Justia Insurance Law Opinion Summaries

Plaintiff, a law firm with offices in Dallas, Texas and Atlanta, Georgia, sued to recover lost income and expenses incurred as a result of the COVID-19 pandemic under an insurance policy issued by The Cincinnati Insurance Company. The district court dismissed Plaintiff’s claims and the Fifth Circuit affirmed.   The court explained that under the policy a “Covered Cause of Loss” is a “direct ‘loss’ unless the loss is excluded or limited in this Coverage Part,” and “loss” is an “accidental physical loss or accidental physical damage.” So, to recover under any of the three forms of coverage, there must be a physical loss or physical damage to the Plaintiff’s property. Here, there was no Covered Cause of Loss as there was no underlying physical loss or damage to insured property. Plaintiff was not deprived of its property nor was there a tangible alteration to its property, so there was no underlying “direct ‘loss’” to trigger coverage. View "Ferrer & Poirot v. Cincinnati Ins Company" on Justia Law

Saltz, a plastic surgeon, was sued by a former patient for releasing her photographs to a news outlet. Saltz submitted his legal defense to his malpractice insurance provider, UMIA, which initially defended Saltz but sought a declaratory judgment, claiming that Saltz lacked insurance coverage for the former patient’s claims. The district court found that Saltz was not covered under the plain language of the policy and dismissed his claim for waiver and his request for punitive damages but denied UMIA’s motion for judgment as a matter of law and allowed Saltz’s promissory estoppel and breach of the duty of good faith claims. Over UMIA’s objections, the court also allowed evidence from a settlement negotiation to be presented to the jury, which found in favor of Saltz on both claims.The Utah Supreme Court affirmed in part, reversed in part, and remanded for further proceedings on Saltz’s requests for punitive damages and for attorney fees incurred on appeal. The district court properly allowed Saltz’s claims for promissory estoppel and breach of the duty of good faith to go to the jury; the court was correct to deny UMIA’s motion for a new trial on the claim for breach of the duty of good faith. The court upheld the admission of evidence from the settlement talks. The district court erred in dismissing Saltz’s claims for waiver and for punitive damages. View "UMIA Insurance, Inc. v. Saltz" on Justia Law

A Surety on a $50,000 bail bond appeals from an order denying its motion to set aside a summary judgment entered on the bond. Surety contends the summary judgment entered on the bail bond is voidable and must be vacated because it was not filed within 90 days after the appearance period expired as required by Penal 2 Code section 1306, subdivision (c).   The trial court concluded the Surety was estopped from arguing the reinstatement order was void. As Surety’s challenge to the summary judgment was based on the invalidity of the reinstatement order, the court concluded that the challenge must fail.   The Fifth Appellate District agreed with Surety’s contention that the trial court lacked the authority to reinstate the bond after the appearance period expired. However, the trial court correctly decided that Surety’s conduct estopped it from raising the invalidity of the reinstatement order as a basis for vacating the summary judgment. Here, Surety (1) had prior notice that a reinstatement order would be entered, (2) gave its written consent to the reinstatement, (3) paid a $50 reinstatement fee a few days after the reinstatement order, and (4) benefited when the forfeited $50,000 bail bond was reinstated. Furthermore, the trial court relied on Surety’s consent when it vacated the forfeiture and reinstated the bail bond. The court concluded such circumstances estop Surety from arguing the reinstatement order was invalid. Because the invalidity of the reinstatement order is a necessary condition to Surety’s argument that the summary judgment is voidable. View "P. v. Accredited Surety and Casualty Co." on Justia Law

The First Circuit certified to the Massachusetts Supreme Judicial Court (SJC) a question regarding whether Massachusetts recognizes a common-law duty for insurers to cover costs incurred by an insured party to prevent imminent covered loss.Ken's Foods incurred extensive losses from an accidental discharge at one of its processing facilities caused wastewater to enter Georgia waterways. Ken's Foods filed a claim with Steadfast Insurance Company seeking clean-up expenses and business losses resulting from a "pollution event" that cause a "suspension of operations." When Steadfast refused to reimburse Ken's Foods for the cost of its prevention efforts Ken's Foods sued in Massachusetts federal court. At issue was whether Ken's Foods could recover from Steadfast the costs it incurred to avoid suspending its operations after the pollution discharge. The district court granted summary judgment for Steadfast. The First Circuit concluded that certification was necessary and certified to the SJC the issue. View "Ken's Foods, Inc. v. Steadfast Insurance Co." on Justia Law

