SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
A-4107-95T3
LAWRENCE BROMFELD and
CAROLE ANN BROMFELD,
Plaintiffs-Respondents,
v.
THE HARLEYSVILLE INSURANCE
COMPANIES and HURON INSURANCE
COMPANY,
Defendants-Appellants.
__________________________________________________
Argued January 7, 1997 - Decided February 27, 1997
Before Judges Dreier, Newman and Villanueva.
On appeal from the Superior Court of New Jersey,
Law Division, Essex County.
Michael J. Mernin argued the cause for appellants
(Gennet, Kallmann, Antin & Robinson, attorneys;
Mr. Mernin, of counsel and on the brief).
Allan Maitlin argued the cause for respondents
(Sachs, Maitlin, Fleming, Greene & Wilson,
attorneys; Mr. Maitlin, of counsel and on the brief).
The opinion of the court was delivered by
VILLANUEVA, J.A.D.(retired and temporarily assigned on recall).
Defendants, Huron Insurance Company (Huron) and The Harleysville Insurance Companies (Harleysville), appeal from a summary judgment entered against them in the amount of $107,151.92 plus interest for damages caused by the collapse of a basement wall
in plaintiffs' house. HuronSee footnote 1 had issued a homeowner's insurance
policy ("Policy") which plaintiffs claim covered the loss or they
reasonably expected covered the loss.
Plaintiffs, Lawrence Bromfeld and Carole Ann Bromfeld, have
been living at 48 Wingate Drive, Livingston, New Jersey, since
February of 1970. Their house is a typical two-story suburban
design. On January 28, 1994, Mrs. Bromfeld returned home to find
that her basement was flooded and various items, including
furniture, were floating in the water. Upon closer inspection,
Mrs. Bromfeld determined that the water was approximately one-foot
deep. She also noticed that the entire rear exterior wall had
caved into the basement, and that the ceiling on the same side of
the basement was down and the lighting fixtures were hanging from
the ceiling. Plaintiffs moved out of the house for almost seven
months and lived elsewhere until the damage was repaired.
On January 27, 1994 at 1:00 a.m. there had been seven inches
of snow cover which was reduced to one inch from the rain and
above-freezing temperatures. Although it had been raining the
following morning, it was not raining at the time that Mrs.
Bromfeld made her observations.
Plaintiffs made a claim under the Policy. Defendants did not
deny the claim nor honor it. On July 22, 1994, plaintiffs filed a
complaint in the Superior Court seeking compensatory and punitive
damages for defendants' breach of the Policy and their covenant of
good faith. No answer was filed to the complaint until December 6,
1994. In the interim, on August 19, 1994, plaintiffs demanded an
appraisal of their loss pursuant to the terms of their insurance
policy. When no response was made, on October 20, 1994, plaintiffs
filed a motion to compel the appraisal. In March 1995 the
defendants complied.
The defendants' appraiser and the plaintiffs' appraiser agreed
on the building loss of $85,631.92, personal property loss of
$7,520 and a loss of use of the premises of $14,000, for a total
loss of $107,151,92. The plaintiffs' expert, John J. Hare, was
deposed and testified that:
[T]he wall collapsed due to the additional
loads applied eccentrically to the foundation
wall due to the installation of the wood deck
combined with the unusually high snow/ice
loads coupled with wind. The wall collapsed
catastrophically due to the lack of any
available tensile bond strength of the
interior shell of the masonry.
In his report Hare stated:
Due to the nature of the construction of wood frame exterior bearing walls, roof wind and snow floor loads, as well as wall wind loads, are transmitted eccentrically to the foundation wall. This generates bending stresses, both tension and compression, in the foundation wall which must be counteracted by internal resistance within the wall. The wall is acting as a beam/column with an eccentrically applied vertical load. The lack of mortar bond at the interface of the 8" to 12" transition prevented the wall from developing an internal couple to resist the eccentrically applied loads. The addition of the exterior deck magnified the above problem in that the surcharge snow drift load which would normally accumulate at the ground level 2-1/2 to 3 feet below the mud sill, was transferred by the ledger board of the deck to the header at the face of the first floor joists, applying this additional load
eccentrically to the 8" masonry upper course.
