Bexar Cty Hosp Dist v. Factory Mutual ( 2007 )

United States Court of Appeals
Fifth Circuit
F I L E D
REVISED JANUARY 24, 2007
January 5, 2007
IN THE UNITED STATES COURT OF APPEALS
FOR THE FIFTH CIRCUIT Charles R. Fulbruge III
Clerk
No. 05-51665
BEXAR COUNTY HOSPITAL DISTRICT d/b/a
UNIVERSITY HEALTH SYSTEM
Plaintiff-Appellant,
versus
FACTORY MUTUAL INSURANCE COMPANY,
Defendant-Appellee.
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Appeal from the United States District Court
for the Western District of Texas
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Before JONES, Chief Judge, WIENER and BARKSDALE, Circuit Judges.
WIENER, Circuit Judge,
Plaintiff-Appellant Bexar County Hospital District
(“University Health System” or “UHS”) sued Defendant-Appellee
Factory Mutual Insurance Company (“Factory Mutual” or “FM”) for
breach of contract, alleging that FM improperly calculated the
deductible applicable to a claim UHS made on its FM property
insurance policy. The district court eventually granted FM’s
motion for summary judgment, denied a like motion by UHS, and
dismissed UHS’s action. We affirm.
I. FACTS & PROCEEDINGS
In May 2003, UHS discovered water in its Electrical Switchgear
Room and Central Plant. It determined that its chilled water
system was leaking badly. To keep the hospital functioning while
it located the source of the leak and made the necessary repairs,
UHS rented temporary cooling towers for its air conditioning
system. UHS eventually found that a 20-inch bypass line serving
one of its cooling towers in the energy plant had developed a
substantial leak. Over a period of some 90 days, UHS spent
$557,134 to repair the leak and the machinery it had damaged, plus
$1,001,093 to rent the temporary water chillers.
At the time the damage occurred, UHS had in place Factory
Mutual’s Global Advantage policy (“the Policy”), an “all risks”
property insurance policy covering both physical damage and “time
element” (business interruption) loss. UHS filed separate claims,
one for property damage (repairs of leak and machinery), and
another for time element loss (rental expense for cooling towers).
The Policy required UHS to take all reasonable steps to prevent or
minimize time element losses, so the cooling towers rental could
not be ascribed to the direct cost of repairing the leaks and the
damaged machinery.
FM paid UHS $532,134 for its property damage loss but only
$375,600 for its time element loss. The property damage payment
covered the full cost of repairing the leak and damaged equipment
2
($557,134), less a $25,000 deductible. The time element payment
equaled the full costs to rent the temporary cooling towers
($1,001,093), less a separate deductible for a time element loss
resulting from Boiler & Machinery damage, which FM calculated as
$625,493, or the value of one day’s worth of UHS’s total projected
operating revenue.
UHS complained to FM that the appropriate “Time Element value”
to be used in calculating the particular deductible for that claim
should have been the value of its actual time element loss —— here
the rental costs of the temporary cooling towers, as there had been
no business interruption as such, thanks to the rented towers ——
and not UHS’s projected operating revenue. FM stuck to its
position, so in March 2004, UHS filed suit in Texas state court for
declaratory judgment and breach of contract. FM removed the case
to the district court, basing jurisdiction on diversity of
citizenship. After filing an Agreed Stipulation of Material Facts,
both FM and UHS moved for summary judgment, each arguing that its
proffered method for calculating the appropriate time element loss
deductible was the only reasonable interpretation of the pertinent
provisions of the Policy. The district court granted FM’s motion
and denied UHS’s, and dismissed the case. UHS timely filed a
notice of appeal.
II. ANALYSIS
A. Standard of Review
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We review the district court’s grant of summary judgment and
its interpretation of the insurance policy involved de novo.1
B. Contract Interpretation
As this appeal involves a diversity action that turns on
contractual interpretation, Texas substantive law governs.2 In
Texas, insurance policies are subject to the same standards of
interpretation and construction as are applicable to contracts
generally.3 The Texas Supreme Court has specified the methodology
for courts to use when interpreting insurance contracts:
The primary concern of a court in construing a
written contract is to ascertain the true intent of the
parties as expressed in the instrument. If a written
contract is so worded that it can be given a definite or
certain legal meaning, then it is not ambiguous. Parol
evidence is not admissible for the purpose of creating an
ambiguity.
