TBL Collectibles, Inc. v. Owners Ins. Co.
TBL Collectibles, Inc. v. Owners Ins. Co.
Opinion of the Court
This matter is before the Court on Plaintiff's Motion for Partial Summary *1176Judgment on Its First Claim for Declaratory Relief [Docket No. 62], Defendant Owners Insurance Company's Motion for Summary Judgment [Docket No. 63], Plaintiff's Motion to Exclude Certain Opinions and Testimony of Defendant's Expert, John P. Craver, Esq. [Docket No. 54], and Owners' Motion to Exclude Certain Opinions and Testimony of Plaintiff's Expert David Young [Docket No. 83]. This Court has jurisdiction pursuant to
I. BACKGROUND
This case involves a dispute between the parties regarding payment of an insurance claim for stolen coins. Plaintiff TBL Collectibles, Inc. owns and operates Colorado Coins, Cards & Comics, a retail coin and collectibles store in Arvada, Colorado. Docket No. 62 at 2, ¶ 1; Docket No. 63 at 3, ¶ 2. At all times relevant to this action, plaintiff held an insurance policy with defendant Owners Insurance Company, that provided commercial property insurance coverage. Docket No. 63 at 3, ¶ 1. On August, 30, 2015, plaintiff's store was burglarized after hours. Docket No. 62 at 3, ¶ 4. The only items stolen were a floor safe and its contents.
Plaintiff reported the loss to the Arvada Police Department ("APD") on August 30, 2015. Docket No. 62-19 at 7. As part of its investigation into the incident, the APD prepared an Incident/Investigation Report containing a list of the stolen items as reported by Bruce Wray, the co-owner and manager of the store. Docket No. 1 at 3, ¶ 11; Docket No. 62-18 (APD Report); Docket No. 62-19 (APD Report continued); Docket No. 75 at 3 (stating that the "APD generated an Incident and Investigation Report ('APD Report'), which also lists the coins Mr. Wray asserts were taken during the burglary"); Docket No. 62 at 3, ¶ 2 (stating that store is managed by owner of TBL, Bruce Wray). On August 31, 2015, plaintiff informed defendant of the loss and submitted a claim under the insurance policy. Docket No. 62 at 3, ¶ 5. Defendant immediately assigned the claim to an adjuster, Jayme Larson. Docket No. 63 at 5, ¶ 9. Ms. Larson contacted Mr. Wray on September 1, 2015.
At defendant's request, plaintiff provided the following documentation to substantiate the loss: (1) a handwritten list of the stolen items, which included the description and cost of each coin; (2) the APD Report; (3) invoices and deposit slips from Cornerstone Bullion, from which plaintiff had purchased coins prior to the theft; and (4) check copies, cash receipts, and bank statements reflecting plaintiff's coin purchases in the four years prior to the theft. See Docket No. 62 at 6, ¶¶ 17-18; Docket No. 67 at 8-9, ¶¶ 1, 5; Docket No. 62-24 at 6, 23:18-25 (discussing Cornerstone Bullion invoices and deposit slips); 62-25 (handwritten list of stolen items); Docket No. 62-26 at 2 (discussing invoices for coin purchases from Cornerstone Bullion); Docket No. 62-32 at 2 (discussing check copies and bank statements); Docket No. 67-2 at 3, 47:21-25 (noting that plaintiff *1177purchased certain coins from Cornerstone Bullion); Docket No. 67-4 (APD Report).
On November 6, 2015, defendant authorized a policy limit payment of $15,000 for the stolen cash. Docket No. 1 at 7, ¶ 22; Docket No. 67-11 at 11. According to defendant, the Cornerstone Bullion invoices confirmed the existence of the cash in the safe. Docket No. 63 at 5, ¶¶ 9-10; Docket No. 62-24 at 6, 23:14-24:8.
Ms. Larson continued her investigation of the stolen coins. See Docket No. 63-13 at 1; Docket No. 67-11 at 11. After discussions with the Home Office claims department, Ms. Larson ultimately concluded that the coins would be considered business personal property under the terms of plaintiff's insurance policy. See Docket No. 63-13 at 1; Docket No. 67-11 at 9-10.
On March 16, 2016, defendant sent plaintiff a letter denying its claim for the stolen coins. Docket No. 63-13.
The March 16, 2016 letter does not reference fraud as a basis for defendant's denial of payment. See
Plaintiff filed this lawsuit on July 13, 2016, asserting three claims for relief: (1) declaratory judgment as to whether plaintiff fulfilled its post-loss obligations under the insurance policy; (2) breach of contract; and (3) unreasonable delay or denial of benefits under
II. MOTIONS TO EXCLUDE
The Court will begin by addressing the parties' motions to exclude certain opinions of expert witnesses given that the outcome of those motions may affect the Court's resolution of the pending summary judgment motions.
A. Legal Standard
The admissibility of expert testimony is governed by Federal Rule of Evidence 702, which provides:
A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if: (a) the expert's scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue; (b) the testimony is based on sufficient facts or data; (c) the testimony is the product of reliable principles and methods; and (d) the expert has reliably applied the principles and methods to the facts of the case.
Fed. R. Evid. 702. As the rule makes clear, while required, it is not sufficient that an expert be qualified based upon knowledge, skill, experience, training, or education to give opinions in a particular subject area. Instead, the Court must "perform[ ] a two-step analysis." 103 Investors I, L.P. v. Square D Co. ,
Rule 702 thus imposes on the district court a "gatekeeper function to 'ensure that any and all scientific testimony or evidence admitted is not only relevant, but reliable.' " United States v. Gabaldon ,
Although the proponent of the challenged testimony has the burden of establishing admissibility, United States v. Nacchio ,
Assuming the standard for reliability is met, the Court must also ensure that the proffered testimony will assist the trier of fact. See Kumho Tire ,
B. Analysis
1. Plaintiff's Motion to Exclude Testimony of John Craver
Defendant has designated John P. Craver, an attorney who practices in the field of insurance law, as an expert witness. Docket No. 54-1 at 3, 6. In his expert report, Mr. Craver concludes that defendant had a "reasonable basis to deny portions of [plaintiff's] claim based on the evidence they had in their claim file at the time of the denial." Id. at 10. Plaintiff does not challenge Mr. Craver's qualifications as an expert witness. See Docket No. 61 at 1. Instead, plaintiff seeks to exclude a number of his statements and opinions on grounds that: (1) they are irrelevant, (2) they improperly usurp the function of the trial judge, (3) they are conclusory, and (3) they are factually erroneous. See generally Docket No. 54; Docket No. 61.