It is my professional opinion that the failure
[was] initiated at the upper portion of the
wall which fell inward to hit and be
restrained by the interior wood stud wall.
This caused the wall to crack at the base
which then slid inward kicking out the bottom
of the stud wall.
The defendants' expert, Henry R. Naughton, attributed the
collapse to underground soil pressure on the rear foundation wall,
specifically indicating in his report that the collapse was "the
result of excessive lateral loading from the wet soil and not as a
consequence of eccentric loading from the deck." He concluded that
the wall collapsed "as a result of rain and warmer temperatures,
water infiltrated the soil increasing the lateral pressure against
the wall and decreasing the soil strength. The increased wet soil
lateral pressure caused the wall to fail and the decreased soil
strength resulted in a soil shear failure driving a soil wedge into
the basement area." Although defendants sent their expert to
examine the premises within five days of the loss, they never
advised plaintiffs whether the loss would be paid.
Defendants moved for summary judgment to dismiss plaintiffs'
complaint. Plaintiffs opposed the motion and cross-moved for
summary judgment. After hearing argument, the trial court ruled
from the bench that the Policy violates the New Jersey Plain
Language Law, N.J.S.A. 56:12-1 to -13, and the reasonable
expectations doctrine. An order granting summary judgment to the
plaintiffs against defendants in the amount of $107,151.92 together
with prejudgment interest in the amount of $3,745, for a total of
$110,896.92 was entered on March 15, 1996.
On March 28, 1996, defendants filed a notice of appeal. On
April 2, 1996, the trial court filed a fourteen-page supplemental
written opinion.
entitled to a finding of no liability pursuant to N.J.S.A.
56:12-5. Section 5 of the Plain Language Law protects an insurer
from liability under that statute where the insurer has followed
(or relied upon a predecessor having followed) the established
procedure for obtaining "plain language" approval of a policy form.
It provides as follows:
Nonliability Conditions
There shall be no liability under sections 3 and 4 if: a.
both parties to the contract have performed their
obligations under the contract, b. the creditor, seller,
insurer or lessor attempts in good faith to comply with
this act in preparing the consumer contract, c. the
contract is in conformity with a rule, regulation, or the
opinion or interpretation of the Attorney General or the
Commissioner of Insurance, in regard to contracts of
insurance provided for in subsection c. of section 1 of
this act (C. 56:12-1c), or d. the consumer supplied the
contract or the portion of the contract to which the
consumer objects.
[N.J.S.A. 56:12-5 (emphasis supplied).]
As provided by subsection (c) of Section 5, an insurer cannot
be liable under Sections 3 or 4 (N.J.S.A. 56:12-3 and 4) if the
policy it issued is in "conformity with a rule, regulation, or the
opinion or interpretation ... of the Commissioner of Insurance."
Furthermore, Section 8 provides that the Commissioner of
Insurance ("Commissioner") may certify policies such as the Policy
in question, and, at subparagraph (d), provides:
Any consumer contract certified pursuant to
this section is deemed to comply with this
act. Certification of a consumer contract
pursuant to this section is not otherwise an
approval of the contract's legality or legal
effect.
[N.J.S.A. 56:12-8d.]
The two sections clearly anticipate the promulgation by the
Commissioner of regulations regarding approval of policy forms
under the statute, and explicitly protects insurers relying on
approved forms.
Pursuant to N.J.S.A. 56:12-1 to -13, the Commissioner
promulgated regulations pertaining to the implementation of the
Plain Language Law, codified at N.J.A.C. 11:2-18 et seq., which, in
effect, provide that defendants had no obligation to obtain
independent certification from the Commissioner as to the Policy's
compliance with the Plain Language Law. As stated in Section 11:2-18.5(e) of the New Jersey Administrative Code:
Pursuant to N.J.S.A. 56:12-5, an insurer need
not request an opinion as to compliance with
the Plain Language Law for policy forms
identical to those which have already been
certified for some other insurer or rating
organization.
