Zbegner v. Allied Property & Casualty Insurance ( 2011 )

FILED
United States Court of Appeals
Tenth Circuit
December 6, 2011
UNITED STATES COURT OF APPEALS
Elisabeth A. Shumaker
Clerk of Court
FOR THE TENTH CIRCUIT
JOSEPH H. ZBEGNER,
Plaintiff-Appellant,
No. 10-1421
v. (D.C. No. 1:09-CV-02872-BNB-KMT)
(D. Colo.)
ALLIED PROPERTY AND
CASUALTY INSURANCE
COMPANY, an Iowa corporation,
Defendant-Appellee.
ORDER AND JUDGMENT *
Before O’BRIEN, ANDERSON, and HOLMES, Circuit Judges.
Plaintiff Joseph H. Zbegner appeals from a district court order dismissing
without prejudice his claims against Allied Property and Casualty Insurance Co.
(Allied) as not ripe for adjudication. Exercising jurisdiction under 28 U.S.C.
§ 1291, we affirm.
*
After examining the briefs and appellate record, this panel has determined
unanimously that oral argument would not materially assist the determination of
this appeal. See Fed. R. App. P. 34(a)(2); 10th Cir. R. 34.1(G). The case is
therefore ordered submitted without oral argument. This order and judgment is
not binding precedent, except under the doctrines of law of the case, res judicata,
and collateral estoppel. It may be cited, however, for its persuasive value
consistent with Fed. R. App. P. 32.1 and 10th Cir. R. 32.1.
I.
Zbegner was in an automobile accident in Boulder, Colorado, on June 15,
2007. At that time he had an automobile insurance policy with Allied, which
included underinsured motorist (UIM) coverage. In his complaint against Allied,
Zbegner alleged that he suffered severe injuries as a result of the accident and
sustained damages exceeding $150,000. He claimed Jesse Hanson was the person
at fault in the accident, but Hanson was underinsured, having only $25,000 in
liability coverage with Allstate Insurance Company (Allstate). Allstate paid
Zbegner $351.74 for property damage and offered him $2,145.00 to settle his
injury claim. Zbegner did not accept Allstate’s offer and has not resolved his
claim against Hanson.
According to his complaint, Zbegner provided Allied with information
regarding his injuries and damages and offered to settle his claim for policy limits
UIM benefits. After Allied declined, Zbegner filed this action. His complaint
included claims for breach of contract, breach of the duty of good faith and fair
dealing, and violation of Colo. Rev. Stat. § 10-3-1115, which provides that an
insurer shall not unreasonably delay or deny payment of a claim.
Allied moved to dismiss Zbegner’s claims under Fed. R. Civ. P. 12(b)(1)
(lack of subject matter jurisdiction). Allied asserted it could not know the amount
due Zbegner for UIM benefits until he had resolved his claim against Allstate,
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Hanson’s insurer. Because his claims were contingent on a future event, Allied
contended they were not ripe for adjudication.
The district court 1 granted Allied’s motion, citing the Colorado Court of
Appeals’ decision in Freeman v. State Farm Mutual Automobile Insurance Co.,
946 P.2d 584 (Colo. App. 1997). Freeman held:
Once recovery is made from the tortfeasor, the insured may
collect an additional amount necessary to compensate the insured for
injuries sustained, up to his or her UIM policy limits. In fact, until a
recovery is made from the at-fault party, the actual amount of
coverage to which an insured is entitled under an UIM policy cannot
be known.
Id. at 585-86. Applying this holding, the district court assessed whether
Zbegner’s claim for UIM benefits was ripe. It considered the fitness of the claim
for judicial resolution and the hardship to the parties of withholding judicial
consideration. It concluded:
Whether, and how much, the plaintiff may recover from Allstate is
completely contingent at this time; a recovery against Allstate and its
amount are future events that may not occur as anticipated or may
not occur at all; and the actual amount of coverage to which the
plaintiff may be entitled under his Allied underinsured motorist
policy cannot be known until the claim against the tortfeasor is
resolved.
