NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court." Although it is posted on the internet this opinion is binding only on the parties in the case and its use in other cases is limited. R.1:36-3.
SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION DOCKET NO. A-5505-14T1
PAUL J. BANACH and APRIL BANACH,
Plaintiffs-Appellants,
v.
ALEX TARAKANOV and ELENA TARAKANOV,
Defendants,
and
NEW JERSEY MANUFACTURERS INSURANCE COMPANY,
Defendant-Respondent. ——————————————————————————————————
Argued May 18, 2017 – Decided September 12, 2017
Before Judges Hoffman, O'Connor and Whipple.
On appeal from Superior Court of New Jersey, Law Division, Bergen County, Docket No. L- 6238-13.
Barry D. Epstein argued the cause for appellants (The Epstein Law Firm, PA, attorneys; Mr. Epstein, of counsel and on the brief; Michael A. Rabasca, on the brief). David T. Robertson argued the cause for respondent (Harwood Lloyd, LLC, attorneys; Mr. Robertson, of counsel and on the brief).
PER CURIAM
Plaintiffs Paul and April Banach1 filed suit against defendant
New Jersey Manufacturers Insurance Company (NJM) asserting claims
of negligence, gross negligence, and willful misconduct relating
to inadequate underinsured motorist (UIM)2 coverage in their
commercial automobile insurance policy. Plaintiffs now appeal
from two Law Division orders: the first denied their motion to
amend their complaint, and the second granted NJM's motion for
summary judgment, dismissing their complaint.
In denying plaintiffs' motion to amend their complaint, the
Law Division concluded the "purported amendment . . . would be
futile" and also "prejudicial" to NJM. From our review, the record
does not support these conclusions. We therefore reverse the
order denying plaintiffs leave to amend their complaint.
In considering NJM's summary judgment motion, the Law
Division refused to consider the report of plaintiffs' expert,
concluding it constituted a net opinion. Plaintiffs' expert based
1 For ease of reference, we refer to plaintiffs by their first names. We do not intend any disrespect by this informality. 2 According to NJM's Commercial Auto Insurance Buyer's Guide, uninsured motorist (UM) and UIM coverages are "sold together." Frequently, the combined coverage is referred to as UM/UIM coverage. 2 A-5505-14T1 his opinions upon his extensive experience in New Jersey's
insurance market and its regulation, after reviewing all relevant
parts of the record. Following our review of the expert's report,
we reject the trial court's conclusion that plaintiff's expert
offered a net opinion. The judge further concluded that
plaintiffs' claim against NJM is barred by N.J.S.A. 17:28-1.9.
Because the record reveals factual questions whether NJM satisfied
the criteria to benefit from the immunity provided by this statute,
we reverse the trial court's grant of summary judgment and remand
for trial.
I.
Viewing the record in the light most favorable to plaintiffs
as the non-moving parties, see Angland v. Mountain Creek Resort,
Inc., 213 N.J. 573, 577 (2013), we discern the following facts.
On May 27, 2013, Paul sustained serious bodily injuries while
operating his motorcycle in Paramus. The accident occurred when
defendant Elena Tarakanov, while driving a car owned by her
husband, defendant Alex Tarakanov, made an improper left-hand turn
in front of Paul. IFA Insurance Company insured the Tarakanov
vehicle, providing $100,000 of bodily injury liability coverage.
Plaintiffs ultimately settled with the Tarakanovs for their
$100,000 policy limit. Foremost Insurance Company insured Paul's
3 A-5505-14T1 motorcycle; however, the policy included only liability and
collision coverage.
On January 21, 2000, NJM issued a business auto policy to
plaintiffs' newly formed company, Paul Banach Construction LLC
(Banach Construction). The policy provided $500,000 of liability
coverage but only $100,000 of UM/UIM coverage.
April handled the insurance for Banach Construction. Before
purchasing the policy from NJM, which does not have brokers or
agents, April spoke with one of its representatives on the
telephone. According to April, "I asked them to just let me know
what I had to have. I went by their guidance[,]" and "[I] asked
them what would be my benefit to have." Referring to NJM's
coverage selection form3 (CSF), April said,
Basically they went over it and told me just to sign my name and fax it[,] and they would do the rest.
