State Farm Mutual Automobile Insurance v. Fennema

2005 NMSC 010, 110 P.3d 491, 137 N.M. 275
CourtNew Mexico Supreme Court
DecidedMarch 28, 2005
Docket28,626
StatusPublished
Cited by14 cases

This text of 2005 NMSC 010 (State Farm Mutual Automobile Insurance v. Fennema) is published on Counsel Stack Legal Research, covering New Mexico Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State Farm Mutual Automobile Insurance v. Fennema, 2005 NMSC 010, 110 P.3d 491, 137 N.M. 275 (N.M. 2005).

Opinion

OPINION

CHÁVEZ, Justice.

{1} Appellant Russell Fennema appeals a district court summary judgment in favor of State Farm Mutual Automobile Insurance Company 1 . The district court held that State Farm was not liable for underinsured motorist benefits to Fennema because Fennema breached a contract provision requiring Fennema to obtain the written consent of State Farm before settling his claim with the tortfeasor and her insurance carrier (consent-to-settle provision). Fennema argues that despite his breach of contract, recent developments in New Mexico insurance law require State Farm to show that it was substantially prejudiced by the breach before it can escape liability.

{2} For the first time we consider whether an insurance company must demonstrate substantial prejudice from the breach of a consent-to-settle provision before it can be relieved from paying underinsured motorist benefits. We answer this question in the affirmative. Consistent with the approach outlined in Roberts Oil Co. v. Transamerica Ins. Co., 113 N.M. 745, 833 P.2d 222 (1992), we hold that for an insurer to justify foreclosing an insured’s right to underinsured motorist benefits, the insurer must demonstrate it was substantially prejudiced by the insured’s breach of the consent-to-settle provision. Although the insurer has the ultimate burden of persuasion, proof that the insured breached the consent-to-settle provision creates a presumption of substantial prejudice. See id. at 755, 833 P.2d at 232. In this case no genuine issues of material fact exist and State Farm is still entitled to summary judgment because Fennema did not offer evidence that could meet or rebut the presumption of substantial prejudice.

Facts

{3} Defendant Moses (tortfeasor) negligently struck the rear of the vehicle driven by Fennema, causing serious injuries to Fennema. The tortfeasor had a $25,000 liability policy. Fennema paid premiums for three $25,000 uninsured/underinsured motorist policies issued by State Farm. The parties seem to agree that these policies could be stacked, affording Fennema $75,000 in uninsured/underinsured motorist coverage. Assuming tortfeasor’s negligence proximately caused at least $75,000 in damages to Fennema, Fennema would be entitled to $50,000 from State Farm for underinsured motorist benefits having already collected $25,000 directly from the tortfeasor’s insurer.

{4} However, the consent-to-settle provision in the State Farm policy denies uninsured/underinsured motorist coverage “for any insured who, without [State Farm’s] written consent, settles with any person or organization who may be liable for the bodily injury or property damaye.” (Emphasis added.) Fennema settled with the tortfeasor, accepting $25,000 from the tortfeasor’s insurer and as consideration gave a complete release of liability to the tortfeasor and her insurer. Fennema admits he breached the consent-to-settle provision of the policy because he did not obtain the written consent of State Farm to settle his claim against the tortfeasor.

Insurer Must Demonstrate Substantial Prejudice from Breach of Consent-to-Settle Provision

{5} In 1965 this Court held it was “well established” that if an insured, without the knowledge of his insurer, effectively releases a wrongdoer from liability, the insured destroys any right of subrogation the insurer may have against the wrongdoer and is, thereafter, precluded from recovering from his insurer. Armijo v. Foundation Reserve Ins. Co., 75 N.M. 592, 596, 408 P.2d 750, 752 (1965). This principle of law was applied to underinsured motorist claims in March v. Mountain States Mutual Casualty Co., 101 N.M. 689, 687 P.2d 1040 (1984) (upholding a consent-to-settle provision in an underinsured motorist policy, and holding an insured’s breach of such a provision precluded the insured from collecting underinsured motorist benefits). However, we subsequently held in Roberts Oil that when the insured breached a “voluntary payment” provision in the policy, the insurer was required to show “substantial prejudice” before voiding the policy. 113 N.M. 745, 833 P.2d 222 (clarifying for the first time that the substantial evidence rule could apply to claims involving injury to an insured rather than simply innocent third parties). The court of appeals, in Eldin v. Farmers Alliance Mut. Co., 119 N.M. 370, 890 P.2d 823 (Ct.App.1994), extended the substantial prejudice rule in Roberts Oil to cover an insured’s breach of misrepresentation and concealment provisions.

{6} Fennema argues that the court of appeals’ adoption of the substantial prejudice rule in Eldin requires that March be modified or overruled. While we disagree that March must be overruled, we do agree it must be modified. In March, we considered the limited question of whether a consent-to-settle provision in an underinsurance policy was valid and enforceable. See March, 101 N.M. at 690, 687 P.2d at 1041. Although both Roberts Oil and Eldin contained broad discussions of contract law and public policy that are certainly relevant to the consent-to-settle provisions at issue here and in March, neither case mentioned March or questioned its holding. Thus, we believe the basic holding of March is still good law, although we modify its holding in light of the adoption of the substantial prejudice rule in both Roberts Oil and Eldin.

{7} The substantial prejudice rule provides that an insurer “must demonstrate substantial prejudice as a result of a material breach of the insurance policy by the insured before it will be relieved of its obligations under a policy.” Foundation Reserve Ins. Co. v. Esquibel, 94 N.M. 132, 134, 607 P.2d 1150, 1152 (1980). The rationale for the rule is that failure by an insurer to show substantial prejudice by an insured’s breach will frustrate the insured’s reasonable expectation that coverage will not be denied arbitrarily. Roberts Oil, 113 N.M. at 751-52, 833 P.2d at 228-29. “[T]he rule implements a fundamental characteristic of all, or nearly all, insurance contracts-namely, the essential nature of the contract as a promise by the insurer to indemnify and defend the insured against certain risks, in exchange for the insured’s payment of the premium.” Id. at 751, 833 P.2d at 228. Although an insurer must demonstrate substantial prejudice, a presumption of substantial prejudice arises upon proof of a breach of a policy provision. Id. at 755, 833 P.2d at 232. The ultimate issue of substantial prejudice is, in most cases, a question for a jury. Eldin, 119 N.M. at 375, 890 P.2d at 828.

{8} We believe it is consistent with the purpose of our uninsured motorist statute to require a showing of substantial prejudice before allowing an insurer to void an under-insured motorist policy when an insured breaches a consent-to-settle provision.

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Cite This Page — Counsel Stack

Bluebook (online)
2005 NMSC 010, 110 P.3d 491, 137 N.M. 275, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-farm-mutual-automobile-insurance-v-fennema-nm-2005.