GUISEPE A. IELLIMO VS. AMICA MUTUAL INSURANCE COMPANY (L-3123-16, BERGEN COUNTY AND STATEWIDE) ( 2018 )

NOT FOR PUBLICATION WITHOUT THE
APPROVAL OF THE APPELLATE DIVISION
This opinion shall not "constitute precedent or be binding upon any court." Although it is posted on the
internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.
SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-4975-16T1
GUISEPE A. IELLIMO a/k/a
JOSEPH IELLIMO and
BARBARA IELLIMO, his wife,
Plaintiffs-Appellants,
v.
AMICA MUTUAL INSURANCE
COMPANY,
Defendant-Respondent.
___________________________________
Argued October 18, 2018 – Decided December 21, 2018
Before Judges O'Connor and DeAlmeida.
On appeal from Superior Court of New Jersey, Law
Division, Bergen County, Docket No. L-3123-16.
Nabil N. Kassem argued the cause for appellants
(Kassem & Associates, PC, attorneys; Nabil N. Kassem
and Dominique J. Carroll, on the brief).
Steven M. Pardalis argued the cause for respondent
(Smith Mazure Director Wilkins Young & Yagerman,
PC, attorneys; Steven M. Pardalis, on the brief).
PER CURIAM
Plaintiffs Guisepe A. Iellimo (Iellimo) and Barbara Iellimo appeal from
the June 8, 2017 order of the Law Division granting summary judgment in favor
of defendant Amica Mutual Insurance Company (Amica) on plaintiffs' claims
for underinsured motorist (UIM) coverage. We affirm.
I.
On December 1, 2012, Iellimo, while walking in Manhattan, was struck
and injured by a motor vehicle owned and operated by Saul Casiano. On the
date of the incident, Casiano's vehicle was insured by GEICO Insurance
Company (GEICO) under a policy with a liability limit of $25,000. Iellimo was
insured under an automobile policy issued by Amica with UIM coverage with a
limit of $250,000.
In 2015, Iellimo initiated a legal action against Casiano in New York
Supreme Court for damages resulting from the accident. There is no evidence
in the record that Iellimo's counsel notified Amica of the New York action.
On January 11, 2016, Iellimo executed a release of all of his claims arising
from the December 1, 2012 accident against Casiano in exchange for Casiano's
policy limit of $25,000. On that date, Iellimo's counsel sent the signed release
to GEICO with a signed stipulation of dismissal of the New York action. The
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letter requested that a representative of Casiano sign the release and file the
stipulation. Iellimo's counsel also stated, "[t]hank you in advance for promptly
forwarding the settlement check made payable to this firm and Mr. Guisepe A.
Iellimo."
The following day, January 12, 2016, Iellimo's counsel sent a letter to
Amica. The letter provides, in relevant part:
As you are aware, this firm represents the claimant, Mr.
Guisepe (a.k.a. Joseph) A. Iellimo, for personal injuries
he sustained in the December 1, 2012 motor vehicle
accident. By way of this letter, I am hereby putting you
on notice of my client's intent to immediately file an
Underinsured Motorist Claim in this matter. This is due
to the fact that Mr. Iellimo was involved in an accident
with a motor vehicle that was insured by GEICO
Insurance Company, which policy has limited bodily
injury coverage.
Accordingly, I would request that upon receipt of the
within correspondence that you kindly acknowledge
this UIM Claim.
The January 12, 2016 letter does not alert Amica that the prior day Iellimo
released Casiano from all claims arising from the December 1, 2012 accident in
exchange for $25,000, or that Iellimo had filed a complaint against Casiano in
New York Supreme Court, and had signed a stipulation of dismissal in that
action. On January 19, 2016, GEICO issued a settlement check to Iellimo and
his counsel for $25,000.
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On January 22, 2016, Iellimo's counsel again wrote to Amica. Counsel
stated that "Mr. Casiano's carrier has tendered their policy limit to Mr. Iellimo
in settlement of his claims. Additionally, enclosed for your review is their
January 13, 2016 correspondence offering their policy limit of $25,000.00. In
light of the above, I would ask that you review Longworth et al. v. Ohio
Casualty, et al.[,] 223[] N.J. Super. 174 (App. Div. 1988)." The January 13,
2016 correspondence referenced in counsel's letter is not included in the record.
It is not possible, therefore, for us to review the letter to determine why a GEICO
representative would write a letter offering to settle Iellimo's claims two days
after Iellimo had executed a release in favor of Casiano and a stipulation of
dismissal of the pending New York action.