a. Relevance
Plaintiff argues that the following opinions and statements expressed in Mr. Craver's expert report are irrelevant and that the Court should order that Mr. Craver not state them at trial: (1) Mr. Craver's references to
Plaintiff first argues that Mr. Craver's references to *1180
Plaintiff next challenges Mr. Craver's references to Colo. Code Regs. § 702-5:5-1-14 ("Regulation 5-1-14"). That regulation prescribes certain penalties for an insurer's failure to make timely decisions and/or payment on first-party claims. See Colo. Code Regs. § 702-5:5-1-14(4)(A)(1). Specifically, the statute imposes a monetary fine if an insurer "fails to make a decision and/or pay benefits due under the policy within sixty (60) days after a valid and complete claim has been received, and there is not a reasonable dispute between the parties." § 702-5:5-1-14(4)(A)(1)(b). A "valid and complete claim" has been "received" by an insurer when
(1) All information and documents necessary to prove the insured's claim have been received by the insurer; ... 3) The terms and conditions of the policy have been complied with by the insured; ... (5) There are no indicators on the claim requiring additional investigation before a decision can be made; and/or ... (7) Negotiations or appraisals to determine the value of the claim have been completed; and/or (8) Any litigation on the claim has been finally and fully adjudicated.
§ 702-5:5-1-14(4)(A)(2)(a). The statute further provides that a "reasonable dispute" may exist when: (1) information necessary for a determination on the claim has not been submitted; (2) conflicting information has been submitted and additional investigation is needed; (3) the insured has failed to comply with the terms of the insurance policy; or (4) litigation has commenced regarding the claim. § 702-5:5-1-14(4)(A)(2)(b).
In his expert report, Mr. Craver states that: (1) the regulation "provides guidance to insurers on when the [sic] have a duty to pay first party claims" in Colorado, Docket No. 54-1 at 9; (2) "[in] reviewing these ... regulations, it does not appear that there is a valid and complete claim that Owners Insurance owes at this time,"
Defendant contends that Mr. Craver's discussion of the regulation "provides context for the parameters of insurance claims handling." Docket No. 60 at 5. In response, plaintiff claims that at least two cases have specifically held that Regulation 5-1-14 is irrelevant in bad faith actions brought pursuant to
In Fisher v. State Farm Mutual Automobile Insurance Co. , --- P.3d ----,
Plaintiff's citation to Etherton v. Owners Insurance Co. ,
*1182Etherton ,
Plaintiff also challenges the relevance of Mr. Craver's opinions on the timeliness of defendant's claims handling. Docket No. 54 at 10. Mr. Craver states in his report that (1) "there were no substantial delays in the adjustment" of plaintiff's claim, Docket No. 54-1 at 9; (2) defendant's investigation of the claim was "prompt and proactive,"
Plaintiff lastly requests that the Court exclude Mr. Craver's opinions regarding fraudulent insurance claims and Special Investigation Unit ("SIU") investigations. Docket No. 54 at 11-12. In his report, Mr. Craver states:
It should also be noted that the Colorado legislature, through C.R.S. § 10-1-128, makes it clear that there is a strong public policy within the state wherein the state is critically interested in investigating and stopping insurance fraud. The General Assembly has stated that insurance fraud is expensive and that it increases premiums and places businesses at risk. Insurance fraud reduces the customer's ability to raise their standard of living and decreases the economic vitality of the state. I am not suggesting here that Owners Insurance has alleged its insured is committing insurance fraud. I think it is simply important for a jury to know that a critical investigation into theft claims and the amount of the damages sustained, including the use of SIU departments to investigate background, credit and financial issues, is clearly authorized and in fact encouraged by the state's statutes and regulations. There was nothing unusual in an insurer conducting an SIU investigation in a claim of this nature.
Docket No. 54-1 at 9. Plaintiff contends that these opinions are irrelevant and prejudicial because there is no evidence that defendant suspected Mr. Wray of reporting a false or fraudulent claim. Docket No. 54 at 11. The Court agrees. Although plaintiff's claim was initially referred to the SIU for investigation, see Docket No. 60-4 at 2-5, 34:1-35:23, 40:1-41:1, there is no evidence that anyone at Owners suspected Mr. Wray of lying about the stolen coins. See Docket No. 62-24 at 6-7, 24:14-25:4; Docket No. 67-11 at 4 (2/1/16 claim note); Docket No. 77-4 at 3, 15:6-13. The sole reason defendant gave for denying plaintiff's claim was that plaintiff had failed to provide adequate documentation of the stolen coins. See Docket No. 63-13. Any statements or opinions regarding insurance fraud and SIU investigations will therefore be excluded as irrelevant.
*1184b. Statements Regarding Applicable Law
Plaintiff identifies nineteen statements in Mr. Craver's expert report which allegedly constitute impermissible statements of law. See Docket No. 54 at 6-7. These statements appear to set forth the various legal standards Mr. Craver applied in reaching his conclusions. According to defendant, the statements were meant to "provide context as to the legal parameters for insurance industry standards." Docket No. 60 at 9-10. The Court notes that statements eleven through thirteen and nineteen, as identified in plaintiff's motion, see Docket No. 54 at 7, have already been excluded as irrelevant. However, the Court agrees with plaintiff that statements one through eight and fourteen and fifteen should also be excluded.
