DeMario et al v. Lamadrid-Maldonado et al

Filing 321

OPINION AND ORDER: For the reasons set forth in this Opinion and Order, Plaintiffs' Motion for Summary Judgment at Docket No. 152 and Motion for Summary Judgment at Docket No. 202 requesting Declaratory Judgment pursuant to 28 U.S.C. §§ 2201-2 are DENIED. Signed by Judge Raul M. Arias-Marxuach on 4/26/2023. (mrr)

Case 3:16-cv-02897-RAM-BJM Document 321 Filed 04/26/23 Page 1 of 28

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF PUERTO RICO

DINO DEMARIO, et al.
Plaintiffs
v.

CIVIL NO. 16-2897(RAM)

ANTHONY LAMADRID-MALDONADO, et al.
Defendants
OPINION AND ORDER
RAÚL M. ARIAS-MARXUACH, District Judge
This matter comes before the Court on Dino Demario and Cheryl
Steele’s (collectively “Plaintiffs”) motions for summary judgment
against co-defendant MAPFRE-PRAICO Insurance Company (“MAPFRE”)
seeking

declaratory

judgment

with

regards

to

two

different

insurance policies issued by MAPFRE. (Docket Nos. 152 and 202).
Having

reviewed

the

parties’

submissions,

the

Court

DENIES

Plaintiffs’ requests for declaratory judgment.
I. BACKGROUND
Plaintiffs are the parents of the late Nicholas DeMario.
(Docket No. 99 ¶¶ 3-4). On November 1, 2015, Nicholas DeMario was
assisting his friends with pushing their vehicle, a Mazda Protege
with license plate number 1KG-492, which had suffered a mechanical
breakdown on a road in the Municipality. Id. ¶ 16. Co-defendant
Anthony Lamadrid-Maldonado (“Lamadrid”) was driving a Mitsubishi

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2

Eclipse with license plate number GLG-871 in the same direction.
Id. ¶ 17. Lamadrid’s Mitsubishi hit the rear end of the Mazda and
Nicholas DeMario was pronounced dead at the scene. Id.
On October 31, 2016, Plaintiffs filed a lawsuit against
Lamadrid, the Puerto Rico Electric Power Authority (“PREPA”), the
Puerto Rico Highway and Transportation Authority (“PRHTA”), the
Municipality

of

Hormigueros,

and

unnamed

insurance

companies

seeking emotional damages as well as medical and funeral expenses
caused by the loss of their son. (Docket No. 1). Plaintiffs
subsequently filed three (3) amended complaints incorporating as
co-defendants

the

Commonwealth

of

Puerto

Rico

and

various

insurance companies, including MAPFRE. (Docket Nos. 2 ¶ 10; 61 ¶¶
11-12; 99 ¶ 13).1
In Plaintiffs’ Third Amended Complaint, i.e., the operative
complaint, they allege that MAPFRE was the liability insurer of
co-defendant PRHTA and the Commonwealth of Puerto Rico and is thus
“jointly and severally liable for the damages caused” by its
insured. (Docket No. 99 ¶¶ 11, 36).
Plaintiffs filed motions for summary judgment against MAPFRE
seeking declaratory relief with regards to two different insurance
policies issued by MAPFRE (collectively, the “Policies”). First,
with regards to the Commercial General Liability Insurance Policy

1

Accordingly, Plaintiffs’ Third Amended Complaint at Docket No. 99 is the
operative complaint.

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3

No. CBP-008869025 (the “Commercial General Liability Policy”)
issued by MAPFRE, Plaintiffs ask the Court to declare that: (1)
the Commonwealth of Puerto Rico is a named insured under the
Commercial General Liability Policy; and (2) that the Commercial
General

Liability

Policy

affords

coverage

for

direct

actions

asserted by Plaintiffs against MAPFRE as a liability insurer of
the Commonwealth of Puerto Rico. (Docket No. 152 at 9). Second, as
to the Business Protector Occurrence Excess Policy No. CLX-004564
(the “Business Excess Policy”) issued by MAPFRE, Plaintiffs ask
the Court to declare that: (1) the PRHTA and the Commonwealth of
Puerto Rico are named insured under the Business Excess Policy;
and (2) that the Business Excess Policy affords coverage for direct
actions asserted by Plaintiffs against MAPFRE as a liability
insurer of the PRHTA and the Commonwealth of Puerto Rico to Each
Occurrence Limit of Insurance of $10,000,000.00. (Docket No. 202
at 11).
In its responses, MAPFRE concedes that the Commonwealth of
Puerto Rico is an extended named insured pursuant to the terms of
both the Commercial General Liability Policy and the Business
Excess Policy. (Docket Nos. 159 and 222). Nevertheless, MAPFRE
contends that the insurance policies at issue only afford coverage
to the PRHTA’s operations. Id. Thus, MAPFRE contends that the
Policies do not afford coverage in the case of direct action

