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Category Archives: Insurance Law

Insurance Company Must Defend Contractor Regardless of CGL Policy’s Breach-of-Contract Exclusion.

29 Wednesday Aug 2018

Posted by Celia C. Elwell, RP in Construction General Liability, Contract Law, Duty to Defend, Insurance Law

≈ Comments Off on Insurance Company Must Defend Contractor Regardless of CGL Policy’s Breach-of-Contract Exclusion.

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Construction General Liability, Contract Law, Duty to Defend, Insurance Law, Justia US Law

Normally, an insurance company has no duty to defend a contractor under a construction general liability (“CGL”) policy against breach-of-contract and negligence allegations. Not this time. This time, in the Western District of Texas, the insureds won against the insurance company. The court held the breach of contract exclusion did not apply because the contractor’s subcontractor, not the contractor, could be responsible for a construction defect.

A municipality hired the general contractor to construct a sports complex that included a swimming pool, baseball and softball fields, and parking lots. The contractor hired two subcontractors – one to design and build the swimming pool, and another to do all the dirt work, grading, and storm drainage for the entire complex.

At the beginning of 2017, a contractor employee saw cracks beginning the pool and parking lot after completion of the pool and most of the sports complex. The contractor put the pool subcontractor on notice to fix the cracks. About three months later, a contractor employee noticed the cracks were worse. The contractor and the pool subcontractor were unable to agree on how to fix the pool. By the end of the year, more cracks and other defects had appeared. The city, contractor, and subcontractors could not agree on how to solve these problems.

The city sued the contractor for breach of contract and negligence. The contractor notified its insurance company and, relying on its CGL policy, asked its insurance company to defend it against the city’s lawsuit. The insurance company refused. It sued the contractor requesting a judgment declaring that it had no duty to defend the contractor in the lawsuit filed by the city based on the CGL exclusion clause.

The insurance company relied on language in its policy that specifically denied coverage to the contractor for property damage caused by the contractor. In it its lawsuit against the contractor, the city had specifically alleged that work performed by the contractor and its subcontractors was defective. The insurance policy’s exclusion did not apply to work performed by a subcontractor. The court held that, because the city’s allegations included the possibility that subcontractor alone had created the defects at issue in the city’s lawsuit, the insurance company had a duty to defend the contractor.

Mt. Hawley Insurance Company v. Slay Engineering, Texas Multi-Chem and Huser Construction, LLC, No. 5:2018cv00252 – Document 19 (W.D. Tex. 2018). You can read the entire Memorandum and Order at Justia US Law here: https://bit.ly/2wul7ka. -CCE

 

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When Insurance Is Not Renewed, What Constitutes Legal Notice?

12 Thursday Feb 2015

Posted by Celia C. Elwell, RP in Insurance Coverage, Insurance Law, Nonrenewal

≈ Comments Off on When Insurance Is Not Renewed, What Constitutes Legal Notice?

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Barry Zalma, Negligence, Nonrenewal, State Farm, Zalma on Insurance Blog

Mailing is All Needed to Perfect Nonrenewal, by Barry Zalma, Zalma On Insurance Blog

http://zalma.com/blog/mailing-is-all-needed-to-perfect-nonrenewal/

Some cases go on and on with trial decisions reversed, remanded, retried and appealed again. In Collins v. State Farm Ins. Co., ___ So.3d ___, 2015 WL 468970 (La. App. 4 Cir.), 2014-0419 (La. App. 4 Cir. 2/4/15) after eight years of litigation over damages resulting from Hurricane Katrina the insured ended up with nothing. His last attempt at recovery was to sue his agent for negligence because he did not inform the plaintiff that his policy had been non-renewed well before Katrina hit New Orleans.

The insured, Edward Collins, brought this suit against his insurer, State Farm Fire and Casualty Company (‘State Farm’), and his insurance agent, Reggie Glass. From the trial court’s judgment granting Mr. Glass’ motion for summary judgment. Mr. Collins appeals.

FACTUAL BACKGROUND

In January 2000, Mr. Collins filed a claim under his homeowner’s policy with State Farm for roof damage to his property located at 7508 Lafourche Street in New Orleans, Louisiana. State Farm adjusted the claim and paid the damages due under the policy. In September 2004, Mr. Collins submitted another claim under his homeowner’s policy. During its investigation of this claim, State Farm discovered that Mr. Collins failed to repair his roof after he was paid for his 2000 claim. State Farm thus decided not to renew Mr. Collins’ homeowner’s policy when it expired on May 30, 2005. . . .

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Duty to Defend In Insurance Case.

05 Thursday Feb 2015

Posted by Celia C. Elwell, RP in Duty to Defend, Insurance Law, Litigation, Motion in Limine, Summary judgment

≈ Comments Off on Duty to Defend In Insurance Case.

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Barry Zalma, Duty to Defend, Insurance, Motion for Summary Jugdment, Motion in Linine, Zalma on Insurance Blog

Duty to Defend Not Effected by Denial of Motion for Summary Judgment, by Barry Zalma, Zalma on Insurance

http://zalma.com/blog/duty-to-defend-not-effected-by-denial-of-motion-for-summary-judgment/

Defense Can’t Be Avoided by Use Of Limine Motions

The duty to defend owed by an insurer is very broad and requires an insurer to defend even if there is only a potential for coverage on the facts of the case and the policy wording. Usually, an order denying a motion for summary judgment seeking an order that there is no duty to defend will usually be sufficient to reveal the potential for coverage and a requirement for defense – at least under a reservation of rights – to those insured. In McMillin Companies, LLC v. American Safety Indemnity Company, — Cal.Rptr.3d —-, 2015 WL 270034 (Cal.App. 4 Dist., 1/22/15) the right to claim no duty to defend will still exist even after a motion for summary judgment is denied if the motion order is not dispositive of the claims made by the motion for summary judgment. It also criticized the use of a motion in limine (to limit testimony allowed at trial) when it had the effect of a motion for summary judgment without the protections of a motion for summary judgment. . . .

