STEPHENS, J.
¶ 1 This court has long recognized that a liability insurer uncertain of its obligation to defend its insured may undertake a "reservation of rights" defense while seeking a declaration regarding coverage. The question in this case is whether the insurer may unilaterally condition its reservation of rights defense on making the insured absorb the defense costs if a court ultimately determines there is no coverage. We answer no. We recognize, however, that an insurer may avoid or minimize its responsibility for defense costs when an insured belatedly tenders a claim and the insurer demonstrates actual and substantial prejudice as a result. We affirm the Court of Appeals.
¶ 2 National Surety Corporation insured Immunex Corporation
¶ 3 Beginning no later than 2001, a string of complaints was filed against Immunex. These complaints alleged that Immunex reported inflated average wholesale prices of its drugs that enabled providers of drugs — such as physicians, hospitals, and pharmacies — to receive reimbursements from Medicare and other third-party payors in amounts greater than what they actually paid. In all, at least 23 lawsuits related to pricing manipulation were filed against Immunex and other drug manufacturers under theories including breach of contract, civil conspiracy, fraud, and violations of state unfair trade and protection statutes and the federal Racketeer Influenced and Corrupt Organizations Act (RICO), 18 U.S.C. §§ 1961-1968.
¶ 4 It was not until October 3, 2006 that Immunex first tendered defense of the litigation to National Surety. In its tender letter, Immunex informed National Surety that it was on the eve of settling a California lawsuit, identified other pending lawsuits, and requested payment for reasonable defense expenditures and settlement costs. Specifically, Immunex asserted that coverage fell under the umbrella insurance "Coverage B," which applied to cover "injury ... arising out of ... [d]iscrimination," Clerk's Papers (CP) at 654. National Surety requested suit papers
¶ 5 In March 2008, National Surety informed Immunex by letter that it "believe[d] there [wa]s no coverage ... for the claims alleged against Immunex in the [average wholesale price] litigation." CP at 1074. While National Surety disclaimed any obligation to defend or indemnify, it indicated it "wishe[d] to complete its investigation regarding coverage," CP at 1075, suggesting that its lack of coverage determination was only preliminary. The letter stated:
CP at 1074-75.
¶ 6 About the same time it issued its reservation of rights letter, National Surety filed a declaratory judgment action in King County Superior Court. Immunex continued to be represented by its independent counsel in the average wholesale price litigation. After determining in April 2009 that National Surety had no duty to defend because the complaints did not allege claims arising out of discrimination, the trial court considered cross motions for summary judgment on the issue of defense costs. The court concluded National Surety bore responsibility for these costs incurred until the April 2009 ruling under its reservation of rights defense, subject to set-off if it could prove prejudice from Immunex's late tender at trial. The court denied National Surety's motion for reconsideration and entered partial final judgment under CR 54(b) to facilitate an appeal. Both parties appealed.
¶ 7 The Court of Appeals affirmed. Nat'l Sur. Corp. v. Immunex Corp., 162 Wn.App. 762, 256 P.3d 439 (2011). The Court of Appeals held National Surety was liable for defense costs incurred up until the April 2009 determination of no coverage, unless it could show prejudice from late notice. Id. at 780, 256 P.3d 439. Because fact issues remained on the question of prejudice, the appellate court affirmed the denial of National Surety's summary judgment motion. Id. at 782, 256 P.3d 439. We granted National Surety's petition for review. Nat'l Sur. Corp. v. Immunex Corp., 173 Wn.2d 1006, 266 P.3d 880 (2012).
¶ 8 The first question to be answered is whether an insurer may recover defense costs incurred under a reservation of rights in the event a court ultimately determines no duty to defend is owed. In answering this question, it is useful to consider the nature of the duty to defend and the purposes of providing a defense under a reservation of rights.
¶ 9 Both courts and the legislature have recognized that insurance contracts are imbued with public policy concerns. Or. Auto. Ins. Co. v. Salzberg, 85 Wn.2d 372, 376-77, 535 P.2d 816 (1975); RCW 48.01.030 ("The business of insurance is one affected by the public interest."). Indeed,
Love v. Fire Ins. Exch., 221 Cal.App.3d 1136, 1148, 271 Cal.Rptr. 246 (1990) (citations omitted).
¶ 10 The insurer's duty to defend is separate from, and substantially broader than, its duty to indemnify. Truck Ins. Exch. v. VanPort Homes, Inc., 147 Wn.2d 751, 760, 58 P.3d 276 (2002) (citing Hayden v. Mut. of Enumclaw Ins. Co., 141 Wn.2d 55, 64, 1 P.3d 1167 (2000)). The duty to indemnify applies to claims that are actually covered, while the duty to defend "`arises when a complaint against the insured, construed liberally, alleges facts which could, if proven, impose liability upon the insured within the policy's coverage.'" Truck Ins. Exch., 147 Wash.2d at 760, 58 P.3d 276 (quoting Unigard Ins. Co. v. Leven, 97 Wn.App. 417, 425, 983 P.2d 1155 (1999)); see also Woo v. Fireman's Fund Ins. Co., 161 Wn.2d 43, 53-54, 164 P.3d 454 (2007) (recognizing duty to defend when claims against the insured are conceivably covered).
