Employers Mutual Casualty Company and Hamilton Mutual Insurance Company v. John Skoutaris, D/B/A Open Flame Restaurant

453 F.3d 915, 2006 U.S. App. LEXIS 17476
CourtCourt of Appeals for the Seventh Circuit
DecidedJuly 13, 2006
Docket04-3287, 04-3288
StatusPublished
Cited by22 cases

This text of 453 F.3d 915 (Employers Mutual Casualty Company and Hamilton Mutual Insurance Company v. John Skoutaris, D/B/A Open Flame Restaurant) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Employers Mutual Casualty Company and Hamilton Mutual Insurance Company v. John Skoutaris, D/B/A Open Flame Restaurant, 453 F.3d 915, 2006 U.S. App. LEXIS 17476 (7th Cir. 2006).

Opinion

MANION, Circuit Judge.

On April 7, 2000, a fire ravaged the Open Flame Restaurant (“Open Flame”), a Valparaiso, Indiana establishment owned and operated by John Skoutaris. Hamilton Mutual Insurance Company (“Hamilton Mutual”), a subsidiary of Employers Mutual Casualty Company, insured the building, business personal property, and business lost income. Hamilton Mutual, an Ohio corporation with its principal place of business in Ohio, filed a declaratory judgment action in 2001 in the Northern District of Indiana, claiming that Skoutaris failed to abide by the insurance policy provisions governing Skoutaris’s duty to cooperate and duty to submit to an examination under oath. Skoutaris, in turn, brought claims of breach of contract and bad faith against Hamilton Mutual. The district court eventually granted Hamilton Mutual’s motion for summary judgment and denied Skoutaris’s motion for partial summary judgment. Skoutaris appeals. We affirm.

I

A

John Skoutaris opened the Open Flame on February 26, 2000. He had purchased the Valparaiso building from Porter National Bank for $225,000 and had personally made a variety of improvements before opening for business. Skoutaris held insurance policies from both Hamilton Mutual and Ohio Casualty Group covering damage to the Open Flame, and the policies contemplated dividing any loss between the two insurance companies.

As this case involves the duties and procedures under the Hamilton Mutual policy once a claim is filed, we examine the rele *918 vant policy provisions in detail. The Hamilton Mutual policy covered three distinct areas of loss: (1) building; (2) business personal property; and (3) business income. 1 When making a claim under the Hamilton Mutual policy, Skoutaris had certain obligations:

a. You must see that the following are done in the event of loss or damage to Covered Property:
(2) Give us prompt notice of the loss or damage. Include a description of the property involved.
(5) At our request, give us complete inventories of the damaged and undamaged property. Include quantities, costs, values, and amount of loss claimed.
(6) As often as may be reasonably required, permit us to inspect the property proving the loss or damage and examine your books and records.
Also permit us to take samples of damaged and undamaged property for inspection, testing and analysis, and permit us to make copies from your books and records.
(8) Cooperate with us in the investigation or settlement of the claim.
b. We may examine any insured under oath, while not in the presence of any other insured and at such times as may be reasonably required, about any matter relating to this insurance or the claim, including an insured’s books and records. In the event of an examination, an insured’s answers must be signed.

In addition to these provisions relating to the insured’s duties, the Hamilton Mutual policy also provided an appraisal process to determine the value of a particular loss. The policy did not call for the parties to automatically undergo the formal appraisal process upon the filing of a claim. Rather, the parties had the opportunity to conduct some preliminary investigation and attempt to resolve the claim in a mutually agreeable fashion. However, the policy stated:

If we and you disagree on the value of the property or the amount of loss, either may make written demand for an appraisal of the loss. In this event, each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will:
a. Pay its chosen appraiser; and
b. Bear the other expenses of the appraisal and umpire equally.
If there is an appraisal, we will still retain our right to deny the claim.

In addition, Skoutaris elected for replacement cost coverage, which entitled him to receive the full replacement cost of the destroyed property, but only after the property was repaired or replaced. To allow an insured to begin reconstruction after a loss, one aspect of this coverage was that an insured could elect to receive a payment of the actual cash value, a depreciated portion of the full replacement cost, in advance of the full replacement cost payment. Having received such an actual *919 cash value payment, an insured could only recover the remainder of the replacement costs after all repairs or replacements were made.

B

Open Flame turned out to be an unfortunately apt name, as the restaurant suffered a massive fire on April 7, 2000. Hamilton Mutual and Skoutaris both retained the services of adjusters to investigate the fire and determine the loss. There was no suggestion of arson.

The two adjusters produced radically different damage assessments. Skoutaris’s adjuster found that the building, including the basement, was a complete loss, with a replacement cost value of $642,700, and concluded that the business personal property loss was $346,767. Hamilton Mutual (through its own adjuster) responded with a substantially lower assessment and claimed that Skoutaris’s submission lacked the necessary detail or documentation to support the figures. Hamilton Mutual also concluded that the basement was not a total loss. It found that the replacement value of the building was $310,231.21, while pegging the replacement cost value of the business personal property at $158,292.57. Hamilton Mutual’s adjuster explained that he assigned values to the business personal property items claimed by attempting to match the item to an invoice, or, if an invoice could not be found, looking up the replacement cost in restaurant catalogs. Hamilton Mutual offered an actual cash value payment of approximately $128,000 on its portion of the claim. 2 Eventually Skoutaris accepted the $128,000 as the actual cash value payment under the Hamilton Mutual policy.

Although Skoutaris accepted Hamilton Mutual’s payment, the parties continued to disagree about the replacement value of the building and business personal property destroyed in the fire. For several months, the parties exchanged correspondence on this subject, culminating in a November 21, 2000, meeting. At the meeting, the parties made some progress towards a resolution (Hamilton Mutual agreed to consider the basement a complete loss and raise its valuation of the building loss commensurately), but ultimately the parties continued to have serious disagreements about the value of the business personal property.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

VC Management, LLC v. Reliastar Life Insurance Co.
195 F. Supp. 3d 974 (N.D. Illinois, 2016)
Medical Assur. Co., Inc. v. Hellman
610 F.3d 371 (Seventh Circuit, 2010)
Jackson v. McKAY-DAVIS FUNERAL HOME, INC.
717 F. Supp. 2d 809 (E.D. Wisconsin, 2010)
Auto-Owners Insurance v. Websolv Computing, Inc.
580 F.3d 543 (Seventh Circuit, 2009)
A.T.N., Inc. v. McAirlaid's Vliesstoffe GmbH & Co. KG
557 F.3d 483 (Seventh Circuit, 2009)
Bowden v. Town of Speedway, Ind.
539 F. Supp. 2d 1092 (S.D. Indiana, 2008)
Deich-Keibler, Eliza v. Bank One
243 F. App'x 164 (Seventh Circuit, 2007)
Potter v. Janus Investment Fund
483 F. Supp. 2d 692 (S.D. Illinois, 2007)

Cite This Page — Counsel Stack

Bluebook (online)
453 F.3d 915, 2006 U.S. App. LEXIS 17476, Counsel Stack Legal Research, https://law.counselstack.com/opinion/employers-mutual-casualty-company-and-hamilton-mutual-insurance-company-v-ca7-2006.