FIRST BAPTIST CHURCH OF IOWA, LOUISIANA v. CHURCH MUTUAL INSURANCE COMPANY, S.I.
No. 23-30514
United States Court of Appeals for the Fifth Circuit
June 26, 2024
Irma Carrillo Ramirez, Circuit Judge
Before WILLETT, WILSON, and RAMIREZ, Circuit Judges.
IRMA CARRILLO RAMIREZ, Circuit Judge:
First Baptist Church of Iowa, Louisiana (FB Church) sued Church Mutual Insurance Company, S.I. (CM Insurance) under an insurance policy, alleging failure to pay benefits for property damage caused by Hurricane Laura. After a bench trial, the district court found in favor of FB Church and awarded it damages, statutory penalties, attorney‘s fees, and costs. CM Insurance appealed. We affirm in part and reverse in part.
I
FB Church owns real property in Iowa, Louisiana, on which sit three buildings: (1) the main building (the church), (2) the parsonage, and (3) a vacant building. The church includes a sanctuary, fellowship hall, classrooms, nursery, kitchen, bathrooms, and offices. The property was insured under a commercial insurance policy issued by CM Insurance. It provided replacement cost coverage for the church, the parsonage, and all personal property on those premises with a blanket limit of $1,236,000, and actual cash valuе coverage for the vacant building with a $65,000 limit. The church and parsonage had a 5% deductible, and the vacant building had a $5,000 deductible. In the event of a covered loss, CM Insurance had the option to pay for the cost to repair or replace damaged property “as of the time of loss or damage.”
On August 27, 2020, Hurricane Laura caused considerable damage to the property. The next day, FB Church reported the loss to CM Insurance. CM Insurance retained a third-party administrator, Engle Martin & Associates, LLC (CM Insurance‘s Administrator), to adjust the loss on its behalf. On September 7, 2020, CM Insurance‘s Administrator‘s field adjuster, Wesley Ellis (Adjuster), met with FB Church‘s pastor at the property for an initial inspection. Adjuster inspected and photographed the exterior and interior of the church and parsonage.
On September 8, 2020, Adjuster sent CM Insurance a three-page Immediate Advice Report, along with the photographs, which estimated the total loss at $630,000, before deductibles. The report notеd that the church‘s roof, including the gable roof covered by shingles and the recently installed roof over the backside of the building, had significant damage. As a result, the interior of the building also suffered significant damage, including to the ceiling, insulation, electrical lighting, wall paneling, trim work, VCT tile, and
On September 17, 2020, FB Church sent a bid totaling $9,195.33 for replacement of the parsonage‘s roof. Adjuster reviewed the bid and used Xactimate, a computer software system commonly used by insurance adjusters to generate loss estimates, to estimate a replacement cost of $10,178.05, or $8,269.03 with depreciation.
On September 22, 2020, Adjuster and Executive Adjuster sent CM Insurance a report with more information on the damages observed from the September 7, 2020 inspection of the church and parsonage. The report estimated the net loss after applying the deductible to be $560,150. This was based on the same $630,000 estimate of loss from the Immediate Advice Report. The report included Adjuster‘s Xactimate estimate for replacing the parsonage roof and recommended accepting the $9,195.33 bid. It also noted that Bret O‘Steen, an engineer and construction consultant with Young & Associates (Engineer), had been retained to assist in the clаim. The report explained that the expected loss was approximately $630,000 and recommended that CM Insurance issue an advance payment of $50,000 to allow for commencement of repairs. It also advised CM Insurance of its obligation to pay claims under
Adjuster stopped working on the claim after this report was sent to CM Insurance.
On September 22, 2020, Engineer visited the property and inspected all three buildings. On October 12, 2020, CM Insurance sent FB Church an advance payment of $100,000.
On October 14, 2020, Engineer sent Executive Adjuster three separate reports, estimating the damage to the church at $244,984.16, the parsonage at $19,780.17, and the vacant building at $8,656.05, for total damages of $273,420.38. He generated the estimates on Xactimate, and used a September 2020 price list for materials to determine costs because the price list was created within a few days of the hurricane.
