Tuesday, July 8, 2014

Insurance Coverage Newsletter June 2014

insurance

NEW YORK                                                                                          June 2014

Late Notice - Statutory Waiver
Policyholder's § 3420(d) Waiver Rebuttal to Insurer's Late Notice Defense is Limited to Bodily Injury Claims Arising in New York State; Inapplicable in Environmental Property Damage Dispute
  
KeySpan Gas E. Corp. v. Munich Reins. Am., Inc., 2014 N.Y. LEXIS 1319 (N.Y. June 10, 2014)
   
The New York Court of Appeals ruled that an appellate court wrongly applied the strict timeliness standard from Insurance Law § 3420(d)(2) in considering whether insurer waived its late-notice defense in an environmental property damage coverage action.

The insured, the former owner and operator of multiple gas plant facilities, brought the following action against several excess insurers seeking a declaration that these insurers owed a duty to defend and indemnify the insured for liabilities associated with the investigation and remediation of the environmental damage at its facilities.  In later 1994, the insured first notified the excess insurers of "environmental concerns" at the facilities - -though no regulatory suit had been filed nor investigation commenced - - and requested the insurers acknowledge its indemnity obligation for liabilities the insured may incur.  In response, the insurers generally reserved all rights, including its right to disclaim based on late notice, and sought documentation showing exhaustion of underlying policy limits.  Shortly thereafter, in early 1995, the New York State Department of Environmental Conservation commenced a formal investigation.


Declaratory Judgment - Fee Shifting
Court Rules Insurer Must Reimburse Policyholder's Counsel Fees Incurred in Connection with Declaratory Judgment Counterclaim

American Home Assur. Co. v Port Auth. of N.Y. & N.J., 2014 N.Y. Misc. LEXIS 2540 (N.Y. Sup. Ct. June 4, 2014)

A New York trial court applied the Mighty Midgets fee-shifting rule to a policyholder which successfully prevailed on a counterclaim in response to an insurer's affirmative declaratory judgment action, requiring the insurer to reimburse the policyholder's reasonable attorneys' fees incurred in defending against the insurer's lawsuit and in prosecuting its "mirror image" counterclaim.

An insurer initiated a declaratory judgment against its insured seeking a ruling regarding its obligations under a policy for underlying asbestos claims arising out of the construction of the original World Trade Center.  Specifically, the insurer argued it had paid its full policy limits and sought a declaration it had no further obligation to defend or indemnify its insured for any pending asbestos claim.  The insured answered and asserted four claims, one of which, was a "mirror-image declaration to the one sought by [the insurer], i.e. that [the insurer] 'is obligated to provide the [insured] with insurance coverage for the WTC Asbestos Claims pursuant to the terms of the Policy and applicable law.'"


NEW JERSEY

Claims Made - Late Notice 
Notice Requirement in Claims Made Policy Strictly Enforced; Six Months' Late Notice Voids Coverage

Templo Fuente De Vida Corp. v. National Union Fire Ins. Co., 2014 N.J. Super. Unpub. LEXIS 1303 (App. Div. June 6, 2014)

The New Jersey Appellate Division strictly enforced the policy condition of a claims-made insurance policy that required the policyholder to notify the insurer of a claim "as soon as practicable" and ruled that the question of whether the insurer was prejudiced by virtue of late notice is irrelevant when considering the notice condition in a claims-made policy.

The insured failed to provide its claims-made insurer with notice "as soon as practicable" when six months elapsed between the date on which the insured was served with an underlying complaint to the date on which the insured notified the insurer of the claim. That finding alone vitiated coverage, as the "appreciable prejudice" prong of late notice analysis in New Jersey applies to occurrence policies but not claims-made ones.


