November 16th, 2018
By, Alex Brockmeyer, Esq.,
Most insurance policies have some sort of provision that addresses what happens when an insured misrepresents or attempts to defraud an insurer. This provision, otherwise known as a “fraud provision” or “forfeiture provision” varies in effect depending on its breadth. In Flores v. Allstate Ins. Co., 819 So. 2d 740 (Fla. 2002), the Florida Supreme Court identified three types of fraud/forfeiture provisions:
- those that state any misrepresentation will void the entire policy or policy;
- those that state that any misrepresentation as to a particular coverage voids coverage under that part; and
- those that neither reference the “entire policy” nor “this coverage part.”
Id. at 748. Things become interesting when an insurance policy does not contain language that falls within either the first or second category. When a fraud/forfeiture provision does not clearly void the entire policy or a particular coverage, insurers may still attempt to prove fraud or misrepresentation to void the entire policy. In such circumstances, Flores directs courts to use Florida’s well-established rules of insurance policy interpretation. Id. at 750.
Insurers retain control over the scope of their coverage and can alter policy language when desired. To that end, insurers must incorporate unambiguous language into its policy. See Berkshire Life Ins. Co. v. Adelberg, 698 So. 2d 828, 830 (Fla. 1997). Ambiguity exists whenever terms of the policy are subject to different reasonable interpretations, one that provides coverage and one that does not, or where more than one interpretation of a policy provision fairly exists. Weldon v. All Am. Life Ins. Co., 605 So. 2d 911, 915 (Fla. 2d DCA 1992). Where ambiguity exists, Florida law requires courts adopt the interpretation affording coverage. Westmoreland v. Lumbermens Mut. Cas. Co., 704 So. 2d 176, 179 (Fla. 4th DCA 1997). Florida uses this standard because an insured is “entitled to a clear explanation of terms rather than a fine distinction which was never written into his contract for insurance coverage.” Adelberg, 698 So. 2d at 830.
Applying these principles, Flores held a fraud/forfeiture provision that does not fall into either the first or second categories, must be interpreted as only effecting the specific portion of the claim connected to the misrepresentation or fraud. Flores, 819 So. 2d at 750. For example then, a misrepresentation in connection with a PIP claim does not preclude the insured from recovering under the uninsured/underinsured portion of his policy. Id. In the homeowners’ insurance policy context, other courts have reached similar conclusions. For example, in Tempelis v. Aetna Cas. & Surety Co., 485 N.W. 2d 217 (Wis. 1992), the Wisconsin Supreme Court held that an insured was entitled to recover under the dwelling and contents portions of the insurance policy even though a misrepresentation occurred in connection with the insured’s additional living expenses. Id. at 222.
In conclusion, policy language matters and insureds, insurers, and courts alike should be mindful of policy language when a fraud/forfeiture provision is at issue.
November 12th, 2018
By, Austin Bersinger, Esq.
Moore v. Home Depot USA, Inc., No. CV 16-00810-BAJ-RLB, 2018 WL 4976811, at *1 (M.D. La. Oct. 15, 2018)
A Louisiana federal court recently rejected an insurer’s attempt to escape providing defense and indemnity to an additional insured. In Moore v. Home Depot USA, Inc., the Court expressly rejected an insurer’s argument that a blanket AI endorsement only provided coverage for vicarious liability.
This lawsuit arose when Steven Moore was electrocuted while involved in a project to install rooftop air-conditioning units at a Home Depot store. Mr. Moore was electrocuted by a power line as he unloaded air-conditioning supplies for Commercial Coolants, Inc. (“Commercial Coolants”). After the injury, Mr. Moore and his wife sued Home Depot, Entergy, Commercial Coolants and others involved in the project. Plaintiffs also brought a direct-action claim against Commercial Coolants’ insurer, Depositors Insurance Company (“Depositors”). Depositors answered the Amended Complaint and crossclaimed against Home Depot. In response, Home Depot counterclaimed against Depositors for penalties, damages, attorneys’ fees, and a declaration that Depositors owes it defense and indemnity.
On summary judgment, Depositors asked the Court, among other things, to declare that Depositors need not defend or indemnify Home Depot as an additional insured under the commercial general liability policy Depositors issued to Commercial Coolants. The blanket additional-insured endorsement at issue provided:
B. The insurance provided to the additional insured is further limited as follows:
1. That person or organization is an additional insured, but only with respect to liability for
“bodily injury” or “property damage” caused, in whole or in part, by “your work” for the additional insured which is the subject of the written contract or written agreement.
Depositors asked the Court to enter summary judgment in its favor because its additional-insured endorsement did not cover the claims against Home Depot because Depositor’s blanket additional-insured endorsement limited coverage to Home Depot’s vicarious liability for Commercial Coolants’ fault. Depositor’s argument boiled down to because Home Depot cannot have vicarious liability for Commercial Coolants’ fault, its blanket additional-insured endorsement did not cover the claims against Home Depot.
The Court rejected Depositors’ argument for two reasons. First, Depositors’ interpretation required the Court to read into the policy a limit on coverage that is not in the policy’s text. The Court held that “[n]othing in the text of the blanket additional-insured endorsement limits coverage to Home Depot’s vicarious liability for Commercial Coolants’ fault. If Depositors intended to limit coverage to vicarious liability, it could have used language reflecting that intent. See McIntosh v. Scottsdale Ins. Co., 992 F.2d 251, 255 (10th Cir. 1993).”
Second, the Court held that Depositors’ interpretation misconstrued the “caused, in whole or in part, by” language in the endorsement. The Court held that the endorsement language clashed with an interpretation that equates “liability” with “vicarious liability” because vicarious liability is an all or nothing proposition. Simply put, the Court stated that Home Depot cannot have partial vicarious liability for Commercial Coolants’ work. However, the Court did give guidance. The Court stated that the “better reading of the blanket additional-insured endorsement is that it extends additional-insured coverage to Home Depot for Home Depot’s alleged liability for “bodily injury” or “property damage” caused, in part, by Commercial Coolants’ work for Home Depot under the MSA.” In rejecting the insurer’s “cramped” interpretation of the additional-insured endorsement, the Court communicates an all important lesson in insurance coverage. If the insurance contract doesn’t say it, courts will not strain to add conditions under which insurers can arbitrarily avoid coverage.
1 As background, Home Depot and Commercial Coolants entered into a Maintenance Services Agreement (“MSA”). The MSA contained an indemnification provision as well as a provision that required Commercial Coolants to obtain insurance naming Home Depot as an additional insured.
October 5th, 2018
By, Laura Locklair, Esq.
Though the saying goes “better late than never,” the Court’s opinion in Episcopal Church in South Carolina v. Church Insurance Company of Vermont, 53 F.Supp.3d 816 (D.S.C. 2014) suggest that an insurer’s failure to timely acknowledge its defense obligations to its insured, even when the insurer later agrees to participate in the insured’s defense, can still result in stiff penalties, not all of which are monetary.