¶ 11 "[I]f there is any reasonable interpretation of the facts or the law that could result in coverage, the insurer must defend." Am. Best Food, Inc. v. Alea London, Ltd., 168 Wn.2d 398, 405, 229 P.3d 693 (2010). Facts that are extrinsic to the pleadings, but readily available to the insurer, may give rise to the duty. Woo, 161 Wash.2d at 54, 164 P.3d 454. Although this duty to defend is broad, it is not triggered by claims that clearly fall outside the policy. Kirk v. Mt. Airy Ins. Co., 134 Wn.2d 558, 561, 951 P.2d 1124 (1998). An insurer's broad duty to defend against colorable claims tendered by the insured, particularly when the insurer elects to defend under a reservation of rights, is central to our decision. While the dissent focuses on National Surety's contractual obligations, we have repeatedly held that the scope of an insurer's duty to defend is broader than the terms of the policy.
¶ 12 When an insured is uncertain of its duty to defend, it may defend under a reservation of rights while seeking a declaratory judgment relieving it of its duty. Woo, 161 Wash.2d at 54, 164 P.3d 454 (citing Truck Ins. Exch., 147 Wash.2d at 761, 58 P.3d 276). Because a reservation of rights defense is fraught with potential conflicts, it implicates an enhanced duty of good faith toward the insured. Tank, 105 Wash.2d at 383, 715 P.2d 1133. But we have recognized that the risks of a reservation of rights defense are coupled with benefits:
Woo, 161 Wash.2d at 54, 164 P.3d 454. Additionally, defending under a reservation of rights enables the insurer to protect its interests without facing claims of waiver or estoppel and to walk away from the defense once a court declares it owes no duty.
¶ 13 By insuring itself against potentially disastrous findings of breach, bad faith, waiver, and coverage by estoppel, an insurer unquestionably benefits from its decision to defend under a reservation of rights — even when, as here, a court later finds that it owes no duty to continue that defense. The dissent's conviction that National Surety was pressed into defending Immunex without receiving any benefit in return simply ignores the context in which this arrangement occurred. We are not dealing here with otter sanctuaries, marital property, or choice-of-forum rules. Instead, the insurance relationship — a relationship affected by the public interest — allows for situations such as this when an insurer makes a rational decision to protect itself against a greater downstream risk by undertaking certain costs. Unjust enrichment is simply irrelevant because any "enrichment" of Immunex was more than matched by benefit to National Surety. Our understanding of the broad and reciprocal nature of an insurer's duty to defend provides the proper context for answering the principal question in this case.
¶ 14 National Surety contends the trial court erred in requiring it to reimburse
¶ 15 National Surety now contends it should not have to pay Immunex's defense costs — despite its offer to defend subject to a reservation of rights — because the court later determined it had no duty to defend. See, e.g., Suppl. Br. of Pet'r at 8 (arguing against imposing defense costs "now, after a determination of non-coverage").
¶ 16 Recognizing that we have not considered this issue before, National Surety relies on the leading California decision allowing recoupment of defense costs, Buss v. Superior Court, 16 Cal.4th 35, 65 Cal.Rptr.2d 366, 939 P.2d 766 (1997). There, a complaint filed against the insured asserted 27 causes of action, only one of which (defamation) fell within coverage under its insurance policy with Transamerica Insurance Company. Transamerica accepted the defense of the action as tendered, but reserved its rights to reimbursement or an allocation of covered and noncovered claims. Id. at 42, 65 Cal.Rptr.2d 366, 939 P.2d 766. Later, the insured and Transamerica entered into an agreement providing that the insured would reimburse Transamerica a proportionate amount as determined by a court. Id.
¶ 17 Eventually, the insured settled the claims against him for over $8 million. Transamerica had paid over $1 million in defense fees, only a small fraction of which was allocable to defending the defamation claim. Id. The court first noted that in a "mixed" action involving covered and uncovered claims, the insurer's contractual duty to defend extends only to the potentially covered claims, even though a prophylactic defense of the entire action is necessary to meaningfully defend the potentially covered claims. Id. at 48-49, 65 Cal.Rptr.2d 366, 939 P.2d 766. The court held that an insurer may not seek reimbursement for defense costs as to claims that are at least potentially covered because it has bargained to bear those costs. Id. at 49, 65 Cal.Rptr.2d 366, 939 P.2d 766. In such a situation, the court reasoned that "the insurer may not proceed by means of a `reservation' of its `right' of reimbursement" because there is no such right to reserve. Id. at 50, 65 Cal.Rptr.2d 366, 939 P.2d 766. Where claims are not even potentially covered, however, the court held that an insurer may seek to recover defense costs allocable solely to such claims. Id. at 52-53, 65 Cal.Rptr.2d 366, 939 P.2d 766.
¶ 18 Similarly, Colorado courts have endorsed reimbursement in situations in which the insurer "believes ... it is under no obligation to defend" but defends under a reservation of rights to seek reimbursement. Hecla Mining Co. v. N.H. Ins. Co., 811 P.2d 1083, 1089 (Colo.1991).
