Great Lakes Reinsurance (UK) PLC v. Kan-Do, Inc.

Case: 15-11939 Date Filed: 01/25/2016 Page: 1 of 13
[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
No. 15-11939
Non-Argument Calendar
________________________
D.C. Docket No. 8:12-cv-02923-VMC-TGW
GREAT LAKES REINSURANCE (UK) PLC,
Plaintiff-Counter
Defendant-Appellant,
versus
KAN-DO, INC.,
Defendant-Counter
Claimant,
KAN-DO MARINE RESEARCH & PRODUCTS, INC.,
Defendant-Counter
Claimant-Appellee.
________________________
Appeal from the United States District Court
for the Middle District of Florida
________________________
(January 25, 2016)
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Before MARTIN, ROSENBAUM, and ANDERSON, Circuit Judges.
PER CURIAM:
This is a declaratory-judgment action initiated by an insurer, Plaintiff-
Appellant Great Lakes Reinsurance (UK) PLC (“Great Lakes”), against its insured,
Defendant-Appellee Kan-Do Marine Research & Products, Inc. (“Appellee”)1,
asking the district court to declare that the sinking of Appellee’s yacht due to
mechanical failure was not covered by an “all-risk” marine insurance policy. After
denying summary judgment to Great Lakes, the district court entered judgment in
favor of Appellee based upon stipulated facts. The court found that Appellee met
its initial burden of proving a fortuitous loss under the policy and that the policy
exclusion on which Great Lakes relied to avoid coverage was ambiguous. On
appeal, Great Lakes argues that Appellee failed to present evidence showing a
fortuitous loss and that the policy exclusion is not ambiguous. After careful
review, we affirm the district court as to the former ruling but vacate and remand
for further proceedings on the application of the exclusionary provision.
I.
On November 5, 2012, the Kan-Do, a 51-foot Bluewater Motor Yacht
owned by Appellee, sank in its “home slip” at Port Tarpon Marina in Tarpon
Springs, Florida. The Kan-Do sank due to water intrusion after the bilge-pump
1
Kan-Do, Inc., was originally named in the complaint but later changed in district court
proceedings to the “correct” corporate name of Kan-Do Marine Research & Products, Inc.
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system failed, preventing the boat from dewatering. The bilge-pump system, in
turn, failed because of a blown fuse.
No one knows what caused the fuse to blow. As of October 23, 2012, the
Kan-Do’s bilge-pump system was in good working order. In general, the Kan-Do
was well-maintained.
When it sank, the Kan-Do was covered by what the parties agree is an “all-
risk” marine insurance policy issued by Great Lakes to Appellee. The policy
provided coverage “for accidental physical loss of, or accidental physical damage
to” the Kan-Do during the policy period (“Coverage A”). The policy does not
define “accidental physical loss.” Appellee filed a claim with Great Lakes based
on the sinking of the Kan-Do. After investigating the facts and circumstances of
the loss, Great Lakes denied the claim.
Great Lakes then filed this action in the United States District Court for the
Middle District of Florida, pursuant to the court’s admiralty jurisdiction, see 28
U.S.C. § 1333, seeking a declaration that no coverage arising out of the Kan-Do’s
sinking existed under the policy. In pertinent part, Great Lakes disclaimed
coverage because it concluded that no “accidental” or “fortuitous” loss had
occurred and because an exclusion otherwise barred coverage. Great Lakes relied
on Exclusion “r” to Coverage A, which provided that the policy did not cover
losses for the following: “Damage to the [Kan-Do’s] engines, mechanical and
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electrical parts, unless caused by an accidental external event such as collision,
impact with a fixed or floating object, grounding, stranding, ingestion of foreign
object, lightning strike or fire.”2
The district court denied Great Lakes summary judgment, and the case was
submitted to the court on stipulated facts. In finding for Appellee, the court issued
two rulings, both of which are challenged by Great Lakes on appeal. First, the
court ruled that the blown fuse, which caused the bilge pumps to fail, was an
accidental or fortuitous event under the policy. Second, the court found that Great
Lakes could not rely on Exclusion r because it was inconsistent with the grant of
coverage and created ambiguity in the policy. The court entered judgment in favor
of Appellee in the amount of $94,960.12. This appeal followed.
