Reported in New York Official Reports at Right Solution Med. Supply, Inc. v Republic W. Ins. Co. (2018 NY Slip Op 51125(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Republic Western Ins. Co., Appellant.
Bryan, Cave, Leighton, Paisner, LLP (William T. O’Connell and Daniel Klein of counsel), for appellant. Law Offices of Emilia I. Rutigliano, P.C., for respondent (no brief filed).
Appeal from an order of the Civil Court of the City of New York, Kings County (Katherine A. Levine, J.), entered October 16, 2015. The order denied defendant’s motion to vacate a default judgment of that court entered December 3, 2013 upon defendant’s failure to proceed at trial.
ORDERED that the order is reversed, with $30 costs, and defendant’s motion to vacate the default judgment is granted.
In this action by a provider to recover assigned first-party no-fault benefits arising out of an accident that occurred on December 21, 2009, defendant moved to vacate a judgment, entered December 3, 2013, that had apparently been entered upon its failure to proceed at trial on December 17, 2012. In support of its motion, defendant submitted an affidavit by plaintiff’s assignor in which plaintiff’s assignor admitted that the December 21, 2009 accident underlying this no-fault proceeding had been staged, and an order dated April 26, 2013, from the Supreme Court, New York County, in a declaratory judgment action, entered on default, finding that defendant herein had no duty to pay any no-fault benefits to plaintiff herein and its assignor, among others, with respect to this accident. The Civil Court denied defendant’s motion, finding that defendant had failed to establish a reasonable excuse for its failure to proceed at trial.
Defendant’s motion should have been granted, as defendant demonstrated both a reasonable excuse for its failure to proceed at trial and a meritorious defense (see CPLR 5015 [a] [1]; Eugene Di Lorenzo, Inc. v A.C. Dutton Lbr. Co., 67 NY2d 138, 141 [1986]).
Accordingly, the order is reversed and defendant’s motion to vacate the default judgment is granted.
WESTON, J.P., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: July 13, 2018
Reported in New York Official Reports at V.S. Med. Servs., P.C. v Allstate Ins. Co. (2018 NY Slip Op 51124(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Allstate Insurance Company, Respondent.
Korsunskiy Legal Group, P.C. (Koenig Pierre of counsel), for appellant. Law Offices of Peter C. Merani, P.C. (Eric M. Wahrburg and Samuel Kamara of counsel), for respondent.
Appeal from a judgment of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered December 11, 2015. The judgment, entered pursuant to a determination of that court that plaintiff had defaulted by failing to comply with a condition for the granting of an adjournment of the trial, dismissed the complaint.
ORDERED that the appeal is dismissed except insofar as it brings up for review the determination that plaintiff had defaulted by failing to comply with the condition for the granting of an adjournment of the trial; and it is further,
ORDERED that the judgment, insofar as reviewed, is reversed, with $30 costs, the determination that plaintiff had defaulted by failing to comply with the condition for the granting of an adjournment of the trial is vacated, and the matter is remitted to the Civil Court for a new determination, following a hearing, of whether plaintiff had satisfied the condition for the granting of an adjournment and for any and all further proceedings, in accordance with this decision and order.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from a judgment dismissing the complaint, which was entered upon the Civil Court’s determination that plaintiff had defaulted by failing to comply with a condition set by the court for granting plaintiff an adjournment of the trial, to wit, that plaintiff provide proof of the funeral [*2]which plaintiff’s counsel alleged his witness had been attending on the scheduled trial date.
We note that, although no appeal lies from a judgment entered on the default of the appealing party (see CPLR 5511), an appeal from such a judgment brings up for review those matters which were the subject of contest below (see James v Powell, 19 NY2d 249, 256 n 3 [1967]), which, in this case, was the Civil Court’s determination that plaintiff had defaulted by failing to satisfy the condition for the granting of an adjournment (see Park Lane N. Owners, Inc. v Gengo, 151 AD3d 874 [2017]; Delijani v Delijani, 100 AD3d 823 [2012]; Matter of Branch v Cole-Lacy, 96 AD3d 741 [2012]; Sarlo-Pinzur v Pinzur, 59 AD3d 607 [2009]).
“The granting of an adjournment for any purpose is a matter resting within the sound discretion of the trial court” (Matter of Anthony M., 63 NY2d 270, 283 [1984]), and the Civil Court acted within its discretion in conditioning the granting of an adjournment of the trial upon plaintiff’s providing proof of the funeral that its witness had allegedly been attending. However, we find that, in the circumstances presented, the Civil Court improvidently exercised its discretion in not allowing plaintiff’s witness to testify in order to try to provide the required proof. Consequently, we remit the matter to the Civil Court for a hearing to give plaintiff such an opportunity, following which the court shall determine whether it is satisfied with plaintiff’s proof.
Accordingly, the judgment, insofar as reviewed, is reversed, the determination that plaintiff had defaulted by failing to comply with a condition for the granting of an adjournment is vacated, and the matter is remitted to the Civil Court for a new determination, following a hearing, of whether plaintiff had satisfied the condition for the granting of an adjournment and for any and all further proceedings.
WESTON, J.P., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: July 13, 2018
Reported in New York Official Reports at Acupuncture Work, P.C. v Infinity Ins. Co. (2018 NY Slip Op 51109(U))
Acupuncture Work,
P.C., AAO, Ngozichuwwu (Lis) Amadi, Plaintiffs,
against Infinity Insurance Company, Defendant. |
CV-023737-10
For Plaintiff: Marcote & Associates, P.C.
For Defendant: Freiberg, Peck & Kang, LLP
Armando Montano, J.
After conducting a no-fault bench trial on the above captioned matter, this Court makes the following findings and conclusions:
At the commencement of the above captioned trial, the attorneys for the respective parties entered into a Stipulation that contained documents to be relied upon by the defendant’s witness, to wit: letters, correspondence, statements, denials and an insurance policy application. Respective counsels acknowledged having examined all documents contained in the Stipulation and agreed that foundation for their introduction had been established and put into evidence, which was marked as Court Exhibit I, which contained documents marked as Exhibits A through J.
In his opening statement, plaintiff’s counsel stated that the above captioned matter involved a rescission of an automobile policy with regard to no-fault law benefits. Plaintiff’s counsel essentially was contesting whether defendant’s witness’ testimony as to the basis for the rescission of the automobile policy and the documentation contained within Court Exhibit I would be sufficient to establish a foundation for the rescission. Plaintiff’s counsel final representation was that the parties would further stipulate that the plaintiff’s claims for medical services rendered had been mailed to the defendant’s insurance company and as such, that the plaintiff established its prima facie case.
Defendant’s counsel stated that the automobile insurance policy referenced by plaintiff’s counsel was a South Carolina policy which resulted in a conflict of laws between South Carolina and New York State with respect to the rescission of the policy. Defendant’s counsel acknowledged that in establishing an automobile insurance policy rescission issued for another state, New York case law placed the burden on the defendant/insurer to establish that the rescission was actually executed, by establishing that the rescission letter was mailed and that the policy premiums were refunded to the insured.
Defendant’s counsel further argued that New York case law did not impose a burden to [*2]establish that any underlying fraud had occurred before establishing a sister state rescission. Defendant’s counsel nonetheless represented that Court Exhibit I provided some proof of the underlying fraud to which defendant’s witness, Barbara Terry, would testify to. Defendant counsel, in his opening statement, also stated that if the automobile insurance policy rescission was found to be proper then the injured party and even the third party, the plaintiff in the above captioned matter, would be precluded from obtaining any insurance benefits. Finally, counsel for the respective parties further stipulated that on November 7, 2007, the defendant insurer had mailed out a rescission letter with two (2) premium refund checks in the amounts of $16,762.76 and $1,562.00, respectively, sent to the policyholder, which the latter cashed. See Exhibit J contained in Court Exhibit I.
This Court’s review of Exhibit A attached to Court Exhibit I, reveals that the November 15, 1999, application for automobile insurance, purportedly submitted by the insured, Jerome McDowell, only lists his name as the motorist. Furthermore, in the “Applicant’s Statement-Read Before Signing” of Exhibit A, Jerome McDowell, certified that, in relevant part, “(a) all operators of my vehicle have been reported to the company and (b) my principal residence/place of vehicle garaging is in South Carolina, ten (10) or more months each year “
Further contained in the Applicant’s Statement is a representation by the insured, Jerome McDowell, that he has applied to the company ” for a policy of insurance as set forth in this application on the basis of the statements contained herein. I agree that such policy of insurance shall be null and void if such information is false, or misleading, or could materially affect acceptance of the risk by the company ” Exhibit A furthermore contains the November 15, 2006, Renewal Declarations which then added the 2000 Dodge Intrepid to the insurance policy. Exhibit A also contains as an attachment the Personal Automobile Policy- South Carolina. In Part F- General Provisions of the policy, there is a termination clause, paragraph 1, that provides that “this policy may be cancelled during the policy period as follows: iii. If the policy was obtained through willful misrepresentation, or concealment of any material fact or circumstances, or fraud.”
The policy’s termination clause in the insurance policy furthermore states in relevant part, “the statements made by you in the application are deemed to be representations. If any representation is false, misleading or materially affects the acceptance of this risk by us, by either willful misrepresentation, omission, concealment of facts or incorrect statements, this policy may be null and void from its inception, whether before or after the loss. We do not provide coverage for any insured who has made fraudulent statements or engaged in fraudulent conduct in connection with any accident or loss for which coverage is sought under this policy.”
Also contained within the insurance policy are declarations stating, in relevant part, that by accepting this policy you agree that this policy is issued upon the truth of the information provided by you. Exhibit C of Court Exhibit I contains the March 12, 2007, police accident report listing as the driver of the 2000 Dodge Intrepid, Ngozichakwuu Amadi, residing at 772 Jefferson Avenue, Brooklyn, New York, and listing the vehicle’s owner as Jerome Wallace McDowell, residing at 110 Madison Street, Olanta, South Carolina.
This Court also reviewed Exhibit G of Court Exhibit I, the May 7, 2007, tape recorded telephone interview of Garis McDowell. In said interview, Garis McDowell stated, in relevant part, the following: that he resided at 772 Jefferson Avenue, Brooklyn, New York, for the past approximately seven to eight years; that Ngozichakwuu Amadi, the operator of the 2000 Dodge Intrepid involved in the March 12, 2007, automobile accident has resided together with him for [*3]approximately twelve years and who he considers his common-law wife; that although his brother, Jerome McDowell, the insured and the documented owner of the 2000 Dodge Intrepid, gave him permission to use said vehicle, that the vehicle was kept in Brooklyn, New York, and which he used on and off for years, and that in turn, he had given Ms. Amadi permission on March 12, 2007, to drive the automobile. Garis McDowell further stated that his brother, Jerome McDowell, was aware that he, Garis McDowell, had given Ms. Amadi permission to drive the subject vehicle. Garis McDowell further stated that motor vehicles have been shared by the family. At the conclusion of the interview, Garis McDowell stated that he truthfully answered all questions asked of him and that he understood all questions asked of him.
This Court has reviewed Exhibit H, the September 26, 2007, examination under oath of the insured, Jerome McDowell. In relevant part, Jerome McDowell acknowledged that although he maintained automobile insurance, he denied ever owning the 2000 Dodge Intrepid, although it was insured on his insurance policy, that Mary McFadden, the sister of both himself and Garis McDowell, made all the arrangements to insure the motor vehicles, Jerome could not even state with certainty that he himself was the signatory on the insurance application and that his sister, Mary McFadden had his authorization to sign his name to obtain insurance. Jerome McDowell furthermore stated that as far as the 1960’s all motor vehicle purchases by various family members were placed in his mother’s name and all vehicles were placed on the same insurance policy. Jerome McDowell further stated that Garis McDowell drove the 2000 Dodge Intrepid back and forth from New York to South Carolina, never leaving it for more than three months at a time in South Carolina. Jerome McDowell also stated that he himself never gave permission to his brother Garis McDowell’s “common-law wife”, Ms. Amadi, to drive the subject vehicle as he does not even know her.
This Court then reviewed Exhibit I and Exhibit J, respectively, contained in Court Exhibit I. Exhibit I is the November 7, 2007, rescission letter by the insurer’s Senior Special Investigator, Robert Dwy. Said letter informed the insured, Jerome McDowell, in relevant part, that upon completion of the investigation into the claims, it had been determined that material misrepresentations in the procurement of the automobile insurance policy had been made by Jerome McDowell; that the insurer had issued the insurance policy based upon those misrepresentations in the application for issuance; it appearing that the insured, Jerome McDowell, insured his vehicles for other family members that were never listed on the policy and that the listed vehicles were not garaged in the State of South Carolina.
Senior Special Investigator Robert Dwy concluded his November 7, 2007, letter by stating that “in accordance with the policy terms and as a result of [the] investigation, [the] policy has been voided back to the inception. All moneys paid on [the] policy are being refunded to you. Furthermore, coverage for all claims resultant from the accident of March 12, 2007, is being denied.” Exhibit J documents the payments made to the insured, Jerome McDowell, and received by his attesting to the return of all moneys paid by him on the policy.
On November 17, 2017, a non-jury trial in the above captioned no-fault proceeding was conducted by this Court, wherein in addition to the joint submission into evidence of Court Exhibit I, the defendant insurer called New York Personal Insurance Protection Specialist Barbara Terry as a witness. Ms. Terry testified that her duties for the insurer was to handle any claims that originate for the State of New York pertaining to accidents occurring within New York State. Ms. Terry testified she was familiar with the claim having read the file and that the claim decision was to rescind the policy based on material misrepresentations and fraud. Said [*4]decision was based on the vehicle involved in the accident was not garaged in South Carolina where the policy originated from as it was garaged in New York. This information as to where the subject vehicle was garaged was obtained from statements made by the insured, Jerome McDowell (Exhibit H), and his brother, Garis McDowell (Exhibit G).
Ms. Terry furthermore testified that the insurance policy application never made any indication of Garis McDowell nor Ms. Amadi as additional drivers. Ms. Terry furthermore testified that the failure to list either Garis McDowell or Ms. Amadi as additional drivers was a misrepresentation constituting a material risk to what was insured. As such, Ms. Terry stated that the insurer would not have underwritten the particular policy or insured Jerome McDowell. Ms. Terry also testified that the information provided in the application and for which the insurer relied were misrepresentations made to defraud the insurer.