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4

against MAPFRE as the liability insurer of the Commonwealth of
Puerto Rico. (Docket Nos. 159 at 7; 222 at 11).
The parties filed several replies and sur-replies. (Docket
Nos. 167, 176, 177, 230, 234, 237).2
Lastly, MAPFRE sought leave to file its own motion for summary
judgment to assert that the Policies do not cover damages for
mental anguish. (Docket No. 313). Plaintiffs opposed MAPFRE’s
request on procedural grounds as well as on the merits. (Docket
Nos. 314 and 315). The Court ultimately denied MAPFRE’s request
but noted that the totality of the Policies would be considered.
(Docket No. 316).
II. LEGAL STANDARD
A. Summary Judgment Standard under Fed. R. Civ. P. 56
Summary judgment is proper under Fed. R. Civ. P. 56(a) if a
movant shows “no genuine dispute as to any material fact” and that
they are “entitled to judgment as a matter of law.” A genuine
dispute exists “if the evidence about the fact is such that a
reasonable jury could resolve the point in favor of the non-moving
party.” Alicea v. Wilkie, 2020 WL 1547064, at *2 (D.P.R. 2020)
(quotation omitted). A fact is material if “it is relevant to the
resolution of a controlling legal issue raised by the motion for

2

Importantly, in one of their supplemental replies, Plaintiffs note that
although they previously admitted MAPFRE’s fact that the PRHTA does not have
jurisdiction, control, or maintenance on the road where the accident occurred,
Plaintiffs have since identified evidence that contradicts MAPFRE’s assertion.
(Docket No. 176).

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5

summary judgment.” Bautista Cayman Asset Co. v. Terra II MC & P,
Inc., 2020 WL 118592, at *6 (D.P.R. 2020) (quotation omitted).
The party moving for summary judgment “bears the initial
burden of showing that no genuine issue of material fact exists.”
Feliciano-Munoz v. Rebarber-Ocasio, 2020 WL 4592144, at *6 (1st
Cir. 2020) (citation omitted). Whereas the non-movant may “defeat
a summary judgment motion by demonstrating, through submissions of
evidentiary quality, that a trialworthy issue persists.” Robinson
v. Town of Marshfield, 950 F.3d 21, 24 (1st Cir. 2020) (quotation
omitted). However, it “cannot merely ‘rely on an absence of
competent evidence, but must affirmatively point to specific facts
that

demonstrate

the

existence

of

an

authentic

dispute.’”

Feliciano-Munoz, 2020 WL 4592144, at *6 (quoting McCarthy v. Nw.
Airlines, Inc., 56 F.3d 313, 315 (1st Cir. 1995)). Solely relying
on “conclusory allegations, improbable inferences, and unsupported
speculation” is insufficient to defeat summary judgment. River
Farm Realty Tr. v. Farm Family Cas. Ins. Co., 943 F.3d 27, 41 (1st
Cir. 2019) (quotation omitted).
Local Rule 56 also governs summary judgment. See L. CV. R.
56. Per this Rule, a nonmoving party must “admit, deny or qualify
the facts supporting the motion for summary judgment by reference
to each numbered paragraph of the moving party’s statement of
material facts.” Id. The First Circuit has stated that adequately
supported facts “shall be deemed admitted unless controverted in

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Civil No. 16-2897 (RAM)
the

manner

prescribed

6
by

the

local

rule.”

Advanced

Flexible

Circuits, Inc. v. GE Sensing & Inspection Techs. GmbH, 781 F.3d
510, 520 (1st Cir. 2015) (quotation omitted). Hence, “litigants
ignore Local Rule 56 at their peril.” Calderón Amézquita v. Vices,
2019 WL 3928703, at *1 (D.P.R. 2019) (citation omitted).
III. FINDINGS OF FACT
After analyzing Plaintiffs’ Statements of Material Facts
(Docket Nos. 153 and 202-2), MAPFRE’s Opposition and Additional
Facts (Docket Nos. 159, 160, 222-1), Plaintiffs’ Reply (Docket
Nos. 167-2 and 231), and their corresponding exhibits, and only
crediting material facts that are properly supported by a record
citation

and

uncontroverted,

the

Court

makes

the

following

findings of facts:3
1.

The motor vehicle accident that resulted in Nicholas
DeMario’s death occurred on November 1, 2015. (Docket No.
153 ¶ 2).

A. The Commercial General Liability Insurance Policy
2.

At

all

relevant

times

herein,

MAPFRE

had

issued

a

Commercial General Liability Insurance Policy No. CBP008869025 (the “Commercial General Liability Policy”) to
the PRHTA, which provides coverage with a $1,000,000 per
occurrence limit and a $2,000,000 aggregate limit. (Docket

3

References to a Finding of Fact shall be cited as follows: (Fact ¶ _).

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7

Nos. 153 ¶ 1, 159-1, 202-2 ¶ 1).
3.

The Commercial General Liability Policy’s “COMMON POLICY
RENEWAL

DECLARATIONS”

identify

as

named

insured

the

“PUERTO RICO HIGHWAY AND TRANSPORTATION AUTHORITY &/OR ET
ALS” and states the COMMERCIAL GENERAL LIABILITY COVERAGE
PART as having a $2,339,083 premium (Docket Nos. 153 ¶ 3;
159-1 at 1; 160 ¶ 3).
4.

