IN THE SUPREME COURT OF
════════════
No. 05-0849
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PAJ, Inc., d/b/a Prime Art & Jewel, Petitioner,
v.
The Hanover Insurance Company, Respondent
════════════════════════════════════════════════════
On Petition for Review from the
Court of Appeals for the Fifth District of
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Argued October 18, 2006
Justice Willett, joined by Justice Hecht, Justice Wainwright, and Justice Johnson, dissenting.
I respectfully dissent. I would follow Members Mutual Insurance Co. v. Cutaia[1] and hold that a policy’s unambiguous notice-of-suit language, a condition precedent to coverage, constitutes a defense to liability and must be enforced as written, unless positive law dictates otherwise.[2] Because positive law does not dictate otherwise, I would affirm the court of appeals.
I. Discussion
PAJ
argues that under Hernandez v. Gulf Group Lloyds[3] and Harwell v. State Farm Mutual
Automobile Insurance Co.,[4]
the policy’s notice provisions are covenants, not conditions precedent to
coverage, and therefore
A. The Timely Notice Provision Is a Condition Precedent, Not a Covenant
The parties dispute whether the policy’s prompt-notice language constitutes a condition precedent (as Hanover argues), the failure of which defeats coverage,[5] or a covenant (as PAJ argues), the breach of which, if immaterial, does not defeat coverage.[6] PAJ concedes that “[f]or years, Texas courts have held that timely notice of suit provisions in liability insurance policies [are] conditions to coverage” and that a “long line of Texas cases hold[s] that the notice requirements of policies similar to the Policies [in this case] are conditions precedent to liability,” but contends that those cases involved “materially different” policy language.
This Court has indeed repeatedly described insurance policy notice provisions as conditions precedent to coverage.[7] In 1972, we held in Cutaia that when a notice provision requiring the immediate forwarding of suit papers is breached, “liability on the claim [was] discharged, and harm (or lack of it) resulting from the breach [is] immaterial.”[8] The policy in Cutaia provided that “‘no action shall lie against the company unless, as a condition precedent thereto, the insured shall have fully complied with all the terms of this policy,’” including the notice requirement in issue.[9]
PAJ
insists the notice requirement in
The notice provision at issue is a condition precedent, as coverage is expressly conditioned on compliance with the notice requirement. Section IV of the policy, entitled “Commercial General Liability Conditions,” contains a list of “Duties In The Event Of Occurrence, Offense, Claim Or Suit,” one of which states: “If a claim is made or ‘suit’ is brought against any insured, you must . . . . [n]otify us as soon as practicable.” Section IV also specifies that “[n]o person or organization has a right under this Coverage Part . . . to sue us on this Coverage Part unless all of its terms have been fully complied with” (emphasis added). The prompt-notice requirement, expressly identified in the policy as a condition and, more importantly, providing that no suit may take place absent full compliance, is plainly a condition that precedes the insurer’s obligations to perform under the policy.
PAJ’s reliance on Hernandez is misplaced. Hernandez involved an insured’s breach of a settlement-without-consent exclusion in an automobile policy, which said that the insurance did not apply to “bodily injury or property damage with respect to which the insured . . . shall, without written consent of the company, make any settlement with any person or organization who may be legally liable therefor.”[17] Rather than treat the exclusion as a condition precedent, the Court viewed it as a covenant, an ordinary contractual obligation, the performance of which was excused only if the breach were material.[18] As such, we found it “unenforceable absent a showing by the insurer that it has been prejudiced by an insured’s failure to obtain consent before settling.”[19] The Court recognized a prejudice requirement in Hernandez consistent with the basic contract law principle that one party’s breach of a covenant must be material in order to excuse performance by the other party.[20]
Hernandez’s
materiality-of-breach analysis is inapposite here because PAJ did not breach a
covenant. Rather, it failed to comply with a condition precedent, a strict
requirement that precedes any obligation on the part of
B. A Late-Notice Defense Should Require No Showing of Prejudice Unless the Policy or Positive Law Specifically Provides Otherwise
PAJ’s reliance on our 1995 decision in Harwell likewise falls short. In Harwell, prejudice was expressly required by the policy itself: “If we show that your failure to provide notice prejudices our defense, there is no liability coverage under the policy.”[23] Given this unambiguous requirement, we enforced the contract’s literal text and examined whether the insurer had in fact demonstrated actual prejudice.[24] PAJ’s policy, by contrast, does not require the insurer to show prejudice with respect to advertising injury claims.
