WILLIAM F. JUNG, UNITED STATES DISTRICT JUDGE.
This matter comes before the Court on the parties' cross motions for summary judgment (Dkts. 49-50, 52), as well as their respective responses and replies (Dkts. 58-59, 62, 65). The Court also received briefing from amicus curiae (see Dkt. 41), the Florida Department of Financial Services (Dkts. 51, 60, 64), and heard oral argument from counsel for the parties and the amicus curiae. Upon consideration, the Court grants Defendant's motion for summary judgment and denies Plaintiff's motion for summary judgment.
Plaintiff Akshay M. Desai, M.D. ("Dr. Desai") is an officer and director of a
RSUI Indemnity Company ("RSUI") issued Directors and Officers Liability Policy No. HP648986 to UHCG effective November 1, 2012 to November 1, 2013 ("RSUI Policy"), affording $5 million in limits. Dkt. 17-2. Defendant Navigators Insurance Company ("Navigators") issued NAVEXCESS Policy No. PT12DOL301885NV for the same period ("Navigators Policy"). Dkt. 17-1. The Navigators Policy is a "follow form" excess policy under which the RSUI Policy is the designated "followed policy."
The RSUI Policy (the terms of which are incorporated into the Navigators Policy, see Dkt. 17-2 at 2) states:
Dkt. 17-2 at 23.
Id. at 26. "Loss" means:
Id. at 25. The policy also provides that "Loss (other than Defense Expenses) shall not include" a number of items, including "[m]atters that may be uninsurable under the law pursuant to which this policy shall be construed." Id.
The policy also includes a number of exclusions, including an exclusion for "Loss in connection with any Claim made against any Insured" that is
Id. at 26 (the "Illegal Remuneration Exclusion"). There is also an exclusion for a loss that is
Id. (the "Illegal Advantage Exclusion").
In February 2013, the Florida Department of Financial Services ("DFS") began receivership proceedings in the Circuit Court for the Second Judicial Circuit of Florida in and for Leon County against UHCIC and UHC (the "Receivership Entities") pursuant to Florida Statutes §§ 631.031 and 631.061.
Florida Statutes § 631.261(1)(b) makes certain transfers of the property of an insurer voidable:
On April 4, 2013, DFS (as receiver for the Receivership Entities) sent Dr. Desai a letter invoking Fla. Stat. §§ 631.154(1) and 631.261(1)(b) and demanding the return of $2,537,580:
Dkt. 50-8 at 1-3. This letter from DFS is the claim that is at the center of the dispute between the parties in this action (the claim is referred to as the "DFS Claw Back Claim" and the payment demanded is referred to as the "Claw Back Payment").
Dr. Desai contested the DFS Claw Back Claim in state court, but the state court granted summary judgment to DFS on July 6, 2017, and entered a "Summary Final Judgment," requiring Dr. Desai to pay DFS $2,537,580, plus interest. Dkt. 50-17 at 11 ("Accordingly, it is
Around the same time that DFS initiated the claim to recoup Dr. Desai's compensation, it also made claims against Dr. Desai and other insured individuals seeking damages of at least $15 million for alleged breaches of fiduciary duties in the management of the Receivership Entities (the "DFS Fiduciary Duty Claims"). Dkt. 52-1 ¶¶ 11-12; Dkt. 52-6. The trustee of the bankruptcy estates of UHCG and AMC ("Trustee") also made claims against Dr. Desai and others in bankruptcy court based on alleged wrongful acts (the "Trustee Claims"). Dkt. 52-1 ¶ 14; Dkt. 52-8; see also In re Universal Health Care Grp., Inc., No. 8:13-bk-01520-KRM, Dkt. 182 (Bankr. M.D. Fla. Apr. 3, 2013).
In the meantime, DFS and the Trustee notified Navigators of the various claims against Dr. Desai (including the DFS Claw Back Claim) no later than January 16, 2014. Dkt. 52-6 (DFS Fiduciary Duty Claims); Dkt. 52-7 at 2 (DFS Claw Back Claim); Dkt. 52-8 (Trustee Claim). On February 13, 2017, Navigators, DFS, the Trustee, and others entered into a settlement agreement. Dkt. 52-10. Navigators paid $1.8 million in exchange for an agreement that DFS and the Trustee would not seek any recovery from Navigators for any judgment against Dr. Desai. Id. at 1, 5-6; Dkt. 50-12 at 6. Although Dr. Desai did not participate in the settlement, Navigators obtained a release of all claims against Dr. Desai that were "subject to indemnification as a `Loss' under" the RSUI Policy and/or the Navigators Policy, leaving DFS free to pursue any claims against Dr. Desai that were not covered by those policies. Dkt. 52-10 at 5-6.
