Judicial Council of California Issues Opinion in Coast Restaurant Group Vs. AmGUARD Insurance Case
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IN THE COURT OF APPEAL OF THE
COAST
OPINION
Appeal from a judgment of the
Shernoff Bidart Echeverria,
United Policyholders, Covington & Burling,
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Coast
Accordingly, we affirm.
I
FACTUAL AND PROCEDURAL BACKGROUND
A. First Amended Complaint
On
The FAC further alleged that in
The FAC alleged appellant submitted a claim for its business income loss. The FAC asserted that appellant "did not lose any business income as a result of virus contamination," but rather its "losses of business income were caused by, and a direct result of, government stay-at-home orders in
The FAC attached a copy of the insurance policy. Under "Additional Coverages" for "Business Income," the policy provides: '"[w]e [respondent] will pay for the actual loss of [b]usiness [i]ncome you sustain due to the necessary suspension of your 'operations' during the 'period of restoration.' The suspension must be caused by direct physical loss of or damage to property at the described premises. The loss or damage must be caused by or result from a Covered Cause of Loss."' The policy defines "suspension" of operations as the "partial slowdown or complete cessation of your business activities" and "[t]hat a part of or all of the described premises is rendered untenantable." '"Period of restoration"' is defined as beginning "72 hours after the time of direct physical loss or damage" and ending on the earlier of "(a) [t]he date when the property at the described premises should be repaired, rebuilt, or replaced with reasonable speed and similar quality; or (b) [t]he date when business is resumed at a new permanent location." The policy limits payment for business income loss on "[r]esumption [o]f [o]perations," providing that business income loss will be reduced "to the extent you can resume your 'operations' in whole or in part, by using damaged or undamaged property (including merchandise or stock) at the described premises or elsewhere."
The policy defines "Covered Causes of Loss" as all "[r]isks of direct physical loss" except those specifically excluded in "Paragraph B. Exclusions in Section 1." Section 1 provides: "We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. These exclusions apply whether or not the loss event results in widespread damage or affects a substantial area." The relevant exclusions include: B.1.a.(1) "The enforcement of any ordinance or law: [] (a) Regulating the construction, use or repair of any property"; and B.1.j. (1) "Any virus, bacterium or other microorganism that induces or is capable of inducing physical distress, illness or disease." Paragraph B, Section 2.b., provides that the insurer will not pay for loss or damage caused by "Consequential Losses," which are defined as "[d]elay, loss of use or loss of market."
The FAC also attached the governmental orders restricting on-site gatherings at restaurants. The
B. Demurrer
Respondent demurred to the FAC. In the demurrer, respondent contended there was no breach of contract claim because the insurance policy does not cover "losses arising from the COVID-19 virus, including government[al] directives issued in response to the virus." Separately, respondent contended that appellant did not allege any "direct physical loss or damage to" the covered property because governmental orders limiting the use of respondent's property do not amount to "direct physical loss of or damage to property." Respondent further asserted the "Ordinance or Law" exclusion precludes coverage for "losses arising from government-imposed use restrictions." Respondent also asserted the claim for breach of the implied covenant of good faith and fair dealing should be dismissed because its denial decision is "consistent with the plain language of the [insurance policy] and supported by numerous recent cases denying similar COVID19-related business interruption claims."
Appellant opposed the demurrer, arguing the insurance policy covers the loss of beneficial use or possession of the property as a "direct physical loss of . . . property," which occurred here because the governmental orders effectively deprived appellant of possession and use of its restaurant. Appellant also argued the policy's virus exclusion did not apply because under the efficient proximate cause doctrine where the loss is the product of two perils (the virus and the governmental orders), there is coverage if the predominating cause is a covered peril (the governmental orders) even if the noncovered peril (the virus) is the "triggering cause."
In reply, respondent argued the governmental orders did not cause direct physical loss of property because appellant did not lose physical possession of its property permanently. Additionally, respondent argued, appellant's loss of use claim is barred by the policy's "Ordinance or Law" exclusion which excludes coverage for any ordinance or law "'[r]egulating the construction, use or repair of any property.'" Respondent also argued that the efficient proximate cause doctrine did not apply because the virus was the sole cause of loss.
On
II
DISCUSSION
Appellant contends the trial court erred in sustaining respondent's demurrer without leave to amend. "On appeal from a judgment dismissing an action after sustaining a demurrer without leave to amend, the standard of review is well settled. We give the complaint a reasonable interpretation, reading it as a whole and its parts in their context. [Citation.] Further, we treat the demurrer as admitting all material facts properly pleaded, but do not assume the truth of contentions, deductions or conclusions of law. [Citations.] When a demurrer is sustained, we determine whether the complaint states facts sufficient to constitute a cause of action. [Citation.]" (City of Dinuba v.
