{"id":887411,"date":"2016-03-02T09:54:13","date_gmt":"2016-03-02T16:54:13","guid":{"rendered":"https:\/\/www.myconstructionexpert.com\/blog\/?p=887411"},"modified":"2016-03-02T09:54:13","modified_gmt":"2016-03-02T16:54:13","slug":"finding-coverage-for-additional-insured-third-circuit-cautions-that-insurer-cannot-bury-its-head-in-the-sand","status":"publish","type":"post","link":"https:\/\/www.myconstructionexpert.com\/blog\/finding-coverage-for-additional-insured-third-circuit-cautions-that-insurer-cannot-bury-its-head-in-the-sand\/","title":{"rendered":"Finding Coverage for \u201c Additional Insured \u201d Third Circuit Cautions that \u201cInsurer Cannot Bury its Head in the Sand\u201d"},"content":{"rendered":"<p>Michael H. Sampson, Jay M. Levin, Andrew J. Muha, Douglas R. Widin and Caitlin R. Garber | Reed Smith | February 22, 2016<\/p>\n<p><strong>Executive Summary<\/strong> Using the \u201cfour corners\u201d rule, the U.S. Court of Appeals for the Third Circuit decided in <em>Ramara, Inc. v. Westfield Insurance Co.<\/em>, No. 15-1003 (3d Cir. Feb. 17, 2016), that an insurer owed a garage owner a duty to defend because it was an \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u201c <a href=\"https:\/\/www.myconstructionexpert.com\/blog\/indemnity-provision-provides-relief-to-contractor-additional-insured-provision-does-not\/\" target=\"_blank\">additional insured<\/a> \u201d under a subcontractor\u2019s commercial general liability policy. The Third Circuit held that duty was triggered because \u2013 applying either a \u201cbut-for\u201d causation standard or the more demanding \u201cproximate\u201d causation standard \u2013 the bodily injury alleged in the underlying complaint was \u201ccaused\u201d by the subcontractor\u2019s acts or omissions. Ultimately agreeing that \u201cbut-for\u201d causation was the relevant standard, the court considered not just the policy\u2019s \u201c <a href=\"https:\/\/www.myconstructionexpert.com\/blog\/insurer-duty-defend-additional-insured-construction-defect-case\/\" target=\"_blank\">Additional Insured Endorsement<\/a> \u201d but another policy provision, explaining that courts must construe the policy \u201cas one harmonious document.\u201d The Third Circuit also addressed the propriety of recognizing the impact of the Pennsylvania Workers\u2019 Compensation Act in applying the \u201cfour corners\u201d rule, holding that, in assessing coverage, an insurer cannot ignore the impact the Act may have on plaintiff\u2019s counsel\u2019s drafting of a personal-injury complaint. \u201c[A]n insurer cannot bury its head in the sand,\u201d the court cautioned, \u201cand disclaim any knowledge of coverage-triggering facts.\u201d<\/p>\n<p><strong>Discussion<\/strong> At issue in Ramara was whether a parking garage owner was entitled to a defense under a subcontractor\u2019s general liability insurance policy in a suit brought by one of the subcontractor\u2019s employees, who was injured while working at the owner\u2019s garage. The insurer denied coverage, based largely on the perceived absence of allegations in the complaint regarding the role of the subcontractor, which allegations the insurer viewed as necessary to trigger an obligation to defend the garage owner. Despite the state of the pleadings, however, the insurer had knowledge that the underlying plaintiff was the subcontractor\u2019s employee, and it was clear that had the plaintiff alleged actions by the subcontractor, he could have risked facing defenses under the Pennsylvania Workers\u2019 Compensation Act.<\/p>\n<p><em>Pennsylvania\u2019s \u201cfour corners rule\u201d<\/em> The Third Circuit observed that the question whether the insurer owed the garage owner a defense required it to compare \u201cthe language of the allegations\u201d in the underlying complaint \u201cto the language of the [p]olicy.\u201d \u201cPennsylvania adheres to the \u2018four corners\u2019 rule (also known as the \u2018eight corners\u2019 rule), under which an insurer\u2019s potential duty to defend is determined <strong>solely<\/strong> by the allegations of the complaint in the [underlying] action,\u201d the court explained.<\/p>\n<p><em>Policy language and causation<\/em> Pursuant to the policy\u2019s \u201c <a href=\"https:\/\/www.myconstructionexpert.com\/blog\/overlooked-obtaining-an-additional-insured-endorsement-you-might-be-saved-by-the-automatic-additional-insured-endorsement-or-might-not\/\" target=\"_blank\">Additional Insured Endorsement <\/a>,\u201d the garage owner was covered under the subcontractor\u2019s policy \u201conly with respect to liability for \u2018bodily injury\u2019 \u2026 caused, in whole or in part, by\u201d the subcontractor\u2019s \u201cacts or omissions &#8230;.