Although the current dispute between the parties does not directly involve the settlement, the settlement has potential implications for both this case and the state court action on the DFS Claw Back Claim, as discussed more fully below. Briefly, Navigators and DFS take the position that the Navigators Policy and, thus, the settlement apply only to the DFS Fiduciary Duty Claims and the Trustee Claims (that is, the claims that involved allegations of wrongdoing) and not to the DFS Claw Back Claim. If Navigators and DFS are incorrect and the DFS Claw Back Claim is covered by the Navigators Policy, then that claim was released by the settlement, a conclusion that is in tension with the state court's order requiring Dr. Desai to make the Claw Back Payment. Further complicating matters is the fact that Dr. Desai did not raise the release as a defense in the state court action on the DFS Claw Back Claim. See, e.g., Dkt. 50 at 11, 13; Dkt. 51 at 14-15.
In any event, after Navigators settled with DFS and the Trustee, Dr. Desai settled his lawsuit with RSUI. Dkt. 52-1 ¶ 28. Although that settlement agreement is not in the record, Dr. Desai has averred that "no further benefits are available under the RSUI Policy." Id. ¶ 28. Regardless of the terms of the settlement agreement, he takes the position that the RSUI Policy has been exhausted—and, thus, the Navigators Policy has been triggered—because RSUI paid out $4,532,322.30 and other expenditures bring the total outlay over $5 million. Dkt. 52 at 20-21.
On June 5, 2018, Dr. Desai filed a lawsuit in state court against Navigators alleging breach of contract and seeking a declaratory judgment. Dkts. 1-1 and 1-2. Navigators removed the case to this Court under the Court's diversity jurisdiction. Dkt. 1. In his amended complaint (Dkt. 17), Dr. Desai seeks a declaratory judgment that Navigators is obligated to defend him against the DFS Claw Back Claim, indemnify him for fees incurred in defending against that claim, and indemnify him for any amounts he is required to pay as part of a judgment in the state court action on that claim (id. at 11-14). He also alleges that Navigators breached the Navigators Policy when it refused coverage for the DFS Claw Back Claim. Id. at 14-15.
"The court shall grant summary judgment if 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). An issue of fact is "genuine" only if "the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). A fact is "material" if the fact could affect the outcome of the lawsuit under the governing law. Id.
The moving party bears the initial burden of identifying those portions of the record demonstrating the lack of a genuinely disputed issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). If the movant does so, the burden then shifts to the non-moving party to demonstrate that there are, in fact, genuine factual disputes which preclude judgment as a matter of law. Porter v. Ray, 461 F.3d 1315, 1320 (11th Cir. 2006). To satisfy its burden, the non-moving party "must do more than simply show that there is some metaphysical doubt as to the material facts." Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). The non-moving party must go beyond the pleadings and "identify affirmative evidence" that creates a genuine dispute of material fact. Crawford-El v. Britton, 523 U.S. 574, 600, 118 S.Ct. 1584, 140 L.Ed.2d 759 (1998).
In determining whether a genuine dispute of material fact exists, the Court must view the evidence and draw all factual inferences therefrom in the light most favorable to the non-moving party and must resolve any reasonable doubts in the non-moving party's favor. Skop v. City of Atlanta, 485 F.3d 1130, 1136 (11th Cir. 2007) (citation omitted). Summary judgment should only be granted "[w]here the record taken as a whole could not lead a rational trier of fact to find for the non-moving party[.]" Matsushita, 475 U.S. at 587, 106 S.Ct. 1348.
The parties have filed cross motions for summary judgment. As noted above, there is coverage under the Navigators Policy only if there has been a "Claim" for a "Wrongful Act" and an insured person is legally obligated to pay a "Loss." The parties agree that the DFS Claw Back Claim is a "Claim" within the meaning of the policy but dispute whether it is a claim for a "Wrongful Act" and whether Dr. Desai was obligated to pay a "Loss." Navigators also contends that, even if the DFS Claim was a claim for a "Wrongful Act" that resulted in a "Loss," the Illegal Advantage Exclusion applies—a contention that Dr. Desai disputes. In addition, Navigators and DFS argue that the Court should abstain from hearing this dispute.
