Civil action commenced in the Superior
Court Department on February 24, 2021.
Motions to dismiss and for judgment on the
pleadings were heard by Kristen Buxton, J.
Michael L. Mahoney for the plaintiff.
Lincoln A. Rose (Scarlett M. Rajbanshi
also present) for the defendant.
DITKOFF, J. The plaintiff, John Moriarty &
Associates, Inc. (JMA), a general contractor, was an additional insured on a
commercial general liability insurance policy issued by the defendant, Zurich
American Insurance Co. (Zurich), to one of JMA's subcontractors. After an employee of that subcontractor
brought a negligence action against JMA related to a job site injury, Zurich
agreed to defend and indemnify JMA subject to a reservation of rights that
expressly included, among other things, a right to recoup defense costs. Over eight months after JMA made its first
demand for a defense and indemnity, JMA initiated the present action alleging
that Zurich failed to pay or reimburse any of JMA's defense costs in the
ongoing negligence action and that Zurich otherwise committed a breach of its
duty to defend and indemnify by refusing to withdraw its reservation of
rights. JMA now appeals from a judgment
dismissing its complaint pursuant to Mass. R. Civ.
P. 12 (b) (6), 365 Mass. 754 (1974).
Concluding that an insured may recover its
costs to prosecute an action against an insurer who admits that it has a duty
to defend the insured but refuses to do so, we vacate so much of the judgment
as dismissed the breach of contract claim.
Similarly concluding that an insurer's refusal to defend while admitting
that it has the duty to do so makes out G. L. cc. 93A and 176D
claims, we vacate so much of the judgment as dismissed the unfair business
practices claims. We further conclude
that JMA has demonstrated that an actual controversy exists with respect to the
issue whether Zurich may reserve the right to recoup defense costs as a matter
of law, such that we vacate so much of the judgment as dismissed the request
for declaratory relief on that issue. We
otherwise affirm the judgment.
1.
Background. We summarize the
pertinent facts as set forth in the complaint, the exhibits attached thereto,
and the document (which is not contested) incorporated by reference that was
provided to the motion judge.[1] See
Boston Med. Ctr. Corp. v. Secretary of the Executive Office of Health &
Human Servs., 463 Mass. 447, 450 (2012).
a.
The subcontract and insurance policy.
JMA served as the general contractor on a project to construct a new
residence hall on the Emmanuel College campus in the city of Boston
(project). JMA subcontracted with PJ
Spillane Company, Inc. (PJ Spillane), to perform waterproofing work on the
project. The subcontract included a
provision that, "[t]o the fullest extent permitted by law," PJ
Spillane would indemnify and hold harmless JMA
"from and
against all claims, damages, losses and expenses, including but not limited to
attorneys fees, caused by, arising out of, in connection with, or resulting
from the performance of [PJ Spillane's] Work under this Subcontract, where any
such claim, damage, loss, or expense is attributable to bodily injury,
. . . and is caused by or arises in whole or in part, from any
negligent or non-negligent act or omission of [PJ Spillane or its employees]
. . . ."
The subcontract
acknowledged that the indemnity provision must be construed in compliance with
G. L. c. 149, § 29C. That
statute, in turn, states that "[a]ny provision for or in connection with a
contract for construction . . . which requires a subcontractor to
indemnify any party for any injury to persons or damage to property not caused
by the subcontractor or its employees, agents or subcontractors, shall be
void." G. L. c. 149,
§ 29C. See RCS Group, Inc. v.
Lamonica Constr. Co., 75 Mass. App. Ct. 613, 616 (2009).
The subcontract also required that PJ
Spillane maintain a commercial general liability insurance policy and include
JMA as an additional insured on that policy.
At the relevant time, PJ Spillane was covered under a commercial general
liability insurance policy issued by Zurich.
That policy provided,
"We will pay
those sums that the insured becomes legally obligated to pay as damages because
of 'bodily injury' or 'property damage' to which this insurance applies. We will have the right and duty to defend the
insured against any 'suit' seeking those damages. However, we will have no duty to defend the
insured against any 'suit' seeking damages for 'bodily injury' or 'property
damage' to which this insurance does not apply.
We may, at our discretion, investigate any 'occurrence' and settle any
claim or 'suit' that may result."
JMA was listed on an additional insured
endorsement to the policy. The
endorsement specified that JMA was insured "only with respect to liability
arising out of [PJ Spillane's] ongoing operations performed for [JMA]." The endorsement also explained that, if the
insured and additional insured had entered into a construction contract,
"the insurance afforded to [JMA] only applies to the extent permitted by
law."
b.
