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Case Law - save on Lexis / WestLaw. Original WP 5.1 Version This case can also be found at 155 N.J. 29.
(This syllabus is not part of the opinion of the Court. It has been prepared by the Office of the Clerk for
the convenience of the reader. It has been neither reviewed nor approved by the Supreme Court. Please
note that, in the interests of brevity, portions of any opinion may not have been summarized).
Argued March 16, 1998 -- Decided June 15, 1998
STEIN, J., writing for a unanimous Court.
This appeal presents the issue whether an employee exclusion contained in a comprehensive
general liability (CGL) insurance policy precludes a corporate policyholder from securing coverage for
damages arising from a claim of wrongful termination.
Plaintiff John Picciallo worked as a salesman for LCA for over thirty years until his termination on
December 31, 1991. At the time of his dismissal, Picciallo was sixty-seven years old.
In April 1992, Picciallo filed suit against LCA, alleging that he had been harassed by company
employees for the purpose of forcing him into retirement. He further alleged that LCA violated the Law
Against Discrimination (LAD) by terminating him simply because of his age. The complaint set forth several
other causes of action, including breach of contract, negligence, and tortious interference with contract.
During discovery, Picciallo asserted that as a result of his wrongful dismissal from LCA, he suffered from
various emotional and physical ailments.
The events surrounding Picciallo's dismissal occurred at about the same time LCA changed its
insurance carrier from Michigan Mutual to American Motorists and Lumbermens Mutual, the latter of the two
belonging to the Kemper Companies and collectively referred to as Kemper. Both Michigan Mutual and
Kemper had issued comprehensive general liability (CGL) policies that contained a standard employee
exclusion clause, providing that the insurance did not apply to bodily injury to an employee of the insured
arising out of and in the course of employment by the insured.
Ultimately, both Michigan Mutual and Kemper were joined in the suit. Subsequently, the trial court
granted summary judgment in favor of both carriers, holding that the language of the employee exclusion was
clear and precluded coverage for Picciallo's claim.
In an unreported decision, the Appellate Division affirmed the grant of summary judgment in favor of
the carriers, but held that coverage was not precluded by the employee exclusion. Extending the reasoning of
Cairns v. City of East Orange,
267 N.J. Super. 395 (App. Div. 1993), the court determined that Picciallo's
termination did not arise out of his employment and concluded that the employee exclusion sufficed only to
exclude workers compensation claims. The court further determined that Picciallo's claim was an
occurrence within the meaning of the policies and that the occurrence (receipt of the letter of termination)
fell within the period of Michigan Mutual's coverage, but that LCA's delay of nearly two years before
notifying Michigan Mutual of the suit violated the policy's notice requirement and precluded coverage.
The Supreme Court granted LCA's petition for certification, Picciallo's petition for certification,
Kemper's cross-petition for certification, and Michigan Mutual's cross-petition for certification.
HELD: The employee exclusion contained in the insurers' comprehensive general liability insurance policy
precluded LCA, a corporate policyholder, from securing coverage for damages arising from Picciallo's claim
of wrongful termination.
1. The critical phrase arising out of, which frequently appears in insurance policies, has been interpreted
expansively by New Jersey courts in insurance coverage litigation. (p. 9)
2. Although, pursuant to Schmidt v. Smith, also decided today, LCA may have had coverage for Picciallo's
claims under the employer's liability section of its workers' compensation policy, that issue is not before the
Court and, therefore, is not addressed. (pp. 9-11)
3. Cairns is distinguishable from the issue presented by this appeal because it dealt with the interpretation of
the Workers' Compensation Act rather than the application of an employee exclusion in a CGL insurance
policy. (pp. 11-13)
4. The clear weight of authority from other jurisdictions favors enforcement of the employee exclusion to bar
coverage for claims similar to that advanced by Picciallo. (pp. 13-16)
5. In general, insurance policy exclusions must be narrowly construed, the burden to bring the case within the
exclusion resting with the insurer. Although ambiguities in policy language will be resolved in favor of the
insured in order to give effect to the insured's reasonable expectations, an insurance policy should generally
be interpreted according to its plain and ordinary meaning so as not to disregard the clear import and intent of
a policy exclusion. (pp. 16-17)
6. Whether specific acts of harassment or discrimination took place outside the workplace, such as harassing
telephone calls to Picciallo's home, is of no consequence because such conduct nevertheless would have arisen
out of the employment relationship between Picciallo and LCA. (pp. 17-18)
7. Were the employee exclusion interpreted only to bar coverage for workers' compensation claims, the
workers' compensation exclusion in LCA's CGL policy would be redundant. (pp. 18-19)
8. Because the relevant contract is a CGL policy rather than a workers' compensation policy, the public
policy considerations underlying the workers' compensation system are not implicated. (pp. 19-20)
9. The added disclaimer in Michigan Mutual's umbrella policy does not represent a concession that defeats
the plain language and intent of the CGL policy to exclude coverage. Rather, it is more likely that the added
disclaimer reflects Michigan Mutual's intention to assure that such claims would not be covered by the excess
policy. (p. 20)
The judgment of the Appellate Division is AFFIRMED as modified.