Pursuant to the Plain Language Law and procedures established by the Commissioner, the HO-3 policy form (which comprises the bulk of the coverage terms and conditions of the Policy) was approved by the Commissioner and adopted by defendants for use. It is not in dispute that the policy terms to which plaintiffs object are part of the form so approved. The Office of the Commissioner confirmed that the HO-3 policy form in question had been submitted by the Insurance Services Organization with the appropriate request for Plain Language Certification, and that the policy form was subsequently approved. Although the Office of the Commissioner did not provide the form or correspondence which specifically approved the policy form, it stated: "As you will note, the matter was not
specifically addressed, but appears subsumed in the general
approval of the filing in December 1986."
Plaintiffs argue that the entire Policy, as assembled, should
have been submitted to the Commissioner for statutory approval.
Again, such a requirement would negate the effect of the statute
which protects subsequent insurers when they use an approved form.
The Code and statute read together clearly do not anticipate such
submission and resubmission ad infinitum.
In this case, the statute specifically anticipates the
Commissioner's regulations on this precise issue; the regulations
are on their face within the authority delegated, and the
regulations are presumptively valid. Medical Society of New Jersey
v. Dept. of Law & Public Safety,
120 N.J. 18, 25 (1990). As such,
plaintiffs bear the burden of demonstrating that the regulations
are not valid.
The statutory and administrative framework protects defendants
from liability under the Plain Language Law, and plaintiffs have
failed to show that the Commissioner's regulations are not valid.
The defendants argue that the Policy is unambiguous, and is
crafted to explain the coverage provided in as clear a fashion as
possible. They argue that the Policy provided certain defined
collapse coverage to the plaintiff's dwelling at "Section I
Perils Insured Against" which provides:
COVERAGE A - DWELLING and
COVERAGE B - OTHER STRUCTURES
We insure against risks of direct loss to
property described in Coverages A and B only
if that loss is a physical loss to property;
however, we do not insure loss:
1. involving collapse, other than as provided
in Additional Coverage 8.
[SECTION I - PROPERTY COVERAGES]
The Section entitled "Additional Coverages" begins at page 3,
and contains eight numbered subparts. Number 8 of "ADDITIONAL
COVERAGES" is labeled, in bold print, "Collapse." It provides:
8. Collapse. We insure for direct physical
loss to covered property involving collapse of
a building or any part of a building caused
only by one or more of the following:
a. Perils Insured Against in Coverage C -
Personal Property. These perils apply to
covered building and personal property for
loss insured by this additional coverage;
b. hidden decay;
c. hidden insect or vermin damage;
d. weight of contents, equipment, animals or
people;
e. weight or rain which collects on a roof;
or
f. use of defective material or methods in
construction, remodeling or renovation if the
collapse occurs during the course of the
construction, remodeling or renovation.
Loss to an awning, fence, patio, pavement, swimming pool, underground pipe, flue, drain, cesspool, septic tank, foundation, retaining wall, bulkhead, pier, wharf or dock is not included under items b, c, d, e and f unless
the loss is a direct result of the collapse of
a building.
Collapse does not include settling, cracking,
shrinking, bulging or expansion.
This coverage does not increase the limit of
liability applying to the damaged covered
property.
Under "ADDITIONAL COVERAGES" 8, the Policy again refers to another
policy section, incorporating additional covered causes of
collapse.
Defendants argue that the section referenced, "Perils Insured
Against in Coverage C - Personal Property" is clearly identified
and labeled, and is on page 6, the following page. Defendants
argue further that this cross-reference reveals that the Policy is
structured so as not to contradict itself because the Policy takes
care to include this coverage, so that a policy holder's collapse
coverage and personal property coverage conform with one another
with respect to the perils insured against. To the extent that
these provisions are "exceptions to exceptions," defendants assert
that they are clear and necessary to the efficient explication of
collapse coverage.
At his deposition, plaintiffs' expert testified that the
collapse was caused, in part, by improper methods of construction.
Defendants, therefore, argue that plaintiffs adopted below the
theory of causation offered by defendants' expert, namely
underground soil pressure, caused by water saturation far from the
house, and water pressure is in turn excluded from coverage. Thus,
defendants contend that regardless of which of plaintiffs' theories
is correct, or if both evaluations are in part correct, or if
defendants' expert alone is correct, there is no coverage.