\u201d The insurer argued that this provision limited coverage to only those instances where a subcontractor\u2019s acts or omissions proximately caused a plaintiff\u2019s injuries. The garage owner countered that only less-restrictive \u201cbut-for\u201d causation was required to trigger coverage for \u201c <a href=\"https:\/\/www.myconstructionexpert.com\/blog\/utahs-anti-indemnification-statute-and-additional-insured-provisions\/\" target=\"_blank\">additional insureds<\/a> .\u201d<\/p>\n<p>The court concluded that the insurer\u2019s obligations were triggered here under either test. It found that the injured employee\u2019s complaint was \u201crife with allegations\u201d indicating that the subcontractor\u2019s acts were a proximate cause of the employee\u2019s injuries, even though the complaint asserted no claim against the subcontractor itself. Because the complaint satisfied the more restrictive \u201cproximate\u201d cause test, the court concluded that it also necessarily satisfied the \u201cbut-for\u201d cause test. That said, the court held that the garage owner\u2019s \u201cbut-for interpretation is correct,\u201d reasoning that the policy\u2019s \u201cOther Insurance Endorsement\u201d could not be squared with the insurer\u2019s restrictive \u201cproximate\u201d cause test, and stating that \u201c[c]ourts must interpret an insurance policy as one harmonious document and resolve ambiguities in favor of coverage.\u201d<\/p>\n<p><em>The Pennsylvania Workers\u2019 Compensation Act<\/em> Finally, the Third Circuit considered the interplay between the Pennsylvania Workers\u2019 Compensation Act and the \u201cfour corners\u201d rule. The court acknowledged that the employee pleaded very little about his employer, the subcontractor, in the complaint against the garage owner, but recognized this was because the Act barred any such claim. The Third Circuit continued: \u201cThe four corners rule \u2013 even under Pennsylvania\u2019s strict construction \u2013 does not permit an insurer to make its coverage decision with blinders on, disclaiming any knowledge of coverage-triggering facts.\u201d Rather, the court held that where the Act is \u201crelevant to a coverage determination,\u201d the Act must serve as an \u201cinterpretive constraint\u201d in applying the \u201cfour corners\u201d rule \u2013 meaning that insurers \u201cmust interpret the allegations of an underlying complaint recognizing that the plaintiff\u2019s attorney in the underlying action drafted the complaint taking the Act into account.\u201d The court took pains to emphasize that its conclusion expressed only \u201cwhat should be obvious\u201d \u2013 that \u201can insurer cannot bury its head in the sand and disclaim any knowledge of coverage-triggering facts[.]\u201d Viewing the case against the garage owner through the prism created by the Workers&#8217; Compensation Act, the court found it natural and understandable that the complaint said very little expressly about the employer, but read the complaint in a more fulsome manner to acknowledge the employer\u2019s contribution to the factual scenario.<\/p>\n<p><em>Impact of <\/em>Ramara&#8230;<\/p>\n<p><a href=\"http:\/\/www.reedsmith.com\/Finding-coverage-for-additional-insured-Third-Circuit-cautions-that-insurer-cannot-bury-its-head-in-the-sand-02-22-2016\/?utm_source=Mondaq&amp;utm_medium=syndication&amp;utm_campaign=View-Original\" target=\"_blank\">To finish reading this article<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Michael H. Sampson, Jay M. Levin, Andrew J. Muha, Douglas R. Widin and Caitlin R. Garber | Reed Smith | February 22, 2016 Executive Summary Using the \u201cfour corners\u201d rule, the U.S. Court of Appeals for the Third Circuit decided in Ramara, Inc. v. Westfield Insurance Co., No. 15-1003 (3d Cir. Feb. 17, 2016), that&hellip; <a class=\"more-link\" href=\"https:\/\/www.myconstructionexpert.com\/blog\/finding-coverage-for-additional-insured-third-circuit-cautions-that-insurer-cannot-bury-its-head-in-the-sand\/\">Continue reading <span class=\"screen-reader-text\">Finding Coverage for \u201c Additional Insured \u201d Third Circuit Cautions that \u201cInsurer Cannot Bury its Head in the Sand\u201d<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[3],"tags":[382,3],"class_list":["post-887411","post","type-post","status-publish","format-standard","hentry","category-insurance-claims","tag-additional-insured","tag-insurance-claims","entry"],"jetpack_publicize_connections":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Finding Coverage for \u201c Additional Insured \u201d Third Circuit Cautions that \u201cInsurer Cannot Bury its Head in the Sand\u201d - Advise &amp; 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