Commercial Auto - Loading and Unloading Coverage
Commercial Auto Policy Extends "Loading and Unloading" Coverage Only Where Negligence Directly Results from Policyholder's Use of the Insured Auto; Not to Claims Couched in Premises Liability   

Burlington Coat Factory of N.J., L.L.C. v. Jay Dee Trucking, 2014 N.J. Super. Unpub. LEXIS 1252 (App. Div. June 2, 2014)

The New Jersey Appellate Division clarified the scope of "loading and unloading" coverage prescribed in a commercial auto policy is limited to circumstances where the insured's alleged negligence stems from loading and unloading of the insured truck or vehicle, and declined to extend coverage to claims sounding in premises liability.

In this commercial auto coverage dispute, the underlying plaintiff sued a premises owner after slipping on a piece of plywood which bridged the gap between a delivery truck and a loading dock.   In turn, the premises owner sued the insurer of the delivery truck seeking "loading and unloading" coverage under a commercial auto policy covering the delivery truck. The Appellate Division rejected the premises owner's demand for loading and unloading coverage, because the alleged negligence resulted from a condition of the premises, as opposed to the actual unloading of the truck.
  


Occurrence - Prior Acts Endorsement
No Coverage for Philandering Priest Under Prior Acts Counseling Endorsement

Drew v. Church Mut. Ins. Co., 2014 U.S. Dist. LEXIS 73562 (D.N.J. May 29, 2014)

A priest counseled a man in his parish to get divorced. The priest neglected to tell the parishioner that he was having an affair with the man's wife. The priest's insurer was found to have no coverage responsibility in relation to the eventual settlement pursuant to the "Prior Acts" endorsement in the policy.

A priest had sexual relations with a married parishioner in early 2009. Soon after, he counseled the woman's husband to acquiesce to her request for a divorce. The husband learned of the affair and filed suit against the priest, alleging a breach of fiduciary duty and negligent infliction of emotional distress. The priest filed a declaratory judgment action against his insurer after the latter refused to provide defense or indemnification. The underlying parties subsequently settled the suit, and the priest assigned his claim for indemnification under the policy to the husband. 


This newsletter contains summaries of New York and New Jersey insurance coverage decisions entered during the previous month. If you see a topic that interests you, click the link to read more and obtain a full copy of the case.
For further information, please contact the Newsletter Editors, Jonathan McHenry, Neil Mody, William P. Krauss 
and William D. Deveau at (973) 535-0500 or email us by clicking here.
The cases annexed to this newsletter have been reproduced by Connell Foley LLP with the permission of LexisNexis. Copyright 2014, LexisNexis, a division of Reed Elsevier Inc. No copyright is claimed as to any part of the original work prepared by a government officer or employee as part of that person's official duties.

©2014 Connell Foley.

The information contained in this electronic message and any attached document(s) is intended for the personal use of designated recipients. This document is for informational purposes only, and is a means of disseminating general information about judicial insurance coverage law developments. It is not to be interpreted as legal advice, which must always be tailored to individual needs and particular circumstances.
 
Should you wish to unsubscribe from this list, and remove yourself from future Connell Foley mailings, please reply to contact@connellfoley.com,
 contact@connellfoley.com, with UNSUBSCRIBE
 in the subject line. 

Thursday, June 5, 2014

Insurance Coverage Newsletter May 2014

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NEW JERSEY                                                                                        May 2014

Property Coverage - Consumer Fraud Act
No Consumer Fraud Act Claim against Insurer for Failure to Pay Insurance Proceeds
  
Baskay v. Franklin Mut. Ins. Co., 2014 N.J. Super. Unpub. LEXIS 910 (App. Div. Apr. 23, 2014)

In this consolidated appeal, the New Jersey Appellate Division affirmed a trial court's dismissal of the policyholders' claims against their insurers under the Consumer Fraud Act for failure to pay a first-party property claim. The policyholders claimed their well was damaged by lightning and needed to be replaced.  The insurer retained an expert who opined that the damage to the well was caused by pressure exerted by ground and surface water rather than by lightning and, as a result, declined to pay costs incurred in repairing and replacing the well.  In the ensuing coverage action, the Appellate Division found the insurer could not be held liable under the Consumer Fraud Act for simply refusing to pay benefits it did not believe were warranted. 
 

