NOT FOR PUBLICATION WITHOUT THE
RAYMOND PINTO, JR.,
Plaintiff-Respondent,
v.
NEW JERSEY MANUFACTURERS
INSURANCE COMPANY,
Defendant-Appellant.
Argued: November 10, 2003 - Decided: January 21, 2004
Before Judges Havey, Fall and Hoens.
On appeal from the Superior Court of New Jersey, Law Division, Ocean County,
Docket Number L-162-02.
Glenn T. Dyer argued the cause for appellant (Connell Foley, attorneys; Brian G.
Steller, of counsel; Mr. Dyer, on the brief).
John M. Vlasac, Jr. argued the cause for respondent (Gill & Chamas, attorneys;
Mr. Vlasac, on the brief).
PER CURIAM
The issue posed by this appeal is whether the underinsured motorists (UIM) benefits
claim of an employee, injured while operating a motor vehicle owned and insured
by his employer, is effectively reduced by the "step-down" coverage clause contained in
the UIM endorsement of the employer's business auto policy to the limit of
UIM coverage contained in the employee's personal auto policy when that employee is
listed as an individual "named insured" in his personal auto policy but is
not listed as an individual named insured under the employer's business auto policy.
Here, plaintiff Raymond Pinto, Jr. was injured in an auto accident while operating
a vehicle owned by his employer that was insured by defendant New Jersey
Manufacturers Insurance Company (NJM) under a business auto policy. The NJM policy contained
a $1 million UM/UIM coverage limit, and a step-down clause in its UM/UIM
endorsement that limited UM/UIM claims to the UM/UIM coverage limit contained in any
other policy having similar coverage that listed the claimant as an individual named
insured when that claimant was not an individual named insured under the NJM
policy. The tortfeasor's auto policy had $300,000 in auto liability coverage. Plaintiff had
a personal auto policy naming him as a named insured with $100,000 in
UIM coverage.
We conclude that because plaintiff was a "named insured" under his personal auto
policy and was not a named insured under his employer's business auto policy
issued by NJM, his claim for UIM coverage under the business auto policy
was limited by the step-down clause contained in that policy's UM/UIM endorsement to
the amount of UIM coverage he elected in his personal auto policy. We
find the language of the step-down, coverage-limitation clause to be clear, unambiguous and
uncontroverted by any other provisions contained in the business auto policy issued by
NJM. Furthermore, because the limit of liability coverage contained in the tortfeasor's policy
exceeded the limit of UIM coverage contained in plaintiff's personal auto policy, plaintiff
was not an "underinsured motorist" as defined in the NJM policy. We therefore
reverse the November 22, 2002 order entered in the Law Division that had
granted summary judgment in favor of plaintiff and remand for entry of judgment
in favor of NJM on the UIM coverage issue.
In reaching these conclusions, we discern no bright-line test or rule for determining
competing UIM claims in the context of multiple policies that contain UIM coverage.
The critical factor in resolving competing claims for UIM coverage is the language
of the policies. If clear, unambiguous and uncontroverted by any other provisions contained
in the policy, courts should apply the policy language to the peculiar facts
and circumstances of each case in determining coverage issues.
In this case, the following factual and procedural history is relevant to our
consideration of the arguments advanced on appeal. Plaintiff was employed by R.W. Vogel,
Inc. (Vogel). Environmentally Clean Naturally, Inc. (ECN) was engaged in a street-cleaning project
on the northbound lanes of Route 9 in Howell Township pursuant to its
subcontract with Reilly Sweeping, Inc. Because of a manpower shortage, ECN prevailed upon
Vogel to work on the street-cleaning job. On December 22, 1997, plaintiff was
driving the lead truck in a three-vehicle street-cleaning convoy. The vehicle being operated
by plaintiff was owned by Holgate Property Associates (Holgate), another company owned and
operated by the owners of Vogel, and had been rented by ECN.
At that time and place, a Ford Expedition vehicle being operated by Theresa
Trotter struck plaintiff's vehicle from the rear, resulting in severe personal injuries to
plaintiff. The Trotter vehicle was insured by New Jersey Re-Insurance Company, which provided
liability coverage of $300,000 on a combined, single-limit basis.
Plaintiff was a "named insured" under a personal auto policy he had purchased
from Liberty Mutual/Liberty Guard (Liberty Mutual), under which he had selected UM/UIM coverage
protection in the amount of $100,000 per person and $300,000 per accident. Vogel
and Holgate were "named insureds" under the business auto policy issued by NJM
which provided UIM coverage limits of up to $1 million. At the time
of the December 22, 1997 accident, the NJM business auto policy identified no
natural persons as "named insureds."
The NJM business auto policy contained a "step-down" clause in the policy's UM/UIM
endorsement, limiting its UIM coverage to "the highest applicable limit of insurance under
any coverage form or policy providing coverage to that insured as an individual
named insured." Plaintiff filed a claim with NJM, seeking UIM coverage for his
injuries up to the policy limit of $1 million. NJM denied coverage based
upon the step-down clause in its policy pertaining to UIM coverage.
The following appeared on the first page of the NJM business auto policy
in effect at the time of the December 22, 1997 accident:
BUSINESS AUTO COVERAGE FORM
Various provisions in this policy restrict coverage. Read the entire policy carefully to
determine rights, duties and what is and is not covered.
Throughout this policy the words you and your refer to the Named Insured
shown in the Declarations. The words we, us, and our refer to the
Company providing this insurance.
Under its policy, NJM agreed to "pay all sums the insured [was] legally
entitled to recover as compensatory damages from the owner or driver of an
uninsured motor vehicle or an underinsured motor vehicle[.]" The definition of "insured" includes
"[a]nyone else occupying a covered auto[.]"