Aplee. Supp. App. at 64-65. In addition, it concluded, Zbegner had not alleged
undue hardship as a result of withholding judicial consideration of his UIM claim
1
The order was issued by a magistrate judge who, with the consent of the
parties, was assigned to decide the case under 28 U.S.C. § 636(c)(1).
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until he had resolved his claim against the tortfeasor. It its words, “plaintiff’s
claims stemming from an underinsured motorist insurance policy are not ripe for
determination until the plaintiff either obtains judgment against or enters into a
good faith settlement with the underinsured tortfeasor.” Id. at 58. It dismissed
Zbegner’s claims without prejudice. Zbegner filed a timely notice of appeal. 2
He contends that the district court misconstrued Colorado law in its ripeness
analysis.
II.
“Ripeness doctrine is rooted both in the jurisdictional requirement that
Article III courts hear only ‘cases and controversies’ and in prudential
considerations limiting [the court’s] jurisdiction.” Alto Eldorado P’ship v. Cnty.
of Santa Fe, 634 F.3d 1170, 1173 (10th Cir.), cert. denied, No. 11-50, 2011 WL
4533416 (U.S. Oct. 3, 2011). Allied did not argue, and the district court did not
find, that Zbegner’s claims failed to satisfy the case and controversy requirement.
The district court’s analysis concerned prudential ripeness, which is a question of
timing intended to discourage the premature adjudication of abstract
2
The order dismissing Zbegner’s claims without prejudice was entered on
August 18, 2010, and he filed his notice of appeal on September 13, 2010.
Although the district court did not enter judgment in a separate document, and the
judgment therefore did not become final until 150 days after entry of the
dismissal order, see Fed. R. Civ. P. 58(c)(2)(B), Zbegner’s notice of appeal was
nonetheless valid, see Constien v. United States, 628 F.3d 1207, 1211 (10th Cir.
2010), cert. denied, 131 S. Ct. 2884 (2011).
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disagreements. See New Mexicans for Bill Richardson v. Gonzales, 64 F.3d 1495,
1499 (10th Cir. 1995). “In short, the doctrine of ripeness is intended to forestall
judicial determinations of disputes until the controversy is presented in clean-cut
and concrete form.” Id. (quotations omitted); see also Morgan v. McCotter,
365 F.3d 882, 890 (10th Cir. 2004) (holding ripeness issue focuses on “whether
the harm asserted has matured sufficiently to warrant judicial intervention”
(quotation omitted)). Courts apply a two-factor ripeness analysis, initially
considering “whether an issue is fit for judicial review.” New Mexicans for Bill
Richardson, 64 F.3d at 1499. At this first step, “the central focus is on whether
the case involves uncertain or contingent future events that may not occur as
anticipated, or indeed may not occur at all.” Id. (quotation omitted). The second
prong of the ripeness analysis considers “the hardship to the parties of
withholding court consideration.” Morgan, 365 F.3d at 890 (quotation omitted).
“This court reviews de novo the district court’s order of dismissal premised on
lack of ripeness.” Alto Eldorado P’ship, 634 F.3d at 1173.
A.
The district court decided the claims were not ripe under Colorado law. It
relied on Freeman, in which the court held that, “until a recovery is made from
the at-fault party, the actual amount of coverage to which an insured is entitled
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under an UIM policy cannot be known.” 946 P.2d at 585-86. Zbegner argues
Freeman is distinguishable because his policy with Allied does not contain the
same language as the Freeman policy. The State Farm policy in Freeman
provided, “There is no [UIM] coverage until the limits of liability of all bodily
injury liability bonds and policies that apply have been used up by payment of
judgments or settlements.” Id. at 585 (emphasis added, all-caps omitted). State
Farm relied on this policy language in refusing to arbitrate a claim for UIM
coverage because its insured had not yet resolved his claim against the tortfeasor.
Id. In response, Freeman sought a judgment declaring State Farm was required to
arbitrate his UIM claim. The Colorado Court of Appeals held that, because the
amount of UIM coverage remains unknown until a recovery is obtained from the
tortfeasor, State Farm could, without violating public policy, require its insured to
obtain judgment or settlement from the underinsured driver as a precondition to
his claim for UIM benefits. Id. at 586.
