Singletary et al v. Beazley Insurance Company Inc

Filing 25

ORDER granting 16 Motion for Summary Judgment Signed by Honorable David C Norton on 11/5/2013.(cahe, )

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF SOUTH CAROLINA
CHARLESTON DIVISION
HELEN SINGLETARY and
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FAMILY ASSISTANCE
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MANAGEMENT SERVICES,
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)
No. 2:13-cv-1142-DCN
Plaintiffs,
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)
vs.
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)
ORDER
BEAZLEY INSURANCE CO., INC.,
)
)
Defendant.
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)
This matter is before the court on defendant Beazley Insurance Co., Inc.’s motion
for summary judgment. For the reasons set forth below, the court grants summary
judgment.
I. BACKGROUND
Plaintiff Family Assistance Management Services (“FAMS”) works as a
representative payee for individuals who receive social security or supplemental security
income.1 Plaintiff Helen Singletary is apparently the principal of FAMS. Beazley issued
a management liability insurance policy to FAMS for the period of November 6, 2009 to
November 6, 2010. Def.’s Mot. for Summ. J. Ex. 3. The policy provides coverage under
Insuring Clause A for a “Loss resulting from any Claim first made against any of the
Insureds during the Policy Period for a Wrongful Act.” Id.
On August 3, 2011, the Social Security Administration (“SSA”) met with
representatives of FAMS to discuss the allegation that Toni Melendez, a former director

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A representative payee is an individual or organization designated to receive social
security payments for a beneficiary, either for direct payment to the individual or for his
or her benefit. See 42 U.S.C. § 405(j).
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and employee of FAMS, embezzled SSA beneficiaries’ funds.2 Pls.’ Reply to Countercl.
¶ 7. The SSA informed FAMS that it would review all of FAMS’s financial records and
interview a sample of beneficiaries for whom FAMS acted as representative payee from
January 2004 to October 2010. Id.
The SSA issued a report, concluding that FAMS “did not adequately have controls
over the receipt and disbursement of Social Security and Supplemental Security Income
benefits” and, “as a result, the funds of beneficiaries were at risk for improper
safekeeping and use.” Pls.’ Reply to Countercl. ¶ 9; Def.’s Mot. Ex. 6. Representative
payees are liable for misused funds. 42 U.S.C. § 405(j)(7)(A). The report concluded that
FAMS did not use $513,471.49 appropriately as part of its duties as a representative
payee. Def.’s Mot. Ex. 6. The SSA ordered FAMS to repay that amount to the SSA,
which would then return the funds to the beneficiaries identified in the review. Id.
On July 26, 2012, FAMS reported the SSA review to Beazley and provided a copy
of the report. Def.’s Mot. Ex. 7. FAMS indicated that it had other insurance through The
Hartford, which paid its full coverage of $300,000. Id. FAMS requested that Beazley
pay the balance under the policy. Id. Beazley responded on August 15, 2012, advising
FAMS that the policy did not afford coverage for the SSA review or any portion of the
amount FAMS was required to pay in relation to that review. Def.’s Mot. Ex. 9.
On February 28, 2013, FAMS and Singletary filed an action in the Charleston
County Court of Common Pleas alleging breach of the insurance policy for failure to pay
and bad faith refusal to pay. FAMS and Singletary also seek a declaratory judgment that
Beazley owes benefits under the policy. Beazley removed the case to federal court on

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As reported by FAMS to its insurance broker in a November 15, 2010 letter, Melendez
admitted to the embezzlement. Def.’s Mot. Ex. 5.
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April 26, 2013. Beazley filed an answer and counterclaim on April 30, 2013, seeking a
declaratory judgment that it is not obligated to pay plaintiffs under the policy. Beazley
moved for summary judgment on September 4, 2013. ECF No. 16. Plaintiffs responded
on October 7, 2013. A hearing was held October 30, 2013. The matter is ripe for the
court’s review.
II. STANDARD
Summary judgment is proper “if the movant shows that there is no genuine
dispute as to any material fact and that the movant is entitled to judgment as a matter of
law.” Fed. R. Civ. P. 56(a). “By its very terms, this standard provides that the mere
existence of some alleged factual dispute between the parties will not defeat an otherwise
properly supported motion for summary judgment; the requirement is that there be no
genuine issue of material fact.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48
(1986). “Only disputes over facts that might affect the outcome of the suit under the
governing law will properly preclude the entry of summary judgment.” Id. at 248.
“[S]ummary judgment will not lie if the dispute about a material fact is ‘genuine,’ that is,
if the evidence is such that a reasonable jury could return a verdict for the nonmoving
party.” Id. “[A]t the summary judgment stage the judge’s function is not himself to
weigh the evidence and determine the truth of the matter but to determine whether there
is a genuine issue for trial.” Id. at 249. The court should view the evidence in the light
most favorable to the non-moving party and draw all inferences in its favor. Id. at 255.

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III. DISCUSSION
A.