Standard Flood Insurance Policy Applied
Non-Owned Debris Removal Not Covered under Standard Flood Insurance Policy Unless Debris Located In or On Insured Dwelling
 
Torre v. Liberty Mut. Fire Ins. Co., 2014 U.S. Dist. LEXIS 57133 (D.N.J. Apr. 24, 2014)

Policyholders sought coverage under their standard flood insurance policy for the removal of debris that had collected outside their shore home after Hurricane Sandy. The District Court applied the policy to find that the policy did not cover costs associated with removing non-owned debris because that debris was not in or on the insured dwelling itself.

Policyholders owned a home at the New Jersey shore that was damaged by Hurricane Sandy. They filed a claim under their standard flood insurance policy in relation to damage to the covered dwelling. The policyholders later pursued a supplemental claim for indemnification for the cost associated with removing debris that had collected outside the exterior perimeter walls of their dwelling.


Auto Coverage - Statutory Minimum 
Insurer Disclaimed under Applicable Rider Yet Still Required to Cover Up to Statutory Minimum

Csap v. Am. Millennium Ins. Co., 2014 N.J. Super. Unpub. LEXIS 1131 (App. Div. Unpub. 2014)

A passenger in an ambulance was injured when she fell out of her wheelchair during the ride. The passenger sued the ambulance owner, who sought coverage from two insurers. One insurer disclaimed because the ambulance driver had not been "listed" in accordance with a policy rider. The Appellate Division panel acknowledged the policy rider, but nevertheless found for equitable reasons that the insurer owed coverage up to the statutory coverage minimum for ambulances.

Both of the ambulance owner's insurers sought to avoid providing coverage in relation to the accident. The first insisted that no coverage was available pursuant to an auto exclusion clause. The second admitted it owed coverage under a $35,000 vehicle-related insurance policy; but it disclaimed in relation to a second vehicle-related policy that covered the difference between the $35,000 policy and the $500,000 statutory minimum for ambulances.


NEW YORK

Occurrence / Construction Defects
Policy Amendment of the Definition of "Occurrence" Did Not Expand the Definition to Include Faulty Workmanship

National Union Fire Ins. Co. of Pittsburgh, PA v Turner Constr. Co., 2014 N.Y. App. Div. LEXIS 3546 (N.Y. App. Div. 1st Dep't May 15, 2014)

New York court applying New Jersey law finds that a policy's definition of "occurrence" that includes "accident, event or happening" does not provide coverage for claim of faulty workmanship against the insured.

The insurer sought a declaration that it was not obligated to defend and indemnify its insured in a lawsuit in New Jersey arising out of allegations of defects in the design and installation of a pipe rail system in a commercial building.  The insured was the general contractor who subcontracted the design and building of an exterior wall, which included a pipe rail system.  After the installation, a segment of the pipe rail system fell to the street from the eighth floor of the building. An outside consultant hired by the building's owner determined that the installation did not conform to the building plans.
  

Priority of Coverage - Professional Liability
Court Finds General Liability Policy is Excess to Professional Liability Policy Based on Other Insurance Provision

WCHCC (Berm.) Ltd. v. Granite State Ins. Co., 2014 U.S. App. LEXIS 8383 (2d Cir. N.Y. May 5, 2014)

Court finds professional liability policy does not explicitly provide its position in a priority of coverage analysis with respect to other excess policies.

An insurer who issued a professional liability policy to a nurse brought a declaratory judgment action against the general liability insurer of a medical center seeking a declaration that the general liability insurer was the primary carrier and solely responsible for a settlement entered into by the insured.  First, the court recognized the policies at issue reflect two types of excess policies under Lumbermens Mut. Cas. Co. v. Allstate Ins. Co.: (1) those that purport to be excess over other sources of insurance; and (2) those that purport to be excess and delineate the interplay with other excess policies.  


