Fireman's Fund Ins. Co. v. TD Banknorth Ins. Agency, Inc.
CourtSupreme Court of Connecticut
Date FiledJuly 30, 2013
DocketSC18796
JudgeRogers; Norcott; Palmer; Zarella; McDonald; Vertefeuille
StatusPublished
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Full Opinion
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FIREMAN’S FUND INSURANCE COMPANY v. TD
BANKNORTH INSURANCE AGENCY, INC.
(SC 18796)
Rogers, C. J., and Norcott, Palmer, Zarella, McDonald and Vertefeuille, Js.
Argued February 5—officially released July 30, 2013
Frederick M. Klein, for the appellant (defendant).
Christopher B. Weldon, with whom, on the brief, was
Darren P. Renner, for the appellee (plaintiff).
James Andriola filed a brief for United Policyholders
as amicus curiae.
Coleman C. Duncan III and Laura Pascale Zaino
filed a brief for the National Association of Subrogation
Professionals as amicus curiae.
Opinion
ZARELLA, J. This case comes before us upon our
acceptance of a certified question from the United
States Court of Appeals for the Second Circuit, arising
within the context of a dispute between the defendant,
TD Banknorth Insurance Agency, Inc. (TD Banknorth),
and the plaintiff, Fireman’s Fund Insurance Company
(Fireman’s Fund), pertaining to a liability insurance
policy. Pursuant to General Statutes § 51-199b,1 we
accepted certification with respect to the following
question: ‘‘Are insurance policy deductibles subject to
Connecticut’s make whole doctrine?’’2 Fireman’s Fund
Ins. Co. v. TD Banknorth Ins. Agency, Inc., 644 F.3d
166, 172–73 (2d Cir. 2011). Because it does not appear
that Connecticut expressly has adopted the make whole
doctrine, we deem it appropriate to reformulate the
question, pursuant to § 51-199b (k),3 in the following
manner: (1) Is the make whole doctrine recognized as
the default rule under Connecticut law; and, if so, (2)
does the make whole doctrine apply to insurance policy
deductibles under Connecticut law? We conclude that
(1) the make whole doctrine is the default rule under
Connecticut law but that (2) the doctrine does not apply
to insurance policy deductibles.
In certifying the question to us, the Second Circuit
Court of Appeals set forth the following relevant facts
and procedural history. ‘‘In 2005 Haynes Construction
Company [Haynes] began work on a housing develop-
ment and retained TD Banknorth as its agent to arrange
insurance. TD Banknorth procured a [b]uilder’s [r]isk
insurance policy from Peerless Insurance Company
[Peerless] and an [i]nland [m]arine insurance policy
from Hartford Insurance Company [Hartford]. In Febru-
ary 2006, a fire destroyed a house being built on Lot
14 of the Haynes development. Peerless denied cover-
age of the loss because Lot 14 was not listed in its
[b]uilder’s [r]isk policy—an error of omission by TD
Banknorth. Haynes thereupon claimed against TD Ban-
knorth for its negligent omission of Lot 14.
‘‘To protect against the risk of such negligence, TD
Banknorth had purchased [e]rrors [and] [o]missions
coverage [(errors and omissions contract) from] Fire-
man’s Fund . . . . Fireman’s Fund undertook to pay
on TD Banknorth’s behalf any sums TD Banknorth
became ‘legally obligated to pay as damages because
of a negligent act, error or omission in the performance
of [TD Banknorth’s] professional services.’ The [errors
and omissions] [c]ontract had a deductible of $150,000
per claim. TD Banknorth gave timely notice of the loss
to Fireman’s Fund.
‘‘In July 2006, TD Banknorth and Fireman’s Fund
settled with Haynes for $354,000. Of that, TD Banknorth
contributed $150,000 (its single claim deductible) and
Fireman’s Fund contributed the $204,000 remainder.
In the settlement, Haynes assigned its rights against
Peerless and Hartford to Fireman’s Fund and TD Bankn-
orth collectively.
‘‘TD Banknorth—and Fireman’s Fund as subrogee—
then proceeded against Peerless and Hartford for the
$354,000. In the ensuing settlement, Peerless paid
$88,000 and Hartford paid [$120,000] in exchange for
complete releases. TD Banknorth and Fireman’s Fund
‘reserve[d] all rights that they may have against each
other relating to the allocation of the [settlement funds]
held in escrow.’ The $208,000 was deposited in an
escrow account.
‘‘In March 2008, Fireman’s Fund commenced this
action against TD Banknorth in the [United States Dis-
trict Court for the] District of Connecticut, seeking a
declaratory judgment that it was entitled to all of the
escrow funds. Fireman’s Fund claimed $10,000 in
defense costs (incurred on TD Banknorth’s behalf) in
addition to the $204,000 it had paid Haynes: a total of
$214,000. TD Banknorth counterclaimed for a declara-
tory judgment that, under Connecticut’s make whole
doctrine, it was entitled to recover its $150,000 deduct-
ible from the escrow funds.
