524 F.Supp.3d 242
S.D.N.Y.2021Background
- Food for Thought, a New York catering business, purchased a Business Owners Policy from Sentinel that covered "Business Income" and "Extra Expense" only when suspension was "caused by direct physical loss of or physical damage to property," and included a Civil Authority clause requiring access be "specifically prohibited by order of a civil authority" as a direct result of a covered loss to property in the immediate area.
- In March 2020 New York State and City issued COVID-19 executive orders closing non-essential businesses and prohibiting gatherings; Food for Thought suspended operations and submitted claims under the Business Income, Extra Expense, and Civil Authority provisions.
- Sentinel denied the claim; Food for Thought sued for breach of contract and declaratory relief. Sentinel moved to dismiss under Rule 12(b)(6).
- The Amended Complaint alleged loss of use of the premises and asserted the likely presence of COVID-19 on the property as the basis for physical loss or damage; it relied on state and local executive orders and public statements.
- The district court reviewed New York law on insurance-contract interpretation and precedent requiring physical damage or loss to trigger such coverage, and granted Sentinel’s motion, dismissing all counts for failure to plead a covered "direct physical loss or physical damage" or a civil-authority order that specifically prohibited access as a direct result of physical damage to nearby property.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Business Income coverage was triggered by COVID-19 closures | Loss of use and likely presence of the virus on premises constitute a "direct physical loss" | Policy requires actual physical loss or physical damage to the insured property | Dismissed — allegations of loss of use or speculative viral presence insufficient under NY law requiring physical damage/loss |
| Whether Extra Expense coverage was triggered | Extra expenses incurred due to shutdown are covered because they result from the same "direct physical loss" | Same threshold applies as Business Income; no physical loss alleged | Dismissed — Extra Expense requires physical loss/damage and plaintiff failed to plead it |
| Whether Civil Authority coverage was triggered by executive orders | State and city closure orders that prevented normal operation invoked Civil Authority coverage | Civil Authority requires access be "specifically prohibited" by order and to result from physical loss to nearby property | Dismissed — orders did not specifically prohibit access and plaintiff did not plead physical damage to property in the immediate area |
Key Cases Cited
- Roundabout Theatre Co. v. Cont'l Cas. Co., 751 N.Y.S.2d 4 (App. Div. 2002) (interpreting similar policy language to require physical damage or loss to insured property for business-interruption coverage)
- United Air Lines, Inc. v. Ins. Co. of State of Pa., 439 F.3d 128 (2d Cir. 2006) (denying BI coverage where government shutdown after 9/11 did not stem from physical damage to insured property)
- Port Auth. of N.Y. & N.J. v. Affiliated FM Ins. Co., 311 F.3d 226 (3d Cir. 2002) (physical contamination evidence may support coverage where physical alteration or contamination is shown)
- Studio 417, Inc. v. Cincinnati Ins. Co., 478 F. Supp. 3d 794 (W.D. Mo. 2020) (held COVID-19 contamination allegations could state a physical loss claim under that jurisdiction’s law)
- Abner, Herrman & Brock, Inc. v. Great N. Ins. Co., 308 F. Supp. 2d 331 (S.D.N.Y. 2004) (Civil Authority coverage triggered only when access was completely denied by civil order)
- Bell Atlantic Corp. v. Twombly, 550 U.S. 544 (2007) (plausibility pleading standard)
- Ashcroft v. Iqbal, 556 U.S. 662 (2009) (legal conclusions and speculative assertions are insufficient to plead plausibly)
- Olin Corp. v. Am. Home Assurance Co., 704 F.3d 89 (2d Cir. 2012) (principles of contract/insurance policy interpretation under New York law)
