Lead Opinion
[EDITORS' NOTE: THIS PAGE CONTAINS HEADNOTES. HEADNOTES ARE NOT AN OFFICIAL PRODUCT OF THE COURT, THEREFORE THEY ARE NOT DISPLAYED.] OPINION
Under the policy Stop Loss procured, the Regents were required to notify the insurer of any potential and actual claims exceeding 50 percent of the policy's deductible. BTMG and Stop Loss worked
In 2001, a new insurance policy Stop Loss had procured expressly precluded coverage for any preexisting claim not disclosed by the Regents. The Regents signed a binder that purported to disclose all reportable claims, but unbeknownst to them the binder did not include a disclosure of the claim made by a BTMG plan member who had been repeatedly hospitalized for renal failure. When this patient's claim was submitted to the insurer for payment later in 2001, it was denied.
On October 6, 2003, the Regents filed a complaint against Stop Loss for breach of contract and negligence. The Regents alleged BTMG had submitted timely information to Stop Loss about the patient's renal failure claim but Stop Loss failed to prepare the form for reporting it in a timely fashion. As a result, the complaint claimed Stop Loss breached its contractual agreement with the Regents and also breached its professional duty of care as the Regents' insurance broker, causing the Regents to suffer a loss of over $1 million in unreimbursed expenses for the claim.
Stop Loss answered the complaint and filed a cross-complaint against BTMG. After the trial court sustained a demurrer to this pleading, Stop Loss filed a second amended cross-complaint against BTMG for comparative equitable indemnity and declaratory relief. In it, Stop Loss described the procedure it had established with BTMG to report claims to the Regents' insurer, though it noted this system "was not established pursuant to a contract."1 Because BTMG knew its failure to analyze claims properly and submit information to Stop Loss in a timely fashion could result in the denial of insurance coverage for such claims, the cross-complaint alleged "BTMG owed a duty to [the Regents] to analyze claims properly, provide claims information to Stop Loss timely, and submit claim forms to the reinsurer timely." (Fn. omitted.) Stop Loss alleged BTMG breached this duty to the Regents because it did not make Stop Loss aware of the subject claim until well after the Regents had signed the disclosure form for the new insurance policy. As a result, the cross-complaint claimed BTMG was obligated to partially or fully indemnify Stop Loss for any damages it might be compelled to pay to the Regents. The trial court sustained a demurrer to Stop Loss's second amended cross-complaint without leave to amend, noting the cross-complaint "fail[ed] to state sufficient facts to give rise to a duty owed by BTMG to [the Regents] sounding in tort." This appeal followed.
It is well settled in California that equitable indemnity is only available among tortfeasors who are jointly and severally liable for the plaintiff's injury. (Leko v.Cornerstone Bldg. Inspection Service (2001)
The cross-complaint here does not allege vicarious or strict liability, nor an implied contractual obligation for BTMG to indemnify Stop Loss. Rather, after describing the process by which BTMG and Stop Loss analyzed claims and gave notice to the insurer, and alleging BTMG understood the consequences that could result from the failure to disclose a qualifying claim to the insurer, the cross-complaint simply asserts, "BTMG owed a duty to Plaintiff [the Regents] to analyze claims properly, provide claims information to Stop Loss timely, and submit claims forms to the reinsurer timely." Asserting this legal conclusion does not make it so, however. The question is whether, with respect to the claims analysis, BTMG owed the Regents a duty of care sounding in tort. While the cross-complaint alleges that "BTMG . . . assumed and understood its duties" under the parties' system for disclosing claims, this obligation could only have arisen out of the business relationship between BTMG and the Regents. The law imposes no duty on strangers to promptly process another's data that is comparable to the duty imposed on all persons to exercise due care to avoid injuring others. (See, e.g., Quelimane Co. v.Stewart Title Guaranty Co. (1998)
"A person may not ordinarily recover in tort for the breach of duties that merely restate contractual obligations.
