Miles v. Great Northern Insurance

Filing

OPINION issued by Juan R. Torruella, Appellate Judge; Kenneth F. Ripple and Kermit V. Lipez, Appellate Judge. Published. [10-1063, 10-1064]

Miles v. Great Northern Insurance

Doc. 0

Case: 10-1063 Document: 00116181614 Page: 1

Date Filed: 03/10/2011

Entry ID: 5532511

United States Court of Appeals
For the First Circuit
____________ Nos. 10-1063, 10-1064 JAMES F. MILES, THERESA B. MILES, Plaintiffs, Appellants, v. GREAT NORTHERN INSURANCE COMPANY, Defendant, Appellee. ____________ APPEALS FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MASSACHUSETTS [Hon. Nathaniel M. Gorton, U.S. District Judge] ____________ Before Torruella, Ripple,* and Lipez, Circuit Judges. ____________ Roger J. Brunelle, with whom Sbrogna & Brunelle LLP was on brief, for appellants. Mark W. Corner, with whom Riemer & Braunstein LLP was on brief, for appellee.

March 10, 2011

*

Of the Seventh Circuit, sitting by designation.

Dockets.Justia.com

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RIPPLE,

Circuit

Judge.

James

and

Theresa

Miles

originally brought this action against Great Northern Insurance Company in Massachusetts Superior Court. They sought to obtain

coverage for a fire loss to their home and asserted claims for breach Northern of contract the and unfair to insurance the practices. court and Great filed The

removed

action

district

counterclaims for breach of contract and unjust enrichment.1

parties cross-moved for summary judgment; at this point, the Mileses abandoned certain of their unfair insurance practices claims. The district court denied summary judgment on the breach

of contract claims but granted summary judgment to Great Northern on the remaining unfair insurance practices claims. The breach

of contract and unjust enrichment claims then were tried to the bench, and the district court concluded that only the plaintiffs, Mr. and Mrs. Miles, had breached in the of contract. the The court Great

therefore Northern.2

entered

judgment

favor

defendant,

The jurisdiction of the district court was based on 28 U.S.C. § 1332. The district court entered judgment in favor of Great Northern on all claims, including counterclaims for advance payments, subrogation and unjust enrichment. On appeal, neither party challenges the ruling on the unjust enrichment claims. - 2 2

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Entry ID: 5532511

Theresa Miles now seeks review of the decision of the district court that she and her husband, James Miles, breached their contract with Great Northern Insurance Company.3 Theresa

Miles contends that the district court improperly imputed the conduct of her husband to her and, therefore, incorrectly ruled that she had breached the contract with Great Northern. Because

this issue presents an unresolved interpretation of state law, we decide this case on an alternative ground. We hold that Theresa

Miles independently breached the contract with Great Northern and, therefore, is barred from recovery under the insurance

policy. court.4

Accordingly, we affirm the judgment of the district

On January 15, 2010, we ordered that the appeal of James Miles be consolidated with that of his wife for purposes of briefing and oral argument. Therefore, James Miles joins the brief of his wife, Appellant Theresa Miles, under Federal Rule of Appellate Procedure 28(i). James Miles asserts on appeal that, if we hold that Theresa Miles is entitled to recover under the policy, we then must reverse the judgment entered against him on the counterclaims because it was predicated upon the district court's conclusion that Theresa Miles was barred from recovery based upon her husband's misconduct.
4

3

Our jurisdiction is predicated on 28 U.S.C. § 1291. - 3 -

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Entry ID: 5532511

I BACKGROUND A. Facts James and Theresa Miles obtained a comprehensive home insurance policy from Great Northern for their home in Rehoboth, Massachusetts. The policy included protection for fire loss.

Although Theresa Miles alone held title to the property, both James and Theresa Miles were named as insureds under the policy. According to the terms of the policy, if the Mileses filed a claim, they were obligated to submit to an examination under oath and to deliver to Great Northern, within sixty days of request, proof of loss, along with any supporting documentation. The policy also included a "[c]oncealment or fraud" clause, which stated, "This policy is void if you or any covered person has intentionally concealed or misrepresented any material fact

relating to this policy before or after a loss." policy included a clause, which stated,

Finally, the applies

"Coverage

separately to each covered person." In the early morning on October 17, 2004, a fire

occurred at the Mileses' Rehoboth home.

The subsequent police

investigation indicated that the fire had been set intentionally because accelerants were found in the house and there was no sign

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of forced entry.

James Miles was named as a "person of interest"

in the investigation. The Mileses reported the fire to Great Northern on October 18, the day after the fire occurred, and the insurance company initiated an investigation. were uncooperative. From the start, the Mileses

Both James and Theresa Miles refused to

answer Great Northern's interrogatories about the loss and their financial affairs or to cooperate otherwise during the

examinations under oath.