Breach of Insurance Policy Claim

Beazley argues that it is entitled to summary judgment on the breach of insurance
policy claim because there has been no covered “loss” under the policy, and therefore
coverage has not been triggered. Def.’s Mot. 9. The policy’s definition of “loss”
excludes “damages representing amounts allegedly owed under an express written
contract, including a guarantee or obligation to make payments.” Def.’s Mot. Ex. 3. A
representative payee is appointed by the SSA only after the commissioner conducts an
investigation of the person or entity to determine that such appointment is in the interest
of the individual due the SSA benefits. See 42 U.S.C. § 405(j)(2)(A). As set forth in the
SSA’s “Program Operational Manual System,” Def.’s Mot. Ex. 10, the representative
payee is required to complete Form SSA-11 as part of the appointment process. Def.’s
Mot. Ex. 11. That form includes a term requiring that the representative payee
“[r]eimburse the amount of any loss suffered by any claimant due to misuse of Social
Security or SSI funds by me/my organization.” Def.’s Mot. Ex. 11. Beazley argues that
the amounts identified in the SSA review as misused funds constitute amounts owed
under an express written contract, Form SSA-11, and, as such, do not constitute a covered
loss within the meaning of the policy.
Plaintiffs advance two arguments for why coverage exists under the policy. First,
plaintiffs argue that there is no evidence that Singletary or FAMS misused any of the
funds, claiming that Beazley is trying to impute Melendez’s wrongful acts to Singletary.
Second, plaintiffs argue that the claim itself is not that of the SSA, but of the social

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security beneficiaries, and that therefore the SSA’s demand for payment actually arises
out of tort and not breach of contract.
Neither of plaintiffs’ arguments is persuasive. First, funds were misused by a
former director of FAMS acting in her capacity as an employee. This is enough to
constitute misuse by “[the] organization” under Form SSA-11. Next, courts have held
that “it is clear that nothing in these statutes expressly states that a beneficiary may file a
lawsuit against a representative payee who has misused his or her benefits payments or
otherwise violated the terms of the representative payee provisions.” Bates v. Nw.
Human Servs., Inc., 466 F.Supp.2d 69, 98 (D.D.C. 2006). The beneficiaries have no
claim against FAMS under the statutory scheme, and therefore the demand for payment
by the SSA cannot be construed as a claim in tort. Regardless of whether the claim
belongs to the beneficiaries, Form SSA-11 clearly requires that the representative payee
reimburse the SSA for misuse of benefits. The form does not contemplate eventual
payment to the aggrieved beneficiaries; it simply indicates that FAMS and Singletary
“[m]ay be held liable for repayment if [FAMS] misuse[s] the payments.” Def.’s Mot. Ex.
11.
The court grants Beazley’s motion for summary judgment on plaintiffs’ breach of
insurance policy claim. Plaintiffs do not dispute that Form SSA-11 created a contract
between FAMS and the SSA, under which FAMS agreed to reimburse the SSA for any
misused funds. Therefore, the claim for repayment by the SSA was under an express
written contract. Because the term “loss” explicitly excludes “damages representing
amounts allegedly owed” under such a contract, coverage was not triggered by the SSA’s
demand, and Beazley had no obligation to pay under the policy.

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B.

Bad Faith Claim

Beazley argues that if there is no coverage under the policy, it is entitled to
summary judgment on the bad faith claim. Under South Carolina law, an insurer’s
reasonable ground for contesting a claim for coverage precludes a finding of bad faith.
Myrick v. Prime Ins. Syndicate, Inc., 395 F.3d 485, 493 (4th Cir. 2005) (quoting Crossley
v. State Farm Auto. Ins. Co., 307 S.C. 354, 360 (1992)). Beazley argues that the absence
of coverage establishes a reasonable basis on which to decline plaintiffs’ request for
coverage.
However, as noted by plaintiffs, South Carolina recognizes a cause of action for
breach of the implied covenant of good faith and fair dealing independent of any breach
of contract, and “breach of an express contractual provision” is not a “prerequisite to
bringing the action.” Tadlock Painting Co. v. Md. Cas. Co., 473 S.E.2d 52, 55 (1996).
South Carolina courts have held that “the covenant of good faith and fair dealing extends
not just to the payment of a legitimate claim, but also to the manner in which it is
processed.” Mixson, Inc. v. Am. Loyalty Ins. Co., 562 S.E.2d 659, 662 (S.C. Ct. App.
2002).
There is, admittedly, some tension between the proposition that a reasonable
ground for contesting a claim for coverage precludes a finding of bad faith and the
existence of separate, distinct causes of action for bad faith and breach of contract.
However, another court in this district, when considering this apparent tension, held that
“the crux of a bad faith claim is still whether there is a reasonable ground for the insurer’s
actions.” Wactor v. Jackson Nat. Life Ins. Co., No. 8:11-cv-3167, 2013 WL 3479767, at
*6 (D.S.C. July 10, 2013) (citing Crossley, 415 S.E.2d at 397; Helena Chem. Co., 594

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S.E.2d at 462). Plaintiffs have advanced no evidence disputing Beazley’s claim that it
acted reasonably by relying on the policy. Because Beazley acted reasonably in denying
coverage under the policy, the court grants Beazley summary judgment on the bad faith
claim.
C.

Declaratory Judgment

Plaintiffs’ final claim is for a declaratory judgment that Beazley owes benefits
under the policy. As discussed above, there is no coverage under the policy for amounts
owed under a written contract. Therefore, the court grants summary judgment for
Beazley on plaintiffs’ declaratory judgment claim.
IV. CONCLUSION
Based on the foregoing, the court GRANTS defendant’s motion for
summary judgment.

AND IT IS SO ORDERED.

DAVID C. NORTON
UNITED STATES DISTRICT JUDGE
November 5, 2013
Charleston, South Carolina

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