Insurance Bad Faith, Expert Witnesses, and Lawyers–Part I

Expert Witnesses (Sometimes Lawyers) in Insurance Bad Faith [IBF]Cases[1]:An Mostly Elementary Introduction to Some Fundamentals in Two Parts (Part One) Table of Contents  I.                  Introduction(Part One) II.               Insurance BadFaith (IBF)—Broad Characterization of Coverages (Part One) III.   Types of Insurance Bad Faith (Part One) IV.   Typical Issues and Conduct of Insurers &Adjusters in an IBF Case:        Expert Witnesses(Part Two) V.  Other Uses for Insurance Expert Witnesses(Part Two) VI.  Qualifyingand Preparing Proposed Experts & Other Recommendations (Part Two) VII. Lawyers as Insurance Expert Witnesses (Part Two)  VIII. ConclusionPart (Part Two)     I. IntroductoryRemarks           Widespread Error inNomenclature.  One way to describeall acts of (at least) common law bad faith is to say that they lack bond fide or that each act whichconstitutes an act of insurance bad faith is one not characterized by bona fide.  This is quite a popular namein various appellate courts around the country. This is by itself a mistake, however, since it is not terribly helpful.  The Latin phrase being discussed originallyapplies to contracts, and it means “made in good faith, that is, without fraudor deception.”  It also means an act whichis “sincere or genuine.”  There are fivedistinct theses wrong here.  (1)Insurance bad faith does not refer to contract formation. (2) Insurance badfaith cannot be defined in terms of its self, to wit, bona fide which is a phrase meaning “bad faith.” And (3) fraud anddeceit in an insurance adjustment process are by themselves insurance badfaith. A lack of sincerity in at least part of the adjustment practice is notsufficient to establish IBF.  Imagine anadjuster posing as being attentive or loyal to an insured’s problem if he isnot.  He still may do it right, even ifhe despises.  An adjuster might act asthough he believed every word of a claimant, and yet believe that the claimantis a lying can of cheap and odor filled black shoe polish. Genuineness issomewhat similar, and my case it is even easier to make.[2]  (5) The reader will see shortly that one ofthe names for insurance good faith is “good faith and fair dealing.”Bona fide obviouslymatches up the first phrase, but it doesn’t fit well with the second. Thus,one has to try again.  Most courts havedone exactly that and often setting forth reasonable several-element standards.  It is the name bona fide taken by itself that’s wrong and unhelpful; usually themore complex and more jury-understandable standards actually set forth bycourts are not consistent with the definition of bona fide to be found, for example, in any recent edition ofBLACK’S LAW DICTIONARY and THE OXFORD COMPANION TO LAW.B. Revision of Nomenclature.  Here is one way the duty of good faith isthat the insurer must deal with the insured in a fair manner and process claimsin a good faith manner.  As all readypointed the second conjunct of this definition is unhelpful, but the firstconjunct is extremely helpful.  Thus allinstances of insurance good faith in the adjustment context require fairness orfaith dealing.  Interestingly, therequirement of insurer bad faith is often actually called the “duty of goodfaith and fair dealing.”            Sometimes the duty of good faith isformulated as something like this.   Aninsurer has failed to adjust a claim in good faith if it has failed to provideor negotiate a settlement of a claim when it knew or should have known that thevalidity and/or value of the claim were reasonably clear.   Insurer bad faith is not terriblyinteresting, when an insurer fails or refuses to “settle” a claim when it knowsthat it is valid and (roughly) its monetary value is not terribly interesting.  C.Insurer Had Knowledge.  Often an expert witness is not needed to prove the existenceof this knowledge.  An expert may noteven be needed if the insurer denies that it had the requisite knowledge. Inthat type of case, the insured would have to prove that it probably had therequire knowledge; in that latter type of case some sort of expert testimonymay be required.  It would be this noinsurer of even minimal competence could possible have failed to know thesignificant propositions.D. Insurers Should Have Had Knowledge.  Expert testimony is much more required when the issue iswhether should have known some crucial proposition(s).  In these types of cases, the testimony willbe much more probabilistic and sophisticated that regarding what even a near“idiot” insurance company would have to know.  The kind of expert testimony required in the second type of context willhave to do what must be understand and believed because it isinsurance-adjustment-context-reasonable (“reasonable”) and because its oppositeis not reasonable, or is less reasonable, to a significant degree.  This kind of testimony has many dimensionsand is much more interesting than “This insurer knew that it a claim was valid(a) because it admits that this is true, (b) has admitted that it is true, or(c) was and still is the greatest “idiot” insurance company in the history ofeconomies with the slightest component of free markets.” II.Insurance Bad Faith (IBF)—Broad Characterization of Foci Insurancerelated expert witnesses are usuallycalled only to testify on insurer bad faith matters, and not directly oncoverage or legal issues.[3]  Thus, this outline will appear to be simplerthan these types of discussions generally are. Then again, it will not be as boring as these “papers” and presentationsoften are.   So, let’s begin with theunderlying substance:  typical areas ofbad faith.A.      FirstParty Coverage (FPC) involves insurance policies where the insuranceproceeds or benefits are to be payable to the insured(s) or beneficiariesdirectly and usually involve disputes between one or more insureds and one ormore insurers, e.g., property insurance, health insurance, or workerscompensation insurance.B.       Third Party Coverage (“TPC”) occurring mostfrequently with liability insurance “LI”), involves insurance policies (or thatpart of them), where the insurance proceeds are to be paid, not directly to theinsured, usually but to third parties on behalf of the insured.  The coverage is designed so that the insurer paysin the insured’s stead the damages owed or probably to be owed by the insuredto others for certain types of liabilities.  Those covered liabilities of an insured must always arise under certainspecific circumstances. Most commonly when the injurious event was (1) not “fortuitous”or (what pretty much amounts to the same thing, (2) was an accident, or (3) wascertainly unintended, at least, usually. (4) Sometimes the act causing theinjury was intentional but had an injurious consequence which was bothunintended and unexpected.  Whetherdamages arise from an accident, whether fortuity characterizes a casual event,or whether its one if its linguistic “cousins” apply, are jury issues.  Still, an insurer’s decisions regarding theseissues can constitute bad faith; this too is a jury issue.          As a general rule, the law of insurance badfaith has a much more diverse and complex relationship with FPC than it doeswith LC.  (In at least some states forexample, common law insurer bad faith does not apply to LC at all, and inothers it does not apply to parts of LC.) III.Other Waysto OutlineTypes of  IBF Types           In this section I spell outadditional details generally outlined in the previous section.  In this way, I focus a bit more on thefunctions of adjusters and experts on adjustment practiceA.       Different Types of Bad Faith.  I start with the claims adjustment processand insurer decision-making conduct.                  1.       Common Law IBF (CL/IBF) Issues: performanceof significant matter in the adjustment of a claim or claims, and whether itwas done or decided with or without a reasonable basis.  a. If adenial is decided without a reasonable basis, the insurer is guilty of commonlaw bad faith.b. In provingor defending against allegations of commonlaw bad faith, reference needonly be to general principles of insurer performance and the acts or omissionsof the carrier and applied to the situation(s) in which those decisions, acts,or omission took place.  Statutory badfaith is the opposite.  c. This rulecan be understood as something starting with a negligence rule, namely that theinsurer failed to meet the industry-business adopted or prescribed standards ofcare for performance.  Many applicationsof the negligence rule apply to bodily injuries and damage to physicalproperty.  This is not really true,however.  IBF is like or starts with thenegligence rule because it is actually very much like a rule of professionalmalpractice. It is as if there is such a thing as “adjuster malpractice.”  There is another principle involved injudging malpractice however, as we shall see, and it is a breach of  a fiduciary duty (as it may be for lawyers).d. Someobservers and a court here and there, have contended that IBF has only to dowith the insurer having been unreasonable with respect to discovering, analyzing,and coming to conclusions about the facts, and they try to say that there canbe no IBF when it comes to the language of the policy.  This idea is non-sense.  A person can make an unreasonable error ininterpreting language in a whole variety of different ways.e. Manystates have this rule CL/IBF, but some states don’t.  Some states use this idea. f. In manystates who have adopted this rule, it applies only in cases of first partyinsurance “FPC”.  This means that it doesnot apply across the board to liability insurance, except—maybe—to the duty todefend.                  A.     Statutory Bad Faith—Specific Statutes[4]: Anumber of acts or omissions are explicitly required of insurers in connectionwith an insurance claim.  E.g.:                  1.   Specific Acts: for example, misrepresentation, failure to settle in areasonable manner, giving erroneous reasons for denial, etc.                  2.      Certainacts must be performed “promptly” and reasonably understood in context.  Often promptness is fixed to a specifiednumber of days.  It is also, however,linked to having received needed and requested documents, etc.          3. In states at least insurers must provide insureds with the reasons orjustification for certain of its decisions, e.g., denial of a claim, substantialdelay of deciding a claim, the reasons it does or does not do something inadjusting a claim, or reserving its right(s) to do something (or several things)later.                    4.  IBF allegations and/or the defenses against them should referspecifically to the terms at issue in the relevant statute.  The term “specific” does not require that thespecification be perfect—or even really—precise.          Atthe same time the difference between the two types of IBF are recognized, it needsto be kept in mind that they have a similar spirit and virtually identicallypurposes. My creativity energy and my imagination is always more at home withthe common law because of its generality than it is with statutes because ofits being more specific. The reader might find that attitude helpful.IIIBad Faith and the Expert Witness  A.   Types of Actionable Insurer IBF Errors.  A great many cases of insurer bad faithinvolve situations in which an insurer has significantly misconstrued, misunderstood,or misrepresented the meaning of its own insurance policy.          B.  The Idea of “Long Distance.” Alternatively,it could be that the insurer understood its policy, but its adjustment behaviorwas at a “long distance,” conceptually conceived, from what is required by themeaning of at least one relevant term in      itspolicy.  An insurer’s mistake is a “longdistance” from (i) what it ought to do or, (ii) how it should take its policylanguage to mean when it makes either a quite substantial error or makes anobvious and injury casing error, e.g. of money. These mistakes need not be deliberate (i.e., intentional), but they canbe.  B. Another Source of “Long Distance.” Rulesand principles, if they exist in writing, for all  of these various types of errors can often befound in records of various types of the insurance company. Usually they are tobe found in the records of insurer’s adjustment department, if they exist.  If they existed in the past, but no longerexist, the chances are that the insurer destroyed them for some reason.  It may be important for the policyholder topursue this topic, to the extent possible. The rules and/or principles are often called something like “AdjustmentGuidelines” or “Adjustment Manuals.” Policyholder lawyers should not set up their inquires to insist thatthese exact words or titles be used or counsel for the insurer will avoidproducing them.  Interestingly,sometimes these manuals are designed to independent adjusters. Sometimes thesematters are handles in training and education sessions provided adjusters whenthey first enter the company or thereafter on a periodic basis.  Sometimes the adjuster’s have kept the“textbooks” sometimes not.  The chancesare that the insurer has them in its library, or something like it.  Many big insurers have education departments.  Sometimes they are kept in the generalcounsel’s office.  Sometimes an outsideeducational or training firm is used. Such companies will almost certainly have the texts it used, and it willprobably have been approved by the insurer at some point.  Experts often find these texts valuable.  This true of experts on both sides of aninsurer-policyholder controversy.In anycase, often policies are standard form policies, so there may be well-establishedcase law on a good deal of the important language or topics.          An expert witness on insurance adjustment should be readyto testify about the “distance” between the meaning of the terms of theinsurance contract and the conduct of the insurer in performing theinvestigation, its decision-making, the language, contents, and omissions inits—say—denial letter, the language, contents, and omissions in its reservationof rights letter, and so forth.  Interestingly, to do this the expert will haveto testify to some degree about the law or about accepted law.          If there are no guidelines or printed principal-books orpamphlets of any kind, this may be a problem for an insurer.  If there are or were such things, and theyare not produced, that too will be a problem. Of course, if any of all this occurred in recent years, it will be inelectronic “storehouses” and will hence be “findable” and subject to productionin litigation.B.      GeneralPrinciple of Common Law IBF—simply put—This principle is that an insurermay not make substantially unreasonable adjustment or claims decisions,as a result of which the policy holder is, in effect, deprived of money towhich it is entitled.          (Of course, those involved believe or at leasthope that the coverage decision is the end of the “game.”  Very, very often, the hope is satisfied.)  In any case, the actions and/or decisionscannot be “unreasonable in a minor way” or “unreasonable in minor ways.”  In addition, there must be an error as tocoverage, whether its existence or its amount.         Thus, asjust indicated the policyholder must have been deprived of some or all proceedsunder the policy to which it was entitled. That policyholder may also beentitled to money damages as the result, having nothing to do with the natureand extent of coverage in of itself, but caused by the bad faith conduct,including omissions.  Its damages may, inthe end, be far larger than the award of coverage to which the policyholder isentitled.  Considerthe following illustration.  What if aninsured hotel owner sustains $1m physical damage to its hotel as the result ofa storm but the insurer denies coverage on the ground that they physicalinjury  is not the result of wind damageand the water damage it causes, but water damage by itself without there havingbeen preceding and causative wind damages. Now suppose the insurer is wrong, and did not perform anywhere near asatisfactory investigation, investigative reasoning, or inquiry into how statelaw works when an insurer, in effect, water over wind.  So the insured gets its $1M, but it hasn’tbeen able to attract customers for 2 years, and it has lost $5M.  The hotel might well recover the $1M incoverage and  an additional $5M for theinsurer’s conduct, of course, plus interest and perhaps some of its attorneys’fees.  Thus, bad faith claims can beextremely powerful.  Adjustment actions or decisions can includemany various things, such as:                    1.       denialof coverage;                   2.       issuance of amounts of recovery under the policy;                   3.       calculation amounts of policy holder entitlement frominsurers, [5]                   4.       issuanceof a reservation or rights;                   5.       language of the reservation of rights communiqué (letter);                    6.       andso forth.  If these acts ordecisions are manifestly unreasonable,[6] irrational,and/or falling way, way below the accepted standard of care generally acceptedin the “industry,” it is obvious there will be insurer bad faith.  It must be remembered that adjusting a claimis not as simple as driving a motor scooter. The more complex the case, and hence the more the adjustment process,the less resemblance there is between the analogy used here—or anything like it—andthe “real thing” of the adjustment process. The same goes for situations in which the insured is, shall we say,unhelpful, uncooperative, deliberately difficult to deal with, and/or so forth.  This is true in general and across the board. Still, if the insurer “screws” thepolicy holder or blunders into its equivalent, there is IBF.C.      Epistemology.  Many of the principles of soundadjustment are principles of epistemology, i.e., how we can know truths, whatare sound ways of discovering truth, what counts as truth in this or thatsituation?  What is to done aboutinconsistent stories, especially when each of them is probably?  What is to done about inconsistent butplausible disagreements as to the meaning of policy language?    So hereare some epistemologically based principles of reasonable insurance adjustment:

1. Look for the truth as well ascoverage.   Indeed, look hard for thetruth. 2. Empirical evidence must be thefoundations of denying a claim.3. All evidence must be sought in an energetic manner.4. All evaluations of empiricalmethodology and empirical evidence must be objective, and neither subjective orbiased in any direction.[7]5. Determine what are the mostappropriate and best methods for obtaining appropriate and needed empiricalinformation?6. Determine the right method fordealing with evenly but clearly conflicting empirical evidence.  (Of course, in many situations there isexactly only one way to do this.)7. Determine how conflicting stories should be dealt with. Maybe determinewhat other back-up evidence should be devised and use.8. Determine what experts, if any,need to be used.9. Determine the logical reason which should be used in making coveragedecisions.10. Determine what sort of dialogues,“round table discussions,” objective reviews, and so forth, should beperformed.11. At some point, and perhaps at an early point in the reasoning process,determine how long a reasonable adjustment should take.  12. At every stage an adjustment process is slowed down or blocked, a newschedule should be devised, checked, reviewed, shared, and so forth.  a. Oftenproblems of scheduling and rescheduling should be discussed, etc., with thepolicyholder.  b. Determinea reasonable temporal decision-making process, if at all possible, which can bedecided by both the insurer and the policyholder.  (It is amazing how frequently exactly this isnot done.)[8]Of course, after all thisepistemological work has been performed, appropriate behavior and actions mustfollow.  Equally, “of course,” is thefact that in many types of at least simple adjustments, all of thesepropositions have been thought out well in advance.  Nevertheless, whether there is any need forany of these must be considered on every adjustment.  It doesn’t take very long in many simple case.          D.      CommonLaw Bad Faith vs. Negligence                    1.       Asalready asserted, common law IBF is NOT identical to negligence, inadvertence byitself is not enough; it is not a sufficient condition for there being IBF. (Somemight say that it is nothing like negligence at all.)  Here are different approaches. One can lighta match negligently, call somebody by the wrong name, or misspell a wordnegligently.  One can even drive a car ina sloppy or inattentive way. Such errors do not constitute acts performed in badfaith.  IBF requires seriousness,relevance (or materiality), and guilt laden diversion from honorable practice.  Accidental blunders are not IBF if they arecorrected.  Curiously, the extent of aninjury caused is not relevant to whether an event has been caused by negligentconduct.  The same may not be true ofIBF, at least in the practical world.                    2.Common law bad faith requires a complex system deliberate, purposeful conductby the insurer into which IBF actions must fit. This is something close to the immediately preceding remarks.  IBF is relatively complex over-all conduct whichis to be pursued integral to the complex framework.                                                                  3.  Someone might analogize bad faith insurerconduct to gross negligence, although that isn’t quite right either.[9]  Actual recklessness is not required forIBF.  Maybe something close to it may besufficient, though not necessary, condition.                   4.   In contrast to IBF, negligent acts must bealmost completely an unintentional performance or one not explicitly motivatedby its actor-oriented self-interest, evil, or close-to-evil’s, distant cousins. (Here “performance,” also includesomissions.)                     5. Still, even an excessive lack ofintentionality—something like intensely ignoring something relevant—can itself bea symptom of IBF, since adjusters—given that the insurer,  insurer’s employees and its independent contractoradjusters—are supposed to treat policyholders, and their interests, as at leastequal to the insurer, together with its interests. All adjusters are supposedto be thorough, careful, objective, rational, and equality-committed.                    6. Of course, all of thetypes of conduct just listed require that the adjuster pay close and careful attention to what s/he is doing.  This entails that very speedy adjustment can becontrary to principle, even if conclusions turn out to be correct.  Why? We’ll see presently.                           g. Still, IBF has aconnection to negligence.  An act (oromission) constitutes bad faith only if it is at least negligent or worse. This principle is necessary for IBF, but it is not sufficient.  Thus, negligence, recklessness, or problematic and disturbing intentionalityare necessary conditions, under normal conditions, of insurer bad faith, butnone of them are not sufficient conditions. Materiality and injury-or-damages are also necessary.                                     b. Probably, an expert will (or shouldbe) permitted to testify about these matters.           3.       Different Standard of Care thanNegligence.                   a.       Here is a different approach to what hasnow been  discussed for a while.  In the negligence context, actors owe eachother only the duty of ordinary care.  Insurers, because they have a  special relationship with each of theirinsureds, owe each of their insureds the dutyof good faith and fair dealing.  Generally,as already indicated, in many, and perhaps most states, this means that an insurer must treat the insured’s interestson a par with its own, or at leastequal to its own.  Quite frequently, findingsof IBF involve an insurer not following this important principle.  Adherence is often a matter of perspective,which is easily lost in the heat of the moment. In any case, if a policy holder wants to prove IBF this is key principleto emphasize, of course, among several others.          b.       Significantly,an expert witness should be allowed to testify as to whether an insurer objectivelyacted in good faith.  This is not simplya matter of law.        c.       With two exceptions, IBF does not applyto LI.   Often, generally speaking, as alreadyobserved, the standard common law of insurer bad faith does not apply to the“we the insurer will pay specified losses” parts of the policy.          (i)     First Exception:  Unreasonably wrongful failure or deliberatefailure to provide a defense to the insured, if called for in the policy.[10]  As a general rule, the duty to defendrequires notice from an insured.  Oncenotice is provided the insurer must treat the duty to defend as FPC (or itsequivalent).[11]          (ii)    Second Exception: IBF in LI situationscan be created by unreasonably wrongful failure or wrongfully deliberatefailure or refusal to settle a covered case against an insured, after areasonable demand has been made to settle within policy limits.[12]  (Often this is called a “Stowers Demand.”[13]  This name originates from a Texas case, but it is used by at least someinsurance adjusters, examiners, and more senior claims department people allover the country.)  (iii) Experts on LI claims practice and related decision-making are usuallypermitted to testify about whether an insurer made a reasonable “Stower’s decision” and is therefore not“guilty” of IBF.   Thus, the Stowers situation is distinct from mostdimensions of insurer conduct pertaining to liability policies.(iv) If an LI insurer has erroneouslydenied coverage and the insured has received a “Stowers demand” and settled it for amounts beyond policy limits, isthe insurer liable for the whole sum? Would it matter if the settlement sum was reasonable?  What if it was unreasonable?  What if the underlying case was tried?  Suppose the verdict and/or judgment exceededpolicy limits.  Would the nature andstructure of the underlying case matter? Insurance experts should be able to testify as to parts of all this.(v) Would it matter whether or notthe insurers denial was reasonable or not? Some experts should be able to testify about some of this at least.(vi) Suppose an insurer indicatedthat it would defend under a Reservation of Rights but the insured rejectedthat “offer” of defense? It is saying, “You defend me without a reservation ofany rights, or I will go forward without you.”[14]         4.       FPC mostly focuses on “property damages,”and/or what used to be called “Business Interruption Insurance,” and which isnow “officially” called “Loss of Business Income Insurance”[15]  is entirely different, although the latter isusually tied to the former.  There areexceptions; there is FPI which is not tied to “property damage.”                 a.  Here is examples of first party insurancewhich concerns property but not “property damage:”  (i) insuranceupon art work which is designed to deal with the risk of its being stolen, orsold to the policyholder fraudulently;[16]  (ii) insurance upon making a motion picturewhen one of the actors drops out;[17](iii)insurance triggered by a kidnapping of a business worker and his/her familywhile in a foreign country;(iv) Thereare other FPC business insurance which are rather esoteric.  Here are four of them: b.Disability, health, and accidental insurance all focus on “bodily injury,” andthey are first party insurance.c. How shouldwe think about life insurance?d. How shouldwe think about insurance on jet airplanes which cover not only the plane butalso those who are killed when the plane crashes.   

[1]  Thisis a revised version of a speech-paper distributed at a Continuing LegalEducation program held in the winter of 2011 at South Texas School of Law.There have been no changes in the fundamental dimensions of the applicable law. [2]Then again, an adjuster can be genuine (and/or sincere, for that matter) and beguilty of bad faith.  I “saw” this notlong ago.  The adjustment was passingthrough difficult stages: data collection and recollection, sworn proof aftersworn proof, equivocal indicators from the insurer, and statement from theinsurer which the policyholder took to be devious.  At one point he said the the adjuster, “I amthrough with your shell games.”  Theadjuster replied, “I will engage in shell games with you as often as I please.”Now there’s an adjuster who should be sacked forthwith.  Imagine how dreadful if a coverage litigatorsaid something like this in a deposition? 