II.
We review a district court’s interpretation of a maritime insurance contract
de novo. St. Paul Fire & Marine Ins. Co. v. Lago Canyon, Inc., 561 F.3d 1181,
1189 n. 17 (11th Cir. 2009). In general, as a reviewing court, we must interpret an
insurance policy so as to give effect to the parties’ reasonable expectations
2
Great Lakes initially pled two other grounds for denying coverage: (1) that the loss was
due to wear and tear or gradual deterioration and (2) that the vessel was unseaworthy. Great
Lakes since has withdrawn reliance on these grounds, leaving only Exclusion r at issue in this
appeal.
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regarding the risks and protections to which they agreed. Morrison Grain Co., Inc.
v. Utica Mut. Ins. Co., 632 F.2d 424, 429-30 (5th Cir. 1980). 3
III.
Under Coverage A of the insurance policy, Great Lakes agreed to “provide
coverage for accidental physical loss of, or accidental physical damage to” the
Kan-Do subject to, among other provisions, any applicable exclusions. The parties
have stipulated that this is an “all-risk” marine insurance policy.
In broad terms, all-risk insurance policies cover all “fortuitous” losses,
“unless the policy contains a specific provision expressly excluding the loss from
coverage.” Dow Chem. Co. v. Royal Indem. Co., 635 F.2d 379, 386 (5th Cir. Jan.
26, 1981); Goodman v. Fireman’s Fund Ins. Co., 600 F.2d 1040, 1042 (4th Cir.
1979) (“[A]ll risks policies have been construed as covering all losses that are
‘fortuitous.’”). “A fortuitous event . . . is an event which so far as the parties to the
contract are aware, is dependent on chance. It may be beyond the power of any
human being to bring the event to pass; it may be within the control of third
persons; it may even be a past event, as the loss of a vessel, provided that the fact
is unknown to the parties.” Morrison Grain Co., Inc., 632 F.2d at 431 (quoting
Restatement of Contracts § 291, cmt. a (1932)). At the very least, fortuity excludes
3
This Court adopted as binding precedent all Fifth Circuit decisions prior to October 1,
1981. Bonner v. City of Prichard, 661 F.2d 1206, 1209 (11th Cir. 1981) (en banc).
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intentional or fraudulent losses and normal wear and tear. City of Burlington v.
Indem. Ins. Co. of N. Am., 332 F.3d 38, 47-48 (2d Cir. 2003).
In order to recover under an all-risk insurance policy, the insured must first
show (1) a fortuitous loss (2) that occurred during the policy period. See Banco
Nacional De Nicaragua v. Argonaut Ins. Co., 681 F.2d 1337, 1340 (11th Cir.
1982); see also Morrison Grain Co., 632 F.2d at 429-31. It is undisputed that the
loss occurred during the policy period. The insured’s burden of showing a
fortuitous loss is “not a particularly onerous one.” Morrison Grain Co., Inc., 632
F.2d at 430. Indeed, we have recognized that “all risks insurance arose for the very
purpose of protecting the insured in those cases where difficulties of logical
explanation or some mystery surround the (loss of or damage to) property.”
Id. (internal quotation marks omitted). Therefore, the insured need not prove “the
precise cause of the loss or damage” to demonstrate fortuity. Id.
Once the insured meets the light burden of establishing that a loss occurred
due to some fortuitous event or circumstance, the burden shifts to the insurer to
show that the loss is excluded by some language set out in the policy. See Banco
Nacional De Nicaragua, 681 F.2d at 1340; Morrison Grain Co., Inc., 632 F.2d at
431; Jewelers Mut. Ins. Co. v. Balogh, 272 F.2d 889, 892 (5th Cir. 1959).
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IV.
