Evanston Insurance Co. v. ATOFINA Petrochemicals, Inc.
Evanston Insurance Co. v. ATOFINA Petrochemicals, Inc.
Opinion of the Court
delivered the opinion of the Court,
Rehearing is granted. We withdraw the opinion and judgment previously issued in this case and substitute the following opinion.
In this ease, we examine the interplay between a contractual indemnity provision and a service contract’s requirement to name an additional insured. More particularly, we must decide whether a commercial umbrella insurance policy that was purchased to secure the insured’s indemnity obligation in a service contract with a third party also provides direct liability coverage for the third party. In addition, we must decide whether the insurer is bound to pay the amount of an underlying settlement between the additional insured and a plaintiff. Finally, we must determine whether article 21.55 of the Texas Insurance Code, the “Prompt Payment of Claims” statute, authorized the imposition of penalties and attorney’s fees for the insurer’s failure to pay the claim timely. We conclude that the umbrella policy provides coverage for liabilities arising from the additional insured’s sole negligence, that the settlement agreement binds the insurer to the amount recited therein, and that the additional insured is not entitled to penalties for untimely payment of claims. We affirm the judgment of the court of appeals to the extent that it resolves the coverage dispute in favor of the additional insured, and to the extent that it binds the insurer to the amount recited in the settlement agreement, but we reverse the court of appeals’ judgment regarding damages and attorney’s fees under article 21.55 because the additional insured is not entitled to recovery of such damages and fees.
I
ATOFINA Petrochemicals, Inc.
Matthew Todd Jones, a Triple S employee working at the ATOFINA facility pursuant to his employer’s contract with ATO-FINA, drowned after he fell through the corroded roof of a storage tank filled with fuel oil. Jones’s survivors sued Triple S and ATOFINA for wrongful death. Admiral tendered its $1 million policy limits. ATOFINA then demanded coverage from Evanston as an additional insured under the umbrella policy. Evanston denied the claim, and ATOFINA brought Evanston into the case as a third-party defendant for a declaration of coverage. ATOFINA then severed its suit against Evanston from the remainder of the Jones litigation. Both ATOFINA and Evanston moved for partial summary judgment in the severed action. While the motions were pending, the Jones case was settled for $6.75 million. ATOFINA seeks to recover from Evanston the $5.75 million not covered by Admiral.
The trial court granted summary judgment in favor of Evanston. The court of appeals reversed the judgment, holding that the Evanston policy covered ATOFI-NA, and remanded the case to the trial court for determination of statutory penalties and attorney’s fees.
II
Evanston argues it should not have to indemnify ATOFINA for its contribution to the Jones settlement for several reasons. First, it says ATOFINA agreed in its service contract with Triple S that it would not seek indemnification for losses resulting from its own negligence. Evans-ton says the language of its policy similarly excludes coverage for such losses caused by ATOFINA’s negligence. The umbrella policy was a “following form” policy as required by the service contract, meaning that its coverage was no broader than the underlying policy, which identified ATOFI-NA as an additional insured “only with respect to liability arising out of [Triple S’s] ongoing operations performed for [ATOFINA], but in no event for [ATOFI-NA’s] sole negligence.” Second, Evanston says this court’s decision in Fireman’s Fund Insurance Co. v. Commercial Standard Insurance Co.
A
In its service contract with Triple S, ATOFINA disclaimed any right of indemnity for losses “attributable to [its] concurrent or sole negligence.” Under the terms of the service contract, ATOFINA is not entitled to be indemnified by Triple S if the Jones loss was occasioned in any way by ATOFINA’s negligence. But ATOFI-
In support of its insured status, ATOFI-NA points to part III of the Evanston policy, which defines who is an insured. Section III.B.6 states that an insured includes:
A person or organization for whom you have agreed to provide insurance as is afforded by this policy; but that person or organization is an insured only with respect to operations performed by you or on your behalf, or facilities owned or used by you.
ATOFINA claims it is fully covered as an insured by virtue of this paragraph because it is a “person or organization for whom [Triple S has] agreed to provide insurance,” because the Evanston policy is the kind of insurance that was intended to secure that obligation, and because the loss “respect[ed] ... operations performed by [Triple S].”
But Evanston counters that ATOFINA fails to qualify as an additional insured under section III.B.6 because the language does not cover an additional insured for its own negligence. Although no fact finding has been made regarding who was responsible for Jones’s death, Evanston contends that because Jones’s death was caused solely by ATOFINA’s negligence, the death did not “respect ... operations performed by [Triple S].”