Around this time, Executive Adjuster advised FB Church to use a licensed, bonded remediation company who had access to Xactimate for mitigation work because it would make the scope of work easier. Based on his recommendation, FB Church hired ServPro to perform drying and mitigation work. ServPro originally submitted an invoice for $59,664.42, followed up by a supplemental invoice for $16,994.34 for special equipment. Even though he believed the amounts were excessive, Executive Adjuster instructed FB Church to pay the original invoice, which it did. He then reached out to ServPro about the supplemental invoice and was told that it did not include additional mitigation work, and that an updated supplemental invoice would be sent in the future.
On October 22, 2020, Executive Adjuster sent CM Insurance a report along with Engineer‘s damage estimate reports and the estimates ServPro had provided FB Church for mitigation work. The report
On November 12, 2020, Engineer sent Executive Adjuster an updated damage estimate of $298,845.63 to account for electrical damage in the church. On November 20, 2020, Executive Adjuster sent CM Insurance this estimate with his status rеport. Based on Engineer‘s updated estimate, Executive Adjuster revised the recommended payment to $219,707.02 in addition to the $10,000 payment for temporary office space.
FB Church was frustrated with how its claim was being handled, so on December 4, 2020, it hired a public adjuster, Strategic Claims Consultants, LLC (FB Church‘s Adjuster), to help with the claim. After FB Church‘s Adjuster was retained, Executive Adjuster had limited contact with FB Church and directed all communications about the claim to FB Church‘s Adjuster. FB Church‘s Adjuster later prepared an estimate using Xactimate for over $1 million in damages, which was sent to Executive Adjuster and CM Insurance. This estimate was not offered by either party and is not in the record.
On December 21, 2020, CM Insurance paid FB Church $102,075.48 for all three buildings.
On March 3, 2021, CM Insurance‘s representatives, including Executive Adjuster and Engineer, met with representatives from FB Church‘s Adjuster and FB Church at the property to reinspect the buildings and discuss the competing damage estimates.
On April 9, 2021, Executive Adjuster sent CM Insurance a status report on the joint inspection. Thе total estimate of loss was still $630,000, and the net outstanding estimate was reduced to $358,074.52, reflecting FB Church‘s $69,850 deductible, CM Insurance‘s payment of the $100,000 advance, and CM Insurance‘s December 21 payment of $102,075.48. A senior claims adjuster, John Kubant (Senior Adjuster), took over the claim in April 2021.
On June 17, 2021, Engineer revised his estimate to include electrical work that was overlooked in the original inspection. The following day, Executive Adjuster sent a status report to CM Insurance, recommending an additional indemnity payment of $39,107.17 for the overlooked electrical work. The report also showed an additional outstanding balance of $10,000 on the claim. On June 22, 2021, CM Insurance sent a payment for $49,107.17.
On July 23, 2021, Executive Adjuster sent CM Insurance a report, noting that the revised estimate did not include sales tax and that FB Church was owed $8,663.57. CM Insurance paid this amount on July 27, 2021.
