SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
A-0590-01T5
A-2712-01T3
JEROME EDWARDS and JOSEPH
GAROFOLO, on behalf of themselves
and all others similarly situated,
Plaintiffs-Appellants,
v.
PRUDENTIAL PROPERTY AND CASUALTY
COMPANY AND THE PRUDENTIAL PROPERTY
AND CASUALTY INSURANCE COMPANY OF
NEW JERSEY,
Defendants-Respondents.
KENNETH DAVIS, on behalf of himself
and all others similarly situated,
Plaintiff-Appellant,
v.
ALLSTATE INSURANCE COMPANY, ALLSTATE
INDEMNITY COMPANY and ALLSTATE NEW
JERSEY INSURANCE COMPANY,
Defendants-Respondents.
Argued November 18, 2002 - Decided
January 21, 2003
Before Judges Havey, Wells and Payne.
On appeal from Superior Court of New Jersey,
Law Division, Camden County, Docket Numbers
L-182-01 and L-2988-01.
John W. Trimble, Jr. and James C. Shah argued
the cause for appellants in A-0590-01T5 and
A-2712-01T3 (Morrison & Trimble, attorneys;
Mr. Trimble, Natalie Finkelman Bennett and
Mr. Shah, on the brief).
Robert J. Del Tufo argued the cause for
respondents in A-0590-01T5 (Skadden, Arps,
Slate, Meagher & Flom, attorneys; Mr. Del
Tufo and Cynthia V. Fitzgerald, on the
brief).
Mark J. Levin (Ballard, Spahr, Andrews &
Ingersoll) of the Pennsylvania Bar, admitted
pro hac vice, argued the cause for
respondents in A-2712-01T3 (Ballard, Spahr,
Andrews & Ingersoll, attorneys; Glenn A.
Harris, Mr. Levin and Margo Weinstein
(Sonnenchein, Nath & Rosenthal) of the
Chicago Bar, admitted pro hac vice, on the
brief).
The opinion of the court was delivered by
HAVEY, P.J.A.D.
Automobile general liability policies issued by the
defendant insurance companies in this case contain a Compensation
Provision, under which defendants agree to reimburse their
insureds for out-of-pocket expenses incurred while the insureds
attended court proceedings in a personal injury action defended
by the insurers. In these consolidated appeals, the central
issue is whether defendants have an affirmative duty to alert the
insureds to their right to reimbursement under the Compensation
Provision when the expenses are incurred, and to provide them
with "claim forms" in order to facilitate their reimbursement
claims. In granting defendant's motion to dismiss for failure to
state a claim, Rule 4:2-6(e), the trial court held that
defendants owed no such duty. We agree and affirm.
Plaintiff Kenneth Davis filed a class action complaint
against defendants Allstate Insurance Company, Allstate Indemnity
Company and Allstate New Jersey Insurance Company (Allstate)
asserting, among other causes of action, breach of implied
covenant of good faith and fair dealing, breach of contract, and
insurance bad faith. Plaintiffs Jerome Edwards and Joseph
Garofolo filed a separate class action advancing the same causes
of action against defendants Prudential Property and Casualty
Company and the Prudential Property and Casualty Insurance
Company of New Jersey (Prudential). In both complaints,
plaintiffs allege that: (1) they and class members are current or
former named insureds or "other" insureds under automobile
liability policies issued by Allstate or Prudential; (2) they
were named as defendants in personal injury actions for which
defendants provided a defense; and (3) they incurred lost wages
and other expenses as a result of attending pretrial court
proceedings in the underlying actions.
The policies issued by Allstate and Prudential contain a
Compensation Provision. Allstate's policy provides:
In addition to our limit of liability, we
will pay on behalf of an insured:
. . . .
4, Up to $50 a day for loss of earnings,
but not other income, because of
attendance at hearings or trials at our
request.
Prudential's policy provides:
We'll pay any reasonable bills connected with
the defense of you or any other insured
incurred at our request, such as travel
expenses to attend court. But we won't pay
more than $50 per day for actual net wages
lost if the insured has to take time off from
work.
It is undisputed that plaintiffs have never made a claim for
reimbursement under the Compensation Provisions of the policies
issued to them.
