Plaintiff-Respondent,
v.
ZURICH AMERICAN INSURANCE
GROUP, a Stock Insurance
Company,
Defendant-Appellant,
v.
GARDEN STATE BROKERS, INC.,
and HARRY DELBOSCO,
Defendants-Respondents.
______________________________________
Argued November 15, 2005 - Decided January 26, 2006
Before Judges Skillman, Payne and Miniman.
On appeal from Superior Court of New Jersey, Law Division, Union County, Docket
No. L-2725-02.
Beverly M. Barr argued the cause for appellant (Reger, Rizzo, Kavulich & Darnall,
attorneys; Ms. Barr, on the brief).
Joseph Suarez argued the cause for respondents Garden State Brokers, Inc. and Harry
Delbosco (Suarez & Suarez, attorneys; Mr. Suarez, of counsel; Denise R. Wasserman, on
the brief).
Respondent Hornet Express did not file a brief.
The opinion of the court was delivered by
SKILLMAN, P.J.A.D.
The issue presented by this appeal is whether an insurance policy that provides
coverage for New Jersey workers' compensation benefits should be construed to require the
insurer to pay the portion of a workers' compensation judgment entered in another
state that would have been awarded if the claim petition had been filed
in New Jersey. We conclude that the plain and unambiguous language of the
insurance policy limits coverage to compensation benefits awarded under the New Jersey Workers'
Compensation Act.
Plaintiff Hornet Express, a trucking company with a base of operations in New
Jersey, applied for workers' compensation coverage through the New Jersey Workers Compensation Insurance
Plan (NJWCIP). The NJWCIP provides involuntary assigned risk coverage to New Jersey employers
that cannot obtain coverage in the voluntary market. The risk covered by policies
issued through the NJWCIP is defined as "the entire insured operations within the
State of New Jersey or to which the New Jersey Compensation Law is
applicable."
The application form for workers' compensation coverage that Hornet submitted to the NJWCIP
asked: "Do you have operations in states other than New Jersey?" Hornet answered:
"no." The application form also included a "Trucker Supplemental Application" page, which stated:
"If you or your employees spend a majority of driving time in a
certain state, name that State for yourself and each employee." In the blank
following this inquiry, Hornet identified "NJ" as the only state where its employees
spend a majority of driving time. Contrary to the representations set forth in
its application to the NJWCIP, Hornet employed drivers who operated trucks solely in
Pennsylvania.
The application containing these misrepresentations was prepared on Hornet's behalf by its insurance
broker, defendant Garden State Brokers, Inc. Defendant Harry DelBosco is the principal of
this brokerage company.
The NJWCIP assigned responsibility to defendant Zurich American Insurance Group to provide coverage
to Hornet under the New Jersey Assigned Risk Program. Under this program, the
policy Zurich issued to Hornet was required to contain the specific policy provisions
set forth in the New Jersey Workers Compensation Insurance Manual.
In conformity with this manual and the application Hornet submitted to the NJWCIP,
Zurich issued a policy to Hornet, which stated:
3A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation
Law of the state(s) listed here:
NJ
The policy also stated:
3C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if
any, listed here:
COVERAGE EXCLUDED
Hornet did not obtain any workers' compensation coverage other than the policy issued
by Zurich.
On June 7, 2001, one of Hornet's Pennsylvania drivers, Bret Kegarise, was involved
in a fatal accident while operating a Hornet truck in the course of
his employment in Pennsylvania. Kegarise's work for Hornet consisted exclusively of driving a
daily route between King of Prussia, Pennsylvania and Allentown, Pennsylvania. Kegarise also lived
in Pennsylvania with his family and parked the Hornet truck in Pennsylvania when
he was not working.
Kegarise's widow filed a workers' compensation death benefit claim against Hornet in the
Bureau of Workers' Compensation of the Pennsylvania Department of Labor and Industry. Zurich
disclaimed coverage for this claim on the ground that the policy it had
issued to Hornet only provided coverage for New Jersey workers' compensation benefits. Hornet
did not defend the claim petition, and a Pennsylvania Workers' Compensation judge issued
a final decision requiring Hornet to pay death benefits to Kegarise's widow. This
decision included a finding that Hornet "did not carry Workers' Compensation insurance coverage
in the Commonwealth of Pennsylvania."
Hornet subsequently brought this action against Zurich, Garden State Brokers and DelBosco. Hornet
sought a declaration that the Zurich policy provided coverage for the death benefits
awarded to Kegarise's widow by the Pennsylvania Bureau of Workers' Compensation. In the
alternative, Hornet asserted a negligence claim against Garden State Brokers and DelBosco for
failing to obtain comprehensive workers' compensation coverage that would apply to the Pennsylvania
claim by Kegarise's widow.