The underlying action. On August
8, 2018, a foreman employed by PJ Spillane was walking to the roof of a
building on the job site when he stepped over the counterweights of the
scaffolding and into a hole that was supposed to be covered by a metal
grate. The foreman fell three feet and
injured his knee. As a result of the
accident, on May 15, 2020, the foreman brought a negligence action against JMA
and Triple G Scaffold Services Corp. (Triple G), the subcontractor
hired by JMA to perform scaffolding work at the job site (underlying
action). The foreman alleged that JMA
committed a breach of its duty to provide a safe job site by "leaving an
unguarded hole that acted as a trap door."
The foreman further alleged that "someone from Triple G had
removed that metal grate leaving the hole exposed and unguarded."
On June 2, 2020, JMA demanded that PJ
Spillane agree to indemnify JMA in connection with the foreman's claim, pay for
JMA's defense, and satisfy any judgment entered against JMA in the underlying
action. JMA also demanded that PJ
Spillane satisfy its insurance obligations under the subcontract, including
taking all actions necessary to ensure that its insurance carrier defended and
indemnified JMA.
On July 24, 2020, Zurich accepted JMA's
tender, agreed to defend and indemnify JMA without a reservation of rights, and
assigned counsel to assume JMA's defense.
Five days later, JMA requested that Zurich reimburse JMA for all defense
costs incurred prior to Zurich's acceptance of coverage. To that end, JMA forwarded copies of the
legal bills from its retained counsel to Zurich, but Zurich did not reimburse
or pay JMA for any of its costs in the underlying action at that time.
On August 11, 2020, Triple G demanded
that JMA defend and indemnify Triple G for any losses incurred in the
underlying action under the terms of their agreement, and JMA, in turn,
requested that Zurich defend and indemnify JMA against Triple G's claim as
part of Zurich's acceptance of coverage.
Zurich responded by rescinding its acceptance of coverage, denying JMA's
tender for defense and indemnity in connection with Triple G's claim, and
tendering a defense in connection with the foreman's claim against JMA in the
underlying action only with a full reservation of "any and all
rights."
Thereafter, on October 15, 2020,
Triple G rescinded its demand to JMA for a contractual defense and
indemnity. After JMA notified Zurich of
Triple G's rescission, Zurich refused JMA's request that Zurich withdraw
its reservation of rights with respect to JMA's tender. Instead, by letter dated December 3, 2020,
Zurich renewed its reservation of rights, including expressly reserving
"the right to recoup any amounts paid as defense expenses that can be
attributable to liability that is not potentially covered, if allowed by
law." Zurich explained, "At
this time, it is questionable whether the claims being asserted are covered
under the terms of the policy. We are
agreeing to defend JMA (only) in this suit because there is a potential for
coverage." With respect to
coverage, Zurich stated PJ Spillane "may be found to possess no liability"
(and, therefore, in Zurich's view, the claim would not be covered) if it is
proven that a Triple G employee removed the metal grate, leaving the hole
in which the foreman fell open and unguarded.
JMA responded by letter on December 18,
2020, explaining that counsel retained by JMA would continue to defend it in
the underlying action and JMA would continue to submit its bills for defense
costs to Zurich for payment. JMA further
asserted its position that "Zurich has breached its contractual obligations
under the Zurich Policy by refusing to accept JMA's tender for defense and
indemnity without reservation." JMA
received no response to the December 18 letter.
c.
The present action. On February
24, 2021, nearly seven months after JMA first requested reimbursement for
defense costs, JMA initiated this action against Zurich for breach of contract,
declaratory relief concerning Zurich's obligations under the terms of the
policy and subcontract, and violations of G. L. cc. 93A and 176D. In the complaint, JMA alleged that Zurich had
paid nothing for its defense in the underlying action as of the date of the
filing, and that JMA was entitled to a defense and indemnification without a
reservation of rights.
On May 11, 2021, Zurich moved to dismiss
the complaint pursuant to Mass. R. Civ. P. 12 (b) (6), and JMA
cross-moved for judgment on the pleadings pursuant to Mass. R. Civ.
P. 12 (c), 365 Mass. 754 (1974).
On October 18, 2021, Zurich finally paid JMA's defense counsel's July
2020 invoice, "exclud[ing] any fees related to the coverage litigation
and/or the coverage dispute between JMA and Zurich." The hearing on the motions was held November
8, 2021. The next day, Zurich paid JMA's
defense counsel's invoices from August 2020 through July 2021, again "exclud[ing]
any fees related to the coverage litigation and/or dispute between JMA and
Zurich."
