Bethany Christian Church v. Preferred Risk Mutual InsuranceBethany Christian Church v. Preferred Risk Mutual Insurance
MEMORANDUM AND ORDER GRANTING PREFERRED RISK MUTUAL INSURANCE COMPANY’S MOTION FOR SUMMARY JUDGMENT AND DENYING BETHANY CHRISTIAN CHURCH’S MOTION FOR SUMMARY JUDGMENT
Before the Court is Bethany Christian Church’s Motion for Summary Judgment (Document No. 16) and Preferred Risk Mutual Insurance Company’s Cross Motion for Summary Judgment (Document No. 19). On December 8, 1995, the parties consented to trial before United States Magistrate Judge Frances H. Stacy. Upon such consent, the District Judge referred the case for all proceedings to Magistrate Judge Stacy.
Based on a review of the motions for summary judgment, the summary judgment evidence, and the applicable law, the Court is of the opinion that Preferred Risk Mutual Insurance Company’s Cross Motion for Summary Judgment should be granted, and that Bethany Christian Church’s Motion for Summary Judgment should be denied, for the reasons set forth below.
I. Applicable Law
The United States Supreme Court has held that Rule 56 of the Federal Rules of Civil Procedure mandates the entry of summary judgment, after adequate time for discovery and upon motion, against a party who fails to make a showing sufficient to establish an essential element of that party’s case, and on which that party will bear the burden of proof at trial.
Celotex Corp. v. Catrett,
Rule 56(c) of the Federal Rules of Civil Procedure provides that summary judgment “shall be rendered forthwith if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue of material fact and that the moving party is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(c). This standard provides that the mere existence of some factual dispute will not defeat a motion for summary judgment.
See Krim v. BancTexas Group, Inc.,
The party moving for summary judgment bears the initial burden of showing an absence of evidence to support the non-moving party’s case.
Celotex Corp. v. Catrett,
Even if the standards of Rule 56 are met, a court may deny a motion for summary judgment if, in its discretion, it determines that “a better course would be to proceed to a full trial.”
Anderson,
In resolving the question of which law, federal or state, is applicable to the particular facts of this case, the Court is mindful of the principle that a federal court sitting in a diversity case is obligated to apply the substantive law of the state in which it is sitting.
Hanley v. Forester,
II. Background
Plaintiff Bethany Christian Church (“the Church”) located in Houston, Texas, purchased an insurance policy from defendant Preferred Risk Mutual Insurance (“Preferred”), an Ohio Company, on or about January 24, 1994. See Plaintiffs Original Petition, Exhibit A, Document No. 1 (Policy). This policy, numbered 1136-423, covered various situations including employee dishonesty. Preferred Policy, CR 00 01 10 90, Employee Dishonesty Coverage Form (Coverage Form A — Blanket), p. 2 of 2. The Preferred policy was effective from December 1, 1993 to December 1, 1994 with a coverage limit of $50,000 per occurrence.
During the Preferred coverage period, the Church lost $51,421.24 in'cash to theft by an employee, Linda Smith. During two previous policy periods while the Church was covered by Atlantic Mutual, Smith stole $1,493.97 in 1991-1992 and $29,629.92 in 1992-1993. During these three separate policy periods in effect from 1991 to 1994, Smith embezzled a total of $82,545.13 from the Church through' altered and unauthorized checks. (See Exhibit D of Preferred’s Response to the Church’s Motion for Summary Judgment/Counter-Motion for Summary Judgment for a breakdown of the various thefts by Linda Smith). A summary of coverage and the thefts during the three policy periods follows:
COVERAGE DATE INSURER LOSS LIMIT
12/91-12/92 Atlantic Mutual $ 1,493.97 $60,000
12/92-12/93 Atlantic Mutual $29,629.92 $50,000
12/93-12/94 Preferred Risk $51,421.24 $50,000
TOTAL $82,545.13
The Church discovered the theft on or about November 1, 1994, whereupon it notified Preferred. The Church began furnishing proof of loss to Preferred on November 11,1994. On December 14, 1994 and February 22, 1995, the Church furnished sworn proofs of loss setting out the Church’s claim for Preferred to pay its policy limits of $50,-00Ó.
