Fire Ins Exchange v. Oltmanns
Fire Ins Exchange v. Oltmanns
Opinion
INTRODUCTION
¶1 Robert Oltmanns was named as a defendant in a personal injury case. He filed a claim with his insurer, Fire Insurance Exchange, who questioned whether the claim was covered under the policy. Rather than deny the claim outright, Fire Insurance brought a declaratory judgment action to determine whether the claim was covered under Mr. Oltmanns's policy. The court of appeals ultimately held that it was covered, and Mr. Oltmanns filed a counterclaim seeking attorney fees for the declaratory judgment action, arguing that it was brought in bad faith. The question presented for this court is whether the court of appeals erred in concluding that Fire Insurance's denial of Mr. Oltmanns's insurance claim was "fairly debatable," thus negating Mr. Oltmanns demand for attorney fees and expenses for the coverage dispute and appeal. We affirm the court of appeals' decision to uphold the summary judgment of the district court.
BACKGROUND
¶2 In 2006, Mr. Oltmanns was piloting a Honda F-12 AquaTrax personal watercraft that was towing Mr. Oltmanns's brother-in-law, Brady Blackner. Mr. Blackner sustained injuries, and filed a lawsuit against Mr. Oltmanns. Mr. Oltmanns tendered the defense to Fire Insurance Exchange under his homeowner's insurance policy. The insurance policy contains the following provision under Section II-Liability, Coverage E-Personal Liability:
We pay those damages which an insured becomes legally obligated to pay because of bodily injury, property damage or personal injury resulting from an occurrence to which this coverage applies.... At our expense and with attorneys of our choice, we will defend an insured against any covered claim or suit. We are not obligated to pay defense costs, including attorneys' fees of any claim or suit where you select an attorney not chosen by us because there is a dispute between you and us over coverage. We may investigate and settle any claim or suit that we consider proper. Our obligation to defend any claim or suit ends once we have paid our limit of liability.
In the same liability section of the insurance contract, in a subsection titled "Additional Coverages," Fire Insurance agrees to pay "[i]n addition to the limits of liability ... all costs we incur in the settlement of a claim or defense of a suit with attorneys of our choice."
¶3 Fire Insurance conducted an in-house review of Mr. Oltmanns's claim and then submitted his claim to outside counsel for a coverage opinion. Whether the accident was deemed covered was uncertain because of the following exclusion in its liability coverage:
We do not cover bodily injury [that]....
7. results from the ownership, maintenance, use, loading or unloading of:
a. aircraft
b. motor vehicles
c. jet skis and jet sleds or
d. any other watercraft owned or rented to an insured and which:
(1) has more than 50 horsepower inboard or inboard-outdrive motor power; or
(2) is powered by one or more outboard motors with more than 25 total horsepower; or
(3) is a sailing vessel 26 feet or more in length.
Exclusions 7c and d do not apply while jet skis, jet sleds or watercraft are stored.
¶4 Fire Insurance also asked Mr. Oltmanns's attorney to continue to represent him, indicating that Fire Insurance might reimburse him for his fees and expenses should the accident be deemed a covered occurrence. Fire Insurance's outside counsel advised Fire Insurance that he believed there was a high probability that the incident would not be covered, but that Fire Insurance should authorize him to file a declaratory judgment action seeking a determination of its responsibility to Mr. Oltmanns under the policy. He advised this course of action because "[u]nder Utah law, a liability insurance carrier's duty to defend is broader than its duty to indemnify," and "[i]t would be dangerous to simply deny coverage because Mr. Blackner and Mr. Oltmanns may enter into an agreement to stipulate to a large judgment and Mr. Oltmanns could then assign his claims against Fire Insurance Exchange to Mr. Blackner."
¶5 Fire Insurance filed the action and then moved for summary judgment. The district court ruled in favor of Fire Insurance, finding that the exclusion precluded coverage. Mr. Oltmanns appealed and the court of appeals reversed, holding that the term "jet ski" as used in the exclusion was ambiguous and construed the contract against the insurer in favor of the insured.
Fire Ins. Exch. v. Oltmanns
,
¶6 Fire Insurance did not pay for Mr. Oltmanns's costs of defending the declaratory judgment action. Mr. Oltmanns then filed a counterclaim against Fire Insurance in the still open declaratory judgment action seeking "damages for breach of the implied covenant [of good faith and fair dealing], which include his attorney fees for prosecuting this coverage action and the successful appeal" as well as "damages for the severe emotional distress that was caused by the coverage denial and his self-defense of a significant personal injury claim." Fire Insurance once again moved for summary judgment and for a motion to dismiss. The district court granted summary judgment finding that Fire Insurance's actions were reasonable because the coverage issue was "fairly debatable." Fire Insurance then withdrew its motion to dismiss. Mr. Oltmanns appealed and the court of appeals affirmed the district court, holding that "when an insurance company proceeds in a reasonable way to resolve a difficult coverage question, its eventual loss at the appellate level does not foreclose a determination that an issue of interpretation was fairly debatable, as was the case here." Id. ¶ 15.
STANDARD OF REVIEW
¶7 This case comes before us on certiorari review from the court of appeals decision. "[W]e review the court of appeals' decision for correctness. The review focuses on whether the court of appeals correctly reviewed the trial court's decision [to grant
summary judgment to Fire Insurance] under the appropriate standard of review."
