Zervas v. USAA Gen. Indem. Co.
Zervas v. USAA Gen. Indem. Co.
Opinion of the Court
Emily Zervas was severely injured as a passenger in a motorcycle accident caused by an uninsured driver, and her loss exceeded the $500,000 combined limits of the three uninsured-motorist (UM) policies that covered the accident. Geico and State Farm each paid out their $100,000 policy limits. But defendant USAA tendered just *117160% of its $300,000 limit, so Zervas sues for breach of contract and declaratory relief, seeking the remainder of the USAA coverage.
USAA moves for summary judgment. It acknowledges that its $300,000 policy makes up 60% of the $500,000 in available coverage, but it contends that the "other insurance" clause in its policy sets its coverage obligation at 60% of its own policy limit-for a total of just $180,000. Because USAA's other-insurance clause conflicts with the allocation provisions in the other applicable policies, Nevada law requires me to disregard USAA's formula and instead prorate Zervas's loss among the insurers based on their share of the aggregate policy limits, making USAA responsible for 3/5 of the $500,000 covered loss, or $300,000. I therefore deny USAA's motion for summary judgment and instead grant summary judgment in favor of Zervas on her breach-of-contract and declaratory-relief claims. And with good cause appearing, I grant Zervas's motion to amend her complaint to add a bad-faith claim.
Discussion
I. USAA's summary-judgment motion [ECF No. 14]
Like many insurance disputes involving multiple polices, this case turns on the interplay between clauses in the applicable policies that dictate who pays how much when several policies provide benefits for a covered loss. Known in insurance-industry speak as "other insurance" provisions, these ubiquitous clauses "seek to limit the insurer's obligations in the event that there is another policy [i.e., other insurance] that covers the same risk."
A. When there's a conflict among applicable policies' allocation methods, the court must prorate the loss based on the aggregate policy limits.
Difficulties arise when a loss is covered by several policies and each provides a different method of allocating benefits. Courts have developed several approaches to address this type of conflict. Nevada has adopted
If the other-insurance clause in Zervas's mother's USAA policy conflicts with the other-insurance language in the State Farm or Geico policy here, Nevada law requires me to apply the Lamb-Weston rule, disregard USAA's other-insurance provision, and hold USAA responsible for its pro rata share of the loss based on the aggregate $500,000 in coverage. Before I can conclude that this rule applies, however, I must first determine whether the allocation methods in the policies are consistent or contradictory.
B. The allocation method in USAA's other-insurance clause conflicts with those in the State Farm and Geico policies.
Looking at the coverage that Zervas is entitled to under these policies, it is clear that one affords primary coverage and the other two afford excess coverage. "Primary insurance coverage is provided when, under the terms of the policy, liability attaches immediately upon the happening of an occurrence that gives rise to liability, as opposed to excess or secondary coverage, which attaches only after a predetermined amount of primary coverage has been exhausted."
Because the accident involved a motorcycle insured by its owner's Geico policy, that policy provided Zervas primary UM coverage.
Zervas's father had a State Farm policy that also covered this accident. That policy provides primary UM coverage only if a person covered by the policy is injured while "occupying" a car owned by the policyholder.
Zervas's mother held the USAA policy at issue. Like the State Farm policy, USAA's provides only excess coverage for this accident because Zervas was injured in a vehicle not owned by her mother, the policyholder.
On an excess basis, we will pay only our share of the loss that must be paid under insurance providing coverage on a [sic] excess basis. Our share is the proportion that our limit of liability bears to the total of all applicable limits of liability for coverage provided on a [sic] excess basis .14
Because the total available excess coverage is $400,000 (State Farm's $100,000 + USAA's $300,000), USAA's share under this provision would be $300,000/$400,000 or 3/4, and State Farm's share is $100,000.
But USAA paid just $180,000, not 3/4 of the $400,000 in available excess coverage (which works out to $300,000). To justify a reduced share, USAA relies on a different portion of its other-insurance clause, which states that "[a]ny recovery for damages under all [applicable UM] policies or provisions of coverage may equal but not exceed the highest applicable limit for any one vehicle under any insurance providing coverage on either a primary or excess basis."