After the parties' submission of
supplemental pleadings, including an affidavit detailing the October and
November 2021 payments, a judge of the Superior Court allowed the motion to
dismiss in its entirety. Relying on
those payments and Zurich's acknowledgment that it had a duty to defend subject
to a reservation of rights, the judge reasoned that Zurich was not in breach of
the policy and no actual controversy existed regarding the duty to defend. The judge further acknowledged that it is an
open issue whether Massachusetts law permits an insurer to recoup defense
costs, but she concluded that question need not be resolved here because
Zurich's reservation of rights was limited to what the law allows and Zurich
had made no attempt to recoup costs at that time. The judge also concluded that any request
concerning Zurich's duty to indemnify was premature because no determination
has been made in the underlying action concerning JMA's liability. For the same reasons, the judge explained
that the claim for violation of G. L. cc. 93A and 176D must be
dismissed. This appeal followed.
2.
Standard of review. We review the
allowance of a motion to dismiss de novo, "accept[ing] as true the
allegations in the complaint and draw[ing] every reasonable inference in favor
of the plaintiff." Dartmouth v.
Greater New Bedford Regional Vocational Tech. High Sch. Dist., 461 Mass. 366,
374 (2012). In evaluating the dismissal
of a claim for declaratory relief, we first determine whether the claim is
"properly brought," meaning that an actual controversy exists, the
plaintiff has standing to sue, and all necessary parties have been joined. Buffalo-Water 1, LLC v. Fidelity Real Estate
Co., LLC, 481 Mass. 13, 18 (2018).[2] If
a claim is "properly brought," we then determine whether the facts
alleged in the complaint state a claim for declaratory relief. Id.
3.
Breach of contract. a. Breach.
It is well settled that the duty to defend is broader than the duty to
indemnify. See Boston Symphony Orch.,
Inc. v. Commercial Union Ins. Co., 406 Mass. 7, 10 (1989). An insurer's duty to defend is triggered when
the allegations in a third party's complaint against an insured are "reasonably
susceptible of an interpretation that states or roughly sketches a claim
covered by the policy terms."
Preferred Mut. Ins. Co. v. Vermont Mut. Ins. Co., 87 Mass. App. Ct. 510,
513 (2015), quoting Billings v. Commerce Ins. Co., 458 Mass. 194, 200 (2010). "The underlying complaint 'need only
show, through general allegations, a possibility that the liability claim falls
within the insurance coverage. There is
no requirement that the facts alleged in the complaint specifically and
unequivocally make out a claim within the coverage.'" Holyoke Mut. Ins. Co. in Salem v. Vibram USA,
Inc., 480 Mass. 480, 484 (2018), quoting Billings, supra at 200-201.
In the scenario, as here, where the
"insurer seeks to defend its insured under a reservation of rights, and
the insured is unwilling that the insurer do so, the insured may require the
insurer either to relinquish its reservation of rights or relinquish its
defense of the insured and reimburse the insured for its defense costs." Herbert A. Sullivan, Inc. v. Utica Mut. Ins.
Co., 439 Mass. 387, 406–407 (2003) (Sullivan).
A breach of the duty to defend constitutes a breach of the insurance
contract. See Metropolitan Prop. &
Cas. Ins. Co. v. Morrison, 460 Mass. 352, 359 (2011) (Morrison).
The parties do not dispute that the
negligence claim against JMA as alleged in the foreman's complaint is
potentially covered by the policy and, thus, that Zurich has a duty to defend
JMA at this time. Where Zurich insisted
on proceeding subject to a reservation of rights, JMA was entitled to maintain
control of its defense and to seek payment of its legal bills from Zurich. At that point, Zurich was required to
reimburse JMA for reasonable attorney's fees incurred by JMA's chosen counsel. See, e.g., Sullivan, 439 Mass. at 406–407;
Rass Corp. v. Travelers Cos., 90 Mass. App. Ct. 643, 657 n.16 (2016).[3] JMA alleged that Zurich failed to do so, thus
prompting JMA's initiation of this action.
These allegations adequately set out a breach of contract claim premised
on Zurich's nonpayment of JMA's defense costs.
See Sarnafil, Inc. v. Peerless Ins. Co., 418 Mass. 295, 305 (1994)
("An insurer which reserves its rights and takes no action in defense of
its insured, when it knew, or should have known, of a covered claim,
. . . despite repeated claims of coverage and requests for a defense
from an insured facing demands for immediate action, could be found to have
committed a breach of the duty to its insured").
b.
Damages. Even if the claim was
adequately pleaded, Zurich contends that dismissal nonetheless was appropriate
where Zurich has now reimbursed JMA for its defense costs in the underlying
action and, Zurich argues, JMA is not entitled to recover costs for the
prosecution of this action as a matter of law.
Putting aside the fact that payments after the filing of the complaint
are not a proper basis for a dismissal for failure to state a claim,[4]
Zurich's latter argument is premised on its theory that it is responsible only
for the defense costs in the underlying action and not for JMA's litigation
costs in compelling Zurich to pay those defense costs. JMA, by contrast, argues that it is entitled
to recover its costs to enforce its right to a defense where the insurer fails
to pay for the defense until forced to do so by litigation.
