Ali Ekhlassi v. National Lloyds Insurance Co.
Opinion of the Court
Ali Ekhlassi challenges the summary judgment awarded National Lloyds Insurance Company pursuant to the National Flood Insurance Act (the Act),
*133I.
This action concerns the Act's government program,
The above-referenced Standard Flood Insurance Policy, provided in the Code of Federal Regulations and utilized by WYO carriers participating in the National Flood Insurance Program, states the "Requirements in Case of Loss". 44 C.F.R. Pt. 61, App. A(1), Art. VII (J). Among those requirements, the policyholder "must ... send [the insurer] a proof of loss, which is [the insured's] statement of the amount [the insured is] claiming under the policy [and is] signed and sworn to by [the insured]".
Ekhlassi insured his house in Houston, Texas, with a National Flood Insurance Program policy from Lloyds and a homeowner's policy from Auto Club Indemnity Company (ACIC). ACIC is not a party on appeal. An extensive rain-storm that caused flooding damaged Ekhlassi's home on 25 May 2015, and he reported the loss to Lloyds the next day.
On 28 May 2015, the Federal Emergency Management Agency (FEMA) issued a notice with a waiver for National Flood Insurance Program policyholders, extending the time within which to file a proof of loss by 180 days for "all claims for the flood damage related to the Texas and Oklahoma flooding" that began on 16 May 2015 and included Ekhlassi's house. As stated in the notice, policyholders had "a total of 240 days after the date of loss" to file the proof of loss. The notice stated it did "not ... waive any other provisions of the [Standard Flood Insurance Policy]".
One such non-waived provision in the policy is the one-year statute of limitations. 44 C.F.R. Pt. 61, App. A(1), Art. VII (R). That provision states: "If you do sue, you must start the suit within one year after the date of the written denial of all or part of the claim, and you must file the suit in the United States District Court of the district in which the covered property was located at the time of loss."
Ekhlassi had an adjuster inspect his house. After doing so, the adjuster obtained estimates from contractors for the cost of repair, which exceeded $ 200,000. Lloyds also inspected the house, and concluded flooding from the 25 May storm did not cause much of the claimed damage.
As a result, Lloyds' subsequent 6 October 2015 letter to Ekhlassi stated it had reviewed his adjuster's report and would process a claim for $ 3,768.25 upon receipt of a "signed, dated and sworn to proof of loss". The letter also stated it was "denying payment for any building and contents items not subject to direct physical loss by or from flood" and "denying payment for all non-covered items located below the lowest elevated floor of [Ekhlassi's house], pursuant to the Standard Flood Insurance Policy".
More to the point, the 6 October letter warned Ekhlassi about the above-quoted, one-year limitations period. As noted, this period is provided in the Act,
*134Shuford v. Fidelity Nat'l Prop. & Cas. Ins. Co. ,
Ekhlassi submitted a proof of loss in late December 2015 for $ 274,940.05. In response, Lloyds' 11 January 2016 letter to Ekhlassi acknowledged receipt of the proof of loss, and rejected all but $ 3,768.25 (the amount offered by the 6 October letter). The 11 January letter also instructed Ekhlassi to "refer to the denial letter dated October 6, 2015[,] for what Federal law allows under the Standard Flood Insurance Policy and for reasons of denial for damages that have been claimed".
In mid-January, Ekhlassi signed, inter alia , a different proof of loss for $ 3,768.25, but he disagreed with the amount and stated his intent not to "conclude this claim in any manner whatsoever".
One year from the 11 January 2016 denial, Ekhlassi filed this action in Texas state court on 11 January 2017. He claimed, inter alia , breach of contract against Lloyds. This action was removed to federal court on 24 April 2017.
ACIC, the issuer of the homeowner's policy, filed a summary-judgment motion, which was granted in November 2017. (As noted, ACIC is not a party on appeal.)
Lloyds also filed a summary-judgment motion, which was granted in January 2018. Ekhlassi v. Nat'l Lloyds Ins. Co. ,
In early February 2018, pursuant to Federal Rule of Civil Procedure 59(e), Ekhlassi moved to reconsider the summary judgment awarded Lloyds. The March 2018 order denying the motion reiterated the court's prior holding: the 6 October letter served as the denial triggering the limitations period.
II.
