Doe v. Ins. Co. Of The State Of Pennsylvania
Doe v. Ins. Co. Of The State Of Pennsylvania
Opinion of the Court
THIS CAUSE comes before the Court upon Defendant The Insurance Company of the State of Pennsylvania's ("Defendant") Motion for Final Summary Judgment (the "Motion"). [ECF No. 45]. The Court has considered the Motion, the record, argument of counsel at the hearing on the Motion, and is otherwise fully advised. For the reasons set forth below, the Motion is GRANTED.
I. BACKGROUND
A. The Underlying Action
On July 26, 2013, Plaintiff Jane Doe ("Plaintiff") filed an action (the "Underlying Action") against Cayman Style Ocean Adventures, Inc. ("CSOA") and its employee Shawn Mourao ("Mourao"). On March 3, 2014, Plaintiff filed her Second Amended Complaint in the Underlying Action bringing claims for negligence, sexual assault, battery, intentional infliction of emotional distress, and negligent infliction of emotional distress (the "Underlying Complaint"). [ECF No. 29]. Aside from the direct negligence claim against CSOA, Plaintiff's claims were brought against Mourao individually and against CSOA based on vicarious liability.
As set forth in the Underlying Complaint, on July 22, 2012, Plaintiff embarked on a seven-day Caribbean cruise on the Carnival Legend. For the cruise's stop in Grand Cayman, Plaintiff purchased a three-hour beach and party boat snorkeling excursion operated by CSOA. On July *136127, 2012, Plaintiff went ashore to participate in the excursion. Upon arriving at the CSOA excursion vessel, Plaintiff was introduced to Mourao who identified himself as the captain. When the CSOA excursion vessel returned to the harbor, Plaintiff disembarked and remarked that she needed to use the bathroom before returning to the Carnival Legend. Mourao offered to direct Plaintiff to the nearest bathroom. Rather than assist Plaintiff, Mourao led her to a nearby shopping center where he detained her against her will in a small room and sexually assaulted her.
CSOA and Mourao failed to appear in or defend the Underlying Action. After clerk's defaults were entered against both, Plaintiff filed a Motion for Entry of Final Default Judgment [ECF No. 42-4]. The court entered a Final Default Judgment as to Liability [ECF No. 42-6], but reserved judgment as to damages pending an evidentiary hearing. After the evidentiary hearing, the court entered a Final Default Judgment in the amount of $ 1,988,460.54 against CSOA and Mourao jointly and severally. [ECF No. 42-7].
B. The Policies
At the time of the allegations in the Underlying Complaint, CSOA and Mourao were insured by Defendant under a Foreign Commercial General Liability Policy [ECF No. 1-1]. A second policy, the Foreign Commercial Package Policy, which is materially identical, was also issued to "Cayman Style Ocean Adventures, Ltd." [ECF No. 1-2] (collectively the "Policies"). The relevant provisions of the Policies provide:
SECTION I - COVERAGES
COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY
Subject to any deductibles, limitations, terms, conditions, sublimits and exclusions contained in the Declarations, together with any Schedules applicable to this Foreign Commercial General Liability Coverage Part, we agree to provide coverage to you to the extent herein provided.
1. Insuring Agreement
a. We will pay those sums that an insured becomes legally obligated to pay as damages because of bodily injury or property damage to which this insurance applies....
b. This Foreign Commercial General Liability Coverage Part applies to bodily injury and property damage only if:
(1) The bodily injury or property damage is caused by an occurrence that takes place in the coverage territory.
* * *
SECTION V - DEFINITIONS
* * *
15. Occurrence means an accident, including continuous or repeated exposure to substantially the same general harmful conditions.
* * *
2. Exclusions
This insurance does not apply to:
a. Expected or Intended Injury
Bodily injury or property damage expected or intended from the standpoint of the insured.
* * *
ABUSE OR MOLESTATION EXCLUSION
* * *
The following exclusion is added to Paragraph 2., Exclusions of Section I -*1362Coverage A - Bodily Injury And Property Damage Liability ...
This insurance does not apply to bodily injury ... arising out of:
1. The actual or threatened abuse or molestation by anyone of any person while in the care, custody or control of any insured, or
2. The negligent:
a. Employment;
b. Investigation;
c. Supervision;
d. Reporting to the property authorities, or failure to so report; or
e. Retention
of a person for whom any insured is or ever was legally responsible and whose conduct would be excluded by Paragraph 1., above.