. . . .
After . . . a discussion[,] they advised me that they would put what I needed.
I didn't really understand any of the document[,] I'm embarrassed to say. . . . I wanted somebody to guide me[,] and I was with them since I was 17. I wanted them to guide me. I guess I was wrong.
3 The form is labeled, "COMMERCIAL AUTO COVERAGE SELECTION FORM." 4 A-5505-14T1 At the end of the phone call, April followed the instructions
she received and signed the CSF in blank, before faxing the form
to NJM. At her deposition, she confirmed the coverage selections
on the form "aren't my markings[,]" expressing certainty because
"I don't do this x swirly thing."
The completed CSF selected $500,000 for liability coverage
but only $100,000 for UM/UIM coverage. The form also reflected
selection of the "No Limitation on Lawsuit Option," above a
paragraph that stated this selection will result in a higher
liability premium. Thereafter, NJM issued a policy that included
these coverages.
According to April, "in the years following[,] I would call,
ask if there were any changes I should know about, anything that
I should choose differently[,] and they would tell me to just
write no changes across the top[,] which is what I would always
do."4 In January 2011, April contacted NJM to add a vehicle to
their policy and spoke with NJM representative Ryan Ennis.5 After
4 The record indicates recordings of at least some of these conversations are still available; however, the record only contains the transcript of a January 6, 2011 conversation. 5 At his deposition, Stanley Brzezinski, NJM's commercial lines underwriting manager, described Ennis as a "call center rep." All NJM call center reps hold a New Jersey insurance producer's license. 5 A-5505-14T1 obtaining the information regarding the additional vehicle, Ennis
initiated the following colloquy with April:
Q: Alright. I will put that on there for you. Now do you have your own . . . personal auto policy or is this your only policy in the household?
A: This is it.
Q: This is it. OK . . . because what I would suggest adding, since you don't currently have a personal auto policy in your household . . . there's no coverage for yourself or . . . for your husband for . . . personal injury protection in case you were to . . . borrow anyone's vehicle or be a passenger in someone else's vehicle.
A: Hmm.
Q: What we can offer is an endorsement to the policy which adds that coverage . . . 'cause that way you would have . . . protection for yourself, personal injury for no matter where you're at . . . whoever's vehicle you're in, whether it be a passenger or borrowing a vehicle, . . . you would have that coverage.
Q: How much is that?
A: Well, it depends on the . . . options that you choose[;] it could be as low as about $100 or up to about $200 depending on different options that you . . . .
Q: A month?
A: Uh, no, that's per year.
Q: Oh.
6 A-5505-14T1 A: It's not, not much money, you know, more[,] and it does give you . . . a benefit that way since you don't have a personal policy, it protects you, you know, for personal injury . . . as far as it can go.
Q: Um. OK. Yeah, I definitely need to look into that, well, especially with that cost, I mean, it's really not much of a difference . . .
A: Yeah.
Q: . . . broken down.
A: It's taking me so long to fill out this form. There's so many questions.
Q: I know . . . I know.
A: Because I am a generally like a person . . . who doesn't, isn't an insurance broker or anything, it's really hard to understand most of it.
Q: Yeah . . . yeah. Well, I mean, what I can do with you here, if you have a minute, I can . . . go over the price of what the difference would be for . . . selecting the options and, recommend . . . what you would want from these.
Ennis proceeded to "suggest" that April increase the medical
expense limit on plaintiffs' policy from $250,000 to $1 million,
with a $250 deductible (the minimum deductible permitted by law).
April accepted his suggestion. Ennis then agreed to fax the
coverage selection form to April, telling her "you need to check
7 A-5505-14T1 off everything that we just discussed. So what I'll do is I'll
put an arrow next to . . . the options that I just chose for you."
April complied, checking off the coverages selected by Ennis and
faxing the form back to him.
