Justice LONG delivered the opinion of the Court.
The question presented on this appeal is whether a Portee
In 2007, defendants, Jack and Sally Pomeranc, d/b/a Mansard Gardens Associates, LLC (Mansard), were the owners of an apartment building on West 23rd Street in Bayonne, New Jersey. At the time, Greater New York Mutual Insurance Company (GNY) was Mansard's insurer under a commercial general liability insurance policy (Policy). The Policy provided, in relevant part:
Plaintiffs Magdy and Manal Abouzaid
The fire spread rapidly through the apartment and Moustafa, Omar, and Tarek (collectively "minor plaintiffs") were trapped by the flames. Moustafa sustained first-degree burns to his lower torso and second-degree burns to his left foot. Omar suffered burns on the top of his left foot. Tarek's injuries are not specified. The children's mothers, Manal Abouzaid and Eman Kandil (collectively "plaintiffs"), heard the explosion and saw their sons "engulfed by a fireball." The flames did not physically injure the women.
On June 2, 2008, Magdy Abouzaid and Emadildin Osman, the fathers of the minor plaintiffs, sued Mansard as guardians ad litem for their sons. The boys' mothers also joined the complaint as individual plaintiffs.
The complaint alleged three counts of tortious activity by Mansard. Count I was a negligence claim for Mansard's alleged breach of the duty of reasonable care, which resulted in physical injury to the minor plaintiffs who "experienced pain and suffering, loss of enjoyment of life," and "were caused to undergo medical treatment," which resulted in "expenses to their caregivers, scarring, and emotional injury."
Count III did not allege physical injury to plaintiffs or specify that their alleged emotional distress was accompanied by physical manifestations.
Mansard forwarded the complaint to its insurer, GNY, which responded on August 18, 2008, by issuing a "reservation of rights and partial disclaimer." GNY agreed to provide a limited defense in the underlying litigation, but denied coverage and representation for the claims asserted in Count III. GNY explained that the emotional distress claims in Count III did not satisfy the "bodily injury" requirement and therefore fell outside the coverage of the Policy. GNY also reserved the right to deny coverage for the minor plaintiffs' claims of emotional injury included in Count I "in the event that there is no physical manifestation of the emotional injury."
Mansard then retained independent counsel who filed an answer to Count III and a third-party complaint against GNY, asserting that it was obligated to defend against Count III. On December 31, 2008, GNY filed a motion to dismiss the third-party complaint on the grounds that Mansard failed to state a cause of action. On January 15, 2009, while GNY's motion was still pending, Mansard filed a summary judgment motion to dismiss the emotional distress claim as inadequately pled.
On February 27, 2009, the trial court denied both summary judgment motions, reasoning that it was premature to dismiss Mansard's third-party complaint against GNY regarding coverage, and that plaintiffs had asserted a viable negligent infliction of emotional distress claim under Portee.
On March 18, 2009, Mansard moved for summary judgment against GNY and for the award of counsel fees pursuant to Rule 4:42-9(a)(6). On April 7, 2009, GNY filed a cross-motion for reconsideration of the February 27, 2009, order denying its motion to dismiss the third-party complaint.
As Mansard and GNY awaited the return date for their dueling motions, the trial court permitted plaintiffs to file an amended complaint in the underlying action. The amended complaint revised Count III to read as follows: "Plaintiffs Manal [Abouzaid] and Eman Kandil have had to incur the cost of medical treatment for the physical impact caused by their emotional distress and suffering." (Emphasis added).
On May 1, 2009, based on plaintiffs' amended complaint, GNY issued a "supplemental notice of reservation of rights" expanding its defense to include the amended
That same day, the trial court granted Mansard's motion for summary judgment on the coverage issue, declaring that the duty to defend was triggered by the initial complaint. The trial court also denied GNY's motion for reconsideration of its February 27, 2009, denial of GNY's motion for summary judgment.
Ultimately, a plenary hearing was conducted on Mansard's application for counsel fees expended in defense of Count III of the original complaint. On July 31, 2009, the trial court awarded Mansard fees and costs in the amount of $38,345.75. GNY appealed.
