Carteret Investment Associates, LLC v. Mt. Hawley Insurance Company
E.D.N.C.12/29/2023
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IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF NORTH CAROLINA EASTERN DIVISION NO. 4:21-CV-157-FL CARTERET INVESTMENT ) ASSOCIATES, LLC and CARTERET ) SURGICAL ASSOCIATES, P.A., ) ) Plaintiffs, ) ) ORDER v. ) ) MT. HAWLEY INSURANCE COMPANY, ) ) Defendant. ) This matter is before the court upon a plethora of motions. The court addresses here defendantâs motion for summary judgment (DE 44); plaintiffsâ motion to strike (DE 63); defendantâs opposition to notice of filing (DE 75); plaintiffsâ motion for oral argument (DE 76); and defendantâs motion for leave to file a reply in support of opposition to notice of filing (DE 78). STATEMENT OF THE CASE Plaintiffs began this insurance contract and tort suit by filing a complaint in Carteret County superior court on September 13, 2021. Defendant removed the action to this court October 21, 2021. Plaintiffs assert claims for breach of contract, common law bad faith, and unfair and deceptive trade practices (âUDTPâ) in violation of N.C. Gen. Stat. §§ 58-63-15 and 75-1.1. (Compl. (DE 1-1) ¶¶ 37â54).1 Plaintiffs seek damages, fees, and costs. 1 Plaintiffs originally named an additional insurer in its complaint, but voluntarily dismissed that party November 18, 2021. Defendant filed the instant summary judgment motion April 19, 2023, relying upon 1) the insurance policy at issue; 2) correspondence between the parties; 3) several documents pertaining to the insurance policy; 4) plaintiffsâ expert disclosures; and 5) various third partiesâ and proposed expertsâ depositions. In opposition, plaintiffs rely upon the depositions and affidavits of various proposed experts and third parties, and numerous documents relating to the insurance policy. On May 23, 2023, plaintiffs filed the instant motion to strike certain statements included in defendantâs statement of material facts and exhibits, and requested that the court disregard those statements in its summary judgment ruling. Plaintiffs filed a purported supplement to one of their exhibits August 21, 2023. Defendant responded with an âopposition to notice of filing,â which the court construes as a motion to strike. (See Oppân Notice of Filing (DE 75) (âthe Court should disregard the [supplement] in connection with [defendantâs] motion for summary judgmentâ)). The parties filed briefs on the âopposition,â and defendant has moved for leave to file a reply in support thereof. Finally, plaintiffs have requested oral argument on the summary judgment motion. STATEMENT OF FACTS Plaintiff Carteret Investment Associates, LLC (âCIAâ) is a limited liability company that owns several medical office buildings in Morehead City, North Carolina (the âbuildingsâ), located at: 1) 3714 Guardian Avenue; 2) 306 Medical Park Court; 3) 3700 Symi Circle; 4) 3726 Guardian Avenue; and 5) 221 Professional Circle. (Compl. ¶¶ 1, 8â10). Plaintiff Carteret Surgical Associates, P.A. (âCSAâ) operates a surgical practice throughout eastern North Carolina, including in the subject buildings. (Id. ¶ 12). Defendant insured the buildings under a policy covering wind and hail damage (the âpolicyâ). (Id. ¶ 18). The policy covers water damage only if water enters a building through structural damage caused by wind or hail. (Undisputed Facts Supp. Mot. Sum. J. (DE 46) (âDefâs SMFâ) ¶ 13). In September, 2018, Hurricane Florence made landfall in North Carolina. (Id. ¶ 2). Hurricane Florence inflicted significant water damage on the buildings, (Compl. ¶ 21), and the partiesâ central dispute is whether the policy covered these damages. (See id. ¶ 22; Defâs SMF ¶¶ 4â13). Plaintiffs notified defendant of a claim for damage to the buildings shortly after the hurricane. (Defâs SMF ¶ 3). In September, 2018, an independent insurance adjuster inspected the buildings on defendantâs behalf, (id. ¶ 4), and an engineering firm inspected each building except one for defendant. (Id. ¶ 5). Plaintiffs submitted a proof-of-loss form for $200,000 in damage on October 26, 2018. (See App. Statement of Facts (DE 62) (âPlsâ App. SMFâ) Ex. 4 (DE 62-4) 4). After these and other investigative steps, defendant paid plaintiffs $200,000 as an advance, although defendantâs investigation had not yet concluded. (Defâs SMF ¶ 9). While awaiting defendantâs final coverage decision, plaintiffs made $1.3 million worth of repairs to the buildings, out-of-pocket. (Compl. ¶ 32). Then, on May 26, 2020, defendant notified plaintiffs that defendant had determined plaintiffsâ covered damages (the âMay Letterâ). Defendant claimed its engineering firm had found that wind caused only 10-12% of the water damage at one building. (Id. ¶ 8). Taking this figure, the advance payment, and the policyâs deductible into account, defendantâs covered damage calculation produced a net payment of $9,155.94. (Id. ¶ 10). The parties continued to discuss payments and defendantâs investigation from 2018 to 2021. After plaintiffs filed this action in 2021, defendant issued additional payments totaling $241,063.02 on January 19, 2022, which defendant communicated in a December 30, 2021 letter (the âDecember Letterâ). (Defâs SMF ¶ 11). COURTâS DISCUSSION A. Ancillary Motions (DE 75, 78) As a threshold matter the court has determined, in the exercise of its discretion, that oral argument is not necessary. Plaintiffsâ motion for oral argument (DE 76) therefore is DENIED. Similarly, because the court concludes that defendantsâ opposition to notice of filing, construed as a motion to strike (DE 75), should be granted for the reasons discussed below based on the existing record, no reply brief in support of the motion is necessary. Defendantsâ motion for leave to file a reply brief in support of the motion to strike (DE 78) is therefore DENIED. The court turns below to the meat of the matter before it. B. Motions for Summary Judgment and to Strike (DE 44, 63, 75) 1. Standard of Review The court sets forth here guiding standards for address of a summary judgment motion. Summary judgment is appropriate where âthe movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.