The step-down clause in dispute in the NJM business auto policy provided in
pertinent part:
D. LIMIT OF INSURANCE
1. Regardless of the number of covered autos, insureds, premiums paid, claims made or
vehicles involved in the accident, the LIMIT OF INSURANCE shown in the Declarations
for Uninsured Motorists Coverage and Underinsured Motorists Coverage is the most we will
pay for all damages resulting from any one accident with an uninsured motor
vehicle or an underinsured motor vehicle.
a. However, subject to our maximum Limit Of Insurance for this coverage, if:
(1) An insured is not the individual named insured under this policy;
(2) That insured is an individual named insured under one or more other policies
providing similar coverage; and
(3) All such other policies have a limit of insurance for similar coverage which
is less than the Limit Of Insurance for this coverage;
then the most we will pay for all damages resulting from any one
accident with an uninsured motor vehicle or an underinsured motor vehicle shall not
exceed the highest applicable limit of insurance under any coverage form or policy
providing coverage to that insured as an individual named insured.
Section F.4 of the NJM policy contained the following definition of an "underinsured
motor vehicle:"
4. Underinsured motor vehicle means the following:
a. With respect to an insured who is:
(1) Not the individual named insured under this policy, and
(2) An individual named insured under one or more other policies providing similar coverage,
underinsured motor vehicle means a land motor vehicle or trailer of any type
to which a liability bond or policy applies at the time of an
accident but its limit of liability is less than the highest applicable limit
of liability under any coverage form or policy providing coverage to that insured
as an individual named insured.
The insurance needs of Vogel and Holgate were handled by insurance brokerage companies
with which Arthur Nelson and Karen Jessie were associated. Jessie was employed by
Capacity Coverage Company, Vogel's broker. Nelson had several conversations with Roger Vogel (Roger)
about the Vogel/Holgate business automobile policy, which usually took place when Nelson would
attempt to convince Roger to consider quotes from other insurers. "[S]ometime around" 1996,
Nelson specifically discussed with Vogel how the UM/UIM provision of the business auto
policy worked. At the time of this conversation, NJM had changed its UM/UIM
coverage to include the subject step-down coverage clause. Roger understood the UM/UIM coverage
changes, he was happy with NJM and he wanted to stay with the
company.
In August 1997, Jessie placed a renewal policy with NJM without either Capacity
Coverage Company or the insureds having completed and returned the yearly commercial automobile
renewal questionnaire (which NJM had provided to Jessie in early July 1997, a
month before the renewal policy took effect), or discussing the policy with NJM.
On July 24, 1997, NJM had written to Jessie again and asked that
she "carefully review the enclosed contract for accuracy" in light of the absence
of a completed questionnaire. In both July letters, NJM offered to meet with
Jessie or the insureds at any time to discuss the policy.
Enclosed with NJM's July 24th letter was a document called "IMPORTANT CHANGES IN
YOUR AUTO INSURANCE POLICY." One of the changes was identified and described as
follows:
A NEW COVERAGE RESTRICTION
Other Insurance: The "Other Insurance" section of NJM's Uninsured and Underinsured Motorists Coverage
now imposes a limit on the total damages that an NJM policyholder can
recover if he or she is injured in an accident and more than
one policy can provide Uninsured and Underinsured Motorists Coverage. Under the new limit,
the injured person can receive no more than the highest applicable limit provided
by any one policy, either on a primary or excess basis.
Plaintiff never reviewed nor inquired about any business auto policy insuring Vogel or
Holgate. At no time prior to the accident did plaintiff have any understanding
of the coverages, terms, conditions, or limitations contained in Vogel's and Holgate's business
auto policy with NJM.
The parties disagree over whether plaintiff was acting within his duties as a
Vogel employee at the time of the accident and whether the GMC truck
being operated by plaintiff was owned and insured by Vogel and Holgate, or
simply Vogel. However, this factual dispute is not material because the truck was
clearly insured by the NJM policy, and NJM did not disclaim coverage on
the grounds that plaintiff was not acting in the course of employment or
that he was employed by an entity to which the business auto policy
did not apply.
On or about December 26, 2001, plaintiff filed a declaratory judgment complaint in
the Law Division against NJM, seeking an order requiring NJM to provide him
with UIM coverage up to the $1 million limit in the Vogel business
auto policy. NJM answered, contending that the step-down clause contained in the UM/UIM
endorsement of its policy with Vogel limited plaintiff's coverage to the UIM policy
limit in plaintiff's personal automobile policy with Liberty Mutual, under which plaintiff was
a "named insured." After discovery was completed, the parties filed cross-motions for summary
judgment.
The motions were argued in the Law Division on November 22, 2002. Citing
to the rationale set forth in Macchi v. Connecticut Gen. Ins. Co.,
354 N.J. Super. 64 (App. Div.), certif. denied,
175 N.J. 79 (2002), and Araya
v. Farm Family Cas. Ins. Co.,
353 N.J. Super. 203 (App. Div.), certif.
denied,
175 N.J. 77 (2002), the motion judge denied NJM's motion, and granted
summary judgment in favor of plaintiff. Although the record is not clear, apparently
the motion judge had concluded that the UIM coverage provided by NJM would
be "illusory" if denied to plaintiff because the "named insured" under its policy
was a business entity, not a natural person, and an entity could not
sustain personal injuries. Under that rationale, plaintiff would be considered a "named insured"
under the NJM business auto policy, entitled to compensation for his injuries up
to the full limit of its UIM coverage.
On appeal, NJM presents the following argument for our consideration:
NJM IS ENTITLED TO REVERSAL AND JUDGMENT IN ITS FAVOR SINCE THE TRIAL
COURT ERRED WHEN IT DETERMINED THAT PLAINTIFF MAY PURSUE UNDERINSURED MOTORIST COVERAGE UNDER
THE NJM BUSINESS AUTO POLICY.
We begin our analysis of this argument with a review of well-established principles
involving the construction of insurance policies. When the terms of an insurance contract
are clear, they will be enforced as written. Weedo v. Stone-E-Brick, Inc.,
81 N.J. 233, 245-50 (1979); Botti v. CNA Ins. Co.,
361 N.J. Super. 217,
225 (App. Div. 2003); Christafano v. New Jersey Mfrs. Ins. Co.,
361 N.J.
Super. 228, 235 (App. Div. 2003). However, because insurance contracts are contracts of
adhesion, ambiguous language will be construed liberally and resolved against the insurer and
in favor of coverage. Botti, supra, 361 N.J. Super. at 224; Christafano, supra,
361 N.J. Super. at 234. "A 'genuine ambiguity' exists only 'where the phrasing
of the policy is so confusing that the average policyholder cannot make out
the boundaries of coverage.'" Botti, supra, 361 N.J. Super. at 224 (quoting Weedo,
supra, 81 N.J. at 247).
