TBL Collectibles, Inc. v. Owners Ins. Co.
This text of 285 F. Supp. 3d 1170 (TBL Collectibles, Inc. v. Owners Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, D. Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
Opinion
PHILIP A. BRIMMER, United States District Judge
This matter is before the Court on Plaintiff's Motion for Partial Summary *1176Judgment on Its First Claim for Declaratory Relief [Docket No. 62], Defendant Owners Insurance Company's Motion for Summary Judgment [Docket No. 63], Plaintiff's Motion to Exclude Certain Opinions and Testimony of Defendant's Expert, John P. Craver, Esq. [Docket No. 54], and Owners' Motion to Exclude Certain Opinions and Testimony of Plaintiff's Expert David Young [Docket No. 83]. This Court has jurisdiction pursuant to
I. BACKGROUND1
This case involves a dispute between the parties regarding payment of an insurance claim for stolen coins. Plaintiff TBL Collectibles, Inc. owns and operates Colorado Coins, Cards & Comics, a retail coin and collectibles store in Arvada, Colorado. Docket No. 62 at 2, ¶ 1; Docket No. 63 at 3, ¶ 2. At all times relevant to this action, plaintiff held an insurance policy with defendant Owners Insurance Company, that provided commercial property insurance coverage. Docket No. 63 at 3, ¶ 1. On August, 30, 2015, plaintiff's store was burglarized after hours. Docket No. 62 at 3, ¶ 4. The only items stolen were a floor safe and its contents.
Plaintiff reported the loss to the Arvada Police Department ("APD") on August 30, 2015. Docket No. 62-19 at 7. As part of its investigation into the incident, the APD prepared an Incident/Investigation Report containing a list of the stolen items as reported by Bruce Wray, the co-owner and manager of the store. Docket No. 1 at 3, ¶ 11; Docket No. 62-18 (APD Report); Docket No. 62-19 (APD Report continued); Docket No. 75 at 3 (stating that the "APD generated an Incident and Investigation Report ('APD Report'), which also lists the coins Mr. Wray asserts were taken during the burglary"); Docket No. 62 at 3, ¶ 2 (stating that store is managed by owner of TBL, Bruce Wray). On August 31, 2015, plaintiff informed defendant of the loss and submitted a claim under the insurance policy. Docket No. 62 at 3, ¶ 5. Defendant immediately assigned the claim to an adjuster, Jayme Larson. Docket No. 63 at 5, ¶ 9. Ms. Larson contacted Mr. Wray on September 1, 2015.
At defendant's request, plaintiff provided the following documentation to substantiate the loss: (1) a handwritten list of the stolen items, which included the description and cost of each coin; (2) the APD Report; (3) invoices and deposit slips from Cornerstone Bullion, from which plaintiff had purchased coins prior to the theft; and (4) check copies, cash receipts, and bank statements reflecting plaintiff's coin purchases in the four years prior to the theft. See Docket No. 62 at 6, ¶¶ 17-18; Docket No. 67 at 8-9, ¶¶ 1, 5; Docket No. 62-24 at 6, 23:18-25 (discussing Cornerstone Bullion invoices and deposit slips); 62-25 (handwritten list of stolen items); Docket No. 62-26 at 2 (discussing invoices for coin purchases from Cornerstone Bullion); Docket No. 62-32 at 2 (discussing check copies and bank statements); Docket No. 67-2 at 3, 47:21-25 (noting that plaintiff *1177purchased certain coins from Cornerstone Bullion); Docket No. 67-4 (APD Report).
On November 6, 2015, defendant authorized a policy limit payment of $15,000 for the stolen cash. Docket No. 1 at 7, ¶ 22; Docket No. 67-11 at 11. According to defendant, the Cornerstone Bullion invoices confirmed the existence of the cash in the safe. Docket No. 63 at 5, ¶¶ 9-10; Docket No. 62-24 at 6, 23:14-24:8.3
Ms. Larson continued her investigation of the stolen coins. See Docket No. 63-13 at 1; Docket No. 67-11 at 11. After discussions with the Home Office claims department, Ms. Larson ultimately concluded that the coins would be considered business personal property under the terms of plaintiff's insurance policy. See Docket No. 63-13 at 1; Docket No. 67-11 at 9-10.4 She determined, however, that the documentation provided did not adequately substantiate plaintiff's loss. Docket No. 62-29 at 2; Docket No. 63-13 at 2-3; Docket No. 67-11 at 5-7. Ms. Larson assigned a forensic accounting firm-RGL Forensics-to inspect plaintiff's business records. Docket No. 63-13 at 2. The accountant who reviewed the records, Paul DeBoer, determined that, although the records demonstrated a pattern of coin purchases, they did not prove the ownership or existence of the specific coins allegedly kept in the safe. Docket No. 63 at 6, ¶ 15; Docket No. 68 at 5-6, ¶ 15; Docket No. 62-32 at 2; Docket No. 67-11 at 3 (2/1/16 claims note).5 Mr. Wray was unable to provide further documentation because he did not keep written records of the coins he bought and sold. Docket No. 63 at 4-5, ¶ 8; Docket No. 68-5 at 9, 12. In addition, plaintiff admitted that many of the stolen items were purchased with cash and it did not have receipts. Docket No. 68-5 at 12-14.
On March 16, 2016, defendant sent plaintiff a letter denying its claim for the stolen coins. Docket No. 63-13.6 The letter states: "The documentation you have provided has show a pattern of purchasing coins, however it has not substantiated the specific coins you are claiming."
The March 16, 2016 letter does not reference fraud as a basis for defendant's denial of payment.
