Showing posts with label Punitive Damages. Show all posts
Showing posts with label Punitive Damages. Show all posts

Tuesday, May 30, 2023

When an Ambiguous Policy Provision Does Not Necessary Mean a Loss in the Win/Loss Columns

LIFE INSURANCE – POLICY INTERPRETATION – AMBIGUITY – GENERAL BUSINESS LAW § 349 – PUNITIVE DAMAGES 

Hobish v. Axa Equitable Life Ins. Co. 
(NY App. Div., 1st Dept., 05/25/2023) 

Although this is a life insurance, rather than a property/casualty insurance, case, there are several important #insurance coverage/policy interpretation points at work in this decision:
  1. A policy provision is ambiguous when it is susceptible to two or more reasonable interpretations. 

  2. A New York court is not required to resolve the ambiguity against the insurer when extrinsic evidence presented in the case is not conclusory as to the provision's meaning. 

  3. Unless the extrinsic evidence supports only one party's proposed interpretation, the ambiguity should not be resolved by the court as a matter of law.
The court also:
  • AFFIRMED Supreme Court's denial of summary judgment to the defendant dismissing plaintiff's General Business Law § 349(h) cause of action, holding that "even if the decedent did not read the policy herself, issues of fact exist as to whether there was consumer impact in this case"; 

  • AFFIRMED Supreme Court's grant of summary judgment to defendant dismissing plaintiffs' claim for compensatory and consequential damages on the breach of contract cause of action, based on plaintiffs' election not to terminate the contract and sue for a total breach, but instead maintain the policy with higher rates and then under protest exercise the surrender provisions of the policy;

  • AFFIRMED Supreme Court's dismissal of plaintiffs' claim for "restitutionary" damages pursuant to General Business Law § 349(h), holding that such damages were "too speculative to constitute actual damages under the statute"; 

  • AFFIRMED Supreme Court's dismissal of plaintiffs' claim for punitive damages of $12 million on its General Business Law § 349(h) cause of action based on its observation that GBL 349(h) provides for only "limited punitive damages" in the form of "an award of actual damages or fifty dollars, although a court may increase an award up to three times, up to one thousand dollars".

Monday, December 19, 2011

Claim Professionals Cannot be Held Personally Liable

HOMEOWNERS – BREACH OF CONTRACT – PUNITIVE DAMAGES – FRAUD – ATTORNEYS' FEES – PERSONAL LIABILITY
O'Keefe v. Allstate Ins. Co.

(2nd Dept., decided 12/13/2011) 

There's nothing new in this decision, but it sets forth a number of important and useful principles relating to the defense of first-party property coverage disputes:

Personal Liability of Claims Professionals 

Agents of a disclosed principal cannot be held personally liable for the principal's breach of contract.  Supreme Court properly dismissed this action against the Allstate claims professionals who were named as individual defendants in the complaint.  
The Supreme Court properly granted that branch of the defendants' motion which was pursuant to CPLR 3211(a)(7) to dismiss the complaint insofar as asserted against the individual defendants, Mark Malenczak, David Mateer, and Freida Hicks (hereinafter collectively the individual defendants), all employees of the defendant Allstate Insurance Company (hereinafter the insurer), as they cannot, under the circumstances of this case, be held personally liable to the plaintiffs (see Bardi v Farmers Fire Ins. Co., 260 AD2d 783, 787; Schunk v New York Cent. Mut. Fire Ins. Co., 237 AD2d 913, 915; Benatovich v Propis Agency, 224 AD2d 998, 998-999). 
Fraud Cause of Action

If a complaint's fraud cause of action relates directly to its breach of contract cause of action, it must be dismissed.  
With respect to the complaint insofar as asserted against the insurer, the third cause of action sounds in fraud but relates directly to the breach of contract claims, in that it alleges that the insurer's actions were undertaken to avoid paying the plaintiffs the amounts specified in their insurance policy. Accordingly, the third cause of action cannot be sustained (see Pepper v Hezghia, 307 AD2d 959, 960; Schunk v New York Cent. Mut. Fire Ins. Co., 237 AD2d at 913-915; F. Nathanson & Co. v Marinello, 192 AD2d 575; Manshul Constr. Corp. v City of New York, 143 AD2d 333, 336). 
Attorneys' Fees

As a general rule, attorneys' fees are not recoverable in a breach of contract action.  An insured may not recover the expenses incurred in bringing an affirmative action against an insurer to settle the insured's rights under the policy.
Moreover, the Supreme Court properly granted that branch of the motion which was to dismiss so much of the complaint as sought an award of an attorney's fee against the insurer. An "insured may not recover the expenses incurred in bringing an affirmative action against an insurer to settle its rights under the policy" (New York Univ. v Continental Ins. Co., 87 NY2d 308, 324; see Mighty Midgets v Centennial Ins. Co., 47 NY2d 12, 21).
Punitive Damages

Punitive damages are not recoverable unless the complaint alleges facts supporting the contention that the insurer's conduct was egregious or fraudulent, or that it evidenced wanton dishonesty so as to imply a criminal indifference to civil obligations directed at the public generally.  Private breach of contract disputes generally do not warrant punitive damages.
Further, punitive damages are not warranted, as "[t]he insureds failed to set forth any facts or allegations to support their contention that the defendant insurer'[s] conduct was egregious or fraudulent, or that it evidenced wanton dishonesty so as to imply a criminal indifference to civil obligations directed at the public generally. This case is, in effect, simply a private breach of contract dispute between the insurer[ ] and [its] insureds with no greater implications" (Flores-King v Encompass Ins. Co., 29 AD3d 627, 627; see Rocanova v Equitable Life Assur. Socy. of U.S., 83 NY2d 603, 615).

Tuesday, January 19, 2010

Insureds' Deceptive Acts and Practices Claim Against Their Homeowners Insurer Survives Motion to Dismiss. Broad Discovery Ordered.

