No. 99SC500Supreme Court of Colorado.
January 22, 2001
Certiorari to the Colorado Court of Appeals
JUDGMENT REVERSED AND CASE REMANDED
Page 224
No. 99SC500, Clementi v. Nationwide Mutual Fire Ins. Co.:Notice Prejudice Rule — Automobile Insurance —Uninsured/Underinsured Motorist — Insurer
The supreme court reverses the court of appeals judgment affirming the trial court’s grant of summary judgment in this insurance case. Nationwide, the insurer, filed a declaratory judgment action in the trial court to determine whether notice filed by the Clementis’, the insureds, was untimely as a matter of law and whether Nationwide was required to demonstrate prejudice before forfeiting benefits under the Clementis’ uninsured motorist (“UIM”) policy. The court of appeals held that the Clementis’ five-month delay in filing notice was unreasonable and that Nationwide was not required to make a showing of prejudice prior to forfeiting the insureds’ benefits.
The supreme court holds that the trial court properly found that the insureds’ notice was untimely as a matter of law. The supreme court also expressly adopts the notice-prejudice rule in Colorado UIM cases. In doing so, the court holds that once it has been established that an insured has unreasonably provided delayed notice to an insurer, an insurer may only deny benefits if it can prove by a preponderance of the evidence that it was prejudiced by the delay. Applying this rule, the supreme court holds that because the record is insufficient to determine whether Nationwide was prejudiced by the Clementis’ delay, the court of appeals erred in affirming the trial court’s grant of summary judgment. Accordingly, the court reverses the court of appeals’ judgment and remands the case for further proceedings consistent with this opinion.
Nicholas Gradisar, Gradisar, Trechter, Ripperger, Roth Croshal, Pueblo, Colorado, Attorney for Petitioners.
Franklin D. Patterson, Patterson, Nuss Seymour, P.C., Englewood, Colorado, Attorney for Respondent.
EN BANC
JUSTICE RICE delivered the Opinion of the Court.
[1] We issued a writ of certiorari to review the court of appeals’ judgment in Nationwide Mutual Fire Ins. Co. v. Clementi, 989 P.2d 192 (Colo.Ct.App. 1999). Respondent, Nationwide Mutual Fire Insurance Company (“Nationwide”), filed a declaratory judgment action against Petitioners, the Clementis, seeking a determination that the Clementis had forfeited coverage under their uninsured motorist (“UIM”) policy by failing to provide timely notice of their claim. The trial court concluded as a matter of law that the Clementis’ notice was untimely, that the Clementis’ delay was unreasonable, and that Nationwide was not required to demonstrate prejudice before forfeiting benefits under the Clementis’ UIM policy. The court of appeals affirmed the trial court’s ruling, holding that a five-month delay in the Clementis’ filing notice was unreasonable. The court of appeals also held, based on this court’s decision in Marez v. DairylandInsurance Co., 638 P.2d 286 (Colo. 1981), that Nationwide was not required to make a showing of prejudice prior to forfeiting the Clementis’ benefits. [2] We granted certiorari to determine whether the Clementis’ notice was untimely and whether Nationwide was required to demonstrate prejudice before forfeiting benefits under the UIM policy in question. We now reverse the court of appeals and expressly adopt the notice-prejudice rule in UIM cases. We decline to overrule Marez at this time because we find that its holding applies only to liability cases and is thus inapplicable to this case. However, to the extent that Marez has been applied by the court of appeals to UIM cases, we disapprove.FACTS AND PROCEDURAL HISTORY
[3] On March 11, 1994, James Clementi, a Colorado state trooper, was injured in an automobile accident while acting within the course and scope of his employment. In August 1994, Clementi was notified by State Farm that the other driver’s policy was limited to $50,000. The following spring, Clementi’s physician determined that he had reached maximum medical improvement and had sustained a seventeen percent impairment rating. In March 1995, Clementi was awarded workers’ compensation benefits of approximately $43,000. Clementi gave notice to Nationwide of his UIM claim for damages exceeding the State Farm and workers’ compensation benefits in August 1995, seventeen months after the accident. In April 1996, Clementi received $50,000 from State Farm, pursuant to a settlement agreement.
