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1. Declaratory Judgments; Insurance_commercial casualty insurance--premature
invocation of appraisal clause
Plaintiff insured prematurely invoked appraisal under a commercial casualty insurance
policy for damages to his properties in an ice storm because: (1) by the terms of the appraisal
clause, it was contemplated that the parties would engage in some meaningful exchange of
information sufficient for each party to arrive at a conclusion before a disagreement could exist;
(2) plaintiff's disagreement with defendant's adjustment of the claims was unilateral since
plaintiff did not communicate to defendant any amount of loss greater than what defendant had
already paid; (3) the unsupported opinion of the insured that the insurer's payment was
insufficient does not rise to the level of a disagreement necessary to invoke appraisal; (4) to the
extent defendant requested that plaintiff comply with plaintiff's post-loss duties prior to invoking
appraisal, such compliance was a necessary condition precedent to the invocation of appraisal
since otherwise those terms of the contract would be rendered meaningless; and (5) even
assuming arguendo that the pertinent letter sent by defendant to plaintiff about the amount of loss
from the inception of the ice storm claims served as a blanket denial of those claims, the parties
still did not disagree on the amount of the losses pursuant to the appraisal clause since plaintiff
failed to substantiate the amount of loss he allegedly sustained for each of the properties.
2. Appeal and Error-_motion for stay pending appeal-_mootness
Although defendant insurance company contends the trial court erred in a declaratory
judgment action by denying its motion for stay pending appeal, this issue is dismissed as moot
because the Court of Appeals already determined that appraisal should not have gone forward,
and thus a determination of the proprietary of the trial court's denial of defendant's motion for
stay pending appeal can have no practical effect on the case.
Armstrong & Armstrong, PA, by L. Lamar Armstrong, Jr., for
Plaintiff-Appellee.
Brown, Crump, Vanore & Tierney, L.L.P., by O. Craig Tierney,
Jr., for Defendant-Appellant.
McGEE, Judge.
Auto-Owners Insurance Company (Defendant) appeals from a
declaratory judgment entered 29 June 2005 and from the denial of
its motion for stay pending appeal. For the reasons stated below,
we reverse the declaratory judgment and dismiss as moot Defendant's
appeal of the denial of its motion for stay pending appeal.
Jerry A. Hailey, Jr., d/b/a Hailey Properties (Plaintiff)
filed a complaint against Defendant seeking a declaratory judgment.
Plaintiff alleged he owned several properties in Wake County that
were insured with Defendant under a commercial all-risk property
casualty insurance policy. Plaintiff alleged that his properties
were damaged and filed damage claims with Defendant. Plaintiff
alleged that Defendant made payments on the claims, but that
Plaintiff later discovered the payments were insufficient to cover
Plaintiff's losses. Plaintiff eventually invoked the appraisal
clause under the policy, appointed an appraiser, and requested that
Defendant appoint its appraiser. The parties' appraisers failed to
agree on umpires, and Plaintiff petitioned the trial court to
appoint umpires. The trial court appointed umpires for some of the
claims. Defendant contended that Plaintiff was not entitled to
petition the trial court for the appointment of umpires. Plaintiff
sought a declaration as to the rights, liabilities, obligations,
and interests of the parties.
Defendant filed an answer and counterclaim dated 7 May 2004.
In its counterclaim, Defendant alleged that "[p]rior to demanding
appraisal on these claims, [Plaintiff] failed to timely produce any
documentation, invoices, bills, estimates, [or] cost of repair[] tosupport any claim in excess of what had already been paid for the
subject claims, or to support [Plaintiff's] value of the claim[s]."
Therefore, Defendant alleged, there was no disagreement between
Plaintiff and Defendant as to the value of the claims, and
Plaintiff's requests for appraisal were premature.
Defendant's counterclaim extended to all of Plaintiff's
claims, which included claims arising from (1) an ice storm on 5
December 2002, (2) a fire on 4 July 2003, and (3) a windstorm on 18
September 2003. Moreover, all of Plaintiff's properties that were
allegedly damaged were listed under four insurance policies with
Defendant. The sections of each policy, dealing with appraisal and
duties in the event of loss, are substantially similar. The
"appraisal" section of one of the policies provides that "[i]f we
and you disagree on the value of the property or the amount of
loss, either may make written demand for an appraisal of the loss."
The policies define "we" as Defendant and "you" as Plaintiff. One
of the policies provides the following "duties in the event of loss
or damage":
a. You must see that the following are done
in the event of loss or damage to Covered
Property:
(1) Notify the police if a law may have
been broken.
(2) Give us prompt notice of the loss or
damage. Include a description of the
property involved.
(3) As soon as possible, give us a
description of how, when and where the
loss or damage occurred.
(4) Take all reasonable steps to protectthe Covered Property from further damage
by a Covered Cause of Loss. If feasible,
set the damaged property aside and in the
best possible order for examination.
Also keep a record of your expenses for
emergency and temporary repairs, for
consideration in the settlement of the
claim. This will not increase the Limit
of Insurance.
(5) At our request, give us complete
inventories of the damaged and undamaged
property. Include quantities, costs,
values and amount of loss claimed.
(6) As often as may be reasonably
required, permit us to inspect the
property proving the loss or damage and
examine your books and records.
Also permit us to take samples of damaged
and undamaged property for inspection,
testing and analysis, and permit us to
make copies from your books and records.
(7) Send us a signed, sworn proof of
loss containing the information we
request to investigate the claim. You
must do this within 60 days after our
request. We will supply you with the
necessary forms.
(8) Cooperate with us in the
investigation or settlement of the claim.
b. We may examine any insured under oath,
while not in the presence of any other insured
and at such times as may be reasonably
required, about any matter relating to this
insurance or the claim, including an insured's
books and records. In the event of an
examination, an insured's answers must be
signed.