The Tenth Circuit has held that "a witness may refer to the law in expressing an opinion" or "aid the jury in understanding the facts in evidence even though reference to those facts is couched in legal terms." Specht v. Jensen ,
Defendant argues that industry standards in Colorado are defined by state statute and case law and thus it is impossible for Mr. Craver to express any opinion that defendant complied with those standards without citing to the relevant legal authorities. Docket No. 60 at 10. But defendant's argument fails to distinguish between those statements of Mr. Craver that merely rephrase the determinative legal standard in this case-whether defendant acted reasonably in denying plaintiff's claim-and Mr. Craver's references to statutory and regulatory provisions that, though not conclusive of liability, may illustrate what constitutes "reasonable" conduct in the insurance industry. See Hangarter v. Provident Life & Accident Ins. Co. ,
In summary, the Court will permit testimony as to Regulation 5-1-14. All other statements identified by plaintiff, see Docket No. 54 at 6-7, will be excluded.
c. Conclusory Opinions
Plaintiff also argues that the following statements and opinions contained in the expert report are unsupported: (1) defendant's claim handling complied with industry practices, Docket No. 54-1 at 10; (2) defendant acted in compliance with the Unfair Claims Practices Act,
Fed. R. Evid. 702(b) requires that expert testimony be "based on sufficient facts or data." Thus, a district court is not required "to admit opinion evidence that is connected to existing data only by the ipse dixit of the expert." Etherton ,
The Court also agrees that Mr. Craver does not adequately support his opinions concerning defendant's compliance with the "Unfair Claims Practices Act." Most notably, Mr. Craver does not specify the portions of the Act to which his second and fourth opinions pertain.
The Court reaches a different conclusion, however, insofar as Mr. Craver opines as to defendant's compliance with
*1187(internal quotation marks omitted). Although Mr. Craver's explanation for these conclusions is thin, he references particular requirements of § 10-3-1104, see, e.g. , Docket No. 54-1 at 9 ("The statute also provides insurers should consider all available information in making claims decisions."), and identifies specific actions by defendant that purportedly complied with those requirements. See id. at 10 (stating that defendant "investigated coverage promptly" and "proactively looked for coverage to assist the insured"). As to the claim that defendant complied with "industry practices," the Court agrees that Mr. Craver should have clarified the particular practices to which he refers. Nevertheless, he does address defendant's compliance with § 10-3-1104 and Regulation 5-1-14, both of which provide some evidence of applicable "industry standards." The Court therefore declines to exercise its gatekeeping role to exclude Mr. Craver's opinions on defendant's compliance with (1) § 10-3-1104 and (2) Regulation 5-1-14.
d. Erroneous Statements of Fact
Plaintiff contends that Mr. Craver's expert report contains the following erroneous factual statements: (1) plaintiff submitted no documentary or independent proof of ownership; (2) the only evidence submitted supporting ownership is the statement of the insured that he owned his property; (3) the insured's lack of proof supports an inference that he did not own or purchase the coins; (4) there is no regulation, statute, or formula to determine the adequacy of proof of ownership to substantiate a loss; and (5) an insurer does not act unreasonably in seeking resolution through the courts. Docket No. 54 at 14. Defendant argues that these facts are simply Mr. Craver's "observations" based on the evidence he reviewed. Docket No. 60 at 12.
To the extent these statements constitute mere factual assertions based on the evidence reviewed, the Court finds that Fed. R. Evid. 702 is an inappropriate vehicle for challenging them. Although the accuracy of the facts and assumptions underlying an expert opinion may impact the reliability of that opinion, see Crabbe ,
2. Defendant's Motion to Exclude Testimony of David Young
Plaintiff has designated David Eugene Young, a certified professional public adjuster, as an expert witness. Docket No. 83-1 at 1. Mr. Young opines that Mr. Wray complied with his obligations under the terms of the insurance policy and that defendant's denial of insurance benefits was unreasonable. Docket No. 83-1 at 8-9; Docket No. 84 at 3. In particular, his report concludes that: "[t]he Home Office blocked [Jayme Larson] from paying [plaintiff's claim] and forced her to throw every possible argument not to do so to the insured"; Owners made up requirements not found in the insurance policy; Owners "has attempted to create a level of ownership proof that the insured cannot meet when in fact, the insured HAS complied with the Duties After Loss provision of his policy"; Owners has failed to effectuate a prompt, fair, and equitable settlement of claims "even though liability has become 'reasonably' clear"; and "Bruce Wray ... has complied with the terms of his policy and is therefore entitled to payment." Docket No. 83-2 at 5-6.
Defendant moves to exclude certain of Mr. Young's opinions on grounds that Mr. Young is generally unqualified to opine on the matters addressed in his report, see Docket No. 83 at 9-11, and that his opinions are: (1) based on an unreliable methodology, see id. at 5-8, 13-15; (2) based on insufficient facts or data, see id. at 11-15; (3) irrelevant, see id. at 8-9; and (4) unhelpful to the trier of fact. See id. at 11.
a. Qualifications
Defendant argues that Mr. Young is unqualified to opine as to whether defendant's handling of plaintiff's claim was reasonable because he has never worked as an accountant, attorney, or adjuster for an insurance company. Docket No. 83 at 10. According to defendant, this places Mr. Young "on the outside looking in, with no clear view of either the applicable Colorado industry standards or whether they were met in this particular case." Id.
Plaintiff responds by citing Mr. Young's qualifications. Mr. Young has his own insurance adjusting firm and is licensed to provide public adjusting services in several states, including Colorado. See Docket No. 83-1 at 12; Docket No. 84-2 at 12, 58:18-20, 60:2-3.
In light of this experience, the Court finds that Mr. Young is sufficiently qualified to offer the opinions challenged by defendant. Defendant maintains that Mr. Young has no experience with industry-side claims handling. See Docket No. 83 at 10; Docket No. 85 at 3. But defendant does not cite any authority for the proposition that a public adjuster is unqualified to opine on an insurance company's handling of an claim merely because he serves as an advocate for the insured. Cf. Williamson v. Metropolitan Property & Cas. Ins. Co. ,
Defendant also ignores the breadth and variety of Mr. Young's experience. In addition to being a certified public adjuster, Mr. Young is trained in SIU adjusting,
*1190b. Reliability
Defendant challenges the reliability of certain opinions expressed in Mr. Young's expert report. See Docket No. 83 at 5-8, 11-15. Specifically, defendant argues that: (1) Mr. Young did not apply a methodology to reach his conclusions, id. at 6; (2) the methodology employed by Mr. Young is unreliable because he fails to address the ultimate fact question (i.e. , whether defendant complied with industry standards), Mr. DeBoer's analysis of plaintiff's financial records, and the legal standards cited in Mr. Young's report, id. at 6-7; and (3) Mr. Young's opinions are conclusory and/or based on insufficient facts or data. Id. at 12-15.
