Wednesday, June 24, 2020

TWENTY-FIRST CENTURY: DUTY TO DEFEND NOT AT ALL DEMOLISHED: TEXAS SUPREME COURT ANSWERS FIFTH CIRCUIT QUESTION AND ADDRESSES THE DISTRICT COURT’S RICHARDS DECISION PART THREE OF THREE



TWENTY-FIRST CENTURY:
DUTY TO DEFEND NOT AT ALL DEMOLISHED: TEXAS SUPREME COURT ANSWERS FIFTH CIRCUIT QUESTION AND ADDRESSES THE DISTRICT COURT’S RICHARDS DECISION

PART THREE OF THREE

Michael Sean Quinn**
Quinn and Carmona



The court’s unanimous opinion in this case, Richards v. State Farm Lloyds, 19-0802, delivered on March 20, 2020 is brilliant. It also belongs in the law school case-books. Its greatness is not because is revolutionizes anything or transforms the law in any dramatic way. Indeed, literally speaking the opinion identifies itself as a narrow one and affirms already existing law. However, it provides a deep discussion and exposition of how to interpret contracts of insurance in Texas and probably in a number of other “elsewheres.” Indeed, if one understands the undercurrent of this opinion there is a roadmap as to how to think about all standardized contracts and as to how to think about the interaction between contract language and the broader legal realm.  To say that an opinion is brilliant is not to say that it is perfect.

The facts of the case need not be repeated here. It was a coverage issue regarding an insurer’s duty to defend in a death of a child case, where a young boy had been permitted to drive around on an ATV by his grandparents, more but also less on their property, and where there almost certainly was no duty to indemnity. One of the most obvious features of this case is that it affirms the “Eight Corners Rule” (8CR) in bold letters, as it were. Almost jurisprudentially sacrosanct, as one might say. (I use “8CR” throughout. I even use in in quotation from others. Anything to save space.)

In doing this the court recognized the centrality of the duty to defend in both individual-person and business markets of many sorts. The assault on or siege of 8CR–what some have been recently calling “obsolete” is over, among all rational-minded coverage lawyers, underwriters,  senior, adjusters, agents and brokers, as well as risk managers or decision-makers.  See Lydon F. Bittle, “Eight-Corners Rule Under Siege,” EXPERT COMMENTARY, IRMI.com (August 2019).

On a more subtle level, the court has refuted semantic-based poor arguments which would have, if adopted, had a dramatic negative impact on the role of liability insurance in the economics of insurance markets. Since risk-spreading is central to industrial economies, and its citizenry, if the view of the district court in B. Hall Contracting and Richards, were really adopted, there would have been a revolution in the role of liability insurance, or its price at any rate. (These two cases are discussed in Part One of Three in this series of Quinn’s Commentaries on Insurance Law.)

In effect, without saying so, the Supreme Court reaffirmed, and recognized a long and strong  tradition in Texas law, namely, that fundamental economic needs of individual insureds, insofar as interpreting contracts of insurance is concerned, will be embraced in preference to the financial desires of insurers, at least, a lot of the time. This is how deeply the Ambiguity Rule fits it to Texas insurance jurisprudence. (It is also a hint of old-time Texas liberal populism, but don’t tell anybody.)

What it does, on the surface, is to recognize that “even if” clauses in insurance policies do not by themselves change the nature of the contracts. Without saying so, it recognizes that insurers cannot use the word “apply” in a way to defeat an important coverage. (See Part One and below.) Some think that this is an unrecognizable application of the “Ambiguity Rule” to the nature of insurance policies, when it comes to the application of 8CR. That actually is quite dramatic, if one sees what has happened.

By the way, there is also one rather sarcastic remark the court makes that will tell insurance-wonks how firmly the Court stands and how one must think about interpreting standard policies and, really, all standardized contracts in which all sorts of individual persons are parties. The  court’s remark can even be taken to be a statement of public policy when it comes at least to contracts of insurance. See below.

The reader will grasp the drama the depth of what has been done here, presently, if they don’t see it already. First, however, the reasoning of the Court must be laid out.