Page 225
he had a seventeen percent disability and knew that his actual damages were already approaching the other driver’s policy limits. The court found that the Clementis’ unexplained failure to notify Nationwide of their potential UIM claim until five months after this date was unreasonable. The court found that the language in the policy requiring that notice be provided “as soon as practicable” was not ambiguous within the context of Colorado case law. The court also recognized that the policy reason for enforcing notice requirements is to allow insurers to investigate and protect against false claims. Finally, the court rejected the Clementis’ argument that Nationwide should be required to show prejudice from their late notice in order to void their UIM benefits. Citing Marez, the court noted that Colorado law appeared to require no such showing. Thus, the trial court granted Nationwide’s motion for summary judgment and declared the Clementis’ UIM coverage null and void.
[5] On appeal, the court affirmed the trial court’s ruling, holding that the policy’s language requiring notice “as soon as practicable” was not ambiguous, and that it did not violate public policy. Clementi, 989 P.2d at 194-95. The court also agreed with the trial court’s finding that the Clementis’ five-month delay was unreasonable as a matter of law. Id. at 195. Finally, the court noted that although other jurisdictions have adopted a rule requiring an insurance company to show prejudice when an insured fails to give timely notice of a UIM claim, Colorado courts have refused to impose that requirement. Id. at 196. [6] We granted certiorari to determine whether the trial court properly granted summary judgment in favor of Nationwide on the basis that the Clementis’ notice was untimely as a matter of law and on the basis that Nationwide was not required to demonstrate prejudice before it could forfeit the Clementis’ UIM benefits.[1] II. ANALYSIS
[7] This case presents an opportunity for us to address the status of the so-called notice-prejudice rule[2] in Colorado. Nearly twenty years ago, this court refused to adopt the notice-prejudice rule in a liability insurance case, holding that in denying benefits, an insurer is not required to demonstrate that it was prejudiced by an insured’s failure to comply with a policy’s notice requirements. See Marez, 638 P.2d at 291. The court of appeals has applied our ruling in Marez to both liability and UIM cases. See Haller v. Hawkeye-Security Ins. Co., 936 P.2d 601, 604 (Colo.Ct.App. 1997); Emcasco Ins. Co. v. Dover, 678 P.2d 1051, 1054 (Colo.Ct.App. 1983). However, this court has not previously considered whether the notice-prejudice rule applies in UIM cases. Therefore, as this is a matter of first impression, our analysis encompasses an examination of the treatment of the notice-prejudice rule in other jurisdictions, as well as a discussion of the principles and rationale underlying the rule.
A. Standard of Review
[8] We are reviewing the trial court’s grant of Nationwide’s motion for summary judgment under C.R.C.P. 56. Under this rule, a motion for summary judgment should be granted only when there are no issues of material fact. C.R.C.P. 56; Bebo Constr. Co. v.Mattox O’Brien, P.C., 990 P.2d 78, 83 (Colo. 1999). Summary judgment is a drastic remedy and should be granted only if it has been clearly established that the moving party is entitled to a judgment as a matter of law. Bebo, 990 P.2d at 83; Dale v. Guar.Nat’l Ins. Co., 948 P.2d 545, 553 (Colo. 1997). In determining whether summary judgment is proper, the nonmoving party is entitled to
Page 226
any favorable inferences that may reasonably be drawn from the facts, and all doubts must be resolved against the moving party. Bebo, 990 P.2d at 83.
B. Timeliness of Notice
[9] The Clementis’ policy requires an insured to “submit written proof of the claim . . . as soon as practicable.” R. at 68. The Clementis did not notify Nationwide of their UIM claim until seventeen months after the accident. The trial court found that at the latest, the Clementis should have provided Nationwide notice of their UIM claim five months before notice was actually given. The court found that the Clementis’ unexplained delay was unreasonable as a matter of law. The Clementis argue that the trial court erred in holding that their notice was untimely because it was given seven months before their settlement with State Farm, and thus was in substantial compliance with the terms of the policy. We disagree.
