PER CURIAM.
This case involves a claim for attorney's fees pursuant to
Hartford's contribution to the settlement of the underlying tort action, standing alone, did not render TGI a "successful claimant."
TGI employee Charles Johnson suffered significant personal injuries performing railroad maintenance and repair work for TGI in October 2006. Johnson was using a jackhammer to remove railroad ties when the hydraulic line of a nearby tamping machine burst, disabling its brakes. Johnson's back was turned to the machine, and he wore sound-deadening headphones, so he did not see or hear the machine coming. The machine struck Johnson and crushed his legs, causing permanent disabling injuries.
Johnson sued TGI almost two years later.
After an investigation following Johnson's injury, the United States Occupational Safety and Health Administration (OSHA) imposed a $1500 penalty against TGI for failing to provide a safe workplace. However, the OSHA citation did not address maintenance of the machine. Rather, it faulted TGI for failing to establish safe operating procedures, including "precautions for employees working in close proximity of the tamper [machine]."
NJM provided counsel to defend TGI (defense counsel) in Johnson's suit, subject to a reservation of rights. As previously noted, NJM furnished TGI workers' compensation coverage, as well as $1 million in employer's liability coverage. NJM asserted that its policy exclusion of "bodily injury intentionally caused or aggravated" by TGI excluded coverage for injuries that TGI subjectively intended to cause. NJM conceded that the exclusion did not bar coverage for bodily injuries that TGI knew were substantially certain to result from its actions.
TGI had two insurance policies with Hartford: (1) a separate commercial general liability policy with a $1 million limit per claim (CGL policy) and (2) a $4 million umbrella liability policy (umbrella policy) that identified the NJM policy as primary or underlying coverage. Among other things, the CGL policy specifically excluded on-the-job injuries to TGI's employees.
The umbrella policy provided excess coverage, but its coverage was subject to three exclusions relevant to this case. First, the policy excluded claims for "`[b]odily injury' or `property damage' expected or intended from the standpoint of the insured" unless the bodily injury or property damage resulted from the use of reasonable force to protect persons or property (expected-or-intended exclusion).
The third exclusion was itself subject to an exception. The policy excluded bodily injury to the insured's employee arising out of and in the course of employment or "[p]erforming duties related to the conduct of the insured's business" as well as bodily injury to certain relatives of the employee as a consequence of the employee's injury (employer's liability exclusion). However, that exclusion did not apply in cases in which "underlying insurance," described in a "Schedule of Underlying Insurance Policies," provided coverage for such liability with minimum limits. The NJM policy was included in such a schedule.
In late January or early February 2009, after TGI forwarded a copy of the Johnsons' complaint to its insurance broker, the broker notified Hartford of the claim pursuant to the CGL policy, identifying it by the policy number. The notice did not refer to or identify the umbrella policy.
An apparent claims administrator for Hartford, Specialty Risk Services (SRS), responded on February 16, 2009, that Hartford had no duty to defend or indemnify. SRS's letter expressly referred only to the CGL policy, and identified it by its policy number. TGI did not dispute Hartford's February 2009 response, nor did it communicate with Hartford for over two years. Meanwhile, the Johnson case proceeded through discovery.
On March 28, 2011, TGI's defense counsel wrote to Hartford to explain the status of the underlying suit and "to request that Hartford provide coverage to [TGI] under the commercial umbrella policy." Defense counsel explained that Johnson alleged an intentional wrong to avoid workers' compensation exclusivity. Defense counsel acknowledged that Hartford denied a defense and coverage under the CGL policy in 2009, but noted that Hartford did not address coverage under the umbrella policy. He advised Hartford that the Johnson plaintiffs had filed a motion seeking to further amend their complaint to name Hartford as a direct defendant.
In support of his request for coverage, defense counsel noted the employer liability exception in the umbrella policy did not apply if "`underlying insurance' is maintained providing coverage for such liability with minimum underlying limits, as described in the Schedule of Underlying Insurance Policies." Defense counsel added that NJM's policy was listed as underlying insurance. He also noted that NJM already had a workers' compensation lien of over $1 million.
Defense counsel did not address the impact of the expected-or-intended exception. Nor did defense counsel expressly ask Hartford to provide a defense to TGI.
Hartford did not respond to defense counsel's letter. However, on May 10, 2011, the Johnson plaintiffs filed a second amended complaint asserting that they were third-party beneficiaries of the umbrella policy, and seeking a declaratory judgment that the umbrella policy covered Johnson's accident. Thereafter, on June 16, 2011, TGI filed a separate four-count coverage action. In count one, TGI sought a declaratory judgment that Hartford was obliged under both the CGL and umbrella policies to defend it in the Johnson action, and to indemnify it against any claims in the action. TGI alleged breach of its insurance contracts in count two, and breach of the covenant of good faith and fair dealing and bad faith in count three. TGI based those claims on Hartford's decision to decline coverage and a defense under the CGL policy, and its refusal to provide TGI with its position regarding coverage under the umbrella policy. TGI also alleged, in count four, that Hartford was estopped from denying coverage under the umbrella policy because it allegedly refused to provide TGI with its coverage position within a reasonable time period.