According to Brzezinski, from the time defendant issued its
first policy to plaintiffs in 2000, to the time of Paul's accident,
NJM had a "practice and procedure" of including "a coverage
selection form (CSF) and a Buyer's Guide," as required by law,
with every application for a business auto insurance policy, and
each and every renewal. Although Brzezinski said NJM did not have
a practice or policy of aligning an insured's liability coverage
with the insured's UM/UIM coverage, he admitted he did not know
the industry standard outside of NJM. When asked if he was "aware
of any statistic at NJM of the percentage of policies that do not
match liability with UM[-]UIM," he responded, "It's low."
Additionally, Brzezinski was asked about April's testimony,
"that she was told to sign [the CSF] and send it back and the
representative would fill in the coverage and place the check
marks for the applicable coverage." Plaintiff's counsel then
inquired, "Is that the way it's supposed to go? Is that proper
procedure?" Brzezinski responded, "It's backward."
In August 2013, plaintiffs filed their complaint seeking
damages from Tarakanov, alleging she negligently caused the
8 A-5505-14T1 accident. Thereafter, plaintiffs filed an amended complaint
adding NJM as a defendant, alleging NJM "seriously and flagrantly
failed to meet its obligations to plaintiff, including its
obligation to properly advise plaintiff of coverages, the effect
of coverages, the inadequacy of coverages, has given
misinformation and has otherwise failed to properly furnish
information of proper insurance coverages in its dealing with
plaintiff." Plaintiffs further alleged NJM's conduct "represents
negligence, gross negligence, willful and wanton conduct and
malice as a matter of law."
After receiving discovery, plaintiff obtained an expert
report from Armando M. Castellini. According to his certified
biography, Castellini has been a technical consultant and expert
witness to attorneys in insurance matters and litigation involving
approximately 1700 cases in twenty-four states.6
6 Castellini's biography further states he previously served in various positions within the insurance industry, including: president of the Independent Insurance Agents of New Jersey; the New Jersey Insurance Commissioner's agent representative to the governing committee of the Automobile Insurance Plan; member of the committees involved in the drafting, enactment, and implementation of the New Jersey No-Fault Law; vice-president of the Insurance Broker's Association of New Jersey; member of the New Jersey Department of Insurance Task Force on Banking and Insurance; Member of the New Jersey Automobile Full Insurance Underwriting Association's Rules and Forms Committee; member of the New Jersey Department of Insurance Commissioner's Producer Advisory Committee; director of the New Jersey Association of Insurance Licensing Schools.
9 A-5505-14T1 Before issuing his report, Castellini reviewed voluminous
records, including "[a]pproximately 700 pages of documents
produced by [defendant] consisting of [c]overage [s]election
[f]orms and policy declaration pages."
According to Castellini,
Because insurance companies believed they could not "under-write" the exposures presented by UM and UIM coverages, they generally tended to be adverse to selling the coverages, and the statutory change that made it the insured's option to purchase increased limits of UM/UIM when prior to this it had been the insurer's option to sell increase[d] limits was not well received by most insurance companies. An . . . example of this reaction is found in [NJM's memo from around January 1974]. These memos from management to personnel of carriers were clearly intended to avoid the application of the statutory change, and a direction to not "sell" increased limits of UM/UIM – unless an insured was wise enough to understand the coverage, its availability, and the serious nature of the exposure they faced absent the coverages.
Castellini attached a copy of the January 1974 NJM memo to
his report.7 Addressed to "SALES, CLAIMS & UNDERWRITING
PERSONNEL," the memo stated, in relevant part:
. . . Insureds may now purchase high limits of coverage to protect themselves more fully against damage or injury by an uninsured motorist and by so doing, automatically receive an extension of their coverage to
7 At his deposition, Brzezinski stated the individuals listed on the memo "were attorneys with [NJM] and the president of the company." 10 A-5505-14T1 include Under-insured Motorist Coverage as well.
At present[,] it is not our intent to actively market this new form of coverage. You nevertheless should be aware of its existence and the fact that on an insured's request, we will provide it.
Castellini cited "the introduction of the Basic Auto
Policy . . . and the Special Auto Policy" as explaining "why the
very large majority [of] Insurance Producers have developed the
practice of recommending high limits of liability coverage so that
their clients may then procure up to those high limits for their
protection against [u]ninsured and [u]nderinsured drivers or
vehicles."