Resolution of this appeal requires the interpretation of appellant's insurance policy. "The principles governing the interpretation of insurance policies in
"[I]n cases of ambiguity, basic coverage provisions are construed broadly in favor of affording protection, but clauses setting forth specific exclusions from coverage are interpreted narrowly against the insurer. The insured has the burden of establishing that a claim, unless specifically excluded, is within basic coverage, while the insurer has the burden of establishing that a specific exclusion applies." (Minkler, supra, 49 Cal.4th at p. 322.) "The policy must be examined as a whole, and in context, to determine whether an ambiguity exists." (Id. at p. 322.) "It is black-letter insurance law that exclusions are only considered after it is established that coverage exists under the policy." (
Here, appellant has the burden of showing that its business income loss was within basic coverage. Accordingly, appellant must show the governmental orders prohibiting on-site dining is a "risk of physical loss" and that the orders resulted in "direct physical loss of or damage to the property." Appellant contends "direct physical loss" includes deprivation or dispossession of property even if the property has not been physically damaged or altered. Appellant's contention has merit.
"Words in an insurance policy, unless given special meanings by the policy itself, must be understood in their ordinary sense." (Scott v. Continental Ins. Co. (1996) 44 Cal.App.4th 24, 28.) The policy here does not define "direct physical loss" as a whole or separately. Thus, we may resort to dictionary definitions, taking care to "consider the policy context in which the word or term was used and attempt[ing] to put [our]self in the position of a layperson and understand how he or she might reasonably interpret the particular language." (Jordan v. Allstate Ins. Co. (2004) 116 Cal.App.4th 1206, 1216.) Webster's Third New International Dictionary (2002) defines
* "direct" as "marked by absence of an intervening agency, instrumentality, or influence: immediate";
* "physical" as "of or relating to natural or material things as opposed to things mental, moral, spiritual, or imaginary"; and
* "loss" as "failure to keep possession: deprivation," "act or fact of failing to gain, win, obtain or utilize," or "destruction, ruin, perdition." (Webster's 3d New Internat. Dict. (2002) pp. 640, 1706, 1338.)
Based on the above dictionary definitions, the governmental orders at issue directly affected the property because there was no intervening cause. The orders also physically affected the property because they affected how the physical space of the property and the physical objects (chairs, tables, etc.) in that space could or could not be used. The remaining issue is whether the orders caused a "loss." We conclude that appellant suffered a covered loss under the policy because the governmental restrictions in this case deprived the appellant of important property rights in the covered property.
A governmental order that temporarily deprives the insured of possession and use of covered property can qualify as a "direct physical loss." American Alternative Ins. Corp. v.
Respondent argues American Alternative is distinguishable because in that case there was an exclusion precluding coverage for seizure and confiscation, but the insured purchased an endorsement deleting that exclusion. Respondent also argues interpreting "loss" to include loss of use contradicts provisions in the policy excluding loss of use. For example, the policy excludes "loss or damage caused directly or indirectly by . . . enforcement of any ordinance or law . . . [that] [r]egulates the construction, use or repair of any property[.]" It also excludes "[c]onsequential losses," including "delay, loss of use or loss of market." Those arguments, however, persuade us that our interpretation is correct. As the appellate court in American Alternative explained, "[the insurer] presumably . . . construed the policy [as applying to governmental seizures and confiscation] since there was an explicit exclusion included in the policy precluding such coverage. The insureds, however, had purchased an endorsement expressly deleting that exclusion. In our view, this supports an objectively reasonable expectation that [the policy] provided coverage for a governmental seizure." (American Alternative, supra, 135 Cal.App.4th at pp. 1246-1247.) Similarly, here, the explicit exclusion for governmental orders restricting use of covered property supports our interpretation that loss of use is covered under the policy./2
Respondent contends our interpretation that loss of use is covered is inconsistent with the policy's definition of the term "period of restoration." As noted, the policy only covers business income loss from a "direct physical loss" during "the period of restoration." "Period of restoration" is defined as beginning "72 hours after the time of direct physical loss or damage" and ending on the earlier of "(a) [t]he date when the property at the described premises should be repaired, rebuilt or replaced with reasonable speed and similar quality" or "(b) [t]he date when business is resumed at a new permanent location." Appellant argues that because there is no ending date for governmental orders restricting use under the above policy definitions, interpreting those orders as creating a "loss" would render the "period of restoration" superfluous. We disagree. First, the "period of restoration" only provides one method of calculating the duration of coverage, and does not purport to define the scope of coverage. Second, the ending date provisions in the "period of restoration" are not superfluous because they provide an ending date calculation for those cases where covered property is "damage[d]." In cases of a "loss" arising from governmental-use restrictions, those provisions would result in an open-ended "period of restoration" because there would be no ending date./3
Respondent also contends American Alternative is factually distinguishable because there the insured "lost actual possession of and access to an aircraft when it was confiscated . . . not just the inability to use property in a particular way." The policy here, however, does not distinguish between a partial loss or a total loss. Thus, even if appellant's deprivation here is less than the insured's deprivation in American Alternative, there is still a "loss" under the policy, although the amount of the loss would be different.
