“As long as the complaint ‘might or might not’ fall within the policy's coverage, the insurance company is obliged to defend. Accordingly, it is the potential, rather than the certainty, of a claim falling within the insurance policy that triggers the insurer’s duty to defend.”
How later courts described this case
- “As long as the complaint ‘might or might not’ fall within the policy's coverage, the insurance company is obliged to defend. Accordingly, it is the potential, rather than the certainty, of a claim falling within the insurance policy that triggers the insurer’s duty to defend.”
- “A carrier’s duties to defend and indemnify an insured in a suit brought by a third party depend upon a determination of whether the third party’s complaint triggers coverage.”
- adopting two-part test articulated in Terletsky v. Prudential Property & Cas. Ins. Co., 649 A.2d 680 (Pa. Super. 1994)
- noting that, although plaintiff could not maintain a separate claim for breach of the implied covenant of good faith and fair dealing, “the claim may proceed under her breach of contract claim”
Written by the judges who cited it.
The opinion
IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF PENNSYLVANIA
MARONDA HOMES, LLC, )
)
) 2:20-CV-01526-CCW
Plaintiff, )
)
v. )
)
)
MOTORISTS MUTUAL INSURANCE
)
COMPANY, )
)
Defendant.
MEMORANDUM OPINION AND ORDER
Before the Court is Defendant Motorists Mutual Insurance Company’s Motion to Dismiss.
ECF No. 5. For the reasons that follow, Defendant’s Motion will be GRANTED IN PART AND
DENIED IN PART.
I. Background
Plaintiff, Maronda Homes, LLC, filed its Complaint in the Court of Common Pleas of
Allegheny County, Pennsylvania, on September 9, 2020. ECF No. 1 at ¶ 1. Plaintiff served
Defendant on September 18, 2020, and Defendant timely removed the case pursuant to 28 U.S.C.
§ 1441 to this Court on October 9, 2020, invoking this Court’s diversity jurisdiction. See id. at ¶¶
2, 5, 16 and 18; 28 U.S.C. § 1332.
Plaintiff, a Pennsylvania LLC engaged in the construction and sale of homes, see ECF No.
1 at ¶¶ 10–12 and ECF No. 1-1 at ¶ 3, alleges that Defendant is obligated to defend and indemnify
it under an insurance policy (the “Policy”) issued to Frey Excavating (“Frey”), one of Plaintiff’s
subcontractors, and under which Plaintiff is named as an “additional insured.” See id. at ¶¶ 1–2.
In its Complaint, Plaintiff asserts three claims: (1) breach of contract; (2) breach of the implied
covenant of good faith and fair dealing; and (3) bad faith insurance practices under 42 Pa.C.S. §
8371. See ECF No. 1-1. Plaintiff is seeking monetary and declaratory relief. See id. at ¶ 1.
The alleged facts underlying this case are as follows: In 2017, Plaintiff entered into
contracts with two sets of future homeowners (“Homeowners”) for houses to be built in Plaintiff’s
Granite Ridge development in McDonald, PA. See ECF No. 1-1 at ¶¶ 3, 51–52. The homes were
constructed in 2017, and the homeowners closed on and took possession of the properties in
October and December 2017, respectively. See id. at ¶ 52. Within months of moving into their
new homes, however, Homeowners discovered cracking in the foundations and brickwork, which
was later linked to soil erosion/movement on the lots.1 See id. at ¶¶ 60, 62. Homeowners thereafter
sued Plaintiff in two, virtually identical, state court actions (the “Underlying Actions”), alleging
that unsuitable fill material and improper compaction of the lots by Plaintiff and its subcontractors
caused the damage to the homes. See id. at ¶¶ 53, 57–58, 60.
Homeowners commenced the Underlying Actions by filing Writs of Summons in April
2019. See id. at ¶ 53. Plaintiff notified Defendant of the Underlying Actions shortly thereafter,
informing Defendant that Homeowners “were asserting claims arising out of the Grading Services
at the Premises and provided information regarding the claims and the investigation performed to
date.” See id. at ¶¶ 54–55. In June, 2019, Defendant confirmed that Plaintiff was an “additional
insured” under the Policy, but, according to Plaintiff, did not give any indication of its coverage
position or issue any reservation of rights under the Policy. See id. at ¶ 56.