Orvis v. Johnson
,
ANALYSIS
¶8 In both his trial- and appellate-level briefing, Mr. Oltmanns advanced the same basic argument: because it wasn't "fairly debatable" whether the term "jet ski" encompassed a Honda F-12 Aquatrax (in Mr. Oltmanns view, it obviously did not), Fire Insurance breached its duty to Mr. Oltmanns by seeking a declaratory judgment that the "jet ski" exclusion in Mr. Oltmanns's insurance policy encompassed bodily injuries resulting from the use of that jet-ski-like watercraft. As Mr. Oltmanns has put it:
[Fire Insurance] relied on the advice of counsel [that an Aquatrax would be encompassed by the "jet ski" policy exclusion] in refusing the tender of defense. However, the advice was patently flawed. Therefore, the claim was not "fairly debatable," and [Fire Insurance] breached the insurance contract and the implied duty of good faith [and] fair dealing.
¶9 On Mr. Oltmanns's account of the governing law, then, whether Fire Insurance breached its duties to Mr. Oltmanns turned entirely on whether the "jet ski" exclusion's applicability to an Aquatrax was fairly debatable: If it was fair for Fire Insurance to argue that the "jet ski" exclusion encompassed an Aquatrax then there was no breach; otherwise, according to Mr. Oltmanns, there was.
¶10 Mr. Oltmanns's argument fails on its own terms. It was more than fair for Fire Insurance to argue that its policy's "jet ski" exclusion applied to bodily injuries resulting from the use of an Aquatrax. In litigating whether the "jet ski" exclusion encompassed Aquatrax accidents, Fire Insurance put forward substantial usage evidence suggesting that the term "jet ski" is, in Fire Insurance's words, a "genericized term for any type of personal watercraft." Fire Insurance's argument is bolstered by the fact that "jet ski" is frequently treated as a generic term in cases, ordinances, and dictionaries. 1 The cited dictionaries, ordinances, and cases show that the public uses the trademarked term "jet ski" generically, at least on occasion. That suggests that the scope of the term may be fairly debatable.
¶11 That conclusion is also confirmed by the context of the "jet ski" exclusion in the insurance policy. The governing language excludes injury resulting from "the ownership, maintenance, use, loading or unloading of aircraft, motor vehicles, jet skis and jet sleds, or any other watercraft owned or rented to an insured." (numbering omitted). With the exception of jet ski, each of the excluded terms unambiguously refers to the generic name for a category of items. None refers to a specific brand. This supports a generic reading of "jet ski" under the
noscitur a sociis
canon of construction.
See
Third Nat'l Bank in Nashville v. Impac Ltd., Inc.
,
¶12 True, in a decision from an earlier phase of this case-a decision not currently before us-the court of appeals concluded that the "jet ski" exclusion did not apply to injuries resulting from the use of an Aquatrax, apparently declaring the term "jet ski" irredeemably obscure.
See
Fire Ins. Exch. v. Oltmanns
,
¶13 The concurrence, however, doesn't affirm the court of appeals on the basis that Mr. Oltmanns's argument fails on its own terms. Instead, the concurrence concludes that Mr. Oltmanns waived his argument that he was entitled to attorney fees because Fire Insurance breached its duties when it sought a declaratory judgment that it did not have to defend Mr. Oltmanns in connection with the Aquatrax accident. It then devotes many pages of dicta to its view that Mr. Oltmanns's "fair debatability" argument analyzed the problem the wrong way. According to the concurrence, Mr. Oltmanns should have characterized his claims against Fire Insurance as "third-party claims." Infra ¶¶ 26-27. Under this characterization of Mr. Oltmanns's lawsuit, the concurrence tells us that "fair debatability" is irrelevant. Instead, because it arose in the third-party context, the appropriateness of Fire Insurance's decision to file a declaratory judgment action turned not on whether the "jet ski" coverage question was fairly debatable, but on whether Fire Insurance's position was "reasonable under the circumstances." Infra ¶ 28.
¶14 The concurrence then proceeds to outline the entire syndrome of duties and obligations that an insurer owes an insured in the third-party context. Because Fire Insurance's declaratory judgment action arose in the third-party context, the concurrence says that Fire Insurance was operating under a "heightened duty" to act as an agent or fiduciary for Mr. Oltmanns. Infra ¶¶ 41-42. It therefore owed Mr. Oltmanns four duties:
(1) [T]he duty to defend an action brought against [Mr. Oltmanns] that could conceivably fall within the scope of the policy coverage (as defined by the insurance contract), (2) the duty to be fair and reasonable in diligently investigating the validity of claims, (3) the duty to indemnify [Mr. Oltmanns] for valid claims, and (4) the duty to settle claims within the policy limits where possible.
Infra ¶ 48.
¶15 And, despite concluding that Mr. Oltmanns failed to preserve his argument that Fire Insurance breached its duty to defend him in the underlying lawsuit arising from the Aquatrax accident, the concurrence also details the scope and nature of the duty an insurer owes an insured to defend against a third-party lawsuit. Infra ¶¶ 49-50.
¶16 We have two problems with the concurrence's analysis. First, we don't agree that Mr. Oltmanns "waived his argument that Fire Insurance breached the implied covenant of good faith by bringing the declaratory judgment action" because he somehow "conceded that [Fire Insurance's decision to file that action] was merited in his brief to the court of appeals and his brief to this court." Infra ¶ 24. The court of appeals certainly didn't see it this way. It understood Mr. Oltmanns to have argued that Fire Insurance breached its fiduciary duties in seeking declaratory judgment because the coverage question-whether an Aquatrax was covered by the term "jet ski"-was not "fairly debatable."