In Cutaia, we held that a late-notice defense requires no showing of prejudice, refusing to “insert a provision that violations of conditions precedent will be excused if no harm results from their violation.”[25] The Board of Insurance (now the Texas Department of Insurance (TDI)) responded the following year, issuing two Board orders mandating a prejudice requirement for bodily injury and property damage coverage in automobile and general liability policies:
As respects bodily injury liability coverage and property damage liability coverage, unless the company is prejudiced by the insured’s failure to comply with the requirement, any provision of this policy requiring the insured to give notice of action, occurrence or loss, or requiring the insured to forward demands, notices, summons or other legal process, shall not bar liability under this policy.[26]
PAJ casts this 1973 Board action as a “regulatory rejection” of Cutaia’s no-prejudice rule. As concerns the dispositive issue before us, I disagree. This Board-mandated policy language, while clearly applicable to the automobile policy in Harwell, was not an across-the-board abrogation of Cutaia’s no-prejudice rule; by its terms, the Board’s endorsement reaches only certain lines of insurance and a defined subset of claims for bodily injury and property damage.
PAJ’s policy provided for three kinds of coverage: Coverage A, for bodily injury and property damage; Coverage B, for personal and advertising injury; and Coverage C, for medical payments. The agency’s required endorsement is targeted solely at Coverage A. The endorsement imposes no prejudice requirement for any other types of coverages.
My text-based construction of the policy is consistent with the principle of expressio unius est exclusio alterius, meaning that the naming of one implies the exclusion of others.[27] This maxim, while not conclusive, is useful and applies perfectly here, where TDI’s prejudice requirement, by its terms, covers only a specified subset of claims. My construction also honors stare decisis as explained recently in Fiess v. State Farm Lloyds.[28] In Fiess, the Court discussed one of our prior decisions and observed that if TDI disputed our construction of the insurance policy in that case, “it is strange that insurance regulators did nothing to change the policy for a quarter century.”[29] In the instant case, the Board acted following Cutaia, but in a circumscribed manner.
The
Court points out that the prejudice requirement TDI imposed in 1973 predated
the availability of CGL coverage for advertising injury. True enough, but as
the Court also acknowledges, such coverage has now been available through
standard CGL policies for nearly three decades during which TDI declined to
broaden its 1973 order even as new coverages, like
advertising injury, were added to the standard CGL policy. Given this lengthy
inaction by the agency charged with mandating changes in policy forms, Fiess counsels us to “decline the invitation to
overrule” our earlier precedent.[30]
If anything, the argument for deference to state regulators in the instant case
is even stronger than it was in Cutaia. The
Board responded swiftly following Cutaia, to
be sure, but also surgically, overriding Cutaia
as to some coverages but not
others. The implication from this targeted response followed by decades
of subsequent executive and legislative inaction is plain:
I would reaffirm Cutaia’s recognition that the Legislature and the state agency overseeing the insurance industry are better suited to decide whether an insurer must show prejudice to deny coverage based on late notice. TDI and legislators are free to supplant Cutaia’s no-prejudice rule with a more liberal notice-prejudice rule if they believe, on public policy grounds, that the latter is preferable. I would not fault them for doing so. But when interpreting text—whether a contract, regulatory edict, statute, or constitution—formalism matters, and key to formalism is consistency in entrusting policy matters to policymakers.
In any event, I find it understandable that an insurer would insist on a strict notice requirement. An insured’s failure to provide prompt notice of a suit or claim to an insurer, who has the resources and experience to handle such claims, can obviously work a substantial hardship on both the insurer and the insured. The insurer understandably wishes to discourage late notice and to avoid ancillary litigation devoted to whether or not it was prejudiced by a failure to provide prompt notice; litigation could have the effect of raising premiums on all insured parties, thus forcing punctual insured parties to subsidize those who flout the policy’s notice requirements.