‘‘Both parties moved for summary judgment. The
[D]istrict [C]ourt found that the subrogation clause in
the [errors and omissions] [c]ontract abrogated Con-
necticut’s make whole doctrine . . . and accordingly
granted summary judgment in favor of Fireman’s Fund.’’
(Footnote omitted.) Fireman’s Fund Ins. Co. v. TD
Banknorth Ins. Agency, Inc., supra, 644 F.3d 168.
Thereafter, TD Banknorth appealed to the Second
Circuit Court of Appeals. Relying on our decision in
Wasko v. Manella, 269 Conn. 527, 533–34, 541, 849 A.2d
777 (2004), for the proposition that boilerplate subroga-
tion clauses are inadequate to abrogate default com-
mon-law subrogation rules, the Second Circuit con-
cluded that the District Court incorrectly determined
that the terms of the errors and omissions contract
abrogated the make whole doctrine. Fireman’s Fund
Ins. Co. v. TD Banknorth Ins. Agency, Inc., supra, 644
F.3d 169–70. In addition, the Second Circuit rejected
Fireman’s Fund’s alternative argument that, under Con-
necticut law, the make whole doctrine applied only to
insurance for first party losses rather than third party
liability. See id., 171. With respect to Fireman’s Fund’s
argument that the make whole doctrine does not apply
to deductibles, however, the Second Circuit determined
that ‘‘no statutory or precedential support for either
position’’ could be found in Connecticut law. Id., 172.
Accordingly, the Second Circuit certified the question
to this court under § 51-199b (d), and we accepted certi-
fication.
Relying on the make whole doctrine, TD Banknorth
claims that, before Fireman’s Fund may assert any right
of equitable subrogation against a responsible third
party, TD Banknorth is entitled to recover $150,000,
which represents the amount of its deductible that it
paid to settle the Haynes claim. Fireman’s Fund, by
contrast, maintains that the deductible is not part of
the loss to which the make whole doctrine applies and
that to conclude otherwise would essentially convert
the policy into one without a deductible, thereby provid-
ing TD Banknorth with an unbargained for windfall
at the expense of Fireman’s Fund. We agree with the
position advanced by Fireman’s Fund.
The resolution of the questions before us presents a
question of law, over which our review is plenary. See,
e.g., DeLeo v. Nusbaum, 263 Conn. 588, 593, 821 A.2d
744 (2003); see also New London County Mutual Ins.
Co. v. Nantes, 303 Conn. 737, 753, 36 A.3d 224 (2012)
(determination of rights and liabilities under insurance
policy presents question of law).
I
We begin with the threshold question of whether
the make whole doctrine should apply in Connecticut,
because it has not heretofore been addressed expressly
by this court. The doctrine arises in the context of
legal or equitable subrogation. ‘‘In its simplest form,
subrogation allows a party who has paid a debt to step
into the shoes of another (usually the debtee) to assume
his or her legal rights against a third party to prevent that
party’s unjust enrichment.’’ (Internal quotation marks
omitted.) Rathbun v. Health Net of the Northeast, Inc.,
133 Conn. App. 202, 211, 35 A.3d 320, cert. granted,
304 Conn. 905, 38 A.3d 1201 (2012). The common-law
doctrine of legal or equitable subrogation therefore
enables an insurance company that has made a payment
to its insured to substitute itself for the insured and to
proceed against the responsible third party. See, e.g.,
Allstate Ins. Co. v. Mazzola, 175 F.3d 255, 258 (2d Cir.
1999); Albany Ins. Co. v. United Alarm Services, Inc.,
194 F. Supp. 2d 87, 93 (D. Conn. 2002).
‘‘As we stated in Westchester Fire Ins. Co. v. Allstate
Ins. Co., [236 Conn. 362, 372, 672 A.2d 939 (1996)],
insurers that are obligated by a preexisting contract to
pay the losses of an insured proceed in a subsequent
action against the responsible party under the theory
of equitable subrogation, and not conventional subroga-
tion.’’ (Emphasis omitted.) Wasko v. Manella, supra,
269 Conn. 533. In such cases, in the absence of express
contractual language indicating an intention to depart
from the default rules, ‘‘[t]he contract . . . is not the
source of the right, but rather is a reference to those
rights that may exist at law or in equity.’’ (Internal
quotation marks omitted.) Id.; see also id., 532 (‘‘[t]he
right of [legal or equitable] subrogation . . . does not
arise from any contractual relationship between the
parties, but takes place as a matter of equity, with or
without an agreement to that effect’’ [internal quotation
marks omitted]). Thus, although a ‘‘right of true [equita-
ble] subrogation may be provided for in a contract . . .
the exercise of the right will . . . have its basis in gen-
eral principles of equity rather than in the contract,
which will be treated as being merely a declaration of
principles of law already existing.’’ (Internal quotation
marks omitted.) Id., 533–34.