¶17 We see this same argument in Mr. Oltmanns's brief to this court. It's true that there are stray comments in Mr. Oltmanns's supreme court briefing to the effect that Fire Insurance "had the right to seek declaratory relief." But the obvious thrust of Mr. Oltmanns's argument is that he is entitled to attorney fees in connection with the declaratory judgment action because "[t]here was no good basis for [Fire Insurance's decision to] fil[e] the declaratory judgment action"-and this because whether the term "jet ski" encompassed an Aquatrax was not a " 'fairly debatable' coverage question." We therefore consider this argument on its own terms. And we conclude that, even accepting Mr. Oltmanns's premises-i.e., even accepting that Mr. Oltmanns would be entitled to attorney fees if the coverage question was not fairly debatable-Mr. Oltmanns loses.
¶18 We are also concerned by the concurrence's decision to explain, in detail, the differences between first-party and third-party insurance claims. On its own terms, the concurrence's opinion is good stuff. It's, as Judge Chamberlain Haller might put it, "lucid, intelligent, [and] well thought-out." 2 And it may very well be entirely correct. But this isn't the case for it. Mr. Oltmanns framed his claim as a first-party claim: Fire Insurance is liable because it could not fairly argue-it wasn't "fairly debatable"-that an Aquatrax was a "jet ski." Fire Insurance then responded to this argument on those same terms. As a consequence, nobody-not the parties, not the insurance industry, not the plaintiffs' bar-is fairly on notice that this is the case in which we intend to announce that an insurer's decision to seek a declaratory judgment in connection with a third-party lawsuit must be analyzed under third-party insurance law. Nor, needless to say, has anybody been put on notice that we're prepared to announce an overarching framework for the analysis and resolution of third-party claims-a framework that, on its face, purports to occupy the field, controlling a vast array of possible insurance lawsuits. We need adversarial briefing before we can fairly do this.
¶19 To be clear, we don't mean that we're categorically bound by litigants' decision to litigate a case under the wrong legal principles (if wrong legal principles they be). We agree with the concurrence that our court will not "be forced to ignore the law just because the parties have not raised or pursued obvious arguments."
Infra
¶ 27 (quoting
Kaiserman Assocs. v. Francis Town
,
¶20 But there is a pragmatic reason to draw our decision here narrowly: the law in this area is unsettled. Courts around the country take different approaches to the issues the concurrence resolves. Some courts part ways with the concurrence's repudiation of the "fairly debatable" standard in the third-party context, denying bad faith claims in this context as long as the coverage question on which the insurer sought a declaratory judgment is "fairly debatable."
See, e.g.
,
Universal-Rundle Corp. v. Commercial Union Ins. Co.
,
¶21 The concurrence claims that the law in Utah is well-settled on all of these issues. Infra ¶ 27 n.3. But we've never held that an insurer must defend against all third-party liability claims that could "conceivably" fall within insurance coverage. Nor have we considered whether an insurer may, consistent with its fiduciary obligations, stay the underlying proceedings until any dispute over coverage is resolved. Nor, in our view, have we squarely repudiated any role for the "fairly debatable" standard in the third-party insurance context. And because there are a variety of possible approaches to the issues the concurrence explores, we won't take a stand on any of them until after they have been put squarely before us. Here, the parties have litigated this as a first-party insurance dispute, and we therefore lack the benefit of adversarial briefing on the principles the concurrence elucidates.
¶22 We certainly agree with the concurrence that we shouldn't bind ourselves to a "confuse[d] ... distinction between first-party insurance claims and third-party insurance claims" just because the litigants have potentially misapplied this law. Infra ¶ 27. Nor do we need to commit ourselves to a third-party insurance framework in a case where nobody has asked us to. Instead, we chart a middle ground. We affirm the court of appeals on the basis that Mr. Oltmanns's argument isn't persuasive on its own terms-the coverage question was fairly debatable. But we expressly flag, for future litigants, the questions (1) whether claims like those before us should be analyzed under third-party insurance principles and (2) if so, what those principles are.
CONCLUSION
¶23 For the reasons set forth above, Mr. Oltmanns's claim that Fire Insurance did not fairly evaluate his claim and unreasonably rejected it fails. Thus, we affirm the court of appeals' decision to uphold the district court's grant of summary judgment to Fire Insurance.
Justice Durham, concurring in part and concurring in the result:
¶24 I concur in the portion of the majority opinion that concludes that Mr. Oltmanns's claim that Fire Insurance did not fairly evaluate his claim and unreasonably rejected it fails. In doing so, I affirm the court of appeals' decision to uphold the summary judgment of the district court, but do so on alternate grounds. "It is well settled that an appellate court may affirm the judgment appealed from if it is sustainable on any legal ground or theory apparent on the record."
Moss v. Parr Waddoups Brown Gee & Loveless
,
¶25 I also concur in the majority's decision to reject Mr. Oltmanns's argument that Fire Insurance breached its duty to defend on preservation grounds. Mr. Oltmanns failed to preserve his claim for a breach of the duty to defend in his opposition to Fire Insurance's summary judgment motion.
¶26 Unfortunately, parties and the lower courts have conflated the common law principles regarding insurer's duties under insurance contracts regarding third-party claims against the insured on the one hand, and first-party claims where the insured sues the insurer on the other. While both third-party and first-party claims involve coverage decisions, the relationship of the insurer to the insured, the implied obligations of good faith performance, and the remedies available to the insured are different depending on the type of claim. These differences are significant. "[T]he relationship between the insurer
and its insured [in a first-party context] is fundamentally different than in a third-party context."
Beck v. Farmers Ins. Exch.