This newsletter contains summaries of New York and New Jersey insurance coverage decisions entered during the previous month. If you see a topic that interests you, click the link to read more and obtain a full copy of the case.
For further information, please contact the Newsletter Editors, Jonathan McHenry, Neil Mody, William P. Krauss 
and William D. Deveau at (973) 535-0500 or email us by clicking here.
The cases annexed to this newsletter have been reproduced by Connell Foley LLP with the permission of LexisNexis. Copyright 2014, LexisNexis, a division of Reed Elsevier Inc. No copyright is claimed as to any part of the original work prepared by a government officer or employee as part of that person's official duties.

©2014 Connell Foley.

The information contained in this electronic message and any attached document(s) is intended for the personal use of designated recipients. This document is for informational purposes only, and is a means of disseminating general information about judicial insurance coverage law developments. It is not to be interpreted as legal advice, which must always be tailored to individual needs and particular circumstances.
 
Should you wish to unsubscribe from this list, and remove yourself from future Connell Foley mailings, please reply to contact@connellfoley.com,
 contact@connellfoley.com, with UNSUBSCRIBE
 in the subject line. 

Friday, May 2, 2014

Insurance Coverage Newsletter April 2014

insurance
NEW YORK                                                                                               April 2014

Professional Liability - Conduct Exclusion
SEC Administrative Order Does Not Establish Insured's Guilt Under Dishonest Acts Exclusion

J.P. Morgan Sec. Inc. v Vigilant Ins. Co., 2014 N.Y. Misc. LEXIS 796 (N.Y. Sup. Ct. Feb. 28, 2014)

The court finds that an SEC Administrative Order entered after a settlement does not implicate the policy's Dishonest Acts Exclusion as the settlement was not a final adjudication or judgment that establishes insured's guilt.

The insured sought coverage under professional liability policies in connection with a settlement that was reached with the SEC relating to alleged violations of federal securities law.  The insured brought the present declaratory judgment action following the insurer's denial of coverage on the grounds that the loss included disgorgement payments are not insurable as a matter of law and were otherwise barred by the Dishonest Acts Exclusion.  The insured argued the that the Dishonest Acts Exclusion did not apply because the Administrative Orders were settlements, not judgments or other final adjudications of the underlying claims, and therefore did not establish the insured's guilt as required for the exclusion to apply.  In response, the insurers argued that the exclusion does not require a finding of guilt from an actual trial since "the Administrative Orders constitute final adjudications of [the insured's] dishonest conduct.


Property Coverage - Contractual Suit Limitation
New York's Highest Court Recognizes Contractual Suit Limitations are Generally Enforceable, but Finds Application Unreasonable Where Policy also Required Policyholder to Replace Damaged Property, and Reasonable Replacement Time Exceeded Suit Limitation Period

Executive Plaza, LLC v. Peerless Ins. Co., 2014 N.Y. LEXIS 165 (N.Y. Feb. 13, 2014)

The New York Court of Appeals ruled that a contractual suit limitation provision that required the policyholder to replace the damaged property within two years was unreasonable and unenforceable where the damaged property could not reasonably be replaced within the policy suit limitation period.

The insured owned a commercial property that was severely damaged by fire.  The policy provided a choice between the payment of the "actual cash value" or "replacement cost."  The policy provided the insured "will not pay on a replacement cost basis for any loss or damage: '(i) Until the lost or damaged property is actually repaired or replaced; and '(ii) Unless the repairs or replacement are made as soon as reasonably possible after the loss or damage."  The limitation provision stated "No one may bring a legal action against us under this insurance unless: . . . : b. The action is brought within 2 years after the date on which the direct physical loss or damage occurred."


