CONNOLLY, J.
Appellant, D & S Realty, Inc. (D & S), owned a building known as the North Tower, located in Omaha, Nebraska. Markel Insurance Company (Markel) insured the building. After the building incurred water damage, Markel denied liability. Markel claimed that D & S violated a policy clause which provided that Markel would not be liable for water damage if the insured property had been vacant for more than 60 consecutive days before the loss or damage occurred.
At the heart of D & S' breach of contract action is the interpretation and application of Neb.Rev.Stat. § 44-358 (Reissue 2004). Section 44-358, in part, precludes an insurer from denying liability for an insured's breach of a warranty or condition unless the breach existed at the time of the loss and contributed to the loss. Before trial, D & S argued that the contribute-to-the-loss standard applied to its alleged breach of the vacancy provision. It alleged the breach did not contribute to the loss. Markel countered that the statute did not apply. The court agreed with Markel.
At trial, the court found as a matter of law that the policy was in effect and that the building was vacant for more than 60 days. The court also refused to instruct the jury on, or to allow D & S to argue, the following: (1) § 44-358 prevented Markel from denying liability based upon the vacancy clause; or (2) Markel waived
The only issues before the jury were whether Markel had wrongfully denied coverage or whether the policy terms excluded D & S' loss. The jury returned a verdict for Markel.
We conclude that the court erred in ruling that § 44-358 did not apply to the vacancy clause. Because it applied, the court should have allowed the jury to decide whether D & S' breach of the vacancy clause contributed to the loss. But we conclude that the court did not err in refusing to instruct the jury on D & S' claim of waiver and estoppel.
In January 2003, in preparation for renovations, a D & S employee turned off the heating system. But he did not drain the pipes or put in antifreeze to prevent damage. Three days later, the pipes burst and the building sustained water damage.
D & S claimed the loss under its insurance policy. The policy provided coverage for damage to the North Tower and personal property resulting from covered causes of loss, subject to various conditions and exclusions. The "Loss Conditions" section contained a "Vacancy" clause. It provided that "[i]f the building where loss or damage occurs has been vacant for more than 60 consecutive days before loss or damage occurs," Markel would not pay for any loss caused by listed items, including water damage, "even if they are Covered Causes of Loss." The vacancy clause separately defined "vacant" for owners of buildings: "(b) ... Such building is vacant when 70% or more of its square footage: (i) Is not rented; or (ii) Is not used to conduct customary operations. (2) Buildings under construction or renovation are not considered vacant."
And a Nebraska endorsement to the policy provided, in relevant part, that "[a] breach of warranty or condition will void the policy if such breach exists at the time of loss and contributes to the loss."
When D & S sought recovery under the policy, it represented that the North Tower was 60-percent vacant. But Markel determined that when the loss occurred, the North Tower had only a 5-percent occupancy and had less than a 30-percent occupancy for more than 60 days before the loss. Markel denied D & S' claim.
D & S sued for breach of the insurance contract. It alleged that Markel breached its obligations in denying coverage for the water damage. Markel denied that it breached any obligations. It affirmatively alleged that the policy did not cover D & S' loss because D & S failed to comply with the vacancy clause. It also claimed that D & S' loss was not covered under a limitation provision.
After Markel filed its answer, D & S moved for leave to file a reply.
In ruling on the reply, the court permitted D & S to file it, but limited the reply to D & S' waiver and estoppel claims. It sustained Markel's objection to D & S' § 44-358 claim. Later, D & S moved for leave to file an amended reply. But the court reaffirmed its earlier order striking D & S' § 44-358 claim. It determined
At trial, the evidence showed that in October 2002, 3 months before the loss, Markel's inspection revealed that the following parts of the building were occupied: the 10th floor of the building, the penthouse, two apartments on the 9th floor, one apartment on the 8th floor, one commercial office on the 3rd floor, and one commercial office on the 1st floor. The inspector concluded that the building was 80-percent unoccupied. The inspector also reported that 85 percent of the interior of the North Tower was "unfinished," or under construction. D & S, however, claimed that Markel knew of the building's percentage of occupancy before the loss, but had not informed D & S of the possible insurance consequences. D & S argued that because of this, Markel had waived the vacancy provision or should be estopped from asserting it to deny liability.