1 The cause of the earth movement on the properties is contested. Homeowners allege it was caused by use of
improper fill material and faulty soil compaction by Plaintiff and its subcontractors. ECF No. 1-1 at ¶ 60. Plaintiff,
on the other hand, argues that local mine subsidence is to blame. Id. at ¶ 63.
Then, in November 2019, Homeowners filed their complaints in the Underlying Actions,2
and Plaintiff tendered the claims to Defendant for coverage under the Policy. See id. at ¶ 59.
Defendant then informed Plaintiff that coverage for the damages alleged in the Underlying Actions
would be denied (1) pursuant to an exclusion to the Policy and/or (2) because Defendant did not
believe any “enforceable indemnity agreements between Maronda and Frey” existed. See id. at ¶¶
67, 71, and 73. According to Plaintiff, Defendant’s denial of coverage came without warning, see
id. at ¶¶ 66, 68. In response, Plaintiff threatened to pursue a coverage action to enforce its alleged
rights. See id. at ¶ 78. Apparently seeking to avoid litigation, Plaintiff, Defendant, and Frey
worked cooperatively to attempt to settle the Homeowners’ claims in the Underlying Actions. See
id. at ¶¶ 80–83. Those efforts ultimately proved unsuccessful, and this litigation followed. See id.
at ¶ 84–85.
In its Motion, Defendant argues that (1) “there are no factual allegations that trigger
coverage for Maronda as an ‘additional insured’ within the four corners of the Complaint[s]” filed
in the Underlying Actions; and (2) even if Plaintiff qualifies as an “additional insured,” an
exclusion to the Policy is established on the face of the complaints in the Underlying Actions and,
therefore, Plaintiff’s breach of contract claim (Count I) should be dismissed. See ECF No. 6 at
11–12. Under that exclusion, property damage will not be covered once the “work” has been
“completed” or “put to its intended use.” See id. at 4, 11–12. According to Defendant’s denial of
coverage letter, because the Underlying Actions allege that the damage did not “manifest” until
after the homeowners took possession of the homes, any of Plaintiff’s or Frey’s “work” was
complete and had been put to its intended use. See id. at 12–14. Defendant further argues that
2 Homeowner’s complaints in the Underlying Actions are virtually identical, aside from the specific dates that the
individual Homeowners entered into their contracts with Plaintiff and then took possession of the properties.
Compare ECF No. 5-1 with ECF No. 5-2.
Plaintiff’s claim for breach of the implied covenant of good faith and fair dealing (Count II) should
be dismissed because (1) it is duplicative of the breach of contract claim and (2) because there can
be no violation of the implied covenant where coverage is denied under the plain terms of the
Policy. See id. at 14–15. Finally, Defendant claims that Plaintiff’s bad faith insurance practices
claim (Count III) should be dismissed because its denial of coverage was based on a reasonable
interpretation of the Policy and applicable law. See id. at 16–17. In sum, Defendant’s Motion
hinges on the argument that an affirmative defense—the exclusion to the Policy—is clearly
established on the face of the complaints in the Underlying Actions. See id. at 17–18.
II. Standard of Review
A motion to dismiss under Rule 12(b)(6) tests the legal sufficiency of a claim. In reviewing
a motion to dismiss, the court accepts as true a complaint’s factual allegations and views them in
the light most favorable to the plaintiff. See Phillips v. Cty. of Allegheny, 515 F.3d 224, 228 (3d.
Cir. 2008). Although a complaint need not contain detailed factual allegations to survive a motion
to dismiss, it cannot rest on mere labels and conclusions. Bell Atl. Corp. v. Twombly, 550 U.S.
544, 555 (2007). That is, “a formulaic recitation of the elements of a cause of action will not do.”
Id. Accordingly, “[f]actual allegations must be enough to raise a right to relief above the
speculative level,” id., and be “sufficient to state a claim for relief that is plausible on its face.”
Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Twombly, 550 U.S. at 570). “The plausibility
standard is not akin to a ‘probability requirement,’ but it asks for more than the sheer possibility
that a defendant has acted unlawfully.” Id. (quoting Twombly, 550 U.S. at 556).
The United States Court of Appeals for the Third Circuit has established a three-step
process for district courts to follow in analyzing a Rule 12(b)(6) motion:
First, the court must “tak[e] note of the elements a plaintiff must
plead to state a claim.” Second, the court should identify allegations
that, “because they are no more than conclusions, are not entitled to
the assumption of truth.” Finally, “where there are well-pleaded
allegations, a court should assume their veracity and then determine
whether they plausibly give rise to an entitlement for relief.”
Burtch v. Milberg Factors, Inc., 662 F.3d 212, 221 (3d Cir. 2011) (quoting Santiago v. Warminster
Twp., 629 F.3d 121, 130 (3d Cir. 2010)).
As relevant here, “[w]here an insurer relies on a policy exclusion as the basis for its denial
of coverage and refusal to defend, the insurer has asserted an affirmative defense and, accordingly
bears the burden of proving such defense.” Canal Ins. Co. v. Underwriters at Lloyd’s London,
435 F.3d 431, 435 (3d Cir. 2006). “To prevail on a Rule 12(b)(6) motion to dismiss based on an
affirmative defense…a defendant must show that ‘the defense is “apparent on the face of the
complaint” and documents relied on in the complaint.’” Id. (quoting Bohus v. Restaurant.com,
Inc., 784 F.3d 918, 923 n.2 (3d Cir. 2015) (quoting Schmidt v. Skolas, 770 F.3d 241, 249 (3d Cir.
2014))). “Generally speaking, [courts] will not rely on an affirmative defense . . . to trigger
dismissal of a complaint under Rule 12(b)(6).” Victaulic Co. v. Tieman, 499 F.3d 227, 234–35 (3d
Cir. 2007).
III. Discussion
As noted above, federal jurisdiction in this case is based on diversity of citizenship under
28 U.S.C. § 1332(a). Accordingly, the Court will apply the substantive law of the forum state,
Pennsylvania, in resolving this Motion. See Spence v. ESAB Group, 623 F.3d 212, 216 (3d Cir.
2010) (noting that “as a federal court sitting in diversity, we are required to apply the substantive
law of the state whose law governs the action.”) (citing Erie R.R. Co. v. Tompkins, 304 U.S. 64,
78 (1938)).
A few principles of Pennsylvania law regarding insurance contracts, recently summarized
by the Third Circuit, provide the framework for our opinion here:
First, a liability insurer’s duty to defend an insured and its duty to
indemnify are distinct, though related obligations. See Kvaerner
U.S., Inc. v. Commercial Union Ins. Co., 908 A.2d 888, 896 n.7 (Pa.
2006). Both are creations of contract. See Donegal Mut. Ins. Co. v.
Baumhammers, 938 A.2d 286, 290–91 (Pa. 2007); Genaeya Corp.
v. Harco Nat. Ins. Co., 991 A.2d 342, 347 (Pa. Super. Ct. 2010).
Second, in the context of a declaratory judgment action to determine
an insurer's obligations, Pennsylvania courts consistently apply
what is known as the “four-corners rule.” See Lupu v. Loan City
LLC, 903 F.3d 382, 389–90 (3d Cir. 2018) (collecting cases). That
is, when a policyholder is sued, “an insurer's duty to defend is
triggered, if at all, by the factual averments contained in [the
underlying] complaint[.]” Kvaerner, 908 A.2d at 896; Am. &
Foreign Ins. Co. v. Jerry's Sport Ctr., Inc., 2 A.3d 526, 541 (Pa.
2010); Mut. Ben. Ins. Co. v. Haver, 725 A.2d 743, 745–46 (Pa.
1999) (“A carrier’s duties to defend and indemnify an insured in a
suit brought by a third party depend upon a determination of whether
the third party’s complaint triggers coverage.”); Ramara, Inc. v.