 [3] Asa general rule, when testifying before a jury, experts on insurance—insurerconduct, for example—are not asked or allowed to testify as to the precisecontent of cases or statutes, per se. (Sometimes, when an expert is testifying before a judge only, theopposite may be true when the expert is acting as an explanatory witness abouthow insurance policies work; this is also frequently the case indepositions.)  It often helps for theexpert to have the short relevant sections of the pertinent statutes or lawphotocopied and on hand, as well ad a summary of the most recent pronouncementof—the elements of  common law bad faith(either off to the side or in “the” stack to be used anyway, or in one’spocket).  The same is true for lists ofall of those who are part of the cast of character in the pending case, as wellas the lawyers examining the expert witness. [4] See for example §§ 54l.060 and 542 ofthe Texas Insurance Code. This law is derived to some degree from modelstatutes, and many states have statutes like those of Texas and/or which aredrawn in whole or in part from the rule just mentioned. [5] This oneapplies to both small amounts and most interestingly to complex commercialcases. [6]This one might be described in the following slang, “Wow; Unreasonable,”  “By God! Unreasonable,”  “Intolerably unreasonable,” and so on.  [7]Here is amazing story which is difficult to believe.  My deposition was taken on April Fool’s Dayin 2011.  I asserted that in anadjustment process insurance carriers had a duty to be empirically-oriented,objective, and logical in their reasoning. Deposing counsel actually asked me what was my “authority” formaking that assertion.  [8] Ofcourse, complex adjustment processes will resemble construction projects.  They will never run on schedule.  But if everyone has laid out the plan andeveryone is working according to the plan agreed upon, bitter complaints andbad faith suits are less likely., [9] Recklessis still classifiable as unintentional, even though it is close tointentional.  Reckless conduct issomething like negligent conduct performed in the context of a flagrantdisregard of other’s rights, “I don’t give a damn,” or even worse, “F-them, Ido as I see fit without paying any one’s interests, except under my ownnarcissistic conceptions.” [10]And it is called for in most liability insurance policies.  Sometimes liabilities are also called“indemnity” policies.  Ignore thisdifference, except in some rare situations. Be sure adjusters and experts know what they are talking abouthere.  Perhaps the expert cannot testifyas to the semantic difference.  Semantics differences can be treated as matters of law.  This strikes me as unjustified. The usage andthe evolution of meaning is a historical matter, as a rule.  If an insurer has actually issued a real“indemnity” contract of insurance, this fact must be, and probably will be,clearly indicated in the policy.  In anycase an expert can testify to an insurer’s mistake in confusing the two terms,if it has influenced its behavior or indicates that the insurers’ rationale isunreasonably defective as to generally applicable knowledge.  (From now on we will refer to all adjustersand all experts as “he.”  It is notSexist in the slightest.  It is simplethat the word “he” is shorter and easier to type.)   In any case, observation in this footnoteapplies across the board.  Thus,explaining how an insurer misused the phrase “surety bond”—which is or is closeto a type of insurance–indicates that the insurer is ill informed, and thismay indicate something indicative of bad faith or something dangerously closeto it. [11] Totrigger the obligations of an insurer, notice is always required.  Under many or most circumstances, notice mustcome from the insured, or someone very close to that policyholder. [12] Atleast most jurisprudence (and therefore its courts) rejects the idea thatinsurers have a duty to make the settlement offer themselves.  An expert should not this mistake.  This is true though that some believe thatthis rule is a mistake—a legal mistake and a relatively “ancient,” uselessanomaly, which is nothing but insurer protective. [13] G.A.StowersFurniture Co.v. Am. Indem. Co., 15 S.W.2d 544 (Tex. Comm’n App. 1929,holding approved).[14] Iregard this as almost always as a bad idea for policyholder, even if it will not end up being a lack ofcooperation on the part of the insured. [15]Experts better know the accepted vocabulary difference and the unreasonablenessof an adjuster misusing these phrases. [16] Ofcourse, this insurance involves, it just isn’t tied to physical damage/injuryto tangible property. [17] Ofcourse this also looks like business interruption insurance.

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INSURANCE: BUILDER’S RISK & CONSTRUCTION COVERAGE

AN INTRODUCTION

Michael Sean Quinn[1]

Quinn & Quinn

1300 West Lynn #208

Austin, Texas 78703

(o) & (c) 512-656-0503

mquinn@msqlaw.com

(Resumes on Website:

www.michaelseanquinn.com,
or

simply as Michael Sean Quinn)

            We
begin with a story.   A couple borrowed a
lot of money to build a dream house in Orange County.
They borrowed almost $700,000 to do it, and the lender required that they
procure Builder’s Risk[2]
insurance, and at least one other policy. 
Construction began in 2002 and continued for two years.  In 2004, the couple noticed cracks in the
floor and then in the foundation and then in the retaining wall.  The cracks in the retaining wall got worse
over the next few months.  Severe rains fell
in early 2005, and these caused severe damage to the house.  The insurer was notified. 

            The
loss notice was timely and reported that the house next door was built up a
hill and had caused slope failure.  The
problems became so severe that the city ordered both houses demolished and the
insurer was notified.  The insured hired
an expert—and he really was an expert—who said that the house up the hill and
the insured house never should have been on top of landfills which had been
added on top of a place where there had been an “ancient landslide.”  The expert said that the 2005 rains were the
second immediate cause of the landslide.

            As
you might expect, the insurer denied coverage based on exclusions which were to
be found in the Builder’s Risk policy: 
The exclusions were these:

Earth movement,
Bad weather which causes the earth movement,
Acts or decisions of a governmental, regulatory,
or  controlling body, and
Faulty, inadequate, or defective planning,
development, surveying, siting, design, construction or grading.

The point is that none of the
things on this list are what builders do when building buildings, but what
other persons or entities do and for which they can procure a different kind of
insurance, to wit: relevant E/O insurance, e.g., with respect to design.  These are relatively standard exclusions in Builder’s
Risk insurance policies.  Some can be eliminated
by negotiation and money; some cannot.

            Still, does anyone reading this paper react to this story thinking that the characters in the story may not have been received complete and total justice?  Even the insurance agent walked away without
any liability. Is this story simply about the miseries of the adult lives of
the somewhat rich and not so famous?  Is
it about the wretchedness of a type of insurance to be found everywhere in the
English-speaking world?  Is it about how
much people need to be told about how many different types of insurance they
really need to buy if they are going to spend a lot of money on a construction
project?  Is it about how people should
approach asking their insurance agents for advice and information?  Is it about how to make sure all the people
who provide you construction services get sued if a project goes to hell in a
handbasket?  Is it about how to make
sure you have the right lawyer?  We shall
return to some of these topics in due course. [3]

I.                  
Builder’s Risk
– What Is It? An Introduction

These days Builder’s Risk insurance is a special form of property
insurance coverage that generally provides coverage for projects under
construction, renovation, or repair and insures against accidental losses,
damages, or destruction of property.   Usually,
Builder’s Risk insurance is nothing but first-party insurance—nothing but property
insurance.  This has not always been
true, and it is still not always true, but it is almost always true, and it is
all we will talk about.[4]  Builder’s Risk policies are not always
separate policies.  Sometimes they come
as endorsements to other policies. 
Obviously, this can be very confusing.[5]

Some say that Builder’s Risk policies are different from other property
insurance policies in that they try to provide coverage for a “moving target.”  This point here is that sometimes Builder’s Risk
insurance may cover a construction company that builds house after house after
house.  (The same point might apply to a
company that repairs one house after another.) 
Or sometimes it may cover a company that is building a huge building
that goes up floor after floor after floor after floor. Any of these, of
course, is in some sense a moving target.  (Of course, come to think of it, auto
insurance—in so far as it is property insurance—insures a moving target, as
does vessel, airplane, and rocket insurance. 
Then again, the word “moving” here is a paradigm of ambiguity.  So much for clarity!)

Here is an excellent summary of some of what has been said in the last
couple of paragraphs, although some of it is a bit exaggerated.  “Builder’s Risk insurance is a unique[[6]]
form of property insurance that typically covers only projects under
construction, renovation, or repair and insures against accidental losses,
damages or destruction of property for which the insured has an insurable
interest. [Citation omitted.] An ‘insurable interest’ includes ‘any lawful and
substantial economic interest in the safety or preservation of the property of
loss, destruction, pecuniary damage,’ [Citation omitted.] A contractor
obligated to repair or replace any damage to the building has an insurance
interest in the project.[7]     Similarly, a building contractor is obligated
to ‘secure and insure’ the project has an insurable interest in the building
during the course of construction.  A Builder’[s]
Risk policy ‘should be read, if it can be without twisting words and rendering
plain meaning nugatory, so as to protect the builder [against covered loss]”.[8]

Business Risk insurance, at least on building construction, is certainly
different from some property insurance in that business Risk insurance
automatically insures at replacement value. 
It is obvious why this would be true. 
It is insuring new property at the time it is new.  We shall return to this matter later.

Almost every construction project has, or is supposed to have Builder’s Risk
insurance. Virtually all lending entities require it.  Virtually all genuinely solvent and honest construction
entities which are anything but tiny have it. 
All lawyers advising clients considering having buildings they own
remodeled or repaired to any substantial extent should advise their clients to
demand it or get it themselves.

Builder’s Risk insurance is sometimes purchased by the construction
company and sometimes by the owner of the building or by the owner-to-be of the
building.  Sometimes it is even purchased
by this or that sub-contractor. Who does all this depends on the
situation.  Sometimes “the situation” is
more or less determined by the construction contract.  If a construction company is building a large
number of houses in a subdivision, it is likely to be the purchaser of the
insurance.  If the construction company
is working on building an extension for an already existing complex building
owned by a large corporation, the chances are that the property owner will
arrange for and buy the insurance.  Of course,
the construction company (or, companies) may have input.  Usually, the property owner, the construction
company, various subcontractors, perhaps lenders, and sometimes others may be
insureds of various sorts.  They may be
named insureds on some policies; named insureds and additional named insureds
on others; and named insureds and additional insureds on others.   Obviously, this can produce problems, now and
then.

II. What’s Covered?

Actual Construction Project.  The property covered under a Builder’s Risk
policy usually includes the structures being built, the structures upon which
work is being done, sometimes structures quite close to the structures just
mentioned (sometimes not), foundations, materials that have not yet been incorporated
into the structure but are on-site, materials being moved on-site that will
ultimately be used in construction but are not yet on site, scaffolding, movable
warehouses, lawns, trees, plants, and yet other temporary structures may also
be covered by the policies, some of which may be subject to sub-limits.

Repair or Remodeling Projects.  Where the property being insured is
already erected and is only being repaired, renovated, or remodeled, the only
property that is insured under the Builder’s Risk policy is the new materials
being used and incorporated into the existing structure.  Building contents are not usually covered
without an endorsement. And why would there be an endorsement; who would need
one?  People usually have insurance on
that anyway. The same thing is true for original construction as well.

III. What Is Not
Covered?

In general, the equipment and tools of the contractor and the
subcontractors are usually not covered in standard forms, although they can be if there is an endorsement
or language to change this.  (In addition,
a crane used by the contractor to build the structure, but not intended to be
incorporated within the finished structure is not covered by Builder’s Risk.[9]   Presumably, it would be much more difficult
to get an endorsement for a crane than a hammer or a saw.)

If requested, other risks can be covered by variant policies or endorsements.  Often these are subject to additional prices
or fees, and there are sub-limits.  The
point here is that some of these things are—or at least classically were― not
actually to be found in exclusions.  They
were simply not found in coverage and were therefore not covered.  Here are some of them:

·        
Pollution cleanup

·        
Terrorism Risks

·        
Additional material transits (if there were
limits in the policy)

·        
Additional material storages (if there were
limits in the policy)

·        
Weather problems

·        
Earthquake coverage

·        
Flood coverage

·        
Blanket model home contents coverage

·        
Soft Cost Coverage (here is the additional cost
to pay attention to – and it is discussed in its own section below).

