Employers Assurance Company v. The Ford Store Morgan Hill Inc.

District Court, N.D. California·Decided June 23, 2022·No. 5:21-cv-06800·Unknown

Opinion

EMPLOYERS ASSURANCE Case No. 21-cv-06800-BLF COMPANY, Plaintiff, ORDER GRANTING IN PART AND DENYING IN PART EMPLOYERS’ v. MOTION TO DISMISS COUNTERCLAIM, THE FORD STORE MORGAN HILL, INC., [Re: ECF 20]

Defendant. _________________________________

INC., Counterclaimant, v. EMPLOYERS ASSURANCE Counterdefendant.

This action arises out of an insurance coverage dispute between Plaintiff-Counterdefendant Employers Assurance Company (“Employers”) and Defendant-Counterclaimant The Ford Store Morgan Hill, Inc. (“Ford”). The action was filed by Employers, which seeks a declaration that a workers’ compensation and employment liability policy it issued to Ford did not give rise to a duty to defend or indemnify Ford in a state court action arising from the shooting death of one of Ford’s employees, Xavier Anthony Souto (“Souto”). Ford filed an answer and counterclaim, asserting that Employers breached its policy obligations with respect to the state court action and Before the Court is Employers’ motion to dismiss Ford’s counterclaim under Federal Rule of Civil Procedure 12(b)(6). For the reasons discussed below, the motion is GRANTED IN PART I. BACKGROUND1 A. Policy Employers issued a workers’ compensation and employers liability insurance policy to Ford, effective March 1, 2019 to March 1, 2020. Counterclaim (“CC”) ¶ 25, ECF 12. The Policy contains six parts, three of which are relevant here: Part One, Workers Compensation Insurance; Part Two, Employers Liability Insurance; and Part Four, Your Duties if Injury Occurs. See Policy, Exh. E to CC. Part One, Workers Compensation Insurance Part One of the Policy provides coverage for Ford employees’ bodily injuries that are covered by workers’ compensation law, and it obligates Employers to defend Ford against claims brought before the California Workers’ Compensation Appeals Board (“WCAB”). The relevant provisions of Part One are set forth below.

A. How This Insurance Applies This workers compensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. Bodily injury by accident must occur during the policy period. 2. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee’s last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. Policy at 18.2

B. We Will Pay We will pay promptly when due the benefits required of you by the workers compensation law. Id. 1 Ford’s well-pled factual allegations are accepted as true for purposes of the motion to dismiss. See Reese v. BP Exploration (Alaska) Inc., 643 F.3d 681, 690 (9th Cir. 2011). C. We Will Defend We have the right and duty to defend at our expense any claim or proceeding against you before the California Workers’ Compensation Appeals Board or its equivalent in any other state (and any appeal of a decision therefrom) for the benefits payable by this workers’ compensation insurance. We have the right to investigate and settle these claims or proceedings. We have no duty to defend a claim, proceeding, or suit that is not covered by this insurance.

Nothing contained in this Section shall amend, modify, restrict, or otherwise alter any obligations or conditions under Part Two – Employer’s Liability Insurance of the policy. Policy at 18, 32. Part Two, Employers Liability Insurance Part Two of the Policy provides coverage for Ford employees’ bodily injuries that meet certain policy requirements. The relevant provisions of Part Two are set forth below.

A. How This Insurance Applies This employers liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must arise out of and in the course of the injured employee’s employment by you. 2. The employment must be necessary or incidental to your work in a state or territory listed in Item 3.A. of the Information Page. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee’s last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5. If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. Policy at 19.

B. We Will Pay We will pay all sums that you legally must pay as damages because of bodily injury to your employees, provided the bodily injury is covered by this Employers Liability Insurance. The damages we will pay, where recovery is permitted by law, include damages: 1. For which you are liable to a third party by reason of a claim or suit against you by that third party to recover the damages claimed against such third party as a result of injury to your employee; 2. For care and loss of services; and 3. For consequential bodily injury to a spouse, child, parent, brother or sister of the injured employee; provided that these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee’s employment by you; and 4. Because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer. Id.

C. Exclusions This insurance does not cover: . . . . 4. Any obligation imposed by a workers compensation, occupational disease, unemployment compensation, or disability benefits law, or any similar law; . . . . 7. Damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, or any personnel practices, policies, acts or omissions. . . . Policy at 20.

D. We Will Defend We have the right and duty to defend, at our expense, any claim, proceeding or suit against you for damages payable by this insurance. We have the right to investigate and settle these claims, proceedings and suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance. Id. Part Four, Your Duties if Injury Occurs Part Four of the Policy imposes certain duties on Ford, including:

Tell us at once if injury occurs that may be covered by this policy. Your other duties are listed here. . . . . 4. Cooperate with us and assist us, as we may request, in the investigation, settlement or defense of any claim, proceeding or suit.

. . . .

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Employers Assurance Company v. The Ford Store Morgan Hill Inc., (N.D. Cal. 2022).

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