In addition, defendants argue that none of the proferred
causes of collapse are covered. Specifically they assert that even
if plaintiffs' expert's cause of collapse is accepted, it was an
excluded loss, and therefore not covered by the Policy. In
addition, the Policy contains the following exclusion:
1. We do not insure for loss caused directly
or indirectly by any of the following. Such
loss is excluded regardless of any other cause
or event contributing concurrently or in any
sequence to the loss.
* * *
c. Water Damage, meaning:
(1) flood, surface water, waves,
tidal water, overflow of a body of
water, or spray from any of these,
whether or not driven by wind;
(2) water which backs up through
sewers or drains; or
(3) water below the surface of the
ground, including water which
experts pressure on or seeps or
leaks through a building, sidewalk,
driveway, foundation, swimming pool
or other structure.
* * *
However, as plaintiffs note under "COVERAGE C- PERSONAL
(sic) PROPERTY" it states:
" COVERAGE C - PERSONAL PROPERTY "
We insure for direct physical loss to the
property described in Coverage C caused by a
peril listed below unless the loss is excluded
in Section 1 - Exclusions.
...
11. Weight of ice, snow or sleet which causes damage to
a building or property contained in the building."
Looking at the policy itself, there may be a basis for
coverage. "Section I," which defines the perils insured against,
appears on page five of fifteen pages. The introductory language
of this section first grants coverage, but then there are several
exceptions, the last of which incorporates additional "Section I-Exclusions", which appears two pages later. The first of the
exceptions contained within the "Perils Insured Against" portion of
Section I states that the company does not insure against a loss
"involving collapse, other than as provided in Additional Coverage
8." Although this coverage appears on the same page, to find out
where the additional coverages start one must look through the
entire policy. Instead of proceeding forward, however, one must
first go back two pages to find the heading "Additional Coverages,"
and then go forward to find that coverage 8 was, in fact, on the
same page as the "Perils Insured Against."
There are a variety of clauses providing coverage for
collapses, the first of which is located under "Perils Insured
Against" in Coverage C-Personal Property. Moving ahead one page to
that provision, the reader sees that one of the perils insured
against for personal property is number 11 "weight of ice, snow or
sleet which causes damage to a building or property contained in
the building." Plaintiffs' expert determined that the recent
construction of a deck transmitted the weight of ice and snow onto
the house frame immediately above the foundation, and that pressure
upon the exterior face of the wall (as opposed to proper downward
pressure on the center of the wall) had a tendency to push the wall
inward, ultimately causing the wall to collapse. Defendants focus
upon this as a construction error. However, if the actual collapse
was caused by the weight of ice or snow, the provision of the
policy just noted would appear to cover plaintiffs.
Defendants' expert, McNaughton, found no excessive loading,
but rather that increased wet soil lateral pressure caused the wall
to fail. Specifically, decreased soil strength resulted in a soil
shear failure that drove a soil wedge into the basement area. The
soil pressure which itself had been caused by the movement of water
over fifty feet from the house (as McNaughton claims) should not,
however, constitute "water damage" within the policy exclusions,
nor can it be qualified as water pressure on the foundation, as
indicated under the noninsurance exceptions in the "Perils Insured
Against" provision 2b(2). In fact, there is some question whether
a collapse which has been caused by the expansion or bulging of the
foundation due to exterior pressure of the soil falls within the
term "collapse" of the Policy. This court notes that the Policy
contains a provision stating that "[c]ollapse does not include
settling, cracking, shrinking, bulging or bracket expansion."
While defendants' theory most probably does not fall within
the covered collapses of a building, it also does not fall within
any exclusion or exceptions to a peril insured against. Thus, if
the collapse was attributed to this extraneous factor combined with
the factor of the weight of the ice transmitted through the deck to
the outside face of the upper blocks of the foundation wall, then
plaintiffs would be covered.
There may be a basis for coverage here, depending upon the
testimony of the experts upon which a jury may base its findings as
to the cause of the loss. If there is need for any interpretation
for this "plain language" Policy, the trial court can do so.