The courts of appeals have confronted these additional insured provisions on several occasions, producing divergent results. Like Triple S’s policy, the insured contractor’s policy in Granite Construction Co. v. Bituminous Insurance Cos.
The First and Third Courts of Appeals reached different results under a more liberal causation theory of additional insured provisions. In those cases, the additional insured provisions created coverage only “with respect to liability arising out of’ the named insured’s operations, and in both cases the claimants alleged that the additional insured companies acted negligently.
[Bjecause the accident in this case occurred to a[n] [insured’s] employee while the employee was on the premises for the purpose of performing preventive maintenance on the compressor that exploded, the alleged liability for the employee’s injuries “arose out of [the insured’s] operations,” and, therefore, was covered by the “additional insured” provision.11
The court in McCarthy Brothers Co. v. Continental Lloyds Insurance Co. applied a similar theory to find that a worker’s slip-and-fall injury while retrieving tools at the job site “arose out of’ the insured subcontractor’s operation, even for purposes of a negligence claim against the additional insured premises owner.
We prefer the reasoning of Admiral and McCarthy to Granite for two reasons. First, Granite relied on an underlying service contract that made the additional insured company responsible for the specific injury-causing act.
Second, regardless of the underlying service agreement’s terms, we do not follow Granite because the fault-based interpretation of this kind of additional insured endorsement no longer prevails.
Our interpretation results, in part, from the ordinary and natural meaning of the phrase “with respect to.”
B
Evanston and ATOFINA both look to section III.B.5 of the policy to support their respective positions regarding the scope of coverage under the Evanston policy. ATOFINA claims that section III.B.5 provides an independent basis for coverage, while Evanston argues that section III.B.5 does not apply. Section III.B.5 says an insured can be:
Any other person or organization who is insured under a policy of “underlying insurance.” The coverage afforded such insureds under this policy will be no broader than the “underlying insurance” except for this policy’s Limit of Insurance.
This is a catch-all section that appears intended to bring within the policy coverage any “other” entities that are insured by the underlying policy but are not included within the preceding who-is-an-insured sections of paragraph III.B of the policy. Because ATOFINA cannot be an insured under sections III.B.l through III. B.4, section III.B.5 applies in this case as long as ATOFINA was insured under the Admiral policy.
Evanston argues section III.B.5 establishes the policy’s identity as a “following form” policy of the kind that was specified by the service contract, and that the nature of the policy precludes coverage.
C
Evanston and ATOFINA disagree about the scope of coverage available in the event that ATOFINA qualifies as an insured under both sections III.B.5 and III.B.6 of the Evanston policy. ATOFINA favors a broader scope of coverage under section III.B.6, relying on the fact that it, unlike section III.B.5, does not expressly limit the coverage afforded to an insured to that provided by an underlying policy.
When interpreting an insurance contract, we “must adopt the construction of an exclusionary clause urged by the insured as long as that construction is not unreasonable, even if the construction urged by the insurer appears to be more reasonable or a more accurate reflection of the parties’ intent.”
Reading paragraph III.B as a whole, we conclude that each who-is-an-insured clause operates to grant coverage independently. Nothing in paragraph III.B suggests that the limitations of one section granting coverage should be read into another separate section granting coverage.
D
Evanston next contends that this Court’s 1972 decision in Fireman’s Fund v. Commercial Standard Ins. Co.
In Fireman’s Fund, Wallace’s obligation to purchase insurance was to secure only its agreement to indemnify GM for Wallace’s own negligence.
This case is more analogous to our 1992 decision in Getty Oil Co. v. Insurance Co. of North America.
Although the service contract in this case does not include an insurance requirement quite as clear as the one in Getty, it is clear enough — it requires that ATOFI-NA “shall be named as additional insured in each of [Triple S’s] policies.” Evanston argues that this “brief statement” in the contract is insufficient to extend insured status to ATOFINA for its own negligence because the insurance requirement and certificates of insurance cannot expand coverage beyond the language of the policy.
E
Next we examine Evanston’s obligation to pay $5.75 million of the $6.75 million settlement. Evanston argues that ATOFINA failed to meet its burden of showing that the amount was reasonable, and argues instead that its evidence proves the amount was unreasonable as a matter of law, entitling Evanston to summary judgment. ATOFINA asserts the opposite, contending that its summary judgment evidence proves the settlement amount was reasonable as a matter of law. Before reaching that question, we must address ATOFINA’s additional contention
Our last occasion to address this issue was Employers Casualty Co. v. Block,
In Block, “[t]he basic issue before the trial court was the reasonableness of the damages recited in the agreed judgment” between the defendant roofing company and the plaintiff homeowners.