As to the involvement, if any, of Ms. Amadi pertaining to the misrepresentations made to the insurer, Ms. Terry testified that although the former was not listed as a driver on the policy, that she must have been aware of the misrepresentations on the basis of having resided for twelve years with the insured’s brother, Garis McDowell. This Court rejects Ms. Amadi’s alleged awareness as to the misrepresentation as being based on speculation.
On cross examination, Ms. Terry acknowledged that the insurer received plaintiff’s bills for acupuncture treatments rendered to Ms. Amadi. When questioned as to the insurer issuing delay and/or denial letters until the investigation was completed, Ms. Terry stated that they were sent but other than the November 7, 2007, rescission letter no such letters were introduced into evidence and defendant insurer’s attorney stipulated on the record hat no specific claim denials of any of the bills in dispute were in evidence. Ms. Terry furthermore testified that none of the claims in connection with the March 12, 2007, accident were ever paid. At the conclusion of her testimony, Ms. Terry acknowledged that no statements were made or taken of the driver, Ms. Amadi, nor was there any request that she submit to an examination under oath.
In order for this Court to render a decision, it would in the first instance have to resolve the conflict of laws between New York law and South Carolina Law. According to plaintiff’s counsel, under New York law there is no preclusion of defenses if a claim is not paid or denied within thirty days. And as stipulated by the parties on the record that once the claims in dispute were mailed to the insurance company, the plaintiff has established its prima faie case and is entitled to payment as no payment nor denial of payment was made by the insurer. In effect, the plaintiff is arguing that by mailing out the claim and with the failure of the insurer to pay the claim or dispute payment of the claim within thirty days of receipt of the claim, the insurer is strictly liable for payment under New York’s No-Fault Law.
According to the defendant’s counsel, the argument is that the applicable law to decide the case is not New York law but South Carolina law. Defense counsel argues that South Carolina law allows the rescission of the insurance policy and also allows the rescission to be made retroactively, including after the occurrence of the accident.
The case of Careplus Medical Supply, Inc., as Assignee of Luis Gomez v Selective Insurance Company of America, 25 Misc 3d 48 [App Term 2009], is instructive as it pertains to a conflict of law, the very issue presented in the case at bar relating to an insurance policy which must be resolved by the conflict of laws relevant to contracts. (see Zurich Ins. Co. v Shearson Lehman Hutton, 84 NY2d 309, 319 [1994]; Matter of Allstate Ins. Co. [Stolarz—New Jersey Mftrs. Ins. Co.], 81 NY2d 219, 226 [1993). The Court of Appeals has adopted a “center of gravity” or “grouping of contacts” approach (Auten v Auten, 308 NY 155, 160 [1954]), which [*5]gives controlling effect to the law of the state that has “the most significant relationship to the transaction and the parties” (Restatement [Second] of Conflict of Laws § 188 [1]). In addition to the traditional determinative factor of the place of contracting, which should be given “heavy weight” in a grouping of contacts analysis (see Haag v Barnes, 9 NY2d 554, 560 [1961]), the places of negotiation and performance, the location of the subject matter of the contract, and the domicile or place of business of the contracting parties are also to be considered (see Zurich Ins. Co., 84 NY2d at 319; Restatement [Second] of Conflict of Laws § 188 [2]). The accident herein occurred in New York. The relevant insurance policy was negotiated and entered into in South Carolina by the insured who lived in South Carolina, for a vehicle which was to be garaged and registered in South Carolina. The assignor, who was driving the insured’s vehicle at the time of the accident, resided in New York.
While “strong governmental interests . . . [may] be considered” (Matter of Allstate Ins. Co. [Stolarz—New Jersey Mfrs. Ins. Co.], 81 NY2d at 226), I find that governmental policy is not an overriding factor under the circumstances presented herein (see e.g. Matter of Eagle Ins. Co. v Singletary, 279 AD2d 56 [2000]). Therefore, upon the application of a “center of gravity” or “grouping of contacts” analysis, I find that the dispositive factors weigh in South Carolina’s favor and, therefore, its law should control (see e.g. Scotland v Allstate Ins. Co., 35 AD3d 584 [2006]; Matter of Eagle Ins. Co. v Singletary, 279 AD2d at 56).
I do not see how any reasonable inference can be drawn from the record, other than it was the intent of the insured, Jerome McDowell, with the knowledge and cooperation of his brother, Garis McDowell, in making false and untrue answers to the questions asked in the insurance policy application to deliberately deceive the insurer and thereby procure the liability insurance. The intent with which misrepresentations of fact are made in the application for automobile liability insurance, may be deduced from the facts and circumstances surrounding the making of the misrepresentations. The 2000 Dodge Intrepid
This Court further credits the testimony of Ms. Terry that the insurer that had Jerome McDowell answered the questions on the insurance application truthfully the insurer would not have accepted the risk and issued the policy of insurance in question. Clearly there is a higher probability of accidents occurring in a congested metropolitan area than in a small rural area which would impact the premiums charged in the respective areas. The subject motor vehicle was never garaged in South Carolina for at least 10-months out of the calendar year and was not driven by the only listed driver, Jerome McDowell.
Defendant established, prima facie, that the underlying Florida automobile insurance policy had been properly rescinded ab initio, in accordance with Florida law, and that there was therefore no coverage available to plaintiff’s assignor. Defendant’s evidence at trial included the submission of Court Exhibit I which contained attached documents labelled Exhibits A through J and the testimony of its litigation specialist and other proof demonstrating that a rescission notice was sent to the assignor-insured and that defendant had returned all premiums paid within a reasonable time after discovery of the grounds for rescinding the policy (see W.H.O. Acupuncture, P.C. v Infinity Prop. & Cas. Co., 36 Misc 3d 4, 6-7 [App Term, 2d, 11th & 13th Jud Dists 2012], citing Leonardo v State Farm Fire & Cas. Co., 675 So 2d 176, 179 [Fla 1996]; see also Hu-Nam-Nam v Infinity Ins. Co., 51 Misc 3d 130 [A], 2016 NY Slip Op 50391[U] [App Term, 2d, 11th & 13th Jud Dists 2016]).
Although the insurer neither paid nor denied the claims within 30 days as required by Insurance Law § 5106 (a) and 11 NYCRR 65.15 (g) (3), and failed to request verification within [*6]the prescribed time frames (see, 11 NYCRR 65.15 [d] [1], [2]) resulting in the plaintiff then commencing the within action, pursuant to Insurance Law § 5106 (a), to recover its assigned no-fault billing charges the insurer’s untimely disclaimer does not preclude it from denying liability on a strict lack of coverage ground.
I am persuaded that an insurer, despite its failure to reject a claim within the 30-day period prescribed by Insurance Law § 5106 (a) and 11 NYCRR 65.15 (g) (3), may assert a lack of coverage defense premised on the fact or founded belief that the automobile policy was void ab initio for fraudulent misrepresentations made in the application for the policy. The denial of liability based upon lack of coverage within the insurance agreement, as framed in part by the litigation strategy and nature of the instant dispute, is distinguishable from disclaimer attempts based on a breach of a policy condition (see, Zappone v Home Ins. Co., supra, 55 NY2d, at 136-137; contrast, Presbyterian Hosp. v Maryland Cas. Co., 90 NY2d 274 [decided today]). Precedent and logical analysis support the extension of the Zappone exception here. Strict compliance with the time requirements of both the statute and regulations may be obviated and the preclusion remedy rendered unavailable when denial of claims is premised on a lack of coverage.
As held by the Supreme Court of South Carolina in Government Employess Insurance Company v Chavis, 254 S.C. 507, the insurer did not have any duty or obligation to investigate the truthfulness of the insured’s statements made in his insurance application and having no prior knowledge that the insured’s statements were untruthful did not constitute a waiver and did not estop the insurer from rescinding the policy for fraudulent misrepresentation. The insurer met its burden to not only show that the insured’s statements were untrue, but that their falsity was known to him, that they were material to the risk and relied upon by the insurer, and that they were made with intent to mislead and defraud the insurer.
Rescission is not merely a termination of a contractual obligation but is the abrogation or undoing of it from the beginning which seeks to create a situation the same as if no contract ever existed. It was also established that prior to the institution of this lawsuit the insured, Jerome MsDowell, accepted a full refund of the policy premium that he had paid to the insurer.
Therefore, the above captioned lawsuit is dismissed with prejudice.
Dated: July 12, 2018
Hon. Armando Montano
Justice, Supreme
Court
Reported in New York Official Reports at Body Acupuncture Care, P.C. v Erie Ins. Co. of N.Y. (2018 NY Slip Op 51362(U))
Body Acupuncture
Care, P.C., As Assignee of Ghislaine Jean Mary, Plaintiff,
against Erie Insurance Company of New York, Defendant. |
722422/16
For Plaintiff:
Emilia I. Rutigliano Esq.
Law Offices of Emilia I.
Rutigliano, PC.
1733 Sheepshead Bay Rd., Suite 11
Brooklyn, NY 11235
For Defendant:
Robyn Brilliant Esq.
333 W. 39th St, Suite 400
New York NY
10018-1410
Odessa Kennedy, J.
RECITATION, AS REQUIRED BY CPLR2219(A), OF THE PAPERS CONSIDERED IN THE REVIEW OF THIS MOTION:
Notice of Motion 1
Notice of Cross-Motion 2
Affirmation in Opposition 3
In an action to recover assigned first-party no-fault insurance benefits, plaintiff moves for summary judgment pursuant to CPLR 3212. Defendant cross-moves for summary judgment seeking dismissal of the complaint. After oral argument, the Court sua sponte vacates order dated November 17, 2017, in place of the following.
To prevail on its motion, plaintiff has the burden to demonstrate by admissible proof that the no-fault claim forms underlying the action were submitted to the defendant, and that either that defendant had failed to deny the claims within the requisite 30-day period, or that defendant had issued timely denials of the claims that were conclusory, vague or without merit as a matter of law (see Insurance Law section 5106[a]; Westchester Med. Ctr. v. Nationwide Mut. Ins. Co., 78 AD3d 1168, 911 N.Y.S.2d 907 [2d Dept., 2010]).
In the case at bar, plaintiff did not establish that defendant had failed to deny the claims within the requisite 30-day period, or that defendant had issued timely denials that were conclusory, vague or without merit as a matter of law. Plaintiff’s motion is accordingly denied.
The basis of Defendant’s cross motion is the failure of plaintiff’s assignor to attend IMES, which constitutes violation of a condition precedent to coverage. (See Stephen Fogel Psychological P.C. v Progressive Casualty Ins. Co., 35 AD3d 720 [2d Dept 2006], affg 7 Misc 3d 18 [App. Term, 2d Dept 2004]). However, to establish proper denial, the insurer must inform the applicant at the time the IME is scheduled, that the applicant will be reimbursed for any lost earnings and reasonable transportation expenditure incurred in attending the IME (11 NYCRR 65-3.5 (e)). Thus, the insurer has the burden to demonstrate that the IME notice contained the requisite reimbursement language. (See Matter of Unitrin Advantage Ins. Co. Kemper A. Unitrin Business v Professional Health Radiology, 143 AD3d 536, 39 N.Y.S.3d 428 [1st Dept 2016]).
In the case at bar, defendant failed to establish that the IME notice sufficiently apprised the assignor of such reimbursement. The reimbursement language merely recites the governing statute which states ” the insurer shall inform the applicant” of the right to reimbursement. The notice is devoid of a plain, affirmative statement, that the applicant has the right to receive such reimbursement.
The reimbursement language is further obscured in very fine italicized print, which is inexplicably, smaller than the print used in the remainder of the letter, and potentially unreadable, thus facially deficient.
Moreover, the presentation of the language in the notice, potentially creates ambiguity and confusion regarding the origin of the language. There is no explanation in the notice, that the reimbursement language is recitation of statute or a legal requirement. The only reference to the governing statute, is that the letter ‘e’, immediately appears before the reimbursement language, presumably signifying the end of the citation, 11 NYCRR 65-3.5 (e). However, said letter would be meaningless, if not perplexing, to applicants who lack the requisite legal training to decode its meaning.
For the foregoing reasons, plaintiff’s motion and defendant’s cross motion are denied as both parties failed to establish entitlement as a matter of law.
Dated: July 6, 2018
ODESSA KENNEDY
Judge of the Civil Court
Reported in New York Official Reports at Acupuncture Now, P.C v GEICO Ins. Co. (2018 NY Slip Op 51084(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
GEICO Ins. Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Law Office of Goldstein & Flecker (Lawrence J. Chanice of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Katherine A. Levine, J.), entered April 8, 2016. The order granted the branch of defendant’s cross motion seeking summary judgment dismissing the complaint on the ground of lack of coverage and implicitly denied plaintiff’s motion for summary judgment.
ORDERED that the order is modified by providing that the branch of defendant’s cross motion seeking summary judgment dismissing the complaint on the ground of lack of coverage is denied, and the matter is remitted to the Civil Court to determine the remaining branch of defendant’s cross motion; as so modified, the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant opposed the motion and cross-moved for summary judgment dismissing the complaint on the ground of lack of coverage, in that defendant had cancelled the policy, for nonpayment of the premium, prior to the accident at issue. In the alternative, defendant, in effect, sought partial summary judgment dismissing so much of the complaint as sought to recover sums that were in excess of the amounts permitted by the workers’ compensation fee schedule. By order entered April 8, 2016, the Civil Court granted the branch of defendant’s cross motion seeking summary judgment dismissing the complaint on the ground of lack of coverage without addressing the remaining branch of the cross motion, and implicitly denied plaintiff’s motion for summary judgment.
While defendant asserts that Virginia law applies to this case, as the insurance policy had been obtained in Virginia, and it insured a Virginia resident and vehicle, defendant failed to demonstrate that it had mailed its cancellation notice in accordance with its office practices and procedures (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) “by registered or certified mail,” as required by the applicable statute (Va. Code Ann. § 38.2-2208 [A] [1] [a]). Consequently, the Civil Court should have denied the branch of defendant’s cross motion seeking summary judgment dismissing the complaint on the ground that defendant had properly cancelled the policy and that there was, therefore, no coverage at the time of the accident at issue.
As the remaining branch of defendant’s cross motion was not addressed by the Civil Court, we remit the matter to the Civil Court to determine that branch of defendant’s cross motion.
