SYLLABUS
(This syllabus is not part of the opinion of the Court. It has
been prepared by the Office of the Clerk for the convenience of the
reader. It has been neither reviewed nor approved by the Supreme Court. Please
note that, in the interests of brevity, portions of any opinion may not
have been summarized).
On January 9, 2000, an automobile driven by Father Fred Miller struck and
injured a pedestrian, plaintiff John Gazis. Miller was driving a car owned by
his employer, the Archdiocese of Newark, and insured by Lumbermans Mutual Casualty, with
liability protection of $250,000, and an excess policy in the amount of $750,000
issued by the National Catholic Risk Retention Group, Inc. (National). Nationals policy contains
language to the effect that an insured forfeits coverage if the insured fails
to notify National in writing, and within 120 days, of an event that
may trigger the policy. National denied coverage on the Archdioceses indemnification claim solely
because it did not receive notice of the claim within the 120 day
period required by the policy.
Gazis filed a complaint and the matter went to arbitration, resulting in an
award to Gazis that exceeded $1 million. The Archdiocese obtained a trial de
novo and ultimately settled with Gazis for $500,000. Cross-motions for summary judgment were
filed by the remaining parties, National and Gazis. The trial court denied the
motion filed by Gazis and granted summary judgment to National based on the
late notice. Gazis appealed.
The Appellate Division reversed and remanded for entry of judgment against National, holding
that under this occurrence-based liability policy the excess carrier could not forfeit coverage
unless it proved both a breach of the notice provision and a likelihood
of appreciable prejudice. Gazis v. Miller,
378 N.J. Super 59, at 60, 64
(2005). The panel relied on the rational of Cooper v. Govt Employees Ins.
Co.,
51 N.J. 86 (1968), for imposing an appreciable prejudice requirement before late
notice of a claim could justify a forfeiture of coverage. The panel found
the Cooper Courts concern with affording compensation for tort victims to be the
more compelling justification for adhering to Coopers prejudice requirement in this excess insurance
setting and further found unassailable the trial courts finding that National failed to
prove that it suffered any prejudice as a result of the delay in
notice because National had no duty to defend the case and was aware
of the circumstances of the case six months before suit was filed.
The Supreme Court granted Nationals petition for certification.
HELD : In the absence of "appreciable prejudice," a carrier providing an occurrence-based excess
liability insurance policy cannot decline coverage based on the insureds failure to comply
with the policys 120-day notice provision.
1. In Cooper the Court held that an insurance carrier may not forfeit
coverage unless the carrier proves both a breach of the notice provision and
a likelihood of appreciable prejudice. Although, to date, Coopers principles have been applied
in a variety of contexts, we specifically declined to extend Cooper to a
claims-made policy where doing so would have constituted an unabashed rewriting of the
policy coverage purchased. In the context of primary insurance coverage, the distinction between
occurrence policies and claims-made policies has continued to be observed in respect of
the application of Coopers appreciable prejudice rule. This appeal presents our Court with
its first opportunity to address Coopers applicability to an excess insurer. (Pp. 6-10)
2. In this matter the Court concludes that the Appellate Division was correct
in applying the Courts rationale in Cooper to an excess automobile liability insurer.
The Court agrees essentially with the reasoning set forth in the succinct and
persuasive opinion authored by Judge Coburn. Our strong public policy in favor of
spreading the risk of protecting innocent victims of automobile accidents permeates our approach
to primary policies of automobile liability insurance and logically extends to excess policies
acquired to enhance the amount of liability coverage available to protect such victims.
Moreover, although this is an excess liability setting, application of Coopers prejudice requirement
does not have the perverse effect of using Coopers rationale to write a
better policy for an insured than that which was purchased. Finally, National has
not demonstrated the materiality of the notice provision to the coverage purchased through
the risk retention group. Having failed that hurdle, National therefore must show that,
in respect of each particular claim, it has been prejudiced by the late
notice. (Pp. 10-13)
The judgment of the Appellate Division is AFFIRMED.
