Court Opinion

ID: 9764538
Source: CourtListenerOpinion
Date Created: 2023-08-29 03:26:37.998636+00
Date Added: 2024-06-11T07:29:57.657058
License: Public Domain

LAMBERT, Chief Justice,
dissenting.
Respectfully, I dissent.
The controlling issue in this case is whether alleged acts of misrepresentation, concealment or non-disclosure by the decedent’s insurance carrier, Allstate Insurance Co., were sufficient, on grounds of estoppel, to preclude summary judgment against respondent, Alsabi, and in favor of movant, the decedent’s administrator. Proper resolution of this issue requires an analysis of the relationship between an insured and an automobile liability insurance carrier to determine whether misconduct by the latter may be attributed to the former so as to prevent the running of statutes of limitations.
On or about June 3, 1991, respondent, Hashim M. Alsabi, and Fred Whalen, mov-ant’s decedent, were involved in a motor vehicle accident. Thereafter, respondent received basic reparation benefits from his no-fault carrier, but on February 4, 1992, the last of such payments was made. The next day, February 5, 1992, Fred Whalen, a man of eighty-two years, died of causes unrelated to the motor vehicle accident, and on March 2, 1992, his will was probated by order of the Jefferson District Court. There was no appointment of a personal representative and this circumstance prevailed until respondent obtained appointment of the public administrator in November of 1994, two and one-half years later.
On April 29, 1992, respondent’s counsel contacted Allstate, Whalen’s liability insurance carrier, concerning settlement of respondent’s personal injury claim. Thereafter, counsel for respondent negotiated with Ms. Peggy Smith, the Allstate adjuster handling the claim, concerning settlement. In a letter dated May 13, 1993, respondent’s counsel replied to Ms. Smith’s letter of April 26, 1993, and discussed the method of calculating the value of the claim and advised Ms. Smith that he would recommend rejection of her existing offer. Respondent’s counsel also established a target date for commencement of litigation if no settlement was achieved. Exactly when the Allstate adjuster, Ms. Smith, learned of Fred Whalen’s death is unknown, but there is no doubt that on or about September 8, 1993, she was so informed. On that date, Mrs. Crystal G. Whalen, the decedent’s daughter-in-law, wrote Ms. Smith confirming their conversation of that same date and in the letter stated that Mr. Whalen had passed away on February 5, 1992. In her letter, Crystal G. Whalen also expressed the concern of her mother-in-law, the decedent’s widow, as follows:
As I advised, Mrs. Whalen is concerned about exposure in the event this case cannot be settled within the policy limits of $25,000. This is a very real concern for an elderly woman. The Whalen family would appreciate every effort you can put forth to resolve this matter. To avoid litigation and exposure to the *606Whalen’s personal property, settlement would be appreciated.
Contacts continued between respondent’s counsel and Allstate concerning settlement. On October 15, 1993, Ms. Smith wrote respondent’s counsel a letter which referenced “our insured: Fred Whalen.” While the text of the letter concerned settlement, there was no disclosure that Mr. Whalen had died more than twenty months earlier and Ms. Smith reiterated a settlement offer, “Of course, our offer of settlement in the amount of $2,000 still stands.” About a month later, on November 22, 1993, a similar letter was written, likewise without any disclosure of Mr. Whalen’s death.
On February 3, 1994, in the Jefferson Circuit Court, respondent filed a personal injury claim against “Fred Whalen.” Process was issued but returned unserved on February 16, 1994, with the notation that Fred Whalen was deceased. All parties agree that the complaint was filed within the time allowed by law and that process was issued in good faith. Manifestly, however, the proper party defendant was not named and by the time the complaint was properly amended, time for bringing the claim had expired.
We must first consider the relationship between an insured and an automobile liability insurance carrier and determine whether misconduct by the latter may prevent the running of statutes of limitations in favor of the former. Here it is contended that alleged misconduct of Allstate prevented the statute of limitation from running in favor of movant, administrator of the estate of Fred Whalen, an Allstate insured.