â Fed. R. Civ. P. 56(a). The party seeking summary judgment âbears the initial responsibility of informing the district court of the basis for its motion, and identifying those portions of [the record] which it believes demonstrate the absence of a genuine issue of material fact.â Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). Once the moving party has met its burden, the non-moving party must then âcome forward with specific facts showing that there is a genuine issue for trial.â Matsushita Elec. Indus. Co. Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586-87 (1986). Only disputes between the parties over facts that might affect the outcome of the case properly preclude the entry of summary judgment. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986) (holding that a factual dispute is âmaterialâ only if it might affect the outcome of the suit and âgenuineâ only if there is sufficient evidence for a reasonable jury to return a verdict for the non-moving party). â[A]t the summary judgment stage the [courtâs] function is not [itself] to weigh the evidence and determine the truth of the matter but to determine whether there is a genuine issue for trial.â Id. at 249. In determining whether there is a genuine issue for trial, âevidence of the non-movant is to be believed, and all justifiable inferences are to be drawn in [non-movantâs] favor.â Id. at 255; see United States v. Diebold, Inc., 369 U.S. 654, 655 (1962) (âOn summary judgment the inferences to be drawn from the underlying facts contained in [affidavits, attached exhibits, and depositions] must be viewed in the light most favorable to the party opposing the motion.â). Nevertheless, âpermissible inferences must still be within the range of reasonable probability, . . . and it is the duty of the court to withdraw the case from the [factfinder] when the necessary inference is so tenuous that it rests merely upon speculation and conjecture.â Lovelace v. Sherwin-Williams Co., 681 F.2d 230, 241 (4th Cir. 1982). Thus, judgment as a matter of law is warranted where âthe verdict in favor of the non-moving party would necessarily be based on speculation and conjecture.â Myrick v. Prime Ins. Syndicate, Inc., 395 F.3d 485, 489 (4th Cir. 2005). By contrast, when âthe evidence as a whole is susceptible of more than one reasonable inference, a [triable] issue is created,â and judgment as a matter of law should be denied. Id. at 489-90. 2. Analysis a. CSAâs Status Defendant argues that CSA is not an insured under the policy, and therefore an improper plaintiff in this case. The court agrees. Under North Carolina law, a breach of contract claim requires 1) the existence of a valid contract and 2) breach of the terms of the contract. Wells Fargo Ins. Servs. USA, Inc. v. Link, 372 N.C. 260, 276 (2019). A UDTP claim requires 1) an unfair or deceptive act or practice, 2) in or affecting commerce, and 3) which proximately caused injury to plaintiff. Walker v. Fleetwood Homes of N.C., Inc., 362 N.C. 63, 71â72 (2007). The policy in this case insures only CIA. (See App. Statement of Facts (DE 48) (âDefâs App. SMFâ) Ex. A-1 (DE 48-2) (âInsurance Policyâ) 1).2 Plaintiffs do not dispute this fact, (see Plâs Resp. Statement of Material Facts (DE 61) (âPlsâ SMFâ) ¶ 12), and have introduced no evidence that any alleged UDTP or common law bad faith injured CSA. In addition, plaintiffs produce no evidence that could support CSAâs right to sue for breach of contract as a third party. See Raritan River Steel Co. v. Cherry, Bekaert, & Holland, 329 N.C. 646, 651â53 (1991). Because CSA is therefore not a party to the relevant contract, and because plaintiffs have produced no evidence of injury to CSA, defendant is entitled to summary judgment against all claims brought by CSA.3 2 Unless otherwise specified, page numbers specified in citations to the record in this order refer to the page number of the document designated in the courtâs electronic case filing (ECF) system, and not to page numbering, if any, specified on the face of the underlying document. 