On March 24, 1995, Preferred notified the Church it would pay only $19,776.54 for the losses. Preferred maintained that because the series of thefts by Smith from 1991
On or about March 30, 1995, Preferred tendered a check in the amount of $19,776.54 to the Church. Preferred intended the check to be for full satisfaction of the losses. The Church returned the cheek to Preferred to avoid the appearance of accord and satisfaction of Preferred’s obligation to the Church. Subsequently, the Church filed suit against Preferred in the 11th Judicial District Court of Harris County, Texas. Preferred removed the case to the United States District Court for the Southern District of Texas, and filed a counter-claim for summary judgment.
For its December 1993-December 1994 loss of $51,421.24, the Church seeks $50,000, the policy limit, with prejudgment interest at the highest legal rate, from the date Preferred offered $19,776.54, March 24, 1995, plus attorney’s fees of $25,000 and court costs, all to bear post-judgment interest at the highest legal rate until paid.
Preferred seeks $6,000 in attorney’s fees and all costs of defense. Preferred argues that the Church’s request for $25,000 in attorney’s fees in this type of case is excessive and should, at most, be $10,000.
III. Summary of the Argument of the Parties
In determining insurance coverage for employee dishonesty, the Church contends that a series of acts resulting in loss constitutes multiple occurrences, allowing it to recover separately under each policy in effect during the various losses. Additionally and alternatively, the Church asserts that an other insurance provision does not limit an insurer’s liability to pay the highest policy limit in effect at the time of the discovery of the loss. Finally, the Church contends that an insured may stack non-overlapping policy limits in order to recover the full amount of the loss sustained where the occurrence extends through several policy periods.
Preferred contends that a series of acts resulting in loss constitutes a single occurrence under Texas law, limiting recovery by the insured to the highest policy limit in effect at the time of the discovery of the loss. As set forth below, an occurrence, as defined in the Preferred insurance policy and as interpreted by applicable law, means all loss caused by or involving one or more employees, whether the result of a single act or series of acts. Texas law also provides that the insured’s indemnity limit is the highest limit that applies at a single point in time during the coverage period, and that non-overlapping policy limits are not stackable even where the claim occurrence extends throughout several policy periods.
IV. Definition of Occurrence
In order to determine the policy limits available in this case, the Court must determine whether the series of thefts committed by Linda Smith is considered one occurrence. If the series is considered one occurrence, the total recovery for the entire amount stolen may not exceed the amount of the policy limit of the insurance policy that was in effect when the loss was discovered.
The Church asserts that the acts of Linda Smith constitute three separate occurrences, since they occurred over the course of three
A. Occurrence as Defined in the Preferred Policy
Pursuant to the Preferred policy, occurrence is defined as: “all loss caused by or involving one or more ‘employees,’ whether the result of a single act or series of acts.”. Preferred Policy, CR 00 01 10 90, Employee Dishonesty Coverage Form (Coverage Form A — Blanket), p. 2 of 2. This policy language does not limit an occurrence to the coverage period, nor does it distinguish between a single act versus a series of acts. What is critical in the policy language is the sum total of the loss caused by “dishonest acts committed by an ‘employee,’ whether identified or. not, acting alone or in collusion with other persons.... ” Preferred Policy, CR 00 01 10 90, Employee Dishonesty Coverage Form (Coverage Form A — Blanket), p. 2 of 2. The Atlantic Mutual policy defines occurrence in the same way. See Defendant’s Response to Plaintiffs Motion for Summary Judgment and Defendant’s Counter-Motion for Summary Judgment, Exhibit B, Document No. 19 (“Defendant’s Response”). ■
B. Applicable Case Law
The coverage trigger issue for continuing occurrences has troubled courts across the country in recent years, and Texas has limited precedent on that issue.