While we agree with the court of appeals’ conclusion that [the insurer] was barred from collaterally attacking the agreed judgment by litigating the reasonableness of the damages recited therein, we do not agree with its conclusion that the recitation in the agreed judgment that the damage resulted from an occurrence on August 6, 1980 is binding and conclusive against [the insurer] in the present suit.58
In this case, the plaintiffs sued ATOFI-NA, ATOFINA requested coverage from Evanston, and Evanston wrongfully denied coverage, citing the policy terms. ATOFI-NA brought Evanston into the case as a third-party defendant for a declaration of coverage, and Evanston continued to deny coverage in its pleadings. ATOFINA then settled with the underlying plaintiffs and litigated the remaining coverage issues against Evanston. Though this case differs from Block in several respects, none of the differences justify departing from Block.
First, the forms of settlement and policy claims differ. Block’s insurer violated the policy’s duty to defend,
Some cases in this area bar an insurer’s invocation of policy provisions as a defense, not what we have here — an insurer’s invocation of the common law reasonableness requirement. However, the principles of notice to the insurer and an intentional choice to forego participation in settlement discussions operate the same no matter how the insurer chooses to attack the settlement. That is, the particular source of the insurer’s later-raised attack on the settlement amount— be it a policy provision or a common law rule — does not control our inquiry. One case cited by Block noted that, “[h]ad [the insurer] accepted the defense, it would have had, of course, the opportunity to conduct the defense in the manner most likely to have defeated the plaintiffs’ claim or at least to have reduced the amount of the damages.”
In addition, this case’s posture is different than Block’s. In Block, the underlying plaintiff sued the insurer as a judgment creditor, leading to some disapproval from this Court in State Farm Fire & Casualty Co. v. Gandy
In no event, however, is a judgment for plaintiff against defendant, rendered without a fully adversarial trial, binding on defendant’s insurer or admissible as evidence of damages in an action against defendant’s insurer by plaintiff as defendant’s assignee. We disapprove the contrary suggestion in dicta in Employers Casualty Company v. Block, 744 S.W.2d 940, 943 (Tex. 1988), and United States Aviation Underwriters, Inc. v. Olympia Wings, Inc., 896 F.2d 949, 954 (5th Cir. 1990).67
Gandy does not disrupt the application of Block to this case for two reasons. First, this case does not fall within Gan-dy’s holding. Gandy’s holding was explicit and narrow, applying only to a specific set of assignments with special attributes.
Barring Evanston’s challenge here does not implicate Gandy’s concerns. Preventing insurers from litigating the reasonableness of a settlement does not extend disputes; by definition, it shortens them. Nor is there a risk of distorting litigation or settlement motives here. ATOFINA settled without knowing whether or not it would be covered by the policy, leaving in place its motive to minimize the settlement amount in case it became solely responsible for payment.
F
Finally, Evanston argues that the court of appeals erroneously awarded ATOFINA 18% per annum of the claim amount and attorney’s fees for Evanston’s failure to promptly pay claims under article 21.55 of the Texas Insurance Code.
Though the statute does not define first-party claims, we distinguish first-party and third-party claims based on the claimant’s relationship to the loss.
Ill
We affirm the court of appeals’ holding that ATOFINA is an insured under the Evanston insurance policy and is thus entitled to coverage for the Jones litigation settlement, and we affirm the court of appeals’ holding that Evanston is bound to pay the $5.75 million settlement amount. We reverse the court of appeals’ judgment permitting ATOFINA to recover attorney’s fees and damages under article 21.55 of the Texas Insurance Code because ATOFINA is entitled to no such damages or fees. We remand the case to the trial court for further proceedings on ATOFI-NA’s other claims for attorney’s fees, on its claim for prejudgment interest, and for rendition of judgment consistent with this opinion.
Justice HECHT filed an opinion concurring in part and dissenting in part, in which Justice JOHNSON joined.
. ATOFINA is the successor company to FINA Oil and Chemical Company, which originally executed the independent contractor agreement with Triple S. For purposes of this opinion, we shall refer to FINA and ATO-FINA, without distinction, as ATOFINA.
. 104 S.W.3d 247, 251-52 (Tex.App.-Beaumont 2003) (per curiam).
. 490 S.W.2d 818 (Tex. 1972).
. See id.