3 Although the court concludes that all claims brought by CSA should be dismissed, the court will continue to refer to âplaintiffsâ in the plural throughout this order for the sake of consistency. b. Plaintiffsâ Motion to Strike (DE 63) Throughout its summary judgment briefing and exhibits, Defendant relies upon an assertion that only 10-12% of the water damage here occurred because of wind. Plaintiffs contend that this assertion should be stricken as inadmissible hearsay. Defendantâs statement of material facts and exhibits repeat this figure in numerous places, and defendantâs briefing relies heavily upon it. The court agrees with plaintiffsâ argument, and grants the motion to strike. Hearsay is an out-of-court statement offered to prove the truth of the matter asserted. Fed. R. Evid. 801(c). Hearsay evidence is generally inadmissible unless an exception applies, Fed. R. Evid. 802, and hearsay that will be inadmissible at trial cannot be considered at summary judgment. E.g., Giles v. Natâl R.R. Passenger Corp., 59 F.4th 696, 704 (4th Cir. 2023); Md. Highways Contractors Assân, Inc. v. Maryland, 933 F.2d 1246, 1251 (4th Cir. 1991). Finally, hearsay within hearsay is inadmissible unless each level of statement meets an exceptionâs requirements. Fed. R. Evid. 805. Several of defendantâs exhibits contain the assertion that Madsen, Kneppers & Associates, Inc. (âMKAâ), defendantâs engineering firm, advised defendant that only 10-12% of the water damage to one of the buildings occurred because of wind damage to the buildingâs roof. (See Defâs App. SMF Ex. A-3 (DE 48-4) 9; id. Ex. A-9 (DE 48-10) 7; id. Ex. A-10 (DE 48-11) (âDec. Letterâ) 2). These statements were not made in court or through affidavit or similar means, and defendant depends on the truth of this statement to support one of its breach of contract arguments. (See Mem. Supp. Mot. Summ. J. (DE 45) (âDefâs Br. Supp.â) 7). Defendant largely does not engage with plaintiffsâ hearsay arguments in its opposition brief, other than to contend that its independent adjuster made the 10-12% statement, and so testified at his deposition. However, the relevant deposition shows merely that the adjuster adopted these figures from some uncertain combination of MKA employees. (See Resp. Mot. First Mot. Strike (DE 69) Ex. A (DE 69-1) 10â 12)). These statements do not come from any affidavit or deposition, are presented for their truth, and are therefore hearsay. The court further concludes that no hearsay exception applies to these statements. To be admissible, both the documents containing the statements, and the statements themselves, must qualify for at least one hearsay exemption or exception. Fed. R. Evid. 805. Plaintiffs assume in their briefing that each document that references the 10-12% statement is itself a business record, and therefore admissible under Fed. R. Evid. 803(6). (See Plsâ Mem. Law Supp. Mot. Strike Aff., Statement of Material Facts, Exhibits, References Thereto (DE 64) (âBr. Supp. Strikeâ) 5). However, any information provided by an outsider to the business preparing the record must itself fall within a hearsay exception. See Fed. R. Evid. 805; Andrew v. United States, 91 F. Supp. 3d 739, 749 (M.D.N.C. 2015). The relevant documents were prepared and maintained by defendant or defendantâs adjuster, but assert that the 10-12% figure comes from MKA, a separate entity. (See Defâs App. SMF Ex. A-3 at 9; id. Ex. A-9 at 7; Dec. Letter 2). The record contains no evidence from any MKA employee addressing this figure, as required under Rule 803(6), except for the deposition of the MKA engineer who wrote the summary report submitted to defendant. This engineer denies making the statement and professes uncertainty about its origin. (See Plsâ App. SMF Ex. 9 (DE 62-9) (âRader Dep.â) 143:21â146:11). The statement therefore cannot qualify as a business record under Rule 803(6). Further, the court concludes that no other hearsay exemption or exception applies. The statements across defendantâs exhibits, asserting that MKA advised defendant that wind produced only 10-12% of the water damage at issue, are inadmissible hearsay. The court therefore grants plaintiffsâ motion to strike. The court will not consider these statements for their truth at summary judgment. c. Defendantâs Motion to Strike (DE 75) As part of their summary judgment materials, plaintiffs filed an affidavit from David Dees, whom plaintiffs timely designated as an expert on the reasonableness of the repair costs plaintiffs incurred. (See Plsâ App. SMF Ex. 1 (DE 62-1) (âDees Affidavitâ); Defâs App. SMF Ex. C (DE 48-15) (âPlsâ Expert Disclosuresâ)).4 After the close of briefing on defendantâs summary judgment motion, plaintiffs filed an updated affidavit with additional material. (See Notice of Filing (DE 73) (âUpdated Dees Affidavitâ) 5). Defendant then filed an âopposition to notice of filingâ to this updated affidavit, which the court construes as a motion to strike the newly added material. (See generally Oppân Notice of Filing). The parties spill much ink on this de facto motion to strike, but the issues involved are simple. The case management order in this action, as amended, required plaintiffs to serve their expert reports by May 6, 2022. (See Am. Order Am. Pre-Trial Deadlines (DE 27)). Expert designations and reports must contain a complete statement of all opinions to be expressed and the basis and reasons therefor. Fed. R. Civ. P. 26(a)(2). Plaintiffs designated two experts, both retained solely to opine on the reasonableness of plaintiffsâ repair costs. (See generally Plsâ Expert Disclosures). Deesâs original affidavit and report confine themselves entirely to this issue. (See Dees Aff. 1â2; Oppân Notice of Filing Ex. 2 (DE 75-2) (âDees Reportâ) 1). Despite the narrowly circumscribed scope of Deesâs opinions in his designation, report, and original affidavit, Plaintiffs seek to update his affidavit with additional material about the 4 Although plaintiffsâ amended expert disclosures were filed after the pertinent deadline, the record does not reflect when plaintiffs made their original expert disclosures, and defendant does not make any argument on timeliness. causes of damage to the buildings. (See Updated Dees Aff. ¶¶ 15â18). But the deadline to designate expert witnesses and serve expert reports passed over a year ago. See Fed. R. Civ. P. 26(a)(2)(B)(i); (Am. Order Am. Pre-Trial Deadlines 1â2). In addition, Rule 26(e) requires a party to âsupplement or correct its disclosure . . . in a timely manner if the party learns that in some materials respect the disclosure or response is incomplete or incorrect,â which âduty to supplement extends both to information included in the report and to the information given during the expertâs deposition.