NOEL L. HILLMAN, District Judge.
This case concerns plaintiff's claims that the defendant insurance company, American Hardware Mutual Insurance Company, is equitably estopped from denying his entitlement to Underinsured Motorist Insurance ("UIM") coverage and, if not, whether he is entitled to coverage under a policy issued to his employer. Presently before the Court are the parties' cross-motions for summary judgment.
Plaintiff, Foyell D. Owens, was assigned a cargo van to drive to his job assignments repairing and adding accessories to forklifts for Delaware Valley Lift Truck, Inc. ("DVLT"). In the mornings, he called DVLT from home in Mount Laurel, New Jersey for his job assignments for the day and drove the van to the job sites. At the end of the work day, he would drive immediately home, or to DVLT in Bensalem, Pennsylvania, for supplies and then home.
On October 29, 2007, after driving the work van to his home, he took the work van out again around 5:00pm.
On October 7, 2009, plaintiff filed suit against Khan in New Jersey Superior Court, Law Division, Burlington County. The car Khan was driving was insured by Allstate Insurance Company with a policy providing $50,000 in liability coverage. The DVLT work van was insured by defendant American Hardware Mutual Insurance Company, which provided $500,000 in Pennsylvania underinsured motorist coverage. On March 4, 2010, plaintiff's counsel sent American Hardware a letter asking whether it would waive its subrogation rights and permit plaintiff to accept Allstate's offer of the $50,000 policy limits to settle plaintiff's case against Khan.
According to plaintiff, his damages far exceeded $50,000. Plaintiff, however, claims that he accepted the $50,000 from Allstate in settlement of his case against Khan because American Hardware had previously confirmed in June 2009 that the DVLT van policy provided $500,000 in UIM benefits. After dismissing his case with prejudice against Khan, plaintiff then presented a claim to American Hardware for UIM benefits. To date, American Hardware has not administered plaintiff's UIM benefits claim.
Plaintiff filed the instant suit against American Hardware alleging that the UIM policy requires that his claim be arbitrated, but American Hardware has refused to go to arbitration. Plaintiff alleges that American Hardware is equitably estopped from refusing to arbitrate his UIM claim because he settled his case against Khan, and accepted a fraction of his damages, based on the representation by American Hardware that up to $500,000 was available to him through the UIM policy. Plaintiff seeks judgment in his favor on his claim that he is entitled to UIM coverage, and to compel American Hardware to arbitrate the amount of his claim.
American Hardware has opposed plaintiff's motion, and crossmoved for summary judgment, arguing: (1) Pennsylvania law applies to the interpretation of the UIM policy; (2) the policy contains an exclusion to coverage for, "Anyone using a vehicle without a reasonable belief that the person is entitled to do so"; (3) when plaintiff was hired, he had signed a document acknowledging that the van was not to be used for personal use; (4) he was involved in the accident while using the van for a personal use; (5) the policy exclusion therefore applies; (6) it did not know about the implication of the non-permissive use exclusion when it informed plaintiff's counsel of the availability of UIM benefits;(7) because plaintiff knew of the non-personal use, but American Hardware did not, at the time plaintiff relinquished his claims against Khan, plaintiff cannot claim that equity compels American Hardware to provide coverage under the UIM policy; and (8) plaintiff has not been prejudiced by releasing his claims against Khan because both Khan and the vehicle owner, Hasan, are judgment proof.
In reply, plaintiff argues that American Hardware is incorrect that Pennsylvania law applies, and New Jersey law is controlling. Plaintiff also contends that regardless of how the van was being used at the time of the accident, equitable estoppel principles bar American Hardware from refusing to arbitrate his UIM claim.
This Court has jurisdiction over this matter pursuant to 28 U.S.C. § 1332 because there is complete diversity of citizenship between the parties and the amount in controversy exceeds $75,000. Plaintiff is a citizen of New Jersey, and defendants' citizenship is as follows: American Hardware Mutual Insurance Company is an Ohio corporation with a principal place of business in Minnetonka, Minnesota; Motorists Commercial Mutual Insurance Company (the new name of American Hardware) is an Ohio corporation with its principal place of business in Minnesota; The Motorists Insurance Group (of which American Hardware/Motorists Commercial is an affiliate) is an Ohio corporation with its principal place of business in Columbus, Ohio.