Although Theresa Miles appeared for an

examination under oath, she refused, at the direction of her husband, who purported to act as her attorney, to answer Great Northern's questions. related to their home The Mileses did not turn over documents security system or to their financial

affairs until well after Great Northern had denied coverage. Although Great Northern had advanced living expenses to the

Mileses during the investigation, it ultimately decided to deny coverage under the policy because of the Mileses' failure to cooperate. B. District Court Proceedings After the Mileses' suit for breach of contract and unfair insurance practices was removed to the district court, Great Northern filed counterclaims for breach of contract and unjust enrichment. The parties cross-moved for summary judgment; - 5 -

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the

Mileses

eventually

abandoned

certain

of

their

unfair

insurance practices claims relating to the denial of coverage and breach of the covenant of good faith and fair dealing. district court granted summary judgment in favor of The Great

Northern on the remaining unfair insurance practices claims but denied summary judgment on the breach of contract claims.

Additionally, the district court considered whether James Miles's conduct during the claims adjustment process could be imputed to Theresa Miles. The court ruled that "the express language of

[the policy] unambiguously bars coverage for an innocent coinsured spouse through the inclusion of the term `any covered person' and, accordingly, it will be so construed. . . . Mr. Miles's alleged breach will be imputed to his wife." Thus, Miles

v. Great N. Ins. Co., 656 F. Supp. 2d 218, 224 (D. Mass. 2009) ("Miles I"). The parties tried the breach of contract and unjust enrichment claims to the bench. The district court ruled against

the Mileses and in favor of Great Northern, concluding that both "James and Theresa duty to Miles are found with to have breached their

contractual

cooperate

Great

Northern

Insurance

Company, thereby discharging Great Northern from its obligations to provide coverage under the Policy." Miles v. Great N. Ins.

Co., 671 F. Supp. 2d 231, 241 (D. Mass. 2009) ("Miles II"). - 6 -

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II DISCUSSION Theresa Miles now contends that the district court

erred by concluding that James Miles's conduct could be imputed to her under Massachusetts law. Because resolution of this issue

would require that we address a question of state law upon which the courts of Massachusetts have not yet had occasion to speak, we prefer to base our affirmance of the district court's judgment on an independent alternative ground.5 The district court's

factual findings require the conclusion that, independent of any wrongdoing on the part of her husband, Theresa Miles breached her contract with Great Northern and, therefore, is barred from

recovery under the insurance policy. Massachusetts courts have held that "a wilful,

unexcused refusal to submit to an examination under oath . . . constitutes discharging a the material breach of the insurance the contract contract." 692, 695­96

insurer's v. Safety

liability Ins. Co.,

under 790

Lorenzo-Martinez

N.E.2d

(Mass. App. Ct. 2003); see Mello v. Hingham Mut. Fire Ins. Co., 656 N.E.2d 1247, 1250 (Mass. 1995). In the course of rendering

its decision, the district court made several findings of fact
5

We may affirm a district court's judgment on any ground supported by the record. InterGen N.V. v. Grina, 344 F.3d 134, 141 (1st Cir. 2003). - 7 -

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Entry ID: 5532511

that

require

the

conclusion

that

Theresa

Miles,

by

her

own

misconduct, independently breached the insurance contract with Great Northern. The court found that, although the contract

explicitly required her cooperation,6 Theresa Miles refused to respond to questions or turn over requested documents during her examination under oath. Miles II, 671 F. Supp. 2d at 236

(Finding # 33).

Additionally, although Great Northern's attorney

followed up with a letter addressed to both of the Mileses, again requesting previously withhold the had documents failed to and information the that the insureds to

provide,

Mileses the

continued

certain

documents

relevant

to

investigation.

Massachusetts courts have stated that they see "no basis for a distinction requested between an obligation under oath to and submit the to duty a reasonably to produce

examination

documents pertinent to the claimed loss."

Rymsha v. Trust Ins.

Co., 746 N.E.2d 561, 563-64 (Mass. App. Ct. 2001) (concluding that financial documents, including tax returns, were relevant to

In its opinion, the district court noted that the relevant portion of the insurance policy stated: "We have the right to examine under oath, as often as we reasonably require, you, family members, and other members of your household. We also ask you to give a signed description of the circumstances surrounding a loss and your interest in it, and to produce all records and documents we request and permit us to make copies." Miles v. Great N. Ins. Co., 671 F. Supp. 2d 231, 234 (D. Mass. 2009). - 8 -

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the insurer's investigation of a theft claim when claimant was suspected of staging the loss). It is clear from the district court's findings that Theresa Miles independently refused to cooperate with Great

Northern.

