1. Statutes of Limitation and Repose_amended counterclaim_fraud_no relation back
Defendant insured's amended counterclaim against plaintiff insurer for fraud did not
relate back for statute of limitations purposes to the date of filing of the original counterclaim
because a claim for fraud must allege all material facts and circumstances constituting fraud with
particularity, and the allegations in the original counterclaim go only to the face of the policies at
issue and the interpretation of the terms of those policies and do not give notice of the
circumstances constituting the alleged fraud. N.C.G.S. § 1A-1, Rule 15(c).
2. Statutes of Limitation and Repose--fraud--personal liability umbrella insurance
policy
The trial court erred by entering an order estopping plaintiff insurance company from
denying coverage of its personal liability umbrella policy to defendant deceased husband's estate
from defendant wife's claims for injuries and damages sustained in a car accident occurring 29
October 1996 even though there was a fiduciary relationship, because: (1) reasonable diligence
required defendant wife to inquire as to the scope of her coverage under the personal liability
umbrella policy (PLUP) when claims were ripe and even required by the policy; (2) defendant
wife did not lack capacity to challenge the policy at all times after the accident and before the
three years preceding her counterclaims dated 10 May 2001; and (3) the three-year statute of
limitations under N.C.G.S. § 1-52(9) began to run sometime within a year of the accident since
sometime within a year after the accident, defendant was both on notice of the alleged fraud by
her insurance agent and had capacity to bring an actionable fraud claim against the insurance
company.
Patterson, Dilthey, Clay, Bryson & Anderson, L.L.P., by Mark
E. Anderson, for plaintiff appellant.
Pulley, Watson, King & Lischer, P.A., by Guy W. Crabtree, for
defendant appellees.
McCULLOUGH, Judge.
This case arises from an order estopping State Farm from
denying coverage of its Personal Liability Umbrella Policy (PLUP)
to the Estate of Bernard Leinfelder for Mrs. Leinfelder's claims
for injuries and damages sustained in a car accident occurring 29
October 1996. The following facts were found without exception by
the trial court issuing the order. Beginning in 1984 and continuing
at least through 1996, Mr. and Mrs. Leinfelder (the Leinfelders
collectively) considered Mr. Larry High (Mr. High) their insurance
agent. During that time, Mr. High was an agent for State Farm. The
Leinfelders continuously carried their homeowner's and automobile
insurance coverage with State Farm.
In 1994, the Leinfelders altered their insurance coverage. At
that time, they were in their midsixties and were the sole
employees of their own electronics business run out of their
basement. Before the alteration to their coverage, they carried
automobile insurance with State Farm which provided them with
liability and UM (uninsured motorist)/UIM (underinsured motorist)
coverage limits of $500,000 per person and $500,000 per accident
(500/500). The limits of this policy applied to both first-party
claims (claims brought by an insured or family member against
another insured or family member) and third-party claims (claims
brought by all others). In 1993 or early 1994, the Leinfelders were
solicited by Mr. High to consult with him for an insurance check-
up. In February of 1994, Mrs. Leinfelder met with Mr. High while
Mr. Leinfelder stayed at home to run their business. At that
meeting Mrs. Leinfelder took notes of Mr. High's recommendations of
a better coverage scheme and so reported to her husband. As aresult of the meeting and Mr. High's recommendations, the
Leinfelders reduced their automobile liability coverage to $100,000
per person/$300,000 per accident (100/300) and purchased a
$1,000,000 PLUP.
Included in the PLUP was a first-party exclusion or intra-
family exclusion that read:
10. For bodily injury or personal injury to
the named insured, spouse, or anyone
within the meaning of Part A. or Part B.
of the definition of insured. This
exclusion also applies to any claim or
suit made against you to share damages
with or repay someone else who may be
obligated to pay damages because of the
bodily injury or personal injury.
Thereafter, for first party claims, rather than increase the
Leinfelders' liability coverage up to $1,000,000, because the
underlying automobile limits were reduced from 500/500 to 100/300,
the intra-family exclusion of the PLUP actually reduced the
coverage limit that they had before the 1994 alteration by 80% (500
to 100).
On 29 October 1996, the Leinfelders were involved in a serious
automobile accident, resulting in the death of Mr. Leinfelder.
Mrs. Leinfelder sustained substantial injuries with ensuing medical
expenses exceeding $500,000. The wreck was caused by the negligence
of Mr. Leinfelder when he drove on the wrong side of a divided
highway. On that day, both the State Farm PLUP and automobile
policy were in effect.