The omission of a copy of the January 13, 2016 letter is troubling in light
of the following statement in the January 22, 2016 letter:
Please allow this letter to serve as formal notice that it
is our client's intention to accept the tendered policy
limit of $25,000.00 under the policy of the tortfeasor in
full and final settlement of any and all claims against
the tortfeasor. If, however, you should desire to protect
your subrogation interests, please be advised that our
client will assign their claim against Saul Casiano to
your company in exchange for payment of the
settlement offer of $25,000.00. It is our client's
intention to accept this offer any time after thirty (30)
days from the date of this correspondence. If your
company intends to pay the policy limits and accept an
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assignment of Mr. Guisepe A. Iellimo's claim against
Saul Casiano, you should notify our offices, in writing,
within that thirty (30) day period. In the absence of any
such notice, the settlement from GEICO Indemnity
Company will be accepted as indicated above.
These statements are obviously false. As of January 22, 2016, Iellimo had
already accepted $25,000 as a settlement from GEICO. He had executed a
release in favor of Casiano with respect to all claims arising from the December
1, 2012 accident, and his counsel had signed a stipulation of dismissal of the
New York action. In addition, GEICO had already issued a $25,000 settlement
check to Iellimo and his counsel. Thus, the offer by Iellimo's counsel to assign
Amica his client's claims against Casiano in the event that Amica elected to
pursue its subrogation claim was illusory. Counsel's reference to the January
13, 2016 letter appears to be designed to create the impression that a settlement
offer from GEICO was pending at the time of the January 22, 2016 letter when,
in fact, the settlement had already been completed.
On February 11, 2016, Amica acknowledged in writing having received
the January 22, 2016 letter. Amica stated that "[b]efore we are able to make a
decision with regard to our subrogation rights, we require the following
information." Amica requested a copy of the GEICO declarations page for
Casiano's policy, a copy of the complaint filed against Casiano "protecting the
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statute of limitations" and an "affidavit of available assets from Saul Casiano,
as it appears from our initial investigation that he owns a rental income
generating property."
On February 18, 2016, Amica again wrote to Iellimo's counsel. The letter
provided:
In the process of investigating the assets of the
tortfeasor in this matter, Saul Casiano, we have
determined that he appears to reside in and own a multi-
unit property which we assume generates rental
income. As such, it appears he may have assets with
which he could contribute something toward settlement
of this claim.
However, in speaking with GEICO, Mr. Casiano's
insurer, we have been advised that your client has
executed a release against Mr. Casiano, and
extinguished any and all claims. We believe that doing
so may have prejudiced our right of subrogation against
Mr. Casiano. Also, your Longworth letter is void, as
Longworth provides us with 30 days to investigate
assets and either tender on behalf of the tortfeasor
policy, or waive our rights. We are unable to do either
of those options as you have already released the
tortfeasor from any further involvement in this matter.
On April 21, 2016, Iellimo and his spouse filed a complaint in the Law
Division against Amica seeking UIM benefits for Iellimo's injuries from the
December 2, 2012 accident. On October 20, 2016, Amica moved for summary
judgment. The trial court denied Amica's motion without prejudice on
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December 2, 2016. The court gave plaintiffs' counsel sixty days to conduct
discovery on the question of whether Amica was prejudiced by Iellimo's failure
to provide notice prior to settling his claims against Casiano.
Following the close of discovery, Amica again moved for summary
judgment. At oral argument on the motion, plaintiffs' counsel admitted a failure
to comply with the procedures established in Longworth. The parties agreed
that the only issue before the court was whether the failure to comply with
Longworth prejudiced Amica. The court, therefore, examined only whether
Casiano had assets available to compensate Amica in the event it paid Iellimo
UIM benefits.
In its bench opinion, the court found that plaintiffs' "former counsel lied
[when he] sent a notice saying we're thinking about accepting this after their
release had already been signed in an attempt retroactively to create a Longworth
record to support the U.I.M. claim." However, noting precedents permitting an
insured who failed to comply with Longworth to pursue UIM benefits in some
circumstances, the court held that "the burden of proof is on the plaintiff who
did [not] give the proper notice to demonstrate the lack of prejudice" to the
carrier. Having reviewed evidence of Casiano's income, car, and income-
producing, multi-unit home, the court held that it was "not satisfied that the
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plaintiff has shown a lack of prejudice." The trial court, therefore, granted
Amica's motion in a June 8, 2017 order. This appeal followed.
II.
We review the trial court's decision granting summary judgment de novo,
using "the same standard that governs trial courts in reviewing summary
judgment orders." Prudential Prop. & Cas. Ins. Co. v. Boylan, 307 N.J. Super.
