Justia Insurance Law Opinion Summaries

Defendant-appellant Ricardo Lara, the California Insurance Commissioner, filed a notice of noncompliance against plaintiffs-respondents Mercury Insurance Company, Mercury Casualty Company, and California Automobile Insurance Company (collectively Mercury) alleging Mercury charged rates not approved by the California Department of Insurance (CDI) and that the rates were unfairly discriminatory in violation of Insurance Code sections 1861.01 (c) and 1861.05 (b). The allegedly unapproved rates were in the form of broker fees charged by Mercury agents, which should have been disclosed as premium. After prevailing at an administrative hearing, the Commissioner imposed civil penalties against Mercury totaling $27,593,550 for almost 184,000 unlawful acts. Mercury filed a petition for writ of mandate, which the court granted, reversing the Commissioner’s decision. The court found the “broker fees” were not premium because they were charged for separate services. The court also rejected the Commissioner’s interpretation of the term premium under the Insurance Code and regulations. In addition, the court ruled Mercury did not have proper notice it was subject to penalties, in violation of due process, and the action was barred by laches because CDI had unduly delayed in bringing the action. Commissioner and intervener-appellant, Consumer Watchdog (CWD), appealed on several grounds, among them: (1) the trial court did not use the proper standard of review; (2) failed to give the Commissioner’s findings a strong presumption of correctness and failed to put the burden of proof on Mercury to show the findings were against the weight of the evidence; (3) the trial court’s finding the fees were charged for separate services was precluded by collateral estoppel; (4) Mercury received proper notice of the potential imposition of a penalty; and (5) laches did not bar the action. The Court of Appeal agreed with Commissioner and CWD the writ was issued in error and reversed the judgment. View "Mercury Insurance Co. v. Lara" on Justia Law

The Covenants for Berkeley’s East Shore Commercial Condominiums Owners’ Association require it to maintain a master policy of all risk property insurance coverage, naming as insured the Association, the owners and all mortgagees. “Any insurance maintained by the Association shall contain [a] ‘waiver of subrogation’ as to the Association, its officers, Owners and the occupants of the Units and Mortgagees.” Article 13.4 prohibits an individual owner from obtaining fire insurance while allowing an owner to obtain individual liability insurance. The defendants leased a Commercial Condominium for a furniture manufacturing business. The Lease required the Lessee to maintain liability insurance, naming Lessor as an additional insured but did not specify which party would carry fire insurance. Western issued an insurance policy to Eastshore for the commercial properties; each owner was a named insured. A fire erupted in the condominium leased by defendants, damaging that and other units. Western paid for the fire damage then filed a subrogation complaint against defendants, alleging the fire was caused by their negligence. The trial court concluded that the Lease contemplated that the Western policy would be for defendants’ benefit so that subrogation was inappropriate. The court of appeal affirmed, concluding that defendants reasonably expected their landlord, an insured under the policy, to procure fire insurance. Western was barred from suing its own insured for negligently causing a fire, and the defendants were implied insureds under the policy, even if defendants were negligent. View "Western Heritage Insurance Co. v. Frances Todd, Inc." on Justia Law

Plaintiff appealed a judgment in favor of Farmers Insurance Exchange and Truck Insurance Exchange after the trial court determined that she was entitled to coverage under the Farmers policy as an heir of an insured under Insurance Code section 11580.2, subdivision (a)(1), but was not entitled to coverage under the Truck umbrella policy.The Court of Appeal affirmed the trial court's judgment and held that it properly ruled that plaintiff was not entitled to the uninsured motorist coverage under the Truck umbrella policy, because section 11580.2, subdivision (a)(1) did not modify the language of the Truck uninsured motorist endorsement and the endorsement governed who would be paid by Truck. The court also held that the trial court properly denied leave to file a second amended complaint; plaintiff was not entitled to coverage by estoppel; and the complaint failed to allege facts sufficient to justify reformation. View "Komorsky v. Farmers Insurance Exchange" on Justia Law