Exclusions are scattered throughout the policy and are difficult to
find. For instance, collapse is a covered risk and the exceptions
seem to be buried. Defendants' expert presents a cause that is not
included, but apparently is not excluded, and thus it may be
combined with an included cause to create liability.
The natural assumption of a homeowner when he or she purchases
a homeowner's policy is to assume that he or she is covered by a
comprehensive policy that will protect him or her from an
unexpected event, such as a basement collapse. See Campbell v.
Norfolk & Dedham Mut. Fire, 682 A.2d 933 (R.I. 1996) (material
issue of fact as to whether collapse of portion of basement wall
was covered under homeowner's policy was raised by ambiguity of
material terms employed in homeowner's policy where ordinary
purchaser of policy could have reasonably understood its provisions
as insuring against such collapse, even if exclusion required that
any loss to foundation result from complete collapse of building.)
reasonable expectations doctrine. It has often been stated that
"[Insureds] are entitled to the broad measure of protection
necessary to fulfill their reasonable expectations [and they]
should not be subjected to technical encumbrances or to hidden pit-falls ...." Kievit v. Loyal Protective Life Ins. Co.,
34 N.J. 475,
482 (1961).
While insurance policies ... are contractual
in nature, they are not ordinary contracts but
are "contracts of adhesion" between parties
not equally situated .... The company is
expert in its field and its varied and complex
instruments are prepared by it unilaterally
whereas the assured or prospective assured is
a layman unversed in insurance provisions and
practices. He justifiably places heavy reli-ance on the knowledge and good faith of the
company and its representatives and they, in
turn, are under correspondingly heavy respon-sibility to him. His reasonable expectations
in the transaction may not justly be frustrat-ed and courts have properly molded their
governing interpretative principles with that
uppermost in mind.
[Allen v. Metropolitan Life Insurance Co.,
44 N.J. 294, 305
(1965)(citations omitted).]
An insurance policy is a contract. However, "while insurance policies are contractual in nature, they are not ordinary con-tracts but contracts of adhesion between parties who are not equally situated." Meier v. New Jersey Life Insurance Co., 101 N.J. 597, 611 (1986). Even the most astute insured must find his or her "bargaining power is necessarily limited." Zuckerman v. National Union Fire Co., 100 N.J. 304, 320 (1985). Insurance policies are often unilaterally "prepared by the company's experts, [persons] learned in the law of insurance who serve its interest in
exercising their draftsmanship art. The result of their effort is
given to the insured in printed form upon the payment of his
premium." Mazzilli v. Acc. and Cas. Insurance Co. of Winterthur,
35 N.J. 1, 7-8 (1961). Moreover, insurance contracts are not
typically read or reviewed by the insured, whose understanding is
often impeded by the complex terminology used in the standardized
forms. See Gaunt v. John Hancock Mutual Life Insurance Co., 160
F.2d 599, 601 (2d Cir.), cert. den,
331 U.S. 849,
67 S.Ct. 1736,
91 L.Ed. 1858 (1947).
Because of the unique nature of contracts of
insurance, courts assume "a particularly
vigilant role in ensuring their conformity to
public policy and principles of fairness."
Voorhees v. Preferred Mut. Ins. Co.,
128 N.J. 165, 175, 607 A.2d 1255 (1992). To further
that end, New Jersey courts often have con-strued ambiguous language in insurance poli-cies in favor of the insured and against the
insurer. Sears Mortgage Corp. v. Rose,
134 N.J. 326, 347, 634 A.2d 74 (1993); Walker
Rogge, Inc. v. Chelsea Title & Guar. Co.,
116 N.J. 517, 529, 562 A.2d 208 (1989); Sandler v.
New Jersey Realty Title Ins. Co.,
36 N.J. 471,
479, 178 A.2d 1 (1962); Matits v. Nationwide
Mut. Ins. Co.,
33 N.J. 488, 495, 166 A.2d 345
(1960); Hunt v. Hospital Serv. Plan,
33 N.J. 98, 102, 162 A.2d 561 (1960). Consistent with
that principle, courts also have endeavored to
interpret insurance contracts to accord with
the objectively reasonable expectations of the
insured. "Recognizing the position of laymen
with respect to insurance policies prepared
and marketed by the insurer, our courts have
endorsed the principle of giving effect to the
`reasonable expectations' of the insured for
the purpose of rendering a `fair interpreta
tion' of the boundaries of insurance cover-age." Di Orio v. New Jersey Mfrs. Inc. Co.,
79 N.J. 257, 269, 398 A.2d 1274 (1979). The
insured's "reasonable expectations in the
transaction may not justly be frustrated and
courts have properly molded their governing
interpretative principles with that uppermost
in mind." Allen v. Metropolitan Life Ins.