Free access — add to your briefcase to read the full text and ask questions with AI
PHILIP A. BRIMMER, United States District Judge
This matter is before the Court on Plaintiff's Motion for Partial Summary *1176Judgment on Its First Claim for Declaratory Relief [Docket No. 62], Defendant Owners Insurance Company's Motion for Summary Judgment [Docket No. 63], Plaintiff's Motion to Exclude Certain Opinions and Testimony of Defendant's Expert, John P. Craver, Esq. [Docket No. 54], and Owners' Motion to Exclude Certain Opinions and Testimony of Plaintiff's Expert David Young [Docket No. 83]. This Court has jurisdiction pursuant to
I. BACKGROUND1
This case involves a dispute between the parties regarding payment of an insurance claim for stolen coins. Plaintiff TBL Collectibles, Inc. owns and operates Colorado Coins, Cards & Comics, a retail coin and collectibles store in Arvada, Colorado. Docket No. 62 at 2, ¶ 1; Docket No. 63 at 3, ¶ 2. At all times relevant to this action, plaintiff held an insurance policy with defendant Owners Insurance Company, that provided commercial property insurance coverage. Docket No. 63 at 3, ¶ 1. On August, 30, 2015, plaintiff's store was burglarized after hours. Docket No. 62 at 3, ¶ 4. The only items stolen were a floor safe and its contents.
Plaintiff reported the loss to the Arvada Police Department ("APD") on August 30, 2015. Docket No. 62-19 at 7. As part of its investigation into the incident, the APD prepared an Incident/Investigation Report containing a list of the stolen items as reported by Bruce Wray, the co-owner and manager of the store. Docket No. 1 at 3, ¶ 11; Docket No. 62-18 (APD Report); Docket No. 62-19 (APD Report continued); Docket No. 75 at 3 (stating that the "APD generated an Incident and Investigation Report ('APD Report'), which also lists the coins Mr. Wray asserts were taken during the burglary"); Docket No. 62 at 3, ¶ 2 (stating that store is managed by owner of TBL, Bruce Wray). On August 31, 2015, plaintiff informed defendant of the loss and submitted a claim under the insurance policy. Docket No. 62 at 3, ¶ 5. Defendant immediately assigned the claim to an adjuster, Jayme Larson. Docket No. 63 at 5, ¶ 9. Ms. Larson contacted Mr. Wray on September 1, 2015.
At defendant's request, plaintiff provided the following documentation to substantiate the loss: (1) a handwritten list of the stolen items, which included the description and cost of each coin; (2) the APD Report; (3) invoices and deposit slips from Cornerstone Bullion, from which plaintiff had purchased coins prior to the theft; and (4) check copies, cash receipts, and bank statements reflecting plaintiff's coin purchases in the four years prior to the theft. See Docket No. 62 at 6, ¶¶ 17-18; Docket No. 67 at 8-9, ¶¶ 1, 5; Docket No. 62-24 at 6, 23:18-25 (discussing Cornerstone Bullion invoices and deposit slips); 62-25 (handwritten list of stolen items); Docket No. 62-26 at 2 (discussing invoices for coin purchases from Cornerstone Bullion); Docket No. 62-32 at 2 (discussing check copies and bank statements); Docket No. 67-2 at 3, 47:21-25 (noting that plaintiff *1177purchased certain coins from Cornerstone Bullion); Docket No. 67-4 (APD Report).
On November 6, 2015, defendant authorized a policy limit payment of $15,000 for the stolen cash. Docket No. 1 at 7, ¶ 22; Docket No. 67-11 at 11. According to defendant, the Cornerstone Bullion invoices confirmed the existence of the cash in the safe. Docket No. 63 at 5, ¶¶ 9-10; Docket No. 62-24 at 6, 23:14-24:8.3
Ms. Larson continued her investigation of the stolen coins. See Docket No. 63-13 at 1; Docket No. 67-11 at 11. After discussions with the Home Office claims department, Ms. Larson ultimately concluded that the coins would be considered business personal property under the terms of plaintiff's insurance policy. See Docket No. 63-13 at 1; Docket No. 67-11 at 9-10.4 She determined, however, that the documentation provided did not adequately substantiate plaintiff's loss. Docket No. 62-29 at 2; Docket No. 63-13 at 2-3; Docket No. 67-11 at 5-7. Ms. Larson assigned a forensic accounting firm-RGL Forensics-to inspect plaintiff's business records. Docket No. 63-13 at 2. The accountant who reviewed the records, Paul DeBoer, determined that, although the records demonstrated a pattern of coin purchases, they did not prove the ownership or existence of the specific coins allegedly kept in the safe. Docket No. 63 at 6, ¶ 15; Docket No. 68 at 5-6, ¶ 15; Docket No. 62-32 at 2; Docket No. 67-11 at 3 (2/1/16 claims note).5 Mr. Wray was unable to provide further documentation because he did not keep written records of the coins he bought and sold. Docket No. 63 at 4-5, ¶ 8; Docket No. 68-5 at 9, 12. In addition, plaintiff admitted that many of the stolen items were purchased with cash and it did not have receipts. Docket No. 68-5 at 12-14.
On March 16, 2016, defendant sent plaintiff a letter denying its claim for the stolen coins. Docket No. 63-13.6 The letter states: "The documentation you have provided has show a pattern of purchasing coins, however it has not substantiated the specific coins you are claiming."
The March 16, 2016 letter does not reference fraud as a basis for defendant's denial of payment. See
Plaintiff filed this lawsuit on July 13, 2016, asserting three claims for relief: (1) declaratory judgment as to whether plaintiff fulfilled its post-loss obligations under the insurance policy; (2) breach of contract; and (3) unreasonable delay or denial of benefits under
II. MOTIONS TO EXCLUDE
The Court will begin by addressing the parties' motions to exclude certain opinions of expert witnesses given that the outcome of those motions may affect the Court's resolution of the pending summary judgment motions.
A. Legal Standard
The admissibility of expert testimony is governed by Federal Rule of Evidence 702, which provides:
A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if: (a) the expert's scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue; (b) the testimony is based on sufficient facts or data; (c) the testimony is the product of reliable principles and methods; and (d) the expert has reliably applied the principles and methods to the facts of the case.
