Brown MacH. Works & Supply Co. v. Ins. Co. of North Am.
Brown MacH. Works & Supply Co. v. Ins. Co. of North Am.
Opinion
This Court agreed to answer the following questions certified by the United States District Court for the Middle District of Alabama, the Honorable Ira DeMent presiding:
"(1) In a breach of contract action when an insurer fails to deliver a copy of the policy to an insured in accordance with Ala. Code 1975, §
27-14-19 , but does provide a certificate of insurance which sets out the general coverage without enumerating the limitations and exclusions,1 is the insurer estopped from asserting an otherwise valid exclusion?"(2) Would it alter the opinion of the Court if, in addition to the above facts, the insurer's agent made representations to the insured that the insured had full coverage under the policy, upon which [representations] the insured relied to its detriment?"
As phrased, the certified questions ask this Court to decide an abstract question of law. Unfortunately, the parties here have, for the most part, focused their arguments on the facts of the case rather than on the wisdom of adopting any of the various answers to this abstract question. Basically, the question is, if all facts are as the plaintiff alleges: Is there a theory upon which the plaintiff may recover in this case? Specifically, whether an exception to our long-standing rule against enlarging the coverage of an insurance policy by estoppel should be created to give effect to the statutory requirement that an insurer deliver a copy of an insurance policy to the insured. The certification of a question of law does not place this Court in a position to decide questions of fact. The defendants' motions for summary judgment are pending in the Federal court. The resolution of factual questions necessary to reach the certified questions is therefore assumed to be in the plaintiff's favor, and we set out *Page 53 the essentially uncontested facts of the case merely to provide a context within which our answer may be understood.
In June 1991, Brown Machine Works Supply Company, Inc. ("Brown"), the owner of a 1973 Cessna 421 aircraft, entered into a contract with Texas Corporate Aircraft Sales, Inc. ("TCAS"), under which TCAS would attempt to sell the aircraft. The parties agreed that TCAS would take possession of the aircraft in exchange for a check in the amount of $100,000 — post-dated to October 15, 1991. The parties agreed that if the aircraft was not sold within 120 days, then Brown would accept the check as payment in full for the aircraft.
The parties also agreed that TCAS would provide insurance on the aircraft while it was in the possession of TCAS. TCAS had a "blanket policy" with Insurance Company of North America ("INA") on all the aircraft it possessed. Coverage under that policy for Brown's Cessna 421 was issued by INA and was secured through Bodi Wachs Aviation Insurance Agency ("Bodi Wachs").
On June 5, 1991, Brown received a copy of a certificate of insurance issued by Bodi Wachs on behalf of INA. The certificate stated, in pertinent part, the following:
"Brown Machine Supply Company is named as the owner/lessor and additional insured only as respects the operations of the named insured effective 6/6/91.
"Certificate of Insurance does not amend, extend, or otherwise alter the terms and conditions of insurance coverage contained in policies listed above issued by Insurance Company of North America."
The certificate also has "All Risks" printed under the "Aircraft Physical Damage" designation of the type of policy and lists the corresponding "Limits of Liability" as being "Not Less Than . . . $105,000 Value Insured."
It is undisputed that Brown did not obtain a copy of the policy of insurance until after Brown had filed a complaint against INA and Bodi Wachs. In October 1991, Brown discovered that TCAS, by forging a certificate of title to the aircraft, had sold it to a third party. Brown then attempted to cash the $100,000 check, but TCAS had stopped payment on it.
Brown began to inquire whether the policy issued by INA provided theft coverage. The parties dispute when and if a representative of Brown actually spoke with a representative at Bodi Wachs. The parties also dispute whether a representative at Bodi Wachs informed Brown that it had coverage for the theft of its aircraft. On July 22, 1992, Brown filed a claim with INA for coverage under the policy's theft provision. The policy INA had issued to TCAS had been cancelled in October 1991 for nonpayment of premiums. INA rejected Brown's claim, asserting that the policy did not provide for theft coverage to Brown as an additional insured and that, even if it did, exclusion 12 of the policy excluded coverage for "conversion."2 The parties dispute whether TCAS's illegal sale of the aircraft constituted conversion or theft.
