WOLFSON, District Judge.
In the instant motion for reconsideration, Defendant American National Insurance Company ("ANICO") asks the Court to reconsider two aspects of the Court's September 28, 2012 ruling, 893 F.Supp.2d 686 (D.N.J.2012), which were both in favor of Plaintiff Munich Reinsurance America Inc. ("Munich"). ANICO contends: (a) that the Court failed to fully consider the applicability of Article XVI of the parties' 2000 and 2001 agreements in connection with ANICO's cross-motion for summary judgment on its untimely claim submission defense; and (b) with respect to Article X of the parties' agreements, that the Court erred in granting summary judgment on ANICO's prejudice defense to Munich's untimely claim submissions.
With respect to Article X, the Court grants ANICO's motion for reconsideration of the Court's ruling on the prejudice defense, yet affirms its prior grant of summary judgment to Munich on that defense. With respect to Article XVI, the Court, grants ANICO's motion for reconsideration of Article XVI, and vacates its grant of summary judgment to Munich on the untimely claim submission defense regarding the 2000 and 2001 claims submitted after December 31, 2007 and December 31, 2008, respectively. With regard to the 2000 claims, the Court now grants summary judgment to ANICO. With regard to the 2001 claims, the Court denies summary judgment on both parties' motions, finding that there is a genuine issue of material fact that precludes summary judgment for either party.
My September 28, 2012 decision includes a detailed factual and procedural history, and hence I recount here only that background related to this ruling. The retrocessional agreements at issue are based upon Munich's reinsurance relationship with Everest National Insurance Company ("Everest"). Munich reinsures Everest's workers compensation insurance program under an excess of loss reinsurance treaty that covers claims dated January 1, 1998 through December 31, 2001. Seeking to ameliorate some of its risk under the Munich-Everest agreement, Munich entered into retrocessional treaties with ANICO. The ANICO-Munich retrocessional agreements are for the periods of November 1, 1999 through December 31, 2000 ("the 2000 Agreement"), and January 1, 2001 through December 31, 2001 ("the 2001 Agreement"). For purposes of this motion, the parties agree that these two agreements are identical in substance.
Generally, these agreements provide that ANICO will indemnify Munich for losses Munich sustains under the Munich-Everest reinsurance agreement as long as Munich gives ANICO notice of those claims in the manner directed by the Munich-ANICO agreements. See LeBlanc Cert., Exh. 2 ("2001 Agreement"), Art. 1(A). Article X of the agreements directs Munich to provide ANICO with notice of all workers' compensation claims Munich receives from Everest and, for which, Munich intends to seek retrocessional cover from ANICO:
2000 Agreement at Endorsement No. 1.
I explained, in my September 28, 2012 decision, how subsection A of Article X operates:
893 F.Supp.2d at 702 (emphasis added).
Thereafter, I explained the additional temporal requirement of immediacy applicable to claims falling within subsection B:
Id. (internal citations omitted).
Finally, subsection C of Article X addresses ANICO's obligation to pay the claims for which Munich properly provided notice under subsections A or B, respectively. Per the plain text of subsection C, ANICO "agrees to pay the Company on demand, the Reinsurer's proportion of all losses and/or loss expenses paid by the Company arising from the Underlying Agreement...." 2000 Agreement at Endorsement No. 1.
Separate and apart from the Article X notice requirements, Article XVI directs Munich to advise ANICO of all claims within seven years following the expiration of each agreement. See id., Art. XVI. Article XVI states, in pertinent part,
2001 Agreement at 5. As the plain text of this article makes clear, ANICO is not
The text of the Article XVI notice requirement differs from Article X in two material respects. For one, Article XVI is not limited to those claims "coming under this Agreement," as Article X provides. Rather, Article XVI applies to all claims "likely to result in a claim under this Agreement." In this way, Article XVI covers those claims that are not yet reportable under Article X. Second, Article X directs Munich to provide "particulars and estimates" in connection with the claims notices mandated therein, whereas Article XVI does not.
Munich initially brought the instant action against ANICO in December 2009, claiming that ANICO failed to pay all monies due under the retrocessional agreements. Munich's Complaint asserts two breach of contract claims — one relating to each retrocessional agreement — and a declaratory judgment claim regarding any future losses under the agreements. In its amended answer, ANICO asserted several counterclaims against Munich: fraudulent inducement, breach of the duty of good faith and fair dealing, breach of the duty of utmost good faith owed to a reinsurer, rescission of the retrocession agreements, and breach of contract.
As noted, Munich moved for partial summary judgment on its claims and ANICO cross-moved for summary judgment on certain of its defenses and counterclaims. I granted in part and denied in part Munich's motions and denied ANICO's cross-motion in its entirety. Pertinent here, I granted Munich's motion for summary judgment on ANICO's untimely claim submission affirmative defense based upon Article X of the agreements and, consequently, denied ANICO's cross-motion on that same defense. ANICO seeks reconsideration of this ruling, arguing that it presented sufficient evidence of prejudice to withstand summary judgment. Furthermore, ANICO argues that I did not fully consider the applicability of Article XVI of the parties' agreements to its untimely claim submission defense to certain of the claims. The parties have submitted briefing, including responding to specific inquiries from the Court, and have also presented oral argument.
Local Rule 7.1(i) allows parties to seek reconsideration by the Court of matters "which [it] believes the Court has overlooked" when it ruled on the initial motion. L. Civ. R. 7.1(i). The burden on the moving party, however, is quite high. The movant must demonstrate either: "(1) an intervening change in controlling law; (2) the availability of new evidence; or (3) the need to correct [a] clear error of law or prevent manifest injustice." Lazaridis v. Wehmer, 591 F.3d 666, 669 (3d Cir.2010). The Court will grant such a motion only if the matters overlooked might reasonably have resulted in a different conclusion. Bowers v. Nat'l Collegiate Athletic Assoc., 130 F.Supp.2d 610, 613 (D.N.J.2001) rev'd on other grounds by 475 F.3d 524 (3d Cir.2007).
In my September 28, 2012 decision, I devoted ten pages to discussion of ANICO's untimely claim submission defense. I began by acknowledging that this defense is rooted in ANICO's Second Affirmative Defense that Munich
Amended Answer, ¶ 47. In short, I noted, ANICO argued that it may deny payment of certain claims that were submitted by Munich in an untimely fashion because, under ANICO's interpretation of the agreements, such notice is a condition precedent to payment.