On August 13, 2021, FB Church sued CM Insurance, alleging claims for additional covered losses and for statutory penalties, costs, and attorney‘s fees under
After a three-day bench trial in May 2023, the district court found that CM Insurance had failed to pay what was due under the policy and that it owed FB Church an additional $883,947.89 for covered damages. It also found that CM Insurance was subject to penalties under
CM Insurance appealed, contending that (1) the district court erred in finding the policy ambiguous and adopting inflated prices to calculate damages and penalties; (2) the district court erred in finding that CM Insurance failed to adjust the claim and disregarding its estimates on that erroneous finding; (3) the finding of “bad faith” and award for statutory penalties and attorney‘s fees was contrary to law and unsupported by any evidence; (4) the district court erred in awarding penalties on the total loss; (5) the district court erred in denying CM Insurance‘s motion for judgment as a matter of law; (6) the judgment was mathematically incorrect; and (7) the district court erred in admitting FB Church‘s estimate because it was incompetent evidence under
II
After a bench trial, findings of fact are reviewed for clear error and legal issues are reviewed de novo. Luwisch v. Am. Marine Corp., 956 F.3d 320, 326 (5th Cir. 2020) (per curiam) (quoting Barto v. Shore Constr., LLC, 801 F.3d 465, 471 (5th Cir. 2015)). “A finding is clearly erroneous if it is without substantial evidence to support it, the court misinterpreted the effect of the evidence, or this court is convinced that the findings are against the preponderance of credible testimony.” French v. Allstate Indem. Co., 637 F.3d 571, 577 (5th Cir. 2011) (quoting Becker v. Tidewater, Inc., 586 F.3d 358, 365 (5th Cir. 2009)). “We will reverse under the clearly erroneous standard ‘only if we have a definite and firm conviction that a mistake has been committed.‘” Id. (quoting Canal Barge Co. v. Torco Oil Co., 220 F.3d 370, 375 (5th Cir. 2000)). When “the district court‘s account of the evidence is plausible in light of the record viewed in its entirety,”
A
CM Insurance argues that the district court improperly calculated FB Church‘s damages for replacement cost in violation of the policy‘s valuation provision, and it disputes the district court‘s ruling that the policy is ambiguous.
“The district court‘s interpretation of an insurance contract is a question of law that we review de novo.” Consol. Cos. v. Lexington Ins. Co., 616 F.3d 422, 425 (5th Cir. 2010) (citing Admiral Ins. Co. v. Ford, 607 F.3d 420, 422 (5th Cir. 2010)). Because this is a diversity case, thе interpretation of a contract is controlled by Louisiana law. See Guidry v. Am. Pub. Life Ins. Co., 512 F.3d 177, 181 (5th Cir. 2007) (citing Am. Int‘l Specialty Lines Ins. Co. v. Canal Indem. Co., 352 F.3d 254, 260 (5th Cir. 2003)).
Under Louisiana law, an “insurance policy is a contract between the parties and should be construed by using the general rules of interpretation of contracts set forth in the Louisiana Civil Code.” Cadwallader v. Allstate Ins. Co., 2002-1637, p. 3 (La. 6/27/03); 848 So. 2d 577, 580 (first citing Carbon v. Allstate Ins. Co., 97-3085, p. 4 (La. 10/20/98); 719 So. 2d 437, 439; and then citing La. Ins. Guar. Ass‘n v. Interstate Fire & Cas. Co., 93-0911, p. 5 (La. 1/14/94); 630 So. 2d 759, 763). A court‘s primary goal in interpreting insurance contracts is “to ascertain the common intent of the parties to the contract.” Id. (first citing
“An insurance policy should not be interpreted in an unreasonable or a strained manner so as to enlarge or to restrict its provisions beyond what is reasonably contemplated by its terms or so as to achieve an absurd conclusion.” Louisiana Ins., 93-0911, p. 5 (La. 1/14/94); 630 So. 2d 759, 763 (citing Lindsey v. Poole, 579 So. 2d 1145, 1147 (La. Ct. App. 2d Cir. 1991)). “If the policy wording at issue is clear and unambiguously expresses the parties’ intent, the insurance contract must be enforced as written.” Cadwallader, 2002-1637 at p. 4; 848 So. 2d at 580.
Where an insurance policy includes ambiguous provisions, the “[a]mbiguity
Here, the policy provides coverage for “direct physical loss of or damage to Covered Property at the premises described in the Declarations Page caused by or resulting from any Covered Cause of Loss.” Under the relevant provisions of the policy, CM Insurance will pay for covered loss or damage by paying the value of the lost or damaged property or paying the repair or replacement cost for that property, purchase the lost or damaged property, or replace the lost or damaged property with a comparable substitute. The value of the property or cost of repairs or replacement will be assessed according to the valuation provision, which states that CM Insurance will pay either the replacement cost or the actual cash value3 of the property. Regardless of whether replacеment cost or actual cash value is “shown in the Declarations Page as applicable to Covered Property,” the payment amount will be determined “as of the time of loss or damage[.]” The policy further provides that CM Insurance “will not pay on a Replacement Cost basis for any loss or damage: (a) Until the lost or damaged property is actually repaired or replaced; and (b) Unless the repairs or replacement are made as soon as reasonably possible after the loss or damage.”