Thus, when an insurance policy "does not make clear its intention to exclude
a class of claimants or claims otherwise allowed thereunder, coverage will be found
to exist," Botti, supra, 361 N.J. Super. at 224-25, so as "to comport
with the insured's objectively reasonable expectations of coverage." Christafano, supra, 361 N.J. Super.
at 234.
N.J.S.A. 17:28-1.1 governs UM/UIM coverage. Specifically, all motor vehicle liability policies, except for
basic automobile insurance policies, must include minimum UM coverage. N.J.S.A. 17:28-1.1(a). Although insurers
must offer UIM coverage to their policyholders, the statute does not require any
motor vehicle liability policy to include UIM coverage. Ibid.; N.J.S.A. 17:28-1.1(b); Aubrey v.
Harleysville Ins. Cos.,
140 N.J. 397, 404 (1995). In determining when a vehicle
is considered to be underinsured the statute provides, in pertinent part:
A motor vehicle is underinsured when the sum of the limits of liability
under all bodily injury and property damage liability bonds and insurance policies available
to a person against whom recovery is sought for bodily injury or property
damage is, at the time of the accident, less than the applicable limits
for underinsured motorist coverage afforded under the motor vehicle insurance policy held by
the person seeking that recovery. A motor vehicle shall not be considered an
underinsured motor vehicle under this section unless the limits of all bodily injury
liability insurance or bonds applicable at the time of the accident have been
exhausted by payment of settlements or judgments. The limits of underinsured motorist coverage
available to an injured person shall be reduced by the amount he has
recovered under all bodily injury liability insurance or bonds[.]
[N.J.S.A. 17:28-1.1(e).]
Thus, "the statute states that the determination whether a vehicle is underinsured requires
ascertaining whether the liability limits of the person 'against whom recovery is sought'
are 'less than' the amount of UIM coverage 'held by the person seeking
that recovery.'" Aubrey, supra, 140 N.J. at 403. Here, applying the criteria contained
in N.J.S.A. 17:28-1.1(e) in light of the step-down coverage clause of the NJM
business auto policy, the tortfeasor Trotter's vehicle could not be considered as an
"underinsured" vehicle because the liability limit of her policy ($300,000) exceeded the UIM
coverage limits of plaintiff's personal auto policy ($100,000). Conversely, if the step-down clause
is deemed inapplicable, then the tortfeasor's vehicle would be statutorily considered an underinsured
vehicle because the NJM UIM policy limit ($1 million) exceeded the liability limits
on the tortfeasor's policy with New Jersey Re-Insurance Company.
In evaluating the soundness of our conclusion that the step-down coverage in the
UM/UIM endorsement contained in NJM's business auto policy limits plaintiff's recovery of UIM
benefits to that limit of UIM coverage provided in his personal auto policy,
we must embark upon a review and analysis of the evolving and relevant
jurisprudence in the area of UIM coverage when there are multiple policies containing
UIM coverage under which a claimant is considered to be an "insured."
In Aubrey, supra, 140 N.J. at 403, the Court concluded "that UIM coverage,
which is limited to the amount contained in the insured's policy, is 'personal'
to the insured[,]" and that UIM "[c]overage is linked to the injured person,
not the covered vehicle." Ibid. Therefore, the Court concluded that "[t]he right to
recover UIM benefits depends on the UIM limits chosen by the insured." Id.
at 405. In Aubrey, the plaintiff was injured in a three-car accident while
driving a vehicle loaned to her by an automobile dealer. The dealer had
insured its vehicles through a garage policy issued by the defendant, which contained
a UIM coverage limit of $1 million. Id. at 399-400. The plaintiff received
$40,000 by settling for the liability limits of the tortfeasors' insurance policies. Id.
at 400. The plaintiff's personal auto policy provided $15,000 in UIM coverage. Ibid.
Therefore, under the terms of plaintiff's personal auto policy, she was not "underinsured[,]"
ibid., because the amounts recovered from the tortfeasors' policies exceeded the amount of
UIM coverage under her personal auto policy.
However, the plaintiff sought access to the $1 million in UIM coverage limit
contained in defendant's garage policy. Ibid. The defendant denied coverage, claiming that the
plaintiff's UIM coverage was limited to that set forth in her own policy.
Ibid. The Court agreed, concluding that limiting UIM coverage to that contained in
the plaintiff's personal auto policy comported with the plaintiff's reasonable expectations, since she
could not have reasonably anticipated the possibility of receiving benefits under the UIM
endorsements issued by the automobile dealer's carrier when she purchased her UIM coverage
under her personal auto policy. Id. at 404.
Because UIM coverage is discretionary, the Court reasoned that "a 'purchaser would reasonably
and objectively expect that he is buying such protection up to the declared
limits primarily for himself and his resident spouse.'" Ibid. (quoting Clegg v. N.J.
Auto Full Underwriting Ass'n,
254 N.J. Super. 634, 640 (App. Div. 1992)). Stated
another way, "[t]he right to recover UIM benefits depends on the UIM limits
chosen by the insured. Recovery does not depend on the limits of other
UIM policies[.]
. . ." Id. at 405.
In addition, the liability section of the garage policy in Aubrey contained a
step-down clause that limited the recovery of a customer of the automobile dealer
to $15,000, the statutory minimum. Id. at 401. The defendant's UIM endorsement did
not contain a step-down clause, but defined "insured" to include any person "occupying
a covered auto." Ibid. The Court noted, however, that the parity provision of
N.J.S.A. 17:28-1.1(b) "states that an insured's UIM coverage 'shall not exceed the insured's
motor vehicle liability policy limits. . . .'" Ibid. The Court concluded that
the plaintiff could not be considered "underinsured" under defendant's UIM endorsement because the
plaintiff's right to recovery was limited to the statutory minimum of $15,000 by
the parity provision of N.J.S.A. 17:28-1.1(b) and the step-down clause, which amount was
exceeded by the $40,000 recovered from the tortfeasors. Id. at 406.