Regardless
of which side makes the superior public policy argument as to what an insurance
policy should provide, I would decline to insert nonexistent language
into the parties’ agreement. The Court is construing a contract, not editing
it, and just six months ago, in Fortis Benefits v. Cantu, this Court
unanimously stressed that “contract rights generally arise from contract
language; they do not derive their validity from principles of equity but
directly from the parties’ agreement.”[31]
Fortis Benefits directs courts in contractual interpretation cases to
follow a “modest, text-based approach” anchored in the parties’ agreed
contract,[32]
rather than imposing external, judge-made rules. Indeed, Fortis Benefits
cited Cutaia, which should control today, for
the sound principle that balancing policy concerns is best left to nonjudicial bodies.[33]
The Court affirmed that view last year in Fiess
when it concluded: “If the political branches of
In
a post-submission brief, Hanover points out that since October 2000 a “Texas
Changes” endorsement, designated endorsement “CG 01 03” and published by the
Insurance Services Office (ISO), has included a prejudice requirement for
personal and advertising injury claims as well as bodily injury and property
damage claims.
Today
the Court treats Cutaia as a dead letter,
overruled by Hernandez, reasoning that the Court in Hernandez
declined to draw any distinction between covenants and conditions and
“apparently rejected” Cutaia’s holding that
failure to comply with a coverage condition precluded liability irrespective of
harm.[38]
I disagree. This Court has never expressly equated covenants with conditions or
abolished the sometimes fine (but sometimes significant) distinction between
them;
Put simply, Hernandez concerned a policy exclusion—not a policy condition—and this Court has restated the distinction repeatedly since Hernandez was decided.[40] In any event, Hernandez did not overrule or modify Cutaia, expressly or by implication; the Hernandez majority never even mentions Cutaia. Nor has any subsequent case from this Court, until today, limited Cutaia or remotely criticized it. For the reasons discussed above,[41] Cutaia and Hernandez can be reconciled, with today’s notice case falling squarely under Cutaia, a case this Court recently cited and unanimously reaffirmed for the core teaching regarding policy intervention/abstention.[42]
The
Court finds my reading of the policy unreasonable because “identical policy
language creates a condition precedent as to one type of coverage (advertising
injury), but a covenant as to the other (bodily injury and property damage).”[43] I think my reading of the policy is
exactly what is expected when a national insurance company uses a standard CGL
form but modifies it only to the extent necessary to comply with the law of the
jurisdiction where the policy is sold, in this case Texas. The policy generally
provides that notice of an occurrence or claim is a condition precedent to
coverage and that “[n]o person . . . has a right . . . [t]o sue” the insurer
absent compliance with this requirement, as discussed more fully above, but
modifies these standard provisions as needed to comply with Texas law. Hence,
the policy includes an endorsement, titled “Texas Changes—Conditions Requiring
Notice” and providing that prejudice must be shown to deny coverage “[w]ith regard to Bodily Injury and Property Damage Liability”
only. The absence of a similar endorsement for advertising injury claims is
unsurprising since
Finally,
the Court views my approach as imposing “draconian consequences for even de minimis deviations from the duties the policy places on
insureds.”[44]
In this case, PAJ’s failure to comply with the
policy’s prompt-notice requirements cannot be described as de minimis. The record shows that several months passed
before PAJ notified
II. Conclusion
Courts
should enforce unambiguous policy terms in accordance with their plain meaning.[46] As this Court recently affirmed in Fiess, we cannot fashion for parties a
new-and-improved contract, “nor change that which they have made under the
guise of construction,”[47]
nor impose by judicial fiat a brand of justice, however earnest and strongly
felt, that we find more personally congenial. The “better
policy” remains that insurance contracts should be construed by courts and
spruced up, if necessary, by nonjudicial bodies.[48] Accordingly, I would decline to
embellish this policy’s unequivocal notice-of-suit and “no action” restrictions
by imposing an extra-contractual prejudice requirement that excuses the failure
of a condition precedent to coverage.[49]
I would affirm the court of appeals’ judgment that
____________________________________
Don R. Willett
Justice
Opinion delivered: January 11, 2008
[1]
476 S.W.2d 278, 279 (
[2]
[3]
875 S.W.2d 691 (
[4]
896 S.W.2d 170 (
[5] Klein
v. Century Lloyds, 275 S.W.2d 95, 96 (
[6] See Hernandez, 875 S.W.2d at 692.