Fed. R. Evid. 702. As the rule makes clear, while required, it is not sufficient that an expert be qualified based upon knowledge, skill, experience, training, or education to give opinions in a particular subject area. Instead, the Court must "perform[ ] a two-step analysis." 103 Investors I, L.P. v. Square D Co. ,
Rule 702 thus imposes on the district court a "gatekeeper function to 'ensure that any and all scientific testimony or evidence admitted is not only relevant, but reliable.' " United States v. Gabaldon ,
Although the proponent of the challenged testimony has the burden of establishing admissibility, United States v. Nacchio ,
Assuming the standard for reliability is met, the Court must also ensure that the proffered testimony will assist the trier of fact. See Kumho Tire ,
B. Analysis
1. Plaintiff's Motion to Exclude Testimony of John Craver
Defendant has designated John P. Craver, an attorney who practices in the field of insurance law, as an expert witness. Docket No. 54-1 at 3, 6. In his expert report, Mr. Craver concludes that defendant had a "reasonable basis to deny portions of [plaintiff's] claim based on the evidence they had in their claim file at the time of the denial." Id. at 10. Plaintiff does not challenge Mr. Craver's qualifications as an expert witness. See Docket No. 61 at 1. Instead, plaintiff seeks to exclude a number of his statements and opinions on grounds that: (1) they are irrelevant, (2) they improperly usurp the function of the trial judge, (3) they are conclusory, and (3) they are factually erroneous. See generally Docket No. 54; Docket No. 61.
a. Relevance
Plaintiff argues that the following opinions and statements expressed in Mr. Craver's expert report are irrelevant and that the Court should order that Mr. Craver not state them at trial: (1) Mr. Craver's references to
Plaintiff first argues that Mr. Craver's references to *1180
Plaintiff next challenges Mr. Craver's references to Colo. Code Regs. § 702-5:5-1-14 ("Regulation 5-1-14"). That regulation prescribes certain penalties for an insurer's failure to make timely decisions and/or payment on first-party claims. See Colo. Code Regs. § 702-5:5-1-14(4)(A)(1). Specifically, the statute imposes a monetary fine if an insurer "fails to make a decision and/or pay benefits due under the policy within sixty (60) days after a valid and complete claim has been received, and there is not a reasonable dispute between the parties." § 702-5:5-1-14(4)(A)(1)(b). A "valid and complete claim" has been "received" by an insurer when
(1) All information and documents necessary to prove the insured's claim have been received by the insurer; ... 3) The terms and conditions of the policy have been complied with by the insured; ... (5) There are no indicators on the claim requiring additional investigation before a decision can be made; and/or ... (7) Negotiations or appraisals to determine the value of the claim have been completed; and/or (8) Any litigation on the claim has been finally and fully adjudicated.
§ 702-5:5-1-14(4)(A)(2)(a). The statute further provides that a "reasonable dispute" may exist when: (1) information necessary for a determination on the claim has not been submitted; (2) conflicting information has been submitted and additional investigation is needed; (3) the insured has failed to comply with the terms of the insurance policy; or (4) litigation has commenced regarding the claim. § 702-5:5-1-14(4)(A)(2)(b).
In his expert report, Mr. Craver states that: (1) the regulation "provides guidance to insurers on when the [sic] have a duty to pay first party claims" in Colorado, Docket No. 54-1 at 9; (2) "[in] reviewing these ... regulations, it does not appear that there is a valid and complete claim that Owners Insurance owes at this time,"
Defendant contends that Mr. Craver's discussion of the regulation "provides context for the parameters of insurance claims handling." Docket No. 60 at 5. In response, plaintiff claims that at least two cases have specifically held that Regulation 5-1-14 is irrelevant in bad faith actions brought pursuant to
In Fisher v. State Farm Mutual Automobile Insurance Co. , --- P.3d ----,
Plaintiff's citation to Etherton v. Owners Insurance Co. ,
*1182Etherton ,
Plaintiff also challenges the relevance of Mr. Craver's opinions on the timeliness of defendant's claims handling. Docket No. 54 at 10. Mr. Craver states in his report that (1) "there were no substantial delays in the adjustment" of plaintiff's claim, Docket No. 54-1 at 9; (2) defendant's investigation of the claim was "prompt and proactive,"
Plaintiff lastly requests that the Court exclude Mr. Craver's opinions regarding fraudulent insurance claims and Special Investigation Unit ("SIU") investigations. Docket No. 54 at 11-12. In his report, Mr. Craver states:
It should also be noted that the Colorado legislature, through C.R.S. § 10-1-128, makes it clear that there is a strong public policy within the state wherein the state is critically interested in investigating and stopping insurance fraud. The General Assembly has stated that insurance fraud is expensive and that it increases premiums and places businesses at risk. Insurance fraud reduces the customer's ability to raise their standard of living and decreases the economic vitality of the state. I am not suggesting here that Owners Insurance has alleged its insured is committing insurance fraud. I think it is simply important for a jury to know that a critical investigation into theft claims and the amount of the damages sustained, including the use of SIU departments to investigate background, credit and financial issues, is clearly authorized and in fact encouraged by the state's statutes and regulations. There was nothing unusual in an insurer conducting an SIU investigation in a claim of this nature.
Docket No. 54-1 at 9. Plaintiff contends that these opinions are irrelevant and prejudicial because there is no evidence that defendant suspected Mr. Wray of reporting a false or fraudulent claim. Docket No. 54 at 11. The Court agrees. Although plaintiff's claim was initially referred to the SIU for investigation, see Docket No. 60-4 at 2-5, 34:1-35:23, 40:1-41:1, there is no evidence that anyone at Owners suspected Mr. Wray of lying about the stolen coins. See Docket No. 62-24 at 6-7, 24:14-25:4; Docket No. 67-11 at 4 (2/1/16 claim note); Docket No. 77-4 at 3, 15:6-13. The sole reason defendant gave for denying plaintiff's claim was that plaintiff had failed to provide adequate documentation of the stolen coins. See Docket No. 63-13. Any statements or opinions regarding insurance fraud and SIU investigations will therefore be excluded as irrelevant.10
*1184b. Statements Regarding Applicable Law
Plaintiff identifies nineteen statements in Mr. Craver's expert report which allegedly constitute impermissible statements of law. See Docket No. 54 at 6-7. These statements appear to set forth the various legal standards Mr. Craver applied in reaching his conclusions. According to defendant, the statements were meant to "provide context as to the legal parameters for insurance industry standards." Docket No. 60 at 9-10. The Court notes that statements eleven through thirteen and nineteen, as identified in plaintiff's motion, see Docket No. 54 at 7, have already been excluded as irrelevant. However, the Court agrees with plaintiff that statements one through eight and fourteen and fifteen should also be excluded.
