JOAO ZACARIAS,
Plaintiff-Appellant,
v.
ALLSTATE INSURANCE COMPANY
and GEORGE SINCOX,
Defendants-Respondents.
______________________________
Argued March 7, 2000 - Decided April 20, 2000
Before Judges Pressler, Kimmelman
and Ciancia.
On appeal from the Superior Court
of New Jersey, Law Division,
Union County.
Gary Alan Blaustein argued the
cause for appellant.
William H. Mergner, Jr. argued the
cause for respondents (Leary, Bride,
Tinker & Moran, attorneys; John G. Tinker,
Jr., on the brief).
The opinion of the court was delivered by
KIMMELMAN, J.A.D.
Plaintiff Joao Zacarias appeals from the entry on May 15,
1998, of a summary judgment in favor of defendant dismissing
plaintiff's complaint in which he sought a declaratory judgment
that defendant was obligated to indemnify him with respect to a
negligence action brought against him by his wife for injuries
sustained in an accident while riding in a twenty-foot outboard
recreational boat owned by plaintiff.
At the time of the purchase of the boat in 1989, plaintiff
obtained from defendant through its agent, co-defendant George
Sincox, an "Allstate Boatowners Policy." The policy was renewed
annually thereafter.
On November 27, 1995, Mrs. Zacarias filed an action against
her husband, plaintiff, for damages for injuries she allegedly
sustained because of his negligent operation of the boat.
Defendant disclaimed coverage but agreed to provide a defense for
plaintiff under a reservation of rights agreement. Plaintiff then
filed a declaratory action against defendant to adjudicate
coverage. The two suits were consolidated for discovery and trial.
Defendant moved for summary judgment asserting that, as an
insured person under its policy, Mrs. Zacarias was precluded from
coverage. Plaintiff countered that (1) the preclusion of his
spouse from coverage was against public policy and that (2)
defendant should be held responsible on the theory of respondent
superior because its agent had not brought the exclusionary clause
to his attention.
While the record does not incorporate the declarations page of
the policy, it does appear that the policy provides for "Watercraft
Liability." However, under the heading labeled "Losses We Do Not
Cover," the policy provides:
We do not cover bodily injury to an insured
person or property damage to property owned by
an insured person.
An "insured person" under the policy means "the person named
on the declaration page as the insured and that person's resident
spouse." Thus, under defendant's policy, Mrs. Zacarias, as a
resident spouse, was an insured person for whom bodily injury was
excluded from coverage.
Although not raised as a direct issue on appeal by plaintiff,
it is suggested that insurance contracts are subject to special
rules of interpretation since they are contracts of adhesion
between parties of unequal bargaining power. Consequently, the
policy in question should be construed to comport with plaintiff's
reasonable expectation of coverage. Gibson v. Callaghan,
158 N.J. 662, 669-71 (1999); Doto v. Russo,
140 N.J. 544, 555-57 (1995).
However, we find the language of defendant's policy to be free
from ambiguity. The words of the policy are to be given their
plain and ordinary meaning. Longobardi v. Chubb Ins. Co.,
121 N.J. 530, 537 (1990). As a resident spouse of the named insured, Mrs.
Zacarias is an insured person. The clear language of the policy
will not support any expectation of coverage for Mrs. Zacarias'
accident. Therefore, the personal injury loss sustained by her is
not covered.
Unless the abolition of interspousal immunity, Merenoff v.
Merenoff,
76 N.J. 535 (1978), has rendered the exclusion of Mrs.
Zacarias from coverage contrary to the State's legislatively
established public policy, we are bound by the pertinent ruling of
the Supreme Court in Kampf v. Franklin Life Ins. Co.,
33 N.J. 36
(1960), where the Court said:
When the terms of an insurance contract are
clear, it is the function of the court to
enforce it as written and not to make a better
contract for either of the parties.
[Id. at 43.]