CHIEF JUSTICE PORITZ and JUSTICES HANDLER, POLLOCK, O'HERN, GARIBALDI and
COLEMAN join in JUSTICE STEIN's opinion.
SUPREME COURT OF NEW JERSEY
AMERICAN MOTORISTS INSURANCE
COMPANY AND LUMBERMENS MUTUAL
CASUALTY COMPANY,
Plaintiffs-Respondents
v.
L-C-A SALES COMPANY, JOEL SCHWARTZ,
ELLEN SCHWARTZ and JOHN PICCIALLO,
Defendants-Appellants
and Cross-Respondents,
and
MICHIGAN MUTUAL INSURANCE COMPANY,
Defendant-Respondent
JOHN PICCIALLO,
Plaintiff,
v.
L-C-A SALES COMPANY, JOEL SCHWARTZ,
Defendants.
Argued March 16, 1998 -- Decided June 15, 1998
On certification to the Superior Court,
Appellate Division.
Stacy L. Moore, Jr., argued the cause for
appellants and cross respondents L-C-A Sales
Company, Joel Schwartz and Ellen Schwartz
(Parker, McCay & Criscuolo, attorneys).
Donald A. Beshada argued the cause for
appellant and cross-respondent John Picciallo
(Cohen and Beshada, attorneys, Mr. Beshada
and Charles R. Cohen, on the briefs).
James P. Richardson argued the cause for
respondents and cross-appellants American
Motorists Insurance Company and Lumbermens
Mutual Casualty Company (Sellar Richardson,
attorneys; Mr. Richardson and Narinder S.
Parmar, on the brief).
Elliott Abrutyn argued the cause for
respondent and cross-appellant Michigan
Mutual Insurance Company (Morgan, Melhuish,
Monaghan, Arvidson, Abrutyn & Lisowski,
attorneys; Michael A. Sicola, of counsel;
Warren Usdin, on the briefs).
The opinion of the Court was delivered by
According to Picciallo, Joel Schwartz, a partner at LCA, and Steven Hall, an employee, began to harass him in 1990 in an effort to force him into retirement. Picciallo alleged that a younger employee was hired in June 1991 to assume control over Picciallo's sales territory. Picciallo asserted that Hall began informing LCA customers that the new employee was replacing Picciallo because of his impending retirement. On December 17, 1991, Picciallo received a letter from Schwartz dated December 13, 1991, informing Picciallo of the termination of his employment effective two weeks after receipt of the letter. Pursuant to that letter, Picciallo's employment was terminated on December 31, 1991. At the time of his dismissal, Picciallo was sixty-seven years old. In April 1992, Picciallo filed suit against LCA, Schwartz, Ellen Schwartz (another LCA partner), and Hall (collectively "LCA"). The gravamen of Picciallo's complaint was that LCA violated the LAD by terminating him simply because of his age. Picciallo also alleged causes of action based on breach of contract, breach of the implied covenant of good faith, wrongful discharge, negligence, tortious interference with contract, respondeat superior, and intentional infliction of emotional distress. During discovery, Picciallo asserted that as a result of his wrongful dismissal from LCA he suffered emotional distress with resulting heart palpitations, sleepwalking, loss of libido, decrease in frequency of sex, constipation, bloating, headaches, diarrhea and stomach pains. Picciallo also complained of a loss of appetite that precipitated weight loss, indigestion and loss of cognitive skills, and alleged that he also suffered a stroke. The events surrounding Picciallo's dismissal occurred at about the same time LCA changed its insurance carrier. From December 28, 1990, to December 28, 1991, LCA was insured under CGL and umbrella liability policies issued by Michigan Mutual Insurance Company (Michigan Mutual). From December 28, 1991, to December 28, 1992, LCA was insured under a CGL policy issued by American Motorists Insurance Company (American Motorists). During that same period, LCA was also insured under a commercial catastrophe policy issued by Lumbermens Mutual Casualty Insurance Company (Lumbermens). (Because both American Motorists and Lumbermens are part of the Kemper Companies, we refer to them collectively as "Kemper.") Both CGL policies issued by Michigan Mutual and Kemper contained a standard employee exclusion clause, providing that the insurance did not apply to "bodily injury" to
"[a]n employee of the insured arising out of and in the course of
employment by the insured."
Ultimately, the trial court granted summary judgment to both
insurance companies, holding that the language of the employee
exclusion was clear and precluded coverage for Picciallo's claim.