COVERAGE C MEDICAL PAYMENTS
1. Insuring Agreement
a. We will pay medical expenses as described below for bodily injury caused by an accident:
(1) On premises you own or rent;
(2) On ways next to premises you own or rent; or
(3) Because of your operations; provided that:
(1) The accident takes place in the coverage territory and during the Policy Term;
(2) The expenses are incurred and reported to us within one year of the date of the accident; and
(3) The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require.
* * *
g. Coverage A Exclusions
Excluded under Coverage A.
[See ECF No. 43-3, 43-3]. Based on its interpretation of the Policies, Defendant denied coverage in the Underlying Action.
C. The Current Action
Plaintiff brought this lawsuit for breach of contract and declaratory relief seeking to recover the full amount of the Final Default judgment in the Underlying Lawsuit. In her First Amended Complaint [ECF No. 29] and in the pleadings presently before this Court, Plaintiff argues that Defendant must indemnify its insureds because the Final Default Judgment falls within the terms of the Policies and no exclusions apply. Defendant has moved for summary judgment arguing that there is no coverage for the Final Default Judgment under the Policies because Plaintiff's losses are excluded by the Abuse and Molestation Exclusion endorsement and under the plain language of the insuring agreements. Defendant has also filed a counterclaim, seeking a declaratory judgment that neither policy applies.
II. LEGAL STANDARD
Pursuant to Federal Rule of Civil Procedure 56(a), "[t]he court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). "[T]he plain language of Rule 56 [a] mandates the entry of summary judgment, after adequate time for discovery and upon motion, against a party who *1363fails to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial." Celotex Corp. v. Catrett,
"The moving party bears the initial burden to show the district court, by reference to materials on file, that there are no genuine issues of material fact that should be decided at trial. Only when that burden has been met does the burden shift to the non-moving party to demonstrate that there is indeed a material issue of fact that precludes summary judgment." Clark v. Coats & Clark, Inc. ,
III. ANALYSIS
A. General Principles
Under Florida law, "interpretation of an insurance policy is a question of law to be decided by the court." Gulf Tampa Drydock Co. v. Great Atl. Ins. Co. ,
If there is a dispute over coverage and exclusions, the Court employs a burden-shifting framework. See E.S.Y., Inc. v. Scottsdale Ins. Co. ,
The duty to indemnify is dependent upon the "actual facts" of the underlying action, which are generally developed through entry of a final judgment, settlement, or other final resolution of the underlying claim. See Stephens v. Mid-Continent Cas. Co. ,
B. Interpretation of the Policy Language
Defendant raises two primary arguments for why Plaintiff's injuries are not covered: (1) that the assault was not an "accident" or "occurrence" covered under the Policy's terms, and (2) that the plain language of the insurance policy excludes Plaintiff's injuries, namely that Mourao's conduct is excluded from coverage under the abuse or molestation endorsement. Each is discussed in turn.
1. Whether The Judgment Falls Under The Policies' Insuring Agreement
At issue is whether the assault is covered under the policy because it constituted a "bodily injury ... caused by an occurrence." The insurance policy defines "occurrence" as an "accident."
Florida precedent defines "accident" as an "accidental event [causing] injuries or damage" that is "neither expected nor intended from the standpoint of the insured." Singer v. Colony Ins. Co. ,
Defendant relies heavily on Compupay for the proposition that sexual harassment is always an intentional act and therefore cannot be an "accident." In Compupay , however, the insured employer had knowledge of its employee's past bad behavior. Compupay ,
*13662. The Abuse or Molestation Exclusion
The insurance policy contains an "abuse or molestation exclusion," which effectively releases Defendant from coverage if its insured sexually assaults anyone in the insured's "care custody or control." Both parties agree that Doe's rape constitutes "abuse or molestation." At issue is whether the abuse occurred when she was under the "care, custody, or control" of CSOA and Mourao.
Defendant argues that CSOA and Mourao had "care, custody, or control" of Plaintiff because: (1) Plaintiff alleged that both CSOA and Mourao owed her a duty to protect and care for her safety, and (2) Mourao was acting in the course and scope of his employment at the time of the assault. In support of this, Defendant cites a series of cases discussing materially similar abuse or molestation exclusions, where children were placed in the custody of a caregiver other than their parents, were abused, and subsequently were found to be outside the scope of relevant insurance provisions. E.g., Am. Empire Surplus Lines Ins. Co. v. Chabad House of N. Dade, Inc. ,
Plaintiff argues that this exclusion does not apply because she was not in the "care, custody, or control" of CSOA or Mourao at the time of the incident for two reasons: (1) the excursion ended when she reached her destination and disembarked the party boat, ending Mourao and CSOA's "care, custody, or control," and (2) that although Mourao's actions originated in the course and scope of his employment during the assault, whether he was acting in the "course and scope of his employment" is legally different from whether she was in his "care, custody, or control." [ECF No. 48 at 12-13].