Notice-Prejudice Rule
[14] Traditional Approach
Page 227
Ouellette v. Maine Bonding Cas. Co., 495 A.2d 1232, 1234 (Me. 1985); Brakeman v. Potomac Ins. Co., 371 A.2d 193, 195 (Pa. 1977); Alcazar v. Hayes, 982 S.W.2d 845, 849 (Tenn. 1998). The traditional approach furthers the public policy purposes for a notice requirement in an insurance policy: (1) to allow the insurer to conduct a prompt investigation and adequate defense of the claim; and (2) to protect the insurer from potentially fraudulent claims. Marez, 638 P.2d at 291; Thun, 439 P.2d at 30; Shelter Mut. Ins. Co. v. Selley, 942 P.2d 1370, 1371
(Colo.Ct.App. 1997); Appleman, supra, at 292-93; Richard L. Suter, Insurer Prejudice: Analysis of an Expanding Doctrine inInsurance Coverage Law, 46 Me. L. Rev. 221, 223 (1994).
(Colo.Ct.App. 1997); Haller, 936 P.2d at 604 (Colo.Ct.App. 1997);Hansen, 779 P.2d at 1362; Graton v. United Sec. Ins. Co., 740 P.2d 533, 534 (Colo.Ct.App. 1987); Emcasco, 678 P.2d at 1054. [17] In Marez, this court refused to depart from the traditional approach and require an insurer to demonstrate that it was prejudiced by an insured’s failure to comply with the notice requirements of a liability policy in order to deny benefits. 638 P.2d at 286. Marez had been injured when his bicycle collided with an automobile. Id. at 287. The automobile owner’s insurer was never provided with written notice of the accident, as required under the owner’s liability policy. Id. at 288. Marez later died from causes unrelated to the accident and a suit was brought against the owner on behalf of Marez. Id. The owner failed to forward the suit papers to the insurer. Id. Instead, the insurer learned of the accident only by chance two and a half years after it had occurred. Id. We held that the owner’s total failure to notify the insurer constituted a material breach of the insurance contract, thus relieving the insurer from its duties under the policy. Id. at 289. [18] We declined to join those jurisdictions that had adopted the modern approach and allow the petitioners to show that the insurer had not been prejudiced by their failure to comply with the policy’s notice requirements. Id. at 290. We noted that Colorado had consistently followed the traditional approach, which was the majority rule at the time. Id. We reasoned that adopting the notice-prejudice rule would negate the purpose of the notice requirements, and concluded that the salutary purposes of the notice provisions should not be set aside without substantial justification. Id. at 291. We held that the case did not provide a factual context compelling a departure from the traditional approach, noting that “it is jurisprudentially sound to leave the matter to another day, or to the wisdom of the general assembly.” Id.[3] ,[4] [19] The court of appeals has applied Marez in various contexts involving both liability
Page 228
insurance and UIM policies. Estate ofRick Harry by Through Harry v. Hawkeye-Security Ins. Co., 972 P.2d 279, 282 (Colo.Ct.App. 1998) (relying on Marez in rejecting the adoption of a prejudice rule with regard to a violation of a consent-to-settle clause in a UIM policy); Shelter, 942 P.2d at 1373(relying on Marez to hold that insurers were not required to demonstrate that they had been prejudiced by an insured’s failure to comply with the notice provisions of a UIM policy); Haller, 936 P.2d at 604 (holding, based on Marez, that it is improper to consider prejudice in assessing compliance with the notice provisions of a liability policy); Graton, 740 P.2d at 534 (relying on Marez to hold that where delay in giving notice required under a no-fault policy is unexcused, prejudice to the insurer need not be shown); Emcasco, 678 P.2d at 1054 (noting that, under Marez, prejudice to a liability insurer is not a factor to be considered in a late-notice case).