The Appellate Division reversed the trial court's decision regarding defense and counsel fees. In so doing, the panel ordered the dismissal of Mansard's third-party complaint with prejudice, and reversed the award of fees and costs. According to the panel, plaintiffs' assertion of a Portee claim, without a reference to related physical injury, was insufficient to trigger coverage for "bodily injury" under the Policy. The panel reasoned that nothing in Portee or its subsequent jurisprudence demands "a physical manifestation as a required element of [a negligent infliction of emotional distress] cause of action." As such, the panel found that GNY was not obligated to defend Mansard until plaintiffs amended Count III to include an allegation of "physical impact." We granted Mansard's petition for certification, Abouzaid v. Mansard Gardens Associates, LLC, 205 N.J. 14, 11 A.3d 373 (2010), and now reverse.
Mansard argues that a Portee claim, by its very nature, involves a physical manifestation; that the assertion of a Portee claim thus triggers a duty to defend under an insurance policy covering "bodily injury"; and that, in any event, under Voorhees an insurer must defend a Portee claim until the question of physical injury clearly drops out of the case.
GNY counters that the Appellate Division properly determined that the Policy did not provide coverage for emotional distress claims unaccompanied by an allegation of resulting physical harm; that Portee claims do not require the assertion of physical harm and thus do not trigger the duty to defend under an insurance policy covering only "bodily injury"; that Mansard erroneously interprets this Court's case law to create a duty to defend purely emotional claims; and that emotional distress claims must be accompanied by allegations of physical manifestations to trigger coverage under an insurance policy covering only "bodily injury."
The history of the tort of negligent infliction of emotional distress has had many twists and turns. Historically, under Ward v. West Jersey & Seashore R.R. Co., 65 N.J.L. 383, 47 A. 561 (Sup.Ct.1900), a plaintiff could not recover for emotional distress resulting from negligent conduct without the showing of a contemporaneous physical injury. Id. at 384-86, 47 A. 561;
"With the passage of time and the decisions in a series of cases in which practically nonexistent impact was the peg upon which recovery for serious emotional disturbance was allowed, the impact rule came under nearly universal criticism." Strachan v. John F. Kennedy Mem'l Hosp., 209 N.J.Super. 300, 334, 507 A.2d 718 (App.Div.1986) (citing Comment, Negligently Inflicted Mental Distress: The Case for an Independent Tort, 59 Geo. L.J. 1237 (1971)), aff'd in part and rev'd in part, 109 N.J. 523, 538 A.2d 346 (1988).
Eventually, the physical impact requirement fell by the wayside. In Falzone v. Busch, 45 N.J. 559, 214 A.2d 12 (1965), we rejected the reasons previously advanced by courts in support of the physical impact rule as no longer "tenable." See id. at 563-69, 214 A.2d 12. As we explained in Portee:
Falzone adopted what was denominated the "zone of danger" rule, which recognized that immediate fear of personal injury could serve as the basis for recovery for emotional distress from negligent conduct so long as "substantial bodily injury or sickness" resulted. Falzone, supra, 45 N.J. at 569, 214 A.2d 12. That remains our law today. Jablonowska, supra, 195 N.J. at 104, 948 A.2d 610.
In ruling, we specifically recognized that severe "mental and emotional harm," standing alone, can trigger Portee recovery. That distinguishes such a claim from ordinary emotional distress, which requires substantial bodily injury or sickness to survive. Compare ibid., with Falzone, supra, 45 N.J. at 569, 214 A.2d 12. Although Portee plaintiffs have a right to assert physical harms associated with emotional distress, the unique emotional distress injuries contemplated by Portee need not be paired with physical conditions in order to be pursued.
At issue in this case is whether an insurer must defend a Portee claim under a "bodily injury" provision in a commercial general liability insurance policy. To answer that question, some basic principles require review.
