Court Opinion

ID: 9554722
Source: CourtListenerOpinion
Date Created: 2023-08-09 19:01:04.62772+00
Date Added: 2024-06-11T15:36:20.592741
License: Public Domain

Case: 22-60450        Document: 00516851578             Page: 1      Date Filed: 08/09/2023

              United States Court of Appeals
                   for the Fifth Circuit
                                                                                 United States Court of Appeals
                                                                                          Fifth Circuit

                                             FILED
                                     ____________
                                                                                     August 9, 2023
                                      No. 22-60450                                   Lyle W. Cayce
                                     ____________                                         Clerk

   Tavita Farani; Tyler Bunting; Michael Locke,

                                                                    Plaintiffs—Appellees,

                                            versus

   Leslie File

                                                                               Defendant,

                                            versus

   Evanston Insurance Company,

                                                 Debtor—Appellant.
                     ______________________________

                     Appeal from the United States District Court
                       for the Southern District of Mississippi
                               USDC No. 3:16-CV-227
                     ______________________________

   Before Higginbotham, Graves, and Douglas, Circuit Judges.
   Per Curiam: *

         _____________________
         *
             This opinion is not designated for publication. See 5th Cir. R. 47.5.
Case: 22-60450         Document: 00516851578               Page: 2       Date Filed: 08/09/2023

                                           No. 22-60450

           Before the court is whether Evanston Insurance Company (“EIC”) is
   required to pay insurance coverage under its automobile policy with Prime
   Time Healthcare LLC (“Prime Time”). For the reasons below, EIC must
   honor its insurance obligations, so we AFFIRM.
                                     Factual Background
           On July 23, 2014, in North Dakota, a car driven by Leslie File struck a
   van carrying nine passengers. All of the van’s occupants claimed injuries
   arising out of the accident, including the three Appellees in this case, Tavita
   Farani, Tyler Bunting, and Michael Locke. 1 File, a resident of Mississippi,
   was employed by Prime Time as a traveling nurse. She was on assignment in
   Montana and driving an automobile rented for her use by Prime Time.
   However, she was not on official work duties at the time of the wreck and was
   returning to Montana after visiting friends. Farani sued File in Mississippi
   federal court under diversity jurisdiction for the injuries, and the jury found
   File liable but did not find against Prime Time because it concluded that File
   was not acting within the course and scope of her employment at the time of
   the wreck. After a trial lasting six days, the jury found in favor of Farani and
   against File in the following amounts: $877,780.00 for Tavita Farani,
   $617,707.61 for Tyler Bunting, and $583,519.00 for Michael Locke. The total
   verdict was $2,079,006.61.
           Travelers Casualty Insurance Company of America (“Travelers”), an
   automobile insurer for Prime Time, acknowledged coverage for the wreck
   and paid Farani up to the limits of its policy. Travelers determined that File
   was insured under its policy because she was the “driver, with permission,”

           _____________________
           1
             Both Bunting and Locke filed Rule 28(i) letters joining Farani’s briefs. For clarity,
   the collective Appellees are identified as Farani.

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Case: 22-60450      Document: 00516851578          Page: 3   Date Filed: 08/09/2023

                                    No. 22-60450

   of an automobile rented by Prime Time for her use, and that its policy was in
   effect since before the date of the accident.
          EIC refused to pay under its policy. On March 24, 2022, the district
   court found that the EIC policy covered File’s accident and granted summary
   judgment in favor of Farani. EIC appealed.
                                Standard of Review
          The standard of review on summary judgment is de novo. Davidson v.
   Fairchild Controls Corp., 882 F.3d 180, 184 (5th Cir. 2018). The court should
   grant summary judgment where there is no genuine dispute of material fact
   “and the movant is entitled to judgment as a matter of law.” Id. (quoting
   FED. R. CIV. P. 56(a)). Further, interpretation of an insurance contract is a
   question of law subject to de novo review. Travelers Lloyds Ins. Co. v. Pacific
   Employers Ins. Co., 602 F.3d 677, 681 (5th Cir. 2010). This court “may affirm
   [summary judgment] on any grounds supported by the record.” McGruder v.
   Will, 204 F.3d 220, 222 (5th Cir. 2000).
                                    Discussion
          The controversy here implicates Mississippi’s rules for construction
   of insurance policies, which are as follows:
                 First, where an insurance policy is plain and
                 unambiguous, a court must construe that
                 instrument, like other contracts, exactly as
                 written. Second, it reads the policy as a whole,
                 thereby giving effect to all provisions. Third, it
                 must read an insurance policy more strongly
                 against the party drafting the policy and most
                 favorably to the policyholder. Fourth, where it
                 deems the terms of an insurance policy
                 ambiguous or doubtful, it must interpret them
                 most favorably to the insured and against the
                 insurer. Fifth, when an insurance policy is