"Care, custody, or control" is a phrase frequently used in insurance contracts. Shankle v. VIP Lounge, Inc. ,
"Care" refers to the "conduct" or "function" of a party with obligations towards *1367another. Care , MERIAM-WEBSTER DICTIONARY ("Webster's"), https://www.merriam-webster.com/dictionary/care (last visited September 20, 2018); see also Care , BLACK'S LAW DICTIONARY (10th Ed. 2014). "Custody," refers to "guarding" or "control" of a person for specific purposes. Custody , Webster's, https://www.merriam-webster.com/dictionary/custody (last visited September 20, 2018); see also Custody , BLACK'S LAW DICTIONARY (10th Ed. 2014). And finally, "control" refers to "power" or "influence" over another. Control , Webster's, https://www.merriam-webster.com/dictionary/custody (last visited September 20, 2018); see also Control , BLACK'S LAW DICTIONARY (10th Ed. 2014). The parties here do not dispute these definitions, only how they apply.
The parties agree that Plaintiff is an adult woman who went on a cruise excursion. Mourao, a staff member of the cruise excursion and her assailant, guided her to the bathroom at her request, where he then assaulted her. And the Underlying Complaint, whose facts are accepted as true, alleges that "at all relevant times, Mourao was acting within the course and scope of his employment and/or exercising his duties as a member of the CSA crew[,]" and that the sexual assault happened "during" the excursion. [ECF No. 42-1 ¶¶ 26, 47, 48]. This fact was key to obtaining a judgment against CSOA in the underlying action, as opposed to judgment only against Mourao. [Id. ¶¶ 38-40, 45-54, 57-63, 66-75, 78-85]. Plaintiff cannot change her position on this key fact now.
The Court finds that the admitted allegations in the Underlying Complaint establish that the Abuse or Molestation exclusion eliminates coverage. All of the underlying claims either involved abuse or molestation or are deemed to have arose out of the abuse or molestation of Plaintiff. See Chabad House ,
C. Defendant's Counterclaim
Defendant's counterclaim seeks a declaratory order that Defendant "has no duty to indemnify Jane Doe for the default judgment" against CSOA and Mourao under either of the two policies. Plaintiff asserted four affirmative defenses, but conceded her fourth affirmative defense in her pleadings, and has also agreed that her third affirmative defense only applies if the Court rules that coverage exists. The policies are materially and functionally similar, and the Court has found for the Defendant on the pertinent issues. Thus, Plaintiff's remaining defenses are rendered moot.
IV. CONCLUSION
For the foregoing reasons, it is ORDERED AND ADJUDGED that Defendant's Motion for Summary Judgment [ECCF No. 45] is GRANTED . It is further ordered that:
*1368(1) Defendant's Counterclaim for Declaratory Relief [ECF No. 30] is GRANTED;
(2) This case shall be administratively closed.
DONE AND ORDERED in Chambers at Miami, Florida, this 22nd day of October, 2018.
Defendant also challenges Plaintiff's standing to bring suit, arguing that Plaintiff has no standing to assert her claims because she has no legally protected interest in Defendant's duty to indemnify its insureds. Standing is a jurisdictional issue, and the Court must consider it before reaching any questions on the merits. Dillard v. Baldwin County Comm'rs ,
Defendant argues that the assault was not an accident because it was intentional conduct by Mourao, and intentional actions are not accidents. See Allstate Ins. Co. v. McCranie ,
Defendant also argues that Plaintiff failed to timely or properly assert claims for medical payment coverage. Plaintiff counters that Defendant was on notice of the claim as early as five months following the accident, and that Defendant's failure to timely provide the policies for Plaintiff's review precluded reporting the expenses within the time limitations. The insurance policy does not specify how claims must be reported. The only clear guidance from the policy is that the medical payments claim must have been "reported" within a year of the accident. And here, no such report or claim for medical payments occurred during that timeframe.
Reference
- Full Case Name
- Jane DOE v. The INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA
- Cited By
- 1 case
- Status
- Published