Brown argues that because INA failed to deliver a copy of the insurance policy to it, INA cannot now assert exclusions of which Brown did not have notice. Neither this Court nor the Alabama Legislature has addressed the effect an insurer's failure to deliver a policy to an insured has on the insurer's right to assert an otherwise applicable exclusion in the policy.
"(a) Subject to the insurer's requirements as to payment of premium, every policy shall be mailed or delivered to the insured or to the person entitled thereto within a reasonable period of time after its issuance, except where a condition required by the insurer has not been met by the insured."
There are no cases interpreting or otherwise citing §
Other jurisdictions have held that an insurer may be estopped to deny coverage based on an insured's failure to comply with a notice requirement or based on an exclusion in the policy, if the insurer did not provide a copy of the policy to the insured. See generally Thomas M. Fleming, Annotation, Insurer'sDuty, and Effect of its Failure, to Provide Insured or Payeewith Copy of Policy or Other Adequate Documentation of itsTerms, 78 A.L.R.4th 9 (1990). Louisiana statutes and cases address the precise question at issue here. Louisiana adheres to the rule that generally estoppel cannot be used to enlarge the coverage of an insurance contract beyond what is set out in the policy. Ledoux v. Old Republic Life Ins. Co.,
In Louisiana Maintenance Services, Inc. v. CertainUnderwriters at Lloyd's of London,
The law of Georgia is also closely on point. As a general matter, it appears that the doctrine of equitable estoppel can be asserted by an insured "against [an insurance company's assertion of] a right which it may have under the policy," where the insured is "actually ignorant of the contents of the policy." Union Fire Ins. Co. v. Stone,
The Georgia appellate courts have interpreted a more specific statutory provision requiring that an individual policy be delivered to the insured for all credit life insurance and credit accident and sickness insurance and that a group certificate of insurance be delivered to the insured in the case of group insurance. See Ga. Code Ann. § 33-31-7(a) (Michie 1990). In Investor's Nat'l Life Ins. Co. v. Norsworthy,
Id.,"In order for the appellant insurance company to rely on the exclusions in its [group credit life and accident and sickness insurance] policy, it must show that the certificate of insurance was delivered or that the insured otherwise had notice and therefore assented to the terms of the master policy excluding coverage for preexisting conditions."
The law in Utah is consistent with the Louisiana and Georgia position on this issue. Failure to comply with a statute requiring delivery of credit life and credit accident and health policies to the insured has been held by the Utah Supreme Court to estop an insurance company from relying on an undisclosed exclusion in a credit life or disability insurance policy. General Motors Acceptance Corp. v. Martinez,
Additionally, a Utah statute requires an insurer issuing a group insurance policy to provide for each member of the insured group a certificate containing a summary of the essential features of the insurance coverage. Utah Code Ann. § 31A-21-311 (1994). In Moore v. Energy Mut. Ins. Co.,
Other states have adopted positions on this issue consistent with those of Louisiana, Georgia, and Utah. See Cal.Ins. Code § 383.5 (West 1993) (requiring that the "original or true copy" of every automobile insurance policy be delivered to each named insured or loss payee), and Espree v. Western Pioneer Ins. Co., 159 Cal.App.2d Supp. 875, 324 P.2d 749 (1958) (holding that delivery of only a certificate of insurance does not comply with § 383.5 and, therefore, that an insurance company may not enforce a condition contained in the policy but not in the certificate received by the insured); Mich.Comp. Laws Ann. §
On the other hand, some other states either recognize only in limited circumstances an estoppel to assert an otherwise valid exclusion where the insurer has failed to deliver the policy to the insured or do not recognize the estoppel at all. Seegenerally Fleming, Annotation, supra. Illinois has adopted the first of those positions. Illinois law has been interpreted as not imposing any general positive duty for insurers to forward a copy of "agreed forfeiture conditions to the insured,"Advanced Methods, Inc. v. Grain Dealers Mut. Ins. Co.,
The Illinois Appellate Court has reached a contrary result upon different facts. Where a delivered certificate of insurance was not inconsistent with the undelivered policy and the certificate contained a disclaimer stating that it was not a policy of insurance and did not in any way alter the coverage afforded by the referenced policy, the court held that the certificate would not operate to "supersede *Page 57
and vitiate the terms of the underlying policy." Lezak LevyWholesale Meats, Inc. v. Illinois Employers Ins. Co.,
The Tennessee Supreme Court has entertained the argument that an insurance company should be estopped from relying upon an exclusion that was left out of a memorandum of insurance delivered to the insured where the actual policy was not delivered to the insured. See Provident Washington Ins. Co. v.Reese,