HOMEOWNERS – INSURED'S OBLIGATION TO PROTECT INSURER'S SUBROGATION RIGHTS – GENERAL BUSINESS LAW § 349 – PUNITIVE DAMAGES – ATTORNEY'S FEES – DISCOVERY
Wilner v. Allstate Ins. Co.
(2nd Dept., decided 1/12/2010)

New York property insurers better sit up and pay attention to this decision.  In combination with the erosion of other longstanding common law rules regarding bad faith and consequential damages, this decision augurs poorly for avoiding expansive claims and expansive discovery in traditional first-party, breach of contract actions. Trouble is now spelled W-I-L-N-E-R.

Allstate insured the Wilners under a Deluxe Plus Homeowners' Policy.  On October 8, 2005, while that policy was in effect, a storm allegedly caused a hillside on the plaintiffs' property in the Village of Roslyn, New York, to collapse, destroyed their retaining wall, felled several trees, and caused other damage.  The Wilners' policy contained a fairly standard provision regarding protecting Allstate's subrogation rights:
When we pay for any loss, an insured person's right to recover from anyone else becomes ours up to the amount we have paid. An insured person must protect these rights and help us enforce them. You may waive your rights to recover against another person for loss involving the property covered by this policy. This waiver must be in writing prior to the date of loss.
The Wilners submitted a claim for coverage to Allstate, which they alleged Allstate deliberately refused timely to decide, forcing them to commence a lawsuit against the Village before the applicable statute of limitations expired in order to protect Allstate's potential subrogation interests.  In September 2007, the Wilners also commenced this lawsuit against Allstate, alleging in three, separate causes of action:
(1)  that Allstate breached the contract by refusing to pay the amounts due to them under their policy of insurance;
(2)  the Allstate breached the contract by refusing to provide them with a defense after the Village instituted criminal proceedings against them for damage to Village property which resulted from the collapse;
(3)  that Allstate violated New York General Business Law § 349 by deliberately refusing to reach a timely coverage decision, thereby compelling the plaintiffs to comply with the policy's provision concerning protecting Allstate's subrogation rights and sue the Village at their own expense; plaintiffs alleged that the Allstate's actions "caused injury to Plaintiffs, and have the potential to harm the public at large" because every Allstate Deluxe Plus Homeowners' Policy contains the provision requiring those insureds to protect Allstate's right to subrogate.  On this case of action plaintiffs sought the recovery of actual and punitive damages and attorney's fees. 
Allstate moved under CPLR 3211(a)(7) to dismiss the second and third causes of action of plaintiffs' complaint, contending that the plaintiffs had failed to allege consumer-oriented conduct, that any act by the defendant was deceptive or misleading in a material way, and that they had been injured as a result of an allegedly deceptive act. In addition, Allstate asserted that the insurance policy did not require an insured to file a lawsuit against anyone, and no reasonable policy holder would conclude that it did.

Plaintiffs opposed Allstate's motion and cross-moved to compel Allstate to provide full, unredacted versions of relevant computer notes, and documents and information pertaining to other claims filed under the Deluxe Plus Homeowners' Policy resulting from the October 2005 storm.

In an order entered October 7, 2008, Nassau County Supreme Court ordered Allstate to:
"produce in camera all property damage claims under the Allstate Deluxe Plus Homeowners Policy for damages resulting from a rain and/or wind storm which occurred on or about October 7, 2005 in Nassau County as well as all claims that resulted in litigation, such documents being limited to property damage claims between October 7, 2005 to January 7, 2007 in Nassau County only."
By order to show cause returnable December 8, 2008, Allstate sought leave to reargue, asserting, among other things, that the order went beyond the scope of the relief sought by the plaintiffs in their cross motion.  Allstate claimed that the plaintiffs sought information regarding claims under the Deluxe Plus Homeowners Policy, while the court's order compelled production of all property damage claims arising from the storm at issue. Allstate claimed that the requirements of the court's October 2008 order were onerous.

In an order entered January 21, 2009, Nassau County Supreme Court granted that branch of Allstate's motion which sought dismissal of the second cause of action. The court denied those branches of the defendant's motion which were pursuant to CPLR 3211(a)(7) to dismiss the third cause of action alleging a violation of General Business Law § 349, and to dismiss the demand for punitive damages and attorney's fees, stating that, "at this stage of the proceedings, it [could not] determine that Plaintiffs' cause of action under [General Business Law] § 349 is insufficient as a matter of law."  The court granted the plaintiffs' cross motion to compel discovery.  Allstate appealed.

In AFFIRMING the denial of Allstate's motion to dismiss plaintiffs' General Business Law § 349 cause of action, Justice Dickerson, writing for the Second Department, noted:
The types of goods and services to which General Business Law § 349 applies is expansive. With regard to matters pertaining to insurance, it has been determined to apply to:

Coverage & Rates (see Gaidon v Guardian Life Ins. Co. of Am., 94 NY2d 330 ["out-of-pocket premium payments [for life insurance policies] would vanish within a stated period of time"]; Monter v Massachusetts Mut. Life Ins. Co., 12 AD3d 651 [allegations of misrepresentations concerning terms of Flexible Premium Variable Life Insurance Policies, and deception concerning marketing thereof]; Beller v William Penn Life Ins. Co. of N.Y., 8 AD3d 310 [plaintiff stated General Business Law § 349 cause of action by alleging that the defendant engaged in deceptive practices by increasing the cost of insurance rates without regard to certain flexible factors which would have required the raise to decrease]; Skibinsky v State Farm Fire & Cas. Co., 6 AD3d 975 [allegations of intentional misrepresentation concerning coverage of a insurance policy provided to plaintiff]; Brenkus v Metropolitan Life Ins. Co., 309 AD2d 1260 [amount of life insurance coverage]; Batas v Prudential Ins. Co. of Am., 281 AD2d 260; Makastchian v Oxford Health Plans, 270 AD2d 25 [allegations of deceptive practices that would cause subscribers to believe that they still had health insurance when coverage had already been cancelled]);

