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Smart Summary

Factual and Procedural Background

On August 17, 1963 Charles M. Gross allegedly struck and seriously injured Lynn Butch. Gross notified the police but did not notify his insurer, Allstate. The Butches served Gross on October 14, 1963; Gross delivered the summons and complaint to Allstate on October 15, 1963, Allstate's first notice. On October 24, 1963 Allstate sent Gross a reservation of rights letter reserving its right to disclaim "because of late notice and for other reasons." Allstate answered the underlying action for Gross, sought and received a bill of particulars, and represented Gross at his pretrial examination. The Motor Vehicle Accident Indemnification Corporation (MVAIC) intervened.

On May 23, 1964 Allstate commenced this declaratory judgment action seeking a declaration that it was not obligated to defend or pay any claim. The trial court, after a nonjury trial, found for Allstate, holding Gross had breached the policy by failing to give timely notice. The Appellate Division reversed, holding Allstate's seven-month delay was unreasonable as a matter of law (31 A.D.2d 389). The Court of Appeals affirmed the Appellate Division's order, with costs to respondents MVAIC and Gross.

Legal Issues Presented

  1. Whether Insurance Law § 167, subdivision 8, which requires that an insurer give written notice "as soon as is reasonably possible" of a disclaimer or denial of coverage, requires the insurer to reach a decision to disclaim or deny coverage within a reasonable time (i.e., whether the statute imports an obligation to decide promptly as well as to give prompt notice).
  2. Whether an insurer may delay deciding to disclaim liability indefinitely in the absence of a showing of prejudice to the insured, injured party, or MVAIC.
  3. Whether undue delay in disclaiming or denying coverage under the Motor Vehicle Accident Indemnification Law is governed by pre-existing common-law doctrines (waiver/estoppel) requiring prejudice, or by a statutory, time-based rule of reasonableness.

Arguments of the Parties

Appellant's Arguments (Allstate)

  • An insurer is not obliged to decide to disclaim liability or deny coverage within any particular time so long as no prejudice to the insured or injured party is shown.
  • The statute's language requires prompt notice of a disclaimer once the insurer decides to disclaim, but does not impose a like requirement to make the decision promptly.
  • Allstate could bring a declaratory judgment action to determine its right to disclaim and should not be compelled to disclaim prematurely or be penalized for choosing declaratory relief.
  • Allstate asserted it had never formally disclaimed, even though seven years had elapsed since the accident.

The opinion does not contain a detailed account of the respondents' separate legal arguments beyond the Appellate Division's conclusion that Allstate's seven-month delay was unreasonable as a matter of law.