Although the Allied policy does not include the same language as the State
Farm policy, Freeman is, nevertheless, on point because the Freeman court’s
holding did not rely solely on the policy language. The court also construed the
following statutory definition of the maximum liability under UIM coverage:
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The maximum liability of the insurer under the uninsured [3] motorist
coverage provided shall be the lesser of:
(a) The difference between the limit of uninsured motorist coverage
and the amount paid to the insured by or for any person or
organization who may be held legally liable for the bodily injury; or
(b) The amount of damages sustained, but not recovered.
Colo. Rev. Stat. § 10-4-609(5). 4 The court held, “The plain language of both the
statute and the policy limits the insurer’s liability to providing UIM coverage to
an amount equal to the gap between the amount an insured receives from an
underinsured driver and the insured’s UIM policy limits.” 946 P.2d at 585
(emphasis added); see also State Farm Mut. Auto. Ins. Co. v. Tye, 931 P.2d 540,
543 (Colo. App. 1996) (“According to the plain language of § 10-4-609(5)(a),
[the insured] is entitled to underinsured motorist compensation up to the
difference between the amount paid by the [tortfeasor’s] insurer and the
underinsured motorist policy limit.” (citation omitted)). It was on this basis the
3
Although this statutory section refers only to uninsured motorist coverage,
it applies as well to underinsured motorist coverage. See Farmers Ins. Exch. v.
Star, 952 P.2d 809, 812 (Colo. App. 1997) (“[Section] 10-4-609(5) articulates the
maximum liability of the insurer with respect to both uninsured and underinsured
motorist coverage.”); see also Colo. Rev. Stat. § 10-4-609(4) (2007) (“Uninsured
motorist coverage shall include coverage for damage for bodily injury or death
which an insured is legally entitled to collect from the owner or driver of an
underinsured motor vehicle.”).
4
While the court in Freeman construed the 1994 version of § 10-4-609(5),
the language of that section remained unchanged in 2007.
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Freeman court held that the amount of UIM coverage cannot be determined until
recovery is made from the tortfeasor. See 946 P.2d at 585-86.
Under Colorado law, the terms of § 10-4-609(5) were incorporated into
Allied’s policy. See Claire v. State Farm Mut. Auto. Ins. Co., 973 P.2d 686, 689
(Colo. App. 1998) (“Section 10-4-609 is incorporated into every contract of
automobile insurance issued in Colorado . . . .”). 5 Consequently, the holding in
Freeman is applicable to Allied’s policy and Zbegner’s claim for UIM benefits.
B.
Allied argues its policy language also supports the district court’s
conclusion that Zbegner’s claim is not ripe. 6 It cites the following language,
which falls under the heading “Uninsured Motorist Coverage – Limit of
5
Section 10-4-609(5) was repealed effective January 1, 2008, but it was in
effect on the date of Zbegner’s accident and during the applicable Allied policy
period. See Snell v. Progressive Preferred Ins. Co., No. 09CA0923, 2010 WL
2853754, at *1 (Colo. App. July 22, 2010) (noting amendments to § 10-4-609
applied to policies issued or renewed on or after effective date of act); cf. Sellers
v. Allstate Ins. Co., 82 F.3d 350, 352 (10th Cir. 1996) (holding earlier amendment
to § 10-4-609 not applicable to policy issued and accident occurring before
effective date of amendment).
6
Zbegner notes Allied did not make this contention in the district court, but
he does not develop an argument for waiver. While we generally do not consider
issues raised for the first time on appeal, the rule “loses its force where a new
ground or reason for affirming a lower court ruling is advanced as opposed to a
new basis for reversing a lower court.” Stahmann Farms, Inc. v. United States,
624 F.2d 958, 961 (10th Cir. 1980). And this court is “free to affirm a district
court decision on any grounds for which there is a record sufficient to permit
conclusions of law, even grounds not relied upon by the district court.” United
States v. Lott, 310 F.3d 1231, 1242 n.7 (10th Cir. 2002) (quotation omitted).