Summary judgment is appropriate where the Court is satisfied that the materials in the record, including depositions, documents, electronically stored information, affidavits or declarations, stipulations, admissions, or interrogatory answers, demonstrate that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.
As a federal court sitting in diversity jurisdiction, this Court must apply the law of the state in which it sits, including the choice of law rules of the forum state. The Court must therefore look to New Jersey's choice of law rules to determine whether a New Jersey court would apply the law of New Jersey or Pennsylvania when interpreting this Pennsylvania insurance contract.
American Hardware presents what appears to be a very straightforward argument. Succinctly stated, American Hardware argues that the policy explicitly excludes coverage for accidents that occurred during a non-permissible use, plaintiff knew he was driving the van for personal use, which was not permitted by his employer, and thus he is not entitled to coverage. Because the place of contracting is Pennsylvania, American Hardware contends that Pennsylvania law therefore applies to the interpretation of the contract. American Hardware further contends that even if the court compares Pennsylvania and New Jersey law, there is no conflict, however, because the policy exclusion against covering an impermissible use would be enforced in either state. Moreover, American Hardware argues that the principles of equity would weigh in favor of American Hardware in either state because in order for equitable estoppel to apply, plaintiff must show detrimental reliance under the law in both states. American Hardware contends that plaintiff cannot do so because Khan is judgment proof — that is, even if it was inequitable for American Hardware to renege on its assurances that plaintiff would be entitled to the UIM benefits if he settled his claim against Khan, plaintiff could not have recovered any more from Khan if he had not settled that claim. American Hardware also argues that for equitable estoppel to apply, plaintiff must have clean hands, and because he knew he was using the van impermissibly but did not inform American Hardware, he is not entitled to the UIM benefits.
In contrast, plaintiff argues that under New Jersey law, which should apply here, American Hardware must be estopped from reneging on its representation that UIM benefits were available to him by virtue of American Hardware's consent to settlement of plaintiff's suit against Khan. Plaintiff argues that American Hardware's failure to be aware of its own policy exclusion and investigate the nature of the accident cannot be absolved by the fortuitous post hoc determination that Khan was apparently "judgement proof."
The Court finds, as argued by plaintiff, that the starting point in the choice of law analysis in this case should be the determination of which state's equitable estoppel principles govern American Hardware's refusal to arbitrate plaintiff's claim for UIM benefits, and not whether the policy exclusion is enforceable under New Jersey or Pennsylvania law to completely deny his claim. Even accepting as true that plaintiff knew he was using the van for personal use, and such use was prohibited by his employer,
Thus, it must first be determined what law to apply to plaintiff's claim that American Hardware has acted inequitably. An analysis of the case law in New Jersey and Pennsylvania reveals that no real conflict exists, and that the analysis of the facts in this case yields the same result under either state's law.
In New Jersey and Pennsylvania, the seminal principle in the interpretation of an insurance contract is that it be given its ordinary meaning, but in cases of ambiguity, the policy must be construed against the insurer and in favor of coverage for the insured, because insurance contracts are essentially contracts of adhesion.
In this case, plaintiff and American Hardware do not dispute these tenets of New Jersey and Pennsylvania law governing an insurance company's duty to its insured. They diverge, however, on (1) whether it was American Hardware who mislead plaintiff or plaintiff who mislead American Hardware, (2) whether an insured must show detrimental reliance under New Jersey or Pennsylvania law, and (3) whether plaintiff suffered any detriment because of American Hardware's actions.
With regard to the first point, American Hardware argues that plaintiff knew he was driving the van in a non-permissible manner, and his attorney should have asked to examine the insurance policy prior to settling plaintiff's claim against Khan. If he had done so, American Hardware contends that plaintiff would have been aware of the exclusion to coverage for "Anyone using a vehicle without a reasonable belief that the person is entitled to do so," and not be surprised about American Hardware's ultimate decision to deny plaintiff's claim to UIM benefits.
As a primary matter, and as noted above, plaintiff disputes that he believed he was driving the van "impermissibly." But, as also noted above, even if it is accepted as true that plaintiff was driving the van "without a reasonable belief" he was permitted to do so, American Hardware's placement of responsibility on plaintiff and his counsel to discover a policy exclusion to UIM benefit coverage is inequitable under the circumstances, for several reasons.
First, unlike most of the insurance policies at issue in the case law, plaintiff did not enter into the contract with American Hardware, as the insurance coverage was procured by plaintiff's employer, DVLT, and plaintiff did not have any opportunity to read the policy and know of its exclusions prior to coverage being provided to him. Second, as the drafter of the insurance policy, American Hardware is presumed to know its own policy terms.