Table of Precedents Cited

Precedent Rule or Principle Cited For Application by the Court
Appell v. Liberty Mut. Ins. Co., 22 A.D.2d 906, affd. 17 N.Y.2d 519 Delay in disclaimer may prejudice an injured party by misleading into litigation rather than settlement with MVAIC. Used to illustrate how delayed disclaimer can harm injured parties and support prompt disclaimer requirement.
Allstate Ins. Co. v. Manger, 30 Misc.2d 326 An insurer's declaratory judgment action is not itself a disclaimer; six- and twelve-month delays held not unreasonable in that case. Identified as the principal case relied on by Allstate; distinguished by this Court as not controlling the statutory interpretation adopted here.
Matter of Crump [MVAIC], 44 Misc.2d 180 Similar holding to Manger regarding timing of disclaimer in context of declaratory actions. Noted as another case reaching the same conclusion as Manger; contrasted with the Court's view favoring promptness measured from knowledge of accident.
Cohen v. Atlantic Nat. Ins. Co., 24 A.D.2d 896 Time for notice measured from insurer's first learning of the accident or grounds for disclaimer. Cited among authorities supporting the view that delay should be measured from insurer's knowledge, not from moment it chooses to disclaim.
Royal Ind. Co. v. Kay, 48 Misc.2d 1086, 1088 Authority measuring time for notice from insurer's knowledge. Grouped with other precedents supporting promptness from knowledge of claim.
Wallace v. Universal Ins., 227 N.Y.S.2d 999 Authority supporting measuring time from insurer's first knowledge. Included among cases favoring the view adopted by the Court.
Safeguard Ins. Co. v. Trent, 29 A.D.2d 780 Discussed in context of preexisting and statutory rules on delay. Referenced as part of the body of case law addressing timing of disclaimer.
Allstate Ins. Co. v. Bianco, 28 A.D.2d 676 Authority concerning timing of disclaimer notices. Cited among cases considering when delay becomes unreasonable.
Matter of Allstate Ins. Co. v. Flaumenbaum, 62 Misc.2d 32, 41-42 Authority measuring time for notice from insurer's knowledge and discussing timing issues. Cited as supportive precedent for the Court's view on timing.
Moore Constr. Co. v. United States Fid. Guar. Co., 293 N.Y. 119 Illustrates prejudice-causing delay leading to estoppel in prestatutory cases. Used to show historical concerns that delayed disclaimer could prejudice insureds and claimants.
Ashland Window Housecleaning Co. v. Metropolitan Cas. Ins. Co., 269 App. Div. 31 Prestatutory case noting prejudice from delay and estoppel consequences. Referenced as part of authorities demonstrating prejudice-based estoppel before the statute.
Merchants Mut. Cas. Co. v. Wildman, 21 Misc.2d 1073, affd. 12 A.D.2d 664, affd. 9 N.Y.2d 985 Prestatutory estoppel decisions noting prejudice from delay; cited again re: common-law defenses. Used to show prior-case treatment of prejudice and estoppel; Court explains statute provides a distinct time-based rule.
S. E. Motor Hire Corp. v. New York Ind. Co., 255 N.Y. 69 Example of pre-statute authority where estoppel required a showing of prejudice. Appears in discussion distinguishing common-law defenses from statutory time limit.
Gerka v. Fidelity Cas. Co., 251 N.Y. 51 Another pre-statute case illustrating estoppel/prejudice requirement. Cited to show historical legal landscape prior to the Motor Vehicle Accident Indemnification Law.
General Acc. Fire Life Assur. Corp. v. Blersch, 46 Misc.2d 480, affd. 25 A.D.2d 764, affd. 18 N.Y.2d 633 Demonstrates that common-law defenses (waiver/estoppel) are not precluded when the statute is invoked. Relied upon to show that old defenses remain available though the statute establishes an independent rule on delay.
Great American Ins. Co. v. Schaefers, 47 Misc.2d 522 Cited by way of comparison regarding defenses and statutory invocation. Referenced as part of the body of cases discussing interplay of statute and common-law defenses.
Mason-Henry Press v. Aetna Life Ins. Co., 146 App. Div. 181, 186-188 Holds reservation of rights letters effective against a claim of waiver under decisional rule. Used to explain efficacy of Allstate's reservation-of-rights letter against a waiver defense.
31 A.D.2d 389 The Appellate Division decision in this case reversing the trial court and holding Allstate's seven-month delay unreasonable as a matter of law. Described in the opinion as correctly reading the statute; the Court of Appeals affirms this order.

Court's Reasoning and Analysis

The Court began from the statutory text, Insurance Law § 167, subdivision 8, which commands that an insurer "give written notice as soon as is reasonably possible" of a disclaimer of liability or denial of coverage for motor-vehicle death or bodily-injury claims. The Court held that the statute's literal requirement of prompt notice necessarily imports an obligation to reach the decision to disclaim or deny coverage within a reasonable time so that notice can follow promptly.

The Court rejected Allstate's argument that the statute requires only prompt notice after a decision to disclaim, permitting indefinite delay in making that decision. It explained the statute's purpose: to protect injured parties and MVAIC by enabling timely investigation, earlier settlement negotiation, and earlier recovery from MVAIC; delayed disclaimers frustrate those purposes and may prejudice injured parties and MVAIC.

