Leland DeMent, Plaintiff v. Nationwide Mutual Insurance Company,
Defendant
1. Insurance--automobile--supplementary payments clause--emergency first aid--
application to third party
The trial court should have entered a judgment on the pleadings for defendant in a
declaratory judgment action to define plaintiff's rights under an insurance policy where plaintiff
was in an accident with a driver insured by defendant, plaintiff received on-site first aid from
emergency medical technicians and further emergency medical care at a hospital, and plaintiff
sought to recover under a supplementary payments clause in the driver's liability policy that
referred to expenses for emergency first aid. Plaintiff is without standing as a third-party
beneficiary and the supplementary payment clause is not triggered unless the insured becomes
responsible for expenses for emergency first aid to others. Since nothing on the face of the
pleadings shows that the insured incurred any expenses for plaintiff's first aid treatment,
judgment on the pleadings was appropriate.
2. Pleadings--Rule 11 sanctions--case of first impression
The trial court did not err by denying a motion for Rule 11 sanctions in a declaratory
judgment action to interpret an insurance policy where there was no evidence to support a
conclusion that sanctions were appropriate under the legal insufficiency or improper purpose
standard and the issue raised in the compliant was one of first impression.
3. Appeal and Error--assignments of error--statute not mentioned
Defendant did not preserve for appellate review the issue of whether the trial court should
have awarded sanctions under N.C.G.S. § 6-21 where defendant made no reference to that statute
in any assignment of error.
DONALDSON & BLACK, P.A., by Rachel Scott Decker, for
plaintiff-appellee.
TEAGUE, ROTENSTREICH & STANALAND, L.L.P., by Kenneth B.
Rotenstreich and Paul A. Daniels, for defendant-appellant.
TIMMONS-GOODSON, Judge.
Leland DeMent (plaintiff) brought this action for a
declaratory judgment defining his rights under the SupplementaryPayments clause of an insurance policy issued by Nationwide Mut
ual
Insurance Company (defendant) to Paula Keene, the driver of an
automobile involved in an accident with plaintiff's vehicle.
Defendant moved to dismiss the action and for judgment on the
pleadings alleging, inter alia: (1) failure to state a claim upon
which relief may be granted; (2) lack of a justiciable issue or
genuine controversy; (3) failure to join the real party in
interest; (4) lack of standing and/or privity of contract; and (5)
absence of ripeness. Following a hearing, the trial court denied
the motions, and defendant appeals.
The averments in plaintiff's complaint show that on 23 April
1998, while operating her vehicle along Rural Paved Road 2370 in
Rowan County, North Carolina, Paula Keene failed to heed a stop
sign and collided with plaintiff's vehicle. As a result of the
collision, plaintiff sustained severe bodily injuries. Emergency
medical technicians responding to the accident administered on-site
first aid to plaintiff. Plaintiff was then airlifted to North
Carolina Baptist Hospital, where he received further urgent medical
treatment. Plaintiff incurred significant medical expenses as a
consequence of his emergency medical care.
Keene had a motor vehicle liability insurance policy with
defendant, which policy was in full force and effect at the time of
the accident. Under the Supplementary Payments clause of the
Liability Coverage section of the policy, defendant agreed that
[i]n addition to [its] limit of liability, . . . [it would] pay on
behalf of an insured: . . . Expenses for emergency first aid to
others at an accident involving any auto covered by this policy. Pursuant to this provision, plaintiff requested that defenda
nt pay
his emergency medical expenses. Defendant refused, and plaintiff
filed the present action seeking a judicial declaration of his
rights under the policy provision.
Any person interested under a deed, will,
written contract or other writings
constituting a contract, or whose rights,
status or other legal relations are affected
by a . . . contract or franchise, may have
determined any question of construction or
validity arising under the instrument, . . .
contract, or franchise, and obtain a
declaration of rights, status, or other legal
relations thereunder.
N.C. Gen. Stat. § 1-254 (1999). Thus, standing to seek a
declaration as to the extent of coverage under an insurance policy
requires that the party seeking relief have an enforceable
contractual right under the insurance agreement. Terrell v.
