ARLENE MARSDEN,
Plaintiff-Respondent,
v.
ENCOMPASS INSURANCE CO.,
Defendant-Appellant.
______________________________________
Argued: December 15, 2004 Decided: January 12, 2005
Before Judges Newman, R.B. Coleman and
Holston, Jr.
On appeal from the Superior Court of New
Jersey, Law Division, Union County,
L-2686-03.
Edward J. Rebenack argued the cause for
appellant (Hoagland, Longo, Moran, Dunst
& Doukas, attorneys; John C. Simons, of
counsel; Joseph V. Leone, on the brief).
Joel I. Rachmiel argued the cause for
respondent.
The opinion of the court was delivered by
NEWMAN, J.A.D.
Defendant Encompass Insurance Company (Encompass) appeals from an order compelling the submission of
an underinsured motorist claim (UIM) to three-party motorist arbitration. We affirm.
The facts are not in dispute. Plaintiff, Arlene Marsden, sustained personal injuries in
a car accident caused by tortfeasor, Carol Farley (Farley or tortfeasor), on July
10, 1999. Farley was insured through Prudential Insurance Company, with liability policy limits
of $100,000/$300,000. Plaintiff was covered by a policy issued by defendant Encompass, which
provided UM/UIM limits of $250,000/$500,000.
On December 5, 2000, plaintiff filed suit against Farley. On May 30, 2001,
plaintiff filed an Amended Complaint, adding a per quod claim on behalf of
her husband, Robert Marsden.
In non-binding arbitration on March 15, 2002, plaintiff was awarded $250,000, well over
the tortfeasor's policy limits of only $100,000. On March 20, 2002, plaintiff forwarded
to defendant a Longworth
See footnote 1 notice of a potential UIM claim.
On April 8, 2002, defendant notified plaintiff that "in order for [them] to
determine whether or not [she] ha[d] a valid underinsured motorist claim, [they] need
to obtain the following:" proof of tortfeasor's policy limits and offer of settlement;
copy of the filed suit papers, discovery and arbitration award; complete package of
specials including loss wage verification; and diagnosis and medical history.
Plaintiff complied with defendant's request in a letter of April 16, 2002, confirming
the $250,000 arbitration award, but notifying defendant a trial
de novo was filed
by tortfeasor. Plaintiff enclosed the award and a copy of the trial notice,
as well as, answers to defendant's interrogatories and a copy of plaintiff's deposition
transcript.
Following a verbal authorization, defendant through its claims supervisor, on July 8, 2002,
confirmed that it waived "any future subrogation right[s]" and authorized plaintiff's settlement with
the tortfeasor for the $100,000 policy limit. Believing that the UIM claim would
either be settled or failing that, submitted to three-party arbitration, plaintiff settled her
claim for $90,000 against the tortfeasor during July 2002 and dismissed the underlying
lawsuit.
On February 26, 2003, plaintiff's counsel sent a letter to defendant, confirming his
phone conversation with claims specialist, Louis Negrin (Negrin), and requesting that defendant review
the medical specials that were forwarded on April 16, 2002 and contact counsel
to discuss a resolution of the claim. Counsel prefaced his UIM settlement demand
of $100,000 by describing the accident and the nature of the injuries in
the following terms:
As can be seen, as a result of this violent rearend impact caused
by the negligence of the underinsured tortfeasor, my client sustained an avulsion fracture
at C7. Additionally, she sustained disc herniations at L4-5 and C6-7. Both her
treating physician and orthopedic surgeon, Dr. Glushakow, and the referred neurosurgeon, Dr. Prada,
recommended cervical fusion and laminectomy due to this severe injury. However, due to
my client's severe fear of surgery, she has declined, thus far, that procedure.
However, due to continuing complaints and the pressure resulting from these injuries, she
is considering that surgery.
Additionally, as a result of this impact and injury, my client was forced
into early retirement as indicated in answer 10 to Form A Interrogatories. That
early retirement has resulted in a loss of approximately $12,000 in pension per
year due to my client's loss of anticipated salary increases when she was
unable to return to work due to these injuries.