Westfield Ins. Co., 814 F.3d 660, 673 (3d Cir. 2016). And “[i]f the
allegations of the underlying complaint potentially could support
recovery under the policy, there will be coverage at least to the
extent that the insurer has a duty to defend its insured in the case.”
Ramara, 814 F.3d at 673; see Jerry's Sport Ctr., 2 A.3d at 541. If
triggered, the duty to defend also carries “a conditional obligation to
indemnify in the event the insured is held liable for a claim covered
by the policy.” Gen. Accident Ins. Co. of Am. v. Allen, 692 A.2d
1089, 1095 (Pa. 1997). Both duties are at issue until the underlying
“claim is confined to a recovery that the policy does not cover.” Id.
Third, because the duty to defend is “broader” than the duty to
indemnify, if a court determines that the former does not exist,
neither does the latter. See Kvaerner, 908 A.2d at 896 n.7; Ramara,
814 F.3d at 673.
Sapa Extrusions, Inc. v. Liberty Mutual Ins. Co., 939 F.3d 243, 249–50 (3d Cir. 2019).
Accordingly, in determining whether Plaintiff’s breach of contract claim (Count I) should be
dismissed, either because Plaintiff is not an “additional insured” within the context of the
Underlying Actions or because the completed work/intended use exclusion bars coverage, we will
look to the complaints in the Underlying Actions for the relevant factual allegations.
A. Defendant’s Motion will be Denied with Respect to Plaintiff’s Breach of
Contract Claim (Count I)
Defendant advances two arguments in favor of dismissal of Count I of Plaintiff’s
Complaint. Neither argument is availing; therefore, Defendant’s Motion with respect to Count I
will be denied.
1. The Underlying Actions Sufficiently Reference Frey to Trigger
Coverage for an “Additional Insured” under the Policy
First, Defendant contends that it did not breach the Policy by refusing to defend or
indemnify Plaintiff because the allegations in the Underlying Actions do not reference “Frey or
any part that Frey played in causing any alleged injury or damage” and, therefore, “there are no
factual allegations that trigger coverage for Maronda as an ‘additional insured’ within the four
corners of the Complaint[s].” ECF No. 6 at 11. In support, Defendant points out that both
“additional insured” provisions which might provide Plaintiff coverage under the Policy require
alleged injury or damage “be ‘caused, in whole or in part, by,’ ‘your acts or omissions’ or ‘those
acting on your behalf,’ where ‘you’ and ‘your’ are singularly defined on the Policy as the Named
Insured—Frey.” Id.
The problem for Defendant, though, is that the complaints in the Underlying Actions do
reference Frey, not by name but as an agent of Defendant, and allege damages caused by improper
fill and soil compaction on the subject lots. See, e.g., ECF No. 5-1 at ¶ 25 (“Defendant, through
its agents, failed to properly place and compact fill on the Lot”). Furthermore, Homeowners
incorporated into their allegations two engineering reports which identify Frey as the excavation
contractor at the Granite Ridge Development. See ECF No. 5-1 at ¶ 13 (attaching Ex. C, PS&R
House Distress Investig. Report) and ¶ 20 (attaching Ex. E, Report of Bodhan I. Czmola, P.E.).
Thus, because “[i]n ascertaining whether an insurer's duties are triggered under a policy, the
allegations in the underlying complaint are accepted as true and are construed in favor of the
insured,” Erie Ins. Exch. v. Costa Constr., No. 1516 WDA 2014, 2015 Pa. Super. Unpub. LEXIS
1288, at *7 (May 8, 2015) (citing Kvaerner, 908 A.2d at 896), and because the complaints in the
Underlying Actions point to Plaintiff and “its agents” (i.e. Frey, according to the reports attached
to and expressly relied on by the complaints), the allegations contained in the Underlying Actions
are sufficient to trigger coverage for Plaintiff as an “additional insured.” See also Am. & Foreign
Ins. Co. v. Jerry’s Sport Ctr., Inc., 2 A.3d 526, 541 (Pa. 2010) (“As long as the complaint ‘might
or might not’ fall within the policy's coverage, the insurance company is obliged to defend.