Recognizing an insured's right to recover
costs associated with the prosecution of a coverage action in these
circumstances is a natural extension of the Supreme Judicial Court's decision
in Preferred Mut. Ins. Co. v. Gamache, 426 Mass. 93 (1997) (Gamache), and its
progeny. In Gamache, the Supreme
Judicial Court recognized an exception to the so-called "American
rule," which otherwise prohibits successful litigants from recovering
attorney's fees and expenses. Id. at
95. The court explained that "an
insured . . . is entitled to the reasonable attorney's fees and
expenses incurred in successfully establishing the insurer's duty to defend
under the policy." Id. at 98. The court later recognized that the rule in
Gamache extends to coverage actions regarding the duty to defend
notwithstanding the type of comprehensive liability policy at issue, see
Rubenstein v. Royal Ins. Co. of Am., 429 Mass. 355, 357 (1999); whether the
insurer's refusal to defend was in good or bad faith, see id. at 359-360; and
whether insurer or insured initiates the coverage action, see id. at 358.[5]
Gamache addressed a slightly different
scenario than here, because there the parties disputed the existence of the
insurer's duty to defend against a claim by a third party. See Gamache, 426 Mass. at 95-96. Nonetheless, the reasoning in the Gamache
line of cases applies with greater force to the facts alleged here -- namely,
where the insurer concedes the existence of a duty to defend but the insured is
forced to bring an action to compel the insurer to actually satisfy its
duty. The breach of the duty to defend
is worse where the insurer acknowledges that it has the duty to defend but then
refuses to comply with that duty than where the insurer merely has a good faith
disagreement about its duty to defend.
In so holding, we recognize the broad nature of the insurer's duty to
defend and the heavy burden on the insured in the event of breach. See Gamache, supra at 96. In light of that dynamic, "the insurer
should not enjoy the usual freedom to litigate without concern about the
possibility of having to pay the [insured's] attorneys' fees." Id., quoting Gibson v. Farm Family Mut. Ins.
Co., 673 A.2d 1350, 1354 (Me. 1996). See
Wilkinson v. Citation Ins. Co., 447 Mass. 663, 671 (2006) ("By the time
the insurer's duty to defend has been established through litigation, the
insured may already have been denied much of the benefit and protection of that
defense, depriving the insured of the benefit of the bargain and requiring an alternative
compensatory measure like attorney's fees"). Indeed, where an insurer wrongfully refuses
to defend,[6] the insured is deprived of the benefit of the contractual bargain
for which it paid, namely, to shift the responsibility to defend a potentially
covered claim to the insurer. See
Rubenstein, 429 Mass. at 358. Even if
the insured is ultimately compensated for its defense in the underlying action,
"it would remain permanently uncompensated for the costs associated with
the . . . action it was forced to initiate because of the insurer's
violation of its duty to defend."
Id. at 358–359. The same risk is
presented here.
For the reasons described above, JMA
adequately pleaded a breach of contract claim against Zurich. If JMA succeeds in proving that Zurich
violated the duty to defend by failing to fund JMA's defense, JMA may recover
attorney's fees and expenses associated with prosecution of this action to
compel Zurich's compliance with its duty.
4.
Violation of G. L. cc. 93A and 176D. JMA also has adequately stated a claim of a
violation of G. L. cc. 93A and 176D based on Zurich's nonpayment of
JMA's defense costs. General Laws
c. 93A, § 2 (a), renders "unfair or deceptive acts or
practices in the conduct of any trade or commerce . . . unlawful." In the insurance context, G. L.
c. 176D, § 3 (9) (g), defines an unfair claim settlement
practice to include "[c]ompelling insureds to institute litigation to
recover amounts due under an insurance policy by offering substantially less
than the amounts ultimately recovered in actions brought by such
insureds." Where, as here, the
injured party is engaged in the conduct of trade or commerce, "a violation
of c. 176D, § 3 (9), provides evidence of an unfair or deceptive
practice in violation of c. 93A, but is not conclusive." Rass Corp., 90 Mass. App. Ct. at 656. See G. L. c. 93A, § 11.
We have previously acknowledged that a
claim against an insurer may lie under G. L. c. 93A, § 11, where
the insurer "unnecessarily and unreasonably delay[s] payment [of the
insured's attorney's fees expended in defense of underlying action] for
fourteen months," despite acknowledging that it had a duty to reimburse
reasonable expenses. Northern Sec. Ins.