The Court surveyed precedent, noting some cases (e.g., Allstate v. Manger, Matter of Crump) which treated insurer declaratory actions differently, but found a greater weight of nisi prius and Appellate Division authority measuring the time for notice from the insurer's knowledge of the accident or grounds for disclaimer (e.g., Cohen, Royal Ind. Co., Wallace, Matter of Flaumenbaum). The Court concluded the Appellate Division correctly read the statute to require a reasonably prompt decision to disclaim.

The Court also explained the statute creates a time-based rule independent of preexisting common-law defenses (waiver or estoppel), which required proof of prejudice; while such defenses remain available, the statute establishes that unduly delayed disclaimer violates the rights of insureds, injured parties, and MVAIC. The standard for delay is unreasonableness measured by the circumstances: reasonableness is a question of fact, or if extreme, of law.

Holding and Implications

Order affirmed, with costs, to respondents MVAIC and Gross.

Direct consequences: the Court holds that Insurance Law § 167(8) requires not only prompt written notice after a disclaimer decision but also that the insurer reach the decision to disclaim or deny coverage within a reasonable time. Unduly delayed disclaimers violate the rights of the insured, injured parties, and MVAIC. Whether delay is unreasonable is determined by the circumstances of each case (fact question unless extreme).

ALLSTATE INSURANCE COMPANY, Appellant, v. CHARLES M. GROSS et al., Respondents.

BREITEL, J.

An automobile public liability insurer, plaintiff Allstate, contends, in this action for a declaratory judgment, that it is not obliged to decide to disclaim liability or to deny coverage within any particular time, in the absence of prejudice to an insured or injured party. The trial court found in its favor but on appeal the Appellate Division reversed, holding that there had been an unreasonable delay as a matter of law. There should be an affirmance for the reasons stated below.

Whatever the rule may have been before, the matter is now controlled by statute (Insurance Law, § 167, subd. 8). The statute reads as follows: "If under a liability policy delivered or issued for delivery in this state, an insurer shall disclaim liability or deny coverage for death or bodly [sic] injury arising out of a motor vehicle accident occurring within this state, it shall give written notice as soon as is reasonably possible of such disclaimer of liability or denial of coverage to the insured and the injured person or any other claimant." Its literal language requires prompt notice of disclaimer after decision to do so, and by logical and practical extension, there is imported the obligation to reach the decision to disclaim liability or deny coverage promptly too, that is, within a reasonable time. The insurer concedes that there is an obligation to give prompt notice of the decision to disclaim liability or to deny coverage but seeks shelter behind the words of the statute to argue that there is no like requirement to make a decision promptly. Indeed, although seven years have passed since the accident in suit Allstate contends that it has never disclaimed and it is not obliged to do so now. It urges that the instant action for a declaratory judgment is its choice and the proper mode for determining whether it has a right to disclaim, and it may not be compelled to act prematurely or suffer any consequences for not having done so.

On August 17, 1963 insured Gross allegedly struck and seriously injured Lynn Butch with his automobile. Gross notified the police but did not inform his insurer, Allstate. On October 14, 1963 the Butches served Gross and the next day Gross turned the summons and complaint over to Allstate; this was Allstate's first notice of the accident and claim. In a letter to insured dated October 24, 1963, Allstate reserved its right to disclaim "because of late notice and for other reasons." Allstate served an answer in the action on behalf of insured, sought and received a bill of particulars, and represented insured at his pretrial examination. The Motor Vehicle Accident Indemnification Corporation (MVAIC) intervened because of its possible liability to the injured parties.

On May 23, 1964, nearly seven months after its letter of reservation, Allstate brought the present action for a declaration that it was not obligated to defend the Butches' action against Gross or to pay any claim. In granting judgment, the trial court, after a nonjury trial, held that Gross had breached his policy by failing to give timely notice of the accident. The Appellate Division reversed on the strength of the statute, explaining that, despite its reservation of rights, Allstate's seven-month delay was unreasonable as a matter of law ( 31 A.D.2d 389). Neither court found that Allstate's delay had prejudiced the insured, the injured parties or MVAIC.