Per the COMMERCIAL GENERAL LIABILITY RENEWAL DECLARATIONS,
the

policy

period

runs

from

September

28,

2015

to

September 28, 2016 and the coverage afforded is $1,000,000
for each occurrence. (Docket Nos. 153 ¶ 4; 160 ¶ 4; 1591 at 90).
5.

The extended name schedule includes the Commonwealth of
Puerto Rico, among other Puerto Rico government entities,
as a named insured under the Commercial General Liability
Policy. (Docket Nos. 153 ¶ 5; 160 ¶ 5; 159-1 at 148).

6.

SECTION

IV

-

COMMERCIAL

GENERAL

LIABILITY

CONDITIONS

provides that:
Except with respect to the Limits of
Insurance, and any rights or duties
specifically assigned in this Coverage
Part to the first Named Insured, this
insurance applies
a. As if each Named Insured were the only
Named Insured; and
b. Separately to each insured against
whom claim is made or “suit” is

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brought.
(Docket Nos. 153 ¶ 6; 160 ¶ 6; 159-1 at 133).
7.

The

COMMERCIAL

GENERAL

LIABILITY

RENEWAL

DECLARATION

provides coverage for:
LOCATION OF ALL PREMISES YOU OWN, RENT OR
OCCUPY:
LOC # 1: Refer to
Property Schedule

Endorsement

B

for

LOC #2: Anywhere in the Island of Puerto
Rico
(Docket No. 159-1 at 90; 167-2 ¶ 1).
8.

Endorsement B of the Commercial General Liability Policy
contains a property schedule listing all locations for
which commercial general liability coverage is provided
and includes “Anywhere in the Commonwealth of Puerto Rico”
as an insured location. (Docket Nos. 153 ¶ 7; 160 ¶ 7;
159-1 at 101).

9.

The COMMERCIAL GENERAL LIABILITY RENEWAL DECLARATION lists
LOC CLASSIFICATION 1 of “Streets, Roads, Highways or
Bridges - existence and maintenance hazard only.” (Docket
Nos. 153 ¶ 9; 160 ¶ 9; 159-1 at 91).

10.

Pursuant to the COMMERCIAL GENERAL LIABILITY COVERAGE
FORM, SECTION I, COVERAGE A – BODILY INJURY AND PROPERTY
DAMAGE LIABILITY’S Insuring agreement, MAPFRE shall “pay
those sums that the insured becomes legally obligated to

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9

pay as damages because of ‘bodily injury’ or ‘property
damage’ to which this insurance applies. For the insurance
to apply, the bodily injury or property damage must be
“caused

by

an

‘occurrence’

that

takes

place

in

the

‘coverage territory[.]’” (Docket Nos. 153 ¶ 11; 160 ¶ 11;
159-1 at 121).
11.

SECTION I, COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE
LIABILITY’S Insuring agreement also notes that “[d]amages
because of ‘bodily injury’ include damages claimed by any
person or organization for care, loss of services or death
resulting at any time from the ‘bodily injury’.” (Docket
No. 159-1 at 121).

12.

Per SECTION V – DEFINITIONS of the Commercial General
Liability Policy, “Bodily Injury” is defined as “bodily
injury,

sickness

or

disease

sustained

by

a

person,

including death resulting from any of these at any time.”
Id. at 133.
13.

Pursuant to SECTION V – DEFINITIONS of the Commercial
General

Liability

Policy,

“‘[o]ccurrence’

means

an

accident, including continuous or repeated exposure to
substantially

the

same

general

harmful

conditions.”

(Docket Nos. 153 ¶ 12; 160 ¶ 12; 159-1 at 148)
14.

According to SECTION V – DEFINITIONS of the Commercial
General Liability Policy, “‘Coverage territory’ means, in

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10

pertinent part and redundantly, the United States of
America (including its territories or possessions) and
Puerto Rico.” (Docket Nos. 153 ¶ 13; 160 ¶ 13; 159-1 at
133).
B. The Business Protector Occurrence Excess Policy
15.

At all relevant times, MAPFRE had also issued a Business
Protector Occurrence Excess Policy No. CLX-004564 (the
“Business Excess Policy”), with a Limit of Insurance for
Each Occurrence of $10,000,000.00; a Policy Aggregate
Limit

of

$10,000,000.00;

a

Self-Insured

Retention

of

$10,000.00 for Each Occurrence not covered by Underlying
Insurance; and a Schedule of Underlying Insurance with
MAPFRE’s Commercial General Liability Policy. (Docket Nos.
202-1; 202-2 ¶ 2).
16.

The Business Excess Policy identifies the named insured
as “PUERTO RICO HIGHWAY & TRANSPORTATION AUTHORITY &/OR
ETALS.” (Docket No. 202-2 ¶ 3).

17.

