Harold J. Warren, Inc., D/B/A Professional Realty Co. v. Federal Mutual Insurance Company

386 F.2d 579, 1967 U.S. App. LEXIS 4232
CourtCourt of Appeals for the First Circuit
DecidedDecember 8, 1967
Docket6958
StatusPublished
Cited by9 cases

This text of 386 F.2d 579 (Harold J. Warren, Inc., D/B/A Professional Realty Co. v. Federal Mutual Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the First Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Harold J. Warren, Inc., D/B/A Professional Realty Co. v. Federal Mutual Insurance Company, 386 F.2d 579, 1967 U.S. App. LEXIS 4232 (1st Cir. 1967).

Opinion

McENTEE, Circuit Judge.

This is an appeal from a declaratory judgment that a certain fire insurance policy issued by plaintiff on defendant’s, building is null and void. The basis for this judgment is the district court’s finding that in making claim against the plaintiff insurer under the policy for a fire loss in its building, defendant wil-fully misrepresented and overstated the amount of the loss, thereby attempting to defraud or gain an advantage in negotiating with the plaintiff.

The principal question raised is whether the evidence adduced supports this finding. The insured building is a four story structure of Class A construction consisting of brick walls with reinforced steel and poured concrete structural ceil *580 ings and floors. It is located on Massachusetts Avenue in Boston and contains stores and offices. Among other things, the policy provided coverage for physical damage and loss of rents. It also contained the following Massachusetts statutory “Fraud and Concealment Clause”:

“This entire policy shall be void if, whether before or after a loss, the insured has wilfully concealed or misrepresented any material fact or circumstance concerning this insurance or the subject thereof, or the interest of the insured therein, or in case of any fraud or false swearing by the insured relating thereto.” Mass.Gen. Laws ch. 175, § 99.

Following the fire, which occurred in April 1965, the defendant corporation, through one Warren, its president, and Winnick, its treasurer, hired an experienced public adjuster named Milton to represent it in adjusting its fire loss. The company through Warren also engaged an architect named Larkin to draw plans and specifications for work to be done on the building. These plans encompassed both fire and nonfire damage repairs and alterations. Plaintiff insurance company retained one Stratton as its adjuster. Milton who had full authority to act for the defendant, submitted a claim to Stratton for some $40,680 which was later revised to $67,-698.46. Stratton testified that there was also a rental loss claim for an additional $12,000.

Because of failure to agree on amount, the parties went to reference under the Massachusets statute. 1 The referees awarded the defendant some $42,967 for damages to the building, plus $3,000 for rental loss. Before this award was returned, plaintiff notified defendant it was -denying all liability under the policy and commenced this diversity action to have the policy declared null and void.

Defendant contends that the referees' award may not be collaterally attacked unless there was evidence of fraud before the district court that was not before the referees. It claims there was no such evidence here. We do not agree.

From our reading of the record it seems clear that new evidence of fraud was presented at the trial but even if this were not the fact, defendant’s conclusion does not follow. Under the reference statute, the sole function of the referees is to determine the amount of loss — not the ultimate liability 2 Of course, the issue of fraud presents a question of ultimate liability. Gechijian v. Richmond Ins. Co., 298 Mass. 487, 11 N.E.2d 478 (1937) and Gechijian v. Richmond Ins. Co., 305 Mass. 132, 25 N.E.2d 191 (1940).

These cases clearly voice the strong Massachusetts policy against insurance fraud. The parties may not consider themselves free to bargain over terms with disregard of the actual amount of loss. In Gechijian 1 the court stated at 488-489, at 479 of 11 N.E.2d:

“In our opinion a design on the part of the insured to gain a position of advantage in the settlement of the loss through false representations is a fraudulent design and the making of such representations knowingly for that purpose is an ‘attempt to defraud’ within the meaning of those words as used in the policy, even though the insured may not have expected or intended ultimately to obtain more than compensation for the actual loss. * * * The policy does not contemplate that after a loss the insured and insurer shall occupy the positions of vendor and vendee, free to haggle over the price of the property destroyed without regard to its true value.”

*581 An analysis of the evidence in the light of these principles shows that the district court’s finding of fraud was clearly justified. 3 The first item in the revised claim was a contract for $44,100 with New England Partition & Fixture Company, based on plans and specifications drawn by defendant’s architect. Stratton requested a breakdown of this sum from Milton but was unable to get it prior to reference.

At an early stage in the reference proceedings defendant conceded that $7,320 of the $44,100 represented non-fire damage and should not have been included. Moreover, the architect testified and Warren himself admitted that New England’s bid was for both fire and nonfire work. In any event, because of Warren’s testimony that the plans had been drawn at his direction and that he had brought the architect through the building pointing out certain things to him, there can be no doubt of his awareness that the specifications were for both fire and nonfire damage.

Another pertinent item in the revised claim is $8,750 for third floor ventilating and air-conditioning. There was evidence from which the district court could reasonably conclude that this amount represented the cost of replacing all the air-conditioning on the third floor and that the repairs for fire damage actually amounted to little more than $3,000. Indeed, Milton had previously received a fire damage estimate of approximately $3,000, an estimate that was supported by an expert produced by plaintiff. In fact the company that submitted the $8,750 bid indicated that only one of the air-conditioning units appeared to be damaged and that it had bid on replacing all the air-conditioning on the third floor, not merely the fire damage.

Defendant also claimed a fee of $3,678 for the architect who had drawn the plans but there is a question whether any new plans were needed in order to repair the fire damage. As pointed out in the district court’s opinion, a 1960 plan showing the building as it existed before the fire was available. In addition, no explanation was given as to why any plans were needed for the fourth floor since the evidence is clear there was no significant fire damage on that floor.

Still another indication of fraud is the claim for rental loss. Despite the original claim for $12,000, a breakdown of which Stratton was unable to get, Winnick testified at the' trial that the actual rent loss was $6,025 and that all but $750 of this amount had been paid subject to refund.

We are concerned here, of course, not merely with the question of whether excessive figures were submitted but also whether this was done wilfully.

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Bluebook (online)
386 F.2d 579, 1967 U.S. App. LEXIS 4232, Counsel Stack Legal Research, https://law.counselstack.com/opinion/harold-j-warren-inc-dba-professional-realty-co-v-federal-mutual-ca1-1967.