¶ 19 A few other states have allowed recoupment with reasoning along these lines. See, e.g., Sec. Ins. Co. of Hartford v. Lumbermens Mut. Cas. Co., 264 Conn. 688, 826 A.2d 107, 125 (2003) ("Where the insurer defends the insured against an action that includes claims not even potentially covered by the insurance policy, a court will order reimbursement for the cost of defending the uncovered claims in order to prevent the insured from receiving a windfall."); Jim Black & Assocs. Inc. v. Transcontinental Ins. Co., 932 So.2d 516, 518 (Fla.Dist.Ct.App. 2006) (holding insurer entitled to reimbursement of defense costs where duty to defend never existed and the insurer sent a reservation of rights letter and appointed mutually agreeable defense counsel); Hebela v. Healthcare Ins. Co., 370 N.J.Super. 260, 851 A.2d 75, 86 (Ct.App.Div.2004); see also United Nat'l Ins. Co. v. SST Fitness Corp., 309 F.3d 914, 920 (2002) (predicting Ohio would allow recoupment where there is no duty to defend if the insurer "1) timely and explicitly reserve[s] its right to recoup the costs; and 2) provide[s] specific and adequate notice of the possibility of reimbursement" and insured
¶ 20 More recently, however, courts deciding in the first instance whether insurers can recover defense costs have generally concluded that they cannot. Their decisions provide valuable guidance.
¶ 21 In refusing to allocate costs between covered claims and uncovered claims in a "mixed" action, the Supreme Court of Wyoming held that "unless an agreement to the contrary is found in the policy, the insurer is liable for all of the costs of defending the action." Shoshone First Bank v. Pac. Employers Ins. Co., 2 P.3d 510, 514 (Wy.2000). The court likened a reservation of rights to recoup costs to a unilateral modification of the coverage policy. Id. at 515-16.
¶ 22 Adopting similar reasoning, the Supreme Court of Illinois held that "[a]s a matter of public policy, we cannot condone an arrangement where an insurer can unilaterally modify its contract, through a reservation of rights, to allow for reimbursement of defense costs in the event a court later finds that the insurer owes no duty to defend." Gen. Agents Ins. Co. of Am., Inc. v. Midwest Sporting Goods Co., 215 Ill.2d 146, 293 Ill.Dec. 594, 828 N.E.2d 1092, 1102 (2005). Likewise, the Supreme Court of Pennsylvania reasoned:
Am. & Foreign Ins. Co. v. Jerry's Sport Ctr., Inc., 606 Pa. 584, 2 A.3d 526, 544 (2010).
¶ 23 Following this line of reasoning, courts have refused to allow reimbursement of defense costs based on a later determination of no coverage. See, e.g., Perdue Farms, Inc. v. Travelers Cas. & Sur. Co. of Am., 448 F.3d 252, 258-59 (4th Cir.2006) (predicting Maryland law would not permit reimbursement of defense costs for noncovered claims); Capitol Indem. Corp. v. Blazer, 51 F.Supp.2d 1080, 1090 (D.Nev.1999) (holding that under Nevada law, reimbursement for defense costs is allowed only if an agreement between the parties provides for reimbursement); Med. Liab. Mut. Ins. Co. v. Alan Curtis Enters., Inc., 373 Ark. 525, 285 S.W.3d 233, 237 (2008) (holding that in the absence of statutory authority, insurer may not recoup defense fees under a unilateral reservation of rights); Shoshone First Bank, 2 P.3d at 513-14 (disallowing allocation of defense costs where the policy did not provide for recoupment). Notably, a federal district court in Virginia recently predicted, albeit without much analysis, that Washington would disallow recoupment of defense costs incurred in defending uncovered claims. Zurich Am. Ins. Co. v. Pub. Storage, 743 F.Supp.2d 548, 550-51 (E.D.Va.2010).
¶ 24 By our decision today, this prediction proves accurate. Disallowing reimbursement is most consistent with Washington cases regarding the duty to defend, which have squarely placed the risk of the defense decision on the insurer's shoulders.
¶ 25 It is the insurer that decides whether to defend (with or without a reservation of rights) before any judicial determination of coverage. Providing a defense benefits the insurer by giving it the ability to monitor the defense and better limit its exposure. When an insurer defends under a reservation of rights, it insulates itself from potential claims of breach and bad faith, which can lead to significant damages, including coverage by estoppel. Truck Ins. Exch., 147 Wash.2d at 761, 58 P.3d 276. In turn, the insured receives the benefit of a defense until a court
¶ 26 We reject National Surety's view that an insurer can have the best of both options: protection from claims of bad faith or breach without any responsibility for the costs of defense if a court later determines there is no duty to defend. This "all reward, no risk" proposition renders the defense portion of a reservation of rights defense illusory. The insured receives no greater benefit than if its insurer had refused to defend outright.
¶ 27 National Surety argues that we approved its win-win option for insurers in our decisions in Truck Insurance and Kirk. In Truck Insurance, we described a reservation of rights defense while seeking a declaratory judgment as "a means by which the insurer avoids breaching its duty to defend while seeking to avoid waiver and estoppel." 147 Wash.2d at 761, 58 P.3d 276. Quoting Kirk, we then observed that "`[w]hen that course of action is taken, the insured receives the defense promised and, if coverage is found not to exist, the insurer will not be obligated to pay.'" Id. (quoting Kirk, 134 Wash.2d at 563 n. 3, 951 P.2d 1124). National Surety relies on ambiguity in the phrase "will not be obligated to pay" as supporting its contention that an insurer need not pay for defense costs incurred before a court determination of no coverage.