The trial court entered a partial declaratory judgment on 9
September 2004, resolving the issue regarding Plaintiff's requests
for the appointment of umpires in Plaintiff's favor. The trial
court conducted hearings on Defendant's counterclaim on 9 and 10June 2005. At the conclusion of Defendant's evidence, Plaintiff
moved for involuntary dismissal pursuant to N.C. Gen. Stat. § 1A-1,
Rule 41(b). The trial court granted Plaintiff's motion and entered
a declaratory judgment on 29 June 2005.
The trial court made the following findings of fact, which
Defendant challenges:
15. There is no word, phrase or other express
linkage in the appraisal section to the duties
after loss section and the appraisal section
does not in any express manner provide any
condition precedent to invoking appraisal
other than the insured and insurer
"disagree[."]
. . .
17. The duties after loss section contains no
word, phrase or other express linkage of any
of the duties of the insured provided therein
to the appraisal section and does not in any
express manner provide that any duty listed
therein is a condition precedent to invoking
appraisal.
18. [Defendant] agreed that appraisal is a
policy benefit that it was obligated to
proactively and in good faith provide
[Plaintiff] to the full extent to which
[Plaintiff] was entitled.
19. Pursuant to insurance policies
[Defendant] issued to [Plaintiff] that were in
force at the time of [Plaintiff's] claims and
applied to [Plaintiff's] claims, [Plaintiff]
had a right to invoke appraisal as provided by
the policies according to the sections
described above.
20. After the ice storm on 5 December 2002,
[Plaintiff] gave prompt and proper notice of
claims for damage to several of his properties
insured by [Defendant].
. . .
24. On or about 11 January 2003, [Mr.] Wilsonwrote a letter to [Plaintiff] advising that
"(. . .)[i]n looking at your claim, it has
been determined that there was no physical
damage to any of your property. Due to there
being no damage to any of the dwellings or any
other structures, [Defendant] is not in a
position to make any payment[."]
. . .
26. [Defendant] and [Mr.] Wilson never
retracted the letter.
27. The [Trial] Court relies on this
testimony only for the purpose of finding that
as a result of its blanket denial of ice storm
claims, [Defendant] and [Plaintiff] disagreed
from the inception of the claims.
28. On or about 27 February 2003, [Defendant]
mailed checks to [Plaintiff] for amounts it
determined unilaterally were appropriate for
[Plaintiff's] ice storm claims.
. . .
30. Disagreement between [Defendant] and
[Plaintiff] continued thereafter.
. . .
32. [Plaintiff] provided notice of
[Plaintiff's] appointment of his appraiser and
his demand for appraisal by sending a letter
to [Defendant] through its agent, Darren
Carrino, an independent agent with Craft
Insurance Co., who forwarded notice to
[Defendant].
. . .
36. One of [Defendant's] bases for its
withdrawal from appraisal was that it did not
"disagree" with [Plaintiff] because
[Plaintiff] had not submitted a detailed
written estimate that [Defendant] advised the
policies required before [Plaintiff] was
entitled to invoke appraisal.
. . .
38. [Defendant's] response to all suchrequests for appraisal was substantially
similar.
39. In all of these claims, [Defendant]
refused to appoint an appraiser and refused to
participate in appraisal or afford [Plaintiff]
appraisal on the ground that [Defendant] did
not "disagree" with [Plaintiff] as [Defendant]
interpreted the policies.
40. In each case, [Defendant's] contention
that it did not "disagree" with [Plaintiff]
was based on its contention that it had a
right to a detailed written estimate, with
subsequent disagreement, before [Plaintiff]
invoked appraisal.
. . .
42. Although [Defendant] had alleged in its
Answer & Counterclaims that [Plaintiff's]
conduct in failing to give notice to
[Defendant] prior to approaching the Judge for
umpire appointments was wrongful, [Defendant]
conceded that neither the policy nor the law
of North Carolina required notice.
43. [Plaintiff's] conduct in pursuing
appointments of umpires was proper.
The trial court made the following conclusions of law, which
Defendant challenges:
4. When [Plaintiff] did not agree with the
positions taken by [Defendant] regarding its
denial of ice storm claims, its payment of
less than what [Plaintiff] thought he was
entitled to receive, and the passage of time
without further adjustment or payment,
[Plaintiff] in the ordinary and plain meaning
of the terms did "disagree" with [Defendant]
as to "the amount of loss[."]
5. The policies do not expressly create any
other condition precedent to invoking
appraisal other than the parties "disagree" as
to "the amount of loss[."]
6. Considering the lack of any term or
provision in the appraisal section or in the
duties after loss section that correlates oneto the other, or in any way expressly
conditions invocation of appraisal to the
insured's satisfactory (to the insurer)
compliance with duties after loss, the duties
after loss section is not a condition
precedent to invoking appraisal.
. . .
8. [Defendant] implied and read into the
appraisal section a condition precedent to
appraisal that does not exist by the express
terms of the policies.
. . .
11. [Plaintiff] was entitled to invoke
appraisal and his demands for appraisal were
not premature and were appropriate.
12. [Plaintiff] complied with the policies'
terms and conditions in his petitions to
appoint umpires.
The trial court declared and ordered that Plaintiff had complied
with the policy terms and conditions related to invoking appraisal.
The trial court also declared and ordered that the orders
appointing umpires were valid and that appraisal was appropriate
and could proceed.
Defendant filed a motion for stay pending appeal on 27 July
2005, which the trial court denied on 7 October 2005. Defendant
appeals both the declaratory judgment and the order denying its
motion for stay pending appeal.
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