Nevertheless, Stop Loss argues a duty of care on the part of BTMG can be inferred from the factors outlined in Biakanjav. Irving (1958)
Contrary to Stop Loss's assumption, courts have not applied theBiakanja factors to create broad tort duties in arms-length business dealings whenever it is convenient to resort to the law of negligence. Biakanja andJ'Aire address the specific situation that arises when (1) the defendant was acting pursuant to a contract, and (2) the defendant's negligent performance of the contract injures a third party. Neither of these prerequisites is met in this case. First, the cross-complaint alleges BTMG's handling of the Regents' claims was not undertaken pursuant to a contract. Second, and more importantly, even if one concludes BTMG was acting pursuant to an implied contract with the Regents, the cross-complaint does not allege BTMG injured any thirdparty. Rather, Stop Loss claims BTMG's negligent
Likewise, very little precedent supports our concurring colleague's theory that equitable indemnity may be had based upon breach of an implied tort duty arising from negligent performance of an implied contract. (Cone. opn., post, at pp. 1056-1057, 1059-1062.) In North American ChemicalCo. v. Superior Court (1997)
Even though no implied contract was pleaded in the cross-complaint, nor the breach of any duty of care arising from such an implied contract, and even though the Supreme Court has expressly held that the negligent breach of such a duty does
Parrilli, J., concurred.
Concurrence Opinion
Although I concur in the judgment for the limited reason explained in part II.3., post, I believe that the issues presented by the pleadings in this case present an opportunity for reconsideration of some basic principles concerning the law of equitable indemnity. If twо parties breach separate contracts with a third party, jointly causing indivisible damage to the third party, and the injured party seeks recovery from only one of the two defaulting parties, is there any good reason for which that party should not be entitled to equitable indemnity from the second defaulting party? If two parties jointly cause harm to a third party, one by an act of negligence and the other by negligently breaching a contractual obligation, and the injured party seeks recovery from only the former, is there any good reason for which that party should not be entitled to equitable indemnity from the latter? Although the decision of the trial court and the majority precluding indemnity in such situations rests on what appears to be well-settled law, I believe that closer analysis of the underlying principles calls for a different conclusion.
"[I]n 2001," the complaint continues, "Stop Loss assumedall responsibility for claims submissions. Stop Loss did so by first meeting with BTMG and [the Regents'] officials and advocating a new program that allowed Stop Loss to take over all steps involved in the claim submission process from data analysis to claim-denial appeal. [The Regents] agreed and in 2001, BTMG provided Stop Loss with monthly electronic data of those claims that might require notice to the reinsurer. Stop Loss would review the electronic data, revise the information and decide what claims needed to be sent to the reinsurer. Stop Loss would then complete a `Hospital Excess Managed Care Claim Form,' send it to BTMG for proforma approval, BTMG would send the form back to Stop Loss and then Stop Loss would forward the form to the reinsurer for payment." The reinsurance policy required the Regents to notify the insurer of any potential or actual claims exceeding 50 percent of the Regents' deductible. The Regents' complaint alleges that "BTMG timely submitted [information regarding the claim in question] to Stop Loss through its monthly electronic data information" and that the Regents suffered damages in excess of $1 million when its insurer denied a claim because Stop Loss failed to submit the claim to the insurer in a timely manner.1
Stop Loss filed an answer denying the allegations and also a cross-complaint against BTMG for comparative equitable indemnity and declaratory relief. The cross-complaint was amended twice in response to demurrers filed by BTMG. As amended, Stop Loss's cause of action for comparative indemnity alleges that any damage sustained by the Regents as a result of the failure to timely notify the insurer of the potential claim was caused entirely or partially by BTMG and that, as a result, BTMG is obligated to partially or fully indemnify Stop Loss for any sums that Stop Loss may be compelled to pay the Regents as damages. The cross-complaint alleges that "[i]n order to provide the requisite notice of such claims to the reinsurer, [the Regents], BTMG, and Stop Loss established a system under which information was exchanged among them (the `System'). Although the System was not established pursuant to a contract, [the Regents], BTMG and Stop Loss each assumed
According to Stop Loss's pleading, BTMG did not notify it of the claim in question until August 2001, "well after" the claim was required to be disclosed. "BTMG's failure to report [the claim in question] constituted a breach of its duty to [the Regents]." Stop Loss further alleged, on information and belief, "that if [the Regents] suffered any damage as a result of the failure to timely submit a claim to the reinsurer, such a failure is the result of BTMG's acts or failures to act, and not of any act or failure to act of Stop Loss. BTMG owed a duty of care to [the Regents] to analyze its patients' claims properly, to report claims information to Stop Loss timely, and to submit claims forms to the reinsurer timely. BTMG breached this duty. Therefore, if it is determined that [the Regents] sustained damage and [are] entitled to recover from Stop Loss, BTMG should be required to indemnify Stop Loss."
BTMG demurred to the cross-complaint on the ground that it failed to allege that BTMG owed a duty of care to the Regents with regard to the manner in which it analyzed claim information. The trial court found that the "second amended cross-complaint fails to state sufficient facts to give rise to a duty owed by BTMG to [the Regents] sounding in tort" and sustained the demurrer without leave to amend. A judgment dismissing the cross-complaint wаs entered thereafter. Stop Loss timely filed a notice of appeal.