CM Insurance contends that the policy pays to replace or repair covered losses “at the time of the loss or damage,” and that the district court erred in finding this provision ambiguous. The district court‘s written opinion does not address the ambiguity finding or explain why the valuation of costs of repair or replacement “as of the time of loss or damage” in a replacement cost policy is ambiguous.
FB Church argues that the district cоurt correctly found that a provision freezing the cost as of the date of the loss conflicts with “the purpose and nature of a replacement policy.” It contends that the “obligation to replace the lost or damaged property with other property of comparable material and quality expressly included in the policy cannot be squared with freezing those costs at the moment of the loss.” Id. But “an insurance policy is to be construed as a whole and each provision in the policy must be interpreted in light of the other provisions. One provision cannot be construed separately at the expense of disregarding other provisions.” Sims, 2007-0054 at p. 12; 956 So. 2d at 591-92.4
When read as a whole, the policy is clear: the cost of repairing or replacing the damaged property is determined based upon prices “as of the time of loss or damage.” The district court erred in finding the policy ambiguous. Because the judgment awards damages and penalties based on January 2023 prices and costs in violation of the policy‘s terms, the award must be vacated and remanded for recalculation using prices from the time of loss.5
B
CM Insurance argues that the district court erred in disregarding its estimate of loss and relying solely on FB Church‘s Expert‘s estimate. “When reviewing a district court‘s factual findings, this court may not second-guess the district court‘s resolution of conflicting testimony or its choice of which experts to believe.” Grilletta v. Lexington Ins. Co., 558 F.3d 359, 365 (5th Cir. 2009). It is well established that the district court‘s “reasonable evaluations of credibility and reasonable inferences of fact should not be disturbed on review unless clearly erroneous.” Real Asset Mgmt., Inc. v. Lloyd‘s of London, 61 F.3d 1223, 1227 (5th Cir. 1995) (first citing United States v. Ornelas-Rodriguez, 12 F.3d 1339, 1346 (5th Cir. 1994); and then citing United States v. Raymer, 876 F.2d 383, 386 (5th Cir. 1989)).
At trial, CM Insurance presented its Engineer‘s Xactimate estimate that the total damage to all three buildings was $352,455.85. Engineer testified that he is a construction consultant and deals with thе construction of buildings and exterior and interior building components. He is not a licensed adjuster; nor is he authorized to perform loss adjustments in Louisiana. He was retained by CM Insurance to inspect the property, scope and photograph the damages, and generate an estimated cost of repairs to return the buildings to their
FB Church presented FB Church‘s Expert‘s estimate that the damage to all three buildings was $1,178,739.53. FB Church‘s Expert has a Louisiana independent adjuster‘s license and was accepted as an expert in insurance claims handling and construction. He testified that he visited the property and inspected all three buildings on at least six occasions. He measured the buildings, photographed the damage, reviewed pre-demolition pictures, and used Xactimate to prepare an estimate of the cost to return the buildings to their pre-loss condition.
The district court accepted FB Church‘s Expert‘s estimate of damages as the amount of damages CM Insurance was required to pay under the policy because it was the “only credible adjustment made by a Louisiana licensed adjuster.” It specifically considered his testimony on how he inspected the property and prepared his estimate. The district court discredited Engineer‘s estimate because, unlike FB Church‘s Expert, he was not a licensed adjuster. Engineer also did not include repairs for damages to the parsonage that were detailed in CM Insurance‘s Administrator‘s reports and in FB Church‘s Expert‘s estimate. “The district court, as the finder of fact in a bench trial, is best positioned to evaluate the credibility of the witnesses.” French, 637 F.3d at 580 (quoting Dickerson v. Lexington Ins. Co., 556 F.3d 290, 295 (5th Cir. 2009)). On this record, a reasonable factfinder could conclude that FB Church‘s Expert‘s estimate provided the more credible assessment of the damages and costs to restore the property to its pre-loss condition.