Finally, we note that a United States district court applying New Jersey law has held that the lack of delivery of a master policy does not estop the insurer from binding the insured by the policy's terms where an unambiguous memorandum of insurance was delivered to the insured that put the insured "on notice that her rights under the insurance policy could be determined only with reference to the actual master policy".Vandermeulen v. Allstate Ins. Co.,
We find that the clear weight of the persuasive authorities stands for the proposition that, where a statute requires delivery of a policy to the insured and the insurer fails to deliver the policy according to the statute, the insurer may be estopped from asserting coverage conditions or exclusions that are in the policy but are not disclosed to the insured. There is also authority in Alabama for this general proposition. InMoses v. American Home Assurance Co.,
We conclude that when an insurer has not complied with §
As we pointed out above, the general rule in Alabama is that insurance coverage cannot be created or enlarged by estoppel.See Johnson, supra. However, we recognize an exception to this rule in answering these certified questions. To do otherwise would defeat the purpose of the statute. If we were to hold that the general rule controls, then §
Thus, on the most fundamental level, the answer to the first certified question is yes; an insurer who fails to follow the statutory mandate of §
We are hesitant to draw hard and fast lines at this point as to the meaning of the term "the insured" in §
As a general matter, it has been written that "[t]he party who enters into the contract of insurance or assurance with the insurer or assurer is called the 'insured' or 'assured.' "Couch on Insurance 2d (Rev. ed.) § 23:1 at 769 (1984). Further, "as a general rule the term 'insured' as used in [a standard policy] refers to the owner of the property insured, to whom the policy is issued and by whom the premium is paid, and does not include a person appointed to receive a portion of the proceeds in case of loss." Id. at 770. Although the generalities set out by Couch may not substantially aid in comprehensively defining "the insured or . . . the person entitled thereto," as that phrase is used in §
It is clear that the phrase "the insured or . . . the person entitled thereto," as it is used in §
The persuasive authorities discussed above, holding, where a statute requiring delivery of a policy is not complied with, that delivery of a certificate of insurance is insufficient to allow the insurer to avoid coverage by asserting conditions or exclusions not communicated to the insured, generally rely on the following propositions of law: first, that any ambiguity in an insurance contract, including an ambiguity in an exclusion provision, is construed against the insurer and in favor of the insured; see Louisiana Maintenance, 616 So.2d at 1252; Moore, 814 P.2d at 1143; second, that the first proposition may be based upon the premise that insurance contracts are generally contracts of adhesion and are frequently written to afford the most protection to the insurer; see Moore, 814 P.2d at 1143; and third, that a certificate of insurance delivered to the insured and containing terms more favorable to the insured than those in the policy will control over the policy if the policy is not delivered to the insured; Moore, 814 P.2d at 1144;John Bader, 65 Ill.Dec. at 794, 441 N.E.2d at 1308.4 Thus, the extent to which these propositions are recognized by Alabama law is relevant to the determination of whether, or to what extent, the delivery of a certificate of insurance in lieu of the actual policy may fulfill an insurer's obligations under §
It is well settled in Alabama that ambiguities in an insurance contract are to be construed in favor of the insured and that "exceptions to coverage must be interpreted as narrowly as possible in order to provide maximum coverage to the insured." Amerisure Ins. Cos. v. Allstate Ins. Co.,
While the fact that an insurance policy is written by the insurance company is often noted in conjunction with the proposition that an ambiguous provision is construed against the insurer, see Guaranty Nat'l Ins. Co. v. Marshall County Bd.of Educ.,
As to the proposition that a certificate of insurance delivered to the insured and containing terms conflicting with those in the *Page 60
policy will control over the policy if the policy is not delivered to the insured, we have located no Alabama cases directly on point, but we have precedent establishing the relationship between an insurance certificate and certain kinds of master policies. Initially, we note that this Court has held that "[t]he [group insurance] policy contract is to be found upon examination of the provisions of the certificate in connection with those of the 'Master Policy' and application therefor, and the individual application of the insured person." All States Life Ins. Co. v. Steward,
Page v. Prudential Ins. Co.,"We do not hold that a certificate issued by the insurer to the employer to be furnished the employee as evidence of his insurance benefits is to be ignored in construing the contract. If its terms definitely contradict those of the master policy on a material point, so as to silence inquiry in that regard, the rule of liberal construction should be applied in favor of the certificate holder."