After its workers’ compensation insurance premiums rapidly increased, Jackpot believed that Applied Underwriters had mishandled its claims and had wrongfully failed to disclose how it calculated premiums. Jackpot filed suit. Applied sought to compel arbitration based on the arbitration agreement contained in a Request to Bind. Jackpot argued that the arbitration agreement was invalid. Applied contended that, under the Federal Arbitration Act, only the arbitrator could decide the threshold question of whether the arbitration agreement was enforceable. The trial court held that the arbitration agreement was invalid. The court of appeal affirmed. In light of Jackson’s specific arguments that the arbitration provision was unenforceable due to fraud, ambiguity, and unconscionability, the trial court was obligated to consider its validity. Allied violated California law in issuing the Request to Bind without first submitting it for regulatory approval. The policy does not provide for arbitration but allows for administrative review by the Insurance Commissioner for certain disputes and otherwise leaves Jackpot’s rights to judicial review intact. The Request to Bind’s arbitration agreement, which compels arbitration in Nebraska for a wide array of disputes, materially changes the policy's dispute-resolution terms and constituted “a collateral agreement that should have been filed and endorsed to the Policy” under Insurance Code section 11658. View "Jackpot Harvesting, Inc. v. Applied Underwriters, Inc." on Justia Law

After plaintiff's insured (a general contractor) secured a default judgment against defendant's insured (a subcontractor), when a homeowner obtained an arbitration award against the general contractor, plaintiff indemnified the general contractor for the arbitration award. Defendant refused to indemnify the subcontractor for the amount of the default judgment and plaintiff then filed suit to recover from defendant under Insurance Code section 11580 the amount of the default judgment against the subcontractor.The Court of Appeal affirmed the trial court's grant of summary judgment for plaintiff, holding that the default judgment was not void. The court also held that it was doubtful that the default judgment was secured in an action based upon property damage, and none of the authorities defendant cited required a contrary conclusion. The court rejected defendant's claims supporting its contention that plaintiff did not prove the default judgment was covered under any of defendant's policies. Finally, the court denied defendant's claim regarding the "per occurrence limits," and NMH's attorney fees and costs claims. View "The Insurance Company of the State of Pennsylvania v. American Safety Indemnity Co." on Justia Law

Numerous claims were filed in various jurisdictions against Deere for personal injuries arising from alleged exposure to asbestos-containing brakes, clutch assemblies, and gaskets used in Deere machines. Deere sought declaratory relief, alleging breach of contract with respect to more than 100 umbrella and excess general liability policies issued to Deere from 1958-1986. In the third phase of litigation, the trial court ruled in favor of the insurers. The court of appeal reversed, in favor of Deere. Once the first-layer excess policy’s annual aggregate limit for products liability has been exhausted, the higher-layer excess insurers’ policies are not subject to a self-insured retention per occurrence for subsequent claims. The insurers’ indemnity obligation extended to Deere’s defense costs incurred in asbestos claims that had been dismissed. View "Deere & Co. v. Allstate Insurance Co." on Justia Law

In an earlier appeal, Indiana Lumbermens Mutual Insurance Company (Lumbermens) challenged an order denying its motion to vacate summary judgment on a bail bond forfeiture and to exonerate the bail bond. The day after Lumbermens filed its notice of appeal, American Surety Company (American), the appellant here, filed an undertaking to stay enforcement of the summary judgment during the first appeal. In an unpublished opinion, the Court of Appeal affirmed the order denying Lumbermens’ motion to vacate the summary judgment and to exonerate the bail bond. Six days before the Court of Appeal issued the remittitur in the first appeal, American filed a motion in the trial court to exonerate the undertaking and to be released from liability on the undertaking. The undertaking was filed pursuant to Code of Civil Procedure section 917.1; because Lumbermens’ appeal was from a postjudgment order denying a motion to vacate the summary judgment, which was not a money judgment or an order directing the payment of money, American argued section 917.1 did not apply, and the undertaking was ineffective at all times. The trial court denied the motion, concluding American forfeited its challenge to the validity of the undertaking by waiting to file its motion until 57 days after the Appeals Court issued its opinion in the first appeal, and six days before the remittitur. In this case, American renewed its argument the undertaking it filed on behalf of Lumbermens was ineffective because Lumbermens appealed from a postjudgment order, and not from the summary judgment itself and, therefore, the stay provided for in section 917.1 was never triggered. In addition, American argued the undertaking never became effective because the trial court did not approve it as required by statute. The Court of Appeal determined American was correct that the undertaking it filed in the first appeal was never effective. Likewise, American was correct that, even if section 917.1 applied to Lumbermens’ appeal, the undertaking was not effective because the trial court did not approve of it pursuant to section 995.840 (a). Nonetheless, the Court agreed with the State that American forfeited its challenge to the validity of the undertaking by waiting until six days before the issuance of the remittitur to file its motion to vacate the undertaking. And, even if the Court concluded American did not forfeit its challenges to the undertaking, the Court agreed with the State that American was estopped from challenging the undertaking on appeal. View "California v. American Surety Co." on Justia Law

