Employers Reinsurance Corp. v. Mid-Continent Casualty Co.

358 F.3d 757, 2004 U.S. App. LEXIS 2681, 2004 WL 296973
CourtCourt of Appeals for the Tenth Circuit
DecidedFebruary 17, 2004
Docket02-3274, 02-3291
StatusPublished
Cited by36 cases

This text of 358 F.3d 757 (Employers Reinsurance Corp. v. Mid-Continent Casualty Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Tenth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Employers Reinsurance Corp. v. Mid-Continent Casualty Co., 358 F.3d 757, 2004 U.S. App. LEXIS 2681, 2004 WL 296973 (10th Cir. 2004).

Opinion

HARTZ, Circuit Judge.

The parties to this appeal are two insurance companies. Employers Reinsurance Corp. (ERC) and Mid-Continent Casualty Co. (MCCC), a property and casualty in *761 surance company, entered into a Liability Excess Reinsurance Agreement (the Agreement). Under the Agreement ERC reinsured MCCC with respect to certain payments and expenses for which MCCC was responsible to its insureds under policies it issued. In addition, ERC insured MCCC for some extra-contractual liabilities it might incur to its insureds — such as liability for bad faith denial of a claim. Of particular concern on appeal, if MCCC had to pay a “loss” exceeding $300,000, ERC would reimburse MCCC for the excess of the loss above $300,000, up to a maximum loss of $1,000,000. (We will refer to the $300,000 threshold as MCCC’s “retention,” which is similar to a deductible in ordinary insurance policies.) Additionally, the Agreement required ERC to pay a share of “claim expenses” incurred by MCCC if the retention was exceeded.

The amounts disputed in this case arise out of declaratory judgment actions between MCCC and its insureds. In several such actions it was determined that MCCC should have provided its insured with a defense to a tort action brought by a third party against the insured. As a result, (1) MCCC had to pay its insureds the attorney fees and expenses incurred by the insureds in the declaratory judgment actions; (2) MCCC paid its own attorney fees and expenses in the declaratory judgment actions; and (3) MCCC had to pay the attorney fees incurred by the insureds in defending the underlying tort actions. This appeal centers on whether these payments and expenses were covered by the Agreement as “losses,” “claim expenses,” or neither.

Regarding the first type of payment, MCCC contends that the Agreement’s definition of “loss” unambiguously requires ERC to reimburse amounts MCCC paid to its insureds to cover the insureds’ attorney fees in the declaratory judgment actions. ERC contends that the Agreement unambiguously imposes no such obligation. We disagree with both, reverse the district court’s summary judgment on the issue in favor of MCCC, and remand for further proceedings to resolve the meaning of Agreement language that we hold to be ambiguous in this context.

As for MCCC’s own attorney fees incurred in the declaratory judgment action, we affirm the district court’s ruling that under the contractual language presented to the district court, ERC must reimburse these attorney fees as “claim expenses.”

With respect to the third challenged item — MCCC’s payment of the insureds’ attorney fees incurred in defending the underlying tort claims — we reverse the district court and hold that ERC need not reimburse MCCC for those payments as “loss.” Rather, those payments should be treated as “claim expenses” for which ERC need make only a proportionate payment.

We also address several additional issues, including the Agreement’s characterization of postjudgment interest as “loss” or “claim expenses,” the percentage rate at which damage payments should be included as “loss” under the Agreement, prejudgment interest, a discovery dispute, and a cross-appeal by MCCC for attorney fees in this action.

I. BACKGROUND

A. Description of Reinsurance Agreement

Reinsurance is essentially insurance for insurance companies. Spreading part of the risk to the reinsurer can prevent a catastrophic loss from falling upon the insurance company and enable the insurance company to serve more clients. See, e.g., Unigard Sec. Ins. Co., Inc. v. North River Ins. Co., 4 F.3d 1049, 1053 (2d Cir.1993). *762 Unlike typical insurance contracts that are offered on a take-it-or-leave-it basis, rein-sureds ordinarily negotiate the terms, conditions, and rates in their reinsurance contracts.

For nearly 30 years MCCC purchased reinsurance coverage from ERC. From January 1, 1994, until April 1, 2000, ERC and MCCC operated under the Agreement whose meaning is at issue in this appeal.