Mrs. Leinfelder instituted a claim against her husband's
estate for damages on 5 October 1999. State Farm contended the
extent of her husband's automobile liability coverage was $100,000,and the $1,000,000 coverage purchased in 1994 did not cover the
liability of first-party claims pursuant to the intra-family
exclusion. Being the wife and one of the insured, she thus had no
claim beyond $100,000 as of the 1994 alterations to their coverage.
The action now before this Court was originally instituted by
State Farm on 4 February 2000 for determination of the respective
parties' rights and obligations under the automobile insurance
policy and PLUP sold to the Leinfelders. Mrs. Leinfelder served a
counterclaim on State Farm on 8 March 2000, denying that the State
Farm coverage was limited, and arguing that the intra-family
exclusion clause was void as against public policy.
(See footnote 1)
By order
dated 10 May 2001, after both parties took discovery depositions,
Mrs. Leinfelder was allowed to amend her counterclaim to add the
claim of fraudulent misrepresentation, and relief in the form of
equitable estoppel and reformation of the PLUP. On 20 November
2001, partial summary judgment was entered in favor of State Farm
wherein the trial court determined the intra-family exclusion of
the PLUP policy was clear and unambiguous. Summary judgment was
denied as to State Farm's affirmative defense of statute of
limitations, and on the issues of fraud, equitable estoppel, and
reformation. In a trial without a jury, the trial court held as
a matter of law that the statute of limitations on a claim of fraud
had not run in this case, and in light of the relationship Mr. Highestablished with the Leinfelders, they were entitled to reformation
of the PLUP.
State Farm raises two issues on appeal: first, that the trial
court was incorrect in finding the statute of limitations had not
run on the Leinfelders' claim of fraud; and second, that there was
insufficient evidence to support the trial court's finding of
fraud. Because we hold the statute of limitations had run by the
time Mrs. Leinfelder made her claim for fraud, equitable estoppel,
and reformation, we reverse the trial court's order reforming the
PLUP policy and hold Mrs. Leinfelder is bound by the intra-family
exclusion.
65) A few weeks after signing the application
for the personal umbrella policy, the
umbrella policy and accompanying
documents were mailed to, and received
by, Mr. and Mrs. Leinfelder.
66) Mrs. Leinfelder received and reviewed the
insurance policy and documents to make
sure that it was an umbrella policy as
Mr. High had told her, that it did have
limits of $1,000,000.00, and that she and
her husband were the insured partiesunder the policy. However, she did not
read the policy from cover to cover.
67) Mr. and Mrs. Leinfelder relied on what
Mr. High told them was contained in the
policy, and since they trusted him
completely, they did not feel it
necessary to check behind what he had
told them, to wit: that they would have
better coverage with increased limits for
the same claims that they would have had
under their existing coverages if they
made the changes that he recommended.
68) Mr. and Mrs. Leinfelder rightly expected
that Mr. High would tell them if part of
their coverage was actually removed or
decreased because of the recommended
changes.
We agree with Mrs. Leinfelder that these findings by the trial
court are supported by competent evidence of record. Furthermore,
we agree that our Court and our Supreme Court have extended the
statutory trigger of reasonable diligent discovery of fraud in an
insurance policy when the fraud was procured by a fiduciary. The
essence of these holdings is that the fiduciary, acting as a
trustee or confidant, supplements for a party's own reasonable
diligence. Small v. Dorsett, 223 N.C. 754, 763, 28 S.E.2d 514, 518
(1944); see also Phillips v. State Farm Mut. Auto. Ins. Co., 129
N.C. App. 111, 113, 497 S.E.2d 325, 327, disc. review denied, 348
N.C. 500, 510 S.E.2d 653 (1998) (stating that An insurance agent
acts as a fiduciary with respect to procuring insurance for an
insured, correctly naming the insured in the policy, and correctly
advising the insured about the nature and extent of his coverage);
see also R-Anell Homes v. Alexander & Alexander, 62 N.C. App. 653,
659, 303 S.E.2d 573, 577 (1983) (upholding a trial court's finding
of fact that the plaintiff failed to reasonably discover lack ofcoverage based upon evidence that the insured relied upon the
superior knowledge and advice of an insurance agent).
Here the trial court's findings, which we believe are based on
competent evidence, along with supporting case law, excuse Mrs.