Lawyers Mut. Liab. Ins. Co., 131 N.C. App. 655, 507 S.E.2d 923
(1998). Whether such a right exists depends on the intent of thecontracting parties. Raritan River Steel Co. v. Cherry, Bekaert &
Holland, 329 N.C. 646, 407 S.E.2d 178 (1991).
Our courts have established several rules pertaining to the
construction of insurance policies, the most rudimentary being that
the language of the policy controls its interpretation. Nationwide
Mutual Ins. Co. v. Mabe, 115 N.C. App. 193, 198, 444 S.E.2d 664,
667 (1994), affirmed, 342 N.C. 482, 467 S.E.2d 34 (1996). The
various terms of an insurance policy are to be harmoniously
construed, and if possible, every word and every provision is to be
given effect. Cone Mills Corp. v. Allstate Ins. Co., 114 N.C.
App. 684, 690, 443 S.E.2d 357, 361 (1994), disc. review
improvidently allowed, 340 N.C. 353, 457 S.E.2d 300 (1995).
Furthermore,
Where the language of a contract is plain and
unambiguous, construction of the agreement is
a matter of law; and the court may not ignore
or delete any of its provisions, nor insert
words into it, but must construe the contract
as written, in light of the undisputed
evidence as to the custom, usage and meaning
of its terms.
Id. (quoting First Citizens Bank & Trust Co. v. McLamb, 112 N.C.
App. 645, 649-50, 439 S.E.2d 166, 169 (1993)). Since the objective
of construing an insurance policy is to ascertain the intent of the
parties, the courts should resist piecemeal constructions and
should, instead, examine each provision in the context of the
policy as a whole. Blake v. Insurance Co., 38 N.C. App. 555, 557,
248 S.E.2d 388, 390 (1978).
The motor vehicle liability policy issued to Keene bydefendant contains the following relevant provisions:
Part B _ Liability Coverage
Insuring Agreement
We will pay damages for bodily injury or
property damage for which any insured becomes
legally responsible because of an auto
accident. Damages include prejudgment
interest awarded against the insured. We will
settle or defend, as we consider appropriate,
any claim or suit asking for these damages.
In addition to our limit of liability, we will
pay all defense costs we incur. Our duty to
settle or defend ends when our limit of
liability for this coverage has
been exhausted. We have no duty to defend any
suit or settle any claim for bodily injury or
property damage not covered under this
policy.
. . . .
Supplementary Payments
In addition to our limit of liability, we will
pay on behalf of an insured:
. . . .
5. Expenses for emergency first aid to others
at an accident involving any auto covered by
this policy.
Plaintiff takes the position that pursuant to the emergency
first aid provision, he may proceed directly against defendant for
payment of the emergency medical expenses he incurred as a result
of the collision involving defendant's insured. Plaintiff contends
that as an emergency first aid recipient, he falls squarely within
the class of persons whom the provision was intended to benefit.
Therefore, plaintiff claims to have an enforceable contractual
right as a third-party beneficiary of the Keene policy, which right
confers standing in him to seek declaratory relief. No North
Carolina decision addressing this specific issue has come to ourattention. However, in other jurisdictions, courts have
interpreted similar first aid provisions as inuring to the benefit
of the insured, and thus, bestowing no rights on third parties.
In Dalrymple v. Lumbermens Mut. Cas. Ins. Co., 380 N.Y.S.2d
900 (1976), the plaintiff sustained personal injuries in a
collision involving an automobile insured by the defendant.
Plaintiff required immediate medical treatment following the
accident and incurred medical expenses related thereto. The policy
issued to the defendant's insured contained a supplementary
payments provision, under which the defendant agreed to pay
expenses incurred by the insured for such immediate medical and
surgical relief to others as shall be imperative at the time of the
accident. Id. at 902. Based on this provision, the plaintiff
filed an action against the defendant to recover payment of her
medical expenses. The plaintiff argued that she [was] a member of
that class of 'others' referred to in the policy provision, and
thus, was a third party beneficiary of the insurance agreement.
