Justia Insurance Law Opinion Summaries

Where an insurance policy is restricted to liability for any bodily injury “caused, in whole or in part” by the “acts of omissions” of the named insured, the coverage applies to injury proximately caused by the named insured.The Appellate Division denied summary judgment in favor of the insurance company on the issue of coverage after interpreting this policy language as extending coverage broadly to any injury causally linked to the named insured. The court also concluded that an additional insured may collect for an injury caused solely by its own negligence even where the named insured bears no legal fault for the underlying harm. The Court of Appeals reversed, holding that the language “caused, in whole or in part” requires the insured to be the proximate cause of the injury giving rise to liability, not merely the “but for” cause. View "Burlington Insurance Co. v. New York City Transit Authority" on Justia Law

Plaintiffs commenced this action seeking a declaration of coverage under a program of builder’s risk insurance furnished by Defendants for weather-related damage to a tower crane. The Appellate Division granted summary judgment declaring that Defendants had no obligation to provide coverage for the subject loss under the policy. At issue in this case was (1) whether the crane was covered in the first instance under the insurance provided for temporary works and, if so, whether the contractor’s tools exclusion defeated that initial grant of coverage; and (2) whether the contractor’s tools exclusion was ineffective because it would render the coverage granted in the first instance for temporary works illusory. The Court of Appeals affirmed, holding (1) assuming that the policy contains coverage for the crane in the first instance, the contractor’s tools exclusion would defeat that coverage; and (2) the contractor’s tools exclusion does not render the coverage afforded under the temporary works provision of the policy illusory. View "Lend Lease (US) Construction LMB Inc. v. Zurich American Insurance Co." on Justia Law

Luz Herrera was injured in an accident while operating a vehicle insured by Hanover Insurance Company, a no-fault insurer. Herrera also had private health insurance through Aetna Health Plan. Herrera received medical treatment for her injuries, and the medical providers submitted some of their bills directly to Aetna, who paid the bills. Aetna subsequently sought reimbursement from Hanover, but Hanover did not respond. Meanwhile, Aetna filed a lien against Herrera for reimbursement. Herrera then resubmitted all of the medical bills to Hanover and assigned her rights against Hanover to Aetna. Aetna then commenced this action against Hanover seeking reimbursement for the medical bills it paid on Herrera’s behalf. Supreme Court dismissed the complaint, concluding (1) because Aetna was not a “health care provider” under the no-fault statute, it was not entitled to direct payment of no-fault benefits; (2) Aetna was neither in privity of contract with Hanover nor an intended third-party beneficiary of Hanover’s contract with Herrera; and (3) Aetna could not maintain a subrogation claim against Hanover. The Appellate Division affirmed. The Court of Appeals affirmed, holding that New York’s Comprehensive Motor Vehicle Reparations Act statutory law and regulatory scheme does not contemplate reimbursement to a health insurer, as opposed to a health care provider. View "Aetna Health Plans v. Hanover Ins. Co." on Justia Law

The Glidden Company - now known as Akzo Nobel Paints LLC (ANP) - made, marketed, and sold lead paint. Based on a 1986 purchase agreement, Millennium Holdings LLC, which Appellant insurance companies insured, and its predecessors were required to indemnify ANP and its predecessors from 1986 to 1994. In turn, ANP and its predecessors were required to indemnify Millennium and its predecessors from 1994 onward. Beginning in 1987, a number of lead paint related lawsuits were filed against the predecessors of Millennium and ANP (the lead cases). Appellants satisfied Millennium’s obligations pursuant to monetary settlements reached in the cases. Appellants subsequently commenced this action against ANP seeking to be subrogated to the right of Millennium to indemnification against ANP. Supreme Court determined that the antisubrogation rule prohibited Appellants' right of subrogation. The Appellate Division affirmed. The Court of Appeals reversed, holding that there was no reason to apply to antisubrogation rule under the facts of this case, and therefore, the courts below erred in granting summary judgment for ANP on that basis. View "Millennium Holdings LLC v. Glidden Co." on Justia Law

At issue in this case was whether two companies (the Insureds) were entitled to coverage under additional excess policies issued to their predecessor by the Excess Insurers and, if so, how indemnity should be allocated across the triggered policy periods. The Delaware Court of Chancery granted summary judgment for the Insureds with respect to the availability of coverage and the allocation of liability under the excess policies, concluding that New York law applied to the dispute, that the Insureds were each entitled to coverage under the excess policies, and that the proper method of allocation was the all sums approach, as compared with the pro rata allocation method propounded by the Excess Insurers. After a trial, the Delaware Superior Court entered judgment largely in the Insureds’ favor. On appeal, the Delaware Supreme Court concluded that resolution of the parties’ disputes over allocation and exhaustion depended on unsettled questions of New York law. The Court of Appeals answered (1) under New York law, the contract language of the applicable insurance policies controlled the questions certified to the Court; (2) all sums allocation was appropriate based on the language of the policies at issue here; and (3) vertical, rather than horizontal, exhaustion was required before the excess policies attached. View "In re Viking Pump, Inc." on Justia Law