Subdivision 8 of section 167 was enacted as part of the Motor Vehicle Accident Indemnification Law, which also created the MVAIC (L. 1958, ch. 759, § 3, as amd. by L. 1959, ch. 650, § 2). On its face it mandates speed in giving notice of disclaimer or denial of coverage. The purpose undoubtedly is concern for the MVAIC and the injured party whose interests will be affected by disclaimer. In the statutory scheme, MVAIC has an obligation to its members, who are insurers (Insurance Law, § 605). It is empowered to investigate claims or defend actions against insureds subject to disclaimers and to pay limited sums in the event the disclaimer or denial is sustained ( id. §§ 605, 606, 613, 614). Obviously, if it can make its investigation earlier rather than later, the investigation will be more complete.

Reasonably prompt disclaimer would also aid injured parties, for whose benefit, primarily, the statute was enacted (see id. § 600, subd. [2]). Quick disclaimer would speed recovery against the MVAIC which is also empowered to negotiate settlements with injured parties and other claimants (see id. § 613). Delayed disclaimer may prejudice the injured party by misleading him into engaging in costly litigation against the insurer rather than negotiating or arbitrating a settlement with MVAIC (see Appell v. Liberty Mut. Ins. Co., 22 A.D.2d 906, affd. 17 N.Y.2d 519).

Although not expressed, interests of the insured, as well as those of the injured party and MVAIC, also benefit from prompt disclaimer. Prejudice to these several interests caused by delay have frequently been noted in cases holding insurers estopped from disclaiming (cf. Moore Constr. Co. v. United States Fid. Guar. Co., 293 N.Y. 119; Ashland Window Housecleaning Co. v. Metropolitan Cas. Ins. Co., 269 App. Div. 31; Merchants Mut. Cas. Co. v. Wildman, 21 Misc.2d 1073, affd. 12 A.D.2d 664, affd. 9 N.Y.2d 985).

Given, then, the statutory plan to protect the injured parties and their alternative source of compensation, MVAIC, and given, too, the risks unnecessarily delayed disclaimers of liability or denials of coverage pose to each, Allstate's tenuous distinction that the statute required speedy notice, not speedy disclaimer, if credited, would accomplish no more than circuitous and prolonged litigation. No readily discernible purpose appears in requiring speed once the decision to disclaim has been made, while permitting delay in making the decision, especially when such a requirement may be circumvented by delaying the decision (but cf. N.Y. Legis. Ann., 1959, pp. 277-278).

In Allstate Ins. Co. v. Manger ( 30 Misc.2d 326) the case most relied on by Allstate, the court held that an action by the insurer for a declaratory judgment was not a disclaimer, and, therefore, the insured's insistence on prompt notice was premature. The court appeared to hold that six- and twelve-month delays in seeking a declaratory judgment were not unreasonable under the statute. It was concluded that the issue of prompt notice was not and ought not be raised in an action to determine whether the insurer could disclaim at all. (See, also, Matter of Crump [ MVAIC], 44 Misc.2d 180, to the same effect.)

Precedents at nisi prius and in the Appellate Division are not lacking, however, for the view that time for notice should be measured from the moment the insurer first learns of the accident or of grounds for its disclaimer and not from the time when it chooses to disclaim (see Cohen v. Atlantic Nat. Ins. Co., 24 A.D.2d 896; Royal Ind. Co. v. Kay, 48 Misc.2d 1086, 1088; Wallace v. Universal Ins., 227 N.Y.S.2d 999 [Sup. Ct., N Y County]; cf. Safeguard Ins. Co. v. Trent, 29 A.D.2d 780; Allstate Ins. Co. v. Bianco, 28 A.D.2d 676; Matter of Allstate Ins. Co. v. Flaumenbaum, 62 Misc.2d 32, 41-42). Indeed, in number and persuasiveness they more than outweigh the apparently contrary cases. Actually, the results in most of the cases are really not in conflict as are the divergent reasons offered for the conclusions reached (see, however, 31 N.Y. Jur., Insurance, § 1334).