Under Florida
Upon review, and for the reasons discussed below, the Court declines to abstain from hearing this dispute. It also concludes that the Illegal Advantage Exclusion applies and that the DFS Claw Back Claim was not a claim for a "Wrongful Act" within the meaning of the relevant policy language. Because the Illegal Advantage Exclusion applies and there was no "Wrongful Act," there is no coverage for the DFS Claw Back Claim and no duty to defend or indemnify Dr. Desai. Accordingly, Navigators's motion for summary judgment is due to be granted and Dr. Desai's motion for summary judgment is due to be denied.
Navigators and amicus curiae DFS contend that the Court should abstain from hearing this dispute, arguing that, because "Dr. Desai was released by DFS for all claims subject to coverage under the Navigators Policy, a determination by this Court in this action will directly affect the assets at issue in the Claw Back Claim." Dkt. 50 at 11. DFS takes that argument one step further and argues that Dr. Desai is seeking to make a "collateral attack" on the state court judgment in this action. Dkt. 51 at 14. Essentially, Navigators and DFS contend that a finding of coverage by this Court will set off a domino effect: If this Court finds that the DFS Claw Back
As stated at the hearing, the Court declines to abstain. The abstention concerns of DFS and Navigators largely relate to what will happen if this Court finds that there is coverage for the DFS Claw Back Claim.
With respect to the merits, the Court concludes that the Illegal Advantage Exclusion applies, thereby removing the DFS Claw Back Claim from coverage. As noted above, the Illegal Advantage Exclusion provides that the insurer "shall not be liable to make any payment of Loss in connection with any Claim made against any Insured ... [b]ased upon, arising out of, directly or indirectly resulting from or in consequence of, or in any way involving the gaining or any profit or advantage to which an Insured was not legally entitled." Dkt. 17-2 at 26. It also provides that the exclusion "shall not apply unless a judgment or other final adjudication adverse to any Insured in the Claim shall establish that such Insured gained profit or advantage to which such Insured was not legally entitled." Id.
Here, it is undisputed that Dr. Desai was not legally entitled to the $2,537,580 in payments after DFS voided the transfer and demanded repayment. It is also undisputed that the state trial court's grant of "summary final judgment" requiring Dr. Desai to return the $2,537,580 was a "judgment
Dr. Desai argues, however, that the exclusion does not apply because the $2,537,580 in funds at issue was not a "profit" or "advantage" within the plain language of the exclusion and because the Illegal Advantage Exclusion does not apply to claims involving compensation. The Court disagrees. First, Dr. Desai's claim that payments totaling $2,537,580 were not a "profit" or "advantage" is unconvincing. As Dr. Desai's motion for summary judgment acknowledges, Black's Law Dictionary defines the term "advantage" as a "benefit or gain"—a description that plainly applies here. Dkt. 52 at 18 (quoting Black's Law Dictionary (10th ed. 2014)).
Second, Dr. Desai's argument that the Illegal Advantage Exclusion does not apply to claims involving compensation is unavailing. He argues that the Illegal Advantage Exclusion cannot apply to compensation because—if it did—the Illegal Remuneration Exclusion (which applies to a loss related to the "granting of any remuneration to any Insured, without the previous approval of the stockholders or the Board of Directors, which remuneration is found to have been illegal") would be superfluous. Dkt. 52 at 18-19; see also Dkt. 17-2 at 26. He does not explain, however, why—on the facts of this case
Rather than explain his argument that the Illegal Remuneration Exclusion is superfluous on the facts of this case, Dr. Desai relies on International Insurance Co. v. Johns, 874 F.2d 1447 (11th Cir. 1989). In Johns, the insurance policy at issue included an exclusion similar to the Illegal Advantage Exclusion (referred to as "paragraph 5(b)") and an exclusion similar to the Illegal Remuneration Exclusion (referred to as "paragraph 5(c)"). According to Dr. Desai, the Johns court "recognized that if the illegal profits exclusion were to apply to claims involving compensation then the remuneration exclusion would be rendered superfluous" and "concluded that the illegal profits exclusion does not apply to claims [for] illegal compensation." Dkt. 52 at 19. That description of Johns is not correct. In Johns, the Eleventh Circuit concluded that the exclusion for illegal profit (paragraph 5(b)) was inapplicable on the facts of the case, reasoning:
Id. at 1456-57 (citation omitted) (emphasis added). This does not, as Dr. Desai contends, amount to a ruling that all claims for compensation (including compensation that had the appropriate approvals—like the compensation Dr. Desai received—but was subsequently voided) must be considered under the Illegal Remuneration Exclusion.
