Travelers Home & Marine Insurance Company v. Castellanos ( 2015 )

In the Supreme Court of Georgia
Decided: June 1, 2015
S14G1878. TRAVELERS HOME AND MARINE INSURANCE
COMPANY v. CASTELLANOS.
HUNSTEIN, Justice.
In this dispute over recovery under an uninsured motorist (UM) insurance
policy, we granted certiorari to consider the burden of proof on summary
judgment as between the insured plaintiff and the UM carrier, where the UM
carrier has denied coverage based on a claim that the at-fault driver was not
“uninsured” as defined in the UM policy because the driver’s liability carrier
had not “legally denied” coverage. We conclude that the Court of Appeals erred
in placing the burden of proof on the UM carrier in this instance, and we
therefore reverse.
In connection with a 2009 car accident, Appellee Luis Castellanos
obtained a judgment against Jose Santiago for compensatory and punitive
damages. In the tort litigation, Santiago was defended by his insurer, United
Automobile Insurance Company; Santiago was absent from trial. After the trial,
United offered to settle with Castellanos for an amount less than the total
judgment, claiming that punitive damages were not covered under Santiago’s
policy. After Castellanos rejected United’s offer, United denied coverage to
Santiago on the ground that he had failed to cooperate in defending the lawsuit
as required under his policy.
Castellanos then sought payment of the judgment from his uninsured
motorist carrier, Travelers Home & Marine Insurance Company. Travelers had
participated in discovery in the underlying tort suit and its counsel had attended
the trial. The Travelers policy provides coverage for, inter alia, compensatory
damages that an insured is “legally entitled to recover from the owner or
operator of an ‘uninsured motor vehicle.’” An “uninsured motor vehicle” is
defined, in pertinent part, as a motor vehicle “[t]o which a liability bond or
policy applies at the time of the accident but the bonding or insurance company
. . . [l]egally denies coverage.”1 Castellanos made a written demand for payment
under his UM policy, but Travelers never responded to the demand. Castellanos
thereafter sued Travelers for bad faith refusal to pay under its policy. See
This policy language is consistent with the Georgia Uninsured Motorists Act.
1
OCGA § 33-7-11 (b) (1) (D) (iii).
2
OCGA § 33-7-11 (j) (authorizing suit for recovery of penalties and attorney fees
for insurer’s bad faith refusal to pay covered loss). As part of its defense,
Travelers contends that United did not “legally deny” coverage under Santiago’s
policy, such that Santiago was not an “uninsured motorist” and Castellanos’
accident was not covered under the UM policy.
On cross-motions for summary judgment, the trial court agreed with
Travelers, concluding that Castellanos had “failed to present evidence that there
was a ‘legal denial’ of coverage by United.” A fractured Court of Appeals
reversed the award of summary judgment to Travelers, holding that the trial
court had improperly shifted the burden onto Castellanos to come forward with
evidence to rebut Travelers’ defense. Castellanos v. Travelers Home & Marine
Ins. Co., 328 Ga. App. 674 (1) (760 SE2d 226) (2014). The majority concluded
that
[a]lthough evidence may exist that United's denial of benefits (on
the basis that Santiago failed to cooperate with the defense) was not
legally sustainable (for example, if United never requested his
cooperation), once Castellanos met his threshold burden of showing
that he was entitled to UM benefits, Travelers had the burden of
presenting such evidence to justify its denial of coverage, as it
would for any other affirmative defense.
Id. at 678-679. The dissent disagreed, opining that it was Castellanos’ burden
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to show that Santiago was an uninsured motorist and that, as part of that
showing, Castellano bore the burden, on motion for summary judgment, of
producing evidence that United had legally denied coverage. Id. at 680-685(McMillian, J., dissenting). The dissent further opined that the mere fact that
Santiago had failed to appear at trial was not sufficient to meet this burden and
that Castellanos was required to furnish “proof, at the very least, that the insurer
made good faith efforts to secure the insured’s attendance and/or cooperation.”
Id. at 685. This, the dissent opined, Castellanos had failed to do.
We granted certiorari to clarify the burden of proof issue. We agree with
the Court of Appeals’ dissenting judges as to the proper allocation of the burden
of proof; we also agree that Castellanos failed to satisfy this burden.
1. We adopt the straightforward analysis employed by the Court of
Appeals dissent regarding the parties’ relative burdens of proof on Travelers’
motion for summary judgment:
It is well settled . . . that Castellanos, as the insured, had “the . . .
burden to prove (1) the existence of a policy of liability insurance
containing uninsured motorist protection, and (2) that [Santiago]
was an uninsured motorist at the time of the [wreck]”. . . .
