Royal Insurance Co. of America v. Caliber One Indemnity Co.

465 F.3d 614, 2006 U.S. App. LEXIS 24194, 2006 WL 2716506
Court of Appeals for the Fifth Circuit·Decided September 25, 2006·No. 04-20895·Published·Cited by 8 cases

Opinion

OWEN, Circuit Judge:

An excess carrier sued two primary insurance carriers to recover $1,000,000 the excess carrier paid on behalf of the parties’ common insured to settle wrongful death and survival claims arising out of the care of a nursing home resident. We hold that (1) the excess carrier was entitled to pursue a cause of action based on equitable subrogation, (2) there was an occurrence within each of the primary policies’ definí *616 tion of that term, (3) the excess carrier’s policy period did not overlap with the first primary carrier’s, and (4) the second, consecutive primary carrier was required to exhaust its $1,000,000 limits. We affirm the summary judgment in favor of the first primary carrier, Hartford Underwriters Insurance Company, reverse the summary judgment in favor of the second primary carrier, Caliber One Indemnity Company, and remand this case to the district court for further proceedings.

I

Pietra Nieto Treviño was 83 years old when she was admitted on July 1, 1997 to Turner Geriatric Center, a nursing home operated by Methodist Retirement Communities. She was not ambulatory, was in fragile condition, and suffered from a number of illnesses and conditions including degenerative joint disease, Parkinson’s Disease, and dementia. She remained at the nursing home for almost three years, except for brief hospitalizations, until she was hospitalized on April 10, 2000. She died eleven days later, on April 21, 2000, from a Stage IV pressure ulcer, overwhelming sepsis, and pneumonia.

Treviño’s survivors brought a wrongful death and survival action in state court against MRC Edgewater (doing business as Turner Geriatric Center) and five nurses who attended Treviño at Turner. Methodist Retirement Communities maintained primary and excess insurance coverage for general and professional liability that covered Turner Geriatric Center and its employees. Hartford Underwriters Insurance Company provided primary coverage of up to $1,000,000 for each “medical incident” under a professional liability policy or “occurrence” under a general liability policy from April 1, 1997 to April 1, 1998. That policy was renewed for April 1, 1998 through April 1, 1999, and the limit of liability for that twelve-month period was also $1,000,000. Caliber One Indemnity Company provided the same type of primary coverage for April 1, 1999 to July 1, 2000. Royal Insurance Company of America provided excess coverage for April 1, 1999 through July 1, 2000. While reserving their respective rights to deny coverage, Hartford and Caliber One agreed to share the cost of defending Methodist in the state court action brought by Treviño’s survivors.

In the wrongful death and survival suit, Treviño’s family offered to settle for $3,000,000, and Methodist sent a “Stow-ers” 1 demand letter to Hartford, Caliber One, and Royal requesting them to accept the offer. Correspondence from Methodist indicates that it thought it had only $1,000,000 in primary coverage, although Royal took the position that the policy limits of both the Hartford and Caliber One policies were available because there was more than one occurrence. After further negotiations, the Treviño family’s suit was settled for $2,000,000. Caliber One contributed $800,000, Hartford contributed $200,000, and Royal contributed $1,000,000 under protest, asserting that it would attempt to recover that amount from the primary carriers.

Royal then sued Hartford and Caliber One in state court to recoup the $1,000,000 it had paid, and that suit was removed to federal district court on the basis of diversity jurisdiction. The parties consented to conduct all proceedings before a United States magistrate judge, including trial and entry of final judgment. They filed *617 cross-motions for summary judgment, and the magistrate granted judgment in favor of the primary carriers. The magistrate concluded that under Texas law, which governs this action, an excess carrier has an equitable subrogation claim against a primary insurer “only when it is predicated on the violation of a tort duty owed to the insured” 2 and that the only tort theory under which such an insured may proceed is negligence. The magistrate concluded that neither of the primary carriers had been negligent. The judge reasoned that because Methodist had indicated that it had only $1,000,000 in primary coverage when it demanded that its insurers settle, this was an admission by the insured that was binding on Royal. The primary insurers had done all that Methodist asked, the magistrate concluded. The magistrate further concluded that even if Royal could assert an equitable subrogation claim based on breach of the contractual duties the primary carriers owed to Methodist, there was only one occurrence or medical incident within the meaning of the primary insurance policies because Treviño’s death stemmed from an ongoing course of care and treatment. Under such circumstances, the magistrate concluded, Texas law does not allow an insured to “stack” coverage. Rather, the highest limits under any one policy apply, even if the negligence spanned multiple policy periods, and Hartford and Caliber One therefore had tendered the full limits, $1,000,000. The magistrate also rejected Royal’s contention that the general commercial liability policies applied. Royal has pursued this appeal.

II

As an initial matter, we disagree with the magistrate’s characterization of Texas law regarding the nature of an excess carrier’s causes of action against a primary carrier. More than thirty-five years ago, the Supreme Court of Texas recognized that a carrier had both a right of “ ‘conventional subrogation, which arises from the express insurance contract,’ ” against another carrier, and that if there were no contractual rights “authoriz[ing] recovery of a pro rata share of the sum paid, ... equitable subrogation does.” 3 In support of the proposition that there was a right of “conventional subrogation,” that court quoted the Seventh Circuit, which had held in a suit by an excess carrier against the primary insurer that “ ‘[t]his is an action governed by contractual subrogation in favor of an excess insurer against the primary insurer.’ ” 4

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Royal Insurance Co. of America v. Caliber One Indemnity Co., 465 F.3d 614, 2006 U.S. App. LEXIS 24194, 2006 WL 2716506 (5th Cir. 2006).

465 F.3d 614 (Royal Insurance Co. of America v. Caliber One Indemnity Co.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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