If, however, the language of a policy or contract is
subject to two or more reasonable interpretations, it is
ambiguous. Whether a contract is ambiguous is a question
of law for the court to decide by looking at the contract
as a whole in light of the circumstances present when the
contract was entered. Only where a contract is first
determined to be ambiguous may the courts consider the
parties' interpretation, and admit extraneous evidence to
determine the true meaning of the instrument.4
1
Schneider Nat. Transp. v. Ford Motor Co., 280 F.3d 532,
536 (5th Cir. 2002)(citations omitted).
2
Erie R.R. v. Tompkins, 304 U.S. 64, 82 (1938).
3
Kelley-Coppedge, Inc. v. Highlands Ins. Co., 980 S.W.2d
462, 464 (Tex. 1998).
4
Id. (citing Nat’l Union Fire Ins. Co. v. CBI Indus., 907
S.W.2d 517, 520 (Tex.1995).
4
Accordingly, we must first decide whether the policy at issue is
ambiguous.
An ambiguity does not arise merely because the parties advance
conflicting contractual interpretations.5 A contract is ambiguous
only when there is a “genuine uncertainty as to which one of two or
more meanings is proper.”6 In making that determination, courts
must take care not to isolate particular phrases or sentences from
their setting, and must consider the contract “as a whole,” giving
effect to all of its provisions so that none is rendered
meaningless.7 Words used in one sense in one part of the contract
should be deemed to have been used in the same sense elsewhere in
the contract unless there is a clear indication otherwise.8 If a
court determines that the policy is not ambiguous, it may construe
the policy provisions as a matter of law. If, however, the court
concludes that the policy is ambiguous on the point at issue, i.e.,
susceptible to more than one reasonable interpretation, it should
5
Id. at 465 (citing Grain Dealers Mut. Ins. Co. v. McKee,
943 S.W.2d 455, 458 (Tex.1997)).
6
Pioneer Chlor Alkali Co. v. Royal Indem. Co., 879 S.W.2d
920, 929 (Tex. App. 1994)(quoting State Farm Lloyds v. Williams,
791 S.W.2d 542, 545 (Tex. App. 1990)).
7
Forbau v. Aetna Life Ins. Co., 876 S.W.2d 132, 133-34
(Tex. 1994).
8
Gonzalez v. Mission Am. Ins. Co., 795 S.W.2d 734, 736
(Tex. 1990).
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adopt the interpretation that favors the insured.9 This rule
follows from the generally accepted principle that an ambiguous or
inconsistent provision of a contract should be construed strictly
against the party that drafted it.10
C. Relevant Policy Provisions
1. Deductibles
The deductible provisions are found in Section A-11 of the
Policy. The parties agree that the controlling provision is found
in the “Boiler and Machinery” exception to the $25,000 default
policy deductible. This exception specifies that the deductible
for a time element loss resulting from “Boiler and Machinery”
damage will be “1 Day Equivalent Time Element, subject to a minimum
of 25,000.” The Policy defines “Day Equivalent” as:
An amount equivalent to the number of days stated times
the 100% daily Time Element value that would have been
earned following the occurrence at the Location where the
physical damage occurred . . . .11
The dispute here centers on the meaning of “Time Element value,”
which determines the calculation of “1 Day Equivalent.”
2. Value Reporting Provisions
Section A-9 of the Policy requires that “[t]he Insured will
provide the Company 100% values by location.” The “values”
9
Id. at 737.
10
Id.
11
Emphasis added.
6
required to be furnished are (1) property value, (2) stock and
supply value, and (3) time element value. The time element values
required are those “values anticipated for [the approximate term of
the policy, here one year] and the actual Time Element values for
the previous 12 month period.” Notably, this is the only other
place in the Policy in which the disputed phrase, “Time Element
value” appears.
When it negotiated the purchase of the Policy, UHS complied
with Section A-9 by submitting to FM a “profit and loss statement
by location” detailing its operating revenues. UHS contends that
(1) it was required to provide these operating revenue reports to
facilitate FM’s risk assessment function, and (2) risk assessment
was the sole purpose of the Value Reporting Provisions. UHS thus
denies that it provided any such information “as a basis for
computation of a time element deductible” in the event of such a
claim. None disputes, however, that UHS’s operating revenue data
was the only time element information FM ever sought or UHS ever
furnished.