USAA argues that its pro rata provision doesn't conflict with Geico and State Farm's other-insurance clauses because the three policies require each respective insurer to prorate the highest individual policy limit.
But USAA's argument misapprehends how standard proration works. Although there are multiple ways that insurers can prorate a loss,
C. Because these allocation methods conflict, the Lamb-Weston rule requires the court to prorate the loss based on the aggregate policy limits.
By capping exposure using the lower value of its own policy limit and not by the total of all applicable coverage as the Geico and State Farm policies do, USAA's interpretation puts these provisions in irreconcilable conflict and triggers the Lamb-Weston rule.
And because the facts of this case are undisputed and the question of how much Zervas is entitled to under USAA's policy is purely legal, I also exercise my discretion under Federal Rule of Civil Procedure 56(f) to sua sponte grant summary judgment on these claims in favor of Zervas. Although Rule 56(f) requires a court to first give a party "notice and a reasonable time to respond" before granting a non-moving party summary judgment, I find that the legal issues involved were sufficiently addressed by the extensive briefing on USAA's summary-judgment motion.
D. Nevada's anti-stacking statute has no impact on USAA's obligation to Zervas.
This result is in no way undermined by USAA's contention that its policy complies with Nevada's anti-stacking statute, NRS 687B.145. Under this statute, an insurance policy
may provide that if the insured has coverage available to the insured under more than one policy or provision of coverage, any recovery or benefits may equal but not exceed the higher of the applicable limits of the respective coverages, *1176and the recovery or benefits must be prorated between the applicable coverages in the proportion that their respective limits bear to the aggregate of their limits.27
To comply with this statute, an insurance policy must satisfy three requirements: (1) it must express its limitation in "clear language"; (2) the limiting language must be "prominently displayed in the document"; and (3) "the insured must not have purchased separate coverage on the same risk nor paid a premium calculated for full reimbursement under that coverage."
The parties devote the bulk of their briefing to addressing whether USAA's policy satisfies these requirements. But assuming without deciding that the policy does satisfy these requirements and that USAA's policy-limits proration formula complies with Nevada law,
II. Remaining motions related to USAA's summary-judgment motion [ECF Nos. 40, 41, 44]
USAA moved to stay discovery while its summary-judgment motion was pending.
Zervas moves for leave to file a motion to strike a portion of USAA's reply brief in support of its summary-judgment motion addressing the filed-rate doctrine, and USAA moves for leave to file a supplemental brief on this same issue.
III. Motion to amend the complaint [ECF No. 45]
Finally, Zervas moves to amend her complaint to add a new claim to allege that USAA acted in bad faith by remitting less than its policy limit and that she is therefore entitled to punitive damages. Federal Rule of Civil Procedure 15 directs that "[t]he court should freely give leave when justice so requires,"
Conclusion
Accordingly, IT IS HEREBY ORDERED THAT
• USAA's motion for summary judgment [ECF No. 14] is DENIED ;
• Partial summary judgment is granted in favor of Zervas on her breach-of-contract and declaratory-relief claims; Zervas is entitled to $120,000 in additional UM benefits from USAA;
• The court declines to certify this ruling on these claims as final under Rule 54(b) certification at this time;
• USAA's objection to the magistrate judge's order [ECF No. 40] and its motion to file a supplemental brief [ECF No. 44] are DENIED as moot;
• Zervas's motion for leave to file a motion to strike a portion of USAA's reply brief [ECF No. 41] is DENIED as moot; and
• Zervas's motion for leave to amend her complaint [ECF No. 45] is GRANTED. Zervas has ten days to file her amended complaint in the form proposed at ECF No. 45.
Hous. Grp. v. Gerling Am. Ins. Co. ,
Although Zervas was not the policyholder on any of these three polices, it is undisputed that each policy afforded her UM coverage for the accident.