CNA Lloyds of Texas v. St. Paul Ins. Co.,
Although not many courts have dealt with the meaning of occurrence as it relates to insurance coverage for employee dishonesty, this Court looks for guidance to a federal court sitting in Texas that has applied the same definition of occurrence described in the insurance industry’s standard Employee Dishonesty Coverage Form (Coverage Form A — Blanket), p. 2 of 2. In an unpublished opinion,
Potomac Ins. Co. of Illinois v. Lone Star Web, Inc.,
No. 3:93-CV-2122-H
In determining what constitutes an occurrence in such a case, the Court in
Lone Star
looked to the definition of occurrence used in
Diamond Transp. Sys. v. Travelers Indem.,
Consistent with the Lone Star and Diamond cases, this Court rejects the Church’s contention that it is entitled to separate recoveries on each of the three policies that were in effect during the thefts. Like the insured, Lone Star, the Church misinterprets the terms of the insurance contract, particularly the term occurrence. The thefts committed by the Church’s employee Linda Smith, are a series of acts, which, as defined in Preferred’s policy, constitute one occurrence. Although separate insurance companies provided coverage to the Church, in all of the coverage periods during which Smith converted funds from the Church, the policies of both Preferred and Atlantic Mutual clearly described an occurrence as a series of acts resulting in loss. This Court determines that the series of thefts by Smith at issue herein are a single occurrence under the three identical policy definitions of occurrence in the insurance industry’s standard Employee Dishonesty Coverage Form (Coverage Form A — Blanket), p. 2 of 2. The Church may only recover from all its insurers, a combined total of $50,000, the policy limit in effect at the time the loss was discovered. 5
In the alternative, the Church maintains that in order for Preferred to exclude or limit coverage, its exclusions must be clearly and expressly stated in the insurance contract.
The Church’s arguments are inapplicable to this case because the terms of the Preferred insurance contract, especially the definition of occurrence, are clear and unambiguous, and because Preferred is not asserting an exclusion, but is only applying to the occurrence the coverage limit described in its policy.
V. The Other Insurance Provision and the Stacking of Policy Limits Arguments
A. The Other Insurance Provision
The other insurance provision in the Preferred Policy provides:
OTHER INSURANCE: This insurance does not apply to loss recoverable or recovered under other insurance or indemnity. However, if the limit of the other insurance or indemnity is insufficient to cover the entire amount of the loss, this insurance will apply to that part of the loss, other than that falling within any deductible amount, not recoverable or recovered under" the other insurance or indemnity. However, this insurance will not apply to the amount, of loss that is more than the applicable limit of insurance shown in the declarations.
Preferred Policy, CR 10 00 10 90, Crime General Provisions, p. 2 of 4. Preferred contends that the other insurance provision in its policy protects it from liability for the full $50,000 per occurrence policy limit specifically outlined in its insurance contract. Because the series of thefts constitute one occurrence, Preferred maintains that the total recovery is limited to $50,000 for the combined loss caused by Smith where the loss was spread over the three policy periods. Preferred contends that the other insurance provision makes Atlantic Mutual liable for the losses sustained during its coverage periods, $1,493.97 from December 1991 — December 1992 and $29,629.92 from December 1992 — December 1993, up to the total policy limit of $50,000 for each of the two Atlantic policy periods. This would leave Preferred to pay only $18,876.11, the difference between the $50,000 policy limit and Atlantic Mutual’s payments which total $31,123.89, for the losses sustained during Preferred’s coverage period, $51,421.24 from December 1993 — December 1994.
The Church disagrees with Preferred’s interpretation of the other insurance provision, seeing the provision as a grant of coverage, rather than a limit on coverage. The Church relies on Section B, Limit of Insurance as providing coverage up to the $50,000 policy limit. Section B. provides: “The most we will pay for loss in any one ‘occurrence’ is the applicable Limit of Insurance shown in the Declarations.” Preferred Policy, CR 00 04 10 90, Theft, Disappearance and Destruction Coverage Form (Coverage Form C), p. 1 of 2. The Church argues that there is no mention in Section B. of exceptions for other insurance. Nevertheless, the other insurance provision is mentioned at Section 11 of the Crime General Provisions of the Policy. Preferred Policy, CR 10 00 10 90, Crime General Provisions, p. 2 of 4. Plaintiffs either overlook the other insurance provision, or choose to ignore it.