With respect to being found in exclusions or simply not being found in coverage the times
are changing.  Many insurers in many
policies these days are going out of their way to mention explicitly everything
(or at least more things) they want to make sure no one will think—or no one
will spend a lot of money trying to argue—is found in coverage.  The dangers are something like this.  First Argument:  You—insurer—have included something like X, namely Y.  One of the terms you used
to describe Y is ambiguous and may
be interpreted to include X.  (Anyone can see that from reading the
novels of George Eliot.) Second Argument: You—the insurer—sell another
insurance policy that includes X, so
even though you did not explicitly include it here, it is implicitly included.  Otherwise, you are either trying to cheat me
or you are trying to defraud me or you are committing bad faith—whichever.

            One kind of weather problem is rain,
and it has been listed as a cause that is not covered under some
circumstances, at least historically, although routine rain has not been a
significant matter from a coverage litigation point of view.  In other words, there have not been very many
reported cases.  Here is a typical “We
will not pay clause” or “This is not a covered cause” clause:
Rain,
snow, sand, or dust, whether driven by wind or not to the interior of any building
or structure or the property inside the building or structure, unless the building or structure first sustains
damage from a covered peril to its roof or walls through
which the rain, snow, sand or dust enters.

At least some of
the reported cases have involved temporary “roofs”—canvas tarps, and that sort
of thing.  In one case a state supreme
court found coverage when a sudden wind storm blew off a new addition to an
old building and a rainstorm that followed immediately did damage to some of
the contents of the older building.[10]

            In a more recent rain case, the
court sided with the insurer, and explicitly rejected the case just discussed
as authority.  The case of Aginsky v. Farmers Insurance Exchange.[11]  Owners of apartment buildings decided to
reroof them.  Property insurance was
purchased.  It is not clear that it was a
Builder’s Risk policy, but it was quite similar, in any case.  The roofs were removed, but the city “red-tagged” the buildings for some reasons pertaining to worries about structural
problems, and the projects came to a standstill. Naturally, tarps were put in
place.  Alas, high winds came and rainwater penetrated, so that water entered at least one of the buildings.

            The building owners sought
coverage.  The insurer denied it on the
basis of exclusion similar to the paradigm set forth above. And litigation
ensured.  This litigation contained a
twist.  It was such that the classic issue
of permanent roof versus temporary roof was never reached. The policy at issue in this case required that an actual roof of some sort be involved.  One of the issues in this case was whether a
temporary substitute, like a tarp, could be a roof at all, under Oregon law.  The court cited cases from California,[12] Mississippi, and Florida for the
proposition that tarp substitutes are not roofs.  The cases convinced the court.  The term, he said, is not even
ambiguous.  Tarps are simply not even
roofs.  A temporary roof is a “wooden
framing” of some sort and a “plastic tarp would not be considered a ‘roof’ by
any reasonable person.”[13]

            One of the most recent of these
cases resembles the case just discussed, except that it was a 20 story
condominium tower, and the construction contractor had settled, so that only
the property owner was left to adjudicate anything.[14]  In any case, the case involved virtually no
factual controversies; there were stipulations or agreements to virtually all
the facts. Rain came through preexisting openings in the building under
construction—whether where roofs or windows would be—which were covered by
tarps.  The court decided the case just
as the Oregon
court had, although the Nevada
court did not cite the Oregon
court.  Both agreed that there was no
roof, and hence no roof failure of any kind and both agreed that the California decision upon
which the Oregon
court had relied—the Diep case―was
the decisive case.

            The last bullet—Soft Costs—is the
topic most discussed by commentators these days, so we will return to it
briefly later, both in our discussion of exclusions and in a final discussion
of a particular case.

             For now, let us take a look at material in
transit as opposed to material in the contractor’s warehouse.  There is a neat Texas case precisely on this point, which
may have avoided stating its real motivation. 
 The case was United Stated Fidelity and Guaranty v. Hutson Construction Company, Inc.,[15]
which concerned a construction project in Paris,
Texas.  Paris is a smallish city in northeast Texas about
105 miles from Dallas and about 112 miles from Duncanville, a good sized suburb
that is south and very slightly west of (much of) Dallas.  Hutson was building a new building in Paris, and it had Builder’s
Risk insurance with limits of liability of over $338,000 if property was lost
while at the Paris
premises.  The policy covered losses of
property while in the “due course of transit,” although there was a limit of
$5000.

            Hutson purchased copper wiring for
use in the building.  It purchased it,
not all at once, but in smaller quantities. 
(We speculate that it did so in order to get better prices, or perhaps
better wiring.)  In any case, Hutson
stored the wiring in what it said was a designated location in a warehouse in Duncanville.  Alas! There was a theft, so Hutson made a
claim under the Builder’s Risk policy, surely ―in part― because it had not
purchased other insurance upon the wiring.  The carrier denied coverage, since the wiring
was not in transit, but the trial court agreed with Hutson.  The Dallas Court of Appeals, however, agreed
with the carrier, and the Texas Supreme Court agreed with the court of appeals.

            Here is the reasoning of the court
of appeals.  The meaning of the phrase
“in transit” when it comes to property was decided by the Texas Supreme Court
long ago in the case of Amory
Manufacturing Co. v. Gulf C. & S. F. Ry.,[16]  where that court drew a distinction
between “in transit” and “in transitu.”  The former phrase, held the court, meant,
“having been set in motion towards its destination” whereas the latter phrase
included being readied to be set in motion and would therefore include, for
example, sitting on a railroad platform. 
Lower Texas courts have followed this
precedent for many years.  Goods in
storage waiting to be shipped, for example, have been held not to be in
transit; they are not “in [the] course of passing from point to point.”[17]  (Of course, movement is not the only
issue.  In one case, a truck arrived at
the delivery point, but the building was closed, so the truck pulled up to the
loading dock and was locked.  Thereafter,
over the weekend, the theft occurred. 
The insurer denied coverage.  The
court held that the goods were still in transit and that the seemingly
precedential cases did not apply.[18]

IV. How long Is This Type of Policy In Force?

Builder’s Risk
coverage is not permanent coverage and provides coverage only during the
“course of construction.”  The coverage
period for a Builder’s Risk policy depends on the language of the policy
itself, as well as the contract between the property owner and the
contractor.  The language of the policy
is not always crystal clear.

      Some of these policies are blanket
policies, in the sense that they cover multiple projects, some are single
project policies.  Some of them last for
particular periods of time; some of them do not.  All of them which specify particular periods
of time usually specify a year or two. 
Virtually all that specify a year, at one point in time, had an
automatic and enforceable extension if a covered ongoing incomplete project or
projects come at the end of the year. Obviously this can be a problem.  This can be particularly true if the insured
contractor has run out of money, has been misbehaving in some relevant manner,
if the property owner is troublesome in a relevant way, and so forth.              Nowadays,
many of these policies have a number of termination dates built into them.  Insurers like to take the view that the first
one to be satisfied terminates the policy. It is an interesting question
whether this is really clearly set forth in the policy.  It is also an interesting question whether
this fact—if it is a fact—is made clear to policy purchasers, much least to
each policyholder, or even each significant policy holder, such as the owner,
the lender, and the general contractor. 
Let us take them one by one, and see what we end up with.

Beginning.   A policy might run for the length of time it
takes to build a building but not longer than X days after the beginning of the project. The start date for coverage may begin on the first day of
construction, or may even begin before the construction has actually or officially
started, providing coverage when the contractor is in the preparation phase,
e.g., when material has begun to arrive on the premises.[19] 

      End.  When
coverage ends can be a point of dispute between the insured and its carriers.  A Builder’s Risk policy may provide that
coverage ends on a date certain or upon the happening of a certain event such
as occupancy, owner’s acceptance, date on which the construction contract is
complete, or date certificate of occupancy is issued by a government agency – or
it may not provide any termination date. 
The determination of when a building is “occupied” or when construction
is “completed” has been addressed by many courts.  Courts have consistently held that a building
is “occupied: or “completed,” and the Builder’s Risk coverage terminates, only
when the building is ready for its “intended use.” Often this means that it
must really be completely ready.  If the
punch list work isn’t done, the construction or similar type work isn’t done.[20]    

      Here is a summary of some of
the main triggers which have ended Builder’s Risk policies.

·        
The interest of the insured  terminates,

·        
Occupancy begins,

·        
The project is abandoned,

·        
A number of days specified in the insurance
contract pass after required testing,

·        
The expiration date of the policy,

·        
The property is accepted as finished by the
purchaser, and/or

·        
X days
(usually 30, 60, 90 days) after construction is complete.[21]

            Regardless
of the actual event that triggers the termination of Builder’s Risk coverage,
it is imperative that the owner purchase property and fire insurance to provide
coverage once the Builder’s Risk insurance expires.  Overlap is probably safer that trying to get
it exactly right.

V.            
How Do
Policies Cover Loses?

Builder’s Risk
policies cover fortuitous losses resulting from damage to the construction,
unless excluded.  There are two types of
policies.  They can be either “all Risk” policies, like most standard property policies, that insure
all Risks not specifically excluded from the policy or “named-peril” policies, only providing coverage for specific perils
set forth in the policy.  One does not
see “named peril” Builder’s Risk insurance policies these days very often,
although there are no doubt some out there. 

      Here is some standard “all Risk”
policy language “Section I insures against all Risk of physical loss of and/or
physical damage to property covered hereunder, provided such loss or damage
arises from an Occurrence within the Policy Period. . . .” [22]  When the language is all risk, it thereby
includes any fortuitous cause of loss while construction is going on fire,
theft, vandalism, accident, etc.  Notice
that the word “fortuitous” is restricted to the insured.  Someone else—entirely outside the control,
and perhaps the knowledge of the insured—can do something deliberate, and that
would be considered fortuitous. 
Fortuitousness is to be judged from the point of view of the
insured.  If there is a string of
insureds, what is fortuitous from the point of view of one insured may not be
from the point of view of another, depending upon what they all know about what
is going on.

      Here is some standard “named
peril” insuring agreement language.  It
is to be found in a standard policy.  ‘We
will pay for direct physical loss of or damage to “Covered Property at the
premises described in the Declarations at the premises described caused by or
resulting from any Covered Cause of Loss at the premises described in the
Declarations caused by or resulting from any Covered Cause of Loss.’  The capitalization of letters in this policy,
as in many policies, usually indicates that the terms are defined terms; thus
the phrase ‘Covered Cause of Loss’ is a defined term, and there is a whole
several pages listing covered causes of losses. 
Of course, policies are not always consistent on this point.

      To determine whether a loss is
fortuitous, and therefore covered by the policy, courts must determine whether
the loss resulted from a “chance”-appearing event—chance-looking, that is from
the point of view of the person sustaining the injury or loss, rather than one
that was deliberate, intended, planned, or quite within the control of the
insureds.  As in a standard property or CGL policy, losses that result from the principal
insured’s intended misconduct will not be covered under the Builder’s Risk
policy. (Problems can arise here.  What
if an insured subcontractor hates the contractor and burns down the building
under construction in the midst of the construction project?  Can the owner recover?  Can the contractor?)

VI.         
What Is Most Commonly Excluded From Coverage?

            Think about the organization of the
paper this way.  Section IV,  “What is Not Covered,” was about the natural
events and natural forces which are not included among those things which are
not covered.  This section is about those
activities of insureds, or other facts and factors, which can defeat or stand
in the way of coverage. Oh unhappy day!