Castellini further opined, "[I]n today[']s insurance
environment in New Jersey, it is very rare to find a [p]ersonal
or [c]ommercial [a]uto policy that does not have UM/UIM limits
that match the policy's liability limits – and when that occurs,
it is deemed to be violative of [industry] standards and
practices." He therefore concluded, NJM
failed to conform to the generally accepted standards and practices relative to the matching of an insured's UM/UIM limits to the policy's liability limits; arbitrarily and capriciously established is own internal processes and procedures with regard to UM/UIM sales and limits; and did so intentionally and willfully; in violation of the statute as well as the industry practice. 11 A-5505-14T1 He further noted, "A very minimal increase in the UM/UIM premium
would have been charged for the increase from $100,000 to
$500,000."
In December 2014, NJM filed a motion for summary judgment.
The trial court heard oral argument on January 23, 2015, and
reserved decision.
Plaintiffs then filed their motion to amend their complaint,
seeking to include an allegation that NJM violated the New Jersey
Consumer Fraud Act8 (CFA). Following oral argument on May 29,
2015, a different judge denied plaintiffs' motion. He first noted
that in Myska v. New Jersey Manufacturers Insurance Company, 440
N.J. Super. 458, 485 (App. Div. 2015), appeal dismissed as
improvidently granted, 224 N.J. 523, 524 (2016), this court held,
"[T]he CFA is not appropriate where a regulatory scheme deals
specifically, concretely, and pervasively with a particular
activity implying a legislative intent not to subject parties to
multiple regulations that as applied will work at cross purposes."
He then concluded,
We now have a regulatory system where a party is entitled to purchase what they call insurance which is a basic policy which gives people recovery for property damage of $5,000 and medical bills for $10,000 and provides no liability insurance. People buy those policies. They get sued. They think they
8 N.J.S.A. 56:8-1 to -206. 12 A-5505-14T1 have insurance, but they have no liability insurance. . . .
The fact that . . . there's no contest and no dispute that NJM offered the option of having the insured purchase UM/UIM coverage to equal the amount purchased by the insured for liability coverage. There's no dispute as to that. That was the option of the consumer, and the consumer chose not to do it.
Based upon that highly regulatory and statutory scheme, the purported amendment to include the claim for a violation of the [CFA] would be futile, and it would certainly be prejudicial to this defendant who has been litigating this case without that allegation presented before [it] until two weeks before trial.
On June 18, 2015, the first judge issued his reserved
decision, granting NJM's summary judgment motion and dismissing
all claims against NJM with prejudice. The judge set forth his
reasons in a thirty-eight-page written opinion. He first noted
that plaintiffs were not entitled to assert a UIM claim because
Tarakanov had $100,000 of liability coverage, and plaintiffs had
the same amount of UIM coverage. He then concluded, "Even if . . .
a mistake could be found in this case, the [c]ourt cannot find
that any fraudulent or unconscionable conduct has taken place to
merit reformation."
The judge further ruled that plaintiffs' "expert's opinion
in this case will play no part in the discussion of whether
13 A-5505-14T1 [plaintiffs] are entitled to reformation of the insurance policy
or damages, because [the expert] has rendered an inadmissible net
opinion." The judge further found that NJM was "entitled to
immunity under N.J.S.A. 17:28-1.9," providing it with "a shield
against both claims for reformation and damages." He therefore
granted NJM's summary judgment motion and dismissed plaintiffs'
complaint. This appeal followed.
II.
We first address the Law Division order denying plaintiffs'
motion to amend their complaint to assert a CFA claim. Our Supreme
Court has "made clear that 'Rule 4:9-1 requires that motions for
leave to amend be granted liberally' and that 'the granting of a
motion to file an amended complaint always rests in the court's
sound discretion.'" Notte v. Merchs. Mut. Ins. Co., 185 N.J. 490,
501 (2006) (quoting Kernan v. One Washington Park Urban Renewal
Assocs., 154 N.J. 437, 456-57 (1998)). "That exercise of
discretion requires a two-step process: whether the non-moving
party will be prejudiced, and whether granting the amendment would
nonetheless be futile." Ibid.
