Marsden v. Encompass Ins. Co.

863 A.2d 1133, 374 N.J. Super. 241, 2005 N.J. Super. LEXIS 19
CourtNew Jersey Superior Court Appellate Division
DecidedJanuary 12, 2005
StatusPublished
Cited by6 cases

This text of 863 A.2d 1133 (Marsden v. Encompass Ins. Co.) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Marsden v. Encompass Ins. Co., 863 A.2d 1133, 374 N.J. Super. 241, 2005 N.J. Super. LEXIS 19 (N.J. Ct. App. 2005).

Opinion

863 A.2d 1133 (2005)
374 N.J. Super. 241

Arlene MARSDEN, Plaintiff-Respondent,
v.
ENCOMPASS INSURANCE CO., Defendant-Appellant.

Superior Court of New Jersey, Appellate Division.

Argued December 15, 2004.
Decided January 12, 2005.

*1134 Edward J. Rebenack, New Brunswick, argued the cause for appellant (Hoagland, Longo, Moran, Dunst & Doukas, attorneys; John C. Simons, of counsel; Joseph V. Leone, on the brief).

Joel I. Rachmiel, Springfield, argued the cause for respondent.

Before Judges NEWMAN, R.B. COLEMAN and HOLSTON, JR.

The opinion of the court was delivered by

NEWMAN, J.A.D.

Defendant Encompass Insurance Company (Encompass) appeals from an order compelling the submission of an underinsured motorist claim (UIM) to three-party motorist arbitration. We affirm.

The facts are not in dispute. Plaintiff, Arlene Marsden, sustained personal injuries in a car accident caused by tortfeasor, Carol Farley (Farley or tortfeasor), on July 10, 1999. Farley was insured through Prudential Insurance Company, with liability policy limits of $100,000/$300,000. Plaintiff was covered by a policy issued by defendant Encompass, which provided UM/UIM limits of $250,000/$500,000.

On December 5, 2000, plaintiff filed suit against Farley. On May 30, 2001, plaintiff filed an Amended Complaint, adding a per quod claim on behalf of her husband, Robert Marsden.

In non-binding arbitration on March 15, 2002, plaintiff was awarded $250,000, well over the tortfeasor's policy limits of only $100,000. On March 20, 2002, plaintiff forwarded to defendant a Longworth[1] notice of a potential UIM claim.

On April 8, 2002, defendant notified plaintiff that "in order for [them] to determine whether or not [she] ha[d] a valid underinsured motorist claim, [they] need to obtain the following:" proof of tortfeasor's policy limits and offer of settlement; copy of the filed suit papers, discovery and arbitration award; complete package of specials including loss wage verification; and diagnosis and medical history.

Plaintiff complied with defendant's request in a letter of April 16, 2002, confirming the $250,000 arbitration award, but notifying defendant a trial de novo was filed by tortfeasor. Plaintiff enclosed the award and a copy of the trial notice, as well as, answers to defendant's interrogatories and a copy of plaintiff's deposition transcript.

Following a verbal authorization, defendant through its claims supervisor, on July 8, 2002, confirmed that it waived "any future subrogation right[s]" and authorized plaintiff's settlement with the tortfeasor for the $100,000 policy limit. Believing that the UIM claim would either be settled or failing that, submitted to three-party arbitration, plaintiff settled her claim for $90,000 against the tortfeasor during July 2002 and dismissed the underlying lawsuit.