Co. v. R.H. Realty Trust, 78 Mass. App. Ct. 691, 696 (2011). See Rass Corp., 90
Mass. App. Ct. at 657 ("by surrendering control of the defense to the
insured under a reservation of rights, yet at the same time refusing to pay
[insured's counsel's] hourly rate, which was reasonable, [insurer] unfairly
compelled [insured] to seek the unpaid fees through litigation"). At the motion to dismiss stage, the
allegations that Zurich, without adequate excuse, had not paid defense costs
for seven months after receiving invoices from JMA is sufficient to support a
claim for a violation of G. L. cc. 93 and 176D.
5.
Declaratory judgment. a. Duty to defend. i.
Actual controversy. JMA argues
that the motion judge erred in dismissing its request for declaratory relief
concerning Zurich's duty to defend on the basis that no actual controversy has
arisen. Specifically, JMA maintains that
Zurich's baseless reservation of the right to recoup defense costs renders
Zurich's agreement to defend nothing more than a sham.[7]
The purpose of G. L. c. 231A
"is to remove, and to afford relief from, uncertainty and insecurity with
respect to rights, duties, status and other legal relations, and it is to be
liberally construed and administered."
G. L. c. 231A, § 9.
Declaratory relief proceedings "are concerned with the resolution
of real, not hypothetical, controversies; the declaration issued is intended to
have an immediate impact on the rights of the parties." Massachusetts Ass'n of Indep. Ins. Agents
& Brokers, Inc. v. Commissioner of Ins., 373 Mass. 290, 292 (1977).
"An actual
controversy exists where there is: 'a
real dispute caused by the assertion by one party of a legal relation, status
or right in which he has a definite interest, and the denial of such assertion
by another party also having a definite interest in the subject matter, where
the circumstances attending the dispute plainly indicate that unless the matter
is adjusted such antagonistic claims will almost immediately and inevitably
lead to litigation.'"
Gay & Lesbian
Advocates & Defenders v. Attorney Gen., 436 Mass. 132, 134–135 (2002),
quoting Bunker Hill Distrib., Inc. v. District Attorney for the Suffolk Dist.,
376 Mass. 142, 144 (1978).
As discussed further infra, the parties'
dispute implicates a question of law that is unsettled in Massachusetts -- if,
and in what circumstances, an insurer may seek to recoup defense costs provided
to an insured. Given the legal
uncertainty regarding the enforceability of Zurich's reservation of a right to
recoup, JMA has demonstrated a real dispute concerning the parties' rights in
which they have a definite interest.[8]
Zurich urges us that an actual controversy
may arise only if, at some point in the future, it determines that claim is not
covered and then seeks recoupment. We
disagree where Zurich has a present duty to defend in ongoing litigation. JMA seeks a declaration concerning the scope
of that duty and asserts that Zurich's reservation of the right to recoup
"has an immediate impact on JMA's defense strategy (and ability to defend
itself) in the [u]nderlying [a]ction."
This is so even if Zurich never actually seeks recoupment; as things
stand, JMA must weigh the vigorousness of its defense against the possibility
that it ultimately will have to reimburse Zurich for the entire cost of that
defense. See Boston v. Keene Corp., 406
Mass. 301, 304 (1989) ("party seeking declaratory judgment need not
demonstrate an actual impairment of rights"). See also G. L. c. 231A, § 1
(party may seek declaratory relief "either before or after a breach or
violation thereof has occurred in any case in which an actual controversy has
arisen"). An actual controversy has
arisen with respect to whether Zurich has a right to recoup defense costs. Cf. Improved Mach., Inc. v. Merchants Mut.
Ins. Co., 349 Mass. 461, 463 (1965) (actual controversy existed in dispute
between two insurers over duty to defend insured in third party action where
liability of insured not yet determined); S. Plitt, D. Maldonado, J.D. Rogers,
& J.R. Plitt, 16A Couch on Insurance 3d § 227:29 (rev. ed. 2021) ("whether
an insurer has a duty to defend a suit against its insured is generally
considered a controversy ripe for declaratory relief, even when the issue of
the insurer's actual liability in the underlying suit may not be considered
until after a resolution of that suit").[9]
ii.
Recoupment. Given our conclusion
that JMA is entitled to declaratory relief concerning Zurich's purported right
to recoup, we provide some further guidance for the parties on remand. As noted above, whether an insurer may seek
to recoup costs of a defense undertaken pursuant to a unilateral reservation of
rights is an open issue under Massachusetts law. See Holyoke Mut. Ins. Co. in Salem, 480 Mass.
at 481 n.4; Metropolitan Life Ins. Co. v. Cotter, 464 Mass. 623, 642 n.21
(2013) (Cotter). Other jurisdictions are
closely split on the issue. See Cotter,
supra.