. We have held that an indemnity agreement will not be construed to cover an indemnitee’s sole negligence absent express language to that effect. Id. at 822. Evanston urges us to take this rule and apply it to additional insured provisions as well. However, we have also noted that where an additional insured provision is separate from and additional to an indemnity provision, the scope of the insurance requirement is not limited by the indemnity clause. See Getty Oil Co. v. Ins. Co. of N. Am., 845 S.W.2d 794, 804 (Tex. 1992). In fact, we specifically declined to extend the rule in Fireman’s Fund to contractual provisions other than indemnity agreements. Id. at 806.
. 832 S.W.2d 427, 428 (Tex.App.-Amarillo 1992, no writ).
. Id. Several courts recognize no material difference between the common term "arising out of operations" and the Evanston policy term "with respect to operations.” See McCarthy Bros. Co. v. Cont'l Lloyds Ins. Co., 7 S.W.3d 725, 730 n. 8 (Tex.App.-Austin 1999, no pet.); Miller v. Superior Shipyard & Fabrication, Inc., 2001-2907, p. 5-6 (La.App. 1 Cir. 8/20/03); 859 So.2d 159, 162-64; Acceptance Ins. Co. v. Syufy Enters., 69 Cal.App.4th 321, 81 Cal.Rptr.2d 557, 561-62 (1999); Lim v. Atlas-Gem Erectors Co., 225 A.D.2d 304, 638 N.Y.S.2d 946, 946-48 (N.Y.App.Div. 1996); Fla. Power & Light Co. v. Penn Am. Ins. Co., 654 So.2d 276, 279 (Fla.Dist.Ct.App. 1995). We cite cases addressing both terms because, even if there is a difference, whatever qualifies as "arising out of operations” also qualifies under "with respect to operations,” the broader term.
.Granite, 832 S.W.2d at 430.
. Id. According to the court:
Under the Granite-Brown contract, the loading operation was the sole obligation of Granite, and Brown was not responsible for that operation. Measuring the policy coverage provided Granite by the allegations in Valchar’s petition, it is at once obvious that Valchar’s claim of Granite's liability arose out of the loading operations performed by Granite; it was not a claim "arising out of operations performed for [Granite] by or on behalf of [Brown]," the only operations for which Granite was insured.
Id.; see also N. Ins. Co. of N.Y. v. Austin Commercial, Inc., 908 F.Supp. 436, 437 (N.D.Tex. 1994) (applying Granite to slip-and-fall cases).
. Admiral Ins. Co. v. Trident NGL, Inc., 988 S.W.2d 451, 453-54 (Tex.App.-Houston [1st Dist.] 1999, pet. denied) (emphasis omitted); McCarthy, 7 S.W.3d at 727 & n. 4 (emphasis omitted).
. GuideOne Elite Ins. Co. v. Fielder Rd. Baptist Church, 197 S.W.3d 305, 307-08 (Tex. 2006) (citing King v. Dallas Fire Ins. Co., 85 S.W.3d 185, 187 (Tex. 2002), and Nat’l Union Fire Ins. Co. of Pittsburgh, Pa. v. Merchants Fast Motor Lines, Inc., 939 S.W.2d 139, 141 (Tex. 1997)). In this case, the principles triggering the insurer's duty to defend apply equally to the insurer’s duty to indemnify.
. See Admiral, 988 S.W.2d at 454-56; McCarthy, 7 S.W.3d at 729-31 & n. 9; Mid-Continent Cas. Co. v. Swift Energy Co., 206 F.3d 487, 496-500 (5th Cir. 2000).
. Mid-Century Ins. Co. of Tex. v. Lindsey, 997 S.W.2d 153, 155-56 (Tex. 1999) (determining whether "injuries were caused by an accident arising out of the use of [a] truck”); accord Admiral, 988 S.W.2d at 454-56; McCarthy, 7 S.W.3d at 729-31; see also Utica Nat. Ins. Co. of Tex. v. Am. Indem. Co., 141 S.W.3d 198, 201-03 (Tex. 2004) (contrasting "arising out of” with “ ‘due to,’ [which] requires a more direct type of causation that could tie the insured’s liability to the manner in which the services were performed.”).
. Admiral, 988 S.W.2d at 454-56 ("[I]t is sufficient that the named insured's employee was injured while present at the scene in connection with performing the named insured’s business, even if the cause of the injury was the negligence of the additional insured.”); McCarthy, 7 S.W.3d at 729-31; Highland Park Shopping Vill. v. Trinity Universal Ins. Co., 36 S.W.3d 916, 918 (Tex.App.Dallas 2001, no pet). Our causation analysis is limited to these facts. Because the premises itself caused the injury in this case, we do not decide what level of causation, but-for or otherwise, would be required in a case where the additional insured's premises is merely the situs of the injury.