The relationship between an insured and an automobile liability insurance carrier arises by contract. The essence of the contract is the payment of premium costs in return for promised indemnity, defense and associated services. The terms of the contract, however, are heavily regulated by the law as liability insurance is mandatory (KRS 304.39-080) and any inconsistency between the policy and the law will result in reformation of the policy to comply with the law. State Farm v. Mattox, Ky., 862 S.W.2d 325 (1993); Allstate v. Dicke, Ky., 862 S.W.2d 327 (1993). Policy provisions which invalidate coverage or reduce coverage below statutory mínimums have been held invalid on public policy grounds. Bishop v. Allstate Ins. Co., Ky., 623 S.W.2d 865 (1981). Moreover, the Kentucky General Assembly has enacted a statute known as the “Unfair Claims Settlement Practices Act” which proscribes various acts or omissions among which are misrepresenting pertinent facts or insurance policy provisions relating to coverage. KRS 304.12-230. In State Farm Mutual Auto Ins. Co. v. Reeder, Ky., 763 S.W.2d 116 (1988), this Court authorized a third party claimant to bring an action for damages under the Unfair Claims Settlement Practices Act and held that not only was the Act enforceable by the Commissioner of Insurance, but a private citizen who had been damaged by the action of such insurance carrier could sue in his own right.
We find no reason to excuse this matter because it is brought by a third party claimant. The action results from the bad faith in adjusting the claim. If a first-party carrier can be sued for bad faith, there is no reason why a third party carrier cannot also be sued.
Id. at 118.
While this Court has not heretofore directly answered whether the misconduct of an insurance carrier in adjusting a claim can be imputed to the insured so as to deny benefit of a statute of limitation, we have come close. In Miller v. Thacker, Ky., 481 S.W.2d 19 (1972), an action was brought in Kentucky by one who was an adult under Kentucky law but a minor under the law of Mississippi, her place of domicile. As the states of Kentucky and Mississippi had different ages of majority and different statutes of limitations for personal injury actions, it was contended that by virtue of misrepresentation by in*607surance adjusters, the defendant should be estopped to assert the Kentucky one-year statute of limitations. In a thorough discussion this Court focused on the alleged misconduct of the insurance adjusters and applicable decisional law and concluded that under the evidence presented, “plaintiff was justified in delaying the institution of the action until a reasonable time after the insurer gave notice of its intention to rely upon the expiration of the statutory limitations.” Id. at 23. Of principal significance here, the Court in Miller made no distinction between the insured and the insurer. While the insurer was joined as a party defendant, in the opinion there is no suggestion that the misconduct of the insurer was not attributable to the insured. Likewise in Burke v. Blair, supra, no distinction was made between the defendant and his attorney who allegedly induced inaction on the part of plaintiff by fraud or concealment. The Court seems to have assumed that if the evidence justified it, the actions of the attorney would be attributable to the client. We have held that “[ajgency is a legal conclusion to be reached only after analyzing relevant facts,” (Wright v. Sullivan Payne Co., Ky., 839 S.W.2d 250, 253 (1992)), and automobile liability insurance policies generally grant the insurer an unconditional right to settle the claim within policy limits without regard to the wishes of the insured. The letter of Crystal G. Whalen, quoted herein-above, on behalf of her mother-in-law, the decedent’s widow, contains an express grant of authority to settle within policy limits and broadly requests termination of litigation.
In view of the mandatory nature of automobile liability insurance, the comprehensive statutory and regulatory control of the industry, the broad discretion allowed insurers in settlement of claims, and public perception that the insurer controls the claims adjustment process, we should have no reluctance in holding that to the extent of available insurance coverage the insurance carrier is the agent of the insured and the death of the insured while legal obligations remain outstanding does not terminate the agency relationship. The foregoing is consistent with our public policy as expressed in KRS 396.011(2)(b).
