James v. Integon National Insurance

744 S.E.2d 491, 228 N.C. App. 171, 2013 WL 3305436, 2013 N.C. App. LEXIS 719
CourtCourt of Appeals of North Carolina
DecidedJuly 2, 2013
DocketNo. COA12-1417
StatusPublished
Cited by2 cases

This text of 744 S.E.2d 491 (James v. Integon National Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals of North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
James v. Integon National Insurance, 744 S.E.2d 491, 228 N.C. App. 171, 2013 WL 3305436, 2013 N.C. App. LEXIS 719 (N.C. Ct. App. 2013).

Opinion

CALABRIA, Judge.

Integon National Insurance Company (“defendant”) appeals from an order granting summary judgment in favor of Michael Thomas James (“plaintiff’). We reverse and remand.

I. Background

Natalie Williams (“Williams”) applied for a North Carolina Personal Auto Insurance policy (“the policy”) through Huff’s Insurance & Realty, Inc. in September 2010. On the application, Williams listed two vehicles [172]*172to be covered under the policy and listed herself as the sole driver of both vehicles. On 18 April 2011, Williams added her mother as an additional driver on the policy. The policy provided Underinsured Motorist (“UIM”) coverage in the amount of $50,000.00 per person and $100,000.00 per occurrence. On 12 October 2011, the policy was renewed for another year.

On 6 November 2011, plaintiff, Williams’s flaneé, was involved in a motor vehicle accident. At the time, plaintiff was driving one of Williams’s vehicles. As a result of the accident, plaintiff sustained serious bodily injuries, for which he incurred medical expenses in excess of $50,000.00. Following exhaustion of the minimum liability coverage on the other vehicle involved in the collision, plaintiff submitted a UIM claim to defendant. Defendant denied plaintiff’s claim.

On 16 May 2012, plaintiff filed a complaint and subsequently an amended complaint for declaratory relief. Plaintiff sought, inter alia, “a declaration of the rights and obligations of the parties as to Integon National Insurance Company Policy Number 6616109, and in particular that the policy provides UIM coverage ... and that such UIM coverage is available for the [p]laintiff.” Defendant filed an answer, claiming that prior to the time plaintiff was involved in the accident, Williams had made a material misrepresentation in her application for the insurance policy that barred plaintiff’s recovery.

On 19 September 2012, plaintiff moved for summary judgment. On 12 October 2012, after a hearing, the trial court granted plaintiff’s motion for summary judgment, finding that “there is no genuine issue of material fact that the [p]laintiff is an insured for the purpose of UIM coverage under the policy;” and that defendant “failed to come forward with admissible evidence establishing scienter by [] Williams necessary to establish the affirmative defense of fraud.” Defendant appeals.

II. Standard of Proof

Defendant argues that the trial court erred by granting plaintiff summary judgment by applying the wrong standard of proof. We agree.

In the instant case, plaintiff’s complaint sought a declaratory judgment that he was entitled to UIM coverage under Williams’s policy. In its answer, defendant asserted the affirmative defense of material misrepresentation, alleging that Williams procured the policy by making a material misrepresentation in her insurance application and that, as a result, plaintiff was not covered by her policy. In its order granting summary judgment in favor of plaintiff, the trial court treated defendant’s [173]*173affirmative defense as one of fraud, and found that defendant did not forecast sufficient evidence to establish scienter. Defendant contends that the trial court’s determination was erroneous because evidence of scienter is not required to establish a material misrepresentation.

To prove fraud, a party must show that the defendant made a false “representation relating to some material past or existing fact.” Myers & Chapman, Inc. v. Thomas G. Evans, Inc., 323 N.C. 559, 568, 374 S.E.2d 385, 391 (1988)(citation omitted). However, in addition to proof of a material misrepresentation, establishing fraud also requires proof of the element of scienter. Id. “The term ‘scienter’ embraces both knowledge and an intent to deceive, manipulate or defraud.” Id. Therefore, while both fraud and material misrepresentation involve a false representation by the insured, it is unnecessary to prove that the insured had an intent to deceive in order to prove material misrepresentation. Thus, defendant is correct that fraud and material misrepresentation represent different affirmative defenses.

However, plaintiff, relying on Odum v. Nationwide Mut. Ins. Co., 101 N.C. App. 627, 401 S.E.2d 87 (1991), contends that “fraud is the correct affirmative defense to coverage in excess of the minimum required by” N.C. Gen. Stat § 20-279 et seq., the Financial Responsibility Act of 1953 (“FRA”). Based upon this contention, plaintiff argues that the trial court properly treated defendant’s affirmative defense as a defense of fraud.

The issue in Odum was whether the insurer of an automobile liability policy could avoid liability after an injury had occurred on the ground that the policy was procured by the insured’s deliberate and material misrepresentations on the application, i.e., fraud. Id. at 631, 401 S.E.2d at 89. This Court held that fraud “is not a defense to the insurer’s liability once injury has occurred.” Id. at 634, 401 S.E.2d at 91. Fraud could not be a total affirmative defense under the FRA because pursuant to N.C. Gen. Stat. § 20-279.21(f)(1)(2011), insurance required by the FRA “shall become absolute whenever injury or damage covered by said motor vehicle liability policy occurs,” and “no statement made by the insured ... and no violation of said policy shall defeat or void said policy.”

However, the Odum Court further determined that its holding only applied to the minimum insurance coverage amounts required by the FRA. 101 N.C. App. at 634, 401 S.E.2d at 91. The Court based this determination on N.C. Gen. Stat. § 20-279.21(g), which states:

Any policy which grants the coverage required for a motor vehicle liability policy may also grant any lawful coverage in excess of or in addition to the coverage specified for [174]*174a motor vehicle liability policy and such excess or additional coverage shall not be subject to the provisions of this Article. With respect to a policy which grants such excess or additional coverage the term ‘motor vehicle liability policy’ shall apply only to that part of the coverage which is required by this section.

N.C. Gen. Stat. § 20-279.21(g) (2011)(emphasis added). Because the coverage amounts in the policy at issue in Odum were greater than the statutory minimum, the Court held “that as to any coverage in excess of the statutory minimum, the insurer [was] not precluded by statute or public policy from asserting the defense of fraud.” Odum, 101 N.C. App. at 635, 401 S.E.2d at 92; see also Hartford Underwriters Ins. Co. v. Becks, 123 N.C. App. 489, 494, 473 S.E.2d 427, 430 (1996) (where this Court held the insurer was not precluded from seeking to avoid a claim for UIM coverage where the insureds fraudulently misrepresented or concealed material facts concerning their state of residence on which the insurance company reasonably relied in providing coverage).

In the instant case, plaintiff is only seeking to recover from the portion of Williams’s policy which provided UIM coverage in the amount of $50,000.00 per person and $100,000.00 per occurrence.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
744 S.E.2d 491, 228 N.C. App. 171, 2013 WL 3305436, 2013 N.C. App. LEXIS 719, Counsel Stack Legal Research, https://law.counselstack.com/opinion/james-v-integon-national-insurance-ncctapp-2013.