Accordingly, it is the potential, rather than the certainty, of a claim falling within the insurance
policy that triggers the insurer’s duty to defend.”).
2. Application of the Completed Work/Intended Use Exclusion is Not
Sufficiently Clear at this Stage of the Case to Warrant Dismissal
Second, Defendant argues that Count I should be dismissed because exclusions to the
Policy applicable to the relevant “additional insured” provisions bar coverage for damages
“occurring” after the named insured’s (here, Frey’s) work has been either (1) completed or (2) put
to its intended use. See ECF No. 6 at 11–13. Under Pennsylvania law, occurrence-based insurance
policies, like the one at issue here, are triggered when injury first manifests. Importantly,
“manifestation” is distinct from both the cause of an injury and the actual discovery of the injury.
Instead, “[a]n occurrence happens when the injurious effects of the negligent act first manifest
themselves in a way that would put a reasonable person on notice of injury.” D’Auria v. Zurich
Ins. Co., 507 A.2d 857, 861 (Pa. Super. Ct. 1986); see also City of Erie v. Guar. Nat’l Ins. Co.,
109 F.3d 156, 162–63 (applying D’Auria definition of “occurrence”). In other words, while
“manifestation” could occur contemporaneously with either the cause or discovery of an injury, it
may also occur some time after the act or omission that causes an injury but some time before the
injury is actually discovered. See D’Auria, 507 A.2d at 862.
In St. John, the Pennsylvania Supreme Court applied the “first manifestation rule”
articulated in D’Auria, holding that injury to a herd of dairy cows caused by improper installation
of a plumbing system, resulting in contamination to the herd’s water supply, “manifested” when
the cows first began exhibiting illnesses related to drinking contaminated water, not when the
farmer finally identified the contaminated water as the cause of the cows’ ill health. See Pa. Nat’l
Mut. Cas. Ins. Co. v. St. John, 106 A.3d 1, 17–18 (Pa. 2014). Of course, this date was also after
the faulty installation of the plumbing system. See id. at 3–4.
Significantly, for our purposes, the Pennsylvania Supreme Court’s decision in St. John
came after a jury trial had determined the relevant, material facts of the case. Id. at 4–5. This
procedural posture is important because determining when an injury “manifested…for purposes
of triggering coverage…present[s] mixed questions of law and fact.” Id. at 13. Accordingly,
“[w]hile identifying the timing and nature of physical injury requires fact finding by the trial court,
determining whether these physical injuries trigger coverage by manifesting themselves in a
manner that would put a reasonable person on notice of injury is a question of law.” Id.
Here, there has been no fact finding yet. The complaints in the Underlying Actions paint
a factual scenario that, read in the light most favorable to Plaintiff, is like that found in St. John.
That is, Homeowners discovered damage to their properties weeks or months after taking
possession of the residences. This was some time after the alleged improper placement and
compaction of fill material on the lots. Thus, although possible, it is not clear from the complaints
in the Underlying Actions that Homeowners’ discovery of the damage to their property coincided
with manifestation of the damage. Rather, discovery is needed to determine when “the injurious
effects of the negligent act[s] first manifest[ed] themselves in a way that would put a reasonable
person on notice of injury.” D’Auria, 507 A.2d at 861. Thus, Defendant’s Motion with respect to
Count I will be denied.
B. Plaintiff’s Claim for Breach of the Implied Covenant of Good Faith and Fair
Dealing (Count II) will be Dismissed
Plaintiff’s claim for breach of the implied covenant of good faith and fair dealing (Count
II) must be dismissed because “under Pennsylvania law, a ‘claim for breach of the implied
covenant of good faith and fair dealing is subsumed in a breach of contract claim.’” Davis v. Wells
Fargo, 824 F.3d 333, 352 (3d Cir. 2016) (quoting Burton v. Teleflex Inc., 707 F.3d 417, 432 (3d
Cir. 2013)). That is, a claim for breach of the implied covenant of good faith and fair dealing
“separate and distinct from a breach of contract claim” cannot be maintained because “the covenant
does nothing more than imply certain obligations into the contract itself.” Id. (quoting JHE, Inc.
v. SEPTA, No. 1790, 2002 Phila. Ct. Com. Pl. LEXIS 78, at *13 (May 17, 2002)); see also Tubman
v. USAA Cas. Ins. Co., 943 F.Supp.2d 525, 529 (E.D. Pa. 2013) (collecting cases).
