Ward v. Certain Underwriters at Lloyd's of London, Subscribing to Certificate No. B1132HGBA15062712

CourtDistrict Court, N.D. California
DecidedSeptember 27, 2019
Docket3:18-cv-07551
StatusUnknown

This text of Ward v. Certain Underwriters at Lloyd's of London, Subscribing to Certificate No. B1132HGBA15062712 (Ward v. Certain Underwriters at Lloyd's of London, Subscribing to Certificate No. B1132HGBA15062712) is published on Counsel Stack Legal Research, covering District Court, N.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ward v. Certain Underwriters at Lloyd's of London, Subscribing to Certificate No. B1132HGBA15062712, (N.D. Cal. 2019).

Opinion

1 2 3 4 5 6 7 8 9 IN THE UNITED STATES DISTRICT COURT 10 FOR THE NORTHERN DISTRICT OF CALIFORNIA 11 12 ANDRE WARD, an individual; ROC No. C 18-07551 WHA 13 NATION SPORTS, LLC, a Delaware Limited Liability Company, 14 Plaintiffs, ORDER ON MOTIONS 15 TO DISMISS v. 16 CERTAIN UNDERWRITERS AT LLOYD’S 17 OF LONDON, Subscribing to Certificate No. B1132HGBA15062712; and, 18 INTERNATIONAL SPECIALTY INSURANCE, INC., a North Carolina 19 Corporation, 20 Defendants. / 21 AND RELATED CROSS-CLAIMS AND 22 THIRD-PARTY CLAIMS / 23 24 INTRODUCTION 25 In this insurance action, both an insured and the beneficiary of his insurance policy seek 26 to recover from both their insurance broker and the insurance company. This order resolves the 27 insurance company’s cross-complaint and the broker’s third-party complaint. Specifically, to 28 the extent stated below, the broker’s motion to dismiss the cross-complaint is DENIED and the 1 STATEMENT 2 This insurance story began in 2015 when plaintiffs Andre Ward and Roc Nation Sports, 3 LLC, sought a professional athlete disability insurance policy. At the time, Andre Ward boxed 4 professionally. Plaintiffs, through their wholesale insurance broker, International Specialty 5 Insurance, Inc., secured a policy with underwriters at Lloyd’s of London. The policy listed the 6 “Insured Person” as Andre Ward and the “Owner & Beneficiary” of the policy as Roc Nation 7 Sports. At bottom, the policy provided a lump sum payment of $6.3 million if Andre Ward 8 suffered a career-ending injury during the policy period (from December 23, 2015 to December 9 23, 2016) (Amd. Compl. ¶¶ 23–28) (Dkt. No. 46). 10 Lloyd’s of London works as follows. “Lloyd’s of London . . . provides a market for the 11 buying and selling of insurance risk among its members.” Majestic Ins. Co. v. Allianz Inter’l 12 Ins. Co., 133 F. Supp. 2d 1218, 1219 (N.D. Cal. 2001) (Judge Samuel Conti). More 13 specifically, Lloyd’s members are anonymous underwriters who invest in a percentage of an 14 insurance policy risk. Members belong to subgroups, known as “syndicates.” A syndicate is 15 not a legal entity. Syndicates are comprised of anywhere from a few hundred to a few thousand 16 members. Any single policy risk is insured by multiple syndicates. The individual members in 17 a syndicate do not manage their own investments and do not actively participate. Instead, each 18 syndicate appoints one of its members to represent the collective interests of the members in 19 that syndicate. This person is known as the “lead” underwriter. The lead underwriter usually is 20 designated as the representative for all the members and relevant syndicates with respect to that 21 policy. Id. at 1219–20. As such, each policy is supposedly separate and unique: even if the 22 insured is exactly the same, in the sense that each policy is backed by different members and 23 syndicates. Often, the actual insurance policy itself will only disclose that single lead 24 underwriter. Whether or not this unique setup excuses any of the conduct at issue is not the 25 immediate point. This paragraph is simply background. 26 International Specialty is an approved “coverholder” for Lloyd’s of London. This 27 means that International Specialty “will normally be allowed to collect premiums, and may be 28 allowed to handle claims or perform other functions.” For Lloyd’s, “[c]overholders enable 1 syndicates to underwrite locally without the need for expensive local infrastructure.” A contract 2 between Lloyd’s and the “coverholder” will delineate the exact scope of the coverholder’s 3 authority (Amd. Compl. ¶¶ 8–10). 