Id. The Supreme Court of New York, however, rejected the
plaintiff's argument, reasoning as follows:
The clause, above referred to, which the
plaintiff relies on, must be read in
conjunction with all of the other paragraphs
contained in that portion of the insurance
policy entitled Defense, Settlement,
Supplementary Payments[.] Supplementary
payments as used in an automobile liability
policy are those payments which are to be made
by an insurance company to reimburse an
insured named in the policy for certain out-
of-pocket expenses incurred by the insured.
This is the purpose of a supplementary
payments provision in an insurance policy.
Had the defendant's insured, for example,after the accident, paid the expenses of the
plaintiff herein for emergency treatment or
for immediate medical and surgical relief,
then, and in that event, the defendant's
insured would have a right to seek
reimbursement from the defendant under the
supplementary payments provision.
Id. at 903. The court further concluded that the parties did not
intend the first aid provision to create any actionable right in a
third party, but intended that the provision operate exclusively to
the benefit of the insured. Id. Accordingly, the court held that
the plaintiff lacked standing to proceed directly against the
insurance company under the terms of the policy. Id.
In Vega v. State Farm Auto. Ins. Co., 401 So.2d 368 (La. Ct.
App. 1981), the plaintiff filed an action against the defendant and
his insurance company for personal injuries arising out of a head-
on collision. The plaintiff argued that he was entitled to recover
the amounts he expended for his wife's medical care under the
supplementary payments provision of the defendant's liability
insurance policy. The provision stated that the insurer would
pay, in addition to the applicable limits of liability: . . . (c)
Expenses incurred by the insured for such immediate medical and
surgical relief to others as shall be imperative at the time of an
accident involving an automobile insured hereunder and not due to
war. Id. at 374. The plaintiff took the position that the first
aid clause was a stipulation pour autri or a stipulation in favor
of a third person. Id. The Louisiana Court of Appeals disagreed,
stating that th[e] clause, otherwise known as the 'good samaritan'
clause, [was] designed to reimburse an insured for expensesincurred on behalf of another party who does not qualify as an
insured under the policy contract. Id. Hence, the court
concluded that the plaintiff had no right of recovery under the
supplementary payments provision. Id.
In the case currently before us, the supplementary payments
clause contained in the Keene policy set forth defendant's
agreement to pay on behalf of an insured . . . [e]xpenses for
emergency first aid to others. (Emphasis added.) Although this
language varies slightly from that used in the Dalrymple and Vega
policies, we are of the opinion that those decisions lend some
guidance as to the purpose and effect of the provision at issue
here.
First, we note that in North Carolina, a person may bring an
action to enforce a contract to which he is not a party, if he
demonstrates that the contracting parties intended primarily and
directly to benefit him or the class of persons to which he
belongs. Chemical Realty Corp. v. Home Fed'l Savings & Loan, 84
N.C. App. 27, 33, 351 S.E.2d 786, 790 (1987). The intent of the
parties is ascertained by construction of the 'terms of the
contract as a whole, construed in the light of the circumstances
under which it was made and the apparent purpose that the parties
are trying to accomplish.' Id. at 34, 351 S.E.2d at 790 (quoting
Lane v. Surety Co., 48 N.C. App. 634, 639, 269 S.E.2d 711,714-15
(1980), disc. review denied, 302 N.C. 219, 276 S.E.2d 916 (1981)).
Furthermore, '[w]hen a third person seeks enforcement of a
contract made between other parties, the contract must be construedstrictly against the party seeking enforcement.' Id. at 34
, 351
S.E.2d at 791 (quoting Lane, 48 N.C. App. at 638, 276 S.E.2d at
714).
Critical to our understanding of whether it was the parties'
intent to confer a direct benefit on first aid recipients is the
declaration that payment of such expenses would be made on behalf
of an insured. Giving ordinary meaning to the phrase, we regard
action taken on behalf of a person as that done in the interest
of, [f]or the benefit of, or [a]s the agent of that person.