The next month, Hartford removed the coverage action to federal court and filed an answer raising "applicable coverage defenses."
A mediation occurred early in 2012, but did not resolve the Johnson action. In a
On June 14, 2012, at 12:38 p.m., Hartford's counsel transmitted a letter to TGI's defense counsel and coverage counsel, stating that Hartford "[would] agree to contribute $4 million to settle" the underlying case "on behalf of its insured, [TGI]." Hartford's counsel stated that he intended to notify counsel for the Johnson plaintiffs by the end of business that day. Counsel expressed his expectation that NJM would contribute $1 million and "secure the release of all claims brought by plaintiff against [TGI]." Counsel then addressed the issue of fees, stating:
Before receiving a written response from TGI's coverage counsel, Hartford's counsel wrote to the Johnson plaintiffs' counsel, accepting their settlement offer. He wrote, "On behalf of its insured [TGI], Hartford ... accepts the offer that you have made to settle the claims that your client has asserted in this action. Accordingly, upon receipt of an appropriate release and settlement agreement, Hartford will tender the $4,000,000 limit of its umbrella policy." The letter was sent at 4:38 p.m., with copies to TGI's coverage counsel and defense counsel as well as the other defendants' attorneys.
Thirty-three minutes later, TGI's coverage counsel transmitted a letter to Hartford's counsel stating that TGI expected Hartford to reimburse its fees, which then exceeded $71,000:
Hartford's counsel responded the next day. He rejected coverage counsel's request for fee reimbursement, and asserted that TGI was not a "successful claimant" under
Hartford reserved "its right to seek recoupment from [TGI] of the $4 million in uncovered expenses that Hartford ha[d] paid on [TGI's] behalf" if TGI persisted in litigating coverage and counsel fees. Coverage counsel replied that TGI would continue to seek its fees by filing a summary judgment motion in the coverage action.
Hartford, TGI and the Johnson plaintiffs executed a formal settlement agreement and release, in September and October 2012, which expressly excluded the issue of fees. The agreement stated:
Once the $5 million settlement was paid, TGI filed its motion for summary judgment on count one, declaratory judgment, and count three, breach of the covenant of good faith and fair dealing. TGI also sought fees under
After oral argument, the court denied TGI's motion and granted Hartford's cross-motion. In a written decision, the court held that Hartford had no duty to defend under the umbrella policy based on a provision in the policy that conditioned Hartford's duty on the exhaustion of underlying insurance. The court held that the NJM policy was not exhausted until NJM paid the full policy limit to settle the Johnson action. Finding no evidence "that coverage exist[ed]," the Court also concluded Hartford had no duty to indemnify. However, it rejected the suggestion that the expected-or-intended exclusion necessarily barred coverage, to the extent TGI may have been "substantially certain" to cause Johnson's injury. Finally, citing
This appeal followed. Focusing solely on its rights under the umbrella policy, TGI argues that Hartford had a duty to defend and to indemnify it for Johnson's claims.
We review the trial court's grant of summary judgment de novo, applying the same standard that governs the trial court.
As we noted above, Hartford's contribution to the settlement of the Johnson action did not automatically render TGI a "successful claimant" in its coverage action, making it eligible to recover fees under
We first reject TGI's argument that it was entitled to a defense from Hartford under the umbrella policy. The language of the policy predicates a defense on the exhaustion, by payment, of the underlying coverage. The provision states that Hartford agreed to defend a suit, including groundless, false or fraudulent suits, for covered bodily injury, if: (1) "no coverage is provided under any `underlying insurance'" or (2) "the underlying limits of any `underlying insurance' policy have been exhausted solely by payments of `damages' because of `occurrences' during the `policy period.'" We confine our discussion to the second category.
Based on its plain language, the umbrella policy required full payment of the underlying NJM policy limit before Hartford's defense obligation would be triggered. NJM's policy placed a $1 million limit on its employer liability coverage. There was no dollar limit on the payment of workers' compensation benefits.
The umbrella policy's provision avoids duplicative defense costs. Until NJM exhausted its limits, it retained the obligation to defend TGI, and did in fact defend TGI. NJM's defense duty was also tied to payment. Its policy states, "We have no duty to defend or continue defending after we have
We recognize that generally, the duty to defend is broader than the duty to indemnify. An insurer must defend if the underlying suit "states a claim constituting a risk insured against."