Defendant's arguments challenge the methodology employed by Mr. Young in reaching his conclusions. See Docket No. 83 at 6. As plaintiff argues, the purpose of standard of care experts in bad faith litigation is to "[a]pply[ ] the facts of a case to the applicable industry standards." Docket No. 84 at 6; see also O'Sullivan v. Geico Cas. Co. ,
Specifically, although Mr. Young makes factual "observations" based on the evidence and cites authorities ostensibly reflecting insurance industry standards, his ultimate conclusions do not clearly apply those standards to the facts. See Fed. R. Evid. 702(b)-(d) (requiring that the testimony be "based on sufficient facts or data," that the testimony be "the product of reliable principles and methods," and that the expert "reliably appl[y] the principles and methods to the facts of the case"). Instead, many of his opinions reflect his own interpretations of the evidence-interpretations that are both unhelpful to the jury, which is capable of interpreting the evidence without expert assistance, and unsupported. The Court finds that the following challenged opinions in Mr. Young's expert report suffer from these flaws: (1) Ms. Larson lacked final authority regarding the claim, Docket No. 83-2 at 5; (2) the Home Office prevented Ms. Larson from paying plaintiff's claim and forced her to assert every possible argument against paying the claim,
The Court reaches the opposite conclusion as to Mr. Young's statements regarding the legal standards applicable in this case. Defendant challenges the following statements in Mr. Young's report:
Couch on Insurance points out, however, that [a provision requiring the insured to provide an inventory of damaged and undamaged property] "must be given a reasonable construction, and should not be used to relieve the insurer from liability for loss where literal compliance with the contract has become impossible...."
Docket No. 83-2 at 5.
Colorado Law (Colorado Revised Statute § 10-2-1104) requires an insurer to effectuate a prompt fair and equitable settlement of claims when liability has become reasonably clear.
Id. at 6.
Colorado's Unfair Claims Practices Act requires each insurer to develop standards for reasonable claims handling. ( Colorado Revised Statute § 10-3-1104(h) ).
Docket No. 83-3 at 3.
State Statutes and Standard of Care in the Industry also dictate appropriate behavior in the adjustment of claims.
Id. at 2.
Defendant contends that these opinions are unreliable because Mr. Young fails to adequately describe the legal standards he cites. Docket No. 83 at 7. But defendant does not argue that Mr. Young's descriptions of the above-cited legal standards are inaccurate or that the standards themselves are irrelevant to the issues in the case. Accordingly, defendant's argument goes to the reliability of Mr. Young's application of the standards to the facts in this case, not to the reliability of his citations to *1192the standards themselves. Mr. Young's purported lack of comprehension as to the relevant legal standards may call into question the reliability of his ultimate conclusions regarding the reasonableness of defendant's conduct; however, it is not a sufficient basis for excluding any reference to the applicable legal standards. These opinions will therefore not be excluded.
The Court further declines to exclude certain factual statements deemed "erroneous" by defendant. Defendant specifically challenges the following statements in Mr. Young's expert report: (1) "Jayme Larson testified in her deposition that the conduct of Auto Owners in this case was unreasonable," Docket No. 83-2 at 3; (2) the applicable insurance policy requires the insured to submit to an examination under oath as a duty after loss, id. at 4; (3) "Owners would not accept [the hundred of pages of documents submitted by TBL Collectibles, including past business records and the Arvada Police Department Inventory, as] proof of the loss," id. ; and (4) Donald Gibson is an SIU adjuster. Docket No. 83-3 at 3; Docket No. 83 at 12.
c. Whether Opinions Will Assist the Trier of Fact
Defendant argues that certain of Mr. Young's opinions will not assist the trier of fact because they are either irrelevant, see Docket No. 83 at 8, or generally unhelpful to resolving the issues in this case. See id. at 11.
Defendant first contends that Mr. Young's opinions regarding the SIU have no bearing on the ultimate issues in the case-whether plaintiff complied with the terms of the policy and whether defendant acted unreasonably in denying the insurance claim. Docket No. 83 at 8. In his expert report, Mr. Young makes three references to the SIU. First, he observes that "Mr. Gibson told [Ms. Larson] that this claim should be run past SIU," Docket No. 83-2 at 3. Second, he suggests that "[t]he Home Office blocked [Ms. Larson] from paying the claim and forced her to throw every possible argument not to do so," including "reporting the claim to the SIU." Id. at 5. Finally, Mr. Young opines that
the SIU (Special Investigative Unit) is called upon to review claims when one or more issues exist: (1) there is suspected *1193fraud involved, (2) there is questions of coverage or (3) when the insurer suspects a lawsuit. When an insurer assigns its SIU to a claim it is to find a reason not to pay the claim. The SIU in this case saw no reason to proceed and, after a brief review, took the SIU out of further investigation of the claim.
Id. at 6.
Finally, defendant challenges Mr. Young's assertions that (1) "Owners Insurance Company has attempted to create a level of ownership proof that the insured cannot meet when in fact, the insured HAS complied with the Duties After Loss provision of his policy," and (2) Owners has failed to "effectuate a prompt fair and equitable settlement of claims." Docket No. 83-2 at 6; Docket No. 83 at 11. Defendant argues that these are unhelpful conclusory opinions because Mr. Young never explains what " 'reasonableness' means within the context of insurance claims handling in Colorado" or "how Owners' failed to comport with such standards." Docket No. 83 at 11. The Court agrees. Although Mr. Young appears to base his opinions-at least in part-on the standards set forth in § 10-3-1104, he does not articulate the factual basis for his conclusions or explain how the standards applied relate to the issue of defendant's reasonableness. As the Supreme Court has noted, "nothing in either Daubert or the Federal Rules of Evidence requires a district court to admit opinion evidence that is connected to existing data only by the ipse dixit of the expert." Joiner ,
III. SUMMARY JUDGMENT
A. Legal Standard
Summary judgment is warranted under Federal Rule of Civil Procedure 56 when the "movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a) ; see Anderson v. Liberty Lobby, Inc. ,
Where "the moving party does not bear the ultimate burden of persuasion at trial, it may satisfy its burden at the summary judgment stage by identifying a lack of evidence for the nonmovant on an essential element of the nonmovant's claim." Bausman v. Interstate Brands Corp. ,
B. Analysis
Defendant moves for summary judgment on plaintiff's claims for declaratory judgment, breach of contract, and insurance bad faith under § 10-3-1115. Plaintiff has filed a cross motion for summary judgment on the declaratory judgment claim.