The insured church, which was also the plaintiff in Episcopal Church in S.C. (the “Insured”), was sued by another church on March 5, 2013 concerning disputes regarding the ownership of certain real, personal and intellectual property (the “Underlying Action”). Episcopal Church in S.C., 53 F.Supp.3d at 819. The Insured tendered its defense in the Underlying Action to its insurer in August of 2013, and the insurer denied the defense on August 29, 2013. Id. at 819-820. On February 28, 2014, and only after the Insured was forced to file a declaratory judgment action and successfully persuaded the Court to find on summary judgment that the insurer owed a duty to defend, the insurer issued a reservation of rights letter agreeing to participate in the Insured’s defense in the Underlying Action. Id. At 820. However, in its reservation of rights correspondence, the insurer alleged that it was entitled to replace the Insured’s attorney who had represented the insured for over a year in the Underlying Action with new counsel of the insurer’s choosing. Id. When called upon to predict whether the South Carolina Supreme Court would find that an insurer retains the right to control the defense after it refused to defend in breach of the insurance contract , the Court in Episcopal Church in S.C. concluded that the insurer’s wrongful refusal to defend the Insured in the Underlying Action forfeited the insurer’s right to control the defense of the Insured, even after the Insurer later reversed its position and acknowledged its defense obligations. Id.
In reaching its determination, the Court first acknowledged that South Carolina courts have found that where a policy provides an insurer with the right and duty to defend, the insurer has “the right and the duty to control the defense until such time as it [i]s determined that it ha[s] no liability insurance coverage.” Id. at 823, citing Allstate Ins. Co. v. Wilson, 259 S.C. 586, 193 S.E.2d 527, 530. That right to control the defense, the Court suggested “includes the right to control the defense and select defense counsel.” Episcopal Church in S.C., 53 F. Supp.3d at 823.
However, the insurer’s right to control the defense and appoint counsel is not without limit. In this instance, the Court concluded that the insurer “lost its right to control the defense and select defense counsel when it breached its duty to defend.” Episcopal Church, 53 F.Supp.3d at 826. The Court’s opinion is in line with and relied on both treatises on insurance law and decisions from other courts. Id. at 824-825. Namely, compendiums reviewed by the Court universally agreed that an unjustified refusal by an insurer to defend an insured results in the insurer’s loss of the ability to control the defense and select defense counsel. See, e.g., 49 A.L.R.2d 694 at § 18; 1 Insurance Claims & Disputes § 4:38; 3-17 New Appleman on Insurance law Library Ed. § 17.07. Likewise, courts around the country have opined that an insurer’s refusal to defend forfeits any right to control the defense, including selection of counsel. See, e.g., BellSouth Telecomms., Inc. v .Church & Tower of Fla., Inc., 930 So.2d 668 (Fla.Dist.Ct.App.2006); Eigner v. Worthington, 57 Cal.App.4th 188, 66 Cal.Rptr.2d 808 (1997), Royal Ins. Co. of Am. V. Kirksville Coll. Of Osteopathic Med., Inc., 304 F.3d 804 (8th Cir.2002); Wells’ Dairy, Inc. v. Travelers Indem. Co. of Ill., 266 F.Supp.2d 964 (N.D. Iowa 2003), Sentinel Ins. Co., Ltd. v. First Ins. Co. of Haw., Ltd., 76 Hawai’i 277, 875 P.2d 894, on reconsideration sub nom. Sentinel Ins. Co., Ltd. v. First Ins. Co. of Haw., Ltd., 76 Hawai’i 453, 879 P.2d558 (1994); Grube v. Daun, 173 Wis.2d 30, 496 N. W.2d 106 (Wis.Ct.App.1992).
Moreover, the Court was not persuaded that the insurer’s later about face and belated acceptance of the defense was sufficient to cure the breach or permitted the insurer to control the Insured’s defense. To that point and as additional support for its decision that the insurer’s breach forfeited its right to participate in the defense, the court focused on the fact that the Insured, which had been forced to retain and pay its own attorney in the Underlying Action for over a year, would “suffer material harm if forced to relinquish control of its defense.” Episcopal Church in S.C., 53 F.Supp.3d at 826.
As a result of the insurer’s unjustified refusal to defend the Insured, the Court determined that the insurer was not only precluded from appointing defense counsel of its choosing, it was also required to reimburse the Insured for the reasonable costs of defense of the Underlying Action, including costs incurred pretender. Episcopal Church in S.C., 53 F.Supp.3d at 830.
Insurers in South Carolina and beyond should be cautioned that their failure to get it right the first time by assuming the timely demanded defense of an insured can have significant consequences, including forfeiting the right to select counsel, loss of the ability to control defense strategy, and the responsibility for shouldering the entirety of the insured’s reasonable defense costs, including those fees and costs incurred pretender.
1 Because the Court’s jurisdiction was based on diversity, the Court looked to South Carolina law to evaluate the rights and responsibilities of the Insured and insurer. Episcopal Church in S.C., 53 F.Supp.3d at 821. However, because the South Carolina Supreme Court had not addressed the particular issue before the Court, the Court required to predict how that the South Carolina Supreme Court would rule if presented with the issue. Twin City Fire Ins. Co. v. Ben Arnold-Sunbelt Beverage Co. of S.C., 433 F.3d 365, 369 (4th Cir. 2005).
2 For example, Florida insurers are statutorily required to retain “independent counsel which is mutually agreeable to the parties.” FLA. STAT. § 627.426. To be mutually agreeable, the insured must actually approve the selected counsel. See Cont’l Ins. Co. v. City of Miami Beach, 521 So. 2d 232, 233 (Fla. App. 3d Dist. 1988); Am. Empire Surplus Lines Ins. Co. v. Gold Coast Elevator, Inc., 701 So. 2d 904, 906 (Fla. App. 4th Dist. 1997).
3 Though not an issue before the Court in Episcopal Church of S.C., courts have found that an insurer’s unjustified refusal to defend also waives its right to be involved in defense strategy, reject settlements, and receive notice of developments in the underlying action. See, e.g., Orleans Vill. V. Union Mut. Fire Ins. Co., 133 Vt. 217, 335 A.2d 315, 318 (1975) (“[A]n insurer who refuses to defend after timely demand is made upon it to do so cannot control the defense or expect advance notice of the refused party’s trial strategy.”); Royal Ins. Co. of Am. V. Kirksville Coll. of Osteopathic Med., Inc., 304 F.3d 804 (8th Cir. 2002) (“When an insurance company refuses to defend its insured, the insurer loses its right to control the litigation and to reject what it considers an unfavorable settlement.”); 14 Couch on Insurance 3d § 202:7 (explaining that “where insurer breaches its contract by refusing to defend…the insurer…cannot object to the insured’s handling of the case .. is not entitled to notice of the insurer’s trial strategy, and has no right to notice of pleadings filed in the underlying action.”).