Provision Of Defense Counsel (see Elacqua v Physicians' Reciprocal Insurers, 52 AD3d 886 ["This threat of divided loyalty and conflict of interest between the insurer and the insured is the precise evil sought to be remedied . . . hence the requirement that independent counsel be provided at the expense of the insurer and that the insurer advise the insured of this right. Defendant's failure to inform plaintiffs of this right, together with plaintiffs' showing that undivided and uncompromised conflict-free representation was not provided to them, constitutes harm within the meaning of General Business Law § 349"]);

Claims Procedures (see Shebar v Metropolitan Life Ins. Co., 25 AD3d 858 [allegations that "despite promises to the contrary in its standard-form policy sold to the public, defendant made practice of not investigating claims for long-term disability benefits in good faith, in a timely fashion, and in accordance with acceptable medical standards . . . when the person submitting the claim . . . is relatively young and suffers from a mental illness'"]; Makuch v New York Cent. Mut. Fire Ins. Co., 12 AD3d 1110; Acquista v New York Life Ins. Co., 285 AD2d 73 ["allegation that the insurer makes a practice of inordinately delaying and then denying a claim without reference to its viability, may be said to fall within the parameters of" an unfair or deceptive practice]; Rubinoff v U.S. Capitol Ins. Co., NYLJ, May 10, 1996, at 31, col 3 [automobile insurance company fails to provide timely defense to insured as promised]).
Justice Dickerson then continued his analysis by holding that plaintiffs' complaint adequately stated a cause of action under General Business Law § 349 by alleging:
  • consumer-oriented conduct ("Consequently, any consumer holding this policy, whose loss is potentially attributable to a third party, is required to protect the defendant's rights. Therefore, the conduct complained of has a "broad impact on consumers at large" and is thus consumer-oriented"); 
  • materially misleading acts ("In essence, the plaintiffs are alleging that the defendant purposely failed to reach a decision on the merits of their insurance claim in order to force the plaintiffs to bring a suit against the Village before the statute of limitations expired, because, if they did not do so, the defendant could refuse reimbursement of the claim on the ground that the plaintiffs had failed to protect the defendant's subrogation rights (citation omitted). Presumably, the purpose of this alleged conduct would be to save the defendant money; if the plaintiffs initiate the suit, the plaintiffs have to pay for it, whereas if the defendant initiates its own suit, the cost will fall upon the defendant. Accepting the plaintiffs' allegations as true (citations omitted), the plaintiffs have successfully pleaded conduct on the part of the defendant which was misleading in a material way."); and
  • injury ("Here, the plaintiffs allege that, as a result of the defendant's conduct, they were forced to 'incur the costs and expense of hiring an attorney to prevent forfeiture of coverage for a covered loss.' ... The plaintiffs alleged that they were forced to pay for an attorney, and thus adequately pleaded damages under General Business Law § 349").
In discussing plaintiffs' recoverable damages under General Business Law § 349, Justice Dickerson pointed out that the statute permits the recovery of actual, treble and punitive damages.  With respect to plaintiffs' claim for punitive damages, without citing to and in seeming departure from earlier New York insurance case law precedent, the court held:
"An award of punitive damages is warranted where the conduct of the party being held liable evidences a high degree of moral culpability, or where the conduct is so flagrant as to transcend mere carelessness, or where the conduct constitutes willful or wanton negligence or recklessness'" (Pellegrini v Richmond County Ambulance Serv., Inc., 48 AD3d 436, 437, quoting Buckholz v Maple Garden Apts., LLC, 38 AD3d 584, 585). Initially, it should be noted that the plaintiffs do not seek punitive damages on their breach of contract claim, but only on their claim under General Business Law § 349. Under that claim, they allege that the defendant intentionally did not reach a final decision on their claim, so as to force them to commence a suit against the Village. If that is true, and for purposes of a CPLR 3211(a)(7) motion to dismiss, "all allegations must be accepted as true" (Pacific Carlton Dev. Corp. v 752 Pac., LLC, 62 AD3d at 679; see Leon v Martinez, 84 NY2d at 87), such conduct may be considered to be "so flagrant as to transcend mere carelessness'" (Pellegrini v Richmond County Ambulance Serv., Inc., 48 AD3d at 437, quoting Buckholz v Maple Garden Apts., LLC, 38 AD3d at 585). Consequently, the plaintiffs' claim for punitive damages should not be dismissed.
On plaintiffs' claim for attorney's fees, the Second Department ruled that "[s]ince General Business Law § 349(h) provides that the court has the discretion to award reasonable attorney's fees, the plaintiffs' request for attorney's fees should not be dismissed."

Finally, with respect to the lower court's order compelling Allstate to produce information and materials regarding certain property damage claims, Justice Dickerson agreed with plaintiffs that since Allstate's objections to plaintiffs' discovery demands were not served within 20 days of service as required by CPLR 3122(a), the appellate court's review was limited to determining whether the requested material was privileged under CPLR 3101 or the demand was palpably improper.  Finding neither to be the case, Justice Dickerson concluded:
The defendant states that the information sought is likely to contain privileged information. However, this conclusory statement is insufficient to establish that the information sought is, in fact, privileged. Moreover, there is nothing "palpably improper" about the plaintiffs' demand. Here, the court has already narrowed the plaintiffs' request and ordered the defendant to produce documents relating to 375 claims made in connection with the October 2005 storm.

The defendant argues that it was improper for the court to allow discovery to bolster what is otherwise an insufficient cause of action. However, as discussed above, the cause of action was sufficiently pleaded. The information sought, regarding claims the defendant has handled for other insureds, relates to the plaintiffs' attempt to establish that the defendant has engaged in a pattern of deception, and, thus, the request is proper (see Gillen v Utica First Ins. Co., 41 AD3d 647, 647 [information sought "was relevant to the plaintiff's cause of action alleging a violation of General Business Law § 349"]).
One need not be prescient to predict that this decision will become the model upon which policyholders will construct future General Business Law § 349 causes of action and their associated claims for punitive damages and attorney's fees.  For now, property insurers in New York may wish to consider clarifying what the Second Department apparently believes is an ambiguous standard subrogation protection provision of a homeowners policy.   At a point in time when Allstate had not yet reached its coverage decision, would it have mattered if Allstate had sent a letter to the Wilners advising them that they were not obligated to sue the Village in order to protect Allstate's then only potential subrogation rights?