162, 167 (App. Div. 1998). Rule 4:46-2 provides that a court should grant
summary judgment when "the pleadings, depositions, answers to interrogatories
and admissions on file, together with the affidavits, if any, show that there is no
genuine issue as to any material fact challenged and that the moving party is
entitled to a judgment or order as a matter of law." "Thus, the movant must
show that there does not exist a 'genuine issue' as to a material fact and not
simply one 'of an insubstantial nature'; a non-movant will be unsuccessful
'merely by pointing to any fact in dispute.'" Prudential, 307 N.J. Super. at 167
(quotation omitted).
Self-serving assertions that are unsupported by evidence are insufficient
to create a genuine issue of material fact. Miller v. Bank of Am. Home Loan
Servicing, L.P., 439 N.J. Super. 540, 551 (App. Div. 2015). "Competent
opposition requires 'competent evidential material' beyond mere 'speculation'
A-4975-16T1
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and 'fanciful arguments.'" Hoffman v. Asseenontv.Com, Inc., 404 N.J. Super.
415, 426 (App. Div. 2009) (quotations omitted). We review the record "based
on our consideration of the evidence in the light most favorable to the parties
opposing summary judgment." Brill v. Guardian Life Ins. Co., 142 N.J. 520,
523-24 (1995).
The relationship between an insured and an insurance carrier is
contractual. The obligation to offer UIM coverage, however, is statutory. Zirger
v. General Accident Ins. Co., 144 N.J. 327, 333 (1996). Insurance carriers are
required to offer each insured the option of purchasing coverage up to the limits
of liability coverage, but not exceeding $250,000 per person and $500,000 per
accident against the risk of injury caused by underinsured tortfeasors . N.J.S.A.
17:28-1.1(b). An individual against whom recovery is sought after an accident
is considered "underinsured" when his or liability limits are "at the time of the
accident, less than the applicable limits for underinsured motorist coverage
afforded under the motor vehicle insurance policy held by the person seeking
that recovery." N.J.S.A. 17:28-1.1(e)(1).
A UIM carrier who pays benefits to an insured has the right to subrogate
the insured's claim against the tortfeasor to permit the carrier to recover from
the tortfeasor the UIM benefits paid to its insured. To effectuate this right, a
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UIM carrier may intervene in an insured's trial against a tortfeasor as a way to
avoid relitigating the insured's claim, and to bind the tortfeasor to the issues
decided at trial. Zirger, 144 N.J. at 340-42.
In Longworth, we held that, in order to protect the UIM carrier's
subrogation interest
an insured receiving an acceptable settlement offer
from the tortfeasor should notify his UIM carrier. The
carrier may then promptly offer its insured that sum in
exchange for assignment to it by the insured of the
claim against the tortfeasor. While promptness is to be
ultimately determined by the circumstances, [thirty]
days should be regarded as the presumptive time period
if the insured notices his carrier prior to assignment of
a trial date.
[223 N.J. Super. at 194.]
Our Supreme Court endorsed this approach, holding that there are three
notices that an insured must give to a UIM carrier. Rutgers Cas. Ins. Co. v.
Vassas, 139 N.J. 163, 174 (1995). First, the insured must notify the carrier when
the insured commences a legal action against the tortfeasor. Ibid. Second, the
insured must advise the carrier when he determines the tortfeasor's insurance
coverage is insufficient to compensate the insured for his injuries. Ibid. Third,
the insured must notify the insurer of any settlement offer or arbitration award
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that does not satisfy the insured's damages. Id. at 174-75. This is commonly
known as a Longworth notice.
We addressed the consequences of the insured's failure to follow the
holding in Vassas in several cases. In Breitenbach v. Motor Club of Am. Ins.
Co., 295 N.J. Super. 328 (App. Div. 1996), we held that an insured who accepted
a settlement offer after informing his UIM carrier of the offer, but before he
received permission from the UIM carrier to do so and before the thirty-day
period had expired, was not necessarily precluded from receiving UIM benefits.
Id. at 332-34. We reasoned that the carrier's failure to object to the settlement
in the thirty-day period, even though the settlement had already been accepted,
effectively extinguished its right to subrogation. Id. at 335.
In Rivers v. Allstate Ins. Co., 312 N.J. Super. 379, 381 (App. Div. 1998),
an insured informed her UIM carrier of a suit she filed against a tortfeasor, and
the likelihood that the tortfeasor's insurance coverage would be inadequate to
cover her damages. This satisfied the first two notice requirements established
in Vassas. Id. at 383-84. The insured, however, settled her suit against the
tortfeasor without sending her UIM carrier a Longworth notice, or securing the
carrier's permission to do so. Id. at 381, 384-84. The insured sent a letter to the
carrier after executing a general release in favor of the tortfeasor. Id. at 381.