Markel moved for a directed verdict on several issues. The court determined, as a matter of law, that the insurance policy was in effect when the loss occurred and that the North Tower was more than 70-percent vacant for more than 60 days preceding the loss. In addition, the vacancy clause contained an exception for buildings under construction or renovation. The court ruled that whether the North Tower was under construction or renovation when the loss occurred was a fact question for the jury. And it took under advisement whether waiver and estoppel applied. But after Markel rested, the court ruled that they did not apply and that D & S could not argue waiver or estoppel to the jury. The court also ruled that § 44-358 did not apply to D & S' breach of the vacancy clause. It refused to instruct the jury on whether § 44-358 precluded Markel from avoiding liability and on waiver and estoppel. The jury returned a verdict for Markel.
D & S moved for judgment notwithstanding the verdict and for a new trial. The court denied both motions.
D & S argues that the district court erred in refusing to submit to the jury whether (1) under § 44-358, the breach of the vacancy clause existed at the time of the loss and contributed to the loss; (2) Markel waived the provisions of the policy regarding occupancy; and (3) Markel was estopped from raising the policy provisions regarding occupancy as a defense. D & S also alleges that the court erred in denying its motion for judgment notwithstanding the verdict and its motion for a new trial.
The interpretation of an insurance policy is a question of law
Although a party can seek equitable estoppel in both legal and equitable actions, as its name implies, it is a judicial doctrine that is equitable in nature.
D & S does not contest the district court's conclusion that the building was more than 70-percent vacant for more than 60 days preceding the loss. Nor does D & S contest the jury's implicit finding that the building was not under construction or renovation. D & S only argues that the court erred in failing to instruct the jury on whether under § 44-358, the breach of the vacancy clause contributed to the loss, and on whether the doctrines of waiver or estoppel prevented Markel from denying liability based upon the vacancy clause.
D & S argues that the vacancy clause is a condition under the policy and, therefore, § 44-358 applies. It argues that because § 44-358 applies, whether its breach of the condition contributed to the loss was an issue for the jury. The second sentence of § 44-358 imposes a contribute-to-the-loss standard for breaches of insurance warranties and conditions:
Markel views the matter differently. It argues that § 44-358 does not apply. Although Markel included the vacancy clause in the "Loss Conditions" section of the policy, it argues that this label is not determinative. It contends that we should look to the language of the clause to determine the parties' intent. Markel contends that the vacancy clause functions as an exclusion; thus, § 44-358 does not apply.
We agree that we must determine the vacancy clause's purpose and function from the plain language of the policy. Insurance contracts, like other contracts, are to be construed according to the meaning of the terms which the parties have used. Yet, when the terms of an insurance contract are clear, we should not resort to rules of construction. Instead, we will give the terms their plain and ordinary meaning as a reasonable person in the insured's position would understand them.
Whether the contribute-to-the-loss standard under § 44-358 applies depends on the vacancy clause's purpose and function. And the purpose and function of an insurance provision can only be determined with an understanding of the relevant terms.
A notable insurance treatise divides insurance policy conditions into
Markel concedes that the vacancy clause is not a condition precedent. But relying on our definition of an exclusion, Markel argues that the clause is an exclusion and not subject to § 44-358. We have defined an exclusion as "a provision which eliminates coverage where, were it not for the exclusion, coverage would have existed."
Here, the vacancy clause does not provide that there is no coverage for water damage. Instead, the clause was clearly intended to permit Markel to suspend or avoid coverage for water damage while D & S failed to maintain a specified occupancy level. That level of occupancy was the condition that D & S was required to comply with to maintain coverage. The clause itself does not eliminate coverage unless the insured breaches the condition. These types of provisions are distinct from exclusions:
So, it is more precise to define an exclusion in an insurance policy as a limitation of liability, or a carving out of certain types of loss, to which the insurance coverage never applied.
We concede that some of our earlier cases could be read to support Markel's position that the vacancy clause is an exclusion. Markel relies on Omaha Sky Divers Parachute Club, Inc. v. Ranger Ins. Co.,
In Omaha Sky Divers Parachute Club, Inc., an aircraft insurer denied coverage for loss or damage to the aircraft while in motion. The declarations page provided that only pilots holding valid pilot and medical certificates with required ratings would operate the plane. And a clause in the exclusions section provided that the policy did not apply to "`any loss or damage occurring while the aircraft is operated in flight by other than the pilot or pilots'" set forth in the declarations page.