¶ 28 Taken in context, the language in Kirk and Truck Insurance does not support National Surety's view. After obtaining a declaration of noncoverage, an insurer "will not be obligated to pay" from that point forward. Any other rule would be at odds with our observation that, under a reservation of rights defense, "the insured receives the defense promised" — at least until the determination of noncoverage. Kirk, 134 Wash.2d at 563 n. 3, 951 P.2d 1124 (emphasis added). If there were any question after Kirk and Truck Insurance that a reservation of rights defense must be a real defense, there is no question after Woo that "the insurer must bear the expense of defending the insured." Woo, 161 Wash.2d at 54, 164 P.3d 454.
¶ 29 If National Surety were allowed to recover defense costs, its "offer" to defend would serve solely to protect itself from claims of breach while placing the full risk of a determination of noncoverage on its insured. This provides no security to the insured. As the Third Circuit Court of Appeals has explained:
Terra Nova Ins. Co. v. 900 Bar, Inc., 887 F.2d 1213, 1219-20 (3d Cir.1989) (footnote and citations omitted).
¶ 30 Additionally, allowing recoupment to be claimed in a reservation of rights letter would allow the insurer to impose a condition on its defense that was not bargained for.
Midwest Sporting Goods, 293 Ill.Dec. 594, 828 N.E.2d at 1102 (quoting Shoshone First Bank, 2 P.3d at 516). Forcing an insured to make this "Hobson's choice" is inconsistent with our holding in Tank, which requires an insurer to give its insured's interests equal consideration. See Tank, 105 Wash.2d at 385-86, 715 P.2d 1133.
¶ 31 Disallowing recoupment in this instance does not leave insurers without options to protect their interests. An insurer is not forced to undertake a defense if it believes the claims asserted against the insured are not covered at all. See id. at 391, 715 P.2d 1133. Here, however, National Surety did choose to defend Immunex, following the reservation of rights approach our precedent allows. It cannot claim the benefits of doing so and simultaneously avoid the costs.
¶ 32 We hold that insurers may not seek to recoup defense costs incurred under a reservation of rights defense while the insurer's duty to defend is uncertain.
¶ 33 We next consider whether National Surety's duty to defend may be excused because of Immunex's untimely tender of the claims.
¶ 34 National Surety argues it cannot be held to pay for defense costs when Immunex breached the policy by providing late notice of the underlying litigation. There are two components to its argument. First, National Surety argues that no duty to defend arises until a claim is tendered, and therefore it cannot be responsible for defense costs incurred before this point. Second, it contends that Immunex's late tender caused prejudice as a matter of law so that it is entitled to summary judgment relieving it of any responsibility for defense costs.
¶ 35 In support of its argument that no duty to defend arose before tender, National Surety cites to Leven, 97 Wn.App. 417, 983 P.2d 1155. There, this court noted that "an insurer's duty to defend does not arise unless the insured specifically asks the insurer to undertake the defense of the action." Id. at 426-27, 983 P.2d 1155. National Surety interprets this language to mean that an insurer is exempt from paying pretender defense costs. But Leven clearly states that an insured's late tender in violation of the insurance contract does not relieve the insurer of its duty to defend unless it proves actual and
¶ 36 Leven is consistent with our decision in Mutual of Enumclaw Insurance Co. v. USF Insurance Co., 164 Wn.2d 411, 421, 191 P.3d 866 (2008), which recognized that "[t]he duties to defend and indemnify do not become legal obligations until a claim for defense or indemnity is tendered." National Surety seems to interpret this statement to mean that it cannot be legally obligated to pay pretender defense costs. All that USF establishes, however, is that a "`breach of the duty to defend cannot occur before tender.'" Id. (quoting Griffin v. Allstate Ins. Co., 108 Wn.App. 133, 141, 29 P.3d 777, 36 P.3d 552 (2001)). In noting that the duty to defend is not a legal obligation until tender, the court was stating the rather obvious proposition that in terms of timing, the duty to defend or indemnify is not legally enforceable until the insured has apprised its insurer that it seeks its performance. Nothing in our opinion in USF suggests that pretender defense costs are not recoverable once tender has been made.
¶ 37 In fact, the duty to defend arises not at the moment of tender, but upon the filing of a complaint alleging facts that could potentially require coverage. Truck Ins. Exch., 147 Wash.2d at 760, 58 P.3d 276. As the Court of Appeals noted in Griffin, "Certainly breach of the duty to defend cannot occur before tender. The scope of a duty, however, is defined not by its breach, but by the contract." 108 Wash.App. at 141, 29 P.3d 777. Accordingly, an insured can recover pretender fees and costs except where a late tender prejudiced the insurer. Id. at 139, 29 P.3d 777.
¶ 38 As in other contexts involving breach of policy provisions by the insured, the insurer must show that late notice actually and substantially prejudiced its interests before performance of its duties will be excused. USF, 164 Wash.2d at 426, 191 P.3d 866. "Prejudice" means a damage or detriment to one's legal claims. BLACK'S LAW DICTIONARY 1299 (9th ed. 2009). In line with this definition, to establish prejudice an "insurer must prove that an insured's breach of a notice provision had an identifiable and material detrimental effect on its ability to defend its interests." USF, 164 Wash.2d at 430, 191 P.3d 866. This rule will require a different showing depending on the interest at stake. See id. Several of the factors mistakenly seized upon by the dissent as free-floating "equitable considerations" are in fact relevant to a showing of actual and substantial prejudice. See dissent at 701-02 (failure to cooperate with the insurer or comply with policy terms); id. at 693-94 (long delay).