‘‘The object of [legal or equitable] subrogation is the
prevention of injustice. It is designed to promote and
to accomplish justice, and is the mode [that] equity
adopts to compel the ultimate payment of a debt by
one who, in justice, equity, and good conscience, should
pay it.’’ (Internal quotation marks omitted) Id., 532.
Subrogation further promotes equity by preventing an
insured from receiving more than full indemnification
as a result of recovering from both the wrongdoer and
the insurer for the same loss, which would unjustly
enrich the insured. See, e.g., 16 L. Russ & T. Segalla,
Couch on Insurance (3d Ed. 2005) § 223:135, pp. 223-
151 through 223-152; E. Rinaldi, ‘‘Apportionment of
Recovery Between Insured and Insurer in a Subrogation
Case,’’ 29 Tort & Ins. L.J. 803, 803 (1994) (‘‘Although
an insured is entitled to indemnity from an insurer pur-
suant to coverage provided under a policy of insurance,
the insured is entitled only to be made whole, not more
than whole. Subrogation prevents an insured from
obtaining one recovery from the insurer under its con-
tractual obligations and a second recovery from the
tortfeasor under general tort principles.’’).
When the amount recoverable from the responsible
third party is insufficient to satisfy both the total loss
sustained by the insured and the amount the insurer
pays on the claim, however, this principle may lead to
inequitable results. See, e.g., 16 L. Russ & T. Segalla,
supra, § 223:133, p. 223-145. The make whole doctrine
addresses this concern by restricting the enforcement
of an insurer’s subrogation rights until after ‘‘the insured
has been fully compensated for her injuries, that is . . .
made whole.’’ (Internal quotation marks omitted.) In
re DeLucia, 261 B.R. 561, 567 (Bankr. D. Conn. 2001),
quoting Barnes v. Independent Automobile Dealers
Assn. of California Health & Welfare Benefit Plan, 64
F.3d 1389, 1394 (9th Cir. 1995); see also United States
v. Lara, United States District Court, Docket No. 3:08-
cr-00169 (VLB) (D. Conn. November 6, 2009) (‘‘the
insurer may enforce its subrogation rights only after
the insured has been fully compensated for all of its
loss’’); J. Parker, ‘‘The Made Whole Doctrine: Unraveling
the Enigma Wrapped in the Mystery of Insurance Subro-
gation,’’ 70 Mo. L. Rev. 723, 737 (2005) (‘‘[I]n the event
of a subrogation dispute between the insurer and its
insured, the insured has priority of rights to collect from
the responsible third party. Thus, [when] the insured’s
recovery from both the insurer and [the] tortfeasor is
less than or equal to its loss the insurer forfeits its right
to subrogation.’’). As one authority on insurance law
explains, ‘‘[t]he equitable principle underlying the
[make] whole [doctrine] is that the burden of loss
should rest on the party paid to assume the risk, and
not on an inadequately compensated insured, who is
the least able to shoulder the loss.’’ 16 L. Russ & T.
Segalla, supra, § 223:136, pp. 223-152 through 223-153.
In light of this reasoning, we are persuaded that the
make whole doctrine is sound policy. We note, however,
that the parties rely on our decision in Wasko v. Manella,
supra, 269 Conn. 527, to support the doctrine’s adoption
in this state, as have other courts. See, e.g., United
States v. Lara, United States District Court, Docket
No. 3:08-cr-00169 (VLB), supra; cf. Yeager v. Alvarez,
Superior Court, judicial district of Waterbury, Docket
No. CV-XX-XXXXXXX-S (July 19, 2010), rev’d on other
grounds, 134 Conn. App. 112, 38 A.3d 1224 (2012). In
Wasko, we observed that, ‘‘under traditional principles
of subrogation, if an insured brings an action against a
negligent party, an insurer generally is entitled to
recover the amount it paid to the insured only if the
amount of damages awarded exceeds the difference
between the amount the insurer paid and the insured’s
actual damages’’; Wasko v. Manella, supra, 537; and
referred to decisions in other states, along with a trea-
tise on insurance law, in support of this premise. Id.