The

Business

Excess

Policy

has

a

Policy

Period

form

September 28, 2015 to September 28, 2016. Id. ¶ 4.
18.

The

Business

Excess

Policy’s

business

description

is

“AUTORIDAD DE TRANSPORTACION Y CARRETERAS (GOBIERNO)”.
(Docket No. 202-1 at 3).
19.

Pursuant to the Business Excess Policy Change Number A,
affecting the Commercial Umbrella coverage part, Tort

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11

Endorsement, MAPFRE agrees “that it will not use, either
in the adjustment of claims or in the defense of suits
against the Insured, the immunity of the Insured from Tort
Liability unless requested by the Insured to interpose
such defense.” (Docket Nos. 202-1 at 5; 202-2 ¶ 5).
20.

Pursuant to the Business Excess Policy Change Number A,
affecting the Umbrella Policy, the Extended Named Insured
is: “Puerto Rico Highway & Transportation Authority &/or
Tren

Urbano

&/or

Commonwealth

of

Puerto

Rico

&/or

Department of the Treasury c/o Bureau of Public Insurance
and/or

any

subsidiary,

associated,

affiliated,

newly

acquired or controlled corporation and/or company and/or
individuals as now or hereafter [may] be constituted, or
for which the named insured is responsible for placing
insurance

and

for

which

coverage

is

not

otherwise

specifically provided.” (Docket Nos. 202-2 ¶ 6; 201-1 at
5).
21.

Under the EXTENDED NAMED INSURED, the PUERTO RICO HIGHWAY
& TRANSPORTATION AUTHORITY and the COMMONWEALTH OF PUERTO
RICO, among others, are listed as named insureds under the
Business Excess Policy. (Docket No. 202-2 ¶ 7).

22.

Per the Business Excess Policy,
The words “you” and “your” in this policy
refer to the named insured shown in the
Declarations and all other persons or

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12

organization
qualifying
as
named
insureds under the policy. The words
“we”, “us”, and “our” refer to the
company providing this insurance. The
word “insured” means any person or
organization qualifying as such under
SECTION M - WHO IS AN INSURED[.]
(Docket Nos. 202-1 at 16; 202-2 ¶ 9).
23.

Pursuant to SECTION III - WHO IS AN INSURED of the Business
Excess Policy, if you are designated in the Declarations
as an organization other than a partnership, or joint
venture, or limited liability company, you are an insured.
(Docket No. 202-2 ¶ 11).

24.

Pursuant

to

SECTION

I

-

INSURING

AGREEMENTS,

in

consideration of the payment of premium and in reliance
upon representations made when obtaining the Business
Excess Policy, MAPFRE agreed to pay on behalf of the
insured

for

“‘ultimate

net

loss’”

in

excess

of

the

‘retained limit’ because of ‘bodily injury’ or ‘property
damage’ to which this insurance applies[,]” as limited by
SECTION

IV

–

LIMIT

OF

INSURANCE

and

the

enumerated

Exclusions within the Business Excess Policy. (Docket Nos.
202-1 at 16-17; 202-2 ¶ 9).
25.

SECTION I - INSURING AGREEMENTS, COVERAGE A. BODILY INJURY
AND PROPERTY DAMAGE LIABILITY specifies that the Business
Excess

Policy

insurance

only

applies

if

the

“bodily

injury” or “property damage” occurs during the policy

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Civil No. 16-2897 (RAM)
period,

is

caused

13
by

an

“occurrence,”

and

such

“occurrence” takes place in the “coverage territory.”
(Docket No. 202-2 ¶ 10).
26.

SECTION

V

–

CONDITIONS,

2.

provides

that

bankruptcy

insolvency or receivership of the insured, the insured’s
estate or any “underlying insurer” does not relieve MAPFRE
of its obligations under the Business Excess Policy.
(Docket No. 202-2 ¶ 12).
27.

Pursuant to SECTION V – Conditions, 10. Other Insurance,
if other valid and collectible insurance is available to
the insured for the ultimate net loss covered by the
Business Excess Policy, MAPFRE’s obligations under the
Business Excess Policy are limited as follows:
a. As this insurance is excess over any
other
insurance,
whether
primary,
excess, contingent or on any other basis,
except such insurance as is specifically
purchased to apply in excess of this
policy’s Limit of Insurance, we will pay
only our share of the amount of “ultimate
net loss”, if any, that exceeds the sum
of:
1.

The total amount that all such
other insurance would pay for the
loss in the absence of this
insurance; and

2.

The total of all deductible and
self-insured amounts under this or
any other insurance.

b. We will have no duty under Coverages A or
B to defend the insured against any

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14

“suit” if any other insurer has the duty
to defend the insured against that
“suit”[.] If no other insurer defends, we
may undertake to do so but we will be
entitled to the insured’s rights against
all other insurers.
(Docket Nos. 202-1 at 35; 222 ¶ 3).
28.