"Under New York law, when a reinsurance contract expressly requires a reinsured to provide its reinsurer with prompt notice of a claim or occurrence as a condition precedent to coverage and the reinsured fails to do so, that failure excuses the reinsurer from its duty to perform, regardless whether the reinsurer suffered prejudice as a result of the late notice." Pacific Employers Ins. Co. v. Global Reinsurance Corp. of America, 693 F.3d 417, 421 (3d Cir.2012) (applying New York law). Where, in contrast, the reinsurance agreement does not expressly make prompt notice a condition precedent to coverage, the reinsurer (or retrocessionnaire) "must show prejudice resulted from the delay." Id. at 433 (quoting Christiania Gen. Ins. Corp. of N.Y. v. Great Am. Ins. Co., 979 F.2d 268, 274 (2d Cir.1992)).
Against this legal backdrop, I interpreted ANICO's untimely notice defense to hinge upon Article X of the 2000 and 2001 retrocessional agreements. After reviewing the language and structure of Article X in detail, and considering the Third Circuit's then-recent decision in Pacific Employers, supra, which interpreted a similar reinsurance provision under New York law, I concluded that Article X did not create a condition precedent to payment. Having found that Article X did not create a condition precedent, I further concluded that ANICO had to demonstrate that it was prejudiced by the untimely notice in order to withstand summary judgment on its untimely claim defense.
Still focusing on Article X, I then concluded that ANICO failed to point to sufficient
In addition, Munich had argued that certain claims appearing in an August 8, 2008 spreadsheet submitted via email were timely noticed because the spreadsheet entries would have constituted sufficient notice under the agreements. Munich contended that these email notices constituted bordereau reporting — a form of claim reporting customarily used in the reinsurance industry. ANICO challenged Munich's reliance on the emailed reports, arguing that the reports were inadequate. Because I concluded that timely notice was not a condition precedent to payment under Article X, I did not address whether the email notices would have constituted sufficient notice. But in framing Munich's bordereau-reporting argument in this way, the opinion created the impression that the bordereau-reporting argument relates to Article X when, in fact, it relates to Article XVI instead. This error is one of the bases for ANICO's motion for reconsideration.
As noted, ANICO urges the Court to reconsider two aspects of its ruling. First, ANICO argues that the Court failed to fully consider the applicability of Article XVI of the parties' agreements in connection with ANICO's cross-motion for summary judgment on its untimely claim submission defense. Second, with respect to Article X of the parties' agreements, ANICO argues that the Court erred in
At the outset, I note that the section of ANICO's reconsideration brief addressing prejudice fails to satisfy the reconsideration standard. Rather that discussing how its motion satisfies the reconsideration standard, ANICO proceeds directly to its argument on the merits. Substantively, ANICO argues that those aspects of Schouweiler's testimony that appear contradictory at first blush can be reconciled through a closer look at his deposition testimony as compared with his 2012 affidavit. By structuring its argument in this way, ANICO has not pointed to an "(1) an intervening change in controlling law; (2) the availability of new evidence; or (3) the need to correct [a] clear error of law or prevent manifest injustice." Lazaridis, 591 F.3d at 669. Moreover, in its briefing on the initial motions, ANICO did not point to the deposition testimony to which it now directs the Court in its reconsideration briefing. As Local Rule 7.1 case law makes clear, reconsideration may not be used "to raise arguments or present evidence that could have been raised prior to the entry of judgment." NL Indus., 935 F.Supp. at 516. See also Tischio v. Bontex, Inc., 16 F.Supp.2d 511, 532 (D.N.J. 1998) ("[a] motion for reconsideration should not provide the parties with an opportunity for a second bite at the apple.") (internal citation omitted). On this basis alone, ANICO's motion could be denied.
Nevertheless, for the sake of completeness, and because I did not reach the substance of the prejudice argument in my prior ruling in light of my reliance on the sham affidavit doctrine, I will reconsider my decision and address ANICO's prejudice proofs. This means that I will consider Steven Schouweiler's affidavit along with his deposition testimony and other relevant evidence of record.
As noted, ANICO's central prejudice argument is that, with knowledge of Munich's untimely claims, Steven Schouweiler would have not have commuted the Max Re treaty, which decision would have afforded ANICO a greater economic benefit than the commutation itself. The evidence that ANICO presents in support of this argument follows.
Schouweiler was the only ANICO employee involved in the Max Re retrocession. October 2011 Sch. Dep. 47:14-19. The retrocessional treaty between ANICO and Max Re was "finite," which means that it is a type of quota share reinsurance that transfers risk up to a defined amount and then transfers back risk to the ceding insurer. See id. at 56:20-58:16.
75 N.Y.2d 295, 301-02, 552 N.Y.S.2d 891, 552 N.E.2d 139 (1990) (quoting Butler & Merkin, Reinsurance Law, at A5.1-02) (emphasis added).
Schouweiler asserts that, when he, on ANICO's behalf, entered into the retrocessional agreement with Max Re, the cover slip he negotiated was followed by a more formal written agreement (hereinafter, "the final agreement"). October 2011 Schouweiler Dep. 59:7-17. However, he acknowledged at his October 2011 deposition that he was the sole person who stored ANICO's copy of the final agreement, that he could not locate the final agreement in his files, and that he had not seen the final agreement recently. Id. at 59:17-61:5. He further noted that, while he had "a memory of it ... [w]hether [his memory was] correct or not [wa]s another question after 12 years ...." since last seeing the final agreement. Id. 60:5-12. In terms of his efforts in locating a copy of the final agreement, Schouweiler testified that, to his knowledge, no one else at ANICO searched for a copy and that he was otherwise unsuccessful in locating a copy himself. Id. at 60:13-23. Thus, and quite appropriately, Schouweiler refers to the final agreement in his deposition as "the phantom agreement." Id. at 111:16.
To be clear, while the term "cover slip" may evoke images of a one or two-page document marked by its brevity, in fact, the Max Re cover slip is fifteen pages long, and is content heavy, addressing such topics as, for example, the types of business covered by the treaty, treatment of allocated loss adjustment expenses, claim reserve amount, aggregate loss limit, and material breaches of underwriting guidelines. See generally Max Re Cover Slip, Klein Afft. II, Exh. 63B ("Cover Slip"). The slip even specifies the nine types of reports that ANICO must remit to Max Re every thirty days while the agreement is in effect. See id. at 14.