As such, to the extent it purports to state a separate claim from Count I, Count II will be
dismissed as an independent cause of action because it merges with Plaintiff’s breach of contract
claim at Count I. Davis, 824 F.3d at 352 (“Because Davis cannot maintain an independent cause
of action for breach of the covenant of good faith and fair dealing under Pennsylvania law, that
claim should be dismissed and his arguments concerning bad faith should be addressed in
connection with his surviving breach of contract claim”); see also Tubman, 943 F.Supp.2d at 529
(noting that, although plaintiff could not maintain a separate claim for breach of the implied
covenant of good faith and fair dealing, “the claim may proceed under her breach of contract
claim”). Furthermore, because amendment of Count II would be futile—Pennsylvania law does
not allow for a plaintiff to maintain a claim for breach of the implied covenant of good faith and
fair dealing separate and apart from a breach of contract claim—Plaintiff will not be afforded leave
to amend.
C. Defendant’s Motion will be Denied with Respect to Plaintiff’s Claim for Bad
Faith Insurance Practices (Count III)
Finally, Defendant argues that Plaintiff’s claim for bad faith insurance practices under 42
Pa.C.S. § 8371 (Count III) should be dismissed because (1) if applicable, the completed
work/intended use exclusion to the Policy makes Defendant’s declination of coverage per se
reasonable and (2) even if Defendant incorrectly refused coverage, a reasonable basis exists under
Pennsylvania law and the Policy for its denial of coverage such that a statutory bad faith claim
cannot stand. See ECF No. 6 at 17. Because we have already concluded that application of the
completed work/intended use exclusion is not clear, we will address only whether Plaintiff has
sufficiently pled a claim for bad faith insurance practices under § 8371.
Two elements are necessary to state a claim for bad faith insurance practices: “(1) that the
insurer did not have a reasonable basis for denying benefits under the policy and (2) that the insurer
knew of or recklessly disregarded its lack of reasonable basis” in denying the claim. Rancosky v.
Wash Nat’l. Ins. Co., 170 A.3d 364, 365 (Pa. 2017) (adopting two-part test articulated in Terletsky
v. Prudential Property & Cas. Ins. Co., 649 A.2d 680 (Pa. Super. 1994)). Importantly, “[b]ad faith
claims are fact specific and depend on the conduct of the insurer vis a vis the insured.” Condio v.
Erie Ins. Exch., 899 A.2d 1136, 1143 (Pa. Super. Ct. 2006). Thus, while Plaintiff will be required
to prove its bad faith claim by “clear and convincing evidence,” Rancosky, 170 A.3d at 365, the
allegations in the Complaint—namely, that Defendant failed to investigate Plaintiff’s tender of the
claims, denied coverage despite cooperatively participating in attempts to settle the Underlying
Actions, and rejected settlement offers from Homeowners within the limits of the Policy, see ECF
No. 1-1 at ¶¶ 75–77, 80–84—are sufficient at this stage to survive Defendant’s Motion.
IV. Conclusion
For the foregoing reasons, Defendant’s Motion is hereby GRANTED IN PART AND
DENIED IN PART as follows:
1. With respect to Plaintiff’s claim for breach of the implied covenant of good faith and
fair dealing, Defendant’s Motion is GRANTED and Count II of the Complaint is
hereby DISMISSED;
2. With respect to Plaintiff’s claims for breach of contract (Count I) and bad faith
insurance practices (Count III), Defendant’s Motion is DENIED.
Defendant shall respond to Plaintiff’s Complaint on or before April 30, 2021.
DATED this 16th day of April, 2021.
BY THE COURT:
/s/ Christy Criswell Wiegand
CHRISTY CRISWELL WIEGAND
United States District Judge
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