â Fed. R. Civ. P. 26(e)(1)-(2). âRule 26(e)(1) requires a party to supplement its expertsâ reports and deposition testimony when the party learns of new information.â S. States Rack & Fixture, Inc. v. Sherwin-Williams Co., 318 F.3d 592, 595â96 (4th Cir. 2003). âBut this duty does not permit a party to make an end- run around the normal timetable for conducting discovery.â Colony Apartments v. Abacus Project Mgmt., Inc., 197 F. App'x 217, 223 (4th Cir. 2006). Accordingly, â[c]ourts distinguish âtrue supplementationâ (e.g., correcting inadvertent errors or omissions) from gamesmanship, and have therefore repeatedly rejected attempts to avert summary judgment by âsupplementingâ an expert report with a ânew and improvedâ expert report.â Gallagher v. S. Source Packaging, LLC, 568 F. Supp. 2d 624, 631 (E.D.N.C. 2008). The additional material in Deesâs affidavit is not a mere attempt to correct a mistake or inadvertent omission from his report. Plaintiffs designated Dees solely to âprovide opinions as to the reasonable costs to repair/remediate defects at the properties.â (Plsâ Expert Disclosures 2). Deesâs short report did exactly that, and no more. (See Dees Report 1). Further, Dees testified clearly at his deposition that he had not been retained to opine on causation, and had no opinions on that issue. (See Oppân Notice of Filing Ex. C (DE 75-3) 57:24â58:6). However, Deesâs updated report offers opinions on unrelated causation issues far beyond the scope of his designation. The updated affidavit is therefore not a mere correction, but an attempted untimely expansion of the scope of Deesâs designation. The court must therefore exclude the new portions of Deesâs updated affidavit unless the new opinions are harmless, or plaintiffs offer âsubstantial justificationâ for failing to offer them on time. Fed. R. Civ. P. 37(c)(1); see S. States Rack & Fixture, Inc., 318 F.3d at 596; see also, e.g., Poulis-Minot v. Smith, 388 F.3d 354, 357â59 (1st Cir. 2004) (affirming striking of opinions that exceeded scope of designation). Given the importance of causation to this case, the introduction of new expert evidence on this issue is not harmless. In addition, plaintiffs assert that the omission of the last page of Deesâs affidavit from its original filing resulted from a series of clerical errors, and offer a detailed explanation on how this occurred. (See Resp. Defâs Oppân Notice of Filing Mot. Supp. Leave Correct Affidavit (DE 77) 8â10). The court finds this explanation plausible. But even if plaintiffsâ account is true, meaning that Deesâs new opinions should have appeared in his original affidavit, those opinions still would have been untimely. Plaintiffsâ explanation does not address why Deesâs expansion of his opinions would have been substantially justified even there. The court therefore construes defendantâs opposition to filing as a motion to strike paragraphs 15 to 20 of Deesâs updated affidavit, and grants the motion to strike. The court will not consider these paragraphs to any extent at summary judgment. d. Breach of Contract Defendant argues that plaintiffs present no evidence on the causation of the damages to plaintiffsâ buildings, as required to bring its claims within the language of the policy, and that the damage to the building at 3714 Guardian Avenue was below the policyâs deductible.5 The court disagrees with each argument. An insured bears the burden of showing that its claim falls within the coverage language of a policy. See Abernethy v. Hosp. Care Assân, Inc., 254 N.C. 346, 348 (1961). The parties therefore agree that plaintiffs must produce some evidence that the policyâs coverage language encompasses the building damages here to avoid summary judgment. (See Defâs Br. Supp. 3â4; Mem. Oppân Defâs Mot. Sum. J. (DE 60) (âPlsâ Br. Oppânâ) 8â9). The insurance policy in this case covers wind and hail damage, and covers water damage only if the water entered the building through openings or flaws created by wind or hail. (See Defâs SMF ¶ 13). As such, defendantâs overarching argument on this claim is that plaintiffs produce no evidence that the damage to the building resulted from wind or hail within the language of the policy. Specifically, defendant argues that expert testimony on causation is required to support a claim involving damage to a building, and that plaintiffsâ lack of expert testimony on causation is therefore inherently fatal to this claim. (See generally Defâs Br. Supp.). Defendant relies upon Ritz Gormet, Inc. v. Nationwide Mut. Fire Ins. Co., No. 1:13-cv- 303, 2014 WL 12539655 (M.D.N.C. June 24, 2014), for this point. (See Defâs Br. Supp. 3â8). However, defendant misreads Ritz Gormet, and overlooks plaintiffsâ non-expert evidence which creates a dispute of fact. Ritz Gormet involved facts admittedly similar to this case. There, an insured procured a policy covering hail damage to its premises, and sought proceeds under the policy following a storm. See Ritz Gormet, 2014 WL 12539655, at *1â2. There, as here, the insurer disputed that 5 Plaintiffs present no evidence or argument on its