The next step in the analysis is to determine whether misrepresentation, concealment or non-disclosure by Allstate, if proven to the satisfaction of the jury, would be sufficient to estop movant from asserting the statute of limitations defense. Initially, it should be observed that it is well settled that “a party may be estopped to plead limitation where he has induced inaction on the part of the plaintiff by his false representation or fraudulent concealment.” Burke v. Blair, Ky., 349 S.W.2d 836, 838 (1961) (quoted with approval in Cuppy v. General Accident Fire & Life Assurance Corp, Ky., 378 S.W.2d 629, 630-31 (1964). In Miller v. Thacker, Ky., 481 S.W.2d 19 (1972), discussed supra, the Court’s legal analysis is highly persuasive. After reviewing prior case law and articulating the “clashing policy considerations,” the Court stated:
Equity’s right to prevent by estoppel the pleading of limitations is historic and well recognized. Perhaps we have been over stringent in some of our prior opinions. In any event, since cases differ on their facts and the relationship and relative bargaining positions of the parties change, we can come no closer than saying that the relevant inquiry should be whether or not under all the facts and circumstances the plaintiff was justified in relying upon the representations and activities of the insurance adjuster in delaying fifing suit until time had run out.
Id. at 23.
As to misleading or failing to disclose, in Munday v. Mayfair Diagnostic Laboratory, Ky., 831 S.W.2d 912 (1992), we reviewed various statutes, and decisions and discussed application of equitable estoppel principles where fraud, misrepresentation or concealment was alleged as a basis for avoidance of a statute of limitation. We *608summarized our decision as requiring “some act or conduct which in point of fact misleads or deceives plaintiff and obstructs or prevents him from instituting his suit while he may do so.” Id. at 914 (quoting Adams v. Ison, Ky., 249 S.W.2d 791, 792 (1952)). We recognized that while fraud ordinarily requires an affirmative act by the party charged, an exception might be found where the law imposed a duty to speak or disclose. We concluded with the holding that failure to comply with a statute which had the purpose of informing the public of the identity of partners doing business under an assumed name estopped the partners from using the statute of limitations.
This Court has recently dealt with the issue at hand where the misconduct was by plaintiffs counsel who did not disclose the death of her client to opposing counsel and settled the case as if the client were still living. In Kentucky Bar Association v. Geisler, Ky., 938 S.W.2d 578 (1997), we publicly reprimanded counsel for the misconduct and in our opinion established or reiterated certain important points. We stated that failure to disclose the fact of her client’s death amounted to an affirmative misrepresentation in violation of SCR 3.130, and that letters exchanged in the negotiations implied a falsehood. We expressed the view that guidelines should be unnecessary, “... for an attorney to understand that when their client dies, they are under an obligation to tell opposing counsel such information. This seems to be a matter of common ethics and just plain sense.” Id. at 580.
I believe the majority is wrong when it excuses the misleading nature of Ms. Smith’s, the Allstate adjuster’s, letter with the facile explanation that “of course, every business person knows that file references are just that: something to assist both the sender’s and the addressee’s clerical employees in identifying the file into which this correspondence should be placed.” This view ignores the positive assertions contained in the letters by which Fred Whalen was identified in the present tense as “our insured” or like reference. Moreover, I believe the majority errs in asserting that “Fred Whalen was Allstate’s insured, whether alive or dead.” In my view, upon the death of an insured, the benefit of the insurance runs to the decedent’s estate or the decedent’s successor in interest.
