Professional Documents
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United States v. Milton Raphelson, Appeal of Massachusetts Property Insurance Underwriting Association, 802 F.2d 588, 1st Cir. (1986)
United States v. Milton Raphelson, Appeal of Massachusetts Property Insurance Underwriting Association, 802 F.2d 588, 1st Cir. (1986)
2d 588
Joseph J. Walsh and Sloane & Walsh, Boston, Mass., on brief, for
defendant, appellant.
Roger M. Olsen, Asst. Atty. Gen., Michael L. Paup, David English
Carmack, Joan I. Oppenheimer, Tax Div., Dept. of Justice, Washington,
D.C., and William F. Weld, U.S. Atty., Boston, Mass., on brief, for
plaintiff, appellee. U.S.
Robert V. Deiana, James C. Donnelly, Jr., Michael R. Mosher and Mirick,
O'Connell, DeMallie & Lougee, Worcester, Mass., on brief, for defendant,
appellee Mechanics Bank.
Before BOWNES, BREYER and TORRUELLA, Circuit Judges.
BOWNES, Circuit Judge.
On June 24, 1975, Joseph Walsh, counsel for MPIUA, wrote a letter to counsel
for R & R in which he stated that MPIUA appraised the loss at $30,880, was
prepared to pay that amount, and that the district court should determine to
whom the payments were to be made.1 On August 4, MPIUA filed an answer
and interpleader on R & R's district court action admitting liability for $30,880
on the Auburn policy and $4,541.85 on the Moynagh policy, and asking that it
be discharged from all liability except to the person or persons to whom the
court determined these sums were owed.
In the spring of 1976, the parties to R & R's district court action agreed to its
dismissal on the motion of the United States, on the understanding that a new
action would be instituted. On July 16, 1976, the United States filed the present
action naming as party defendants all persons making claims to the insurance
proceeds. In its answer, filed July 20, 1976, MPIUA admitted that Auburn
sustained losses which "should be covered under the fire insurance policies,"
and admitted that it had appraised the losses under the two policies at $30,880
and $4,541.85. MPIUA for the first time denied liability. It asserted "that the
amount of the losses under the policies referred to in the Complaint cannot be
adjudicated by this Court for the reasons that the reference provisions of the
policy have not been complied with." The reference provisions of the policy
were to the effect that a dispute over the amount of the loss had to be referred to
arbitration before suit could be brought.
On July 1, 1983, the United States and Merchants Bank filed the joint motion
for summary judgment against MPIUA and R & R Plumbing that is the subject
of this appeal. The motion asked that $30,880, MPIUA's appraisal value of the
loss, plus interest, be paid to them in equal amounts pursuant to a settlement
agreement between them.
The district court entered summary judgment, ordering MPIUA to pay $30,880
to the United States and Mechanics Bank in equal amounts, with interest. It
made the following rulings. R & R did not have an interest in the proceeds.
Although Auburn had not filed a sworn proof of loss in conformity with the
policy requirement, MPIUA had waived this requirement by failing to request
such a proof of loss after receiving the loss notices. Since MPIUA had reached
an agreement with Auburn that the minimum amount due under the policy was
$30,880, the policy requirement that any dispute as to the amount of loss be
referred to arbitration before suit could be brought would not come into play
unless more than $30,880 was sought under the policy. In an alternative ruling,
the court held that MPIUA's course of conduct estopped it from now relying on
the arbitration reference provisions of the policy to deny liability. Finally, the
court held that MPIUA must pay interest on the amount owed from November
6, 1974, the date when it received the appraisal of the loss from its accountant
and acted on it as if it had received a proof of loss. MPIUA challenges each of
the district court's rulings.
The Issues
8
The first issue is whether Auburn violated the policy requirement covering a
proof of loss. The policy, incorporating the standard language required by
Mass.Gen.Laws Ann. ch. 175, Sec. 99, states in pertinent part:
9 case of any loss or damage under this policy, a statement in writing, signed and
In
sworn to by the insured, shall be forthwith rendered to the company, setting forth the
value of the property described, the interest of the insured therein, all other insurance
thereon in detail, the purposes for which and the persons by whom the building
described, or containing the property described was used, and the time at which and
manner in which the fire originated, so far as known to the insured. The company
may also examine the books of account and vouchers of the insured, and make
extracts from the same.