July 12th, 2018
Insureds Re-Joyce, Multipliers Are Alive and Well: the Florida Supreme Court Rejects the Rare and Exceptional Circumstances Requirement
By, Katherine L. Sloan, Esq.
In certain circumstances, Florida courts impose contingency fee multipliers to increase an attorneys’ fee award. This multiplier can increase the fees awarded from 1.5% to 2.5% and the case law dictates specific factors that must be considered before imposition of the same. The recent decision in Joyce v. Federated National Ins. Co., 228 So. 3d 1122 (Fla. 2017), rejected the application of a rare and exceptional circumstances requirement to contingency fee multipliers.
Generally, in American law, each party is responsible for his or her own attorneys’ fees, regardless of the prevailing party in the lawsuit. See Johnson v. Omega Ins. Co., 200 So. 3d 1207, 1214 (Fla. 2016). However, an exception to this rule arises when an award of attorneys’ fees is statutorily imposed or the parties otherwise agree to the imposition of attorneys’ fees. Id.
As a matter of public policy—primarily to discourage carriers from denying valid claims—the State of Florida imposed a fee shifting statute, which authorizes an insured to collect reasonable attorneys’ fees from a carrier upon the rendering of a judgment or decree in its favor. § 627.428, Fla. Stat. The statute provides in relevant part:
Upon the rendition of a judgment or decree by any of the courts of this state against an insurer and in favor of any named or omnibus insured or the named beneficiary under a policy or contract executed by the insurer, the trial court or, in the event of an appeal in which the insured or beneficiary prevails, the appellate court shall adjudge or decree against the insurer and in favor of the insured or beneficiary a reasonable sum as fees or compensation for the insured’s or beneficiary’s attorney prosecuting the suit in which the recovery is had.
Id. Notably, this fee-shifting benefit does not extend to the carrier in the event of a judgment or decree in its favor.
The Joyces, an elderly couple, sustained water damage to their home and subsequently submitted a claim to their insurer, Federated National Insurance Company (“Federated”). Joyce, 228 So. 3d at 1123. Federated denied the claim on the basis of material misrepresentations made by the Joyces in their application. The Joyces, due to financial limitations, were forced to hire an attorney on a contingency fee arrangement. Id. After several months embroiled in litigation, Federated agreed to settle the claim. Id. at 1134. In this settlement, Federated stipulated to the Joyces’ entitlement to reasonable attorneys’ fees. Id. at 1124.
Thereafter, the trial court thoroughly examined the timesheets prepared by the Joyces’ attorneys and heard testimony from both the insureds’ fee expert and the fee expert for Federated. Id. After the hearing, the trial court first calculated the “lodestar” amount. Id. In Florida, the “lodestar” is defined as the number of hours reasonably incurred by the attorneys of record, multiplied by a court-determined reasonable hourly rate. Id. In this determination, the court considers factors set forth in the Florida Rules of Professional Conduct 4-1.5 such as, the fee customarily charged in the locality, the amount at issue in the case, the experience of the attorney, and the time and labor required pursuant to the novelty and difficulty of the questions involved. Id. The trial court then applied a multiplier of 2.0 to the lodestar amount after consideration of the factors set forth in Standard Guaranty Ins. Co. v. Quanstrom, 555 So. 2d 828 (Fla. 1990) and Florida Patient’s Compensation Fund v. Rowe, 472 So. 2d 1145 (Fla. 1985). Joyce, 228 So. 3d at 1124.
Under Rowe, the Florida Supreme Court determined that a trial court could adjust the lodestar and apply a multiplier between 1.5 and 3.0 based on, among other factors, the likelihood of success at the case’s outset. 472 So. 2d 1145. Specifically, Rowe outlined the following criteria for the imposition of a multiplier:
(1) The time and labor required, the novelty and difficulty of the question involved, and the skill requisite to perform the legal service properly.
(2) The likelihood, if apparent to the client, that the acceptance of the particular employment will preclude other employment by the lawyer.
(3) The fee customarily charged in the locality for similar legal services.
(4) The amount involved and the results obtained.
(5) The time limitations imposed by the client or by the circumstances.
(6) The nature and length of the professional relationship with the client.
(7) The experience, reputation, and ability of the lawyer or lawyers performing the services.
(8) Whether the fee is fixed or contingent.
Id. at 1150, n. 5.
The subsequent Quanstrom decision modified the analysis for contingency fee multipliers holding that a trial court must consider whether to apply a multiplier, but is not required to do so. 555 So.2d at 831. Pursuant to Quantrom, a trial court should consider three factors in determining whether to impose a contingency fee multiplier: 1) whether the relevant market requires a contingency fee multiplier to obtain competent counsel; (2) whether the attorney was able to mitigate the risk of nonpayment in any way; and (3) whether any of the factors set forth in Rowe are applicable, especially, the amount involved, the results obtained, and the type of fee arrangement between the attorney and his or her client. Id. at 834. Finally, the Court detailed that evidence must be presented to justify the utilization of the multiplier. Id.
In Joyce, the trial court found that first factor—the relevant market—supported a multiplier. 228 So.3d at 1136. The insureds’ attorney and fee expert testified that they were unaware of any other attorneys in St. Johns County who specialized in representing first-party plaintiffs against insurers. Id. at 1135. The trial court concluded, “there are few or no other attorneys who undertake this work who have offices in the St. Augustine area.” Id. Without the possibility of a contingency fee multiplier, the insureds would not have found another competent attorney who would have agreed to take the case. Id. The trial court also determined that the case was complex, and therefore the third Quanstrom factor supported the imposition of a multiplier. Id. at 1134.
The Fifth District Court of Appeal in Joyce reversed the trial court’s decision construing the language of Quanstrom to indicate that a multiplier is only to be utilized in rare and extraordinary circumstances. 228 So. 3d at 1128-29. Notably, this decision aligns with the United States Supreme Court’s view of multipliers. Perdue v. Kenny A. ex rel. Winn, 559 U.S. 542 (2010). In fact, the Fifth District relied upon this precedent in support of its reversal of the trial court’s decision in Joyce. 228 So. 3d at 1131.
The Florida Supreme Court, however, rejected the rare and exceptional circumstances argument set forth by Federated, found that a multiplier of 2.0 was appropriate in the Joyce case, and determined that the trial court came to such a conclusion based on competent and substantial evidence. Id. at 1136. The Court specifically noted that no such rare and exceptional circumstances requirement exists under Rowe, Quanstrom, or in Bell v. U.S.B. Acquisition Co., Inc., 734 So. 2d 403 (Fla. 1999) (holding that a multiplier could be applied to court awarded fees based upon a contractual provision). Joyce, 228 So. 3d at 1133.