A. Appellee’s Burden of Showing Fortuity
We affirm the district court’s ruling that Appellee carried its “light” burden
of establishing a fortuitous loss. Appellee established that the Kan-do sank
because of water intrusion after the bilge-pump system failed and that the bilge-
pump system failed because of a blown fuse. No one knows what caused the fuse
to blow. Appellee also presented evidence that the Kan-Do was well-maintained,
and Great Lakes does not assert in this appeal that the losses were caused by wear
and tear or lack of maintenance. Under these circumstances, the blown fuse is
consistent with an unexplained event that, “so far as the parties are aware, is
dependent on chance.” Morrison Grain Co., Inc., 632 F.2d at 431 (citation
omitted).
Great Lakes contends that without any “evidence showing what fortuitous
event caused the fuse to fail” or evidence that the bilge-pump system failed
prematurely, the insured did not meet its burden of showing fortuity because a
court cannot distinguish whether the loss was caused by a fortuitous event or a
non-fortuitous event. We disagree.
We have long held that requiring insurance claimants to prove the “precise
cause” of loss or damage in order to recover under an “all-risk” insurance policy is
“inconsistent with the broad protective purposes of ‘all risks’ insurance.”
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Morrison Grain Co., 632 F.2d at 430. Under the circumstances here, where Great
Lakes does not contend that the losses were caused by wear and tear or lack of
maintenance, there was no need for Appellee to present evidence on the cause of
the fuse’s failure. It was enough to show that the bilge-pump system’s failure was
caused by a blown fuse.
Nor did Appellee have to present evidence indicating that the bilge-pump
system failed prematurely. Evidence of a premature mechanical failure may, in
some instances, be persuasive to rebut an insurer’s claim that the loss or damage at
issue was occasioned by normal wear and tear or the lack of appropriate
maintenance rather than by chance. But Great Lakes has withdrawn any reliance
on the policy exclusions for wear and tear or lack of maintenance.
In sum, we conclude that the district court properly determined that Appellee
met its initial, light burden of establishing a fortuitous loss within the policy
period. Consequently, the burden shifted to the insurer, Great Lakes, to show that
the loss was otherwise excluded under the policy.
B. Great Lakes’s Burden of Showing an Exclusion
Great Lakes claims that Exclusion r in the policy applies to preclude
coverage. Exclusion r states that the following is not covered under the policy:
“Damage to the Scheduled Vessel’s engines, mechanical and electrical parts,
unless caused by an accidental external event, such as collision, impact with a
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fixed or floating object, grounding, stranding, ingestion of a foreign object,
lightning strike or fire.” (emphasis added).
Courts must enforce insurance provisions as written when they are
unambiguous and understandable. Parks Real Estate Purchasing Grp. v. St. Paul
Fire & Marine Ins. Co., 472 F.3d 33, 42 (2d Cir. 2006) (applying New York
insurance law).4 Ambiguity exists in an insurance policy when its terms are
susceptible to different reasonable interpretations. Fireman’s Fund Ins. Co. v.
Tropical Shipping & Constr. Co., Ltd., 254 F.3d 987, 1003 (11th Cir. 2001). “[T]o
negate coverage by virtue of an exclusion, an insurer must establish that the
exclusion is stated in clear and unmistakable language, is subject to no other
reasonable interpretation, and applies in the particular case and that its
interpretation of the exclusion is the only construction that [could] fairly be placed
thereon.” Parks Real Estate Purchasing Grp., 472 F.3d at 42. Any ambiguity is
resolved in favor of the insured. Id. at 42-43; Dow Chemical Co., 635 F.2d at 386.
Here, the district court concluded that Exclusion r created ambiguity in the
policy because, giving the ordinary meaning to the operative terms in both
Coverage A and Exclusion r—such as “mechanical parts,” “machinery,” and
“equipment”—“many of the same parts of the Kan-Do could reasonably fall under
4
As mentioned in footnote 4 above, a choice-of-law provision in the policy provides that
New York law governs unless entrenched principles of admiralty law apply. In any case, the
parties do not suggest that choice of law affects the inquiry into ambiguity or the effect of the
exclusion.