Similarly, in Krause v. Pacific Mutual Life Ins. Co., the plaintiff's decedent was killed in an airplane crash while he was covered under an accident policy. But a clause in the policy provided that it did not provide coverage for bodily injury sustained while riding in an airplane unless the following conditions were met:
Although the decedent had paid a nominal fee for a "trip pass," we concluded that air travel was "a strictly excluded risk, save and except when it is carried out in compliance with the words framing the exception."
We believe that these cases provide little guidance for determining whether a policy clause operates to define the insured risk or to condition coverage on the doing or omission of some act after the risk has attached. And we have struggled with the chameleon-like terms "conditions" and "exclusions." But in Krause, there was no meaningful difference between that policy, which excluded coverage for air travel unless specified conditions were met, and one that would provide coverage for air travel if specified conditions were met. Either policy would allow the insurer to avoid liability—after the risk of loss had attached—because the insured failed to satisfy preloss conditions for coverage of bodily injury sustained while riding in an airplane.
Such "exclusions," as in Krause and Omaha Sky Divers Parachute Club, Inc., do not define the insured risk in the same sense as a suicide clause in a life insurance policy that unconditionally excludes coverage for that risk. The insurer in Krause clearly would have been liable if the decedent had paid the full legal fare for his transportation. Krause provides an example of a policy that conditions coverage for a loss rather than unconditionally excluding that loss from the insured risk.
The insured risk in Krause was bodily injury sustained while riding in an airplane. The conditions permitted the insurer to avoid liability if the insured failed to act in a manner that would avoid an increased hazard during air travel. Similarly, property insurance policies commonly terminate or avoid the policy if the insured acts or fails to act in a way that increases the hazard to which the insured property is exposed or changes the nature of the risk.
In 1907, before the Legislature enacted § 44-358, this court strictly enforced a vacancy clause that forfeited coverage by allowing the insurer to treat the policy as void upon breach of the condition, even though the breach was unrelated to the
Omaha Sky Divers Parachute Club, Inc. presented a similar classification problem. The certification provision excluded coverage unless the pilot possessed the necessary medical certification, which was proof of the pilot's medical fitness. The proof was intended to protect the insurer from the increased hazard of a pilot with health problems flying the plane.
These cases illustrate that insurers have couched increased hazard provisions as both conditions and exclusions. But we do not believe that the application of § 44-358 should hinge upon the policy's labeling. We conclude that regardless of an insurer's labeling, a clause that requires an insured to avoid an increased hazard is a condition subsequent for coverage. To the extent that Omaha Sky Divers Parachute Club, Inc. and Krause can be read to hold that increased hazard provisions are exclusions, they are overruled.
Markel argues that even if the vacancy provision is a condition or warranty, it is a "`promissory warranty'" to which § 44-358 does not apply.
In Coppi, a business owner's policy, which covered loss by theft up to $10,000, contained an "iron-safe" clause. The clause required the business to keep record from which losses could be determined. The issue on appeal was whether the trial court erred in failing to rule that § 44-358 prevented the insurer from denying coverage. We held the insured could not rely on § 44-358 because his breach of the recordkeeping provision was a promissory warranty to which the contribute-to-the-loss standard did not apply. We set out the following definitions regarding warranties, promissory warranties, and conditions precedent:
Consistent with what other courts had held, we concluded that the recordkeeping provision was a promissory warranty. We recognized that we had previously held that § 44-358 cannot apply to the breach of postloss conditions, those "terms of a policy which could arise only after the loss has occurred."
Upon further analysis, we were wrong. Before Coppi, we had already implicitly held that the contribute-to-the-loss standard does not apply to warranties that function as conditions precedent to the existence of a contract (i.e., fraudulent statements
Section 44-358 has two sentences. The first sentence provides:
By its terms, the first sentence applies only to warranties made in the negotiations for a contract of insurance, i.e., those that relate to whether the contract is effective. So, to the extent that Nebraska law permits an insured's statements in the negotiation for a contract to be treated as warranties, the first sentence of § 44-358 applies only to warranties that function as conditions precedent to the policy's being effective.
In contrast to misrepresentations and affirmative warranties, the second sentence of § 44-358 applies only to the breach of warranties and conditions that exist at the time of the loss. But an insurer can rescind a policy for breach of an affirmative warranty or condition precedent to the policy's being effective as soon as it learns of the relevant facts, regardless of whether a loss has occurred; its failure to act until a loss occurs will result in a waiver of the defense if it has continued to accept premiums with knowledge of the facts constituting a breach.
In Coppi, we correctly characterized a promissory warranty as a stipulation that the insured will act or refrain from acts to maintain a term of the policy.
