Opinion Number: 1999-NMCA-158
Filing Date: November 17, 1999
Docket No. 19,514
EARL T. MARTIN,
Plaintiff-Appellant,
v.
WEST AMERICAN INSURANCE
COMPANY, a foreign corporation doing
business in New Mexico,
Defendant-Appellee.
APPEAL FROM THE DISTRICT COURT OF BERNALILLO COUNTY
Susan M. Conway, District Judge
J. E. Casados
Gail Stewart
Gallagher, Casados & Mann, P.C.
Albuquerque, NM
for Appellant
M. Eliza Stewart
Shannon A. Parden
Madison, Harbour, Mroz & Brennan, P.A.
Albuquerque, NM
for Appellee
APODACA, Judge.
{1}
Plaintiff Earl T. Martin (Insured) appeals the trial
court's summary judgment in favor of Defendant West American
Insurance Company (Insurer). Insured sued Insurer for bad
faith, breach of contract, unfair trade practices, and unfair
insurance practices. The suit arose from Insurer's initial
denial of defense of a personal injury action against Insured
and its subsequent denial of indemnification for a settlement
Insured negotiated without Insurer's participation or consent.
Insured raises two issues on appeal: (1) his homeowner's
insurance policy covered the personal injury action because it
arose out of self-defense, and (2) the trial court erred in
concluding as a matter of law that Insurer acted in good faith
in denying a defense. We affirm.
I. FACTUAL AND PROCEDURAL BACKGROUND
{2}
The homeowner's insurance policy excluded coverage for bodily injury that was "expected or intended by the insured."
In July 1991, Insured had a physical confrontation with his
stepdaughter in his home. The stepdaughter filed a complaint
for personal injury against him in August 1993. The complaint
alleged that Insured battered his stepdaughter, resulting in
serious physical and emotional injuries. Additionally, the
complaint stated that Insured's conduct was "egregious and
oppressive, and characterized by malice or wantonness." The
complaint did not allege Insured's negligence or any facts
from which it could be inferred that Insured acted in self-defense.
{3}
In September 1993, Insured notified Insurer of his
stepdaughter's lawsuit. After receiving the complaint,
Insurer contacted the stepdaughter's counsel to ascertain
whether the stepdaughter was alleging negligence or
unintentional conduct that might trigger a duty to defend or
indemnify under the homeowner's policy. The stepdaughter's
counsel informed Insurer that the suit was solely based on
intentional battery. Insurer assigned a claims representative
to investigate. The claims representative interviewed Insured
by telephone that same month.
{4}
In this interview, which was taped, Insured explained
that his stepdaughter lived next door and that they had an
argument concerning water use. After the argument, when
Insured got out of the shower, he found his stepdaughter in
his kitchen. He perceived that she was in a mood to quarrel.
They yelled at each other, and Insured approached her to push
her out the door. In response, she knocked his glasses off.
He kept trying to push her out the door, and she kept lunging
at him. The two exchanged blows and words. Insured denied
that he was the aggressor. Later, there was other information
provided by Insured to Insurer, which we discuss in other
parts of this opinion.
{5}
Insurer initially denied Insured's claim for defense and
indemnification. The letter of denial considered the
stepdaughter's allegations outside the scope of Insured's
coverage and advised Insured to contact Insurer if new facts
emerged. Insured's counsel responded, stating that Insured
did not expect to involve Insurer in the lawsuit and that he
understood the basis of denial. Later, Insured filed an
answer denying his stepdaughter's allegations. In his answer,
he did not allege negligence or raise self-defense as an
affirmative defense.
{6}
By February 1995, Insured retained different counsel, who
renewed his claim for policy benefits. Counsel stated to
Insurer that Insured would refute the stepdaughter's complaint
on the basis of intent. Consequently, Insured maintained, a
judgment in negligence could result if the stepdaughter
amended her pleadings. Insured's counsel also asserted that
the policy would cover a negligence judgment. Insurer advised
Insured to contact it with new facts or pleadings to consider.
In April 1995, Insured informed Insurer that he intended to
defend by asserting that he was not the aggressor and that the
stepdaughter's injuries were unintentional. He provided his deposition stating that the injuries were unintentional.
Based on these new arguments, Insurer agreed, with a full
reservation of rights, to defend Insured beginning April 28,
1995, the date it received Insured's deposition.
