SILLIEST INSURANCE COVERAGE CASE EVER + LEGAL FEES

Duty to Defend v. Duty to Pay for Defense

This insurance case is styled Coreslab Structures (Texas), Inc. v. Scottsdale Insurance Company, Cause No. 14-14-00865-CV (Houston–14th Court of Appeals. Opinion Filed July 28, 2016).  The underlying case–the one which gave rise to the insurance case–involved $38M water damage at a well-known Houston hospital and its building, Memorial Hermann Tower (I-10 at Gessner).

The liability case involving Hospital was settled and played no role in this litigation. This case is solely legal fees and a carrier’s duty to defend.

The Hospital had sued Coreslab and its subcontractor to recover for its property damage. Coreslab sought a defense for the CGL carrier for one of its subs, namely, Scottsdale (“Scott”) claiming it was a named insured. It also sought a defense from (one of) its own carriers, Lexington (“Lex”). Scott fallaciously denied coverage, while Lex paid defense expenses.

Scott was found in error and was ordered to pay.  The costs of defense were substantial $825K+. Eventually, both Lex and Scott paid substantial sums. Scott paying over $409K. In the end, all the legal fees were agreed to be reasonable and necessary, and it was also agreed that Coreslab itself never paid any legal fees.

However, Coreslab sued Scott for breach of its duty to defend, apparently seeking all of the money to which it would have been entitled if Scott had not made its original mistake of denying coverage.  Lex, of course, has corrected that mistake, so far as Coreslab was concerned, by picking up the whole tab. (Curiously, Lex is not a party to this suit, and I say “is” because I suspect that this case–silly as it be–is not over.)  I would have expected Lex to try and get some of its money back somehow.

As any court in its right mind would do, the trial court granted Scott summary judgment, and the court of appeals affirmed. I expect Coreslab to go to the Texas Supreme Court, but I expect that it will refuse to take it.

The basic issue is this. Coreslab says this: “Scott had a duty to defend me. It failed in this contractual duty. Therefore I have a valid breach of contract action against it. In addition by failing to defend me, it violated sections of the Texas Insurance Code which prohibits insurers’ bad faith and calls for damages, attorney fees, and penalties. So I want the enforcement of that statute and the relief it specifies.”

There is just one (or at least one) problem with this line of “reasoning.” Coreslab did not pay any defense costs. Lex paid them. Hence, it suffered no damages.  So, from what does it want relief? For from what injury is it seeking relief.  I’ll come back to this.

Coreslab gave three arguments on its behalf. (1) “[A]n insurer has the duty to provide a full defense to its insured rather than pro-rata defense.” (2) If a petition alleges one cause of action which may be covered and one which obviously is not, the liability carrier has a duty to defend the entire case. (3) It is Texas law “that the insured is in the best position to identify the policy or policies that would maximize coverage[,]” so it gets to pick which one will defend it. Coreslab picked Scott, so it should be compensated for that violation of the law.

All three of these are wretched arguments.  If they were set forth on a law school exam, the student would have to take the course again. This is true for a very simple reason. Coreslab did not suffer any damages; it did not pay any legal bills at all.

Coreslab seems to have thought that it was injured by the fact that the legal fees Scott did not pay but Lex did would somehow drive up the premiums it would owe in the future for similar insurance. Of course, this might happen whoever the down-the-road carrier might be. Maybe it thought that Lex would charge it higher premiums in the future since Lex (as opposed to another insurer) was paying legal bills and that fact would affect Coreslab loss ratio with it and thereby increase its premiums. Significantly, Lex was not a party to this case.

What’s a little nutty about this is that any insurer will look to the entire loss history over a specified, relatively recent period of time in calculating a premium.  It will not restrict its inquiry to the applicant’s loss history with it.  Thus, if Scott had paid the legal fees the way it was supposed to, Lex would still know about the suit, the claim, the settlement, plus the attorney fees, and all those facts would affect its underwriting decision.

So what can we learn here? How’s about this one as a start.

Not every mistake made by an insurer in handling a claim inflicts compensable damages upon a claiming insured.  This is true especially if the insurer’s error hurt somebody, just not the insured.—MSQ

Here’s another possible lesson. The decision-maker at Coreslab did not think this one through well.  This is why risk management departments and/or capable coverage counsel experienced in litigation are a good idea. This point is evidenced especially vividly if Coreslab has had to foot the bill for all or any part of this lawsuit. (What irony it would be if Coreslab had to pay Scotts’ legal fees.)

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BIRD DEFECATION COVERAGE

FLYING DUNG INSURANCE?