1. Declaratory Judgment
Plaintiff's first claim for relief seeks a declaratory judgment that (1) plaintiff has substantially complied with the terms of the insurance policy and (2) defendant is estopped from requiring, and/or has waived the right to require, further documentation of the existence and/or value of the stolen bullion coins. See Docket No. 1 at 11, ¶¶ 46-47.
Because declaratory judgment acts are procedural rules, "federal law determines whether a district court may properly enter a declaratory judgment" in a diversity case. Addison Ins. Co. v. Maynard , 08-cv-00054-WDM-BNB,
The Tenth Circuit has identified five factors (" Mhoon factors") a district court should consider in determining whether to exercise its discretion to hear a declaratory judgment action:
[1] whether a declaratory action would settle the controversy; [2] whether it would serve a useful purpose in clarifying the legal relations at issue; [3] whether the declaratory remedy is being used merely for the purpose of "procedural fencing" or "to provide an arena for a race to res judicata "; [4] whether use of a declaratory action would increase friction between our federal and state courts and improperly encroach upon state jurisdiction; and [5] whether there is an alternative remedy which is better or more effective.
*1195
Courts have typically applied the factors listed above to decline jurisdiction over declaratory judgment claims where there is parallel litigation in state and federal courts, see Golf Club, L.L.C. v. Am. Golf Corp. ,
*1196(dismissing declaratory judgment claim without prejudice on ground that it "serve[d] no useful purpose" because "all issues identified for resolution by declaratory judgment [would] be decided in adjudicating [plaintiff's] other claims"); U.S. Aviation Underwriters, Inc. v. Dassault Aviation ,
The Court finds both of these rationales persuasive. Assuming the Mhoon factors apply in cases such as this where there is no pending state court litigation, the Court finds that the first, second, and fifth factors weigh in favor of dismissal.
*1197However, even if the Mhoon factors do not apply, the Court agrees with the rationale in PDX Pro Co. and United States Aviation Underwriters. As the Tenth Circuit has noted, the Declaratory Judgment Act "enables parties uncertain of their legal rights to seek a declaration of rights prior to injury." Kunkel v. Continental Cas. Co. ,
In short, the Court discerns no reason-and plaintiff offers none-for issuing a declaratory judgment when the parties' obligations under the insurance policy will necessarily be resolved in the context of plaintiff's breach of contract and bad faith claims. Accordingly, the Court finds that summary judgment in favor of defendant on this claim is appropriate.
2. Breach of Contract
Defendant also seeks summary judgment on plaintiff's breach of contract claim.
In Colorado, "a party attempting to recover on a claim for breach of contract must prove the following elements: (1) the existence of a contract; (2) performance by the plaintiff or some justification for nonperformance; (3) failure to perform the contract by the defendant; and (4) resulting damages to the plaintiff." W. Distrib. Co. v. Diodosio ,
As relevant here, plaintiff's insurance policy listed eight duties that plaintiff was required to perform in the event of a loss:
(1) Notify the police if a law may have been broken. (2) Give us prompt notice of the loss or damage. Include a description of the property involved. (3) As soon as possible, give us a description of how, when and where the loss or damage occurred. (4) Take all reasonable steps to protect the Covered Property from further damage, and keep a record of your expenses necessary to protect the Covered Property, for consideration in the settlement of the claim.... (5) At our request, give us complete inventories of the damaged and undamaged property. Include quantities, costs, values and amount of loss claimed. (6) As often as may be reasonably required, permit us to inspect the property proving the loss or damage and examine your books and records. Also permit us to take samples of damaged and undamaged property for inspection, testing and analysis, and permit us to make copies from your books and records. (7) Send us a signed, sworn proof of loss containing the information we request to investigate the claim.... (8) Cooperate with us in the investigation or settlement of the claim.
Docket No. 63-12 at 9 ("Duties in the Event of Loss or Damage"). Defendant has admitted that, at all relevant times, Ms. Larson believed that plaintiff had complied with duties one through four and six through eight. See Docket No. 62 at 5, ¶¶ 12, 14. Defendant's only argument as to this claim is that plaintiff failed to provide a "complete inventory" as required under duty five. See
It is undisputed that Mr. Wray did not maintain up-to-date records of his purchases and sales of gold coins. Docket No.
*119863 at 4, ¶ 8. After the burglary, however, he created a handwritten list of the stolen coins from memory and provided it to defendant. See Docket No. 67 at 5, ¶ 12. The list included descriptions, quantities, and costs for each coin. Docket No. 62 at 6, ¶¶ 17-18. Plaintiff also supplied defendant with the APD report, which contained a similar list of the stolen coins created from Mr. Wray's memory, along with additional items Mr. Wray remembered and identified at a later date. Id. at 6-7, ¶¶ 18, 20. The total amount of plaintiff's claimed loss could be calculated by adding the costs identified in the complete list of stolen items contained in the APD Report. Id. at 7, ¶ 20.
Duty five does not define "inventory." Docket No. 68 at 8, ¶ 23. Defendant argues that the term should be read in light of plaintiff's insurance policy as a whole, which covered business personal property
[t]he estimated value at the end of an inventory procedure that is based on retail price and cost. Includes the following steps: (1) maintaining detailed records of stock and prices, (2) computation of cost to retail percentage, (3) estimation of price of goods remaining against price of goods sold and (4) conversion of the estimation of inventory at a retail price as compared to the cost price.
Docket No. 63 at 10; Docket No. 67 at 15. The term "retail inventory method" does not appear in the policy, and defendant cites no cases that construe "inventories" in duty five to require a policyholder to employ the "retail inventory method" in order to fulfill its duties in making a claim.
