Scottsdale Indemnity Company v. Martinez Inc

Filing

Opinion issued by court as to Appellant Martinez Inc. Decision: Affirmed. Opinion type: Non-Published. Opinion method: Per Curiam.

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Date Filed: 06/22/2015

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[DO NOT PUBLISH]

IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
No. 14-14958
Non-Argument Calendar
________________________
D.C. Docket No. 2:12-cv-02146-KOB
SCOTTSDALE INDEMNITY COMPANY,
Plaintiff-Counter Defendant-Appellee,
versus
MARTINEZ INC,
Defendant-Counter Claimant-Appellant.
________________________
Appeal from the United States District Court
for the Northern District of Alabama
________________________
(June 22, 2015)
Before ROSENBAUM, JULIE CARNES, and FAY, Circuit Judges.
PER CURIAM:
This declaratory-judgment action concerns a dispute over whether an
insurance policy covers losses incurred by the insured as a result of one of its

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employee’s fraudulent conduct. The district court concluded that the insurer could
avoid coverage under the policy because of material misrepresentations in the
insurance application and, alternatively, because the fraudulent actor’s knowledge
of her own fraud could be imputed to the insured for purposes of determining when
the fraud was “discovered” under the policy. After careful review, we affirm.
I.
Martinez Inc. (“MBS”) is a building-maintenance company servicing
commercial properties. Greg Martinez has been the company’s president since its
inception. The majority of his time was spent obtaining and servicing clients.
Before 2004, MBS utilized the accounting firm of Ben Bowen & Associates
for nearly all of its bookkeeping, accounting, and tax services. In 2004, Ben
Bowen recommended that MBS hire an internal accountant to handle its day-today finances. In August 2004, MBS hired Brenda Walters, who later became the
Chief Financial Officer (“CFO”) and Chief Executive Officer (“CEO”). Walters’s
job duties included handling the company’s financial accounting. In that capacity,
she had authority to make withdrawals from and deposits into MBS’s bank
accounts.
Walters was fired in August 2011 after Martinez discovered that Walters had
been embezzling funds from MBS since at least 2006. An investigation into her
fraudulent activities at MBS revealed that Walters wrote checks to herself and
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others from MBS accounts and otherwise used company funds, such as the pettycash account, and company credit cards for personal benefit. In total, Walters stole
more than $2 million from MBS.
At the time that MBS learned of Walters’s fraud, MBS was insured by
Scottsdale Indemnity Company (“Scottsdale”) under a Business and Management
Indemnity Insurance policy, which ran from September 15, 2010, to September 15,
2011. The policy had a “Crime Coverage Section,” which provided coverage for
losses caused by employee theft or fraud. In January 2012, MBS submitted a
claim for losses of over $2 million based on Walters’s conduct.
In June 2012, Scottsdale denied coverage on two grounds. First, Scottsdale
asserted that MBS had made material misrepresentations in the insurance renewal
application—which was filled out and submitted by Walters—relating to its
financial accounting practices. According to Scottsdale, the misrepresentations
materially affected the risk of loss it assumed in insuring MBS. The pertinent
provision from the insurance policy excludes coverage as follows:
In the event the Application . . . contains any
misrepresentation or omission made with the intent to
deceive, or contains any misrepresentation or omission
which materially affects either the acceptance of the risk
or the hazard assumed by Insurer under this Policy, this
Policy, including each and all Coverage Sections, shall
not afford coverage . . . for any Claim alleging, based
upon, arising out of, attributable to, directly or indirectly
resulting from, in consequence of, or in any way
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involving, any untruthful or inaccurate statements,
representations or information[.] 1
This provision applies to specified insureds only, including
any Company . . . that is an Insured, if any past or present
chief executive officer, chief financial officer, general
counsel, risk manager or human resources director (or
equivalent positions) of the Parent Company knew the
facts misrepresented or the omissions, whether or not
such individual knew of the Application, such materials,
or this Policy.
Second, Scottsdale alternatively denied coverage on the ground that
Walters’s knowledge of her own fraudulent conduct is imputed to the company for
purposes of determining when the loss was “discovered.” In support, Scottsdale
cited two provisions from the policy. One states that knowledge of an officer is
imputed to the company as a whole: “If any Insured, or any partner, officer or
director of that Insured, has knowledge of any information relevant to this Crime
Coverage Section, that knowledge is considered knowledge of every Insured.” The
other relates to “Discovery” of the loss:
The Insurer will pay for loss sustained by the Insured
through acts committed or events occurring at any time
and discovered by the Insured during the Policy Period.
Discovery of loss occurs when an officer, director,
Insurance Manager or Risk Manager first becomes aware
of facts which would cause a reasonable person to
assume that a loss covered by this Crime Coverage
Section has been or will be incurred . . . .
1