In Taylor v. Nat'l Union Fire Ins. Co. of Pittsburgh, Pa.,
289 N.J.
Super. 593, 598 (App. Div.), certif. denied,
145 N.J. 376 (1996), and Cook-Sauvageau
v. The PMA Group,
295 N.J. Super. 620, 622 (App. Div. 1996), certif.
denied,
150 N.J. 29 (1997), we expressly rejected the proposition that Aubrey limited
a claimant's eligibility for and entitlement to UIM coverage only to that provided
in his or her personal auto policy in circumstances when the claimant also
was entitled to UIM coverage under another applicable policy. The policies in Taylor
and Cook-Sauvageau did not contain step-down provisions.
In Taylor, supra, the plaintiff was injured while driving a vehicle provided for
his personal use by his employer. 289 N.J. Super. at 595. The plaintiff
was a "named insured" on the employer's policy issued by the defendant covering
that vehicle. Ibid. The tortfeasor's liability limit was $100,000. Id. at 596. The
plaintiff's personal auto policy provided $100,000 in UIM coverage. Ibid. The employer's business
auto policy issued by defendant provided UIM coverage in the amount of $250,000
per person and $500,00 per accident. Id. at 601. Even though the plaintiff
in Taylor was not deemed underinsured under his personal auto policy, he was
considered underinsured under the business auto policy issued to his employer by the
defendant because the plaintiff was a "named insured" under that policy for his
use of the employer's vehicle. Id. at 599-600.
In Cook-Sauvageau, supra, the issue presented was "whether an employee who is injured
while operating his or her employer's motor vehicle during the course of employment
is entitled to the [UIM] coverage provided under the employer's business automobile policy
or is subject to the limits of such coverage provided under the employee's
own personal automobile policy." 295 N.J. Super. at 622. There, the tortfeasor's liability
coverage was limited to $15,000; the plaintiff's personal auto policy provided $50,000 in
UIM coverage; and the employer's business auto policy provided $1 million in UIM
coverage "to anyone occupying a covered auto," including employees. Ibid.
The plaintiff settled for the $15,000 limit of the tortfeasor's liability policy. Id.
at 622-23. Thereafter, the employer's business auto carrier sent the plaintiff's lawyer a
letter confirming that its policy was primary, took the plaintiff's statement under oath,
and obtained his medical records. Id. at 623. However, after Aubrey was decided,
the employer's carrier reversed its position, claiming that the plaintiff was only entitled
to the UIM coverage provided for in his personal policy. Ibid.
The plaintiff filed a declaratory judgment action and sought an order directing the
business auto carrier to show cause why an arbitrator should not be appointed
to determine the amount of UIM benefits to which the plaintiff was entitled
under its policy. Ibid. The trial court ruled that the plaintiff was entitled
to UIM coverage under the business auto policy because the availability of such
coverage was the reasonable expectation of both employer and employee, and "'when a
corporate entity is the insured, the personal injury coverage can only apply to
its individual employees.'" Ibid. (quoting the trial court's decision). We affirmed. Id. at
628.
We first observed that, although the UM/UIM statute only prescribed the amount of
UIM coverage that an insurer was required to offer, the insurer was "free
to offer broader UIM coverage than what is statutorily mandated." Id. at 624.
There, even though the insurer had been statutorily obligated to offer the plaintiff's
employer $500,000 of UIM coverage, the insurer chose to offer $1 million. Ibid.
We held that "so long as the statutorily mandated coverage has been offered,
the scope of the UIM benefits provided under an automobile liability policy is
determined by the language of the policy and the reasonable expectations of the
persons insured thereunder." Ibid.
Noting that Aubrey "involved a rather unusual factual situation[,]" we concluded that Aubrey
did "not stand for the proposition that only the purchaser of an automobile
insurance policy may recover UIM benefits." Id. at 625. We observed that in
Taylor we had ruled that the employee was entitled to coverage under the
business auto policy because he was a specifically named insured on the policy.
Id. at 626. Even though the plaintiff in Cook-Sauvageau had not been named
on the employer's policy, we ruled that "the essential risk for which [the
insurer]'s business automobile policy was intended to provide coverage was an accident involving
an employee's operation of one of the employer's vehicles." Id. at 627. We
held that the UIM coverage in the business auto policy in Cook-Sauvageau applied
to "any person occupying a covered auto," which clearly included someone in the
plaintiff's position. Ibid. Although an employee's own policy might also provide UIM coverage,
we held that the "other insurance" clause in standard automobile policies rendered the
employer's UIM coverage primary, and the employee's coverage secondary. Ibid. We concluded:
Consequently, it would be manifestly inconsistent with the plain language of the UIM
endorsement of [the insurer]'s business automobile policy and with the reasonable expectations of
both the employer and employee to deny the benefits of UIM coverage to
an employee injured while operating one of the employer's vehicles during the course
of employment.
[Ibid.]
We also noted that if the UIM provision of the standard business auto
policy was construed to cover only the employer, "the premium paid for UIM
coverage would not provide any meaningful benefit either to the employer or to
its employees[,]" ibid., because a corporate employer cannot itself suffer bodily injury and,
therefore, could not maintain an UIM claim unless its collision coverage was insufficient
to cover the property damage sustained by the vehicle. Id. at 627-28. Yet,
if the endorsement was construed to provide coverage to the employer's employees, then
it would provide a financial benefit not only to the employees but also
to the employer. Id. at 628. Relying on the plain language of the
UIM endorsement and "other insurance" clause of the business auto policy, as well
as the reasonable expectations of the employer and employee, we concluded that the
plaintiff was entitled to UIM coverage under his employer's business automobile policy. Ibid.
Our reasoning in Taylor and Cook-Sauvageau was approved by the Court in French
v. New Jersey School Bd. Ass'n Ins. Group,
149 N.J. 478 (1997). There,
the Court considered an employee's right to recover UIM benefits under her employer's
policy rather than her personal automobile insurance policy. Id. at 480. In French,
the plaintiff, a Hudson County Area Vocational Technical School bus driver, was severely
injured when the bus she was driving was struck from the rear by
a taxi cab. Ibid. Her claim against the taxi company was settled for
the full $25,000 liability limit of its policy. Id. at 481.