A plaintiff may pursue a CFA claim "against an insurance
company for 'fraudulent, deceptive or other similar kind of selling
or advertising practices,' [but] there are limits on the statute's
application." Myska, supra, 440 N.J. Super. at 485 (quoting
14 A-5505-14T1 Daaleman v. Elizabethtown Gas Co., 77 N.J. 267, 271 (1978)). "To
prevail on a CFA claim, a plaintiff must establish three elements:
'1) unlawful conduct by defendant; 2) an ascertainable loss by
plaintiff; and 3) a causal relationship between the unlawful
conduct and the ascertainable loss.'" Id. at 484 (quoting Zaman
v. Felton, 219 N.J. 199, 222 (2014)). Under the CFA, an "unlawful
practice" includes
any unconscionable commercial practice, deception, fraud, false pretense, false promise, misrepresentation, or the knowing, concealment, suppression, or omission of any material fact with intent that others rely upon such concealment, suppression or omission, in connection with the sale or advertisement of any merchandise or real estate, or with the subsequent performance of such person as aforesaid, whether or not any person has in fact been misled, deceived or damaged thereby.
[N.J.S.A. 56:8-2.]
In Myska we further noted that, although "the CFA
'encompass[es] the sale of insurance policies as goods and services
that are marketed to consumers,' it was not intended as a vehicle
to recover damages for an insurance company's refusal to pay
benefits." Myska, supra, 440 N.J. Super. at 485 (quoting Lemelledo
v. Benefit Mgmt. Corp., 150 N.J. 255, 270 (1997)). We nevertheless
agreed that "Lemelledo authorizes pursuit of a private right of
action against an insurance company for 'fraudulent, deceptive or
15 A-5505-14T1 other similar kind of selling or advertising practices.'" Ibid.
(quoting Daaleman, supra, 77 N.J. at 271).
Here, plaintiffs do not seek to recover damages for an alleged
refusal to pay benefits; instead, plaintiffs seek reformation of
their NJM policy to match their UM/UIM coverage with their $500,000
of liability coverage. In their initial complaint against NJM,
plaintiffs alleged NJM's conduct represents "gross negligence,
willful and wanton conduct and malice as a matter of law." These
allegations not only loosely track the exception to the immunity
statute, N.J.S.A. 17:28-1.9, they also allege conduct that would
violate the CFA's broad proscription "of any unconscionable
commercial practice, deception . . . , misrepresentation, or the
knowing, concealment, suppression, or omission of any material
fact with intent that others rely upon such concealment,
suppression or omission." N.J.S.A. 56:8-2.
Based upon our review of the record, including the admitted
"backward" procedure followed in the initiation and amendment of
plaintiffs' policy, and the opinions of plaintiff's expert, we
reject the conclusion plaintiff's proposed amended complaint
"would be futile." Additionally, we discern no prejudice to NJM
by the proposed amendment since the CFA claim is based on the same
underlying facts and events set forth in the original pleading.
We further conclude NJM has no cause to complain of the late
16 A-5505-14T1 assertion of claims grounded on the same conduct already alleged
in the complaint. We hold that no cognizable prejudice will inure
to NJM by the amendment sought by plaintiffs. We therefore reverse
the May 29, 2015 order denying plaintiffs' motion to file an
amended complaint.
III.
We next address the rejection of the report of plaintiffs'
expert as a net opinion. The admissibility of expert testimony
is committed to the sound discretion of the trial court. Townsend
v. Pierre, 221 N.J. 36, 52 (2015). A trial court's grant or denial
of a motion to preclude expert testimony is entitled to deference
on appellate review. Ibid. Our Supreme Court has instructed us
to "apply [a] deferential approach to a trial court's decision to
admit expert testimony, reviewing it against an abuse of discretion
standard." Id. at 53 (alteration in original) (quoting Pomerantz
Paper Corp. v. New Cmty. Corp., 207 N.J. 344, 371-72 (2011)).