537 n.8, citing Skauge v. Mountain States Telephone &
Telegraph Co., 172 Mont. 521, 528, 565 P.2d 628 (1977),
Transamerica Ins. Co. v. Barnes, 29 Utah 2d 101, 105,
505 P.2d 783 (1972), and 6A J. Appleman & J. Appleman,
Insurance Law and Practice (1972) § 4094, p. 265. As
the United States District Court for the District of Con-
necticut has recognized, however, the discussion in
Wasko regarding the make whole doctrine was dictum;
see ACSTAR Ins. Co. v. Clean Harbors, Inc., 783 F.
Supp. 2d 312, 319 (D. Conn. 2011); presumably because,
in Wasko, the recovery from the third party tortfeasor
was equal to the amount that the insurer had paid to
the insured, and thus it was unnecessary to determine
priority between the insurer and the insured. See Wasko
v. Manella, supra, 529–30. Consequently, we deem it
appropriate to expressly recognize the make whole doc-
trine at this time. Accordingly, to the extent that we
have not previously done so, we now clarify that the
make whole doctrine operates as a default rule in Con-
necticut insurance contracts.
II
With respect to the make whole doctrine’s application
to deductibles, the second issue under our reformula-
tion of the certified question, we must determine
whether an insured is fully compensated for purposes
of the make whole doctrine when she receives compen-
sation equal to the full amount of her loss, less the
value of her deductible. TD Banknorth, relying on a law
review article for the proposition that the make whole
doctrine should apply to deductibles, advances a posi-
tion that would require us to answer this question in
the negative. Fireman’s Fund maintains that the make
whole doctrine does not apply to deductibles, relying
on the decisions of several of our sister states and a
treatise on insurance law to support its claim that an
insured should be considered fully compensated for her
loss under the make whole doctrine if she recovers
all but the amount of her deductible. We agree with
Fireman’s Fund.
The question of whether the make whole doctrine
applies to deductibles has been addressed in only a
small number of cases. E.g., Jones v. Nationwide Prop-
erty & Casualty Ins. Co., 613 Pa. 219, 234–36, 32 A.3d
1261 (2011); Averill v. Farmers Ins. Co. of Washington,
155 Wn. App. 106, 111–15, 229 P.3d 830, review denied,
169 Wn. 2d 1017, 238 P.3d 502 (2010); see also Birch
v. Fire Ins. Exchange, 122 P.3d 696, 698 (Utah App.
2005) (observing that, as of 2005, ‘‘it appears that the
precise question arising from this factual scenario had
not been addressed by courts in [Utah] or any other
[state]’’). Relying primarily on these cases and on gen-
eral equitable principles, the author of one insurance
treatise notes that ‘‘the [make] whole doctrine does not
apply to deductibles. If the insured were to be reim-
bursed for its deductible before the insurer is made
whole, the insured would be receiving an unbargained
for, unpaid for, windfall. Under the terms of the insur-
ance policy, it was agreed that, as a condition precedent
to the insurer being out of pocket for even one dollar,
the insured had to first be out of pocket the amount of
the deductible. The [make] whole doctrine deals with
situations in which the combination of the amount of
the deductible and the amount of the insurance payment
is a sum that was insufficient to make the insured whole,
and a recovery is made from a third party (typically, the
insurer for the tortfeasor [who] injured the insured).’’
(Footnote omitted.) 2 A. Windt, Insurance Claims and
Disputes: Representation of Insurance Companies and
Insureds (6th Ed. 2013) § 10:6, pp. 10-42 through 10-43,
citing Jones v. Nationwide Property & Casualty Ins.
Co., supra, 234–36, Averill v. Farmers Ins. Co. of Wash-
ington, supra, 111–15, and Birch v. Fire Ins. Exchange,
supra, 699–700.4
In Jones v. Nationwide Property & Casualty Ins. Co.,
supra, 613 Pa. 219, the Supreme Court of Pennsylvania
addressed the application of the make whole doctrine
to deductibles within the context of collision coverage
under an automobile insurance policy. See id., 227–36.
The named plaintiff in that case, Brenda Jones, brought
a class action against the defendant, Nationwide Prop-
erty and Casualty Insurance Company (Nationwide),
Jones’ insurance carrier. Id., 224. Jones claimed that
Nationwide’s practice of reimbursing insureds’ deduct-
ibles pro rata following recovery from third party tort-
feasors violated the common-law make whole doctrine
despite state insurance regulations expressly sanc-
tioning such a practice. Id., 224–25. Although the make
whole doctrine applied generally in Pennsylvania, the
court relied on the argument of the acting state insur-
ance commissioner (commissioner), as amicus curiae,
that the make whole doctrine could not apply to colli-
sion coverage because, unlike other forms of insurance,
there are no coverage limits; according to the commis-
sioner, therefore, there could never be a shortfall of
coverage between the coverage limit and the actual
damages sustained by an insured. Id., 231–32. Instead,
as the commissioner explained, ‘‘a deductible is a thin
layer of first dollar liability retained by the consumer
(and specifically not transferred to the insurer) to
ensure risk-sharing and loss avoidance. . . . Under the
policy, the insured agreed to pay the deductible as a
first dollar obligation prior to implicating the insurer’s
obligation to cover the damages. Therefore, the loss
of the deductible is not a shortfall in the insurance
coverage.’’ (Citation omitted; internal quotation marks
omitted.) Id., 232.
