Leticia Morales v. Zenith Insurance Company

714 F.3d 1220, 2013 WL 1501654, 2013 U.S. App. LEXIS 7469
Court of Appeals for the Eleventh Circuit·Decided April 15, 2013·No. 12-11755·Published·Cited by 22 cases

Opinion

HULL, Circuit Judge:

In this diversity case, Plaintiff-Appellant Leticia Morales, on behalf of herself, the Estate of Santana Morales, Jr., and two minor children under her guardianship, along with Marciela Morales (collectively, “the Estate”), challenges the district court’s grant of summary judgment to Defendant-Appellee Zenith Insurance Company (“Zenith”) on the Estate’s breach of the insurance contract claim. After review and oral argument, we certify questions to the Florida Supreme Court.

I. BACKGROUND

A. Employer Lawns’s Insurance Policy with Zenith

On December 4, 1997, Santana Morales, Jr., was working as a landscaper for Lawns Nursery and Irrigation Designs, Inc. (“Lawns”). That day Morales was crushed to death by a palm tree as it was being unloaded from a flatbed trailer.

At the time of Morales’s death, his employer Lawns maintained an insurance policy with Zenith, entitled “Workers Compensation and Employers Liability Insurance Policy.” The policy contained two types of coverage.

Part I provided “Workers Compensation Insurance.” Under Part I, Zenith was obligated to: (1) pay “the benefits required of [Lawns] by the workers compensation law” in Florida; and (2) defend Lawns in “any claim, proceeding or suit against [Lawns] for benefits payable by this insurance.” Part I contained no explicit policy limits, but stated that Lawns—and not Zenith—would be responsible for “any payments in excess of the benefits regularly provided by the workers compensation law,” including, for example, “those required because ... of [Lawns’s] serious and willful misconduct.”

Part II provided “Employers Liability Insurance.” 1 Under Part. II, Zenith was obligated to: (1) “pay all sums [Lawns] legally must pay as damages because of bodily injury to [its] employees, providéd the bodily injury is covered by this Employers Liability Insurance”;' and (2) defend lawsuits for such damages. Thus, Part II expressly limited its coverage to bodily injury sustained by employees only.

Part II contained policy limits of $100,000 for bodily injury sustained by one or more employees in any one accident, $100,000 for bodily injury caused by disease to any one employee, and $500,000 for all damages covered by the policy, regardless of the number of employees involved.

Part II, however, contained several exclusions, including one barring employer *1223 liability insurance coverage for “any obligation imposed by a workers compensation ... law.” That exclusion (the “workers’ compensation exclusion”) in full states: “This insurance does not cover: .... any obligation imposed by a workers compensation, occupational disease, unemployment compensation, or disability benefits law, or any similar law....”

Because Morales’s death occurred during the course and scope of his employment, his employer Lawns was required to pay workers’ compensation benefits to Morales’s family. See Fla. Stat. § 440.09(1). Accordingly, under Part I of the policy, Zenith was obligated to pay workers’ compensation benefits on Lawns’s behalf. After Morales’s death, Zenith began paying workers’ compensation benefits equal to 66%% of Morales’s gross salary to Morales’s family in biweekly installments of $513.36. Zenith also contributed $5,000 to Morales’s funeral expenses. 2

B. The Estate’s Tort Lawsuit against Lawns in State Court

On December 3, 1999, the Estate filed a wrongful death action against Lawns in Florida circuit court, alleging that Lawns’s negligence caused Morales’s death. 3 Specifically, the Estate alleged that Lawns’s “use of the flatbed trailer without retaining stakes, sides or any manner to prevent the trees from falling off the trailer and killing those persons who were unloading it was negligent.” The Estate did not allege that Lawns had engaged in any intentional tor-tious conduct or gross negligence.

Zenith agreed to defend Lawns in the action under Part II of the policy pursuant to a reservation of rights, and Zenith retained J. Gregory Giannuzzi to represent Lawns in the lawsuit. As counsel for Lawns, Giannuzzi filed Lawns’s answer to the Estate’s complaint and asserted affirmative defenses. One of Lawns’s affirmative defenses was that the Estate’s claim was barred because of the Estate’s receipt of workers’ compensation benefits. Gian-nuzzi filed Lawns’s motion to dismiss on the same ground. 4

Representing Lawns in the suit proved difficult. Lawns never responded to Gian-nuzzi’s letters and phone calls, and Gian-nuzzi’s firm was never able to locate Lawns’s lone corporate officer. Giannuzzi eventually filed a motion to withdraw as counsel because of Lawns’s lack of cooperation, which the state court granted. The state lawsuit proceeded with Lawns unrepresented. . The Estate subsequently filed a motion for sanctions due to Lawns’s failure to respond to discovery requests and comply with court orders. The state court granted the motion, striking Lawns’s pleadings as a sanction and entering a default judgment in the Estate’s favor on the issue of Lawns’s liability to the Estate.

The case proceeded to a one-day jury trial as to damages. Lawns did not ap *1224 pear at trial. On March 14, 2005, the jury awarded the Estate $9,525 million in damages against Lawns.

C. The Workers’ Compensation Settlement

While the Estate’s wrongful death lawsuit was still ongoing, Zenith continued to pay workers’ compensation benefits to the Estate on Lawns’s behalf until August 2003, when Zenith made a final lump sum payment of $20,000 in full settlement of the Estate’s workers’ compensation claim against Lawns. The parties entered a settlement agreement at the same time. 5 The settlement agreement included a section entitled “Election and Waiver,” under which the Estate agreed that

in exchange for the consideration described below, the [Estate] hereby waives all rights to any and all benefits under The Florida Workers’ Compensation Act. Further, this settlement and agreement shall constitute an election of remedies by the [Estate] with respect to the employer and the carrier as to the coverage provided to the employer.

A judge of compensation claims approved the settlement agreement. 6 In all, the Estate received over $100,000 in workers’ compensation benefits from Zenith, pursuant to the Florida Workers’ Compensation Act and Part I of the policy.

D. The Estate’s Lawsuit in Federal Court

The Estate filed an action in Florida circuit court against Zenith asserting that Zenith had breached its insurance policy with Lawns when it did not pay the Estate the $9,525 million tort judgment entered against Lawns.

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Leticia Morales v. Zenith Insurance Company, 714 F.3d 1220, 2013 WL 1501654, 2013 U.S. App. LEXIS 7469 (11th Cir. 2013).

714 F.3d 1220 (Leticia Morales v. Zenith Insurance Company) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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