contract claim regarding the other buildings. The breach of contract claim therefore revolves around this particular building. the damages rested within the policyâs language on covered causes of structural damage. Id. The insurer offered evidence that general disrepair and improper maintenance caused the damages, not hail, which the insured attempted to rebut at summary judgment with hearsay statements and the lay opinion testimony of the insured entityâs owner. See id. at *3â4. The court disregarded the former as inadmissible, and discounted the latter as a combination of hearsay and an attempt to âprovide expert opinion on causation,â notwithstanding the ownerâs status as a lay witness. See id. The Ritz Gormet court therefore granted summary judgment to the insurer. Id. at *4. Defendant therefore argues that Ritz Gormet and an Eastern District of Louisiana case upon which it relies demonstrate a per se rule that expert opinion testimony is required in insurance cases involving structural damage to buildings. The court disagrees, and concludes that Ritz Gormet actually reflects an implicit application of Federal Rule of Evidence 701, not a per se rule on required witnesses in insurance cases. Ritz Gormetâs holding was that the plaintiff-insured had no causation evidence to support its claim at all, not that its lack of expert testimony was dispositive. See id. The Ritz Gormet court excluded and declined to consider any of the plaintiffâs evidence, on grounds that it all constituted hearsay, and that the insured entityâs owner was not an expert but attempted to introduce expert testimony. Crucially, the ownerâs testimony constituted opinions on the cause of structural damage to a building, which the owner, ânot an engineer[,]â was unqualified to present. See id. This conclusion represents an implicit but unremarkable application of Rule 701, which forbids lay opinion testimony based on scientific or technical knowledge. The Ritz Gormet court therefore implicitly concluded that the causes of structural damage involved scientific or technical knowledge, so that the lay witness owner could not offer opinion testimony on that subject. Because the insuredâs only other causation evidence was inadmissible hearsay, the insured had no evidence on causation at all. Ritz Gormet therefore does not stand for the broad rule that defendant advances. Nor do the other cases from this and other jurisdictions which defendant cites in its reply brief. See H/S Wilson Outparcels, LLC v. Kroger Ltd. Pâship I, No. 5:15-CV-591-RJ, 2017 WL 4293404, at *3â 5 (E.D.N.C. Sept. 27, 2017) (applying Rule 701); Guyther v. Nationwide Mut. Fire Ins. Co., 109 N.C. App. 506, 514â15 (1993) (ruling that lay opinion testimony on cause of structural collapse was improper); Quarter Holdings, LLC v. Axis Surplus Ins. Co., No. 11-2765, 2012 WL 3879525, at *2 (E.D. La. Sept. 6, 2012) (applying Rule 701); Qualls v. State Farm Lloyds, 226 F.R.D. 551, 555â59 (N.D. Tex. 2005) (relying upon aspects of Texas substantive law not applicable here); Am. Family Mut. Ins. Co., S.I. v. Secura Ins., 2021AP1831, 2023 WL 2173945, at *2â3 (Wis. Ct. App. Feb. 23, 2023) (same with Wisconsin law). Having concluded that plaintiffsâ lack of expert testimony on causation is not inherently and in itself fatal to plaintiffsâ claims, the court turns to the evidence that plaintiffs do possess. Defendantâs own engineer concluded in his report that wind created an opening in the buildingâs roof, which permitted water to enter the building. (Defâs App. SMF Ex. A-4 (DE 48-5) (âMKA Reportâ) 8). However, the engineer attributed this to a prior structural flaw which improper repairs permitted the wind to aggravate. (See id.). In contrast, plaintiffs offer an affidavit from the contractor who made the repairs who, on the basis of his personal knowledge, asserts that all repairs were conducted properly and that some of the engineerâs factual assertions about the buildingâs repair history are incorrect. (See Plsâ App. SMF Ex. 5 (DE 62-5) (âHipkiss affidavitâ) ¶¶ 7â11).6 6 Defendant argues that the court should disregard this affidavit because the court ruled in May, 2023 that plaintiffs could not untimely designate the affiant as an expert. (See generally Order (DE 50)). However, Hipkissâs affidavit does not attempt to introduce any expert testimony, but rather Hipkissâs personal experience with the building and its repair history. The court therefore rejects defendantâs argument on this point. These two sources collide directly on the factual issue of whether the admitted water entry occurred because of wind alone, or because of improperly performed pre-hurricane repairs. These clashing pieces of evidence thus create an issue of fact on causation and therefore on coverage. That part of defendantâs motion seeking summary judgment on this claim cannot rest on this argument. The court turns next to defendantâs argument that the damages to the 3714 Guardian Avenue building did not exceed the policyâs deductible. Defendant contends that, because only 10-12% of the water damage to that building occurred through covered causes, defendant is responsible for only 12% of the repair costs for that building. (See Defâs Br. Supp. 6â7). Specifically, the policyâs deductible on that location is $182,005.08, and plaintiffs spent $768,033.26 repairing the premises.7 (Defâs Br. Supp. 6â7; Defâs App. SMF Ex. F-1 (DE 48-19) 1). Thus, defendant is responsible for only 12% of the latter figure, which calculates to $92,163.99. Because