Additionally, the Court determined that the Fifth District’s reliance on Perdue missed the point that Perdue addressed lodestar enhancements in contexts other than contingency fee multipliers, and was therefore inapplicable to the instant case. Joyce, 228 So. 3d at 1131. Moreover, the Florida Supreme Court expressed its rejection of the United States Supreme Court’s rationale for rejecting contingency fee multipliers. Id. at 1132. Justice Scalia, writing for the majority in City of Burlington v. Dague, 112 S.Ct. 2638 (1992), couched his disapproval of contingency fee multipliers by reasoning that the multipliers incentivize nonmeritorious claims. The Florida Supreme Court determined that, to the contrary, a contingency fee multiplier provides a trial court with the necessary flexibility to ensure that lawyers that take on difficult cases under a contingency fee are adequately compensated, thereby providing plaintiffs with access to competent counsel. Joyce, 228 So. 3d at 1132.
The Joyce decision reaffirmed Florida’s continued commitment to allow the use of contingency fee multipliers where appropriate. Accordingly, in the wake of Hurricane Irma and the massive influx of coverage disputes resulting from the same, a carrier should appreciate its exposure to a potential contingency fee multiplier when analyzing its risk. Navigating an insurance claim can be a confusing and arduous process. It is always best to consult with an attorney that specializes in insurance coverage disputes to assist in the process.
June 29th, 2018
By, Alex Brockmeyer, Esq.
Rule 9.310, Florida Rules of Appellate Procedure, controls how a party can stay execution on a final or non-final order pending appellate review, including a money judgment. FLA. R. APP. P. 9.310(a). Traditionally, a party could only stay execution on a money judgment by posting a bond that encompassed the full amount of the judgment plus interest. E.g. Kulhanijan v. Moomjian, 105 So. 2d 783, 784 (Fla. 1958). Now, however, a conflict exists between the District Courts of Appeal on whether Rule 9.310(b)(1) is the only way to stay execution on a money judgment.
In Platt v. Russek, 921 So. 2d 5 (Fla. 2d DCA 2004), the Second District addressed under what conditions a party can stay of execution on a money judgment pending appellate review. Citing the Third District’s decision in Campbell v. Jones, 648 So. 2d 208 (Fla. 3d DCA 1994), the judgment-creditors argued the only way to obtain a stay of execution on a money judgment was by posting “a bond equal to the amount of the judgment plus two years of interest at the statutory rate….” Platt, 921 So. 2d at 7. The Second District disagreed with the Third District’s interpretation of Rule 9.310. Id. The court interpreted Rule 9.310 to permit two types of stays. First is an automatic stay obtained under Rule 9.310(b)(1) by posting the requisite bond. Id. Second is a stay obtained by motion under Rule 9.310(a), where a court imposes certain conditions, which may not guarantee full payment of the judgment but, at the same time, do not prejudice the judgment-creditor—a stay the Third District does not recognize. Id.
The express and direct conflict between the Second and Third District has increased since Platt. In 2006, the Fourth District agreed with the Third District and held that a trial can only stay execution under Rule 9.310(b)(1). Caruso v. Caruso, 932 So. 2d 457, 458 (Fla. 4th DCA 2006). A little over a year ago, the First District joined the Second District and held “that [R]ule 9.310(b)(1) is not the only avenue for obtaining a stay of a money judgment. A trial court has the authority, upon the motion of a party pursuant to rule 9.130(a), to enter a stay upon conditions other than a bond, so long as the conditions are adequate to ensure payment.” Silver Beach Towers Property Owners Ass’n, Inc. v. Silver Beach Investments of Destin, LC, 231 So. 3d 494, 495 (Fla. 1st DCA 2017) (citations omitted).
Recognizing the conflict, the First District certified conflict with the Third District. But the Florida Supreme Court did not accept jurisdiction. Silver Beach Investments of Destin, LC v. Silver Beach Towers Property Owners Ass’n, Inc., 223 So. 3d 997 (Fla. 2017). For now then, the conditions on which a judgment-debtor can stay execution on a money judgment pending appellate review depends on the jurisdiction. In the Third and Fourth District, a stay can only be obtained under Rule 9.310(b)(1) by posting a bond in the amount of the judgment plus interest. * In the First and Second District, a party can obtain a stay of execution under Rule 9.310(a) predicated on conditions other than a bond.
* The Waves of Hialeah, Inc. v. Machado, 3D18-300 (Fla. 3d DCA 2018), indicates the Third District will deviate from this rule based on Section 45.045, Florida Statutes. Id. at 4-7. Section 45.045 gives courts discretion to stay execution pending review by imposing conditions other than a typical Rule 9.310(b)(1) bond. FLA. STAT. §45.045(2). However, Section 45.045(2) does not apply where the appellant has “an insurance or indemnification policy applicable to the case.” Id.
June 15th, 2018
California Supreme Court holds that commercial general liability policy covers employer for negligent hiring, retention, and supervision of employee who intentionally injures third party
By, Mark A. Boyle, Esq.
In Liberty Surplus Insurance Corporation vs. Ledesma & Meyer Construction Company, Inc. (L & M), the California Supreme Court found that the standard commercial general liability (“CGL”) policy provides coverage when a third-party sues an employer for negligent hiring, retention, and supervision of an employee who intentionally injured that third-party.
L & M was sued by a third-party who alleged that they have been abused by an employee of L & M. Specifically, L & M was sued for negligence by hiring, retaining, and supervising the employee that conducted the abuse.
The legal issue involved in the case was whether under the CGL policy issued to L & M, the claims constituted and “occurrence“ and “accident“ within the meaning of the CGL policy. The CGL policy provided coverage for “bodily injury” caused by an “occurrence.” The policy defines an occurrence as an “accident.”
The court found coverage even though the acts of one of the employees was clearly intentional, specifically noting:
Because liability insurance is a contract between an insurer and insured, and the policy is read in light of the parties’ expectations, the relevant viewpoint is of the insured rather than the injured party.
Thus, California, consistent with most jurisdictions, held that coverage is available under a CGL policy to an insured as long as the damages are not subjectively intended or expected from the standpoint of the insured.
In this respect, California law is in conformity with the overwhelming majority of jurisdictions who have decided this issue. See Carylye King vs. Dallas Fire Ins. Co., 85 S.W. 3d 185 (Tex. 2002); Lamar Homes, Inc. v Mid-Continent Cas. Co., 242 S.W. 3d 1 (Tex. 2007); State Farm Fire and Casualty Co. v CTC Development Corp., 720 So.2d 1072 (Fla. 1998); George Koikos v Travelers Ins. Co., 849 So. 2d 263 (Fla. 2003); and Travelers Indemnity Co. v PCR Inc., 889 So. 2d 779 (Fla. 2004) All of these cases hold that bodily injury and property damage claims are covered under the CGL policy unless the damage was intended or expected from the standpoint of the insured. This is true even if the insured intend the conduct giving rise to liability.
The California ruling affirms the broad coverage which was intended to be provided under the standard commercial general liability policy.
May 16th, 2018
By, Laura L. Locklair, Esq.
