Thomas H. Noble v. Corporacion Insular De Seguros, Thomas H. Noble v. Corporacion Insular De Seguros

738 F.2d 51, 1985 A.M.C. 1146, 1984 U.S. App. LEXIS 20784
Court of Appeals for the First Circuit·Decided July 5, 1984·No. 83-1858, 83-1891·Published·Cited by 21 cases

Opinion

BREYER, Circuit Judge.

The parties in this appeal disagree about how the law of Puerto Rico assesses damages when an insurance company wrongfully refuses to pay a policy claim. The facts underlying this diversity action are as follows:

The main mast of plaintiff Noble’s sailboat, Indigo, collapsed while it was under sail just south of Puerto Rico. He sought reimbursement for the loss from his insurance company, the defendant. But, the insurance company, having examined the boat, jumped to the conclusion that a rusty mast cable caused the accident. It pointed to a policy exclusion for accidents caused by “wear and tear and gradual deterioration;” and it refused to pay. Noble sued; the company looked into the matter further; and on the day of trial it conceded that it was wrong. The rusty cable had nothing to do with the accident; and, it should have paid the claim. In the meantime, Noble had sold the boat in unrepaired condition.

Since the parties still did not agree about how much the company should pay, they continued to litigate, finally submitting the case to the district court on the basis of the plaintiff’s deposition, an insurance company adjuster’s memorandum, briefs and the following stipulations:

1. There is coverage under the policy which was issued.
2. The defendant erroneously denied coverage.
3. The sound market value of the yacht Indigo before the casualty was $130,-000.
4. The insured value under the policy was $130,000.
5. The reasonable cost for repairs was $23,900.
6. The vessel was sold in distress because the vessel was damaged for the amount of $55,000.
7. Noble did not obtain funds to repair the yacht.
8. At the time of the damages, and at the time the vessel was for sale, Noble was residing in Texas.

The district court awarded plaintiff $23,-900 for the cost of repairs and $35,000 additional damages flowing from the company’s “erroneous denial of coverage.” Both parties appeal, the defendant claiming that the $35,000 consequential damage award is too large and the plaintiff claiming that it is too small.

1. At the outset defendant argues that the plaintiff’s action, insofar as it seeks consequential damages (flowing from the company’s refusal to pay repair costs *53 on time), is a “tort” action, arising under Article 1802 of Puerto Rico’s Civil Code, 31 L.P.R.A. § 5141. Defendant notes that this Article obliges a person to pay for damages that he “causes ... to another through fault or negligence.” And, defendant claims that the district court did not find “fault.or negligence” in its course of conduct.

We do not believe that defendant is correct, however, in characterizing this action as one in tort. The policy itself required defendant to pay “within thirty days after proof of [covered] loss or damage.” One might view plaintiff’s suit as one for breach of this provision. See Prieto v. Maryland Casualty Co., 98 D.P.R. 594, 619 (1970); Arroyo v. Caldas, 68 P.R.R. 639, 641-42 (1948). Alternatively, the Puerto Rico Insurance Code forbids firms from denying coverage without, for example, “carrying out a reasonable investigation.” 26 L.P.R.A. § 2716a. The Insurance Code apparently does not provide a direct remedy for violation of this provision. (It instructs the Insurance Commissioner to adopt “regulations” for enforcement but neither the district court nor the parties refer to any such regulations.) But, its terms might be viewed as incorporated by reference into the contract. Article 1210 of the Civil Code, 31 L.P.R.A. § 3375 (“contracts ... are binding not only with regard to the fulfillment of what has been expressly stipulated, but also with regard to all the consequences which, according to their character, are in accordance with good faith, use and law”); E.L.A. v. Great American Insurance Co., 106 D.P.R. 825, 829 (1977) (when parties conclude agreements on matters regulated by statute, statutory provisions are implicitly incorporated into contract). And, plaintiff’s suit might be considered one for breach of such an implicit term. . In either event, the suit would arise under Civil Code Article 1054, 31 L.P.R.A. § 3018, which states that

[t]hose who in fulfilling their obligations are guilty of fraud, negligence, or delay and those who in any manner whatsoever act in contravention of the stipulations of [their contractual obligations] ... shall be subject to indemnify for the losses and damages caused thereby.

A majority of states characterize actions like the one here as “contract,” while a minority characterize them as “tort.” A.V. Windt, Insurance Claims and Disputes §§ 6.35, 6.36 (1982). The courts of Puerto Rico have not decided the question. Morales v. Automatic Vending Services, Inc., 103 D.P.R. 281 (1975), which plaintiff cites, concerns liability for a judgment exceeding policy limits, and it is not on point. But, for the reasons stated, we believe it likely they would find that Civil Code Article 1054 governs plaintiff’s claim.

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Thomas H. Noble v. Corporacion Insular De Seguros, Thomas H. Noble v. Corporacion Insular De Seguros, 738 F.2d 51, 1985 A.M.C. 1146, 1984 U.S. App. LEXIS 20784 (1st Cir. 1984).

738 F.2d 51 (Thomas H. Noble v. Corporacion Insular De Seguros, Thomas H. Noble v. Corporacion Insular De Seguros) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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