Another argument asserted by the Church is that Section 13(b) of the Crime General Provisions expressly provides for coverage
The plain language of the other insurance provision limits the total recovery from all three policies to the $50,000 policy limit in effect at the time of the discovery of the loss, since the three policies cover one occurrence. Therefore, the most the Church can recover for Linda Smith’s theft is the amount of the policy limit in effect at the time the Church discovered the theft.
Diamond,
B. Stacking of Policy Limits
In order for the Church to recover $50,000 from Preferred, as opposed to the difference between the $50,000 policy limit and the $31,-123.89 Atlantic Mutual paid, the Church would have to stack the policy limits of all three policies in effect' during the thefts. Stacking the policy limits would mean adding together the policy limits of the two Atlantic Mutual policies and the Preferred policy to make the maximum potential recovery a total of $150,000. Plaintiffs seemingly maintain that they can stack the policies because they received the full amounts of their losses from Atlantic Mutual. But Plaintiffs fail to acknowledge that the total of the two losses of $1,493.97 and $29,629.92 is still substantially less than $50,000, the policy limit available under all three policies for the one occurrence.
The Texas Supreme Court has held that where two insurance policies do not overlap chronologically, the limits of those policies, may not be stacked.
Am. Physicians Ins. Exch. v. Garcia,
In
Garcia,
the Cardenas family was seeking compensation from Dr. Garcia’s medical malpractice insurer, American Physicians Insurance Exchange (“APIE”). In an earlier malpractice suit against Dr. Garcia, a jury awarded the Cardenas family approximately $2.5 million in damages for the harm Dr. Garcia caused Gustavo Cardenas.
Garcia,
In this case, the Church was covered by three non-overlapping policies with identical $50,000 policy limits. The theft occurrence triggered coverage by all three policies. This Court applies the rule in Garcia and determines that the policy limits of the three applicable policies cannot be stacked. The Church’s total recovery for Smith’s thefts is therefore, limited to $50,000.
In its final argument, the Church maintains that it should recover $51,421.24 because it sustained $51,421.24 in losses during the Preferred policy period. The Church relies on
Cullen/Frost Bank of Dallas v. Commonwealth Lloyd’s Ins. Co.,
Cullen and Dorchester concern coverage issues, but there is no dispute in this case about Preferred’s coverage of the Church’s $51,421.24 loss or the timing of Smith’s theft of this amount. The parties agree that the Church sustained losses of $51,421.24 during Preferred’s coverage period and that the Church is entitled to recover from Preferred for the loss sustained during the Preferred policy period. The dispute lies in the determination of how much money the Church is entitled to recover from Preferred for its losses. This can only be determined by defining occurrence, applying the correct policy limit, and enforcing the other insurance provision. Because the Church is entitled to reimbursement for losses sustained during the coverage period, limited by the policy limit for the occurrence, the Court finds that the Church is entitled to collect $18,876.11 from Preferred. This amount equals $50,-000, the policy limit for a single occurrence, minus $31,123.89, the total amount already paid to the Church by Atlantic Mutual on other insurance policies. 9
VI. Attorneys ’ Fees
Both sides have requested attorneys’ fees in this action. The Church seeks $25,000 in attorneys’ fees, which Preferred maintains is excessive and should be limited to no more than $10,000. Preferred also seeks attorneys’ fees in the amount of $6,000. Based on a review of the foregoing requests for attorneys’ fees, the Court finds that there is insufficient documentation to support said requests. As such, the parties are hereby ORDERED to submit supplemental briefing, together with affidavits and time sheets, in support of their respective requests for . attorneys’ fees within 15 days of receipt of this
VII. Conclusion
Based on the foregoing, the Court finds that an occurrence, as defined in the Preferred insurance policy and as interpreted by Texas law, means all loss caused by or involving, one or more employees, whether the result of a single act or series of acts. As such, the series of thefts over a three-year period by the Church’s employee, Linda Smith, constitutes one occurrence. Furthermore, the Court finds that the Church may not stack its policy limits, even though the claim occurrence extends throughout several policy periods, because the three insurance policies cover three separate policy periods and do not overlap chronologically. Accordingly, the Church is entitled to receive from Preferred the $50,000 policy limit amount less the $31,123.89 already paid to the Church by Atlantic Mutual, or $18,876.11.