A. Range of Exclusions. 

There are several standard exclusions in Builder’s Risk policies.  Some of the most common and often litigated
exclusions are those relating to faulty workmanship, faulty materials and
defective design.  This insurance is for
bad and injurious stuff which happens during the process of constructing,
renovating, or repairing a building, not stuff that happens before that. It is
not for manufacturing errors committed by companies that make that which the
builder buys and uses. It is also not for professional errors in design, even
if the builder did the designing; of course, that is often not so and it was
done before construction began.  Besides,
it is not building, and that is what
is insured.

An interesting
and unpublished opinion involving Builder’s Risk exclusions is Indian Harbor Insurance Co.  v. Clarinet, LLC.[23]  Clarinet purchased a near century-old building
in St. Louis in
order to convert it into luxury apartments and retail/commercial space.  Clarinet applied for and purchased a Builder’s
Risk policy from Indian
Harbor.  A year or so into the project, a storm passed
through St. Louis
and the building partially collapsed.  A
claim was made with Indian
Harbor and they denied
coverage.  Although windstorm damage was
covered by the policy, Indian
Harbor took the position
that the collapse was caused, not by wind storm, but by the following:

·        
Inadequate, faulty or defective workmanship;

·        
Methods of construction;

·        
The building was not maintained in a reasonable
condition; and

·        
Failure to provide adequate bracing to the
structure.

The policy stated
that coverage will not be provided where the loss results from, “rust or other
corrosion, decay, deterioration, hidden or latent defect or any quality in the
property that causes it to damage or destroy itself.”[24]

      The Court’s opinion focuses a great deal
on whether the loss was, in fact, caused by a windstorm, and what if, any effect
does it have on coverage if other, specifically excluded, “causes of loss” were
involved.  The Court ultimately held that
when given its plain meaning and considering the policy in its entirety, a
windstorm, which is a Covered Cause of Loss, need not be the sole cause of the
collapse of the building for coverage to exist.[25]  Furthermore, according to the Court to the
extent the policy is ambiguous in regard to whether an exclusion applied, where
a Covered Cause of Loss (such as wind) is also a cause of loss, the ambiguity
must be resolved in favor of the insured; Clarinet, in this case.[26]  Thus, in order to be a covered windstorm, the
windstorm must have been a “substantial factor” in bringing about the collapse
of the building.[27]

Let us take a
look at these exclusions—the ones we just mentioned―in what we shall call ¨real
[that is, litigation] life.¨ Then we shall look at some others.

B. Faulty Design. 

Insofar as these exclusions appear in policies covering builders keep the
following in mind.  To be sure, exactly
these words appear in the exclusionary sections of Builder’s Risk
policies.  The reasons for this exclusion
are two.  First, contractors do
not—indeed, almost never—design the buildings they build.  Second, if they do build them, they do it
before they build them.  One wonders what
would happen if a contractor did actually design a building, and then had to
change the design in the middle of construction.  Would this not be part of the building
process?  What if the contractor’s
design accomplished during construction was disastrous and caused
problems, should that not be covered? 
Clearly, it is not![28] 

Now let’s start over again. 
Builder’s Risk insurance policies often insure property owners while
construction projects are proceeding or while renovation, expansion, or repair
projects are proceeding.  Such
undertakings may all involve design.  And
of course, the faulty design exclusion will deny the property owner coverage no
less than it would deny the builder coverage. 
An interesting example of this is a commercial-industrial Texas case from the
1980s involving a huge addition to an oil refinery in Corpus Christi.[29]  This case involved an all-risk Builder’s Risk
insurance policy with a faulty design exclusion, where the exclusion did not
“exclude physical loss or damage arising as a consequence of [for example] that
faulty. . . design.”  Interestingly, that
appears to have been exactly what happened in this case.  Part X was
faulty design; its installation caused rust and corrosion on part Y, which would normally have been
excluded, and that lead to other losses. 
Rust and corrosion would normally have been excluded.  But, at least at that time, under Texas law,
at that time, if an excluded peril was caused by a peril which was not
excluded, but covered the excluded peril was not excluded, so at least part of
the loss was not excluded.  And that part
of the loss was absolutely enormous.[30]

C. Faulty Workmanship.

First-party property insurance policies, in general, do not provide
coverage for property damage directly caused by contractors of virtually any
sort working on insured properties.  In
other words, faulty workmanship is quite often a standard exclusion in
virtually all kinds of property policies.[31]  We have difficulty understanding why a
property owner cannot obtain coverage against an accidental loss caused by
someone, say, repairing the roof of his house who fouls the whole thing up
injuriously so that the job has to be done again.  That is surely physical injury to tangible
property.

            In any case, Builder’s Risk
insurance policies are, quite often, no different from other property
insurance in this regard:  faulty
workmanship in such cases is not covered. 
This is true whether or not the general contractor or any sub-contractor
is or is not covered.  The property owner
may alone be covered.  There is no
coverage for direct physical injury caused by faulty workmanship, although
there may be coverage for physical property damage caused by the faulty
workmanship itself.  Thus, if the roof is
poorly done, and it rains, and it floor is injured, the floor may be
injured.  And so forth.  Then again, if there is no explicit exception
to the exclusion of the sort just laid out, there will be no coverage
whatsoever.  Here is an example of such
policy language: there is an exclusion for “[t]he cost of making good any
faulty or defective workmanship or material. . . .”[32]

            There are other types of cases, of
course.  In one significant case, the
Builder’s Risk policy covered only the general contractor.  Only the faulty workmanship—or any
activities—of its employees were subject to the policy terms, including the
exclusions, such as the faulty workmanship exclusion.[33]  (This case involved welding at a gigantic
public facility in El Paso.)

            The court in the Kroll Construction case found a way to
be helpful to the general contractor. 
The exclusion did not exclude coverage for “physical damage directly
resulting from such faulty or defective workmanship or material[,]” and it turns out
a gigantic portion of the contractor’s expenses were taken up with that,[34]
so he got some judicial help.

            Sometimes, the phrase “faulty
workmanship” is found to be ambiguous. 
Sometimes it is found to refer (i) the quality of a finished product,
and sometimes it is taken to refer to a (ii) flawed process.[35]  Obviously, if it referred only to a finished
process, then a failure of a roofer to put a temporary cover over a partially
completed job for a night could not be faulty workmanship.  In our view, this particular argument over
ambiguity is nonsense.  What the phrase
means depends on the context in which the problem of injury arises.  The Ninth Circuit did not agree and reversed
the District Court.  It held that there
had to be a flawed product in order for there to be flawed workmanship, and
that means that alternative (i) by itself is correct.  Of course, that is the alternative       favorable to the insured, and the
insurer had to pay the property owner to the extend consistent with the policy.

            One of the most interesting of these
types of cases is Otis Elevator Company
v. Factory Mutual Insurance Company,[36]  wherein
Otis had been retained to build and finish a tram system in a large
airport, and had naturally had utilized a prominent subcontractor to help it,
which had, in turn, hired an individual sub-subcontractor to help them both.  The latter and foul-up, doing considerable
damage to the tram-cars which were being tested and to other parts of the tram
line.[37]

            The court refused to rely on the
faulty workmanship exclusion, since the faulty workmanship of the suburb did
not directly cause any physical damage directly to the tram cars or anything
else.  Of course, the negligent
workmanship of the “sub-sub” was such that the tram car should never have been
accelerated to “full-speed-ahead,” since it had no effective brakes at that speed
(or any other), but the faulty workmanship of the sub-sub, did not directly
cause physical injury to the car itself.[38]

            For the lawyer representing an
insured, it is worth keeping in mind that workmanship exclusions are written
quite differently and various Builder’s Risk policies.  This means that different policies present
different litigation possibilities.  We
ran across a policy recently in which the workmanship exclusion worked this
way:  “the insurer excludes liability for
faulty design, specifications, workmanship, surveying, engineering, material
selected and delivery,” etc. Arguably this restricts the excluded workmanship
to that which occurs before actual physical building begins.  This is rare, of course, but it is a genuine
possibility.

      We have also noticed that
controversies over workmanship exclusions occur most frequently, when we are
dealing with all-risk property policies, including Builder’s Risk policies.  We are not clear about why this would be
true.  Maybe it is because there was
more of them at least at one time. 

VII.       What Is the “Soft Cost” Problem?

Builder’s Risk
coverage is intended to reimburse for additional expenses, incurred after the
project would have been completed if no loss had occurred, and resulting from a
delay in the completion of the project, caused by direct physical loss or
damage from a covered peril.  It is often
said that “hard costs” are associated with the “sticks and bricks” of a
project, the “soft costs” coverage is extended to a very specific list of
construction overhead costs and expense categories and can often be selected by
the insured a the time of application. 
Categories of soft costs can include:

·        
Interest on construction financing

·        
Real estate taxes

·        
Marketing and leasing expenses

·        
Architect, consultant, engineering and developer
fees

·        
Construction general conditions

·        
Bond and permit fees

·        
Testing and inspection fees

·        
Bank and letter of credit fees

·        
Administrative costs, licensing, and permits

·        
Legal and accounting

·        
Commissions for re-negotiations of leases

·        
Insurance premiums for Builder’s Risk, Workers
Compensation and General Liability.

As you can see, soft costs are not
necessarily incurred in connection with the actual process of repairing,
rebuilding or replacing damaged property and may also include business
interruption and other time element losses. 
Soft costs seem to have become an increasingly important component of Builder’s
Risk claims.  This is especially true in
the case of long-term projects involving complex financing arrangements where
an insured’s cumulative claim for additional costs resulting from project
delays, extra expenses and lost rental income may equal or even exceed the hard
costs of labor, materials, and equipment incurred in rebuilding damaged
property. 

            The
case that brought the issue of soft costs into the forefront (and presumably
sent shock waves through the insurance industry) is Zurich American Ins. Co. v. Keating Building Corp.[39]  Prior to this case, it appears that
courts had little occasion to provide guidance on which delay and soft costs
are covered under standard Builder’s Risk policy forms and endorsements or,
when coverage was determined, how the specific costs are to be measured.[40]  The court in Keating applied basic principles of general contracting and policy
interpretation and held that a standard Builder’s Risk policy provided coverage
for three standard categories of soft costs – 1) extended general conditions;
2) delay costs and 3) price increases.  
This was decided despite limiting language in the policy’s coverage
agreement and an exclusion for consequential losses. 

            Prior
to Keating, courts had provided
little, if any, guidance on which delay and soft costs are covered under
standard Builder’s Risk policy forms and endorsements.  Also missing was any discussion or direction
on how specific costs should be measured. 
The District Court of New Jersey applied basic principles of general
contract and policy interpretation and held that the standard Builder’s Risk
policy provided coverage for three categories of soft costs:

Extended general conditions
Delay costs
Price increases

Perhaps the most impactful of this
ruling was that coverage was found to exist for these damages despite limiting
policy language and a broad consequential loss exclusion in this particular
policy.  The policy involved in Keating was an “all Risk” policy as
opposed to one written on a “Named Peril” basis.[41] 

            This
suit involved an expansion and renovation project by the owners of the
Tropicana hotel and casino in Atlantic
City, New Jersey.  Keating was hired as the general contractor
on the project which was scheduled to be completed some time in the first
quarter of 2004.[42]  The work included a three-floor dining,
retail and entertainment space topped by a seven-level parking garage and
seventeen additional floors of hotel rooms. 
   