However, the obligation of an excess carrier to provide a defense is also predicated on the exhaustion of underlying coverage, and therefore, the termination of the duty to defend by the underlying carrier. "Generally, the primary insurer must pay its policy limits toward the satisfaction or settlement of the claim or judgment against the insured for an excess insurer to have any obligation to its insured. A primary insurer that properly pays its policy limits is said to have `exhausted' its limits." 4 Douglas R. Richmond,
We are unconvinced by TGI's argument that Hartford's duty to defend was triggered when NJM's limits were "functionally exhausted," because NJM expressed the willingness to pay its policy limits. The only record support we discern for the assertion that NJM was prepared to pay $1 million to settle was defense counsel's response to the Johnson plaintiffs'
We also reject TGI's argument that Hartford had a duty to defend because exhaustion was "inevitable." TGI relies on the fact that Johnson incurred over $1 million in medical expenses. Yet, the $1 million in medical payments would only trigger the exhaustion of the NJM policy limits if coverage were provided under the portion of the policy covering employer liability, as opposed to workers' compensation.
We also find unpersuasive or distinguishable the out-of-state authority TGI cites for the proposition that an excess carrier may be obliged to provide a defense before the underlying insurer pays the limits of its coverage. For example,
Moreover, the crux of the issue in
Significantly, NJM's policy provided that its duty to defend TGI would expire "after we have paid our applicable limit of liability under this insurance." Thus, NJM's offer to pay $1 million — as opposed to actual payment — did not terminate its duty to defend. As a public policy matter, we discern no compelling ground to interpret the insurance provisions to require the excess carrier to provide a defense when the underlying insurer remains obliged to provide one.
We next consider TGI's argument that it was entitled to indemnification under the umbrella policy. An analysis of an insurer's duty to indemnify, like its duty to defend, "turns on the particular language of the policy that defines the coverage and the exclusion."
As we noted above, the policy contains three exclusions of coverage: the workers' compensation exclusion; the expected-or-intended exclusion; and the employer's liability exclusion. The combination of the first two exclusions defeats TGI's claim for indemnity coverage for damages suffered by an employee covered under workers' compensation.
The workers' compensation provision excluded "[a]ny obligation of the insured under workers' compensation, disability benefits or unemployment compensation law or any similar law." Thus, to the extent the Johnson plaintiffs were limited to recovery under
TGI does not dispute that under
Moreover, to the extent the Johnson plaintiffs might have avoided the workers' compensation bar by satisfying the intentional wrong exception, the expected-or-intended exclusion barred coverage. TGI argues that the umbrella policy's exclusion of "`bodily injury' ... expected or intended from the standpoint of the `insured'" did not exclude coverage of Johnson's claim, which rested on the allegation that TGI engaged in conduct substantially certain to cause Johnson injury. TGI relies on
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Finally, we find no error in the court's order dismissing TGI's claims of bad faith and breach of the covenant of good faith and fair dealing. TGI does not argue bad faith in settlement. Hartford contributed $4 million — its umbrella policy limit — toward settlement of the Johnson action. In so doing, Hartford shielded TGI from a potential judgment exceeding its coverage. Hartford also shielded itself from a possible
TGI focuses on Hartford's delay in providing it with its position regarding TGI's request for a defense and indemnification under the umbrella policy. In short, it alleges bad faith processing of its claim.
TGI asserts inconsistent positions. It argues that Hartford failed to provide it with a decision as to coverage under the umbrella policy, forcing it to file the coverage action. Yet, TGI also claims it assumed that SRS's February 2009 letter denying defense and coverage pertained to the umbrella policy as well. That may explain why TGI had no communications with Hartford for over two years.
We recognize that Hartford did not timely respond to defense counsel's March 2011 letter, inquiring as to Hartford's position regarding coverage under the umbrella policy. At that point, defense counsel discerned that TGI's broker's demand was limited to the CGL Policy and that TGI had neither sought nor obtained a definitive decision from Hartford regarding the umbrella policy.
We do not condone Hartford's failure to respond. Absent Hartford's admission of coverage, the Johnson plaintiffs filed suit against Hartford on May 10, 2012. TGI followed on June 16, 2012. Hartford removed TGI's action in July, along with an answer that interposed coverage defenses, thus alerting TGI that Hartford contested coverage.
An insurer owes a duty of good faith in processing an insured's claim.
Moreover, Hartford's mere failure to issue a timely response to defense counsel's letter is insufficient to establish bad faith. Simple negligence is not enough.
TGI, through defense counsel, made its first written demand for coverage under the umbrella policy almost two-and-a-half years after the Johnson action began. By contrast, the umbrella policy included standard provisions requiring the insured to notify the insurer "as soon as practicable" of a claim "under this policy." We have no doubt that if TGI's broker had included the umbrella policy in its claim form, TGI would have received a coverage position with respect to that policy in early 2009.
After defense counsel failed to receive a prompt response to its March 28, 2011 letter, the record indicates that neither defense counsel nor TGI followed up with additional inquiries. There is also no evidence that TGI or its broker submitted a standard claim form pertaining to the umbrella policy. Additionally, neither TGI nor its broker apparently contacted SRS, which conveyed the February 2009 coverage decision, to inquire whether Hartford's position was the same with respect to the umbrella policy.
In sum, we discern no error in the court's order dismissing TGI's bad faith claim.
Any remaining arguments of TGI that we may not have addressed lack sufficient merit to warrant discussion in a written opinion.
Affirmed.