In Arizona, the owner of a condo sued the association and the management company for failing to clean up after the birds that defecated on her property.  The liability insurance for the association and/or the management firm denied coverage, and filed a suit in federal court, probably seeking a declaratory judgment.

If this controversy had been over a simple homeowner’s policy the insurer (American Family Mutual) probably would have denied on the grounds that property damage resulting from a policyholder’s failure to maintain is not covered,  just as wear and tear are not covered.

But this was a liability policy, so exactly the same exclusion would not exist. Then again, it is not “professional liability” insurance.  But one would think that property damage caused by the negligent performance of real estate managerial duties might be covered. One would think that the omissions of the insured did constitute part of the cause of the property loss. (It is well established that pigeon droppings on roofs damage the roofs. Then again that takes time.)

One may be tempted to immediately infer that the insurer’s reasoning as to coverage is bullshit. Then again, the coverage decisions of insurers are frequently correct, and even if the insurer gets coverage wrong, their decisions are often rational (even though mistaken). But on the other hand, there are many forms of actionable insurer bad faith.

There is an urban problem with pigeons. See Jon Mooallem “Pigeon Wars” New York Times Magazine, October 15, 2006

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DEPOSITION TAKING: HOW NOT TO

RESEMBLANCE AND EXACTITUDE

Witness (W) has testified that he had authority from boss/supervisor to do something, some time ago.
L asks the following question:
Q. Do you remember exactly what he said to you? A. No.
Q. Then how do you know that he gave you authority?
Comment: Last question is silly. Three errors. (1) “Exactly?  Most of us don’t remember exactly what was said to us yesterday, unless it’s “No.”(2)  We often don’t really member what was said. We just know that Boss said something like, “Do this, and not that,” more or less.  (3) When we have repeat tasks, we are often authorized to do them in generally patterned ways. Thus the instruction W received on Monday the 1st will resemble the one she gets on Tuesday the 14th, but they may not have similar wording at all.
Thus one answer to the more general version of the question is, “I know because I know, looking back,  sort of what he might have said, and–in any case–I did my assigned thing and I don’t remember his bitching about it.”
Obviously the following question is absurd: “Very well, do you remember exactly how he communicated his not bitching?” Semantic exactitudenarianism is ill advised, under most–or at least many–circumstances.
*Michael Sean Quinn, Ph.D., J.D.

The Law Firm of Michael Sean Quinn

1300 West Lynn Street, Suite 208
Austin, Texas 78703
(512) 296-2594
(512) 344-9466 – Fax

E-mail:  mquinn@msquinnlaw.com

In honor of the general topic, not proofed carefully

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DEPOSITIONAL DISCOVERY IN INSURANCE LITIGATION

FUNDAMENTAL PRINCIPLES OF INSURANCE CLAIM HANDLING/ADJUSTING/EXAMINING

Michael Sean Quinn*

To a considerable degree, if not almost universally among knowledgeable and reasonable insurance companies, the principles on the following are deeply part the intra-regulation process for adjusters; they are used by various insurance companies to judge the performance of other. I have met only one person in the insurance industry who rejected any of them, and he was an opposing witness a litigation matter who had never really been part of the adjustment sector of the industry, or really any of it (much); indeed, his principal role in the industry had been that of a commissioner in obscure place, and all he said was that the principle he rejected was “Quinn’s brain child,” and he impliedly admitted that “brain child” is an ambiguous phrase which refers either to vocabulary (and therefore formulation) or to how an idea of imagined and either case, his “observation” was consistent with my representations as to the principle might well true.  (At the same time, they can be thought of by some in a different way namely, as ideals and not just regulations demanding excellence. The second way of thinking does not take seriously the “special relationship” that is often required by state law, e.g., Texas.)
LOOK FOR COVERAGE. These words are all “in-caps” for a reasons. (1) Under no circumstances is it permissible to simply look for ways to deny coverage. (2) Adjusters must actually try to find maximal coverage within the claim. (3) Claims handlers are not obligated to try and find coverages outside the claim, broadly construed. There are four “directions” for looking for coverage: vertical, horizontal, semantic, and behavioral. 

Insurers are obligated to treat the interests of their insured as at least equal to their own. This is called the “special relationship.” In a case like this one, the insurer  must treat their interest of the policyholder as superior to (or on top of) their own, since coverage can be denied only if there is overwhelming evidence  supporting denial or rescission.