Since we are reviewing the sufficiency of Stop Loss's cross-complaint, we must assume the truth of all well-pleaded facts in that pleading. (Jones v. American PresidentLines (1957)
2. Stop Loss's cross-complaint sufficiently alleges a cause of action for equitable indemnity.
a. The issues defined
The trial court's ruling that the cross-complaint fails to state a cause of action
The cross-complaint alleges that BTMG was wholly or partially responsible for the Regents' financial loss, but the sufficiency of this pleading is significant only if partial responsibility is assumed. If the evidence proves that BTMG was wholly responsible for the Regents' loss, then Stop Loss bears no liability and the sufficiency of its cross-сomplaint is academic. The issues are framed only by assuming to be true, as we must, that the actions or failures to act of both Stop Loss and BTMG jointly gave rise to a single economic loss to the Regents, namely, the loss of $1 million of insurance coverage.
The Regents' complaint against Stop Loss alleges both breach of the Regents/Stop Loss contract, and negligent breach of Stop Loss's professional duties as an insurance broker.2 The cross-complaint alleges that BTMG's liability arises from its failure to perform under the "system" established by the three parties for the processing of information. "Although the System was not established pursuant to a contract," the cross-complaint reads, "[the Regents], BTMG, and Stop Loss each assumed and understood its duties under the System." This allegation is essentially self-contradictory, undoubtedly made in an attempt to avoid the rule that equitable indemnity may not be obtained from one who contributed to a loss only by breaching a contractual obligation. As the majority opinion points out (maj. opn., ante, at p. 1042), the law imposes no duty on strangers to promptly process another's commercial data comparable to the duty imposed on all persons to exercise due care to avoid injuring others. If, as Stop Loss's cross-complaint alleges, BTMG "assumed and understood" an obligation to the Regents to timely process and forward insurance data, that obligation necessarily was based on an implied agreement arising out of the business relationship between those two parties.3 The Regents' complaint confirms the existence of a business relationship between the Regents and BTMG. While the precise terms of the arrangement are not specified, the Regents allege that "BTMG managed premium payments and recoveries for the [Regents]." The duties that BTMG assumed pursuant to that arrangement are necessarily the source of any obligations that BTMG owed to the Regents.
Thus, consistent with the allegations of the cross-complaint, it must be assumed that BTMG did not timely transmit to Stop Loss the information necessary for the submission of the reinsurance claim as it had undertaken to do, that once received, Stop Loss did not diligently process and forward the information, and that as the combined result of both delays the reinsurer did not receive timely notification and the Regents were unable to recover on the reinsurance claim. Under these assumptions, Stop Loss is liable to the Regents for the full amount of the loss. The issue is whether, under these assumptions required
b. The limitation of equitable indemnity to joint tortfeasors
The first premise on which the decision of the trial court and the majority rests undoubtedly сorrectly reflects the current state of California law. "Indemnity has been defined as the obligation resting on one party to make good a loss or damage another party has incurred. [Citation.] In this state the obligation may arise from either of two general sources: `First, it may arise by virtue of express contractual language establishing a duty in one party to save another harmless upon the occurrence of specified circumstances. Second, it may find its source in equitable considerations brought into play either by contractual language not specifically dealing with indemnification or by the equities of the particular case.'"Kramer v. Cedu Foundation, Inc. (1979)
With respect to the latter, with which we are here exclusively concerned, "the equitable indemnity doctrine originated in the common sense proposition that when two individuals are responsible for a loss, but one of the two is more culpable than the other, it is only fair that the more culpable party should bear a greater share of the loss. Of course, at the time the doctrine developed, common law precepts precluded any attempt to ascertain comparative fault; as a consequence, equitable indemnity, like the contributory negligence doctrine, developed as an all-or-nothing proposition." (AmericanMotorcycle Assn. v. Superior Court (1978)
"Originally applied to defendants whose negligence caused the plaintiff's loss (see, e.g., American Motorcycle Assn. v.Superior Court, supra,
The historical limitation excluding contract liability from the scope of equitable indemnity is consistent with the manner in which damages are awarded in a simple two-party breach of contract action. In order to recover for breach of contract, the nonbreaching party must prove that it has substantially performed the conditions of the breaching party's рerformance (or that performance was excused). If it fails to do so, it obtains no recovery. If it does establish this predicate, it is entitled to recover all damages foreseeably caused by the other party's breach. (Bruckman v. Parliament Escrow Corp.
