The case may have seemed simple enough to the courts at first: interpret a contract. The main question in the case before the U.S. Court of Appeals for the Fifth Circuit was whether to apply the business’ projected income versus the actual income when calculating the coinsurance reward. The Court had to determine whether the language in the insurance policy and contract was clear as to which income it referred to. The Court applied Louisiana law, and indicated that courts must apply the contract as a whole, rather than in separate parts. The Court also applied the same law, which prior Louisiana Supreme Court decisions established, in determining that a court must enforce a contract as it is written when the contract’s meaning is clear and unambiguous.
Advance Products & Systems, Inc., (APS) of Scott, Louisiana, purchased an insurance policy in from Mt. Hawley Insurance Company in November of 2009 for its commercial property. Mt. Hawley Insurance Company is an Illinois company with a Baton Rouge agent. A fire damaged APS’s facility in September of 2010, about ten months after Mt. Hawley issued the policy. A dispute subsequently arose between Mt. Hawley and APS during the claims-adjustment process, and Mt. Hawley then sued APS in a Louisiana federal court – the United States District Court for the Western District of Louisiana. Mt. Hawley had the option to sue in federal court since the two parties were incorporated in different states.
The dispute stemmed from two provisions in the insurance policy. The first provision involved coverage for income lost – business income coverage; the second, a coinsurance clause, required APS to be responsible for a percentage of certain losses because APS chose to purchase a limited level of coverage, as opposed to the full value of its income. The policy applied the coinsurance clause as a penalty when the policy limit amounted to less than 90 percent of the sum of the net income and operating expenses ‘that would have been earned or incurred’ over a 12-month period. APS’s coverage limit was $500,000; whereas it claimed to have lost $723,109 of income as a result of the fire.