Important here, the cover slip explicitly addresses commutation and contains the financial formula applicable to any such commutation. Id. at 11. The formula provides:
Id. Stated more simply, the cover slip's commutation formula was: [premiums paid by ANICO to Max Re] — [commissions and
In addition to explicitly providing for commutation, the cover slip speaks to the layers of risk assumed by ANICO and places caps on Max Re's risk. In a section titled Aggregate Loss Corridor, the slip provides: "[ANICO] shall retain ... Claims otherwise recoverable hereunder equal to the amount between 95% and 108.5% of the Net Reinsurance Premium... received by [Max Re] for Section F." Cover Slip at 10. In the section titled Aggregate Loss Limit, the slip limits Max Re's exposure to 95% of the Net Reinsurance Premium for Sections C, D, E, and F combined." Id. Both of these provisions apply to the Munich worker's compensation claims, which claims fall within the section F coverage category. See id. at 8 ("F. Accident and Health Reinsurance Limit"); October 2011 Schouweiler Dep. 67:22-67:1 (agreeing that "the special risk business ... was within section F of the coverage being provided").
At his October 2011 deposition, Schouweiler testified that his recollection of the terms of the final, written agreement differ from that of the cover slip. He recalled that the final agreement "provided for a corridor risk to the reinsurer that attached at some point something on the order of 110 to 115%." October 2011 Schouweiler Dep. 62:7-11. In terms of ANICO's risk, he recalled that ANICO "would retain some level of risk ... beyond, I think, this says 95% or 99%, something like that, up to generally 110 or 112 or 115%, depending on the structure of the program; and then the reinsurer would have come in at that upper level and would have come back in for something generally on the order of 5 or 10 additional percent and then the risk would have reverted back to [ANICO]." Id. at 62:16-63:4. However, when asked whether he recalled "what the specific retained level of risk was for ANICO," he responded, "I do not." Id. at 63:11-14.
Upon further questioning, Schouweiler admitted that he executed the cover slip and that he read it before signing. Id. at 64:1-18. Ironically, in contemporaneously forwarding a copy of the executed cover slip to Greg Whelan, the Comptroller at IOA Re, and requesting that Whelan disburse funds to consummate the agreement, Schouweiler referred to the "executed version" of the cover slip as "the Max Re treaty." Cover Slip at 1 (emphasis added).
Nevertheless, at his deposition, Schouweiler persisted that the cover slip is distinct from the final agreement. He recalled having a discussion with a broker, in which he indicated that the terms of the deal, as expressed in the cover slip, needed to be altered. October 2011 Schouweiler Dep. at 64:23-65:7. But, he could not recall whether that conversation was before or after he signed the cover slip. Id. Furthermore, Schouweiler acknowledged that the terms found in the cover slip were honored by the parties. By way of example, the ceding commission money was paid under the terms of the cover slip.
More importantly, Schouweiler agreed, in his deposition, that once Max Re and ANICO decided to commute their treaty, the parties utilized the commutation formula found in the cover slip. Id. at 69:12-22; 81:11-15. He further noted, with respect
Following his deposition, Schouweiler executed an affidavit and ANICO presented that affidavit in connection with the then-pending motions for summary judgment. In his affidavit, Schouweiler adds that, if he had been presented with Munich's untimely claim submissions at the time he was deciding whether to commute the Max Re treaty it would have affected his decision to commute. Schouweiler Afft. at 4 ("The reporting of the[ ] additional claims would have had a material effect on the decision I made to commute the reinsurance agreement with Max Re."). Operating under the impression that the final agreement terms provided ANICO greater insurance protection than that set forth in the cover slip, Schouweiler attempts to explain why it would have been more advantageous for ANICO to forego commutation:
Id. at 3. That his argument is premised on the terms of the final "phantom" agreement is clear from his affidavit testimony, wherein he states, explicitly, "my recollection of the final reinsurance agreement with Max Re concerning this additional band of risk in excess of 100% of net premiums appears to differ from the placement slip." Id.
With respect to the data Schouweiler relied upon in making his decision to commute the Max Re treaty in 2003, Schouweiler avers that IOA Re "maintained records with respect to individual [Munich] claims, including individual claim paid losses and reserve information," and that "[t]his information was then provided to [ANICO], along with information related to other reinsurance agreements, as an aggregate number, including an amount for outstanding loss reserve," which, in March of 2003, "was only $500,000." Id. at 3. According to him, "[a]t the time these financial calculations were made by IOA Re, IOA Re was aware of only 4 or 5 claims related to the Treaties." Id. He implies that Munich's failure to provide IOA Re with timely notice of all claims
In my September 2012 decision, I rejected certain aspects of Schouwelier's affidavit testimony. I reasoned:
September 28th Opinion, 893 F.Supp.2d at 705.
Thereafter, I explained that, where an affidavit is offered solely for the purpose of defeating summary judgment, and that affidavit testimony conflicts with the party's prior deposition testimony, "it is proper for the trial judge to conclude that no reasonable jury could accord that affidavit evidentiary weight and that summary judgment is appropriate." Id. (quoting Jiminez v. All Am. Rathskeller, Inc., 503 F.3d 247, 253 (3d Cir.2007)). I further noted that, in ruling on the sham affidavit doctrine, courts consider whether the party has explained away the discrepancies, which ANICO did not do in its briefing. Lastly, I noted that the only exception to the sham affidavit doctrine is that a court should consider the affidavit where there is independent evidence to bolster the contradictory testimony. Id. Since ANICO did not point to any such evidence, I applied the doctrine, granted summary judgment to Munich, and denied ANICO's cross-motion.
The parties agree that, under New York law, to demonstrate prejudice from untimely filed claims a retrocessionaire, like ANICO, "bears the burden of showing that it suffered tangible economic injury...." Unigard Sec. Ins. Co., Inc. v. North River Ins. Co., 4 F.3d 1049, 1069 (2d Cir.1993); Folksamerica Reinsurance Co. v. Republic Ins. Co., Civil Action No. 03 Civ. 0402(HB), 2003 WL 22852737, *9 (S.D.N.Y.2003) ("Any relevant prejudice as a result of late notice must take the form of tangible economic injury.") vacated on other grounds by 182 Fed.Appx. 63 (2nd Cir.2006). Cf. CIH Intern. Holdings, LLC v. BT United States, LLC, 821 F.Supp.2d 604, 612 (S.D.N.Y.2011) ("Under New York law, to plead prejudice for purposes of a breach of contract claim, a plaintiff `bears the burden of showing that it suffered tangible economic injury' as a result of the alleged breach.") (citing Unigard, 4 F.3d at 1069).