Third, for over three years between the time of the accident and plaintiff's
Fourth, the purpose of plaintiff's
Based on these facts, the Court cannot find that plaintiff acted inequitably toward American Hardware. Instead, these undisputed facts suggest that American Hardware did not fully investigate plaintiff's entitlement to UIM benefits prior to providing its consent to plaintiff to settle and dismiss with prejudice his case against the tortfeasor Khan. Thus, these undisputed facts suggest that American Hardware misled plaintiff and induced him to settle his claim against Khan because American Hardware led him to believe that he was not precluded from UIM benefits.
Moving on to the second point of contention between the parties, regardless of any apparent mishandling of plaintiff's UIM claim, American Hardware argues that plaintiff cannot maintain his estoppel claim against it because plaintiff was not actually prejudiced by American Hardware's actions. American Hardware argues that because Khan is "judgment proof," plaintiff could not have recovered anything more from Khan had plaintiff not dismissed his suit against him. Therefore, American Hardware contends that plaintiff's reliance on American Hardware's consent to settlement was not to plaintiff's detriment.
The Court does not find that Pennsylvania and New Jersey law are in conflict on the premise that an insured must have suffered prejudice in some way in order to estop the insurer from disclaiming coverage.
In
For four months thereafter, from December 2006 through April 2007, Bortiz's counsel negotiated with NJM for UIM benefits, with her last demand being $75,000, and NJM's last counteroffer being $32,023. In May 2007, NJM finally received the declarations page from Bortiz's GEICO policy it requested in October 2006, and NJM determined that Bortiz was only entitled to $10,000 of the $100,000 UIM because of a "step-down" provision in the NJM policy. The "step-down" provision limited the UIM benefits to a person not named on the policy to the maximum of the UIM benefits available to that person's own insurance policy. Because GEICO provided $25,000 in UIM to Boritz under her own policy, and she had already recovered $15,000 from the tortfeasor, NJM limited its UIM coverage to Bortiz to $10,000, to provide Bortiz with a total recovery of $25,000, which was equal to her own UIM policy limits.
Bortiz filed suit against NJM, arguing that NJM should be estopped from enforcing the step-down provision. The lower courts sided with NJM, but the New Jersey Supreme Court agreed with Bortiz, for two reasons. First, the court found that NJM was estopped because it confirmed to Bortiz's counsel that the UIM coverage limit was $100,000, and plaintiff was entitled to rely on that representation to forego the opportunity to seek redress from the tortfeasor personally.
The court then addressed NJM's argument that it was unaware that the step-down provision would be triggered until it received Boritz's insurance declaration sheet, which it had requested from Bortiz's counsel on October 3, 2006. The court rejected that argument, noting that NJM had requested the declarations page of Bortiz's policy to verify her chosen tort threshold, not to make a determination of whether to invoke the step-down provision.
Nothing in the
Thus, having resolved the first two points of contention between the parties — finding that it was American Hardware who mislead plaintiff, and that an insured must show prejudice under both New Jersey or Pennsylvania law — the Court now must turn to the third, which is whether plaintiff actually suffered any prejudice because of American Hardware's actions.
As noted several times above, American Hardware's main argument is that because Khan is "judgment proof," plaintiff could not have recovered anything more than the policy limit from Khan had plaintiff not dismissed his suit against him, and therefore, plaintiff's reliance on American Hardware's consent to settlement was not to plaintiff's detriment. The Court finds, under the circumstances of this case, American Hardware's argument to be persuasive, and that plaintiff has not met his burden of demonstrating that he has suffered a detriment by relying upon American Hardware's representation that UIM benefits were available to him.