this figure is below the deductible, defendant owes nothing on that building and has not breached the contract as a matter of law. (See Defâs Br. Supp. 6â7). However, the court has already concluded that the 10-12% statements are hearsay, and declines to consider them for their truth at summary judgment. Defendantâs deductible argument collapses without the 10-12% figure in the calculations. Because the court will not consider those statements for their truth, this argument fails. In sum, plaintiffs have introduced sufficient evidence to create a dispute of material fact on whether the policy language applies to the building damages here, and on whether defendant breached the policy by failing to pay amounts due. The court therefore denies defendantâs motion on the breach of contract claim as regards the 3714 Guardian Avenue building. By contrast, 7 Plaintiffs argue that this figure is not the correct deductible for this location. Because the correct deductible ultimately has no impact on defendantâs argument here, the court reserves its full discussion of the deductible dispute for plaintiffsâ UDTP claim, where it is potentially dispositive of part of that claim. plaintiffs have produced no argument or evidence supporting a breach of contract regarding defendantâs business income coverage determinations, or the other buildings, located at: 1) 3700 Symi Circle; 2) 306 Medical Park; 3) 3726 Guardian Avenue; and 4) 221 Professional Circle. The court therefore grants defendantâs motion on this claim regarding these other buildings, and plaintiffsâ business income losses. e. UDTP Plaintiffs assert a UDTP claim for several alleged violations of N.C. Gen. Stat. § 58-63- 15(11) and § 75-1.1. To establish a UDTP claim, a plaintiff must show 1) an unfair and deceptive act or practice; 2) in or affecting commerce; 3) which proximately caused injury to the plaintiff. Walker, 362 N.C. at 71â72. Conduct that violates N.C. Gen. Stat. § 58-63-15(11) satisfies the first element as a matter of law. DENC, LLC v. Phila. Indem. Ins. Co., 32 F.4th 38, 50 (4th Cir. 2022). Plaintiffs argue that defendant violated Section 58-63-15(11) in several ways. i. Misrepresenting Policy Terms (N.C. Gen. Stat. § 58-63-15(11)(a)) Section 58-63-15(11)(a) forbids misrepresenting the terms of a policy. Id. Plaintiffs argue that defendant misrepresented the policyâs contractual statute of limitations, and its deductible. The court examines each contention in turn. First, plaintiffs argue that defendant misrepresented the policyâs contractual statute of limitations. Defendantâs May 26, 2020 letter to plaintiffs quotes part of the policy, which establishes a two year statute of limitations for any suit against defendant based on the policy. (See Defâs App. SMF Ex. A-8 (DE 48-9) (âMay Letterâ) 2). However, the policy contains an endorsement enlarging this period to three years and one day. (Insurance Policy 32). Defendant therefore misrepresented the terms of the policy to plaintiffs, as defendant concedes in its brief. (See Reply Supp. Mot. Summ. J. (DE 71) (âDefâs Reply Br.â) 13). But that conclusion is not dispositive. A UDTP plaintiff who relies upon a misrepresentation to satisfy the statuteâs first element must show actual reasonable reliance on the misrepresentation to establish proximate cause. See Bumpers v. Cmty. Bank of N. Va., 367 N.C. 81, 88â89 (2013). Plaintiffs produce no evidence or argument that they actually, reasonably relied upon this misrepresentation to their detriment, besides conclusory statements in their brief that they had to retain attorneys to read the policy. Bare arguments of counsel alone, without any record evidence, cannot create a genuine issue of material fact. Rountree v. Fairfax Cnty. Sch. Bd., 933 F.3d 219, 223 (4th Cir. 1991). Plaintiffs therefore cannot sustain their UDTP claim on this misrepresentation. The court next turns to the policyâs deductible. The parties offer clashing interpretations of the policyâs deductible terms. Defendant argues that the deductible is 2% of the value of each insured building, while plaintiffs contend the deductible for each building is a flat $50,000. Plaintiffs therefore argue that defendantâs position, which defendant stated in its correspondence to plaintiffs, was a misrepresentation under Section 58-63-15(11)(a). The court interprets a plain and unambiguous contract as a matter of law. Schenkel & Schultz, Inc. v. Hermon F. Fox & Assocs., P.C., 362 N.C. 269, 273 (2008). Contractual ambiguity exists when the meaning of words, or the effect of provisions, is uncertain or capable of several reasonable interpretations. Id. The partiesâ disagreement revolves around the policyâs deductible provision. That clause reads as follows: Peril Deductible(s) $50,000 Per Occurrence for All Covered Perils, except: 2.00% of the Total Insurable Values per location (including time element if applicable) at the time of loss or damage subject to a minimum of $50,000 Per Occurrence for Named Storm[.] (Insurance Policy 2) (emphasis added). Plaintiffs admit that Hurricane Florence was a named storm within the meaning of this provision. (See Plsâ Br. Oppân 11). Plaintiffs therefore argue that the sub-provision emphasized above establishes a per se deductible of just $50,000. (Id. 11, 26). The court concludes that no ambiguity exists in this language, and that plaintiffsâ position is an unreasonable construction of the policy. The clear language of the policy states that for named storms, the deductible is 2% of the insured buildingâs