In the Richards case federal district court distinguished between an insurer’s promise to defend “all actions against its insured” and a promise to defend “all[*] actions against its insured no matter if the allegations of the suit are groundless, false, or fraudulent.” (The clause here, “no matter if” is also worded as “even if” in many policies. That difference is obviously trivial; one phrasing  is the same as the other. The phrase “even if” will be used here.) The district court argued that “even if” clauses create an exception to the insurer promising to defend its insured “against all actions against the insured.”)


[*MSQ Comment. No participant in these legal conversations, debates, arguments, etc., thinks that the “all actions” clause is actually unlimited. If the policy says something like “there is coverage for bodily injury caused by an occurrence, [i.e., accident],” and there is no other coverage, then there is no duty to defend if the plaintiff’s live pleading never, even impliedly, so much as hints, that a bodily injury is being alleged, nor would there be if no unintentional conduct were whispered at the margin of the pleading’s themes. However, the idea of “bodily injury” and the idea of “accident” are built into the whole coverage system in that policy and right at its basis. It is not the case that a minor-looking clause obscurely slipped into a huge statement of obligation is similar to a coverage restriction like “bodily injury” or “accident.” Perhaps it was the district judge’s conception of contract interpretation that mislead him?]

My conjecture is that it is to “even if” and “no matter if” -type clauses that the Fifth Circuit and the Texas Supreme Court refer and identify as a “policy language-exception to the Eight Corner Rule.” If so, then the restricted nature of the clause, as well the physical location of the phrase in the policy are of some relevance to identifying it as a “policy-language restriction.”

In any case, the grandparents’ homeowners policy did not contain an “even if” clause, and Lloyds, after defending for a while, subject to a reservation of rights clause, collected enough external evidence to deny coverage on the grounds that since there was demonstrably no duty to indemnify, there was not duty to defend. The “bet” of many is that it was the lack of such a clause that was the foundation of the district’s court reasoning when it said there was no duty to defend when extrinsic evidence demonstrated that there was no duty to indemnify. (In truth, that argument is invalid.)

In its legal reasoning (or, legal analysis, or discussion-of-law, which ever the reader prefers), the Supreme Court emphasized that it has never endorsed the idea of there being a “policy-language restriction” on the 8CR, even though it has flirted with some cases that do and has never explicitly denied its possibility.

Said the Court, often quoting from earlier opinions, “Insurance policies are controlled by rules of interpretation and construction which are applicable to contracts generally. As with any contract, the parties may displace default rules of construction by agreement. We consider the entire agreement and, to the extent possible, resolve any conflicts by harmonizing the agreement’s provision, rather than by applying arbitrary or mechanical rules. Where a valid contract prescribes particular obligations equity generally must yield unless the contract violates positive law or offends public policy. Thus, if an insurance policy contained language inconsistent with the 8CR the policy language would control. But the question here is not whether the parties can contract around the eight-corners rule 8CR. They can. The question [here] is whether these parties have contracted around it by declining to expressly agree that State Farm must defend claims ‘even if groundless, false or fraudulent.’”

The Court continue on a number of fronts.

“Because the circumstances giving rise to the rise to the 8CR (the language commonly used in insurance policies) have changed, [it is not the case that that] the 8CR itself must change, no matter how deeply embedded in law it has become.”

(MSQ Comment: The phrase “eight-corners” rule does not often occur in common liability insurance polies, except perhaps rarely. I cannot recall ever seeing it. The point makes no difference because its presence is implied, at least because for the regulatory status of such policies and to some extent similar surplus lines policies.)

“Because the presence or absence of a groundless-claim clause has rarely, if ever, been important to Texas courts’ analysis of the contractual duty to defend and because Texas courts routinely apply the 8CR without looking for a groundless-claims clause, the idea that there is a “policy-language exception” is erroneous. An insurer does not contract away the  8CR altogether merely by omitting from its policy an express agreement to defend claims that are ‘groundless, false or fraudulent. [W]e have never held or suggested that the eight-corners rule is contingent on a groundless-claim clause.] Consistent with [Supreme Court] decisions, Texas courts of appeal have routinely applied the 8CR for many decades without regard to whether the policy contained a groundless-claims clause.” Remember, the “8CR” abbreviation is mine.

(MSQ Comment: At this point, Footnote 8 is to be found; it is a concatenation of Texas cases supporting the Court’s statement.)