JUSTICE RIVERA-SOTO filed a separate dissenting opinion, agreeing with the trial court and
stating that the majority has denied National the benefit of its bargain and
has in effect rewritten the contract between the parties.
CHIEF JUSTICE PORITZ and JUSTICES LONG, ZAZZALI, ALBIN, and WALLACE join in JUSTICE
LaVECCHIAs opinion. JUSTICE RIVERA-SOTO filed a separate dissenting opinion.
SUPREME COURT OF NEW JERSEY
JOHN A. GAZIS
Plaintiff-Respondent,
v.
FRED B. MILLER, ARCHDIOCESE OF
NEWARK, (improperly pled as ABC
ARCHDIOCESE), and RELIGIOUS ORDER
or ORGANIZATION (whose names are
presently unknown),
Defendants and Third-
Party Plaintiffs,
v.
THE NATIONAL CATHOLIC RISK
RETENTION GROUP, INC.,
Third-Party Defendant-
Appellant.
Argued February 15, 2006 Decided March 20, 2006
On certification to the Superior Court, Appellate Division, whose opinion is reported at
378 N.J. Super. 59 (2005).
Gerald T. Ford argued the cause for appellant (Landman Corsi Ballaine & Ford,
attorneys; Mr. Ford and Andrew C. Chien, on the brief.
Michael T. McDonnell, III argued the cause for respondent (Ryan, Brown, McDonnell, Berger
& Gibbons, attorneys).
JUSTICE LaVECCHIA delivered the opinion of the Court.
In this appeal we must determine whether an occurrence-based excess liability policy of
insurance is unavailable to an accident victim because the tortfeasor failed to give
timely notice to its excess carrier. The Appellate Division held that, in the
absence of prejudice, the excess insurer could not decline coverage based on the
insureds failure to comply with the policys 120 day notice provision. Gazis v.
Miller,
378 N.J. Super. 59 (2005). We agree with the conclusion reached by
the panel and, therefore, affirm.
. . . .
In the event the Insured fails to provide such notice within a 120
day period after receiving notice of any event, this Policy will not apply
to any such injury.
The day after the accident, Miller reported the accident to Kemper. By April
2000, Kemper had learned that Gazis had retained counsel in respect of the
accident. And, by October 2, 2000, Kemper knew enough about the extent of
Gaziss injuries that it set its reserve at $275,000. It also was plainly
aware by then that it should give notice to National, but did not
do so until June 21, 2001, apparently without excuse. National denied coverage on
the Archdioceses indemnification claim solely because it did not receive notice of the
claim within the 120 day period required by the policy.
Gazis filed his complaint against the Archdiocese in January 2002 and the Archdiocese
impleaded National as a third-party defendant to obtain indemnification. The matter went to
arbitration and resulted in an award to Gazis that exceeded $1 million. The
Archdiocese obtained a trial de novo and ultimately settled with Gazis for $500,000.
In settlement, Gazis accepted payment of the Lumbermans policy limit of $250,000 and
an assignment of the Archdioceses rights, if any, to recover the remaining $250,000
from National.
Thereafter, cross-motions for summary judgment were filed by the remaining parties, National and
Gazis. The trial court determined that although National had suffered no prejudice as
a result of the late notification, prejudice did not have to be present
for National to deny coverage when an insured violated the 120-day notice requirement
for claims. The court noted that the contracting parties in this risk retention
arrangement were sophisticated and that the excess policy negotiated with National was not
a contract of adhesion. Furthermore, the court found the policys requirement of notice
within 120 days to be unambiguous. Accordingly, the trial court denied the motion
filed by Gazis and granted summary judgment to National based on the late
notice. Gazis appealed.
The Appellate Division reversed and remanded for entry of judgment against National, holding
that under this occurrence-based liability policy the excess carrier could not forfeit coverage
unless it proved both a breach of the notice provision and a likelihood
of appreciable prejudice. Gazis v. Miller, supra, 378 N.J. Super. at 60, 64.
The panel relied on the rationale of Cooper v. Govt Employees Ins. Co.,
51 N.J. 86 (1968), for imposing an appreciable prejudice requirement before late notice
of a claim could justify a forfeiture of coverage. Gazis, supra, 378 N.J.