Plaintiffs, a group of restaurants, filed claims through their respective insurance policies seeking coverage for losses and expenses related to the COVID-19 pandemic. Insurers denied Plaintiffs' claims and, upon Plaintiff's filing suit, the district court granted the insurance companies' motion for summary judgment.On appeal to the Eighth Circuit, the court held that under either Kansas or Missouri law, Plaintiffs' claims fail. Under both states' laws, there is a "physical loss or damage" which requires some form of "physical alteration" to the insured's property. Here, Plaintiffs did not prove that the presence of COVID-19 resulted in any physical alteration to their property. The court also rejected Plaintiffs' argument that their claims were covered under the "Limited Extension for Food-Borne Illness," finding that this claim also required a showing that there was a "direct physical loss of or damage to property," which Plaintiffs did not allege. View "Planet Sub Holdings, Inc. v. State Auto Property & Casualty" on Justia Law

SUNZ Insurance Company (“SUNZ”) appealed from the denial of its motion to dismiss or, in the alternative, to compel arbitration of the crossclaims filed in a complex insurance dispute. SUNZ argued the district court lacked subject matter jurisdiction over the crossclaims between non-diverse parties in the underlying interpleader action and otherwise erred by denying arbitration.   The Eighth Circuit reversed and remanded the district court’s denial of Defendant’s motion to compel arbitration of the crossclaims. The court explained arbitration agreements are generally favored under federal law. Further, a court may not rule on the potential merits of the underlying claim that is assigned by contract to an arbitrator, even if it appears to be frivolous.Here, the Program Agreement sets forth the terms and conditions of the Policy and contains the disputed statements pertaining to collateral, costs, and fees. The Policy cannot be read without the Program Agreement, which explicitly controls the administration of the Policy and only becomes binding and enforceable after its execution. While the other party’s crossclaim alleges that SUNZ breached the Policy, it is the Program Agreement that drives the question of liability. And, under the Program Agreement, both parties agreed to submit to arbitration any disagreement regarding its terms. This is a challenge to the contract’s validity that, under Buckeye, shall be considered by an arbitrator, not a court. Thus, the district court erred when it denied SUNZ’s alternative motion to compel arbitration. View "SUNZ Insurance Company v. Butler American Holdings Inc." on Justia Law

Dukes Clothing, LLC (“Dukes”) operated two clothing stores. As a result of the state orders and a customer’s exposure to COVID-19, Dukes was forced to close its doors. These closures resulted in lost business income for Dukes. Dukes’s insurer, The Cincinnati Insurance Company (“Cincinnati”), had issued an all-risk commercial insurance policy to Dukes. Dukes submitted a claim under its policy to recover its loss of business income due to its store closures caused by COVID-19. Cincinnati denied the claim on the basis that Dukes’s income loss was not caused by a direct physical loss or damage to the insured’s property.   The Eleventh Circuit affirmed the district court’s dismissal of Plaintiff’s claims holding that Plaintiff’s income loss was not caused by a direct physical loss or damage to the insured’s property. The court explained that when examining insurance policies, Alabama courts consider the language of the policy as a whole, not in isolation. There are no Alabama appellate court decisions interpreting the relevant terms here—physical loss or damage—or interpreting these types of all-risk policies in the COVID-19 context so the court looked to its’ decisions interpreting nearly identical terms under Florida and Georgia law. Ultimately, the court found that since COVID-19 does not cause a “tangible alteration of the property” such that the property could not be used in the future or needed repairs to be used, lost business income resulting from COVID-19 could not constitute a “physical loss of or damage to” the property necessary for insurance coverage. View "Dukes Clothing, LLC v. The Cincinnati Insurance Company" on Justia Law