            Before
construction began, Zurich
issued a Builder’s Risk policy covering both the project owner and the general
contractor for losses arising out of an accident.  This policy contained a Policy Valuation
Clause providing that Zurich
would only cover costs to “repair or replace property lost or damaged
at the time and place of loss with materials of like kind and quality.”[43]  The policy also expressly excluded damages
“caused directly or indirectly and/or contributed to, in whole or in part” by
“consequential loss, damage or expense of any kind or description including but
not limited . .. penalties for non-completion, delay in completion, or non-compliance with contract conditions . . . .”[44]  Finally, Zurich’s policy included a “Delay in
Completion” endorsement insuring the owner, but not the contractor or any of
the subcontractors, against the loss of gross earnings, rental income and “soft
costs/additional expenses” associated with a delay in the schedule.[45]

            In
October 2003, a portion of six floors of the garage collapsed on top of the
three-level retail, dining and entertainment complex.  The collapse caused significant damage and
numerous injuries, including four deaths, to construction workers.[46]  Keating, the contractor, submitted a claim
under the Zurich
policy for costs that it claimed resulted directly from the accident, such as
debris removal, repair of the garage, and increased construction costs due to
delay.    The owner submitted its own
claim under the “Delay in Completion” endorsement for losses it allegedly
sustained as a result of delay in finishing the project, mostly lost rental income,
other lost hotel revenue and was subjected additional financing costs.[47]  The claim totaled $80 million for the eight-month delay and the cost increase.

            Zurich paid half of the
claim but refused to pay the remainder. 
According to Zurich,
the delay claims were not covered because the insuring provision language was
limited to the costs to repair or replace the damage portion of the project and
did not extend to increased costs needed to complete construction of the
undamaged property.[48]

            The
Court rejected Zurich’s
argument and held that the policy covered all of the disputed categories of
soft costs.  There were several reasons
for the Court’s conclusion.  First, the
Court began with the proposition that the policy was an “all Risk” policy,
insuring against all risks of direct physical loss or damage so absent a
specific exclusion the policy covered all
fortuitous losses proximately caused by a covered peril.  Second, according to the Court, the policy
did not distinguish between losses resulting from damage and undamaged portions
of the property and insured damage at the entire insured project, not just the
area of the project where the accident occurred.[49]  Finally, the Court stated that Zurich could have limited
the coverage under its policy by including restrictive language to the effect
that only repair costs were covered, but it failed to do so. 

            Regarding
the policy’s consequential loss exclusion, the Court adopted the so-called
“efficient proximate cause” doctrine, which provides that coverage is available
if the covered peril was the efficient proximate cause of the loss and an
excluded peril merely occurred in the chain of events that followed.  The Court also stated that the types of
losses excluded in the policy – “liquidated damages,” “performance penalties,”
“loss of market or delay,” and “penalties of non-completion, delay in
completion, or non-compliance with contract conditions” – were purely economic
losses separate from regular construction costs.[50]  The Court held that to extend the exclusion
of consequential losses to include regular construction costs incurred to
complete the project was impermissible and unwarranted under the New Jersey rule
requiring narrow interpretation of exclusionary language.[51]  The Court held that Zurich must pay the extra costs that the
owner paid to complete the project, without regard to whether the costs involve
work at the project away from the immediate are of the collapse.[52]

            The
impact of Keating (decided in 2007)
may not be fully known at this time.  The
case has been cited four or five times (for the “efficient proximate cause”
doctrine and basic construction of ambiguous/unambiguous policy language
discussions), but the decision has not been fully scrutinized as to its all-encompassing
soft costs ruling. After Keating, it
could be that soft costs, whether incurred on or off –site will be recoverable
even though they would appear to fall squarely into the category of excluded
consequential losses.  Also, the court
held that those costs were recoverable under the property damage coverage even
though they are more in the nature of time element costs that grow with
time.  Traditionally, time element
coverages are subject to a very different set of limits and deductibles to
control costs and prevent any incentive for insurers to claim coverage for
project delays resulting from other causes or even non-covered perils.

            It
has been noted that some insurers have altered policy language in an attempt to
better control soft cost exposure.  These
policies provide coverage for all soft costs under a general “Delay in Completion
Coverage Part.”[53]  Obviously, insurer’s are trying to create
policy language that will provide them with better control over their exposure
and define exactly what “soft costs” are covered and to what extent.
   

VIII.            
The Question
of Appraisals?

Most
property insurance policies and homeowners policies, for that matter, contain
appraisal clauses.  For a lengthy discussion of  appraisals in general, there are four other blogs found in “Quinn’s  Commentaries on Insurance Law.”  Each is entitled “The Insurance Appraisal Process.”        (See 9/2/13 and 9/4/13.) Builder’s Risk policies uniformly contain appraisal clauses.  The basic Builder’s
Risk coverage form includes the following “Loss Condition”:

2.                 
Appraisal

If we and you disagree on the value of the property or the amount of
loss, either may make written demand for an appraisal of the loss.  In this event, each party will select a
competent and impartial appraiser.  The
two appraisers will select an umpire.  If
they cannot agree, either may request that selection be made by a judge of a
court having jurisdiction.  The
appraisers will state separately the value of the property and amount of
loss.  If they fail to agree, they will
submit their differences to the umpire. 
A decision agreed to by any two will be binding.  Each party will:

a.     
Pay its
chosen appraiser; and 

  

b.     
Bear the
other expenses of the appraisal and umpire equally.

If there is an appraisal, we will still retain our right to deny the
claim.

            No
court in the State of Texas
has examined the appraisal clause in a Builder’s Risk policy.  However, the Texas Supreme Court recently
upheld an appraisal clause in a homeowner’s policy in State Farm v. Johnson.[54]  The Johnson
case involved a claim of hail damage to the roof of the insured’s house.  State Farm’s inspector and the insured’s
contractor disagreed on whether the roof needed to be repaired or
replaced.  The insured, Johnson, demanded
appraisal of the “amount of loss” under the standard appraisal clause, similar
to that quoted above.  State Farm refused
to participate in the appraisal process asserting that the parties’ dispute
concerned causation and not the amount of the loss.[55]

Johnson filed suit seeking to
compel the appraisal. 

            The
Court granted State Farm’s petition to decide whether the dispute fell within
the scope of the policy’s appraisal clause. 
Historically, courts held that the scope of an appraisal clause is
limited to damages, not liability – although the line between the two is not
always clear.[56]  According to the Court in Johnson, even when
the parties’ dispute involves causation, there is not necessarily a question of
liability vs. damages because causation can relate to both, relying primarily
on Lundstrom v. United Services
Automobile Ass’n.[57]   The Johnson Court wrote:

If State Farm is correct that
appraisers can never allocate damages between covered and excluded perils, then
appraisals can never assess hail damage unless a roof is brand new.  That would render appraisal clauses largely
inoperative, a construction we must avoid.

IX.               
Subrogation & Waiver

There
are very few reported subrogation cases involving Builder’s Risk insurance.  What not?  There are three reasons.

Settlement. If there is subro cases that cannot be gotten rid of on technicality, the case may well settle. If it is not  “humongous”  it will not be in the papers, the trade publications, nor the rags.

       Waiver. A great many construction contracts include waiver clauses in which at least one of the parties, in effect, bars itself form from successfully suing and recovering any other party to the contract for injuries or damages it may have caused.  This is in fact standard fare.  It is worth remembering that one main ideas built into the idea of waiver, although not the only one, is that the person doing the waiving is giving up one or more known legal rights.

It is important for builder’s risk insurer to determine whether it has a subro case against whoever caused damages to the building it insures. A can have a subrogation action against a person that injured its insured, only if it can “step into the shoes” of its insured.  If the insured has waived a right to recovery, then there are no “shoes into which the carrier can step.” 

The idea of one of the principal issues that come up in builder’s risk subro litigation is not so much whether there has been a valid waiver of somebody, although there can be a controversy as to who is actually included in it. One of the issues involves the extent of the waiver.  What all injuries are covered by the waiver is the question.  This issue is to be resolved by the waiver clause in the construction contract. 
    Here is part of a typical waiver clause, although, of course, not the only one: “Notwithstanding any other provisions contained in this Contract, the Owner and the Contractor each waives all rights against each other and any of their agents and/or employees, each of the other, from damages caused by fire or other perils to the extent to the extent covered by property insurance obtained pursuant to this Contract or other property insurance applicable to the Work. . . .” Why the clause proceeds in terms of “fire or other perils” is a mystery to me; “all perils covered by” would work just fine.
In recent years, one of the principal issues in this sort of insurance litigation is whether the waiver covered only property damages (physical injury to tangible property) directly connected to the “Work,” i.e., that which was established by the terms of the contract as that which the contractor was to do.  Naturally, the builder’s risk insurer wants the waiver to be as narrow and restricted as possible. 
The courts are going the other way.  Although they are reasoning not explicitly as follows, here is the basic idea.  The policies are perfectly clear that the waiver extends to all property insurance policies any part of which is applicable to the “Work” however that meaning of that term is sketched in the policy.  If a policy is applicable to any extent and it covers the loss in dispute, the waiver applies. American Zurich Insurance Company v. Barker Roofing, L.P., 387 S.W.3d 54 (Tex. App–Amarillo 2012, no pet.). (The abbreviation “no pet.” means that the party that lost in the Court of Appeals did not appeal to the Texas Supreme Court.) See Security National Insurance Company, v. Briohn Building Corporation, 2012 WL 5439017 ()(Judge Stadtmueller being more sympathetic to the insurer’s point of view, but regards himself as being controlled by clear Wisconsin law.) 
    The Barker Roofing illustrates the reach of the courts’ positions.  It explicitly says that business interruption is within the waiver.  The reason is that BI claims are inherently connected to property damage.  For that court, this connection was enough, and the court was right.
    The position reflected in these two cases will be the controlling law until the standard construction contracts change their waiver clauses, and this is not likely to happen any time soon. The result in these two cases is–and has been for a long time–so obvious, it is hard to see why insurers are contesting it. 
Same Insurer. At least under many circumstances, all of the parties participating in
the covered project are insured by the came carrier. 
Therefore, there would be no reason for subrogation.  However, with different circumstances, where
fault could be placed upon a party not involved in the project, there is no
reason to believe that a Builder’s Risk insurer would not have the right to
subrogation, barring some statutory or common law exclusion of such subrogation
cases.[58]
On final point on the matter of waiver should be mentioned.  Usually, these subrogation case not an insurance company against an ordinary person.  Usually it is a property insurer against another carrier–a liability carrier for the named defendant.  

X.       Valued Policy Statutes

Many states,
including Texas,
have what’s called “Valued Policy” statutes.[59]  These statutes typically apply to fire
policies and provide that when a total loss is decided, the insurer is required
to pay its policy limits to the insured. 
There are very few opinions addressing similar statutes and Builder’s
Risk insurance.  However, on at least two
occasions, courts have held that Builder’s Risk policies are exempt from these
statutes.[60]

XI.        Conclusion

            This paper began with a story.  The story was designed to make it appear as
though the event happened in or around Jefferson County in Texas.  They well could have since Builder’s Risk
insurance policies are roughly the same all over the country.  It was also designed to express our puzzlement
over property owners not being able to obtain first-party property insurance
for their property when general contractors injure their property.  They can, of course, sue the contractor for negligence,
but it cannot obtain liability insurance for its own negligence, although it
can sue a subcontractor, and may have liability insurance for its negligence in
not having sufficiently looked out for or carefully supervised the
subcontractor, assuming he, she, or it was guilty of negligence.

            Our attitude here is not just
puzzlement.  It is disagreement.  We think there should be coverage available
for this sort of thing.  There is no
reason it should not be available, and there are good reasons it should be
available. The case which provides the basis of the story is a California
case.  It is Roberts v. Assurance Company of America, a paradoxical name for
this particular insurance company, as a trip through the last several years of
WestLaw cases will show you, and the case may be found at 78 Cal.Rptr.3d 361 (Cal.App. 2008).

[1] This
was originally a CLE presentation to a Texas audience. Texas law regarding these policies is not atypical.   No significant cases have been decided in or
about Texas since that presentation. It was done with the assistance of Susan
Scott Hayes.