See also State v. Signo Trading Int'l, Inc.,
130 N.J. 51, 66 (1992)
and Summit Assocs., Inc. v. Liberty Mut. Fire Ins. Co.,
229 N.J.
Super. 56, 63 (App. Div. 1988).
Following the Merenoff case, this court held that the
exclusion from coverage of intra-family torts in a homeowner's
policy was not void as against public policy. Foley v. Foley,
173 N.J. Super. 256 (App. Div. 1980). We reasoned that there is no
public policy that requires a homeowner to obtain an insurance
policy protecting him/her against actions that might be brought
against him/her by anybody. Id. at 259. See also Horesh v. State
Farm Fire & Cas. Co.,
265 N.J. Super. 32, 36-37 (App. Div. 1993)
(following Foley, supra, and validating a similar exclusionary
clause applying to resident relatives of the insured).
We may not analogize this matter to the pattern of liability
insurance coverage for automobiles. In the case of automobiles
principally garaged in this state, the Legislature has mandated
compulsory automobile liability insurance coverage. N.J.S.A.
39:6A-3. Because of this mandate, claims brought by members of the
named insured's household may not be excluded from coverage.
N.J.S.A. 39:6A-4. In Weitz v. Allstate Ins. Co.,
273 N.J. Super. 548, 551-52 (App. Div. 1994), this court noted that the scope of
coverage of a primary automobile insurance policy was controlled by
law. However, we concluded that other insurance policies
"unencumbered" by statutory requirements were governed by the plain
language of the policy. Ibid.
In the absence of a legislative mandate requiring liability
insurance coverage for boat owners, we may not establish a
corresponding public policy in this case. Thus, because she was an
"insured," the claim of Mrs. Zacarias was not covered. It is clear
that the defendant's insurance policy, as written, does not run
afoul of the expressed public policy of this State.
Plaintiff's alternative claim for negligence against the agent
of defendant who sold the policy of insurance is likewise without
merit.
For the foregoing reasons, the summary judgment rendered May
15, 1998, is affirmed.
SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
A-6202-97T3
JOAO ZACARIAS,
Plaintiff-Appellant,
v.
ALLSTATE INSURANCE COMPANY
and GEORGE SINCOX,
DEFENDANTS-Respondents.
PRESSLER, P.J.A.D., dissenting.
I respectfully dissent.
Once again we have before us a non-automobile general
comprehensive and liability policy of insurance containing an
intra-family exclusion. Since automobile insurance is mandatory
and intended to protect all motorists, we have had no difficulty in
concluding that, as a matter of public policy, the insurance
contract may not exclude coverage for the named insured's liability
to members of his own family who sustain injury as a result of his
negligence. Kish v. Motor Club of Am. Ins. Co.,
108 N.J. Super. 405 (App. Div.), certif. denied,
55 N.J. 595 (1970). See also
Horesh v. State Farm Fire & Cas. Co.,
265 N.J. Super. 32, 37 (App.
Div. 1993). We have thus far, however, concluded otherwise in
respect of homeowner's insurance, which is not statutorily
mandated, and we have sustained, against the public policy
argument, the exclusion by which the carrier excepts from liability
coverage claims against the named insured made by members of his
household. Horesh, supra, 265 N.J. Super. at 37; Foley v. Foley,
173 N.J. Super. 256 (App. Div. 1980). The policy here in question
is a boat policy, and since not mandated by statute, falls
essentially into the same category as homeowner's insurance.
I dissented in Horesh, supra, 265 N.J. Super. at 39, without
confronting the basic public policy issue, having concluded that
the family exclusion could not, as a matter of reasonable
expectation and fundamental fairness, be applied in that case
because the liability claim there made by the named insured husband
on behalf of his infant son was not a direct claim against his
wife, the boy's mother. Rather, the husband had sued the
tortfeasor who, he claimed, was responsible for the boy's injury,
and the tortfeasor, seeking indemnity or contribution from the
wife, in whose care the boy was at the time of his injury, had
impleaded her on a theory of wanton and wilful carelessness. I was
of the view that the family exclusion did not and was not meant to
apply in those circumstances, carelessness in the supervision of
her child. I need not repeat here what I said there.
