Pennsylvania Supreme Court Rejects Recoupment of Defense Costs
The Pennsylvania Supreme Court rarely agrees on anything. Next to the Washington Supreme Court, the Pennsylvania Supreme Court features the largest number of divided decisions and nasty dissents of any court in the country. It is with some surprise that we note the Supreme Court's unanimous opinion last week in American & Foreign Ins. Co. v. Jerry’s Sports Center, No. J-48-2009 (Pa. August 17, 2010) holding that an insurer cannot recoup costs that it has paid to defense a law suit that it has in the interim been held not to owe coverage for. The Pennsylvania court's analysis stands in direct contrast to a Colorado opinion issued the day before by the U.S. Court of Appeals for the Tenth Circuit.
For the past ten years, courts around the country have grappled with the issue of whether an insurer that is later declared not to owe coverage may recoup defense costs that it paid in the interim under a reservation of rights. While many courts have rejected such claims outright, others have permitted recoupment, so long as the insurer advised the insured at the outset that it was asserting this right.
In American & Foreign Ins. Co. v. Jerry’s Sports Center, No. J-48-2009 (Pa. August 17, 2010), a gun shop was sued by the NAACP seeking to enjoin a public nuisance that the insured and others allegedly created by failing to prevent the illegal sale of firearms. Royal agreed to defend the case and hired defense counsel on behalf of the insured but did so under a comprehensive reservation of rights, including the right to recoup its costs of defense if it was later owed not to owe coverage. Royal thereafter filed an action for declaratory relief, in which the Court of Common Pleas ruled that the NAACP suit did not seek damages for any “bodily injury” suffered by the plaintiff. After this finding was affirmed in 2004 by the Pennsylvania Superior Court, the trial court further ruled that Royal was entitled to recoup $309,126 that it had paid to defense the case. On appeal, however, the Superior Court ruled that Royal had no such right. Royal appealed to the Supreme Court of Pennsylvania.
In affirming the Superior Court’s ruling that liability insurers have no right of recoupment, the Pennsylvania Supreme Court aligned itself with General Agents Ins. Co. v. Midwest Sporting Goods, 215 Ill. 2d 146, 828 N.E.2d 1092 (2005) (GAINSCO) where, under nearly identical facts, the Illinois Supreme Court had ruled that an insurer cannot recover defense costs pursuant to a reservation of rights absent an express provision to that effect in the insurance contract between the parties.
Further, as with GAINSCO, the Pennsylvania Supreme Court declared that the NAACP suit at least potentially set forth a claim for “bodily injury” triggering the insurer’s duty to defend. The court emphasized the fact that Royal’s claim personnel had never explicitly disclaimed any duty to defend and had, indeed, proceeded as if the claim triggered its duty to defend. As a result, it found that the trial court’s subsequent determination that Royal did not have a duty to defend did not have retroactive effect.
It would seem that this ruling that Royal had a duty to defend would have been the end of the story as, absent proof that discrete portions of the defense were solely attributable to non-covered causes of action a la Buss, no court has allowed an insurer to recoup costs of defense that it was contractually obligated to pay. Nevertheless, the Pennsylvania Supreme Court proceeded to address the equitable theories that other courts have adopted in permitting a right to recoup the cost of defending law suits that were found not to trigger an insurer’s defense duty. Thus, various courts have ruled an insured that receives a defense to claims that are not covered is unjustly enriched. Alternatively, some courts have permitted recovery on the grounds of quantum meruit or have found that an implied in fact contract is created when the insured accepts a defense on the basis of a reservation of rights that includes an asserted right to recoupment.
In this case, however, the Pennsylvania court ruled that Royal could not manufacture a right to recoupment by issuing a reservation of rights where no such right was contained in the policy itself. Further, the court held that the insured was not unjustly enriched by accepting the defense of a suit that was later found to fall outside of its insurance coverage. Indeed, the court found that the insured had little alternative, as rejecting the insurer’s proferred defense might have been treated as a breach of the insured’s duty to cooperate. There was also benefit to Royal as, in defending, the insurer was able to use it own chosen defense counsel, implement its own audit and litigation management procedures, protect against indemnity exposures and avoid bad faith claims.