[20] However, because Marez involved a no-notice liability case, we find that Marez is inapplicable in determining whether insurer prejudice should be considered in the UIM late-notice case at bar.[5] Accordingly, we now address whether the notice-prejudice rule should apply to UIM cases in Colorado. In doing so, we review the case law in other jurisdictions on this issue in light of Colorado’s treatment of UIM policies. [21] Few courts today strictly adhere to the traditional approach which allowed for no consideration of insurer prejudice in determining whether benefits should be denied due to noncompliance with an insurance policy’s notice requirements. Alcazar, 982 S.W.2d at 853 (citing New York and Colorado as the “only two states whose highest courts have considered the issue within the last twenty years [and that] have continued to strictly adhere to the traditional approach.”)[6] . While some courts continue to apply the traditional approach to late-notice liability cases,[7] the vast majority of courts have joined the modern trend in the context of a UIM case. Appleman, supra, at 293; Alan I. Widiss, Uninsured and Underinsured Motorist InsuranceCoverage § 16.2, at 25 (2d ed. 2000); see e.g., Burgess, 474 So.2d 634, 637 (holding that in Alabama uninsured motorist cases, unlike liability insurance cases, prejudice to the insurer is a factor to be considered in determining the overall reasonableness of a delay in giving notice of an accident); Alcazar, 982 S.W.2d 845, 853 (holding that in Tennessee, the notice requirement in a UIM policy is immaterial to the insurance contract in the event that the insurer was not prejudiced).[8]Page 229
Modern Trend
[22] Courts that have joined the modern trend by adopting the notice-prejudice rule consider insurer prejudice in determining whether the insurer may deny benefits in late-notice cases.Alcazar, 982 S.W.2d at 850. Although many courts that have adopted the notice-prejudice rule have failed to supply a definition of prejudice, generally, an insurer is prejudiced by an insured’s breach of a policy requirement when the purposes of the requirement are defeated. Suter, supra, at 222-23. Since the purpose of a policy’s notice requirement is to allow an insurer to adequately investigate and defend a claim, courts that have adopted the notice-prejudice rule have permitted an insurer to deny benefits only where its ability to investigate or defend the insured’s claim was compromised by the insured’s failure to provide timely notice. Suter, supra, at 224; see Alcazar, 982 S.W.2d at 849 (noting that the purpose of a notice requirement is to allow the insurer to make a prompt investigation, prepare a defense and to protect it from the presentation of spurious claims).
Page 230
the Colorado insurance law [reflected in] the adoption of the `Colorado Automobile Accident Reparations Act.'” 638 P.2d at 291.
[29] Courts that have adopted the notice-prejudice rule have also expressed concern for the severity of forfeiting one’s insurance benefits based on the technical violation of a notice provision.See, e.g., Brakeman, 371 A.2d at 198 (reasoning that “[a]llowing an insurance company, which has collected full premiums for coverage, to refuse compensation to an accident victim or insured on the ground of late notice, where it is not shown timely notice would have put the company in a more favorable position, is unduly severe and inequitable”).[9] Some courts that have taken this position have pointed to the Restatement (Second) of Contracts, which states that: “To the extent that the non-occurrence of a condition would cause disproportionate forfeiture, a court may excuse the non-occurrence of that condition unless its occurrence was a material part of the agreed exchange.” Restatement (Second) of Contracts § 229 (1981). These courts hold that when an insurer is not prejudiced, an insured’s failure to comply with a notice requirement is excused, since a “disproportionate forfeiture” ensues from enforcing such a requirement. Alcazar, 982 S.W.2d at 853. [30] Indeed, in Colorado, an analogous line of reasoning has been employed to invalidate insurance provisions that are void as against public policy. As relevant here, Colorado courts have refused to enforce certain provisions in UIM policies whose enforcement would result in some forfeiture of coverage. Petermanv. State Farm Mut. Auto. Ins. Co., 961 P.2d 487, 493 (Colo. 1998) (holding that a consent to sue clause in a UIM policy is void as against public policy); Huizar, 952 P.2d at 350 (holding that a trial de novo clause in a UIM policy is unenforceable); Briggs v.Am. Fam. Mut. Ins. Co., 833 P.2d 859, 862 (Colo.Ct.App. 1992) (holding that a consent to sue clause in a UIM policy is void as against public policy); but see Farmers Ins. Exch. v. Chacon, 939 P.2d 517, 521 (Colo.Ct.App. 1997) (holding that a UIM provision precluding recovery for wrongful death does not violate public policy and is thus enforceable). These courts have based their conclusions