In a phone conversation of April 23, 2003 with Negrin, defendant claimed for
the first time that the policy requires litigation of the UIM claim, rather
than arbitration. A few days later, Negrin called plaintiff's counsel back to indicate
he was mistaken and that the policy in effect on the date of
the accident permitted arbitration and that the claim would be submitted to UIM
arbitration. On April 28, 2003, plaintiff's counsel sent a letter to Negrin demanding
three-party UIM arbitration.
On July 17, 2003, plaintiff filed a Complaint against defendant seeking to compel
UIM arbitration. Plaintiff filed a notice of motion to compel arbitration on September
18, 2003.
On September 30, 2003, counsel for defendant notified plaintiff by letter that defendant
did not agree to arbitrate and advised plaintiff to file a complaint in
a court of competent jurisdiction. On the same date, defendant's counsel submitted a
letter in opposition to plaintiff's motion to compel UIM arbitration. Defendant indicated in
its letter that the plaintiff's policy allows it to reject arbitration and choose
to have a trial on the UIM claim.
In granting plaintiff's motion, Judge Perfilio found that defendant waived its right to
request plaintiff to go to trial because, by its conduct, defendant impliedly consented
to an arbitration. The motion judge also suggested that an estoppel could be
invoked against defendant from requesting a trial when it led plaintiff to believe
that the matter would proceed to arbitration if it was not settled.
On appeal, defendant raises the following issues for our consideration:
POINT I
THE ENCOMPASS UNDERINSURED MOTORIST ENDORSEMENT CONTROLS THE RIGHTS OF MARSDEN AND ENCOMPASS RELATIVE
TO MARSDEN'S CLAIMS AND ENTITLEMENT TO UNDERINSURED MOTORIST BENEFITS.
POINT II
THE DOCTRINE OF EQUITABLE ESTOPPEL SHOULD NOT APPLY BECAUSE ENCOMPASS DID NOT ENGAGE
IN INTENTIONAL CONDUCT OR CONDUCT WHICH INDUCED MARSDEN TO ACT OR CHANGE HER
POSITION TO HER DETRIMENT.
Defendant argues that the Arbitration Clause in plaintiff's policy controls the rights of
both parties. Defendant asserts that Section (a) specifically requires defendant to consent to
arbitrate the UIM claim, and if it does not consent, then the covered
person must file a lawsuit in the proper court against the tortfeasor and
defendant. Furthermore, defendant asserts that, because it changed its mind and no longer
agreed to arbitrate, plaintiff must bring a lawsuit in court based on its
right not to agree to arbitrate under part (b)(4) of the UIM arbitration
clause.
The pertinent parts of the UIM arbitration clause read:
a. Two questions must be decided by agreement between covered person and us:
(1) If the covered person is legally entitled to collect damages from the owner
or driver of an uninsured motor vehicle or underinsured motor vehicle; and
(2) If so, in what amount?
. . . .
(2) If either party does not consent to arbitrate these questions or if
the arbitrators selected by each party cannot agree on a third arbitrator, the
covered person shall:
(a) File a lawsuit in the proper court against the owner or driver
of the uninsured motor vehicle or underinsured motor vehicle and us, or if such
owner or driver is unknown, against us; and
. . . .
(3) If the covered person files suit against the owner or driver of the
uninsured motor vehicle or underinsured motor vehicle, we have the right to defend
on the issues of legal liability and of the damages owed by such
owner or driver.
b. If the covered person and the person or organization legally liable for the
covered person's bodily injury and/or property damage reach a settlement agreement to pay
the covered person such person's limits of liability, the covered person must submit
the agreement to us in writing for our approval prior to final execution
of such settlement agreement if:
(1) The settlement would not fully satisfy the covered person's claim; and
(2) An Uninsured Motorists Coverage claim has been or will be made against us.