D. Competing Interpretations
1. Factory Mutual
FM interpreted and computed the Policy’s deductible provisions
as follows: (1) The time element deductible for loss caused by
“Boiler and Machinery” damage is “1 Day Equivalent Time Element”;
(2) “Day Equivalent” is defined as:
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An amount equivalent to the number of days stated times
the 100% daily Time Element value that would have been
earned following the occurrence at the Location where the
physical damage occurred;
(3) “Time Element value” equals the maximum time element risk
covered under the Policy, here UHS’s total operating revenue for
the term of the policy, i.e., one year; and (4) The total operating
revenue “that would have been earned following the occurrence” is
UHS’s “projected revenue,” based on its reported revenue for the
three months nearest in time to the date of the damage-causing
occurrence.12 FM insists that its approach is the only reasonable
interpretation of the Policy’s deductible provisions, because it is
the only reading that is internally consistent and gives meaning to
each Policy provision.
2. UHS
Section C-2 of the Policy, “Time Element Coverages,” specifies
the kinds of time element loss covered under the Policy, viz., (1)
gross earnings, (2) extra expenses, (3) leasehold interests, (4)
rental insurance, and (5) commissions, profits, and royalties. UHS
contends that, as this section enumerates five different types of
time element losses covered, the Policy anticipates the possibility
of up to five different types of time element claims. UHS insists
12
UHS determined that the bypass line leak occurred
sometime between March 26, 2003 and May 5, 2003. FM based its
“projected revenue” figures on the revenue reported for April,
May, and June 2003.
8
that the “Time Element value” to be used in calculating the
appropriate deductible for a time element claim depends on the type
or types of time element loss incurred. Under this reading, “Time
Element value” equals the total value of the actual time element
loss, and “1 Day Equivalent Time Element” equals the per diem
value of the specific type of time element loss incurred, i.e., the
total loss divided by the number of days for which that loss
continued. In this case, UHS asserts that, because it incurred
only an “Extra Expense” loss, its deductible should be only the
value of one day’s ratable share of its “extra expenses,” i.e.,
$1,001,093 divided by the number of days the cooling towers were
rented (91). UHS acknowledges that, as that amount is less than
$25,000, the minimum $25,000 deductible would apply.
E. Merits
1. Plain Language
According to FM, “[t]he plain language of the Policy supports
a single time element deductible regardless of the type of time
element loss sustained.” The district court agreed, noting that
“nothing in the Policy indicates that a different deductible
applies depending upon the type of Time Element loss.” FM contends
that, by employing the terms “value” and “earned” in its definition
of “Day Equivalent,” the Policy contemplates a deductible based on
9
revenues or gross earnings and not “Extra Expenses,” as UHS argues.
The district court, for its part, undertook an analysis of the
commonly understood meanings of the terms “value” and “earned” and
concluded that “[t]he use of the word ‘earned’ indicates that the
Time Element value refers to operating revenues, not expenses or
charges.”
UHS attempts to refute the district court’s reasoning by
identifying definitions of “value” and “earned” that would include
“expenses” and “incurred,” respectively. UHS also quotes from the
Policy itself, which states:
In determining the liability payable as the Actual Loss
Sustained, the Company will consider the continuation of
only those normal charges and expenses that would have
been earned had no interruption . . . occurred.13
In the end, even though we believe that common usage supports
FM’s and the district court’s conclusion on this point, we view
UHS’s reading as at least plausible. UHS insured not only its
potential loss of revenue per se, but also any costs it would incur
in providing the services it was required by law to provide to the
public should its operation be interrupted. Its “Time Element
value,” then, could foreseeably include particular “expenses” not
necessarily includable as “earnings.”
UHS also points to subsection A-11, which states that, “if two
or more deductibles provided in this policy apply to a single
occurrence, the total to be deducted will not exceed the largest
13
Emphasis added.
10
deductible applicable, unless otherwise provided.” UHS contends
that this provision clearly indicates that the Policy contemplates
separate deductibles for each type of time element loss. For
example, if “Boiler and Machinery” damage resulted in gross
earnings losses, extra expenses, and lost rental income, FM should
calculate separately the “1 Day Equivalent Time Element value” for
each loss and apply the largest deductible.14
FM responds that the plural, “deductibles,” is used in the
foregoing provision to address a situation in which multiple peril-
specific deductibles could apply to covered losses resulting from
a single, multi-peril occurrence. FM reasons that, “[i]t is
relatively easy to envision a situation where a single loss could,
for example, result from both Flood and Wind,” in which case the
larger of the Wind or Flood deductibles would apply. FM’s argument
is bolstered by the fact that the language referencing more than
one possible deductible for a single occurrence is found in the
Policy’s “Deductibles” section, which mentions only peril-specific
deductibles and says nothing about multiple time element
deductibles. As the district court noted, “the statement cited by
UHS does not support its assertion that a different deductible
applies to each type of Time Element loss.” Nevertheless, nothing
in the “Deductibles” section absolutely precludes UHS’s
interpretation either. Accordingly, we do not hold that our
14
UHS does not challenge FM’s application of separate
deductibles to its property damage and time element claims.
