Ausch v. St. Paul Fire & Marine Insurance

125 A.D.2d 43, 511 N.Y.S.2d 919, 1987 N.Y. App. Div. LEXIS 40599
Appellate Division of the Supreme Court of the State of New York·Decided February 17, 1987·Published·Cited by 51 cases

Opinion

OPINION OF THE COURT

Per Curiam.

The plaintiff Julius Ausch, as the assignee of Abbey Residential Home, Inc. (hereinafter Abbey), the named insured, and Abbey commenced the instant action to recover for fire losses on an insurance policy issued by the defendant covering premises located at 86 Van Ness Place, Newark, New Jersey. Two incendiary fires occurred on the premises during the month of December 1981 approximately two months after the insurance coverage was increased from $150,000 to $380,000 and approximately six months after the shelter-care home being operated by Abbey on the premises was closed by the New Jersey Department of Health. After the shelter-care home was closed, the premises were operated as a rooming house.

The defendant challenges the dismissal, after a Bench trial, of its second and third affirmative defenses for failure of proof. The second affirmative defense alleged that the plaintiff Abbey breached the standard fire insurance policy provision requiring disclosure by way of submission to examinations under oath, as often as may be reasonably required, in that Abbey [45] failed to produce for examination the corporate officer and shareholder Naftali Ausch, the accountant Twerski, and its books and records. The third affirmative defense alleged that the plaintiff Julius Ausch, a corporate officer, concealed, misrepresented and swore falsely as to material matters at his examination under oath. It was alleged, in particular, that Julius falsely swore that he owned Abbey and that his brother, Naftali Ausch, did not have an interest in Abbey at the time of the fires. Although its arson expert had opined that the subject fires were incendiary in origin, the defendant consented to strike its arson defense due to its inability to show the fires were set with the knowledge and consent of the insured.

On appeal, the defendant contends for the first time that the Trial Judge applied an erroneous standard of proof. In issuing his decision from the Bench, the Trial Judge stated that the defendant had the burden of proof with respect to the second and third affirmative defenses and that both defenses had to be established by clear and convincing evidence. The latter is a higher, more demanding standard than the preponderance of the evidence standard (Rossi v Hartford Fire Ins. Co., 103 AD2d 771; Simcuski v Saeli, 44 NY2d 442, 452). "A party who must prove his case by a preponderance of the evidence only need satisfy you that the evidence supporting his case more nearly represents what actually happened than the evidence which is opposed to it. But a party who must establish his case by clear and convincing evidence must satisfy you that the evidence makes it highly probable that what he claims is what actually happened” (PJI 1:64 [1986 Supp]). Although no objection to the application of this standard of proof appears in the record, the Trial Judge’s ruling in this regard constituted error warranting the exercise of our discretionary powers of review in the interest of justice.

The defendant clearly has the burden of proof regarding both affirmative defenses. While the clear and convincing evidence standard of proof applicable to fraud cases has been held applicable to defenses of arson and false swearing (Hutt v Lumbermens Mut. Cas. Co., 95 AD2d 255; Rossi v Hartford Fire Ins. Co., supra; see, Simcuski v Saeli, supra; Saks & Co. v Continental Ins. Co., 26 AD2d 540, affd 23 NY2d 161), this standard has not been expressly applied to the affirmative defense of refusal to comply with policy requirements (PJI 4:80 [1986 Supp]). The defendant’s burden of proving lack of cooperation on the part of its insured has been described as a [46] "heavy” one (see, Dyno-Bite, Inc. v Travelers Cos., 80 AD2d 471, 475, appeal dismissed 54 NY2d 1027), especially in cases where an innocent accident victim would be deprived of his source of payment because a liability carrier claims that its assured has failed to cooperate (see, Thrasher v United States Liab. Ins. Co., 19 NY2d 159, 168; Van Opdorp v Merchants Mut. Ins. Co., 55 AD2d 810). Notwithstanding this characterization, we hold that the standard of proof applicable for establishing a breach of the policy’s cooperation clause in a case involving an indemnity carrier seeking to avoid payment to a fire insured, which is a party in control of its own fate (see, Dyno-Bite, Inc. v Travelers Cos., supra, at pp 475-476), is a preponderance of the evidence. Accordingly, the trial court erred in applying the clear and convincing evidence standard with respect to the second affirmative defense, but not with respect to the third affirmative defense.

A factual issue material to the defendant’s second affirmative defense that the insured had breached its duty to assist in an investigation regarding a possible arson was whether or not Naftali Ausch had an interest in Abbey sufficient to require his appearance at an examination under oath. Upon reviewing the record, we conclude that the trial court’s finding that Naftali was neither a principal nor officer of the insured, a close corporation, is against the weight of the credible evidence. Since this was a Bench trial, we have exercised our power to make new findings of fact and to render a judgment warranted by our findings "taking into account in a close case 'the fact that the trial judge had the advantage of seeing the witnesses’ ” (Northern Westchester Professional Park Assoc. v Town of Bedford, 60 NY2d 492, 499; Cohen v Hallmark Cards, 45 NY2d 493, 498).

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Ausch v. St. Paul Fire & Marine Insurance, 125 A.D.2d 43, 511 N.Y.S.2d 919, 1987 N.Y. App. Div. LEXIS 40599 (N.Y. Ct. App. 1987).

125 A.D.2d 43 (Ausch v. St. Paul Fire & Marine Insurance) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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