Indulgently read, plaintiffs complaints charge that
defendants are deliberately "silent" regarding their duty to
reimburse under the Compensation Provisions. Specifically,
plaintiffs complaints charge that defendants:
intentionally fail[] to inform insureds of
their right to payment under the Compensation
Provision, even though [defendants] know[]
that [they are] requiring [their] insureds to
incur expenses and likely lose wages, which
automatically entitles the insureds to
payment under the Compensation Provision.
[Defendants] know[] that the vast
majority of [their] insureds are unaware that
they are automatically entitled to benefits
under the Compensation Provision as a result
of complying with [defendants'] request that
they attend and give testimony. [Defendants
rely] on the ignorance of [their] insureds
and conceal[] the right to payment from
[their] insureds.
Plaintiffs add:
[Defendants do] not provide insureds who
have attended a deposition, hearing or trial
with any type of notification or claim form,
or any other means by which payments under
the Compensation Provision can be sought. On
information and belief, no such form exists.
[Defendants] make[] it difficult, or
impossible, for insureds to obtain the
benefits to which they are entitled under
[defendants'] policies.
[Defendants] fail[] to provide a simple
form related to the Compensation Provision to
the attorneys [they] retain to defend claims
against [their] insureds, despite the fact
that [defendants] know[] that the attorneys
will be present whenever [their] insureds are
required to attend and give testimony at a
deposition, hearing or trial.
. . . .
In addition to the lack of forms and/or
claims mechanism, upon information and
belief, [defendants train their] agents and
representatives not to inform insureds that
they are entitled to payments for lost wages
and expenses under the Compensation
Provision.
Plaintiffs seek, on behalf of themselves and class members,
declaratory and injunctive relief, disgorgement and restitution
of defendants' "wrongful profits and revenue," and compensatory
and punitive damages.
The trial court granted separate motions to dismiss made by
Allstate and Prudential under Rule 4:6-2(e). The court found no
facts in the pleadings supporting plaintiffs' claim that
defendants had created a "barrier" inhibiting plaintiffs'
opportunity to make a claim for reimbursement under the
Compensation Provisions. The court also found no duty imposed by
law that required defendants to alert plaintiffs to the
Compensation Provisions, or to provide them with claim forms when
the insureds incurred the expenses.
The standard of review is well-settled. Because this appeal
arises from defendants' motion on the pleadings under Rule 4:6-
2(e), we must assume the truthfulness of the allegations
contained in plaintiffs' complaints, giving plaintiffs the
benefit of all reasonable factual inferences that those
allegations support. F.G. v. MacDonell,
150 N.J. 550, 556
(1997). At such a preliminary stage of the proceeding, we are
not concerned with plaintiffs' ability to prove the facts alleged
in their complaints. Printing Mart-Morristown v. Sharp Elec.
Corp.,
116 N.J. 739, 746 (1989). Nevertheless, the motion should
be granted if even a generous reading of the allegations does not
reveal a legal basis for recovery. Camden County Energy Recovery
Assocs. v. N.J. Dep't of Envtl. Prot.,
320 N.J. Super. 59, 64-65
(App. Div. 1999), aff'd o.b.,
170 N.J. 246 (2001). The motion
may not be denied based on the possibility that discovery may
establish the requisite claim; rather, the legal requisites for
plaintiffs' claim must be apparent from the complaint itself.
Id. at 64.
Plaintiffs first argue that defendants breached an implied
covenant of good faith and fair dealing by creating a "barrier"
by their affirmative conduct that prevents insureds from availing
themselves of the reimbursement benefits under the policies. The
trial court properly rejected the claim.
A duty of good faith and fair dealing is implicit in every
contract of insurance, and the insurer has an even greater duty
than the insured to act fairly and in good faith. Clients' Sec.
Fund of the Bar of New Jersey v. Security Title & Guaranty Co.,
134 N.J. 358, 372 (1993). Such duty is grounded on the
fundamental principle that in every contract there is an implied
covenant that neither party shall commit any act which shall
destroy or injure the rights of the other party to enjoy the
fruits of the contract. R.J. Gaydos Ins. Agency, Inc. v.
National Consumer Ins. Co.,
168 N.J. 255, 277 (2001); Sons of
Thunder, Inc. v. Borden, Inc.,
148 N.J. 396, 420 (1997). Also,
"although the implied covenant of good faith and fair dealing
cannot override an express term in a contract, a party's
performance under a contract may breach that implied covenant
even though that performance does not violate a pertinent express
term." Wilson v. Amerada Hess Corp.,
168 N.J. 236, 244 (2001)
(citing Sons of Thunder, supra, 148 N.J. at 419).