The insurance policy also provided that the insurance application was incorporated into
and constituted a part of the policy.
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Based on these provisions, Scottsdale asserted, the loss was not discovered during
the policy period because Walters’s knowledge of her own embezzlement, before
any policy had been issued by Scottsdale, is imputed to MBS.
Shortly after denying coverage, Scottsdale filed this lawsuit in the United
States District Court for the Northern District of Alabama, seeking a declaratory
judgment that no coverage exists under the policy in question. Scottsdale moved
for summary judgment. Finding no genuine dispute as to any material fact and that
Scottsdale was entitled to judgment as a matter of law, the district court granted
summary judgment. This appeal followed.
II.
We review de novo the district court’s grant of a motion for summary
judgment. Travelers Props. Cas. Co. of Am. v. Moore, 763 F.3d 1265, 1268 (11th
Cir. 2014). In reviewing summary judgment, we resolve all factual ambiguities
and draw all reasonable inferences in favor of the non-moving party.

Id.

Summary judgment should be granted “if the moving party shows that there is no
genuine dispute as to any material fact and the movant is entitled to judgment as a
matter of law.” Fed. R. Civ. P. 56(a). We also review de novo the interpretation of
provisions in an insurance contract. St. Paul Fire & Marine Ins. Co. v. ERA
Oxford Realty Co. Greystone, LLC, 572 F.3d 893, 897 (11th Cir. 2009).