Every insurer in adjusting every claim must look for coverage. In a case like this one, that would require the adjuster to try and think of ways in which there would be coverage. That proposition is especially true in the light of the internal rules governing adjuster conduct.  Looking for coverage may be vertical (look deeper into the insured claim), horizontal (look for related, connected covered claims), policy oriented (look carefully at coverage and exclusion language to see if there are reasonable ways to grant coverage. )This bullet point and the one to immediately follow have been grouped together–instead of being double spaced–because they are so closely linked.)

 Resolve uneliminable, and consciously nagging doubts in favor of the insured. (This one is closely connected to the last one. (There are much stronger version of this, e.g., when exclusions or negative and applicable conditions require overwhelming evidence. If any of these principles are subject to controversy it is part of this one, and it is not to be controverted when the policy or the company’s adjustment manual requires overwhelming evidence.) 

In handling a claim, an insurer has a duty to be reasonable in all ways, at all times, with any claimant, with every claim and any component of any claim.

In handling a claim, the adjuster is required to know and understand the policy at issue, the application(s) which are attached to and in some policies said to be part of the policy, the questions and answers in those applications, the legal requirements for denying a claim, the applicable  internal guidelines (aka internal rules of adjustment), and the evidence presented, which would included medical records. 

Adjusters are always required to know the applicable law of the relevant jurisdiction. In virtually all states, insurance law requires that all ambiguities in insurance policies (including applications for coverage included in the policies or attached threto) be construed in favor of the insured.

Adjusters must understand and act only in accordance with the principal logical process for denying claims, and never its opposite.  In a case like this, industry practice is that a claim can correctly and reasonably be denied only if based on correctly gathered evidence, proper evaluation, policy language, proper grasp of the application (whether questions or answers), statements of physicians or the agents of the insurer, recognized fundamental principles, company guideline rules, and state law. 

Another acceptable principle in the area of life insurance at least, is, when surrounded by all the others, is that denial  is permitted  because of deliberate falsity in the application only if  the policy would not have been issued by the company, given  all the evidence collected by otherwise acceptable means. Notice that this principle can make some underwriters into adjusters for individual case.  (Of course, this logic may apply to all kinds of insurance, but it appears to be most explicitly employed in the areas of life insurance.)

All reasonable insurance adjusting and adjustment standards require satisfactory and therefore comprehensive, objective  empirical investigations, evidence gathering, objectivity, without bias of any sort, but with a thorough understanding of the risks actually undertaken in the policy at issue. In addition to this adjusters are required to apply logical (deductive and inductive) inferences in reasonable ways. Sometimes this involves investigating the mental state of an insured; sometimes not. 

All adjusters of a given company are required to know the  relevant guidelines of their company, i.e., guidelines for the handling of claims. 

All insurers are required to “insure” by some means, e.g.,, seminars, workshops, explicit use by motors and supervisors, etc., that their adjusters know, understand, remember, and routinely apply the rules contained in the guidelines. 

In general, an insurer’s guidelines are not simply abstract ideas, helpful principles, aspirational formulae, important hints, or mere suggestions. They are rules, commands, internal business ordinances, or something like intra-company statutes governing adjustment conduct in relevant states. This would include instances of adjusting life insurance claims, of course.

Judging the reasonableness of an insurer’s adjustment process  is influenced positively by observance of the claim processing guidelines of the insurer, so long as they are reasonable. In other words, if a carrier’s guidelines are above the usually accepted standard, it is customary in the industry that an insurer be judged by its own standards. Insurers and insurance adjusters often think of each claim as being uniques.

Thus, if a company’s guideline is that a given type of claim cannot be denied for anything less than overwhelming evidence, then that is the standard of reasonableness for that company.  (it is interesting to ponder what a question for the jury will look like. Perhaps this: “Do you find from a preponderance of the evidence that the the insurer denied the claim of the insured on less than overwhelming evidence?”

All insurance companies in many states are required to have sound and reasonable guidelines (or something like them), and guidelines are a key to understanding and evaluating an insurer’s claim performance. It is generally understood in the industry that this is part of why they are required. They are also required to induce reasonable adjustment conduct and decisions.

With regard to the last principle, if an insurer and/or an insurer’s adjuster fails to act in accordance with the principle of having and following reasonable guidelines, the insurer and/or its adjuster has behaved in an unreasonable, below standard, and unsatisfactory manner.  

It is universally recognized by the knowledgeable  that  substantial, serious deviation from one or more of these fundamental principles can and often does constitute insurer bad faith. 

*Michael Sean QuinnQuinn and  Quinn

1300 West Lynn Suite 208

Austin, TX 78703

Office Phone: 512-296-2594

Cell:512-656-0503

Fax: 512-344-9466
                                      Email: mquinn@msqlaw.com  

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LAWYER CLINTON AND HER EMAIL SCANDAL(?) (EMAILGATE?)