Super. at 64. The panel explained that whether this policy, issued as part
of a risk-pooling arrangement, could be called a contract of adhesion was not
determinative of application of Coopers prejudice requirement. Id. at 67. Rather, the panel
found the Cooper Courts concern with affording compensation for tort victims to be
the more compelling justification for adhering to Coopers prejudice requirement in this excess
insurance setting. Ibid. The Appellate Division further found unassailable the trial courts finding
that National failed to prove that it suffered any prejudice as a result
of the delay in notice because National had no duty to defend the
case and was aware of the circumstances of the case six months before
suit was filed. Id. at 67-68.
We granted Nationals petition for certification seeking review of the Appellate Divisions judgment.
185 N.J. 265 (2005).
CHIEF JUSTICE PORITZ and JUSTICES LONG, ZAZZALI, ALBIN, and WALLACE join in JUSTICE
LaVECCHIAs opinion. JUSTICE RIVERA-SOTO filed a separate dissenting opinion.
SUPREME COURT OF NEW JERSEY
JOHN A. GAZIS
Plaintiff-Respondent,
v.
FRED B. MILLER, ARCHDIOCESE OF
NEWARK, (IMPROPERLY PLED AS ABC
ARCHDIOCESE), ET AL.),
Defendants and Third
Party-Plaintiffs,
and
THE NATIONAL CATHOLIC RISK
RETENTION GROUP, INC.,
Third-Party Defendant-
Appellant.
JUSTICE RIVERA-SOTO, dissenting.
In this appeal, we have been asked to extend the appreciable prejudice rule
of Cooper v. Govt Employees Ins. Co.,
51 N.J. 86 (1968), to the
notice-of-claim provision of an occurrence-based excess liability policy of insurance that requires, as
a condition precedent to coverage, that the insured provide the insurer notice no
later than 120 days after the event that causes the insured to seek
coverage. On the application of The National Catholic Risk Retention Group, Inc. (National),
a risk retention group consisting of defendant Archdiocese of Newark and over sixty
dioceses and other Roman Catholic organizations nationwide operating pursuant to the Liability Risk
Retention Act of 1986, 15 U.S.C. §§ 3901-3906, the trial court entered summary judgment
in Nationals favor. The Appellate Division reversed, Gazis v. Miller,
378 N.J. Super. 59 (App. Div. 2005), a conclusion the majority endorses in its holding that,
in the absence of prejudice, the excess insurer could not decline coverage based
on the insureds failure to comply with the 120 day notice provision. Ante,
___ N.J. ___ (2005) (slip op. at 2). Because I disagree with such
an unwarranted extension of the Cooper rule, particularly in the circumstances presented here,
I respectfully dissent.
In my view, the trial courts analysis is the correct one:
[T]he Cooper prejudice rule and its progeny are not dispositive of the issues
presented. The Cooper prejudice rule has not been extended to include reinsurance policies
containing specific notice requirements. . .
The Court in Pfizer stated [that] the policy behind requiring a showing of
prejudice in late notice claims is to protect the interests of policyholders because
insurance contracts are contracts of adhesion and policyholders should not lose the benefits
of coverage unless the delay has prejudiced the insurance company. Pfizer[, Inc.] v.
Employers Ins. Of Wausau,
154 N.J. 187, 206 (1998). However, reinsurance contracts are
not contracts of adhesion. Rather, they are contracts entered into between sophisticated parties
bargaining at arms length.
See footnote 3
As the trial court held, [t]he notice provision at the heart of this
matter provides for a specific time period in which notice must be provided.
Furthermore, the provision clearly enunciates those types of high-risk claims that must be
reported and the consequences for failure to provide timely notice. The trial court
found that the terms of Nationals excess liability insurance policy in respect of
the requirement of written notice as soon as practicable but no more than
120 days after receiving notice of any event which gives rise to or
may give rise to a covered Loss irrespective of any apparent liability were
unambiguous. As a result, the trial court held that the insured under that
policy of excess insurance, the Archdiocese of Newark, breached the insurance contract by
failing to provide notice within the 120-day timeframe. In fact, notice was not
given until June 21, 2001, nearly one and one-half years after the subject
accident. In the end, the trial court concluded -- in my view, correctly
-- that the Cooper prejudice rule does not apply to a reinsurance contract
between sophisticated parties that contains an unambiguously specified time limit of 120 days.