The plaintiff's personal auto policy provided for UIM coverage in the amount of
$25,000. Ibid. Plaintiff sought recovery under the school's policy, which provided for $1
million in UIM coverage. Ibid. Citing to Aubrey, the trial court limited any
UIM recovery that the plaintiff might receive to the $25,000 available under her
personal auto policy. Ibid. Because the plaintiff's UIM coverage equaled the tortfeasor's liability
coverage, she was not deemed to be "underinsured," and summary judgment was granted
in favor of the school's insurer. Ibid. We affirmed. Ibid. The Supreme Court
reversed. Ibid.
The Court held "that when an automobile accident occurs in the course of
employment, a policy 'held' by a regular employee of a business enterprise includes
the policy of the enterprise that covers the employee in the course of
employment." Ibid. Citing to N.J.S.A. 17:28-1.1(e), the Court stated that "[a] motor-vehicle tortfeasor
is 'underinsured' only when all the liability coverage insuring his or her purportedly
underinsured vehicle is less than the UIM benefits 'held' by the UIM claimant."
Id. at 483.
Concluding that its decision in Aubrey had been misconstrued, the Court ruled that
its interpretation in Aubrey of the word "held" in N.J.S.A. 17:28-1.1(e) had referred
to the "UIM policy actually purchased by or purchased for the benefit of
the prospective UIM claimant" and that the facts in Aubrey illustrated that the
Court "did not expect or intend that the amount of liability held under
a personal insurance policy would be the sole criterion or litmus test for
determining UIM coverage issues." French, supra, 149 N.J. at 485-86. More specifically, the
Court explained:
[W]e note the problem that Aubrey has apparently been interpreted by some courts
as establishing the UIM policy purchased by the injured person as not only
the policy of "comparison" (for the purpose of gauging whether a UIM claim
exists in the first place) but also as the only UIM policy that
the injured person has resort to once the threshold test is met. That
is simply too broad a reading. Indeed, other portions of the statute and
the standard uninsured/ underinsured motorist endorsement approved by the Commissioner of Insurance plainly
envision one potentially being able to secure benefits under more than one UIM
endorsement.
[Id. at 486.]
The Court noted that N.J.S.A. 17:28-1.1(c), which prohibits the stacking of UM and
UIM coverage, contemplated that one could be a named insured under multiple policies
with UIM coverage. Id. at 486-87. In addition, the standard UM/UIM endorsement definition
of an "insured," which had been approved by the Commissioner of Insurance for
use in personal automobile insurance policies, contemplated situations where "one could conceivably receive
benefits under more than one UIM policy." Id. at 487. The Court ruled
that if the "only trigger to UIM coverage were the limits 'chosen' by
an injured person, a broad class of victims such as those who did
not own or did not drive automobiles would be entirely excluded from UIM
coverage." Ibid. Because the Legislature could not have intended that these individuals would
not receive any UIM benefits under the host vehicle's policy, "a policy 'held'
by a claimant is not always a policy purchased by a claimant." Ibid.
"Others may provide coverage for the claimant." Ibid.
The Court observed that even after Aubrey, "insurance companies seemed to assume that
an employer's UIM policy would cover an employee for work-connected injuries, although there
might be a dispute about whether the employer's policy or the personal policy
would be primary." French, supra, 149 N.J. at 487. Citing to Cook-Sauvageau and
Taylor with approval, the Court noted that the essential risk for which the
carrier's business auto policy was intended to provide coverage was an accident involving
an employee's operation of one of the employer's vehicles. Id. at 488.
Thus, the Court found that it would be "manifestly inconsistent" with the plain
language of the UIM endorsement in the business automobile policy, as well as
the reasonable expectations of the employer and the employee, to deny UIM coverage
under the business auto policy to an employee who is injured while driving
one of the employer's vehicles during the course of employment. Id. at 489.
Again, it is critical to our analysis here that the business auto policies
in French, Cook-Sauvageau, and Taylor did not contain step-down clauses in their UM/UIM
business auto policy endorsements. In two subsequent decisions, the Court further considered UIM
coverage in the context of multiple insurance policies. These decisions, in dicta, reflect
the Court's tacit approval of step-down coverage limitation clauses and the definition of
an "underinsured motor vehicle" similar to those contained in the NJM policy at
issue here.
In Magnifico v. Rutgers Cas. Ins. Co.,
153 N.J. 406 (1998), the plaintiff
was injured in an automobile accident while she was a passenger in a
car driven by her friend. Id. at 409. The plaintiff's personal auto policy
contained UIM coverage with a $100,000 limit. Ibid. The UIM limit of the
driver's personal auto policy was $250,000. Ibid. Both policies exceeded the liability limit
of the tortfeasor's policy. Ibid. When the plaintiff submitted claims for UIM coverage
to both carriers, the plaintiff's carrier invoked the "other insurance" clause of its
policy and declared that its policy would be excess to the driver's carrier.
Id. at 410.
The issues presented to the Court were: (1) the total amount of UIM
coverage to which the plaintiff was entitled; (2) whether the anti-stacking provisions of
N.J.S.A. 17:28-1.1c limited the amount of UIM coverage available to the plaintiff; and
(3) the respective liability of the UIM carriers for payment of UIM benefits
to the plaintiff. Id. at 412.
The Court ruled that since the plaintiff was a permissive passenger, the driver's
policy was "held" by the plaintiff and its UIM limit of $250,000 was
available to the plaintiff. Id. at 416. The Court found that the plain
language of the "other insurance" clause in the plaintiff's policy clearly established that
the UIM coverage in the driver's policy was primary, and the UIM coverage
in the plaintiff's policy was excess. Ibid. That the plaintiff had "purchased only
$100,000 of UIM coverage under her personal policy does not affect her right
to recover the higher limit of UIM coverage to which she was expressly
entitled under the [driver's] policy." Id. at 418.
The Court also ruled that the anti-stacking provision contained in N.J.S.A. 17:28-1.1c unmistakably
limited the plaintiff's UIM recovery to the highest limit available under any one
of the policies available to that claimant, irrespective of whether any available carrier
is primary or excess. Id. at 421.