Leinfelder's discovery of the terms of the PLUP policy as of the
date of its issuance and receipt in 1994. Further, without any
event between February 1994 and October 1996 that would cause her
to question or inquire into the terms of the PLUP policy as colored
by her fiduciary, during those years there was no failure on her
part to review the policy and discover any fraud or
misrepresentation.
Because we find the record adequate to support the trial
court's finding of a fiduciary relationship, we distinguish this
case from the general rights and obligations of parties to
insurance transactions where no such relationship exists. These
are set out clearly in Baggett v. Summerlin Ins. & Realty Inc., 143
N.C. App. 43, 545 S.E.2d 462 (2001), rev'd per curiam, 354 N.C.
347, 554 S.E.2d 336 (2001) (where a party has an opportunity to
read an insurance policy under which he claims coverage, he is held
to be on notice of those terms in the policy which are otherwise
clear and unambiguous. Failure to read the policy will bar his
right to reformation.).
2. Within a Year of 29 October 1996
Despite the lower court's determination of a fiduciary
relationship, and after close review of the record and exhibits
thereto, we believe the above findings do not establish competent
evidence to toll N.C. Gen. Stat. § 1-52(9) beyond sometime withina year of 29 October 1996. As we noted above, a fiduciary
relationship can at times supplement for reasonable diligence in
complete understanding of one's own affairs. However, in cases such
as insurance claims, when a claim becomes ripe and due under a
policy requiring action on the part of the insured, at that point
or a reasonable time thereafter, the policyholder is charged with
more than a cursory knowledge of the extent of their coverage. In
general, this Court will not wholly excuse discovering a fraud
merely because a relationship of trust and confidence exists.
Where something happens which reasonably excites suspicion that a
fiduciary has failed to disclose all essential facts, diligent
inquiry puts one on notice and triggers the time period for which
a claim can be made. Shepherd v. Shepherd, 57 N.C. App. 680, 682-
83, 292 S.E.2d 169, 170-71 (1982); Vail v. Vail, 233 N.C. 109, 116-
17, 63 S.E.2d 202, 208 (1951).
State Farm evoked the statute of limitations defense in their
response to Mrs. Leinfelder's amended counterclaim. The burden then
rests upon Mrs. Leinfelder to remove the statutory bar. See
Swartzberg, 252 N.C. 150, 113 S.E.2d 270. Therefore, when the
statute of limitations' trigger is based on discovery by reasonable
diligence, as in a case of fraud, there must be some competent
evidence as to when discovery of the fraud was reasonable. Or
alternatively, when it was otherwise reasonable to discover, there
must be some competent evidence that plaintiff lacked capacity and
opportunity at all times while discovery was reasonable and before
the three years preceding the claims. Grubb Properties, 101 N.C.
App. 498, 400 S.E.2d 85. Based on the uncontradicted evidence in the record set out
below, we hold as a matter of law that an otherwise reasonable time
to discover fraud or misrepresentation in the PLUP policy was when
the policy itself required certain claims, such as an accident, be
brought to the attention of the insurer for the purposes of
determining coverage. Id. at 501, 400 S.E.2d at 88 (where we held
that the mistake or discrepancy in a deed that plaintiff complains
of should have been discovered through the exercise of due
diligence, at least by 30 May 1984, when plaintiff filed its
Declaration converting the apartment complex to condominiums, and
that the action filed nearly four years later was barred). We
charge Mrs. Leinfelder with due diligence at least sometime within
a year of the accident.
We next conclude there is no evidence of record that Mrs.
Leinfelder lacked opportunity and capacity to inquire into her
coverage under the policy at all times after the accident and
before the three years preceding her counterclaims dated 10 May
2001. In fact, the record shows that she did make such inquiries
via her stepdaughter-in-law, Janice Nichols (Janice), to whom she
gave power of attorney.
The PLUP policy Mr. and Mrs. Leinfelder contracted for has a
section entitled Your Duties To Us. The section begins:
These are the things you must do for us. We
may not provide coverage if you refuse to:
1. notify us of an accident. If
something happens that might involve
this policy, you must let us know
promptly. Send written notice to us
or our agent.
Under the policy, assuming one was covered thereunder, notice was
to be given to State Farm promptly after an accident. Mrs.
Leinfelder had Janice, acting with power of attorney soon after the
accident, make this prompt contact with State Farm. Mrs.
Leinfelder therefore took the initial step in exercising reasonable
diligence in determining the extent of her coverage, and the person
acting as her attorney-in-fact was put on notice of the denial of
coverage. In a 13 July 2002 deposition taken by her attorney, Mrs.