N.J.R.E. 702 and 703 frame our analysis for determining the
admissibility of expert testimony. N.J.R.E. 702 identifies when
expert testimony is permissible and requires the experts to be
qualified in their respective fields. N.J.R.E. 703 addresses the
foundation for expert testimony. Expert opinions must "be grounded
in 'facts or data derived from (1) the expert's personal
observations, or (2) evidence admitted at the trial, or (3) data
17 A-5505-14T1 relied upon by the expert which is not necessarily admissible in
evidence but which is the type of data normally relied upon by
experts.'" Townsend, supra, 221 N.J. at 53 (quoting Polzo v. Cty.
of Essex, 196 N.J. 569, 583 (2008)).
"The net opinion rule is a 'corollary of [N.J.R.E. 703] . . .
which forbids the admission into evidence of an expert's
conclusions that are not supported by factual evidence or other
data.'" Id. at 53-54 (alteration in original) (quoting Polzo,
supra, 196 N.J. at 583). Therefore, an expert is required to
"'give the why and wherefore' that supports the opinion, 'rather
than a mere conclusion.'" Id. at 54 (quoting Borough of Saddle
River v. 66 E. Allendale, LLC, 216 N.J. 115, 144 (2013)). The net
opinion rule directs "that experts 'be able to identify the factual
bases for their conclusions, explain their methodology, and
demonstrate that both the factual bases and the methodology are
reliable.'" Id. at 55 (quoting Landrigan v. Celotex Corp., 127
N.J. 404, 417 (1992)). In short, the net opinion rule is "a
prohibition against speculative testimony." Harte v. Hand, 433
N.J. Super. 457, 465 (App. Div. 2013) (quoting Grzanka v. Pfeifer,
301 N.J. Super. 563, 580 (App. Div. 1997), certif. denied, 154
N.J. 607 (1998)).
Plaintiffs argue the Law Division abused its discretion when
it rejected Castellini's report as a net opinion. We agree.
18 A-5505-14T1 Castellini based his report on his extensive background,
education, and experience, along with his review of the significant
record in this case. He has been actively involved in the
insurance business and its regulation for many years, dating back
to the enactment of No Fault Insurance in New Jersey. He properly
based his conclusions on these facts and experiences. See
Townsend, supra, 221 N.J. at 53 (quoting Polzo, supra, 196 N.J.
at 583).
IV.
Our review of a ruling on summary judgment is de novo.
Parsons v. Mullica Twp. Bd. of Educ., 440 N.J. Super. 79, 83 (App.
Div. 2015). We apply the same legal standard as the trial court.
Ibid. Summary judgment is appropriate when "the pleadings,
depositions, answers to interrogatories and admissions on file,
together with the affidavits, if any, show that there is no genuine
issue as to any material fact challenged and that the moving party
is entitled to a judgment or order as a matter of law." R. 4:46-
2(c). When determining whether the record contains a genuine
issue of material fact, the court must consider "whether the
competent evidential materials presented, when viewed in the light
most favorable to the non-moving party, are sufficient to permit
a rational factfinder to resolve the alleged disputed issue in
19 A-5505-14T1 favor of the non-moving party." Brill v. Guardian Life Ins. Co.
of Am., 142 N.J. 520, 540 (1995).
NJM argues the Law Division properly granted summary
judgment, claiming entitlement to immunity, pursuant to N.J.S.A.
17:28-1.9, which provides, in pertinent part:
a. [N]o . . . insurer . . . shall be liable in an action for damages on account of the election of a given level of motor vehicle insurance coverage by a named insured as long as those limits provide at least the minimum coverage required by law or on account of a named insured not electing to purchase [UIM] coverage, collision coverage or comprehensive coverage. Nothing in this section shall be deemed to grant immunity to any person causing damage as the result of [its] willful, wanton or grossly negligent act of commission or omission.
b. The coverage selection form required pursuant to [N.J.S.A. 39:6A-23] shall contain an acknowledgement by the named insured that the limits available to him for [UM] coverage and [UIM] coverage have been explained to him and a statement that no . . . insurer . . . shall be liable in an action for damages on account of the election of a given level of motor vehicle insurance coverage by a named insured as long as those limits provide at least the minimum coverage required by law or on account of a named insured not electing to purchase [UIM] coverage, collision coverage or comprehensive coverage, except for that person causing damage as the result of [its] willful, wanton or grossly negligent act of commission or omission.
