{"id":894986,"date":"2018-10-03T11:09:51","date_gmt":"2018-10-03T17:09:51","guid":{"rendered":"https:\/\/www.myconstructionexpert.com\/blog\/?p=894986"},"modified":"2018-10-04T11:18:35","modified_gmt":"2018-10-04T17:18:35","slug":"failure-plead-plausible-claims-defeats-lawsuit","status":"publish","type":"post","link":"https:\/\/www.myconstructionexpert.com\/blog\/failure-plead-plausible-claims-defeats-lawsuit\/","title":{"rendered":"Failure to Plead Plausible Claims Defeats Lawsuit"},"content":{"rendered":"

Barry Zalma | Zalma on Insurance<\/a> | September 11, 2018<\/p>\n

It is the obligation of every lawyer representing a plaintiff to plead plausible claims for relief or find the suit dismissed summarily. In\u00a0Eileen Coonce v. CSAA Fire & Casualty Insurance Company, and Automobile Club Insurance Company; AAA Fire & Casualty Insurance Company,<\/em>\u00a0No. 18-7000, United States Court Of Appeals For The Tenth Circuit (September 4, 2018) the failure to plead plausible claims for relief resulted in dismissal by the trial court and affirmed by the Tenth Circuit.<\/p>\n

FACTS<\/strong><\/h2>\n

On February 15, 2014, tenants living in a certain house in Broken Arrow, Oklahoma, returned home from dinner to find the ceiling in the living and dining areas had caved in. An engineering survey determined the nails used in construction had failed to hold. The home\u2019s owner, Eileen Coonce, made a claim against an insurance policy (the Policy) issued for the house by CSAA Fire & Casualty Insurance Company, doing business as AAA Fire & Casualty Insurance Company. CSAA denied coverage.<\/p>\n

After giving Coonce two opportunities to amend her complaint, the district court granted CSAA\u2019s Fed. R. Civ. P. 12(b)(6) motion to dismiss for failure to state a claim. It held the Policy excluded coverage for the ceiling collapse, and because the Policy did not cover the collapse, there could be no bad-faith claim.<\/p>\n

ANALYSIS<\/strong><\/h2>\n

In\u00a0Ashcroft v<\/em>.\u00a0Iqbal<\/em>, 556 U.S. 662 (2009), the Supreme Court directed:<\/p>\n

To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to state a claim to relief\u00a0<\/em>that is plausible on its face. A claim has factual plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged. The plausibility standard is not akin to a probability requirement, but it asks for more than a sheer possibility that a defendant has acted unlawfully.<\/em>\u00a0Where a complaint pleads facts that are merely consistent with a defendant\u2019s liability, it stops short of the line between possibility and plausibility\u00a0of entitlement to relief. (Emphasis added)
\n<\/em><\/p><\/blockquote>\n

Iqbal<\/em>\u2018s plausibility standard controlled the outcome of the appeal. Coonce argued her Second Amended Complaint pleads plausible claims. To the contrary, the Second Amended Complaint fails to allege any facts to overcome the Policy\u2019s unambiguous exclusions and limitations of coverage, and therefore it fails to plausibly establish coverage under the Policy or a bad-faith denial of coverage.<\/p>\n

Although the Policy undisputedly covers the dwelling, it explicitly does\u00a0not<\/em>\u00a0cover losses \u201c[i]nvolving collapse, except as provided in [paragraph] Collapse under Section I \u2013 Property Coverages.\u201d\u00a0\u00a0 The Second Amended Complaint invokes paragraph E.8. to allege coverage under the Policy.<\/p>\n

Paragraph E.8. first defines \u201ccollapse\u201d for purposes of the Policy. It then establishes coverage for direct physical loss to covered property involving collapse of a building or any part of a building\u00a0if the collapse was caused by one or more of the following<\/em>: (1) The Perils Insured Against named under Coverage C; (2) Decay that is hidden from view, unless the presence of such decay is known to an \u201cinsured\u201d prior to collapse; (3) Insect or vermin damage that is hidden from view, unless the presence of such damage is known to an \u201cinsured\u201d prior to collapse; (4) Weight of contents, equipment, animals or people; (5) Weight of rain which collects on a roof; or (6) Use of defective material or methods in construction, remodeling or renovation if the collapse occurs during the course of the construction, remodeling or renovation.\u201d<\/p>\n