On the same date, Picciallo settled with LCA for $130,000, of
which LCA agreed to pay $25,000, and LCA assigned to Picciallo
its rights, if any, to coverage for the balance of Picciallo's
claim.
II The Michigan Mutual and Kemper CGL policies each contain an exclusion for workers' compensation claims, and an employee exclusion, that state: This insurance does not apply to:
. . . .
d. Any obligation under a workers'
compensation, disability benefits or
unemployment compensation law or any similar
law.
e. "Bodily injury" to:
Additionally, each policy provides that the employee exclusion
applies "[w]hether the insured may be liable as an employer or in
any other capacity . . . ."
Insurers have also begun to offer separate Employment Practices
Liability Insurance (EPLI) policies, which provide coverage for
employment-related claims. Ibid.; see also Paul E.B. Glad &
Richard V. Rupp, Employment-Related Liability Claims and
Insurance, 716 PLI/Comm 121, 124 (1995)(describing advent of
employment exclusions and recent development of EPLI policies).
umbrella policy, to bolster the argument that the employee
exclusion in Michigan Mutual's CGL policy does not apply.
initially sought coverage under both its CGL policy (that
contained the standard employee exclusion) and under the
employer's liability section of a workers' compensation policy.
The Appellate Division agreed that coverage should not have been
afforded to PAV under the CGL policy, noting that PAV "concede[d]
in its appellate brief that, inasmuch as plaintiff's judgment
against it was based upon the jury's finding of a hostile work
environment, PAV 'does not seek coverage for the judgment under
the general liability policy.'" Id. at 580. The court also
noted that with regard to the claims asserted against PAV's
president and chief executive officer, the CGL employee exclusion
barred coverage except for pre-employment injury to the
plaintiff. Id. at 586. Although the Schmidt court noted that
coverage was not available under the CGL policy, the court found
that PAV was entitled to coverage under the employer's liability
section of its workers' compensation policy. Id. at 583. It
reasoned that an exclusion contained in the policy was not
applicable to liability for sexual harassment claims when the
liability was imposed vicariously and not directly. Ibid.
was a "gapfiller," providing coverage for employees' job-related
bodily injuries whether or not covered under the Workers'
Compensation Act. Ibid. We concluded that "[t]o the extent [the
exclusion] would otherwise operate to deny coverage for such
[bodily] injuries, the exclusion violates the public policy
underlying the workers' compensation scheme and is therefore
void." Id. at __ (slip op. at 10). Thus, our holding in Schmidt
was based on the invalidity of an exclusion found in a workers'
compensation insurance policy that we found to be inimical to the
purposes of New Jersey's system of workers' compensation.
Pursuant to Schmidt, LCA may have had coverage for Picciallo's
claims under the employer's liability section of its workers'
compensation policy. That issue is not before us and we do not
address it.
compensation for personal injuries, occupational disease, or
death "arising out of and in the course of his employment." Id.
at 399 (quoting N.J.S.A. 34:15-30 and N.J.S.A. 34:15-7). Relying
on Walck v. Johns-Manville Products Corp.,
56 N.J. 533, 556
(1970) and Goyden v. State Judiciary,
256 N.J. Super. 438, 458
(App. Div. 1991), aff'd o.b.,
128 N.J. 54 (1992), the Cairns
court determined that the meaning of the "arising out of"
language in the Act depended to a certain extent on whether the
events had some "essential relation to the work or its nature" or
were "peculiar" to the workplace. 267 N.J. Super. at 400-01.
The court held that receipt of a layoff notice was neither
peculiar to the plaintiff's employment nor essentially related to
the nature of plaintiff's work, noting that "layoff decisions and
notices related to terminations are common to all employment."
Id. at 401.
(slip op. at 10), reached a result that was informed primarily by
the policies underlying the Workers' Compensation Act, it does
not govern the disposition of this appeal. Unlike the layoff in
Cairns, this was an employee-specific layoff notice allegedly
targeted at Picciallo because of his age. The Cairns reasoning
is that the general economic risks of employment termination
arising from an employer's effort to downsize do not equate with
an industrial injury. Picciallo's injuries, however, were not
the result of general economic risks.
harassment claim did not fall within the scope of the employee
exclusion. Id. at 420 & n.22. The court observed that in
assessing whether an insurer has a duty to defend, the
appropriate focus must be on the essence of the cause of action
rather than on the conduct relied on in support of the claim.
