MALACHY E. MANNION, District Judge.
Pending before the court is defendant's motion for summary judgment, (Doc.
This lawsuit arises from defendant American Alternative Insurance Corporation's ("AAIC") denial of an insurance claim for damage to plaintiff Honesdale Volunteer Ambulance Corporation's ("Honesdale EMS") property at 364 12
The building is an old 2-3 story unreinforced masonry factory building. It sits near the Lackawaxen River, and some of its lateral support was taken when the river bed was widened by the Army Corps of Engineers in the 1950s. In 2005, Honesdale EMS identified structural concerns with the building, and Stephen Knash, P.E. did an engineering evaluation of the building. He particularly inspected settling and cracking in the floor of the basement, cracking in the west gable wall, and separation of the concrete floor in the building's ambulance garage. He noted that erosion was occurring, causing the settlement of the floor slab. He noted cracks in the west gable wall, which he concluded were caused by erosion and associated movement of the building. (Doc.
Defendant engaged Gary Capri, an independent safety inspector and risk surveyor, to examine the building in 2002, 2005, and 2008. (Doc.
On the day of the earthquake, workers at the Honesdale EMS building reported feeling it shaking and hearing squeaking noises from the walls. They evacuated the building, and, once outside, found issues with the building that plaintiff contends were not preexisting. This damage included cracks in the masonry, loose bricks on window arches, and the window at the top of the west gable wall being dislodged and appearing to be falling into the building. The building was condemned on that day after a preliminary inspection by Wayne Earley, the town code enforcer, and Arnie Bertsche, an engineer.
The day after the earthquake, Honesdale EMS reported its claim to AAIC through its insurance agent AM Skier. An outside adjustment company, Gerald Williams Adjustment Service ("Gerald Williams"), was engaged by AAIC to assist in investigating the claim. Jack McDermott, an adjuster from Gerald Williams, inspected the property on June 24. He opined that the earthquake had not damaged the building. The testimony of Jennifer Fountain, (Doc.
Ms. Fountain also testified that she felt that Gregory Joy, another Gerald Williams adjuster, was also determined not to pay the claim. (Doc.
In 2008 and 2009, Ms. Gumpper had requested grant funding from elected officials, describing the building as "deteriorating rapidly" and indicating that it was a race against time before the building became unfit for occupation. Plaintiff admits this, but contends that the part of the building that was inadequate was the ambulance garage, and not the office space which plaintiff alleges was harmed by the earthquake.
Michael. H. Queen, P.E., an engineer engaged by AAIC, also did an initial inspection of the building on June 25, 2010. Queen opined that his investigation of the building and discussions with Arnie Bertsche and Sharon Gumpper led him to conclude that the building had not been damaged as a result of the earthquake. The claim was denied on July 9, 2010.
Honesdale EMS requested additional consideration of the claim following the July 9 denial. Plaintiff submitted a report by Arnie Bertsche in support of the request for reconsideration. His report concluded that the building had significant structural issues that made it "more than plausible" that the building could suffer damage from the earthquake. AAIC agreed to consider the claim further, and re-inspected the building on July 23, 2010. Mr. Queen, Mr. Bertsche, Mr. McDermott, and Alan Cooper, an AM Skier representative, were present for the second inspection. Mr. Queen submitted a supplemental report addressing Mr. Bertsche's report and the re-inspection, and again concluded that the building was not damaged as a result of the earthquake. AAIC maintained its prior denial of the claim on August 10, 2010.
Following the second denial of the claim, Honesdale EMS filed the instant suit alleging breach of contract and bad faith. (Doc.
Summary judgment is appropriate if the "pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law."
To prevail on summary judgment, the moving party must affirmatively identify those portions of the record which demonstrate the absence of a genuine issue of material fact.
The parties dispute whether the damage caused to the Honesdale EMS building was caused by the Val-des-Bois earthquake, and therefore covered under plaintiff's insurance policy with AAIC. Defendant argues that plaintiff has failed to establish that it suffered a "direct physical loss" as a result of the earthquake, and that the evidence instead shows that any damage to the building was caused by preexisting, excluded conditions, including earth movement, building settlement, and neglect.
"To sustain a breach of contract claim under Pennsylvania law, a plaintiff must prove: (1) the existence of a contract; (2) a breach of duty imposed by the contract; and (3) resultant damages."
"`The insured bears the [initial] burden of proving facts that bring its claim within the policy's affirmative grant of coverage.'"
Here, the policy covers "direct physical loss or damage to `real Property' at a `premises' caused by or resulting from any `covered cause of loss.'" (Doc.
The earth movement exclusion in the policy states that any "sinking, rising, shifting, freezing, thawing, erosion, compaction, or expansion of the earth, including mine subsidence" is not covered. Building settlement is also not covered. However, "earthquake" damage is explicitly noted to be covered in the text of the exclusion. There is no dispute that the building suffered damage on account of earth movement. The question is whether that movement was erosion and settlement, excluded under the policy, or earthquake.