At oral argument, ANICO's counsel made clear that ANICO's sole argument with respect to tangible economic loss hinges on Schouweiler's statement in his affidavit regarding the additional 8.5% insurance protection to which he believes that ANICO would have been entitled under the "phantom" agreement. However, at oral argument, ANICO's counsel conceded
To accept Schouweiler's position that ANICO would have been entitled to the additional band of coverage, the factfinder would have to credit his testimony that the "phantom" agreement, in fact, exists. But no reasonable factfinder could credit this testimony because, as Schouweiler candidly acknowledges, the terms of the "phantom" agreement flatly contradict the terms of the cover slip, no one (other than he) at ANICO has seen this agreement, and he cannot produce a copy of it from his own files. Moreover, there appears to have been no attempt to locate or obtain a copy of the final agreement from Max Re, nor has ANICO produced even an unsigned copy or a prior draft of this agreement.
The problem for ANICO on this motion, in not having shown the existence of these favorable treaty terms, is compounded by the generally speculative nature of Schouweiler's testimony. ANICO would have the factfinder believe that, had Schouweiler been advised of the untimely claims prior to deciding whether to commute the Max Re treaty, he would have considered the effect of those claims on the commutation, and then, having considered that effect, he would have chosen not to commute the Max Re treaty altogether.
As to this latter contention — that Schouweiler would have cancelled the entire commutation — ANICO points to Schouweiler's testimony, in his deposition, that, with notice of the untimely claims, he would have foregone commutation of the Max Re treaty as a whole. October 2011 Schouweiler Dep. 113:2-7. At oral argument, the Court expressed its skepticism of this testimony, as the Max Re commutation involved over 1,500 treaties and it seems unlikely that Schouweiler would have foregone the commutation of that large number — the entire book of business with Max Re — on account of the two Munich treaties.
Finally, even if Schouweiler's testimony regarding the existence of a final agreement's terms could be credited, under the best evidence rule, his testimony could not be admitted at trial to prove the agreement's terms. The best evidence rule, found in Federal Rule of Evidence 1001-1002, requires that "[t]o prove the content of a writing, recording, or photograph, the original writing, recording, or photograph is required...."
Accordingly, for the foregoing reasons, in reconsidering my grant of summary judgment to Munich on ANICO's prejudice defense, I affirm my prior ruling that summary judgment is appropriate. ANICO has not presented sufficient evidence to create a genuine issue of material fact as to whether notice of the untimely claims would have affected Schouweiler's decision to commute, that he would have chosen not to commute, and that, as a result, ANICO would have been in a better economic position. These attenuated, and unsupported, leaps of logic do not demonstrate a tangible economic loss. Cf. Black Car Assistance Corp. v. New Jersey, 351 F.Supp.2d 284, 286 (D.N.J.2004) (stating that the nonmoving party must "point to concrete evidence in the record which supports each essential element of its case.") (citing Celotex, 477 U.S. at 322-23, 106 S.Ct. 2548) (emphasis added). For these reasons, since ANICO has failed to present sufficient evidence from which a factfinder could conclude that ANICO was prejudiced by Munich's late notice under Article X of the parties' agreement, I affirm my prior ruling granting summary judgment to Munich on ANICO's Article X prejudice defense.
Contrary to my ruling on ANICO's Article X prejudice defense, a different result attends for that aspect of ANICO's reconsideration motion relating to Article XVI of the parties' agreements. Upon review of my September 28th decision, I conclude that I did not treat ANICO's argument to be that Article XVI — as opposed to, and apart from, Article X — creates its own condition precedent to payment under the parties' agreements. Based upon the manner in which ANICO briefed this issue, I did not appreciate ANICO to be arguing that there was specific language in Article XVI that creates a condition precedent. While ANICO's brief states that Article XVI is a condition precedent, that statement was buried in one sentence in the middle of its thirty-nine page moving brief, and ANICO did not engage in any legal analysis as to why the Court should conclude that Article XVI creates a condition precedent, other than to cite to general contract interpretation principles.
Nevertheless, because I conclude that ANICO intended for the Court to consider Article XVI as an independent basis for its untimely claim submission defense, I find reconsideration appropriate on this issue. My failure to discuss Article XVI in my prior ruling could rise to the level of a clear error of law if that article does, in fact, operate as a condition precedent. Moreover, as noted, Munich's bordereau-style reporting argument relates solely to Article XVI and my prior opinion creates the impression that it applies to Article X instead. Having concluded that reconsideration is appropriate, I now turn to the law governing interpretation of Article XVI and the facts relating to my analysis.
As explained in my discussion of Article X of the Munich-ANICO agreements, Munich was obligated to promptly advise ANICO of all claims coming under their agreements. For certain claims, Munich was obligated to notify ANICO immediately, as follows:
2000 Agreement at Endorsement No. 1, subsection B. For those claims that did not require immediate notice, Article X directed Munich to "promptly" report those claims. Id., subsection A.
Early in the treaty administration process, Munich employee Joe Kanuncio was responsible for overseeing Everest's claims and for deciding which of those claims should be reported to ANICO. Giacobbe Dep. 66:7-75:7. In 2002, Arthur Giacobbe took over for Kanuncio. Giacobbe testified at his deposition that, in taking over that position, he did not review the Munich-ANICO agreements; he simply followed in Kanuncio's footsteps. Id. at 77:9-10; 95:14-96:15; 381:23-382:6. Giacobbe's practice — like his predecessor — was to report to ANICO only those Everest claims that had reached a $500,000 retention threshold.
At one point during Giacobbe's tenure, an employee at IOA Re challenged his reporting procedure. Specifically, Lisa Hoekstra, an underwriter at IOA Re, sent an email dated October 23, 2003 to Timothy Schmidt, that was then forwarded to Giacobbe. The email addresses an Everest claim submitted to ANICO for payment:
In 2007, Munich employee Sam Freda took over for Giacobbe and he, like Giacobbe and his predecessor, reported only those claims that had reached a $500,000 retention threshold. Freda Dep. 101:13-102:15. However, in August 2008, Freda became aware that Munich's reporting procedure was flawed and that there were multiple claims under the 2000 and 2001 agreements that should have been reported at 50% of the reinsured attachment point but were not. Id. at 96:11-99:24. Armed with this knowledge, Freda reviewed the Everest claim files and compiled a spreadsheet of all those claims that should have been reported. See id. at 107:8-110:17; 282:6-284:3 (describing his review of those Everest claims that had not yet reached $500,000 retention but were at 50% of ANICO's attachment point). He forwarded this spreadsheet to Timothy Schmidt.