Tuesday, March 3, 2009

Negligence, Slander and Punitive Damages Claims Dismissed Against Property Insurer and Its Special Investigator -- Continuation of EUO Ordered

COMMERCIAL PROPERTY – NONCOOPERATION – EUO – SPOUSAL PRIVILEGE – NEGLIGENCE CAUSE OF ACTION AGAINST PROPERTY INSURER – DEFAMATION CLAIM AGAINST SPECIAL INVESTIGATOR – PUNITIVE DAMAGES
LeBaron v. Erie Ins. Co.

(4th Dept., decided 2/6/2009)


If you had read just the Fourth Department's "ORDERED that the order so appealed from is unanimously affirmed without costs for reasons stated in the decision at Supreme Court" memorandum of February 6, 2009, you might have passed right over this case.  What caught my eye, however, was the court's description of the order appealed from, viz, one granting "those parts of the motion of defendants seeking dismissal of the negligence and slander causes of action and the punitive damages claim."

The term "slip ops" refers to court decisions that may or may not later be published officially in the New York State Reporter.  Written decisions from the New York Court of Appeals and four departments of the Appellate Division are always published officially.  Less than 6% of the decisions received from the Appellate Term and trial-level courts get published officially in the Miscellaneous Reports.  Under a program approved by the Court of Appeals, however, most of the remainder are selected for publication electronically in the New York Slip Opinion Service.  These opinions are classified by subject to the Official Reports Digest-Index and are assigned a unique Slip Opinion citation (e.g., 2007 NY Slip Op 52588[U]) and pagination to permit point-page citations. Some opinions are published in image (PDF) format.

The statutory criteria used to select a lower court decision for publication in the Miscellaneous Reports (the books, not just online),  are:  precedential significance; novelty; public importance; practical significance;subject matter diversity; geographical diversity; author diversity; and literary quality.  Both judges and lawyers can and do submit lower court decisions to the New York Law Reporting Bureau for consideration and possible publication in the Miscellaneous Reports. 

There are several ways of searching for an "unpublished" lower court decision other than by using a paid legal research service such as LexisNexis or Westlaw.  I found the motion court's decision in this case by checking the New York Official Reports and using its Advanced Search tab or feature.  Searching "LeBaron" produced several results, including Stueben County Supreme Court Justice Peter Bradstreet's decision of December 12, 2007, which formed the basis of the parties' appeal and cross appeal to the Fourth Department.  Another way of searching for written decisions that may not get published electronically as a slip opinion is through the eCourts portal of the New York State Unified Court System.  Written decisions are sometimes saved as PDF files to the court's electronic files and can be found by searching with an index number, party's name, judge's name, and or venue.

Which brings us back to this case. It's the trial-level decision that provides the procedural and substantive information, and plenty of it.  

On July 29, 2006, a fire in plaintiff LeBaron's van damaged many of the tools and machinery plaintiff used in his business. After plaintiff reported the loss, defendant Erie Insurance Company began an investigation into the claim.  In August 2006, after Erie had reviewed the list of items plaintiff claimed were damaged in the fire, Erie's special investigator Piontkowski met with representatives of the Corning Police and Fire Departments. According to a Corning Police Department report, Piontkowski told the police and fire investigators that there were inconsistencies between the items listed on plaintiff's claim and the items that were actually damaged in the fire. The police report further indicated that Piontkowski was going to re-interview plaintiff and then forward the matter to the New York State Insurance Frauds Bureau.

In September 2006, the parties attempted to schedule an examination under oath (EUO) of plaintiff. Conflicts between counsel for the parties developed immediately thereafter when plaintiff, prior to the EUO, refused to release a jet washer, one of the items allegedly damaged in the fire, without receiving adequate assurances that the item would be protected. After more than two months of correspondences between counsel, in which the parties argued about Erie's right to inspect and test the disputed item, Erie finally was able to inspect the jet washer in December 2006 after which its expert found that the item was not damaged by the van fire.

On April 12, 2007, counsel for Erie finally conducted the EUO of plaintiff. After some introductory questions, counsel for Erie asked plaintiff whether he had spoken with anyone other than his attorney about the testimony he was to give at the EUO. Plaintiff responded that he had discussed the matter with his wife. When Erie's counsel for inquired about the nature of the discussions with his wife, plaintiff's counsel refused to allow plaintiff to answer the question, citing a spousal privilege. Plaintiff's counsel indicated that Erie's counsel for could ask plaintiff any other questions, but that plaintiff would not answer any questions concerning conversations plaintiff may have had with his wife. Based upon plaintiff's refusal, Erie's counsel declined to ask any further questions and the EUO ended.

Ultimately Erie denied plaintiff's claim, presumably based in part on plaintiff's noncooperation and refusal to answer questions during his EUO.  Plaintiff sued Erie and Piontkowski, asserting causes of action sounding in breach of contract, negligence, slander and punitive damages.  Erie moved to dismiss the action as premature, based on plaintiff's asserted noncooperation with Erie's investigation, including his delay in providing the jet washer for inspection and refusal to answer questions during his EUO.  Erie aslo sought dismissal of the slander claim against Piontkowksi based on qualified privilege, and the negligence claim based on the absence of any duty independent of the insurance contract.

Plaintiff cross-moved for leave to serve an amended complaint specifying his causes of action sounding in negligence, slander and punitive damages.  In opposition to defedants' motion to dismiss, plaintiff argued that defendants had not shown sufficiently willful noncompliance with the insurance contract to warrant dismissal of the action since plaintiff acted reasonably in insisting that proper safeguards be established before he submitted the jet washer for testing and inspection. Plaintiff also contended that he correctly asserted a spousal privilege during the EUO, that he was not required to adhere to Erie's "almost Godlike stance that he who represents an insurance company must be obeyed", and that Erie's position that plaintiff and his wife were involved in a conspiracy to obtain insurance proceeds was "preposterous".