CM Insurance argues that the district court disregarded its estimate of damages upon the erroneous finding that it did not adjust FB Church‘s claim. As discussed, the district court credited FB Church‘s Expert‘s Xactimate estimate because it was an adjustment by a licensed adjuster, whereas Engineer‘s Xactimate estimate was just an estimate. The significance of this distinction was recognized by one of CM Insurance‘s witnesses at trial: Executive Adjuster testified that an estimate and adjustment “are two separate things.”
Even if the district court disregarded CM Insurance‘s estimate based on the finding that it had failed to adjust the claim, CM Insurance has not shown that this finding is clearly erroneous. As evidence that FB Church‘s claim was adjusted, CM Insurance points to Executive Adjuster‘s testimony explaining that adjusting a claim is an ongoing process and why FB Church‘s claim was adjusted. He explained that Engineer was retained to assist in the overall scopе of damages and that Engineer‘s estimates were provided with his reports to CM Insurance. As noted, however, Executive Adjuster also testified that an estimate is not the same as an adjustment. On multiple occasions, the district court asked Executive Adjuster to point to an adjusting report or any adjustment of FB Church‘s claim, but he was unable to do so. The district court found that Executive Adjuster did not adjust the claim because he only relied on Engineer‘s estimate of damages. Based on the record, we cannot say that this finding was clearly erroneous.
CM Insurance also points to the testimony of its corporate representative, Senior Adjuster. He testified that it was common practice for CM Insurance and other insurance carriers to retain engineers and
After reviewing the record and giving due weight to the district court‘s credibility determinations, we hold that the district court did not err in finding that CM Insurance failed to adjust the claim or in disregarding its estimate of damages. See Real Asset Mgmt., 61 F.3d at 1227.
C
CM Insurance argues that the judgment is not supported by the record because it includes damages not caused by the hurricane and inflates the value of damaged items.
The determinations of a district court concerning causation and the amount of damages are factual findings subject to clear error review. Luwisch, 956 F.3d at 326. If the award of damages is plausible in light of the entire record, an appellate court may not reverse the award even if convinced it would have reached a different cоnclusion. See St. Martin v. Mobil Expl. & Producing U.S. Inc., 224 F.3d 402, 410 (5th Cir. 2000).
Here, the district court accepted FB Church‘s Expert‘s estimate, with modifications, to determine the total amount of covered damages owed under the policy. FB Church‘s Expert‘s 109-page report provides replacement cost estimates for all three buildings with descriptions of the repairs necessary to return the buildings to their pre-loss condition. It also includes floorplans and measurements. Photographs of the buildings are provided in a separate 130-page report. At trial, FB Church‘s Expert and Engineer were questioned about some of the items in FB Church‘s Expert‘s report. Both parties tendered the reports and testimony from civil engineers who inspected the property. The district court heard testimony from FB Church‘s pastor, his wife, and another church representative about the condition of the buildings before and after the hurricane and about some of the repair work. It also considered the deposition testimony of an electrician whо performed electrical work at the property after the hurricane. We consider each of CM Insurance‘s specific disputed damages in turn.
i
CM Insurance objects to the award of $164,235.42 for removing and replacing electrical wiring of the sanctuary, arguing FB Church‘s Expert‘s estimate inflated the costs of electrical repairs. There was no testimony from FB Church‘s Expert about this part of the estimate, and his report does not include a narrative describing the current or past condition of the sanctuary‘s electrical system. The electrician who performed that work, Dylan Guidry, testified that he removed and replaced all the electrical wiring in the sanctuary, but that he never submitted a bid for the remainder of the church building. Although he initially submitted a $26,800 bid for the sanctuary work, including materials and labor, he ultimately did not charge FB Church for labor, and Guidry ultimately charged FB Church only $4,500, which it paid.