The covered person may file suit against us and the legally liable person
if, within 30 days after our receipt of the settlement agreement, we do
not:
(1) Approve the settlement;
(2) Waive our rights of recovery against the person or organization legally liable for the
bodily injury and/or property damage;
(3) Authorize the signing of a full release;
and
(4) Agree to arbitrate the Uninsured Motorists Coverage claim.
The suit shall decide:
(1) If the covered person is legally entitled to collect damages; and
(2) If so, how much?
. . . .
Here, defendant was timely notified of the potential UIM claim by plaintiff and
given the opportunity to intervene. When the tortfeasor rejected the non-binding arbitration award
and filed for a trial de novo, defendant chose not to intervene. When
the tortfeasor offered to settle, defendant authorized plaintiff to settle, even though it
meant there would be a UIM claim. Defendant agreed to waive its subrogation
rights, release the underlying claim, and requested plaintiff to submit medical specials in
conjunction with its UIM settlement demand. Subsequently, defendant's agent, Negrin told plaintiff's counsel
that defendant would arbitrate the UIM claim. After three months, plaintiff had to
file a complaint against defendant and later moved to compel arbitration. Defendant now
contends that it never agreed to arbitrate the UIM claim and, therefore, still
had the option to exercise its right to go to trial if the
settlement discussions were not fruitful. We disagree.
In our view, defendant did not reserve the trial option in its communications
with plaintiff's counsel. More significantly, plaintiff has been prejudiced. Had plaintiff known when
she received the Longworth response of July 8, 2002 from defendant's claims supervisor
that she would face a trial some time later, plaintiff could have rejected
the tortfeasor's settlement offer and had the trial years before and resolved the
matter. Plaintiff's counsel pointed out before us, he could have sought to amend
his complaint and implead defendant as a party. Or if denied that relief,
plaintiff could have reminded defendant that under Zirger v. General Accident Ins. Co.,
144 N.J. 327, 342 (1996), it would be bound by the trial result
even if it did not intervene because it had been put on notice
of the proceedings and could have sought intervention.
In Zirger, our Supreme Court noted "the potential anomaly of the use of
arbitration as a supplement to an adjudication in court." Ibid. Arbitration was recognized
"as a means of resolving disputes ... that ... is quicker and less
expensive than litigation...." Ibid. The Court commented further:
The advantages of arbitration evaporate when arbitration is used not as a substitute
for litigation, but as a supplement to litigation. Used in this manner, a
procedure designed to expedite dispute resolution is transformed into a mechanism
for delaying and obstructing final resolution of disputes....
[Id. at 343.]
What the Court said in Zirger is equally applicable here. Plaintiff expected this
case to proceed on an arbitration track if a settlement was not effectuated.
In so doing, plaintiff gave up her right to trial, anticipating that the
UIM claim would be resolved in a timely and expeditious manner. However, her
expectations were derailed by defendant's belated decision not to arbitrate but instead to
demand a trial. If defendant intended to exercise its trial option under the
arbitration provisions in the policy, it should have expressed its intent on July
8, 2002 at the same time it authorized plaintiff to settle with the
tortfeasor, waived its subrogation rights and requested plaintiff's medical specials in connection with
plaintiff's UIM settlement demand. Had defendant done so and insisted on a trial
in its July 8, 2002 Longworth response, plaintiff could have accommodated defendant by
rejecting the tortfeasor settlement and tried the case then and not be faced
with the prospect of a trial a few years later. Not only was
the "quicker and less expensive" use of arbitration as a means of resolving
disputes underminded, but the "overriding public interest in the efficient and expeditious resolution
of UM/UIM claims" was thwarted. Zirger, supra, 144 N.J. at 342.
We recognize that in Zirger the Court found it offensive to relitigate issues
that had already been tried. While there was no issue of relitigation here,
the same legislative goal of timely payments of benefits that UM/UIM coverage was
intended to provide would be unreasonably delayed by defendant's conduct. Id. at 344.
The difference, at best, is one of degree, and, therefore, the same result
should obtain.