Co.,
44 N.J. 294, 305, 208 A.2d 638 (1965).
Moreover, we have recognized the importance of
construing contracts of insurance to reflect
the reasonable expectations of the insured in
the face of ambiguous language and phrasing,
see State, Dep't. of Envtl. Protection v.
Signo Trading Int'l.,
130 N.J. 51, 62, 612
A.2d 932 (1992), and in exceptional
circumstances, when the literal meaning of the
policy is plain. See Werner Indus. v. First
State Ins. Co.,
112 N.J. 30, 35-36, 548 A.2d
188 (1988) ("At times, even an unambiguous
contract has been interpreted contrary to its
plain meaning so as to fulfill the reasonable
expectations of the insured...."); Sparks v.
St. Paul Ins. Co.,
100 N.J. 325, 338, 495 A.2d
406 (1985); Gerhardt v. Continental Ins. Cos.,
48 N.J. 291, 297-99, 225 A.2d 328 (1966).
[Doto v. Russo,
140 N.J. 544, 556-557 (1995).]
The reasonable expectations doctrine urged by the plaintiffs
applies to insurance policies with private individuals. Nunn v.
Franklin Mutual Insurance Co.,
274 N.J. Super. 543, 550 (App. Div.
1994). In this case, where the Policy is designated as a
homeowners policy of insurance, plaintiffs argue that they expected
to be covered under the Policy for damages caused by the failure of
a wall which allows the outside backyard to come into the basement.
This was a catastrophic loss that no average person would expect to
happen and the loss is devastating to them. They argue that the
purported exclusion was not conspicuous and clear, and the average
layman would have no understanding about the apparent attempt to
exclude what obviously should have been included in the Policy, if
the exclusion applies at all. In fact, defendants' appellate
counsel did not even know if any insurance company issues a policy
which would cover the loss sustained by plaintiffs.
In Bauman v. Royal Indemnity Co.,
36 N.J. 12, 21 (1961), the
Court stated:
In all fairness to the ordinary layman who is
the average insured, an exclusion clause
should be so prominently placed and so clearly
phrased that "he who runs can read." See Lord
St. Leonard in Anderson v. Fitzgerald, 4 H. L.
C. 484, 510,
10 Eng. Rep. 551, 561 (1853).
In Gerhardt v. Continental Ins. Cos.,
48 N.J. 291 (1966), the
Court noted that previously in Bauman, it had stated "approval of
the holding in Gunther v. Metropolitan Cas. Ins. Co.,
33 N.J.
Super. 101 (Law Div. 1954), wherein
the company had deliberately described its
policy in sweeping terms as a comprehensive
personal liability policy, and had sold it as
such, and that while it had the legal right to
exclude particular types of liability, its
responsibility was to do so unequivocally. We
noted that fairness to the ordinary layman who
is the average insured dictates that
exclusions be "so prominently placed and so
clearly phrased that `he who runs can read.'"
[Gerhardt, 48 N.J. at 295-96 (citations omitted).]
Our Supreme Court has often stated that the fundamental
principle of insurance law is to fulfill the objectively reasonable
expectation of the parties. At times, even an unambiguous contract
has been interpreted contrary to its plain meaning so as to fulfill
the reasonable expectations of the insured. Werner Industries,
Inc. v. First State Ins. Co.,
112 N.J. 30, 35-36 (1988). In
Sparks v. St. Paul Ins. Co.,
100 N.J. 325 (1985), the Court
expounded upon its philosophy of according the reasonable
expectations of the insured in interpreting insurance policies,
whether there is ambiguity or not. Since understanding of the
contract through consent and negotiation rarely exists, one cannot
assume that traditional contract consent applies with insurance
contracts. The Sparks Court then states that:
Such consent can be inferred only to the
extent that the policy language conforms to
public expectations and commercially reason-able standards .... In instances in which the
insurance contract is inconsistent with public
expectations and commercially accepted stan
dards, judicial regulation of insurance con-tracts is essential in order to prevent over-reaching and injustice.