,
¶27 These principles are clearly laid out in our precedent. To ignore the incorrect approach the parties have taken in this case could set incorrect precedent for future cases and further confuse the distinction between first-party insurance claims and third-party insurance claims. "[S]ettled appellate precedent is of crucial importance in establishing a clear, uniform body of law."
In re United Effort Plan Tr.
,
Kaiserman Assocs. v. Francis Town
,
¶28 Here, the parties are incorrectly using arguments derived from common-law first-party insurance claims when they should be using the common-law principles of third-party claims. Whether a question of coverage is "fairly debatable" has become a term of art that has only been decided in Utah in the context of first-party claims. Therefore, it is not applicable to this case. Because Mr. Oltmanns's claim falls under third-party liability law, the relevant questions are whether the insurer initiated the declaratory judgment action to have the court determine a "question of construction or validity" as defined by Utah Code section 78B-6-408 and whether the insurer's inquiry was "reasonable under the circumstances," pursuant to Utah Rule of Civil Procedure 11(b). 4
¶29 We take this opportunity now, to restate our precedent concerning first-party claims and third-party claims to fulfill our responsibility "[a]s the state's highest court ... to maintain a sound and uniform body of precedent."
Patterson
,
I. INSURANCE LAW IS CONTRACT LAW THAT CONTAINS ADDED PROTECTIONS FOR THE INSURED
¶30 Basic contract law is based on the assumption that courts act to "adjust a commercial relationship between parties with roughly equal bargaining power." Mark A. Geistfeld,
Interpreting the Rules of Insurance Contract Interpretation
, 68 RUTGERS U. L. REV . 371, 382 (2015) (quoting ROBERT H. JERRY, II & DOUGLAS R. RICHMOND, UNDERSTANDING INSURANCE LAW § 25D(b) (5th ed. 2012) ). However, in the context of insurance contracts, the insured is presumed to be "an ordinary, unsophisticated consumer, possessing an understanding of only the most rudimentary aspects of the coverage."
A. Public Policy Implications
¶31 The practice of treating questions of interpretation of insurance contracts differently and of providing for broader remedies under certain conditions than contracts in general comes as a result of several public policy implications inherent in insurance contracts. Insurance policies are adhesion contracts. Insurance companies typically use standardized forms, and there is no room for negotiation or approval of specific provisions or exceptions. See Douglas R. Richmond, Trust Me: Insurers Are Not Fiduciaries to Their Insureds , 88 KY . L.J. 1, 4 (2000) ; see also Geisfeld, supra ¶ 29, at 382 ; MARGARET N. KNIFFIN , 5 CORBIN ON CONTRACTS § 24.27 (Joseph M. Perillo ed., rev. ed., 1998) ("Disparity of bargaining power is likely to exist when a person applies for an insurance policy. The applicant usually has little or nothing to do with the authorship of the policy provisions. The applicant may not even read the policy, being discouraged by the number of terms and the fineness of print. An insurance company normally issues thousands of such policies, using printed forms prepared and approved by its actuaries, officers, and attorneys." (footnote omitted) ).
¶32 And, purchasing insurance is not always "voluntary." Insurance coverage is often a requirement of obtaining a mortgage and is mandatory for drivers in Utah. See UTAH CODE § 31A-22-302 (requiring owners or operators to carry both no-fault and liability auto insurance). Also, rather than being strictly a commercial relationship, most "insureds purchase their policies for peace of mind and security rather than for financial gain." Richmond, supra ¶ 31 at 4 (footnote omitted).
¶33 Because of these policy considerations, "this Court has expressed its commitment to the principle that 'insurance policies should be construed liberally in favor of the insured and their beneficiaries so as to promote and not defeat the purposes of insurance.' "
U.S. Fid. & Guar. Co. v. Sandt
,
B. The Duty of Good Faith and Fair Dealing
¶34 Insurers have, at minimum, the same implied "duty of good faith and fair dealing implied in all contracts and ... a violation of that duty gives rise to a claim for breach of contract."
Beck v. Farmers Ins. Exch
.,
¶35 In insurance contracts, the good faith performance of an insurer is evaluated by an objective standard that is measured by what a reasonable insured would expect from an insurer.
See
Sandt
,
¶36 Insurers are also required to " 'deal with laymen as laymen and not as experts in the subtleties of law and underwriting' and to refrain from actions that will injure the insured's
ability to obtain the benefits of the contract."
Beck
,
II. IMPLIED AND CONTRACTUAL DUTIES AND OBLIGATIONS UNDER THIRD-PARTY CLAIMS AND FIRST-PARTY CLAIMS
¶37 While all insurers have a duty of good faith and fair dealing with their insureds, there is a difference in the relationship between the insurer and the insured, the insurer's implied obligations of good faith performance, and the remedies available to the insured depending on whether the claim is a third-party liability claim or a first-party claim. This difference gives rise to an heightened duty in the case of third-party claims.
A. Relationships Between Parties
¶38 Third-party cases involve liability, not just coverage. In these cases, a person who is not a party to the insurance contract sues the insured for the losses that are covered by the insurance contract. Insureds seek coverage under their insurance contract for their responsibility for the losses of the third party up to the coverage limit in the policy, tendering the defense of the claim to the insurer. The insurer's duty lies in defending and indemnifying the insured in good faith. An insurer is not in privity of contract with the third party who has made a claim against the company's insured, so the contractual duty to deal fairly and in good faith does not extend to an injured third-party.
See
Pixton v. State Farm Mut. Auto Ins. Co.