. Admiral, 988 S.W.2d at 454-56; McCarthy, 7 S.W.3d at 729-31; Highland Park, 36 S.W.3d at 917-18.
. See The Random House Dictionary of the English Language 1640 (Stuart Berg Flexner ed., 2d ed. unabr. 1987) (With respect to: "with respect to: referring to: concerning”); 2 The Compact Edition of the Oxford English Dictionary 2512 (1971) (With respect: "with reference or regard to something.”).
. McIntosh v. Scottsdale Ins. Co., 992 F.2d 251, 255 (10th Cir. 1993) (quoting Philadelphia Elec. Co. v. Nationwide Mut. Ins. Co., 721 F.Supp. 740, 742 (E.D.Pa. 1989)); accord Mid-Continent Cas. Co. v. Chevron Pipe Line Co., 205 F.3d 222, 228-29 (5th Cir. 2000) (“[The insurer] easily could have limited coverage by including in the endorsement terms such as 'vicarious liability’ or 'negligence of the named insured.’ ”).
. See Mid-Continent, 206 F.3d at 497-99 (observing that “Admiral and McCarthy ... are consistent with the majority view in other jurisdictions”); Steven D. Caley, et al., The Scope of Additional Insured Coverage — A State Survey, in Insurance Law 2006: Understanding the ABC’S, at 149 (PLI Litig. & Admin. Practice, Course Handbook Series No. 741, 2006) (collecting cases); Douglas R. Richmond, The Additional Problems of Additional Insureds, 33 Tort & Ins. L.J. 945, 956-65 (1998) (collecting cases and finding that the "liberal interpretation of the additional insured endorsement is fast becoming the majority rule”).
. See Nat. Union Fire Ins. Co. of Pittsburgh, Pa., 939 S.W.2d at 141 (“[T]he general rule is that the insurer is obligated to defend if there is, potentially, a case under the complaint within the coverage of the policy.”).
. ATOFINA contends Evanston waived any argument regarding the impact of "following form” language in the insurance purchasing agreement by failing to raise this point in its cross-motion for summary judgment. While Evanston did not articulate this argument in precisely the same form as it is enunciated here, we note that Evanston did, in fact, argue before the trial court that the scope of its policy was bounded by the sole-negligence exclusion contained in the Admiral CGL policy. Furthermore, as the party that prevailed in the trial court, Evanston was not required to raise this issue before the court of appeals, as we do not normally require a party defending a judgment to raise every alternative theory on which the trial court could base its action. See Williams v. Khalaf, 802 S.W.2d 651, 658 (Tex. 1990).
.Endorsement 20 to the Admiral CGL policy, which has the same effective date as the Admiral policy itself, supports this interpretation. It states:
WHO IS AN INSURED (Section II) is amended to include as an Insured [ATOFI-NA] but only with respect to liability arising out of [Triple S’s] ongoing operations performed for [ATOFINA], but in no event for [ATOFINA’s] sole negligence.
. Nat’l Union Fire Ins. Co. of Pittsburgh, Pa. v. Hudson Energy Co., 811 S.W.2d 552, 555 (Tex. 1991).
. Id.
. Evanston argues that section III.B.5's use of "under this policy ” rather than "under this provision " expressly limits coverage regardless of the scope of coverage that may apply under another provision within paragraph III.B. We disagree. Such a reading would render any broader coverage provided by the Evanston policy illusory by always limiting coverage to the scope of the Admiral policy. We cannot adopt a construction that renders any portion of a policy meaningless, useless, or inexplicable. ATOFINA Petrochemicals, Inc. v. Cont’l Cas. Co., 185 S.W.3d-440, 444 (Tex. 2005) (per curiam) (rejecting policy construction that would render coverage illusory); Kelley-Coppedge, Inc. v. Highlands Ins. Co., 980 S.W.2d 462, 464 (Tex. 1998); Balandran v. Safeco Ins. Co. of Am., 972 S.W.2d 738, 741 (Tex. 1998).
. 490 S.W.2d 818 (Tex. 1972).
. Id. at 820.
. Id.
. Id.
. Id.
.Id. at 822.
. Id. at 823.
. Id. at 821.
. Id.
. Id.
. Id. at 823.
. Id.
. 845 S.W.2d 794 (Tex. 1992).
. Id. at 796.
. Id. at 804.
. Tex. Civ. Prac. & Rem.Code §§ 127.001-.007.
. Getty Oil, 845 S.W.2d at 804.