South Carolina and Florida are not always aligned in their treatment of issues affecting insurers and policyholders, but the states are in agreement that an insurer’s duty to defend is several, personal and not subject to division by or contribution from other carriers. Cont’l Cas. Co. v. United Pac. Ins. Co., 637 So.2d 270, 272-7 (Fla. 5th DCA 1994) (holding that insurer is not entitled, pursuant to right of equitable subrogation or contribution, to recover from another insurer costs of defending mutual insured); Sloan Constr. Co. v. Cent. Nat’l Ins. Co. of Omaha, 269 S.C. 183, 236 S.E.2d 818, 820 (1977) (an insurer is not entitled to divide duty to defend nor require contribution from another absent specific contractual right); Auto-Owners Ins. Co. v. Travelers Cas. And Sur. Co. of Am., No. 4:12-cv-3423, 2014 WL 3687338 (D.S.C. July 22, 2014 aff’d, 597 (4th Cir. 2015). As a result, where two or more insurers insure the same risk for the same insureds (be it a named insured or an additional insured) and the policies at issue provide for a defense, the insured is entitled to seek its costs of defense from any or all of the insurers but, absent other contractual rights, the defending insurer(s) cannot require contribution from the other carriers or seek to subrogate the expenses of that defense.
South Carolina and Florida, along with a few other states, find themselves in the minority in the refusal to grant insurers a right to recover portions of the defense costs paid from other carriers. Id.; Fid. & Cas. Co. of N.Y. v. Ohio Cas. Ins. Co., 482 P.2d 924, 926 (Okla. 1971). These minority courts recognize that each insurer contracted to defend, at its own expense, any suit within the terms of its policy. Sloan, 269 S.C. at 186 (finding that an insurer’s duty to defend is irrelevant to the rights and duties existing between the insured and another carrier). As a result, compelling each carrier to provide a full defense to its insured requires no more of the insurer than what it was obligated to do under its insurance contract with the insured. While potentially draconian from the carriers’ perspective, the minority rule protects the insured’s rights to the full benefits of the insurance policy and entitles the insured to recover 100% of its defense costs from any one carrier. Moreover, because insurers cannot sue one another seeking a pro-rata share of attorneys’ fees incurred in providing a defense to the mutual insured there is a corresponding reduction in the number of lawsuits and burden on the judiciary. Cont’l Cas. Co., 637 So.2d at 273. Courts in South Carolina and Florida also have reasoned that the threat of bad faith actions, and the corresponding exposure of policy limits and extra-contractual damages, are sufficient to prevent additional carriers from shirking their defense obligations after one carrier picks up the defense of the shared insured.
The majority of courts which recognize an insurer’s right to contribution or to have defense costs shared in some way include the following: (1) Alaska, Marwell Constr., Inc. v. Underwriters at Lloyd’s, London, 465 P.2d 298, 313 (Alaska 1970); (2) Arizona, Nat’l Indem. Co. v. St. Paul Ins. Cos., 150 Ariz. 458, 724 P.2d 544, 545 (1986); (3) California: Cont’l Cas. Co. v. Zurich Ins. Co., 57 Cal.2d 27, 17 Cal.Rptr. 12, 366 P.2d 455, 460-62 (1961); (4) Colorado: Nat’l Cas. Co. v. Great Sw. Fire ins. Co., 833 P.2d 741, 747-48 (Colo.1992); (5) Connecticut: Travelers Cas. & Surety Co. of Am. V. Netherlands Ins. Co., 312 Conn 714 (2014); (6) Cargill, Inc. v. Ace American Ins. Co., 784 N. W. 2d 341 (2010); (7) New Jersey: Marshall v. Raritan Valley Disposal, 398 N.J. Super. 168, 940 A.2d 315, 320 (2008); (8) North Carolina: Medical Mut. Ins. Co. of NC v. American Cas. Co. of Reading, PA, 721 F. Supp.2d 447, 464 (E.N. N. C. 2010); (9) Pennsylvania: J.H. France Refractories Co. v. Allstate Ins. Co., 534 Pa 29, 626 A.2d 502, 209 (1993); (10) Utah: Sharon Steel Corp. v. Aetna Cas. & Sur. Co., 931 P.2d 127, 137-38 (Utah 1997); and (11) Washington: Mut. Of Enumclaw Ins. Co. v. USF Ins. Co., 164 Wash.2d 411, 191 P.3d 866, 872-74 (2008). These cases suggest that permitting contribution and/or subrogation between insurers guarantees that co-carriers honor their obligations to defend their mutual insured and that no one carrier is unfairly saddled with the burden of funding the entire defense. Specifically, such courts conclude that permitting coinsurers to recover from one another creates strong incentives for prompt and proactive involvement by all responsible carriers, reduces the incidence of carriers that avoid their duty to defend in the hope that other insurers will defend and relieve them of the expense, and promotes the efficient use of resources of insurers, litigants, and the court.
Insurers in South Carolina, Florida and like-minded states continue to look for opportunities to create a cause of action for equitable contribution, permit subrogation, or to otherwise alter the minority rule. However, the South Carolina District Court for the Charleston Division recently affirmed the Sloan rule in FCCI Insurance Company v. Island Pointe, LLC, et al., Case No. 2:17-cv-1976. In that declaratory judgment action arising out of the construction of a condominium complex in Charleston, South Carolina, FCCI sought declarations regarding the coverage available to its named insured and general contractor for the project, Complete Building Corporation (“Complete”). While FCCI agreed to defend Complete in the underlying action, FCCI also sought a declarations that Complete qualified as an additional insured under policies issued to Complete’s subcontractors and that the carriers for Complete’s subcontractors were required to contribute to Complete’s defense fees and costs. In granting motions to dismiss filed by the carriers for Complete’s subcontractors, the court determined that the doctrines set forth in Sloan and Auto-Owners applied and precluded FCCI’s claims. Specifically, the court opined that because “FCCI is not a party to any contract between [Complete’s subcontractors and their insurers]” FCCI “cannot compel the [subcontractors’ insurers] to defend Complete in the underlying suit. FCCI at *8-9. Importantly, while insurers may not have the right in South Carolina to compel participation of the other carriers in the defense of a shared insured, the Island Pointe case does not hold that a policyholder is prohibited from all implicated insurers even when another carrier is already defending it.
Ultimately, under either the majority or minority rule, the insured is entitled to payment of 100% of its defense costs per its policy/policies. However, the differences in the law can have practical and meaningful effects on the number and scope of the lawsuits to which the policyholder may be a party, its duties in those cases, and potentially even its tender obligations.
April 11th, 2018
WHERE ONE ASKS FOR THEIR DECLARATIONS MATTERS: DECLARATORY JUDGMENT ACTIONS IN FLORIDA STATE AND FEDERAL COURTS
by, Michael W. Leonard, Esq.
Insurance coverage disputes involving both the duty to defend and indemnity necessarily result in the filing of actions seeking declaratory judgments as to both. The jurisdiction where a party, whether it be the insured or insurer, files for relief matters. Florida and federal courts have their own respective declaratory judgment statutes and they are not identical. These differences may likely lead to different timelines in the litigation process.