The Court goes on to formulate and independent argument. “The eight-corners rule does not arise merely from the courts’ say-so, however. The duty to defend is a creature of contract, “a valuable benefit granted to the insureds by the policy. The goal in interpreting the contractual duty to defend when interpreting any contact language–is to ascertain the true intentions of the parties as expressed in the writing itself. The 8CR is not a judicial amendment to parties’  agreements. Instead, its purpose is to effectuate those agreements, to enforce them consistently and predictably so that parties may write their agreements knowing how courts will interpret them.”

Some readers may be getting nervous at this point and for two reasons:

First, almost no contracts of liability insurance are drafted jointly by the parties. Most of them are standardized and many are subject to regulation by TDI. The closest most insureds get to joint drafting is picking out some endorsements recommend by brokers or others. 

Second, the Court is talking about what is expressed in the written words of the contract. But wasn’t that what the district judge tried to do? Fortunately, the Court cites as authority a law review article which argues that rules of construction reflect “the commonsense expectation within the relevant community of discourse” and mitigate “interpretive mistakes.”  Randy Barnet, The Sound of Silence: Default Rules and Contractual Consent,” 78 Va. L. Rev. 821, 881-82 (1992). Iron-clad, closed-minded, phony academic rigor, whilst concentrating on a few words, as against the whole of the contractual document, is not really in the spirit of the law.

(MSQ Comment: What the Texas Supreme Court  has done is to combine Professor Barnet’s insight, within its own history, the recent history of Texas insurance jurisprudence and suggest that, in the absence of crystal clear changes in terms, what is embedded in the relevant and precedent or near-precedent should be understood as part of the parties’ intentions.

Near the end of the Opinion, the court continued.  If the claim is “for damages because of  bodily injury … to which the coverage applies, the duty to defend is implicated.” The 8CR merely acknowledges that, under many common duty-to-defend clauses, only the petition and the policy are relevant to the inquiry into whether the petition’s claim fits within the policy’s coverage. If any party is familiar with the overwhelming precedent to the effect, it is a large insurance company. State Farm  ‘… is well aware of the courts’ longstanding interpretive approach to contractual duties to defend, and it knows how to contract around that approach. It did not do so merely by omitting the words “groundless, false, or fraudulent,” or similar words from this policy.

(MSQ Comments: (1) One may not be sure how an insurer can draft around anything in a prescribed, TDI regulated policy. That is not at all easy, even if it is possible. (2) One might also be inclined to think that “did not” in the quoted sentence should read “cannot”).

(Another MSQ Comment: Notice the underlined word, “applies” in the last paragraph. The underlined is not that of the court; it’s mine. I put it here in order to call the reader’s attention to the fact that the Supreme Court recognizes that an insurance policy can apply to a risk or injury even it is not covered. Once this is recognized, there is another reason why the decisions of the district court are invalid from the point of view of elementary logic.)

This is a brilliant opinion. It a paradigm of a lovely piece. Lots of clarity. Many supportive citations. An excellent feel for the broader law. Both vision and historical insight. Oh yes. And strands  of important subtility, here and there.

**No person other than the author is responsible for any argument or conclusion in this essay. Quinn’s Resumes–both the “Long” one and the “Short” one can be easily found on the Internet.  Education, experience, writing, and lecturing are all noted there. Various blog postings are not. quinn@QClaw-adr.com

TWENTY-FIRST CENTURY: DUTY TO DEFEND ATTACKED BUT NOT DEMOLISHED: FIFTH CIRCUIT COURT OF APPEALS ADDRESSES THE DISTRICT COURT’S RICHARDS DECISION PART TWO OF THREE


TWENTY-FIRST CENTURY:
DUTY TO DEFEND ATTACKED BUT NOT DEMOLISHED: FIFTH CIRCUIT COURT OF APPEALS ADDRESSES THE DISTRICT COURT’S RICHARDS DECISION

PART TWO OF THREE

Michael Sean Quinn*
Quinn and Carmona


In Part One, three cases were discussed. One of them set forth the current Texas version of the Eight Corners Rule (8CR), which govern insurers’ duty right to defend when it comes to virtually all kinds of liability insurance, whether the contract of insurance stands alone or is part of a bundle of different coverages. The other two cases are recent federal cases decided in the Northern District of Texas which were trying to kill-off 8CR or severely wound it. See Part One.