[7] Harwell,
896 S.W.2d at 173–74;
[8] Cutaia, 476 S.W.2d at 279, 281 (discussing
[9] Cutaia, 476 S.W.2d at 278.
[10]
Hohenberg Bros. Co. v. George E. Gibbons
& Co., 537 S.W.2d 1, 3 (
[11]
[12] See, e.g., Cutaia, 476 S.W.2d at 279.
[13] Landscape Design & Constr., Inc. v. Harold Thomas Excavating, Inc., 604 S.W.2d 374, 376 (Tex. App.—Dallas 1980, writ ref’d n.r.e.); see also Reinert v. Lawson, 113 S.W.2d 293, 295 (Tex. Civ. App.—Waco 1938, no writ).
[14]
Hernandez v. Gulf Group Lloyds, 875 S.W.2d 691, 692–93 (
[15]
Criswell v. European Crossroads Shopping Ctr., Ltd., 792 S.W.2d 945, 948
(
[16] Hohenberg Bros., 537 S.W.2d at 3.
[17] 875 S.W.2d at 692 n.1.
[18]
[19]
[20] See id.
[21] See supra note 7 and accompanying text.
[22] 170 S.W.3d at 263.
[23]
Harwell v. State Farm Mut. Auto. Ins. Co., 896 S.W.2d 170, 173 (
[24]
[25]
Members Mut. Ins. Co. v. Cutaia, 476 S.W.2d 278, 281
(
[26] State Bd. of Ins., Revision of Texas Standard Provision for Automobile Policies Editions of April 1, 1955 and October 1, 1966—Amendatory Endorsement—Notice, Order No. 22582 (Jan. 26, 1973), available at http://www.tdi.state.tx.us/commercial/pcck22582.html; State Bd. of Ins., Revision of Texas Standard Provision for General Liability Policies—Amendatory Endorsement-Notice, Order No. 23080 (Mar. 13, 1973), available at http://www.tdi.state.tx.us/commercial/pcck23080.html.
[27]
CKB & Assocs., Inc. v. Moore McCormack
Petroleum, Inc., 734 S.W.2d 653, 655 (
[28]
202 S.W.3d 744 (
[29]
[30]
[31]
234 S.W.3d 642, 647 (
[32]
[33]
[34] Fiess, 202 S.W.3d at 753.
[35]
Members Mut. Ins. Co. v. Cutaia, 476 S.W.2d 278, 281
(
[36]
Under current law, an insurer offering a CGL policy must use forms filed with
and approved by
[37]
[38] ___ S.W.3d at ___.
[39]
Harwell v. State Farm Mut. Auto. Ins. Co., 896
S.W.2d 170, 173–74 (
[40] In Maldonado, 963 S.W.2d at 40, and Harwell, 896 S.W.2d at 173-74, we characterized insurance policy provisions as conditions precedent.
[41] See supra Part I.A.
[42]
Fortis Benefits v. Cantu, 234 S.W.3d 642, 649–50 (
[43] ___ S.W.3d at ___.
[44] ___ S.W.3d at ___.
