Baylor Scott & White Holdings v. Factory Mutual Insurance Company

CourtDistrict Court, E.D. Texas
DecidedMarch 31, 2023
Docket4:22-cv-00120
StatusUnknown

This text of Baylor Scott & White Holdings v. Factory Mutual Insurance Company (Baylor Scott & White Holdings v. Factory Mutual Insurance Company) is published on Counsel Stack Legal Research, covering District Court, E.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Baylor Scott & White Holdings v. Factory Mutual Insurance Company, (E.D. Tex. 2023).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF TEXAS SHERMAN DIVISION BAYLOR SCOTT & WHITE § HOLDINGS § § v. § CIVIL NO. 4:22-CV-120-SDJ § FACTORY MUTUAL INSURANCE § COMPANY § MEMORANDUM OPINION AND ORDER Before the Court is Defendant Factory Mutual Insurance Company’s Motion to Dismiss. (Dkt. #8). The Court held a hearing on the motion. (Dkt. #25). Having considered the motion, applicable law, extensive briefing—including supplemental briefing—by the parties, and argument presented at the hearing, the Court concludes that the motion should be GRANTED. I. BACKGROUND This case involves an insurance coverage dispute stemming from losses related to COVID-19.1 On October 31, 2019, Baylor Scott & White Holdings (“Baylor”), the largest non-profit health care system in Texas, and Factory Mutual Insurance Company (“FM”), an insurance company, executed an insurance policy (hereinafter, “Policy”) covering Baylor’s properties “against ALL RISKS OF PHYSICAL LOSS OR

1 The Court acknowledges the distinction between SARS-CoV-2, a novel coronavirus, and COVID-19, the disease caused by SARS-CoV-2 viral infections. For purposes of this Memorandum Opinion and Order, however, the Court uses the term “COVID-19” as a blanket term that refers to both the virus and its effects. See, e.g., PS Bus. Mgmt., L.L.C. v. Fireman’s Fund Ins. Co., No. 21-30723, 2022 WL 2462065, at *3 (5th Cir. July 6, 2022) (doing the same). The parties do not contend that any practical difference between these terms impacts the applicability of coverage under the insurance policy or the outcome of the instant motion to dismiss. DAMAGE” from November 1, 2019, through November 1, 2020. (Dkt. #6-1 at 2, 9).2 The term “physical loss or damage” is not defined in the Policy. The Policy includes two primary types of insurance benefits that Baylor can

claim because of “physical loss or damage” to its covered properties. The first is “property damage” coverage, which insures repairs to the properties themselves. (Dkt. #6-1 at 16–43). And the second is “time element” coverage, which covers either “GROSS EARNINGS and [an] EXTENDED PERIOD OF LIABILITY” or “GROSS PROFIT” lost as a result of “physical loss or damage” to the properties. (Dkt. #6-1 at 44–65). The “time element” coverage continues until the properties can be repaired, replaced, or made ready for operations. (Dkt. #6-1 at 44–52). Together, these Policy

provisions operate to compensate Baylor for the value of “physical loss or damage” to its properties, the gross earnings lost due to the “physical loss or damage,” and the period of reduced business earnings while Baylor recovers from the period of loss. The Policy also includes a “communicable disease” provision which covers “Actual Loss Sustained and EXTRA EXPENSE incurred” because of the “presence of [a] communicable disease.” (Dkt. #6-1 at 63–64). “[C]ommunicable disease” is defined

under the Policy as a disease which is “transmissible from human to human by direct or indirect contact with an affected individual or the individual’s discharges, or [is] Legionellosis.” (Dkt. #6-1 at 74–75). This provision can be triggered regardless of whether any “physical loss or damage” has occurred. The Policy caps coverage under this provision at a $5 million annual aggregate. (Dkt. #6-1 at 11).

2 The “physical loss or damage” coverage applies to “property at any location purchased, leased, or rented by” Baylor. (Dkt. #6-1 at 28). Finally, as relevant here, the Policy contains several exclusions to coverage, including the “loss of market or loss of use” exclusion. (Dkt. #6-1 at 17–21). An additional exclusion precludes coverage for “contaminations” unless such

contamination is the direct result of “other physical damage not excluded by this Policy.” (Dkt. #6-1 at 21). The “contamination” exclusion is defined as follows: 1) contamination, and any cost due to contamination including the inability to use or occupy property or any cost of making property safe or suitable for use or occupancy. If contamination due only to the actual not suspected presence of contaminant(s) directly results from other physical damage not excluded by this Policy, then only physical damage caused by such contamination may be insured. (Dkt. #6-1 at 21) (emphases in original). *** Beginning in early 2020, a global pandemic caused by COVID-19 forced Baylor to make substantial investments in its more than 1,100 facilities and change its administrative protocols to allow Baylor to safely treat patients during the ongoing public health crisis. (Dkt. #6 ¶¶ 15, 82–86). Because of COVID-19’s unique characteristics as an airborne viral pathogen and its capacity to remain attached to surfaces for extended periods, Baylor claims that the remedial efforts it took resulted in $192 million of lost income. (Dkt. #6 ¶ 118). Baylor submitted insurance claims under the Policy for the costs borne across its covered healthcare facilities. (Dkt. #6 ¶¶ 115–18). FM denied Baylor’s claims, (Dkt. #6 ¶ 121), though FM ultimately paid Baylor $5 million under the Policy’s “communicable disease” coverage. (Dkt. #6 ¶¶ 15–16). Baylor filed this lawsuit following FM’s denial of coverage, alleging that FM (1) breached the Policy and (2) violated Section 542.060 of the Texas Insurance Code by “failing to timely pay Baylor’s loss in connection with its claim.” (Dkt. #6 ¶¶ 126–

51). FM subsequently filed the instant motion to dismiss, which is fully briefed. The central dispute between the parties concerns (1) whether Baylor’s properties sustained “physical loss or damage” due to COVID-19 to trigger the Policy’s coverage and (2) whether the Policy’s exclusions bar coverage beyond the $5 million “communicable disease” cap. II. LEGAL STANDARDS Under Federal Rule of Civil Procedure 12(b)(6), a court may dismiss a

complaint for “failure to state a claim upon which relief can be granted.” FED. R. CIV. P. 12(b)(6). To survive a Rule 12(b)(6) motion to dismiss, a complaint must provide “enough facts to state a claim to relief that is plausible on its face.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007). Plausibility means “more than a sheer possibility,” but not necessarily a probability. Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009). When assessing a motion to dismiss under Rule 12(b)(6), the facts pleaded are

entitled to a presumption of truth, but legal conclusions that lack factual support are not entitled to the same presumption. Id. The court accepts all well-pleaded facts as true and views them in the light most favorable to the plaintiff. In re Katrina Canal Breaches Litig., 495 F.3d 191, 205 (5th Cir. 2007). To determine whether the plaintiff has pleaded enough to “nudge its claims . . . across the line from conceivable to plausible,” a court draws on its own common sense and judicial experience. Iqbal, 556 U.S. at 680 (quoting Twombly, 550 U.S. at 570) (cleaned up). This threshold is surpassed when “the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Id. at

678. In conducting this review, the court’s inquiry is limited to “(1) the facts set forth in the complaint, (2) documents attached to the complaint, and (3) matters of which judicial notice may be taken under Federal Rule of Evidence 201.” Walker v. Beaumont Indep. Sch. Dist., 938 F.3d 724, 735 (5th Cir. 2019). III.

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Bluebook (online)
Baylor Scott & White Holdings v. Factory Mutual Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/baylor-scott-white-holdings-v-factory-mutual-insurance-company-txed-2023.