The B. Hall Construction case was reversed on other grounds, but the State Farm Lloyds v Richards case was applied to the Fifth Circuit Court of Appeals, and that court sent it on to the Supreme Court of Texas. This essay concerns the per curiam opinion delivered in the Fifth Circuit (18-10721, September 9, 2019). Interestingly, because of the way the judges of the Fifth Circuit ruled the case is not to be published and is not precedent, except under very limited circumstances not relevant here. Appellate Rules of Procedure for the Fifth Circuit 47.5, 47.5.1 and 47.5.4. This is an arcane matter and not something most readers need to read.)

So, what happened in the appellate court? Basically, the court sketched the facts of Richards, quoted the relevant policy language, and both quoted from and outlined an argument of the district court. Without really saying so explicitly, the court recognized that the meaning of the word “apply” played a central role.

Basically, the court noticed that 8CR is a deeply embedded rule of law in Texas, and that the Supreme Court of Texas had never explicitly adopted any exception, even though it had cited some Fifth Circuit cases which have said that there may be an exception and have tried to spell it out. It therefore handed the problem off to the Texas Supreme Court by asking its question.

The circuit court even spelled its most detailed and plausible rule, Northfield Ins. Co. v. Loving Home Care, Inc., 363 F.3d 523, 531 (5th Cir. 2004) and pointed out that, although the Texas Supreme Court may have flirted with this rule, it has never adopted it, though other states have adopted a use-of-extrinsic rule for some circumstances.  Zurich Am. Inc. Co v. Nokia, Inc. 268 S.W.3d 487 (Tex. 2008).

Here is the rule in Northfield: extrinsic evidence as to coverage may be used to determine the applicability of the  duty to defend “when it is initially impossible to discern whether coverage is potentially implicated and when the extrinsic evidence goes solely to a fundamental issue of coverage which does not overlap with the merits of or engages the truth or falsity of any facts alleged in the underlying case.

So, here is the question the Fifth asks:

Is the policy-language exception to the eight-corners rule articulated in B. Hall Contracting Inc. v. Evanston Ins. Inc., 447 F.Supp.2d 634 (N.D. Tex. 2006), a permissible exception under Texas law?”

The Texas Supreme Court answered the question and sent the case back to the Fifth Circuit for a final decision. But what is the question the Texas court had answered? Clearly both the answer and the question turn on the meaning of the  phrase “policy-language exception.”

But what is the meaning of the phrase “policy-language exception”? Unless the meaning of that phrase is understood, then the decision in the Fifth Circuit, the question being asked is flawed, though not badly, perhaps.

A Quinn Question: Do these and analogous questions have a role in further insurance-insurer bad faith litigation? Is this the sort of issue where it would be prudent for claims departments to use (deploy) counsel, whether in-house or out-house?

*The author’s resumes (“Short” and “Long”) are easily findable on the Internet. I alone prepared and wrote this essay, and I alone am responsible for it.


TWENTY-FIRST CENTURY: DUTY TO DEFEND ATTACKED BUT NOT DEMOLISHED: LOGIC REJECTED AND REASON IGNORED PART ONE OF THREE


TWENTY-FIRST CENTURY:
DUTY TO DEFEND ATTACKED BUT NOT DEMOLISHED: LOGIC REJECTED AND REASON IGNORED
PART ONE OF THREE

Michael Sean Quinn*
Quinn & Carmona
Austin Texas


Insurance arrangements of various sorts have been around for thousands of years. Not so with respect to liability insurance.  Bearing anything like that name, it seems to have been invented and sold in the late Nineteenth or early Twentieth Century in connection with motor vehicle policies. If it was railroads that were selling passenger injury policies, then some of it may have been a form of liability insurance.

Liability insurance now a very important component of virtually all developed economies and for obvious reasons. It exists for both individual persons and for larger organizations, e.g., business entities of various sorts.  Just list for yourself all the different sorts of liability insurance coverages of which you have heard and then confidentially conjecture that there are many more.

One very important part of virtually all liability policies is the insurer’s duty to defend its insured under many relevant types of situations. For many insureds, coverage for defending the insured is at least as important as having duty-to-pay coverage. Lawsuits are expensive, and insureds need help conducting defenses and having them paid for.

