ORDER ON DEFENDANT’S MOTION TO DISMISS
This cause is before the Court on Defendant WE Pebble Point, LLC’s Motion to
Legal and Factual Background
Plaintiff Philadelphia Indemnity Insurance Company (“PIIC”) is, as suggested by its name, an insurance company headquartered in Pennsylvania. Compl. ¶ 1. Defendant, WE Pebble Point, LLC (“Pebble Point”), is the owner and operator of the Pebble Point apartment complex located at 3030 Pebble Point Drive in Indianapolis, Indiana. Id. at ¶ 2. PIIC issued Pebblе Point a first-party property insurance policy (“the policy”) for the Pebble Point complex for the period November 22, 2011 to November 22, 2012, with the policy number PHPK795919. Id. at ¶ 6.
The policy states that PIIC will pay for any damage caused by “covered causes of loss,” which include “windstorm or hail” and “water damage.” Pl.’s Resp. 6 (citing PL’s Exs. 1, 2). The policy also specifically excludes from the covered causes of loss any loss caused by “wear and tear” or “rust, corrosion, fungus, decay, deterioration, sрoilage, contamination, hidden or latent defect or any quality in property that causes it to damage or destroy itself.” It further recites that coverage does not extend to loss caused by inadequate or defective: “design, specification, workmanship, repair, construction, renovation, remodeling, grading, compaction ... [or] maintenance.” PL’s Resp. 5.
The policy also contains an “appraisal clause,” which specifies as follows:
2. Appraisal
If we and you disagreе on the value of the property or the amount of “loss”, either may make a written demand for an appraisal of the “loss”. In this event, each party will select a competent arid impartial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and the amount of “loss”. If they fail to аgree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will:
a. Pay its chosen appraiser; and
b. Bear the other expenses of the appraisal and umpire equally.
If there is an appraisal, we will still retain our right to deny the claim.
Compl. ¶ 20; PL’s Ex. 1.
On December 2, 2012, Pebble Point submitted a claim under the policy for roof damage to the complex. According to Pebble Point’s claim, the roof had suffered extensive damage on October 29, 2012, when the remnants of Hurricane Sandy passed through Indianapоlis, bringing with them high winds. Id. at ¶¶ 7-8. Inspectors from PIIC’s contractor, Cunningham Lindsey, and Pebble Point’s contractor, Echo Construction, conducted an initial inspection of the damaged roofs on February 13, 2013. PL’s Resp. 3. PIIC then hired the Rimkus Consulting Group (“Rimkus”) to conduct a further inspection. Rimkus opined that there had not, in fact, been a high wind event in Indianapolis on October 29, 2012—instead, it found that the most recent such wind event occurred on December 20, 2012, after Pebble Point had filed its claim but before inspection by the
Pebble Point challenged Rimkus’s conclusions and demanded appraisal under the contract on May 21, 2013. Compl. ¶ 23. In response, PIIC hired a second engineering firm, PT & C Forensic Consulting Services (“PT & C”), who inspected the apartment complex in July 2013. Engineer Kevin Maxwell, who had inspected on behalf of PT & C, filed a report on August 19, 2013; PIIC characterizes the sеcond report as “generally consistent” with the first one produced by Rimkus. See Compl. ¶ 25; PL’s Ex. D (PT & C report). The report, unlike that produced by Rimkus, attributed some of the roof damage to Hurricane Sandy occurring on October 29, 2012 rather than a later high-wind event. PT & C found that approximately 130 shingles and a “ridge vent” were damaged on October 29, 2012, but it opined that the larger part of the roof damage was “the result of long-term degradation of the sealant strips, improper installation, improper storage of the shingle prior to installation, and/or manufacturing defects.” Pi’s Ex. D. When provided the PT & C report, Pebble Point again rejected its conclusions and renewed its demand for appraisal. See Def.’s Ex. 8.
PIIC continued to maintain that appraisal was not warranted, prompting it to file this suit on September 12, 2013, seeking a judicial declaration that the amount it had paid to Pebble Point discharged its obligation under the policy. PIIC sent Pebble Point a letter the next day informing it of the suit and explaining that PIIC did “not believe that this is a claim where appraisal is warranted.” PL’s Resp. 9 (citing Def.’s Ex. 9).