[2]
Regarding formality, there are many variations on how this insurance is
titled.  For example, sometimes both
words are capitalized, sometimes not, sometimes “builder” ends with an “’s”
sometimes an “s’” and sometimes there is no apostrophe at all.  In this paper, we have aimed for consistency,
but we may not always reach our goal. 
Needless to say, no matter how it looks, it refers to the same thing.

[3]
Actually, not all Builder’s Risk insurance is only used for construction,
etc.  Sometimes these policies are used
for other things, e.g., for vacant buildings. 
Johnson v. Essex Insurance Company,
2002 WL 112561. (Tex.
App. – San Antonio 2002, no writ).  This
fact has nothing to do with the true purpose of Builder’s Risk insurance,
properly understood.

 

[4]
See Wellington Underwriters Agencies Limited v. Houston Exploration Company, 267 S.W.3d 277 (Tex. App.—Houston [14th
Dist] 2008, pet. for rev. filed, Oct. 21, 2008).  (The rather unusual policy in this case,
which originated in England
and which was designed for use with deep sea drilling platforms, consisted of
two coverage parts: Section I and Section II. 
Section I was first-party property insurance, whereas Section II was
third-party liability insurance.  Section
II had been stricken in this deal. Id.
at 280.).

[5] American
General Fire and Casualty Company v. Buford, 716 S.W. 86 (Tex. App.—Austin 1986, writ rfd).

[6] This
word is an example of things being a shade strong.

[7] Board of
Fire Underwriters v. Trans Urban Construction Co., 60 N.Y.2d 912 (1983).

[8] Ira S.
Bushey & Sons v. American Ins. Co., 237
N.Y. 24, 28 (1923).  See also, Rhino
Excavating Corp. v. Assurance Co. of Am., 877 N.Y.S.2d 95 (N.Y. Supp. 2008)

[9]  See e.g., Ajax Bldg. Corp. v. Hartford Fire
Ins. Co., 358 F.3d 795, 799-800 (11th
Cir. 2004).

[10]
Homestead Fire Insurance Company v. DeWitt, 245 P.2d 92 (Okla. 1952). 
(In this case, the insurer also argued the insured had no insurance
interest in the older building to which the new building under construction was
attached, and so for this reason the construction company, which was the
insured, could not seek to obtain money for the property owner, a school
district, who had contracted the job.

[11] 409
F.Supp.2d 1230 (Ore 2005).

[12] Diep v.
California
Fir Plan Assoc., 19 Cal.
Rptr.2d 591 (Cal.
1993).  (This one has some national
influence.

[13] Id. at 1236.

[14] ACE
Property and Casualty Insurance Company Vegas VP, LP, 2008 2001760 (D. Nev. 2008).  The reason why this happened, one suspect, is
because the property owner was seeking to recover principally “soft costs”
only. We shall discuss that topic later.

[15] 544
S.W.2d 762 (Tex.
App.—Dallas 1976, writ ref’d n.r.e.).

[16]
37 S.W. 856 (1896).  For those of you are
curious about such things, the actual name of the railroad was “Gulf, Colorado
& Santa Fe Railway Company,” and for those of you who are old enough to
remember this, the “plaintiff in error” was represented by “Coke & Coke.”

[17] Simons
v. Niagra Fire Insurance Co., 398
S.W.2d 833, 834 (Tex. Civ. App—Fort Worth 1968, no writ).  Of course, this is not a Builder’s Risk
policy, but the principle is the same.

[18]
Haggar Co. v. United States
Fire Ins. Co., 497 S.W.2d 61, 63,-64 (Tex.
Civ. App.—Texarkana 1973, no writ).  A
somewhat similar case, but which distinctions, is Gulf Ins. Co. v. Ball, 324
S.W.2d 605 (Tex. Civ. App.—Amarillo 1959 writ ref’d n.r.e).  In this case, goods were on a truck in
transit to the purchaser; the truck broke down, so the trucker sought
assistance.  Before help arrived (and
presumable while the trucker was away seeking the help) the truck was “invaded”
and goods were stolen.  The goods were
ruled in transit.  Again, this was not a
Builder’s Risk policy, but it can obviously be helpful—at Hutson, that relied
on it found out.

[19] Patton
v. Aetna Insurance Co., 595 F. Supp.
533 (N.D. Miss.1984).

[20]
See Hartford Fire Insurance Co. v.
Riefolo Construction Co., Inc., 10 A.2d 658 (1980). (An owner can be using
a school building, within the meaning of 
Builder’s Risk insurance, but the building still was “   For example, in Reliance Ins. Co. v. Jones, 296 F.2d 71 (10th Cir.
1961), the court held that where only a small amount of grain was placed in a
“storage building as a temporary expedient,” the building was not complete and
the Builder’s Risk policy covered damages to the property.  The court explained that the “evidence is
indicatory of that fact that the building was never put to anything more than a
mere transient [sic] or trivial use; therefore it was not “occupied” under the
terms of the policy and coverage exists under the Builder’s Risk policy.  Id. at 73.

[21] A
theft during the specified interval of insurance after completion would be
covered by most Builder’s Risk insurance. 
Republic Ins. Co. v. Hope, 557 S.W.2d 603 (Tex. Civ. App.- 1977, no
writ).  In this case, the basic policy
was titled a “Texas Standard Policy.” 
Under the word “Property” was typewritten, “Builder’s Risk.”  The “Standard” policy language excluded
property theft from coverage.  But
attached to the policy was Form No. 21 headed “Builder’s Risk Actual Completed
Value Form.”  Paragraph 3 of Form 21
provided coverage for materials, equipment and supplies used int eh
construction of the said building.  According to the court, all of the form
documents together, and in particular, Form No. 21, included coverage for theft
of materials, equipment and supplies located on the premises during
construction.  Id. at p. 607.    See also, Donoho & Sons, Inc. v. Aetna
Ins. Co., 598 S.W.2d 11 (Tex.
Civ. App – 1980, writ ref’d n.r.e.).

[22] Wellington, 267 S.W.3d.
at 280.

[23]
2009 WL 398492(E.D. Mo. 2009).  This case
is interesting because it discusses many of the standard policy exclusions and
how they operate but there is no real ruling here.  The Court goes on and on about the arguments
made on either side but ultimately decides there are fact questions and sent it
back to the trial court.  What one can
learn from this opinion is how complicated Builder’s Risk policies are and the
arguments likely to be made by either side in the event of a claim – which this
court describes in excruciating detail!

[24] Id. at  3.

[25] Id.

[26] Id,
at p. 11.

[27] Id. Because the
Court could not rule as a matter of law that the collapse was caused by a
windstorm, the matter was remanded to the trial court to make that
determination.  Another interesting
aspect of the policy involved in this case is that the policy required that
Clarinet could not recover until it rebuilds! 
There are other policies with this provision.  It is completely barbaric, oppressive, and
extremely difficult to see how this could possibly work!

[28] Harbor Communities LLC v. Landmark American
Insurance Co., 2008 WL 2986424 (S.D. Fla.
2008) contains a nice, detailed discussion of the faulty design exclusion.

  

[29]
National Fire Insurance Company of Pittsburg,
Pennsylvania v. Valero Energy
Corporation, 777 S.W.2d 501 (Tex. App.—Corpus Christi 1989, writ denied).

[30] There
were also various issues of civil procedure which might have been decided
differently today, not to mention handled differently by the lawyers handling
the case  before the lower courts.

[31] Alton Ochsner Medical
Foundation v. Allendale Mutual Insurance Co., 219 F.3d 501 (5th Cir
2000) (cracks found during construction).

[32] Kroll
Construction Company v. Great American Insurance Company, 594 F.Supp. 304,305
(N.D. Ga.
1984).

[33] Dow
Chemical Company v. Royal Indemnity Company, 635 F2d 379 (5th Cir.
1981)(Texas
law).

[34] Kroll
Construction at 305 and 308.

[35]
Allstate Insurance Company v. Smith, 929 F.2d 447 (9th Cir.
1991).  It is not clear that this is a
Builder’s Risk Policy, but it cites a number of such policies as authority, and
similarly is cited by such cases.  See
L.F.Driscoll Company American Protection Ins. Co., 930 F.Supp. 184, 188ff (E.D.
Pa. 1996).  This case lined up with (ii),
instead of (i).  It has the misfortunate
of  having abbreviated the Children’s Hospital of Philadelphia “CHOP.”

[36] 353
F.Supp.2d 274 (D. Conn.
2005). 

[37] There
was exclusion for testing, as well, but the wording the exclusion excluded it
from serious consideration.  It is hard
to see why the insurer even proposed it.

[38]
Interestingly, the court cites all of the footnotes cited all of the cases
cited in the precious several footnotes.

[39] 513 F.
Supp. 2d 55 (D. N.J.  2007). 

[40] For an
earlier discussion of the “soft costs” issue, see Harbor Communities, supra at p. 9, and Belmont Commons v. Axis Surplus Insurance Co., 2008 WL 2945925
(E.D. La. 2008).

[41] Id. at 58-59.

[42] Id.

[43] Id. (emphasis
added).

[44] Id,

[45] Id,
at 60.

[46] Id. at 59.

[47] Id.

[48] Id. at 68.

[49] Id. at 69.

[50] Id. at 70-71.

[51] Id.

[52] Id.

[53] See American Association of Insurance
Services, Builder’s Risk, 2008, Latest
AAIS revision clarifies ’soft costs’ and implements full equipment breakdown
coverage,

http://www.aaionline.com/Eiwpoint/2008/08fall4.html(last
visited 2/10/2009).

[54] 290
S.W.3d 886 (Tex.
2009). 

[55] Id. at 887.

[56] Id. at 888.

[57]
192 S.W.3d 78, 88 (Tex. App. – Houston [14th Dist.] 2006, pet.
denied).  In this case, the appraisers
assessed a certain amount for damages due to water (a covered peril) but made
no finding for damages due to mold (as to which coverage was disputed).

[58] See
Lumbermen’s Underwriting Alliance v. RCR
Plumbing, 969 P.2d 301 (Nev.
1998). (Builder’s risk insurer brought a subrogation action against a plumbing
subcontractor whose employee allegedly cause a fire that resulted in a
substantial payment under the policy. 
The subcontractor was not an insured under the policy).

[59] Texas
Insurance Code, § 862.053 (Vernon’s
2003).

[60] See White v. New Hampshire Ins., Company, 390
N.W.2d 313 (Ct. App. Minn. 1986) and Georgia
Farm Bureau v. Garzone, 523 S.E.2d 386 (Ct. App. Ga. 1999). 

Read More

LAWYERS AND LYING: PART ONE*

      A Philosophical Discussion

Michael Sean Quinn, Ph.D, J.D., Etc.

Quinn & Quinn

2630 Exposition Blvd  #115

Austin, Texas 78703

(o) 512-296-2594

(c) 512-656-0503

mquinn@msqlaw.com

(Resumes: www.michaelseanquinn.com)

*There will be a number of parts on this topic. It is not necessary that they be read in any order.  The designations are designed only for guidance as to dates, etc. Part Two was blog-published on October 22, 2014.