Several jurisdictions espouse the view
that recoupment is not permissible, at least in the absence of an express
provision in the policy or a subsequent agreement between the parties.[10] Indeed, our own Supreme Judicial Court
acknowledged in dicta the line of cases that decline to allow recoupment
"[b]ased on the theory that insurers are in the business of analyzing and
allocating risk, and thus in a better position to do so." Cotter, 464 Mass. at 642 n.21. This view, while dubbed the
"minority" approach, has gained traction in recent years and was
adopted as the default rule by the authors of the Restatement of the Law of
Liability Insurance in 2019. Restatement
of the Law of Liability Insurance § 21 comment a (2019).[11] See American Family Ins. Co. v. Almassud, 522
F. Supp. 3d 1263, 1269 (N.D. Ga. 2021) (applying Georgia law;
adopting no-recoupment default rule); Hayes v. Wisconsin & S. R.R., LLC,
514 F. Supp. 3d 1055, 1062-1064 (E.D. Wis. 2021) (applying Wisconsin
law; same). But see Nautilus Ins. Co. v.
Access Med., LLC, 137 Nev. 96, 102-103 (2021) (reimbursement under express
reservation of rights permitted if determined insurer had no contractual duty
to defend).
In jurisdictions that recognize a right to
recoupment, the issue most often arises in legal actions where none of the
claims are even potentially covered by the policy or in so-called
"mixed" actions, where some of the claims are potentially covered and
some are not.[12] See Restatement of the
Law of Liability Insurance § 21 comments a, e. In support of this view, one court reasoned
that the insurer's right to recover defense costs for claims not even
potentially covered (and, thus, for which there was no duty to defend) "is
implied in law as quasi-contractual, whether or not [the insurer] has one that
is implied in fact in the policy as contractual." Buss v. Superior Court, 16 Cal. 4th 35,
51 (1997).
Where a right to recoup is recognized, the
Restatement of the Law of Liability Insurance distinguishes circumstances in
which the insurer is defending under a reservation of rights based on a factual
uncertainty related to a ground to contest coverage, as opposed to a legal
uncertainty regarding a duty to defend.
See Restatement of the Law of Liability Insurance § 21
comment a. Where there is factual
uncertainty that may place a claim outside the policy's coverage, "courts
generally agree the insurer has a contractual duty to defend until that duty is
terminated" through, for instance, a declaration of rights, or settlement,
dismissal, or adjudication of the underlying claims. Id.
Cf. Buss, 16 Cal. 4th at 49 ("As to the claims that are at
least potentially covered, the insurer may not seek reimbursement for defense
costs. Apparently, none of the
decisional law considering such claims in and of themselves suggests
otherwise"). That distinction makes
sense where, as in Massachusetts, "[t]he obligation of an insurer to
defend is not, and cannot be, determined by reference to the facts proven at
trial." Boston Symphony Orch.,
Inc., 406 Mass. at 10.
For claims where a legal uncertainty
exists whether the insurer has a duty to defend an action, some insurers
ultimately prevailing on that issue have sought recoupment. See Restatement of the Law of Liability
Insurance § 21 comment a.
Others have "sought recoupment for the portions of the defense
costs attributed to noncovered claims incurred in defending legal actions that
they did have a duty to defend" (emphasis added). Id.
Whether Massachusetts would recognize such a right to recoup in those
circumstances is questionable given the Supreme Judicial Court's observation
that "[a] declaratory judgment of no coverage, either by summary judgment
or after trial, does not retroactively relieve the primary insurer of the duty
to defend; it only relieves the insurer of the obligation to continue to defend
after the declaration." Morrison,
460 Mass. at 359, quoting 14 G. Couch, Insurance § 200:48, at 200-65 to
200-66 (3d ed. 2005).
At oral argument, Zurich maintained that
it could seek recoupment if (1) the underlying litigation revealed that
the foreman's claim was not ultimately covered, but cf. Morrison, 460 Mass. at
359; and (2) JMA forced Zurich to defend through some unfair behavior that
had a "flavor of extortion."
Berkley Nat'l Ins. Co. v. Granite Telecomm. LLC, F.
Supp. 3d , , U.S. Dist. Ct., No. 21-10626,
at n.3 (D. Mass. July 29, 2022). In the case relied on by Zurich to support
the proposition, a judge of the United States District Court for the District
of Massachusetts reasoned that it would be manifestly unjust to allow an
insured to retain defense costs when the insurer had no obligation to defend
because the underlying claims were not potentially covered, and the insurer was
effectively forced to defend when the insured threatened to sue. Id. at -
& n.3. Of course, even if Massachusetts
would recognize this basis for recoupment (a point which we do not reach at
this juncture), that does not necessarily mean that an insurer may reserve a
right to recoup on this ground without identifying some factual basis to
support that assertion.[13]
b.