value, and must be at least $50,000. (Insurance Policy 2). Accordingly, defendantâs interpretation is the only possible reasonable reading of this provision, as a matter of law. Schenkel & Schultz, Inc., 362 N.C. at 273. Defendantâs correspondence about the deductible stated these terms, attached its appraisal of the buildingsâ respective values, and used them to calculate deductibles of 2% on each. (See May Letter 2, 5). Defendant accurately represented the policyâs deductible terms as a general matter, and the deductibles for specific buildings in particular. Defendantâs correspondence on the deductible was not a misrepresentation under Section 58-63-15(11)(a). Plaintiffs do not present evidence that they reasonably relied upon defendantâs misrepresentation of the policyâs contractual statute of limitations, and defendant did not misrepresent the policyâs deductible. Plaintiffsâ claims under Section 58-63-15(11)(a) therefore fail. ii. Refusal to Settle (N.C. Gen. Stat. § 58-63-15(11)(f)) Section 58-63-15(11)(f) prohibits an insurer from not attempting to effectuate prompt settlement of claims on which liability has become âreasonably clear[.]â Id. A violation of Section 58-63-15(11)(f) generally requires the insurer to refuse to pay or settle when objective or outside forces demonstrate liability, not when the parties reasonably dispute coverage. See, e.g., Elliot v. Am. States Ins. Co., 883 F.3d 384, 398 (4th Cir. 2018) (liability became reasonably clear when jury returned verdict on fault in underlying events); Gray v. N.C. Ins. Underwriting Assân, 352 N.C. 61, 63â64, 72â74 (2000) (liability under statute when insurer ignored its own adjusterâs figures and conclusions); Luther v. Seawell, 191 N.C. App. 139, 144â45 (2008) (no liability under statute when insurer made genuine argument on coverage). Thus liability is not âreasonably clearâ if a genuine dispute on liability or coverage exists, and advocating a coverage position that ultimately proves incorrect does not violate the statute. See, e.g., Topsail Reef Homeowners Assân v. Zurich Specialties London, Ltd., 11 F. Appâx 225, 234 (4th Cir. 2001). Plaintiffsâ position on this issue depends on the correctness of their argument on the breach of contract claim. Plaintiffs argue that their position on causation and other issues demonstrates that no reasonable dispute on coverage should exist, so that defendant simply obstinately refuses to pay a claim whose validity the parties reasonably should accept. (See Plsâ Br. Oppân 27). But the court has concluded above that issues of fact exist on the underlying events, and that the parties genuinely dispute coverage. Liability under the policy is therefore not âreasonably clear[.]â N.C. Gen. Stat. § 58-63-15(11)(f). Plaintiffs also reply upon Whitworth v. Nationwide Mut. Ins. Co., No. 1:17cv1124, 2018 WL 4494885 (M.D.N.C. Sept. 19, 2018), to argue that reasonable disputes about coverage are irrelevant. (See Plsâ Br. Oppân 29â30). However, Whitworth dealt with a narrow claim under N.C. Gen. Stat. § 58-63-15(11)(d), which prohibits failing to reasonably investigate a claim. See id. The Whitworth court refused to permit the insurer to raise a reasonable dispute on coverage argument under this statute, because such disputes were irrelevant to whether the insurer conducted an investigation. Because reasonable disputes on coverage exist, plaintiffsâ 58-63-15(11)(f) claim fails. iii. Compelled Litigation (N.C. Gen. Stat. § 58-63-15(11)(g)) Section 58-63-15(11)(g) prohibits an insurer from compelling the insured to âinstitute litigation to recover amounts due under an insurance policyâ by offering substantially less than the amounts ultimately recovered. Id. (emphasis added). North Carolina precedent interpreting this provision is sparse. However, this court previously has held that the provision requires a coverage determination in the insuredâs favor. Essentia Ins. Co. v. Stephens, 530 F. Supp. 3d 582, 609 (E.D.N.C. 2021). The statuteâs text refers only to litigation to recover âamounts due,â and ignoring reasonable disputes on coverage would therefore flout the statuteâs plain text, and establish strict liability for any insurer who advances reasonable arguments on coverage or liability ultimately found to be incorrect. The court has already concluded in its discussion of plaintiffsâ breach of contract claim that reasonable disputes on coverage exist here. And no coverage or liability determination has been made in plaintiffsâ favor. Plaintiffsâ Section 58-63-15(11)(g) claim therefore fails as a matter of law, for the same reasons as their claim under Section 58-63-15(11)(f). iv. Undue Delay (N.C. Gen. Stat. § 58-63-15(11)(e)) Section 58-63-15(11)(e) prohibits an insurer from failing to affirm or deny coverage of a claim within a reasonable time after proof-of-loss statements are submitted. Plaintiffs submitted the only proof-of-loss statement in the record on October 26, 2018. (See Plsâ App. SMF Ex. 4 at 4). This statement asserted a right to an advance payment of $200,000. (Id.). Defendant tendered a check for $200,000 to plaintiffs on October 30, 2018. (See Defâs App. SMF Ex. A-7 (DE 48-8)). Thus, only four days elapsed between plaintiffsâ submission of the proof-of-loss form and defendantâs affirmance of coverage on that sum. This short gap was not unreasonable. See, e.g., Nelson v. Hartford Underwriters Ins. Co., 177 N.C. App. 595, 612 (2006) (concluding that gap of five months was not unreasonable); Laschkewitsch v. Legal & Gen. Am., Inc., 247 F. Supp. 3d 710, 720 (E.D.N.C. 2017) (concluding that six week gap was reasonable). Plaintiffsâ claim under Section 58-63-15(11)(e) therefore fails as a matter of law. f. Common Law Bad Faith The precise basis on which plaintiffs assert this claim is unclear. Plaintiffsâ complaint and briefing assert various and shifting legal theories of bad faith, from which the court discerns two threads: 1) breach of the implied covenant of good faith and fair dealing; and 2) bad faith refusal to settle an insurance claim. âIn every contract there is an implied covenant of good faith and fair dealing that neither party will do anything which injures the right of the other to receive the benefits of the agreement.