Defendant argues that the doctrine of equitable estoppel should not be invoked against
it. Defendant asserts that plaintiff should not have relied on its initial agreement
to arbitrate because "the unambiguous terms of the policy [permitted] any claims for
underinsured motorists benefits to be tried if either party did not consent to
arbitration as a forum for resolving the underinsured issues presented." Defendant further contends
that it did not intentionally mislead plaintiff to believe that her claims would
be arbitrated. In any event, defendant maintains that plaintiff did not rely on
its representations to her detriment and that no harm or prejudice was incurred.
"Estoppel is an equitable doctrine, founded in the fundamental duty of fair dealing
imposed by law." Casamasino v. City of Jersey City,
158 N.J. 333, 354
(1999). The doctrine is designed to prevent injustice by not permitting a party
to repudiate a course of action on which another party has relied to
his detriment. Mattia v. Northern Ins. Co. of New York,
35 N.J. Super. 503, 510 (App. Div. 1955). The doctrine is invoked in "the interests of
justice, morality and common fairness." Palatine I v. Planning Bd. of Township of
Montville,
133 N.J. 546, 560 (1993). Estoppel, unlike waiver, requires the reliance of
one party on another. To establish equitable estoppel, plaintiffs must show that defendant
engaged in conduct, either intentionally or under circumstances that induced reliance, and that
plaintiffs acted or changed their position to their detriment. Miller v. Miller,
97 N.J. 154, 163 (1984).
With respect to whether defendant intentionally misled plaintiff into thinking her claims would
be arbitrated, the evidence is inconclusive. However, the evidence is clear that defendant
engaged in a course of conduct that under the circumstances induced reliance by
plaintiff which was exceedingly detrimental. Plaintiff did rely on defendant's representation to her
detriment by settling with the tortfeasor, foregoing any further claims she had against
the tortfeasor, and experiencing an unreasonable delay in pursuit of her UIM claim.
See Busik v. Levine,
63 N.J. 351, 358-59, appeal dismissed,
414 U.S. 1106,
94 S. Ct. 831,
38 L. Ed.2d 733 (1973). All of this
could have been avoided if defendant had voiced its decision to exercise the
trial option when it made its Longworth response. Plaintiff would then have had
one trial two years earlier against one tortfeasor, binding defendant to the judgment
under Zirger. Plaintiff would have had the matter resolved including the UIM claim
in a far more timely fashion than under the present scenario.
Were defendant's contention accepted, discovery would have to be forthcoming with a trial
in the near future when at least three years have passed since the
case could have been resolved. Even if plaintiff were entitled to prejudgment interest,
the
amended complaint was filed on October 14, 2003 and would not cover the
entire period that this matter has been brewing. R. 4:42-11(b). Moreover, interest only
compensates for the time money has been withheld. Plaintiff also suffered from the
anxiety she endured while awaiting closure to the accident, the resulting injuries, and
her claim.
In an analogous context, this court ruled in Barrett v. New Jersey Mfg.
Ins. Co.,
295 N.J. Super. 613, 618 (App. Div. 1996), certif. denied,
150 N.J. 29 (1997), that an insurance company which expressly or impliedly acknowledges that
its policy provides coverage for a particular claim may be estopped from subsequently
denying coverage if an insured has relied upon the availability of that coverage.
So too here. Plaintiff has detrimentally relied upon defendant's course of conduct that
three-party arbitration would be forthcoming if no settlement of the UIM was effectuated.
Had plaintiff known that defendant would demand a trial instead, plaintiff would have
gone to trial against the tortfeasor years before and expeditiously resolved its UIM
claim in this rear-end accident case where plaintiff was a passenger in her
husband's car.
Under the circumstances, the necessary ingredients to invoke equitable estoppel are present. Defendant
is estopped from demanding a trial. The motion judge properly ordered that the
matter proceed to three-party arbitration.
Affirmed.
Footnote: 1
Longworth v. Ohio Casualty,
223 N.J. Super. 174 (App. Div. 1988).