Travelers Ins. Co. v. Lopez ,
Lamb-Weston, Inc. v. Or. Auto. Ins. ,
Port of Portland v. Water Quality Ins. Syndicate ,
Travelers Ins. ,
Travelers Ins. ,
Indus. Finishes & Sys., Inc. v. Am. Universal Ins. Co. ,
ECF No. 14-3 at 8 ("If there is other applicable insurance, we will pay only our share. Our share is the proportion on that our limit of liability bears to the total of all applicable limits. However, any insurance we provide with respect to a vehicle you do not own shall be excess over any other collectible insurance.").
ECF No. 14-4 at 7 ("The Uninsured Motor Vehicle Coverage provided by this policy applies as primary coverage for an insured who sustains bodily injury while occupying your car .... Except as provided ... above, the Uninsured Motor Vehicle Coverage provided by this policy applies as excess coverage.").
ECF No. 34 at 16 ("Any insurance we provide with respect to a vehicle you do not own or to a person other than you or any family member will be excess over any other collectible insurance.").
Because the parties didn't consider the primary-excess distinction, they both calculate USAA's proportion of responsibility as $300,000/$500,000 or 3/5 instead of 3/4. But because I conclude below that the three policies' other-insurance clauses conflict, I ultimately disregard them and prorate Zervas's total loss by the ratio of USAA's policy limit to the sum of all applicable limits and thus arrive at the same ratio the parties assert: 3/5 or 60%. See infra Section I.C, pp. 7-8.
ECF No. 34 at 16 (emphasis omitted).
ECF No. 14 at 9-10.
Without deciding whether this policy language is sufficiently clear under Nevada law, see Nev. Rev. Stat § 687B.145(1) (requiring that insurance policies that limit an insured's benefits under multiple applicable policies to the highest individual policy limit must state this limitation "in clear language [that is] prominently displayed in the policy, binder or endorsement"), I find that USAA's interpretation of its policy is reasonable.
ECF No. 14 at 9 ("The Other Insurance provisions of each policy provide for the exact same result - that each insurer pays its pro-rated share of the highest limit ($300,000).").
Hous. Grp. ,
See, e.g. ,
USAA and Zervas address only the conflict between the three pro rata provisions. But the policies' distinction between primary and excess coverage creates another layer of conflict: Geico sought to prorate Zervas's loss with State Farm and USAA, whose policies call for Geico to first exhaust its coverage before they will pay out benefits. This is the classic Lamb-Weston conflict and is alone grounds for disregarding the other-insurance clauses. See Lamb-Weston ,
10A Charles Alan Wright & Arthur R. Miller, Federal Practice and Procedure § 2720.1 (4th ed. 2018) ("Entering a judgment when there has been a motion but no cross-motion is somewhat different from the situation in which neither party has moved under Rule 56 and the court wishes to act sua sponte. When there has been a motion but no cross-motion, the judge already is engaged in determining whether a genuine dispute as to material fact exists and the parties have been given an opportunity to present evidence designed either to support or refute the request for the entry of judgment.").
See Celotex Corp. v. Catrett ,
See Fed. R. Civ. P. 54(b) ("When an action presents more than one claim for relief-whether as a claim, counterclaim, crossclaim, or third-party claim-or when multiple parties are involved, the court may direct entry of a final judgment as to one or more, but fewer than all, claims or parties only if the court expressly determines that there is no just reason for delay.").
Nev. Rev. Stat. § 687B.145(1).
Bove v. Prudential Ins. Co. of Am. ,
See supra note 18.
ECF No. 16.
ECF No. 39.
ECF No. 40 (objecting to order at ECF No. 39).
ECF Nos. 41, 44.
Fed. R. Civ. P. 15(a)(2).
Johnson v. Buckley ,
See ECF No. 45 at 6-9.
Reference
- Full Case Name
- Emily ZERVAS v. USAA GENERAL INDEMNITY CO.
- Cited By
- 2 cases
- Status
- Published