The reality of modern motor vehicle injury claims adjustment places insurance claims adjusters in a central role. When the claim arises, the adjuster and the claimant usually deal directly with one another. If their negotiations fail, the adjuster negotiates with plaintiffs counsel, and even after litigation is begun, the adjuster frequently deals directly with plaintiffs counsel. While we have never held that claims adjustment constitutes the practice of law and limited that endeavor to members of the bar, neither should adjusters be free of the ethical strictures applicable to lawyers when their participation is a part of the judicial process. If insurance adjusters undertake to negotiate with personal injury claimants or their lawyers, honesty is not too much to require. As lawyers are held to the high ethical standards enunciated in Geisler, no less should be required of their adversaries in the claims adjustment process.
We have not overlooked Pospisil v. Miller, Ky., 343 S.W.2d 392 (1961), Jackson v. Jackson, Ky., 313 S.W.2d 868 (1958), and Hopperton v. Louisville & Nashville R. Co., 34 S.W. 895, 17 Ky.Law Rep. 1322 (1896). Perhaps these cases are distinguishable from the case at bar in that they dealt with claims filed outside the time allowed while in this case the claim was timely brought but not against the proper party. Jackson v. Jackson, supra, also distinguished Adams v. Ison, supra, on the basis of “active concealment of the true facts” and left open the possibility that in such circumstances an estoppel would be discovered. In Pospisil v. Miller, supra, despite allegations which strongly suggested waiver and affirmative misrepresentation, and while denouncing the alleged dis*609honesty, this Court granted no relief from plaintiffs failure to timely file her claim. In a harsh legal analysis and notwithstanding alleged serious misrepresentations, this Court said “The insurance adjuster was her adversary and she had no right to rely upon his representations of this nature.” 1 Id. at 394. This view should be abandoned.
Our decision in Geisler represents the enlightened view that lawyers, while adversaries, have a duty to be truthful with one another. Lawyers may not withhold, mislead or misrepresent as to facts so fundamental as whether their clients in personal injury cases are living or dead. Geisler also recognized that an overtly false statement is not the only means of misrepresentation. For this, the Court quoted from Virzi v. Grand Trunk Warehouse & Cold Storage Co., 571 F.Supp. 507 (E.D.Mich.1988), as follows: “He was never -placed in a position to do so because during the two weeks of settlement negotiations defendants’ attorney never thought to ask if plaintiff was still alive. Instead, in hopes of inducing settlement, plaintiffs attorney chose not to disclose plaintiff’s death.” Virzi at 511. In a fine statement of principle, quoted with approval in Geis-ler, the Virzi Court said:
This Court feels that candor and honesty necessarily require disclosure of such a significant fact as the death of one’s client. Opposing counsel does not have to deal with his adversary as he would deal in the marketplace. Standards of ethics require greater honesty, greater candor, and greater disclosure, even though it might not be in the interest of the client or his estate.
Virzi at 512.
Just as the standards of “the marketplace” no longer apply to dealings between lawyers in settlement negotiations, neither should they apply to insurance adjusters who serve as frontline insurance industry representatives. My view in this regard is strengthened by the recognition that while this Court has direct supervision of the ethical conduct of lawyers, we are without such direct power over insurance adjusters. Our supervision of these participants in the judicial process, for the purpose of enforcing reasonable ethical standards, must be by means of our interpretations of rules, statutes, and common law principles. It is our duty to assure that ethical misconduct not be rewarded.
This aspect of the majority opinion is profoundly disturbing. It seems to allow non-lawyers to act deceptively in their dealings with lawyers. To the extent that non-lawyers participate in the process of tort claim adjustment, they should be held to the same ethical standards as members of the Bar.
STUMBO and WINTERSHEIMER, JJ., join in this dissenting opinion.

. The essential allegations in Pospisil v. Miller are as follows:
The amendment was filed in due time. It charged that a representative of Miller’s insurance carrier told the plaintiff that his company had “assumed and recognized its liability to the plaintiff,” and that a settlement would be made with her when the bills were all in and when she had fully recovered. It is further alleged that he told her she would, in due course, be fully compensated if she did not consult or employ an attorney. The amendment further asserted that the plaintiff relying on these statements did not consult an attorney until two years after the accident.