It is therefore,
ORDERED that Preferred Risk Mutual Insurance Company’s Cross Motion for Summary Judgment (Document No. 19) is GRANTED, and that Bethany Christian Church’s Motion for Summary Judgment (Document No. 16) is DENIED.
Notes
. The $31,123.89 was the total of the losses sustained during the two years of the Atlantic Mutual coverage. The first loss of $1,493.97 occurred during the coverage period 12/91-12/92, and the second loss of $29,629.92 occurred during the coverage period 12/92-12/93.
. The difference between the $50,000 policy limit and what Atlantic Mutual has paid is actually $18,876.11, nevertheless, Preferred tendered $19,776.54 to the Church (see p. 6 of Preferred’s Response to the Church’s Motion for Summary Judgment/Counter-Motion for Summary Judgment, Document No. 19).
. Unpublished opinions issued before January 1, 1996 have value as precedent. Local Rule 47.5.3 (5th Cir.). However, because every opinion believed to have precedential value is published, such an unpublished opinion should normally be cited only when the doctrines of res judicata, collateral estoppel or law of the case are applicable, or notice, sanctionable conduct, entitlement to attorney's fees, or the like are issues. None of these doctrines or issues apply to the instant case.
If such an unpublished opinion is cited in a brief, motion or other document being submitted to the court, a copy shall be attached to each copy of the brief, motion or document. Local Rule 47.5.3 (5th Cir.). A copy of the Lone Star opinion is attached at Exhibit E of Preferred's Response to the Church's Motion for Summary Judgment/Corinter-Motion for Summary Judgment, Document No 19.
. The only policy which was found to apply to the loss was the second policy, because even though some of the loss occurred during the first policy, the policy language indicated that any loss discovered must be reported within one year of the expiration of the policy. The loss was reported on April 26, 1993. Since the first insurance policy had expired on April 3, 1992, April 3, 1993 was the latest date Lone Star could make a loss claim to be covered by the first insurance policy.
. Where a single occurrence triggers coverage by more than one policy, the highest policy limit in effect during the coverage period is the applicable policy limit. See discussion of prohibition against stacking policy limits at § V.B infra.
. Neither side disputes the fact that the $51,-421.24 loss occurred during the Preferred policy period.
. For example, in
St. Paul Mercury Ins. Co. and Centennial Ins. Co. v. Lexington Ins. Co. and Landmark Ins. Co.,
.Garcia was insured by the Insurance Corporation of America in 1980 for $100,000 on a "claims made” basis; in 1981 for $500,000 per occurrence; and in 1982 for $500,000 per occurrence. Garcia was insured by APIE in 1983 for $500,000 per occurrence.
. The Church proffers as exhibits a series of letters sent to it by Preferred, indicating varying degrees of coverage by Preferred. However, no estoppel claim is raised by the Church, and the letters have no effect on the reasoning and result of this opinion.
The Plaintiff tries to demonstrate that Preferred was not sure of its reimbursement responsibility to the Church as modified by the "other insurance” provision. The letters from Preferred are attached to the Plaintiff's Motion for Summary Judgment at Exhibits B-D. The first letter erroneously stated that Preferred would cover any loss above and beyond what Atlantic Mutual would cover. Exhibit B. The second letter was sent to correct the first letter, and stated that if Atlantic Mutual’s policy limit was lower than Preferred's, and Atlantic Mutual exhausted that limit then Preferred would have exposure. Exhibit C. The third letter stated that the Preferred policy does not apply to loss recoverable under other policies except where the other insurance limit is insufficient to cover the loss. Exhibit D. In such a case, the Preferred policy will apply to that part of the loss up to the policy limits in the declarations. Exhibit D.