Per SECTION V – Conditions, 14. Separation of Insureds,
establishes that “except with respect to the limit of
Insurance, and any rights or duties specifically assigned
to the first named insured, this insurance applies: (a)
As if each named insured were the only named insured; and
(b) Separately to each insured against whom ‘claim’ is
made or ‘suit’ is brought.” (Docket Nos. 202-1 at 35; 2022 ¶ 13).

29.

Pursuant to SECTION VI - DEFINITIONS, 4. “Bodily injury”
is

defined

as

“bodily

injury,

sickness,

or

disease

sustained by a natural person. This includes death, shock,
fright, mental anguish, mental injury, or disability which
results from any of these at any time.” (Docket Nos. 2021 at 37; 202-2 ¶ 14).
30.

Per the Business Excess Policy, the term “‘claim’ means
any

demand

upon

the

insured

for

damages

or

services

alleging liability of the insured as the result of an
‘occurrence’ or ‘offense[.]’” (Docket Nos. 202-1 at 37;
202-2 ¶ 15).

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31.

“Coverage

15

territory”

is

defined

by

SECTION

VI

–

DEFINITIONS, as “anywhere in the world if the insured’s
responsibility to pay damages is determined in a “suit”
on the merits, in the United States of America (including
its territories and possessions), Puerto Rico or Canada,
or in a settlement we agree to.” (Docket Nos. 202-1 at 37;
202-2 ¶ 16).
32.

Pursuant to Section VI – Definitions, “occurrence” means
“with respect to ‘bodily injury’ or ‘property damage’, an
accident, including continuous or repeated exposure to
substantially

the

same

general

harmful

conditions.”

(Docket Nos. 202-1 at 39; 202-2 ¶ 17).
33.

The “Self-insured retention” means the amount in item 4
of the Declarations of the Business Excess Policy, namely
$10,000.00 (each occurrence or offense not covered by
Underlying Insurance). (Docket Nos. 202-1 at 1, 40; 2022 ¶ 18).

34.

Per the terms of the Business Excess Policy, a “suit” is
defined as “a civil proceeding in which damages because
of

‘advertising

injury’,

‘bodily

injury’,

‘personal

injury’ or ‘property damage’ to which this insurance
applies are alleged.” (Docket Nos. 202-1 at 40; 202-2 ¶
19).
35.

“Retained Limit” means the greater of:

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Civil No. 16-2897 (RAM)

16

a. The sum of amounts applicable to any “claim” or
“suit” from:
i. “Underlying insurance”, whether such “underlying
insurance” is collectible or not; and
ii. Other collectible primary insurance; or
b. The “self-insured retention”
(Docket No. 202-2 at 40).
36.

Pursuant to Section VI – Definitions, 24., “‘Ultimate net
loss’ means the total amount of damages for which the
insured is legally liable in payment of ‘bodily injury’,
‘property

damage’,

‘personal

injury’,

or

‘advertising

injury’[.] ‘Ultimate net loss’ must be fully determined
as shown in Condition 18 – When Loss Payable.” (Docket
Nos. 202-1 at 41; 202-2 ¶ 20).
37.

Per Condition 18 – When Loss Payable, MAPFRE’s liability
“for any portion of ‘ultimate net loss’ shall not apply
until the insured or any ‘underlying insurer’ shall be
obligated to actually pay the full and complete amount of
the ‘retained limit’”. (Docket No. 202-1 at 36).

C. The PRHTA’s Insurance Program Specifications
38.

The PRHTA issued its Insurance Program Specifications when
requesting

bids

for

insurance

of

its

operations

and

business for the policy period running from September 28,
2015 through September 28, 2016. (Docket Nos. 222-1 ¶ 7;
222-3 at 2).

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Civil No. 16-2897 (RAM)
39.

17

The named insured listed in the PRHTA’s Insurance Program
Specifications

is

the

“Puerto

Transportation

Authority

&/or

Rico

Highway

Tren

Urbano

&
&/or

Commonwealth of Puerto Rico &/or Department of Treasury
c/o

Bureau

entities.
40.

of

Public

Insurance”

among

other

unnamed

(Docket No. 222-3 at 2).

The Insurance Program Specifications provide the following
description of operations: “The Puerto Rico Highway &
Transportation

Authority

is

a

government

corporation,

responsible for the betterment of highways & facilitates
the vehicular movement.” (Docket Nos. 222-1 ¶ 8; 222-3 at
2).
41.

The

Insurance

Program

Specifications

lists

specific

locations where coverage is to be provided under the
General Commercial Liability Policy. (Docket Nos. 222-1 ¶
10; 222-3 at 12-13).
42.

While the list includes the PRHTA’s premises “anywhere in
Puerto Rico,” the Insurance Program Specification does not
include other operations of the Commonwealth of Puerto
Rico or any of its agencies. (Docket Nos. 222-1 ¶ 9; 2223 at 12-13).

