Anthony Marino Construction Corp. v. INA Underwriters Insurance Company, 69 N.Y.2d 798 (1987)

An insured’s failure to file sworn proofs of loss within the contractually required time after a demand from the insurer constitutes a complete defense to an action on the insurance policy, unless the insurer’s conduct justifies estoppel or waiver of the requirement.

Summary

This case addresses the strict enforcement of proof of loss requirements in insurance contracts. Anthony Marino Construction Corp. failed to submit sworn proofs of loss within 60 days of INA Underwriters Insurance Company’s demand. The court held that this failure was a complete defense to Marino’s action to recover under the policy. The court rejected Marino’s arguments for estoppel or waiver based on the content of the demand letter and the insurer’s examination of an employee, reinforcing the importance of timely compliance with policy conditions.

Facts

INA Underwriters Insurance Company issued an insurance policy to Anthony Marino Construction Corp.

Marino sustained a loss covered under the policy and sought to recover from INA.

INA demanded that Marino submit sworn proofs of loss, providing proof of loss forms.

Marino failed to file the sworn proofs of loss within 60 days of receiving INA’s demand.

INA’s demand letter did not specify a date by which the proofs had to be filed.

INA, through its attorney, examined one of Marino’s employees under oath regarding the claim, and the untimely proofs of loss were utilized during the examination, with the attorney reserving the right to assert the untimeliness defense.

Procedural History

Marino sued INA to recover under the insurance policy.

The lower court ruled in favor of INA, citing Marino’s failure to comply with the proof of loss requirement.

The Appellate Division affirmed the lower court’s decision.

The case was appealed to the New York Court of Appeals.

Issue(s)

Whether an insured’s failure to file sworn proofs of loss within 60 days of the insurer’s demand, as required by the insurance policy and Insurance Law § 3407(a), constitutes a complete defense to an action on the policy.

Whether the insurer should be estopped from relying on the proof of loss condition because the demand letter did not specify a filing deadline and included a demand for an examination under oath.

Whether the insurer’s examination of the insured’s employee under oath, and the utilization of untimely proofs of loss during the examination, constituted a waiver of the proof of loss condition.

Holding

Yes, because “Plaintiff’s failure to file sworn proofs of loss within 60 days after receiving a demand to do so by its insurer, accompanied by proof of loss forms, is a complete defense to plaintiff’s action on the insurance policy” as established in Igbara Realty Corp. v New York Prop. Ins. Underwriting Assn., 63 NY2d 201, 216.

No, because the demand letter’s failure to state a specific filing date and the inclusion of a demand for an examination under oath do not justify estopping the insurer, as per Igbara Realty Corp. v New York Prop. Ins. Underwriting Assn., supra; see also, Melendez v United States Fire Ins. Co., NYLJ, Jan. 2, 1987, p 15, col 2.

No, because the examination of the insured’s employee under oath does not constitute a waiver, as per Maleh v New York Prop. Ins. Underwriting Assn., 64 NY2d 613, 614, and the insurer’s attorney reserved the right to assert the untimeliness of the proofs.

Court’s Reasoning

The court strictly applied the established precedent that failure to comply with the proof of loss requirement is a complete defense. It cited Igbara Realty Corp. v New York Prop. Ins. Underwriting Assn., emphasizing the statutory duty imposed on the insured under Insurance Law § 3407(a). The court rejected Marino’s estoppel argument, finding no basis to prevent the insurer from enforcing the policy terms simply because the demand letter did not explicitly state the filing deadline. Similarly, the court found no waiver, distinguishing the case from situations where an insurer’s conduct unequivocally indicates an intention to relinquish its right to enforce the proof of loss condition. The court emphasized that INA’s attorney had expressly reserved the right to assert the untimeliness defense, negating any implication of waiver. The court stated, “Plaintiff’s contentions that defendants should be estopped from relying on the proof of loss condition because their demand letter did not state the date by which the proofs had to be filed and because it also contained a demand that plaintiff appear for an examination under oath are without merit”. The decision reinforces the significance of adhering to contractual obligations in insurance policies and the limited circumstances under which an insurer may be estopped or deemed to have waived its rights.