Duty to indemnify. JMA also seeks
declarations concerning the scope of Zurich's duty to indemnify under the
policy and the subcontract should JMA be held liable in the underlying
action. We agree with the motion judge
that an order regarding indemnification is premature. "[A]n insurer's obligation to defend its
insured is measured by the allegations of the underlying complaint[, but] the
obligation to indemnify does not ineluctably follow from the duty to
defend." Newell-Blais Post No. 443,
Veterans of Foreign Wars of the U.S., Inc. v. Shelby Mut. Ins. Co., 396 Mass.
633, 638 (1986) (Newell-Blais). Here,
the indemnification issue may turn on facts proven in the underlying
action. For instance, JMA could be found
not liable after trial or PJ Spillane's duty to indemnify could be limited by
operation of G. L. c. 149, § 29C, if the injury was "not
caused by the subcontractor or its employees, agents or
subcontractors." As such,
"[t]he issue of indemnification must await the completion of
trial." Newell-Blais, supra
(modifying judgment to delete portion imposing obligation to indemnify if
judgment entered against insured in wrongful death action). Cf. Atain Specialty Ins. Co. v. Boston
Rickshaw LLC, 387 F. Supp. 3d 157, 160 (D. Mass. 2019) ("courts
frequently hold that an insurer's duty to indemnify does not become ripe for
adjudication until the underlying lawsuit for liability is
resolved"). The requests for
declaratory relief on the duty to indemnify under the policy and the
subcontract were properly dismissed as premature.
6.
Conclusion. So much of the
judgment as dismissed the claims for breach of contract, violation of
G. L. cc. 93A and 176D, and declaratory judgment on the duty to
defend is vacated, and the matter is remanded for further proceedings
consistent with this opinion. The
judgment is otherwise affirmed.
So ordered.
footnotes
[1] Specifically,
we consider the Zurich policy referenced in JMA's complaint and attached to
Zurich's motion to dismiss.
[2] "Where
the relief sought through a declaratory judgment claim involves administrative
action, we further require the plaintiff to show that all available
administrative remedies have been exhausted." Buffalo-Water 1, LLC, 481 Mass. at 18 n.8.
[3] Of course, if
Zurich believed -- or even suspected -- that it did not have a duty to defend,
it was free to initiate a declaratory judgment action to resolve the question.
"Where there
is uncertainty as to whether an insurer owes a duty to defend, the insurer has
the option of providing the insured with a defense under a reservation of
rights, filing a declaratory judgment action to resolve whether it owes a duty
to defend or to indemnify, moving to stay the underlying action until a
declaratory judgment enters, and withdrawing from the defense if it obtains a
declaration that it owes no duty to the insured."
Commerce Ins. Co.
v. Szafarowicz, 483 Mass. 247, 257 (2019), quoting Morrison, 460 Mass. at
358-359.
[4] On a motion
under Mass. R. Civ. P. 12 (b) (6), the judge was limited to the
facts alleged in JMA's complaint, that is, that Zurich paid nothing for JMA's
defense. See, e.g., Dartmouth, 461 Mass.
at 374. The motion judge's consideration
of Zurich's affidavit, while expressly declining to convert the motion to
dismiss to one for summary judgment, was error.
The information in the affidavit about Zurich's payments to JMA
postdates the filing of this action and, therefore, was not (and could not have
been) relied on by JMA in the framing of its complaint. Contrast Marram v. Kobrick Offshore Fund,
Ltd., 442 Mass. 43, 45 n.4 (2004) (court may consider documents attached to
motion to dismiss without converting to summary judgment "[w]here
. . . the plaintiff had notice of these documents and relied on them
in framing the complaint"). The
error, however, is of little consequence here where we conclude that, if JMA
prevails, remedies beyond reimbursement of defense costs in the underlying
action are available.
[5] The court
also held that the Gamache rule applies even if the insurer provisionally
provides a defense while litigating whether it has a duty to defend. See Hanover Ins. Co. v. Golden, 436 Mass.
584, 587-588 (2002).
[6] In a
situation where the insurer concedes it has a duty to defend, it ordinarily has
not refused to provide that defense until a reasonable time passes without its
paying invoices presented to it. We need
not explore what that reasonable time is here, where it appears uncontested --
at least for motion to dismiss purposes -- that there was no payment for
approximately fifteen months after the first invoice was submitted to Zurich.
[7] We construe
the complaint broadly to challenge Zurich's right to recoupment where JMA
specifically sought a declaration that "Zurich has the obligation
. . . to defend and indemnify JMA for the full amount of JMA's costs
and expenses, including attorneys' fees, for the defense of [the underlying
action] and the prosecution of this action."
[8] We are not
persuaded by Zurich's argument that no actual controversy exists because it
limited its right to recoup to "any amounts paid as defense expenses that
can be attributable to liability that is not potentially covered, if allowed by
law" (emphasis added). This
disclaimer merely highlights the uncertainty of the law on this point.