Id. at 420. Noting that the plaintiffs' sexual harassment claim
in that case asserted that the plaintiffs' working environment
had become hostile, the court concluded that "[i]t is incongruous
to hold that such a claim can arise anywhere but in the course
and scope of . . . plaintiffs' employment", and found that the
exclusion applied. Ibid.
under similar laws." Id. at 1287. Because the plaintiff's
allegations concerned events taking place only during her
employment and while she was at work, the court concluded that
the employee exclusion barred coverage for the claims. Id. at
1287-88.
one's employment"), writ denied,
548 So.2d 1234 (La. 1989); Board
of Educ. v. Continental Ins. Co.,
604 N.Y.S.2d 399, 400 (App.
Div. 1993)(finding teacher's sexual harassment and retaliatory
discharge action arose out of employment and coverage was barred
by employee exclusion, even though "some of the alleged acts of
sexual harassment [took place] away from the school . . . .");
Aberdeen Ins. Co. v. Bovee,
777 S.W.2d 442, 444 (Tex. Ct. App.
1989) (enforcing plain language of employee exclusion in
liability policy to deny coverage for sexual harassment claim,
noting that employee's action "was against her employer for acts
arising out of her employment").
We have observed that "[i]n general, insurance policy exclusions must be narrowly construed; the burden is on the insurer to bring the case within the exclusion." Princeton Ins. Co. v. Chunmuang, 151 N.J. 80, 95 (1997). We also have held that ambiguities in policy language will be resolved in favor of the insured in order to give effect to the insured's reasonable expectations. Voorhees v. Preferred Mut. Ins. Co., 128 N.J. 165, 175 (1992); DiOrio v. New Jersey Mfrs. Ins. Co., 79 N.J. 257, 269 (1979). Under certain circumstances, even the plain meaning of policy language may be overcome if it conflicts with the reasonable expectations of the insured. Werner Indus., Inc. v. First State Ins. Co., 112 N.J. 30, 35-36 (1988). Nevertheless,
we adhere to the principle that an insurance policy should
generally be interpreted "according to its plain and ordinary
meaning," Voorhees, supra, 128 N.J. at 175 (citing Longobardi v.
Chubb Ins. Co.,
121 N.J. 530, 537 (1990)), so as not to disregard
the "clear import and intent" of a policy exclusion. Westchester
Fire Ins. Co., supra, 126 N.J. Super. at 41. We are persuaded
that the "arising out of and in the course of employment"
language of the CGL policy employee exclusion is clear and
unambiguous, and that it precludes coverage for Picciallo's
wrongful discharge claim.
would be "incongruous to hold that such a claim can arise
anywhere but in the course and scope" of employment.
Meadowbrook, supra, 559 N.W.
2d at 420.
must be covered under workers' compensation in order to fall
within an employee exclusion clause"); Meadowbrook, supra, 559
N.W.
2d at 420 n.21 (finding separate workers' compensation
exclusion defeats argument that employee exclusion precludes only
workers' compensation claims); Fieldcrest Cannon, Inc. v.
Fireman's Fund Ins. Co.,
477 S.E.2d 59, 71 (N.C. Ct. App.
1996)(noting that workers' compensation and employee exclusions
"in tandem" preclude liability for all injuries arising out of
and in the course of employment); McLeod, supra, 865 P.
2d at 1287
(noting that presence of workers' compensation and employee
exclusion "exclude[s] from liability insurance coverage all
bodily injury claims of employees that arise from their
employment"). We also note that coverage for claims analogous to
those asserted by Picciallo is now specifically provided by EPLI
policies that are available to employers. See Glad & Rupp,
supra, 716 PLI/Comm at 124; see also Nancy Ritter, Employer
Liability: The Rush is on for Insurance, N.J. Law., Feb. 2, 1998,
at 1 (stating that number of companies in New Jersey purchasing
EPLI polices has "exploded" in past year).
anticipated that Picciallo's claim would be covered by its CGL
policy. We are unpersuaded that the added disclaimer in the
umbrella policy represents a concession that defeats the plain
language and intent of the CGL policy. More likely, the added
disclaimer reflects Michigan Mutual's intention to assure that
such claims would not be covered by the excess policy. IV
CHIEF JUSTICE PORITZ and JUSTICES HANDLER, POLLOCK, O'HERN,
GARIBALDI, and COLEMAN join in JUSTICE STEIN's opinion.
NO. A-105/6/7/8 SEPTEMBER TERM 1997
ON APPEAL FROM Appellate Division, Superior Court
ON CERTIFICATION TO
AMERICAN MOTORISTS INSURANCE COMPANY AND
Plaintiffs-Respondents and Cross-Appellants,
v.
L-C-A SALES COMPANY, JOEL SCHWARTZ, et al.,
Defendants-Appellants and Cross-Respondents,
and
MICHIGAN MUTUAL INSURANCE COMPANY,
Defendant-Respondent and Cross-Appellant.
DECIDED June 15, 1998
Chief Justice Poritz PRESIDING
OPINION BY Justice Stein
CONCURRING OPINION BY DISSENTING OPINION BY
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