To hold otherwise would make the reinsurance contract, which shareholders bargained for, worthless.
Invoking the public interest in assuring that tort victims receive compensation for injuries
caused by automobile operation, ante, ___ N.J. ___ (2006) (slip op. at 11),
both the Appellate Division and the majority run roughshod over the uncontested facts
and the clear and unambiguous policy language. However, that public interest cannot serve
as the all-purpose excuse for a clear breach of contract. It is undisputed
that the accident for which coverage is sought occurred on January 9, 2000;
that a team of physicians from Kemper National Account Service Co. (Kemper), the
Archdioceses automobile claims administrator that contractually was responsible for all appropriate notices to
National, examined plaintiff and issued a report dated March 1, 2000, still well
within the 120-day notice period; that, on October 2, 2000, under the heading
Future Course of Action, Kempers own status report admitted that [it] also need[ed]
to alert [National] of this loss; that Kempers written admission that [it] also
need[ed] to alert [National] of this loss was a refrain that appeared in
Kempers subsequent status reports; and that, despite those facts, Kemper did not notify
National of this claim until June 21, 2001, eighteen months after the accident
occurred, more than fifteen months after Kempers physicians filed their report concerning this
accident, and more than eight months after Kemper admitted in writing that it
was obliged to notify National concerning this claim.
See footnote 4
The failure to act here was not Nationals but Kempers, the Archdioceses delegatee,
an abject failure that remains unexplained in this record. Moreover, no satisfactory explanation
has been tendered as to why the Archdiocese itself did not seek relief
against Kemper for its breach of contract. When asked at oral argument, counsel
for plaintiffs, who represented the interests of the insured,
See footnote 5
was unable to explain
why the Archdiocese did not proceed directly against Kemper, and the record provides
no indication that Kemper otherwise is unable to answer for its misdeeds.
Given these facts, this case presents a singularly poor candidate for the sweeping
rule the majority announces, particularly in light of the majoritys exclusive reliance on
the public policy favoring recovery for tort victims. Plaintiff here had a full
and complete remedy: a lawsuit for damages against the tortfeasor who injured plaintiff,
Father Fred B. Miller, and the owner/insured of the car, the Archdiocese. That
is precisely what plaintiff did. The availability of insurance to cover the Archdioceses
liability was the Archdioceses concern, and not plaintiffs. To the extent plaintiff voluntarily
assumed that concern by reason of the settlement he entered into with the
Archdiocese, then plaintiffs interests can rise no higher than those of the Archdiocese.
Thus, the application here of our public policy that affords compensation to tort
victims is misguided.
There is an additional, overarching reason that counsels strongly against the result the
majority reaches. As the trial court noted, the excess liability insurance contract at
issue was entered into between two sophisticated parties and was unambiguous in its
terms. Under those circumstances, a primary obligation of the common law is to
provide certainty in outcome. See, e.g., Davidson Bros., Inc. v. D. Katz &
Sons, Inc.,
121 N.J. 196, 225 (1990) (Pollock, J., concurring) (As troublesome as
uncertainty is in other areas of the law, it is particularly vexatious in
the law of real property. . . . [T]he majoritys reasonableness test generates
confusion that threatens the ability of commercial parties and their lawyers to determine
the validity of such covenants.). In a different context, we noted that
[t]he idea of black letter law seduces us. We crave coherence and certainty
in the law as we do in many areas of our lives. We
know better, of course. We know that legal doctrine is often indeterminate --
that in a particular case, perfectly convincing arguments supporting one conclusion can often
be countered by perfectly convincing arguments supporting the opposite conclusion. Yet we continue
to search for rules, principles, tests, approaches - - anything that will impose
order on doctrine.