(1987)
The wisdom of this approach has not gone unquestioned. (See Phillips, Out with the Old: Abandoning the Traditional
California courts have made a small step in this direction. Rejecting the prior all-or-nothing rule, courts have applied apportionment principles to allocate contractual liquidated damages where delays in construction projects have been caused both by the owner and by the contractor. (JasperConstruction, Inc. v. Foothill Junior College Dist. (1979)
Some courts in other jurisdictions have applied this reasoning to permit indemnity from a party whose liability is based solely on breach of contract. In Northern Petrochemical Co.v. Thorsen Thorshov, Inc. (1973)
In In re Consol. Vista Hills Litigation (1995)
The advisability of apportioning damages in contract actions, however, has not been universally accepted. According to the New York Court of Aрpeals, "[t]he policy considerations that underlay . . . the need to liberalize the inequitable and harsh rules that once governed contribution among joint tort-feasors . . . are not pertinent to contract matters. Parties to a contract have
the power to specifically delineate the scope of their liability at the time the contract is formed. Thus, there is nothing unfair in defining a contracting party's liability by the scope of its promise as reflected by the agreement of the parties. Indeed, this is required by the very nature of contract law, where potential liability is determined in advance by the parties." (Bd. of Educ. v. Sargent
(1987)
While this reasoning may apply to the apportionment of damages as between contracting parties, it has little application to the fairness of denying apportionment as between parties who have contributed to causing another's loss but who have no contractual relationship between themselves. Nonetheless, there are conceptual problems in imposing equitable indemnity on a party whose liability is based on breach of contract that do not exist in applying equitable indemnity between two tortfeasors. The measure of damages in most tort cases is all loss proximately caused by the wrongdoing, whether anticipated or not. However, the measure of contract damages remains very much the same as articulated in Hadley v. Baxendale
(1884 Ex.) 156 Eng.Rep. 145 — those damages that the parties could reasonably have anticipated when they entered the contract. (Applied Equipment Corp. v. Litton Saudi ArabiaLtd. (1994)
Particularly in view of these complications, I would be reluctant to adopt a rule departing fundamentally from well-established California law on this issue. The preceding discussion suggests that the refusal to apportion damages simply because the liability of one party arises from breach of contract may warrant reconsideration. There are cirсumstances in which the refusal to apportion contract damages, or damages caused jointly by one party's breach of a duty imposed by law and another's breach of a contractual duty, may produce the same inequitable results that prompted our Supreme Court to abandon the all-or-nothing approach to tort damages. Yet, although there may be good reason to do so, any such fundamental change should come from our Supreme Court, or from the Legislature. Absent such a change, I agree with the majority that we must adhere to the rule that equitable indemnity may be obtained only from one who is jointly and severally liable to the injured party based on the commission of a tort, i.e., based on the breach of a duty imposed by law.
c. BTMG's Alleged Failure to Timely Perform Constitutes the Breach of a Duty Imposed by Law for the Purpose of Granting Equitable Indemnity
Proceeding on the premise that Stop Loss can state a claim for indemnity
As indicated in part II.2.a. above, BTMG could have acquired a duty to the Regents to timely process claims information only by having agreed explicitly or implicitly to do so. Although its failure to perform such a duty may have constituted the breach of a contractually based obligation, the failure may in addition have breached a duty imposed by law. In NorthAmerican Chemical Co. v. Superior Court (1997)
BTMG argues that the decision of the Supreme Court in Aasv. Superior Court (2000)
The line of cases exemplified by Aas andErlich, however, does not preclude a claim for equitable indemnity under the present circumstances. InAas, the Supreme Court held that the so-called "economic loss rule" precludes recovery under tort thеories for losses that are solely economic, and that recovery for such losses normally can be obtained only to the extent available for breach of contract or warranty. (Aas, supra,
The "economic loss rule" applied in Aas "requires a purchaser to recover in contract for purely economic loss due to disappointed expectations, unless he can demonstrate harm above and beyond a broken contractual promise." (RobinsonHelicopter Co., Inc. v. Dana Corp. (2004)
The recovery of tort damages for a breach of contract is seldom permitted. "Generally, outside the insurance context, `a tortious breach of contract . . . may be found when (1) the breach is accompanied by a traditional common
law tort, such as
In Erlich, the Supreme Court confirmed that "`
As appears, the issue with which all of these cases grapple is the type of damages that may be recovered under contract and tort principles. Despite the fact that a negligent failure to perform contractual obligations constitutes a tort, the injured party may recover only contractual damages unless "the duty that gives rise to tort liability is either completely independent of the contract or arises from conduct which is both intentional and intended to harm." (Erlich,supra,