,
¶39 In first-party cases, insureds suffer a loss and then make claims for reparations from their insurers, arguing that the loss is covered by the policy. For example, if a hailstorm damages an insured's roof, she would make a claim under her homeowner's policy for repairs. In these cases, the relationship between the insured and the insurer is more adversarial. They have conflicting interests. The insured wants to get the most compensation possible, and the insurer wants to cover as little as permissible under the contract. "In the [first-party] situation, the insured and the insurer are, in effect and practically speaking, adversaries."
Beck v. Farmers Ins. Exch.
,
B. Standard of Care and Implied and Contractual Obligations
¶40 The differences in the relationships between the insured and the insurer in these two types of claims affect the implied obligations of good faith performance. In third-party claims, the insured has a heightened duty that incorporates not only all of the typical contractual obligations of good faith and fair dealing that exist in every insurance contract, but also a duty as a fiduciary to their insureds. First-party claims, on the other hand do not give rise to this heightened duty.
1. Third-Party Heightened Duty
¶41 In third-party cases, there is not only the implied duty of good faith performance that inheres in any insurance contractual relationship,
but there is an extended duty because "the insurer acts as an agent for the insured with respect to the disputed claim."
Beck
,
¶42 This heightened duty has been characterized as fiduciary in nature in our prior case law.
See, e.g.,
Black
,
¶43 Fiduciary duties are "established, whether by express contract or by conduct and circumstances of the parties, which imply a fiduciary bond and a duty on the party in whom confidence is placed to exercise good faith toward the party reposing that confidence while entering into transactions during the continuance of the relationship."
First Sec. Bank of Utah N.A. v. Banberry Dev. Corp.
,
[T]here are generally two types of fiduciary relationships: "(1) [T]hose specifically created by contract such as principal and agent, attorney and client, and trustee and cestui que trust, for example, and those created by formal legal proceedings such as guardian and/or conservator and ward, and executor or administrator of an estate, among others, and (2) [T]hose implied in law due to the factual situation surrounding the involved transactions and the relationship of the parties to each other and to the questioned transactions."
¶44 Fiduciary duties "arise whenever a continuous trust is reposed by one party in the skill and integrity of another."
Banberry Dev. Corp.
,
¶45 There are, however, some differences between typical fiduciary relationships and the relationship between the insurer and the insured in third-party cases. "In the [third-party] situation, the insurer must act in good faith and be as zealous in protecting the
interests of the insured as it would be in regard to its own."
Beck
,
¶46 Some scholars have argued that third-party insurer/insured relationship should not be lumped together with other fiduciary relationships. "If insurers were made to be true fiduciaries, they would lose their ability to hold down premiums by weeding out illegitimate claims, contesting an insured's liability, or disputing a third-party claimant's damages." Richmond,
supra
¶ 31 at 24. Were this the case, "[t]he cure might then be worse than the illness because insurers would then surely have to fund their new duty through significantly increased premiums."
Id.
We acknowledged this concern in
Ammerman
.
¶47 Because of the insurer's special role "[i]n the third party context, ... an insured may state a cause of action in tort for an insurer's breach of its obligations."
Campbell
,
¶48 Insurers owe their insureds four duties in third-party claims: (1) the duty to defend an action brought against their insureds that could conceivably fall within the scope of the policy coverage (as defined by the insurance contract), (2) the duty to be fair and reasonable in diligently investigating the validity of claims, (3) the duty to indemnify their insureds for valid claims, and (4) the duty to settle claims within the policy limits where possible.
See
Black
,
a. The contractual duties to defend and indemnify in third-party claims
¶49 The duties to defend and indemnify the insured are defined by contract. The insurer has a duty to defend as defined in contract, and that duty may well exceed the duty to indemnify. This duty arises when the insurer has obligated itself to defend the insured in the insurance contract and there is a sufficient factual basis for potential liability of a covered incident. "The duty to defend is broader than the duty to indemnify, but the insurer's obligation is not unlimited; the duty to defend is measured by the nature and kinds of risks covered by the policy and arises whenever the insurer ascertains facts which give rise to the potential of liability under the policy."
Deseret Fed. Sav. & Loan Ass'n v. U.S. Fid. & Guar. Co.
,
¶50 Even where insurers have contracted to defend their insureds in liability cases, they are not required to defend all cases regardless of how frivolous they are or how unlikely it is that the loss is covered by the policy. "Where there is no potential liability, there is no duty to defend."
Deseret Fed. Sav. & Loan Ass'n
,
b. The heightened duty to act as fiduciaries in third-party claims
¶51 Because insurers act as insureds' agents in the disposition of third-party claims, they have an implied heightened duty as fiduciaries to diligently investigate the validity of claims and to settle claims within the policy limits where possible. This duty extends beyond the duty of good faith and fair dealing that exists in first-party claims. This duty arises because
[a]n insurer's failure to act in good faith exposes its insured to a judgment and personal liability in excess of the policy limits.... The insured is wholly dependent upon the insurer to see that, in dealing with claims by third parties, the insured's best interests are protected. In addition, when dealing with third parties, the insurer acts as an agent for the insured with respect to the disputed claim.
Beck
,
¶52 "With such a dependent relationship must come a standard of care that exists independent of the insurance policy and without specific reference to the policy terms." Richmond, supra ¶ 31 at 7 (footnote omitted);
see also
Campbell
¶53 This court has held that "claims submitted by third parties must be diligently investigated to determine their validity and then reasonably evaluated in light of all the facts."
Black
,
ma[d]e a good faith determination based on all the facts known to it, or which by reasonable efforts could be discovered by it, that there is no potential liability under the policy . This means that there are no disputed facts which if proved by the plaintiff at trial would result in liability under the policy. However, this does not mean that the insurer can simply say, "We don't believe that the plaintiff can prove what he is alleging." The insurance contract includes the duty to defend [when] .... the allegations, if proved, could result in liability under the policy .