The Tenth Circuit has held that "a witness may refer to the law in expressing an opinion" or "aid the jury in understanding the facts in evidence even though reference to those facts is couched in legal terms." Specht v. Jensen ,
Defendant argues that industry standards in Colorado are defined by state statute and case law and thus it is impossible for Mr. Craver to express any opinion that defendant complied with those standards without citing to the relevant legal authorities. Docket No. 60 at 10. But defendant's argument fails to distinguish between those statements of Mr. Craver that merely rephrase the determinative legal standard in this case-whether defendant acted reasonably in denying plaintiff's claim-and Mr. Craver's references to statutory and regulatory provisions that, though not conclusive of liability, may illustrate what constitutes "reasonable" conduct in the insurance industry. See Hangarter v. Provident Life & Accident Ins. Co. ,
In summary, the Court will permit testimony as to Regulation 5-1-14. All other statements identified by plaintiff, see Docket No. 54 at 6-7, will be excluded.13
c. Conclusory Opinions
Plaintiff also argues that the following statements and opinions contained in the expert report are unsupported: (1) defendant's claim handling complied with industry practices, Docket No. 54-1 at 10; (2) defendant acted in compliance with the Unfair Claims Practices Act,
Fed. R. Evid. 702(b) requires that expert testimony be "based on sufficient facts or data." Thus, a district court is not required "to admit opinion evidence that is connected to existing data only by the ipse dixit of the expert." Etherton ,
The Court also agrees that Mr. Craver does not adequately support his opinions concerning defendant's compliance with the "Unfair Claims Practices Act." Most notably, Mr. Craver does not specify the portions of the Act to which his second and fourth opinions pertain.14 If the opinions relate to § 10-3-1115, Mr. Craver's statement that defendant acted in compliance with the Act goes to the ultimate legal issue in this case. See Specht ,
The Court reaches a different conclusion, however, insofar as Mr. Craver opines as to defendant's compliance with
*1187(internal quotation marks omitted). Although Mr. Craver's explanation for these conclusions is thin, he references particular requirements of § 10-3-1104, see, e.g. , Docket No. 54-1 at 9 ("The statute also provides insurers should consider all available information in making claims decisions."), and identifies specific actions by defendant that purportedly complied with those requirements. See id. at 10 (stating that defendant "investigated coverage promptly" and "proactively looked for coverage to assist the insured"). As to the claim that defendant complied with "industry practices," the Court agrees that Mr. Craver should have clarified the particular practices to which he refers. Nevertheless, he does address defendant's compliance with § 10-3-1104 and Regulation 5-1-14, both of which provide some evidence of applicable "industry standards." The Court therefore declines to exercise its gatekeeping role to exclude Mr. Craver's opinions on defendant's compliance with (1) § 10-3-1104 and (2) Regulation 5-1-14.16
d. Erroneous Statements of Fact
Plaintiff contends that Mr. Craver's expert report contains the following erroneous factual statements: (1) plaintiff submitted no documentary or independent proof of ownership; (2) the only evidence submitted supporting ownership is the statement of the insured that he owned his property; (3) the insured's lack of proof supports an inference that he did not own or purchase the coins; (4) there is no regulation, statute, or formula to determine the adequacy of proof of ownership to substantiate a loss; and (5) an insurer does not act unreasonably in seeking resolution through the courts. Docket No. 54 at 14. Defendant argues that these facts are simply Mr. Craver's "observations" based on the evidence he reviewed. Docket No. 60 at 12.
To the extent these statements constitute mere factual assertions based on the evidence reviewed, the Court finds that Fed. R. Evid. 702 is an inappropriate vehicle for challenging them. Although the accuracy of the facts and assumptions underlying an expert opinion may impact the reliability of that opinion, see Crabbe ,
2. Defendant's Motion to Exclude Testimony of David Young
Plaintiff has designated David Eugene Young, a certified professional public adjuster, as an expert witness. Docket No. 83-1 at 1. Mr. Young opines that Mr. Wray complied with his obligations under the terms of the insurance policy and that defendant's denial of insurance benefits was unreasonable. Docket No. 83-1 at 8-9; Docket No. 84 at 3. In particular, his report concludes that: "[t]he Home Office blocked [Jayme Larson] from paying [plaintiff's claim] and forced her to throw every possible argument not to do so to the insured"; Owners made up requirements not found in the insurance policy; Owners "has attempted to create a level of ownership proof that the insured cannot meet when in fact, the insured HAS complied with the Duties After Loss provision of his policy"; Owners has failed to effectuate a prompt, fair, and equitable settlement of claims "even though liability has become 'reasonably' clear"; and "Bruce Wray ... has complied with the terms of his policy and is therefore entitled to payment." Docket No. 83-2 at 5-6.
Defendant moves to exclude certain of Mr. Young's opinions on grounds that Mr. Young is generally unqualified to opine on the matters addressed in his report, see Docket No. 83 at 9-11, and that his opinions are: (1) based on an unreliable methodology, see id. at 5-8, 13-15; (2) based on insufficient facts or data, see id. at 11-15; (3) irrelevant, see id. at 8-9; and (4) unhelpful to the trier of fact. See id. at 11.
a. Qualifications
Defendant argues that Mr. Young is unqualified to opine as to whether defendant's handling of plaintiff's claim was reasonable because he has never worked as an accountant, attorney, or adjuster for an insurance company. Docket No. 83 at 10. According to defendant, this places Mr. Young "on the outside looking in, with no clear view of either the applicable Colorado industry standards or whether they were met in this particular case." Id.