[Lebel v. Everglades Marina, Inc.,
115 N.J. 317, 318 (1989) (quoting Richard K.
Greenstein, The Nature of Legal Argument: The Personal Jurisdiction Paradigm,
38 Hastings L.J.
855, 855 (1987)).]
We should be so seduced here. Sophisticated commercial parties are entitled to rely
on the commonsense notion that they will be bound by the plain meaning
of the words to which they agree. When sophisticated parties covenant that an
act is to be performed no more than 120 days after receiving notice
of any event which . . . may give rise to a covered
Loss, they mean precisely that: one hundred twenty days. For a rationale inapplicable
in this setting -- that our public policy favoring compensation for victims of
automobile accidents trumps clear, bargained-for contractual limitations of coverage -- the majority denies
National the benefit of its bargain and rewrites the contract between these parties
to now read that notice must be given no more than 120 days
after receiving notice of any event which . . . may give rise
to a covered Loss, provided, however, that the 120 day deadline for performance
will be extended to the benefit of the defaulting party and to the
detriment of the non-defaulting party for so long as the non-defaulting party is
not appreciably prejudiced thereby. (added text underscored.) In so doing, the majority oversteps
its authority, weakens the import of admittedly unambiguous and clear contractual language, and
protects a wrongdoer at the expense of the innocent.
For the foregoing reasons, I respectfully dissent.
SUPREME COURT OF NEW JERSEY
NO. A-32 SEPTEMBER TERM 2005
ON CERTIFICATION TO Appellate Division, Superior Court
JOHN A. GAZIS
Plaintiff-Respondent,
v.
FRED B. MILLER, ARCHDIOCESE OF
NEWARK, (IMPROPERLY PLED AS ABC
ARCHDIOCESE), and RELIGIOUS ORDER
or ORGANIZTION (whose names are presently
unknown),
Defendants and Third-Party Plaintiffs,
v.
THE NATIONAL CATHOLIC RISK
RETENTION GROUP, INC.,
Third-Party Defendant-Appellant.
DECIDED March 20, 2006
Chief Justice Poritz PRESIDING
OPINION BY Justice LaVecchia
CONCURRING/DISSENTING OPINIONS BY
DISSENTING OPINION BY Justice Rivera-Soto
CHECKLIST
Footnote: 1
Pursuant to a separate contract, claims servicing on the Lumbermans policy was
performed for the Archdiocese by Kemper National Account Service, Co. (Kemper). Lumbermans and
Kemper happen both to be part of the overall family of companies related,
through ownership or operation, to the Kemper Insurance Company. Because Kemper, the claims
servicer, performed the processing activities on Gaziss claim, we shall refer to Kempers
activities in respect of the Lumbermans policy providing coverage to the Archdiocese on
the Gazis claim.
Footnote: 2
If Nationwide had demonstrated that the insureds non-compliance with the 120 day
notice provision caused Nationwide to lose reinsurance coverage for the late claim, then
the appreciable prejudice standard may have been satisfied. That demonstration was not made
here.
Footnote: 3 The contract at issue between the Archdiocese, as an insured, and National, as
the insurer, is a contract of excess liability insurance provided by a risk
retention group of which the Archdiocese was a member. Thus, this is not
a true reinsurance contract. However, to the extent this excess liability insurance policy
was the result of a group of like-minded insureds banding together to create
a liability pool from which covered claims were to be paid, there are
parallels to a reinsurance contract. For that reason, the trial courts reference to
the excess liability insurance contract here as a reinsurance contract, albeit technically incorrect,
is understandable, ultimately is irrelevant to the analysis, and, in any event, was
corrected by a supplementary letter issued by the trial court pursuant to R.
2:5-1(g) (We all understand that the contract of insurance was one of excess
and not reinsurance.).
Footnote: 4
The majority does not hinge its analysis on these failures. They are
relevant, however, to the conclusions I advance.
Footnote: 5
Plaintiff settled his claim against the insured, the Archdiocese of Newark, and,
as part of that settlement, was assigned the Archdioceses rights, if any, against
National under the excess liability policy.