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III.
Under Alabama law, courts must enforce insurance contracts as written
unless an insurance provision is ambiguous. St. Paul Fire & Marine Ins. Co., 572
F.3d at 898. If a provision is ambiguous as to whether coverage is afforded, the
provision must be construed for the benefit of the insured. Id.
A.
Regarding Scottsdale’s first ground for denying coverage, the policy places
the following limits on when coverage may be denied. As relevant to this case,
there must be (1) a misrepresentation or omission of facts, (2) (a) that was made
with the intent to deceive or (b) which materially affects the risk of loss accepted
by the insurer, (3) that resulted in or in any way involved the claim of loss, and (4)
that was known by a past or present chief executive officer or chief financial
officer of the insured company. We address each requirement in turn.
1.
MBS first contends that the district court erred in finding as a matter of law
that Walters’s responses on the insurance application were misrepresentations. In
the application, Walters answered “yes” to the following two questions: “Is there
an annual audit or review performance by an independent CPA on the books and
accounts, including a complete verification of all securities and bank balances?”
(“Question 3”); and “Are bank accounts reconciled by someone not authorized to
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deposit or withdraw from those accounts?” (“Question 4”). Scottsdale contended,
and the district court agreed, that these responses were untrue.
With regard to Question 3, MBS asserts that its accounts were reviewed
every year by Bowen, an independent Certified Public Accountant (“CPA”).
Although Bowen testified that he did not audit the accounts, he “reviewed data and
accounts . . . to verify them for the tax return preparation.” This review included
some steps to ensure the “reasonableness” of the financial information. Based on
Bowen’s testimony, MBS contends that a genuine dispute exists as to whether
Bowen conducted a “review” or “verification” as contemplated by the policy,
particularly when those terms are not defined by the policy itself.
But we need not labor over defining the policy terms “review” or
“verification.” See St. Paul Fire & Marine Ins. Co., 572 F.3d at 897 (“If a word or
phrase is not defined in the policy, then the court should construe the word or
phrase according to the meaning a person of ordinary intelligence would
reasonably give it.”) (quotation omitted). In the district court, MBS acknowledged
in its response to Scottsdale’s motion for summary judgment that Bowen’s review
did not include such a “complete verification.” See Doc. 46 at 17 (“Admittedly,
MARTINEZ did not have a complete verification of all securities and bank
balances performed[.]”). MBS cannot now argue the opposite for the first time on
appeal. See Access Now, Inc. v. Sw. Airlines Co., 385 F.3d 1324, 1331 (11th Cir.
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2004) (“This Court has repeatedly held that an issue not raised in the district court
and raised for the first time in an appeal will not be considered by this court.”)
(internal quotation marks omitted).
In any case, no genuine factual dispute exists regarding whether Bowen
conducted an “annual audit or review” that “includ[ed] a complete verification of
all securities and bank balances.” Bowen testified that he did not verify the
accuracy of MBS’s bank balances at any time after 2004, and that he never
conducted an audit or a “formal report-generating review.” Although he reviewed
the accounts for “reasonableness” for tax-preparation purposes, he verified the
accuracy of the information he received from MBS in only a “very cursory way.”
In sum, no reasonable jury could conclude that an “annual audit or review
performance by an independent CPA on the books and accounts, including a
complete verification of all securities and bank balances” occurred. Consequently,
the district court properly found that Walters’s response to Question 3 was a
misrepresentation.
With regard to Question 4, MBS points to evidence that Walters’s assistant,
Jennifer Smith, reconciled the accounts at the time of the policy application. Smith
was not authorized to deposit into or withdrawal from MBS’s accounts. Therefore,
according to MBS, the response to Question 4 was not false because the accounts

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were in fact “reconciled by someone not authorized to deposit or withdraw from
those accounts.”
Even if we found plausible MBS’s contention that the response was not
technically false, we would nonetheless agree with the district court that the answer
to Question 4 was a misrepresentation. The answer that Walters provided on the
application represented to Scottsdale that reconciliation functions at MBS were
separated from deposit and withdrawal authority, when, in fact, no such separation
of authority existed, as Walters would have been well aware. Other undisputed
evidence—which MBS claims is irrelevant—showed that Walters, who was
authorized to deposit or withdraw from the accounts, also performed reconciliation
functions. For example, Walters had access to Smith’s password and computer
and used them to alter Smith’s reconciliations of the accounts. Thus, MBS’s
accounts were reconciled, at least in part, by someone who had withdrawal and
deposit authority. Accordingly, the district court properly found that there was no
genuine dispute about whether Walters’s answer to Question 4 was a
misrepresentation.
2.
MBS next contends that the district court erred in finding as a matter of law
that Walters’s misrepresentations were made with the intent to deceive or that they
were material to the risk of loss assumed by Scottsdale in insuring MBS. Because
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we conclude that the misrepresentations were material, we do not address whether
they were made with the intent to deceive.
“Under Alabama law, the materiality of a misrepresentation on an
application for an insurance policy is generally a jury question.” Nationwide Mut.
Fire Ins. Co. v. Pabon, 903 So. 2d 759, 767 (Ala. 2004). Nonetheless, “some
misrepresentations, whether made intentionally or innocently, increase the risk of
loss as a matter of law and are therefore material to the issuance of the policy.”
Id.; see Richerzhagen v. Nat’l Home Life Assurance Co. of New York, 523 So. 2d
344, 347 (Ala. 1988) (“If the facts as to materiality are undisputed, then the
question need not be submitted to the jury.”).
In general, a fact is material if it would have increased the risk of loss to the
insurer and would have induced a rational underwriter to reject the risk or accept it
only at an increased premium. Clark v. Ala. Farm Bureau Mut. Cas. Ins. Co., 465
So. 2d 1135, 1139 (Ala. Civ. App. 1984). Ala. Code § 27–14–7 likewise provides
that an insurer may avoid a policy where a misrepresentation is material “to the
acceptance of the risk or to the hazard assumed by the insurer,” or where it would
have caused the insurer in good faith not to issue the policy or not to issue the
policy at the premium rate as applied for. See Pabon, 903 So. 2d at 767.
We