Defendant, Avanguard Medical Group, PLLC was accredited by the State of New York as a facility for the provision of office-based surgery (OBS). Plaintiffs (collectively, GEICO) commenced this action for a declaratory judgment that GEICO was not legally obligated under N.Y. Ins. Law 5102 to reimburse Avanguard for facility fees related to the use of its physical location and related support services. Supreme Court denied GEICO’s motion for summary judgment. The Appellate Division reversed and granted the motion, declaring that GEICO was not required to reimburse Avanguard for OBS facility fees. The Court of Appeals affirmed, holding that neither the applicable statutory nor regulatory framework mandate that a no-fault insurance carrier pay a facility fee to an accredited OBS center. View "Gov’t Employees Ins. Co. v. Avanguard Med. Group, PLLC" on Justia Law

In 2002, Plaintiffs commenced a proposed class action civil rights suit against the County of Rensselaer. The County invoked Selective Insurance Company’s duty to provide a defense under the policies that the company sold to the County. Selective agreed to defend the County in the action, subject to the insurance policy limits and the deductible. Selective’s counsel and the County agreed to settle the actions for $1,000 per plaintiff, determined to be slightly more than 800 individuals in total, with attorney fees also being recoverable. Selective abided by the terms of the settlement. The County, however, refused to pay Selective more than a single deductible payment. Selective then commenced this action for money damages, arguing that each class member was subject to a separate deductible. Supreme Court concluded that a separate deductible payment applied to each class member and that all legal fees should be allocated to one policy. The Appellate Division affirmed. The Court of Appeals affirmed, holding that the class action suit did not constitute one occurrence under the relevant policies’ definition of “occurrence” and that the attorney’s fees generated in defending that suit were properly allocated to the named plaintiff. View "Selective Ins. Co. of Am. v. County of Rensselaer" on Justia Law

This case arose out of dispute over the administration of a workers’ compensation self-insurance plan (“Plan”) administered by Herkimer County. Dozens of municipalities participated in the Plan, including the Village of Herkimer. In 2005, the County passed a resolution to terminate the plan. To ensure funding for outstanding workers’ compensation claims, the County created an Abandonment Plan that allowed municipalities to withdraw from the plan and pay a lump sum withdrawal fee. Several of the participating municipalities, including the Village, filed an action challenging the Plan and Abandonment Plan based on alleged mismanagement by the County. The County counterclaimed for breach of contract, seeking to recover the withdrawal liability. The County prevailed on summary judgment as to the liability on its counterclaim for breach of contract against the Village. After a trial on damages, the jury awarded the full amount of damages sought by the County against the Village. The Appellate Division affirmed the damages award. The Court of Appeals affirmed as modified, holding that the fee for the Village’s withdrawal from the Plan reflected benefits to be paid in the future and therefore should have been discounted to its current value as of the date it was due. View "Village of Ilion v. County of Herkimer" on Justia Law

This action stemmed from property damage and the resulting business interruption sustained by Plaintiffs as a result of water damages that occurred following three separate roof breaches. Plaintiffs were Deborah Voss and three business entities owned and controlled by her. Plaintiffs sued CH Insurance Brokerage Services Co. (CHI), their insurance broker, arguing that a special relationship existed with CHI and that CHI had negligently secured inadequate levels of business interruption insurance for the three losses. Supreme Court granted summary judgment for CHI, and the Appellate Division affirmed. The Court of Appeals reversed, holding that CHI did not satisfy its initial burden of establishing the absence of a material issue of fact as to the existence of a special relationship. View "Voss v. Netherlands Ins. Co." on Justia Law

Plaintiffs brought legal malpractice claims against Jeffrey Daniels, American Guarantee & Liability Insurance Company’s insured. American Guarantee wrongly refused to defend the claims. A default judgment was entered against Daniels, who assigned his rights against American Guarantee to Plaintiffs. Plaintiffs then brought the present action seeking to enforce American Guarantee’s duty to indemnify Daniels for the judgment. Summary judgment was awarded in favor of Plaintiffs. The Appellate Division affirmed. The Court of Appeals affirmed, concluding that American Guarantee’s breach of its duty to defend barred it from relying on policy exclusions as a defense to the present lawsuit. The Court later granted reargument, vacated its prior decision, and reversed the Appellate Division’s order, holding (1) under controlling precedent, American Guarantee was not barred from relying on policy exclusions as a defense; and (2) the applicability of the exclusions American Guarantee relied on presented an issue of fact sufficient to defeat summary judgment. View "K2 Inv. Group, LLC v. Am. Guar. & Liab. Ins. Co." on Justia Law