{7}
In May 1995, the trial on stepdaughter's complaint
against Insured commenced. The stepdaughter, however, never
amended her complaint to allege negligence, and her case in
chief focused on battery. A mistrial resulted part way
through the trial because of the trial court's acquaintance
with the stepdaughter's husband. Insured asked Insurer if it
would contribute to a settlement, but Insurer declined.
Insured did not ask if Insurer would continue its defense in
a second trial. Insured and the stepdaughter then settled.
Insured settled with the stepdaughter, specifically
representing that there existed no monies from Insurer to
satisfy the stepdaughter's claims.
{8}
After the settlement, Insured sent Insurer a bill for
$17,375.78, which represented legal expenses and costs
resulting from the stepdaughter's suit from April 28, 1995,
through May 30, 1995. Insurer paid the requested amount.
Later, Insured demanded payment of defense costs incurred
before April 28, 1995, and for indemnification of his
settlement with his stepdaughter. Insurer denied that claim.
That denial resulted in Insured's lawsuit against Insurer, in
which he sought compensatory and punitive damages, interest,
costs, and attorney fees under NMSA 1978, § 57-12-10 (1987)
(regarding unfair trade practices), or NMSA 1978, § 59A-16-30
(1990) (regarding insurance practices).
{9}
Both parties moved for summary judgment. Insured sought
partial summary judgment on liability on the claims pled.
Insurer moved for summary judgment on all issues raised by
Insured. Both parties agreed to a determination as a matter
of law. At the hearing, the trial court stated that issues
concerning self-defense, defense of residence, and reasonable
force in removing a provoking trespasser were not material to
its decision.
{10}
Although the trial court questioned the appropriateness
of listening to Insured's taped interview, it reasoned that it
should consider all the facts available to Insurer at the time
it denied coverage in evaluating Insurer's good faith in
making a decision concerning coverage. The trial court
considered whether the taped interview raised factual issues
of negligence, requiring Insurer to investigate further. The
court determined that Insured was in a brawl with his
stepdaughter, knew he was hitting her, was infuriated, and
lost control. Consequently, the trial court concluded that
Insured's statement did not raise an inference of negligence
requiring Insurer to investigate further. On this basis, the
trial court denied Insured's summary judgment motion and
granted Insurer's motion. The trial court did not expressly
rule on the question of indemnity.
II. DISCUSSION
A. Standard of Review
{11}
We review de novo questions of law appealed from an entry
of summary judgment. See Gallegos v. State Bd. of Educ.,
1997-NMCA-040, ¶ 11, 123 N.M. 362, 940 P.2d 468. On questions
of law, we are in as good a position as the trial court to
make a determination. See id.
B. Insurer's Duties to Defend
{12}
Insured argues that the trial court erred in holding that
his homeowner's insurance policy excluded acts of self-defense. See, e.g., Berg v. Fall, 405 N.W.2d 701, 704 (Wis.
Ct. App. 1987) (holding that insurance policy that excluded
liability coverage for bodily injury "expected or intended by
the insured" did not apply to privileged acts of self-defense). New Mexico case law has not decided that question.
From our review of the record, it is not clear that the trial
court determined the policy excluded acts of self-defense.
Instead, the court determined that the issue of self-defense
was not material to its decision. Additionally, our
disposition does not require us to determine the issue.
In deciding whether an insurer is obligated to
defend the insured, we must determine whether the
injured party's complaint states facts that bring
the case within the coverage of the policy. If the
allegations of the complaint clearly fall outside
the provisions of the policy, neither defense nor
indemnity is required.
Bernalillo County Deputy Sheriffs Ass'n v. County of
Bernalillo, 114 N.M. 695, 697, 845 P.2d 789, 791 (1992)
(citation omitted). Our analysis therefore begins with the
allegations of the stepdaughter's complaint and the terms of
Insured's policy. The complaint averred that Insured
"battered [the stepdaughter], striking her down several times
and knocking her down," and "as a consequence of [Insured's]
battery upon her," the stepdaughter suffered serious physical
and emotional injuries. Insured's policy expressly excluded
coverage for bodily injury "expected or intended by the
insured." Thus, the allegations of the complaint fall outside
the coverage. Bernalillo, however, holds that "the
allegations of the complaint [must] clearly fall outside the
provisions of the policy." Id. Additionally, we have
recently held that all facts known to the insurer or of which
the insurer should reasonably be aware based on the facts and
circumstances available to it or that it should reasonably
investigate should be considered in determining the insurer's
duty. See G & G Serv. Inc. v. Agora Syndicate, Inc., ____-
NMCA-____, ¶¶ 18-29, ____ N.M. ____ , ____ P.2d ____ [No.