With respect to plaintiff’s motion for summary judgment, contrary to plaintiff’s contention, plaintiff failed to demonstrate its prima facie entitlement to judgment as a matter of law, as the proof submitted in support of its motion failed to establish either that the claims at issue had not been timely denied (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]), or that defendant had issued timely denials that were conclusory, vague or without merit as a matter of law (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).
Accordingly, the order is modified by providing that the branch of defendant’s cross motion seeking summary judgment dismissing the complaint on the ground of lack of coverage is denied, and the matter is remitted to the Civil Court to determine the remaining branch of defendant’s cross motion.
WESTON, J.P., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: July 06, 2018
Reported in New York Official Reports at Bay Plaza Chiropractic, P.C. v Auto One Ins. Co. (2018 NY Slip Op 51082(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Auto One Insurance Company, Appellant.
Law Office of Jason Tenenbaum, P.C. (Jason Tenenbaum of counsel), for appellant. Lewin & Baglio, LLP (Brendan Kearns of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Terrence C. O’Connor, J.), entered December 14, 2015. The order, insofar as appealed from, denied the branches of defendant’s motion seeking summary judgment dismissing the complaint or, in the alternative, to compel plaintiff to appear for an examination before trial.
ORDERED that the order, insofar as appealed from, is modified by providing that the branch of defendant’s motion seeking to compel plaintiff to appear for an examination before trial is granted, and the examination shall be held within 60 days of the date of this decision and order, at such time and place to be specified in a written notice by defendant of not less than 10 days, or at such other time and place as the parties may agree upon; as so modified, the order, insofar as appealed from, is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from so much of an order of the Civil Court as denied the branches of defendant’s motion seeking summary judgment dismissing the complaint or, in the alternative, to compel plaintiff to appear for an examination before trial (EBT).
Upon a review of the record, we agree with the Civil Court’s determination that there is a triable issue of fact regarding the medical necessity of the services at issue (see Zuckerman v City of New York, 49 NY2d 557 [1980]). Consequently, defendant was not entitled to summary judgment dismissing the complaint. However, as defendant’s moving papers established that [*2]defendant had served plaintiff with a notice for an EBT, which examination was material and necessary to defendant’s lack of medical necessity defense (see Great Wall Acupuncture, P.C. v General Assur. Co., 21 Misc 3d 45, 47 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2008]), the branch of defendant’s motion seeking to compel plaintiff to appear for an EBT should have been granted (see CPLR 3101 [a]).
Accordingly, the order, insofar as appealed from, is modified by providing that the branch of defendant’s motion seeking to compel plaintiff to appear for an examination before trial is granted.
WESTON, J.P., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: July 06, 2018
Reported in New York Official Reports at Parisien v 21st Century Ins. Co. (2018 NY Slip Op 51081(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
21st Century Insurance Company, Respondent.
The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Law Offices of Buratti, Rothenberg & Burns (Sharon A. Brennan of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Terrence C. O’Connor, J.), entered August 28, 2015. The order, insofar as appealed from, denied plaintiff’s motion for summary judgment, and granted the branch of defendant’s cross motion seeking to compel plaintiff to respond to defendant’s discovery demands to the extent of compelling plaintiff to respond to certain of defendant’s discovery demands and to produce plaintiff for an examination before trial.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which denied plaintiff’s motion for summary judgment, and granted the branch of defendant’s cross motion seeking to compel plaintiff to respond to defendant’s discovery demands to the extent of compelling plaintiff to provide defendant with “management agreements to the extent available, W-2 forms, business-related bank records, and lease agreements,” and to produce plaintiff for an examination before trial.
Plaintiff’s motion for summary judgment was properly denied, since the proof submitted by plaintiff failed to establish that the claims had not been timely denied (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]), or that defendant had issued timely denial of claim forms that were conclusory, vague or without merit as a matter of law (see [*2]Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).
Plaintiff argues that defendant is not entitled to the discovery ordered by the Civil Court. However, as plaintiff failed to timely challenge the propriety of the discovery demands (see CPLR 3122 [a]), plaintiff is obligated to produce the information sought except as to matters which are privileged or palpably improper (see Fausto v City of New York, 17 AD3d 520 [2005]; Marino v County of Nassau, 16 AD3d 628 [2005]; Midborough Acupuncture, P.C. v State Farm Ins. Co., 21 Misc 3d 10 [App Term, 2d Dept, 2d & 11th Jud Dists 2008]). While discovery demands which concern matters relating to defenses which a defendant is precluded from raising are palpably improper and may not be discoverable, the defense at issue in this case—that plaintiff is not entitled to collect no-fault benefits pursuant to 11 NYCRR 65-3.16 (a) (12) due to its failure to meet licensing requirements (see State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005])—is not precludable (see Matter of Acuhealth Acupuncture, P.C. v Country-Wide Ins. Co., 149 AD3d 828 [2017]). Plaintiff has not demonstrated that the items at issue are privileged or palpably improper. In addition, defendant is entitled to an examination before trial of plaintiff (see CPLR 3101 [a]; Midwood Acupuncture, P.C. v State Farm Fire & Cas. Co., 21 Misc 3d 144[A], 2008 NY Slip Op 52468[U] [App Term, 2d Dept, 2d & 11th Jud Dists 2008]; Great Wall Acupuncture v State Farm Mut. Auto. Ins. Co., 20 Misc 3d 136[A], 2008 NY Slip Op 51529[U] [App Term, 2d Dept, 2d & 11th Jud Dists 2008]).
Accordingly, the order, insofar as appealed from, is affirmed.
WESTON, J.P., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: July 06, 2018
Reported in New York Official Reports at Pavlova v Allstate Ins. Co. (2018 NY Slip Op 51061(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Allstate Insurance Company, Respondent.
The Rybak Firm, PLLC (Damien J. Toell and Karina Barska of counsel), for appellant. Abrams, Cohen & Associates, P.C. (Frank Piccininni of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Richard Montelione, J.), entered October 5, 2016. The order granted defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint on the ground that the insured vehicle had not been involved in the alleged accident in question.
In support of its motion, defendant submitted the transcript of the examination under oath (EUO) of its insured in which she testified that she had been parking her vehicle at the time of the alleged accident, that no accident had occurred and that plaintiff’s assignor, a pedestrian, had not been struck by her vehicle. In a supporting affidavit, the insured attested to the same facts. The EUO testimony and the affidavit are sufficient to demonstrate, prima facie, that “the alleged injury [did] not arise out of an insured incident” (Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195, 199 [1997]; see Andromeda Med. Care, P.C. v NY Cent. Mut. Fire Ins. Co., 26 Misc 3d 126[A], 2009 NY Slip Op 52601[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]; Midwood Med. Equip. & Supply, Inc. v USAA Cas. Ins. Co., 25 Misc 3d 139[A], 2009 NY Slip Op 52379[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]). Since plaintiff opposed defendant’s motion only with an affirmation by counsel, who did not assert that he possessed personal knowledge of the facts, plaintiff failed to raise a triable issue of fact in opposition to defendant’s motion (see Zuckerman v City of New York, 49 NY2d 557 [1980]).
Plaintiff’s remaining contention lacks merit.
Accordingly, the order is affirmed.
PESCE, P.J., WESTON and ALIOTTA, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: June 29, 2018
Reported in New York Official Reports at Maxford, Inc. v Erie Ins. Co. of N.Y. (2018 NY Slip Op 51057(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Erie Insurance Company of New York, Appellant.
Robyn M. Brilliant, P.C. (Robyn M. Brilliant and Barry Montrose of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell and Karina Barska of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Katherine A. Levine, J.), entered March 9, 2016. The order, insofar as appealed from, denied defendant’s cross motion for summary judgment dismissing the complaint and, upon, in effect, denying plaintiff’s motion for summary judgment, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, the Civil Court, in effect, denied plaintiff’s motion for summary judgment and defendant’s cross motion for summary judgment dismissing the complaint, and found, in effect pursuant to CPLR 3212 (g), that plaintiff had established that it had mailed the bill to defendant, that the bill was unpaid, and that defendant had timely denied the claim. The court limited the issues for trial to defendant’s basis for denying the claim, to wit, that plaintiff’s assignor had fraudulently procured the insurance policy by materially misrepresenting her address to obtain a lower insurance premium. Defendant appeals from so much of the order entered March 9, 2016 as denied defendant’s cross motion for summary judgment dismissing the complaint and made, in effect, CPLR 3212 (g) findings in plaintiff’s favor.
On appeal, defendant fails to articulate a sufficient basis to strike the Civil Court findings, in effect pursuant to CPLR 3212 (g), in plaintiff’s favor (see EMC Health Prods., Inc. v Geico Ins. Co., 43 Misc 3d 139[A], 2014 NY Slip Op 50786[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]).
Defendant cross-moved on the ground that plaintiff’s assignor had fraudulently procured the insurance policy in question by making a material misrepresentation on her policy application as to her place of residence and the principal location for the garaging of the vehicle which was to be insured. Upon a review of the record, we find that defendant failed to establish as a matter [*2]of law ” ‘that it would not have issued the same policy if the correct information had been disclosed in the application’ ” (Interboro Ins. Co. v Fatmir, 89 AD3d 993, 994 [2011], quoting Schirmer v Penkert, 41 AD3d 688, 691 [2007]; see Renelique v National Liab. & Fire Ins. Co., 53 Misc 3d 147[A], 2016 NY Slip Op 51615[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]).
Defendant further asserts that plaintiff is collaterally estopped from maintaining the present action by virtue of an order, rendered on default, by the Civil Court, Queens County (Richard G. Latin, J.), in an action against plaintiff’s assignor, finding that the assignor had made “material and/or fraudulent misrepresentations” on her application for the insurance policy. However, the doctrine of collateral estoppel is not applicable here, as plaintiff was not named in the Civil Court, Queens County, action, and, thus, plaintiff was not in privity with the assignor (see Gramatan Home Invs. Corp. v Lopez, 46 NY2d 481, 486-487 [1979]; Magic Recovery Med. & Surgical Supply Inc. v State Farm Mut. Auto. Ins. Co., 27 Misc 3d 67, 69 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2010]). In view of the foregoing, we reach no other issue.
Accordingly, the order, insofar as appealed from, is affirmed.
PESCE, P.J., WESTON and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: June 29, 2018
Reported in New York Official Reports at Nationwide Mut. Fire Ins. Co. v Oster (2018 NY Slip Op 51018(U))
[*1]| Nationwide Mut. Fire Ins. Co. v Oster |
| 2018 NY Slip Op 51018(U) [60 Misc 3d 1208(A)] |
| Decided on June 29, 2018 |
| Supreme Court, Putnam County |
| Grossman, J. |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and will not be published in the printed Official Reports. |
Decided on June 29, 2018
Nationwide Mutual
Fire Insurance Company, Plaintiff,
against Lisette M. Oster, CAROL DANIELE, As Executrix of the Estate of DOUGLAS P. DANIELE, Deceased, and CAROL DANIELE, Individually, GABRIELLE M. OSTER, ANDREW J. ABBENE and STATE FARM MUTUAL INSURANCE COMPANY, Defendants. |
304/2016
Law Office of Galleonardo & Hartford
950 New Loudon Road, Suite 200
Latham, New York 12110
and
Seiger Gfeller Laurie LLP
Attorneys for Plaintiff Nationwide Mut. Fire Ins. Company
977 Farmington Avenue, Suite 200
West Hartford, Connecticut 08540
Rivkin Radler LLP
Attorneys for Defendant State Farm Mut. Ins. Company
926 RXR Plaza
Uniondale, New York 11556-0927
Collins Fitzpatrick & Schoene, LLP
Attorneys for Defendant Lisette Oster
34 South Broadway, Suite 407
White Plains, New York 10601
Mead, Hecht, Conklin & Gallagher, LLP
Attorneys for Defendant Gabrielle Oster
925 Westchester Avenue, Suite 302
White Plains, New York 10604
Gaines, Novick, Ponzini, Cossu & Venditti, LLP
Attorneys for Defendant Carole Daniele
1133 Westchester Avenue, Suite N-202
White Plains, New York 10604
Andrew Abbene
Defendant, Pro Se
Victor G. Grossman, J.
The Court has considered the following papers:
PAPERS/NUMBERED
Joint Record, 4 vols., Exhs. A-T/Trial Transcript 1-20
Nationwide Notice of Motion/Affirmation/Affidavit/Memorandum of Law 21-24
Daniele Notice of Cross-Motion/Affirmations/Memorandum of Law (State Farm) 25-28
Daniele Notice of Cross-Motion/Affirmations/Exhs. U-Y/Memorandum of Law in Support of Cross Motion and in Opposition to Nationwide Motion 29-37
Oster Notice of Cross Motion/Affirmation/Memorandum of Law 38-40
Nationwide Notice of Motion for Default Judgment/Affidavit/Affirmation/Exhs. A-E 41-48
State Farm Notice of Motion for Summary Judgment/Affirmation/Memorandum of Law 49-51
Daniele Reply Memorandum of Law in Support of Cross-Motion 52
Nationwide Reply Memorandum of Law 53
State Farm Further Memorandum of Law in Support of Motion for Summary Judgment and in Opposition to Motions filed by other parties 54
Transcript of Oral Argument (April 19, 2018)[FN1] 55
Post Argument Submissions:
Nationwide Supplemental Brief 56
State Farm – letter submission 57
Daniele, as Executrix, letter submission 58
In this declaratory judgment action, the Court considers six (6) motions, all arising after a jury verdict in the related wrongful death action.[FN2] The motions address the existence, or absence, and extent of, insurance coverage on the particular facts here. The parties dispute which carrier, or carriers, bears the obligation of contributing to a damage award totaling nearly three million dollars. Counsel agreed to a Joint Record, submitted by Plaintiff’s counsel, to facilitate the Court’s efforts. Some individual parties supplemented the Joint Record with their own exhibits. The facts, issues, and relief requested comprise a legal Gordian knot.