As governed by the Act, this action concerns a WYO carrier. Our court has previously, and comprehensively, explained how the WYO program operates:
By enacting the National Flood Insurance Act of 1968,42 U.S.C. § 4001 et seq., Congress established the [National Flood Insurance Program] to make flood insurance available on reasonable terms and to reduce fiscal pressure on federal flood relief efforts. FEMA administers the [p]rogram. Within [that] [p]rogram, the WYO program allows private insurers to issue flood insurance policies in their own names. Under this framework, the federal government underwrites the policies and private WYO carriers perform significant administrative functions including "arrang[ing] for the adjustment, settlement, payment and defense of all claims arising from the policies." WYO carriers must issue policies containing the exact terms and conditions of the [Standard Flood Insurance Policy] set forth in FEMA regulations. Additionally, FEMA regulations govern the methods by which WYO carriers adjust and pay claims. Although WYO carriers play a large role, the government ultimately pays a WYO carrier's claims. When claimants sue their WYO carriers for payment of a claim, carriers bear the defense costs, which are considered "part of the ... claim expense allowance"; FEMA reimburses these costs. Yet, if "litigation is grounded in actions by the [WYO] Company that are significantly outside the scope of this Arrangement, and/or involves issues of agent negligence," then such costs will not be reimbursable to the WYO carrier.
*135Campo ,
WYO carriers are fiscal, not general, agents of the United States. Van Holt v. Liberty Mut. Fire Ins. Co. ,
The summary judgment awarded Lloyds is reviewed de novo . E.g. , Borden v. Allstate Ins. Co. ,
In his original opening brief on appeal, Ekhlassi challenged: the district court's using Lloyds' first claim-denial letter (6 October 2015) to trigger the limitations period; and, its denying his Rule 59(e) motion. But, pending oral argument, we, sua sponte , ordered supplemental briefing by the parties regarding "the effect of the federal court's original exclusive jurisdiction on whether the action is barred by the limitations period".
Accordingly, primarily at issue are: whether
A.
First addressed is whether, as urged by Ekhlassi,
1.
In his supplemental brief, Ekhlassi contends
But, of course, the application of federal-question jurisdiction pursuant to § 1331 does not preclude application of the very federal statute giving rise to the federal *136interest at stake. In other words, merely because § 1331 's jurisdictional grant applies does not mean § 4072 's statute of limitations does not.
2.
Having determined § 1331 does not preclude application of § 4072, next considered is whether § 4072 applies to actions involving WYO carriers. Ekhlassi contends § 4072 applies only to the FEMA Administrator, not WYO carriers. That section provides:
In the event the program is carried out as provided in section 4071 of this title, the Administrator shall be authorized to adjust and make payment of any claims for proved and approved losses covered by flood insurance, and upon the disallowance by the Administrator of any such claim, or upon the refusal of the claimant to accept the amount allowed upon any such claim, the claimant, within one year after the date of mailing of notice of disallowance or partial disallowance by the Administrator, may institute an action against the Administrator on such claim in the United States district court for the district in which the insured property or the major part thereof shall have been situated , and original exclusive jurisdiction is hereby conferred upon such court to hear and determine such action without regard to the amount in controversy.
Without their providing underlying analysis, at least two prior decisions by our court applied § 4072 to actions against WYO carriers. Ferraro v. Liberty Mut. Fire Ins. Co. ,
Our court is not alone in applying § 4072 to WYO actions. The sixth circuit reached a similar conclusion in Gibson v. Am. Bankers Ins. Co. ,
Again, Ekhlassi, in his supplemental brief, contends § 4072 applies only to FEMA's Administrator. Along that line, the seventh circuit declined to apply § 4072 to a WYO action. Downey v. State Farm Fire & Cas. Co. ,
As quoted above, § 4072 only describes an action against "the Administrator", which the statute later defines as "the [FEMA] Administrator".
That framework counsels in favor of applying § 4072 to WYO actions. In doing so, the third circuit's analysis in Van Holt is instructive:
For several reasons, a suit against a WYO company is the functional equivalent of a suit against FEMA. First, a WYO company is a fiscal agent of the United States.42 U.S.C. § 4071 (a)(1). Second, FEMA regulations require a WYO company to defend claims but assure that FEMA will reimburse the WYO company for defense costs.44 C.F.R. § 62.23 (i)(6). Third, an insured's flood insurance claims are ultimately paid by FEMA. After a WYO company depletes its net premium income, FEMA reimburses the company for the company's claims payments. 44 C.F.R. Pt. 62, App. A, Art. IV(A). When a WYO company's proceeds from insurance premiums exceeds its current expenditures, it must pay the excess proceeds to the [Flood Insurance Administration]. 44 C.F.R. Pt. 62, App. A., Art. VII(B). Although a WYO company collects premiums and disburses claims, only FEMA bears the risk under the flood insurance program. Thus, a lawsuit against a WYO company is, in reality, a suit against FEMA. Cf. Gowland [v. Aetna ,143 F.3d 951 , 954-55 (5th Cir. 1998) ], (refusing to estop WYO company due to relationship between company and FEMA).