After Schmidt received this spreadsheet, he forwarded it via email to Cathy Washburn at IOA Re, who received all claim reporting on ANICO's behalf. Schmidt's cover email read:
LeBlanc Cert., Exh. 15.
This August 8, 2008 spreadsheet listed all of the claims submitted by Everest to Munich. It included the name of each insured, the date of loss, and the attachment point, however, the spreadsheet did not delineate which of the claims were likely to result in a claim under the retrocessional agreements. In response to Schmidt's email, Cathy Washburn replied on April 11, 2008 that "[t]his listing is not considered adequate notice of loss. Individual notices must be provided for each claimant and should include claimant name, complete claim details, and financial data broken down by medical, indemnity, and expense." Id. To this, Timothy Schmidt responded: "Cathy, we agree. We are working on getting you the necessary back up documentation." Id. Thereafter, Munich followed up with more detailed notices for the particular claims. The more detailed notices were provided beginning on March 25, 2009 and through September 28, 2011.
Around the same time that Freda took over reporting from Giacobbe, in 2007, Freda and Giacobbe conducted an audit of Everest's claim files. They also conducted
As explained supra, the parties' retrocessional agreements are governed by New York law. Under New York law, "[a] reinsurance contract is governed by the rules of construction applicable to contracts generally." Christiania General Ins. Corp. of New York v. Great American Ins. Co., 979 F.2d 268, 274 (2d Cir.1992) (citation omitted). That is, the terms of unambiguous contracts are enforced as written. An ambiguous contract is one subject to different, reasonable interpretations. Where the terms of the contract are ambiguous, "reference to extrinsic evidence provides guidance to the parties' intent." Id. (citation omitted).
Extrinsic evidence may include evidence of custom and usage. Excess Ins. Co. v. Factory Mut. Ins. Co., 3 N.Y.3d 577, 590-591, 789 N.Y.S.2d 461, 822 N.E.2d 768, 777 (2004) ("Our precedent establishes that where there is ambiguity in a reinsurance certificate, the surrounding circumstances, including industry custom and practice, should be taken into consideration.") (Read, J., dissenting) cited with approval in Stolt-Nielsen S.A. v. AnimalFeeds International Corp., 559 U.S. 662, 130 S.Ct. 1758, 1769 n. 6, 176 L.Ed.2d 605 (2010). Moreover, "when resort to extrinsic evidence is necessary to shed light on the parties' intent summary judgment ordinarily is not an appropriate remedy, and must be denied unless, viewing the evidence in a light most favorable to the nonmovant and resolving all doubts in its favor, no reasonable trier of fact could find against the movant." Christiania, 979 F.2d at 274 (internal citations omitted).
As noted, the pertinent part of Article XVI of both the 2000 and 2001 retrocessional agreements reads as follows:
2001 Agreement at 5 (emphasis added). Following subsection A, the remainder of Article XVI sets forth the terms of the commutation process, stating, for example, that either party may request commutation "seven years from the date of occurrence of the claim...." Id. at subsection B. The Article also directs that disputes related to the value of the claims to be commuted be settled by independent third parties in the event Munich and ANICO cannot agree on the value. Id. at subsection D.
ANICO argues that the "no liability shall attach" language operates as a condition precedent that relieves it from its payment obligations under the retrocessional agreements. According to New York law, "[a] condition precedent is an act or event, other than a lapse of time, which, unless the condition is excused, must occur before a duty to perform a promise in the agreement arises." Oppenheimer & Co. v. Oppenheim, Appel, Dixon & Co., 86 N.Y.2d 685, 636 N.Y.S.2d 734, 660 N.E.2d 415, 418 (1995) (internal quotation marks omitted). See also MHR Capital Partners LP v. Presstek, Inc., 12 N.Y.3d 640, 884 N.Y.S.2d 211, 912 N.E.2d 43, 47 (2009) (quoting same). Failure to fulfill such a condition "excuses performance by the other
In determining whether a condition precedent exists, courts look for clear and unambiguous language that unmistakably creates a condition to performance. See id. "Whether contractual language is deemed to be language of condition or language of promise is, as is the case with most matters of interpretation, generally dependent upon the intention of the parties.... [T]he determination whether a contract term is a promise or a condition is a problem of interpretation, so that each case turns on its own facts." Edelman, 841 F.Supp.2d at 824 (quoting 13 Williston on Contracts § 38:13). See also Greenfield v. Philles Records, Inc., 98 N.Y.2d 562, 750 N.Y.S.2d 565, 780 N.E.2d 166, 170 (2002) ("[It is a] fundamental ... precept of contract interpretation ... that agreements are construed in accord with the parties' intent."). Where the contract language is ambiguous, courts hesitate to interpret the language as a condition precedent. Oppenheimer, 636 N.Y.S.2d 734, 660 N.E.2d at 418. See also Ashkenazi v. Kent South Assocs., LLC, 51 A.D.3d 611, 857 N.Y.S.2d 693, 694 (2008) (stating that if contract "language is in any way ambiguous, the law does not favor a construction which creates a condition precedent."). However, in such an instance, it is appropriate for the court to consider extrinsic evidence to resolve the ambiguity. Edelman, 841 F.Supp.2d at 826 (discussing New York case law).
Before turning to the language of Article XVI, I first provide context for my interpretation by briefly outlining how the Munich-ANICO agreements are structured as a whole. As noted, through the agreements, ANICO agrees to indemnify Munich for the original ceding insurer's — Everest's — workers' compensation claims filed within a given year. See 2001 Agreement at 1. ANICO, of course, can only indemnify those claims of which it is aware, and hence it is Munich's responsibility to notify ANICO once it receives claim information from Everest. As explained in my September 28, 2012 Opinion, Article X of the agreements directs Munich to notify ANICO "promptly of all claims coming under this Agreement on being advised by the Original Ceding Company...." See 2001 Agreement at 4. Munich must then furnish ANICO with cost estimates relating to the claims. Id., Article X.A. ANICO, in turn, "agrees to pay [Munich] on demand ... [for Munich's] losses...." Id., Article X.C.