FB Church argues that Guidry only replaced the electrical system for the sanctuary,
ii
CM Insurance next objects to the inclusion of the ServPro invoice for $119,085.19 because the parties and the district court agreed that the amount was excessive. At trial, it was undisputed that ServPro performed work to mitigate water damage from the hurricane, that it charged FB Church $119,085.19 for that work, and that mitigation work is covered under the policy. Under Louisiana law, once an insured has demonstrated that a claim is covered by the policy, “the insurer has the burden of demonstrating that the damage at issue is excluded from coverage.” Dickerson, 556 F.3d at 295. CM Insurance has failed to show why the invoiced amount is excluded from coverage under its policy. We see no error, clear or otherwise, in the district court‘s award of the ServPro invoice.6
iii
CM Insurance challenges the award of $139,083.86 for removing and replacing all brick veneer of the church as unsupported by the record. It contends that because the estimate is based on general measurements from the report of FB Church‘s structural engineering expert, Ron Martin (FB Church‘s Engineering Expert), and he never took measurements of the church‘s exterior, there is no factual support for FB Church‘s Expert‘s estimate of the square footage of brick needed to reface the entire building. FB Church‘s Expert testified that he conducted the measurements for all three buildings for the estimate, however, and that FB Churсh‘s Engineering Expert relied on his measurements.
CM Insurance also contends that there was no testimony that every brick on the building was damaged by the hurricane, and that its experts attributed cracks in the brick to a sinking slab. Ricardo-Fierro Stevens, CM Insurance‘s civil engineering expert (CM Insurance‘s Engineering Expert), testified that the crack between bricks on the back wall of a new addition to the church was directly caused by slab movement and not from the force of the hurricane. His opinion was based on an elevation survey showing the slab under the addition had dropped 0.6 inch. In contrast, FB Church‘s Engineering Expert testified that based on where the cracks were located on the wall, he was able to determine that the cracked bricks were caused by hurricane winds and not from
iv
CM Insurance argues that the award of $72,972.79 for HVAC replacement in all three buildings is not supported by the evidence. FB Church‘s Expert testified that the HVAC in the church‘s sanctuary was not working during his first three inspеctions, but he was not sure if it was working on his last inspection because the weather was cool. He did not have a licensed professional inspect any of the HVAC units on the property. Although there is scarce evidence concerning the condition of the HVAC units, the record shows that they were located in areas that sustained significant damage from the hurricane. FB Church‘s electrician testified that the entire electrical system of the church was damaged and required replacement, and there was testimony from its engineer noting significant movement of the building during the hurricane. The record also includes several photographs of the damage to all three buildings. These photographs and the testimony of FB Church‘s experts provided the district court with sufficient evidence to award damages for the HVAC units. On this record, we cannot say that the district court‘s award is beyond the “reasonable evaluations of credibility and reasonable inferences of fact.” Real Asset Mgmt., 61 F.3d at 1227.
v
CM Insurance also challenges the award of $65,000 for the vacant building, arguing it is not justified or supported by the record. As discussed, the vacant building was insured for $65,000. FB Church‘s Expert valued the replacement cash value of the vacant building at $96,990.63. At trial, he testified about the extensive damage to the building, which had been a residence at some point. CM Insurance points to testimony from the pastor and another FB Church representative about the vacant building‘s condition before the storm, including that it was unoccupied and not worth repairing, and that it should have been demolished. CM Insurance‘s Executive Adjuster also testified that he was unable to step into the building at his inspection due to its “dilapidated state.” Although there was conflicting evidence at trial as to the value and condition of the vacant building, weighing the credibility of conflicting witness testimony is the responsibility of the district court. See Ornelas-Rodriguez, 12 F.3d at 1347-48. The award for the vacant building was not clearly erroneous.
vi
CM Insurance argues that there is no evidence to support the award of
vii
CM Insurance objects to the award of $93,395.87 for repairing the parsonage, arguing the damage was due to “faulty workmanship” of volunteers rather than the hurricane. It does not cite to the part of the record that supports this argument, however. Even though the pastor and his wife testified that they have been living in the parsonage since October 2020, they also testified about how their home has not been returned to its pre-storm condition. Based on the еvidence presented by FB Church, including the testimony of the pastor and his wife and photographs of the parsonage, the district court did not err in awarding damages for repairing the parsonage.7
D
CM Insurance contends that the district court erred in finding bad faith under
Section 22:1892 provides that insurers “shall pay the amount of any claim due any insured within thirty days after receipt of satisfactory proofs of loss from the insured or any party in interest.”