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18
IV. APPLICABLE LAW

A. Declaratory Judgment
The Declaratory Judgment Act (“DJA”) provides that:
In a case of actual controversy within its
jurisdiction ... any court of the United
States, upon the filing of an appropriate
pleading, may declare the rights and other
legal relations of any interested party
seeking such declaration, whether or not
further relief is or could be sought. Any such
declaration shall have the force and effect of
a final judgment or decree and shall be
reviewable as such.
28 U.S.C. § 2201.
It is an enabling act conferring “discretion on the Courts
rather than an absolute right upon the litigant.” Prime Venture
Corp. v. Fennix Glob. Holdings, Inc., 2020 WL 3244333, at *2
(D.P.R. 2020) (quoting DeNovelis v. Shalala, 124 F.3d 298, 313
(1st Cir. 1997)). The Supreme Court has held that “case of actual
controversy” refers to “the type of ‘Cases’ and ‘Controversies’
that are justiciable under Article III” of the Constitution.
MedImmune, Inc. v. Genentech, Inc., 549 U.S. 118, 127 (2007). Thus,
the declaration must fall within “the type of relief that Article
III allows courts to give—‘decree[s] of a conclusive character’
adjudicating adverse parties’ actual rights and interests.” In re:
Financial Oversight & Mgmt. Bd. For P.R., 916 F.3d 98, 111 (1st
Cir. 2019). Declaratory judgment is favored when the judgment: (1)
serves a useful purpose in clarifying and settling the legal

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relations at issue, and (2) will terminate and provide relief from
the uncertainty, insecurity, and controversy giving rise to the
proceeding. See Cadillac Unif. & Linen Supply, Inc. v. Cent. Gen.
de Trabajadores, 2020 WL 4289389, at *6 (D.P.R. 2020), report and
recommendation adopted, 2020 WL 4289365, at *1 (D.P.R. 2020)
(citation omitted). It seeks to limit avoidable losses and the
unnecessary accrual of damages and to provide a party threatened
with liability an early adjudication without waiting until an
adversary begins an action after the damage has accrued. Id.
B. Interpreting Insurance Policies under Puerto Rico Law
The Insurance Code of Puerto Rico (the “Insurance Code”)
governs insurance contracts, known as policies, in Puerto Rico.
See P.R. Laws Ann. tit. 26, §§ 1101-1137. Under said Insurance
Code, insurance contracts are to be “construed according to the
entirety of [their] terms and conditions as set forth in the
policy, and as amplified, extended, or modified by any lawful
rider, endorsement, or application attached to and made a part of
the policy.” Id. § 1125. Generally, “insurance contracts are
considered contracts of adhesion that are liberally interpreted in
favor of the insured.” Metlife Capital Corp. v. Westchester Fire
Ins. Co., 224 F. Supp. 2d 374, 382 (D.P.R. 2002) (citing Quiñones
Lopez v. Manzano Pozas, 141 D.P.R. 139, 155 (1996) and Rosario v.
Atl. Southern Ins. Co., 95 D.P.R. 759 (1968)).

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When the Insurance Code fails to provide the “interpretative
approach” required for a particular controversy, courts look to
the Puerto Rico Civil Code for a supplemental source of law guiding
contract interpretation. See Marina Aguila v. Den Caribbean, Inc.,
490 F. Supp. 2d 244, 248 n.5 (D.P.R. 2007). The Puerto Rico Civil
Code dictates that “[if] terms of a contract are clear and leave
no doubt as to the intentions of the contracting parties, the
literal sense of its stipulations shall be observed.” P.R. Laws
Ann. tit. 31, § 3471. In such cases, “the court should confine
itself to a literal application of the unambiguous terms of the
contract.” Gonzalez v. John Hancock Mut. Life Ins. Co., 927 F.2d
659, 660 (1st Cir. 1991) (internal quotations and edits omitted).
“Under Puerto Rican law, an agreement is ‘clear’ when it can be
understood in one sense alone, without leaving any room for doubt,
controversies

or

difference

of

interpretation[.]”

Executive

Leasing Corp. v. Banco Popular de Puerto Rico, 48 F.3d 66, 69 (1st
Cir. 1995); see also Heirs of Ramírez v. Superior Court, 81 P.R.R.
347, 351 (1959). In terms of insurance contracts in particular,
the District of Puerto Rico has held that although ambiguities
arising from an insurance policy should “be resolved in the manner
least favorable to the insurer […] this praxis does not compel or
require courts to interpret a clear, unambiguous clause that favors
the insurer in a manner that would benefit the insured.” Metlife
Capital Corp., 224 F. Supp. 2d at 382 (emphasis added).