In Colorado, "[t]he interpretation of an insurance contract is a question of law" to which traditional principles of contract interpretation apply. USAA Cas. Ins. Co. v. Anglum ,
*1199Ins. Co. ,
The Court finds that there is nothing in the phrase "complete inventories" in duty five that requires plaintiff to tender a pre-existing and up-to-date record of purchases and sales. First, the dictionary definition of "inventory" is "a detailed list of assets," "an itemized list of current assets," or "the quantity of goods or materials on hand," Inventory , Black's Law Dictionary (10th ed. 2014); Inventory , Merriam Webster's Collegiate Dictionary (11th ed. 2007), indicating that an "inventory" is simply a list of items. And although the parties do not cite any cases interpreting similar policy terms, decisions of this Court have taken for granted that a list of stolen items, created after a theft, can qualify as an "inventory" for insurance purposes. See, e.g. , Walker v. State Farm Fire & Cas. Co. , No. 16-cv-00118-PAB-STV,
Second, the phrase "complete inventories" contemplates more than a single record of purchases and sales. The phrase appears to require an insured to provide separate "inventories" of both damaged and undamaged property-a task that would be impossible before a loss occurs. Further, because the term "complete" is most naturally read as modifying both types of "inventories," an insured satisfies *1200its obligations under duty five by providing, at the insurer's request, a complete inventory of damaged property and a complete inventory of undamaged property. Ms. Larson testified that she did not request a complete inventory of undamaged property, i.e. , items not stolen. Docket No. 68-3 at 11, 133:18-24. Thus, plaintiff's list of stolen property appears to satisfy plaintiff's obligations under the plain language of duty five.
This conclusion is further supported by duty five's use of the term "include." Duty five states: "give us complete inventories of the damaged and undamaged property. Include quantities, costs, values and amount of loss claimed." Docket No. 63-12 at 9. Because the word "include" instructs the policyholder how to create the "complete inventories" (i.e., make sure the inventory includes quantities, costs, etc.), it supports an interpretation of duty five that the inventories are created after the loss. Use of the word "include" as a directive is inconsistent with defendant's interpretation since, under defendant's theory, the inventory already exists. Directing the insured on what to include in the "inventories" makes sense only if the inventories are created after the loss. In this case, Mr. Wray supplied defendant with an inventory of stolen coins that he created from memory after the burglary. The Court finds that this satisfied plaintiff's obligations under the plain language of the insurance policy.
To the extent that the term "inventory" is ambiguous, the Court reaches the same conclusion. Ambiguous policy terms must be "construed against the insurer ... and in favor of the insured." State Farm Mut. Auto. Ins. Co. ,
Defendant argues, in the alternative, that even if an "inventory" can be created from memory, the Court should grant summary judgment because plaintiff has provided no documentation substantiating the ownership or existence of the specific coins allegedly stolen. Docket No. 63 at 12; Docket No. 67 at 17; Docket No. 77 at 8. This argument is unavailing for two reasons. First, defendant does not point to any policy language requiring the insured to provide such documentation.
In summary, the Court finds that plaintiff complied with its obligations under the insurance policy and thus defendant is not entitled to summary judgment on plaintiff's breach of contract claim.
3. Unreasonable Delay or Denial of Benefits Under
Defendant also moves for summary judgment on plaintiff's claim for insurance bad faith under
Although what constitutes "reasonableness" in the insurance context "is ordinarily a question of fact for the jury," Chateau Village N. Condominium Ass'n v. Am. Family Mut. Ins. Co. ,
Defendant first argues that, because plaintiff failed to adequately substantiate its loss, defendant had a reasonable basis for denying the claim. See id. at 13-15. As the Court determined above, plaintiff complied with its duties under the insurance policy. Moreover, defendant's insurance expert, Mr. Craver, stated in his report that "there is no regulation, statute or formula to determine the adequacy of proof of ownership to substantiate the loss." Docket No. 54-1 at 10. As a result, defendant fails to show that its denial of the claim was reasonable as a matter of law.
Defendant also suggests that plaintiff's failure to substantiate its losses made the claim "fairly debatable" and therefore subject to summary judgment in defendant's favor. Defendant cites Glacier Construction Co. v. Travelers Property Casualty Co. of America ,
Defendant next argues that summary judgment is appropriate because defendant relied on the findings and opinions of an independent expert-Paul DeBoer-in denying plaintiff's claim for benefits. See Docket No. 63 at 15. The cases defendant cites do not support this position.
Defendant relies primarily on Adams v. Allstate Insurance Co. ,
Defendant's remaining cases are equally unpersuasive. Crespo v. Unum Life Insurance Co. of America ,
Defendant's final argument in favor of summary judgment is that plaintiff has failed to obtain any admissible evidence as to the industry standards defendant allegedly breached. See Docket No. 63 at 18. In support of this contention, defendant claims that Mr. Young is not qualified to opine as to the relevant industry standards and plaintiff "has not retained its own forensic accountant as an expert in this matter." Id.
The Court agrees that "[t]he reasonableness of the insurer's conduct must be determined objectively, based on proof of industry standards," Goodson v. Am.Standard Ins. Co. of Wis. ,
The Court finds that these requirements are met in this case. Plaintiff contends that "Owners has misrepresented the provisions of the Policy, not attempted in good faith to effectuate the prompt, fair, and equitable settlement of this claim, and compelled TBL to institute litigation to recover amounts due under the Policy, all in violation of C.R.S. § 10-3-1104(1)(h)." Docket No. 68 at 19. As previously explained in this order and prior orders, § 10-3-1104(1)(h) provides "examples of conduct violative of [insurance] industry standards." Leeper v. Allstate Fire & Cas. Ins. Co. , No. 13-cv-03460-PAB-KMT,
IV. CONCLUSION
For the foregoing reasons, it is
ORDERED that Plaintiff's Motion to Exclude Certain Opinions and Testimony of Defendant's Expert, John P. Craver, Esq. [Docket No. 54] is GRANTED IN PART and DENIED IN PART as stated in this order. It is further
ORDERED that Owners' Motion to Exclude Certain Opinions and Testimony of Plaintiff's Expert David Young [Docket No. 83] is GRANTED IN PART and DENIED IN PART as stated in this order. It is further
ORDERED that Plaintiff's Motion for Partial Summary Judgment on First Claim for Declaratory Relief [Docket No. 62] is DENIED . It is further
ORDERED that Defendant Owners Insurance Company's Motion for Summary Judgment [Docket No. 63] is GRANTED IN PART and DENIED IN PART . It is further
ORDERED that defendant's summary judgment motion is GRANTED as to plaintiff's first claim for relief. It is further
ORDERED that defendant's summary judgment motion is DENIED as to plaintiff's second and third claims for relief.