To prevail under
Here, the district court found that CM Insurance “had notice of the proof of loss on September 8, 2020, the date of” CM Insurance‘s Administrator‘s first report. It noted that the report estimated a total loss of $630,000 and identified significant damage to FB Church‘s property. The district court found that because CM Insurance‘s
i
CM Insurance contends there is insufficient evidence to support the finding that it received satisfactory proof of loss on September 8, 2020. “Louisiana‘s requirements for proofs of loss are flexible, focusing on notice.” Cotton v. Certain Underwriters at Lloyd‘s of London, 831 F.3d 592, 596 (5th Cir. 2016) (first citing Anco Insulations, Inc. v. Nat‘l Union Fire Ins. Co., 787 F.3d 276, 286 (5th Cir. 2015); and then citing La. Bag Co., 2008-0453 at p. 23; 999 So. 2d at 1119-20). “So long as the insurer obtains sufficient information to act on the claim, thе manner in which it obtains the information is immaterial.” Anco Insulations, 787 F.3d at 286. “Satisfactory proof of loss” is only that which is “sufficient to fully apprise the insurer of the insured‘s claims.” La. Bag Co., 2008-0453 at p. 23; 999 So. 2d at 1119. “Whether an insured satisfactorily bears its burden of proving ‘satisfactory proof of loss’ is a question of fact that Louisiana courts review for manifest error.” Anco Insulations, 787 F.3d at 286.
CM Insurance argues that
Louisiana has made clear that satisfactory proof of loss “is a flexible requirement to advise an insurer of the facts of the claim, and . . . need not be in any formal style.” La. Bag Co., 2008-0453 at p. 23; 999 So. 2d at 1119 (internal quotation marks and citation omitted). Louisiana courts have specifically recognized that an insurer can “obtain satisfactory proof of loss as a result of its adjuster‘s inspection of the damaged property.” Korbel v. Lexington Ins. Co., 308 F. App‘x 800, 804 (5th Cir. 2009) (citing cases).
CM Insurance next argues that the district court “erroneously deemed the date of the insurer‘s first report as the date of ‘proof of loss.‘” It asserts that it did not receive this report until September 15, 2020, and points to its internаl claim notes acknowledging this date of receipt. Even though the claim notes were provided at trial, Senior Adjuster testified that they were made by third-party administrators, and he was unfamiliar with their procedures for inputting notes. He also acknowledged that claim notes were not always typed in contemporaneously. The Immediate Advice Report is dated September 8, 2020; it states it was emailed to a CM Insurance email. This is sufficient evidence to support the district court‘s implicit finding that CM Insurance received the report on that day. Because the district court‘s finding is not implausible in light of the evidence in the record, there is no clear error.
ii
CM Insurance contends that the district court erred in finding that its initial payment was untimely because damages were disputed throughout trial. As discussed, an insurer is liable for statutory penalties for failing to pay a claim within thirty days if that failure was “arbitrary,
The Supreme Court of Louisiana has held that an insurer who fails to pay the insured the undisputed portion of the claim within the statutory time limit is, “by definition, arbitrary, capricious or without probable cause.” La. Bag Co., 2008-0453 at pp. 16-17; 999 So. 2d at 1116. “Where the exact extent of the damages is unclear, an insurer must tender the reasonable amount which is due.” Id. at p. 15; 999 So. 2d at 1115. To avoid penalties under
“The statute is not intended, however, to prevent insurers from disputing claims in good faith, including litigating such disputes.” Dickerson, 556 F.3d at 299. “Under Louisiana law, ‘penalties should be imposed only when the facts negate probable cause for nonpayment,’ not ‘when the insurer has a reasonable basis to defend the claim and acts in good-faith reliance on that defense.‘” Levy Gardens Partners, 706 F.3d at 635 (quoting La. Bag Co., 2008-0453 at p. 14; 999 So. 2d at 1114). “[W]hen there are substantial, reasonable and legitimate questions as to the extent оf an insurer‘s liability or an insured‘s loss, failure to pay within the statutory time period is not arbitrary, capricious or without probable cause.” Id. (quoting La. Bag Co., 2008-0453 at p. 14; 999 So. 2d at 1114). An insurer must pay “only when it indisputably owes payment under the insurance contract and only the amount that it indisputably owes.” Demma v. Auto. Club Inter-Ins. Exch., 2008-2810, p. 13 (La. 6/26/09); 15 So. 3d 95, 103-04. “[R]egardless of any disputed amounts in a claim for which there are substantial, reasonable and legitimate questions as to the extent of its insurer‘s liability or of the insured‘s loss, an insurer must still pay any undisputed amount over which reasonable minds could not differ.” La. Bag Co., 2008-0453 at p. 24; 999 So. 2d at 1120.
