Presbyterian Healthcare Services v. Factory Mutual Insurance Company

CourtDistrict Court, D. New Mexico
DecidedJanuary 11, 2021
Docket1:19-cv-00952
StatusUnknown

This text of Presbyterian Healthcare Services v. Factory Mutual Insurance Company (Presbyterian Healthcare Services v. Factory Mutual Insurance Company) is published on Counsel Stack Legal Research, covering District Court, D. New Mexico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Presbyterian Healthcare Services v. Factory Mutual Insurance Company, (D.N.M. 2021).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW MEXICO

PRESBYTERIAN HEALTHCARE SERVICES, a New Mexico nonprofit corporation,

Plaintiff,

v. No. 1:19-cv-00952-WJ-JFR

FACTORY MUTUAL INSURANCE COMPANY, a/k/a FM Global, a Rhode Island limited liability company,

Defendant.

MEMORANDUM OPINION AND ORDER DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT and GRANTING PLAINTIFF’S MOTION FOR PARTIAL SUMMARY JUDGMENT

THIS MATTER comes before the Court upon cross-motions for summary judgment: Defendant Factory Mutual Insurance Company’s Motion for Summary Judgment, filed November 2, 2020 (Doc. 50) (“FMI Motion”) and Plaintiff Presbyterian Healthcare Services’ Phase I Motion for Partial Summary Judgment, filed November 2, 2020 (Doc. 51) (“PHS Motion”). Having considered the parties pleadings and the applicable law, the Court finds that the FMI Motion is not well-taken and is therefore DENIED. In contrast, the PHS Motion is well-taken and is therefore GRANTED. BACKGROUND

I. Procedural History This action centers on an insurance claim related to an August 31, 2013 failure of the electrical system at Presbyterian Hospital (“the Hospital”) in downtown Albuquerque, New Mexico, and the resulting replacement of the Hospital’s electrical infrastructure. Plaintiff Healthcare Services (“PHS”) held property insurance via Policy No. UC211 (the “Policy”), which was issued by the Defendant, Factory Mutual Insurance Company (“FMI”). In November of 2017, after a lengthy investigation, FMI determined that the Policy did not cover certain upgrades to the Hospital’s electrical system and denied coverage for those portions of PHS’s claim. PHS disputed this denial of coverage and filed its Complaint against FMI in state court on August 30, 2019.1 The

Complaint contains three counts: Breach of Contract and the Covenant of Good Faith and Fair Dealing (Count I); Violation of the New Mexico Insurance Code (Count II); and, Violation of the New Mexico Unfair Practices Act (Count III). Docs. 1-1 & 19.2 FMI removed the action pursuant to 28 U.S.C. § 1441(b), invoking this Court’s original jurisdiction under 28 U.S.C. § 1332. Doc. 1. In its Answer, FMI asserts, among other defenses,3 that PHS’s claims are barred by a “time-to- sue” provision in the Policy. Doc. 24 at 8–9. II. Facts4

FMI issued the Policy to PHS in September of 2012. FMI SUMF ¶ 1. The Policy contained, in relevant part, a “Demolition and Increased Cost of Construction” (“DICC”) provision and a “time-to-sue” provision. The DICC provision states that the Policy covers the reasonable and necessary costs incurred to satisfy the minimum requirements of the enforcement of any law or

1 See Doc. 1-1 (original complaint filed in the 2nd Judicial District Court Bernalillo County, case no. D-202- CV-2019-06836).

2 On November 8, 2019, PHS amended its Complaint as a matter of course pursuant to Fed. R. Civ. P. 15(a)(1). Doc. 19. The Amended Complaint contains the same causes of action, and these claims relate back to PHS’s original filing under Fed. R. Civ. P. 15(c).