Reiterated in
In this case, as discussed above, American Hardware did not act as a model of fairness and frankness to plaintiff. Plaintiff provided American Hardware with notice that he was seeking UIM benefits under the insurance policy that American Hardware issued to plaintiff's employer, and American Hardware was in the best position to know the terms of the policy, including any exclusions to coverage. During its investigatory period in response to plaintiff's
It was not until three months later, when a DVLT representative contacted American Hardware to inquire about why American Hardware declined to renew DVLT's insurance policy, that American Hardware finally recognized the non-permissible use exclusion, and considered the circumstances of plaintiff's accident. The nature of the accident and the existence of the exclusion had been knowable to American Hardware since the day of the accident, and at least three years later when plaintiff submitted his
Ultimately, however, plaintiff has not demonstrated that even if American Hardware had acted with the upmost diligence and candor in response to plaintiff's
The dispositive factor in this case, and the one that tips the estoppel issue in favor of American Hardware, is that despite American Hardware's failure to inform plaintiff that UIM benefits might not be available to plaintiff because of a policy exclusion, and despite plaintiff's release of his claims against Khan, plaintiff has not shown any true detriment. Plaintiff has provided no evidence of how his current position would be any different if he had not settled with Khan.
However, it must still be determined if American Hardware properly invoked the policy exclusion to deny plaintiff UIM benefits.
The Pennsylvania Underinsured Motorists Coverage endorsement excludes coverage for "Anyone using a vehicle without a reasonable belief that the person is entitled to do so." (Def. Ex. A, Docket No. 37-1 at 75.) American Hardware argues that when plaintiff was hired, he signed a document acknowledging that the van was not to be used for personal use, and that he was involved in the accident while using the van for a personal use. Plaintiff contests that his use of the van at the time of the accident was not permitted by his employer. Plaintiff further argues that the form, which purportedly confirms his understanding that he was not to use the van for personal use, does not demonstrate that he knew of the restriction or evidences that his use of the van at the time of the accident was knowingly in violation of company policy.
As a threshold matter, the interpretation of an insurance contract is a question of law. In both Pennsylvania and New Jersey, insurance policy terms are given their ordinary meaning. If a term is ambiguous, it must be construed in favor of the insured, and it must also comport with the reasonable expectations of the insured. A court, however, cannot distort the meaning of the language or resort to a strained contrivance in order to find an ambiguity.
Here, the Court finds that American Hardware has satisfied its burden of proving that the exclusion is applicable, and that plaintiff has failed to sufficiently refute American Hardware's proofs. First, the exclusion itself is not ambiguous.
American Hardware has provided sufficient proofs, which plaintiff has not refuted, that plaintiff could not have had a "reasonable belief" that he was permitted to use the van at the time of the accident. Although plaintiff testified at his deposition that at the time of the accident he was not using his van for a personal activity, he cannot recall why he was driving the van at that time on that day, and plaintiff does not dispute that the van was to be used for work-purposes only. (Def. Ex. B, Docket No. 37-2 at 20, 21-23, 41, 42.) It is also undisputed that at the time of the accident, plaintiff was not driving his van to or from any scheduled work-related customer appointment. (Def. Ex. I, Docket No. 37-2 at 89.)
Although plaintiff contends that he and DVLT had a tacit understanding about the permissibility of plaintiff's daily use of the van, when American Hardware issued the UIM policy to DVLT it explicitly exempted from coverage any use of the van that the driver reasonably understood to be impermissible as directed by DVLT. DVLT directed its drivers in writing not to use the van for personal use. Thus, a DVLT driver understood that using the van for anything other than work-related activities would not be reasonable. This is what American Hardware contracted to insure. American Hardware did not contract with DVLT to insure plaintiff's amorphous non-personal, non-work use. American Hardware has demonstrated that at the time of the accident, plaintiff did not have a scheduled customer appointment, and he knew that the van should not be used for personal use.
Plaintiff's only rebuttal to American Hardware's proofs is a simple denial, without more, that he was not using the van for a personal errand. All the record evidence, however, demonstrates otherwise. To simply deny remembering any other details about why he was driving the van at the time of the accident is insufficient to create a disputed issue of material fact. To successfully refute American Hardware's position that plaintiff did not have a "reasonable belief" that he was permitted to use the van at the time of the accident, plaintiff is required to offer more than his self-serving expression of his belief that the use of the van was "reasonable."
Principles of equitable estoppel do not bar defendant's invocation of a policy exclusion because plaintiff has failed to offer sufficient proof that he relied to his detriment on defendant's consent to release plaintiff's claims against the tortfeasor. Moreover, American Hardware properly denied plaintiff's claim for UIM benefits based on that policy exclusion. Plaintiff has failed to raise a material issue of fact that his use of the DVLT van at the time of the accident was based on a reasonable belief he was permitted to use the vehicle as he did. Consequently, plaintiff's motion for summary judgment shall be denied, and defendant's cross-motion for summary judgment shall be granted.
An appropriate Order will be entered.