Tymoc died in a single-car accident. At the time of the accident, Tymoc was traveling between 80-100 miles per hour; the speed limit was 60 miles per hour speed. As Tymoc attempted to pass multiple cars, the gap between a car in the right lane and a box truck in the left lane closed. Tymoc veered to the right, causing his vehicle to drive off the road, roll down an embankment, striking multiple trees, and flip over several times.Through his employer, Tymoc was covered by Unum life insurance; the policy provided both basic life insurance coverage and an additional accidental death benefit. Unum approved a $100,000 payment of group life insurance benefits but withheld $100,000 in accidental death benefits, explaining that Tymoc’s conduct—speeding and reckless driving—caused his death, thereby triggering the policy’s crime exclusion. In a suit under the Employee Retirement Income Security Act, 29 U.S.C. 1001– 1191d, the district court entered in Fulkerson’s favor as to the accidental death benefits. The Sixth Circuit reversed. Reckless driving falls within the unambiguous plain meaning of crime. View "Fulkerson v. Unum Life Insurance Co. of America" on Justia Law

When the first Covid-19 cases appeared in Georgia, the governor declared a public state of emergency. Plaintiff’s restaurant played its part by suspending dine-in service. To recover the income, it was losing by closing its doors, Plaintiff quickly filed a claim with its insurer, Allied Insurance Company of America. Under Plaintiff’s “Premier Businessowners Property Coverage” policy, Allied agreed to “pay for direct physical loss of or damage to Covered Property” if it was “caused by or resulting from any Covered Cause of Loss.”   Allied denied coverage. It found that Plaintiff’s closure was not caused by any “direct physical loss or damage.” And under the policy’s Virus or Bacteria exclusion, Allied refused to “pay for loss or damage caused directly or indirectly” by any “virus.” The district court dismissed Plaintiff’s complaint for failure to state a claim. It held that no “direct physical loss of or damage to” property occurred because the restaurant and its dining room “underwent no physical change.”   The Eleventh Circuit affirmed the district court’s ruling, holding that the harm does not extend to the intangible harm caused by Covid-19 or by a declaration of public emergency issued in its wake. Plaintiff alleged no actual change to its property. Even if the court assumed that the governor’s Covid-19 order caused loss because it deprived the restaurant of the use of its property, that does not result in a win for Plainitff. Allied agreed to provide for only one manner of loss—the physical loss of Henry’s property and to be physical it must be “tangible or concrete.” View "Henry's Louisiana Grill, Inc., et al v. Allied Insurance Company of America" on Justia Law

Plaintiff appealed the district court’s summary judgment dismissal of the breach of contract claims that he has asserted, as a third-party beneficiary, against Defendant. The district court determined that the insurer’s duty to defend its insured, on which Plaintiff’s claims were based, was never triggered, relative to Plaintiff’s underlying personal injury suit, because the insured, N.F. Painting, Inc., never requested a defense or sought coverage.   The Fifth Circuit affirmed finding no error in the district court’s assessment under Texas law. The court explained that it is well-established, that under Texas law, despite having knowledge and opportunity, an insurer is not required to simply interject itself into a proceeding on its insured’s behalf.   Here, as stated, N.F. Painting did not seek defense or coverage from Defendant when it was served with Plaintiff’s original state court petition. The undisputed facts show that N.F. Painting chose, with the assistance of counsel, to handle Plaintiff’s personal injury claims in its own way, without involving Defendantin its defense, as it was entitled to do. And Plaintiff has put forth no evidence suggesting that Defendant was not entitled to rely on that decision. Having made that decision, it is N.F. Painting, and thus Plaintiff, as third-party beneficiary, not Defendant who must bear responsibility for any resulting adverse consequences. In other words, the law will not permit a third-party beneficiary to simply disregard an insured’s litigation decisions, i.e., essentially re-write history, merely because he has no other means of satisfying his judgment against the insured. View "Moreno v. Sentinel Ins" on Justia Law