Leinfelder stated:
Q I see. Now, after you were injured in
this automobile wreck of October, 1996 did you
make a claim for your injuries, or did Miss
Nichols...
A Yes.
Q ...Or your attorney, in fact, your
stepdaughter-in-law made a claim for you?
A Yes, she did.
Q And after that claim was made what did
you find out regarding your insurance
coverage?
A She told - she told me that the
insurance wouldn't cover, the insurance I
had.
Q Okay, and what was your reaction to
hearing that?
A Complete shock.
In a deposition taken by State Farm's attorney, on 12 June 2002,
Mrs. Leinfelder testified as follows:
Q After the accident tell me what
happened with regard to the State Farm
coverage? Did you contact State Farm?
A Yes, indirectly. Q Okay. Who directly contacted State
Farm?
A Janice.
Q Did you ever contact State Farm?
A Yes, through Janice.
Q Through Janice, but did you personally
ever talk to anyone at State Farm?
A After the accident, no.
Q Okay, because you were badly injured
as I understand.
A Very badly.
Q Right. What did Janice tell you that
State Farm had said?
A First thing when she dared to tell me
was that State Farm was not paying anything
for my injuries.
While Mrs. Leinfelder's testimony does not reveal exactly when she
requested Janice to contact State Farm, other circumstantial
evidence suggests that she made this request approximately three
months after the accident. In a deposition taken by Mrs.
Leinfelder's lawyer, Mr. High described Mrs. Leinfelder's file to
include the following:
Q Drawing your attention to the next
page, I see an indication there maybe a third
of the way down, 1/28/97, Jeff Campbell
called. Gave him contact name and number.
R.H.
A Correct.
Q What does that tell you?
A That tells--Jeff Campbell was a claims
person at that time, an auto claims person.
And apparently he didn't have--who is it?
Janice Nichols?--did not have her phone number
and wanted to know if we had any contact
numbers. And they were given to him.
Further testimony by Mrs. Leinfelder on 13 July 2002 reveals Mrs.
Leinfelder was on actual notice of State Farm's denial of coverage,
at least within a year of the 29 October 1996 accident:
Q Okay. Now, when did you first discover
that you and your husband's coverages had been
decreased in regards to the injuries suffered
in the automobile wreck in October of 1996?
A I don't know when Janice let me know.
They were afraid because my fragile condition
to---I wasn't able to even understand with all
the medication I had. I, and she's coming
from---I don't know, it might have been six
months, it might have been a year. I really
can't answer when she told me.
Mrs. Leinfelder alleges fraud in procuring the PLUP policy.
We find as a matter of law that notice of denial of the PLUP
coverage triggered the statute of limitations as the date when
reasonable diligence would result in the fraud's discovery, and she
was first injured by the denial. Mrs. Leinfelder's brief does not
dispute this legal determination, but argues pursuant to the trial
court's finding of fact #43 that she was not put on notice of the
denial of coverage until she brought her claim against Mr.
Leinfelder's estate in 1999. We see no competent evidence in the
record to support this, and in fact only evidence to the contrary.
There is direct deposition testimony that Mrs. Leinfelder herself
had actual notice no later than a year of the accident, and that
her power of attorney had notice soon after the accident. By making
immediate inquiry into her coverage, through her attorney-in-fact,
Mrs. Leinfelder was exercising reasonable diligence as to discovery
of any fraud in the procurement of her policy. We charge her with
discovery of the fraud sometime within a year of the accident, orat least by 29 October 1997. Therefore, without more, her
counterclaims of May 2001 came too late.
(See footnote 2)
Mrs. Leinfelder cites Jefferson-Pilot Life Ins. Co. v.
Spencer, 336 N.C. 49, 442 S.E.2d 316 (1994), in her argument as to
when the statute of limitations accrued. In Jefferson-Pilot, the
insured was misinformed by the insurance company that his wife was
the beneficiary of his life insurance policy. This Court held that
an action for negligent misrepresentation of an insurance contract
does not accrue before the misrepresentation is discovered, neither
does it accrue until the misrepresentation has caused the claimant
harm. Id. at 56, 442 S.E.2d at 320 (holding that because the
beneficiary of the policy only had an expected interest, rights
under the policy did not vest until the death of the policyholder,
and at that point triggered the statute of limitations). We agree
with the applicability of Jefferson-Pilot. However, we believe the
two requirements to trigger the statute of limitations in the case
of a fraudulently procured insurance contract, both its discovery
and the harm caused thereby, will often occur simultaneously. Most
insurance policies require immediate notice of potential claims due
to events such as accidents or deaths.