In drawing together these two subissues and the overall question of the effect of delivering a certificate of insurance, it is instructive to employ a hypothetical spectrum of possible insureds or of persons to whom benefits may possibly be owed under an insurance policy. On one end of the spectrum are the purchaser of the policy and the named insured, both of whom we have concluded are definitely included in the phrase "the insured or . . . the person entitled thereto," as it is used in §
Between the ends of the spectrum are the remainder of the classes of insureds: named and unnamed additional insureds, third-party beneficiaries, fleet policy beneficiaries, etc. The question of Brown's status, given the evidence in this case, and the question of which end of the spectrum the INA/TCAS policy is closest to are for the parties to argue to the trier of fact. This Court is not in a position to decide whether Brown is entitled to a copy of the policy under §
We choose not to draw any further conclusions upon the inclusiveness of the phrase "the insured or . . . the person entitled thereto." Therefore, it is in determining who among those between the ends of the spectrum are included in the term that Alabama law pertaining to construction of policy provisions and Alabama law pertaining to the relationship between a certificate and a policy become relevant. We note the proposition that ambiguities are construed in favor of coverage and that this proposition is based upon the fact that it is the insurance company that writes the policy, but we note that this Court seldom characterizes an insurance contract as one of adhesion. We also note that, at least as to group policies, our law is inclined to recognize that the provisions of a master policy will control over a general certificate evidencing coverage, at least if the certificate disclaims any effect upon the insured's rights and policy and if the language of the certificate does not "definitely contradict" the policy.
In determining who is included in the statutory phrase "the insured or . . . the person entitled thereto," one must interpret the phrase in light of these principles. In determining *Page 61 which persons are included in that phrase beyond those we have herein specifically held to be included, one should be guided by the following statement: In the hypothetical spectrum set out above, the further away a particular insured or beneficiary is from those we have held are definitely included in the statutory phrase, then the less likely that the insured or beneficiary will be included. Accordingly, proceeding in the spectrum away from those to whom the statute definitely applies, it becomes more likely that provisions of undelivered policies will control over the terms of a delivered certificate of insurance if the certificate disclaims any effect on the coverage contained in the policy and if it does not "definitely contradict" the policy; consequently, it also becomes less likely that the insurer will be estopped from asserting otherwise valid conditions of, or exclusions from, coverage that are contained in the policy but not in the certificate.
We hold that §
In conclusion: The basic answer to the first certified question is yes, in a breach of contract action when an insurer fails to deliver a copy of the policy to an insured in accordance with Ala. Code 1975, §
QUESTIONS ANSWERED.
MADDOX, SHORES, HOUSTON, INGRAM and BUTTS,* JJ., concur.
"[This Policy Does Not Apply:]
"As respects Coverage A, to loss due to conversion, embezzlement, or secretion by any person in lawful possession of the aircraft under a lease or rental agreement, conditional sale, mortgage or other encumbrance. . . ."
"Coverage A" provides that INA agrees with the insured
"To pay for any loss of or damage to the aircraft while in flight or not in flight; also disappearance if the aircraft is missing and not reported for sixty (60) days after commencing flight. . . ."
Reference
- Full Case Name
- Brown MacHine Works Supply Company, Inc. v. Insurance Company of North America
- Cited By
- 34 cases
- Status
- Published