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Liability”: “Any amount otherwise payable for damages under this coverage shall
be reduced by all sums . . . [p]aid because of bodily injury by or on behalf of
persons or organizations who may be legally responsible.” Aplee. Supp. App.
at 50. 7 Allied contends under this provision the amount Allied owes for UIM
benefits depends on the amount Zbegner recovers from the tortfeasor. Thus,
according to Allied, this language limits Zbegner’s UIM coverage to the same
extent and in the same manner as § 10-4-609(5).
Zbegner asserts a contrary view, writing: “[T]he provision means that, in
the event someone else has paid [Zbegner] some damages for his injuries, that
amount can be subtracted from what Allied pays [Zbegner].” Aplt. Reply Br.
at 2. Thus, while he seems to concede that Allied’s policy calls for a reduction in
his UIM benefits based on the amount he recovers from the tortfeasor, he
contends a deduction is applicable only if and when he chooses to pursue such a
recovery. He maintains, “[I]f no other person or organization has paid [him] for
his damages, Allied must.” Id.
Most of the courts considering the language found in Allied’s policy have
construed the phrase “any amount otherwise payable for damages under this
coverage” to refer to the UIM policy limit. Those courts have thus held that this
policy language, like § 10-4-609(5), calls for reducing the UIM coverage limit by
7
This policy reference to uninsured motorist coverage appears to encompass
underinsured motorist coverage as well. The parties do not argue otherwise.
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the amount paid by the tortfeasor. See, e.g., Hopkins v. Am. Econ. Ins. Co.,
896 S.W.2d 933, 936-37 (Mo. Ct. App. 1995); Mead v. Aetna Cas. & Sur. Co.,
509 N.W.2d 789, 790-91 (Mich. Ct. App. 1993) (per curiam); Am. Econ. Ins. Co.
v. Motorists Mut. Ins. Co., 605 N.E.2d 162, 164 (Ind. 1992); Thompson v. Nodak
Mut. Ins. Co., 466 N.W.2d 115, 116-17 (N.D. 1991); Kahn v. Aetna Cas. & Sur.
Co., 542 N.E.2d 878, 879-80 (Ill. App. Ct. 1989).
Other courts have held this policy language calls for reducing the amount
of the insured’s damages, rather than the coverage limit, by the amount he has
already recovered from the tortfeasor. See, e.g., Penn. Gen. Ins. Co. v. Cantley,
615 A.2d 477, 480 (R.I. 1992) (per curiam). Notably, however, no courts
considering the language found in Allied’s policy have construed it as Zbegner
urges: permitting him to forgo a recovery from the tortfeasor altogether. We
reject his argument.
The meaning of the policy language cited by Allied is consistent with
§ 10-4-609(5), as that provision was construed in Freeman. To conclude
otherwise would create a conflict between the Allied policy and § 10-4-609(5),
which was incorporated into the terms of the policy, see Claire, 973 P.2d at 689;
see also State Farm Mut. Auto. Ins. Co. v. Kastner, 77 P.3d 1256, 1260
(Colo. 2003) (en banc) (holding § 10-4-609 governs terms of insurance
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contracts). 8 Allied’s policy language and § 10-4-609(5) both provide coverage
equal to “the gap between the amount an insured receives from an underinsured
driver and the insured’s UIM policy limits,” Freeman, 946 P.2d at 585. Under
both the policy language and § 10-4-609(5), therefore, the extent of UIM
coverage is dependent on the amount Zbegner recovers from the tortfeasor and
remains unknown until that amount is determined through a settlement with or
judgment against Hanson. See id. at 585-86.
C.
Zbegner nonetheless maintains that other policy language solely defines
what he needs to establish to recover UIM benefits from Allied. He relies on the
following: “We will pay damages which an ‘insured’ is legally entitled to recover
from the owner or operator of an ‘uninsured motor vehicle’ because of ‘bodily
injury’ . . . [s]ustained by an ‘insured’; and . . . [c]aused by an accident.” Aplee.
Supp. App. at 52. Based on this language, Zbegner contends that all he needs to
8
Moreover, under Zbegner’s construction of the policy, Allied would be
required to pay him the full amount of his damages, subject to the UIM coverage
limit, then proceed to recover what it could from the tortfeasor through
subrogation. Yet the record indicates Allied waived its right of subrogation and
gave Zbegner its consent to settle with the tortfeasor’s carrier. See Aplee. Supp.