Against this backdrop, Article XVI provides an outer limit for the reporting of claims by stating that "no liability shall attach" to any claims not reported within seven years. These sorts of provisions are referred to in the reinsurance industry as "sunset provisions." See Appleman on Insurance 2d § 106.8 (describing sunset clauses as "restrict[ing] the time for making claim under ... reinsurance coverage.")
On its face, the sunset provision here is straightforward: it prevents Munich from reporting claims in perpetuam, by excluding from coverage those claims not noticed within seven years following the expiration of each retrocessional agreement. Article XVI.A also serves the purpose of providing a foundation for commutation. As noted above, the remainder of Article XVI delineates the process by which either party may seek to commute the agreement. The likely impetus behind Article XVI is to ensure that both parties have an accurate understanding of ANICO's exposure at the seven-year mark. Such an accurate appreciation of ANICO's economic liability would undoubtedly inform each party's position on commutation. Based upon the clear and unmistakable language of Article XVI, I conclude that it creates a condition precedent to payment.
While Article XVI is clear on its face, a point that Munich conceded at oral argument, Munich argues that another provision found in the agreements — Article XIII — is a defense to its failure to comply with Article XVI. Article XIII reads:
2001 Agreement at 5. Referring to it as an "errors and omissions" clause, see Munich Supp. Br. at 1-2, Munich argues that this provision serves as a type of generally-applicable escape valve that allows it to correct any failure to report a claim within the seven-year period.
ANICO attacks Munich's reading of Article XIII on two fronts. First, citing to the deposition testimony of its expert, Linda Barber, ANICO argues that Article XIII was intended to correct "mere inadvertence," and to catch the one claim that "fell through the cracks." Barber Dep. 73-74.
Considering both parties' arguments, and the plain language of Article XVI and Article XIII, I find that Article XIII is not as broad as Munich urges. For one, by using the phrase "error, omission or oversight," Article XIII invokes the notion of inadvertent, rather than intentional, errors. Here, the reason underlying Munich's reporting of claims outside of the seven-year window is that its cedent, Everest, did not cede claims to Munich in a timely fashion, see Freda Dep. 195:6-11; 196:15-199:14; 199:1-10, and because Munich erroneously did not report claims until they reached the $500,000 retention threshold. See Giacobbe Dep. 93:18-24; 105:7-10; 147-48; 176:23-180:8. See also Freda Dep. 96:11-99:24; 107:8-110:17; 282:6-284:3; 298:16-305:4.
Moreover, were I to hold that this sort of conduct by Munich constituted an error encompassed by the Article XIII errors and omissions clause, that finding would nullify the intent of Article XVI. As noted, Article XVI bars claims not noticed within the sunset period. The purpose underlying this article is, as Munich conceded at oral argument, to cut-off claims wholesale.
Even if I were to hold that Article XIII is ambiguous, I would reach the same result because my interpretation that Article XIII applies to inadvertent errors is consistent with industry usage of errors and omissions clauses. Courts generally consider the usage and customs of an industry in interpreting agreements, and that is especially true for the reinsurance industry with its insular terminology and practices. See Excess, supra at 590-91, 789 N.Y.S.2d 461, 822 N.E.2d 768. See generally Mellon Bank v. Aetna, 619 F.2d 1001, 1013 (3d Cir.1980) ("Trade terms, legal terms of art, numbers, common words of accepted usage and terms of a similar nature should be interpreted in accord with their specialized or accepted usage....") Historically, errors and omissions clauses were intended to protect ceding insurers from denial of coverage in the event of an inadvertent omission or error in reporting claims via a bordereau report. See Strain, Reinsurance Contract Wording at 89 (3d ed. 1998). And, while at the time the 2000 and 2001 agreements were drafted, the terminology had become more sophisticated, and an errors and omissions clause might expressly state that it applied to "inadvertent" errors, nonetheless, throughout the years, such clauses were always intended to apply only to inadvertent errors, whether that limiting term was expressly stated or not.
In sum, because Article XVI operates as a condition precedent, it makes clear that ANICO is obligated to indemnify only those claims that were noticed within seven years following the expiration of the relevant retrocessional agreement. This means that, for the 2000 agreement that expired on December 31, 2000, Munich was obligated to notify ANICO by December 31, 2007 of all workers' compensation claims that occurred during the 2000 calendar year. Munich concedes that the claims under the 2000 agreement were not reported by this sunset deadline, and therefore, summary judgment is granted to ANICO with respect to these claims.
This analysis applies only to those claims under the 2001 retrocessional agreement found within the spreadsheet that Am Re Brokers employee Timothy Schmidt attached to an August 8, 2008 email to Cathy Washburn at IOA Re:
LeBlanc Cert., Exh. 15. Washburn responded that "[t]his listing is not considered adequate notice of loss. Individual notices must be provided for each claimant and should include claimant name, complete claim details, and financial data broken down by medical, indemnity, and expense." Id. And, Schmidt replied: "Cathy, we agree. We are working on getting you the necessary back up documentation." Id.
Munich argues that, although the April 8, 2008 spreadsheet did not specifically identify those claims by Everest that were likely to result in a claim under the retrocessional agreements, the spreadsheet was a form of bordereau notice that is an accepted type of notice in the reinsurance industry. For the reporting of losses in a reinsurance relationship, a bordereau report has been defined as follows:
Strain, supra at 747. According to another source, "[g]enerally, the loss bordereau will contain risk details such as the insured's name, claimant's name, policy number, claim number, effective date, date of loss, loss reserve, expense reserve, and any paid losses or expenses." Larry P. Schiffer, Patton Boggs, LLP, Reinsurance Terminology Explained: Bordereau, http://www.irmi.com/expert/articles/2011/schiffer08-insurance-reinsurance-law.aspx (August 2011). This report is often "provided in electronic format and often in a standardized design. On a quota share treaty, the loss bordereau is often the only way the reinsurer will obtain information about the losses being ceded to the treaty unless there are special reporting requirements for certain risks ... [T]he loss bordereau will be the tool against which the reinsurer will make selections when doing a claims audit." Id.