This is not a case where a party to a contract commits an
act that destroys or obstructs the right of the other party to
enjoy the fruits of the contract. See id. at 251 (gas supplier
having the contractual right to set prices may nevertheless
breach covenant of good faith and fair dealing if it does so
arbitrarily "with the objective of preventing the other party
from receiving its reasonably expected fruits under the
contract"). Fairly read, plaintiffs' complaints do not assert,
as they argue, that defendants, by affirmative acts, have created
a "barrier" preventing plaintiffs from seeking reimbursement
under the policies. In essence, the claim is that the defendants
violated an implied covenant of good faith and fair dealing by
not alerting insureds to the benefits offered under the
Compensation Provision.
Insurance companies have an obligation to supply insureds
with a copy of their policy. Sears Mortgage Corp. v. Rose,
134 N.J. 326, 348 (1993). However, we have been cited to no
authority for the proposition that a duty exits to make the
insureds aware of specific provisions after the policy has been
received. Courts in sister jurisdictions have held otherwise.
See Union Auto. Indem. Ass'n v. Shields,
79 F.3d 39, 42 (7th Cir.
1996) (holding that insurer is under no duty to advise insured of
conditions or limitations under policy, applying Indiana law);
Miller v. Keystone Ins. Co.,
636 A.2d 1109, 1113 (Pa. 1994)
(absent factual basis to invoke doctrine of equitable estoppel,
insured did not act in bad faith by failing to advise insured of
statute of limitations provision under no-fault policy); Cf. 17
Couch on Insurance §238.24 (3rd ed. 2000) (an insurer is under no
duty to inform claimant of potential benefits under an insurance
policy). Nor is there a duty on the part of the insurer to
explain clearly-worded provisions in the insurance contract. See
Hess v. Allstate Ins. Co.,
614 F.Supp. 481, 487 (W.D. Pa. 1985)
(insurer is required to prove that insured received copy of
policy containing the clear and unambiguous provisions. However,
"mere allegations of failure of their insurer to explain clearly-
worded limitation are legally insufficient"), aff'd,
809 F.2d 1248 (3rd Cir. 1986).
Our courts have held fast to the general rule that an
insured is chargeable with knowledge of the contents of an
insurance policy in the absence of fraud or inequitable conduct
on the part of the carrier. Merchants Indem. Corp. v. Eggleston,
37 N.J. 114, 121-22 (1960). "Normally, insurance purchasers are
expected to read their policies and 'the law may fairly impose
upon [them] such restrictions, conditions and limitations as the
average insured would ascertain from such reading.'" Sears,
supra, 134 N.J. at 348 (quoting Bauman v. Royal Indem. Co.,
36 N.J. 12, 25 (1961)); see also Millbrook Tax Fund, Inc. v. Henry &
Assocs., Inc.,
344 N.J. Super. 49, 53 (App. Div. 2001) ("a policy
holder is obligated to read the policy he receives and is bound
by the clear terms thereof").
Here, there is no claim of fraud or misrepresentation on
defendants' part. Moreover, the Compensation Provisions are
hardly ambiguous; they alert the insured in clear and certain
terms of their entitlement to reimbursement. In the
circumstances, defendants' failure to alert plaintiffs to the
reimbursement benefits can hardly be deemed a breach of an
implied covenant of good faith and fair dealing.
Plaintiffs' breach of contract claim is also legally
deficient. The Compensation Provisions state that defendants
"will pay" the insureds' expenses, subject to limitations not
implicated here. This duty to "pay" under the provisions clearly
presupposes a request or demand for payment and the presentation
of facts supporting the claim before the insurers have a duty to
reimburse. The insureds' obligation to make such a claim is both
logical and necessary to trigger the insurers' duty to reimburse.
See 8 Corbin on Contracts, §37.11 (1999) (if only the promisee
possesses information necessary for performance of a contract
term, "notice to the promisor is, by construction of law, a
condition of the promisor's duty to perform"). For whatever
reason, in this case plaintiffs have chosen not to make any claim
for reimbursement under the policy.
We have considered plaintiffs' additional argument that
defendants have acted in bad faith and are satisfied the issues
are not of sufficient merit to warrant discussion in a written
opinion. R. 2:11-3(e)(1)(E). See Pickett v. Lloyds,
131 N.J. 457, 481 (1993).
Affirmed.