conclude

that

undisputed

evidence

establishes

that

the

misrepresentations were material to the issuance of the policy. Paul Tomasi, the
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President of E-Risk, Scottsdale’s underwriter, executed a declaration stating that
Scottsdale’s underwriting policies assigned a higher rating factor and higher total
premium where an insured answers “no” to Questions 3 and 4. He explained that
the answers to those questions are “extremely important in assessing the crime risk
to be assumed because many, if not most, employee theft losses involve employees
who handle money and who have access to the insured’s receipts, checkbook or
deposits.” Further, Tomasi noted, “internal accounting controls” and independent
oversight to ensure the controls are working and to increase the likelihood of early
detection “directly bear[] on the potential exposure to loss faced by the insurer.”
Such oversight and early detection were particularly important, Tomasi stated, for
policies like MBS’s, which covered losses sustained at any time but discovered
during the policy period. Thus, Tomasi attested that E-Risk as general agent for
Scottsdale would normally have charged an increased premium for the policy in
question had Walters provided correct answers about MBS’s accounting practices.
See Clark, 465 So. 2d at 1139.
MBS contends that the deposition testimony of Michael Kinsley, the
individual underwriter at E-Risk who handled MBS’s account, contradicts
Tomasi’s declaration and shows that the responses to Questions 3 and 4 were not
in fact taken into account in assessing the risk of loss in this case. On that basis,

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MBS asserts that genuine issues of fact remain about whether the
misrepresentations were material. We respectfully disagree.
Kinsley’s testimony reflects that E-Risk’s software program, which normally
generates a baseline quotation based on the answers provided in the insurance
application, could not automatically generate a quotation for MBS for the “Crime
Coverage Section” due to its “nature of operations.”