Because the Illegal Advantage Exclusion applies, there is no coverage for the DFS Claw Back Claim, and Navigators was not obligated to indemnify or defend Dr. Desai. See Dkt. 17-2 at 26 ("The Insurer shall not be liable to make any payment for Loss in connection with any Claim made against any Insured [that falls within the Illegal Advantage exclusion]."); id. at 28 ("It shall be the ... duty of the Insurer to defend any Claim against the Insured for which coverage applies under this policy...."); see also Am. Cas. Co. of Reading, Pa. v. Superior Pharmacy, LLC, 86 F.Supp.3d 1307, 1311-12 (M.D. Fla. 2015) (citations omitted) (where a policy coverage exclusion applies, there is no duty to defend). Accordingly, Navigators's motion for summary judgment is due to be granted.
In addition, even if the Illegal Advantage Exclusion did not apply, summary judgment is warranted because the DFS Claw Back Claim was not a claim for a "Wrongful Act" within the meaning of the relevant policy language. As noted above, for Navigators to have an obligation to pay, there must be a "Claim for a Wrongful Act." Dkt. 17-2 at 23. A Wrongful Act is defined as
Id. at 26. Here, the DFS Claw Back Claim was not a claim for an "act, error, omission, misstatement, misleading statement, neglect or breach of duty" by Dr. Desai or the Insured Organization (UHCG and its subsidiaries). Instead, the DFS Claw Back Claim was made because the Receivership Entities entered delinquency proceedings within one year of the transfer of $2,537,580 in compensation to Dr. Desai and the Receiver voided those transfers under Florida law, thereby depriving Dr. Desai of his right to the funds. There simply was no "act, error, omission, misstatement, misleading statement, neglect or breach of duty" by Dr. Desai or the
The state court did not enter the adverse final judgment for any act of Dr. Desai or the Insured Organization but simply because, upon the filing of the delinquency proceedings and receiver's demand, Dr. Desai was automatically divested of the money as a matter of law. This judgment was not because of any act Dr. Desai or the Insured Organization did; it was simply because upon the receiver's demand Dr. Desai was deemed to be holding property belonging to someone else.
Dr. Desai's arguments to the contrary are unavailing.
But even assuming that approval, payment, or receipt of the $2,537,580 in compensation qualifies as the "act" of an Insured Person or an Insured Organization needed to constitute a "Wrongful Act" within the meaning of the policy
Instead, he attempts to rely on the language of the DFS Claw Back Claim itself, noting that the DFS Claw Back Claim letter "specifically stated that the DFS Claim was asserting claims `against the former officers and directors of the Companies for wrongful acts ... in their respective capacities as such.'" Dkt. 52 at 15 (quoting Dkt. 52-7 at 1). But that argument ignores the rest of the sentence, as well as context of the letter and the larger picture of DFS's actions against Dr. Desai as receiver of the Receivership Entities. The sentence actually reads, in its entirety:
Dkt. 52-7 at 1. As explained above, DFS (as the Receiver of the Receivership Entities) made two claims against Dr. Desai— the DFS Claw Back Claim and the DFS Fiduciary Duty claims. The DFS Claw Back Claim letter also makes it clear that DFS was investigating additional claims against Dr. Desai and others. See, e.g., id. at 2 ("The claims for excess compensation and bonuses total $4,488,760.... The Receiver's investigation is ongoing. To date, this investigation has revealed that the directors and/or officers may have breached additional duties of a fiduciary nature, causing the Companies to suffer further significant damages in excess of the $5,000,000 primary policy limits."). Read in context, then, it is clear that the DFS Claw Back Claim letter was referring to the broader set of allegations against Dr. Desai and not asserting that the DFS Claw Back Claim on its own qualified as a claim for a "Wrongful Act" within the terms of the relevant policy language.
Because the DFS Claw Back Claim was not a "Claim for a Wrongful Act" within the meaning of the Navigators Policy, there was no coverage for it, and Navigators has neither a duty to defend nor a duty to indemnify Dr. Desai for that claim. see Dkt. 17-2 at 23 ("[I]f a Claim for a Wrongful Act is ... made against any Insured Person ..., the Insurer will pay ... all Loss such Insured Person is legally obligated to pay...."); id. at 28 ("It shall be the ... duty of the Insurer to defend any Claim against the Insured for which coverage applies under this policy...."); see also WPC Indus. Contractors, Ltd. v. Amerisure Mut. Ins. Co., 720 F.Supp.2d 1377,
For the reasons stated above, the Court grants Defendant Navigators Insurance Company's motion for summary judgment (Dkt. 49) and denies Plaintiff Akshay M. Desai, M.D.'s motion for summary judgment (Dkt. 52).