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reading of the plain language of the Policy’s deductible provisions
absolutely forecloses the possibility that “Time Element value”
could ever mean “expenses incurred” (or actual loss sustained).
Instead, we rest our decision on our construction of the deductible
provisions in the context of the Policy as a whole.
2. Internal Consistency
FM insists that its interpretation of “Time Element value” is
the only possible reading that gives meaning to all of the Policy’s
provisions and preserves its internal consistency. The only other
provision that references “Time Element value” is section A-9,
which sets out the Policy’s “Value Reporting Provisions.” This
subsection states that “[t]he Insured will provide the Company 100%
values by location,” including “Time Element values anticipated for
the [approximate term of the policy] and the actual Time Element
values for the previous 12 month period.”15 In this case, UHS
reported its gross operating revenue, or the total amount of time
element loss it would suffer from a total interruption of its
operations.
UHS acknowledges that the Value Reporting Provisions relate to
the potential risks for coverage and the premiums to be charged for
such risks. UHS also concedes that it furnished its operating
revenue information to FM “as a basis for [determining FM’s]
insured risk and policy coverage.” UHS denies, however, that its
15
Emphasis added.
12
reported operating revenue equates to the “Time Element value”
specified in the Policy’s Value Reporting Provisions. Instead, it
asserts that “‘time element values’ relate to ‘time element
losses,’” and therefore, “[t]he only reporting required is for
anticipated loss.” UHS goes on to reason that “if UHS had
anticipated loss of any time element coverage . . . then such would
have been reported.” Essentially, UHS argues that the time element
risk assessment purpose of the Policy’s Value Reporting Provisions
is limited to “anticipated” losses.
FM counters that it would be unreasonable to define “Time
Element value” as anything other than the amounts reported in
compliance with the Value Reporting Provisions (here, UHS’s
operating revenue). To do so, it argues, would render those
provisions meaningless. For example, under UHS’s reading, “Time
Element value” means the amount of the actual loss suffered. Time
element losses are relatively rare, however, and most, if not all,
are unanticipated. It is likely, then, that many potential
insureds would report no “Time Element value” at all —— either
“anticipated” or “actual” —— thereby partially defeating the risk-
assessment purpose of the Policy’s Value Reporting Provisions.
We cannot credit UHS’s position on this issue as being
reasonable. As the Value Reporting Provisions are meant to
facilitate FM’s risk assessment, it would make no sense for FM to
require a potential insured to report only the quantum of
anticipated and actual time element losses (here, “Extra
13
Expenses”). We imagine that, were this the case, potential
insureds would routinely report nothing, and FM would have nothing
on which to base its assessment of the time element risks it
assumes under the Policy. UHS’s position is even less defensible
in light of the Value Reporting Provisions relating to “property”
and “stock and supplies.” There is no doubt that the “values”
required to be reported under those provisions provide the basis
for the coverage limits and premium rates for the property damage
component of the Policy. It would be at best inconsistent, then,
for the time element value reported to play little or no part in
FM’s assessing the risk of a time element loss; yet under UHS’s
reading, that would be the result. A time element value would only
be reported if the potential insured had actually suffered a time
element loss in the previous year or had reason to anticipate such
a loss in the coming year; and even then the values reported would
have little or no bearing on the true value of an interruption of
the potential insured’s operations and thus on its revenues. We
cannot accept such an interpretation of the Policy’s language as
reasonable; FM’s interpretation, however, is reasonable.
III. CONCLUSION
As FM’s interpretation is the only reasonable interpretation
available, the Policy is not ambiguous. FM’s reading of the
Policy’s deductible provisions (1) comports directly with the plain
meaning and common usage of policy terms, (2) preserves the
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internal consistency of the Policy, and (3) gives meaning to all
Policy provisions. In contrast, UHS’s proffered interpretation
requires a strained reading of the Policy’s plain language, and
would render meaningless the time element portion of the Policy’s
Value Reporting Provisions. Accordingly, the district court’s
grant of summary judgment to Factory Mutual and denial of UHS’s
motion for summary judgment are, in all respects
AFFIRMED.
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