. Id. ("[T]he additional insured provision of the contract does not support the indemnity agreement, but rather is a separate obligation.”).
. See Granite Const. Co. v. Bituminous Ins. Cos., 832 S.W.2d 427, 429 (Tex.App.-Amarillo 1992, no writ).
. See id.
. See Emery Air Freight Corp. v. Gen. Transp. Sys., Inc., 933 S.W.2d 312, 315 (Tex.App.Houston [14th Dist.] 1996, no writ).
. 744 S.W.2d 940 (Tex. 1988).
. Id. at 943.
. Id. at 942.
. Id.
. Id. at 943.
. Id.
. Id. The dispute between ATOFINA and Ev-anston concerns only the reasonableness of the settlement amount, and not any factual assertions within the settlement agreement text.
. Id. (emphasis added) (citations omitted); see also W. Alliance Ins. Co. v. N. Ins. Co. of N.Y., 176 F.3d 825, 830 (5th Cir. 1999) (citing Block, 744 S.W.2d at 943) ("If an insurer breaches the duty to defend, it may not contest a determination that its insured was liable in the underlying settlement or verdict (or the amount of either).”); Enserch Corp. v. Shand Morahan & Co., 952 F.2d 1485, 1495-96 (5th Cir. 1992) (“Texas law denies insurers like these a collateral attack on the settlement itself.... Recent opinions of both this Court and the Texas Supreme Court have confirmed that, unlike a request for allocation, an attempt to contest the reasonableness of a consent judgment entered into between the insured and an injured third party is unavailable to an insurer who has wrongfully breached its duty to defend.”).
. The dissent suggests that Evanston never breached any duty owed to ATOFINA. - S.W.3d at -. Yet on multiple occasions before the settlement, Evanston explicitly rejected ATOFINA's claim for coverage under the policy. Evanston first denied ATOFINA's request for coverage by letter, and then consistently asserted the same in its pleadings throughout the coverage suit. Even if this conduct does not amount to an anticipatory breach of the contract, which it very well might, see Murray v. Crest Constr., Inc., 900 S.W.2d 342, 344 (Tex. 1995); Johnson & Higgins of Tex., Inc. v. Kenneco Energy, Inc., 962 S.W.2d 507, 515 (Tex. 1998), this kind of explicit, unqualified rejection of coverage surely operates to trigger the equitable principles in Block.
. See Gulf Ins. Co. v. Parker Prods., Inc., 498 S.W.2d 676, 679 (Tex. 1973); Womack v. Allstate Ins. Co., 156 Tex. 467, 296 S.W.2d 233, 237 (1956); see also St. Louis Dressed Beef & Provision Co. v. Md. Cas. Co., 201 U.S. 173, 181, 26 S.Ct. 400, 50 L.Ed. 712 (1906) ("Moreover, the [insurer], by its refusal [to defend], cut at the very root of the mutual obligation, and put an end to its right to demand further compliance with the supposed term of the contract on the other side.”); Benjamin v. Amica Mut. Ins. Co., 2006 UT 37, ¶ 29, 140 P.3d 1210, 1216; Liberty Mut. Ins. Co. v. Wheelwright Trucking Co., 851 So.2d 466, 476-78 (Ala. 2002); D.E.M. v. Allickson, 555 N.W.2d 596, 599-601 (N.D. 1996); Red Giant Oil Co. v. Lawlor, 528 N.W.2d 524, 531-32 (Iowa 1995); Fireman’s Fund Ins. Co. v. Sec. Ins. Co. of Hartford, 72 N.J. 63, 367 A.2d 864, 867-73 (1976); Theodore v. Zurich Gen. Accident & Liab. Ins. Co., 364 P.2d 51, 55 (Alaska 1961); Albert v. Me. Bonding & Cas. Co., 144 Me. 20, 64 A.2d 27, 29-30 (1949). We cite these additional cases for their use of the equitable waiver and es-toppel decision frameworks generally, but not for their opinions of how the equitable balance should be struck.
. Ranger Ins. Co. v. Rogers, 530 S.W.2d 162, 167 (Tex.Civ.App.-Austin 1975, writ ref'd n.r.e.).