Legal Analysis
Standard of Review
Federal Rule of Civil Procedure 12(b)(6) authorizes dismissal of claims for “failure to state a claim upon which relief may be granted.” Fed.R.Civ.P. 12(b)(6). In determining the sufficiency of a claim, the court considers all allegations in the complaint to be true and draws such reasonable inferences as required in the plaintiffs favor. Jacobs v. City of Chi.,
In its decisions in Bell Atlantic Corp. v. Twombly,
Although Twombly and Iqbal represent a new gloss on the standards governing the sufficiency of pleadings, they do not overturn the fundamental principle of liberality embodiеd in Rule 8. As this Court has noted, “notice pleading is still all that is required, and ‘a plaintiff still must provide only enough detail to give the defendant fair notice of what the claim is and the grounds upon which it rests, and, through his allegations, show that it is plausible, rather than merely speculative, that he is entitled to relief.’ ” United States v. City of Evansville,
Discussion
PIIC seeks a declaratory judgment holding that, “in the absence of any affirmative evidence disputing the findings of the engineer, Philadelphia Indemnity Insurance Company has fully satisfied its obligations to the insured with respect to this claim.” Compl. ¶ F. Further, it asks us to declare that appraisal was not warranted because the parties’ dispute concerns the “scope of covered damage as opposed to merely the ‘amount’ of loss.” Id. at ¶ A. For its part, Pebble Point maintains that it has a right of appraisal under the policy, and it seeks dismissal of PIIC’s suit on the grounds that PIIC’s refusal tо accept Pebble Point’s appraisal demand renders any declaratory judgment as to the amount of loss premature.
The motion to dismiss thus raises two issues: whether Pebble Point’s right of appraisal under the policy applies to this type of dispute, and, if so, whether appraisal is a precondition of PIIC’s declaratory judgment suit. We take up these questions in turn, and we answer both in the affirmative.
Both parties acknowledge that Pebble Point is entitled to some recovery under the pоlicy; they disagree, however, on the amount of loss that is attributable to covered storm damage rather than excluded causes such as “wear and tear” or faulty roof installation. See Def.’s Br. 5 (citing Defi’s Ex. 5). PIIC contends that since disputes over whether loss is covered by the policy are different than those concerning only the amount of covered loss, Pebble Point’s attempt to invoke its right of appraisal is not appropriate.
The Indiana courts have repeatedly affirmed the enforceability of appraisal clauses, which are a common feature of first-party insurance contracts. See, e.g., Weidman v. Erie Ins. Grp., 745 N.E.2d 292, 297-299 (Ind.Ct.App.2001). They have not spoken authoritatively, however, on the question of whether appraisal clauses may be invoked in cases involving “coverage disputes,” where the primary bone of contention is the causation of loss. Noting the lack of binding state precedent, this Court recently took up the issue in Shifrin v. Liberty Mutual Insurance,
In concluding that a party should be entitled to invoke its appraisal rights where the insurer and insured dispute causation as well as the amount of damage, the Shifrin court looked to the jurisprudence of other states for guidance. In Mapleton Processing, Inc. v. Soc’y Ins. Co.,
[Appraisers must always consider causation, at least as an initial matter. An appraisal is for damages caused by a specific occurrence, not every repair a home might need. When asked to assess hail damage, appraisers look only at damage caused by hail; they do not consider leaky faucets or remodeling the kitchen. When asked to assess damage from a fender-bender, they include dents caused by the collision but not by something else. Any appraisal necessarily includes some causation element, because setting the “amount of loss” requires appraisers to decide between damages for which coverage is claimed from damages caused by everything else.
We concur with the court’s conclusion in Shifrin, and we find the reasoning it em
PIIC responds that several decisions from courts in the Seventh Circuit buttress its position that “[a]n appraisal is not required in a coverage dispute as appraisal and coverage are two distinct issues.” Pl.’s Resp. 7. PIIC hardly helps itself here, however. Its citations are, at best, an exercise in wishful legal thinking; a less generous reader might call them outright mischaracterizations.