4 In October 2016, plaintiff Ward suffered a significant injury to his right knee. He retired 5 from boxing approximately one year later. After retiring, in October 2017, he filled out a 6 “Disability Insurance Claim Form” which contained International Specialty’s letterhead. The 7 form did not reference any policy number or specific lead underwriter. International Specialty 8 sent the form to a lead underwriter at Lloyd’s of London. It is unclear from the complaint to 9 which lead underwriter International Specialty sent the form. Each year’s policy would have 10 likely corresponded to an entirely different lead underwriter (id. ¶¶ 19–20, 34, 42; Exh. C). 11 Whoever received the claim assigned a third-party administrator — Melania Thompson 12 employed by Empirical Loss Management, LLC — to handle the claim. In December 2017, she 13 informed plaintiffs via e-mail that she was the assigned administrator and claims adjuster for the 14 policy. She provided plaintiffs the 2016–17 version of the policy. The complaint does not 15 specify why she provided the 2016–17 policy number to plaintiffs (id. ¶¶ 43–44, 47; Exh. G). 16 Over the next few months, plaintiff Ward provided detailed and extensive medical 17 records and submitted to an independent medical examination. Nevertheless, in September 18 2018, Ms. Thompson, writing on behalf of the lead underwriter on the 2016–17 policy, denied 19 the claim. According to Ms. Thompson’s letter, plaintiff Ward suffered from pre-existing or 20 degenerative conditions and did not suffer from a “single sudden and unexpected event” as 21 required under the 2016–17 policy (id. ¶¶ 50–51, 53–54; Exh. H). 22 After plaintiffs sent a comprehensive letter pushing back on the denial of their disability 23 claim, counsel appointed by the lead underwriter on the 2016–17 policy affirmed the denial. 24 The reason given by counsel for the denial, however, was a new one, namely that “the alleged 25 disability did not occur while the [2016–17 p]olicy was in force.” In other words, according to 26 the underwriter’s counsel, the claim was now denied because the claim should never have been 27 assessed under the 2016–17 policy at all (id. ¶¶ 55, 58; Exh. J). 28 1 In October 2018, counsel for the underwriters referred the case to the entirely different 2 lead underwriter on the 2015–16 policy (the earlier policy). Somehow, Ms. Thompson (now 3 with McLarens, Inc.) became the third-party administrator for that policy too. In November 4 2018, plaintiffs authorized the new underwriters to access the prior medical information. In 5 December 2018, Ms. Thompson sent a letter to plaintiffs that the claim was still being 6 investigated and that she did not have enough information to make a coverage determination 7 under the 2015–16 policy. For plaintiffs, after fourteen months of pursuing the disability claim, 8 this December letter constituted the last straw (id. ¶¶ 64–71). 9 Approximately one week after receiving Ms. Thompson’s letter, in December 2018, 10 plaintiffs initiated this suit against International Specialty and the lead underwriter on the 11 2015–16 policy, alleging three claims (Dkt. No. 1). The first two claims, for breach of contract 12 and breach of the implied covenant of good faith and fair dealing, were alleged solely against 13 the lead underwriter on the 2015–16 policy. The third claim, for breach of duties by an 14 insurance broker, was alleged solely against International Specialty for breach of its duty to see 15 that the claim was being adjusted under the right policy. 16 After months of Rule 12 motion practice before Chief Magistrate Judge Joseph Spero, 17 plaintiffs amended their complaint in May 2019 (Dkt. No. 46). In June 2019, both defendants 18 answered with cross-complaints (Dkt. Nos. 51, 52). The underwriters brought three cross- 19 claims against International Specialty, specifically for breach of contract, contractual 20 indemnification, and common law indemnification (Cross-Compl. ¶ 1) (Dkt. No. 52). 21 International Specialty brought two self-styled “cross-claims” against third-parties McLarens, 22 Empirical Loss, and Melanie Thompson seeking comparative equitable indemnity and 23 declaratory indemnity (Dkt. No. 51-1).

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Bluebook (online)
Ward v. Certain Underwriters at Lloyd's of London, Subscribing to Certificate No. B1132HGBA15062712, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ward-v-certain-underwriters-at-lloyds-of-london-subscribing-to-cand-2019.