New York Career Institute v. Hanover Insurance

6 Misc. 3d 734
CourtNew York Supreme Court
DecidedJanuary 4, 2005
StatusPublished

This text of 6 Misc. 3d 734 (New York Career Institute v. Hanover Insurance) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
New York Career Institute v. Hanover Insurance, 6 Misc. 3d 734 (N.Y. Super. Ct. 2005).

Opinion

OPINION OF THE COURT

Bernard J. Fried, J.

This action arises out of a dispute between the plaintiff New York Career Institute (NYCI), a paralegal and court reporter [735]*735school, and the defendant, its insurer, Hanover Insurance Company, concerning a claim for loss of business income, following the September 11, 2001 (9/11) terrorist attacks, which caused damage to NYCI’s premises, requiring it to suspend operations for a period of time.

Defendant has moved for summary judgment and the plaintiff has cross-moved for partial summary judgment. While there is a series of issues, essentially, the dispute turns on whether a coinsurance provision applies to a civil authority loss.

The undisputed facts leading up to this dispute are as follows: on February 1, 2001, Hanover issued an insurance policy, which included coverage for business interruption losses and extra expense. On 9/11, NYCI sustained damage to its premises which required suspension of operations, causing it to suffer loss of business income, which it claimed was in the amount of $1,785,988. Timely notice was provided to Hanover concerning the loss, Hanover accepted its liability, and made a $50,000 advance payment on the claim.

Thereafter, a dispute arose as to the amount of the loss and to evaluate NYCI’s claim. Hanover engaged T.D. Davidson, Certified Public Accountants, which prepared a report (Davidson report), dated June 6, 2002, which concluded the claim was subject to a coinsurance assessment of 75.19% which meant a collectible percentage of 24.81%. This calculation was based on a determination that NYCI had failed to purchase sufficient coverage based upon its income, which Davidson determined to be $2,821,369, which it concluded was the required insurance, and not $700,000, the policy coverage. Based on these calculations, Davidson computed a “Collectible Loss of Income, plus ‘Extra Expenses’,” of $83,061. Following this report, Hanover made a supplemental claim payment of what it considered to be the “undisputed amount.”

The Davidson report was reviewed on behalf of plaintiff, NYCI, by Kenneth Greenhut, CPA, a partner in McGladrey & Pullen, Certified Public Accountants. In his report (Greenhut report), dated August 27, 2002, Greenhut made differing calculations concerning various items, concluded that the coinsurance “calculation is in error,” and “recomputed the amount of coinsurance” to arrive at a “co-insurance percentage” of 41.16%. Greenhut’s computations resulted in a collectible loss, together with extra expenses, of $425,559.

The Greenhut report led to a further report from Davidson, dated October 8, 2002, which adhered to its earlier coinsurance calculation of 24.81%.

[736]*736Because of this disagreement over the collectible amount, Hanover made a written demand, dated October 28, 2002, for appraisal as permitted under the insurance policy. Hanover selected as its appraiser James DiChaira, a certified public accountant with Magnan Grazzaro & Associates, CPA, LLC; NYCI appointed as its appraiser Anthony D’Amico, SPPA,1 a principal of Adjusters International; and the parties selected as the umpire Charles Duca, vice-president of Marsh USA, Inc. In advance of the appraisal proceeding, D’Amico wrote a letter, dated August 4, 2003, to both DiChaira and Duca, setting forth his view that the coinsurance provision did not apply to a civil authority loss, because in his opinion, “[t]o apply coinsurance to a civil authority loss would be to reduce a loss which has already been reduced, in effect penalizing the insured twice.” This was disputed by DiChaira, who took the position that the coinsurance provision was applicable. Because Duca, the umpire, viewed the matter as one of “coverage interpretation, rather than damage assessment and thus, beyond the authority of the appraisers and Umpire to decide,” an appraisal award was issued, certified only by D’Amico and Duca, which did “not reflect or resolve the issue of co-insurance.”

When Hanover refused to pay the appraisal award this lawsuit ensued.

At oral argument on this motion and cross motion, I inquired whether a “solution” would be to send this matter back to the appraisers. Counsel for Hanover agreed to its resubmission “for the assessment and calculation of that [coinsurance] penalty.” While counsel for NYCI thought it could “conceivably” go back, he stated that the issue — one of policy interpretation — was properly before me. Thinking that a remand of the matter, together with all the papers submitted on the issue, would be a preferable nonjudicial solution, in the context of the appraisal agreement, I asked that the parties submit a “proposed remand order.” Thereafter, by letter dated October 18, 2004, Hanover submitted a proposed order, directing that the “issue of mathematical calculation of the coinsurance assessment, if any, applicable to the claim of New York Career Institute arising out of the September 11, 2001 loss shall be determined by appr[a]isal.” There was no reference to the issue of the applicability of coinsurance to civil authority. Moreover, the letter stated that the umpire, Duca, repeated his belief that the issue “should be [737]*737made by a Court, [however] he expressed a willingness to consider the issue as framed by the Court, i.e., the mathematical calculation of the coinsurance assessment, if any, applicable to this case.” This was followed by a letter from NYCI, dated October 19, 2004, which requested, in light of the umpire’s statement “that he would not decide the issue,” that I “decide the outstanding motions and not refer it back to appraisal.” However, if I determined to remand the matter, NYCI submitted a proposed order, directing that the panel “finally determine the issue of the applicability of coinsurance to a civil authority loss.” This latter proposed order was objected to by Hanover, which wrote: “We object to the proposed Order submitted by plaintiff, which purports to authorize the panel to depart from the express terms of the contract and pass upon legal arguments raised by plaintiff in an attempt to avoid application of the coinsurance clause.” In light of the disagreement over the terms of my remand proposal, the issue, whether, under the terms of the subject insurance policy, coinsurance applies to a civil authority loss, is one for me to determine. The relevant policy clauses are as follows:

“Coinsurance
“The policy declarations page provides “COVERAGE
“BUSINESS INCOME OTHER THAN RENTAL
“VALUE INCL EXTRA EXPENSE “LIMIT OF INSURANCE: $700,000
“COINSURANCE 100%
“Business Income Coverage “The ‘BUSINESS INCOME (AND EXTRA EXPENSE) COVERAGE FORM’ provides:
“E. ADDITIONAL CONDITION “Coinsurance
“If a Coinsurance percentage is shown in the Declarations, the following condition applies in addition to the Common Policy Conditions and the Commercial Property Conditions.
“We will not pay the full amount of any loss if the Limit of Insurance for Business Income is less than [the amount as calculated in a series of steps set forth in this section of the policy] . . .
[738]*738“We will pay the amount determined ... or the limit of the insurance, whichever is less.

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Cite This Page — Counsel Stack

Bluebook (online)
6 Misc. 3d 734, Counsel Stack Legal Research, https://law.counselstack.com/opinion/new-york-career-institute-v-hanover-insurance-nysupct-2005.