The software program

adjusted the baseline rate based on how an applicant’s business operations were
categorized. Thus, the nature of MBS’s business operations did not fit into one of
the software’s categories, so a quotation could not automatically be generated. But
the fact that a quotation was not automatically generated does not suggest or imply
that Kinsley or Scottsdale did not take into account the responses to Questions 3
and 4 in determining the premium, or that the misrepresentations did not affect the
risk of loss or the hazard assumed by Scottsdale.
MBS also asserts that Kinsley did not or could not have taken into account
the responses to Questions 3 and 4 because he did not understand what was
involved in an audit or review of financial records. But this does not contradict
Tomasi’s testimony that “No” responses to these questions would normally have
resulted in a higher premium. Kinsley did not need to personally understand the
reasons behind Scottsdale’s and E-Risk’s policies in order to apply them. Nor was
Kinsley’s discretion to adjust the premium rate sufficient evidence to create a
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material issue of fact regarding whether the lack of accounting controls and
oversight materially affected the risk of loss.
MBS also argues that summary judgment cannot be granted based solely on
the testimony of the underwriter. This Court has recognized that “under Alabama
law, the uncontradicted testimony of an insurance company’s underwriter that a
misrepresentation was material and that the company in good faith would not have
issued the policy as written, is not necessarily dispositive.” Bennett v. Mut. of
Omaha Ins. Co., 976 F.2d 659, 661 (11th Cir. 1992); see also Nationwide Mut.
Fire Ins. Co. v. Guster Law Firm, LLC, 944 F. Supp. 2d 1116, 1128 (N.D. Ala.
2013) (same). On on at least one occasion since our decision in Bennett, however,
the Alabama Supreme Court has relied solely on the testimony of an insurer’s
underwriter to conclude that a misrepresentation was material to the insurer’s risk
of loss as a matter of law. See Pabon, 903 So. 2d at 767-68 (relying on an
underwriter’s testimony about underwriting standings to conclude that an insured’s
misrepresentation as to whether a family member recently had filed for bankruptcy
was material as a matter of law).
Here, while not necessarily dispositive, Tomasi’s testimony was supported
by other uncontradicted evidence in the record. For example, Scottsdale submitted
evidence of its underwriting guidelines, which provided that an upward “rating
modifier” applied where “no” responses are given to Questions 3 and 4.
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addition, the fact that the questions were asked on the insurance application and
that the application warned that all responses were considered material further
supports the materiality of the responses.2 See Alfa Life Ins. Corp. v. Lewis, 910
So. 2d 757, 762 (Ala. 2005) (finding an answer material because the question was
asked in the insurance application and the application warned that the answer
would have made her ineligible for coverage). Finally, that Walters’s criminal
conduct itself was allowed to continue over a lengthy period of five to seven years,
when it likely would have been found had the controls inquired about in Questions
3 and 4 been in place, indirectly exemplifies the materiality of the
misrepresentations. As the district court stated, “Indeed, if MBS had in place a
complete independent audit and bank reconciliation independent of Walters, her
scheme would not have been successful for as long as it was.”
For these reasons, the district court did not err in concluding as a matter of
law that the misrepresentations were material to the risk of loss.

2

The policy contained a provision deeming all statements in the insurance application
material to the acceptance of the risk or the hazard assumed by Scottsdale. We do not rely on
this provision exclusively to find materiality, see State Farm Fire & Cas. Co. v. Oliver, 854 F.2d
416, 419-20 (11th Cir. 1988) (stating that the insurance contract cannot make the requirements
for voiding an insurance policy more stringent on the insured than those provided by Ala. Code
§ 24–14–7), but the provision is, nonetheless, evidence that Scottsdale considered the responses
to be material.
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3.
MBS does not contest that the misrepresentations and the claim of loss based
on Walters’s conduct were related to one another. For reasons already stated, we
likewise find the evidence undisputed that the third requirement is met.
4.
Finally, there is no genuine dispute of fact that Walters, who was the
CEO/CFO of MBS, knew the facts misrepresented, even assuming that she did not
intend to deceive Scottsdale.

With regard to Question 4, Walters knew that

someone with withdrawal and deposit authority was performing reconciliation
functions, namely, Walters. Regarding Question 3, as CFO, Walters handled all of
MBS’s financial accounting, including supplying financial information to Bowen
for purposes of preparing tax returns. It is also undisputed that Walters was
embezzling funds from MBS for many years and that she altered MBS’s financial
records to cover up her theft.

Based on this evidence, and for the reasons

explained above, the district court did not err in finding that no reasonable jury
could conclude that Walters did not know of the facts misrepresented.
B.
Alternatively, the district court determined that coverage could be avoided
under the policy because the losses suffered by MBS were not “discovered” during
the policy period.

According to the court, Walters’s knowledge of her own
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fraudulent activity is imputed to MBS, so MBS knew of the loss (through Walters)
before the policy period.
On appeal, MBS argues that Walters’s knowledge cannot be imputed to
MBS because Walters was acting adverse to MBS’s interests. If the discovery
provision in the policy could be construed to exclude coverage in these
circumstances, MBS contends, it would effectively “exclude from coverage all
claims for misdeeds of officers and directors—the very people in a position to
cause a loss to an insured.”
We decline to address this alternative ground because the district court
properly granted summary judgment on the first ground for the reasons explained
above.
IV.
In sum, we affirm the entry of summary judgment in favor of Scottsdale.
AFFIRMED.

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