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                                    No. 22-60450

                 subject to two equally reasonable interpretations,
                 a court must adopt the one giving the greater
                 indemnity to the insured. Sixth, where it discerns
                 no practical difficulty in making the language of
                 an insurance policy free from doubt, it must read
                 any doubtful provision against the insurer.
                 Seventh, it must interpret terms of insurance
                 policies, particularly exclusion clauses, favorably
                 to the insured wherever reasonably possible.
                 Finally, although ambiguities of an insurance
                 policy are construed against the insurer, a court
                 must refrain from altering or changing a policy
                 where terms are unambiguous, despite resulting
                 hardship on the insured.
   Centennial Ins. Co. v. Ryder Truck Rental, Inc., 149 F.3d 378, 382–83 (5th Cir.
   1998) (internal citations omitted).
    I.    The EIC policy applies even though there are no insurance
          policies listed as the “controlling underlying insurance”
          EIC’s policy states that it “will follow form over Additional Insureds
   covered in the ‘controlling underlying insurance’ to the extent of their
   liability due to the negligence of the Named Insured.” Travelers paid its
   limits to File. File then turned to Prime Time’s umbrella liability policy with
   EIC, which provides an additional $2,000,000.00 in coverage.
          The wreck occurred on July 23, 2014. The Travelers policy period was
   from July 22, 2014 to July 22, 2015. The EIC policy period was from March
   27, 2014 to March 27, 2015. The dispute here is because the Travelers
   policy—even though purchased, paid for, and in effect from July 22, 2014—
   was not added by EIC to the schedule of insurers until September 22, 2014.
   EIC backdated the Travelers policy to July 22, 2014, a day before the
   accident.

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                                    No. 22-60450

          EIC’s two main arguments fail. First, EIC argues that “the post-
   accident endorsement mistakenly adding the Travelers Policy to the
   Schedule in the EIC Policy . . . does not render that Travelers Policy into the
   required ‘controlling underlying insurance.’” This does not change the fact
   that EIC agreed to backdate the Travelers policy to before the accident, so,
   at the very latest, EIC’s coverage began a day before the accident.
          Even without the backdating, EIC still loses. EIC’s second argument
   is that even though Travelers paid its limit, “[t]he Travelers Policy was . . .
   ‘underlying insurance’ but not ‘controlling underlying insurance’ as those
   terms are defined in the EIC Policy.” According to EIC, there is a distinction
   between “underlying insurance” and “controlling underlying insurance”
   and the EIC policy only applies to bodily injury if the Travelers policy was
   defined as “controlling underlying insurance.” This is a distinction without
   a difference because the definition of “controlling underlying insurance” and
   “underlying insurance” both include “any other insurance available to the
   insured.” Even without the backdating, Travelers and EIC were insurance
   available to Prime Time on the date of the accident because Prime Time
   bought both the Travelers and EIC insurance before the accident occurred.
          This EIC insurance policy is plain and unambiguous, and reading the
   policy as a whole, Travelers insurance was in effect before the accident
   occurred, both by the backdating or by virtue of it being an insurance available
   to the insured. Therefore, EIC must honor its coverage obligations.
    II.   The Nebraska judgment is not binding under res judicata
          EIC filed a declaratory judgment action against Prime Time in the
   United States District Court for the District of Nebraska. On June 20, 2019,
   that court issued a stipulated judgment between EIC and Prime Time. The
   stipulated judgment declared that the Travelers policy was issued in July of
   2014 to “fill[] the gap” in Prime Time’s insurance plan and that no request