The Agreement required ERC to reimburse MCCC for all “loss” in excess of $300,000 for each occurrence, with a reinsurance limit of $1,000,000 for each occurrence. Additionally, the Agreement required ERC to reimburse MCCC for “claim expenses” at a rate equal to the fraction of the “loss” for which ERC was responsible. If, for example, MCCC had to pay a “loss” of $500,000, ERC would have to reimburse MCCC for $200,000 of that “loss” ($500,000 — $300,000). Because ERC thus paid 40% of the total “loss” ($200,000/$500,000 = 40%), ERC would reimburse MCCC for 40% of the “claim expenses” MCCC incurred.

The parties dispute the meaning of the terms “loss” and “claim expenses” in the Agreement. Article VIII of the Agreement defines “loss”:

The word “loss” shall mean only such amounts:

(a) within applicable policy limits as are actually paid by [MCCC] in settlement of claims or in satisfaction of awards or judgments (including prejudgment interest and plaintiffs costs included in the judgment and subject with the judgment to the applicable policy limit);
(b) equal to 80% of the amount paid by [MCCC] in excess of applicable third party liability coverage policy limits occasioned by liability imposed upon [MCCC] on account of the failure of [MCCC] to settle a claim for an amount within such policy limits;
(c)(1) equal to 80% of the amount paid by [MCCC] for punitive, exemplary, or compensatory damages awarded to the insured and arising out of the conduct of [MCCC] in the investigation, trial or settlement of any claim or failure to pay or delay in payment of any benefits under any policy if [ERC] has not, in advance of any such conduct by [MCCC] counseled with [MCCC] and concurred in [MCCC’s] course of conduct; or
(c)(2) equal to 100% of the amount paid by [MCCC] for punitive, exemplary, or compensatory damages awarded to the insured and arising out of the conduct of [MCCC] in the investigation, trial or settlement of any claim or failure to pay or delay in payment of any benefits under any policy if [ERC] has, in advance of any such conduct by [MCCC] counseled with [MCCC] and concurred in [MCCC’s] course of conduct.

App. 600. For the dispute before us, the relevant part of the definition appears in paragraphs (c)(1) and (c)(2), which require ERC to reimburse MCCC for “compensatory damages ... arising out of the conduct of [MCCC] in the investigation, trial or settlement of any claim or failure to pay or delay in payment of any benefits under any policy.” (A subsidiary dispute concerns whether it is (c)(1) or (c)(2) that applies.)

“Claim expenses” are defined in Article VIII of the Agreement as follows:

The term “claim expenses” shall mean all payment under the supplementary payments provisions of the [MCCC] policy, including court costs, interest upon judgments, and allocated investigation, adjustment and legal expenses.”

*763 App. 601.

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

Related

Starstone Insurance SE v. City of Chicago
133 F.4th 764 (Seventh Circuit, 2025)
Osterhout v. Morgan
E.D. Oklahoma, 2023
Stoedter v. Gates
704 F. App'x 748 (Tenth Circuit, 2017)
General Star Indemnity Co. v. Driven Sports, Inc.
80 F. Supp. 3d 442 (E.D. New York, 2015)
ECCLESIASTES 9: 10-11-12, INC. v. LMC Holding Co.
497 F.3d 1135 (Tenth Circuit, 2012)
Kincaid v. Wells Fargo Securities, L.L.C.
870 F. Supp. 2d 1252 (N.D. Oklahoma, 2012)
Bradford v. HSBC Mortgage Corp.
280 F.R.D. 257 (E.D. Virginia, 2012)
Richison v. Ernest Group, Inc.
634 F.3d 1123 (Tenth Circuit, 2011)
Mooring Capital Fund, LLC v. Knight
388 F. App'x 814 (Tenth Circuit, 2010)
Cook v. Randolph County, Ga.
573 F.3d 1143 (Eleventh Circuit, 2009)
Cook v. Medical Savings Insurance
287 F. App'x 657 (Tenth Circuit, 2008)
Hornick v. Boyce
280 F. App'x 770 (Tenth Circuit, 2008)

Cite This Page — Counsel Stack

Bluebook (online)
358 F.3d 757, 2004 U.S. App. LEXIS 2681, 2004 WL 296973, Counsel Stack Legal Research, https://law.counselstack.com/opinion/employers-reinsurance-corp-v-mid-continent-casualty-co-ca10-2004.