WHAT HAPPENED? WHAT COMEY SAID AND WHAT HE DIDN’T SAY

Michael Sean Quinn*

Hillary Clinton is a lawyer. ** (See below)  What did she know? When did she know it? And how did FBI Director, James B. Comey describe it? (Just as a side-note, one should keep in mind that Comey is himself a lawyer, and has a history of being a federal criminal prosecutor–indeed, a distinguished one–and a policy/admin official in the Department of Justice. When he says that a reasonale prosecutor would not take this case, he knows what he is talking about.)

What did she know? About what?*** For sure, she said she did not send or receive classified documents marked such at the time she sent or received them.  Comey says she was mistaken about this to a tiny extent; however, he does not say she was lying. He did not say that all false assertions are lies, and–of course–he would be right about that if he had said it.  He did not say that any of her false assertions, if there are any, were fraudulent. 

He did not denominate her “Crooked Hillary,” or anything of the sort. (** See below.) He did not say that a set of false statements is strong evidence that someone is lying. Had he said this, he would have been right. An over-arching error can generate a number of similar but subordinate errors, and none of them will be lies. 

Here is, roughly, what he did say. First and foremost, he did not say that she would or should be indicted. He implied that no such case could be proved beyond a reasonable doubt; and, of course, that is the requirement of criminal conviction.  

Second, as already indicated, he did not say, or imply, that she received or transmitted any email documents which were marked “Classified” or anything equivalent thereto. But what did he say in this neighborhood?  

In order to understand what he said or implied, it is necessary to have some understanding of what it is for a government document to be CLASSIFIED.  In the context being discussed here, “Classified” is not what I will called a “specific term” as to “secrecy rank.” Thus, there are three categories of Classified documents. Starting at the most sensitive, they are these: (1) Top Secret, followed by (2) Secret, and then (3) Confidential. 

 He said that FBI investigators read all approximately 30,000 emails Hillary provided. 

It also reviewed (1) emails sent to Hillary from the federal agency from whence they came–what he called “the owner” of the documents, or (2) to which they went. The purpose of this was to determine whether a email contained classified information at the time it was sent or received. Notice that this part of the investigation did not have anything to do with how the document was actually marked. The FBI was interested in how it should have been (or might reasonably) have been marked.  It should be noted that electronically created documents or documents attached to electronic documents and then sent can easily be marked “CLASSIFIED” or something of the sort. 

Comey said that of the 30,000 document produced, 110 such documents in 52 email-chains were determined by the “owning agency to contain classified information at the time they were sent or received.” 

The concept “e-mail chain” has a number of meanings. I think that here it probably means a back-and-forth group of emails.  He does not say how many individual emails are to be found in any of the chains.  The phase “email chain” does not tell one how many emails there are, how many were sent by A to B, or how many players there were in the chain.  (“Reply to All” creates many emails. It does not tell us whether there are therefore new chains; one would think it dopes. There might be two emails in a chain; there might be 57; there might be any number in between or any number greater up to just shy of 30,000. (Of course, there cannot be less than 2.)

Of that 110, Comey says that of the 52 chains, 8 of them contained emails classified as “Top Secret” at the time they were sent; 36 chains contained information classified as “Secret” at the time sent;  and 8 contained information classified as “Confidential” at the time sent. (That number of to some extent CLASSIFIED documents comes out to presents on 52 chains.) 

(I would like to know more abut the 52 chains. It seems odd to me that virtually all he classified documents were on such a small number of chains. Then again, I don’t know how many people were on each of those 52 chains. What is they were all the same and there were two people on each of them? The same two–Hillary and one other person. What if there were 1002 on each of the chains? And so forth. Surely the fact that there were so few chains is important somehow.)

Of the 30,000 emails produced, 2000 more were”up-classified,” i.e., classified and as classified, after they were received or sent. (MSQ: It looks like the investigative process, perhaps stimuli of the FBI.) Clearly of the 2000 that were “up-classified,” none of them was marked classified or even actually classified when it was sent or received.****

Comey stated that the FBI found several thousand more work- related email documents that were not produced. How the retention happened, if that what it was, he did not say.  What “several” means he did not say. In any case, the FBI reviewed millions of emails, he said. (I would think that “millions” is more than several thousand. Perhaps what he meant was that it reviewed millions of emails and found several thousand that were relevant.) 