The basis of my disagreement with my colleagues here once
again does not require me to address the basic public policy issue.
My focus is narrower. These are my premises. I believe it is
virtually axiomatic that the named insured, in buying a liability
policy, must be credited with the reasonable expectation that all
legally cognizable liability claims against him arising out of his
use of the insured premises__here the boat__are subject to
coverage. There is nothing in this record to suggest the contrary
here or to support the conclusion that plaintiff knew of the
exclusion or had been advised thereof by the agent who sold him the
policy. Indeed, it is clear that the agent did not so advise him.
And there is, of course, no doubt that interspousal liability
claims are legally cognizable, Merenoff v. Merenoff,
76 N.J. 535
(1978), and that at least to some extent, claims by children
against parents are as well. Foldi v. Jeffries,
93 N.J. 533
(1983).
It is also well-settled that insurance policies are contracts
of adhesion required to be strictly construed against the insurer
and in favor of the insured in order to meet the insured's
reasonable expectations. See, e.g., Gibson v. Callaghan,
158 N.J. 662, 671 (1999); United Serv. Auto. Ass'n v. Turck,
156 N.J. 480,
492-493 (1998); American Motorists Ins. Co. v. L-C-A Sales Co.,
155 N.J. 29, 41 (1998); Harr v. Allstate Insurance Co.,
54 N.J. 287,
303-304 (1969). See also Restatement (Second) of Contracts, §§211
212 (1981). That principle does not govern only the interpretation
of ambiguities in the policy. As Justice Stein pointed out in
Gibson v. Callaghan, supra, 158 N.J. at 571, "[i]n exceptional
circumstances, 'even an unambiguous contract has been interpreted
contrary to its plain meaning so as to fulfill the reasonable
expectation of the insured.'" (quoting Werner Indus., Inc. v. First
State Ins. Co.,
112 N.J. 30, 35-36 (1988). Nor will a plainly
stated exclusion be enforced if doing so will defeat the essential
purpose of the policy. Sparks v. St. Paul Insurance Co.,
100 N.J. 325, 336 (l985); Kievet v. Loyal Protective Life Ins. Co.,
34 N.J. 475, 482-484, 488-489 (1961).
And finally, I think it clear that we cannot impose upon the
insured the onus of reading through and understanding the
interrelationship of coverage, exclusion and exception clauses,
whose meaning is not self-contained and self-evident but requires
rather cross-referencing to other unidentified sections of the
policy and whose meaning, once divined, is contrary to what the
declaration page otherwise reasonably suggests. Thus, as we said
in Lehrhoff v. Aetna Cas. and Sur. Co.,
271 N.J. Super. 340, 346
347 (App. Div. 1994):
There has been little judicial consideration of the
import of the declaration page of an insurance policy in
terms of the construction of the policy as a whole and in
terms of its capacity to define the insured's reasonable
expectations of coverage. We, however, regard the
declaration page as having signal importance in these
respects. A personal automobile insurance policy is a
bulky document, arcane and abstruse in the extreme to the
uninitiated, unversed and, therefore, typical policy
holder. We are persuaded, therefore, that a conscien
tious policyholder, upon receiving the policy, would
likely examine the declaration page to assure himself
that the coverages and their amounts, the identity of the
insured vehicle, and the other basic information
appearing thereon are accurate and in accord with his
understandings of what he is purchasing. We deem it
unlikely that once having done so, the average automobile
policyholder would then undertake to attempt to analyze
the entire policy in order to penetrate its layers of
cross-referenced, qualified, and requalified meanings.
Nor do we deem it likely that the average policyholder
could successfully chart his own way through the shoals
and reefs of exclusions, exceptions to exclusions,
conditions and limitations, and all the rest of the
qualifying fine print, whether or not in so-called plain
language. We are, therefore, convinced that it is the
declaration page, the one page of the policy tailored to
the particular insured and not merely boilerplate, which
must be deemed to define coverage and the insured's
expectation of coverage. And we are also convinced that
reasonable expectations of coverage raised by the
declaration page cannot be contradicted by the policy's
boilerplate unless the declaration page itself clearly so
warns the insured.