As a practical matter, the determination of an insurer's duty to defend requires review of the complaint with liberality to ascertain whether the insurer will be obligated to indemnify the insured "if the allegations are sustained." See Danek, supra, 28 N.J.Super. at 77, 100 A.2d 198; see also Hartford Ins. Grp. v. Marson Constr. Corp., 186 N.J.Super. 253, 260, 452 A.2d 473 (App.Div.1982), certif. denied, 93 N.J. 247, 460 A.2d 656 (1983). "[T]he complaint should be laid alongside the policy and a determination made as to whether, if the allegations are sustained, the insurer will be required to pay the resulting judgment, and in reaching a conclusion, doubts should be resolved in favor of the insured." Danek, supra, 28 N.J.Super. at 77, 100 A.2d 198. Thus, if "the complaint comprehends an injury which may be within the policy," a duty to defend will be found. Id. at 78, 100 A.2d 198 (emphasis added) (quoting Lee v. Aetna Cas. & Sur. Co., 178 F.2d 750, 753 (2d Cir.1949)). In other words, "potentially coverable" claims require a defense. See Stafford v. T.H.E. Ins. Co., 309 N.J.Super. 97, 103, 706 A.2d 785 (App.Div.1998) ("[A] duty to defend clause is enforceable if there is a `potentially-coverable occurrence' that would be indemnified if proved valid.").
That is the nearly-universal rule among our sister jurisdictions as well.
Notably, the potential merit of the claim is immaterial: the duty to defend "is not abrogated by the fact that the cause of action stated cannot be maintained against the insured either in law or in fact—in other words, because the cause is groundless, false or fraudulent." Danek, supra, 28 N.J.Super. at 77, 100 A.2d 198. Moreover, the duty to defend remains even if the asserted claims are "poorly developed and almost sure to fail." Voorhees, supra, 128 N.J. at 174, 607 A.2d 1255.
Although courts generally look to the complaint to ascertain the duty to defend, the analysis is not necessarily limited to the facts asserted in the complaint. See id. at 174-75, 607 A.2d 1255; SL Indus. v. Am. Motorists Ins. Co., 128 N.J. 188, 198-99, 607 A.2d 1266 (1992); Jolley v. Marquess, 393 N.J.Super. 255, 271-72, 923 A.2d 264 (App.Div.2007). Thus, for example, an insurer's duty to provide a defense may also be triggered by "facts indicating potential coverage that arise during the resolution of the underlying dispute." SL Indus., supra, 128 N.J. at 198, 607 A.2d 1266. That notion is said to align with the expectations of insureds, who "expect their coverage and defense benefits to be determined by the nature of the claim against them, not by the fortuity of how the plaintiff, a third party, chooses to phrase the complaint against the insured." Id. at 198-99, 607 A.2d 1266.
With those principles in mind, we turn to our most recent forays into the subject of defense of an emotional distress claim. In Voorhees, we interpreted a "bodily injury" provision, nearly identical to the one before us, which obligated the insurer to:
In its definitions section, the policy stated that
Voorhees was sued by her child's teacher after she questioned the teacher's "competency and fitness." Id. at 169, 607 A.2d 1255. The complaint alleged that Voorhees
When Voorhees unsuccessfully sought a defense from her insurer, she settled the underlying case and later sued the insurer for legal expenses. Ibid. The trial court granted summary judgment in favor of the insurer, finding that the teacher's complaint alleged defamation, which was not covered under the "bodily injury" policy. Id. at 171-72, 607 A.2d 1255.
Voorhees appealed. Over a dissent, the appellate panel reversed, declaring that the teacher's complaint alleged both outrage and negligent infliction of emotional distress, "causes of action that would be covered under the phrase `bodily injury.'" Id. at 172, 607 A.2d 1255. The panel held that, although the teacher's allegations were weak, the pleadings stated covered claims and the insurer had a duty to defend Voorhees. Ibid. The dissenter contended that emotional distress claims did not fall within the protections of a "bodily injury" policy. Ibid.