[45] See Bituminous Cas. Corp. v. Vacuum Tanks, Inc., 75 F.3d 1048, 1056 (5th Cir. 1996) (stating that “this court and Texas courts have held that substantial compliance with an insurance policy notice requirement will suffice,” and holding that failure to forward suit papers as required in policy was excused where insured “substantially complied with the notice requirement by apprising [the insurer] in writing of the essential allegations of the underlying suits”); Bekins Moving & Storage Co. v. Williams, 947 S.W.2d 568, 576 n.1 (Tex. App.—Texarkana 1997, no writ) (recognizing that “proof of loss and notice of claim are conditions precedent to recovery on the policy,” but that “a claimant may still recover upon jury findings supporting theories of waiver or substantial compliance”); Henry v. Aetna Cas. & Sur. Co., 633 S.W.2d 583, 584-85 (Tex. App.—Texarkana 1982, writ ref’d n.r.e.) (holding that failure to comply with written proof of claim requirement was excused because insured substantially complied with requirement when he had his mother report particulars of accident to insurance agent, who prepared written report on insurer’s own form); Dairyland County Mut. Ins. Co. v. Keys, 568 S.W.2d 457, 458-59 (Tex. Civ. App.—Tyler 1978, writ ref’d n.r.e.) (holding, where insurer complained that insured “failed to give the proper notice of proof of loss in accordance with the terms of the policy,” that insured substantially complied with policy when he went to agent’s office and filled out a form providing particulars of loss); Austin Bldg. Co. v. Nat’l Union Fire Ins. Co., 403 S.W.2d 499, 505-06 (Tex. Civ. App.—Dallas 1966, writ ref’d n.r.e.) (holding that insured substantially complied with policy requirement that it provide sworn proof of claim, where insured provided unsworn proof of claim to insurer’s agent and communicated with adjuster regarding particulars of loss); Home Ins. Co. v. F.C. Flewellen Produce Co., 247 S.W. 833, 835-836 (Tex. Comm’n App. 1923, holding approved) (holding that failure to produce one inventory record did not violate policy requiring preservation and production of business records, where insured produced all other records and was not culpable for loss of the missing record); see also Gladding v. Prudential Ins. Co. of Am., 521 S.W.2d 736, 737, 739 (Tex. Civ. App.—Houston [1st Dist.] 1975, writ ref’d n.r.e.) (holding that insured substantially complied with policy change of beneficiary provision by submitting an insurance form referring to designees by initials rather than full names as required by the form).
[46]
Blaycock v. Am. Guarantee Bank Liab. Ins. Co., 632 S.W.2d 719, 721 (
[47]
Fiess v. State Farm Lloyds, 202 S.W.3d
744, 753 (
[48]
Members Mut. Ins. Co. v. Cutaia, 476 S.W.2d 278, 281
(
[49]
Texas courts are not alone in adopting the traditional rule and concluding that
(1) notice requirements are conditions precedent, see Greycoat,
657 A.2d at 768; Livorsi Marine, 856
N.E.2d at 343; Las Vegas Star Taxi, 714 P.2d at 562; Argo, 827
N.E.2d at 764; Goodyear Tire & Rubber Co. v. Aetna Cas.
& Sur. Co., 769 N.E.2d 835, 842 (Ohio 2002); Walton, 423 S.E.2d
at 192; Colonial Ins. Co. v. Barrett, 542 S.E.2d 869, 874 (W. Va. 2000);
Askren Hub States Pest Control Servs., Inc. v. Zurich Ins. Co., 721 N.E.2d 270, 277
(Ind. Ct. App. 1999), (2) the modern CGL “no action” language renders the
notice requirement a condition of coverage that must be honored before the
insurer is liable, see AIG Centennial Ins. Co. v. Fraley–Landers, 450
F.3d 761, 764-65, 767 (8th Cir. 2006) (citing a prior case reviewing Arkansas
law and so holding); Las Vegas Star Taxi, Inc. v. St. Paul Fire & Marine
Ins. Co., 714 P.2d 562, 562–63 (Nev. 1986); Federated Mut. Ins. Co. v. Ownbey Enters.,
Inc., 627 S.E.2d 917, 919 & n.2 (Ga. Ct. App. 2006), and (3) the
insurer need not show prejudice in order to avoid coverage, see AIG,
450 F.3d at 768 (applying Arkansas law and concluding that although there are
some divergent cases, Arkansas courts would not impose a prejudice requirement);
Greycoat Hanover F St. Ltd. P’ship
v. Liberty Mut. Ins. Co., 657 A.2d 764, 768 n.3 (D.C. 1995); Country Mut.
Ins. Co. v. Livorsi Marine, Inc., 856 N.E.2d 338, 346 (
Likewise, leading legal commentators recognize that notice provisions have been treated as conditions precedent rather than covenants. See 22 Eric Mills Holmes, Appleman on Insurance § 139.1[B] (2d ed. 2003); Donald S. Malecki & Arthur L. Flitner, Commercial General Liability 76–77 (4th ed. 1992); 13 Lee R. Russ & Thomas F. Segalla, Couch on Insurance §§ 190.20, 190.25 (3d ed. 1999).