19,551, slip op. at 6-13 (N.M. Ct. App. Nov. 2, 1999)]. For
the reasons that follow, we hold that Insurer had no duty to
defend under these requirements.
{13}
During Insurer's investigation to determine whether any
potential or arguable defenses fell within the scope of the
insurance policy, Insured told the investigator that he and
his stepdaughter "had never gotten along from day one," and
that "there was a lot of hostility between them." Insured
also informed the investigator that during this argument he
became really mad at his stepdaughter and "just totally lost
it." He also informed the investigator that at some point in
the argument, "we just started hitting each other." Insured
said that he was arrested for the incident and had to seek
counseling due to his violent behavior against his
stepdaughter. He could not say definitively whether he or his
stepdaughter struck the first blow, but it is clear that both
parties participated in the physical violence. We believe
that the trial court could properly determine that these
statements would not reasonably indicate to Insurer that
Insured was claiming something other than an intentional tort.
{14}
Based on these statements and the complaint filed in the
stepdaughter's lawsuit, Insurer wrote to Insured, stating that
it would not defend. It denied coverage on that basis.
Insurer also stated, however, that if there were new facts or
pleadings brought to light in the lawsuit that Insured thought
might change Insurer's position, Insured should promptly bring
them to Insurer's attention. Insurer's attorney responded,
"[Insured] does not expect to involve [Insurer] in this
lawsuit. He understands the basis for the denial of
coverage." In 1995, when Insured retained his present
attorneys, they wrote to Insurer, stating that there were new
facts available. Insurer responded, requesting that those
facts be forwarded once depositions were available. The
depositions were forwarded shortly thereafter, and Insured
promptly undertook to provide the defense. We thus conclude
that the trial court did not err in holding that Insurer
determined in good faith that no "potential" or "arguable"
allegations fell within the scope of the policy during the
time it was denying any duty to defend.
{15}
Thus, even if we were to adopt the Wisconsin court's
holding in Berg that the exclusion provisions did not apply to
acts of self-defense, that determination would not require
reversal in this appeal. We hold that the allegations of the
stepdaughter's complaint and Insured's representation of his
actions clearly fell outside the provisions of Insured's
policy. Consequently, Insurer had no duty to defend Insured
from the beginning of the stepdaughter's lawsuit until it
assumed the defense in 1995.
C. Duty to Indemnify
{16}
Although Insured sought indemnification for the
settlement he entered into with his stepdaughter, that aspect
of the case was only briefly addressed in the trial court and
on appeal. Both below and on appeal, Insurer took the
position that, regardless of any potential ruling on its duty
to defend before it undertook the defense, Insured could not be indemnified for the settlement because it was entered into
without Insurer's consent, contrary to the terms of the
insurance contract. The trial court did not rule on this
issue. Because the indemnification issue was raised below and
on appeal, and because there exists no dispute as to any
material fact, we may reach and decide the indemnification
issue.
{17}
Insured's only argument below against Insurer's
contention was that Insurer waived the right to rely on the
policy when it was denying coverage. Insured's argument on
appeal is that the trial court did not rule on the issue and
that "the critical time for determination of the underlying
existence of bad faith . . . focuses on the insurance
company's 1993 'evaluation of its duty to defend' and refusal
of a defense." Because we have previously dealt with
Insurer's determination in 1993 and because Insurer was in
fact defending when Insured entered into the settlement, we
hold that, under the procedural posture and arguments made in
this case, Insurer was not required to indemnify Insured for
a settlement made without requesting its consent.
III. CONCLUSION
{18}
We hold that Insurer was not put on notice of any
potential or arguable claims or defenses that would fall
within the insurance policy coverage and that the trial court
correctly held, as a matter of law, that Insurer acted in good
faith in denying Insured's claims. For the reasons noted
above, we also hold that Insurer had neither a duty to defend
nor to indemnify Insured. We therefore conclude that the
trial court properly granted summary judgment in favor of
Insurer and affirm.
{19}
IT IS SO ORDERED.
_______________________________
RUDY S. APODACA, Judge
WE CONCUR:
___________________________________
LYNN PICKARD, Chief Judge
___________________________________
JONATHAN B. SUTIN, Judge