The insurer appealed as of right on the issue of whether the teacher's complaint asserted a covered claim that triggered the duty to defend. Id. at 173, 607 A.2d 1255. Speaking directly to the complaint, we said:
We then turned to the question of coverage under the "bodily injury" provision and concluded that:
In terms of defense, we added:
Although that language is open to interpretation, in ruling as we did regarding the defense of the emotional distress claim, it is critical that we did not distinguish between the point at which the complaint alleging emotional distress was originally filed and the later point at which the teacher's answers to interrogatories first raised the issue of physical sequelae directly. In other words, in Voorhees, we required the insurer to defend the complaint from the time of its filing although it did not clearly state a claim for emotional distress with physical manifestations.
The same day that we decided Voorhees, we issued our opinion in SL Industries. SL Indus., supra, 128 N.J. at 193, 607 A.2d 1266. There, Newell E. Whitcomb, a vice-president of SL Industries, was told that the company intended to eliminate his position. Id. at 193, 607 A.2d 1266. As a result, he agreed to retire early. Id. at 193-94, 607 A.2d 1266. As it turned out, the company hired a new executive who Whitcomb contended was actually intended as his replacement. Id. at 194, 607 A.2d 1266. Whitcomb claimed that the assertion that his position was to be eliminated was a pretext to force him out. Ibid. In January 1986, he sued SL Industries for willful age discrimination under the Age Discrimination in Employment Act (ADEA), 29 U.S.C.A. §§ 621 to 634, and common-law fraud. Ibid.
SL Industries was covered under a policy that contained nearly the same definition of "bodily injury" as in Voorhees and here. Ibid. When SL Industries sought a defense against Whitcomb's claims, the insurance company declined, arguing that SL Industries' "bodily injury" policy did not cover liability for Whitcomb's claims. Id. at 195, 607 A.2d 1266.
In Whitcomb's answers to interrogatories in June 1986, he stated that he had "suffered loss of sleep, loss of self esteem, humiliation and irritability." Id. at 195, 198, 607 A.2d 1266 (internal quotation marks omitted). He supplemented his response averring that he had "received treatment for his emotional pain and suffering." Id. at 195, 607 A.2d 1266 (internal quotation marks omitted). Whitcomb renewed those complaints in his pretrial stipulation. Ibid. Thereafter, Whitcomb and SL Industries settled. Ibid.
SL Industries brought suit against its insurer seeking a declaration that Whitcomb's claims were covered by its "bodily injury" policy and also sought compensatory, punitive, and other forms of relief. Id. at 195-96, 607 A.2d 1266. A Law Division judge granted the insurer's motion for summary judgment, holding "that the complaint did not obligate [the insurer] to defend the underlying suit because it did not state any claims falling within the terms of the [policy]." Id. at 196, 607 A.2d 1266. The appellate panel reversed, holding that once the insurer "possessed knowledge of Whitcomb's claim for emotional damages, its duty to defend was triggered under the terms of the [policy]." Ibid. (citation and internal quotation marks omitted). The appellate panel also
The insurer appealed on the issue of whether it had a duty to defend SL Industries based on the information included in Whitcomb's complaint. Id. at 193, 197, 607 A.2d 1266. We first turned to the ADEA, which "does not allow the recovery of compensatory damages for emotional injuries caused by age discrimination." Id. at 197, 607 A.2d 1266. As a result, we held that the insurance policy would not cover such claims. Id. at 198, 607 A.2d 1266. Likewise, with respect to the common-law fraud claim, we held that the complaint could not have "alerted the insurance company that the fraud had led to bodily ... injuries potentially covered under the [policy]." Id. at 198, 607 A.2d 1266. Thus, as of the filing of the complaint, no potential "bodily injury" claim was asserted. Ibid.
However, in SL Industries we recognized that facts outside of the complaint could also trigger a duty to defend and stated that insurers, therefore, cannot "construct a formal fortress of the third party's pleadings and ... retreat behind its walls, thereby successfully ignoring true but unpleaded facts within its knowledge that require it, under the insurance policy, to conduct the putative insured's defense." Id. at 199, 607 A.2d 1266 (citation and internal quotation marks omitted). We concluded that
We then reviewed the merits of Whitcomb's "bodily injury" claim to decide whether SL Industries was entitled to a defense as of June 1986, when Whitcomb answered the interrogatories, and concluded that his allegation of "sleeplessness" was not of such a nature as to trigger "bodily injury" defense and coverage. Id. at 201-02, 607 A.2d 1266.