As for his slander claim, plaintiff argued that his allegations did raise questions as to whether defendant Piontowski acted with malice in discussing the insurance claim with the police. As to his negligence claim, plaintiff contended that a separate tort action is allowable because defendants breached their duty of good faith which is independent of the insurance contract. Finally, plaintiff asserted that the complaint's allegation that Piontowski's statements to the police were willful, wanton and reckless supported an award of punitive damages.

Steuben County Supreme Court Justice Peter Bradstreet: (1) conditionally granted defendants' motion to dismiss the complaint unless plainitiff submitted to another EUO within 60 days of the court's decsion and answered "all material and relevant questions, consistent with this Decision and Order"; (2) granted defendants' motion dismissing the negligence, slander and punitive damages claims; and (3) denied plaintiff's cross motion to serve an amended complaint on those causes of action.

In declining to dismiss the entire action based on defendants' noncooperation defense, the court found that plaintiff's delay in providing the jet washer for testing did not, in and of itself, constitute the type of willful noncooperation necessary to warrant a dismissal of the action. "Plaintiff's actions, while not particularly reasonable, did not rise to the level of 'willful and avowed obstruction'".

With respect to plaintiff's assertion of the spousal privilege at his EUO, the court found this to be "more problematic."  In reviewing this issue, the court noted that the purpose of a policy's EUO condition is to enable the insurer to obtain all knowledge and facts concerning the cause of the fire and the loss involved while the information is still fresh in order to protect itself from false and fraudulent claims; that the right to examine under the cooperation clause of an insurance policy is much broader than the right of discovery under the CPLR; that an insurer is permitted to ask, and an insured is required to answer, any material and relevant questions concerning the claim; and that an insured risks the loss of coverage under a fire insurance policy even when refusing to answer questions at an EUO or provide information to the insurer upon the advice of counsel.

Based on these principles, the court held that plaintiff had no basis to refuse to answer questions at the EUO concerning conversations he had with his wife prior to testifying. 
While the Court recognizes the importance of protecting confidential communications between a husband and a wife, if an insured is not permitted to invoke at an EUO a basic Constitutional right, it certainly cannot be said that Plaintiff can refuse to answer questions at an EUO based upon a spousal privilege. 
Although having found that plaintiff improperly refused to answer questions during his EUO regarding his conversations with his wife, the court declined to dismiss the action, instead finding that a conditional order of dismissal was the appropriate remedy in this case because counsel for Erie had terminated rather than continued the EUO when plaintiff invoked the spousal privilege:
While, as noted above, Plaintiff improperly asserted a spousal privilege during the EUO, the record demonstrates that it was counsel for Erie who stopped the EUO and refused to ask any further questions. Cf, Davis v. Allstate Insurance Company, 204 AD2d 592; Evans v. International Insurance Company, 168 AD2d 374; Pizzirusso v. Allstate Insurance Company, 143 AD2d 340. Had counsel continued with the EUO, the record may have revealed that questions concerning conversations Plaintiff had with his wife would, indeed, be information material and relevant to the subject claim. As such, Defendants have, at this point, failed to establish that they acted diligently in seeking Plaintiff's cooperation (Blinco v. Preferred Mutual Insurance Company, 11 AD3d 924) and, notwithstanding Plaintiff's breach of his contractual obligation by failing to answer certain questions at the EUO, and his delay in submitting to Defendants the jet washer, Plaintiff's noncompliance was not so willful or extreme as to warrant dismissal of the action without giving him one last chance to answer the questions. Marmorato v. Allstate Insurance Company, 226 AD2d 156 (1st Dept, 1996).
On plantiff's negligence and bad faith claims, the court agreed with defendants that no such separate claims had been stated:
It is a well established principle that a simple breach of contract is not to be considered a tort unless a legal duty independent of the contract itself has been violated. Bristol-Myers Squibb, Industrial Division v. Delta Star, Inc., 206 AD2d 177 (4th Dept, 1994); City of Watertown v. Stebbins Engineering and Manufacturing Company, 206 AD2d 828 (4th Dept, 1994). Because a tort obligation is apart from and independent of promises made in a contract, a defendant may be liable in tort only when it has breached a duty of reasonable care distinct from its contractual obligations, or when it has engaged in tortious conduct separate and apart from its failure to fulfill its contractual obligations. New York University v. Continental Insurance Company, 87 NY2d 308 (1995). 

In the instant case, the essence of Plaintiff's negligence cause of action is Erie's breach of the insurance policy by failing to timely provide him with the benefits to which Plaintiff contends he is entitled due to damages he sustained in the van fire. The Complaint does not allege the creation of a relationship between Plaintiff and Defendants separate from their contractual relationship (Alexander v. Geico Insurance Company, 35 AD3d 989) and there is no separate tort for the bad faith refusal to comply with an insurance contract. New York University v. Continental Insurance Company, 87 NY2d 308; Paterra v. Nationwide Mutual Fire Insurance Co., 38 AD3d 511 (2nd Dept, 2007); Johnson v. Allstate Insurance Company, 33 AD3d 665 (2nd Dept, 2006); Alexander v. Geico Insurance Company, 35 AD3d 989.
On plaintiff's slander claim, the court agreed with defendants that Erie's special investigator was protected by the doctrine of qualified privilege:
A communication is subject to a qualified privilege where it is made (1) in good faith by a person in the discharge of some public or private duty, legal or moral, or in the conduct of his or her own affairs, in a matter where his or her interest is concerned (Toker v. Pollak, 44 NY2d 211 (1978); or (2) by one person to another upon a subject in which both have a common interest. Liberman v. Gelstein, 80 NY2d 429 (1992); East Point Collision Works, Inc., v. Liberty Mutual Insurance Company, 271 AD2d 471 (2nd Dept, 2000); Herlihy v. Metropolitan Museum of Art, 214 AD2d 250 (1st Dept, 1995). The defense of qualified privilege will be defeated by demonstrating that the party spoke with malice, i.e., where it is shown that the motivation for making such statements was spite or ill will (common law malice), or that the statements were made with a high degree of awareness of their probable falsity (constitutional malice). Foster v. Churchill, 87 NY2d 744 (1996); Liberman v. Gelstein, 80 NY2d 429; Kondo-Dresser v. Buffalo Public Schools, 17 AD3d 1114 (4th Dept, 2005); Fregoe v. Fregoe, 33 AD3d 1182 (3rd Dept, 2006). 