10
It is undisputed that the property loss notice form sent MPIUA was neither
signed nor sworn. In such a case Mass.Gen. Laws Ann. ch. 175, Sec. 102,
provides in pertinent part:
11 failure of the insured under a fire policy in the standard form prescribed by
The
section ninety-nine to render the sworn statement specified therein forthwith upon
the occurrence of loss or damage by fire shall not preclude recovery therefor, if the
insured, forthwith upon the occurrence thereof, gives written notice of the fire, and
the location thereof, to the company and if the insured, immediately upon receipt of
any written request so to do made by the company forthwith after it receives such
written notice, renders such sworn statement to the company.
12
The written loss notices sent MPIUA were received four days after the fire, and
gave the date and location of the fire. They, therefore, met the policy and
statutory substitute provisions. Because MPIUA never requested a proof of loss
executed in conformity with the policy's requirement, that requirement was
waived. See Employers' Fire Insurance Co. v. Garney, 348 Mass. 627, 205
N.E.2d 8, 10-11 (1965); Moran v. Phoenix Insurance Co., 7 Mass.App. 822,
390 N.E.2d 1139, 1140-41 (1979).
13
The second issue is whether the two-year statute of limitations bars this action
because the arbitration reference provision of the policy was not complied with.
The policy, again incorporating required language from Mass.Gen. Laws Ann.
ch. 175, Sec. 99, provides for arbitration and states:
14
No suit or action against this company for the recovery of any claim by virtue
of this policy shall be sustained in any court of law or equity in this
commonwealth unless commenced within two years from the time the loss
occurred[.]
15
MPIUA argues that, although it stated in writing that it stood "ready and willing
to pay the $30,880" on the loss and repeated its admission of liability for that
amount in its interpleader in R & R's federal action, Auburn never accepted this
figure. Using this as its premise, MPIUA contends that because Auburn failed
to initiate arbitration proceedings within two years of the loss, February 21,
1974, the two-year statute of limitations extinguished its liability to Auburn. It,
therefore, follows MPIUA urges, that because United States and Merchants
Bank derive their rights under the policy from Auburn, the statute of limitations
applies to them and bars the action of July 16, 1976.
16
The law is well settled that if the insurer and the insured agree to the amount of
the loss then the arbitration reference provision of a standard Massachusetts fire
insurance policy does not apply. Molea v. Aetna Insurance Co. of Hartford,
Conn., 326 Mass. 542, 95 N.E.2d 749, 752 (1950); Alba v. Fireman's Fund
Insurance Co., 295 Mass. 80, 3 N.E.2d 36, 38 (1936). The key question,
therefore, is whether MPIUA agreed to pay Auburn $30,880 for the loss.
17
The district court expressly ruled that MPIUA and Auburn had agreed that
Auburn would be paid at least MPIUA's appraisal figure of $30,880. We agree.
MPIUA's written representations during the two-year period following the fire
that it would pay its appraised figure did not require a formal acceptance by
Auburn. In its letter to R & R, then the plaintiff in a suit to recover the
insurance proceeds, MPIUA stated it was "ready and willing" to pay the
$30,880, but could not pay until it was determined to whom the money was
owed. The letter suggested that the pending action was the proper forum for
settling the competing claims. It did not suggest resorting to arbitration to
determine the amount due. MPIUA filed an interpleader in the R & R case
admitting liability for the $30,880 and asking that its liability be limited to that
amount. MPIUA argues that the wording of the interpleader establishes that it
has always maintained that no agreement was ever reached as to the loss, and it
points to an affidavit of counsel as evidence reaffirming that position. We
disagree. The interpleader stated in pertinent part:
18
The loss sustained by Auburn as a result of the said fire was appraised by the
defendant at $30,880, and that sustained by Moynagh was appraised by the
defendant at $4,541.85.
19
To date there has been [no] agreement between the defendant and the said
insureds or their representatives as to the amounts of the said losses, but the
defendant stands ready and willing to pay the amounts stated in Paragraph 3
hereof to the party or parties entitled to said monies.