¶ 39 National Surety insists that Immunex's late tender caused prejudice as a matter of law. In this regard, National Surety argues that "prejudice to the insurer is established as a matter of law when, as here, an insured selectively delays tender of a claim for years in order to control the defense and settlement of the claims without the consent of the insurer." Br. of Resp't/Cross-Appellant at 45-46.
¶ 40 It is possible a declaratory judgment might have been obtained much earlier had Immunex promptly tendered the defense. However, in its alternative motion for summary judgment, National Surety asserted it was not liable for any defense costs.
¶ 41 When an insurer undertakes to defend its insured under a reservation of rights, it must pay defense costs until it obtains a judicial declaration that it owes no duty to defend. It cannot unilaterally disavow its financial responsibility in a reservation of rights letter. An insurer who owes a duty to defend may nonetheless be excused from its obligation to the extent it demonstrates actual and substantial prejudice flowing from its insured's untimely tender of the claim.
¶ 42 We affirm the trial court's orders requiring National Surety to reimburse Immunex for reasonable defense fees incurred before the determination of no coverage and denying summary judgment on the late tender question. We remand for further proceedings consistent with this opinion.
WE CONCUR: C. JOHNSON, J., CHAMBERS, J.P.T., OWENS, J., and FAIRHURST, J.
WIGGINS, J. (dissenting).
¶ 43 Rather than focus on the equities of the case at hand, the majority seizes on this opportunity to pronounce that insurers who defend under a reservation of rights may never recoup defense costs after a court determines that an insurance policy does not cover an insured's claim and that the insurer never had a duty to defend. This rule is both overly broad and unnecessary, and in the context of this case, it is unjust. I dissent.
¶ 44 I would reverse the Court of Appeals in part
¶ 45 The majority concludes that insurers may never recoup defense costs paid under a reservation of rights because a defense under a reservation of rights protects insurers by limiting their liability on claims of bad faith or breach, rendering "the defense portion of a reservation of rights defense illusory," majority at 694 (emphasis omitted). But the out-of-state authority the majority says provides "valuable guidance," majority at 693, actually gives little guidance at all. And even the cases that do provide some support for the majority's position involve facts and circumstances very distinct from those at issue here.
¶ 46 More importantly, the majority fails to acknowledge that its rule — that insurers may never recoup defense costs paid under a reservation of rights even when it is later determined that the insurer owed no duty to defend — is the minority view. The majority does not mention that a majority of American courts have allowed insurance companies to recoup reservation-of-rights defense costs and overlooks the leading theory, unjust enrichment, that most of these jurisdictions, and the Restatement (Third) of Restitution and Unjust Enrichment, have invoked to justify insurer recoupment.
¶ 47 This court should follow the majority rule and majority rationale, opting to engage in an analysis based on fairness under the circumstances of this case to determine whether National Surety's payment of Immunex's defense costs would work an unjust enrichment in Immunex's favor. The majority does not acknowledge these considerations and would allow Immunex and other similarly
¶ 48 In this case, because individualized determinations on the issue of recoupment reveal several genuine issues of material fact, summary judgment on the issue of defense costs was inappropriate. We should remand this case for consideration of the facts that bear on whether payment of Immunex's defense costs would result in an unjust enrichment to the detriment of National Surety.
¶ 49 The majority ignores the fact that a majority of American jurisdictions that have considered the recoupment issue have permitted recoupment.
¶ 50 The leading case allowing recoupment, Buss v. Superior Court, 16 Cal.4th 35, 65 Cal.Rptr.2d 366, 939 P.2d 766 (1997), held that forcing an insurer who reserves its right to recoup defense costs paid for uncovered claims would work an unjust "`enrichment' of the insured by the insurer through the insurer's bearing of unbargained-for defense costs." 939 P.2d at 777. Following the line of reasoning in Buss, several other courts the majority cites have recognized the importance of reimbursement under an unjust enrichment theory. As the Connecticut Supreme Court noted,
Sec. Ins. Co. of Hartford v. Lumbermens Mut. Cas. Co., 264 Conn. 688, 826 A.2d 107, 125 (2003). Similarly, in Hebela v. Healthcare Insurance Co., the Appellate Division of the New Jersey Superior Court held that "the right of reimbursement exists because the insured would be unjustly enriched in benefiting by, without paying for, the defense of a non-covered claim." 370 N.J.Super. 260, 851 A.2d 75, 86 (Ct.App.Div.2004); see also Cincinnati Ins. Co. v. Grand Pointe, LLC, 501 F.Supp.2d 1145, 1169 (E.D.Tenn.2007) ("It would be inequitable for Defendants to retain the benefits of the defense [of claim not covered in the insurance policy] without repayment of the defense costs."). These cases hold that insurers that defend subject to a reservation of rights, despite believing a claim is not covered, have an equitable right to reimbursement under an unjust enrichment theory if it turns out the claim was not covered by the pertinent insurance policy.
¶ 51 The Restatement (Third) of Restitution and Unjust Enrichment also endorses the view that insurers should be able to pursue a restitution claim in this scenario. The Restatement provides:
RESTATEMENT (THIRD) OF RESTITUTION AND UNJUST ENRICHMENT § 35(1), at 571 (2011).