Plaintiff responds by citing Mr. Young's qualifications. Mr. Young has his own insurance adjusting firm and is licensed to provide public adjusting services in several states, including Colorado. See Docket No. 83-1 at 12; Docket No. 84-2 at 12, 58:18-20, 60:2-3.18 For the past twenty-five years, he has also owned and operated the Adjusters Insurance School, located in Mesa, Arizona, which offers a one-year training program for in-house insurance adjusters. See Docket No. 84 at 4; Docket No. 84-2 at 8, 38:21-39:19. Mr. Young is further approved as an Instructor in Insurance Topics in Colorado and has contributed to portions of the Insurance *1189Settlement Handbook addressing the appraisal of insurance claims. See Docket No. 83-1 at 14; Docket No. 84-2 at 12, 60:10-16. To maintain his credentials, Mr. Young has completed continuing education training on state-specific laws governing the insurance industry. Id. at 13, 65:5-15.
In light of this experience, the Court finds that Mr. Young is sufficiently qualified to offer the opinions challenged by defendant. Defendant maintains that Mr. Young has no experience with industry-side claims handling. See Docket No. 83 at 10; Docket No. 85 at 3. But defendant does not cite any authority for the proposition that a public adjuster is unqualified to opine on an insurance company's handling of an claim merely because he serves as an advocate for the insured. Cf. Williamson v. Metropolitan Property & Cas. Ins. Co. ,
Defendant also ignores the breadth and variety of Mr. Young's experience. In addition to being a certified public adjuster, Mr. Young is trained in SIU adjusting,20 owns and operates a one-year training program for in-house insurance adjusters, contributes to publications on insurance topics, and participates in continuing education training on state-specific laws governing the insurance industry. His experience is thus not limited to public claims adjusting. Although defendant argues that Mr. Young has never worked as an attorney, let alone practiced law in Colorado, see Docket No. 85 at 3, Mr. Young is licensed as both a public adjuster and an instructor on insurance topics in Colorado. See Docket No. 83-1 at 12, 14. These certifications indicate that he is sufficiently knowledgeable about Colorado laws and regulations governing the insurance industry to offer expert opinions. The question is whether the opinions that defendant has challenged are otherwise admissible.
*1190b. Reliability
Defendant challenges the reliability of certain opinions expressed in Mr. Young's expert report. See Docket No. 83 at 5-8, 11-15. Specifically, defendant argues that: (1) Mr. Young did not apply a methodology to reach his conclusions, id. at 6; (2) the methodology employed by Mr. Young is unreliable because he fails to address the ultimate fact question (i.e. , whether defendant complied with industry standards), Mr. DeBoer's analysis of plaintiff's financial records, and the legal standards cited in Mr. Young's report, id. at 6-7; and (3) Mr. Young's opinions are conclusory and/or based on insufficient facts or data. Id. at 12-15.
Defendant's arguments challenge the methodology employed by Mr. Young in reaching his conclusions. See Docket No. 83 at 6. As plaintiff argues, the purpose of standard of care experts in bad faith litigation is to "[a]pply[ ] the facts of a case to the applicable industry standards." Docket No. 84 at 6; see also O'Sullivan v. Geico Cas. Co. ,
Specifically, although Mr. Young makes factual "observations" based on the evidence and cites authorities ostensibly reflecting insurance industry standards, his ultimate conclusions do not clearly apply those standards to the facts. See Fed. R. Evid. 702(b)-(d) (requiring that the testimony be "based on sufficient facts or data," that the testimony be "the product of reliable principles and methods," and that the expert "reliably appl[y] the principles and methods to the facts of the case"). Instead, many of his opinions reflect his own interpretations of the evidence-interpretations that are both unhelpful to the jury, which is capable of interpreting the evidence without expert assistance, and unsupported. The Court finds that the following challenged opinions in Mr. Young's expert report suffer from these flaws: (1) Ms. Larson lacked final authority regarding the claim, Docket No. 83-2 at 5; (2) the Home Office prevented Ms. Larson from paying plaintiff's claim and forced her to assert every possible argument against paying the claim,
The Court reaches the opposite conclusion as to Mr. Young's statements regarding the legal standards applicable in this case. Defendant challenges the following statements in Mr. Young's report:
Couch on Insurance points out, however, that [a provision requiring the insured to provide an inventory of damaged and undamaged property] "must be given a reasonable construction, and should not be used to relieve the insurer from liability for loss where literal compliance with the contract has become impossible...."
Docket No. 83-2 at 5.
Colorado Law (Colorado Revised Statute § 10-2-1104) requires an insurer to effectuate a prompt fair and equitable settlement of claims when liability has become reasonably clear.
Id. at 6.23
Colorado's Unfair Claims Practices Act requires each insurer to develop standards for reasonable claims handling. ( Colorado Revised Statute § 10-3-1104(h) ).
Docket No. 83-3 at 3.
State Statutes and Standard of Care in the Industry also dictate appropriate behavior in the adjustment of claims.
Id. at 2.