MRI Healthcare Ctr. of
Finally, while physical alteration to covered property could trigger coverage under a "physical loss or damage" insuring provision, that is not the only possible trigger for coverage. As discussed above, deprivation or dispossession also would trigger coverage, even if the property has not been physically altered. (See American Alternative, supra, 135 Cal.App.4th at pp. 1246-1247.) In sum, we are not persuaded by
B. Exclusions Under the Insurance Policy
Having concluded that appellant has demonstrated potential for coverage under the terms of the policy, we turn to whether respondent has shown an exclusion applies to deny coverage. In its demurrer, respondent argued two exclusions in the policy apply to this case: (1) the ordinance or law exclusion, and (2) the virus exclusion. We address each exclusion in turn.
1. The Ordinance or Law Exclusion
Under the ordinance or law exclusion, "loss or damage caused directly or indirectly by . . . enforcement of any ordinance or law . . . [that regulates] the construction, use or repair of any property" are not covered. The governmental orders at issue clearly regulate the use of covered property by prohibiting on-site dining. Accordingly, the ordinance or law exclusion would apply to preclude coverage.
Appellant contends we should apply the rule of noscitur a sociis to interpret the ordinance or law exclusion to apply only to governmental orders that regulate "the physical structural integrity of the property" because the term "use" is part of the phrase "construction, use, or repair." Noscitur a sociis means "'a word takes meaning from the company it keeps. [Citation]'" (People v. Hernandez (2017) 10 Cal.App.5th 192, 200.) Under this rule, "'"[a] word of uncertain meaning may be known from its associates and its meaning 'enlarged or restrained by reference to the object of the whole clause in which it is used.' [Citation.]" [Citation.]' [Citation.] '"'In accordance with this principle of construction, a court will adopt a restrictive meaning of a listed item if acceptance of a more expansive meaning would make other items in the list unnecessary or redundant, or would otherwise make the item markedly dissimilar to the other items in the list. [Citations]'"" (Ibid.) We decline to do so because nothing suggests the term "use" is limited to structural integrity even when interpreted in connection with "construction" and "repair." For example, a governmental order regulating the number of occupancy or the permitted use of properties under applicable zoning laws does not necessarily relate to the structural integrity of a building, but could affect construction, use or repair of the building.
At oral argument, appellant argued interpreting the ordinance or law exclusion as applying to loss of use from governmental orders would cause the basic coverage to be illusory. We disagree. "A contract is illusory if performance is 'conditional on some fact or event that is wholly under the promisor's control and bringing it about is left wholly to the promisor's own will and discretion.'" (
2. The Virus Exclusion
In the alternative, the virus exclusion applies to deny appellant coverage for its business income loss. As detailed above, the policy does not cover "loss or damage caused directly or indirectly by" "[a]ny virus, bacterium or other microorganism that induces or is capable of inducing physical distress, illness or disease." As the FAC acknowledges, COVID-19, a coronavirus, is a "virus." It is undisputed that COVID-19 "induces or is capable of inducing physical distress or illness." In addition, the governmental orders at issue specifically state that they were promulgated "to protect and preserve the public health from, and prevent, the increasing transmission of COVID-19 in
Appellant argues that even if the virus exception applies, the efficient proximate cause doctrine would apply to provide coverage. Under the efficient proximate cause doctrine, "[w]hen a loss is caused by a combination of a covered and specifically excluded risks, the loss is covered if the covered risk was the efficient proximate cause of the loss," but "the loss is not covered if the covered risk was only a remote cause of the loss, or the excluded risk was the efficient proximate, or predominate cause." (
The efficient proximate cause doctrine does not apply because the doctrine requires a combination of covered and specifically excluded risks. Both the virus and the governmental orders here are specifically excluded. Additionally, the two possible causes of appellant's business income loss are not conceptually distinct perils. In Roberts v.
III
DISPOSITION
The judgment is affirmed. The parties are to bear their own costs on appeal.
DELANEY, J.
WE CONCUR:
GOETHALS, ACTING P. J.
SANCHEZ, J.
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Footnotes:
1/ Appellant also alleged a negligence cause of action against its insurance broker, which is not at issue in this appeal.
2/ Whether respondent met its burden to show that one or more of those exclusions apply to deny coverage is a separate issue that will be discussed in the next section.
3/ The open-ended "period of restoration," however, would not create unlimited coverage because the "period of restoration" only provides one method of calculating the duration of coverage. As noted, the policy limits payment for business income loss upon "[r]esumption [o]f [o]perations," providing that business income loss will be reduced "to the extent you can resume your 'operations' in whole or in part, by using damaged or undamaged property (including merchandise or stock) at the described premises or elsewhere." Thus, the insurer must provide coverage until the insured is able to resume full operations.
4/ The appellate court also found there was no coverage because the undisputed facts showed that "the [demagnetization] of the MRI machine was not 'accidental."' (
5/ We decline to consider the issues addressed in amicus curiae's briefing because they are not relevant to this case. Amicus curiae argues that COVID-19 itself can cause "direct physical loss," but in this case appellant alleged that the governmental orders, not the virus itself, caused direct physical loss.
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Original text here: https://www.courts.ca.gov/opinions/documents/G061040.PDF



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