The case was brought before the court by Zurich's motion for summary judgment
seeking dismissal of Hornet's complaint on the ground that the policy it issued
to Hornet did not provide coverage for benefits awarded by the Pennsylvania Bureau
of Workers' Compensation. Garden State filed a cross-motion for summary judgment seeking a
declaration that Zurich was required to indemnify Hornet for defense costs and the
Pennsylvania compensation award.
The trial court concluded in an oral opinion that because Zurich would have
provided coverage to Hornet if Kegarise's widow had filed a claim for workers'
compensation in the New Jersey Division of Workers' Compensation, it was required to
provide "New Jersey coverage" to Hornet for the Pennsylvania workers' compensation award. Accordingly,
the court denied Zurich's motion for summary judgment and granted Garden State's cross-motion.
We conclude that the policy Zurich issued to Hornet only provided coverage for
workers' compensation benefits awarded under the New Jersey Workers' Compensation Act. Therefore, we
reverse the orders denying Zurich's motion for summary judgment and granting summary judgment
to Garden State.
It is the court's responsibility "in construing . . . [a] polic[y] of
insurance, as with any other contract, . . . to search broadly for
the probable common intent of the parties in an effort to find a
reasonable meaning in keeping with the express general purposes of the polic[y]." French
v. N.J. Sch. Bd. Ass'n Ins. Group,
149 N.J. 478, 493-94 (1997) (quoting
Royal Ins. Co. v. Rutgers Cas. Ins. Co.,
271 N.J. Super. 409, 416
(App. Div. 1994)). It cannot be "emphasize[d] too strongly that when an insurance
policy is clear and unambiguous . . . the court is bound to
enforce the policy as it is written." Id. at 494 (quoting Royal Ins.
Co., supra, 271 N.J. Super. at 416).
Under the clear and unambiguous terms of the policy Zurich issued to Hornet
in accordance with the NJWCIP assigned risk plan, coverage was limited to workers'
compensation benefits awarded under the New Jersey Workers' Compensation Act, N.J.S.A. 34:15-1 to
-128. Part 1(b) of the policy stated:
We will pay promptly when due the benefits required of you by the
workers compensation law.
The general section defined "workers compensation law" to mean "the workers or workmen's
compensation law . . . of each state or territory named in Item
3.A. of the Information Page." Item 3A of the information page stated:
WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation
Law of the state(s) listed here:
NJ
Item 3C of the information page stated:
OTHER STATES INSURANCE: Part Three of the policy applies to the states, if
any, listed here:
COVERAGE EXCLUDED
In addition, section 3(A)(4) of the policy stated:
If you have work on the effective date of this policy in any
state not listed in Item 3.A. of the Information Page, coverage will not
be afforded for that state unless we are notified within thirty days.
Therefore, these policy provisions clearly and unambiguously indicated that unless "other states" coverage
was provided under item 3(C) of the information page, which Hornet's policy explicitly
excluded, coverage was provided solely for New Jersey workers' compensation benefits and not
for workers compensation benefits awarded under the laws of any other state.
In addition to these policy provisions, an insert accompanying the policy, which was
required under instructions issued by the NJWCIP, stated:
ATTENTION
NOTICE TO POLICYHOLDERS
IF YOU HAVE EMPLOYEES WHO TRAVEL OR WORK OUT OF STATE, YOU MAY
NEED ADDITIONAL WORKERS' COMPENSATION INSURANCE. CONSULT YOUR INSURANCE ADVISOR OR CARRIER PRIOR TO
COMMENCEMENT OF OPERATIONS IN ANY STATE NOT LISTED ON YOUR POLICY.
Despite the clarity of the policy language and the notice accompanying the policy
that the coverage provided by Zurich was limited to benefits awarded under the
New Jersey Workers' Compensation Act, the trial court held that Zurich must pay
the portion of the judgment entered by the Pennsylvania Bureau of Workers' Compensation
for which Zurich would have been liable if Kegarise's widow had filed her
claim in the New Jersey Division of Workers' Compensation. The trial court did
not determine the amount of such liability or indicate how this determination would
be made.
See footnote 1
Nor did the court point to any policy language that supported
its conclusion that the Zurich policy provided coverage not only for workers' compensation
benefits awarded under the New Jersey Workers' Compensation Act but also for the
portion of an award made under the laws of another state that hypothetically
would have been awarded if the claim petition had been filed in New
Jersey rather than that other state.
Instead, the trial court relied upon this court's decision in Toebe v. Employers
Mut. of Wausau,
114 N.J. Super. 39 (App. Div. 1971) to support imposition
of such liability upon Zurich. In that case, an employee of a Minnesota
trucking company suffered a work-connected injury while operating one of his employer's trucks
in New Jersey. The employee filed a claim petition in the New Jersey
Division of Workers' Compensation and was awarded benefits. When the employer failed to
pay the award, the injured employee filed a Law Division action against the
employer's workers' compensation insurer. Id. at 41. The insurer defended on the ground
that the policy it had issued to the employer only provided coverage for
benefits payable under the Minnesota workers' compensation law. Id. at 43. In support
of this defense, the insurer relied on a provision of the declarations page
of the policy, which stated:
Coverage A of this policy applies to the Workmen's compensation law . .