Defendant contends that these opinions are unreliable because Mr. Young fails to adequately describe the legal standards he cites. Docket No. 83 at 7. But defendant does not argue that Mr. Young's descriptions of the above-cited legal standards are inaccurate or that the standards themselves are irrelevant to the issues in the case. Accordingly, defendant's argument goes to the reliability of Mr. Young's application of the standards to the facts in this case, not to the reliability of his citations to *1192the standards themselves. Mr. Young's purported lack of comprehension as to the relevant legal standards may call into question the reliability of his ultimate conclusions regarding the reasonableness of defendant's conduct; however, it is not a sufficient basis for excluding any reference to the applicable legal standards. These opinions will therefore not be excluded.24
The Court further declines to exclude certain factual statements deemed "erroneous" by defendant. Defendant specifically challenges the following statements in Mr. Young's expert report: (1) "Jayme Larson testified in her deposition that the conduct of Auto Owners in this case was unreasonable," Docket No. 83-2 at 3; (2) the applicable insurance policy requires the insured to submit to an examination under oath as a duty after loss, id. at 4; (3) "Owners would not accept [the hundred of pages of documents submitted by TBL Collectibles, including past business records and the Arvada Police Department Inventory, as] proof of the loss," id. ; and (4) Donald Gibson is an SIU adjuster. Docket No. 83-3 at 3; Docket No. 83 at 12.25 To the extent these opinions or statements are inaccurate, the Court finds, as it did with respect to Mr. Craver's statements above, that the accuracy of Mr. Young's interpretation of the evidence is an issue more appropriately reserved for trial.
c. Whether Opinions Will Assist the Trier of Fact
Defendant argues that certain of Mr. Young's opinions will not assist the trier of fact because they are either irrelevant, see Docket No. 83 at 8, or generally unhelpful to resolving the issues in this case. See id. at 11.
Defendant first contends that Mr. Young's opinions regarding the SIU have no bearing on the ultimate issues in the case-whether plaintiff complied with the terms of the policy and whether defendant acted unreasonably in denying the insurance claim. Docket No. 83 at 8. In his expert report, Mr. Young makes three references to the SIU. First, he observes that "Mr. Gibson told [Ms. Larson] that this claim should be run past SIU," Docket No. 83-2 at 3. Second, he suggests that "[t]he Home Office blocked [Ms. Larson] from paying the claim and forced her to throw every possible argument not to do so," including "reporting the claim to the SIU." Id. at 5. Finally, Mr. Young opines that
the SIU (Special Investigative Unit) is called upon to review claims when one or more issues exist: (1) there is suspected *1193fraud involved, (2) there is questions of coverage or (3) when the insurer suspects a lawsuit. When an insurer assigns its SIU to a claim it is to find a reason not to pay the claim. The SIU in this case saw no reason to proceed and, after a brief review, took the SIU out of further investigation of the claim.
Id. at 6.26 Defendant argues that the SIU investigation is entirely irrelevant to this case because defendant does not assert that Mr. Wray was dishonest in the reporting of his claim. Docket No. 83 at 9. The Court agrees. As discussed above, there is no evidence that defendant suspected plaintiff of having filed a false or fraudulent claim or that defendant denied plaintiff's claim on that basis.27 Accordingly, Mr. Young's statements regarding the SIU are not necessary to "rebut any insinuation that Owners denied [plaintiff's] claim because TBL or its principle [sic], Bruce Wray, were being untruthful about the loss." Docket No. 84 at 10. These statements will therefore be excluded.
Finally, defendant challenges Mr. Young's assertions that (1) "Owners Insurance Company has attempted to create a level of ownership proof that the insured cannot meet when in fact, the insured HAS complied with the Duties After Loss provision of his policy," and (2) Owners has failed to "effectuate a prompt fair and equitable settlement of claims." Docket No. 83-2 at 6; Docket No. 83 at 11. Defendant argues that these are unhelpful conclusory opinions because Mr. Young never explains what " 'reasonableness' means within the context of insurance claims handling in Colorado" or "how Owners' failed to comport with such standards." Docket No. 83 at 11. The Court agrees. Although Mr. Young appears to base his opinions-at least in part-on the standards set forth in § 10-3-1104, he does not articulate the factual basis for his conclusions or explain how the standards applied relate to the issue of defendant's reasonableness. As the Supreme Court has noted, "nothing in either Daubert or the Federal Rules of Evidence requires a district court to admit opinion evidence that is connected to existing data only by the ipse dixit of the expert." Joiner ,
III. SUMMARY JUDGMENT
Summary judgment is warranted under Federal Rule of Civil Procedure 56 when the "movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a) ; see Anderson v. Liberty Lobby, Inc. ,
Where "the moving party does not bear the ultimate burden of persuasion at trial, it may satisfy its burden at the summary judgment stage by identifying a lack of evidence for the nonmovant on an essential element of the nonmovant's claim." Bausman v. Interstate Brands Corp. ,
Defendant moves for summary judgment on plaintiff's claims for declaratory judgment, breach of contract, and insurance bad faith under § 10-3-1115. Plaintiff has filed a cross motion for summary judgment on the declaratory judgment claim.
1. Declaratory Judgment
Plaintiff's first claim for relief seeks a declaratory judgment that (1) plaintiff has substantially complied with the terms of the insurance policy and (2) defendant is estopped from requiring, and/or has waived the right to require, further documentation of the existence and/or value of the stolen bullion coins. See Docket No. 1 at 11, ¶¶ 46-47.
Because declaratory judgment acts are procedural rules, "federal law determines whether a district court may properly enter a declaratory judgment" in a diversity case. Addison Ins. Co. v. Maynard , 08-cv-00054-WDM-BNB,
The Tenth Circuit has identified five factors (" Mhoon factors") a district court should consider in determining whether to exercise its discretion to hear a declaratory judgment action:
[1] whether a declaratory action would settle the controversy; [2] whether it would serve a useful purpose in clarifying the legal relations at issue; [3] whether the declaratory remedy is being used merely for the purpose of "procedural fencing" or "to provide an arena for a race to res judicata "; [4] whether use of a declaratory action would increase friction between our federal and state courts and improperly encroach upon state jurisdiction; and [5] whether there is an alternative remedy which is better or more effective.