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Will Insurers Win Battle Against Rising Cancer Treatment Costs?

17 Tuesday Jun 2014

Posted by Celia C. Elwell, RP in Drug Promotion, Health Law, Health Reform, Insurance Coverage, Insurance Law

≈ Comments Off on Will Insurers Win Battle Against Rising Cancer Treatment Costs?

Tags

Cancer, Chemotherapy, Drug Prices, Health Plans, Highmark, Insurers, Oncologists, Outpatient

Insurers Take Up Fight Against Rising Chemotherapy Costs, by Julie Appleby, Kaiser Health News 

http://tinyurl.com/no6clm6

Some cancer patients and their insurers are seeing their bills for chemotherapy jump sharply, reflecting increased drug prices and hospitals’ push to buy oncologists’ practices and then bill at higher rates.

Patients say, ‘I’ve been treated with Herceptin for breast cancer for several years and it was always $5,000 for the drug and suddenly it’s $16,000 — and I was in the same room with the same doctor same nurse and the same length of time,’ said Dr. Donald Fischer, chief medical officer for Highmark, the largest health plan in Pennsylvania.

Like other insurers, Highmark found that when hospital systems bought doctors’ practices, chemotherapy costs rose because physicians’ offices were then deemed ‘hospital outpatient centers’ and could charge more for overhead.

Now insurers are pushing back. In what may be the first move of its kind, Highmark in April stopped paying higher fees for chemotherapy drugs given to patients whose doctors work for hospitals, instead paying the same price they would have had the doctor remained independent. . . .

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No Insurance Coverage = No Bad Faith.

04 Wednesday Jun 2014

Posted by Celia C. Elwell, RP in Bad Faith, Insurance Coverage, Insurance Law, Pennsylvania Superior Court

≈ Comments Off on No Insurance Coverage = No Bad Faith.

Tags

Bad Faith, Declaratory Judgment, Fire Loss, Insurance Benefits, Insurance Coverage, Traveler's Insurance

Here’s a Thought: If There Ain’t No Coverage, There Ain’t No Bad Faith, by Daniel E. Cummins, TORT TALK

http://tinyurl.com/phwn6cv

In their recent ‘non-precedential’ decision (why do they mark them ‘on-precedential’ on occasion?!) in the bad faith case of Yera v. Travelers Ins. Co., of Am., 1398 EDA 2013 (Pa. Super. April 22, 2014)(Ford Elliott, P.J.E., Ott, J., Strassburger, J.) (Opinion by Ott, J.)(Concurring and Dissenting Op. by Strassburger, J.), the Pennsylvania Superior Court affirmed a trial court’s finding that the homeowner’s insurance  carrier for the Plaintiff did not act in bad faith by waiting six (6) months to deny the Plaintiff’s fire loss claim as there could be no bad faith claim where there was an underlying decision that the carrier need not afford any coverage under the policy in any event. . . .

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The Court’s Plan for Hurricane Sandy Litigation.

05 Saturday Apr 2014

Posted by Celia C. Elwell, RP in Court Orders, Federal Judges, Insurance Law, Judges, Litigation, New Jersey District Court of Appeals

≈ Comments Off on The Court’s Plan for Hurricane Sandy Litigation.

Tags

Case Management, Chief Judge Jerome B. Simandle, Flood Insurance, Hurricane Sandy, Litigation, National Flood Insurance Program, New Jersey

Public Meeting Leads to Plan Speeding Hurricane Sandy Litigation, United States Courts Blog

http://tinyurl.com/obrkuue

Nearly a year and a half after Super Storm Sandy, New Jersey is seeing another wave. This time, it’s a surge in federal cases involving flood insurance carriers.

‘These cases are hitting our docket very hard,’ said Chief Judge Jerome B. Simandle, New Jersey District Court. ‘We have over 600 Hurricane Sandy cases now and we expect the final number could be as many as 2,000.’

With such a large and growing number of cases, Simandle took the lead. He called a public meeting to hear from homeowners, attorneys and other interested groups. On March 20th, the district’s Board of Judges adopted a plan for management of the Super Storm Sandy litigation, contained in a Standing Order and a 15-page Hurricane Sandy Case Management Order No. 1, which are available on the court’s website. . . .

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There’s No Place Like Home For Homeowner’s Insurance

18 Monday Nov 2013

Posted by Celia C. Elwell, RP in Appellate Law, Contract Law, Insurance Law, Trial Tips and Techniques

≈ Comments Off on There’s No Place Like Home For Homeowner’s Insurance

Tags

7th Circuit Court of Appeals, Brian Jones, Homeowner's Insurance, The Bose Insurance Blog

Seventh Circuit: Mailing Addresses Don’t Necessarily Identify What’s Insured, by Brian Jones, The Bose Insurance Blog

http://tinyurl.com/mkuntnh

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