See The American Heritage Dictionary 77 (3rd ed. 1994). Therefore,
we conclude that defendant's obligation of an insurer to pay first
aid medical expenses on behalf of any insured flows primarily and
directly to the insured. Because the benefit running to plaintiff
by reason of the provision is merely incidental, he is without
standing as a third party beneficiary to seek enforcement of the
covenant or a declaratory judgment as to its terms. See Terrell,
131 N.C. App. at 660, 507 S.E.2d at 926.
We believe that like the good samaritan clauses interpreted
by the courts in Dalrymple and Vega, the supplementary payment
clause is not triggered unless and until the insured becomes
responsible, whether legally or gratuitously, for [e]xpenses for
emergency first aid to others. Only then can payment of the
expenses be made on behalf of the insured. Since nothing on the
face of the pleadings shows that Keene incurred any expenses for
plaintiff's first aid treatment, judgment on the pleadings in favor
of defendant was appropriate. Accordingly, we reverse the denialof defendant's motion and remand this matter to the trial court for
entry of judgment on the pleadings.
[2]Defendant next argues that the court erroneously denied
its motion for sanctions under Rule 11 of the North Carolina Rules
of Civil Procedure, on the ground that plaintiff's complaint was
legally insufficient and was brought for an improper purpose. We
disagree.
In pertinent part, Rule 11(a) of our Rules of Civil Procedure
provides as follows:
The signature of an attorney or party
constitutes a certificate by him that he has
read the pleading, motion, or other paper;
that to the best of his knowledge,
information, and belief formed after
reasonable inquiry it is well grounded in fact
and is warranted by existing law or a good
faith argument for the extension,
modification, or reversal of existing law, and
that it is not interposed for any improper
purpose, such as to harass or to cause
unnecessary delay or needless increase in the
cost of litigation. . . . If a pleading,
motion, or other paper is signed in violation
of this rule, the court, upon motion or upon
its own initiative, shall impose upon the
person who signed it, a represented party, or
both, an appropriate sanction[.]
N.C. Gen. Stat. § 1A-1, Rule 11(a) (1999). The trial court's
decision to deny a motion for mandatory sanctions under Rule 11 is
reviewable de novo. Scholar Business Assocs., Inc. v. Davis, 138
N.C. App. 298, 531 S.E.2d 236 (2000). On review, the court must
determine: (1) whether the trial court's conclusions of law
support its judgment or determination, (2) whether the trial
court's conclusions of law are supported by its findings of fact,
and (3) whether the findings of fact are supported by a sufficiencyof the evidence. Twaddell v. Anderson, 136 N.C. App. 56, 7
0, 523
S.E.2d 710, 720 (1999), (quoting Turner v. Duke University, 324
N.C. 152, 165, 381 S.E.2d 706, 714 (1989)), disc. review denied,
351 N.C. 480, ___ S.E.2d ___(2000). If the trial court makes no
factual findings or legal conclusions concerning a Rule 11 motion
for sanctions, remand is necessary, unless 'there is no evidence
in the record, considered in the light most favorable to the
movant, which could support a legal conclusion that sanctions are
proper.' Scholar Business, 138 N.C. App. at 304, 531 S.E.2d at
240 (quoting McClerin v. R-M Industries, Inc., 118 N.C. App. 640,
644, 456 S.E.2d 352, 355 (1995)).
Having reviewed the record in its entirety, we find no
evidence to support a conclusion that sanctions under Rule 11 are
appropriate on either the legal insufficiency or improper
purpose standard. Moreover, we stated in our analysis that the
issue raised by plaintiff's complaint was one of first impression
in this State. Therefore, we conclude that the trial court
committed no error in denying defendant's motion for sanctions.
[3]As to defendant's argument that the court should have
awarded sanctions pursuant to section 6-21.5 of the General
Statutes, we note that defendant made no reference to this statute
in any of the assignments of error appearing in the record on
appeal. Accordingly, defendant has not preserved this argument for
our review. See N.C.R. App. P. 10(c)(1) (requiring assignments of
error in the record on appeal to state plainly, concisely and
without argumentation the legal basis upon which error isassigned). Further, in view of our determination that the trial
court should have awarded judgment on the pleadings in favor of
defendant, we need not consider the balance of defendant's
arguments on appeal.
In conformity with the reasoning expressed herein, the
judgment of the trial court is reversed in part, affirmed in part,
and remanded for further proceedings consistent with this opinion.
Reversed in part, affirmed in part, and remanded.
Judges MARTIN and THOMAS concur.
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