guarantee Bank Liab. Ins. Co.,
. Fiess v. State Farm Lloyds,
. Members Mut. Ins. Co. v. Cutaia,
. Texas courts are not alone in adopting the traditional rule and concluding that (1) notice requirements are conditions precedent, see Greycoat,
Maryland holds otherwise; a court has held that notice provisions are covenants rather than conditions precedent. See Sherwood Brands, Inc. v. Hartford Accident & Indem. Co.,
Likewise, leading legal commentators recognize that notice provisions have been treated as conditions precedent rather than covenants. See 22 Eric Mills Holmes, Appleman on Insurance § 139.1 [B] (2d ed.2003); Donald S. Malecki & Arthur L. Flitner, Commercial General Liability 76-77 (4th ed.1992); 13 Lee R. Russ & Thomas F. Segalla, Couch on Insurance §§ 190.20, 190.25 (3d ed.1999).
