Direct General Insurance v. Houston Casualty Co.

139 F. Supp. 3d 1306, 2015 U.S. Dist. LEXIS 143847, 2015 WL 6160361
CourtDistrict Court, S.D. Florida
DecidedSeptember 30, 2015
DocketCase No. 14-20050-Civ-COOKE/TORRES
StatusPublished
Cited by2 cases

This text of 139 F. Supp. 3d 1306 (Direct General Insurance v. Houston Casualty Co.) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Direct General Insurance v. Houston Casualty Co., 139 F. Supp. 3d 1306, 2015 U.S. Dist. LEXIS 143847, 2015 WL 6160361 (S.D. Fla. 2015).

Opinion

ORDER ON DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT

MARCIA G. COOKE, United States District Judge

As the African proverb states, when two elephants fight, it is the grass that gets trampled. Both sides in this action are large insurance companies that- are unable to agree on the terms governing the insurance policy that binds them. Despite their sophistication in the insurance field, neither accedes to the other’s interpretation of the term, “Related Claims.” The resulting dust up involves class actions, individual lawsuits, and thousands upon thousands of PIP claims. Much litigation grass has been trampled over the course of five years.

Before me now is the fully briefed Defendants’ Joint Motion for Summary Judgment (ECF Nos. 119, 120, 135, 136, 139, 141, 160, 185, 187) (“Defendants’ Motion”). The Court held a‘ hearing on the parties’ motions for summary judgment on June 10, 2015. I have considered the motion, response, reply, supplemental briefing1, record, and the relevant legal authorities. For the reasons provided herein, Defendants’ Motion is granted.

I. Undisputed Facts

Plaintiff Direct General Insurance Company (“Direct Géneral”) is a Tennessee insurance company that issues automobile insurance policies that provide personal injury protection (“PIP”) benefits under Florida law, (ECF No. 120 (“Defs.’ SOF”) at ¶ 13). Since 1971, Florida has required automobile insurers to. provide a PIP no-fault benefit. (ECF No. 133 (“Pl.’s Resp. SOF”) at! 53).

Direct General is an insured under a program of professional liability insurance issued to its parent company, Elara Holdings, Inc., for the policy period March 30, 2008.to March 30, 2009. (Defs.’ SOF at ¶ 1). The. insurance program consists of (a) a primary policy issued by Indian Harbor Insurance Company (“Indian Harbor”) with a $10. million limit of liability and $1 million per Claim retention;2 (b) a first excess policy issued by Defendant Houston Casualty Company (“Houston Casualty”) with an additional $10 million limit of liability; and (c) a second excess policy issued by National Specialty Insurance Company (“National Specialty”) that provides an additional $10' million limit of liability (collectively, the “2008-2009 Policies”). (Id. at' ¶ 2). The excess policies issued by Houston Casualty and National Specialty (collectively, the “Excess Carriers”) “follow form”'to the primary-policy— the Indian Harbor Policy (the “Followed Policy”) — meaning that they contain the same terms and conditions set forth in the [1308]*1308primary policy unless otherwise provided therein. (Id. at ¶ 8).3

Policy Terms

The Policy states, in relevant part, “[t]he Insurer will pay on behalf of the Insured Loss from Claims first made against the Insured during the Policy Period ... for Wrongful Acts first committed on or after the Retroactive Date [September 28, 1983].” (PL’s Resp. SOF at ¶¶4, 44).4

The Policy further states that “[a]ll Related Claims will be treated as a single Claim made when the earliest such Related Claims was first made or when the earliest of such Related Claim's is treated as having been made ..., whichever is earlier.” (PL’s Resp. SOF at ¶ 5). The term Related Claims includes “all Claims for Wrongful Acts based on or directly or indirectly arising out of or resulting from the same or related ... series of facts, circumstances, situations, transactions,' or events.” (Defs.’ SOF at ¶ 6). The term Claim includes “any civil proceeding,” and any “written demand or notice to an Insured indicating that a person or entity intends to hold an Insured responsible for a Wrongful Act.” (Id. at ¶ 7; Pi’s Resp. SOF at ¶46). The term Wrongful Act includes “any actual or alleged act, error, omission, misstatement, misleading statement, or breach of fiduciary duty or other-duty committed by an Insured in rendering, or in failing to render, Professional Services.” (Defs.’- SOF at ¶ 8).

The term Professional Services is defined as “services performed by the Insurance Company ... for a policyholder, customer or client ...,• which, alone or in combination with other services, are performed for. monetary.consideration pursuant to a policy of insurance or other Express Contract or Agreement.” (PL’s Resp. SOF at ¶9). The term Loss is defined as “damages, judgments, awards, settlements, and the Defense Expenses which an Insured is legally obligated to pay as a result of a Claim.” (Id. at ¶¶ 10, 45). “Defense Expenses” means “reasonable legal fees and expenses incurred by or on behalf of any Insured in the defense or appeal of any Claim.” (PL’s Resp. SOF at ¶ 50). The term Loss excludes “penalties imposed by law,” “matters which are unin-surable under the. law pursuant to which this Policy shall be construed” and “any amount due under any contract or policy of insurance ... underwritten [or] issued ... by the Insurance Company.” (Defs.’ SOF at ¶ 10).

■ The Policy states, “no Defense Expenses may be incurred and no settlement of any Claim may be made without the Insurer’s consent, such consent not to be unreasonably withheld.” (Defs.’ SOF at ¶ 11). The policies provide that, “the Insured may settle any Claim without the Insurer’s pri- or written consent if the total Loss resulting from a claim does not exceed fifty (50%) of the amount of the applicable retention .•.. provided, however, the Insured must promptly advise the Insurer of any such settlement and provide information in- connection therewith that the Insurer. may request.” (Id. at ¶ 12; PL’s Resp. SOF at ¶ 12). The Followed Policy permits the Insurer to participate in settlement negotiations “[i]f the Insured reasonably expects that the Loss resulting from any Claim will exceed fifty percent (50%) of the applicable retention...,” (PL’s Resp. SOF at ¶ 12). An endorsement to the Policy provides that:

.-As a condition precedent to any right to payment in respect of any Claim, the Insured must give the Insurer written notice of any such Claim, with full details, as soon as practicable after the [1309]*1309Claim is first made and the risk manager or general counsel of the Insurance Company first becomes aware of such Claim, but in no event later than sixty (60) days after the end of the Policy Period.

(Id. at ¶ 52). Direct General does not have a risk manager, so this endorsement is triggered only when its General Counsel becomes aware of a Claim. (Id.).

Florida PIP Law

In 2003, one of multiple revisions to the Florida PIP statute (the “PIP Statute”) included a “sunset” clause which provided that effective October 1, 2007, the PIP Statute would be repealed, unless the Florida legislature reenacted it. (Pl.’s Resp. SOF ¶ 54). The Florida legislature did not reenact the statute, which expired on October 1, 2007. (Id.). The Florida legislature reenacted the PIP Statute effective January 1, 2008 (the “2008 PIP Statute”).

Before 2008, the PIP Statute permitted insurers to reimburse certain medical providers for 80% of the “reasonable expenses for medically necessary medical, surgical, X-ray, dental and rehabilitative services” (the “Reasonable Amount Method”). (PL’s Resp. SOF at ¶ 55 (citing Fla. Stat. § 627.736(l)(a) (2007)).

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139 F. Supp. 3d 1306, 2015 U.S. Dist. LEXIS 143847, 2015 WL 6160361, Counsel Stack Legal Research, https://law.counselstack.com/opinion/direct-general-insurance-v-houston-casualty-co-flsd-2015.