[Sparks, supra, 100 N.J. at 338 (citations omitted).]
In quoting from R. Keeton, "Insurance Law Rights at Variance
With Policy Provisions,"
83 Harv. L. Rev. 961, 967 (1970), the
Sparks Court said:
The objectively reasonable expectations of
applicants and intended beneficiaries regard-ing the terms of insurance contracts will be
honored even though painstaking study of the
policy provisions would have negated those
expectations.
[Id. at 338-39.]
The doctrine of reasonable expectations and the granting of
coverage even where the company never intended coverage, was best
described in Weedo v. Stone-E-Brick, Inc.,
81 N.J. 233 (1979). The
Court observed:
We conceive a genuine ambiguity to arise where
the phrasing of the policy is so confusing
that the average policyholder cannot make out
the boundaries of coverage. In that instance,
application of the test of the objectively
reasonable expectation of the insured often
will result in benefits of coverage never
intended from the insurer's point of view.
The benefits granted, however, will pertain to
the same landscape of risk as contemplated by
the policy in issue, that is, the "doctrine of
ambiguity" works to effectuate the consumer's
expectation that the policy purchased extended
greater coverage in the particular underwrite-ing area.
[Id. at 247].
Finally, our Supreme Court stated the general rule of
construction in searching for the reasonable expectations of the
insured as follows:
Our expressions have come in a variety of
issues and contexts, but all have indicated as
their keystone the goal of greater protection
to the ordinary policyholder untutored in the
intricacies of insurance. We have
realistically faced up to the fact that
insurance policies are complex contracts of
adhesion, prepared by the insurer, not subject
to negotiation, in the case of the average
person, as to terms and provisions and quite
unintelligible to the insured even were he to
attempt to read and understand their
unfamiliar and technical language and awkward
and unclear arrangement.... We have stressed,
among other things, the aim that average
purchasers of insurance are entitled to the
broad measure of protection necessary to
fulfill their reasonable expectations; that it
is the insurer's burden to obtain, through its
representatives, all information pertinent to
the risk and the desired coverage before the
contract is issued; and that it is likewise
its obligation to make policy provisions,
especially those relating to coverage,
exclusions and vital conditions, plain, clear
and prominent to the layman.
[Harr v. Allstate Ins. Co.,
54 N.J. 287, 303-304
(1969).]
As the Supreme Court in Sparks found that the policy of insurance did not reach the expectations of a reasonable insured and so construed a clear policy against the insurance company and found coverage, so too the trial court herein must look at the reasonable expectations of the average home owner if the court
finds that the Policy does not specifically insure this loss, and
whether the reasonable expectations of the insureds is that their
homeowner's policy covers them for such a catastrophe. Under all
the circumstances, depending upon the factual determination as to
the cause of the collapse, the trial court has to determine if
coverage should be afforded to the plaintiffs under the reasonable
expectations doctrine.
As there is a bonafide dispute as to the cause of the
collapse, that issue must be resolved by a jury as demanded by the
plaintiffs in their complaint. Thereafter, it will be up to the
trial court to interpret of the Policy, Weedo v. Stone-E-Brick,
Inc.,
155 N.J. Super. 474, 479 (App. Div. 1977), rev'd on other
grounds,
81 N.J. 233 (1979), and, if necessary, the reasonable
expectations of the insureds (plaintiffs).
We also note that if a homeowner is not covered for such a
loss, he or she very well may have a claim against his or her
insurance broker or agent for failing to obtain such coverage or,
at least, for failing to advise the homeowner as to the
availability of such coverage. Furthermore, there is nothing in
the record to show that such coverage is even available.
Reversed and remanded for further proceedings consistent with
this opinion.
Footnote: 1Harleysville is the parent company of Huron.