Despite the acknowledged lack of agreement as to the amount of the loss over
20
20
$30,880, the interpleader binds MPIUA to pay $30,880 "to the party or parties"
entitled to it. The wording of both the June 24 letter and the interpleader, as
well as MPIUA's conduct in agreeing to the dismissal of the R & R action, in
which it had admitted liability without raising the possibility of its disclaiming
liability when the second action was filed, constitute an agreement by MPIUA
that it would pay $30,880 for Auburn's fire loss.
21
MPIUA argues that its pleading in a prior case is not binding on it in this case,
and should not be considered here as an admission. Although a pleading in one
case is not a conclusive judicial admission in a later one, it is treated as an
ordinary admission which can be contradicted by other evidence. Slate Printing
Co. v. Metro Envelope Co., 532 F.Supp. 431, 436 (N.D.Ill.1982); see also
Fidelity & Deposit Co. of Maryland v. Hudson United Bank, 653 F.2d 766,
777-78 (3d Cir.1981). MPIUA offered no evidence contradicting its earlier
statements. Neither its answer in this action nor the affidavit of counsel
supporting its opposition to the joint motion for partial summary judgment deny
that it appraised the loss payable under Auburn's policy at $30,880 or that it
earlier stated it was ready and willing to pay the money. Because we find that
MPIUA agreed to pay $30,880, we need not consider appellees' alternative
equitable estoppel ruling.
22
Although the present action was filed more than two years after the fire, the
statute of limitations does not bar it because the first action was filed before the
two-year statute had run, and this action was filed within one year of the
dismissal of that action. The policy, using the language of Mass.Gen. Laws
Ann. ch. 175, Sec. 99, provides:
23suit or action upon this policy is enjoined or abated, suit or action may be
If
commenced at any time within one year after the dissolution of such injunction, or
the abatement of such suit or action, to the same extent as would be possible if there
was no limitation of time provided herein for the bringing of such suit or action.
24
The third issue is whether MPIUA is liable for interest on the $30,880.
Mass.Gen. Laws Ann. ch. 175, Sec. 99, provides for interest payment as
follows:
25 company shall be liable for the payment of interest to the insured at a rate of
The
one percent over the prime interest rate on the agreed figure commencing thirty days
after the date an executed proof of loss for such figure is received by the company,
said interest to continue as long as the claim remains unpaid.
26
MPIUA urges that it is not liable for interest because the insured never filed a
properly executed proof of loss. The statute does not address an insurer's
obligation to pay interest when an improperly executed proof of loss is filed.
We have already noted, however, that under Mass.Gen.Laws Ann. ch. 175, Sec.
102, a written notice of loss which meets its requirements is a valid substitute
for the proof of loss required under the policy if the insurer does not
specifically request the latter. Section 102 makes explicit provision for
computing the period of time within which the insurer must discharge its
liability under the policy where a notice of loss becomes substituted for a
properly executed proof of loss:
27 after receiving such written notice, the company does not forthwith make a
If,
written request for the sworn statement, the periods of time within which the
company shall, as provided in such policy, pay the amount for which it is liable ...
shall be computed from the time when the company receives such written notice.
28
The policy provides that if the insured's claim for an agreed amount remains
unpaid thirty days after the date of receipt of a proof of loss the insurer shall be
liable for interest. It, therefore, follows that MPIUA's obligation to pay interest
on the $30,880 commenced thirty days after February 25, 1974, the date on
which it received the notice of loss.
29
The order of the district court is affirmed in all respects except as to interest
which is modified to provide for interest beginning thirty days after February
25, 1974. Remanded.
30
Costs to appellees.
The loss of the insured, Auburn, under policy number 9573 has been appraised
at $30,880 and the loss of Moynagh under policy 9572 has been appraised at
$4,541.85
The Association stands ready and willing to pay these amounts to the party or
parties to whom it is determined the monies are owing.
As you know, the Association is presently restrained from making any payment
whatsoever under these policies and, additionally, it has been notified of the
existence of a number of Federal Tax Liens as well as a lien of the Mechanics
National Bank.
In these circumstances, it would seem appropriate that the matter be
adjudicated by the United States District Court in the action presently pending