App. at 51. And under Colorado law, “[i]nsurers are not obligated to pay UIM
benefits and then seek recovery from the liable party or his insurer under a right
of subrogation.” Pham v. State Farm Mut. Auto. Ins. Co., 70 P.3d 567, 574
(Colo. App. 2003) (rejecting insureds’ contention it was bad faith for insurer to
deny UIM claims pending determination of amount of recovery from all of
tortfeasor’s liability insurers).
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show is his legal entitlement to recover damages from the underinsured motorist
and the extent of his damages. For this proposition he relies on Borjas v. State
Farm Mutual Automobile Insurance Co., 33 P.3d 1265, 1269 (Colo. App. 2001),
which construed the phrase “legally entitled to recover damages,” as used in
§ 10-4-609(1)(a). The court construed that phrase to mean “that the insured must
be able to establish that the fault of the uninsured motorist gave rise to damages
and the extent of those damages.” Id. Based on that language, he contends that
the similar Allied policy language requires him to prove the tortfeasor’s fault and
his damages–and nothing more.
Borjas is inapposite to the issue here. In Borjas, the court considered
whether the insured was “legally entitled to recover damages” from a negligent
driver who was immune from liability, such that she could collect uninsured
motorist benefits. Id. at 1268. But unlike Zbegner, the insured in Borjas first
brought a claim against the negligent driver. Her action was dismissed on the
basis of the driver’s immunity under the Colorado Governmental Immunity Act.
See id. at 1266. Therefore, at the point the insured in Borjas sought uninsured
motorist benefits from her own insurer, the amount she had recovered from the
tortfeasor–nothing–was already established. No deduction under § 10-4-609(5)
was necessary to determine the extent of her coverage, and the court in Borjas
simply did not address the issue raised here.
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D.
The district court also dismissed Zbegner’s bad-faith and statutory claims
as not ripe for adjudication. “The determination of whether an insurer has in bad
faith . . . breached its duties to an insured is one of reasonableness under the
circumstances. In other words, would a reasonable insurer under the
circumstances have denied or delayed payment of the claim under the facts and
circumstances.” Pham v. State Farm Mut. Auto. Ins. Co., 70 P.3d 567, 572
(Colo. App. 2003) (citation and quotations omitted). “It is reasonable for an
insurer to challenge claims that are fairly debatable.” Id.
Colorado Revised Statutes § 10-3-1115(1)(a) also provides that an insurer
“shall not unreasonably delay or deny payment of a claim for benefits owed to or
on behalf of any first party claimant.” 9 We found no Colorado case defining the
elements of a claim under § 10-3-1115(1)(a), but by its terms it sets forth a
reasonableness standard as well.
The Colorado Court of Appeals has addressed the question of when a claim
for bad-faith nonpayment of UIM benefits accrues. See Cork v. Sentry Ins.,
194 P.3d 422, 428 (Colo. App. 2008). Citing Freeman, the court held “a bad faith
claim for nonpayment of UIM benefits cannot accrue until the insured has
9
“First-party claimant” is defined as one who asserts “an entitlement to
benefits owed directly to or on behalf of an insured under an insurance policy.”
Colo. Rev. Stat. § 10-3-1115(1)(b)(I).
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obtained a judgment against or . . . settled with the underinsured driver.” Id.
Zbegner argues Cork does not apply in this case because it relied on Freeman, but
we have already rejected his contention that Freeman is distinguishable.
III.
Since, under Colorado law, the extent of UIM coverage available cannot be
known until the insured has resolved his claim against the tortfeasor it was
appropriate to consider whether Zbegner’s claims were ripe. The district court
was correct in concluding his claim for UIM benefits involved an uncertain and
contingent event – his recovery from Hanson by judgment or settlement – and he
had not alleged (let alone demonstrated) undue hardship would result from
postponing resolution of this case until his claim against Hanson was resolved.
AFFIRMED.
Entered for the Court
Terrence L. O’Brien
Circuit Judge
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