. Admiral tendered its $1 million before the settlement, invoking Evanston’s duties as an excess insurer. The Evanston policy gave Ev-anston the right to "associate with the insured in the defense and control of any 'claim' or 'suit' that we think may involve this policy.” Cf. Keck, Mahin & Cate v. Nat. Union Fire Ins. Co. of Pittsburgh, Pa., 20 S.W.3d 692, 701 (Tex. 2000) (supporting an excess insurer's
.The dissent cites United States Aviation Underwriters, Inc. v. Olympia Wings, Inc., 896 F.2d 949 (5th Cir. 1990), for the proposition that "an insurer that does have a duty to defend is not estopped to contest the reasonableness of a settlement.” 256 S.W.3d at 677. Though the Fifth Circuit did so hold, the dissent misapplies that case. Unlike Evans-ton, the insurer in that case offered to supply the policy benefit (in that case, the duty to defend) under a reservation of rights. U.S. Aviation Underwriters, 896 F.2d at 952. More importantly, unlike ATOFINA, the insured in that case rejected the insurer's offer. Id. As a result of those two facts, the Fifth Circuit explicitly distinguished its case from Block and other cases where a defense is neither tendered nor rejected. Id. at 954-55. For those latter situations, the Fifth Circuit concluded that "under Texas law an insurer which is obliged to defend its insured but flatly refuses to do so ... cannot contest the reasonableness of a consent judgment agreed to between the insured and the injured party.” Id. at 955. Thus, United States Aviation Underwriters supports our holding today, not the opposite.
. 925 S.W.2d 696 (Tex. 1996).
. Mat714.
. We hold that a defendant’s assignment of his claims against his insurer to a plaintiff is invalid if (1) it is made prior to an adjudication of plaintiff's claim against defendant in a fully adversarial trial, (2) defendant's insurer has tendered a defense, and (3) either (a) defendant’s insurer has accepted coverage, or (b) defendant’s insurer has made a good faith effort to adjudicate coverage issues prior to the adjudication of plaintiff's claim.
Id. ‘“We do not address whether an assignment is invalid when any element of the rule is lacking, such as when an insurer has not tendered a defense of its insured.” Id. at 719.
. Id. at 715 (“In the present case we have focused on the validity of the assignment.”).
. In addition, Evanston never tendered a defense, a fact Gandy purported to rely upon. See id. at 714.
. Id. at 714. Even when it addressed assignments, Gandy did not present an absolute rule: "Not every settlement involving an assignment of rights in exchange for a covenant to limit the assignor's liability has the problems we have described.” Id.
. Cf. Guillen ex rel. Guillen v. Potomac Ins. Co. of Ill., 203 Ill.2d 141, 271 Ill.Dec. 350, 785 N.E.2d 1, 14 (2003) ("[T]he risk of collusion and fraud can be lessened ..., if not avoided altogether, by placing a requirement upon the plaintiff to prove that the settlement it reached with the insured was reasonable before that settlement can have any binding effect upon the insurer.”).
. The denial does not bar Evanston from challenging coverage. See Utica Nat'l Ins. Co. of Tex. v. Am. Indem. Co., 141 S.W.3d 198, 203 (Tex. 2004) ("Even if a liability insurer breaches its duty to defend, the party seeking indemnity still bears the burden to prove coverage if the insurer contests it.”); Block, 744 S.W.2d at 943-44.
. The "Prompt Payment of Claims” statute has been recodified without substantial change. See Tex. Ins.Code §§ 542.051 — .061 ; Lamar Homes, Inc. v. Mid-Continent Cas. Co., 242 S.W.3d 1, 5 (Tex. 2007). For purposes of this opinion, we refer to article 21.55.
. Tex. Ins.Code art. 21.55 § 6.
. Id. § 1.
. Lamar Homes, 242 S.W.3d at 17.
. Id. (quoting Universe Life Ins. Co. v. Giles, 950 S.W.2d 48, 54 n. 2 (Tex. 1997)).
. Id.
. Id. at 20.
Concurring in Part
joined by Justice JOHNSON, concurring in part and dissenting in part.
I agree with the Court that Evanston’s commercial liability umbrella policy covered the Jones claim, and that Evanston must reimburse ATOFINA the settlement amount if it was reasonable. I do not agree that Evanston, which had no duty to defend ATOFINA, is estopped to challenge the reasonableness of the settlement simply because it denied coverage and refused to participate in negotiations with the claimants. I would remand the reasonableness issue to the trial court to resolve the parties’ factual dispute. Accordingly, I respectfully dissent.
An insurer that breaches its duty to defend a claim cannot later be heard to complain that the amount the insured paid in settlement was unreasonable, absent evidence of collusion. This is what we held in Employers Casualty Co. v. Block,
But Evanston had no duty to defend ATOFINA, as ATOFINA itself admits.
A few days ago, the Court refused to allow an insurer to seek restitution for payment of a non-covered claim because the policy did not provide for such an equitable remedy.