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It is worth noting that “[a]mbiguity does not exist simply
because the parties disagree about the proper interpretation of a
policy provision.” Hoffman Garcia v. Metrohealth, Inc., 246 F.
Supp. 3d 527, 530 (D.P.R. 2017). Instead, it “may be found where
the policy's language is susceptible to more than one rational
interpretation.” Id. (quoting Clark School for Creative Learning,
Inc. v. Philadelphia Indem. Ins. Co., 734 F.3d 51, 55 (1st Cir.
2013)). Moreover, whether an insurance policy’s terms, conditions,
and exclusions are clear and unambiguous is a matter of law for
courts to determine. See Marina Aguila, 490 F. Supp. 2d at 249
(quoting Littlefield v. Acadia Ins. Co., 392 F.3d 1, 10 (1st Cir.
2004)).
C. Puerto Rico’s Direct-Action Statute
Section 2003 of the Insurance Code, known as Puerto Rico’s
“direct action statute,” regulates lawsuits against an insurer. It
provides in part:
Any individual sustaining damages and losses
shall have, at his option, a direct action
against the insurer under the terms and
limitations of the policy, which action he may
exercise against the insurer only or against
the insurer and the insured jointly. The
direct action against the insurer may only be
exercised in Puerto Rico. The liability of the
insurer shall not exceed that provided for in
the policy, and the court shall determine not
only the liability of the insurer, but also
the amount of the loss. Any action brought
under this section shall be subject to the
conditions of the policy or contract and to
the defenses that may be pleaded by the

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insurer to the direct action instituted by the
insured.
P.R. Laws Ann. tit. 26, § 2003(1). This statute “merely permits an
injured party to maintain against the insurer the same claim it
could pursue against the insured.” Torres-Troche v. Municipality
of Yauco, 873 F.2d 499, 502 (1st Cir. 1989) (citing Fraticelli v.
St. Paul Fire & Marine Ins. Co., 375 F.2d 186 (1st Cir. 1967)). In
other words, “the direct action statute

does not confer any

additional rights against the insurer than those already held by
the insured.” In re San Juan Dupont Plaza Hotel Fire Litig., 789
F. Supp. 1212, 1217 (D.P.R. 1992) (emphasis added). Therefore, an
“insurer’s

liability

arises

from

and

is

dependent

on

its

contractual obligations to the insured.” Torres-Troche, 873 F.2d
at 502.
V. ANALYSIS
A. Plaintiffs’ Requests for Declaratory Judgment
Plaintiffs request that the Court issue declaratory judgment
on two distinct grounds. The Court addresses each request in turn.
i. Both PRHTA and the Commonwealth of Puerto Rico are named
insureds under the Policies
In the case at bar, there is no controversy with regards to
the fact that both the PRHTA and the Commonwealth of Puerto Rico
are

named

Commercial
Policy.

insureds

pursuant

General

Liability

(Facts

¶¶

5,

to

the

Policy

16-20).

clear
and

Therefore,

text

the

of

both

Business

there

is

no

the

Excess
legal

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23

uncertainty that warrants declaratory judgment for clarification
as to whether the PRHTA and the Commonwealth of Puerto Rico are
named insureds under the Policy.
ii. The Court need not determine whether the Policy provides
coverage for direct actions
Pursuant to Section 2003 of Puerto Rico’s Insurance Code,
P.R. Laws Ann. tit. 26, § 2003(1), Puerto Rico is a “direct action”
jurisdiction, that allows “an injured party to maintain against
the insurer the same claim it could pursue against the insured.”
Torres-Troche, 873 F.2d at 502. Therefore, there is no legal
uncertainty that warrants declaratory judgment for clarification
as to whether the Policy allows for direct actions. See Cadillac
Unif., 2020 WL 4289389, at *6.
However, in their opposition, MAPFRE contends that Plaintiffs
cannot assert a direct cause of action against MAPFRE as the
liability insurer of the Commonwealth of Puerto Rico for claims
unrelated to the operations of the PRHTA under either of the
Policies. (Docket Nos. 159, 222, 234). Construing both Policies
“according to the entirety of [their] terms and conditions” as
required by the Insurance Code, it is evident that MAPFRE’s intent
was to ensure the PRHTA’s operations, not all of the Commonwealth
of Puerto Rico’s operations, including those unrelated to the
PRHTA. (Docket Nos. 159-1, 202-1; Facts ¶¶ 7, 8, 9, 18).

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B. MAPFRE’s liability pursuant to the Commercial General
Liability Policy
MAPFRE has proffered two arguments to establish that it is
not

liable

pursuant

to

the

terms

of

the

Commercial

General

Liability Policy. First, MAPFRE provides a Sworn Statement by Maria
I. Ayala Rivera (“Ayala”), the PRHTA’s Acting Regional Director
for the Western Region – Mayaguez, to assert that the PRHTA lacked
“jurisdiction, control or maintenance” of Highway PR-2, Km 162.7
in the Municipality of Hormigueros, i.e., where the fatal accident
occurred. (Docket No. 170-1). This sworn statement is contradicted
by other evidence on the record. See Docket Nos. 310 ¶¶ 7, 8, 1214, 19, 25; 311 ¶¶ 4, 11, 15, 29, 30, 33, 40. Moreover, it is
insufficient to establish that the PRHTA did not own, rent, or
occupy Highway PR-2, Km 162.7, which would trigger liability
pursuant to the Commercial General Liability Policy. (Fact ¶ 7).
MAPFRE also asserts it cannot be held liable because the
Commercial General Liability Policy does not provide coverage for
mental anguish under any scenario. (Docket No. 313 ¶ 7). Pursuant
to the Commercial General Liability Policy, MAPFRE is obligated to
“pay those sums that the insured becomes legally obligated to pay
as damages because of ‘bodily injury’ or ‘property damage’ to which
this insurance applies.” (Fact ¶ 10). Bodily injury is defined by
the Policy as “bodily injury, sickness or disease sustained by a
person, including death resulting from any of these at any time.”