Of those several thousand 3 emails were classified at the time send or received; 1 was Secret, and 2 were Confidential. Thus, he implied that none was Top Secret.  In any case, if my counting is correct, this makes 112 the number of emails that contained classified information at the time they were sent or received. How many chains? (And more about the chains?) 

It is worth noting that 112 is a very small–miniscule–fraction of even 30,000, something like 0.374%– almost exactly 1/3 of 1%, more or less–of 30,000. And this does not tell us how many of those are Confidential only. 

Be sure and notice that the percentage is “point 0.374%,” not 3.74% The 0.374 number does not equate to a cardinal sin, and they do not add up to a bunch of lies, or few of them. At worst there may be a relatively modest number of mistaken assertions.  Comey did not explicitly say this, but one might think that this was a foundation for his recommendation. 

Now, my exposition of the “Comey Presentation” is only part of it. I am not addressing the level of attention paid to the rigors of dealing with documents which are on topics where something might need to be classified.  It is worth observing, however, that Comey was talking about email chains. Thus, for those emails which should have been classified at some level or other, we don’t know what level Comey is talking about, and we don’t know who sent the emails that most obviously should have been treated as should-have-been-classified. Furthermore, we do not know who would have had the responsibility to actually classify it.  

It seems to me that if Hillary barely any blame for what happened regarding the 112, to the extent they were supposed to be classified by someone else, her blame is probably slight. 

Those lawyers who think Comey is a sap might wish to take a look at how statutes define the terms CLASSIFIED, TOP SECRET, SECRET, AND CONFIDENTIAL. The also might wish to take look at how the 1919 statute, under which the prosecution would proceed, deals with copies of electronic items is treated under the statute.   (Of course, one could adopt the view that statutes are not to be interpreted literally–directly from the intentions of the enactors–but evolutionarily, and that this historicism in statutory interpretation applies in criminal cases as well as others.)

He did say there was no evidence was found indicating that any emails were  deliberated deleted in order to conceal classification or some level thereof. This includes the lawyers that went over the group of email and deleted those they regarded as personal.  

On a vaguely related topic, it strikes me as unfair that Hillary should be judged adversely–even in the political realm–without evidence that (1) since she probably knew that a given proposition was true, (2) she  was therefore lying when she said something that presupposed its falsity.  

**My favorite example of this concern the number of servers she had. Apparently she said she used one when in fact she used several. The fact is that she probably did not know how to count the number of servers she used. One can easily believe that one uses just one, when on in fact one uses more than one, and that number need not be just two.

It is also the case that many government officials use private servers to get the public business done, the reason being that government computer systems are said to be slow and clumsy. Interestingly, these propositions are not themselves being discussed in out present political context. Nor are these kinds of questions being asked regarding congressmen, senators, and their staffs.  

**One final side note: one wonders how much Hillary knew about the public law of classified documents. I wonder if she was particularly concerned about documents which might have been classified “Confidential.” 

***One wonders how many such documents would be national security related documents.  Obviously, this has to do, at least, with the many meanings of the word “Confidential,” in this context. Surely there are gradations within the category of “Confidential,” some more sensitive than others. 

To pick and amusing example: a friend of mine joked to me that if a document could have been classified as “Confidential” because it said that Vladimir was having sex with his sister, and if this document were sent along to Hillary as an attachment to an email which said only “Affair of State?”by an unreliable gossip in the international banking division of the Treasury Department perhaps this would not be as great a security “sin” as emailing the location consisting of 20,000 yards of new and experimental atomic weapons to anyone. 

I told my drunken, pot-head now-lawyer friend of 40+ years that he should change the subject. He remembered nothing about the conversation the following day, or so he said.  Some habits never die.  When I outlined to him what was said and offered to go to “a Meeting” with him, he responded that one should remember that the Department of State handles a great many matters which involve foreign affairs but which do not involve particularly significant matters.  

This is the real focus of Comey’s Presentation, I think, and it looks like there might something to complain about here. But that can’t really be done until one knows the rank to which the email was up-graded. And it cannot be evaluated until one knows who should have done the classifying in the first place. 

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

The Law Firm of Michael Sean Quinn 

                                 1300 West Lynn Street, Suite 208

                                             Austin, Texas 78703

                                                 (512) 296-2594

                                            (512) 344-9466 – Fax

                                E-mail:  mquinn@msquinnlaw.com

In honor of the general topic, not proofed carefully

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Quinn Quotes

General assertions are like that. Even specific assertions can be like that–situations change.  There is truth in the idea that one cannot look into the same brook twice.  Of course, that idea is ambiguous.~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