Facility Investments, LP v. Homeland Insurance

741 S.E.2d 228, 321 Ga. App. 103, 2013 Fulton County D. Rep. 1258, 2013 WL 1277797, 2013 Ga. App. LEXIS 322
CourtCourt of Appeals of Georgia
DecidedMarch 29, 2013
DocketA12A2377
StatusPublished
Cited by4 cases

This text of 741 S.E.2d 228 (Facility Investments, LP v. Homeland Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals of Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Facility Investments, LP v. Homeland Insurance, 741 S.E.2d 228, 321 Ga. App. 103, 2013 Fulton County D. Rep. 1258, 2013 WL 1277797, 2013 Ga. App. LEXIS 322 (Ga. Ct. App. 2013).

Opinion

MILLER, Presiding Judge.

Homeland Insurance Company of New York filed this action against its insured, Facility Investments d/b/a Westminster Commons (hereinafter “Facility”) seeking to recover damages for breach of contract, and seeking to recoup amounts it paid to resolve claims against Facility that it contends were not covered under Facility’s insurance policy. Facility filed a motion to dismiss, arguing that Homeland failed to state a claim upon which relief can be granted. The trial court denied Facility’s motion.

We granted Facility’s application for interlocutory appeal to consider the propriety of the trial court’s order. On appeal, Facility contends that (1) the trial court erred in denying its motion to dismiss because Homeland’s claims are barred by the voluntary payment doctrine and the doctrine of waiver, and (2) the trial court erred in creating a cause of action to allow an insurer to recoup money it paid to settle uncovered claims on behalf of its insured. For the reasons that follow, we reverse the trial court’s ruling.

[104]*104We review a trial court’s ruling on a motion to dismiss de novo and construe the challenged pleading in favor of the party who filed it. See Northway v. Allen, 291 Ga. 227, 229 (728 SE2d 624) (2012).

Amotion to dismiss pursuant to OCGA § 9-11-12 (b) (6) will not be sustained unless (1) the allegations of the complaint disclose with certainty that the claimant would not be entitled to relief under any state of provable facts asserted in support thereof; and (2) the movant establishes that the claimant could not possibly introduce evidence within the framework of the complaint sufficient to warrant a grant of the relief sought.

(Citation and punctuation omitted.) Id.

So viewed, the record reflects that Homeland issued a Long-term Care Organization’s Professional and General Liability policy (hereinafter “the Policy”) to Facility which provided up to $1 million in coverage for Facility’s nursing home. The Policy excluded coverage for dishonest, fraudulent, criminal or intentionally malicious acts, errors or omissions, and wilful violations of law, statutes, rules or regulations.

Facility was subsequently sued for professional negligence arising from the care of a patient at its nursing home (hereinafter “the underlying case”). The complaint in the underlying case alleged that Facility engaged in fraud, intentional misconduct and wilful and wanton conduct. Homeland agreed to defend Facility in the underlying suit under a reservation of rights. Homeland expressly reserved its rights with regard to losses or defense expenses arising out of allegations of fraud, malice or violations of state and federal regulations. However, Homeland did not reserve any right to pursue claims for breach of contract, recoupment, allocation or contribution.

The plaintiffs in the underlying case developed evidence of fraud with respect to the nursing home patient’s medical chart. Plaintiffs’ counsel in the underlying case sent a letter demanding payment of the $1 million Policy limit within 30 days to settle the claims against Facility. The demand letter indicated that based on evidence of fraud, the underlying plaintiffs were entitled to punitive damages. The underlying plaintiffs also indicated that if the demand amount was not paid within the 30-day time limit, they would seek to enforce a verdict in excess of the Policy limit.

Three days before expiration of the 30-day demand, Facility sent a letter to Homeland requesting that Homeland settle the underlying suit within the Policy limit. Facility’s letter noted that discovery in the underlying suit had revealed several major hurdles for the [105]*105defense, including significant charting problems, which were likely to inflame a jury. In the letter, Facility opined that these hurdles, in combination with alleged special damages in excess of $800,000, would likely lead to a judgment in excess of the Policy limit.

The next day, Homeland responded to Facility’s request with an offer to settle the case for an amount up to the Policy limit. Referring to the Policy’s terms, Homeland noted that Facility was obligated to determine a fair and proper allocation of all amounts attributable to covered and uncovered losses (hereinafter the “uncovered loss allocation provision”). Homeland asked Facility to contribute 50 percent of the settlement amount based on Homeland’s opinion that a significant portion of the claimed loss was not covered under the Policy due to Facility’s fraudulent charting. Homeland noted that in the event the parties could not reach an agreement with respect to allocation, it was still obligated to make an interim payment of the amount of the loss that the parties agree is not in dispute. Homeland stated for the first time that it would pursue recoupment/contribution in the event that Facility did not pay its share for the uncovered losses.

On the day before expiration of the 30-day demand, Facility notified Homeland that it would not contribute to a settlement, or otherwise allocate between covered and uncovered losses, because Homeland was obligated to settle the underlying suit on Facility’s behalf. Homeland sent another letter indicating its reservation of rights to pursue claims for breach of contract, recoupment, allocation and contribution. Homeland then made the required interim payment to settle the underlying suit.

Thereafter, Homeland filed the instant suit to recover from Facility the portion of the settlement amount attributable to uncovered losses. Specifically, Homeland alleged that Facility breached the Policy’s terms by failing to contribute to the settlement amount, and that Facility was required to reimburse Homeland for the uncovered losses. Homeland further alleged that Facility breached its contractual obligation to indemnify Homeland for uncovered losses, based on the uncovered loss allocation provision.

Facility moved to dismiss Homeland’s complaint for failure to state a claim, contending that Homeland waived its claims, Homeland’s claims were barred by the voluntary payment doctrine, and Homeland’s claim for recoupment is not cognizable under Georgia law. The trial court denied Facility’s motion, finding that the voluntary payment doctrine did not bar Homeland’s claims at this state of the litigation, and that Facility failed to show that Homeland waived its right to pursue recovery of the noncovered portion of the settlement payment. The trial court also found that Homeland’s claim for [106]*106recoupment did not fail at this stage of the litigation.1 This Court granted Facility’s application for interlocutory review of the trial court’s decision.

1. On appeal, Facility contends that the trial court erred in denying its motion to dismiss, because Homeland waived its right to pursue the uncovered amounts of the settlement payment when it made such payment with knowledge of the circumstances that gave rise to its coverage defense. We agree.

The Policy, which Homeland attached to its complaint and incorporated therein by reference, contained the following pertinent provisions:

III. EXCLUSIONS
(D) Exclusions Applicable to ALL INSURING AGREEMENTS

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741 S.E.2d 228, 321 Ga. App. 103, 2013 Fulton County D. Rep. 1258, 2013 WL 1277797, 2013 Ga. App. LEXIS 322, Counsel Stack Legal Research, https://law.counselstack.com/opinion/facility-investments-lp-v-homeland-insurance-gactapp-2013.