Van Holt ,
Also instructive is
Nevertheless, § 4053 can inform our interpretation of § 4072. Palmieri explains:
The general design of the [National Flood Insurance] Act also evidences an intent to ensure that claims involving the programs it creates are heard in the federal courts. Section 4053, which applied to the now-defunct Industry Program, vested exclusive jurisdiction in the federal courts over any action brought by an insured against a pool of private insurers. See42 U.S.C. § 4053 . Section 4072 similarly provides for exclusive jurisdiction in the federal courts over any action brought by an insured "against the [Administrator]."Id. § 4072. The statutory framework thus indicates not only that private insurers are to act as fiscal agents of the government in administering the federal program, but also that all claims for benefits under a[ ] [National Flood Insurance Act] policy, whether issued as part of the Industry Program or the Government Program and whether sought from a private insurer or the government, are to be litigated exclusively in federal court.
Palmieri ,
Finally, we note Ekhlassi's inconsistent positions regarding § 4072. His supplemental brief urges our holding § 4072 inapplicable to WYO carriers. But, despite his newfound efforts to distance his action from the restrictions of § 4072, he cited § 4072 numerous times in his original and reply briefs.
Even if prior decisions by our court had not applied § 4072 to actions against WYO carriers, we would be persuaded by the well-reasoned opinions from the second, third, and sixth circuits: in short, § 4072 applies to WYO carriers.
B.
Having determined the applicability of § 4072, we turn to whether we can affirm the district court on this alternative basis; and, if we can, whether § 4072 's application renders Ekhlassi's action time-barred. We answer both questions in the affirmative.
1.
Ekhlassi asserts Lloyds waived the statute-of-limitations defense premised on this action's not being filed in federal court. But, even if Lloyds did not raise this precise contention, we can still consider it.
In our court, "a well-settled discretionary exception to the waiver rule exists where a disputed issue concerns 'a pure question of law' ". New Orleans Depot Servs. Inc. v. Director, Office of Worker's Comp. Programs ,
The issue at hand is a question of law; there are no disputed facts needing resolution. Moreover, this is an appeal from a summary judgment-a legal determination. Further, we ordered supplemental briefing on this issue and addressed it during oral argument. See New Orleans Depot Servs. Inc. ,
2.
Ekhlassi's claim is time-barred. Lloyds' first letter was sent on 6 October 2015; its second, on 11 January 2016. Ekhlassi filed this action in state court on 11 January 2017, exactly one year from the second letter.
But,
That Ekhlassi may have filed this action within one year of an operative denial-letter does not save it, because he filed in state court, when
III.
For the foregoing reasons, the judgment is AFFIRMED.
Concurring Opinion
Because we are bound by precedent to apply § 4072 to a WYO carrier, I concur in the judgment of the court in this case. I write separately because, unlike the majority opinion, I conclude that our precedent wrongly construes § 4072 in a counter-textual fashion.
We should instead begin and end with the plain text of the statute, which refers only to suits against the FEMA Administrator. See
The text is unambiguous; it simply does not mention WYO carriers. If Congress had intended § 4072 to apply to WYO carriers it could have added that to the provision. See BedRoc Ltd., LLC v. United States ,
The Second Circuit, although agreeing that " § 4072 does not expressly indicate that anyone other than the [Administrator] may be sued," nevertheless concluded that *140the provision was ambiguous because the word "against" "could mean either 'having as defendant' or 'opposed to'." Palmieri v. Allstate Ins. Co. ,
But even assuming there is some ambiguity in the provision, I agree with the Seventh Circuit that although WYO carriers stand in the shoes of the Administrator in many respects, that does not compel the conclusion that § 4072 applies to WYO carriers. See Downey v. State Farm Fire & Cas. Co .,
Further, although WYO carriers are "place-holder[s]" for FEMA in many respects, id ., they are independent in other respects. As Ekhlassi points out in his supplemental briefing, FEMA regulations provide that WYO carriers (1) "arrange for the adjustment, settlement, payment and defense of all claims arising from policies of flood insurance [they] issue[ ]," (2) use their "own customary standards, staff and independent contractor resources," and (3) "are solely responsible for their obligations to their insured ... such that the Federal Government is not a proper party defendant in any lawsuit arising out of such policies."
Also, WYO carriers are fiscal agents, but not general agents, of the United States. Id . § 62.23 (g) ; cf. Dwyer v. Fidelity Nat. Prop. & Cas. Ins. Co. ,
Thus, while I respect and agree that we are bound by precedent, I disagree that our precedent is correct. For that reason, I concur in the judgment but not in the reasoning beyond citing precedent.
I note that the one-year statute of limitations would be applicable here regardless of whether "Administrator" under § 4072 encompasses the WYO carrier because Paragraph VII.R. of the applicable insurance policy issued to Ekhlassi states that "you must start the suit within one year after the date of the written denial of all or part of the claim."
Reference
- Full Case Name
- Ali EKHLASSI, Plaintiff - Appellant v. NATIONAL LLOYDS INSURANCE COMPANY, Defendant - Appellee
- Cited By
- 4 cases
- Status
- Published