Id. Many contracts also provide for shorter, summary reporting of claims. Such a provision might read: "[t]he Company shall render a monthly account within x days after the end of the period. This account shall summarize ... losses paid, loss adjustment expenses paid, and salvage recovered. The account shall also reflect the balance due by either party." Id. "Where the reinsurance contract does not prescribe detailed bordereau reporting, the reinsurer must audit periodically to test the business being ceded and to ensure compliance with the terms of the reinsurance contract." Id.
Here, the reinsurance agreements do not specify what sort of reporting is required; the Article X notice provision does not address reporting at all, other than to state that notice must be made promptly and, in some cases, immediately, and Article XVI simply provides that Munich must "advise" ANICO of all Everest claims likely to result in a retrocessional claim. ANICO contends that such lack of guidance in the agreements is no impediment to summary judgment in its favor because New York case law rejects the notion that a report, containing hundreds of claims, which fails to designate which claims will be eventually tendered to the retrocessionaire, constitutes sufficient notice. ANICO relies upon Steadfast Ins. Co. v. Sentinel Real Estate Corp., 283 A.D.2d 44, 727 N.Y.S.2d 393 (New York Sup.Ct.App.Div. 2001), for this proposition.
In Steadfast, the New York appellate court addressed whether a commercial policy holder's submission of a "loss run" report constituted the requisite notice to its commercial general liability insurer. This report was a list of all open claims against the insurer. Id. at 51, 727 N.Y.S.2d 393. After first determining that the notice provision in the insurance policy in that case, like here, did not specify what sort of notice was required, the court examined extrinsic evidence — including correspondence contemporaneous to the execution of the policy — to conclude that the policy's notice provision was not intended to encompass loss run reports. Id. at 52, 727 N.Y.S.2d 393.
Implicit in the Steadfast court's decision is the conclusion that the notice provision was ambiguous because it did not specify what sort of notice was required. So too, here, I conclude that Article XVI is ambiguous with respect to both the form of notice required and the precise contents that must be included in the notice. Having concluded that Article XVI is ambiguous, I, like the Steadfast court, turn to extrinsic evidence here to determine whether the email spreadsheet submitted by Munich fits within the sort of reporting that was contemplated by the parties at the time of contracting.
ANICO points to the email correspondence following the submission of the August 8, 2008 spreadsheet as probative of the parties' intent. In its view, that Cathy Washburn informed Timothy Schmidt on April 11, 2008 that the spreadsheet was not considered adequate notice of loss, and that Schmidt responded "we agree," conclusively demonstrates that the parties intended that Article XVI notice would not encompass spreadsheet reporting that did not delineate which claims from the original ceding insurer were likely to result in a claim under the retrocessional agreements.
One could argue that this evidence is not as conclusive as ANICO suggests. Timothy Schmidt's full response was "Cathy, we agree. We are working on getting you the necessary back up documentation." While this statement could be interpreted by a factfinder to mean that Schmidt understood that the August 8th spreadsheet was insufficient, it could also be read to suggest that Schmidt believed that the spreadsheet was sufficient notice under Article XVI but that back up documentation was required before ANICO would pay on the claim. As noted above, loss bordereau reports are often used as tools by a reinsurer when making selections for a claims audit.
However, Schmidt also acknowledges that, prior to the August 8, 2008 email, Am Re Brokers generally provided more claim detail in its notices. Id. at 166:6-11. In this connection, Munich argues that the claim reporting Schmidt was referencing related solely to general billing cycle reporting under the agreements, i.e., Article X reporting. According to Munich, while it is true that Munich typically reported on an individual claim basis, none of the prior instances of reporting involved reporting under the sunset clause.
In support of this argument, Munich points to what it considers differing language
In Munich's view, that Article XVI uses the term "reported" makes clear that the parties contemplated a more abbreviated form of notice for sunset purposes. Moreover, Munich argues, the purposes underlying Articles X and XVI differ — while individual claim reporting is necessary to provide ANICO with sufficient data to justify payment under Article X, such detailed reporting is not necessary, under Article XVI, to alert ANICO that additional claims may become payable outside of the sunset period.
Comparing Articles X and XVI line by line, there are both similarities and differences between the two provisions. The first line of each provision directs Munich to "advise" ANICO of claims. Compare Article X (stating that "[T]he Company agrees to advise [ANICO] promptly of all claims coming under this Agreement on being advised by the Original Ceding Company....") with Article XVI ("Seven years after the expiry of this Agreement, the Company shall advise the Reinsurer of all claims for said annual period, [sic] not finally settled which are likely to result in a claim under this Agreement."). However, as noted, the second and third lines of Article X differ from Article XVI in that Article X directs Munich to "furnish the Reinsurer such particulars and estimates regarding same as are in possession of the Company." No such language is found in Article XVI. That Article X requires Munich to submit "particulars and estimates," whereas Article XVI does not, lends support to Munich's argument that the notice contemplated under the two articles is not one and the same.
In addition, Munich points to the expert report and testimony of its expert, Susan Mack, in support of its argument that the August 8, 2008 spreadsheet constitutes the type of bordereau reporting commonly used in the industry.
Id. at 11.
In this connection, Mack opines that the notice requirements of Articles X and XVI differ. In her view, bordereau-style reporting is acceptable for Article XVI, though not for Article X:
See Mack Dep. 271:5-12. Thus, while she concedes that the industry standard for the reporting contemplated by Article X is individual claim notices, she disputes that this industry standard applies with equal force to sunset clauses. Id. at 272:4-273:13.
With respect to ANICO's argument that the August 8, 2008 spreadsheet is over-inclusive and fails to designate which claims are likely to breach ANICO's layer, Mack concludes that "it is indeed the contemporaneous standard in the insurance and reinsurance industries to provide reporting of all possible claims — new or well-developed — that could possibly penetrate the reinsurance coverage of an agreement via the summary format of bordereau."
ANICO's expert, Barber, takes issue with Mack's reasoning on several fronts. First, Barber disagrees that bordereau reporting is appropriate for sunset purposes because certain claims may still be in the very early stages of claim development. In her deposition, Barber testifies that with workers' compensation claims, the reinsurer (in this case, Munich) should have notice of all claims within seven years of expiration of the parties' agreement. Barber Dep. 224:6-225:9. In her view, "there's a belief by underwriters that at that point in time [seven years], [the claim] would be mature enough to find a basis to commute.... The second or third year I'd call very early, but seven years, no." Id. at 225:1-9. This aspect of Barber's testimony directly contradicts Mack's expert opinion that workers' compensation carve-out claims are often followed by a lengthy period during which medical expenses and disability costs develop and aggregate, and that it is not reasonable to expect ceding reinsurers, like Munich, to possess the claim data needed to provide to ANICO what is typically included in an individual claim report under Article X.