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The letter falsely stated that the tortfeasor had offered to settle the matter and
that it was the insured's "intention" to accept the settlement, when insured had
already signed the release and received the settlement proceeds. Id. at 384. In
addition, the letter stated that if the carrier elected to preserve its subrogation
rights, the insured would refrain from signing the release, and assign her rights
to recover from the tortfeasor to the UIM carrier. Ibid. This promise was
misleading, as the insured had already released all of her claims.
The carrier responded within thirty days of the notice, requesting more
information before it could decide whether to exercise its rights to subrogation.
Id. at 385. The carrier later denied UIM coverage, having discovered that the
insured had released her claims prior to the Longworth notice. Id. at 381.
When determining whether the insured was precluded from recovering
UIM benefits, we explained that
[t]he Breitenbach court would apparently also allow an
insured relief if the insured was capable of proving "a
lack of prejudice" to the insurer, even though the
insurer's subrogation right had been extinguished by the
release. [295 N.J. Super. at 334]. Presumably, this
means, by way of example, if an insured can
demonstrate that the underinsured tortfeasor is
assetless, and that it is improbable that an insurer would
choose to subrogate against the tortfeasor, UIM
benefits should not be withheld from the insured.
....
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We do not read the Supreme Court's opinion in Vassas
to create a bright-line rule that the insured's failure to
protect the insurer's right of subrogation amounts to
prejudice per se, sufficient under all circumstances to
deny the insured UIM benefits and excuse the insurer
from its coverage obligation.
[Id. at 385-86.]
Because the insured "failed to advance any facts demonstrating a lack of
prejudice to" the UIM carrier, we affirmed the trial court order dismissing the
insured's claim for UIM benefits. Rivers, 312 N.J. Super. at 386; accord CNA
Ins. Cos. v. Cave, 332 N.J. Super. 185, 186-88 (App. Div. 2000) (holding an
insured's release of claims against one of two alleged tortfeasors with no notice
to the UIM carrier is not per se preclusive of a claim for UIM benefits where it
was not clear that the released party was actually liable for the insured's
injuries). It was under this line of precedents that the trial court resolved
Amica's summary judgment motion.
After the trial court's decision, the Supreme Court issued its opinion in
Ferrante v. N.J. Mfrs. Ins. Grp., 232 N.J. 460 (2018). In that case, the insured
plaintiff was injured by an underinsured tortfeasor. Without informing his UIM
carrier, the insured initiated a negligence action against the tortfeasor, who was
insured with a limit of $100,000. Id. at 464. The insured entered into a high-
low agreement with the tortfeasor with a floor of $25,000 and a ceiling of
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$100,000, and proceeded to trial. Ibid. A jury found the tortfeasor liable and
awarded $250,000 in damages. Because of the high-low agreement, the court
entered a judgment for $100,000. Id. at 465.
The day after the judgment was entered, the insured's counsel sent the
UIM carrier a letter falsely stating that the tortfeasor "tendered the policy limits
of $100,000 in exchange for execution of a Release in favor of the tortfeasor"
and requesting that the carrier consent to settle on those terms. The letter did
not mention the suit the insured had filed, the high-low agreement, the trial, or
the verdict. Ibid.
The carrier, having conducted an investigation into the tortfeasor's assets,
authorized the "settlement" described in counsel's letter. Ibid. Three years later,
the insured informed the carrier about the $250,000 judgment in the suit against
the tortfeasor. The insured's counsel later informed the carrier of the high-low
agreement. Ibid. The carrier subsequently filed suit to bar the insured's claims
for UIM benefits, arguing that the insured had improperly waived the carrier's
subrogation rights, and failed to comply with the notice requirements established
by the Supreme Court. Id. at 465-66.
The trial court ultimately agreed with the carrier, granting its motion in
limine for dismissal. We reversed and our majority panel remanded the matter
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to the trial court for it to consider whether the carrier had been prejudiced by
plaintiff's failure to provide it with a timely Longworth notice. The dissenting
member of our panel disagreed, asserting that the carrier need not demonstrate
prejudice where the insured failed to provide notice of the suit against the
tortfeasor, the high-low agreement, and the trial verdict, causing an irretrievable
loss of the carrier's subrogation rights. Because of the dissent, the carrier filed
an appeal as of right pursuant to Rule 2:2-1(a)(2).