For instance, PIIC cites Cunningham v. State Farm Insurance Co.,
PIIC’s reliance on Carter v. State Farm Fire and Casualty Co.,
Most puzzlingly of all, PIIC cites Cen-Trust Bank, N.A. v. Montpelier U.S. Insurance Co.,
CenTrust is instructive here, but not in the sense that PIIC seems to think it is. The policy written by PIIC, like that in CenTrust, provides that “if there is an appraisal, we will still retain our right to deny the claim.” Def.’s Ex. 2 at 20. In other words, the рolicy expressly contemplates that the insurer may deny coverage and assert defenses—including that the damage or a portion of it is outside the contractual scope of coverage—after an appraisal has taken place to determine the amount of loss. We find no warrant in the case law or common sense in interpreting this provision to mean that, where an insurer concedes that a covered loss has occurred, it may short-circuit the appraisal procеss by asserting that its estimate of the amount, and only its estimate of the amount, properly allocates the loss between covered and non-covered causes.
Appraisal is a “favored private procedure because it serves as an inexpensive and speedy means of settling disputes.” Shifrin,
II. Appraisal as a Condition Precedent to Suit
The majority of states appear to treat the satisfaction of a party’s demand for appraisal, where such a right is provided in the contract, as a condition precedent to suit on the policy. See, e.g., F.C.I. Realty Trust v. Aetna Cas. & Sur. Co.,
Again, the courts of Indiana do not speak authoritatively on this issue. The only relevant decision applying Indiana law that either party has brought, to our attention is Sketo v. Allstate Ins. Co.,
A contract may provide that compliance with its fact-finding or dispute-resolution provisions is а condition precedent to suit on the contract by saying so either explicitly or implicitly. In the case of an implied condition precedent, the contract’s intent “must be so plain that a contrary intention cannot be supposed.” Shahan v. Brinegar,
PIIC’s policy makes clear that the results of an appraisal do not necessarily constitute the last word; appraisers’ competence is limited to assessing the amount of loss, and not to interpreting other provisions of the policy. Where, as here, the parties dispute the amount of loss and one has demanded appraisal, however, we conclude that it is premature to consider PIIC’s suit for a declaratory judgment enshrining its own estimates of the amount of covered damage. We accordingly GRANT Defendant’s motion to dismiss Plaintiffs complaint for declaratory judgment, which we dismiss WITHOUT PREJUDICE, and we order the parties to proceed to the appraisаl process as provided for in the policy. Plaintiff may re-file this suit within 30 days of the close of the appraisal process; if it does not, we will enter a judgment in favor of Defendant.
IT IS SO ORDERED.
Notes
. Plaintiff has attached the Policy to the Complaint as Exhibits 1 and 2. We may consider this document, as well as the others attached by Plaintiff as part of the pleadings, in ruling on Defendant’s motion. See 188 LLC v. Trinity Indus., Inc.,
. Defendant asserts, and Plaintiff does not deny, that Pebble Point renewed its coverage for the apartment complex in a functionally identical contract with PIIC for the period November 22, 2012 to November 22, 2013. See Def.’s Br. 2 (citing Def.’s Ex. 1). Storm damage occurring on December 20, 2012 would thus have been covered to the same extent that storm damage on October 29, 2012 was.
. In Hayes v. Allstate Ins. Co.,
Neither of the two factors relied upon by Hayes are present in this case. Here, the insured seeks appraisаl, and would be the beneficiary rather than victim of contra prof-erentem. Moreover, the policy here never states that the amount of loss can be determined by court judgment. It does provide that the insurer will pay for loss in the event that the parties agree, an "appraisal award has been made,” or "final judgment has been entered.” Def.'s Ex. 2 at 22. Unlike the contract in Hayes, however, this does not explicitly hold out judicial determination of the amount of loss as an alternative. Rather, it merely reaffirms the unremarkable proposition that judicial final judgment may resolve legal issues not settled by the appraisal.
. PIIC contends that Sketo is unpersuasive because the "most important” factor in the decision was that "the plaintiff [the losing party] did not provide a response to the motion which resulted in the court’s order.” PL's Resp. 10. PIIC again misses the analytical mark. While the court's determination that the plaintiffs had not complied with the appraisal condition precedent was partially guided by the plaintiffs’ failure to respond to defendant’s motion to compel appraisal, the determination that appraisal was a- condition precedent was an antecedent decision of law not related to plaintiff's failure to respond. See
. In Kendrick Memorial Hospital, Inc. v. Totten,