Id. at 580, cmt. c, illus. 12. The Reporter's Note following the illustrations indicates that this scenario is "based on" Buss and other similar cases, concluding that "[r]estitution then permits the insurer to recover that part of the benefit conferred on the policyholder that exceeds the insurer's obligation." Id. at 585, Reporter's Note on cmt. c.
¶ 52 Given that the leading theory permitting recoupment in this context, unjust enrichment, is found both in reported cases and the Restatement, the majority's assertion that unjust enrichment is "simply irrelevant," majority at 691, is simply disingenuous. The majority fixates on the benefit that National Surety receives by providing a defense under a reservation of rights, concluding that Immunex's enrichment is matched by National Surety's avoidance of claims of breach, bad faith, and coverage by estoppel. Id. But it is baffling to say that National Surety is benefited or enriched by complying with the decisional law of this court. National Surety, uncertain of its duty to defend, did exactly as we have instructed: it offered to defend under a reservation of rights to ensure that it complied with its obligation to its insured. See Woo v. Fireman's Fund Ins. Co., 161 Wn.2d 43, 54, 164 P.3d 454 (2007); Truck Ins. Exch. v. VanPort Homes, Inc., 147 Wn.2d 751, 761, 58 P.3d 276 (2002); Kirk v. Mt. Airy Ins. Co., 134 Wn.2d 558, 562, 951 P.2d 1124 (1998); Tank v. State Farm Fire & Cas. Co., 105 Wn.2d 381, 386-87, 390, 715 P.2d 1133 (1986). National Surety did not receive a "benefit"; rather, it prudently made certain that it complied with its duties under the law.
¶ 53 The trial court granted summary judgment in National Surety's favor because it determined that "National Surety ha[d] no duty to defend Immunex with regard to any of the claims made against Immunex in the actions tendered to National Surety." Clerk's Papers (CP) at 1023. Because National Surety never had a duty to defend Immunex under the terms of the insurance policy, ordering National Surety to pay Immunex's defense costs, as the majority does today, gives Immunex something that it never bargained for in its insurance contract.
¶ 54 Unjust enrichment is an equitable doctrine that allows recovery for the value of benefits retained absent a contractual relationship, as required by the notions of fairness and justice. Young v. Young, 164 Wn.2d 477, 484, 191 P.3d 1258 (2008). "`[E]quitable doctrines grew naturally out of the humane desire to relieve under special circumstances from the harshness of strict legal rules.'" Kingery v. Dep't of Labor & Indus., 132 Wn.2d 162, 173, 937 P.2d 565 (1997) (quoting Ames v. Dep't of Labor & Indus., 176 Wn. 509, 513, 30 P.2d 239 (1934)). When a court sits in equity, it has great discretion in considering the complex factual matters involved in each case to "fashion[] broad remedies to do substantial justice to the parties." Esmieu v. Hsieh, 92 Wn.2d 530, 535, 598 P.2d 1369 (1979).
¶ 55 Our case law applying equitable principles supports a balancing approach that weighs case-specific facts to determine whether a party has been unjustly enriched. Most recently in Young, this court considered work performed by Jim and Shannon Young to prepare Judith Young's otter sanctuary.
¶ 56 We engage in a careful balancing of the facts and circumstances in other equitable contexts as well. See, e.g., Gildon v. Simon Prop. Grp., Inc., 158 Wn.2d 483, 495, 145 P.3d 1196 (2006) (noting that the court looks to equity and good conscience that calls for determinations dependent on the facts and circumstances of individual cases when considering joinder of a necessary party under CR 19); In re Pennington, 142 Wn.2d 592, 603, 14 P.3d 764 (2000) (considering the various factors under Connell v. Francisco, 127 Wn.2d 339, 898 P.2d 831 (1995), to determine whether and how to equitably distribute parties' property at the end of a meretricious relationship in order to avoid unjust enrichment); Myers v. Boeing Co., 115 Wn.2d 123, 138, 794 P.2d 1272 (1990) (holding that balancing various factors to determine whether to apply forum non conveniens "will lead to fair and equitable results"); Tyler Pipe Indus., Inc. v. Dep't of Revenue, 96 Wn.2d 785, 792, 638 P.2d 1213 (1982) ("[S]ince injunctions are addressed to the equitable powers of the court, the [injunction] criteria must be examined in light of equity including balancing the relative interests of the parties."). In short, as in other equitable contexts, when considering unjust enrichment, courts balance the unique circumstances of each case to determine whether one party will receive a benefit to which,
¶ 57 Turning to the mechanics of the claim itself, in order to establish an unjust enrichment claim, the plaintiff must demonstrate that "(1) the defendant receive[d] a benefit, (2) the received benefit is at the plaintiff's expense, and (3) the circumstances make it unjust for the defendant to retain the benefit without payment." Young, 164 Wash.2d at 484-85, 191 P.3d 1258. As a result of the majority's opinion, Immunex will receive the benefit of payment for its defense costs at National Surety's expense. Thus, the first two elements of National Surety's unjust enrichment claim would be easily met. The only remaining issue — whether circumstances would make it unjust for Immunex to receive payment of its litigation costs instead of paying for them itself — depends on a careful balancing of the equities in this case.