Regardless of the split view in the cases, logic and practicality suggest that the statute should not be read as attenuatedly as Allstate urges. Little purpose, as noted earlier, is served in prompt notice of disclaimer, if the decision to disclaim may be postponed indefinitely. That would truly be an instance of the tail wagging the dog. On the other hand, no violence is done to the language requiring notice of disclaimer "as soon as is reasonably possible" to import a like requirement of reaching a prompt decision to disclaim in order that there be a prompt notice of the decision. Consequently, the Appellate Division was eminently correct in its reading of the statute.

Allstate argues alternatively that, before it may be held responsible for undue delay, the statute requires a finding that the insurer's delay in disclaiming prejudiced the insured, the injured party, or MVAIC. The argument misses the point of the statute, and the evident purpose for its enactment. Prior to its enactment, attempts to disclaim could always be defeated by showing waiver or estoppel, the latter necessarily requiring prejudice (see, e.g., S. E. Motor Hire Corp. v. New York Ind. Co., 255 N.Y. 69, 72, 74-75; Gerka v. Fidelity Cas. Co., 251 N.Y. 51, 56-57; see, generally, 31 N.Y. Jur., Insurance, §§ 1327-1329, 1555; 45 C.J.S., Insurance, §§ 672-678). Indeed, these "common law" defenses are not precluded, even when the statute is invoked (see, e.g., General Acc. Fire Life Assur. Corp. v. Blersch, 46 Misc.2d 480, 485, affd. 25 A.D.2d 764, affd. 18 N.Y.2d 633; Merchants Mut. Cas. Co. v. Wildman, 21 Misc.2d 1073, 1075, supra; cf. Great American Ins. Co. v. Schaefers, 47 Misc.2d 522). Reservations of right, such as Allstate sent to insured, are effective only against the defense of waiver under the decisional rule (see Mason-Henry Press v. Aetna Life Ins. Co., 146 App. Div. 181, 186-188).

The statute provides a flexible time limit on disclaimer of liability or denial of coverage, but a time limit nevertheless. The limit depends merely on the passage of time rather than on the insurer's manifested intention to release a right as in waiver, or on prejudice to the insured as in estoppel (see Cohen v. Atlantic Nat. Ins. Co., 24 A.D.2d 896, supra). Otherwise there would have been little purpose for the statute, if it were only an inadequately drafted codification of the pre-existing decisional rules, inadequate because the preconditions to the defenses would not have been spelled out. Although some cases arising under the statute have utilized the old prestatutory waiver or estoppel theories, such theories are superfluous when the statute is read in context. The Motor Vehicle Accident Indemnification Law has, in effect, established an absolute rule that unduly delayed disclaimer of liability or denial of coverage violates the rights of the insured, the injured party, and MVAIC.

Whether the absolute rule was enacted because of a presumption of prejudice from any undue delay or for some other reason is of no moment. The statute lays down an unconditional rule. It requires, however, as a foundation, unreasonableness as a standard for delay, which means simply that no particular time is deemed undue delay. Rather the question of unreasonableness becomes a question of fact, or if extreme, of law, depending upon the circumstances of the case which make it reasonable for the insurer to take more or less time to make, complete, and act diligently on its investigation of its coverage or breach of conditions in its policy.

Accordingly, the order of the Appellate Division should be affirmed, with costs.

Chief Judge FULD and Judges BURKE, SCILEPPI, BERGAN, JASEN and GIBSON concur.

Order affirmed, with costs, to respondents MVAIC and Gross.

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ALLSTATE INS. CO. v. GROSS
(Nov 25, 1970)