The court in Jones thus observed that the ‘‘[a]pplica-
tion of the [make] whole doctrine to deductibles would
not only be contrary to the relevant . . . provisions [of
the state’s insurance regulations] but, when considering
the inherent nature of deductibles, would [also] run
counter to the equitable principles underlying the
[make] whole doctrine and subrogation.’’ Id., 235. Spe-
cifically, it would unjustly enrich the insured because
the insurer ‘‘accepted only the risk of paying if the loss
exceeded the amount of the deductible, with premiums
calculated based [on] the amount of first dollar liability
accepted by the insured. Application of the [make]
whole doctrine in such a case would force the insurer
essentially to cover the risk of the deductible [when]
the insured has not paid premiums to cover that risk.’’
Id., 236. The make whole doctrine therefore did not
compel the insurer in Jones to refund the full amount
of the insured’s deductible before enforcing its subroga-
tion rights because the insured, rather than the insurer,
retained the risk associated with the amount of the
deductible under the express language of the insurance
policy. See id.
Similarly, the decision of the Washington Court of
Appeals in Averill v. Farmers Ins. Co. of Washington,
supra, 155 Wn. App. 106, addressed ‘‘whether the [make]
whole doctrine applies to insurance policy deduct-
ibles.’’ Id., 111. The insured and named plaintiff, Pearl
Averill, brought an action against her automobile
insurer, Farmers Insurance Company of Washington
(Farmers), following an automobile accident for which
Farmers paid Averill the value of her loss, less the
amount of her deductible. Id., 109–10. Farmers then
sought to recover from the insurer of the other driver
involved in the accident. Id., 110. After an arbitrator
determined that each driver was ‘‘50 percent at fault’’;
id.; the other driver’s insurer paid Averill an amount
equal to one half of her deductible, and paid Farmers
approximately one half of the total that it had paid to
Averill. Id. Averill contended, however, that she should
have received her full deductible, rather than a prorated
portion, before Farmers was entitled to any subrogation
recovery. See id.
The court in Averill disagreed. See id., 114–15. As
the court explained, a conclusion that the make whole
doctrine does not apply to deductibles ‘‘is consistent
with the purpose of the deductible. A deductible indi-
cates the amount of risk retained by the insured. . . .
The insurance policy shifts the remaining risk of any
damages above the deductible to the insurance com-
pany. . . . Averill contracted to be out of pocket for
the [amount of the deductible]. Farmers’ subrogation
interest was for the amount of the loss it paid Averill,
not including the deductible amount. When Farmers
pursued its subrogation interest, that interest did not
include Averill’s deductible. Allowing Averill to recover
her deductible from Farmers’ subrogation recovery
would have changed the insurance contract to one with-
out a deductible. We are not at liberty to rewrite the
policy in this manner.’’ (Citations omitted.) Id., 114.5
In the present case, TD Banknorth attempts to cast
doubt on Averill and Jones by relying on a law review
article that supports its position that the make whole
doctrine applies to deductibles. See M. Quinn, Review
Essay, ‘‘Subrogation, Restitution, and Indemnity,’’ 74
Tex. L. Rev. 1361, 1385–87 (1996) (reviewing book enti-
tled ‘‘The Law of Subrogation,’’ by Charles Mitchell).
This article arrives at its conclusion by criticizing the
English case of Lord Napier & Ettrick v. Hunter, [1993]
A.C. 713, 2 W.L.R. 42 (H.L.) (appeal taken from Eng.)
(Napier), in which the House of Lords addressed subro-
gation in the context of an insurance policy with a
deductible.6 Accordingly, in order to address the posi-
tion advanced by the author of the article on which TD
Banknorth relies, we turn first to the facts of that case.7
The insureds in Napier were underwriters at Lloyd’s
of London (insurance company) who, due to the pur-
ported negligence of a third party, faced significant
underwriting losses that exceeded their stop loss insur-
ance policy limits. See N. Andrews, Case and Comment,
‘‘Subrogation and Contracts of Insurance,’’ 52 Cam-
bridge L.J. 223, 223 (1993). After a settlement with the
purportedly negligent third party, the insureds recov-
ered an amount insufficient to cover both the total
losses of the insureds and the amounts paid by the
insurance company. See id. The insurance company
maintained that it was entitled to recover its payments
before the insureds recovered their deductibles. See id.