¶ 58 Several considerations would assist in determining whether forcing National Surety to pay Immunex's defense costs would result in Immunex's unjust enrichment. These considerations should be carefully balanced before disposal on summary judgment.
¶ 59 "Recoupment" of National Surety's payments for Immunex's defense is not an actual issue in this case. At least at the time the trial court determined the summary judgment motion on defense costs, National Surety had not paid for any of Immunex's legal defense. Thus, the real issue is whether National Surety now must pay for defense costs that have already been determined to fall outside National Surety's duty to defend.
¶ 60 The majority states that "[i]t makes no difference that National Surety never actually paid any defense costs before the declaration of noncoverage on April 14, 2009." Majority at 695 n. 3. The Court of Appeals came to the same conclusion. Nat'l Sur. Corp., 162 Wash.App. at 777, 256 P.3d 439. I fail to see how this could be so. This is not a clear situation where National Surety is at fault for not paying defense costs. In fact, the record reveals that delay over executing a confidentiality agreement was at least one reason that attorney bills were not more promptly produced to National Surety. See CP at 1199 (letter from Immunex's counsel to National Surety's counsel on April 28, 2009, stating, "for some time we have worked to put in place a confidentiality agreement to allow Immunex to produce to National Surety the attorney bills that it has requested in connection with making payment to Immunex"). National Surety actually requested that Immunex provide attorney billings in its March 2008 reservation of rights letter.
¶ 61 If National Surety's failure to pay costs was a result of its lack of access to billings through no fault of its own, it seems particularly unjust to force National Surety to pay defense costs now, after a determination that it never owed any defense costs. This is just the type of fact-specific inquiry that should enter the calculus in determining whether National Surety's payment for defense costs at this late date would unjustly enrich Immunex.
¶ 62 When insurers are uncertain regarding their duty to defend, Washington law permits them to defend under a reservation of rights and simultaneously seek a declaratory judgment that they have no duty to defend. Woo, 161 Wash.2d at 54, 164 P.3d 454. Upon providing a defense subject to a reservation of rights, insurers are generally able to participate in forming the defense by hiring lawyers, making budgetary determinations, and gathering additional information regarding the claims.
¶ 63 An insurer's participation in setting up a defense to claims against its insured is an important consideration in determining whether insurers should be permitted to recoup defense costs paid under a reservation of rights. This is so because it comprises an essential part of the insurer's bargain with its insured. In this case, Immunex's policies provided that Immunex must "[c]ooperate
¶ 64 The facts of this case demonstrate a protracted claim process. In 2001, Immunex first notified National Surety of civil investigations. National Surety promptly responded, requesting more information. In 2003, Immunex provided a status report, stating that it would forward any complaints against it as soon as they were served. More than three years elapsed before Immunex tendered its claims. Eighteen more months passed while Immunex and National Surety exchanged correspondence regarding whether Immunex's claims were covered until National Surety agreed to provide a reservation-of-rights defense and instituted the instant declaratory judgment action in King County Superior Court in March 2008. Immunex sought a stay of the declaratory judgment action resulting in another year before the trial court made its determination that National Surety owed no duty to defend.
¶ 65 I am not suggesting that any of the delays in this claim process were unreasonable, but only that this is a valid question that remains open. The majority and the Court of Appeals acknowledge that Immunex's delay in tender should be considered as to whether National Surety was prejudiced. Nat'l Sur. Corp., 162 Wash.App. at 782, 256 P.3d 439; majority at 696. Delay should also be considered in the context of a restitutionary claim for recoupment of defense costs.
¶ 66 The record before us does not disclose much regarding Immunex's policy with National Surety, other than that there is an excess policy, not at issue here, and an umbrella policy, under which Immunex sought coverage. Whether such policies cover claims in the first instance depends on whether a primary policy is in place, actually applies, or is exhausted. See Hodge v. Raab, 151 Wn.2d 351, 355, 88 P.3d 959 (2004) (quoting RCW 48.22.030(2), which describes "umbrella policies" as policies that apply only in excess to primary insurance); MacKenzie v. Empire Ins. Cos., 113 Wn.2d 754, 757-59, 782 P.2d 1063 (1989) (describing differences between umbrella policies and general liability policies). If an insured may recover for the same loss from several different insurance providers but opts to pursue only one of them, that fact should certainly be considered as to whether the insured would be unjustly enriched by forcing the insurer to foot the bill, especially where the insurer had no duty to do so.
¶ 67 Washington insurance statutes require that "all persons be actuated by good faith, abstain from deception, and practice honesty and equity in all insurance matters. Upon the insurer, the insured, their providers, and their representative rests the duty of preserving inviolate the integrity of insurance." RCW 48.01.030. Because the legislature
¶ 68 At least in the context of awarding attorney fees to insureds that are forced to litigate against their insurers for coverage determinations, we have recognized a "disparity of bargaining power between an insurance company and its policyholder." Olympic S.S. Co. v. Centennial Ins. Co., 117 Wn.2d 37, 52, 811 P.2d 673 (1991). This disparity should also be taken into account in a situation like the one before us: if there is a significant imbalance of power between insurer and insured, the insurer's ability to recoup defense expenditures under a reservation of rights should be limited accordingly.