The duty to defends is a broader coverage than the duty to pay for the loss for which the insured is liable. What is being insured against is not the liability for causing a loss. What is being insured against is the peril of being sued ostensible for a type of loss, whether the insured is liable or not.

In order to make sure that the coverage for a defense is broad enough, most states have a variant on the rule that if a lawsuit is making an allegation within general area of the policy’s stated sketched areas of what’s insured, as the general area of the policy’s language, the insured will receive a defense. Almost, the insurer is to look only at the live pleading and the insurance policy, then, on that basis, provide a defense if there is possible liability for the insured based on the type of peril the insurance policy covers likely covers. The components, dimensions, and variations on this rule varies from state to state. However, it is usually understood that in most policies, except sof the most technical, complex, and sophisticated in specialist ways, the insurer is to look on the language of both the policy and the petition in ways more-or-less favorable to the insured.

The Texas variant of this rule is strict and favors the insured under almost all circumstances. For this reason, it is called the “Eight Corners Rule” (“8CR”) This means that almost always in deciding whether it has a duty to defend, the insurer looks at the live pleading, the insurance policy (aka contract of insurance) and decides reasonably and favoring the plight of the insured. The insurer may not gather and consider “extrinsic” evidence.  When one thinks about what is being covered by the duty to defend, this is a natural rule. Defense coverage is for protecting the insured from the risk of having to pay to defend itself.

If there is any way the insured might be liable for a covered peril,  given the way the live pleading is formulated (irrespective of whether is clear or otherwise) the insurer must defend, even if it knows that the insured is not liable or that the suit is phony. Well, almost always. 8CR has been the law in Texas and elsewhere for quite a while. It is reasonably-well understood as legal practice rules go and part of  insurance coverage practice has been organized around it for quite some time.

Now, however, as legal fees, court costs, expert witness fees, high-tech costs, and highly regulated  insurance premium prices escalate, some insurers and some commercial insureds want to reduce the scope of the duty to defend. This project is not to be easily accomplished.

A new approach has been devised, however, and that is to claim that insurance contracts must be interpreted is an old-looking but actually a new way. The old way is to say that contracts of insurance are subject to the same rules of interpretation as any other contract, a proposition that is–and has long been–asserted. What’s new is (1) ignoring the fact that insurers and their insureds have a “special relationship,” which is something like a quasi-fiduciary relationship, (2) ignoring the fact that insurers draft the lengthy, complicated, usually non-negotiable contracts, (3) ignoring public policy favoring coverage, (4) ignoring state law and administrative atmospherics that favor coverage, and (5) ignoring some basics of logic and language interpretations.

Two recent federal district court cases in Texas illustrate this point. The earlier of these two cases was reversed for reasons irrelevant here. The latter of these two cases went to the Fifth Circuit; it sent the case on to the Texas Supreme Court; and it sent the case back to the Fifth Circuit, essentially reversing the district court’s decision. Interestingly, the Texas Supreme Court does not consider the fundamental issues that will be discussed here, but its opinion is decisive, well-reasoned, sensitive to history and public policy, and perhaps even brilliant.

One might begin with Guideone Elite Insurance Company f/k/a Preferred Abstainers Insurance Company v. Fielder Road Baptist Church,197 S.W.3d 305 (2006). It might be thought of as the most recent Texas Supreme Court case really shaping duty-to-defend law in Texas in a really influential way. Since the issues to be discussed here are quite abstract, there is no need to discuss facts of these cases.

That case was a sexual abuse of a teenage girl by a “quasi-parson” case. The Texas Supreme Court and the intermediate court of appeals before it based its holding on the following language of the policy to explicate and apply the 8CR: “We [the insurer] shall have the right  and duty. . . to defend any suit brought against you seeking damages, even if the allegations of the suit are groundless, false, and fraudulent[.]”  For the purposes of discussion the two recent federal district court decisions, it’s the “even if” clause that matters.

One might turn to B. Hall Contracting Inc. v. Evanston Ins. Co., 447 F.Supp.2d 634 (N.D.Tex.     2006), rv’d on other grounds, 273 Fed. Appx. 310 (5th Cir 2008), since it is the earlier of the two cases. Another way to do this, however, is to discuss the case decided later first, the one which is actually appealed and ended up in the Texas Supreme Court. It shall be done here in the second–later-first–way, followed by a brief jump backward to the  B. Hall Contracting case.