In the instant case, Defendant Piontkowski is protected by a qualified privilege in that the statements he gave were part of his duties to report possible false insurance claims to the police. Chapo v. Premier Liquor Corporation, 259 AD2d 1050 (4th Dept, 1999). There can be no liability for merely giving information to legal authorities who are left entirely free to use their own judgment in proceeding any further with respect to that information. Lowmack v. Eckerd Corporation, 303 AD2d 998 (4th Dept, 2003); Cobb v. Willis, 208 AD2d 1155 (4th Dept, 1994). Moreover, Defendants and the police certainly have a common interest in the investigation of potentially false insurance claims. Liberman v. Gelstein, 80 NY2d 429; Herlihy v. Metropolitan Museum of Art, 214 AD2d 250.

The Court further finds that both the original and Amended Complaints fail to raise sufficient allegations that Defendant Piontkowski acted with malice in speaking with the police. According to the police report provided by Plaintiff, Defendant Piontkowski's discussion with the police dealt only with possible inconsistencies between the items Plaintiff claimed were damaged by the fire and the photographs taken by the police. While the papers submitted in support of Plaintiff's cross-motion make repeated suggestions that Defendants had falsely accused Plaintiff of arson, the Amended Complaint alleges only that Defendant Piontkowski "did wrongfully advise" the police about the insurance claim. Construing the Amended Complaint in the light most favorable to Plaintiff, the Court finds Defendant Piontkowski's qualified privilege is not overcome by the vague and conclusory allegations set forth in the Amended Complaint that the statements to the police were made with ill will or with a high degree of awareness of their probable falsity. Doherty v. New York Telephone Company, 202 AD2d 627 (2nd Dept, 1994); East Point Collision Works, Inc., v. Liberty Mutual Insurance Company, 271 AD2d 471; cf, Labarge v. Holmes, 30 AD3d 1087 (4th Dept, 2006); Kondo-Dresser v. Buffalo Public Schools, 17 AD3d 1114.
Finally, in dismissing the plantiff's punitive damages claim,  Justice Bradstreet held:
First, inasmuch as the Court is dismissing Plaintiff's negligence and slander claims, there is no independent tort action upon which a punitive damages claim can lie. Even if the negligence and slander claims were to survive, and affording the original and Amended Complaints every possible inference, the Court finds Plaintiff's allegations fail to rise to the level of willful or wanton negligence, recklessness, or moral culpability. Hunter v. Galland, 37 AD3d 1048. Plaintiff's claims that Defendants' behavior "may also be possibly tied to a pattern" of similar behavior towards other claimants is wholly conclusory and completed unsupported in the Complaint. In sum, the acts alleged by Plaintiff constitute private wrongs for which punitive damages may not recovered. Westinghouse Electric Supply Company v. Pyramid Champlain Company, 193 AD2d 928. 
Lots and lots of good stuff in the motion court's decision, which the Fourth Department affirmed wholesale.  Take a look.

Sunday, March 1, 2009

Court Dismisses Bad Faith/Punitive Damages Claims Against Homeowners & CGL Insurers

HOMEOWNERS – CGL – UNDERLYING FALSE ARREST & IMPRISONMENT CLAIMS – BAD FAITH – PUNITIVE DAMAGES
Neff v. Automobile Ins. Co. of Hartford, CT

(SDNY, decided 2/20/2009)


Plaintiff was sued in New York Supreme Court for damages arising from his alleged filing of a false criminal complaint.  The complaint in the underlying action alleged that plaintiff "knew or should have known that the aforementioned arrest and imprisonment were false and without probable cause," "the aforesaid arrest was made without knowledge of and/or negligent and/or reckless disregard of the material falseness of the criminal complaint filed by [plaintiff]", and that plaintiff "knew, or should have known through the exercise of reasonable care and proper police procedure that the said investigation into this matter was flawed and incomplete[.]"

Plaintiff tendered the underlying complaint to his homeowners (Automobile Insurance Company of Hartford, CT) and CGL (Travelers) insurers for defense and indemnification coverage, but they disclaimed on various grounds not set forth in this decision.  Plaintiff then commenced this action for declaratory judgment and breach of contract.  In addition to seeking in excess of $100,000 in "consequential damages", plaintiff's complaint alleged that defendants' refusals to defend him in the underlying action were fraudulent and "so egregious, morally culpable, willful and wanton as to warrant the imposition of punitive damages in the minimum sum of $1,000,000."  Defendant insurers moved to dismiss the complaint's punitive damages claims pursuant to Fed. R. Civ. P. 12(b)(6).

The district court GRANTED the motion, dismissing the punitive damages claims.  Citing the New York Court of Appeals' seminal decision in New York Univ. v. Cont'l Ins. Co., 87 N.Y.2d 308 (1995), the district court reminded that ""the pleading elements required to state a claim for punitive damages as an additional and exemplary remedy when the claim arises from a breach of contract" are:
(1) defendant's conduct must be actionable as an independent tort; 
(2) the tortious conduct must be of the egregious nature set forth in Walker v. Sheldon, 10 N.Y.2d 401, 404-405; 
(3) the egregious conduct must be directed to plaintiff; and 
(4) it must be part of a pattern directed at the public generally.
In an effort to meet the Walker v. Sheldon pleading requirement, plaintiff's complaint alleged:
Defendants' disclaimer of coverage was without an arguable basis and was deliberately made in bad faith and with knowledge of the lack of a reasonable basis, since Hartford was a party to Automobile Ins. Co. of Hartford v. Cook, 7 N.Y. 3d 131, 850 N.E.2d 1152, 818 N.Y.S.2d 176 (2006), which held that Hartford is required to defend its insured in an action where it is alleged that the injury was caused by the negligent conduct of the insured, as negligent conduct is an "occurrence" as defined in the insurance policy.  Defendants' continued failure to defend their insureds against claims alleging negligent conduct, in spite of the holding in Cook, is part of a pattern of behavior aimed at the public generally.
In opposition to defendants' motion, plaintiff argued that "[d]efendants' continued disclaimer of coverage upon grounds previously rejected by the highest court is evidence of defendants' continued scheme to deny coverage to the public without any legitimate basis" constituting "a pattern of fraudulent behavior."