To simplify the analysis, the House of Lords used
the following hypothetical for illustrative purposes. See
Lord Napier & Ettrick v. Hunter, supra, [1993] A.C.
729. The insured, who had suffered a loss of £160,000,
had £100,000 in stop loss insurance that became applica-
ble after the £25,000 deductible was satisfied. Id. Lord
Templeman treated this loss as divisible into three
parts: (1) the insured was responsible for the first
£25,000, that is, the deductible (first part); (2) the
insurer then paid £100,000 to the insured (second part);
and (3) the insured was responsible for the excess
£35,000 (third part). Id. The insured then recovered
£130,000 from the negligent third party. Id. Of this
£130,000, the trial court determined that the insured
should be allocated £60,000, reasoning that this, com-
bined with the £100,000 paid by the insurer, would make
the insured whole; the remaining £70,000 was to be
allocated to the insurer. Id.
Lord Templeman of the House of Lords disagreed,
observing that the trial court’s ‘‘analysis . . . ignores
the fact that the [insured] agreed to bear the first £25,000
. . . of any loss.’’ Id. Lord Templeman determined that
the funds received from the negligent third party were
to be distributed as they would have been if the insured
had obtained insurance from another insurer to cover
the deductible and the excess above the stop loss insur-
ance policy rather than retaining the risk itself.8 See id.,
730. Thus, the £35,000, which constituted the loss in
excess of the policy limits and the deductible, was first
allocated to the insured, as this portion was analogous
to coverage under an excess insurance policy. Id. Next,
the insurer was entitled to the second part, up to the
£100,000 that it had paid on the claim. Because only
£95,000 remained, however—£30,000 recovered from
the negligent third party less the £35,000 loss in excess
of the policy limits—the insurer could not recover the
full amount that it had paid to the insured. Id. Finally,
the loss attributable to the remaining part, namely, the
deductible, appropriately was borne by the insured
because ‘‘an insured is not entitled to be indemnified
against a loss which he has agreed to bear.’’ Id., 731.
In critiquing Napier, the author of the article on
which TD Banknorth relies explained that ‘‘[n]othing
in any insurance contract—whether it is the deductible
provision or the coinsurance clause—remotely implies
that an insurer should be reimbursed, based [on] subro-
gation, before the insured. Nor does the [court in]
Napier . . . give anything in the way of an argument.
The function of the deductible is to relieve the insurer
of dealing with smaller claims, to encourage safety on
the part of the insured, and to control the price of the
contract. None of these considerations suggest[s] that
the insurer should recover ahead of the insured, insofar
as the deductible is at stake. Insurers do not compute
subrogation recoveries into the price-deductible com-
putation. Subrogation recoveries are too iffy to play
any role in controlling moral hazards.’’ M. Quinn, supra,
74 Tex. L. Rev. 1386.
We do not find this rationale convincing. Specifically,
we find it unlikely that an insurer would not consider
such factors in fixing premium costs, and the author
advancing this argument does not cite to any authority
in support of his view that insurers do not do so. See
id.; cf. Jones v. Nationwide Property & Casualty Ins.
Co., supra, 613 Pa. 223 (‘‘[n]ot surprisingly, if an insured
is willing to bear the risk of paying a higher deductible,
[the insured’s] premiums will be reduced to reflect that
the insurer will be responsible for covering less risk’’).
Indeed, the author acknowledges that a primary pur-
pose of a deductible is ‘‘to control the price of the
contract,’’ which would be undermined if the interplay
between subrogation recovery and premium cost was
not taken into account. M. Quinn, supra, 74 Tex. L. Rev.
1386. A deductible represents the level of risk that the
insured has agreed to assume, ordinarily in exchange
for a lower premium cost for the insurance policy. See,
e.g., Averill v. Farmers Ins. Co. of Washington, supra,
155 Wn. App. 114. Therefore, we are not of the opinion
that equity dictates a departure from the terms of the
insurance contract into which the parties voluntarily
entered under such circumstances.