These reasons for adhering to the distinction between damages recoverable in contract and in tort have no bearing on the present claim for equitable indemnity. Stop Loss is not attempting to recover expanded tort damages or any element of damages not customarily available for breach of contract. The Regents' claim against Stop Loss seeks only economic damages — a remedy availablе for a breach of the Regents/Stop Loss agreement — and Stop Loss seeks only to compel BTMG to pay for its proportionate contribution to the Regents' loss — damages that would also be available for breach of agreement between the Regents and BTMG. By recognizing that BTMG's alleged breach of a commitment to the Regents may also violate a duty imposed by law and thus support a claim for equitable indemnity, BTMG is not exposed to liability beyond that which was foreseeable when it made a commitment to the Regents. Requiring BTMG to pay for the share of the Regents' loss for which it is responsible will not interfere with the reasonable expectations of BTMG, expand the scope of damages for breach of contract, or expose BTMG to unlimited liability.8 In simply reiterating
Nor will permitting equitable indemnity in this situation violate the so-cаlled economic loss rule. The indemnitor cannot be liable for negligent breach of contract unless it has in fact breached the contract. Holding the indemnitor responsible for its proportionate share of the injured party's financial loss does not impose any liability beyond that which it has contractually assumed.
Moreover, in Aas, the Supreme Court reaffirmed that in some circumstances economic damages may be recoverable for the negligent performance of a contractual obligation damaging the economic interests of a third party. Liability to one not in privity may be imposed if a balancing of the factors identified in Biakanja v. Irving, supra,
Here, the allegations of Stop Loss's cross-complaint satisfy most of the J'Aire factors. The understanding allegedly reached between the Regents, BTMG and Stop Loss was intended to affect the Regents' ability to obtain insurance coverage and Stop Loss's ability to perform its responsibilities under that arrangement. The harm allegedly caused by BTMG's failure to timely process the claim data was entirely foreseeable. BTMG's alleged failure to perform is closely connected to the denial of the insurance coverage and the harm suffered by the Regents, and in turn to the loss sustained by Stop Loss in incurring liability for the loss of that coverage. While there is not necessarily any moral blame attached to BTMG's conduct, recognizing a duty owed to Stop Loss for this purpose may well decrease the likelihood of similar harm in the future. The preponderance of theJ'Aire factors thus supports finding a special relationship in this case which justifies the recognition of a duty on the part of BTMG owed to Stop Loss to perform its
commitments to the Regents. (See Aas, supra,
Treating the negligent breach of a contractual obligation as sufficient to support a claim for equitable indemnity does not render nugatory the conclusion that such indemnity is available only between joint tortfeasors. Every breach of contract will not support a claim for indemnity but only those that result from a failure "to perform with care, skill, reasonable expedience, and faithfulness." (North American Chemical v.Superior Court, supra,
I thus reach the same conclusion as did the Supreme Court of New Mexico in Amrep, supra,
3. Reversal is not required because of subsequent developments in this case.
Despite my conclusion that Stop Loss sufficiently alleged a cause of action for equitable indemnity, so that the demurrer to the cross-complaint should not have been sustained, for reasons arising subsequent to the trial court's ruling it is not necessary to reverse the dismissal of the cross-complaint. BTMG states in its brief, "Any alleged negligence on the part of BTMG may be imputed to the Regents." At oral argument counsel for BTMG reiterated that BTMG was at all times acting as an "agent," "middleman" or "manager" for the Regents and thus that any conduct on BTMG's part that contributed to the Regents' loss would be attributed to the Regents. The pleadings out of which this appeal arises provide no basis to assume that the Regents would agree or would be compelled to accept responsibility for deficiencies in the performance of BTMG. Nonetheless, the Regents' claim against Stop Loss has already been tried and, as BTMG has represented, Stop Loss was held liable only for that portion of the Regents' loss which the jury attributed directly to Stop Loss.
While this appeal was pending, the Regents' action against Stop Loss was tried before a jury.13 The jury rejected the Regents' breach of contract claim, finding that the Regents did not "do all, or substantially all, of the significant things that the contract required them to do." However, the jury did find Stop Loss liable for "professional negligence in connection with the placement of Provide Excess insurance." The jury was instructed to apportion fault between the Regents and Stop Loss if it determined that any negligence on the part of the Regents contributed to the Regents' harm, and the jury awarded the Regents only $569,400 in damages, significantly