Applying these principles, I am persuaded that enforcement of
the family exclusion here would violate the insured's reasonable
expectations. To begin with, the declaration page of this policy
identifies plaintiff-husband, Joao Zacarias, as the only insured.
Next to the printed text, "Name of Insured," only his is inserted.
He is not even referred to as the "named insured," a designation
which, to a careful reader of the declaration page might suggest
some limitation or qualification to come. This is, as we have
pointed out, both a casualty and a liability policy. The terms of
the liability coverage appear on page ten, which one could locate
there either by consulting the table of contents on page one of the
policy or by simply flipping through the policy. The section
begins with the heading "Losses We Cover." Those losses are
defined as
all sums arising from an accidental loss which an insured
person becomes legally obligated to pay as damages
because of bodily injury or property damage resulting
from the ownership, maintenance, or use of covered
watercraft, boat equipment or boat trailers.
There is, of course, nothing in this definition to suggest that
there is any insured person other than the person identified as the
insured in the declarations page, and so the insured, the sole
owner of the boat here, could safely assume that if he became
legally obligated to pay damages to a family member because of his
negligence, he would be covered therefor.
Then comes the second portion of the liability coverage
entitled "Losses We Do not Cover." In addition to the usual
exclusions for intentional or criminal conduct of an insured
person, illegal or business use of the boat, workers' compensation
claims, and the like, is paragraph 2, which provides in full that:
We do not cover bodily injury to an insured
person or property damage to property owned by
an insured person.
There is still nothing to suggest to the reader of the liability
coverage that there is any insured person subject to this exclusion
other than the insured named in the declaration page.
In order for the reader of the policy to determine who is
intended by the insurer to be embraced within the phrase "insured
person" for purposes of the liability exclusion, he must refer to
paragraph 3 of the definition section appearing on page three of
the policy and to which nothing in the liability coverage sections
on page ten directs him. Then, if he properly completes this
unmapped exercise in contract construction and if does so at the
time the policy is delivered to him__both of which eventualities
I regard as remote in the case of the average buyer of
insurance__he may come to understand that even though he is
exclusively identified on the declarations page as the "insured,"
an "insured person" also includes "any relative" and "any dependent
person in your care" if "resident in your household." And then, if
he is quick witted or experienced in such matters, he may finally
indeed come to realize that the "insured person" whose liability
claims are excluded from coverage on page ten are the members of
his family with whom he lives and who are free, as a matter of law,
to sue him for negligence and to obtain damages for personal injury
from him.
I am convinced that such an exclusion, which by its nature is
prima facie contrary to the insured's reasonable expectations and
whose import is so obscure and obscured, cannot be enforced, and at
least one other jurisdiction has declined to do essentially on
these grounds. See State Farm Mut. Auto. Ins. v. Dimmer,
773 P.2d 1012 (Ariz. Ct. App. 1989). There are, in fact, other boat
insurers whose policies do not contain this exclusion,See footnote 11 and a buyer
of insurance should at least know what he is buying so that he can
make a reasonable choice among available options. The insurer here
could so easily have made this exclusion clear. Either the term
"insured person" as used in the exclusion could have expressly
incorporated by reference the definition appearing on page three
or, even more appropriately, the declaration page could have made
clear that "insured person" for liability purposes was not merely
the sole insured named thereon but also included the persons
specified in the definition. By choosing to do neither, the
insurer, in my opinion, must be deemed to have forfeited the
benefit of the exclusion.
I would reverse the summary judgment in favor of defendant and
direct the entry of summary judgment on plaintiff's cross motion.
Footnote: 1 1The report of plaintiff's insurance expert submitted in opposition to defendant's motion for summary judgment and in support of his cross motion, identifies at least three such insurers, all of whom are well known and highly reputable.