This requirement is simply a reiteration of the principle that an
insured claiming an insurance benefit “has the burden of proving
4
that a claim falls within the coverage of the policy.” Thus, “[t]o
establish a prima facie case on a claim under a policy of insurance
the insured must show the occurrence was within the risk insured
against.”. . .
The applicable policy provisions state that Travelers agreed to “pay
compensatory damages which an ‘insured’ is legally entitled to
recover from the owner or operator of an ‘uninsured motor
vehicle’” because of an insured's bodily injury or property damage
caused by an accident. The Policy defines an “uninsured motor
vehicle” in pertinent part as “a land motor vehicle or trailer of any
type . . . [t]o which a liability bond or policy applies at the time of
the accident but the bonding or insurance company . . . [l]egally
denies coverage.” (Emphasis supplied.) . . . And this Court has
held that “coverage [cannot] be said to have been legally denied
unless the denial is, under applicable law, legally sustainable.”
(Emphasis omitted.)
Castellanos, 328 Ga. App. at 680-681 (McMillian, J., dissenting).
Thus, in order to present a prima facie case for coverage and thereby
withstand Travelers’ motion for summary judgment on his bad faith refusal to
pay claim, Castellanos bears the burden of presenting evidence that Santiago's
vehicle was an uninsured motor vehicle under the UM provisions of the
Travelers policy. Where, as here, Castellanos avers that Santiago’s vehicle was
uninsured by virtue of United’s denial of coverage, Castellanos must show that
this denial was legally sustainable. See Southern General Ins. Co. v. Thomas,
197 Ga. App. 196, 197 (397 SE2d 624) (1990); Frank E. Jenkins III et al., Ga.
5
Automobile Insurance Law § 32:4 (a) (2014-2015 ed.).
To justify the denial of coverage for an insured’s non-cooperation under
Georgia law, the insurer must establish:
(a) that it reasonably requested the insured’s cooperation in
defending against the plaintiff’s claim, (b) that its insured wilfully
and intentionally failed to cooperate, and (c) that the insured’s
failure to cooperate prejudiced the insurer’s defense of the claim.
Vaughan v. ACCC Ins. Co., 314 Ga. App. 741, 742-743 (2) (725 SE2d 855)
(2012); see also Cotton States Mut. Ins. Co. v. Proudfoot, 123 Ga. App. 397 (3)
(181 SE2d 305) (1971); H.Y. Ayers & Sons, Inc. v. St. Louis Fire & Marine Ins.
Co., 120 Ga. App. 800 (3) (172 SE2d 355) (1969). Here, Castellanos must
prove these same elements to demonstrate that United’s denial of coverage was
legally sustainable and that, therefore, Santiago was an uninsured motorist under
the Travelers policy. To withstand Travelers’ motion for summary judgment,
Castellanos must come forward with “‘specific evidence giving rise to a triable
issue’” on each of these elements. Cowart v. Widener, 287 Ga. 622, 623 (1) (a)
(697 SE2d 779) (2010). Specifically, Castellanos bears the burden of producing
evidence that (1) United reasonably requested Santiago’s cooperation in the tort
litigation; (2) Santiago wilfully and intentionally refused to cooperate; and (3)
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prejudice resulting therefrom.
In assessing the nature of the evidence required to discharge the plaintiff’s
burden in this scenario, however, we bear in mind that “[u]ninsured motorist
statutes are remedial in nature and must be broadly construed to accomplish the
legislative purpose.” Smith v. Commercial Union Assur. Co., 246 Ga. 50, 51
(268 SE2d 632) (1980). That “legislative purpose” is
to require some provision for first-party insurance coverage “to
facilitate indemnification for injuries to a person who is legally
entitled to recover damages from an uninsured motorist, and thereby
to protect innocent victims from the negligence of irresponsible
drivers.”
Id. Accordingly, in these circumstances, we must be mindful that the plaintiff
is a stranger to the relationship between the tortfeasor and its insurer and that,
therefore, the plaintiff’s access to the information necessary to establishing his
claims will be limited. In obtaining such evidence, the plaintiff will likely be
compelled to resort to discovery from the insurer regarding its efforts to contact
its insured and its lack of success in securing cooperation; given its potential
liability for refusal to pay a covered claim, we would expect the insurer to
maintain documentation to substantiate its non-cooperation defense, and
requiring the plaintiff to obtain such evidence to establish his resulting
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entitlement to UM coverage is not unreasonable.