N.J.S.A. 17:28-1.9 was enacted "to abrogate prior judicial
decisions holding insurers, agents, and brokers liable for failing
20 A-5505-14T1 to advise their customers of the availability of additional
[UM/UIM] coverage" and to quell the "explosion of litigation by
providing blanket immunity except in cases of willful, wanton, or
gross negligence." Strube v. Travelers Indem. Co., 277 N.J. Super.
236, 237, 242 (App. Div. 1994), aff'd o.b., 142 N.J. 570 (1995).
Immunity applies as long as the insurer establishes the
following:
(1) the named insured's coverage limits were at least the minimum coverage required by law;
(2) the named insured's alleged damages were not caused by a "willful, wanton or grossly negligent act of commission or omission;" and
(3) the carrier complied with the coverage selection requirements of N.J.S.A. 17:28- 1.9(b).
[Baldassano v. High Point Ins. Co., 396 N.J. Super. 448, 453-54 (App. Div. 2007).]
In addition, an insurer must have obtained an insured's
acknowledgement that the available UM/UIM coverage limits were
explained to him, and the insurer will not be liable for the
insured's selection of coverage that was chosen in accordance with
subsection (a) of the immunity statute. N.J.S.A. 17:28-1.9(b).
If applying for a new policy, the insured must check-off the
options elected on the coverage selection form and then sign and
return the form to the insurer. N.J.S.A. 39:6A-23(a); N.J.A.C.
11:3-15.7(a). A completed, executed coverage selection form is
21 A-5505-14T1 "prima facie evidence of the insured's knowing election or
rejection of any option." N.J.S.A. 39:6A-23(e).
Significantly, in Avery v. Wysocki, 302 N.J. Super. 186, 190-
192 (App. Div. 1997), we held:
[T]he insured's completion and execution of the coverage selection form is a condition of the grant of immunity by subsection a. It is plain that the purpose of the immunity is to shift the responsibility for coverage selection from the insurer to the insured. It is also plain that under the legislative scheme, the mechanism by which the insured is enabled to make an informed coverage choice and thereby to protect himself is the coverage selection form mandated by N.J.S.A. 39:6A-23 . . . . We think it clear that without this protection, the grant of the immunity by N.J.S.A. 17:28-1.9a would have far harsher consequences than the Legislature intended. That is to say, the subsection a immunity is based on the assumption that the insurer will have complied with the dictates of N.J.S.A. 39:6A-23 by providing the insured with an adequate description of available coverages and their limits.
We recognize the salutary purposes of the immunity. We also appreciate, however, that insistence on meticulous compliance with the applicable coverage selection form requirements is the legislative trade-off, as it were, for according the immunity.
In Pizzullo v. New Jersey Manufacturers Insurance Company,
196 N.J. 251 (2008), our Supreme Court addressed the immunity
provision at issue in another UIM coverage case involving NJM. In
Pizzullo, NJM argued that "because it is a direct-writing insurer 22 A-5505-14T1 and does not employ brokers or agents, it had no duty to plaintiffs
other than to comply with the statutory notification
requirements." Id. at 263 (citing Andriani v. N.J. Mfrs. Ins.
Co., 245 N.J. Super. 252, 256-57 (App. Div.), certif. denied, 126
N.J. 327 (1991)). NJM asserted "that its customer service
representatives are neither agents nor brokers, because they do
not offer recommendations or advice about insurance needs, give
counsel to the insureds, sell policies or suggest increases or
decreases to coverage." Ibid. Notwithstanding "what its customer
service representative said" to the plaintiffs in Pizzullo, NJM
argued that it was "entitled to immunity because it mailed the
plaintiffs the Buyer's Guides and Coverage Selection Forms
required by the statute." Ibid.
After reviewing the history of the immunity statute, the
Court flatly rejected the "blanket immunity" advanced by NJM. Id.
at 268. Viewed in its historical context, the Court concluded
"the Legislature meant the statute to confer immunity in
circumstances relating to an insured's election of UIM coverage
when the insured attempts to later shift the blame for a decision
to opt for any level of coverage less than the maximum back onto
the insurer." Ibid.