[9] The remaining
requirements of a "properly brought" claim for declaratory relief --
that is, JMA's legal standing to sue, and the joinder of all necessary parties
-- are easily met here, and the parties do not argue otherwise. Buffalo-Water 1, LLC, 481 Mass. at 18.
[10] For case law
declining to recognize a right to recoupment, see, e.g., Attorneys Liab.
Protection Soc'y, Inc. v. Ingaldson Fitzgerald, P.C., 370 P.3d 1101, 1112
(Alaska 2016), abrogated on other grounds by Buntin v. Schlumberger Tech.
Corp., 487 P.3d 595, 598 n.4 (Alaska 2021); Medical Liab. Mut. Ins. Co. v. Alan
Curtis Enters. Inc., 373 Ark. 525, 527-530 (2008); General Agents Ins. Co. of
Am., Inc. v. Midwest Sporting Goods Co., 215 Ill. 2d 146, 162-163, 166
(2005); American & Foreign Ins. Co. v. Jerry's Sport Ctr., Inc., 606 Pa.
584, 613-614 (2010); United States Fid. v. United States Sports Specialty, 270
P.3d 464, 471 (Utah 2012); National Sur. Corp. v. Immunex Corp., 176
Wash. 2d 872, 887-888 (2013); Shoshone First Bank v. Pacific Employers
Ins. Co., 2 P.3d 510, 513–514 (Wyo. 2000).
See also Westchester Fire Ins. Co. v. Wallerich, 563 F.3d 707, 719 (8th
Cir. 2009) (applying Minnesota law); Perdue Farms, Inc. v. Travelers Cas. &
Sur. Co. of Am., 448 F.3d 252, 258-259 (4th Cir. 2006) (applying Maryland law);
Liberty Mut. Ins. Co. v. FAG Bearings Corp., 153 F.3d 919, 924 (8th Cir. 1998)
(applying Missouri law). Cf. Texas Ass'n
of Counties County Gov't Risk Mgt. Pool v. Matagorda County, 52 S.W.3d 128,
131, 135-136 (Tex. 2000) (declining to permit reimbursement of settlement costs
under reservation of rights).
[11] The position
of the Restatement of the Law of Liability Insurance contrasts with that in the
Restatement (Third) of Restitution & Unjust Enrichment § 35
(2011). The latter suggests recoupment
may be appropriate in certain circumstances and provides specific examples of
when an insurer may recover for unjust enrichment. See Restatement (Third) of Restitution &
Unjust Enrichment § 35 comment c, at 578 ("If the insurer --
having given adequate notice that it is proceeding under reservation of rights
-- eventually prevails in the underlying coverage dispute, it may recover that
part of its outlay that exceeds its policy obligation by a claim in restitution
within the rule of this section").
The Restatement of the Law of Liability Insurance expressly rejects that
position. See Restatement of the Law of
Liability Insurance § 21 comment b.
[12] Compare Buss
v. Superior Court, 16 Cal. 4th 35, 52-53 (1997) (mixed action), with
Scottsdale Ins. Co. v. MV Transp., 36 Cal. 4th 643, 655, 662 (2005) (no
claim potentially covered). For other
cases recognizing a right to recoupment, see Jim Black & Assocs., Inc. v.
Transcontinental Ins. Co., 932 So. 2d 516, 518 (Fla. Dist. Ct. App. 2006);
Colony Ins. Co. v. G & E Tires & Serv., Inc., 777 So. 2d 1034,
1038–1039 (Fla. Dist. Ct. App. 2000); Travelers Cas. & Sur. Co. v. Ribi
Immunochem Research, Inc., 326 Mont. 174, 188-190 (2005); Nautilus Ins. Co.,
137 Nev. at 102-103; SL Indus., Inc. v. American Motorists Ins. Co., 128 N.J.
188, 215-216 (1992). See also Travelers
Prop. Cas. Co. of Am. v. Hillerich & Bradsby Co., 598 F.3d 257, 268 (6th
Cir. 2010) (applying Kentucky law); United Nat'l Ins. Co. v. SST Fitness Corp.,
309 F.3d 914, 921 (6th Cir. 2002) (applying Ohio law). Cf. Security Ins. Co. of Hartford v.
Lumbermens Mut. Cas. Co., 264 Conn. 688, 717-718 (2003) (recoupment for periods
of self-insurance). In mixed actions,
Massachusetts has adopted the "in for one, in for all" rule that
obligates an insurer to defend the insured on all counts, including those not
covered. Mount Vernon Fire Ins. Co. v.
Visionaid, Inc., 477 Mass. 343, 351 (2017).
[13] At oral
argument, Zurich could not identify any facts to support an inference that
JMA's conduct had the "flavor of extortion." We are mindful, however, that this matter was
resolved on a motion to dismiss and resolution of that issue implicates factual
questions.