My “byline” is here (almost) only because I ran across this piece and have put it here.  Everything else belongs to the actual author. Not all of those who have
considered the matter think that lying us wrong under all circumstances.  Utilitarians, for example, are committed to
the view that lying is not only permissible, but morally obligatory when it
would enhance the net aggregate happiness of everyone.  Fifteen years ago, a non-utilitarian
philosopher, David Nyberg, wrote a book entitled The Varnished Truth: Truth
Telling and Deceiving in Ordinary Life (1993).  He argues as follows:

[An Argument About Lying]

            “[T]he
suggestion that the moral perfectionist requirement of being set against all
deception is like telling us to loath and distrust all bacteria, including the
ones responsible for wine, cheese, and normal digestive functions.  It is clearly a mistake to neglect context in
evaluating bacteria, only some of which are culprits of disease; others
contribute to the flourishing of life. 
The same is true for deception, which is not only, or always a moral
problem.”  Nyberg at 61.  “The great battle between principled truth
telling and lying represents a deep, strong current in moral and religious
traditions.   It’s another way of
describing the timeless mythic opposition of Good and Evil, Light and
Darkness…”  Id. At 60. 
“It’s the artfulness we have evolved for avoiding both truth telling and
lying at the same time that interests me most—the varnishing, the adding and
subtracting, the partial display and concealment of what one person takes to be
the truth while communicating with another. 
As a communicative strategy, deception is so often rewarded that it
would seem to have become unavoidable and indispensable.  It may actually serve to promote and preserve
emotional equilibrium on a personal level, and a civilized climate for
communicating with each other and living our lives together on a social level.

            “It
is important to stress, given [my] strong pitch…for a re-evaluation of
deception, that truth telling has, had, and always will have, an important
place in moral conduct and, indeed in all of social life.  The point is that we need not assume it to be
a moral good in every instance, nor need we assume it to be present as the
background in every situation.  People
don’t tell the truth merely to tell the truth. 
They tell the truth for some reason. 
Truth telling is a means for accomplishing purposes.  So is deception.  My approach to an understanding of deception
is not the usual one (top down) of focusing on the virtue of truth as a given,
then finding ways to make benevolent compromises.  It is, rather to focus on human communication
(bottom up), and to see what roles both truth telling and deception play in
furthering the process toward the achievement of worthwhile goals.  The patterns and designs we create for
telling the truth and deceiving express who we are, both as individuals and
socially in relation to others.  Both
honesty and deceit are rooted in us, in our moral expectations such as ‘Avoid
doing harmful things and try to do good whenever you can.’”  Id. At 53-54. 

Quinn’s Quote:  Contemplate the following: “when all else fails,
philosophize.”  J.M. Coetzee, Disgrace
(1999).

Quinn’s View: Most lawyers do not believe that they are engaged in a
serious search for truth.  Most lawyers
view themselves as mouthpieces present to explain someone else’s view.   Quinn’s
Question:  Is this view true or false?

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Insurance: Blogs & Defamation–Cyber Insurance

Michael Sean Quinn, Ph.D, J.D., Etc.

2630 Exposition Blvd  #115

Austin, Texas 78703

(o) 512-296-2594

(c) 512-656-9759

mquinn@msqlaw.com
Resumes to be found at 
 www.michaelseanquinn.com)

BLOGGERS DELIGHT, INSURERS TAKE HEART

A blogger can easily count as something like a journalist when commenting on a public concern, and when he/she/it does this, a defamation case is provable against that person only if the blogger is proved negligent.

The case is Obsidian Finance Group LLC v. Cox, 740 F.3d 1284 (9th Cir. January 17, 2014). A man named Kevin Pandrick,  a principal of Obsidian, had been appointed a Chapter 11 trustee for a client that may have been less than honest.  (He is a matter of no consequence to this story, so all references will be to Obsidian.

Crystal Cox (“Cox”)accused firm and him of a number of nefarious acts–fraud, corruption, money laundering, etc; many of Cox’s statements were obviously wild-ass carryings-on.  Mere opinions that do not involve an assertion of fact, even if the proposition is not a fact, are not defamatory under constitutional law.

Cox defended herself.  All but one of the plaintiffs’ causes of actions were dismissed as not really factual statements and hence not defamatory at law. One count, however, remained; that case was tried; Cox defender herself, lost and got hit with big damages by the jury–$1.0 for the company and $1.5 for the principal, and a judgment was entered against her. The blog containing the one count was published on Christmas Day 2010.

Cox appealed the judgment, and the defendants appealed the district court’ dismissal of 19 out of 20 separate causes of action.

There were various procedural matters, but this blog is about only three of them. In addition, there were numerous cites by the appeals court of various background cases. In sum, the prevailing law is that under circumstances like this one, the finder of fact must conclude that the accused defendant asserted proposition motivated by “actual malice,” and under controlling authority that includes negligence.

First, defamation arising out of asserting a false proposition that would otherwise be “actionablely” defamatory is not actionable when the statement addresses a matter of public concern and the “speaker” is not negligent gathering a basis for making the assertion.(The burden is on the plaintiff to prove negligence This is true if made about a person who is not a public official.

Second, the court of appeal held that the topic of Cox’s actionable statement was a matter of public concern even though the targets of the assertions were not public officials or tantamount to them, though they may have come close-ish to it, based on appearances, though not applicable sophisticated property law.

Third, the United States Supreme Court has repeatedly provided First Amendment protection to these sorts of statements, although not to blogging yet. There is no reason to think that it would not apply that freedom to individuals as well as institutions operating on the Internet, a medium of communication unknown when the high court made its controlling decisions.

The problem was that the jury instructions did not warn the jury that “it could not award presumed damages unless it found that Cox had acted with actual malice.)  So the judgment was reversed and sent back for a new trial.

If I were the plaintiff in this case, I could well imagine blowing the whole thing off, or settling for policy limits, if there was a policy.  I am certain that the insurance company, if any, that is defending under Coverage B, would like to get rid of the case.  Its defense costs have already far exceeded policy limits, probably.  (Of course, being certain does not make you right or even epistemologically rational.)

 If the plaintiff has not lost business, why not focus on other matters?  The entire matter has completely discredited Cox, I would expect, and she may be, and  probably is, now regarded as a “crazy” “witch” in the better circles.  (Nota bene: I not saying that these proposition are true.  I am simply hypothesizing, and some might call it speculating.)

Of course, there may be an important component portion of the business community that has intensely negative fillings about her. Said the Ninth Circuit panel: “Cox apparently has a history of making similar allegations and seeking payoffs in exchange for retraction. See David Carr, When Truth Survives Free Speech, NYT, Dec. 1l, 2011, at B1.”

[A blog-essay is to be found on and blog group, Quinn’s Commentaries on Lawyers and Lawyering.]

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Blogging, Defaming, and the Blowing Whistles: New Work for Lawyers?

Michael Sean Quinn, Ph.D, J.D., Etc.

Quinn & Quinn

2630 Exposition Blvd  #115

Austin, Texas 78703

(o) 512-296-2594

(c) 512-656-0503

mquinn@msqlaw.com

(Resumes: www.michaelseanquinn.com)

 BLOGGERS’ DELIGHT

A blogger can easily count as something like a journalist and have First Amendment rights, when commenting on a matter of public concern, and when he/she/it does this, a defamation case is provable against that person only if the blogger is proved negligent.

The case is Obsidian Finance Group LLC v. Cox, 740 F.3d 1284 (9th Cir. January 17, 2014). One Kevin Padrick, a principal of Obsidian, had been appointed a Chapter 11 trustee for a client that may have been less than honest.  Cox accused the firm and him of a number of nefarious acts–fraud, corruption, money laundering, etc; many of Cox’s statements were obviously wild-ass carryings-on.  Mere opinions that do not involve an assertion of fact, even if the proposition asserted does not actually describe a fact, are not defamatory under constitutional law.

Cox defended herself.  All but one of the plaintiffs’ causes of actions were dismissed as not really factual statements and hence not defamatory at law. One count, however, remained; that case was tried; Cox defended herself, lost and got hit with big damages by the jury–$1.0 for the company, $1.5 for the principal, and a judgment was entered against her. The blog containing the one count was published on Christmas Day 2010.

Cox appealed the judgment, and the defendants appealed the district court’s dismissal of 19 out of 20 separate causes of action.

There were various procedural matters, but this blog is about only three of them. In addition, there were numerous cites by the appeals court of various background cases. In sum, the prevailing law is that under circumstances like this one, the finder of fact must conclude that the accused defendant asserted proposition motivated by “actual malice,” and under controlling authority that includes negligence.

First, defamation arising out of asserting a false proposition that would otherwise be “actionablely” defamatory is not actionable when the statement addresses a matter of public concern and the “speaker” is not negligently gathering a basis for making the assertion.(The burden is on the plaintiff to prove negligence This is true if made about a person who is not a public official.)

Second, the court of appeal held that the topic of Cox’s actionable statement was a matter of public concern even though the targets of the assertions were not public officials or tantamount to them, though they may have come close-ish to it, based on appearances, though not applicable sophisticated property law.

Third, the United States Supreme Court has repeatedly provided First Amendment protection to these sorts of statements, although not to blogging as yet. There is no reason to think that it would not apply that freedom to individuals as well as institutions operating on the Internet, a medium of communication unknown when the high court made its controlling decisions.

The problem was that the jury instructions did not warn the jury that “it could not award presumed damages unless it found that Cox had acted with actual malice.”  So the judgment was reversed and sent back for a new trial.

If I were the plaintiff in this case, I could well imagine blowing the whole thing off, or settling for policy limits, if there was an insurance policy with coverage.  I am certain that the insurance company, if any, that is defending under Coverage B, would like to get rid of the case.  Its defense costs have already far exceeded policy limits, probably.  (Of course, being certain does not make you right or even epistemo-logically rational.)  Obviously, this is “old-time” work for insurance defense and for insurance coverage lawyers.  It is a new kind of work for lawyer providing advice on defamation action matters, but it looks like the trial of these cases will be “same old, same old.”

 If the plaintiff has not lost business, why not focus on other matters?  The entire incident has completely discredited Cox, I would expect, and she may be, and  probably is, now regarded as a “crazy” “witch” in the “better” circles.  (Nota bene: I not saying that these proposition are true.  I am simply hypothesizing, and some might call it speculating.  An yet others might call it wondering.)

Of course, there may be an important component of the business community that has intensely negative fillings about her. Said the Ninth Circuit panel: “Cox apparently has a history of making similar allegations and seeking payoffs in exchange for retraction. See David Carr, When Truth Survives Free Speech, NYT, Dec. 1l, 2011, at B1.” I must say, I am surprised that this junk didn’t get into the trial below.  It is particularly odd, that if the judge prevented it from coming in, there is not a more case-centered discussion of it in the Ninth Circuit opinion.

So the question in the title of this piece is more-or-less this:  Does the coming of widely disseminated blogs create new work for lawyers since defamation is always a risk.  The answer is “No,” but there are three important points.  (1) The case is too good a story not to tell; (2) it will create lots of new type work, just not this type; but (3) it makes a blogger safer, and further clarifies the internet.

 (The reader must remember the key role of “public concern” in the Crystal Cox case.  Blogging falsely about you ex-wife having torrid affairs with her female tennis partner and her male gym trainer at exactly the same time and in exactly the same place, all happening under the nose of her new husband, a pansy and the guy she left you for, is not a matter of public concern, no matter how engrossing–and this does not mean “gross”–the lurid telling of the story may be. Remember! In this case, false equals defamatory. Also ask: How many assholes can be the ends of pins when it comes to being a plaintiff in a defamation case.)

[A blog-essay very similar to this one is to be fund on Quinn’s Commentaries on Insurance Law.]

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Quinn Quotes

Variations can be small, or they can be large. No total variation can be both small and large at the same time. If one thing is totally a variation on another, then no part of the second will be something other than a variation on the first. (This is probably an analytic truth too, even in the post modern age, though the classical examples are easy: “All bachelors are unmarried male adults,” may not be.  This is another example of the influence of the power of social change.~Michael Sean Quinn, PhD, JD, CPCU, Etc.Tweet

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Michael Sean Quinn, PhD, JD, CPCU, Etc*., is available as an expert witness in insurance disputes and other litigation matters. Contact