In noting, however, that carriers may limit the amount of UIM coverage contained
in their policies by insertion of step-down coverage clauses, the Court stated:
We also observe, as we did in French, supra, 149 N.J. at 494
. . . , that insurers can modify policy language in an effort
to address issues of UIM coverage and liability. The standard form of the
1996 insurance agreement on file with the Department of Insurance provides that if
an insured is not a named insured under the policy in question but
is a named insured under her own policy, then the limit of liability
under the subject policy will not exceed the highest applicable limit of liability
coverage under the named insured's policy. If included in the [driver's] policy, that
language apparently would limit [the plaintiff's] recovery under that policy to the amount
of UIM coverage provided by [her] policy.
[Id. at 418 (emphasis added).]
Following the reasoning of the Court in Magnifico, if the driver's policy therein
had contained the 1996 step-down clausewhich was, indeed, a part of NJM's policy
herethe amount of UIM coverage that the plaintiff in Magnifico could have recovered
would have been "limited" to the amount contained in her personal auto policy,
and the UIM coverage limit in the driver's policy would not have applied.
Here, Magnifico's tacit approval of the same standard step-down clause that is contained
in NJM's policy supports our conclusion that plaintiff's UIM recovery is limited to
$100,000, the UIM limit contained in his personal auto policy. Under the clear
and unambiguous language of the step-down clause in the UM/UIM endorsement of NJM's
policy, the most NJM would be required to pay to someone who was
not a "named insured" under its policy but was a "named insured" under
another policy was "the highest applicable limit of insurance under any coverage .
. . to that insured as an individual named insured." Here, the highest
applicable UIM limit under the only policy where plaintiff was identified as a
named insuredhis ownwas $100,000. Therefore, it follows that this was the most plaintiff
was entitled to recover, assuming he was actually "underinsured."
In New Jersey Mfrs. Ins. Co. v. Breen,
153 N.J. 424 (1998), the
primary issue concerned the right of a "family member" of "named insureds" under
a business auto policy to receive UIM coverage under the business auto policy
when the family member was injured in an accident while operating her own
vehicle. Id. at 425. The defendant family member's UIM coverage under her own
personal policy was $50,000. Id. at 425-26. The tortfeasor's liability limit was $100,000.
Id. at 426. The defendant lived with her parents whose business auto policy
carried $500,000 in UIM coverage. Ibid. Although the parties disputed whether the family
member had been employed by her parents' company, the business auto policy expressly
applied to family members of the "named insured." Ibid. There, the named insureds
were the family member's parents and the company. Ibid.
In holding that the UIM coverage contained in the business auto policy applied
to the plaintiff, the Court iterated its conclusion in French that "the critical
factor in UIM coverage litigation is the policy language." Id. at 431. Regardless
of whether the family member was an actual employee of her parents' company,
the Court held that its policy applied to her because it applied to
the named insureds or any family member of the named insureds. Ibid. Under
the business auto policy the Court found that the family member thus "held"
the policy as that term is used in N.J.S.A. 17:28-1.1(e). Ibid. As in
French, however, the Court emphasized that insurance companies could attempt to address issues
of UIM coverage by modifications of policy language, stating in pertinent part:
Under the standard form of the 1996 insurance agreement on file with the
Department of Insurance, a vehicle is not considered underinsured with respect to a
person not named as an insured under the policy in question but named
as an insured under her own policy, unless the liability limit under her
own policy exceeds that of the tortfeasor's vehicle. Under that formulation the tortfeasor's
vehicle in this appeal would not have been underinsured with respect to [the
defendant family member].
[Id. at 432.]
Here, the Court's putative approval in Breen of that portion of the standard-policy
definition of an "underinsured motor vehicle"the same definition contained in NJM's policy heresupports
our conclusion that plaintiff was not "underinsured." That definition would render plaintiff here
underinsured only if the tortfeasor's liability limit was less than the highest applicable
limit of UIM coverage under any policy naming plaintiff as an individual named
insured. Inasmuch as Trotter's $300,000 liability limit exceeded the $100,000 UIM per person
limit under the only policy that identified plaintiff as a named insuredhis ownhe
was not "underinsured." Therefore, plaintiff had no valid claim to the $1 million
in UIM coverage under NJM's policy.
The same step-down clause in NJM's policy in this case has been
deemed, on its face, valid and compatible with N.J.S.A. 17:28-1.1. See Botti, supra,
361 N.J. Super. at 222-23; Christafano, supra, 361 N.J. Super. at 235-36.
In Botti, supra, the plaintiff was seriously injured when, while operating a Jeep
owned by his employer, an unidentified vehicle forced him off the road. 361
N.J. Super. at 221-22. The plaintiff's employer had authorized plaintiff to take the
Jeep home on a regular basis for personal and business purposes. Id. at
222. In exchange, the plaintiff paid his employer $15 per week, which was
deducted from his paycheck, to help cover the cost of the insurance. Ibid.
The employer and two related corporations were the "named insureds" on their business
auto policy. Ibid. In addition, the business auto policy provided that anyone occupying
a covered auto was deemed an "insured" for purposes of UM coverage. Ibid.
The Jeep involved in the accident was also identified on the policy. Ibid.
Therefore, the plaintiff was considered to be an "insured" under the business auto
policy because he was occupying a covered auto at the time of the
accident. Ibid. The business auto policy's UM/UIM endorsement contained the same step-down clause
as NJM's policy here. Id. at 222-23.
In Botti, the policy's UM coverage was $1 million. Id. at 222. The
plaintiff and his wife were named insureds under a personal automobile policy with
UM coverage of $100,000. Id. at 223.
The plaintiff sought UM coverage under the CNA business auto policy. Ibid. The
business auto carrier claimed that the plaintiff's coverage was limited to $100,000 pursuant
to the explicit terms of the step-down clause in its policy. Ibid.