In Sanks v. St. Paul Fire & Marine Ins. Co.,
Moreover, if our conclusion in Coppi were correct—that the contribute-to-the-loss standard does not apply to promissory warranties—then the second sentence does not apply to any warranty in an insurance policy. This result is obviously contrary to the statutory interpretation principles and the Legislature's intent. It appears that we got off track in Coppi because we failed to recognize how the term "condition subsequent" is applied to insurance policies.
As noted, in Coppi, we classified the recordkeeping provision as a promissory warranty, which functions as a condition precedent to the insurer's obligation to pay. But we jumped from that principle to our holding that the contribute-to-the-loss standard applies only to "warranties which are conditions precedent to the very existence of an insurance contract" (e.g., insureds' insurability statements).
Any warranty that must be strictly satisfied will serve as a condition precedent to an insurer's obligation to pay. Warranties are effectively policy stipulations that function as conditions on an insurer's obligation to pay a loss.
Using the term "condition subsequent" to refer to any insurance policy condition that applies after the risk of loss has attached is different from its meaning in a noninsurance context. Conditions subsequent are less common in noninsurance contracts because they can permit a party to avoid its obligation after its duty to perform has been triggered.
In Coppi, we did not recognize this use of the term condition subsequent. So we failed to recognize that the contribute-to-the-loss standard in the second sentence of § 44-358 applies to preloss conditions subsequent and promissory warranties. To the extent that Coppi holds the contribute-to-the-loss standard does not apply to promissory warranties and applies only to conditions precedent to the existence of an insurance contract, it is overruled.
In sum, we determine that a vacancy clause in an insurance contract is not an exclusion; it is a condition subsequent to which the contribute-to-the-loss standard applies. We conclude that the court erred in refusing to permit D & S to argue that § 44-358 precluded Markel from denying liability.
The court refused to instruct the jury on waiver and estoppel. It concluded that even if Markel knew about the level of occupancy, it had no duty to inform D & S of the coverage implications. D & S contends that Markel has waived the vacancy provision or should be estopped from denying liability. D & S argues that Markel waived the vacancy provision because it accepted premiums after it knew the building's occupancy was below the required level.
Initially, we note that waiver and estoppel are distinct legal concepts.
A waiver is a voluntary and intentional relinquishment of a known right, privilege, or claim, and may be demonstrated by or inferred from a person's conduct.
Ordinarily, to establish a waiver of a legal right, there must be a clear, unequivocal, and decisive act of a party showing such a purpose, or acts amounting to an estoppel on his or her part.
An insurer is precluded from asserting a forfeiture when, after acquiring knowledge of the facts constituting a breach of condition, it has retained the unearned portion of the premium or has failed to return or tender it back with reasonable promptness.
But Markel argues that these cases are distinguishable because the insured's breach of the condition resulted in a forfeiture of the policy—whereas D & S' breach did not. As stated, we have held that an insurer may waive any provision in a policy
When an insurer knows of a breach of condition or warranty that permits it to treat the policy as void, and the insurer continues to accept premiums, its conduct shows its intent to treat the policy as valid despite the breach.
It is true that the Nebraska endorsement to the policy permitted Markel to treat the breach as voiding the policy "if such breach exists at the time of loss and contributes to the loss." Markel certainly knew that if a loss occurred during the period of a breach that contributed to the loss, it could treat the policy as void. But it could not have treated the policy as void until a loss occurred and Markel had reason to believe that the breach of the vacancy condition contributed to the loss. And until that time, Markel was liable for any other covered losses. A loss was entirely speculative when Markel had the building inspected. Thus, Markel's continued acceptance of premiums is insufficient to show that it intended to abandon a defense based on D & S' breach. We conclude that the court did not err is refusing to instruct the jury on D & S' waiver and estoppel theory.
We conclude that the district court erred in refusing to permit D & S to instruct the jury, or permit D & S to argue, that the contribute-to-the-loss standard under § 44-358 applied to preclude Markel from denying liability for its loss. But we conclude that the court was correct in refusing to instruct the jury on Markel's alleged waiver and estoppel. The evidence was insufficient to show that Markel intended to abandon a defense based on D & S' breach of the vacancy condition. Accordingly, we remand the cause for further proceedings limited to the issue of whether D & S' breach of the vacancy condition contributed to the loss.
AFFIRMED IN PART, AND IN PART REVERSED AND REMANDED FOR FURTHER PROCEEDINGS.