*1195
Courts have typically applied the factors listed above to decline jurisdiction over declaratory judgment claims where there is parallel litigation in state and federal courts, see Golf Club, L.L.C. v. Am. Golf Corp. ,
*1196(dismissing declaratory judgment claim without prejudice on ground that it "serve[d] no useful purpose" because "all issues identified for resolution by declaratory judgment [would] be decided in adjudicating [plaintiff's] other claims"); U.S. Aviation Underwriters, Inc. v. Dassault Aviation ,
The Court finds both of these rationales persuasive. Assuming the Mhoon factors apply in cases such as this where there is no pending state court litigation, the Court finds that the first, second, and fifth factors weigh in favor of dismissal.28 Although a declaration that plaintiff complied with its obligations under the insurance policy would help to clarify the parties' legal relationship, it would not resolve the entirety of the dispute. It is also not clear that a separate adjudication of plaintiff's claim for declaratory relief would serve any useful purpose, given that the question of whether plaintiff fulfilled its duties under the insurance contract will necessarily be addressed in the Court's resolution of plaintiff's breach of contract and bad faith claims. See Golf Club, L.L.C. ,
*1197However, even if the Mhoon factors do not apply, the Court agrees with the rationale in PDX Pro Co. and United States Aviation Underwriters. As the Tenth Circuit has noted, the Declaratory Judgment Act "enables parties uncertain of their legal rights to seek a declaration of rights prior to injury." Kunkel v. Continental Cas. Co. ,
In short, the Court discerns no reason-and plaintiff offers none-for issuing a declaratory judgment when the parties' obligations under the insurance policy will necessarily be resolved in the context of plaintiff's breach of contract and bad faith claims. Accordingly, the Court finds that summary judgment in favor of defendant on this claim is appropriate.
2. Breach of Contract
Defendant also seeks summary judgment on plaintiff's breach of contract claim.
In Colorado, "a party attempting to recover on a claim for breach of contract must prove the following elements: (1) the existence of a contract; (2) performance by the plaintiff or some justification for nonperformance; (3) failure to perform the contract by the defendant; and (4) resulting damages to the plaintiff." W. Distrib. Co. v. Diodosio ,
As relevant here, plaintiff's insurance policy listed eight duties that plaintiff was required to perform in the event of a loss:
(1) Notify the police if a law may have been broken. (2) Give us prompt notice of the loss or damage. Include a description of the property involved. (3) As soon as possible, give us a description of how, when and where the loss or damage occurred. (4) Take all reasonable steps to protect the Covered Property from further damage, and keep a record of your expenses necessary to protect the Covered Property, for consideration in the settlement of the claim.... (5) At our request, give us complete inventories of the damaged and undamaged property. Include quantities, costs, values and amount of loss claimed. (6) As often as may be reasonably required, permit us to inspect the property proving the loss or damage and examine your books and records. Also permit us to take samples of damaged and undamaged property for inspection, testing and analysis, and permit us to make copies from your books and records. (7) Send us a signed, sworn proof of loss containing the information we request to investigate the claim.... (8) Cooperate with us in the investigation or settlement of the claim.
Docket No. 63-12 at 9 ("Duties in the Event of Loss or Damage"). Defendant has admitted that, at all relevant times, Ms. Larson believed that plaintiff had complied with duties one through four and six through eight. See Docket No. 62 at 5, ¶¶ 12, 14. Defendant's only argument as to this claim is that plaintiff failed to provide a "complete inventory" as required under duty five. See
It is undisputed that Mr. Wray did not maintain up-to-date records of his purchases and sales of gold coins. Docket No.
*119863 at 4, ¶ 8. After the burglary, however, he created a handwritten list of the stolen coins from memory and provided it to defendant. See Docket No. 67 at 5, ¶ 12. The list included descriptions, quantities, and costs for each coin. Docket No. 62 at 6, ¶¶ 17-18. Plaintiff also supplied defendant with the APD report, which contained a similar list of the stolen coins created from Mr. Wray's memory, along with additional items Mr. Wray remembered and identified at a later date. Id. at 6-7, ¶¶ 18, 20. The total amount of plaintiff's claimed loss could be calculated by adding the costs identified in the complete list of stolen items contained in the APD Report. Id. at 7, ¶ 20.29 Defendant argues that neither the handwritten list nor the APD Report qualifies as a "complete inventory" under the terms of duty five. Docket No. 63 at 9-12.
Duty five does not define "inventory." Docket No. 68 at 8, ¶ 23. Defendant argues that the term should be read in light of plaintiff's insurance policy as a whole, which covered business personal property30 in plaintiff's retail store. Docket No. 63 at 10-11; Docket No. 67 at 14. Defendant appears to contend that, given that this is a business policy, the term "inventory" necessarily signifies a detailed and up-to-date record of merchandise. See Docket No. 63 at 10-11; Docket No. 67 at 14-15. To support this position, defendant relies on the following definition of "retail inventory method," which is ostensibly found in the second edition of Black's Law Dictionary:31
[t]he estimated value at the end of an inventory procedure that is based on retail price and cost. Includes the following steps: (1) maintaining detailed records of stock and prices, (2) computation of cost to retail percentage, (3) estimation of price of goods remaining against price of goods sold and (4) conversion of the estimation of inventory at a retail price as compared to the cost price.
Docket No. 63 at 10; Docket No. 67 at 15. The term "retail inventory method" does not appear in the policy, and defendant cites no cases that construe "inventories" in duty five to require a policyholder to employ the "retail inventory method" in order to fulfill its duties in making a claim.
In Colorado, "[t]he interpretation of an insurance contract is a question of law" to which traditional principles of contract interpretation apply. USAA Cas. Ins. Co. v. Anglum ,
*1199Ins. Co. ,
The Court finds that there is nothing in the phrase "complete inventories" in duty five that requires plaintiff to tender a pre-existing and up-to-date record of purchases and sales. First, the dictionary definition of "inventory" is "a detailed list of assets," "an itemized list of current assets," or "the quantity of goods or materials on hand," Inventory , Black's Law Dictionary (10th ed. 2014); Inventory , Merriam Webster's Collegiate Dictionary (11th ed. 2007), indicating that an "inventory" is simply a list of items. And although the parties do not cite any cases interpreting similar policy terms, decisions of this Court have taken for granted that a list of stolen items, created after a theft, can qualify as an "inventory" for insurance purposes. See, e.g. , Walker v. State Farm Fire & Cas. Co. , No. 16-cv-00118-PAB-STV,
Second, the phrase "complete inventories" contemplates more than a single record of purchases and sales. The phrase appears to require an insured to provide separate "inventories" of both damaged and undamaged property-a task that would be impossible before a loss occurs. Further, because the term "complete" is most naturally read as modifying both types of "inventories," an insured satisfies *1200its obligations under duty five by providing, at the insurer's request, a complete inventory of damaged property and a complete inventory of undamaged property. Ms. Larson testified that she did not request a complete inventory of undamaged property, i.e. , items not stolen. Docket No. 68-3 at 11, 133:18-24. Thus, plaintiff's list of stolen property appears to satisfy plaintiff's obligations under the plain language of duty five.