Because the inadequate UIM coverage in Pizzullo resulted from
inaccurate responses the plaintiff received from the NJM
23 A-5505-14T1 representative, the Court rejected NJM's argument that the
plaintiff made an "election of . . . coverage," N.J.S.A. 17:28-
1.9(b), that triggered immunity for NJM. Pizzullo, supra, 196
N.J. at 269-70. After concluding the immunity statute did not
apply, the Court reinstated the monetary judgment previously
entered by the Law Division in favor of the plaintiffs following
trial. Id. at 274.
Applying the analysis employed by the Court in Pizzullo, we
are satisfied the record here clearly raises factual questions
precluding summary judgment. Viewed in the light most favorable
to plaintiffs, April never made an election of any coverages to
trigger immunity in favor of NJM; instead, Ennis offered to make
the policy elections, and April accepted his offer. Moreover, in
2000, April signed the CSF before any selections were made, a
procedure which NJM's own underwriting manager described as
"backward." The statute grants an insurer immunity upon "the
insured's completion and execution of the coverage selection
form," Avery, supra, 302 N.J. Super. at 190, not the insurer's
"call center rep." On remand, we expect the trial court will
address, with the benefit of a full trial record, whether NJM's
handling of plaintiffs' policy resulted in the required
"meticulous compliance with the applicable coverage selection form
requirements." Id. at 192.
24 A-5505-14T1 Of further note, the Court in Pizzullo reaffirmed well-
established principles that we find apply to the unusual factual
circumstances under review:
An insurance company is "expert in its field and its varied and complex instruments are prepared by it unilaterally whereas the assured or prospective assured is a [lay person] unversed in insurance provisions and practices." Gibson v. Callaghan, 158 N.J. 662, 669, (1999) (quoting [Allen v. Metro. Life Ins. Co., 44 N.J. 294, 305 (1965)]). Because of the substantial disparity in the sophistication of the parties, and because of the highly technical nature of insurance policies, we have long "assume[d] a particularly vigilant role in ensuring their conformity to public policy and principles of fairness." Id. at 669-70 (quoting Voorhees v. Preferred Mut. Ins. Co., 128 N.J. 165, 175 (1992)).
[Pizzullo, supra, 196 N.J. at 270.]
The record also contains substantial evidence that supports
the opinion of plaintiffs' expert that NJM arbitrarily established
its own internal processes and procedures regarding the sale of
UM/UIM coverage, contrary to "accepted standards and practices
relative to the matching of an insured's UM/UIM limits to the
policy's liability limits." The record contains no contrary expert
opinions.
In addition, notwithstanding the contention of NJM counsel
at oral argument that "it's NJM's practice not to advise as to
coverages," the record contains compelling evidence to the
25 A-5505-14T1 contrary. The record clearly reflects that Ennis advised April
regarding the option and the benefit of adding an endorsement to
plaintiffs' commercial auto policy that would provide plaintiffs
with personal injury protection (PIP) coverage, if they were
driving or occupying a non-owned vehicle. He also recommended
plaintiffs increase the medical expense benefits portion of their
PIP coverage from $250,000 to $1 million. April accepted these
recommendations and Ennis amended plaintiffs' policy to implement
these important changes.9
Having identified two major deficiencies in plaintiffs'
policy, and having rectified them for plaintiffs, a major issue
that remains is why Ennis failed to identify the deficiency of
plaintiffs' UM/UIM coverage not matching their liability coverage.
One possible explanation, advanced by plaintiffs' expert, is that
NJM maintained a policy, dating back to 1974, to "not . . .
actively market" UIM coverage. The record contains no
documentation announcing a change in the policy announced in NJM's
1974 memo.
We conclude the record clearly indicates factual questions
precluding summary judgment: first, whether NJM complied with the
9 We do not suggest any criticism of the changes Ennis recommended and made to plaintiffs' policy. To the contrary, it appears these changes reflected wise counsel and resulted in much improved coverage for plaintiffs. 26 A-5505-14T1 coverage selection requirements of the immunity statute, and
second, whether NJM caused plaintiffs' damages by a "willful,
wanton or grossly negligent act of commission or omission."
N.J.S.A. 17:28-1.9.
Reversed and remanded. We do not retain jurisdiction.
27 A-5505-14T1