O.L. Matthews v. Harleysville Lake States Ins.

CourtCourt of Appeals for the Sixth Circuit
DecidedSeptember 9, 2020
Docket19-1994
StatusUnpublished

This text of O.L. Matthews v. Harleysville Lake States Ins. (O.L. Matthews v. Harleysville Lake States Ins.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
O.L. Matthews v. Harleysville Lake States Ins., (6th Cir. 2020).

Opinion

NOT RECOMMENDED FOR PUBLICATION File Name: 20a0524n.06

No. 19-1994

UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT FILED O.L. MATTHEWS, M.D., P.C., ) Sep 09, 2020 ) DEBORAH S. HUNT, Clerk Plaintiff-Appellant, ) ) ON APPEAL FROM THE v. ) UNITED STATES DISTRICT ) COURT FOR THE EASTERN HARLEYSVILLE INSURANCE CO., ) DISTRICT OF MICHIGAN ) Defendant-Appellee. ) )

BEFORE: GRIFFIN, THAPAR, and READLER, Circuit Judges.

GRIFFIN, Circuit Judge.

This insurance coverage dispute concerns damage to a building that resulted from rainwater

ponding on the roof and eventually finding its way inside. The issue on appeal is whether the

damage is covered under the relevant policy or excluded by one or more of its numerous

“exclusions” or “limitations.” OLM, the insured, argues that the district court applied the wrong

standard of causation when it analyzed whether one of the Policy’s coverage exclusions applied.

OLM is correct on this point, but we conclude that two other provisions of the Policy (one

“exclusion” and one “limitation”) apply to bar coverage. We therefore affirm.

I.

Plaintiff O.L. Matthews, M.D., P.C. (“OLM”) owned a building in Inkster, Michigan and

used it as a medical office. OLM bought the building in the early 1980s, and for many years, No. 19-1994, O.L. Matthews, M.D., P.C. v. Harleysville Ins. Co.

neither OLM nor its owner, Dr. O.L. Matthews, paid much attention to the condition of the roof.

That changed in January of 2017, when the roof started leaking. OLM filed a claim under the

“Businessowners policy” (“the Policy”) it held with defendant Harleysville Insurance Company,

but Harleysville denied coverage and its agent told OLM that the roof needed maintenance.

OLM then hired Darrell Wood, a roofer, but because of the ice and snow on the roof—

typical for January in Michigan—he could not perform the full, necessary maintenance. So Wood

performed what maintenance he could under the then-existing weather conditions. A similar

sequence of events occurred in February 2017. OLM hired Wood to return because of another

leak and he performed limited maintenance due to the ice and snow. Wood characterized the

condition of the roof as “messed up.” When he first climbed up to the roof, it was “all water,”

“like a lake.” Some areas were sagging and the drain wasn’t working properly. In short,

“[e]verything was bad on the roof.” Wood described his temporary fix—draining the water and

patching some areas with roof tar—as “put[ting] a Band-Aid on a damaged roof.”

By July of 2017, the weather had improved and OLM hired a different roofer, who provided

some maintenance to the roof. Then in August, OLM hired King’s Roofing to provide additional

maintenance and prepare the roof for the following winter. Andrew Yonko, the owner of King’s

Roofing, examined the roof and described it as being in “okay condition, but it needed work done.

Definitely needed maintenance.” He observed water ponding on the roof in “low spots” and that

seams in the waterproof membrane were “starting to blister up . . . [and] crack up.” Yonko

explained that the weight of water ponding on a roof tends to “pull[ ] apart” a roof membrane, and

that seams will deteriorate because of normal “wear and tear.” He estimated that the lifespan of a

roof like the building had would typically be between fifteen and twenty years. By the summer of

2017, the roof at issue here was at least thirty-five years old.

-2- No. 19-1994, O.L. Matthews, M.D., P.C. v. Harleysville Ins. Co.

King’s Roofing gave OLM an estimate to repair the roof, which OLM approved. But

before King’s could begin its work, water leaked into the building and caused significant damage

to the inside, including the light fixtures, the carpeting, and even the door locks. King’s eventually

repaired the roof, but the damage was done. OLM promptly filed a second claim with Harleysville,

which hired David Walenga, a structural engineer, to investigate and determine the “cause of loss.”

Walenga examined the roof in October 2017 and reached three major conclusions. First,

Moisture is intruding into the subject building due to the exploitation of breaches in the roof from latent defects and a lack of proper and timely maintenance or repair. The roof lacks sufficient pitch or drainage to prevent ponding. Ponded moisture is capable of intruding into the building via defects such as failed or weak membrane seams, and failed penetration flashings.

Second, based on the corrosion of metal in the ceiling and damage to the ceiling tiles, “[m]oisture

ha[d] been intruding into the subject building to some degree for a duration well exceeding the

timeframe between the claimed loss period, and [the] inspection date.” Third, Walenga found “no

indication that the roof ha[d] been displaced or damaged by a singular weather-related event, such

as wind.” Weather records showed no severe or high wind speeds during the loss period, and the

previous repairs to the roof indicated gradual deterioration over a long period rather than a single,

severe event.

Relying on Walenga’s report, Harleysville concluded that “loss was caused by the

exploitation of breaches in the roof from latent defects and a lack of proper and timely maintenance

or repair” and that the Policy “does not provide coverage for this loss.” Accordingly, Harleysville

denied OLM’s second claim in December 2017. A letter communicating the denial identified

several exclusions in the Policy that, according to Harleysville, applied to preclude coverage.

Meanwhile, OLM hired its own expert to examine the roof, structural engineer Michael T.

Williams. For the most part, his conclusions were consistent with Walenga’s:

-3- No. 19-1994, O.L. Matthews, M.D., P.C. v. Harleysville Ins. Co.

• The roof deck . . . is failing. The more it sags, the more water is ponded every time it gets wet. The more water is ponded in the low spots, the more it sags. With this continued cycle of progressive failure of the deck, the entire deck must be replaced. • The roof system has been repaired many times. The repairs have also added to the weight of the roof. The additional weight plus the standing water caused by the deck sags has overcome the roof deck’s ability to carry such loads. • The weight of the ponded water stretches the roof membrane. This stretching is a “tensile” loading. The weakest parts of the roof membrane are its seams or its transition areas where it is wrapped over or around something. Those are the areas where the roof system has failed[.]

Williams characterized the rainfall that led to the damage to the building in August 2017 as the

“straw that broke the camels’ [sic] back,” as “several areas . . . failed and could no longer support

the weight of the roof and the ponded water.”

OLM believed the damage to the building was covered under the Policy and filed suit

against Harleysville in Michigan state court, asserting a single count of breach of contract under

Michigan law.1 Following removal and discovery, Harleysville moved for summary judgment,

arguing that several “exclusions” or “limitations” contained in the policy precluded coverage for

the damage to the building. The district court agreed, granted the motion, and entered judgment

in favor of Harleysville. O.L. Matthews, M.D., P.C. v. Harleysville Ins. Co., 412 F. Supp. 3d 717

(E.D. Mich. 2019). OLM timely appealed.

II.

“We review de novo a district court’s grant of summary judgment.” Keith v. Cty. of

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