The Supreme Court reversed our judgment and reinstated the trial court's
order of dismissal. The Court rejected our majority panel's holding that the
insured was required to show the carrier was prejudiced before the insured's
UIM claim could be barred. Id. at 466-67. The Court began its analysis by
noting that
[o]ur case law has routinely emphasized the importance
of candor by insureds and the obligation to act in a
forthright, open, and honest manner with their carriers
throughout the entire process of their claim. See
Longobardi v. Chubb Ins. Co. of N.J., 121 N.J. 530, 539
(1990) ("[A]n insured's commitment not to
misrepresent material facts extends beyond the
inception of the policy to a post-loss investigation.")[.]
We have provided insureds "an incentive to tell the
truth. It would dilute that incentive to allow an insured
to gamble that a lie will turn out to be unimportant." Id.
at 541-42. Although this case arises in a different
context, we seek to avoid rewarding insureds for
omitting key details in a UIM claim.
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[Id. at 468-69.]
After reviewing the precedents concerning the duties of an insured to keep
a UIM carrier apprised of potential claims, the Court concluded that Ferrante's
UIM claim was barred
[d]espite Ferrante's efforts to distinguish his case from
Vassas, we find Vassas precludes him from recovering
UIM benefits. Like in Vassas, where the insured
initiated a lawsuit and received an arbitration award
without informing the carrier, Ferrante did the same.
He further violated his duty to inform [his UIM carrier]
by entering into a high-low agreement and taking the
matter through a full jury trial without informing [his
UIM carrier.]
[Id. at 473.]
The Court also held that
the cited Appellate Division cases are distinguishable
due to the numerous times Ferrante failed to inform [his
UIM carrier]. In Breitenbach and Rivers, the insured
informed the carrier during litigation, and both cases
dealt more with at which point, if any, it was
appropriate for the insured to accept the settlement
offer without the carrier's consent. Here, we never
reach that point because Ferrante did not inform [his
UIM carrier] of the litigation until more than two years
after it was initiated and actually completed. Similarly,
this case did not involve a day-of-trial settlement or
include multiple tortfeasors, as in Cave; here, the single
tortfeasor was well known, and [the UIM carrier] was
still kept in the dark throughout.
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[Id. at 473-74.]
The Court also rejected the argument that a negligent, rather than
intentional, violation of Longworth warranted a prejudice analysis. Id. at 474.
The Court instead adopted the following approach:
If . . . the insured, regardless of his state of mind, fails
to give the UIM carrier any notice of the UIM claim
until after the final resolution of the underlying tort
action, thereby causing the irretrievable loss of the
carrier's rights to subrogation and intervention before
the carrier has ever learned of the existence of the
claim, coverage is forfeited.
[Ibid. (quotations omitted).]
After a careful review of the record, we conclude that the holding in
Ferrante precludes plaintiffs' claim for UIM benefits from Amica. The record
contains no evidence that Iellimo's counsel notified Amica of the filing of the
New York Supreme Court action against Casiano. In addition, it is undisputed
that Iellimo's counsel accepted a settlement offer from Casiano, submitted an
executed release of all of Iellimo's claims against Casiano, and signed a
stipulation of dismissal of the New York action without notifying Amica. By
doing so, he caused the irretrievable loss of Amica's subrogation rights.
In addition, after having released all of Iellimo's claims against Casiano,
plaintiffs' counsel sent a letter to Amica falsely claiming that his client was
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considering a settlement offer from Casiano, and offering to assign his client's
claims against Casiano to Amica should the carrier elect to exercise its rights to
subrogation. That offer was misleading, at best, given counsel's knowledge that
Iellimo had already signed a release in favor of Casiano. Moreover, counsel
enclosed with his correspondence to Amica what he described as a letter dated
January 13, 2016, containing a settlement offer from Iellimo's carrier. As noted
above, the January 13, 2016 letter is not included in the record in this appeal.
What is clear from the record, however, is that Iellimo's counsel failed to
comply with the procedures set forth in Longworth and Vassas, and, like the
counsel in Ferrante, caused the UIM carrier to lose its subrogation rights. The
fact that counsel thereafter sent misleading correspondence to Amica only
exacerbated the situation. Iellimo's counsel, in fact, never notified Amica of the
settlement of his client's claims against Casiano. The carrier was infor med of
the settlement by Casiano's insurance carrier. As a result, as held in Ferrante,
plaintiffs' UIM claim is barred, and a showing by plaintiffs that Amica was not
prejudiced by the settlement of Iellimo's claims will not salvage his UIM claim.
We have considered the remaining arguments raised on appeal, and
conclude they lack sufficient merit to warrant discussion in a written opinion.
R. 2:11-3(e)(1)(E).
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Affirmed.
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