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                                      No. 22-60450

   was made to EIC to add the Travelers Policy to the Schedule until after File’s
   accident had occurred and been reported to Travelers. The court ordered
   that the relevant endorsement to the EIC policy be reformed to reflect the
   “Policy Changes Effective” date of September 22, 2014, and the stipulation
   provides that the EIC policy does not apply to and does not provide coverage
   for any auto occurrence which occurred prior to September 22, 2014, which
   excludes coverage for any claims related to the accident.
          “As a matter of federal common law, federal courts sitting in diversity
   apply the preclusion law of the forum state unless it is incompatible with
   federal interests.” Anderson v. Wells Fargo Bank, N.A., 953 F.3d 311, 314 (5th
   Cir. 2020). In Mississippi, the doctrine of res judicata requires the presence
   of four identities: “(1) identity of the subject matter of the action; (2) identity
   of the cause of action; (3) identity of the parties to the cause of action; and
   (4) identity of the quality or character of a person against whom the claim is
   made.” Harrison v. Chandler–Sampson Ins., Inc., 891 So.2d 224, 232 (Miss.
   2005). “[T]he absence of any one of the elements is fatal to the defense of
   res judicata.” Id.
          Res judicata fails most obviously under prong three: the identity of the
   parties to the cause of action. The only parties to the Nebraska proceeding
   were EIC and Prime Time. Neither File nor Farani were made a part of that
   litigation. “[S]trict identity of parties is not necessary for either res judicata
   or collateral estoppel to apply, if it can be shown that a nonparty stands in
   privity with the party in the prior action.” Hogan v. Buckingham ex rel.
   Buckingham, 730 So. 2d 15, 18 (Miss. 1998). “It must be remembered,
   however, that Mississippi follows the general rule that parties must be
   substantially identical for res judicata to apply.” Id.
          Here, Prime Time is not being held liable for the actions of File since
   the jury determined that File was not acting in the course and scope of her

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                                      No. 22-60450

   employment at the time of the wreck. Because of this, Prime Time had no
   interest in covering File—a former employee—under its insurance policies.
   The interests of Prime Time and File were dissimilar because, as the district
   court noted, Prime Time would have had more incentive to exclude the
   former employee File from coverage under its policies for many reasons, such
   as maintaining good relations with its insurer EIC or avoiding possible
   premium increases. Farani notes that “if File or Plaintiffs were involved in
   the Nebraska proceeding, they never would have agreed to the stipulation.”
   Therefore, Farani did not stand in privity with Prime Time in the Nebraska
   action, which is “fatal” to EIC’s defense of res judicata. Harrison, 891 So.2d
   at 232.
   III.      The known-loss doctrine does not apply
             Appellant argues that the “known-loss doctrine,” which is “premised
   upon the simple idea that, normally, one cannot buy insurance coverage for a
   loss already known to be in progress, or for a loss that the insured planned,
   intended, or is aware is substantially certain to occur” applies in this case.
   Nat’l Cas. Co. v. Franklin Cnty., 718 F. Supp. 2d 785, 794 (S.D. Miss. 2010)
   (quoting Buckeye Ranch, Inc. v. Northfield Ins. Co., 134 Ohio Misc.2d 10, 23,
   839 N.E.2d 94 (Ohio Com. Pleas 2005)). There is no indication that
   Mississippi has adopted the known-loss doctrine, but even assuming without
   deciding that Mississippi law recognizes the known-loss doctrine, it does not
   apply here.
             The accident at issue occurred prior to the actual listing of Travelers
   on the EIC schedule of underlying insurers, but it did not occur prior to Prime
   Time’s purchase of the Travelers policy. The doctrine only applies to defeat
   coverage for an occurrence that took place or was in progress prior to the
   purchase of the insurance See, e.g., Sosebee v. Certain Underwriters at Lloyds
   London, 566 F. App’x 296, 297 (5th Cir. 2014) (unpublished) (per curiam)

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                                   No. 22-60450

   (“The ‘known loss’ aspect of the [known-loss] doctrine precludes coverage
   ‘where the insured is, or should be, aware of . . . [a] known loss at the time
   the policy is purchased.’”) (quoting Two Pesos, Inc. v. Gulf Ins. Co., 901
   S.W.2d 495, 501 (Tex. App. 1995)); Essex Ins. v. Redtail Prods., 213 F.3d 636,
   *1 (5th Cir. 2000) (unpublished) (“[U]nder the [known-loss] doctrine,
   Redtail could not receive coverage for a loss or damage which was known to
   have begun at the time the policy was purchased.”). Even if the known-loss
   doctrine is applicable in Mississippi, it does not apply here because the
   insurance coverage existed prior to the accident.
                                   Conclusion
          The judgement of the district court is AFFIRMED.

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