On February 26, 2003, plaintiff's counsel sent a letter to defendant, confirming his phone conversation with claims specialist, Louis Negrin (Negrin), and requesting that defendant review the medical specials that were forwarded on April 16, 2002 and contact counsel to discuss a resolution of the claim. Counsel prefaced his UIM settlement demand of $100,000 by describing the accident and the nature of the injuries in the following terms:

*1135 As can be seen, as a result of this violent rearend impact caused by the negligence of the underinsured tortfeasor, my client sustained an avulsion fracture at C7. Additionally, she sustained disc herniations at L4-5 and C6-7. Both her treating physician and orthopedic surgeon, Dr. Glushakow, and the referred neurosurgeon, Dr. Prada, recommended cervical fusion and laminectomy due to this severe injury. However, due to my client's severe fear of surgery, she has declined, thus far, that procedure.
However, due to continuing complaints and the pressure resulting from these injuries, she is considering that surgery.
Additionally, as a result of this impact and injury, my client was forced into early retirement as indicated in answer 10 to Form A Interrogatories. That early retirement has resulted in a loss of approximately $12,000 in pension per year due to my client's loss of anticipated salary increases when she was unable to return to work due to these injuries.

In a phone conversation of April 23, 2003 with Negrin, defendant claimed for the first time that the policy requires litigation of the UIM claim, rather than arbitration. A few days later, Negrin called plaintiff's counsel back to indicate he was mistaken and that the policy in effect on the date of the accident permitted arbitration and that the claim would be submitted to UIM arbitration. On April 28, 2003, plaintiff's counsel sent a letter to Negrin demanding three-party UIM arbitration.

On July 17, 2003, plaintiff filed a Complaint against defendant seeking to compel UIM arbitration. Plaintiff filed a notice of motion to compel arbitration on September 18, 2003.

On September 30, 2003, counsel for defendant notified plaintiff by letter that defendant did not agree to arbitrate and advised plaintiff to file a complaint in a court of competent jurisdiction. On the same date, defendant's counsel submitted a letter in opposition to plaintiff's motion to compel UIM arbitration. Defendant indicated in its letter that the plaintiff's policy allows it to reject arbitration and choose to have a trial on the UIM claim.

In granting plaintiff's motion, Judge Perfilio found that defendant waived its right to request plaintiff to go to trial because, by its conduct, defendant impliedly consented to an arbitration. The motion judge also suggested that an estoppel could be invoked against defendant from requesting a trial when it led plaintiff to believe that the matter would proceed to arbitration if it was not settled.

On appeal, defendant raises the following issues for our consideration:

POINT I
THE ENCOMPASS UNDERINSURED MOTORIST ENDORSEMENT CONTROLS THE RIGHTS OF MARSDEN AND ENCOMPASS RELATIVE TO MARSDEN'S CLAIMS AND ENTITLEMENT TO UNDERINSURED MOTORIST BENEFITS.
POINT II
THE DOCTRINE OF EQUITABLE ESTOPPEL SHOULD NOT APPLY BECAUSE ENCOMPASS DID NOT ENGAGE IN INTENTIONAL CONDUCT OR CONDUCT WHICH INDUCED MARSDEN TO ACT OR CHANGE HER POSITION TO HER DETRIMENT.

Defendant argues that the Arbitration Clause in plaintiff's policy controls the rights of both parties. Defendant asserts that Section (a) specifically requires defendant to consent to arbitrate the UIM claim, and if it does not consent, then the covered person must file a lawsuit in the proper court against the tortfeasor and defendant. Furthermore, defendant asserts *1136 that, because it changed its mind and no longer agreed to arbitrate, plaintiff must bring a lawsuit in court based on its right not to agree to arbitrate under part (b)(4) of the UIM arbitration clause.

The pertinent parts of the UIM arbitration clause read:

a. Two questions must be decided by agreement between covered person and us:
(1) If the covered person is legally entitled to collect damages from the owner or driver of an uninsured motor vehicle or underinsured motor vehicle ; and
(2) If so, in what amount?
....

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Cite This Page — Counsel Stack

Bluebook (online)
863 A.2d 1133, 374 N.J. Super. 241, 2005 N.J. Super. LEXIS 19, Counsel Stack Legal Research, https://law.counselstack.com/opinion/marsden-v-encompass-ins-co-njsuperctappdiv-2005.