The later of the two cases is State Farm Lloyds  v. Richards, 2018 WL 2225084. (Remember: this is the case which went to the Fifth Circuit and then on the Texas Supreme Court, where it was, in effect, reversed.)

Richards declarative judgment duty-to-defend coverage case arising out of  a death of a child case in which the mother of the child sues her parents.

As set forth by the court, the relevant policy language is this: “[I]f a claim is made or a suit is brought against an insured for damages because of bodily injury. . . to which this insurance applies caused by an occurrence, [plaintiff] will [] pay up to its policy limits of liability for the damages for which the insured is legally liable. . . . And plaintiff  will “provide a defense at [its] expense by counsel of [its] choice.”  

So much for policy language. The court went on to say, “Thus, for an obligation on the part of plaintiff [remember: this is the insurer], there must be a claim made or suit brought because of bodily injury caused by an occurrence as defined in the policy. [Paragraph] In this respect, the policy at issue here is unlike those typically at issue in Texas case where the duty-to-defend is defined more broadly than the duty-to-indemnity. Those cases in which an insurance policy provides that the insurer must defend any suit brought against its insured ‘even if the allegations of the suit are groundless, false or fraudulent[.]” The court is arguing that 8CR applies only if the “even if” clause (or its equivalent, presumably) is found in the policy.  “In this case,” the court said, “the policy does not require plaintiff [the insurer] to defend all actions against its insured no matter if the allegations of the suit are groundless, false or fraudulent. Rather, the duty to defend arises only if suit is brought to which the coverage applies.”

Because various exclusions eliminated any duty to indemnity, the court held that there was no duty to indemnity.

There are three serious mistakes built into the court’s view. And a fourth one which is an apparently unanticipated consequence of the view.

First, and foremost, the court interprets the “even if” clauses in more standard Texas policies as necessary conditions (as opposed to sufficient conditions) for the triggering of the duty to defend. This is plainly the wrong way to read an “even if” clause. It is designed to do nothing more than make sure that the point and extent of the main clause is understood. The phrase “X if Y” is far different, logically speaking, than “X only if Y.”

Second, and independent of the first point, is the meaning of the term “applies.” Is ambiguous. The court thinks that an insurance policy applies to a state of affairs only if it actually covers it. This proposition is not true. A policy may “apply” to bodily injuries, say, caused by occurrences but not cover them because of an exclusion.

Third, the court’s view of  how the language of the SFL policy effectively destroys the idea that the duty to defend is broader than the duty to defend at all. Thus, it destroys one of the most important parts of the liability policy, namely, a coverage for the expenses which will be incurred if there is not duty to defend.  A court must be careful in interpreting the brief phraseology of a part of the  language of a complex contract. Insurance policies, just like other contracts, must be understood as a whole and interpreted in context.

Fourth, and related to the third point, the court’s reading of the SFL policy subjects to the insured to two pieces of litigation at once, namely, the underlying action (“You injured me, so pay me,”) and the coverage lawsuit regarding duty-to-defend (Maybe you did injure him, maybe you didn’t. I’m not defending until I know which is which.”). (a) This makes duty-to-defend money a kind of indemnity contract: you pay now, and maybe I’ll reimburse you. (b) This is the large against the small, quite often. (c) It will create a new form of law practice and a new contingent loan market, where the companies paying for defense will become assignee and suit liability carriers that deny defenses.

The earlier case, the B. Hall Contracting case is a somewhat similar coverage case. It arose partly out a property-damage-by-fire case where that damage allegedly resulted an alleged negligent construction error and different but related bodily injury case arising out of the same problem. An alleged construction error caused a fire, and two fellows had to jump off a roof and were injured.

Here is the policy language as set forth by the court. “The insuring agreement of the policy of the obligates Evanston to pay “those sums that the insured becomes legally obligated to pay as damages because of ‘bodily injury’ or ‘property damage’ to which this insurance applies.” In addition, said the court, the policy goes on to say that “[h]owever, we will have no duty to defend the insured against any ‘suit’ seeking damages for ‘bodily injury’ or ‘property damage’ to which this insurance does not apply.”