Florida’s declaratory judgment statute gives both county and circuit courts’ jurisdiction within their respective jurisdictional amounts to declare rights, status and other equitable and legal relations. §86.011 Florida Statues. This statute goes on to read in relevant part that: “[T]he court may render declaratory judgments on the existence or nonexistence” of any immunity, power, privilege or right whether it now exists or may arise in the future. Id. (emphasis added).
The federal statute governing declaratory actions provides that: “[I]n a case of actual controversy . . . any court of the United States, upon the filing of an appropriate pleading, may declare the rights and other legal relations of any interested party seeking such declaration, whether or not further relief is or could be sought.” 28 U.S.C. § 2201. (emphasis added). Although the highlighted differences between the two statutes may seem subtle, how courts have interpreted their respective statutes matters.
The Distinction Between Duty to Defend and the Duty to Indemnify
Before analyzing the differences between the two statutes and the cases interpreting them, it is important to recap the differences between the duty to defend and indemnify. As we all know, the duty to indemnify is separate and distinct from the duty to defend. Northland Cas. Co. v. HBE Corp., 160 F. Supp. 2d 1348, 1360 (M.D. Fla. 2001). The duty to defend is broader than the duty to indemnify and depends “‘solely on the allegations in the complaint[s] filed against the insured.’” Id. “[T]he duty to indemnify is dependent upon the entry of a final judgment, settlement, or a final resolution of the underlying claims by some other means.” HBE Corp., 160 F. Supp. 2d at 1360; see also Westport Ins. Corp. v. VN Hotel Grp., LLC, 761 F. Supp. 2d 1337, 1348 (M.D. Fla. 2010) (“Except where there is no duty to indemnify for want of a duty to defend, an insurer’s duty to indemnify is dependent on the outcome of a case . . .”). “[W]hereas the duty to defend is measured by the allegations of the underlying complaint, the duty to indemnify is measured by the facts as they unfold at trial or are inherent in the settlement agreement.” HBE Corp., 160 F. Supp. 2d at 1360; see also Stephens v. Mid-Continent Cas. Co., 749 F.3d 1318, 1324 (11th Cir. 2014) (an insurer’s duty to indemnify “is narrower [than the duty to defend] and is determined by the underlying facts adduced at trial or developed through discovery during the litigation.”; “In other words, to determine whether there is a duty to indemnify, one looks at the actual facts, not only those that were alleged in the state court complaint.”).
The Federal Declaratory Judgment Act and Cases Interpreting Same
The Federal Declaratory Judgment Act, since its inception, has been understood to confer on federal courts unique and substantial discretion in deciding whether to declare the rights of litigants.” Wilton v. Seven Falls Co., 515 U.S. 277, 286 (1995). The United States Supreme Court has “repeatedly characterized the Declaratory Judgment Act as an enabling Act, which confers a discretion on the courts rather than an absolute right upon the litigant.” Id. at 286-87. A district court thus always has discretion whether to entertain an action for a declaratory judgment. Cas. Indem. Exch. v. High Croft Enters., Inc., 714 F. Supp. 1190, 1193 (S.D. Fla. 1989) (citing Brillhart v. Excess Ins. Co., 316 US 491 (1942) and Public Affairs Assocs., Inc. v. Rickover, 369 U.S. 111 (1962)); see also Angora Enters., Inc. v. Condo. Ass’n. of Lakeside Village, Inc., 796 F.2d 384, 387 (11th Cir. 1986) (“the district court could have properly refused to address the merits of the claim by resort to its inherent discretion to decline to entertain a declaratory action.”). The Eleventh Circuit has declared that the Act “only gives the federal courts competence to make a declaration of rights; it does not impose a duty to do so.” Ameritas Variable Life Ins. Co. v. Roach, 411 F.3d 1328, 1330 (11th Cir. 2005). As such, “[g]ratuitous interference with the orderly and comprehensive disposition of a state court litigation should be avoided.” Id. (citing Brillhart v. Excess Ins. Co. of Am., 316 U.S. 491, 495 (1942)).
The Federal Declaratory Judgment Act provides that a declaratory judgment may be issued only in the case of an “actual controversy,” which must be immediate, substantial and continuing and must create a “definite, rather than speculative threat of future injury.” 28 U.S.C. §2201 et seq.; Emory v. Peeler, 756 F.2d 1547, 1552 (11th Cir. 1985). The Act is a grant of jurisdiction only as to those rights and liabilities that are immediate and real, or that are certain to arise. See, e.g., Calderon v. Ashmus, 523 U.S. 740, 746-47 (1998). The “case or controversy” requirement of the Constitution limiting federal court jurisdiction similarly requires that “a plaintiff must have suffered some actual injury that can be remedied or redressed by a favorable judicial decision.” Nat’l Advertising Co. v. City of Ft. Lauderdale, 934 F.2d 283, 285-86 (11th Cir. 1991). As such, federal courts have broad discretion to either dismiss without prejudice or stay unripe claims. Pro Net Global Ass’n, Inc. v. U.S. Liab. Ins. Co., Nos. 3:02-cv-396-J-32TEM, 3:02-cv-617-J- 32TEM, 2004 WL 6062923, at *2 (M.D. Fla. Mar. 8, 2004) (citing Wilton, 515 U.S. at 288).
Because an insurer’s duty to indemnify generally depends on the outcome of the underlying dispute against the insurer’s insured, federal court courts have held that an insurer’s duty to indemnify is not ripe until the underlying suit is resolved, and thus either dismiss or stay the claim involving the declaration of rights involving indemnity. See, e.g., Summit Contractors, Inc. v. Amerisure Mut. Ins. Co., No. 8:13-CV-295-T-17TGW, 2014 WL 936734 (M.D. Fla. Mar. 10, 2014) (dismissing for lack of subject matter jurisdiction pursuant to Rule 12(b)(1) request for declaration as to a carrier’s duty to indemnify for pending underlying claims as unripe); Allstate Prop. & Cas. Ins. Co. v. Tomlinson, No. 2:14–cv–1940–HRH, 2015 WL 3439129 (D. Ariz. May 28, 2015) (same); Pro Net, 2004 WL 6062923 (dismissing request for declaration as to a carrier’s duty to indemnify until underlying actions are resolved); Mid-Continent Cas. Co. v. Gozzo Dev., Inc., No. 17-CV-80362, 2017 WL 3578846, at *1 (S.D. Fla. July 19, 2017).
For example, in Mid-Continent Cas. Co. v. Nassau Builders, Inc., No. 3:16-CV-921-J-34JRK, 2017 WL 1191383 (M.D. Fla. Mar. 31, 2017), the Middle District of Florida stayed a declaratory action case until the underlying action was resolved. Importantly, the court noted that the duty to indemnify will “necessarily turn on complex factual findings and issues of Florida law which are currently pending in the Underlying Action before the state court.” Id. at *2.