The district court found untimely the $100,000 advance payment made on October 12, 2020, because it was not made within 30 days of CM Insurance‘s receipt of the September 8, 2020 Immediate Advice Report. The report provided an overview of the significant damages observed from the initial inspection of the church and parsonage and estimated the total loss at $630,000 before deductibles. Photographs from the inspection were also enclosed with the report. Given this large estimate of loss, Adjuster was immediately replaced by Executive Adjuster because the total loss was expected to exceed $500,000. The district court noted that all subsequent reports from CM Insurance‘s Administrator, including the last report dated September 1, 2021, estimated the total loss at $630,000 and used this amount to calculate the net outstanding loss. For example, in the report dated September 22, 2020, which immediately followed the Immediate Advice Report, the net estimate of loss was $560,150. There is substantial evidence in the record to support the district court‘s arbitrary and capricious finding.
iii
CM Insurance contends that the district court erred in imposing penalties on the entire amount it found was due under the policy without deducting for the payments made before the judgment was rendered. At the time of the loss in August 2020,
[F]ailure to make such payment within thirty days after receipt of such satisfactory written proofs and demand therefor . . . when such failure is found to be arbitrary, capricious, or without probable cause, shall subject the insurer to a penalty, in addition to the amount of the loss, of fifty percent damages on the amount found to be due from the insurer to the insured, . . . or in the event a partial payment or tender has been made, fifty percent of the difference between the amount paid or tendered and the amount found to be due as well as reasonable attorney fees and costs.
CM Insurance argues that the phrase “on the amount found to be due” means that penalties are calculated on the unpaid portion of damages found due under the policy by the district court. We have previously concluded, based on the same statutory language, that “the insurer was liable for penalties on the entire amount found to be due, without any subtraction for amounts paid.” French, 637 F.3d at 589 (emphasis added) (citing Grilletta, 558 F.3d at 370). Although the decision applied the prior version of
III
CM Insurance argues that the district court erred in allowing FB Church‘s Expert‘s report into evidence because it did not comply with
By failing to raise this objection at the district court, CM Insurance forfeited its argument for appeal. See Rollins, 8 F.4th at 397. We see no reason to excuse CM Insurance‘s failure to preserve its arguments regarding FB Church‘s Expert‘s report and decline to consider the forfeited arguments.
IV
We AFFIRM the district court‘s decision to disregard CM Insurance‘s estimate of loss, award FB Church additional damages based on FB Church‘s Expert‘s estimate (excluding any damages for slab repair and any damages in excess of $4,500 for electrical repair in the sanctuary), award statutory penalties and attorney‘s fees on the total loss amount, deny CM Insurance‘s motion for judgment as a matter of law, and admit the report and testimony of FB Church‘s Expert. Because the district court erred in awarding damages based on prices in January 2023 instead of at the time of loss and in awarding any damages for slab repair and damages in excess of $4,500 for the sanctuary‘s electrical repair, we REVERSE that portion of the district court‘s decision and REMAND for recalculation of damages.
Notes
(i) a complete statement of all opinions the witness will express and the basis and reasons for them; (ii) the facts or data considered by the witness in forming them; (iii) any exhibits that will be used to summarize or support them; (iv) the witness‘s qualifications, including a list of all publications authored in the previous 10 years; (v) a list of all other cases in which, during the previous 4 years, the witness testified as an expert at trial or by deposition; and, (vi) a statement of the compensation to be paid for the study and testimony in the case.