FACTS
On August 31, 2011, Lisette Oster (“Lisette”), her daughter, Gabrielle Oster (“Gabrielle”), and Andrew J. Abbene (“Abbene”) (an Oster family friend), drove to Cycle City on Route 17 in Sloatsburg, New York in two separate cars. Lisette and Abbene rode together in Abbene’s 1995 BMW. Gabrielle followed them, driving her family’s Honda. Abbene remained at Cycle City while Lisette drove his BMW back to Putnam County. As Lisette and Gabrielle were leaving Cycle City, Abbene instructed them that to return home from Cycle City, they should proceed north on Route 17, make a U-turn onto Harriman Avenue, and travel back in the opposite direction to get onto the New York State Thruway. Lisette drove Abbene’s BMW insured by Defendant State Farm Mutual Insurance Company (“State Farm”). Gabrielle followed in the Honda owned by Lisette and insured by Allstate Insurance Company (“Allstate”).
Lisette turned left onto Harriman Avenue and then made a U-turn in a driveway to go back to Route 17 and the New York State Thruway. After making the U-turn, Lisette stopped her vehicle at an angle on or near the shoulder where Harriman Avenue meets Route 17 to wait for her daughter to make the same turn “because we had to go back the opposite direction to get home.” The engine was running, but the car was not moving. Lisette could not recall whether the gear was in “park,” whether her foot was on the brake, or both.
Lisette saw Gabrielle driving and waved to her through the open driver’s side window “to let her see that that’s where we were turning around, to make sure…that she saw where we were turning around.” Gabrielle saw Lisette and turned left to go onto Harriman Avenue so she could follow her. As Gabrielle changed lanes to make the left turn, Douglas P. Daniele, who was traveling behind Gabrielle on his motorcycle, struck her vehicle, and was fatally injured.
On August 4, 2010, Plaintiff Nationwide Mutual Fire Insurance Company (“Nationwide”) issued a Homeowner’s Policy to William and Lisette Oster for the policy period September 22, 2010 to September 22, 2011.
On or about December 28, 2011, the Estate of Douglas P. Daniele commenced a lawsuit in Supreme Court, Putnam County (Index No. 3481/2011), entitled “Carol Daniele, as Executrix of the Estate of Douglas P. Daniele, Deceased, and Carol Daniele, Individually, Plaintiffs, against Gabrielle M. Oster, Lisette M. Oster and Andrew J. Abbene, Defendants,” seeking damages for the personal injuries and wrongful death of Douglas P. Daniele (hereinafter referred to as “the Wrongful Death Action”).
The Wrongful Death Action included a claim that Lisette Oster “while in the course of operating the aforesaid BMW vehicle owned by Defendant Andrew J. Abbene, did signal, motion and/or wave to the Defendant, Gabrielle M. Oster, who was operating the aforesaid Honda vehicle owned by Defendant Lisette M. Oster, to make an illegal u-turn at the stated location.” The Wrongful Death Action also alleged that Lisette Oster “was negligent, reckless and careless by giving a signal, motion and/or wave to the Defendant Gabrielle M. Oster” without reference to the operation of a motor vehicle. The Wrongful Death Action further alleged that Gabrielle Oster was negligent in the operation of the motor vehicle she was driving.
On or about December 9, 2011, before the Wrongful Death Action was commenced, Nationwide received notice of that action. By letter dated December 16, 2011, Nationwide issued a disclaimer of coverage to Lisette and Gabrielle for the claims contained in the Wrongful Death Action and provided a copy of the disclaimer to Mrs. Daniele’s attorney. In the disclaimer, Nationwide asserted the Homeowner’s policy excluded coverage for claims arising out of the use or operation of a motor vehicle by an insured, and asserted the accident occurred from the use of a motor vehicle. State Farm (Abbene’s insurer) also denied coverage, asserting the “accident was not the result of the ownership, maintenance or use” of Abbene’s BMW from which Lisette waved to Gabrielle.
Allstate provided a defense to Lisette and Gabrielle in the Wrongful Death Action under the Honda’s automobile policy. At the time of the accident, Gabrielle drove the Honda owned by Lisette.[FN3]
The issue of liability in the Wrongful Death Action was tried before a jury in December 2015. At the conclusion of the Wrongful Death Trial, the Court charged the jury regarding Lisette’s liability, as follows:
“In appropriate circumstances, a driver may incur a duty to another by waving that it is safe to turn. This duty extends not only to the waved-to driver, but also to all those reasonably within the ambit of potential injury including any party involved in a collision with the waved-to driver.
In the present case, you must first decide whether Lisette Oster waved to Gabrielle Oster to merely indicate where Lisette Oster was located or to signal to Gabrielle to turn.
If you find that Lisette Oster waved to Gabrielle Oster to solely indicate where Lisette Oster was located, then you must find that Lisette Oster was not negligent.
However, if you find that Lisette Oster waved to Gabrielle Oster to turn, then you must determine whether that wave was negligent under the circumstances.
If you find that Lisette Oster’s wave was negligent, you must then decide whether that wave was a proximate cause or substantial factor in causing the accident.
If you find that Lisette Oster’s wave was not negligent, then you will not decide the question of proximate cause.
Such a wave can only constitute a proximate cause of the accident where the waved-to driver relied on the wave as an implicit assurance that it was safe to turn.
If you find that Gabrielle Oster relied upon Lisette Oster’s wave as an implicit assurance that it was safe to turn, then you may find that Lisette Oster’s wave was a substantial factor in causing the accident, but if you find that Gabrielle Oster did not rely upon Lisette Oster’s wave as an implicit assurance that it was safe to turn, then you may find that Lisette Oster’s wave was not a substantial factor in causing the accident.”[FN4]
The jury concluded that Lisette was negligent in the manner in which she waved to Gabrielle, and that Lisette’s negligence was a substantial factor in causing the accident. Similarly, the jury concluded that Gabrielle was negligent and her negligence was a substantial factor in causing the accident. The jury also concluded Mr. Daniele was negligent and his negligence was a substantial factor in causing the accident. The jury apportioned the percentage of fault, as follows:
| Gabrielle M. Oster | 73% |
| Lisette Oster | 20% |
| Douglas P. Daniele | 7% |
| 100% |
Following the May 2016 trial on the issue of damages, the jury awarded the Estate $2,148,000.00 in damages, and with interest, costs, and disbursements, the total damages were $2,976,402.34. Judgment was entered on July 1, 2017.
THE INSTANT ACTION
On March 2, 2016, before the commencement of the damages portion of the Wrongful Death Action, Nationwide commenced the instant action seeking a judgment:
“(1) declaring that the Nationwide policy does not provide coverage for the incident of August 31, 2011, and the claims set forth in the [Wrongful Death Action] and that Nationwide is not required to defend or indemnify Lisette M. Oster with respect to the incident of August 31, 2011, and the claims set forth in the [Wrongful Death Action] or any claims for contribution or indemnity therein and (2) declaring that the State Farm policy provides coverage for the incident of August 31, 2011, and the claims set forth in [*2]the [Wrongful Death Action] and that State Farm is required to defend and indemnify defendant Lisette M. Oster with respect to the incident of August 31, 2011, and the claims set forth in the [Wrongful Death Action] and any claims for contribution or indemnity therein together with such other and further relief as to the court may seem just and proper.”
Lisette answered and cross-claimed [FN5] against Nationwide, alleging it “has wrongfully refused to fulfill its obligation to defend and indemnify” her in the Wrongful Death Action. Lisette further cross-claimed against State Farm, alleging it too “has wrongfully refused to fulfill its obligation to defend and indemnify” her in the Wrongful Death Action. As to each cross-claim, Lisette sought a declaratory judgment, directing the carrier to defend her in the Wrongful Death Action and to indemnify her against any judgment within the policy limits.
Mrs. Daniele interposed an Answer, containing affirmative defenses, two counterclaims and two cross-claims. She sought a declaration that Nationwide was obligated to defend and to indemnify Lisette within her policy limits. She also asserted a counterclaim, alleging Nationwide acted in bad faith “by wrongfully refusing to defend and indemnify Defendant Lisette M. Oster.” In a cross-claim, she asserted State Farm was obligated to defend its insured, Abbene, and the driver of his car, Lisette, and to indemnify them against any judgment within its policy limits. The second cross-claim alleged State Farm’s bad faith by wrongfully refusing to defend and indemnify Lisette.
Nationwide replied and denied all counterclaims. State Farm denied the cross claims alleged by Mrs. Daniele and Lisette. Abbene has defaulted in all proceedings. His liability in the Wrongful Death Action was that of a vehicle owner vicariously liable for the negligence of the vehicle operator, Lisette, under VTL §388.
PENDING MOTIONS
The following motions are before the Court:
(A) Plaintiff Nationwide moves for an Order, pursuant to CPLR §§3001, 3212:
(1) Granting summary judgment (1) declaring that the Nationwide policy does not provide coverage for the incident of August 31, 2011, and the claims set forth in the Wrongful Death Action and that Nationwide is not required to defend or indemnify Lisette M. Oster with respect to the incident of August 31, 2011, and the claims set forth in the Wrongful Death Action or any claims for contribution or indemnity therein (2) declaring that the State Farm policy provides coverage for the incident of August 31, 2011, and the claims set forth in the Wrongful Death Action and that State Farm is required to defend and indemnify defendant Lisette M. Oster with respect to the incident of August 31, 2011, and the claims set forth in the Wrongful Death Action and any claims for contribution or indemnity therein and (3) dismissing Defendant Lisette Oster’s counterclaim (improperly designated as a “cross-claim”) and Defendant Estate’s counterclaim with such other and further relief as to the Court may seem just and proper.
(B) State Farm Mutual Insurance Company moves for an Order, pursuant to CPLR §3212:
(1) Granting the motion of Defendant State Farm Mutual Automobile Insurance Company i/s/h/a State Farm Mutual Insurance Company (“State Farm”) for summary judgment dismissing the action against State Farm, including any cross-claims, and declaring that State Farm has no obligation to defend Lisette Oster for the underlying lawsuit and no obligation to pay any portion of the judgment in the underlying lawsuit to Mrs. Daniele or indemnify Lisette Oster for the judgment in the underlying lawsuit; and (2) for such other and further relief as may seem proper to the Court.
(C) Carol Daniele, as Executrix, moves for an Order, pursuant to CPLR §3001 and CPLR §3212:
(1) Granting judgment on the counterclaims and declaring that Plaintiff Nationwide is obligated to indemnify Defendant Lisette M. Oster against the judgment entered in the underlying Wrongful Death Action captioned “Carol Daniele, as Executrix of the Estate of Douglas P. Daniele, deceased, and Carol Daniele, Individually v. Gabrielle Oster, Lisette M. Oster and Andrew J. Abbene” (Supreme Court, Putnam Co.) (Index No. 3482/2011) within the limits of its policy ($1,000,000.00), exclusive of interest and costs; (2) that Defendants Carol Daniele, as Executrix of the Estate of Douglas P. Daniele, Deceased, and Carol Daniele, Individually, recover of Plaintiff Nationwide and Defendant State Farm, reasonable attorneys’ fees, as well as costs and disbursements incurred in the prosecution of the instant action; and (3) granting summary judgment dismissing the Complaint herein, together with such other and further relief as may seem just and proper, including but not limited to interest, costs and disbursements.
(D) Carol Daniele, as Executrix, moves for an Order, pursuant to CPLR §3001 and CPLR §3212:
(1) Granting judgment on the Daniele cross-claims and declaring that defendant State Farm is obligated to indemnify defendants Andrew J. Abbene and Lisette M. Oster in the underlying wrongful death action captioned “Carol Daniele, as Executrix of the Estate of Douglas P. Daniele, deceased, and Carol Daniele, Individually v. Gabrielle Oster, Lisette M. Oster and Andrew J. Abbene” (Supreme Court, Putnam Co.) (Index No. 3482/2011) and indemnify them against the judgment entered against them therein, within the limits of its policy ($100,000.00/$300,000.00), exclusive of interest and costs; (2) that Defendants Carol Daniele, as Executrix of the Estate of Douglas P. Daniele, Deceased, and Carol Daniele, Individually, recover of defendant State Farm, reasonable attorneys’ fees, interest, costs and disbursements incurred in the prosecution of the instant action, and (3) granting summary judgment dismissing the State Farm cross-claims herein, together with such other and further relief as may seem just and proper, including but not limited to interest, costs and disbursements.
(E) Defendant Lisette Oster, moves for an Order:
(1) declaring that the Nationwide policy provides Lisette Oster coverage for the incident of August 31, 2011 and the claims set forth in the wrongful death suit and that Nationwide is required to defend and indemnify Lisette Oster with respect to that incident; (2) declaring that the State Farm policy provides Lisette Oster coverage for the [*3]incident of August 31, 2011 and the claims set forth in the wrongful death suit and that Nationwide is required to defend and indemnify Lisette Oster with respect to that incident; (3) granting Lisette Oster’s cross and counterclaims, together with such other, additional and different relief which this court may deem just and proper.
(F) Plaintiff Nationwide moves for an Order pursuant to CPLR §3215 granting default judgment in favor of Plaintiff against Defendant Andrew Abbene together with such other and further relief as the Court deems just and proper.
THE NATIONWIDE AND STATE FARM MOTIONS
Nationwide’s motion pursuant to CPLR §3215 for a default judgment in favor of Nationwide and against Defendant Andrew Abbene is unopposed and granted.
The essence of Nationwide’s motion for summary judgment is that the liability claims against Lisette and Gabrielle arise out of the “use and operation” of the 1995 BMW by Lisette, and the Honda by Gabrielle, and are, therefore, excluded from coverage under the Homeowner’s Policy. Nationwide also asserts the “use” of the Honda by Lisette is a claim that is not covered under the Nationwide Homeowner’s Policy. Nationwide relies on the following policy provision:
“Coverage E – Personal Liability and Coverage F – Medical Payments to Others do not apply to bodily injury or property damage:
g) arising out of the ownership, maintenance or use of; entrustment or the negligent supervision by an insured of; or statutorily imposed liability on an insured related to the use of:
(2) a motor vehicle . . . owned by or operated by, or . . . loaned to an insured.”
(Policy Liability Exclusion 1[g][2]) at p. H1)(emphasis added).
Nationwide contends that Lisette’s use of the BMW and her wave to Gabrielle constitutes “use” of a motor vehicle and is therefore excluded under their Homeowner’s Policy. Nationwide also contends that Gabrielle’s driving and left turn constitutes use of the motor vehicle and is therefore not covered. Regardless, if either activity is insured under the Homeowner’s policy, they are covered.
