Victory in the Eleventh Circuit Concerning Coverage and Extra-Contractual Damages

In an earlier blog concerning this case, I noted we represented two large car dealerships who had been sued in major class actions.  Universal Underwriters Insurance Company insured both dealerships.  The dealers asked Universal Underwriters to defend and indemnify them for the claims in the class actions. Universal agreed to defend the claims, but advised that even though the class actions covered multiple years, the dealers were only entitled to indemnity coverage under one of policy years. Each dealer carried $500,000 in indemnity coverage per year for most of the years involved in the class actions. Therefore, it was Universal's position that the dealers were only entitled to $500,000 in coverage, while the dealers believed that they were entitled to up to the full policy limits per year for each of the years involved in the class actions.

One of my clients also sued Universal for breach of contract for failing to settle the class action when Universal could have settled the claim for slightly more than the $500,000 which it believed was available to pay for damages, but significantly less than what the court ultimately determined were the actual policy limits.  (I did not sue for "bad faith," but filed a simple breach of contract claim for breaching the contract by failing to settle when the insurer could have done so below the actual policy limits.)  Universal defended by claiming that we were actually suing for "bad faith," and could not do so given its reasonable belief concerning its available policy limits. 

Last week the 11th Circuit gave us a complete victory on the two issues involved in the case.  First, the11th Circuit agreed that the car dealers were entitled to the available policy limits for each of the years involved in the class actions.  Second, the court held that the breach of contract action for failing to settle could proceed regardless of Universal's "good faith or bad faith."  The court noted that whether Universal breached the contract can be determined "objectively" without regard to Universal's intent or belief.  A copy of the decision can be downloaded by clicking here

4th DCA Rules that Declaratory Judgment Action Cannot be Stayed Pending Trial of Wrongful Death Case

The Estate of Reinaldo de Morales sued Donel Enterprises for negligently causing Mr. de Morales’s death. Donel defended by claiming it was de Morales’s employer and thus entitled to workers compensation immunity. Donel’s insurer agreed to defend Donel under a reservation of rights.

The insurer also filed a declaratory judgment action against Donel and the estate, seeking a declaration that the claim was excluded from coverage and the insurer had no duty to defend or indemnify the claim under Donel’s commercial general liability policy. Donel asked the trial court to stay the declaratory judgment action pending the resolution of the wrongful death action.

The trial court agreed to stay that portion of the dec action directed towards the insurer’s duty to indemnify, stating: “The same question of fact is going to be determined by a jury in the underlying case.” The trial court refused to abate or stay that portion of the dec action directed towards the insurer’s duty to defend.

The trial court seems to have recognized the distinction between the “duty to defend,” which is simply determined by comparing the allegations in the underlying complaint with the terms of the insurance policy; and the “duty to indemnify,” which is based upon the actual facts of the loss as determined by the fact finder.

Realizing that the jury in the wrongful death action would determine the precise factual issue which controlled the indemnification issue, the trial court stayed the indemnification issue pending resolution of the wrongful death action.

The 4th DCA granted certiorari review, found that this order departed from the essential requirements of the law, and ordered that the entire declaratory judgment action proceed unstayed. The 4th DCA cited to the Supreme Court’s ruling in Higgins v. State Farm Fire & Casualty Co., 894 So. 2d 5 (Fla. 2004), which identified three factors for trial courts to consider when determining whether a coverage action should be tried before the tort action. Those factors are:

1. Whether the two actions are mutually exclusive;

2. Whether proceeding to a decision on the indemnity issue will promote settlement and avoid the problem of collusive actions between the claimant and the insured in order to create coverage where there is none; and

3. Whether the insured has resources independent of insurance, so that it would be immaterial to claimant whether the insured’s conduct was covered or not covered by indemnity insurance.

The 4th DCA determined that the first 2 factors militated in favor of allowing the declaratory judgment action to proceed. The court found that there was no record evidence concerning the third factor. The 4th DCA found support for its decision in Progressive Express Insurance Co. v. Reed, 971 So. 2d 176 (Fla. 5th DCA 2007), and Indemnity Insurance Co. v. Ridenour, 629 So. 2d 1053 (Fla. 2nd DCA 1993).

Given this decision, along with Higgins, Reed, and Ridenour, it seems it will be difficult for either party to stay either of the underlying actions without agreement of the parties.

This case can be found at Century Surety Insurance Company v. de Morales, 34 FLW D93 (Fla. 4th DCA January 5, 2009).
 

Be Careful About Settlements and Coblentz Agreements

Counsel for an insured or a claimant must pay special attention when intending to settle a claim with a Coblentz Agreement.

A "Coblentz Agreement" (named for Coblentz v. Am. Sur. Co. of N.Y., 416 F.2d 1059 (5th Cir. 1969)) is a settlement device which can be utilized only when an insurer refuses to defend an insured.  The insured is permitted to take whatever steps necessary to protect itself from exposure to a claim.  This protection includes the right to enter into a consent judgment which will bind the insurer.