Deseret Fed. Sav. & Loan Ass'n
,
¶54 If an insurer does not defend an action, and a court finds "facts which give rise to the potential of liability under the policy,"
Deseret Fed. Sav. & Loan Ass'n
,
¶55 In light of this precedent, we leave insurers few options when handling a third-party claim. Insurers must (1) be certain that an occurrence is not covered,
see
Deseret Fed. Sav. & Loan Ass'n,
c. The insurer's rights under third-party claims
¶56 Under Utah Code section 78B-6-401, (the declaratory judgment statute) "[e]ach district court has the power to issue declaratory judgments determining rights, status, and other legal relations within its respective jurisdiction.... The declaration ... shall have the force and effect of a final judgment or decree." In
Baird v. State
,
8
we held that the phrase " 'rights, status and other legal relations' in the declaratory judgment statute relates to a justiciable controversy where there is an actual conflict between interested parties asserting adverse claims on an accrued set of facts."
¶57 In addition to our case law about the rights of a party to bring a declaratory judgment action under Utah Code section 78B-6-401, we have specifically recognized this right under third-party liability case law. The standard is whether the insurer initiated the declaratory judgment action to have the court determine a "justiciable controversy."
See
W. Cas. & Sur. Co. v. Marchant
,
¶58 Where an insurer files a declaratory judgment action to determine its responsibilities in a third-party claim that comports with Utah Code section 78B-6-401(1) and Utah Rule of Civil Procedure 11(b), the insured is not entitled to attorney fees unless they are provided for in the insurance contract.
See
Call
,
¶59 However, the right to bring a declaratory judgment action to determine a coverage question does not relieve the insurer of the duty to defend during the pendency of the declaratory judgment action if there is a potentially viable third-party liability claim. "[A]n insurer may have a duty to defend an insured even if ... the insurer is ultimately not liable to indemnify the insured."
Therkelsen
,
2. First-Party Standard of Good Faith and Fair Dealing
¶60 Because "[n]o relationship of trust and reliance is created by the [insurance] contract" in the first-party situation, the insurance contract "simply obligates the insurer to pay claims submitted by the insured in accordance
with the contract."
Beck
,
¶61 Although in the third-party context an insurer's breach of its duties as a fiduciary can expose the insurer to punitive damages in tort liability, a breach of the implied duty of good faith and fair dealing in the first-party context only permits remedies in contract law.
See
¶62 However, the damages recoverable under contract law are not constrained by the policy limits.
See
Beck
,
¶63 If an insurer denies a first-party claim and the insured brings a suit against the insurer, the insurance company does not have to pay the claim until a judgment is made by the court. Noting that "[a]n insured frequently faces catastrophic consequences if funds are not available within a reasonable period of time to cover an insured loss," this court specifically allowed for "damages for losses well in excess of the policy limits" when they are "foreseeable and provable."
¶64 In the first-party context, the insurer does not have a duty beyond the implied duty of good faith and fair dealing. However, this duty still requires an insurer to "diligently investigate the facts to enable it to determine whether a claim is valid, ... fairly evaluate the claim, and ... act promptly and reasonably in rejecting or settling the claim."
¶65 Because of the potential harm to insureds from an unpaid legitimate claim, our case law has recognized that an insurer may not deny a claim and require the insured to bring a suit in order to obtain coverage unless the question of coverage is reasonable or "fairly debatable." This "fairly debatable" standard has become a term of art in first-party claims.
See
Jones v. Farmers Ins. Exch.
,
III. MR. OLTMANNS' COUNTERCLAIMS AGAINST FIRE INSURANCE
¶66 Where Mr. Oltmanns-either through negligence, inexperience, or a combination of the two-caused injury to his brother-in-law while operating a personal watercraft and his brother-in-law sought to recover his expenses associated with the event, Mr. Oltmanns was potentially liable for those injuries. Mr. Oltmanns turned to his insurer, tendering his defense pursuant to the contract. The insurer diligently investigated the claim, but did not defend Mr. Oltmanns in the personal injury case during the investigation. "Fire Insurance asked Mr. Dalton to continue defending Robert Oltmanns and told him that in the event coverage was extended for the July 2006 accident, Fire Insurance would reimburse him for the costs and fees incurred by Robert Oltmanns." Fire Insurance admits that they "did not offer or propose to defend the claim." Mr. Oltmanns argues that the insurer should not have requested a declaratory judgment action because the ambiguity in the contract is presumed to be interpreted in his favor. Mr. Oltmanns claims that the Fire Insurance inappropriately relied on outside counsel in its decision to file a declaratory judgment. Mr. Oltmanns also claims that Fire Insurance breached its duty of good faith by failing to assume the defense while deciding whether the incident was covered. We address each of these claims in turn.