This conclusion is further supported by duty five's use of the term "include." Duty five states: "give us complete inventories of the damaged and undamaged property. Include quantities, costs, values and amount of loss claimed." Docket No. 63-12 at 9. Because the word "include" instructs the policyholder how to create the "complete inventories" (i.e., make sure the inventory includes quantities, costs, etc.), it supports an interpretation of duty five that the inventories are created after the loss. Use of the word "include" as a directive is inconsistent with defendant's interpretation since, under defendant's theory, the inventory already exists. Directing the insured on what to include in the "inventories" makes sense only if the inventories are created after the loss. In this case, Mr. Wray supplied defendant with an inventory of stolen coins that he created from memory after the burglary. The Court finds that this satisfied plaintiff's obligations under the plain language of the insurance policy.
To the extent that the term "inventory" is ambiguous, the Court reaches the same conclusion. Ambiguous policy terms must be "construed against the insurer ... and in favor of the insured." State Farm Mut. Auto. Ins. Co. ,
Defendant argues, in the alternative, that even if an "inventory" can be created from memory, the Court should grant summary judgment because plaintiff has provided no documentation substantiating the ownership or existence of the specific coins allegedly stolen. Docket No. 63 at 12; Docket No. 67 at 17; Docket No. 77 at 8. This argument is unavailing for two reasons. First, defendant does not point to any policy language requiring the insured to provide such documentation.34 Although insurance policies sometimes contain a provision requiring the insured to produce documentation substantiating the claimed loss, see, e.g. , Walker ,
In summary, the Court finds that plaintiff complied with its obligations under the insurance policy and thus defendant is not entitled to summary judgment on plaintiff's breach of contract claim.37
3. Unreasonable Delay or Denial of Benefits Under
Defendant also moves for summary judgment on plaintiff's claim for insurance bad faith under
Although what constitutes "reasonableness" in the insurance context "is ordinarily a question of fact for the jury," Chateau Village N. Condominium Ass'n v. Am. Family Mut. Ins. Co. ,
Defendant first argues that, because plaintiff failed to adequately substantiate its loss, defendant had a reasonable basis for denying the claim. See id. at 13-15. As the Court determined above, plaintiff complied with its duties under the insurance policy. Moreover, defendant's insurance expert, Mr. Craver, stated in his report that "there is no regulation, statute or formula to determine the adequacy of proof of ownership to substantiate the loss." Docket No. 54-1 at 10. As a result, defendant fails to show that its denial of the claim was reasonable as a matter of law.
Defendant also suggests that plaintiff's failure to substantiate its losses made the claim "fairly debatable" and therefore subject to summary judgment in defendant's favor. Defendant cites Glacier Construction Co. v. Travelers Property Casualty Co. of America ,
Defendant next argues that summary judgment is appropriate because defendant relied on the findings and opinions of an independent expert-Paul DeBoer-in denying plaintiff's claim for benefits. See Docket No. 63 at 15. The cases defendant cites do not support this position.
Defendant relies primarily on Adams v. Allstate Insurance Co. ,
Defendant's remaining cases are equally unpersuasive. Crespo v. Unum Life Insurance Co. of America ,
Defendant's final argument in favor of summary judgment is that plaintiff has failed to obtain any admissible evidence as to the industry standards defendant allegedly breached. See Docket No. 63 at 18. In support of this contention, defendant claims that Mr. Young is not qualified to opine as to the relevant industry standards and plaintiff "has not retained its own forensic accountant as an expert in this matter." Id.
The Court agrees that "[t]he reasonableness of the insurer's conduct must be determined objectively, based on proof of industry standards," Goodson v. Am.Standard Ins. Co. of Wis. ,
The Court finds that these requirements are met in this case. Plaintiff contends that "Owners has misrepresented the provisions of the Policy, not attempted in good faith to effectuate the prompt, fair, and equitable settlement of this claim, and compelled TBL to institute litigation to recover amounts due under the Policy, all in violation of C.R.S. § 10-3-1104(1)(h)." Docket No. 68 at 19. As previously explained in this order and prior orders, § 10-3-1104(1)(h) provides "examples of conduct violative of [insurance] industry standards." Leeper v. Allstate Fire & Cas. Ins. Co. , No. 13-cv-03460-PAB-KMT,
IV. CONCLUSION
For the foregoing reasons, it is
ORDERED that Plaintiff's Motion to Exclude Certain Opinions and Testimony of Defendant's Expert, John P. Craver, Esq. [Docket No. 54] is GRANTED IN PART and DENIED IN PART as stated in this order. It is further
ORDERED that Owners' Motion to Exclude Certain Opinions and Testimony of Plaintiff's Expert David Young [Docket No. 83] is GRANTED IN PART and DENIED IN PART as stated in this order. It is further
ORDERED that Plaintiff's Motion for Partial Summary Judgment on First Claim for Declaratory Relief [Docket No. 62] is DENIED . It is further
ORDERED that Defendant Owners Insurance Company's Motion for Summary Judgment [Docket No. 63] is GRANTED IN PART and DENIED IN PART . It is further
ORDERED that defendant's summary judgment motion is GRANTED as to plaintiff's first claim for relief. It is further
ORDERED that defendant's summary judgment motion is DENIED as to plaintiff's second and third claims for relief.
Related
Cite This Page — Counsel Stack
285 F. Supp. 3d 1170, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tbl-collectibles-inc-v-owners-ins-co-cod-2018.