The following facts are undisputed unless noted otherwise.
Plaintiff appears to define "bullion coins" as coins that do not have a face value and are not in current circulation. The value of these coins is based on the value of the gold or silver from which they are made. Id. at 6, ¶ 19.
Plaintiff contends that the invoices from Cornerstone Bullion could not have proven that plaintiff had $31,800 in the safe at the time of the burglary. Docket No. 68 at 2, ¶ 5.
Defendant disagrees with plaintiff's assertion that the stolen coins were "covered" under the policy. Docket No. 67 at 3, ¶ 4. However, there appears to be no dispute that the coins would have been covered under the policy had plaintiff provided the type of documentation defendant claims was necessary. See Docket No. 62-28 at 2; Docket No. 63-13 at 1-2.
As plaintiff acknowledged in its interrogatory responses, the invoices for plaintiff's check purchases reflected only bulk purchases, not the purchase of individual coins. Docket No. 68-5 at 8.
Although the letter indicates that plaintiff could submit further documentation for defendant's review, Ms. Larson confirmed in her deposition that the letter constituted a denial of defendant's claim.See Docket No. 54-4 at 13, 135:10-13.
The regulation lists two additional circumstances potentially constituting a "reasonable basis," but Mr. Craver does not cite or appear to rely on those circumstances in his report.
As discussed in more detail below, plaintiff's statutory bad faith claim is not predicated on defendant's delay in authorizing payment. Accordingly, the regulation is only relevant insofar as it defines "complete and valid claim" and "reasonable dispute," given that such definitions bear on whether plaintiff's claim was "fairly debatable" and, relatedly, whether defendant's nonpayment was reasonable under the circumstances. See Glacier Constr. Co. v. Travelers Property Cas. Co. of Am. ,
Plaintiff's complaint asserts a violation of
Colorado courts have held that an insurer waives the right to assert a particular defense to liability where it did not deny the insured's claim on that basis and only asserted the defense in subsequent litigation. See, e.g. , Colard v. Am. Family Mut. Ins. Co. ,
As the court in Specht explained, these concerns about a witness usurping the function of the trial judge are particularly pronounced where, as here, the expert witness is an attorney. See id. at 808-09 ("There is a significant difference between an attorney who states his belief of what law should govern the case and any other expert witness."). Not only is the jury more likely to be unduly influenced by an attorney-witness, but competing testimony on the applicable law would give rise to significant confusion. Id. at 809.
Moreover, as defendant points out, the decision of whether to admit expert testimony in bad faith insurance cases is "left to the sound discretion of the trial court." Vining v. Enter. Fin. Grp. ,
The Court further notes that statements five, fourteen, and fifteen pertain to a legal standard that is not applicable in this case. Section 10-3-1113 of the Unfair Claims Practices Act codifies the common law tort of bad faith breach of an insurance contract and provides that "[u]nder a policy of first-party insurance, the determination of whether the insurer's delay or denial was reasonable shall be based on whether the insurer knew that its delay or denial was unreasonable or whether the insurer recklessly disregarded the fact that its delay or denial was unreasonable."
The relevant portion of Mr. Craver's expert report states as follows:
The insurer acted in compliance with the Unfair Claims Practices Act. There is no suggestion here of a general business practice. Its denial cannot fairly be considered willful. It investigated coverage promptly. The adjuster proactively looked for coverage to assist the insured. The policy benefits that have been determined owed have been paid in a timely manner. The payment for repairs and the cash loss was prompt. The insurer has given a reasonable explanation for its claims actions and its decision not to pay for the reported stolen collector coins. It has not attempted to settle the claim for less than the amount a reasonable person would. It appears Owners Insurance has fully complied with the requirements of the Unfair Claims Practices Act set forth at C.R.S. § 10-3-1104.
Docket No. 54-1 at 10.
Likewise, Mr. Craver's opinion that the denial of plaintiff's claim "cannot fairly be considered willful" is irrelevant to whether defendant acted reasonably under § 10-3-1115. See Docket No. 54-1 at 10. Statutory bad faith claims contain no requirement of willful conduct and thus any testimony to that effect would only confuse the jury.
Mr. Craver may not opine as to defendant's compliance with "industry practices" generally. His testimony on defendant's compliance with industry standards will therefore be limited to those opinions pertaining to § 10-3-1104 and Regulation 5-1-14, which were identified in his expert report.
Moreover, to the extent Mr. Craver is suggesting that an insured cannot prevail on a statutory bad faith claim prior to a judicial determination of coverage and/or benefits owed, courts in this district have rejected similar arguments. See, e.g. , Baumann v. Am. Family Mut. Ins. Co. , No. 11-cv-00789-CMA-BNB,
Mr. Young testified that in his time with Brown O'Haver, his insurance adjusting firm, he has adjusted approximately three hundred theft claims, twenty percent of which involved commercial theft. Docket No. 84-2 at 10, 49:3-15.
Mr. Young specifically testified that his public adjusting firm "handle[s] issues of ... coverage." Docket No. 84-2 at 9, 45:25-46:1.
Defendant argues that Mr. Young has never actually worked as an SIU adjuster and only obtained the certificate in order to attend SIU meetings. See Docket No. 85 at 3; see also Docket No. 84-2 at 11, 53:25-54:3. But it is not clear how Mr. Young's motivations for seeking an SIU adjuster certificate have any bearing on his training or knowledge in the area. See Docket No. 84-2 at 11, 54:4-7 (testifying that he completed forty hours of continuing education requirements to receive SIU certificate). Moreover, Mr. Young's training in SIU adjusting is supplemented by actual work experience in other areas of the insurance adjusting field.