¶ 69 At the same time, this court has indicated that the power differential is at its greatest when insurance companies use standardized, nonnegotiable contracts presented on a take-it-or-leave-it basis. McGreevy v. Or. Mut. Ins. Co., 128 Wn.2d 26, 35, 904 P.2d 731 (1995). This suggests that when the parties have the ability to negotiate the terms of an insurance policy on relatively equal footing, the power differential would change significantly. Where the insured is, as here, a sophisticated corporation with ready access to legal advice that negotiates an insurance policy in its corporate capacity, one would expect the power differential to be less than for an individual purchasing an insurance policy for personal use. In short, the parties' relative bargaining power is another important factor in considering whether an insurer can assert a restitution claim to recoup defense costs paid under a reservation of rights.
¶ 70 Though by no means exhaustive, the factors discussed here should be used to determine whether insurance companies that provide defenses subject to reservations of rights may state restitution claims to recover defense costs paid to their insureds if it turns out they never had a duty to defend in the first place. In this case, these fact-specific considerations indicate that a genuine issue of material fact still exists whether Immunex's enrichment would be unjust. Summary judgment on the defense cost issue was therefore inappropriate.
¶ 71 The majority's conclusion is based on an assumption that the issue before us is a binary one — either recoupment is allowed in all cases or it is allowed in none.
¶ 72 The majority cites several cases for the proposition that permitting recoupment of defense costs under a reservation of rights
¶ 73 In Shoshone First Bank v. Pacific Employers Insurance Co., 2 P.3d 510, 512 (Wyo.2000), the Wyoming Supreme Court rejected recoupment where there was at least one covered claim and the insurer had already paid for the defense. The court reasoned that the insurance policy did not distinguish "between covered and non-covered claims so far as the defense of those claims [was] concerned." Id. at 515. Thus, the Shoshone court felt that allowing recoupment for all defense costs when some claims were covered under the policy would allow the insurer to unilaterally modify the insurance contract. Id. Unlike Shoshone, there was no mixture of covered and uncovered claims here, just a claim that was never covered by the parties' insurance policy.
¶ 74 Several of the majority's cases are readily distinguished by the fact that those insurers participated in selecting counsel and reviewing bills, and thus benefited from providing a defense. See Am. & Foreign Ins. Co. v. Jerry's Sport Ctr., Inc., 606 Pa. 584, 2 A.3d 526, 544-45 (2010) (noting that the insurer "had not only the duty to defend, but the right to defend under the insurance contract. This arrangement benefited both parties." (emphasis added)); Terra Nova Ins. Co. v. 900 Bar, Inc., 887 F.2d 1213, 1219 (3d Cir.1989) (noting that by defending under a reservation of rights, the insurer avoided the risk of what "an inept or lackadaisical defense of the underlying action may expose [the insurer] to if it turns out there is a duty to indemnify"); see also Perdue Farms, Inc. v. Travelers Cas. & Sur. Co. of Am., 448 F.3d 252, 259 (4th Cir.2006) (same). Unlike these cases, it cannot be said that National Surety was given an opportunity to avoid a subpar defense because, as already discussed, Immunex paid its own defense costs well before it tendered any claim to National Surety and National Surety never participated in any aspect of Immunex's defense.
¶ 75 The majority's other cases are even more easily distinguished. In Capitol Indemnity Corporation v. Blazer, 51 F.Supp.2d 1080 (D.Nev.1999), the court denied recoupment because the insurer failed to give its insured "`unambiguous notice that it may later be held responsible for costs incurred,'" id. at 1090 (quoting Forum Ins. Co. v. County of Nye, No. 91-16724, 26 F.3d 130, 1994 WL 241384, at *3 (9th Cir. June 3, 1994) (unpublished)). Had the insurer clearly indicated that it was reserving its rights and intended to seek reimbursement, as National Surety did in this case, the court likely would have allowed reimbursement. Blazer cuts against the majority's categorical rule.
¶ 76 In Medical Liability Mutual Insurance Co. v. Alan Curtis Enterprises, Inc., 373 Ark. 525, 285 S.W.3d 233 (2008), the real issue was not recoupment of fees following a defense under a reservation of rights but lack of statutory authority to award attorney fees. The court considered various approaches to the issue of recoupment, but ultimately stated that the recoupment issue was irrelevant "because ... attorneys' fees are not allowed in Arkansas except where expressly provided for by statute." Id. at 235. This case hardly supports the majority's position.
¶ 78 In sum, while some of the cases point to the majority's desired result, they are very factually different from the case we must decide here. The majority has relied on these cases for their ultimate conclusion but has overlooked their facts and their reasoning. These cases are unpersuasive and should not control our decision.
¶ 79 The majority's blanket determination that insurers may never recoup defense costs under a reservation of rights ignores the unique facts of each case and fails to appreciate the diversity and inapplicability of the different theories on which out-of-state jurisdictions have denied recoupment in certain circumstances. The majority fails to acknowledge that a majority of jurisdictions allow recoupment and that most do so on the equitable basis of avoiding unjust enrichment. Rather than accept the majority's all or nothing approach, this court should balance the equities of each case to determine whether an insurer has stated a legitimate claim in restitution to recover for its insured's unjust enrichment. Instead of affirming summary judgment on the issue of Immunex's entitlement to enrichment in the form of uncovered defense costs, I would reverse the Court of Appeals and remand this matter to the trial court to consider the facts specific to this case as discussed in this opinion to determine whether such enrichment would be unjust.
¶ 80 I dissent.