The Strawns’ home and pickup, which were insured by State Farm were “damaged and destroyed” by fire on June 1, 2009. They immediately notified State Farm. Dennis Strawn was prosecuted for arson, but the case was dismissed in February 2013. In August 2015, State Farm informed the Strawns that it was denying their claims on the ground that Dennis Strawn had intentionally set the fire and Diane Strawn had fraudulently concealed evidence of this wrongful conduct. In August 2016, the Strawns sued, alleging breach of contract, breach of the covenant of good faith and fair dealing, intentional infliction of emotional distress, invasion of privacy and elder abuse. The claims for invasion of privacy and elder abuse were also alleged against Wood, the attorney who represented State Farm, and MPP, Wood’s law firm. The trial court dismissed the claims against the attorneys. The court of appeal affirmed as to financial elder abuse but reversed as to the claim of invasion of privacy, which alleged that Wood improperly provided the Strawns’ tax returns to State Farm and its accountants despite their assertion of their privilege to not disclose the returns. View "Strawn v. Morris, Polich & Purdy" on Justia Law

The employer, Luxor Cabs, obtained workers' compensation insurance through AUCRA under an EquityComp program. The EquityComp workers’ compensation insurance program has garnered nationwide attention from administrative agencies and judicial tribunals. In 2016, the California Insurance Commissioner issued an administrative decision concluding that the EquityComp program violated state insurance laws and that the reinsurance participation agreement (RPA) between AUCRA and the insured employer, in that case, was void as a matter of law. In 2018, the Fourth Appellate District came to a similar decision in a case essentially identical to this one involving arbitrability under an RPA. Luxor, unhappy with AUCRA's handling of claims, filed suit. The court of appeal affirmed the denial of AUCRA’s motion to compel arbitration pursuant to the terms of an RPA between an employer, Luxor Cabs, and AUCRA. The trial court properly rejected an argument that the validity of the arbitration clause should, itself, have been referred to arbitration in accordance with the RPA’s “delegation clause.” Both the delegation clause and the arbitration provision in the RPA were void and unenforceable because they each separately constituted an “endorsement” to the Policy which was not properly vetted and approved as required by Insurance Code section 11658. View "Luxor Cabs, Inc. v. Applied Underwriters Captive Risk Assurance Co." on Justia Law

A jury convicted former United States Postal Service employee Robert Hamilton of three counts of making a false or fraudulent statement for the purpose of obtaining compensation under the California workers' compensation law. On appeal, Hamilton argued: (1) because, as a federal employee, his workers' compensation benefits were provided under the Federal Employment Compensation Act, the doctrine of federal preemption barred him from being prosecuted under California law for any offense alleging fraud in obtaining federal workers' compensation benefits under FECA; and (2) regardless of whether the prosecution was preempted, his conviction was supported by insufficient evidence under Insurance Code section 1871.4 (a)(1) because that statute applied only to false or fraudulent statements made for the purpose of obtaining compensation afforded under the California workers' compensation law, which was not applicable to him as a federal employee. On the issue of federal preemption, the Court of Appeal concluded that Hamilton did not meet his burden to establish that the State's prosecution of him was preempted. With respect to the sufficiency of the evidence, the Court agreed with the State's concession that insufficient evidence supported Hamilton's convictions because he did not receive compensation under the California workers' compensation law. The Court declined to exercise discretion to modify the judgment to impose convictions on a lesser included offense. Accordingly, the judgment was reversed. View "California v. Hamilton" on Justia Law