Apparently the district court granted plaintiff leave to amend his complaint prior to the issuance of this decision, but plaintiff decided not to do so.  In granting the defendants' motion, the district court held:
Plaintiff's allegations in this case that "Defendants' disclaimer of coverage was without an arguable basis and was deliberately made in bad faith and with knowledge of the lack of a reasonable basis," Compl. P 26, are equivalent to the allegations held to be insufficient to support punitive damages in New York UniversityPlaintiff does not allege that Defendants made any misrepresentation or omission of material fact to support a claim for fraud or that Defendants' breached any other duty independent of their contractual obligations.

Plaintiff's bad faith allegations are inseparable from his contract claims[.]

Sunday, November 30, 2008

Second Department Grants Dismissal of Punitive Damages and Infliction of Emotional Distress Causes of Action Against Insurer

HOMEOWNERS – PUNITIVE DAMAGES – NEGLIGENT & INTENTIONAL INFLICTION OF EMOTIONAL DISTRESS
Tartaro v. Allstate Indem. Co.

(2nd Dept., decided 11/25/2008)


I'm guessing that this is a homeowners coverage case.  Couldn't find any further information on the core facts on eCourts or through New York State Law Reporting Bureau's Slip Decisions Search page.

Plaintiff-insureds sued Allstate for breach of contract.  Their verified complaint also asserted causes of action for punitive damages and negligent and intentional infliction of emotional distress.  Allstate unsuccessfully moved to dismiss those causes of action.

In REVERSING Nassau Supreme's order and dismissing the punitive damages and infliction of emotional distress causes of action, the Second Department held:
Contrary to the plaintiffs' contention, punitive damages are not recoverable in an ordinary breach of contract case, as their purpose is not to remedy private wrongs but to vindicate public rights. Punitive damages are only recoverable where the breach of contract also involves a fraud evincing a high degree of moral turpitude, and demonstrating such wanton dishonesty as to imply a criminal indifference to civil obligations, and where the conduct was aimed at the public generally (see New York Univ. v Continental Ins. Co, 87 NY2d 308, 315-316; Rocanova v Equitable Life Assur. Socy. of U.S., 83 NY2d 603, 613). Punitive damages are available where the conduct associated with the breach of contract is first actionable as an independent tort for which compensatory damages are ordinarily available, and is sufficiently egregious to warrant the additional imposition of exemplary damages. A party must demonstrate not only egregious tortious conduct, but also that such conduct was part of a pattern of similar conduct directed at the public generally (see New York Univ. v Continental Ins. Co, 87 NY2d at 316; Rocanova v Equitable Life Assur. Socy. of U.S., 83 NY2d at 613). Here, the defendant showed that its conduct was not egregious or of high moral turpitude, and thus was not actionable as an independent tort. Furthermore, there is no evidence of a pattern of egregious conduct directed toward the public at large. 

The Supreme Court also erred in denying that branch of the defendant's motion which was pursuant to CPLR 3211(a)(7) to dismiss the third cause of action, alleging negligent and intentional infliction of emotional distress, for failure to state a cause of action. To establish liability for the intentional infliction of emotional distress, the plaintiffs were required to show that the defendant's conduct was "so outrageous in character, and so extreme in degree, as to go beyond all possible bounds of decency" (Ruggiero v Contemporary Shells, 160 AD2d 986, 987; see Freihofer v Hearst Corp., 65 NY2d 135, 143). That same test has been applied to causes of action for the negligent infliction of emotional distress (see Chime v Sicuranza, 221 AD2d 401; Burrell v International Assn. of Firefighters, 216 AD2d 346). Here, accepting the allegations of the complaint as true, they do not allege conduct so outrageous in character, and so extreme in degree, as to state a cause of action for negligent or intentional infliction of emotional distress (see Curry v Dollard, 52 AD3d 642).
Nothing really new here.  New York remains a jurisdiction in which insurance coverage disputes do not ordinarily support causes of action for either punitive damages or negligent/intentional infliction of emotional distress.

Friday, October 24, 2008

Fifth Citing of Bi-Economy

HOMEOWNERS – CGL – PUNITIVE DAMAGES – REGULATION 64 CAUSE OF ACTION – CONSEQUENTIAL DAMAGES
Silverman v. State Farm Fire & Casualty Co.

(Sup. Ct., Nassau Co., decided 10/8/2008)


We now have our fifth citing of the Court of Appeals' February 2008 Bi-Economy Market v. Harleysville holding, this time in a New York state court homeowners and general liability coverage case.

Plaintiffs commenced this declaratory judgment (DJ) action for liability insurance coverage in relation to an underlying personal injury action brought against them for damages flowing from an alleged sexual assault committed by plaintiff Barry J. Silverman, DMD, on Elizabeth Ceparano. It was alleged that the incident took place on September 10, 2006 at the premises of defendants' dental practice in Bayside, New York. In an affirmation in opposition to the defendant insurers' motions to dismiss, plaintiffs' attorney contended that there was no assault, but only a consensual sexual encounter initiated by Ceparano when she was plaintiffs ' employee, the purpose of which was to later extort money from the plaintiffs.