The Homeowner’s policy, like any insurance policy, is a contract. Policies of insurance or indemnity are construed in favor of the insured and against the carrier. However, the policy must be considered in light of existing law. State Farm Mut. Auto Ins. Co. v. Westlake, 35 NY2d 587 (1974). The Court must interpret the contract. Doing so requires an examination of the “plain meaning of its terms”, with some caveats. That “plain meaning” “may not be disregarded to find an ambiguity where none exists.” Atlantic Balloon & Novelty Corp. v. American Motorists Inc. Co., 62 AD3d 920, 922 (2nd Dept. 2009). The phrase “‘arising out of'” is unambiguous and is interpreted broadly to mean “‘originating from, incident to, or having connection with.'” Scottsdale Indemn. Co. v. Beckerman, 120 AD3d 1215 (2nd Dept.), lv. denied 24 NY3d 912 (2014) (citations omitted); see also Maroney v. New York Cent. Mut. Fire Ins. Co., 5 NY3d 467, 472 (2005). At the same time, an exclusion from coverage “must be specific and clear in order to be enforced.” Essex Ins. Co. v. Pingley, 41 AD3d 774, 776 (2nd Dept. 2007). In addition, such exclusions are narrowly drawn and interpreted in favor of insureds. Seabord Sur. Co. v. Gillette Co., 64 NY2d 304, 311 (1984). These rules apply with equal force to the State Farm policy, [*4]which uses the term “involves”, rather than “arising out of,” although it may be argued that “involves” should be interpreted more broadly consistent with a liberal construction.[FN6]
The State Farm motion seeks a declaration that it has no obligation to defend Lisette in the underlying lawsuit or to pay any portion of the Judgment to Mrs. Daniele, or to indemnify Lisette, and, as a consequence, it seeks dismissal of the action, including any cross-claims. State Farm urges three points in support of its motion. One, Gabrielle’s and Mr. Daniele’s accident did not result from the ownership, maintenance, or use of the Abbene vehicle in which Lisette was seated. Two, the Abbene vehicle’s role, in which Lisette was seated, was not the proximate cause of the injuries. Three, the “bad faith” cause of action filed by Mrs. Daniele is without merit because she has no standing to assert a bad faith claim, and the bad faith claim is duplicative of the claim that State Farm wrongly disclaimed coverage.
State Farm relies on the following provision:
Insured means:
1. you and resident relatives for:
a. the ownership, maintenance, or use of:
(1) your car…
3. any other person for his or her use of:
a. your car…
4. Any other person or organization vicariously liable for the use of a vehicle by aninsured as defined in 1., 2., or 3. above, but only for such vicarious liability. Thisprovision applies only if the vehicle is neither owned by, nor hired by, that other person or organization…
Insuring Agreement
1. We will pay:
a. damages an insured becomes legally liable to pay because of:
(1) bodily injury to others; and
(2) damage to property caused by an accident that involves a vehicle for which that insured is provided Liability Coverage by this policy;”
By letter dated March 2, 2012, after the commencement of the Wrongful Death Action, State Farm advised both Abbene, the policyholder, and Lisette (Joint Record, Exh. O):
“….the policy issued to you by State Farm Insurance does not provide insurance coverage for Mr. Abbene, the owner of the vehicle, or to the permissive driver of the vehicle at the time of the accident, Lisette M. Oster.
The State Farm policy of insurance provides coverage for owners of vehicles and permissive users of those vehicles, but only for liability caused by accident resulting from the ownership, maintenance or use of the vehicle.
State Farm denies coverage for this accident due to the fact that this accident was not the result of the ownership, maintenance or use of your insured car, as those terms have been interpreted by New York law.”
Clearly, both State Farm and Nationwide dispute the “use and operation” of the Abbene BMW in which Lisette was seated when she waved to Gabrielle, but for different reasons. If the actions of Lisette constitute solely “use and operation,” then Nationwide’s motion should be granted, and they should not be liable under the Homeowner’s Policy. If it is determined that Lisette’s actions constitute “use and operation,” State Farm’s motion fails and it is obligated to satisfy the Judgment to the extent of the policy limits. However, if Lisette’s actions do not constitute “use and operation,” then Nationwide may be compelled to pay the Judgment to the extent of its policy limits while State Farm escapes liability. Both Lisette and Mrs. Daniele claim Lisette’s actions do not constitute “use and operation.” Abbene has defaulted through the proceedings. Gabrielle cannot seriously dispute the “use and operation” of the Honda automobile she was driving, but her “use and operation” is separate from the claims against Lisette.
Both carriers have asserted their policies do not cover the claims involving Lisette. If their positions are accurate, there is no coverage for her role in the loss. See United Servs. Auto Assn. v. Aetna Cas. & Sur. Co., 75 AD2d 1022 (4th Dept. 1980). The jury found Lisette negligent by waving as she did, and her negligence contributed to the injuries and death of Mr. Daniele. The absence of coverage advanced by both carriers would effectively allow a motor vehicle to utilize the roads of the State of New York without protecting others. Such a result is contrary to statute and public policy, and the Court declines such interpretation. VTL §310, et. seq., 11 NYCRR §60-1.1. Alternatively, one, if not both, of the carriers will be responsible.
Still, the actions present a close question of unusual facts that requires a review of existing cases to understand and apply the reasoning and judicial experience to the facts of this case.
USE AND OPERATION
The definition and application of “use and operation” language varies with the statutory purposes and policies served. For example, Vehicle and Traffic Law §388(1) defines “use and operation” for purposes of vicarious liability. Insurance Law §3420 addresses “use and operation” for policy and coverage issues. Vehicle and Traffic Law §1192 defines “operation,” at times, with a breadth that promotes safe driving policy, but simultaneously strains the imagination (see People v. Alaimo, 34 NY2d 453 [1974]; People v. Prescott, 95 NY2d 655 [200l]), but it too has limits. See People v. O’Connor, 159 Misc 2d 1072, 1074 (Dist.Ct. [Nassau] 1994); People v. Moore, 186 Misc 2d 614 (Dist.Ct. [Suffolk] 2000); People v. DeSantis, Vol. 203, No. 97, NYLJ, p. 32, col. 4 (App.Term [9th & 10th J.D.] May 21, 1990). The phrase has anything but a uniform meaning. Various decisions define “use” broadly as “encompasses more than simply driving it, and includes all necessary incidental activities such as entering and leaving its confines.” Matter of Allstate Ins. Co. v. Reyes, 109 AD3d 468, 469 (2nd Dept. 2013), citing Rowell v. Utica Mut. Ins. Co., 77 NY2d 636, 638 (1991). Moreover, an accident arising from the “use,” “must have arisen out of the inherent nature of the automobile and, as such, inter alia, the automobile must not merely contribute to the condition which produces the injury, but must, itself, produce the injury.” Matter of Allstate Ins. Co. v. Reyes, supra, at 469. Here, the vehicle was parked, and Lisette waved to her daughter through its open window, similar to the parked car and open window through which the dog in Reyes reached out to bite the pedestrian. Historically, “use” was added to denote more than driving to cover those circumstances that were not technically “operation.” Argentina v. Emery World Wide Delivery [*5]Corp. 188 F.3d 86 (2d Cir. 1999); Gering v. Merchants Mut. Ins. Co., 75 AD2d 321 (2nd Dept. 1980); Eckert v. G.B. Farrington Co., 262 A.D. 9 (4th Dept. 1941), aff’d 287 NY 714 (1942).
On the other hand “operation” denotes putting the vehicle into motion, with physical control of the vehicle. A driver is one who “operates or drives or is in actual physical control of a vehicle.” VTL §113. A motor vehicle may be in “operation” without motion. See Bouchard v. Canadian Pac., 267 AD2d 899 (3rd Dept. 1999); Eckert v. G.B. Farrington Co., supra. So too, it would appear that “operation” includes the cessation of motion, such as by applying a foot brake, or shifting a gear to “park.” People v. O’Connor, 159 M.2d 1072 (Dist.Ct. [Nassau] 1994); Matter of Prudhomme v. Hults, 27 AD2d 234 (3rd Dept. 1967).
The “use” and “operation” both incorporate the intended purpose of the automobile to serve as a means of transportation from one location to another. By doing so, the terms may overlap in their application, and, as a result, they can produce conflicting interpretations. Nevertheless, the imposition of liability on a financially responsible defendant is an expression of policy that affects the definitions. Continental Auto Lease Corp. v. Campbell, 19 NY2d 350, 352 (1967).
The “plain language” and meaning of “use” and “operation” encompasses a broad range of activity. The tendency “to know it when one sees it” (to paraphrase Justice Stewart in another context) yields a long line of decisions that reflect varied forms of human behavior, but provide little guidance where there are close questions of fact. “Not every injury occurring in or near a motor vehicle is covered by the phrase ‘use or operation.’ The accident must be connected with the use of an automobile qua automobile (Reisinger v. Allstate Ins. Co., 58 AD2d 1028 [4th Dept.], aff’d. 44 NY2d 881 [1978].” United Servs. Auto Assn. v. Aetna Cas. & Sur. Co., 75 AD2d, supra at 510.
In 1979, the Second Department expressly adopted a three-part test to determine an insurer’s liability under standard automobile policies:
“1. The accident must have arisen out of the inherent nature of the automobile, as such; 2. The accident must have arisen within the natural territorial limits of an automobile, and the accidental use, loading, or unloading must not have terminated; 3. The automobile must not merely contribute to cause the condition which produces the injury, but must, itself, produce the injury;”
Matter of Manhattan & Bronx Surface Transit Operating Authority (Gholson), 71 AD2d 1004, 1005 (2nd Dept. 1979) (internal quotations and citations omitted).
The test was originally set forth in Goetz v. General Acc. Fire & Life Assur. Corp., 47 Misc 2d 67, 69 (App. Term, 2nd Dept. 1965), aff’d. without opn., 26 AD2d 635 (2nd Dept. 1966), aff’d. without opn., 19 NY2d 762 (1967), and Gholson extended it to the issue of no fault benefits. This formulation applies to the collision of Gabrielle’s Honda and Mr. Daniele’s motorcycle, but it is inapplicable to Abbene’s BMW. The BMW was not performing a transportation function at the time of the accident. The accident did not take place within the BMW’s natural territorial limits. Finally, the BMW did not “produce the injury.” Levitt v. Peluso, 168 Misc 2d 239 (Sup.Ct. [Nassau] 1995). This conclusion is troubling from a policy perspective, as it potentially leaves a personal injury victim without protection, in the absence of homeowner’s coverage. See, e.g., Farmers Fire Ins. Co. v. Kingsbury, 118 Misc 2d 735 (Sup.Ct. [*6][Delaware] 1983), aff’d. 105 AD2d 519 (3d Dept. 1984).
The Gholson standard appears slightly modified in Eagle Ins. Co. v. Butts, 269 AD2d 558, 558-59 (2nd Dept. 2000), lv. to appeal denied 95 NY2d 768 (2000), by the elimination of the territorial limits of the automobile criterion:
“Generally, the determination of whether an accident has resulted from the use or operation of a covered vehicle requires consideration of whether, inter alia, the accident arose out of the inherent nature of the vehicle and whether the vehicle itself produced the injury” (see U.S. Oil Ref. & Mktg. Corp. v. Aetna Cas. & Sur. Co., 181 AD2d 768, 581 N.Y.S.2d 822) or, in other words, whether the use of the vehicle was a proximate cause of the injury (see Wausau Underwriters Ins. Co. v. St. Barnabas Hosp., 145 AD2d 314, 534 N.Y.S.2d 982; Lumberman’s Mut. Cas. Co. v. Logan, 88 AD2d 971, 451 N.Y.S.2d 804).
Butts is illustrative of the simplicity, and difficulty, of applying the standard. There, a horse was being unloaded from a van. While on the ramp, the horse jumped, throwing the plaintiff to the ground and causing injury. The complaint alleged the negligence of the owner in the training of the horse, not in the unloading of the horse. The disclaimer of coverage in Eagle Ins. Co. v. Butts, based on the ground that the claim did not arise from the “ownership, maintenance or use” of a motor vehicle was affirmed. The court recognized the act of “loading or unloading” is a “use” and looked to whether the use of the vehicle was a proximate cause of the injury. Concluding the accident was not “the result of some act or omission related to the use of the vehicle (cf. Argentina v. Emery World Wide Delivery Corp., 93 NY2d 554 [1999]),” the court upheld the disclaimer. As evidenced by the reference to Argentina v. Emery World Wide Delivery Corp., the term “use or operation” has multiple meanings, not only in factual interpretation, but also in statutory interpretation.
Applying Butts, the “use” of a motor vehicle was found not to exist where a dog reached through an open window and bit a passer-by when the automobile was parked in a “no parking” zone in front of a store (Matter of Allstate v. Reyes, supra; Allstate Ins. Co. v. Staib, 118 AD3d 625 [1st Dept. 2014]); where a hand truck was moving down a truck ramp (Staker Sheet Metal II Corp. v. Harleysville Ins. Co. of New York, 2018 WL 654445 [EDNY January 31, 2018]); and where trucks had been stationary for two to three hours and rendered immobile by wheel chocks (Great American E & S Ins. Co. v. Hartford Fire Ins. Co., 2012 WL 3186086 [SDNY August 3, 2012], as amended August 9, 2012). But, “use” was found to exist in the loading of equipment onto a truck. See Paul M. Maintenance Inc. v. Transcontinental Ins. Co., 300 AD2d 209 (1st Dept. 2002).
On the other hand, there was no “use” of a vehicle where a crate fell apart while unloading, resulting in injury. See ABC, Inc. v. Countrywide Ins. Co., 308 AD3d 309 (1st Dept. 2003). Nor was there “use or operation” when a tenant fell from a truck while assisting his four-year-old son. See Empire Ins. Co. v. Schliessman, 306 AD2d 512 (2nd Dept. 2003). When a passenger threw a cup from an automobile and struck a pedestrian, the action did not involve the use or operation of the vehicle. “Where the operation or driving function of the automobile or the condition of the automobile itself is not the proximate cause of the injury,” the injuries do not “arise from the use or operation of a motor vehicle.” Ciminello v. Sullivan, 2008 NY Slip. Op. 30911(U) (Sup.Ct. [Suffolk] 2008), aff’d 65 AD3d 1002 (2nd Dept. 2009).