3 FMI’s Answer also asserts that the Amended Complaint fails to state a claim upon which relief may be granted. Doc. 24 at 7. On October 24, 2019, FMI filed a motion to dismiss, arguing that PHS’s suit is time-barred by the Policy’s time-to-sue provision. Doc.15. However, FMI withdrew this motion on December 4, 2019, before the Court issued a ruling thereon. Doc. 22.

4 The Court cites to each party’s Statement of Undisputed Material Facts (“SUMF”). References to supporting exhibits are omitted, since they can be found in the motions for summary judgment (Docs. 50 & 51). ordinance regulating the demolition, construction, repair, replacement or use of buildings, structures, machinery or equipment at an insured location. Such law or ordinance must be in force on the date of insured physical loss or damage and its enforcement must be a direct result of such insured physical loss or damage. Under certain circumstances, the DICC provision provides coverage for the cost of demolishing physically undamaged portions of an insured property and

rebuilding these portions in a manner to satisfy the law being enforced. FMI SUMF ¶ 2; PHS SUMF ¶ 5. The “time-to-sue” provision states, in relevant part, “No suit, action or proceeding for the recovery of any claim will be sustained in any court of law or equity unless. . . legal action is started within twelve months after inception of the loss.” FMI SUMF ¶ 3. The inception of loss in this case occurred on Saturday, August 31, 2013 at approximately 10:00 a.m., when the incoming power to the Hospital shut off, causing loss of electrical power. When Hospital staff and utility personnel worked to reestablish power, their efforts resulted in an explosion in the Hospital’s power distribution and grounding system. Id. ¶ 4–5. PHS claims that to comply with all current safety standards and regulations, it was required to redesign and update

its entire electrical system configuration in a manner that separated the normal and emergency power systems, which included replacing equipment that did not sustain direct physical damage from the August 31, 2013 event. Id. ¶ 6. PHS took the position was that it was required to comply with these regulatory provisions even if not directly ordered to do so. PHS SUMF ¶ 14. FMI took the position that the DICC provision did not provide coverage for the updating the reconfiguration of undamaged equipment unless and until an “Authority Having Jurisdiction” issued an order requiring implementation of an applicable code or ordinance. Id. ¶ 15; FMI SUMF ¶ 13. PHS sought the full cost of this reconfiguration in its property damages claim (hereinafter, the “disputed portion of the claim”).5 PHS SUMF ¶ 14. George Retamoza was FMI’s adjuster for this claim. Id. ¶ 21. FMI investigated the disputed portion of the property damage claim for several years. FMI SUMF ¶¶ 7–20. Correspondence between the parties shows that PHS made several substantive attempts to provide

documentation supporting its position that the DICC position covered its reconfiguration of the Hospital’s electrical infrastructure. With each round of correspondence, FMI indicated that it would review the submitted documentation. FMI regularly asked for more information and even scheduled teleconferences and in person meetings to discuss the disputed portion of the claim. Finally, on November 14, 2017, FMI sent a letter notifying PHS that the information and documentation provided did not satisfy the DICC provision’s enforcement requirement, and therefore the Company would not would not respond to the costs associated with separating the Hospital’s normal and emergency electrical power systems. FMI SUMF ¶¶ 19–20. On February 27, 2018, Robert Frey, PHS’s insurance broker, sent an e-mail to FMI in

which Mr. Frey claimed that PHS had met its burden of proof through PHS’s submission of material from the New Mexico Department of Health. Id. ¶ 21. On July 12, 2018, FMI sent a letter to Mr. Frey stating that FMI’s coverage position remained unchanged. Id. ¶ 22. On February 7, 2019, Mr. Frey sent an email to Jeffrey Casillas, FMI’s Vice President and Los Angeles Operation Claims Manager, that discussed comments from John Heck, one of the engineers hired by PHS. Id. ¶ 23. FMI forwarded Mr. Heck’s comments to its own retained consultant for review, but, on

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Presbyterian Healthcare Services v. Factory Mutual Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/presbyterian-healthcare-services-v-factory-mutual-insurance-company-nmd-2021.