A failed Coblentz Agreement, and failed attempt to base it on provisions of Florida's Claims Administration Statute, was recently at issue in Zurich American Insurance Company v. Frankel Enterprises, Slip Copy, 2008 WL 2787704 (C.A. 11 July 18, 2008) (unpublished opinion).   In Frankel, the United States Court of Appeals, 11th Circuit, upheld summary judgment for an insurer in a dec action, holding the insurer established as a matter of law that it was not bound by a settlement agreement between the claimant and the insured.   In order to more fully appreciate the facts of the underlying case, the opinion should be read in conjunction with the district court case, Zurich American Ins. Co. v. Frankel Enterprises, Inc.,  509 F. Supp.2d 1303 (S.D. Fla. 2007).

The underlying facts were as follows:  In 1992, the claimants purchased a house from the insured.  The house suffered from roof leaks.  The leaks ultimately led to property damage and mold.  The homeowner/claimants filed suit against the insured, alleging that his negligent construction and repairs led to the water infiltration.  The lawsuit included claims not only for property damages, but also for personal injuries.

The insured builder was listed as an "additional insured" on a Zurich American Insurance Company policy with limits of $1 Million per occurrence.   When the insurance company was notified of the claim, Zurich responded with a letter in which the insurer agreed to provide a defense, but did so under a reservation of rights.  Specifically, Zurich asserted a coverage defense under policy exclusions for certain claims related to mold and workmanship. 

As a component of the defense, the insurer selected a lawyer to defend the insured.  In later correspondence, the insurer stated it believed some of the claims fell outside of the insurance coverage.  Notwithstanding, the insurer continued to provide a defense for the insured, including assignment of the defense counsel.  It is undisputed that the insured never rejected the assigned defense counsel, and never rejected the defense offered by Zurich.  It is also undisputed that Zurich never withdrew its defense of the case, even after reserving its rights.

The parties to the lawsuit ultimately participated in court-ordered mediation.  The claimants and their counsel, and the insured and his insurer-appointed counsel attended the mediation in person.  The insurance company's representative attended by telephone, and only spoke with the insured's appointed counsel.  The insurer refused to offer any money at mediation to settle the case.  The insured paid $50,000 to settle, consented to a judgment against it for $1,800,000.00, and also assigned its rights against Zurich to the claimant (a classic Coblentz agreement). 

Zurich did not authorize or consent to the settlement.

Zurich subsequently told its insured it was not bound by the settlement, because it was entered into without the insurer's express consent.  The insurance policy clearly prohibited settlement without its permission, and also clearly provided the insurer's consent to be sued for recovery on an "agreed settlement" (defined in the policy as "a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative.") (emphasis added)  The Coblentz agreement was not signed by Zurich.

Subsequent to the Coblentz agreement, the insurer then filed a dec action seeking a declaration that it was not bound by the settlement.  The trial court noted that an insurer is not bound by an unauthorized settlement unless: the insurer refuses to defend--not merely denies coverage; or if the insurer defends under a reservation of rights, and the insured rejects the defense (neither of which happened here).  The insured/claimant tried to bolster their argument regarding coverage defenses by invoking Florida's "Claims Administration Statute." 

Florida's Claims Administration Statute, Section 627.426, Fla. Stat., provides that an insurer may not deny coverage based on a coverage defense unless it has undertaken specific steps to inform the insured, protect the insured, and allow the insured itself an opportunity to protect its interests.  The trial court deemed the Florida statute did not apply since the policy was issued for delivery and delivered in New York state.  Further, the court determined the insurer's reservation of rights only raised the potential for a lack of coverage, not an outright "coverage defense."  Finally, the court determined that the coverage defenses actually raised by the insurer in the dec action--breach of cooperation and "no action" clauses--arose out of the Coblentz agreement and more than year after the reservation of rights letter was issued.

The district court entered summary judgment for the insurer.  The summary judgment was based on the foregoing, but also was based in part upon an admission by the insured's appointed attorney.  The attorney was asked to admit that "Frankel did not obtain Zurich's authorization to enter into the Memorandum of Settlement reached during the April 22, 2004 mediation."  The attorney replied: "Admitted." 

The 11th Circuit upheld the trial court's order on summary judgment on these grounds, noting that the insured neither objected to the request or asked the court to withdraw or amend the response.   In response to the insured/claimant's argument that a jury could conclude that the appointed attorney's conduct at mediation could allow a jury to conclude that the insurer consented to settlement, the 11th Circuit dismissed this argument noting: "we cannot ignore [the insured's] admission."  The court also dismissed an argument that the appointed lawyer was acting as the insurer's agent during settlement negotiations, because under Florida law, the defense counsel hired to represent the insured is an independent contractor, and the insurer is not liable for the acts and omissions of the lawyer.

When advising a claimant and/or the insured about the viability of a Coblentz agreement, it is wise to be sure the insurer has denied the defense, withdrawn the defense, or failed to abide by the Claims Administration Statute.  A loose interpretation of these requirements will not suffice.