However, regarding the prejudice element, concrete evidence may be
difficult, if not impossible, for the plaintiff to obtain. Nevertheless, in some
circumstances, the likelihood of prejudice may be so high that it can be
presumed, even in the absence of concrete evidence. The complete absence of
the tortfeasor from trial is such a circumstance. As our Court of Appeals has
explained:
Every person familiar with the trial of cases by jury knows that the
case of an individual defendant is seriously, if not hopelessly,
prejudiced by his absence from the trial. His failure to be present
in defense of the claim can have an intangible effect upon the jury
both as to the question of liability and the amount of the verdict, the
net effect of which is difficult to measure. Unexpected
developments in the plaintiff’s evidence might be offset by an
explanation on the part of the insured. This is particularly true
where, as here, the insured is a material witness to the issues, or
some of them.
(Citations and punctuation omitted.) H.Y. Ayers & Sons, Inc., 120 Ga. App. at
803. A number of courts have presumed prejudice to the insurer when the
insured is completely absent from trial. See id. (citing authorities presuming
that insured’s wilful failure to attend trial to aid in his defense is prejudicial).
Such a presumption seems especially warranted in the UM context, where the
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plaintiff and his UM insurer are strangers to the relationship between the
tortfeasor and the tortfeasor’s insurer, and where establishing prejudice from the
tortfeasor’s absence essentially requires the plaintiff to undercut his own legal
position vis-a-vis the tortfeasor by positing that, had the tortfeasor cooperated,
the tortfeasor would have fared better in the tort litigation. Accordingly, in the
UM context, a plaintiff may rely on a presumption that the tortfeasor’s complete
absence from trial prejudiced the tortfeasor’s insurer so as to permit that insurer
to lawfully deny coverage to the tortfeasor, subject to rebuttal by the UM carrier.
Applying this presumption of prejudice and finding no evidence here to
rebut it, we are left to assess whether Castellanos has adduced evidence that
United reasonably requested Santiago’s cooperation in the tort litigation and that
Santiago wilfully and intentionally failed to cooperate. Having carefully
reviewed the record, we find that Castellanos has failed to satisfy this burden.
As both the trial court and the Court of Appeals dissent noted, Castellanos has
presented absolutely no evidence regarding the nature and extent of United’s
efforts to contact Santiago regarding the tort litigation.2 While it is undisputed
2
In fact, we have uncovered no evidence that Santiago had any actual notice of
the litigation at all, which, if true, would prevent a finding that Santiago had wilfully
and intentionally failed to participate in it. Though Castellanos claims to have
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that Santiago failed to appear for trial and that the interrogatory responses
submitted on his behalf by counsel are substantially incomplete, there is no
evidence in the record regarding what measures United took to secure his
presence and participation. Though Castellanos asserted in his brief and at oral
argument that United issued a reservation of rights to Santiago based on his non-
cooperation, the record contains no actual proof thereof.3 While Castellanos
also referred to statements in place made by United’s counsel at trial to the
effect that Santiago had relocated to Mexico, the record contains no trial
transcript reflecting such comments.4 In addition, while Santiago’s son attested
in an affidavit that his father had relocated to Mexico, this fact alone
demonstrates nothing about United’s efforts to contact him regarding the
perfected service on Santiago, the record reflects only that a summons was served on
Santiago’s son, who was also named in the tort litigation, and who attested via
affidavit that his father did not reside with him at the time of service or at any point
during the pendency of the tort litigation.
Rather, on this point, the record contains only Castellanos’ unverified
3
complaint averring that United had issued such a reservation of rights and Travelers’
answer, averring that it lacked information sufficient to admit or deny this allegation.
4
Indeed, it appears that the trial was not transcribed.
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litigation.5 All that appears in the record other than allegations in pleadings and
briefs is the letter – which has nowhere in the record even been formally
authenticated – by which United denied coverage for Castellanos’ claim, citing
Santiago’s “lack of cooperation in the defense of this lawsuit” and “failure to
attend the resulting trial.” This letter contains no information regarding
United’s efforts to contact Santiago.
We are sympathetic to Castellanos, who has endured years of litigation in
a fruitless attempt to obtain and satisfy a judgment, first against the tortfeasor
whose negligence caused his injuries, next against the tortfeasor’s insurer, and
finally against his own UM carrier, to whom he has duly paid premiums to
protect himself against just such an eventuality. But our sympathy for
Castellanos’ unfortunate plight cannot justify suspension of the procedural and
evidentiary standards governing these proceedings. Because Castellanos has
failed to adduce any evidence of United’s efforts to secure Santiago’s
cooperation or Santiago’s wilful and intentional disregard thereof, he has failed
to satisfy his burden of establishing a genuine issue of material fact, see Cowart,
5
The statements in this affidavit are somewhat suspect in any event; though the
affidavit states that Santiago relocated to Mexico in May 2009, the car accident with
Castellanos did not occur until September 2009.
11
287 Ga. at 623, on either of these essential elements of his claim of entitlement
to UM coverage. Accordingly, Travelers is entitled to summary judgment, and
the trial court was correct in so holding.
Judgment reversed. All the Justices concur.
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