The above-cited examples illustrate the conclusion that “use or operation” must be connected to “the use of an automobile qua automobile.” Olin v. Moore, 178 AD2d 517 (2nd Dept. 1991), quoting United Services Auto Assn. v. Aetna Cas. & Sur. Co., 75 AD2d 1022 (4th Dept. 1980). In United Services Auto Assn. v. Aetna Cas. & Sur. Co., the Fourth Department further defined the “use of an automobile qua automobile” in the negative by what it did not include: “[w]here the operation or driving function of an automobile or the condition of the vehicle itself is not the proximate cause of the injury, the occurrence does not arise out of its use or operation.” 75 AD2d, supra at 1022. Under that criteria, there is no “use or operation” of the Abbene BMW by Lisette. Progressive Cas. Ins. Co. v. Yodice, 180 Misc 2d 863 (Sup.Ct. [Richmond] 1999), aff’d. 276 AD2d 540 (2nd Dept. 2000).
However, the Third Department held a disabled vehicle was in “use or operation” where it could not be restarted, and it was pushed to the shoulder where it was struck by two snowmobiles while the driver was returning to the vehicle after making towing arrangements. Trentini v. Metropolitan Prop. & Cas. Ins. Co., 2 AD3d 957 (3rd Dept. 2003). The Third Department focused on the nature of “an unplanned stop due to the temporary disability of his car in a place where the vehicle would not normally be parked,” the use of hazard lights, and the seeking of assistance, as constituting an “on-going activity relating to the vehicle,” leading to the conclusion the vehicle was “in use.” As a result, the plaintiff was entitled to no-fault benefits. Trentini v. Metropolitan Prop. & Cas. Ins. Co., supra at 958. The “use” of a vehicle encompasses “more than just driving a car” (Gering v. Merchants Mut. Ins. Co., 75 AD2d 321, 323 [2nd Dept. 1980]), and can include a temporary interruption “directly connected to the continued ‘use’ of the vehicle.” Id. at 323.
Further, by way of analogy to those cases where the driver of the vehicle undertakes to stop his vehicle to allow a police car to proceed, or to direct a pedestrian safely across the road in front of his vehicle, it is not claimed that there is an issue of “use” or “operation,” but rather the issue, if it arises, is one of whether the driver negligently carried out the duty. See, e.g., Ohlhausen v. City of New York, 73 AD3d 89 (1st Dept. 2010) and cases cited therein.
There is a line of cases involving motorists, including bus drivers, who motion, or signal to other drivers or pedestrians that they may proceed. Often, those motions, or signals, may be confusing, yielding to unanticipated behavior and injuries. In Riley v. Board of Educ. of Cent. School Dist. No. 1, 15 AD2d 303 (3rd Dept. 1962), a school teacher was found negligent where she drove a youngster to his home, and after the child exited the car, she gave a signal, which she said was to warn the child of an oncoming automobile, but which the child might have misunderstood to mean it was safe to cross the road, and the child upon crossing the road, was struck and killed. In another Third Department decision, summary judgment was denied when a driver’s hand motions may have induced a child to cross when it was not safe to do so. See Thrane v. Haney, 264 AD2d 926 (3rd Dept. 1999). There, the issue of the driver’s gesture in directing the child may result in liability if he failed to exercise reasonable care and his conduct was a proximate cause of the child’s injuries. The Third Department again addressed these issues in Barber v. Merchant, 180 AD2d 984 (3rd Dept. 1992), where a driver and passenger gestured to the defendant, before the defendant began her turn, and in the process of making a turn, the defendant collided with a station wagon. As recently as 2013, the Third Department restated the proposition that when a gesturing driver signals that it is safe to proceed, he assumes a duty to [*7]pedestrians, other motorists and passengers, as well as to the person who is being signaled, to do so reasonably under the circumstances. See Dolce v. Cucolo, 106 AD3d 1431 (3rd Dept. 2013).
The meaning of the gesture is crucial to the issue of negligence. In Valdez v. Bernard, 123 AD2d 351 (2nd Dept. 1986), the Second Department reversed a jury verdict and held that the wave of a bus driver’s hand was not the proximate cause of an accident where the pedestrian interpreted the “wave” to mean only that the driver would not move the bus while she walked in front of it. See also Shapiro v. Mangio, 259 AD2d 692 (2nd Dept. 1999). In 2011, the Second Department reversed an award of summary judgment and reinstated the complaint against a bus driver based on issues of fact as to whether pedestrians relied upon bus driver’s wave in crossing the street. See Kievman v. Philip, 84 AD3d 1031 (2nd Dept. 2011). Ultimately, the significance attributable to the hand signal is a question for the trier of fact. See Golding v. Farmer, 273 AD2d 834 (4th Dept. 2000).
Here, there was testimony that the wave was intended by Lisette to assert “Here I am,” not that Gabrielle could make the turn safely. Lisette also acknowledged that her waving to Gabrielle “to make a U-Turn” was “a poor choice of words.” Gabrielle told the police she saw her mother’s wave. She was inconclusive as to whether her mother told her to make a U-Turn at the barrier. She did understand the wave to mean it was safe to cross. She thought the wave was saying “Here I am.” At one point, she said she did not remember; but at another point, she said her mother told her to make a U-Turn at the barrier. The jury had the opportunity to hear this testimony, evaluate it, and reach its verdict. It was for the jury to say what effect, if any, Lisette’s wave had on Gabrielle’s actions. Its verdict compels the conclusion that Lisette waved to Gabrielle to turn, that such wave was negligent under the circumstances, and the wave was a substantial factor in causing the accident. But it cannot be said that the “wave” was essential to the use of the Abbene vehicle.
The “use” or “operation” of a vehicle is not limited to a vehicle in motion. A vehicle is in “use” or being “operated” when stopped in traffic, or not in motion when waiting for a traffic light or the direction of a police officer, or even when it is undergoing repairs while the occupants are traveling. See Gering v. Merchants Mut. Ins. Co., supra. Here, Lisette was sitting in the driver’s seat of the Abbene BMW at an intersection, with the vehicle in “park” or her foot on the brake, or both, when she waved to her daughter. She had driven from her home to Cycle City, and she was returning home when she stopped moving at Harriman Avenue and Route 17, to make sure her daughter followed her on their journey home. While stopped, her hazard lights were off and the engine was running. Defendant’s reliance on Zaccari v. Progressive Northwestern Ins. Co., 35 AD3d 597 (2nd Dept. 2006), overlooks the absence of any connection between Zaccari’s use of his automobile and the automobile involved in the accident that led to Zaccari’s assistance and injury. The Zaccari vehicle was not “closely related to the injury.”[FN7] Zaccari, supra, at 599, quoted in Allstate Ins. Co. v. Reyes, supra, at 469. The facts here do not [*8]lend themselves to a strict application of the three-part test [FN8] set forth in Gholson, and re-stated in U.S. Oil Ref. & Mktg. Corp. v. Aetna Cas. & Sur. Co., 181 AD2d 768, 768-69 (2nd Dept. 1992), citing 6B Appelman, Insurance Law and Practice, §4317 at 367-69. The connection, if any, between events was significantly more remote in U.S. Oil than here, notwithstanding the fact that Lisette’s automobile did not produce the injury.
Still, Lisette’s “actions” and her wave set the events in motion, even if they did not “produce the injury,” unlike the remote and unrelated connections alleged in Zaccari. Gabrielle claims she did not rely on the “wave” from her mother while operating her vehicle. That testimony presents issues of fact, and also raises issues of proximate cause. Ohlhausen v. City of New York, 73 AD3d, supra, at 95-96, Shapiro v. Mangio, 259 AD2d 692, supra. “Proximate cause is generally a factual issue to be resolved by a jury” (Dolce v. Cucolo, supra at 1432), and there can be more than one proximate cause. See Burghardt v. Cmaylo, 40 AD3d 568 (2nd Dept. 2007). Here, the jury’s determination is entitled to great weight. Lisette’s “wave” was an act independent of the “use and operation” of the Abbene BMW. The fact that it was made from the driver’s seat, with the engine running and other indicia of “use and operation” is fortuitous, but it is neither convincing or controlling. “Not every injury occurring in or near a motor vehicle is covered by the phrase ‘use or operation.'” Olin v. Moore, 178 AD2d 517 (2nd Dept. 1991); see Horney v. Tisyl Taxi Corp., 93 AD2d 291 (1st Dept. 1983). There is no nexus between the wave and the actual operation of the automobile. Lisette’s wave could just as easily have been made while standing outside the BMW or 50 feet away from it, without affecting “use and operation.” The accident was not “connected with the use of an automobile qua automobile.” Reisinger v. Allstate Ins. Co., 58 AD2d 1028, supra. While it may be said that the travel plans for Lisette and Gabrielle contemplated continued travel, or use of the BMW (and the Honda) – so as to be a part of a more broad use and operation (see e.g. Gering v. Merchant’s Mut. Ins., supra), Lisette’s wave, which the jury found to be negligent, was not a part of, or reasonably contemplated, within “use and operation,” let alone negligent use and operation. See generally Progressive Ins. Co. v. Yodice, 276 AD2d 540 (2nd Dept. 2000) (a running engine did not lead to the “use” of the vehicle).
The complaint proffered two alternative theories of liability — ordinary negligence, or negligently operating a motor vehicle. The jury charge focused on Lisette’s wave, not her driving, notwithstanding the reference to a “driver” incurring “a duty to another by waving that it is safe to turn.” At the moment of the “wave,” Lisette was neither driving nor was the BMW in a traffic lane. In 1975, the Fourth Department held a vehicle parked and locked on the street in front of the owner’s residence was not being “used” in connection with no-fault benefits. McConnell v. Fireman’s Fund Am. Ins. Co., 49 AD2d 676 (4th Dept. 1975). In so holding, the court stated that “while authority broadly interprets the phrase ‘use or operation’ the determinative predicate in establishing liability therefrom would appear to be the designed purpose of the use or [*9]activity of the involved motor vehicle which is the proximate cause of the injury or damage sustained.” Id. at 677 (emphasis added). While McConnell is factually distinct from the instant case, the “use or activity” here is not connected to the motor vehicle.
Riley v. Board of Educ. Of Cent. Sch. Dist. No. 1, 15 AD2d 303, supra, does not hold that a “wave” by a motorist constitutes “use and operation” of a motor vehicle. The Third Department has distinguished the alleged negligent act from the use of a motor vehicle. In Thrane v. Haney, 264 AD2d 926, supra, the court stated, “It being inferable from the child’s testimony that defendant voluntarily assumed the duty to direct the child [across the street], defendant may be held liable if he failed to exercise reasonable care and his conduct was a proximate cause of the child’s injuries.” Id. at 927.
In Williams v. Weatherstone, 23 NY3d 384 (2014), the Court of Appeals recognized the limitation that must be applied to Riley and similar cases: “All of these cases entail some intentional hand motion or gesture directed by the motorist at the pedestrian. Having thereby assumed a duty to guide the pedestrian safely, the motorist must exercise reasonable care in doing so.” Id. at 402. That duty is “actually a separate duty, one that arises only upon the making of the gesture” and is separate from the duty to operate a vehicle with reasonable care. Ohlhausen v. City of New York, 73 AD3d 89, 92-93 (1st Dept. 2010). That duty neither explicitly nor implicitly involves the “use or operation” of a motor vehicle. Such “use or operation” must still be shown, and negligence in the use or operation must be shown as well. Argentina v. Emery World Wide Delivery Corp., 93 NY2d 554, 562 (1999); Progressive Cas. Ins. Co. v. Yodice, 276 AD2d, supra at 542. Here, it is not disputed that the Abbene vehicle was the location of the “wave” and was incidental to the accident, but no negligence in the operation of the vehicle has been shown. Empire Ins. Co. v. Schliessman, supra; United States Auto Assn. v. Aetna, supra.
Accordingly, the Court concludes that Lisette was not “using” the Abbene vehicle when she waved to her daughter. The vicarious liability of VTL §388 does not apply. Instead, the wave, found by the jury as a negligent act, gives rise to coverage under the Nationwide Homeowner’s policy, and the exclusion for the use of an automobile does not apply here. In addition, since the “accident was not the result of the ownership maintenance or use” of the Abbene vehicle, but was merely the location for which Lisette waved to her daughter, the denial of coverage by State Farm was not improper. In light of these determinations, the Court need not address the sufficiency of the disclaimers asserted by Nationwide and State Farm. Matter of Worcester Ins. Co. v. Bettenhauser, 95 NY2d 185, 188-89 (2000).[FN9]
OBLIGATION TO DEFEND AND INDEMNIFY
Lisette cross-claimed against Nationwide and State Farm, alleging they each failed to fulfill their obligation to defend and indemnify her within policy limits. Mrs. Daniele moved for similar relief, alleging more specifically that Nationwide and State Farm each engaged in bad faith by wrongfully refusing to defend and to indemnify Lisette, and that such actions were a [*10]gross disregard of their responsibilities and obligations under their insurance policies. Mrs. Daniele also asserted she is a third-party beneficiary. Nationwide, inter alia, denied the Oster counterclaim and affirmatively asserted it had no obligation to defend or to indemnify. Nationwide also claimed that Mrs. Daniele lacked standing to assert “bad faith.” State Farm asserted, inter alia, it had no obligation to defend or to indemnify.
Prior to the commencement of the Wrong Death Action, Mrs. Daniele’s counsel, David Lever, notified Lisette by certified mail, return receipt requested, of claims against her, arising from the events on August 31, 2011, resulting in Mr. Daniele’s death. On Monday, December 12, 2011, Mr. Lever received a telephone call from a Nationwide representative, Cheryl Knight, who had been informed about the pending commencement of the lawsuit. In response to Ms. Knight’s inquiry as to why the claim involved a homeowner’s policy and not an automobile policy, Mr. Lever advised her of the claim against Lisette for her negligent waving, or motion, to Gabrielle. Ms. Knight confirmed the conversation by letter dated December 13, 2011. On December 16, 2011, by letter to Lisette, Nationwide denied coverage for the incident, stating (incorrectly), “the accident arose while you were using and occupying your motor vehicle” – a fact true of Gabrielle, but not Lisette. Nationwide also refused to defend Lisette.