In the ensuing declaratory judgment action, on the plaintiff's motion for summary judgment,
the parties stipulated that the plaintiff was an "insured" entitled to coverage under
the business auto policy. Ibid. The plaintiff argued that the step-down clause did
not apply because he was actually a "named insured" by virtue of his
status as an employee who was entitled to use the Jeep for business
and personal reasons. Ibid. Moreover, because the business auto policy did not name
any individuals on the UM endorsement, the plaintiff contended that the employer must
have intended that all its employees be considered as "named insureds." Ibid.
The Botti trial court concluded that the plaintiff was a "named insured" under
the business auto policy because he was an employee who had exclusive use
of the Jeep. Ibid. Therefore, the court found that the step-down clause did
not apply to plaintiff and he was granted summary judgment. Ibid. We reversed.
Id. at 228.
We ruled that the standard UM/UIM endorsement in the employer's business automobile policy
with its step-down coverage limitation clause was not ambiguous on its face. Id.
at 226. Indeed, we held that the step-down provision was valid and enforceable.
Id. at 224. We found no factual or legal support for the plaintiff's
assertion that he was a "named insured" under the business auto policy. Ibid.
In so ruling, we carefully distinguished the meaning of "named insured" from that
of "insured." Id. at 226. We observed that, typically, the declarations page of
a policy contains the term "named insured" "followed by specific names of either
a natural person or any legally cognizable entity." Ibid. Recognizing that a legal
business entity cannot have relatives or family members, we nevertheless observed that "the
term 'named insured' is self-defining" and "refers only to the names so appearing
in the declaration." Ibid. An "insured," on the other hand, "is anyone who
is entitled to coverage." Ibid.
The policy at issue in Botti stated that the "named insureds" were the
employer and two corporate affiliates. Ibid. Nothing suggested that anyone else was a
named insured. Ibid. We concluded that the fact that the named insureds were
corporations did not render the policy language ambiguous. Ibid. We rejected the plaintiff's
claim that, because a corporation cannot sustain a personal injury, the UM coverage
was illusory, stating in pertinent part:
First, we note that the UM endorsement provides coverage for bodily injury and/or
property damage. Second, the UM endorsement does not limit coverage to the "named
insureds." In addition to the "named insureds," coverage is afforded to "anyone occupying
a covered 'auto,' or a temporary substitute for a covered 'auto.'" We further
note that the [business auto] policy covered many 'autos,' the Jeep being number
thirty-eight. Therefore, many individuals were potential UM claimants under the [business auto] policy.
Each potential claimant could receive up to $1 million in UM coverage unless
the claimant was a "named insured" in another policy providing lower UM coverage.
In the latter case, the claimant would still receive a maximum UM coverage
equal to that set by the claimant's policy. This hardly constitutes illusory coverage.
[Botti, supra, 361 N.J. Super. at 226-27.]
We also concluded that the plaintiff "could not have had an objectively reasonable
expectation of being a named insured in the [business auto] policy." Id. at
227. We recognized, however, that a reasonable expectation of coverage can overcome even
the plain meaning of a policy and, further, that an insured who has
a reasonable belief that he or she has purchased certain coverage will not
be denied that coverage if boilerplate language negates it. Ibid. Nevertheless,
[t]hat very sound principle . . . cannot help an insured who makes
a choice about coverage and later that choice turns out to have been
improvident. Here, Botti's name could have been added as a "named insured" in
the UM endorsement. This might have affected the amount of the policy premium,
but as Botti concedes, in the personal injury protection and Drive Other Car
endorsements of the [business auto] policy, other . . . employees were added
as additional insureds.
We also note that neither the declaration pages of the policy nor of
the UM endorsement created any expectation of coverage which was limited by other
provisions of the policy. The provisions of the step down clause itself are
clear and unambiguous. There is no challenge that the language used by the
drafter is capable of different construction. The only challenge is that the drafter
could not have intended for a corporate entity, or entities, to be the
sole "named insured." We have already addressed that argument.
Accordingly, because neither the step-down clause nor the term "named insured" are ambiguous,
the limitation on insurance must be enforced against Botti as written.
[Id. at 227-28 (citations omitted).]
Although the Botti case involved a claim for UM rather than UIM coverage,
the issue is the same, since the step-down clause applies to both forms
of coverage. Like plaintiff here, the plaintiff in Botti was not a "named
insured" on the policy. However, the plaintiff in Botti, like this plaintiff, was
an "insured" because he was occupying a covered auto at the time of
the accident.
Similarly, the business auto policy in Botti did not identify an individual as
a named insured, just as NJM's policy in this case named only the
business entities of Vogel and Holgate. Here, the NJM business auto policylike the
business auto policy in Botticannot be considered to have provided illusory UIM coverage
because plaintiff, and anyone else who was involved in an automobile accident while
occupying a Vogel or Holgate vehicle, was an "insured" and thereby entitled to
UIM coverage if they were not a "named insured" on any other auto
insurance policy.
An analysis of Christafano, supra, yields the same conclusion. There, the plaintiff was
severely injured when he was forced off the road by an unidentified vehicle.
361 N.J. Super. at 231. The plaintiff was insured for UM benefits under
three different policies. Ibid. Under his personal auto policy the plaintiff had $25,000
in UM coverage. Ibid. He also was insured for $100,000 in UM coverage
as a "family member" by a personal auto policy that had been issued
to his sister, and for $300,000 in UM coverage under a personal auto
policy that had been issued to his mother. Ibid. The plaintiff demanded that
each of these companies pay their prorated share of the highest available UM
limit. Id. at 231-32.
The mother's carrier declined coverage, claiming that the step-down coverage clause contained in
the UM/UIM endorsement to its policy limited the plaintiff's coverage to the $25,000
UM coverage provided in his personal auto policy, prorated among the three carriers.
Id. at 232.
On the plaintiff's order to show cause, the motion judge ordered the defendant
to arbitrate the UM claim and declared the maximum UM exposure of the
mother's carrier, on a prorated basis, to be $211,500 based upon maximum available
coverage of $300,000. Id. at 233. The motion judge found that the step-down
provision was ambiguous because it was "subject to an interpretation that the exclusionary
provision . . . is not applicable to the instant situation wherein the
other insurance provides coverage to the other person, the plaintiff . . .
as a direct named insured in the amount of $25,000." Ibid.