The terms “apply” and “applies” appears repeatedly in this policy. Most germane here is its use in an exclusion to be found in the “Roofing Endorsement.” According to the court it states in relevant part as follows: “The coverage under this policy does not apply to bodily injury, property damage, . .  or any injury, loss, or damage arising-out of any [] operations involving any . . . membrane roofing[.]”  Obviously, this is an exclusion. Apparently, the presence of membrane in the roofing was established by affidavits and evidence, though it was not mentioned in any relevant pleading.

There were other exclusions, but they are not relevant here.

The court’s interpretation of the policy language and rejection of a duty to defend works somewhat differently than in the Richards coverage case. In that case, the hinge issue was about the absence of the “even if” clause. Here the issue is much different. Here the contract says bluntly, the insurer will have no duty to defend if the suit seeks damages for a bodily injury (or property damage) to which the policy does not apply. There is no reference to what is to be found in the plaintiff’s pleading in the underlying case. 

Consequently, the reason why the duty-to-defend avoidance strategy in this policy is quite different. As we shall see, the Texas Supreme Court recognized this fact. There is another way to look at it however, one having semantics and interpretation.

The term “apply,” and its verbal siblings, which are used in this policy, must be distinguished from the term “cover” and its siblings. This policy is said to be a CGL policy. This means that there is a section of the policy named “Coverage A.” It is also clear that parts of this section can “apply” to a situation’s, injuries, and/or damages which are not covered, e.g., because there is an exclusion taking them out of coverages. That is more or less the case here, except that the policy seems to use the term “apply” in different ways at different places, and it does not ever equate “apply” to “cover.” In fact, the policy explicitly distinguishes between “cover” and “apply.”

This policy is a mess. It has internal inconsistences. The question then, is how should  one interpret a contract that is incoherent. Obviously, one cannot do it phrase by phrase. That is precisely where the inconsistencies are to be found. One has to look at the overall nature of the policy, at the purposes of the policy, at expectations of the citizenry, lawyers in the field, a hypothetical-congress of insurance underwriters and intermediaries, public policy, local understanding and custom, established patterns of precedent, the standard form used, and more.

So what happens next? Why were the B. Hall Contracting and the Richards coverage cases taken in the wrong order? The Fifth Circuit’s reversal of  B. Hall is about something else entirely and is irrelevant here so it will not be discussed. The fifth Circuit's treatment of Richards is a different matter and a rather unusual one.  Stay tuned. The decision in the Fifth Circuit is discussed next. State Farm Lloyds v. Richards, 18-10721 (5th Cir. 2019)(Certified Order Issued September 9, 2019).

*Quinn’s Resumes--“Short Resume” & “Long Resume” can be found on the internet without difficulty. The theses expressed herein are mine alone and therefor my responsibility alone.











Tuesday, June 23, 2020

AN INSURING AGREEMENT FROM AN 18TH CENTURY POLICY




ONE BRITISH FIRE POLICY 1700


After the Great Fire in London in 1684 many mutual associations and several companies were formed which offered fire insurance. Here is one of the coverage clauses in one of the policies, this one that of "Hand in Hand Mutual Fire Insurance Office." This mutual merged with another and they lasted for many years.  It should be noted that was we call "policies" were then called "Proposals." Apparently, an insurer would make a "Proposal" (advertise?) and a prospective insured might join the mutual society and obtain the same coverage as other members, though policy limits might be different.  I have changed the spelling and capitalizations to make the passage easier to read. 

Here is a coverage term


"If any house injured be demolished by or by reason of fire, (which is accounted to be when the floors from the first floor upward, and roof, are burnt or fallen in) the whole sum insured is paid in sixty days after, or sooner, if[?] found requir[ed]: but if the house is only damnified [partially damaged?], the Office do immediately repair and put it in as good condition as the same was when insured upon notice of such loss given at the Office."

Sound a little familiar maybe?

These policies commonly lasted seven years. What if the owner of the house became a member of the mutual society in year one, but the house was destroyed by fire in the seventh year of coverage. How did the insuring Office (or Society) together with the owning Member handle wear and tear?

Taken from David Jenkins and Takau Yoneyama, 1 HISTORY OF INSURANCE 114 (2000)


Michael Sean Quinn
quinn@QClaw-adr.com
(o) (512) 768-6840
(c) (512) 656-0503

Quinn's resumes, one Long and one Short are easily found on the Internet