On November 3, 2011, Mrs. Daniele’s counsel notified State Farm of the accident and the claims against Abbene and Lisette for causing the accident and death of Mr. Daniele. By letter dated February 9, 2012, State Farm denied coverage, asserting that it was “questionable” whether the accident arose out of the ownership, maintenance, or use of the motor vehicle.
In the interim, on December 28, 2011, the Wrongful Death Action was commenced. The complaint alleged two alternative theories of Lisette’s negligence. One theory involved the negligent operation of the Abbene BMW; the second theory involved Lisette’s negligent wave to Gabrielle. The alternative theories simultaneously supported, and defeated, the conclusions reached by Nationwide and State Farm. The “use” of a motor vehicle, as discussed herein, involves the exclusion relied on by Nationwide and defeats State Farm’s position, while Lisette’s wave, as a negligent act, involves the Nationwide homeowner’s policy and eliminates the State Farm automobile policy. The close factual question further clouds the issue.
The strongest indicia of Nationwide’s “bad faith” can be found in the haste by which they reached their decision to deny coverage. Between Monday, December 12, 2011 and Friday, December 16, 2011, it appears that Nationwide investigated and determined that coverage should be denied. It is unknown, at this stage, when Nationwide received the November 8, 2011 letter from Mr. Lever, but Ms. Knight’s inquiry suggests either an unfamiliarity with the claim, or the need for factual clarity. How that was established, beyond a telephone conversation with Mr. Lever, is unknown. Indeed, Mr. Lever’s Affirmation recites that Ms. Knight advised “she had just received the claim.”
Nationwide and State Farm remained on notice with respect to the progress of the litigation, the pre-trial conference, and the liability and damages trials. Nevertheless, they persisted in their positions and did not participate in the proceedings. They were also advised that Plaintiffs would seek to hold them responsible for any excess verdict over the coverage provided by Allstate covering Gabrielle and Lisette. There was neither a tender of the policies nor entry into negotiations on behalf of the respective insured. However, once liability had been determined against Lisette, the exposure was evident.
Nationwide opted to stay on the sidelines of the Wrongful Death Action. They did so with the knowledge that Insurance Law §3420 grants the victorious plaintiff, here Carol Daniele, as Executrix, and Individually, the right to sue Nationwide to satisfy the Judgment against Lisette. While Nationwide might assert the disclaimer, as it has done here, under Insurance Law §3420, it surrendered the right to challenge the liability or damages contained in the Judgment. Lang v. Hanover Ins. Co., 3 NY3d 350, 356 (2004); see also Martin v. Safeco Ins. Co. of Am., 19 AD3d 221 (1st Dept. 2005).[FN10] The ultimate issue for Nationwide, i.e, whether the negligence arose from Lisette’s “use and operation” of the Abbene BMW, or whether her wave constituted a “personal negligent act” within the meaning of the homeowner’s policy, would be decided at trial, but that does not defeat Nationwide’s obligation to defend the action.
Our Courts have long recognized an insurer’s duty to defend is:
“exceedingly broad” (Colon v. Aetna Life & Cas. Ins. Co., 66 NY2d 6, 8). An insurer must defend whenever the four corners of the complaint suggest — or the insurer has actual knowledge of facts establishing — a reasonable possibility of coverage (Fitzpatrick v. American Honda Motor Co., 78 NY2d 61, 66-67; Seaboard Sur. Co. v. Gillette Co., 64 NY2d 304, 311-312). The duty is broader than the insurer’s obligation to indemnify: “[t]hough policy coverage is often denominated as ‘liability insurance’, where the insurer has made promises to defend ‘it is clear that [the coverage] is, in fact, ‘litigation insurance’ as well'” Seaboard Sur., 64 NY2d at 310, supra.).
Continental Casualty Co. v. Rapid-American Corp., 80 NY2d 640, 648 (1993). That duty encompasses matters of policy, as well as contract interpretation, to virtually all forms of human behavior. See Automobile Ins. Co. of Hartford v. Cook, 7 NY3d 131 (2006)(homeowner’s policy contains duty to defend in wrongful death action involving a shooting committed in self defense); Colon v. Aetna Life & Cas. Ins. Co., 66 NY2d 6 (1985) (issue of whether driver was operating vehicle with owner’s permission required defense where complaint alleged driver had owner’s permission, and insurer disputed claim). The allegations in the complaint and the terms of the policy will invoke the duty to defend and will negate exclusions:
“If the complaint contains any facts or allegations which bring the claim even potentially within the protection purchased, the insurer is obligated to defend (Ruder & Finn v. Seaboard Sur. Co., 52 NY2d 663, 669-670). Moreover, when an exclusion clause is relied upon to deny coverage, the insurer has the burden of demonstrating that the ‘allegations of the complaint cast that pleading solely and entirely within the policy exclusions, and further, that the allegations, in toto, are subject to no other interpretation’ (International Paper Co. v. Continental Cas. Co., 35 NY2d 322, 325).”
Technicon Electronics Corp. v. American Home Assur. Co., 70 NY2d 66, 73 (1989).
Applying this standard, it is evident the Complaint alleges negligent acts independent of the excluded use and operation of a motor vehicle. The Nationwide Homeowner’s policy states:
“COVERAGE E – PERSONAL LIABILITY
We will pay damages an insured is legally obligated to pay due to an occurrence resulting from negligent personal acts or negligence arising out of the ownership, maintenance or use of real or personal property. We will provide a defense at our expense by counsel of our choice. We may investigate and settle any claim or suit.
This coverage is excess over other valid and collectible insurance. It does not apply to insurance written as excess over the applicable limits of liability.
Further, “occurrence” means “bodily injury or property damage resulting from an accident…” The phrase “negligent personal acts” is not defined in the policy. Accordingly, the obligation to defend, as stated in the policy (“We will provide a defense…”) cannot be seriously disputed.
Turning to the duty to defend, the standard has been repeatedly, and recently, stated:
“An insurer’s duty to defend its insured is ‘exceedingly broad’ (BP A.C. Corp. v. One Beacon Ins. Group, 8 NY3d 708, 714, 840 N.Y.S.2d 302, 871 N.E.2d 1128 (2007), quoting Automobile Ins. Co. of Hartford v. Cook, 7 NY3d 131, 137, 818 N.Y.S.2d 176, 850 N.E.2d 1152 [2006]). An ‘insurer will be called upon to provide a defense whenever the allegations of the complaint suggest…a reasonable possibility of coverage’ (id., quoting Cook, 7 NY3d at 137, 818 N.Y.S.2d 176, 850 N.E.2d 1152 [internal quotation marks omitted]). ‘If [a] complaint contains any facts or allegations which bring the claim even potentially within the protection purchased, the insurer is obligated to defend’ (id., quoting Technicon Elecs. Corp. v American Home Assur. Co., 74 NY2d 66, 73, 544 N.Y.S.2d 531, 542 N.E.2d 1048 [1989] [internal quotation marks omitted]). This standard applies equally to additional insureds and named insureds (see id. at 714-715, 544 N.Y.S.2d 531, 542 N.E.2d 1038, citing Pecker Iron Works of NY v. Traveler’s Ins. Co., 99 NY2d 391, 393, 756 N.Y.S.2d 822, 786 N.E.2d 863 [2003]).”
Regal Const. Corp. v. National Union Fire Ins. Co., of Pittsburgh, PA, 15 NY3d 34, 37 (2010); Ruder & Finn v. Seabord Sur. Co., 52 NY2d 663, 670 (1981). That duty extends not only to the insured, but to third persons, such as Lisette, in relation to the State Farm policy as well. Colon v. Aetna Life & Cas. Ins. Co., supra.
Nationwide’s assertion of an exclusion, or State Farm’s disclaimer of coverage, does not relieve the insurer of responsibility “to provide a defense,” “unless it can demonstrate the pleadings [are] solely and entirely within policy exclusions…and are subject to no other interpretation.” Automobile Ins. Co. of Hartford v. Cook, 7 NY3d, supra at 137, quoting Allstate Ins. v. Mugavero, 79 NY2d 153, 159 (1992)(citation omitted). Here, the complaint alleges two theories of liability. One alleges the use and operation of an automobile and the second alleges a personal act of negligence. The Nationwide exclusion applies to the first theory but not the second. The State Farm exclusion applies to the second but not the first. Nationwide has not established that Lisette’s wave, for purposes of a duty to defend, could be only attributable to the use of the automobile. Accordingly, Nationwide’s duty to defend Lisette has been established. Physicians Reciprocal Insurers v. Loeb, 291 AD2d 541, 542 (2nd Dept. 2002).
The duty to defend is broader than the duty to indemnify. Nationwide does not dispute the duty to indemnify, nor could it after the jury’s determination of liability (Servidone Constr. [*11]Corp. v. Security Ins. Co. of Hartford, 64 NY2d 419 (1985), although the arguments in Nationwide’s Memorandum of Law limit the right of indemnification to Lisette, and do not extend to Mrs. Daniele.
Counsel for Nationwide asserts Nationwide was never served with the Judgment with Notice of Entry in the Wrongful Death Action. As such, it is claimed that the requirements of Insurance Law §3420(a)(2), have not been met and the Daniele motions should be denied as to Nationwide. Lever’s Affirmation at Paragraph 15 contains the following assertion:
“On February 15, 2017, on behalf of Daniele, as plaintiff in the underlying wrongful death action, my office served the Notice of Entry of Judgment After Damages Trial by Jury with accompanying Bill of Costs upon all parties. One day later, on February 16, 2017, my office served counsel for the insurer’s [sic] in the declaratory judgment action with the entered judgment and by letter dated February 21, 2017, I served said entered judgment upon the insurers, Nationwide and State Farm. (A copy of the February 21, 2017 letter to Nationwide and State Farm serving the Notice of Entry of the Judgment after Damages Trial By Jury and Bill of Costs, as well as Affidavits of Service upon counsel in the wrongful death action and counsel for the insureds, annexed hereto as Exhibit AA).”
The Affidavits of Service attest to service of the Judgment with Notice of Entry upon the firm of Galleonardo & Rayhill, attorneys for Nationwide. Such an affidavit is prima facie proof of proper service, and it is not rebutted by an unsubstantiated denial that lacks factual specificity and detail, such as Claims Manager Mr. Macaluso’s conclusory statement, “The Judgment after Damages Trial by Jury was not served upon Nationwide.” Deutsche Bank Nat. Trust Co. v. Quinones, 114 AD3d 719 (2nd Dept. 2014); Liriano v. Eveready Ins. Co., 65 AD3d 524 (2nd Dept. 2009); Simonds v. Grobman, 277 AD2d 369 (2nd Dept. 2000).
The procedural posture here adds to the complexities. Nationwide commenced the action for a declaratory judgment after Lisette’s liability had been determined, but before damages had been established in a bifurcated trial and before Judgment had been entered. It sought a declaration that Nationwide is not required to provide coverage for the August 31, 2011 incident, and they were not required to defend or to indemnify Lisette. Lisette asserts the contrary. Mrs. Daniele, in the declaratory judgment action, interposed a counterclaim, inter alia, seeking a declaration that Nationwide is obligated to defend Lisette “against any judgment” with the limits of its policy ($1,000,000.00) exclusive of costs that may be recovered. Mrs. Daniele also sought to recover reasonable attorneys’ fees as well as costs and disbursements. After the declaratory judgment action was commenced and before the instant motion had been made, the damages in the Wrongful Death Action had been determined and Judgment was entered. These procedural developments raise issues involving CPLR§3001 and Insurance Law §3420. CPLR §3001 authorizes the Court to determine “the rights and other legal relations of the parties to a justiciable controversy whether or not further relief is or could be claimed.” Further, CPLR §3019 authorizes a counterclaim for “any cause of action.” Notably, CPLR §3001 contains a specific provision for declaratory judgment actions where the sole issue is the timeliness of a [*12]disclaimer notice under Insurance Law §3420(a)(6).[FN11] Thus, Nationwide asserts that Mrs. Daniele lacks standing to pursue the counterclaims, and, in effect, there is no justiciable controversy involving Mrs. Daniele and Nationwide. Mrs. Daniele argues that the Judgment resolves the standing issue, but if true, then it begs the question of whether there was standing when the counterclaim was interposed and before the Judgment was entered, i.e., after the liability verdict.[FN12]
Clearly, Insurance Law §3420 requires a Judgment as a precondition to a direct action against an insurer on a Judgment, but it is otherwise silent where, as here, Mrs. Daniele is asking the Court for the same type of relief as Nationwide — a determination of the parties’ rights and obligations. The Second Department addressed these issues in Watson v. Aetna Cas. & Sur. Co., 246 AD2d 57 (2nd Dept. 1998). There, the plaintiff was injured at the premises of the defendant’s insured and the plaintiff obtained a default judgment on the issue of liability. The plaintiff sought a judgment declaring the defendant insurer must defend and indemnify its insured. There, as here, the defendant asserted the plaintiff lacked standing as no Judgment had been entered. The Court read Insurance Law §3420 “as prohibiting, by its plain terms, only a direct cause of action to recover money damages, and not prohibiting a declaratory judgment action by the Plaintiff in the underlying tort action seeking a declaration that a disclaiming insurance company owes a duty to defend or indemnify the tortfeasor.” Id. at 62. The court further recognized that the dispute between the plaintiff and the defendant insurer was “a genuine dispute that is justiciable, i.e.’state[s] a real controversy, involving substantial legal interests.'” Id. at 64.
Here, the argument supporting Nationwide’s action is that it should not be obligated to defend and to indemnify its insured, who has been found liable to Defendant. It is patently obvious that Mrs. Daniele’s position is the opposite and where either side stands to benefit from a ruling, it must be said there is “a real controversy involving substantial legal interests.” Id. at 64 (citation omitted). See also Tepedino v. Zurich-American Ins. Group, 220 AD2d 579 (2nd Dept. 1995). Moreover, to entertain only one side of a dispute, as Nationwide argues, by denying the opportunity to Mrs. Daniele, raises issues of res judicata and collateral estoppel, especially if Mrs. Daniele were bound by a ruling against Lisette, without the opportunity to be heard. Alternatively, if Mrs. Daniele had to await the entry of Judgment before commencing an action, the interests of judicial economy would be threatened, as multiple duplicative actions would [*13]surround, and prolong, issues of liability and damages.[FN13]
Watson v. Aetna Casualty, supra, properly distinguishes between a direct action against an insurer to recover an unsatisfied judgment (Jimenez v. New York Cent. Mut. Fire Ins. Co., 71 AD3d 637 [2nd Dept. 2010]), and an action to declare issues of defense and indemnification. In Mortillaro v. Public Serv. Mut. Ins. Co., 285 AD2d 586 (2nd Dept. 2001), the Second Department stated:
“A plaintiff need not be privy to an insurance contract to commence a declaratory judgment action to determine the rights and obligations of the respective parties, so long as the Plaintiff stands to benefit from the policy.”