â Bicycle Transit Auth., Inc. v. Bell, 314 N.C. 219, 228 (1985). More specifically, North Carolina âlaw imposes on the insurer the duty of carrying out in good faith its contract of insurance,â including the insurerâs âright to effectuate settlement.â Alford v. Textile Ins. Co., 248 N.C. 224, 229 (1958) (â[C]ourts have consistently held that an insurer owes a duty to its insured to act diligently and in good faith in effecting settlements within policy limits.â). This court has previously recognized that â[t]o establish a claim for bad faith refusal to settle, [the insured] must show: 1) âa refusal to pay after recognition of a valid claim; 2) bad faith; and 3) aggravating or outrageous conduct.â â Labudde v. Phoenix Ins. Co., No. 7:21-CV-197-FL, 2022 WL 2651846, at *5 (E.D.N.C. July 8, 2022) (quoting Zurich Specialties London, Ltd., 11 F. App'x at 237). Whether analyzed as a claim for implied covenant of good faith or refusal to settle, bad faith is a necessary element. As an initial matter plaintiffs present no evidence of bad faith, because the court already has determined that a genuine dispute on coverage exists. Plaintiffs make several arguments about other practices by defendant that plaintiffs contend demonstrate defendantâs bad faith in the claims process generally. But these also fail for the same reasons plaintiffsâ UDTP claims fail. Plaintiffs add an additional argument for this claim: that defendant improperly relied upon two policy exclusions to deny coverage. This argument calls attention to an anomaly in the record. Both parties take as given that defendant cited two policy exclusions in the May Letter to plaintiffs; defendant argues that it nonetheless did not rely upon these exclusions in reaching a coverage decision. (See Plsâ Br. Oppân 23â24; Defâs Reply Br. 12). However, the court has closely scrutinized both the May Letter and the December Letter, and neither policy exclusion appears in either letter. (See May Letter; Dec. Letter). The parties therefore seemingly agree on a fact that the record evidence contradicts. But because plaintiffs have not actually introduced any evidence that defendant even mentioned the policy exclusions, much less relied upon them to deny coverage, this argument cannot support plaintiffsâ bad faith claim. In addition, as pertinent to a bad faith refusal to settle claim, plaintiffs have not demonstrated a genuine issue of fact that defendant recognized a valid claim. Plaintiffs argue that defendantâs investigation of the claim and partial payment of proceeds constituted recognition of plaintiffsâ full claim as valid. (See Plsâ Br. Oppân 23). However, plaintiffs point to no basis in the law for deeming an investigation a recognition of a claim. In addition, this court previously has held that partial payment of proceeds is not recognition of a claim in full. Labudde, 2022 WL 2651846, at *5. In sum, plaintiffs advance no evidence creating a genuine issue of fact that defendant refused to pay proceeds on the claim portion defendant actually recognized, or that defendantâs actions were not the result of a genuine dispute on coverage. The court thus grants defendantâs motion on plaintiffsâ common law bad faith claim. CONCLUSION Based on the foregoing, defendantâs motion for summary judgment (DE 44) is GRANTED IN PART and DENIED IN PART, as follows. Defendantâs motion is GRANTED with respect to the following claims, which are dismissed with prejudice: 1) Common law bad faith; 2) UDTP. Defendantâs motion is DENIED with respect to plaintiffsâ breach of contract claim, which will proceed to trial. Plaintiffsâ motion to strike (DE 63) is GRANTED. Defendantâs opposition to notice of filing (DE 75) is construed as a motion to strike and GRANTED. Defendantâs motion for leave to file a reply in support thereof (DE 78) is DENIED. Plaintiffsâ motion for oral argument (DE 76) is DENIED. In accordance with the case management order entered December 8, 2021, as amended August 31, 2022, this case now is ripe for entry of an order governing deadlines and procedures for final pretrial conference and trial. The parties are DIRECTED to confer and file within 14 days from the date of this order a joint status report informing the court of 1) estimated trial length; 2) particular pretrial issues which may require court intervention in advance of trial, if any; and 3)at least three suggested alternative trial dates. The parties shall specify if they wish to schedule a court-hosted settlement conference or additional alternative dispute resolution procedures in advance of trial, and if so the date for completion of such. SO ORDERED, this the 29th day of December, 2023. LOUISE W. FLANAGAN United States District Judge 24
Case Information
- Court
- E.D.N.C.
- Decision Date
- December 29, 2023
- Status
- Precedential