The author of the article on which TD Banknorth
relies also criticizes the Napier decision to the extent
that it ‘‘implies that when there [are] . . . layers of
excess policies atop a primary policy . . . the highest
level excess carrier should receive the first monies out
of the subrogation pot,’’ asserting that ‘‘the court’s
vision of sound policy is impaired’’ if this is indeed the
intention of the court in Napier. M. Quinn, supra, 74
Tex. L. Rev. 1386. The author provides no authority for
this assertion, however, and we are not persuaded that
there is anything atypical about this approach to priority
with respect to subrogation recoveries. Indeed, a num-
ber of courts have indicated that, as a matter of course,
‘‘[w]hen more than one insurer contributes to the pay-
ment of a loss, the highest level insurer is . . . entitled
to be made whole before a lower level insurer can be
reimbursed.’’ 2 A. Windt, supra, § 10:5, pp. 10-29 through
10-30; see, e.g., Travelers Property Casualty Ins. Co.
of America v. National Union Ins. Co. of Pittsburgh,
Pennsylvania, 621 F.3d 697, 716 (8th Cir. 2010) (apply-
ing Missouri law and concluding that ‘‘[t]he industry
practice, in short, is that excess carriers are the last
insurers obligated to pay claims and the first insurers
entitled to recover in subrogation’’); Westchester Fire
Ins. v. Heddington Ins. Ltd., 883 F. Supp. 158, 167 (S.D.
Tex. 1995) (‘‘Money recouped by insurers after paying
a claim is first applied to the highest layer of coverage,
or ‘ ‘‘off the top’’ ’ of the ultimate net loss. Vesta Ins.
Co. v. Amoco [Production] Co., 986 F.2d 981, 988 [5th
Cir. 1993] cert. denied, [510] U.S. [822], 114 S. Ct. 80,
126 L. Ed. 2d 48 [1993] [interpreting Texas law].’’), aff’d
mem., 84 F.3d 432 (5th Cir. 1996); Century Indemnity
Co. v. London Underwriters, 12 Cal. App. 4th 1701,
1710, 16 Cal. Rptr. 2d 393 (1993) (‘‘[When] the insurers’
coverage is in the nature of layers, the excess carriers
should recover under subrogation before primary insur-
ers can be reimbursed. One can look at a subrogation
recovery as reducing the net loss in which case the
excess carriers would not be obligated to pay the loss.’’
[Internal quotation marks omitted.]). Commenting on
this industry practice, the Eighth Circuit Court of
Appeals has observed that ‘‘[i]nsurers know and under-
stand this apportionment of risk among fellow insurers,
and they price their insurance accordingly . . . .’’
Travelers Property Casualty Ins. Co. of America v.
National Union Ins. Co. of Pittsburg, Pennsylvania,
supra, 716.
Thus, with this subrogation priority policy in mind,
we find persuasive the analogy that the deductible is,
in effect, akin to ‘‘a primary layer of self-insurance
underlying the [liability insurance] policy, which policy
is, as a practical matter, the equivalent of an excess
policy. . . . [W]hen there is a recovery, the ‘excess’
level of insurance is entitled to recover before a lower
level of insurance/deductible can recover. . . . By the
same token, the amount of the insured’s loss in excess
of the insurance policy must be reimbursed before the
insurer is reimbursed by virtue of the same principle:
reimbursements go to the highest level of excess and
work their way down to the lowest level.’’ (Citation
omitted.) 2 A. Windt, supra, § 10:6, p. 10-44.
Accordingly, we conclude that the equitable consider-
ations supporting the make whole doctrine are inappli-
cable to deductibles. Cf. 16 L. Russ & T. Segalla, supra,
§ 223:136, pp. 223-152 through 223-153. If we were to
decide otherwise, as TD Banknorth urges, we would
effectively disturb the contractual agreement into
which TD Banknorth and Fireman’s Fund entered,
thereby creating a windfall for TD Banknorth for a loss
that it did not see fit to insure against in the first instance
when it contracted for lower premium payments in
exchange for a deductible. See, e.g., Jones v. Nation-
wide Property & Casualty Ins. Co., supra, 613 Pa. 236;
Averill v. Farmers Ins. Co. of Washington, 155 Wn.
App. 114.
The answer to the certified question of whether the
make whole doctrine is the default rule under Connecti-
cut law is: yes; the answer to the certified question of
whether the make whole doctrine applies to insurance
policy deductibles under Connecticut law is: no.9
No costs shall be taxed in this court to either party.
In this opinion the other justices concurred.
1
General Statutes § 51-199b (d) provides in relevant part: ‘‘The Supreme
Court may answer a question of law certified to it by a court of the United
States . . . if the answer may be determinative of an issue in pending
litigation in the certifying court and if there is no controlling appellate
decision, constitutional provision or statute of this state.’’
2
Other courts have referred to this rule as either the ‘‘make whole’’ or
‘‘made whole’’ doctrine. Compare US Airways, Inc. v. McCutchen, U.S.
