Zappone v. Home Ins. Co

In Zappone v Home Ins. Co. (55 NY2d 131 [1982]) Mr. Zappone sent notice to the defendant Home Insurance Company that he had been in an automobile accident and was being sued by those injured in that accident. That notice sought coverage by the carrier in excess of the benefits being provided by the primary carrier. Home Insurance failed to disclaim coverage until some 15 months later, which unquestionably exceeded the mandates of subdivision 8 of section 167 of the Insurance Law. The Court of Appeals was then confronted with applying a statute whose clear effect would result in directing an insurance carrier to provide coverage and reimbursement for which the carrier did not contract. The Court declined to do so and stated that, "Literal interpretation of the words used will not be accorded when to do so will occasion great inconvenience, or produce inequality, injustice or absurdity. It is, moreover, always presumed that no unjust or unreasonable result was intended and the statute must be construed consonant with that presumption" (id. at 137). In Zappone v. Home Ins. Co. an insurer's failure to timely disclaim coverage pursuant to former Insurance Law 167 (which has been superseded by Insurance Law 3420 [d]), did not preclude insurer from later denying liability on the ground that the insurance agreement itself does not cover the particular automobile involved in the accident. The Court of Appeals contrasted the situation where a denial of liability by the insurer is based upon a policy exclusion and a breach of a policy condition, which would require the insurer to make a timely notice of disclaimer, as distinguished from a situation where an insurer claims no contractual relationship with respect to the subject vehicle and incident (Zappone, at 136-137). The Court concluded that the Legislature did not intend to require notice under Insurance Law 3420 (d) when there never was any insurance in effect and intended to cover only situations in which a policy of insurance would otherwise cover the particular accident but is claimed not to cover it because of an exclusion in the policy (Zappone, at 138). Zappone v. Home Ins. Co. (55 NY2d 131) provides some guidance in distinguishing a denial of liability based upon a policy exclusion, in which case there is no coverage, from an exclusion resulting from the breach of a policy condition. The Zappone case dealt with denials of automobile liability insurance coverage. The Court broke the denials into three categories. It held that an insurer may deny liability because the insured has failed to cooperate, or failed to give notice of an accident or of the commencement of an action against the insured. In such cases the policy covers the driver, the vehicle and the accident, and so the carrier will be liable unless it disclaims liability because of the insured's breach. In situations such as where the person injured was an employee of the insured whose injury arose out of and in the course of his employment or was injured while an automobile insured as a pleasure vehicle was being used as a public conveyance, the insurer must deny coverage on the basis of the specific policy exclusion (the Court added "if it is not to mislead the insured and the injured person to their detriment" supra, at 136). On the other hand, where there was no contract of insurance, or if the policy had been terminated prior to the occurrence, the insurer would not be required to deny coverage, there being no contractual relationship with respect to the vehicle. In Zappone, the policy's coverage clause at the outset conditioned recovery on liability 'arising out of the ownership, maintenance or use of a covered or a non-owned automobile' . Because the automobile involved in the accident was owned by a family member and was not within the coverage clause, we concluded that there was never a contractual relationship between the carrier and the claimant giving rise to any duty, including the statutory duty to timely disclaim. We explicitly distinguished the situation where a claim would be covered but for a specific policy exclusion, explaining that 'the carrier must deny coverage on the basis of the exclusion if it is not to mislead the insured and the injured person to their detriment' (Zappone v. Home Ins. Co., supra, 55 NY2d, at 136).