Id. at 587. Accordingly, both Lisette Oster, and Ms. Daniele, may assert the obligation to defend and indemnify.
ATTORNEY’S FEES
Lisette Oster is entitled to recover her attorneys’ fees in opposing Nationwide’s declaratory judgment action and in enforcing her right to a defense and indemnification. Mrs. Daniele is not entitled to recover her attorneys’ fees.[FN14] New York has followed the rule that an insured may not recover in an affirmative action to determine its rights, but may do so, where, as here, the insured has been “cast in a defensive posture by the legal steps an insurer takes in an effort to free itself from its policy obligations (see Johnson v. General Mutual Ins. Co., 24 NY2d 42; Glens Falls Ins. Co. v. United States Fire Ins. Co., 41 AD2d 869 [3rd Dept. 1973] aff’d. on opn. below, 34 NY2d 778 [1974]).” Mighty Midgets v. Centennial Ins. Co., 47 NY2d 12 (1979). This holding is in contrast with the so-called American Rule — that absent a contractual provision or statutory basis for recovery, each party is responsible for their own attorneys’ fees. In Johnson, supra, the insured was permitted to recover costs of defending the action, but could not recover the costs of a cross-claim against the insurer, nor could the injured party recovery its costs. The exception is one of policy, and it is not lightly expanded. However, some courts have recognized the recovery also includes not only the costs and expenses of a defense to the insurer’s actions, but also the costs and defenses of the counterclaim to assert the right to coverage. Admiral Ins. Co. v. Weitz & Luxenberg, P.C., 2002 WL 31409450 (SDNY October 24, 2002); Lancer Ins. Co. v. Saravia, 40 Misc 3d 171, 177 (Sup.Ct. [Kings] 2013). The Second Department has made its position clear:
“[A]n insured who is ‘cast in a defensive posture by the legal steps an insurer takes in an effort to free itself from its policy obligations,’ and who prevails on the merits, may recover an attorney’s fee incurred in defending against the insurer’s action” (Insurance Co. of Greater NY v. Clermont Armory, LLC , 84 AD3d 1168, 1171, 923 N.Y.S.2d 661, quoting U.S. Underwriters Ins. Co. v. City Club Hotel, LLC, 3 NY3d 592, 598, 789 N.Y.S.2d 470, 822 N.E.2d 777 [internal quotation marks omitted]; see Mighty Midgets v. Centennial Ins. Co., 47 NY2d 12, 21, 416 N.Y.S.2d 559, 389 N.E.2d 1080; Johnson v. General Mut. Ins. Co., 24 NY2d 42, 298 N.Y.S.2d 937, 246 N.E.2d 713). ” ‘It is well settled than an insurer’s responsibility to defend reaches the defense of any actions arising out of the occurrence, and defense expenses are recoverable by the insured, including those incurred in defending against an insurer seeking to avoid coverage for a particular claim.'” (RLI Ins. Co. v. Smiedala, 77 AD3d 1293, 1294-1295, 909 N.Y.S.2d 263, quoting National Grange Mut. Ins. Co. v. T.C. Concrete Constr., Inc., 43 AD3d 1321, 1322, 843 N.Y.S.2d 877 [internal quotation marks omitted]). “Moreover, ‘an insured who prevails in an action brought by an insurance company seeking a declaratory judgment that it has no duty to defend or indemnify the insured may recover attorneys’ fees regardless of whether the insurer provided a defense to the insured'” (RLI Ins. Co. v. Smiedala, 77 AD3d at 295, 909 N.Y.S.2d 263, quoting U.S. Underwriters Ins. Co. v. City Club Hotel, LLC, 3 NY3d at 598, 789 N.Y.S.2d 470, 822 N.E.2d 777).”
Farm Family Cas. Ins. Co., v Habitat Renewal, LLC, 91 AD3d 903, 905-06 (2nd Dept. 2012). Accordingly, Lisette Oster may recover her attorney’s fees, but Ms. Daniele may not.
BAD FAITH
The Estate interposed a counterclaim alleging Nationwide engaged in “bad faith” in failing to meet its obligations under the policy. The Estate asserts Nationwide engaged in a “gross disregard” of the rights of its insured, Lisette, by such acts as disclaiming coverage, after little or no real investigation, failing to participate in the liability phase of the trial, failing to respond when placed on notice of Lisette’s liability, failing to participate in the damages phase of the trial, and otherwise failing to participate in the litigation. Nationwide asserts there can be no independent action for “bad faith,” and such action, if any, is one of breach of contract.[FN15] Further, it disputes that its actions were in “bad faith,” but were, at most, a coverage dispute concerning the terms of the policy. Having determined there was no coverage under the Homeowner’s Policy, it followed that there was no reason for Nationwide to participate in the litigation. However, once liability was determined against Lisette, the damage exposure became apparent.
In Pavia v. State Farm Mut. Auto. Ins. Co., 82 NY2d 445 (1993), the Court of Appeals recognized a form of bad faith where an insurer grossly disregarded the insured’s interest by failing to settle within policy limits when liability was clear. Somewhat less clear was whether Pavia created a new cause of action or simply expanded a contractual basis for relief arising from a breach of its “duty of good faith,” but insofar as the duty of good faith was “derived from the [*14]insurance contract,” the cause of action suggested one of contract rather than tort. Id. at 452. But, the performance of a contractual obligation with reasonable care may give rise to a duty of reasonable care, and “the breach of that independent duty will give rise to a tort claim.” New York Univ. v. Continental Ins. Co., 87 NY2d 308, 316 (1995).
The duty imposed on insurers to act in good faith in defending and settling claims derives from their virtually complete control over the settlement and the defense of claims, and reflects, to some degree, a balancing of that control in favor of the insured’s interests. That balancing, however, may be slight in light of the high barrier on the insured of establishing a “gross disregard” of the insured’s interests, which usually entails a pattern of conduct. Each element of a pattern of conduct must be established to conclude the insurer culpably failed to honor a contract. Gordon v. Nationwide Mut. Ins. Co., 30 NY2d 427, 437 (1972); CBL Path Inc. v. Lexington Ins. Co., 73 AD3d 829, 830 (2nd Dept. 2010). One aspect of that pattern is whether the insurer’s obligation to investigate and evaluate the insured’s claim was sufficient. See Pavia v. State Farm Mut. Auto. Ins. Co., supra; Gordon v. Nationwide Mut. Ins. Co., supra. So too, is the notice, participation, or lack of participation in the determination of liability (Knobloch v. Royal Globe Ins. Co., 38 NY2d 471 [1976]), and the risks to the insured of the failure to resolve the matter. Vecchione v. Amica Mut. Ins. Co., 274 AD2d 576 (2nd Dept. 2000). These factual disputes standing alone, are sufficient to deny the motions for summary judgment, based on “bad faith.”
However, it is not “bad faith” where, as here, there was an arguable basis for denying coverage. Nationwide conducted some investigation and took a position that a denial of coverage was warranted. Its actions flowed from that decision. To the extent that the decision denying coverage was a close question (as discussed herein), it cannot support a finding of “bad faith”. Sukup v. State of New York, 19 NY2d 519 (1967). Thus, exclusive of the denial of coverage, any issue of bad faith herein would be based on, among other things, the sufficiency of the Nationwide investigation, and the failure to re-evaluate their position as the facts and litigation progressed.
Accordingly, it is
ORDERED that the motion seeking a default judgment against Defendant Andrew Abbene is granted; and it is further
ORDERED that the Nationwide policy provides coverage for the incident of August 31, 2011, and the claims set forth in the Wrongful Death Action and that Nationwide is required to defend and indemnify Lisette M. Oster with respect to the incident of August 31, 2011, and the claims set forth in the Wrongful Death Action or any claims for contribution or indemnity therein; and it is further
ORDERED that the State Farm policy does not provide coverage for the incident of August 31, 2011, and the claims set forth in the Wrongful Death Action and that State Farm was not required to defend or indemnify Defendant Lisette M. Oster with respect to the incident of August 31, 2011, the claims set forth in the Wrongful Death Action and any claims for contribution or indemnity therein; and it is further
ORDERED that the motion to dismiss Defendant Lisette Oster’s counterclaim (improperly designated as a “cross-claim”) and Defendant’s Estate’s counterclaim is denied; and it is further
ORDERED that the motion of Defendant State Farm Mutual Automobile Insurance Company i/s/h/a State Farm Mutual Insurance Company (“State Farm”) for summary judgment dismissing the action against State Farm, including any cross-claims, and declaring that State Farm had no obligation to defend Lisette Oster for the underlying lawsuit and no obligation to pay any portion of the judgment in the underlying lawsuit to Carole Daniele or indemnify Lisette Oster for the judgment in the underlying lawsuit is granted; and it is further
ORDERED that Carol Daniele, As Executrix, is granted judgment on the counterclaims declaring that Plaintiff Nationwide is obligated to indemnify Defendant Lisette M. Oster against the judgment entered in the underlying Wrongful Death Action captioned “Carol Daniele, as Executrix of the Estate of Douglas P. Daniele, deceased, and Carol Daniele, Individually v. Gabrielle Oster, Lisette M. Oster and Andrew J. Abbene” (Supreme Court, Putnam Co., Index No. 3482/2011) up to the limits of its policy ($1,000,000.00), together with interest and costs, and attorneys’ fees if covered under the policy or otherwise collectible at law; and it is further
ORDERED that Defendants Carol Daniele, as Executrix of the Estate of Douglas P. Daniele, Deceased, and Carol Daniele, Individually, are not entitled to recover of Plaintiff Nationwide and Defendant State Farm, attorneys’ fees, as well as costs and disbursements incurred in the prosecution of the instant action; and it is further
ORDERED that the Complaint herein is dismissed; and it is further
ORDERED that Lisette Oster’s cross claims and counterclaims are granted as set forth herein.
The foregoing constitutes the Decision and Order of the Court.
Dated: Carmel, New York
June 29, 2018
__________________________________
HON. VICTOR G. GROSSMAN, J.S.C.
Footnotes
Footnote 1:Following the submission of the motions, at counsel’s request, the Court entertained oral argument, and allowed post-argument submissions. The Court permitted counsel to submit responses to decisions relied upon by the attorneys for Carole Daniele, Individually and as Executrix, and provided to the Court during oral argument.
Footnote 2:In the wrongful death action, the issue of liability was tried before Hon. Lewis J. Lubell. The issue of damages was tried before Hon. Robert DiBella. The Judgment has not been appealed.
Footnote 3:Prior to the instant actions, on December 19, 2013, Carol Daniele, as Executrix of the Estate of Douglas P. Daniele, Deceased, and Carol Daniele, Individually (hereinafter referred to as the Estate”), initiated a declaratory judgment action against Nationwide, State Farm, Allstate, Gabrielle, Lisette, and Abbene, in Supreme Court, Putnam County (Index No. 2811/13). On August 8, 2014, the Court granted Nationwide’s motion to dismiss the Estate’s complaint on the grounds that the Estate lacked standing (Lubell, J.).
Footnote 4:No objection was made to the charge.
Footnote 5:The pleading was labeled as a cross-claim, but in fact, it was a counterclaim.
Footnote 6:None of the parties have cited any authority defining the term “involves” as it used in the State Farm policy.
Footnote 7:Zaccari is a weak precedent. The Decision cites a “four paragraph affidavit” that “failed to set forth exactly what caused his injury.” 35 AD3d, supra at 600. In contrast, the detail in Encompass Indemn. Company v. Rich, 131 AD3d 476 (2nd Dept. 2015) established the connection not made in Zaccari. Rich, however, involved supplemental underinsured/uninsured coverage rather than a liability policy.
Footnote 8:That test states: “1. The accident must have arisen out of the inherent nature of the automobile, as such; 2. The accident must have arisen within the natural territorial limits of an automobile, and the actual use, loading, or unloading must not have terminated; 3. The automobile must not merely contribute to cause the condition which produces the injury, but must, itself, produce the injury”
Footnote 9:In any event, the Court would limit the issue of sufficiency to those exclusions stated in the disclaimer letters. General Acc. Ins. Group v. Cirucci, 46 NY2d 862 (1979); Abreu v. Huang, 300 AD2d 420 (2nd Dept. 2002).
Footnote 10:The same conclusion is reached when there is a default, in the case of Defendant Abbene, and the insurer remains bound by the Judgment.
Footnote 11:To the extent that Insurance Law §3420 should be construed narrowly as it is in derogation of the common law, the express wording of the statute requires that it be construed “equally or more favorable to the insured and to judgment creditors.”
Footnote 12:While Insurance Law §3420 establishes a Judgment establishing liability as a precondition to recovery, there is a suggestion that a finding of liability may trigger the duty to indemnify. In Westchester Fire Ins. Co. v. Utica First Ins. Co., 40 AD3d 978 (2nd Dept. 2007), the Court observed, “When insurers agree to pay all sums which an insured becomes legally obligated to pay as damages,” there must be “an establishment of legal liability for payment of damages” to trigger the insurers’ duty to indemnify the insured.” Id. at 980.
Footnote 13:Here, the Judgment awarding damages was entered while this action was pending. It may have been fortuitous that the instant action had not been resolved. At the very least, if Mrs. Daniele had to await the entry of Judgment, the Court would be faced with a new declaratory judgment action, possible consolidation, possible inconsistent rulings, and a continuation of the seven years of litigation already completed.
Footnote 14:There is a Fourth Department
case suggesting the contrary. RLI Ins. v.
Smiedala, 77 AD3d 1293 (4th Dept. 2010), but the Second Department appears to limit
the holding to the right of the insured. Farm Family Cas. Ins. Co. v. Habitat Rental, LLC, 91 AD3d 903
(2nd Dept. 2012).
Footnote 15:Nationwide also asserts the Estate lacks standing, an issue previously addressed, supra.