Insurer Failed to Prove Cancellation--57.105 Attorney's Fees Granted to Insured

The appellate court reversed summary judgment for an insurer when the insurer couldn't prove it met statutory conditions for notifying the insured about cancellation of his policy.  The court determined that, because the insurer knew its evidence did not support summary judgment in its favor, attorneys fees under Section 57.105, Fla. Stat. for the insured were an appropriate sanction.

In Magee v. American Southern Home Ins. Co., a Florida Corporation, issued June 2, 2008,
the First District Court of Appeal reversed summary judgment entered for a Florida insurance company. 

In Magee, the insured filed a complaint against his insurance company, alleging breach of contract for its refusal to pay a claim made under the applicable policy.  The Florida insurer denied the insured's claim, asserting it canceled the policy for nonpayment of premium with an effective cancellation date prior to the date of the accident.

The insurer asserted it had mailed premium notices and a cancellation notice, but the insured testified he never received any premium or cancellation notice at the appropriate address, and only received a cancellation notice by certified mail at a different address "way after" the accident occurred. Section 627.7281, Fla. Stat. requires at least 10 days notice of cancellation for nonpayment of premium prior to the cancellation effective date.

As its sole grounds for summary judgment, the Florida insurance company
offered a portion of a certificate of mailing report; and (2) a certificate of bulk mailing.  In a footnote in its appellate Answer Brief, the insurance company admitted the certificates of mailing it offered were from a different day, and did not include the subject mailing.  Although it still sought affirmance of the summary judgment on appeal, the insurance company admitted it offered no proof that the insured's cancellation documents were actually mailed.

The appellate court naturally reversed the summary judgment.  Wisely, counsel for the insured filed a motion for attorney's fees under
section 57.105, Fla. Stat.  The court noted that despite the stringent standard required to support summary judgment, and the Florida insurance company's admission that the evidence it offered did not represent what it was purported to represent, the insurance company continued to assert on appeal that the judgment should be affirmed. The court held that clearly the insurer "knew or should have known its defense of the trial court's order was not supported by the necessary material facts," and it was the insurer's "duty to timely confess error."

This case reveals why it is important to verify the insurance company as strictly complied with notice requirements, and to seek all available recourse when the insurer advances a frivolous and unmerited position.

Declaratory Judgment Is a "Final Judgment" for Attorney's Fees Purposes

A sobering reminder about timely moving for attorneys fees in declaratory judgment actions was issued by the Fourth District Court of Appeal. In Cardillo v. Qualsure Insurance Corp., out of the 4th DCA on February 20, 2007, the court determined a fairly innocuous "Order" which established insurance coverage--but left issues of liaiblity and damages set for a jury trial--was a "judgment" for purposes of Fla. R. Civ. P. 1.525.

Cardillo was initially sued for personal injury. The defendant insured then filed a liability claim with his insurance company. The insurance company contested coverage and its duty to defend. The insurance company then sought a declaratory judgment of its rights and obligations pursuant to section 86.011, Florida Statutes.

On December 1, 2004, the trial court entered an order titled "Findings of Fact - Conclusions of Law-And Order Regarding Trial." In the order, the trial court stated that certain claims of the insured remain pending in the underlying litigation, but based upon the Court's findings of fact and conclusions of law, those issues were no longer "outcome determinative" of the declaratory decree action. In paragraph four of the trial court's order, the court determined that insurance coverage existed under the policy. Next, the order announced that "[a]ll remaining issues of liability and damages" proceed to a jury trial set the following month; "[a]ll stays previously entered . . . are lifted and all counsel advised to be fully ready to commence trial." The order then simply concluded that it is "DONE AND ORDERED."

After various procedural posturings, and upon request, the trial court entered a "judgment," which stated that the " Order rendered on December 1, 2004 is a Final Judgment, for which let execution issue, if appropriate."

On February 17, 2005, the insured filed a motion for attorney's fees pursuant to section 627.428, Florida Statutes.

The question before the appellate court was whether the December 1st order constituted a final order or judgment which would start the 30 day time limit in Fla. R. Civ. P. 1.525. The court stated that Rule 1.525 applies equally, regardless of whether the time runs from a document titled "order," "final order," "judgment," or "final judgment," as long as the document is a final resolution of the rights and obligations of the parties. The court then concluded that the December 1st order was a final order regard the dec action, stating:

"Patently, it was the intent of the trial court that nothing further should stand as an obstacle to concluding the underlying case and that the declaratory issues were 'disposed of.' The language of the order is more than sufficient to alert counsel that the clock is ticking as to a fee motion."

Since Fla. R. Civ. P. 1.525 is no longer construed as requiring a party to move for attorneys fees after a judgment is entered (For clarification of this issue, including effect of the 2005 amendment and interpretation of the Rule pre-amendment) see Barco v. School Board of Pinellas County, 2008 WL 321469 (Fla. Feb. 7, 2008)), and since nothing prohibits a party from moving for attorneys fees before a judgment is actually entered (Barco, above), it would be prudent to file a motion for attorneys fees within 30 days of any order that could be construed as being dispositive of insurance coverage.