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either Coverage ‘A’ or Exclusion ‘r,’ thus creating ambiguity.” Having found
ambiguity, the court construed the contract against Great Lakes and found that
Exclusion r did not apply to exclude coverage.
We conclude that the court erred in finding ambiguity based on the fact that
the same terms appeared in both Coverage A and Exclusion r. “[S]imply because
one provision gives a general grant of coverage and another provision limits this
coverage does not mean there is an ambiguity or inconsistency between the two.
This is the very nature of an insurance contract; exclusions in coverage are
expressly intended to modify coverage clauses and to limit their scope.” Ajax
Bldg. Corp. v. Hartford Fire Ins. Co., 358 F.3d 795, 798-99 (11th Cir. 2004); see
also Central Int’l Co. v. Kemper Nat’l Ins. Cos., 202 F.3d 372, 374 (1st Cir. 2000)
(“[U]nder ordinary principles of contract interpretation, there is little doubt that the
exclusion is presumptively a qualification on the risk coverage.”).
Under the terms of the policy, there is a general grant of coverage for
“accidental physical loss of, or accidental physical damage to the Scheduled
Vessel.” The policy defines “Scheduled Vessel” as the vessel, including the hull,
machinery, electrical equipment, and “all other equipment normally required for
the operation and maintenance of the vessel.” Coverage A states that coverage is
“subject to” certain exclusions, including damage to “engines, mechanical and
electrical parts” unless caused by an “accidental external event.” All told, the
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policy facially provides coverage for “accidental physical damage” to engines and
mechanical and electrical parts only if the damage was caused by an “accidental
external event.” Put differently, the coverage for engines and mechanical
components appears to be narrower than the general all-risk coverage because it
requires an external cause. Cf. Morrison Grain Co., Inc., 632 F.2d at 430 (stating
that the insured was not required “to demonstrate that the loss or damage was
occasioned by an external cause” to establish fortuity); City of Burlington, 332
F.3d at 48 (noting that many courts have rejected “an implicit external-cause
requirement in all-risk policies”). As a result, we do not find the policy to be
ambiguous for the reason given by the district court.5
Appellee responds that the policy is ambiguous because “accidental external
event” is not defined in the policy, so it is left with little guidance as to what is
being excluded. So, for example, Appellee asserts, it is arguable whether water
intrusion as a result of the bilge-pump system’s failure qualifies as an “external”
event. Great Lakes replies that water intrusion was not the relevant “cause,” but
rather the blown fuse or the failed bilge-pump system was, neither of which
Appellee contends is an “external event.” The district court did not address
5
Notably, despite the district court’s adoption of its position on ambiguity from the
Appellee below, Appellee does not defend the court’s reasoning on appeal and instead contends
that “accidental external event” is ambiguous, an issue the district court did not reach.
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whether “accidental external event” or other specific terms in the exclusion itself
were ambiguous.
Although contractual ambiguity is a question of law that we may resolve in
the first instance, we think the better course of action in these circumstances is
simply to vacate the district court’s ruling with respect to Exclusion r and remand
for further proceedings. See Wilkerson v. Grinnell Corp., 270 F.3d 1314, 1322 &
n.4 (11th Cir. 2001) (noting our preference for the district court to address issues in
the first instance). As we understand the exclusionary provision at issue, and as
represented by Great Lakes in its briefing, the scope of the exclusion (the
“Scheduled Vessel’s engines, mechanical and electrical parts”) is narrower than the
extent of the policy’s coverage (the “Scheduled Vessel” itself). Additional fact
finding therefore may be appropriate to determine the extent of damages. Because
further proceedings are required regardless, we leave any arguments respecting
additional sources of ambiguity in the policy for the district court to address in the
first instance.
V.
In sum, we affirm the district court’s ruling that Appellee established a
fortuitous loss covered by the all-risk marine insurance policy. However, we
vacate the court’s determination that the exclusion on which Great Lakes relied to
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avoid coverage was ambiguous. We remand for further proceedings with respect
to the application of Exclusion r.
AFFIRMED IN PART; VACATED AND REMANDED IN PART.
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