Plaintiffs sought defense and indemnification coverage under: a homeowners policy issued by State Farm to Silverman and his wife for a premises located in Merrick, New York; a businessowners liability policy issued by Travelers/Charter Oak to University Dental, PC; and a CGL policy issued by Fireman's Fund/American to plaintiffs. In addition to seeking declaratory relief, plaintiffs' complaint also sought "punitive damages and statutorily mandated damages", based on defendants' alleged failure to settle the plaintiffs' insurance claims fairly and quickly, in violation of Insurance Law § 2601. State Farm, Charter Oak and American moved to dismiss the punitive damages and "statutorily mandated" damages claims, and State Farm also moved to dismiss the entire DJ complaint based on plaintiffs' alleged failure to name Ceprano and her husband as necessary and interested parties.

In granting the defendants' motions to dismiss the plaintiffs' claims for punitive damages and "statutorily mandated" damages, Nassau County Supreme Court Justice Daniel Palmieri held:
Under New York law, punitive damages would be available in this case only where the plaintiffs could demonstrate that they were victims of a tort independent of the insurance contract - even if denial of benefits under that contract could be deemed made in bad faith. New York University Continental Ins. Co., 87 NY2d 308 (1995); Rocanova Equitable Life Assurance Soc. of U.S., 83 NY2d 603 (1994). An independent tort is not alleged here. At best, the Court has before it a breach of contract that might be characterized as egregious, but that is not a tort. Moreover, punitive damages in the current context would require that the insurer's acts be those "evincing a high degree of moral turpitude and demonstrating such wanton dishonesty as to imply a criminal indifference to civil obligations." Rocanova, supra at 613. Again, the allegations, and even the statement of plaintiffs ' attorney, do not indicate behavior that rises to that level. See also, Fabiano v Philip Morris, Inc., __AD3d__, 862 NYS2d 487 (1 Dept. 2008) ("the courts of this State have been so adamant that punitive damages are ' a social exemplary remedy (and) not a private compensatory remedy ' that the imposition of such damages for private purposes has been held to violate public policy" [citation omitted]).

Plaintiffs do not dispute the foregoing law. Rather, citing recent decisions of the Court of Appeals, they contend that they may sue for consequential damages resulting from the failure to provide coverage. Such a failure may indeed support such a claim if it flows from a breach of the covenant of good faith and fair dealing, which the courts will read into all insurance contracts. Bi-Economy Mkt., Inc. v Harleysvile Ins. Co. of N.Y., 10 NY3d 187 (2008); Panasia Estates, Inc. v Hudson Ins. Co., 100 NY3d 200 (2008). However, as a claim for consequential damages is not the subject of the instant motions the Court need not address it as a basis for denying those motions, except to note that it does not serve to bolster a claim for punitive damages. Indeed, the Court of Appeals itself expressly distinguished the two and indicated no change to the law in that regard. Bi-Economy Mk., Inc., supra, at 193-194. "When an insured... suffers additional damages as a result of an insurer's excessive delay or improper denial, the insurance company should stand liable for those damages. This is not to punish the insurer but to give the insured its bargained-for benefit." Id., at 195 (emphasis added).

Accordingly, the Court agrees with the defendants that a claim for punitive damages does not lie and the same is dismissed as to all defendants.

Further, to the extent the "statutory" claim is premised on the alleged failure to settle fairly and quickly the insurance claims made, the reference is deemed to be to Insurance Law § 2601(c), which prohibits unfair claims settlement practices, but New York does not curently recognize a private right of action thereunder. Kantrowitz v Allstate Indem. Co., 48 AD3d 753 (2d Dept. 2008). Accordingly, it too is dismissed as to all defendants.
Without any analysis of whether consequential damages were within the contemplation of the parties when they entered into the particular insurance contracts at issue, Justice Palmieri ruled:
However, in view of the recent Court of Appeals [sic] decisions cited above, and the very early stage of the instant litigation, the plaintiffs may serve an amended complaint seeking consequential damages, as sought in counsel' s request to replead. * * * As noted, this case is in the very early stages, and the law on the subject has at least arguably been changed to allow for a consequential damages claim here.
In a footnote to that last statement, the court added:
This is not to say that the Court has determined that a claim for consequential damages is in fact viable in this case, and the defendants are not barred from moving to dismiss this claim after sufficient discovery has been had.
I'm not sure whether the court is inviting another CPLR 3211 motion to dismiss or a 3212 motion for summary judgment following discovery. Either way, the lack of any legal analysis of whether the homeowners and commercial liability policies contemplated consequential damages yet to be alleged in this case is both troubling and illustrative of what some feared would be New York courts' misapplication of the Bi-Economy ruling to any and all insurance coverage disputes. In decisions like this one, the courts are ignoring these words from Judge Piggott in Bi-Economy:
To determine whether consequential damages were reasonably contemplated by the parties, courts must look to "the nature, purpose and particular circumstances of the contract known by the parties . . . as well as 'what liability the defendant fairly may be supposed to have assumed consciously, or to have warranted the plaintiff reasonably to suppose that it assumed, when the contract was made[.]'"

* * * * *

Thus, the very purpose of business interruption coverage would have made Harleysville aware that if it breached its obligations under the contract to investigate in good faith and pay covered claims it would have to respond in damages to Bi-Economy for the loss of its business as a result of the breach[.]

* * * * *

Therefore, in light of the nature and purpose of the insurance contract at issue, as well as Bi-Economy's allegations that Harleysville breached its duty to act in good faith, we hold that Bi-Economy's claim for consequential damages including the demise of its business, was reasonably foreseeable and contemplated by the parties, and thus cannot be dismissed on summary judgment.
What damages consequential to an alleged breach of a homeowners or general liability insurer's obligation to defend and indemnify an insured could there be other than defense and indemnification costs? Since the nature and purpose of a liability insurance contract is to provide defense and indemnification protection for covered losses and claims, what other damages consequential to an alleged breach of such a contract were reasonably foreseeable and contemplated by the parties at the policy's inception?

The Court of Appeals implicitly recognized in Bi-Economy that not every insurance contract can or will support a claim for consequential damages. If this weren't the case, there would have been no need for the court's analysis and determination of the "nature and purpose" of the commercial property policy at issue, with its business income loss coverage, in that case.