Second, Barber challenges Mack's opinion that individual claim reporting is not mandated by Article XVI. To be clear, Barber, agrees with Mack that it is industry practice for a ceding reinsurer to utilize
Specifically, Barber states in her deposition that the August 8, 2008 email did not satisfy Article X's "particulars and estimates" requirement. Barber Dep. 159:16-23; 163:10-12; 171:6-11; 173:8-15. Yet, she does not explain why the Article X requirement should apply to claims first noticed under Article XVI and not yet subject to reporting under Article X. This aspect of her deposition testimony appears to contradict earlier testimony of hers that Article XVI encompasses those claims not yet reportable under Article X. See id. at 146:16-147:14 (agreeing that "to the extent that other reporting requirements haven't been triggered by other clauses," Article XVI "contemplates that claims will be reported up to seven years after the expiration of the contract").
Under Article X, Munich is not obligated to report claims until it receives notice from Everest, the underlying ceding insurer. The Article X.A. notice requirement is triggered once Everest reports its claims to Munich and Munich concludes that such claims are covered by the Munich-ANICO agreements. The Article X.B. immediate notice requirement is triggered when Everest reports to Munich any accident involving a brain injury, certain types of burns, or a spinal cord injury. In addition, under Article X.B., Munich must report any accident for which it has reserved at 50% of ANICO's attachment point. The Article XVI notice requirement, in contrast, could apply where none of these occurrences have taken place. Because Article XVI, by its terms, serves as an absolute bar to all claims that "are likely to result in a claim under this Agreement," Article XVI places the onus on Munich to report any possible claims of which Munich was aware or should have been made aware. That being the case, it is not clear from Barber's deposition testimony why she believes the Article X "particulars and estimates" requirement would apply to claims not yet subject to Article X but subject only to the Article XVI sunset bar.
Furthermore, Barber relies on the Article X "particulars and estimates" requirement in support of her conclusion that the spreadsheet did not contain sufficient detail. In her view, the following data should have been listed on the spreadsheet: "the name of the claimant, the date of the accident, the nature of the injury, and description of the claim, potential subrogation, the amounts that have been paid, the amount of the reserve, how that reserve was arrived at...." Id. at 161:14-22. To Barber, this data "is the particulars and estimates and information that goes to providing a complete picture of the claim." Id. at 161:22-162:1. With Article X guiding her inquiry, she concludes that the August 8, 2008 spreadsheet, which she refers to as "that one long report," was insufficient. Id. at 162:12-163:12. See also id. at 228:18-229:8 (when asked "what is required to be reported ... according to Article 16," Barber responds "you need to provide, if you haven't already, the particulars
That said, Barber further opines that the August 8, 2008 spreadsheet inappropriately fails to specify which claims are likely to result in a claim under the Munich-ANICO agreements. See Barber Dep. 184:8-16. I find that this opinion testimony provides some support for ANICO's argument that the spreadsheet does not meet Article XVI's dictates. As noted, Barber acknowledges in her deposition that it is industry practice for a ceding reinsurer to utilize bordereau-style reporting, although such reporting is not used as often in excess of loss contracts like the one here. Id. at 182:1-184:16; 223:19-224:5. Her opinion is consistent with the rationale expressed by the Steadfast Court that a bordereau or summary report should designate which claims are likely to result in a claim to the retrocedent.
In sum, and upon review of each parties' experts' deposition testimony, Mack's expert report, the Schmidt-Washburn e-mail chain regarding the August 8, 2008 spreadsheet, and the rationale of the Steadfast court, I conclude that there exists a genuine issue of material fact as to whether Munich's prior practice of individual claim reporting under Article X should be determinative of what type of reporting the parties intended with respect to Article XVI. This key factual dispute is part of a larger genuine issue of material fact as to the type of notice contemplated by Article XVI. Each party has presented evidence which, if believed, could support a finding by the factfinder that the spreadsheet was either sufficient or insufficient notice under that Article.
In reaching this conclusion, I note that New York law makes clear that ambiguity in contract language "must be resolved by determining the parties' intent at the time of contracting, either from within the four corners of the document, if possible, or, as a last resort, from whatever extrinsic evidence is available." Cortese v. Redmond, 199 A.D.2d 785, 786, 605 N.Y.S.2d 506 (N.Y.1993) (emphasis added). See also Fecteau v. Fecteau, 97 A.D.3d 999, 1000, 949 N.Y.S.2d 511 (New York App.Div. 2012). Neither party has pointed to this sort of extrinsic evidence in its papers or at oral argument.
For the foregoing reasons, the Court reconsiders its September 28, 2012 decision.
Regarding the Court's grant of summary judgment to Munich on ANICO's prejudice defense, which applies to those claims not timely noticed pursuant to Article X of the agreements, the Court's prior grant of summary judgment stands for the reasons stated herein.
Fed.R.Evid. 1004. See also New York ex rel. Spitzer v. Saint Francis Hosp., 94 F.Supp.2d 423, 428 (S.D.N.Y.2000). ANICO has not made a showing as to any of the above exceptions to the best evidence rule.
Allen, Thomas A., Current Hot Topics in Reinsurance Disputes in PBI, Intro to Reinsurance Law (2004).
Mack's statement does not alter my analysis because the decision to streamline claim handling in this fashion reflects an intentional choice, not an inadvertent error, and cannot be used as an excuse to disregard contractual obligations. Indeed, nearly 100 years ago, in Atlantic Fruit Co. v. Hamilton Fire Ins. Co., 251 N.Y. 98, 104, 167 N.E. 184 (Ct.App.N.Y. 1929), the New York Court of Appeals held a company accountable for its employees' intentional decision not to align their periodic reporting practices to the governing contract language. Reasoning that "a willful and persistent failure to make accurate ... reports" was not an inadvertent or occasional error, id. at 103, 167 N.E. 184, the Court further concluded:
Id. at 106, 167 N.E. 184. So too, here, Munich should not be able to skirt any failure to comply with the agreements' notice provision by suggesting that it is industry practice for its employees not to review the governing contract language.