Fogelson v. Home Insurance

129 A.D.2d 508, 514 N.Y.S.2d 346, 1987 N.Y. App. Div. LEXIS 45186
CourtAppellate Division of the Supreme Court of the State of New York
DecidedApril 21, 1987
StatusPublished
Cited by6 cases

This text of 129 A.D.2d 508 (Fogelson v. Home Insurance) is published on Counsel Stack Legal Research, covering Appellate Division of the Supreme Court of the State of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fogelson v. Home Insurance, 129 A.D.2d 508, 514 N.Y.S.2d 346, 1987 N.Y. App. Div. LEXIS 45186 (N.Y. Ct. App. 1987).

Opinions

Order and judgment (one paper), Supreme Court, New York County (Seymour Schwartz, J.), entered January 29, 1986, which granted plaintiffs’ motion for summary judgment declaring that defendant The Home Insurance Company (The Home) is obligated to defend and indemnify plaintiffs in a malpractice action, and which denied The Home’s motion for summary judgment against defendant American Home Assurance Company (American Home), modified, on the law, to declare that The Home is not obligated to defend or indemnify plaintiffs, and otherwise affirmed, without costs.

The individual plaintiffs in this declaratory judgment action are the partners of the plaintiff law firm who, while members of a predecessor law firm, represented James and Elizabeth Farrell in a mortgage foreclosure action in 1980. Plaintiffs [509]*509admit their failure to file a timely answer in that action, and their unsuccessful efforts over the next four years to vacate a default judgment entered against the Farrells.

American Home had issued to plaintiffs a one-year "claims made” professional liability policy effective October 5, 1983. Plaintiffs used Country Brokerage Service, Inc. as their broker to obtain this insurance. Upon the expiration of American Home’s policy, The Home issued to plaintiffs a one-year "claims made” professional liability policy effective October 5, 1984, which was cobrokered by Country Brokerage and Bertholon-Rowland Corp.

On April 30, 1984, while plaintiffs were insured by American Home, the Farrells informed plaintiffs that they had been advised by an unnamed attorney to consider the possibility of instituting a malpractice action against the plaintiffs. Plaintiffs advised Bertholon-Rowland by letter of this communication from the Farrells in the mistaken belief that BertholonRowland was their broker on the American Home policy. The record does not indicate that Bertholon-Rowland forwarded plaintiffs’ letter to American Home or otherwise advised American Home of the substance of the letter.

The application for professional liability insurance that plaintiffs submitted to The Home on October 5, 1984 contained the following limitation on coverage appearing in bold-faced print: "This policy does not apply to any claim arising out of any acts or omissions occurring prior to the effective date of this policy if the Insured at the effective date knew or could have reasonably foreseen that such acts or omissions might be expected to be the basis of a claim or suit. Potential claims that you are presently aware of should be reported to your present carrier.”

To similar effect, and as here pertinent, the policy indemnified the insured (plaintiffs) for damages the insured became legally obligated to pay as the result of claims first made against the insured during the policy period by reason of any act, error or omission in professional services rendered:

"provided always that such act, error or omission * * * happens:
"(aa) during the policy period, or
"(bb) prior to the policy period, provided that prior to the effective date of this policy:
"1) the insured did not give notice to any prior insurer of any such act, error, omission or personal injury; and
"2) the insured had no basis to believe that the insured had [510]*510breached a professional duty or committed a personal injury; and
"3) there is no prior policy or policies which provide insurance for such liability or claim, unless the available limits of liability of such prior policy or policies are insufficient to pay any liability or claim in which event this policy will be excess over any such prior coverage.”

On December 20, 1984, the Farrells notified plaintiffs of their definite intention to institute a malpractice action, and, on February 7, 1985, such an action was commenced. The Home declined coverage on the ground of plaintiffs having first been advised of the possibility of a malpractice action against them on April 30, 1984, prior to the inception of The Home’s policy, taking the position that on that basis the claim was not "first made against the insured during the policy period,” and further based its declining coverage on "such other good and sufficient reasons as may hereafter appear.”

American Home disclaimed coverage because the Farrells’ claim was not first made within its policy period, and further because even if the claim was made within the policy period, proper notice to American Home was not given. Plaintiffs then commenced the within declaratory judgment action to determine which company was liable to defend and indemnify them against the Farrells’ malpractice lawsuit.

Prior to any disclosure in this action, plaintiffs moved for summary judgment against The Home and sought a declaration that it was obligated to defend and indemnify them in the underlying professional malpractice action, and The Home moved for summary judgment against defendant American Home declaring that it was obligated to defend and indemnify plaintiffs in the underlying Farrell suit. Special Term ruled that The Home was obligated to defend and indemnify, and denied The Home’s motion for summary judgment against American Home. This appeal by The Home followed.

We need not determine whether the claim was first made on April 30, 1984 (when plaintiffs were advised of the possibility of a malpractice action), or on December 20, 1984 (when plaintiffs were notified that a malpractice action was about to be commenced), or on February 7, 1985 (when the action was actually commenced). It is clear that under coverage clause (bb) (2) of The Home policy the plaintiffs did have a basis to believe they had breached a professional duty prior to the effective date of The Home policy.

Plaintiffs contend that The Home is precluded from assert[511]*511ing the aforesaid coverage provision as a defense to plaintiffs’ demand for coverage, on the ground that The Home’s failure to specifically enumerate any defenses in its January 30, 1985 disclaimer letter beyond the timing of the Farrells’ claim operated as a waiver of all further defenses. However, the doctrine of waiver cannot expand an insuring clause or contract the exceptions to such clause, but is instead limited in its application to those circumstances where the insurer’s conduct demonstrates an intention to abandon such defenses as failure to cooperative or give timely notice of claim. The distinction is clearly set forth in Schiff Assocs. v Flack (51 NY2d 692, 698) as follows: "Waiver evolved because of courts’ disfavor of forfeitures of the insured’s coverage which would otherwise result where an insured breached a policy condition, as, for instance, failure to give timely notice of a loss or failure to co-operate with the insured (16A Appleman, Insurance Law and Practice, § 9082). To defeat the forfeiture, courts find waiver where there is direct or circumstantial proof that the insurer intended to abandon the defense * * * This, however, does not create coverage, for the underlying coverage must be subsisting if the forfeiture is to serve any purpose.

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Cite This Page — Counsel Stack

Bluebook (online)
129 A.D.2d 508, 514 N.Y.S.2d 346, 1987 N.Y. App. Div. LEXIS 45186, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fogelson-v-home-insurance-nyappdiv-1987.