Thus, in both Voorhees and SL Industries, we recognized the relevance of after-acquired information to the duty to defend analysis. However, in terms of result, in SL Industries we held that the insurer was not required to defend the complaint upon filing, whereas in Voorhees we ruled to the contrary. The difference between Voorhees and SL Industries, which were penned by the same Justice of this Court, is straightforward and is based on the principle that the duty to defend arises where a claim is potentially coverable. Where, as in Voorhees, the complaint presented the possibility of a covered claim, defense was required ab initio. Contrariwise, where, as in SL Industries, the complaint excluded the potential for a covered claim, no defense was warranted. Those cases are entirely in synchronicity with each other and provide a bulwark for insurers against the requirement that they defend claims that are clearly outside the contract of insurance while, at the same time, guaranteeing insureds that poorly-pled claims, that have the potential to result in coverage, remain within the sweep of the duty to defend. That state of equilibrium is fair to both insurers and insureds.
Applying those principles, we are satisfied that the trial judge's order requiring GNY to defend plaintiffs' Portee complaint was proper. Here, unlike SL Industries, in which the fraud and age discrimination claims literally excluded "bodily injury" coverage, plaintiffs pled a claim for negligent infliction of emotional distress in their Portee count. As we said in Voorhees, it is well-recognized that "emotional distress can and often does have a direct effect on other bodily functions." Voorhees, supra, 128 N.J. at 178, 607 A.2d 1255 (quoting NPS Corp., supra, 213 N.J.Super. at 553, 517 A.2d 1211) (internal quotation marks omitted). Thus, although that count was silent regarding the existence of physical manifestations, it did not exclude the possibility that such manifestations would be proved during the course of the litigation. Accordingly, it was indefinite whether the claim was within the scope of coverage. In those circumstances, a potential for plaintiffs to prove a covered claim existed and doubts regarding the duty to defend should have been "resolved in favor of the insured." Id. at 173, 517 A.2d 1211.
To be sure, unlike a garden-variety emotional distress claim, a Portee claim does not require the physical sequelae which, in Voorhees, we declared rendered the term "bodily injury" in the policy ambiguous. Id. at 177-78, 607 A.2d 1255. Although that distinction might eventually result in the conclusion that an insurance policy limited to coverage for bodily injury would not provide coverage, see SL Indus., supra, 128 N.J. at 204-05, 607 A.2d 1266, it is of no moment in deciding whether the insurer has a duty to defend. In Voorhees, the complaint did not allege physical manifestations. Voorhees, supra, 128 N.J. at 170-71, 607 A.2d 1255. Yet, we said it provided the insurer with notice of the possibility of a covered claim, meaning that with proper proofs, coverage would ensue. Id. at 174-75, 607 A.2d 1255. The same is true here. Plaintiffs' Portee complaint alleged emotional distress but was silent regarding physical manifestations, thus providing the potential for a covered claim and triggering the requirement of defense.
Indeed, we presume that the extraordinary level of emotional distress required to support a Portee claim—"severe emotional distress," Portee, supra, 84 N.J. at 101, 417 A.2d 521,—will, in most cases, bear with it a physical component. Thus, a policy providing coverage for claims of "bodily injury" will be understood to require a defense from the filing of a Portee complaint unless such defense is specifically excluded by other contract language. That is reasonable from the perspective of the insurer, who is on notice that the plaintiff may, in fact, prove physical sequelae, and from that of the insured, who expects to be defended against potential claims, regardless of the imprecision in the third-party's pleadings.
The judgment of the Appellate Division is reversed; the judgment of the trial court is reinstated.
For reversal and reinstatement—Chief Justice RABNER, and Justices LONG, LaVECCHIA, ALBIN, RIVERA-SOTO, and HOENS—6.
Opposed—None.