Florida’s Declaratory Judgment Statute
Florida courts, in deciding issues involving the duty to indemnify, have found it important to determine whether the issue of coverage is dependent on the resolution of factual issues in the underlying action. If the declaratory action was not dependent on the factual issues in the underlying action courts would not abate or dismiss the declaratory action and instead determine the indemnity issue. For example, in the case of Britamco Underwriters, Inc. v. Central Jersey Invs., Inc., 632 So. 2d 138, 139 (Fla. 4th DCA 1994), the court held that where issue of coverage was not dependent on the resolution of fact issues common to underlying litigation, it was appropriate to determine in declaratory action prior to conclusion of underlying suit. Likewise, in Travelers Ins. Co. v. Emery, 579 So. 2d 798, 800-02 (Fla. 1st DCA 1991), the issue of coverage under a business pursuits exclusion was appropriate for declaratory action prior to filing of underlying action where resolution of this issue leaves material issues in underlying action unaffected. In Allstate Ins. Co. v. Conde, 595 So. 2d 1005, 1008 (Fla. 5th DCA 1992), the appellate court noted that under unusual circumstances where the underlying complaint alleges two alternative, mutually exclusive theories of liability, a court may look beyond the allegations of complaint and determine facts that will answer the duty to defend issue and also thereby answer the duty to indemnify issue.
As such, when the theories of liability in the underlying action and the factual issues associated with indemnity were intermingled, Florida state courts were more likely to abate or dismiss the indemnity issues and allow the facts to develop in the underlying action. In Home Insurance Company v. Gephart, 639 So. 2d 179 (Fla. 4th DCA 1994), the insurer was not entitled to a declaration of the duty to indemnify where the case involved some of the same factual questions that were present in the underlying action and where theories of liability were not mutually exclusive. Marr Investments, Inc. v. Greco, 621 So. 2d 447 (Fla. 4th DCA 1993), is another example. In Marr, a bar owner sought a declaration obligating its insurer to defend it against claims by a patron. Id. On appeal, the court found that the trial court’s finding that there was no coverage was premature and therefore the issue of indemnity was not ripe. Id. at 449. The appellate court stated that the duty to indemnify should be deferred until liability was decided in the underlying action. Id.
In 2005, the Florida Supreme Court heard the case of Higgins v. State Farm Fire and Casualty Company, 894 So. 2d 5 (Fla. 2005). The facts of Higgins are relatively simple. The initial allegation of the complaint filed alleged that while visiting Mrs. Bradley, the estranged wife of Mr. Higgins, Mr. Higgins came to her home and intentionally assaulted Mrs. Ingalls. Id. Mrs. Ingalls thereafter field her amended complaint wherein she alleged that the actions of Mr. Higgins were negligent. Id. Mr. Higgins demanded that State Farm, the homeowner’s carrier, provide him a defense and indemnity for the claims being asserted. Id. State Farm filed a declaratory action as to the duty to defend and indemnify and argued that despite the negligence label, the alleged conduct was still willful and intentional and therefore excluded under the homeowner’s policy. Id. at 8. The declaratory action proceeded to trial and the jury found that Higgins actions were intentional. Id. On appeal, the Fourth District Court of Appeal found that it was appropriate for the declaratory action to decide whether Higgins’ conduct was excluded under the policy. The appellate court also certified the following question to the Supreme Court:
May the insurer pursue a declaratory action in order to have declared its obligation under an unambiguous policy even if the court must determine the existence or nonexistence of a fact in order to determine the insurer’s responsibility?
Id. at 9.
The Florida Supreme Court agreed with the Fourth District that sections 86.011(2), 86.051, 86.071, and 86.101, Fla. Stat., support the conclusion that an insurer may pursue a declaratory action which requires a determination of the existence or nonexistence of a fact upon which the insurer’s obligations under an insurance policy depend. The Court went on to state that:
We conclude that it is illogical and unfair to not allow insureds and insurers to have a determination as to whether coverage exists on the basis of the facts underlying a claim against an insurance policy. Why should an insured be placed in a position of having to have a substantial judgment against the insured without knowing whether there is coverage from a policy? Why should an insurer be placed in a position of either paying what it believes to be an uncovered claim or being in jeopardy of a bad faith judgment for failure to pay a claim? These are precisely the issues recognized by this Court in other contexts that are intended to come within the purpose of the declaratory judgment statute’s “relief from insecurity and uncertainty with respect to rights, status, and other equitable or legal relations.
Id. at 15. The Court thus concluded that the Florida declaratory judgment statutes authorize declaratory judgments in respect to insurance policy indemnity coverage and defense obligations in cases in which it is necessary to resolve issues of fact in order to decide the declaratory judgment action. Id. at 16.
In light of this holding, some carriers are of the mindset that Florida now permits, in all instances, the filing of a declaratory action in state court which will allow them to determine early on both the issue of defense and indemnity. However, this reading of Higgins is not accurate. Important to the Supreme Court’s ruling was the fact that depending on the determining of the factual issue, the claims asserted would be either covered or not. In this regard, the Court went on to site to the factors identified in Allstate Insurance Co. v. Conde, 595 So.2d 1005, 1008 (Fla. 5th DCA 1992), which a court should consider when analyzing whether to allow the factual issues of indemnity to be decided ahead of the underlying action. Id. at 15. One consideration is what issues are involved in the two actions. Id. In Conde, like the Higgins action, the issue was whether all claims against the insured arose from acts which were intentional or negligent (covered or uncovered). Id.
Another factor which a court should weigh is whether proceeding to a decision as to the insurance indemnity issue will promote settlement and avoid the problem of collusive actions between claimants and insureds in order to create coverage where coverage does not exist under the true facts. Id. at 16. As noted by the Conde court, pleadings can create a perfect conspiracy between plaintiff and defendant in the underlying action. Id. As quoted by the Supreme Court in Higgins, the Conde court went on to state that:
The plaintiff pleads negligence in a case like this because he wants a deep pocket from which to satisfy a judgment or, even better, to obtain a settlement. Normally when a defendant is sued on a theory that is inadequately pleaded, he gets the claim dismissed or, if the claim is invalid under controlling law, he gets a summary judgment. But in cases such as this the normal antidotes for invalid claims do not work. An insured defendant is often totally committed to the negligence pleading of the plaintiff because as long as the negligence claim is included in the complaint, the insured must be provided a defense on the intentional tort claim, a benefit he would not have if the spurious negligence claim were missing.
Id. at 17.
Finally, a court should weigh the fact that that there are cases with insureds who have resources independent of insurance and that it would be immaterial to the claimant whether the insured’s conduct was covered or not covered by indemnity insurance. Id. To hit this point home, the Supreme Court stated:
We agree with Judge Diamantis that the resolution of the timing issue in accord with International Surplus Lines Insurance Co. v. Markham, 580 So.2d 251 (Fla. 2d DCA 1991), in which the court indicated that the duty to defend issue should be resolved early but the insurance indemnity action abated until after the underlying tort action is final, may be necessary in some cases. But, for the reasons stated above, we believe that there are factors which weigh in favor of trying the indemnity coverage issue first.