. of each of the following states: Minnesota.
[Ibid.]
The court rejected this defense and held that "an insurer may be liable
for an award granted in a state other than that specified in the
policy, to the extent that the award would have been granted under the
compensation law of the latter state." Id. at 48. In reaching this conclusion,
the court stated that "by holding defendant insurer liable for only that portion
of the award, be it part or all, as would have been recoverable
pursuant to Minnesota's workmen's compensation law, the terms of the policy and its
premium base are not changed." Id. at 49.
The Supreme Court granted the insurer's petition for certification, Toebe v. Employers Mut.
of Wausau,
58 N.J. 599 (1971), and on March 21, 1972, the Court
held oral argument, Toebe v. Employers Mut. of Wausau,
63 N.J. 198 (1973).
On May 2, 1972, with the consent of the parties, the Court
entered an order that stated in pertinent part:
See footnote 2
(1) that plaintiff shall within 60 days from the date hereof institute an
appropriate proceeding in the State of Minnesota against the employer and also against
the defendant carrier if permitted by Minnesota law to join the carrier, for
the recovery of workmen's compensation benefits arising out of the accident involved in
the present proceeding;
(2) that the defendant carrier shall accept service of process in such proceeding
on behalf of its assured and also on behalf of itself if it
is also a party defendant;
(3) that the defendants in the Minnesota proceedings shall not dispute their liability
to plaintiff for the payment of workmen's compensation benefits under the Minnesota law
and shall not assert any claim that notice was not given or that
the proceedings were not instituted timely, all to the end that the amount
of such liability shall be determined and an appropriate judgment entered therefor in
the State of Minnesota;
(4) that upon the satisfaction of such judgment in the State of Minnesota,
the proceedings before this Court shall be terminated by an order reversing the
judgment of the Appellate Division and directing the dismissal of the proceedings in
this State against the defendant carrier, all such orders in this State to
be entered without costs in favor of any party[.]
On May 9, 1973, counsel notified the Court that the claim petition filed
by the employee with the Minnesota Workmen's Compensation Commission had been settled and
that the employee had been paid Minnesota compensation benefits in accordance with the
terms of that settlement. After receiving this notice, the Court entered an order
on June 19, 1973, in accordance with the May 2, 1972 consent order,
"reversing the judgment of the Appellate Division and directing the dismissal of the
proceedings in [New Jersey] against the defendant carrier." Toebe, supra, 63 N.J. at
199. Since the Supreme Court reversed the judgment of the Appellate Division in
Toebe based on the award of compensation benefits in Minnesota, we do not
believe that the Appellate Division decision in Toebe is entitled to any precedential
weight.
In any event, the provisions of the insurance policy involved in Toebe were
not comparable to the policy Zurich issued to Hornet. Although the policy involved
in Toebe contained a provision similar to item 3A of the Zurich information
page, which stated that the workers' compensation coverage provided therein applied to a
specified state, in that instance Minnesota, there is no indication the policy involved
in Toebe included a provision for "Other States Insurance" coverage, which the employer
had explicitly excluded from its coverage, as Hornet did in this case. Nor
is there any indication that the policy contained a provision comparable to 3(A)(4)
of the Zurich policy, which provided: "If you have work on the effective
date of this policy in any state not listed in Item 3.A. of
the Information Page, coverage will not be afforded for that state unless we
are notified within thirty days[,]" or an accompanying notice to the policyholder that
additional coverage may be needed if it has any employees who travel or
work out-of-state. Therefore, even if this court's decision in Toebe were supportable under
the terms of the policy involved in that case, the result in Toebe
could not be justified under the clear and unambiguous language of the Zurich
policy limiting Hornet's coverage to workers' compensation benefits awarded under the New Jersey
Workers' Compensation Act.
Garden State also argues, in the alternative, that Zurich is estopped from denying
coverage for Kegarise's Pennsylvania claim petition because it did not disclaim coverage in
a timely manner. This argument is clearly without merit. Zurich notified Hornet by
letter dated September 5, 2001, less than a month after the filing of
Kegarise's Pennsylvania claim petition, that the Zurich policy "[does] not provide coverage in
Pa[,]" and that unless Hornet has a separate policy for its workers' compensation
liability in Pennsylvania, it "will need to retain counsel to defend [its] position."
Accordingly, the orders denying Zurich's motion for summary judgment and granting summary judgment
to Garden State are reversed.
Footnote: 1
The parties subsequently entered into a settlement agreement establishing this amount. The
determination whether this amount is payable by Zurich or Garden State is contingent
upon the outcome of the present appeal.
Footnote: 2
Although this order is not published in the New Jersey reports, it is
on file with the Clerk of the Supreme Court.
A-