According to the website cited by plaintiff, FC & S stands for "Fire, Casualty, & Surety Bulletins." www.nationalunderwriterpc.com/Pages/AboutUs.aspx (last visited Jan. 17, 2018). This service was "started in 1929 by Edward J. Wolgemuth, founder of The National Underwriter Company."
Defendant characterizes this opinion as "Owners was looking for reasons to deny the claim." Docket No. 83 at 14; Docket No. 85 at 8.
As defendant points out, this opinion misstates the citation for the applicable statute. See Docket No. 83 at 7. The correct citation is
In the same section of its motion to exclude, defendant argues that Mr. Young's methodology is unreliable because he fails to answer the ultimate fact question in the case-whether defendant complied with industry standards-and does not discuss the results of Paul DeBoer's financial analysis. See Docket No. 83 at 6-7. Defendant does not identify the specific opinions it seeks to exclude on these bases. See Practice Standards (Civil Cases), Judge Philip A. Brimmer § III.G ("The motion shall identify with specificity each opinion the moving party seeks to exclude ... [as well as] the specific ground(s) on which each opinion is challenged ...."). In any event, the Court finds that Mr. Young's purported failure to give an ultimate opinion as to defendant's compliance with industry standards or discuss the findings of Paul DeBoer goes more to the weight and credibility of Mr. Young's opinions than to their admissibility. Accordingly, these perceived shortcomings do not warrant the wholesale exclusion of Mr. Young's testimony.
Defendant also challenges as erroneous Mr. Young's statements that Ms. Larson lacked authority over plaintiff's claim and that the Home Office prevented her from authorizing payment. See Docket No. 83 at 12. Setting aside the fact that these statements appear to be statements of opinion rather than fact, the Court notes they have already been excluded as unsupported.
Defendant also notes Mr. Young's misunderstanding as to Mr. Gibson's relationship to the SIU See Docket No. 83 at 9. As previously discussed, however, that misunderstanding was corrected during Mr. Young's deposition and is unlikely to come up at trial.
Although Mr. Craver's statement that "there is a strong public policy within [Colorado] wherein the state is critically interested in investigating and stopping insurance fraud," Docket No. 54-1 at 9, might have created an implication to that effect, the statement has been excluded as irrelevant.
The second and third factors appear to be inapplicable in this case because the Court is unaware of pending litigation in any other forum.
The insurance policy also requires that the "inventory" include "values" for the lost items. Docket No. 63-12 at 9. However, defendant has admitted that, because the value of bullion coins fluctuates based on the value of gold or silver, defendant was only interested in the amount Mr. Wray paid for the coins-i.e., their "cost." Docket No. 62 at 6, ¶ 19. In other words, defendant does not claim that plaintiff failed to comply with duty five merely because neither the handwritten list nor the APD Report listed a value for each coin separate from the cost of that coin.
Under the policy, "business personal property" consists of the following:
(1) [f]urniture and fixtures; (2) [m]achinery and equipment; (3) "[s]tock"; (4) [a]ll other personal property owned by [the policyholder] and used in [the policyholder's] business; (5) [l]abor, materials or services furnished or arranged by [the policyholder] on personal property of others; (6) [the policyholder's] use interest as tenant in improvements and betterments ...; (7) [l]eased personal property for which [the policyholder has] a contractual responsibility to insure ....
Docket No. 63-12 at 1.
The Court was unable to find a definition of "retail inventory method" in the second edition of Black's Law Dictionary. The cited definition can, however, be found at http://thelawdictionary.org/retail-inventory-method/. The website purports to "featur[e]" the second edition of Black's Law Dictionary.
The parties do not cite to any choice-of-law provision in the insurance policy, but they appear to agree that Colorado law governs the interpretation of the insurance policy. See generally Docket No. 62 at 10-11; Docket No. 67 at 14. The Court will operate under the same premise. Cf. Grynberg v. Total S.A. ,
As discussed above, defendant appears to suggest that, because the bullion coins constituted "stock," the term "inventory" must be read in the context of common retail practices. See Docket No. 63 at 6, ¶ 16; Docket No. 67 at 14-15. But defendant does not direct the Court to any language in the policy-other than the phrase "complete inventories"-to support such an interpretation, and the Court is obligated to avoid "strained constructions" in order to give effect to the reasonable intent and expectations of the parties. Allstate Ins. Co. v. Starke ,
Defendant does not argue that there is an implied term in the insurance contract imposing such a requirement.
The policy does require the insured to "permit [the insurance company] to inspect the property proving the loss ... and examine [the insured's] books and records." Docket No. 63-12 at 9 ("Duties in the Event of Loss or Damage"). But defendant does not argue-and the Court does not find-that this provision requires an insured to produce documents proving the existence and/or ownership of the lost items. Moreover, it is undisputed that defendant's denial of plaintiff's insurance claim was not predicated on plaintiff's failure to comply with this policy term. See Docket No. 62 at 5, ¶¶ 12, 14; see also Colard ,
Defendant disputes this fact, asserting that "Paul DeBoer's analysis actually revealed that there was no substantiation of the existence of the coins." Docket No. 67 at 8, ¶ 22. But the document cited by defendant does not support this proposition. See Docket No. 63-9 at 1 (explaining that "purchases by check would likely represent the building of saleable inventory ... and the purchase by invoice from the broker, largely, would result in brokerage fees). Moreover, there is some indication in the record that DeBoer initially declined to express an opinion on whether the documents provided were sufficient to substantiate the claimed loss. Instead, he informed defendant that it was defendant's choice whether to base the claim on the "exact documented loss" or on plaintiff's "spending pattern." Docket No. 67-11 at 3-4 (2/1/16 entry).
Given the Court's determination that plaintiff complied with its obligations under the insurance policy, the Court need not address plaintiff's alternative argument that defendant has waived the right to require, and/or should be estopped from requiring, additional documentation substantiating plaintiff's claim. See Docket No. 68 at 15-17.
Reference
- Full Case Name
- TBL COLLECTIBLES, INC., d/b/a Colorado Coins, Cards & Comics v. OWNERS INSURANCE COMPANY
- Cited By
- 55 cases
- Status
- Published