Berkley Regional Insurance v. Philadelphia Indemnity Insurance

690 F.3d 342, 2012 WL 3126739, 2012 U.S. App. LEXIS 15998
CourtCourt of Appeals for the Fifth Circuit
DecidedAugust 2, 2012
Docket11-50595
StatusPublished
Cited by19 cases

This text of 690 F.3d 342 (Berkley Regional Insurance v. Philadelphia Indemnity Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Berkley Regional Insurance v. Philadelphia Indemnity Insurance, 690 F.3d 342, 2012 WL 3126739, 2012 U.S. App. LEXIS 15998 (5th Cir. 2012).

Opinion

HAYNES, Circuit Judge:

Philadelphia Indemnity Insurance Company (“Philadelphia”) appeals the grant of summary judgment to Berkley Regional Insurance Company (“Berkley”). We REVERSE and REMAND.

I. Facts

As the district court aptly characterized it, this case is “factually straightforward, [but] contractually complex.” Berkley Reg'l Ins. Co. v. Phila. Indem. Ins. Co., No. 1:10-CV-362, Order at 2 (W.D.Tex. Apr. 27, 2011). Accordingly, we describe only those facts necessary to gain an understanding of the insurance coverage question presented here.

The underlying liability case involved a 2004 slip-and-fall by dentist Venus Rouhani (“Rouhani”) on the premises of the Towers of Town Lake Condominiums (“Towers”). Towers had general liability coverage in the form of a primary policy issued by Nautilus Insurance Company (“Nautilus”) with a policy limit of $1 million per occurrence, and excess/umbrella coverage through Philadelphia with a policy limit of $20 million for liability exceeding the primary policy’s coverage. Rouhani sued Towers which submitted the case to Nautilus to provide a defense. 1 - For purposes of the summary judgment at issue here, the parties agree that Philadelphia did not receive notice of the Rouhani lawsuit at that time. 2

Rouhani’s injuries were substantial — she was unable to continue practicing as a dentist. Expert reports put Rouhani’s damages at $800,000 (the defense’s number) or $1.25 million (the plaintiffs number). The parties, however, contested liability, yielding a situation where Rouhani made various settlement demands. Rouhani’s initial settlement demand was $800,000. At a mediation in the underlying litigation, the parties reached an impasse with Rouhani’s “bottom” offer at $215,000 and Towers/Nautilus’s “top” offer at $150,000.

With negotiation attempts having failed, the case went to trial, and the jury awarded Rouhani $1,654,663.50; ultimately, the judgment incorporated the jury verdict plus post-judgment interest and costs. The day of the verdict, Towers demanded that Philadelphia pay the amount in excess of the primary coverage amount. Philadelphia contends this was the first time it had notice of this suit (or claim). In addition to contesting coverage for late notice, Philadelphia also interposed certain policy defenses.

Nautilus filed an appeal on behalf of Towers that was ultimately unsuccessful. *344 Towers of Town Lake Condo. Ass’n v. Rouhani 296 S.W.3d 290 (Tex.App. — Austin 2009, pet. denied). In order to avoid execution of the judgment during the appeal, Nautilus obtained supersedeas bonds from Berkley, its sister company. When the appeals were exhausted, Nautilus paid what it concluded it owed under the primary policy, and Berkley paid the remaining $709,738.89 under its supersedeas bond after Philadelphia, which did not participate in the appeal, denied responsibility for that amount. Through a series of complex assignments that are unchallenged here, 3 Berkley now owns whatever rights Rouhani, Towers, and Nautilus had against Philadelphia. Berkley, in turn, has allowed Nautilus to bring this lawsuit against Philadelphia in Berkley’s name as assignee and subrogee.

In the district court, both sides moved for summary judgment. The only issue pertinent to this appeal is whether the failure to give Philadelphia notice prior to the jury verdict forfeits coverage it may otherwise owe. 4 In support of its position that coverage had been forfeited, Philadelphia argued that its policy requires prompt notice of any occurrence involving, inter alia, “permanent disabilities,” “any coverage issue which may trigger a reservation of rights or coverage declination,” and any “incurred exposure of $500,000 or above.” In addition, Philadelphia pointed out that its policy further provides that “[w]hen [Philadelphia] believe[s] that a claim may exceed the ‘underlying insurance’, [it] may join with the insured and the ‘underlying insurer’ [Nautilus] in the investigation, settlement and defense of all claims and ‘suits’ in connection with such ‘occurrence’ .... In such event, the insured must cooperate with [Philadelphia].” According to Philadelphia, the circumstances surrounding the underlying litigation triggered the notice requirement, and the lack of notice prior to the adverse jury verdict caused prejudice, thereby precluding coverage.

The district court, however, rejected Philadelphia’s position, concluding instead that, as a matter of law, Philadelphia was not prejudiced by the lack of notice prior to the adverse jury verdict. It ultimately granted summary judgment in favor of Berkley for the amount of the judgment in Rouhani in excess of the amount paid under the Nautilus policy. This timely appeal followed.

II. Standard of Review

We review a district court’s award of summary judgment de novo, applying the same standard as the district court. See, e.g., Trinity Universal Ins. Co. v. Emp’rs Mut. Cas. Co., 592 F.3d 687, 690 (5th Cir.2010). Summary judgment is appropriate “if, viewing the evidence in the light most favorable to the non-moving party, there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” United States ex rel. Jamison v. McKesson Corp., *345 649 F.3d 322, 326 (5th Cir.2011); see Fed. R.Civ.P. 56(a).

III. Discussion

The parties agree that Texas law applies to the question presented here: Does the failure to give notice to an excess carrier until after an adverse jury verdict constitute evidence of prejudice that forfeits coverage? 5

The Texas Supreme Court first delved into the area of notice provisions in Members Mutual Insurance Co. v. Cutaia, 476 S.W.2d 278 (Tex.1972). There, the court addressed “[o]nly the condition regarding the forwarding of suit papers,” and concluded that in light of the plain wording of the contract, 6 as well as the prior holdings of the court, the notice-of-suit requirement contained in the automobile liability policy at issue was a condition precedent such that noncompliance yielded forfeiture of coverage. Id. at 278-81. In reaching this conclusion, however, the court acknowledged “the apparent injustice which resulted] in this particular case,” stating farther that it “share[d] some of the impatience which naturally arises when a reasonable provision or' condition in an insurance policy is used by the insurance company to defeat what appears to be a valid claim.” Id.

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Cite This Page — Counsel Stack

Bluebook (online)
690 F.3d 342, 2012 WL 3126739, 2012 U.S. App. LEXIS 15998, Counsel Stack Legal Research, https://law.counselstack.com/opinion/berkley-regional-insurance-v-philadelphia-indemnity-insurance-ca5-2012.