Thus, the Policy makes it clear losses due to a collapse are covered only in certain specified circumstances.<\/p>\n

The parties disputed whether the ceiling cave-in qualified as a \u201ccollapse\u201d under the Policy, with the district court declining to decide the question in favor of CSAA at the dismissal stage. We need not decide that issue. Even assuming the cave-in was a \u201ccollapse,\u201d the Policy covers only a \u201ccollapse\u201d caused by one or more of the listed circumstances. But the Second Amended Complaint does not contain any well-pleaded facts to show any of these circumstances would apply. To the contrary, the sole averment concerning the cause of the cave-in is that CSAA\u2019s \u201cengineering firm concluded that the ceiling collapsed because the nails did not hold.\u201d This assertion undermines any inference paragraph E.8.\u2019s limited coverage would apply.<\/p>\n

In addition, as CSAA argues, the Policy also unambiguously declines to insure \u201closs . . . [e]xcluded under Section I \u2013 Exclusions,\u201d and \u201closs . . . [c]aused by . . . [w]ear and tear, marring, [or] deterioration.\u201d In turn, \u201cSection I \u2013 Exclusions\u201d denied coverage for loss caused by \u201c[f]aulty, inadequate or defective\u201d \u201c[d]esign, specifications, workmanship, repair, [or] construction\u201d or \u201c[f]aulty, inadequate or defective\u201d \u201c[m]aterials used in repair, construction, renovation or remodeling . . . of part or all of [the] property.\u201d The Second Amended Complaint does not contain any facts showing these exclusions do not apply.<\/p>\n

Instead, as with Coonce\u2019s \u201ccollapse\u201d argument, the allegations tend to show the exclusions would apply.<\/p>\n

In sum, to overcome the motion to dismiss, Coonce had to plead\u00a0plausible<\/em>\u00a0claims. And in light of the Policy\u2019s plain language, to make plausible a claim for coverage of the ceiling collapse, she had to include well-pleaded facts showing one or more of the paragraph 8.E. circumstances would apply and the other unambiguous exclusions would not apply. Because she failed to do so, and therefore failed to nudge her claims across the line from conceivable to plausible, the Tenth Circuit concluded her complaint must be dismissed.<\/p>\n

As for the bad-faith claim, under Oklahoma law, tort liability arises only where there is a clear showing that the insurer unreasonably, and in bad faith, withholds payment of the claim of its insured. When a court concludes there was no breach of an insurance policy, it follows a company\u2019s denial of coverage was not unreasonable. Because the Second Amended Complaint lacks well-pleaded facts showing coverage and a breach under the Policy, the district court also did not err in concluding Coonce did not state a plausible bad-faith claim.<\/p>\n

ZALMA OPINION<\/strong><\/h1>\n

Either the insured\u2019s lawyers were incompetent and could not plead a plausible set of facts that would allow for coverage of the \u201ccollapse\u201d or, more likely, there were no facts that plausibly allowed for coverage, the suit was destined to fail. Lawyers, although creative, will not state false facts in a pleading to get to trial. There was simply no coverage for Ms. Coonce\u2019s loss and the best that could be said was she presented a fair try and probably should have accepted the trial court\u2019s decision to save the appellate lawyers\u2019 fees.<\/p>\n","protected":false},"excerpt":{"rendered":"

Barry Zalma | Zalma on Insurance | September 11, 2018 It is the obligation of every lawyer representing a plaintiff to plead plausible claims for relief or find the suit dismissed summarily. In\u00a0Eileen Coonce v. CSAA Fire & Casualty Insurance Company, and Automobile Club Insurance Company; AAA Fire & Casualty Insurance Company,\u00a0No. 18-7000, United States… Continue reading Failure to Plead Plausible Claims Defeats Lawsuit<\/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":[9895,3,10609],"class_list":["post-894986","post","type-post","status-publish","format-standard","hentry","category-insurance-claims","tag-advise-consult","tag-insurance-claims","tag-plead-plausible-claims","entry"],"jetpack_publicize_connections":[],"yoast_head":"\nFailure to Plead Plausible Claims Defeats Lawsuit - 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