Defendant argues that the "earth movement" exclusion applies because there is no evidence that any of the damage reported by plaintiff was new as a result of the earthquake. AAIC contends that the building had well-documented problems regarding cracked walls and floor displacement, which were reflected in the Knash report of 2005. (Doc.
The 2005 Knash report shows that in 2005, there was damage to the building in the form of settling and cracking in the basement, cracking in the west gable wall, and separation of the north wall of the ambulance garage from the concrete floor slab. Knash concluded that the problems in the basement and west gable wall of the building were being caused by loss of fine material from under the building, which resulted in settlement. (Id. at 2-3). Mr. Knash inspected the building again on August 11, 2010. (Doc. 28-20, at 75). He testified at his deposition that he "couldn't say that the conditions did not get worse" between 2005 and 2010, and that his "gut reaction" was that they "probably did get a little worse. I couldn't tell you whether that was a result of an earthquake or just Father Time continuing to make the building move." (Id. at 79-81).
Plaintiff's expert Mr. Bertsche's report also reflects uncertainty about the cause of the damage to the building. He noted that he "can't conclude one way or the other whether" the damage to the building "did or did not happen as a result of the seismic event." (Doc.
Plaintiff has put forth the reports of Mr. Daniels and Mr. Bielinski, as well as the testimony of Suzanne Dey, a Honesdale EMS employee who felt the building shake on the day of the earthquake and who testified that after the earthquake, the top window in the gable wall was tilted inward, which it had not been before the earthquake. She also testified to cracks in the building becoming more visible after the earthquake, with some cracking being visible from her car while driving into work. (Doc.
Defendant submitted expert reports regarding the cause of damage. Andrew Whittaker, Ph.D., S.E., an earthquake engineer, opined that the 2010 Val-de-Bois earthquake did not damage the building, but that damage to the building was preexisting. (Doc.
Drawing all inferences in favor of the non-moving party, the court finds that there is a question of material fact as to the cause of the damage to the Honesdale EMS building. Plaintiff has submitted evidence to establish that it suffered a direct physical loss, and simply because defendant's experts disagree with the plaintiff's as to the cause does not establish what actually caused the damage that led to the plaintiff's claim for coverage. The court cannot determine that no reasonable jury could find that the earthquake caused a covered loss. Thus, summary judgment for the defendant cannot be granted on the grounds that plaintiff has not put forth enough evidence of direct physical loss to create a question of material fact.
AAIC next argues that even if the earthquake was a partial cause of the damage, the lead-in clause to the "exclusions" sections of the policy states that damage resulting "directly or indirectly" from neglect, earth movement, or building settlement "regardless of any other cause or event that contributes concurrently with or before, during, or after the loss or damage" is not covered. (Doc.
Defendant argues that several exclusions apply in this case: earth movement, building settlement, and neglect. The court must determine if these exclusions apply to the case at bar. It is undisputed that earth movement caused the damage in question here, but as discussed above, there is a question of material fact as to whether that earth movement was gradual sinking, shifting, and erosion not covered by the policy, or earthquake, covered by the policy. Thus, the court cannot grant summary judgment on the basis that the lead-in clause and earth movement exception preclude coverage.
The court additionally notes that the T.H.E. Ins. Co. court addressed an earth movement exclusion which was not intended to exclude coverage from non-catastrophic erosion and settlement. The court instead was addressing a policy which excluded coverage for natural disasters, noting:
This "catastrophic event" variety of earth movement exclusion is obviously not at issue in the presently disputed contract, in which earthquake damage is explicitly covered. The present exclusion is quite broad on its face, and, if applied in conjunction with the lead-in clause, which is also broad, it could be read to exclude coverage for any building which had even minor issues with earth settlement or erosion preexisting a loss which was otherwise covered by the contract. Indeed, it is difficult for the court to imagine many buildings which are not somehow affected by the "sinking, rising, shifting, freezing, thawing, erosion, compaction, or expansion of the earth." While the court rests its decision on the grounds that there is an issue of fact regarding the applicability of the earth movement exception to this case, the court also notes that it has not found any Third Circuit or Pennsylvania Supreme Court case enforcing an earth movement exclusion as facially broad as the one at issue in this case.
Defendant similarly argues that the "building settlement" exclusion applies in this case. The exclusion states that the policy does not cover "settling, shrinking, cracking, bulging, or expansion of any pavement, building, or structure." Defendant argues that there had been settling and cracking issues with the building long before the earthquake, and that they are a source or cause of the complained-of damage here. The question of building settlement mirrors that of earth movement in this case. As noted above, there is a question of fact as to causation. Both parties have produced experts who opine oppositely on the question of whether preexisting building settlement caused the complained-of damage, and both have produced other evidence that shows that there is an actual dispute about the cause of damages. Thus, the applicability of the building settlement exclusion is a fact issue for a jury.