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(Fact ¶ 12). Moreover, the Commercial General Liability Policy
notes

that

recoverable

“[d]amages

because

of

‘bodily

injury’

include damages claimed by any person or organization for care,
loss of services or death resulting at any time from the ‘bodily
injury’.” (Fact ¶ 11).
Therefore, MAPFRE is correct that the Commercial General
Liability Policy is silent as to mental anguish and does not
include it in its definition of “bodily injury” or the damages
that can be recovered because of bodily injury. Couch on Insurance,
a leading treatise on insurance law explains that:
The term “bodily injury,” as used in some
insurance
policies,
is
a
narrow
and
unambiguous term that includes only actual
physical injuries to the human body and the
consequences thereof, not humiliation, mental
anguish and suffering, mental pain, or
emotional
distress.
Emotional
distress
without accompanying physical injury was found
not to be “bodily injury” within the meaning
of a commercial general liability (CGL)
insurance policy as the policy defined “bodily
injury” as bodily injury, sickness, or disease
sustained by a person, and the definition
seemed to imply that actual physical injury
was necessary. In other jurisdictions, the
term “bodily injury” is defined broadly, and
often included emotional injury.
14 Couch on Ins. 3d § 201:8.
Plaintiffs counter that under Puerto Rico civil law, they can
seek and recover damages for their mental anguish without having
personally suffered physical injuries. (Docket No. 177 ¶¶ 4-5).
While this is true with regards to a general torts cause of action,

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26

the Supreme Court of Puerto Rico has specified that the terms of
an insurance policy dictate whether the coverage extends to mental
anguish

claims.

When

discussing

whether

a

general

liability

insurance policy provided coverage for mental anguish, the Supreme
Court of Puerto Rico held:
[1-2] A Comprehensive General Liability
Insurance policy is one that “includes all the
warranties that normally apply to a certain
risk.” J. Castelo, Diccionario básico de
seguros 160, Madrid, Ed. Mapfre (1972). That
is, not all covered risks are specifically
enumerated, and insurance is provided for all
enumerated risks and for any other risk that
has
not
been
excluded,
recognized
or
specified. This does not mean, however, that
it is an all-risk policy without conditions,
limitations or exclusions. J. Long and D.
Gregg, Property
and
Liability
Insurance
Handbook 493 (1965)[sic]
[3-4] This type of policy ordinarily contains
a single coverage provision for property
damages and another for bodily injury. The
wording of these two provisions is extremely
important, since it defines the scope of the
coverage. If the personal injury clause
provides that physical or bodily injury will
be compensated, but not so personal injury,
then coverage will be limited to the former,
and any other injury such as libel, mental
anguish, etc., will not be indemnified.
Albany Ins. Co. v. Cia. Des. Comercial P.R., 125 P.R. Dec. 421,
P.R. Offic. Trans. (1990) (emphasis added).
In the case at bar, the Commercial General Liability Policy
only provides coverage for bodily injury (in lieu of personal
injury) and without any mention as to mental anguish, emotional

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27

suffering, or any analogous type of injury. Therefore, per the
clear and unambiguous terms of the Commercial General Liability
Policy, and pursuant to Puerto Rico Supreme Court precedent, this
Policy does not provide coverage for Plaintiffs’ mental anguish
and emotional trauma. Plaintiffs’ only potential remaining claims
as to MAPFRE under the Commercial General Liability Policy are for
reimbursement of funeral and medical expenses for their son in
excess of $15,000.00. (Docket No. 99 ¶¶ 41, 43).4
VI. CONCLUSION
In light of the above, Plaintiffs’ Motion for Summary Judgment
at Docket No. 152 and Motion for Summary Judgment at Docket No.
202 requesting Declaratory Judgment pursuant to 28 U.S.C. §§ 22012 are DENIED. Furthermore, Plaintiffs’ claims against MAPFRE for
their

emotional

damages

and

mental

anguish

pursuant

to

the

Commercial General Liability Policy are also hereby DISMISSED WITH
PREJUDICE.

However,

Plaintiffs’

claims

for

reimbursement

of

funeral and medical costs against MAPFRE in its capacity as insurer
of the Commonwealth of Puerto Rico and the PRHTA pursuant to the
Commercial General Liability Policy remain pending. The totality
of Plaintiffs’ claims against MAPFRE in its capacity as insurer of
the Commonwealth of Puerto Rico and the PRHTA pursuant to the
Business Excess Policy remain pending.

4

The Court notes that the Business Excess Policy expressly provides coverage
for mental anguish. (Fact ¶ 29).

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IT IS SO ORDERED.
In San Juan, Puerto Rico, this 26th day of April 2023.
S/ RAÚL M. ARIAS-MARXUACH
United States District Judge