When an alleged claim under a policy is ripe, notice of the
denial normally will be the time when the claimant is charged with
discovery by reasonable diligence of the underlying fraud, and alsoinjured by the lack of coverage. In her brief, Mrs. Leinfelder
cites R-Anell Homes, 62 N.C. App. 653, 303 S.E.2d 573; and Transit,
Inc. v. Casualty Co., 20 N.C. App. 215, 201 S.E.2d 216 (1973),
aff'd, 285 N.C. 541, 206 S.E.2d 155 (1974), as authority to extend
the statute of limitations by reasonable discovery. However, in
both of these cases, the fiduciary relationship only excuses the
reading of the new or renewed insurance policy during the policy's
dormancy. These cases say nothing about excusing a party from the
discovery of the extent of their policy after claims under the
policy are ripe. Both cases were heard before a superior court
within three years of the date of the incident which implicated the
policy.
III. Incompetent Adult
In North Carolina, statutes of limitation are also "subject to
expansion . . . by North Carolina's . . . 'disabilities' statutes."
Leonard v. England, 115 N.C. App. 103, 106-07, 445 S.E.2d 50, 52
(1994), disc. review denied, 340 N.C. 113, 455 S.E.2d 663 (1995);
see also Soderlund v. Kuch, 143 N.C. App. 361, 369, 546 S.E.2d 632,
638 (2001). The disability statute which might operate to toll the
statute of limitations at bar is N.C. Gen. Stat. § 1-17(a)(3)
(2001), which states in pertinent part:
(a) A person entitled to commence an
action who is at the time the cause of action
accrued under a disability . . . .
. . . .
(3) The person is incompetent as defined
in G.S. 35A-1101(7) or (8).
N.C. Gen. Stat. § 35A-1101(7) (2001) defines an incompetent adult
as being an adult or emancipated minor who lacks
sufficient capacity to manage the adult's own
affairs or to make or communicate important
decisions concerning the adult's person,
family, or property whether the lack of
capacity is due to mental illness, mental
retardation, epilepsy, cerebral palsy, autism,
inebriety, senility, disease, injury, or
similar cause or condition.
(Emphasis added.) The appropriate test for establishing an adult
incompetent "is one of mental competence to manage one's own
affairs." Cox v. Jefferson-Pilot Fire and Casualty Co., 80 N.C.
App. 122, 125, 341 S.E.2d 608, 610 (emphasis added), cert. denied,
317 N.C. 702, 347 S.E.2d 38 (1986).
Mrs. Leinfelder has not argued, nor did the trial court find
as fact or conclude as law, that she lacked capacity or opportunity
to make the proper claims under her PLUP policy. Regardless, we
here feel compelled to close this potential issue. While there is
competent evidence that Mrs. Leinfelder was extremely and
unfortunately injured by the accident, in and out of hospitals, and
on and off of many painkillers, we find no competent evidence that
her injury made her incapable of managing her own affairs. There
is evidence that she named Janice as her attorney-in-fact shortly
after the accident to look after her affairs, that she had Janice
contact the insurance company to discern her auto and PLUP coverage
soon after the accident, and that Janice informed her that coverage
was being denied within a year of the accident. Yet, claims of
fraud were not brought until 10 May 2001, beyond the three years
from 29 October 1997, the latest date Mrs. Leinfelder could be
charged with notice of the fraud. In sum, we hold the evidence in the record, exhibits, and the
lower court's findings of fact, do not establish competent evidence
of the following: (1) that reasonable diligence did not require
Mrs. Leinfelder to inquire as to the scope of her coverage under
the PLUP policy when claims were ripe and even required by the
policy (had she been covered as she thought); or, alternatively,
(2) that she lacked capacity to challenge the policy at all times
after the accident and before the three years preceding her
counterclaims dated 10 May 2001. Furthermore, because we find
evidence showing that sometime within a year after the accident of
29 October 1996, Mrs. Leinfelder was both on notice of the alleged
fraud by Mr. High and had capacity to bring an actionable fraud
claim against State Farm, we hold the statute began to toll
sometime within a year of the accident, 29 October 1996,
statutorily barring her claim of fraud first alleged in 10 May
2001. We reverse the trial court's order.
Reversed.
Judges TYSON and BRYANT concur.
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