Indeed, nothing in the record indicates that Theresa

Miles disputed the district court's findings of fact pertaining to her failure to cooperate with Great Northern's investigation. She maintains, however, that, because there was no finding by the district court that her conduct prejudiced Great Northern in its investigation, she should not be barred from recovery. There are two problems with this argument. First,

Theresa Miles's interpretation of the district court's finding is not a fair one. The district court concluded that, "[d]ue to the

Miles' failure to answer questions and provide the requested documentation, Great Northern was unable to complete its

investigation as to the cause of the fire and was unable to eliminate James Miles as the person who intentionally caused the fire or directed another person to cause the fire." 671 F. Supp. 2d at 238 (Finding # 53). Miles II,

We think that this

language is read most appropriately as including a finding that Theresa Miles's complicity in the couple's pattern of non-

cooperation was an integral part of the activity that thwarted Great Northern's investigation. Second, the general rule is that

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Date Filed: 03/10/2011

Entry ID: 5532511

an insurer may not disclaim coverage by virtue of an insured's breach of its duty to cooperate absent a showing of prejudice. See Boffoli v. Premier Ins. Co., 880 N.E.2d 826, 829 (Mass. App. Ct. 2008). Nevertheless, the Massachusetts courts recognize "a

limited exception to the prejudice requirement in those cases where there was a wilful and unexcused refusal of the insured to comply with an insurer's timely request for an examination under oath." Id. Therefore, if Theresa Miles willfully and without

excuse refused to comply with the insurer's reasonable request for an examination under oath, we may affirm, even without a determination of prejudice, on the ground that Theresa Miles's behavior contract. The Massachusetts standard for determining whether an insured's failure to comply with an examination under oath was willful and unexcused is whether the insured "had an excuse that relieved [her] from submitting to an examination under oath." Lorenzo-Martinez, 790 N.E.2d at 696. In Hanover Insurance Co. v. constituted an independent material breach of the

Cape Cod Custom Home Theater, Inc., 891 N.E.2d 703 (Mass. App. Ct. 2008), the court held that the insured's failure to appear, nonresponsiveness in material respects at examinations and

reluctance to produce documents requested in conjunction with the examination, see id. at 704, - 10 constituted "intentional

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Entry ID: 5532511

obstructionism

in

connection

with

the

examination

under

oath

[and] thwarted the insurer's legitimate efforts to investigate the claim expeditiously," id. at 707­08. questions Northern, reasonable and provide Miles for the requested to In refusing to answer documentation with the oath to Great

Theresa request

failed an

comply

insurer's and most

examination

under

certainly exhibited the obstructionism that, under Massachusetts law, constitutes a willful and unexcused failure to comply with her obligations. Although appellate courts are reluctant to decide mixed questions recognized exceptions. of law and this fact in the first instance,7 must admit we of have some

that

general

hesitancy

In particular, when no further development of facts

would be required in order to resolve the mixed question, a

See, e.g., United States v. Downs-Moses, 329 F.3d 253, 26465 (1st Cir. 2003) (recognizing that claims of ineffective assistance of counsel "usually present mixed questions of law and fact, and should be addressed at the district court level in the first instance"); Barbour v. Browner, 181 F.3d 1342, 1345 (D.C. Cir. 1999) ("Like the mine run of mixed questions, therefore, it should be resolved in the first instance by a jury . . . ."); Garrett v. Higgenbotham, 800 F.2d 1537, 1539 (11th Cir. 1986) (characterizing the question as to whether a channel is "narrow" as a mixed question of fact and law and, therefore, one that the appellate court was "poorly situated to decide in the first instance"). But see Dyer v. Calderon, 151 F.3d 970, 979 (9th Cir. 1998) ("Because implied bias is a mixed question of law and fact reviewable de novo, there is no need to remand to the district court for consideration of this issue in the first instance." (citation omitted)). - 11 -

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remand is neither necessary nor prudent.

See AIDS Action Comm.

of Mass., Inc. v. Mass. Bay Transp. Auth., 42 F.3d 1, 7 (1st Cir. 1994) ("This rule furthers the interest of judicial economy by avoiding the remand of a question over which we eventually will exercise full review . . . ."); see also Williams v. Poulos, 11 F.3d 271, 280-81 (1st Cir. 1993) ("We recognize that it is not ordinarily the province of appellate courts to make findings of fact or to resolve, in the first instance, mixed questions of law and fact. factbound Yet, where only one resolution of a predominantly question would, on a full record, be sustainable,

courts of appeals can, and often should, decline to remand where there has been an error committed."); Societe des Produits

Nestle, S.A. v. Casa Helvetia, Inc., 982 F.2d 633, 642 (1st Cir. 1992) (declining to remand where, once the court of appeals

decided the correct rule of law, the district court's preexisting findings of fact rendered the result obvious). The present situation certainly fits squarely within this well-established exception. The facts found by the district

court make clear that Theresa Miles's refusal to cooperate in the investigation of the fire was willful and unexcused and that her actions constituted a material breach of the contract. Despite

our general reluctance to decide mixed questions of law and fact in the first instance, given the facts in the record, we are - 12 -

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Entry ID: 5532511

entitled to conclude, at this stage, that Theresa Miles's own conduct constituted a material breach of the insurance contract as a matter of law. Conclusion Theresa Great Northern. Miles materially breached her contract with

Her willful, unexcused refusal to comply with

Great Northern's reasonable request for an examination under oath constitutes a material breach of the insurance contract.

Accordingly, the judgment of the district court is affirmed. AFFIRMED.

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