NEW JERSEY

Property Coverage - Reasonable Expectations
Court Upholds Insurer's Declination of Coverage for Loss Caused by Discharge Occurring Off the "Described Location"; Rejects Policyholder's Argument that Undefined Term Frustrated Reasonable Expectation of Coverage for Water Damage to Condo Unit
 
Lubik v. Harleysville Ins. Co., 2014 N.J. Super. Unpub. LEXIS 385 (App. Div. Feb. 27, 2014)

The New Jersey Appellate Division upheld an insurer's declination of coverage despite the policyholder's argument that the undefined term "Described Location" was ambiguous as applied to the condominium complex where the loss occurred.  The policyholder owned a single unit in an 800-unit condominium complex.  The policyholder's unit sustained $60,000 in damages when water leaked into it from a neighboring unit. The policyholder sought coverage under a "perils insured against" policy which covered specified damage for the property. According to the policy, coverage did not include loss caused by accidental discharge or overflow that occurred off the "Described Location," but the policy did not define this term.


Coverage Modification - Required Notice
Deleting Vehicle from Coverage Not Equivalent to a Policy Cancellation

Russo v. Chubb Ins. Co. of N.J., 2014 N.J. Super. Unpub. LEXIS 763 (App. Div. Apr. 4, 2014)

A formerly insured vehicle was dropped from an insurance policy. The insured was subsequently involved in an accident and, in response to the insurer's refusal to cover the insured's damages, argued the insurer had not given proper cancellation notice. The Appellate Division found no such notice was required because the policy had not been canceled -- its terms had instead been modified.

The insured was involved in a traffic accident while driving a vehicle leased by her employer. She sought coverage under the vehicle's business motor vehicle policy. The insurer responded that the vehicle had not been insured at the time of the accident. It relied on the insured's failure to satisfy a condition precedent under the policy: transmit documents to the insurer proving the vehicle's status as a leased company car.


Estoppel 
Insurer Not Estopped from Recovering PIP Benefits Paid to Another Insurer

Hudeen v. Smith, 2014 N.J. Super. Unpub. LEXIS 805 (App. Div. Apr. 10, 2014)

An insurer sought, after a year-long delay, to claw back PIP benefit payments it had made to another insurer. The Appellate Division found reimbursement was appropriate. The paying insurer had not been estopped from requesting repayment because the insurer seeking estoppel had suffered no harm or prejudice.

An individual was involved in a traffic accident while operating his employer's company car. The employer obtained a judgment finding the employee had not been operating the vehicle within the scope of his professional duties. That ruling was based on findings that the accident. 



Homeowners Warranty - Arbitration Clause
Arbitration Not Required Unless Clearly Mandated by Policy

McCloy v. Quality Builders Warranty Corp., 2014 N.J. Super. Unpub. LEXIS 517 (App. Div. Mar. 13, 2014)

Insured homeowners sought coverage under a homeowner's warranty agreement for defects in their home that were reported to the insurer in the eighth year of coverage. The insurer argued the policy required that the dispute be submitted to arbitration. The Appellate Division rejected this contention, finding that the policy's arbitration provision related only to claims made within the first two years of coverage.  


This newsletter contains summaries of New York and New Jersey insurance coverage decisions entered during the previous month. If you see a topic that interests you, click the link to read more and obtain a full copy of the case.
For further information, please contact the Newsletter Editors, Jonathan McHenry, Neil Mody, William P. Krauss 
and William D. Deveau at (973) 535-0500 or email us by clicking here.
The cases annexed to this newsletter have been reproduced by Connell Foley LLP with the permission of LexisNexis. Copyright 2014, LexisNexis, a division of Reed Elsevier Inc. No copyright is claimed as to any part of the original work prepared by a government officer or employee as part of that person's official duties.

©2014 Connell Foley.

The information contained in this electronic message and any attached document(s) is intended for the personal use of designated recipients. This document is for informational purposes only, and is a means of disseminating general information about judicial insurance coverage law developments. It is not to be interpreted as legal advice, which must always be tailored to individual needs and particular circumstances.
 
Should you wish to unsubscribe from this list, and remove yourself from future Connell Foley mailings, please reply to contact@connellfoley.com,
 contact@connellfoley.com, with UNSUBSCRIBE
 in the subject line.