In addition, the court again notes its concern with the breadth of the exclusion. The court has not found, nor have the parties put forth, any cases in the Third Circuit or in Pennsylvania that address a "building settlement exclusion." Like the earth movement exclusion in the present contract, the building settlement exclusion here is very broad, and could be read in conjunction with the lead-in clause to preclude coverage in nearly any situation in which an insured building was not in pristine condition before some covered cause of loss, such as an earthquake, befell it.
Defendant also relies on the neglect exclusion, arguing that plaintiff's failure to maintain and repair the building is as least partially responsible for the damage for which plaintiff is making a claim. The neglect exclusion reads:
Just as with the earth movement exclusion and building settlement exclusion, there is very little case law regarding the application of neglect exclusions in insurance contracts, and defendant has not pointed to any cases interpreting similar exclusions. As noted above, issues of fact as to the true cause of the complained-of damage remain. While there is some evidence in the record that ongoing and uncorrected aging of the building contributed to the damage, plaintiff has put forth counteracting evidence sufficient to defeat the motion for summary judgment on the ground that the neglect exclusion applies, including evidence that the building had a handyman, that Gary Capri said that housekeeping at Honesdale EMS was "above average" in 2005, and that at least some repairs were done prior to the earthquake. Summary judgment cannot be granted for defendant on the ground that the lead-in clause coupled with the various exclusions precludes coverage in this case.
Finally, defendant argues that the "known loss" doctrine applies to this case because plaintiff was aware that the building had issues with settlement and earth movement. The "known loss" doctrine provides an affirmative defense for an insurer, and "provides that one may not obtain insurance for a loss that either has already taken place or is in progress."
Defendant's desire for application of the known loss doctrine makes little sense in this case. Here, plaintiff alleges that an unknowable event, an earthquake, caused a covered loss, in which case the known loss doctrine cannot apply. Defendant argues that plaintiff knew about settlement and earth movement — causes of loss which are not covered by the policy at issue here. Application of the doctrine would be impossible, even assuming that the excluded causes of loss did contribute to the damage, because the terms of the policy do not allow damage from the allegedly known causes to rise to "the level of coverage."
Further, the doctrine properly applies to cases where a plaintiff intentionally or negligently hides or does not disclose the presence of a covered cause of loss when applying for insurance. See
For each of the foregoing reasons, summary judgment is
Plaintiff also brings a bad faith claim against defendant, alleging that defendant determined that it would deny the claim before making any investigation, that defendant's investigators ignored the testimony provided by those present in the building on the day of the earthquake, and that defendant failed to conduct a proper investigation of plaintiff's claim.
For an insurance company to show that it had a reasonable basis, it need not demonstrate its investigation yielded the correct conclusion, or that its conclusion more likely than not was accurate.
"The `clear and convincing' standard requires that the plaintiff show `that the evidence is so clear, direct, weighty and convincing as to enable a clear conviction, without hesitation, about whether or not the defendants acted in bad faith.'"
Pennsylvania's bad faith statute,
Defendant argues that its prompt response to the claim, its agreement to reconsider the claim upon receipt of the July 16, 2010 Bertsche report, and its reliance on the report of its engineer, Mr. Queen, all show that it acted reasonably and in good faith, and that summary judgment should be granted.
Plaintiff has not met its substantial burden of showing by clear and convincing evidence that defendant acted in bad faith. First, and most importantly, "an insurer's reasonable reliance on an engineering expert's report for a coverage decision does not constitute bad faith."
Plaintiff also argues that Mr. McDermott was determined to deny the claim, and that he acted as an advocate for non-payment, rather than as a fact-finder, when he did his investigation. Plaintiff also points to witness testimony indicating that Mr. McDermott was unprofessional, abrasive, and used bad language. Plaintiff cannot succeed in a bad faith claim on this basis. Mr. McDermott's testimony indicates that he had no responsibility for making coverage decisions. (Doc.
Plaintiff points to the testimony of Jennifer Fountain that she had a phone conversation with Mr. Joy in which he was looking at anonymous blog posts regarding Honesdale EMS and Ms. Gumpper having looked for new premises for the business in the past. Plaintiff has not pointed to, and the court has not discovered any, case law in the Third Circuit or Pennsylvania prohibiting claim investigators from researching on the internet. "An insurer does not act in bad faith by investigating and litigating legitimate issues of coverage."
Finally, plaintiff claims defendant's investigation was inadequate because the employees working in the building on the day of the earthquake were not interviewed by defendant. While interviewing the employees may have been helpful in evaluating the claim, the defendant "need not show that the process used to reach its conclusion was flawless or that its investigatory methods eliminated possibilities at odds with its conclusion. Rather, an insurance company simply must show that it conducted a review or investigation sufficiently thorough to yield a reasonable foundation for its action."
Defendant responded to the claim the very day after the earthquake, twice investigated the building, acceded to plaintiff's request to review its decision, and reasonably relied upon its expert engineer's report. Plaintiff thus failed to produce evidence that a reasonable jury could find by clear and convincing evidence that defendant failed to conduct a reasonable investigation. Defendant's motion for summary judgment is thus
For the foregoing reasons, defendant's motion for summary judgment is