A concurring opinion by Justice Saylor suggested that, in appropriate circumstances, an implied in fact contract might be created by the insured’s acceptance of the insurer’s defense that would allow a right of recoupment. He concluded, however, that the better course of action would be for insurers to explicitly include such provisions in their policies to give the insured advance notice
While the Pennsylvania court embraced the Illinois Supreme Court’s opinion in GAINSCO, the U.S. Court of Appeals for the Tenth Circuit took the opposite view, predicting that the Colorado Supreme Court would reject GAINSCO and would allow recoupment under such circumstances.
In Valley Forge Ins. Co. v. Health Care Mgt. Partners, Ltd., No. 09-1251 (10th Cir. August 16, 2010), a long-term care facility was sued by the federal for submitting fraudulent Medicare claims. CNA and Zurich denied that these claims were covered under their professional liability policies but nonetheless agreed to defend under a reservation of rights pending the outcome of a DJ filed to resolve their claimed obligations. The carriers’ position was sustained by the federal district court in Colorado and, on appeal, by the Tenth Circuit. See, Zurich-American Ins. Co. v. O’Hare Regional Center for Rehabilitation, 529 F.3d 916 (10th Cir. 2008). On remand, the District Court ruled in 2009 that Zurich and CNA were entitled to recoup all of the defense costs that they had paid in the interim.
On appeal to the Tenth Circuit, the insured argued that an insurer could not manufacture a right to recoupment that does not appear in its policy. Further, the insured argued that a trial was, in any event, necessary to determine what fees were recoverable.
In rejecting these arguments and affirming the insurers’ right of recoupment, the Tenth Circuit predicted that the Colorado Supreme Court would not follow GAINSCO. In particular, the court found guidance in the opinions of the state Supreme Court in cases such as Hecla Mining v. N.H. Ins. Co., 811 P.2d 1083 (Colo. 1991) and Cotter Corp. v. American Empire Surplus Lines Ins. Co., 90 P.3d 814 (Colo. 2004), in which insurers were directed to defend under a reservation of rights, even if a defense duty was not apparent from the underlying complaint. While acknowledging that the discussion of a right to recoupment in Hecla and Cotter might be mere dicta, the court held that these opinions were a sufficient basis under diversity rules for predicting that the Colorado Supreme Court would allow recoupment even where such a right is not set forth in the insurance contract itself.
The Tenth Circuit also declined to hold that an insurer must wait until the conclusion of the underlying law suit before presenting a claim for reimbursement of defense costs. This is indeed the procedure that the California Supreme Court set forth in Buss. Unlike California, however, Colorado allows insurers to bring an action for declaratory relief to determine their coverage duties ven while the underlying suit is still pending so long as the coverage issues are independent of the underlying liability claims and can be resolved without prejudicing the insured’s position in the underlying suit.
The Tenth Circuit declined to define the doctrinal basis for permitting recoupment, declaring that where the right derives in equity (unjust enrichment), contract (implied in fact) or just as a matter of public policy, Colorado clearly permits recoupment of defense costs.
Further, the court rejected the insured’s argument that disputed issues of fact remained with respect to how much the insurers could lawfully recoup or that certain of the defense costs at issue were excessive and unreasonable and thus beyond what any insured should be expected to pay for. The court held that the insureds had failed to present credible evidence disputing the reasonableness of these costs.
Neither of these opinions breaks significant new ground in the on-going battle over the issue of recoupment. Even so, there are a few interesting take-aways.
First, it remains the case that those courts whose states are most lenient in finding a duty to defend are also most likely to recognize recoupment as a palliative remedy for the insurer that is forced, often as a matter of public policy, to defend suits that on their face do not create a potential for coverage.
Second, a right to recoupment is only likely to arise if the insurer had no duty to defend. This is not to be confused with the separate issue of allocation, where defense costs are pro-rated at the outset of the litigation, or Buss, where the insurer must pay 100% of defense costs while the litigation is on-going but may be entitled to recoup some of its defense costs after the fact.
Finally, it is apparent from these and past cases that the manner in which claims are presented and defended can have an impact on the outcome of the parties’ rights. There seems little doubt that the Pennsylvania Supreme Court’s analysis of this issue was influenced by the fact that Royal took equivocal positions with respect to its claimed coverage obligations yet insisted that the case be defended through counsel of its own choosing, subject to its own litigation management procedures.