ATOFINA has not cited, and the Court has not found, authority of any kind to support the Court’s holding that an excess insurer is estopped to challenge the reasonableness of a settlement in these circumstances. This, too, is hardly surprising. What possible basis could there be to estop an insurer who has not breached a duty to its insured? At least one case suggests that the Court’s holding is wrong. The Fifth Circuit has held in United States Aviation Underwriters, Inc. v. Olympia Wings, Inc. that an insured who rejects a defense tendered under a reservation of rights cannot require the insurer, once coverage has been established, to pay a settlement of the claim without proving that it was reasonable.
Having refused to agree to a settlement because it believed the claim was not covered, and now having had the coverage issue resolved in ATOFINA’s favor, Ev-anston is required to pay the settlement if it was reasonable. But nothing in Evans-ton’s policy obligates it to pay an unreasonable settlement, and the parties still disagree whether ATOFINA’s settlement was reasonable. ATOFINA moved for summary judgment that its settlement was reasonable, based on the affidavits of its lawyer and the mediator in the liability case. This evidence certainly supports ATOFINA’s position, as does its argument that it would not have paid $5.75 million out of its own pocket (in addition to the $1 million its primary insurer paid) to settle the claim if it had thought the amount unreasonable. But ATOFINA’s view of reasonableness changed over time. Only a few months before the case settled, ATO-FINA’s lawyer suggested in a letter to Evanston’s adjuster that a judgment of $5 million was possible. This estimate, though accompanied by caveats about the assumptions on which it was based, was only about three-fourths of the settlement to which ATOFINA eventually agreed. ATOFINA argues that developments after the letter was written cast the case in a poorer light. Evanston offered the letter and affidavits from its adjuster and an insurance defense lawyer in response to ATOFINA’s motion. Both opined that ATOFINA’s settlement was more than what would have been reasonable; one estimated that a reasonable settlement would have been between $1 million and $2 million. These affidavits certainly do not establish that the settlement was unreasonable, but they do raise a fact issue that must be resolved. I would remand the case to the trial court for that purpose.
. 744 S.W.2d 940, 943 (Tex. 1988).
. See ante at 670-71 & n. 62.
. ATOFINA’s Brief in Response at 31 ("To be sure, Evanston did not owe ATOFINA a duty to defend.”); see also ante at 671-72 (“no duty to defend is implicated in this case”).
.The policy stated:
‘ "A. We will have the right to defend any "claim” or "suit” seeking damages for “bodily injury”, "property damage”, "personal injury”, or “advertising injury” to which this insurance applies, but:
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"2. When an "occurrence” or "offense” is covered by this policy and is also covered by “underlying insurance” or by any other applicable insurance, we have no duty to defend. We shall have the right to associate with the*676 insured in the defense and control of any "claim” or "suit” that we think may involve this policy.
“3. When an "occurrence” or "offense”, covered by this policy, would have been covered by "underlying insurance” but for the exhaustion of the applicable limit of such "underlying insurance” as a result of any “occurence(s)” or "offense(s)” to which this policy would have applied, we will have a duty to defend any "claims” or "suits” to which this policy applies.
"4. When an "occurrence" or “offense”, covered by this policy, is not covered by "underlying insurance” or any other applicable insurance, we will have the duty to defend any “claims” or "suits” to which this policy applies.
“5. When we have a duty to defend as described in 3. and 4. above, we will:
“a. Defend any "claim” or “suit” against the insured seeking damages on account of "bodily injury”,
"b. Investigate, negotiate, and settle any "claims” or "suits” as we deem expedient. ..
. Ante at 672.
. Ante at 672 n. 60.
. See Continental Am. Life Ins. Co. v. McCain, 416 S.W.2d 796, 797 (Tex. 1967) (per curiam); Sanders v. Aetna Life Ins. Co., 146 Tex. 169, 205 S.W.2d 43, 45 (1947).
. Ante at 672 n. 60.
. Excess Underwriters at Lloyd’s, London v. Frank’s Casing Crew & Rental Tools, Inc., 246 S.W.3d 42, 45 (Tex. 2008).
. Id. (quoting Fortis Benefits v. Cantu, 234 S.W.3d 642, 649 (Tex. 2007)).
. 896 F.2d 949, 955 (5th Cir. 1990).
. Ante at 673 n. 65 (quoting Olympia Wings, 896 F.2d at 955) (emphasis added).
Reference
- Full Case Name
- EVANSTON INSURANCE COMPANY, Petitioner, v. ATOFINA PETROCHEMICALS, INC., Respondent
- Cited By
- 128 cases
- Status
- Published