A. Mr. Oltmanns's Claim for Attorney Fees for the Declaratory Judgment Action
¶67 One remedy that Mr. Oltmanns seeks here is a right to recover attorney fees in the declaratory judgment action under contract law, claiming that Fire Insurance should not have requested a declaratory judgment action. Utah courts do not allow recovery for attorney fees "in the ordinary lawsuit unless it is provided for by statute or by contract,"
Am. States Ins. Co. v. Walker
,
¶68 We affirm the court of appeals' affirmance of the district court's grant of summary judgment to Fire Insurance on this claim and deny Mr. Oltmanns's request for attorney fees for the declaratory judgment action. Because of the potential liability that is at stake for insurers in third-party cases, insureds face a very high bar in proving that an insurer filed a declaratory judgment in bad faith or to be stubbornly litigious. In this case Fire Insurance relied on the advice of outside counsel. Even though outside counsel believed that Fire Insurance would prevail, he advised Fire Insurance to file a declaratory judgment action to determine coverage. Fire Insurance was "entitled to seek a declaratory judgment as to its obligations and rights,"
Farmers Ins. Exch. v. Call
,
¶69 Additionally, Mr. Oltmanns waived the right to argue that Fire Insurance acted in "bad faith or fraudulently or was stubbornly litigious" when it brought a declaratory judgment action for whether the "jet ski" exception applied in his situation. He did so by stipulating in its brief to the court of appeals and to this court that "Fire Insurance was within its rights to file for declaratory relief. For this, it had the advice of counsel," noting that "no one contended" in the district court that "Fire Insurance [did not have] the right to seek declaratory relief." In fact, in Mr. Oltmanns's briefing, his main contention is that Fire Insurance breached its duty because "[a] reasonable response would have been to assume defense of the Blackner action." Failure to assume the defense does not mean that Fire Insurance breached its duty by filing a declaratory judgment. "What Fire Insurance got [from counsel] was a recommendation to file for declaratory judgment. Fire Insurance argued over-and-over in the trial court that it had the right to seek declaratory relief. No one contended otherwise . However, it never occurred to Fire Insurance that it could argue the coverage question while at the same time defending its insured." (Emphasis added.) Mr. Oltmanns's briefing shows that he seeks a remedy for breach of duty to defend through an award of attorney fees for the declaratory judgment action. This is not how the law works. Mr. Oltmanns therefore waived the argument that Fire Insurance brought the declaratory judgment action in bad faith and seeks damages pertaining to the attorney fees for defending the declaratory judgment action only under contract law; this request is without merit. There are no disputed material facts that indicate that Fire Insurance acted in bad faith in filing the declaratory judgment. Thus, summary judgment was appropriate for this claim.
B. Mr. Oltmanns's Claim of Bad Faith for Relying on Opinion of Outside Counsel
¶70 Mr. Oltmanns also claimed that Fire Insurance impermissibly relied on the allegedly flawed advice of outside counsel. Thus, he argues, Fire Insurance did not fairly evaluate his claim and unreasonably rejected it. We agree with the court of appeals that "[a]n insurance company may reasonably and fairly rely, at least initially, upon a coverage opinion from qualified outside counsel, received in the course of careful investigation and evaluation of a claim."
Fire Ins. Exch. v. Oltmanns
,
C. Mr. Oltmanns's Claim for Breach of Duty to Defend
¶71 Mr. Oltmanns argued in its operative complaint in the district court and its briefing to the court of appeals and this court that "Fire Insurance breached its duty by failing to assume defense of the Blackner action" breaching "both contractual and implied duties." However, Mr. Oltmanns failed to preserve this argument in their memorandum in opposition to Fire Insurance's motion for summary judgment.
¶72 The Utah Rules of Civil Procedure at the time required that "[t]he motion, memoranda and affidavits [filed in summary judgment actions] shall be in accordance with Rule 7." UTAH R. CIV . P. 56(c) (2014). 11 Summary judgment was required "if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Rule 7(c)(3)(A) requires that "[a] memorandum supporting a motion for summary judgment shall contain a statement of material facts as to which the moving party contends no genuine issue exists." Rule 7(c)(3)(B) requires that "[a] memorandum opposing a motion for summary judgment shall contain a verbatim restatement of each of the moving party's facts that is controverted, and may contain a separate statement of additional facts in dispute."
¶73 Fire Insurance submitted a memorandum in support of their motion for summary judgment, which included statements that "Oltmanns tendered defense," that "Fire Insurance asked [Oltmanns's attorney] to continue defending Robert Oltmanns," and "that in the event coverage was extended, ... Fire Insurance would reimburse him for the costs and fees incurred." In Mr. Oltmanns's memorandum in opposition to Fire Insurance's motion for summary judgment, Mr. Oltmanns does not use these facts to raise a breach of the duty to defend claim as an additional fact in dispute. Although Mr. Oltmanns raised this claim in his operative counterclaim, this does not nullify the mandate of rule 7(c)(3)(B) to restate controverted claims and raise "additional facts in dispute."
¶74 Because the claim was not raised as a disputed material fact in Mr. Oltmanns's opposition memorandum, it was not preserved. The claim for failure to defend was not properly presented to the district court in its opposition to summary judgment motion, so the court was not properly put on notice that it should rule on the failure to defend claim separately from the claim regarding the declaratory judgment action.
See
Donjuan v. McDermott
,
¶75 I would affirm the court of appeals' decision to uphold the district court's grant of summary judgment, but do so on alternate grounds. Mr. Oltmanns waived his argument that Fire Insurance breached the implied covenant of good faith by bringing the declaratory judgment action when he conceded that it was merited in his brief to the court of appeals and his brief to this court. Therefore, summary judgment on behalf of Fire Insurance was appropriate.
See, e.g.
,
Calhoun v. Yamaha Motor Corp., U.S.A.
,
My Cousin Vinny (20th Century Fox 1992) (overruling a "lucid, intelligent, and well thought-out objection" given the circumstances).
The majority would have us apply the principles of law for first-party claims because "the parties have litigated this as a first-party insurance dispute."
Infra
¶ 21. We think this unwise and believe that where the inappropriate law
has been
argued or applied, the appellate courts have a duty to ensure that the correct law
is
applied: "[a]s a court of last resort, [the supreme court] ha[s] the authority to decide on whatever grounds we deem appropriate, regardless of
preservation
or
presentation
."