on the principle that insurance provisions that operate to significantly dilute UIM coverage are unenforceable as against the public policy of ensuring that victims of uninsured motorists recover as if they had been injured by an insured driver. Huizar, 952 P.2d at 345. [31] Thus, in light of Colorado’s recognition of the policy reasons underlying the notice-prejudice rule, we are persuaded by the reasoning of courts that have joined the modern trend and conclude that insurer prejudice should now be considered when determining whether noncompliance with a UIM policy’s notice requirements vitiates coverage. Having adopted the notice-prejudice rule in Colorado UIM cases, we now address the appropriate treatment of insurer prejudice in an evaluation of such cases. Burden of Proof
[32] Courts that have adopted the notice-prejudice rule by considering insurer prejudice in determining whether a denial of benefits is justified by noncompliance with a policy’s notice requirements have done so in various ways. A plurality of courts have held that once it is evident that the insured breached the notice provision, the burden of proof should fall upon the insurer to prove that it has been prejudiced by the breach. Ouellette, 495 A.2d at 1234; Alcazar, 982 S.W.2d at 853-54; see, e.g., Salerno v.Atl. Mut. Ins. Co., 6 P.3d 758, 764 (Ariz.Ct.App. 2000); Vega v.Gore, 730 N.E.2d 587, 589 (Ill.App.Ct. 2000); Nat’l Union FireIns. Co. v. F.D.I.C., 957 P.2d 357, 368 (Kan. 1998); Weaver v.State Farm Mut. Auto. Ins., 936 S.W.2d 818, 821 (Mo. 1997); Am.Cont’l Ins. Co. v. PHICO Ins. Co., 512 S.E.2d 490, 494
(N.C.Ct.App. 1999);
Page 231
Brakeman, 371 A.2d at 198; Coop. Fire Ins. Ass’n ofVt. v. White Caps, Inc., 694 A.2d 34, 38 (Vt. 1997); Kaplan v.Northwestern Mut. Life Ins. Co., 990 P.2d 991, 995 (Wash.Ct.App. 2000), amended on other grounds by 6 P.3d 1177
(Wash.Ct.App. 2000).
(Md. Ct. Spec. App. 2000), cert. granted, 755 A.2d 1139 (Md. 2000); Ouellette, 495 A.2d at 1235; Am. Cont’l, 512 S.E.2d at 494;Brakeman, 371 A.2d at 196; White Caps, 694 A.2d at 35. [38] Having rejected the prejudice-as-a-factor approach, we now determine whether the burden of proving prejudice should be placed on the insurer or on the insured. We agree with the courts that have concluded that it is more difficult for an insured to prove a
Page 232
negative, that is, that the insurer was not prejudiced, than it would be for the insurer to demonstrate that it was hampered in its ability to investigate or defend a claim because of the insured’s failure to provide timely notice. See, e.g., Alcazar, 982 S.W.2d at 855 (citing Jones v. Bituminous Cas. Corp., 821 S.W.2d 798, 803 (Ky. 1991)); White Caps, 694 A.2d at 38. Therefore, while we agree that consideration should be given to the fact that the insured is the party seeking to be excused from the consequences of violating a contract provision, we reject the presumption of prejudice approach in favor of placing the burden on the insurer to demonstrate that it was prejudiced. Thus, we now hold that once it has been established that an insured has unreasonably provided delayed notice to an insurer, an insurer may only deny benefits if it can prove by a preponderance of the evidence that it was prejudiced by the delay.[10]
Application of Notice-Prejudice Rule
[39] Having thus adopted the notice-prejudice rule in Colorado UIM cases by assigning the burden of proving prejudice to the insurer, we now apply this rule to the case at bar. As discussed above, we find that the trial court properly found that the Clementis’ notice, which was given five months after the latest date on which they should have reasonably done so, was untimely as a matter of law, and that the Clementis’ delay was unreasonable. See supra
p. 8. Therefore, our final determination concerns whether Nationwide was prejudiced by the Clementis’ delay.
Whether the court of appeals erred in affirming the trial court, which held, as a matter of law, that the notice given by the Clementis to Nationwide, seven months before settlement with the tortfeasor, was not timely and that Nationwide was not required to demonstrate prejudice before it could forfeit underinsured motorist benefits.
(2000); Lexington Ins. Co. v. Rugg Knopp, Inc., 1 F. Supp.2d 937
(E.D.Wis. 1998).
continues to apply to liability insurance cases because this issue is not presented by the case at bar. Cf. Alcazar, 982 S.W.2d at 856
n. 14 (declining to decide whether the notice-prejudice rule should apply to a standard liability policy since the case before the court involved only a UIM policy); but see Am. Justice Ins.Reciprocal v. Hutchison, 15 S.W.3d 811, 817 (2000) (applying notice-prejudice rule in a liability case sixteen months afterAlcazar was decided). However, to the extent that the court of appeals has extended our holding in Marez to non-liability late-notice cases, see Estate of Rick Harry, 972 P.2d at 282;Shelter, 942 P.2d at 1373; Graton, 740 P.2d at 534; Emcasco, 678 P.2d at 1054, we disapprove.
Page 233