, 133 S. Ct. 1537, 1546, 185 L. Ed 2d 654 (2013) (‘‘make-whole doctrine’’),
and In re DeLucia, 261 B.R. 561, 566–68 (Bankr. D. Conn. 2001) (‘‘Make-
Whole Rule’’), with Jones v. Nationwide Property & Casualty Ins. Co., 613
Pa. 219, 222, 227–37, 32 A.3d 1261 (2011) (‘‘made whole doctrine’’), and
Muller v. Soc’y Ins., 309 Wis. 2d 410, 416, 419–49, 750 N.W.2d 1 (2008)
(same). Throughout this opinion, we employ the terminology used by the
Second Circuit Court of Appeals in certifying this question to us. Accordingly,
we refer to the rule as the make whole doctrine.
3
General Statutes § 51-199b (k) provides: ‘‘The Supreme Court may
reformulate a question certified to it.’’
4
The parties advance very different understandings of the decision of the
Utah Court of Appeals in Birch. Although we do not find the result in Birch
inconsistent with our conclusion that the make whole doctrine does not
apply to deductibles, we note that the court narrowly decided that case on
the basis of its ‘‘unique facts,’’ namely, that the insured recovered more than
his total loss even without a full recovery of his deductible. Birch v. Fire
Ins. Exchange, supra, 122 P.3d 700.
5
TD Banknorth urges us to disregard the decision in Averill because the
Washington State Office of the Insurance Commissioner has since promul-
gated a regulation that applies the make whole doctrine to deductibles, and
the case therefore no longer represents the current law in that state. We
disagree that such a regulatory enactment need alter our analysis. In the
present case, we consider only the default rule applicable in the absence
of express contractual, statutory, or regulatory language to the contrary.
Thus, like the Washington State Office of the Insurance Commissioner, our
state’s legislature or insurance commissioner is equally free to alter this
default rule in an appropriate manner.
6
The policy at issue in Napier refers to the deductible as the ‘‘excess’’;
Lord Napier & Ettrick v. Hunter, supra, [1993] A.C. 729; for clarity, however,
we refer to it as the deductible in this opinion.
7
A decision of this nature, of course, is not binding on this court, nor
does this case implicate the particular preference that federal courts have
traditionally afforded to English courts when marine or maritime insurance
policies are at issue. See, e.g., Standard Oil Co. of New Jersey v. United
States, 340 U.S. 54, 59, 71 S. Ct. 135, 95 L. Ed. 68 (1950) (‘‘[I]t is true that
we and other American courts have emphasized the desirability of uniformity
in decisions here and in England in interpretation and enforcement of marine
insurance contracts. Especially is uniformity desirable [when] . . . the par-
ticular form of words employed originated in England. But this does not
mean that American courts must follow [the] House of Lords’ decisions
automatically.’’ [Footnote omitted.]); New York & Oriental Steamship Co.
v. Auto. Ins. Co. of Hartford, Connecticut, 37 F.2d 461, 463 (2d Cir. 1930) (‘‘in
matters maritime, and especially insurance, the importance of conformity
between the English law and our own has been often emphasized’’). Never-
theless, in light of our common legal heritage, and given TD Banknorth’s
reliance on the position of a commentator who is critical of Napier, we
find it appropriate to consider the approach that the House of Lords took
in Napier. Cf. Bassett v. City Bank & Trust Co., 115 Conn. 393, 398, 161 A.
852 (1932) (‘‘[although] Connecticut has not formally adopted the common
law of England by constitutional or legislative provisions, we have made
it our own by ‘practical adoption’ with such exceptions as diversity of
circumstances and customs require’’).
8
Similar to the example in Napier, the author of a treatise on insurance
provides the following hypothetical to illustrate this principle:
‘‘A. A fire causes the insured a $100,000 loss.
‘‘B. The insurance policy provides $50,000 in coverage excess over a
$10,000 deductible.
‘‘C. By virtue of the deductible, the first $10,000 of the loss must be borne
by the insured in order to trigger the insurance coverage. The $50,000 in
insurance is paid, therefore, because the loss equals or exceeds $60,000.
That payment, therefore, leaves a loss of $40,000 that the insured has not
agreed to bear as a condition precedent to triggering the insurance coverage.
‘‘D. $60,000 is then recovered from the person who set the fire.
‘‘E. Under the [make] whole doctrine, the first $40,000 of that recovery
would [g]o to the insured, and the remaining $20,000 would go to the insurer.
[Ten thousand dollars] of that $20,000 could not go to the insured to reim-
burse it for its deductible because . . . the insured must remain out of
pocket for the amount of the deductible. The first $10,000 of the loss must
be borne by the insured because that was the agreement made by the insured
and the insurer. As a practical matter, the $10,000 deductible represents a
primary layer of self-insurance underlying the $50,000 policy, which policy
is, as a practical matter, the equivalent of an excess policy. . . . [W]hen
there is a recovery, the excess level of insurance is entitled to recover before
a lower level of insurance/deductible can recover. . . . (T)he highest level
insurer is, of course