State v. Johnson
,
I note that Oltmanns' claim fails regardless of whether first-party claim law or third-party claim law applies because he waived his argument as to Fire Insurance's breach of duty in filing a declaratory judgment. I agree with the majority that "Mr. Oltmanns's argument fails on its own terms." Supra ¶ 10. However, the reasoning for my holding is that "Fire Insurance was 'entitled to seek a declaratory judgment as to its obligations and rights,' " supra ¶ 24, and that Oltmanns acknowledges this right in his brief, thus waiving any claims for attorney fees for that declaratory judgment.
I disagree with the majority that because both parties have framed their claim as a first-party claim we must apply first-party insurance claim law to the case. Ultimately, I do not apply either. However, as a court, we are not bound to accept arguments regarding incorrect law. This is clearly a third-party insurance claim, and we have clearly defined precedent regarding third-party claims. Nor do I agree with the majority's claims that the common law in third-party insurance claims is unsettled in Utah. Supra ¶ 20. We do not "need adversarial briefing before" we can reiterate what has been litigated by other parties who have had the opportunity to litigate their claims in our adversarial system and been decided by this court.
Supra
¶ 18. The precedent is clear and has been extensively litigated by those who have had the opportunity to present adversarial briefing. Nor is it pertinent that the law in this area is unsettled in other jurisdictions.
Supra
¶ 20. It is well settled in Utah and neither party has asked us to reconsider our precedent. In fact, one of the primary cases on insurance law also reached the United States Supreme Court, who only reversed on the amount of punitive damages awarded.
See
Campbell v. State Farm Mut. Auto Ins. Co.,
This rule was amended in May 2016, but the relevant provision here was unchanged.
But see
Truck Ins. Exch. v. Rutherford
,
See, e.g., Utah Code § 16-10a-840 (explaining the fiduciary duties owed by directors to a corporation); Utah Code § 48-3a-409 (explaining the fiduciary duties owed by members in a member-managed limited liability company); Utah Code §§ 22-1-1 to -2, 75-7-801 to -804 (explaining the fiduciary duties owed by the trustee of a trust).
See, e.g.
,
Daniels v. Gamma W. Brachytherapy, LLC
,
The operative statute in Baird , Utah Code section 78-33-2, was renumbered and amended in 2008 and was the predecessor to Utah Code section 78B-6-401. It read
Any person interested under a deed, will or written contract, or whose rights, status or other legal relations are affected by a statute, municipal ordinance, contract or franchise, may have determined any question of construction or validity arising under the instrument, statute, ordinance, contract or franchise and obtain a declaration of rights, status or other legal relations thereunder.
Although some material changes were made in the 2008 statute, what constitutes a "justiciable controversy" remains the same.
Although not at issue on this appeal, we note that in the underlying case which gave rise to this appeal, the district court found the term "jet ski" in the contract to be "clear and unambiguous in that the meaning would be plain to a person of ordinary intelligence and understanding viewing the matter fairly and reasonably, in accordance with the usual and natural meaning of the words...." In the transcript at oral arguments on this issue, the district court stated that in its "best view ... it would be plain to a person of ordinary intelligence and understanding that the generic term 'jet ski,' as included in the insurance agreement in this case, includes the watercraft involved in this litigation. So I'm going to grant the motion for that reason...." In its memorandum to the district court in support of summary judgment, Fire Insurance attached several websites as exhibits, including boat reviews and a Wikipedia article among others.
Neither the lawyer nor the court explains how a personal "best view" or a self-selected sampling of websites of questionable reliability provides substantial evidence as to how a layman reading the contract would interpret "jet ski." As recognized by this court and others, lawyers should provide courts with meaningful tools using the best available methods when the court is tasked with determining ordinary meaning.
See
FCC v. AT & T, Inc.,
Even though we place great trust in a judge's discernment, a "judge's confidence in her linguistic intuition may be misplaced.... Though the human language faculty is very good at assessing which meanings are linguistically permissible in a given context, human intuition is less successful in selecting the most common meaning or common understanding." Stephen C. Mouritsen,
Hard Cases and Hard Data: Assessing Corpus Linguistics as an Empirical Path to Plain Meaning,
Additionally, both Fire Insurance's and the court of appeals' reliance on Wikipedia is ill-advised.
See
Fire Ins. Exch. v. Oltmanns,
Utah Rule of Civil procedure 11(b) states that
[b]y presenting a pleading, written motion, or other paper to the court (whether by signing, filing, submitting, or advocating), an attorney or unrepresented party is certifying that to the best of the person's knowledge, information, and belief, formed after an inquiry reasonable under the circumstances, ... it is not being presented for any improper purpose, such as to harass or to cause unnecessary delay or needless increase in the cost of litigation; ... the claims, defenses, and other legal contentions are warranted by existing law or by a nonfrivolous argument for the extension, modification, or reversal of existing law or the establishment of new law; ... the allegations and other factual contentions have evidentiary support or, if specifically so identified, are likely to have evidentiary support after a reasonable opportunity for further investigation or discovery; and ... the denials of factual contentions are warranted on the evidence or, if specifically so identified, are reasonably based on a lack of information or belief.
Both rule 56 and rule 7 were substantially modified in 2015 to more closely follow the style of the Federal Rules of Civil Procedure. We use the 2014 rules in place at the time the memoranda were filed.
Reference
- Full Case Name
- FIRE INSURANCE EXCHANGE, Appellee, v. Robert Allen OLTMANNS, Appellant.
- Cited By
- 13 cases
- Status
- Published