In reversing, we concluded that the step-down clause limiting coverage was
clear and unambiguous and limits [the mother's carrier's] UM coverage to that afforded
by [the plaintiff's carrier's] policy because the three enumerated conditions [of the step-down
clause] are met. Namely, plaintiff is not the named insured under the [mother's]
policy, but is a named insured under [his personal auto] policy, which provides
UM coverage with lesser limits of liability than the [mother's] policy.
[Id. at 235.]
We are persuaded by the rationale in Christafano. The correct provision of the
policy that was applicable there although worded slightly differentlyis the same as the
provision applicable here. Here, plaintifflike the plaintiff in Christafanowas a named insured under
his personal auto policy. Like the plaintiff in Christafano, who could not assert
a UM claim against the defendant's policy, the plaintiff here cannot assert a
UIM claim against NJM's $1 million UIM policy limit because NJM's liability cannot
exceed the highest applicable limit under the policy in which plaintiff is a
named insured. Here, plaintiff's personal auto policy with Liberty Mutual has a maximum
UIM limit of $100,000 per person.
We also conclude that our holdings in Botti and Christafano are not contrary
to our rulings in Araya and Macchi. In Araya, supra, 353 N.J. Super.
at 206, the plaintiff appealed a summary judgment order dismissing his declaratory judgment
action seeking UIM coverage under his employer's business auto policy. The plaintiff was
employed as a landscaper by Mahon Landscaping, a sole proprietorship owned by Christopher
Mahon (Mahon). Ibid. While trimming someone's lawn, the plaintiff was struck from behind
by a car and seriously injured. Ibid.
The plaintiff sued the driver who hit him but settled the case for
$100,000, which was the liability limit of the driver's auto insurance policy. Ibid.
The plaintiff then made a claim for UIM coverage under his employer's policy,
which carried a $500,000 policy limit. Ibid. The employer's business auto carrier denied
coverage on the ground that the plaintiff was not an "insured" under its
policy. Ibid. According to the business auto carrier, the policy had been issued
to Mahon personally. Ibid. The motion judge agreed. Ibid.
On appeal, we determined that the issue of coverage turned on whether the
"named insured" was Mahon personally or his business. Ibid. Although we found that
the named insured in the policy was the business, the plaintiff was nevertheless
entitled to UIM coverage pursuant to our holding in Cook-Sauvageau. Id. at 207.
Although the policy identified Mahon and his business as the named insureds, id.
at 208, we ruled that the only named insured was the business because
of the facts surrounding the issuance of the policy. Id. at 208-09. When
the business auto carrier sold the commercial policy to the business, the agent
had provided premium quotes that included UIM coverage for each of the business's
vehicles. Id. at 207. The agent knew that Mahon had personal insurance policies,
and he believed that the vehicles covered under the business policy would only
be used in connection with the landscaping business. Id. at 207-08. In addition,
Mahon, Rafael A. Rojas, and the plaintiff were listed as covered drivers. Ibid.
That had been done at Mahon's direction because "he wanted them to be
covered to the same extent that he was himself." Id. at 208-09. It
was Mahon's intention to include Rojas and the plaintiff as named insureds under
the policy, and the defendant had never explained to Mahon that he (Mahon)
was covered in more situations than his employees under the policy. Id. at
209. Thus, there was nothing about the policy that would have alerted anyone
to the fact that it was intended to only provide personal coverage to
Mahon. Ibid.
The UM/UIM endorsement to the policy in Araya did not expressly apply to
the plaintiff because he was a pedestrian at the time of the accident.
Ibid. Nevertheless, we "construe[d] this automobile insurance policy consistent with the insured's reasonable
expectations of coverage." Ibid. Citing to Lehrhoff v. Aetna Cas. & Sur. Co.,
271 N.J. Super. 340, 346-47 (App. Div. 1994), we noted that the declarations
page of an insurance policy was "the best indicator of what an insured's
reasonable expectations should be." Araya, supra,, 353 N.J. Super. at 209. Specifically, "'reasonable
expectations of coverage raised in the declaration page cannot be contradicted by the
policy's boilerplate unless the declaration page itself so warns the insured.'" Id. at
210 (quoting Lehrhoff, supra, 271 N.J. Super. at 347; alteration in original). We
continued:
The only reference in the Declarations Page as to who can reasonably expect
to be a covered individual for UIM purposes as an agent for the
named insured is the list of included drivers. This is the only rational
interpretation of the ambiguous language used in the UIM endorsement.
Thus, if defendant's position as to UIM coverage is accepted here it would
be reminiscent of the no-win scenario described by Judge Baime in Owens-Illinois, Inc.
v. United Ins. Co.,
264 N.J. Super. 460, 491
. . . (App. Div. 1993), as "the unholy mantra" of "we collect
premiums: we do not pay claims."
[Ibid.]
In Araya, we deemed the policy ambiguous because the defendant had failed "to
designate a natural person or persons entitled to UIM coverage under the policy."
Id. at 210-11. We noted that clearer drafting could have put the ambiguity
"'beyond reasonable question.'" Id. at 211 (quoting Progressive Cas. Ins. Co. v. Hurley,
166 N.J. 260, 274 (2001)). We concluded, as follows:
Here the drafters could have easily and unambiguously identified the named insured. If
Mahon as an individual was the intended insured, the policy should not have
included any reference to the business entity and should have clearly identified Mahon
as an individual by including the words "individually" or "personally." Conversely, if the
business entity is the insured, the employees entitled to UIM coverage should also
be clearly identified.
We hold that when a business auto policy fails to designate the insured
business entity's human agent or agents entitled to receive UIM benefits, we will
look to the Declarations Page as to the best indicator of the insured's
reasonable expectations of coverage. Any ambiguity created by boilerplate provisions found elsewhere in
the policy will be resolved against the drafters of the policy and in
favor of coverage. In this case, the covered drivers listed in the Declarations
Page provide the best indication of who is to receive UIM benefits.
There is no question under this analysis that plaintiff is entitled to UIM
benefits as if he were a named insured. His rights derive from the
issuing of the policy to a business entity and his designation as a
covered driver. Therefore, plaintiff is entitled to recover UIM benefits under this policy.
[Ibid. (emphasis added).]
Ara