Importantly, the circumstances of each case may dictate where the appropriate jurisdiction is to file a declaratory relief action based on the above case law.
March 6th, 2018
The Court of Appeals holds that loss of use of real property constitutes “property damage” under CGL Policy
By, Mark A. Boyle, Esq.
Many lawsuits involving real property and defective construction claims include claims for damages that do not constitute physical damage to tangible property. Generally, COMMERICAL GENERAL LIABALITY (“CGL”) carriers eschew coverage for such claims. The recent decision in Mid-Continent Cas. Co. v Adams Homes of Northwest Florida, Inc., No. 17-12660, 2018 WL 834896 (11 Cir. Feb. 13, 2018) clearly makes loss of use claims—even where no physical damage to tangible property occurs—potentially covered claims under CGL policies in Florida.
Adams Homes of Northwest Florida (“ADAMS”) was sued by a series of homeowners in an integrated community in which the residents were allotted common access to amenities including golf courses, restaurants, a marina, and shops. ADAMS built a series of homes within the development. The homeowners in the development eventually sued ADAMS claiming “homes, the streets adjacent to the homes, and the common areas they have access to, are now prone to flooding “which has made “[Homeowners’] ordinary use or occupation of their property physically uncomfortable” and “disturb[ed] the [Homeowners’] free use … of their property.” Homeowners sued ADAMS in state court seeking damages for ADAMS’ alleged negligence in failing to ensure the installation of adequate drainage.
Mid-Continent Casualty Company (“MCC”) insured ADAMS under a series of commercial general liability policies which included the standard INSURANCE SERVICES OFFICE’s (“ISO”) CGL property damage definition. Under those policies, MCC had the “right and duty to defend the insured against any ‘suit’ seeking damages because of ‘bodily injury’ or ‘property damages’ covered thereunder.” The policy defined property damage as follows:
- Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or
- Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the ‘occurrence’ that caused it.
MCC began defending ADAMS under a reservation of rights but also asserted a declaratory relief action in which MCC attempted to disclaim both the duty to defend and the duty to indemnify. The trial court agreed with MCC that the claims of the Plaintiff did not constitute “property damage” as that terms was defined under the CGL policy.
The 11th Circuit disagreed relying both on the plain language of the policy and a Florida intermediate appellate court decision, McCreary v. Florida Residential Prop. and Cas. Joint Underwriting Ass’n, 758 So.2d 692, 693 (4th Dist. Ct. App. 1999). In McCreary, the court determined that the actions of the defendant ultimately rendered the Rebalko’s property unsafe and unsecure; thereby resulting in loss of use. Id. at 695. In response to MCC’s response argument that the water was “relatively harmless” and not likely to cause “an immediate danger”, the Court noted:
“But the absence of allegations that the storm water runoff is placing Homeowners in immediate danger does not counsel a different result. Physical discomfort in the use of property, like insecurity and unsafety in the use of property, raises the specter of loss of use. Although it is unclear whether the physical discomfort caused by the run-off is severe enough to prevent Homeowners from using their property, the same was true of Rebalko’s allegations in McCreary. Rebalko did not allege he stopped using his property because of the McCrearys’ dogs; rather, Rebalko alleged he felt insecure and unsafe in its use. Like Rebalko, Homeowners are entitled to have any ambiguity about whether the physical discomfort caused by the run-off was severe enough to cause loss of use resolved in their favor. “If the allegations of the complaint leave any doubt as to the duty to defend, the question must be resolved in favor of the insured.” Lime Tree Vill.Cmty., 980 F.2d at 1405.
Thus, the Court held that there was a duty to defend.
In addition to its holding that a potential loss of use claim required a defense under the CGL policy the 11th Circuit held that the fact that the damages in questions were “purely economic” did not bar the claims under the circumstances of this case noting “We have not found any support for applying the principle that general-liability policies do not cover purely economic damages in a case like this one.”
Until the ADAMS v MCC decision, most of the focus in insurance litigation for defective construction involved the question of whether or not the “property damage” definition had been met by a showing of physical injury to tangible property. See U.S. Fire Ins. Co. v. J.S.U.B., Inc., 979 So. 2d 871 (Fla. 2007), Auto-Owners Ins. Co. v Pozzi Windows Co., 984 So. 2d 1241 (Fla. 2008). The ADAMS v MCC decision now gives a potential claimant under a CGL policy two avenues for pleading into coverage: 1. physical damage to tangible property; and/or 2. loss of use. Practitioners who wish to plead their claims into coverage should plead either or both elements as applicable.
February 23rd, 2018
by, Katherine L. Sloan, Esq.
Five months have passed since Hurricane Irma devastated much of the State of Florida. Unfortunately, for many homeowners affected by the devastating storm, the true battle is just beginning. As Floridians report devastating losses to their insurance carriers, many find that these reports are met with either a lack of response from the carrier, or the offer of a settlement check that does not even begin to scratch the surface towards repairing their damaged homes.
It is important for homeowners to be aware that in the State of Florida (and a few other jurisdictions across the country), Section 627.7142, Florida Statutes outlines a Homeowner Claims Bill of Rights detailing the rights of a personal lines residential property insurance policyholder who files a claim with his or her insurance carrier. In fact, in many cases, insurance carriers must provide this Homeowner Bill of Rights to a policyholder within fourteen days after receipt of a claims communication. Under this Homeowner Bill of Rights, the policyholder has a right to:
- Receive acknowledgment of their claim within 14 days after the claim was communicated to the insurer.
- Receive communication from the insurer as to the claim being covered in full, partially covered, or denied, or a written statement that your claim is being investigated, within 30 days after the company receives the policyholders completed proof of loss form.
- Subject to any dual interest noted in the policy, receive full payment of the claim, the undisputed portion of the claim, or the denial of the claim within 90 days.
- Free mediation of your disputed claim, offered through the Division of Consumer Services, under most circumstances and subject to certain restrictions.
- Neutral evaluation of a disputed sinkhole claim if the claim is due to sinkhole damage and is covered under the policy.
- The availability of assistance with any insurance claim or questions pertaining to the handling of your claim from the Division on the notice.
A homeowner dealing with his or her insurance company in the aftermath of Hurricane Irma would be wise to make sure that emergency repairs necessary to prevent further damage are completed and documented. It is also critical to take photographs both before and after any repairs that are completed to document each and every undertaking at the property. To the extent that the repairs are not an emergency and do not require immediate attention, it is important that a homeowner contact the insurer prior to undertaking these types of repairs to provide the carrier with an opportunity to inspect the home. It also never hurts to obtain estimates from licensed general contractors to properly assess the amount of damages at issue. Finally, it is critical for a homeowner to carefully read all correspondence—including any settlement checks that may contain policy release language—from the insurance carrier and cooperate by providing information that may be requested.
Navigating an insurance claim can be a confusing and arduous process. It is always best to consult with an attorney that specializes in insurance coverage disputes to assist in the process.