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
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Friday, April 25, 2014

Insurance Coverage Update March 2014

insurance

NEW YORK                                                                                              March 2014

Duty to Defend
New York's Highest Court Vacates Controversial 2013 Ruling and Rejects Minority "Coverage by Estoppel" Rule

K2 Inv. Group, LLC v American Guar. & Liab. Ins. Co., 2014 N.Y. LEXIS 201 (N.Y. Feb. 18, 2014)

The New York Court of Appeals issued a rare reversal of its own prior ruling that an insurer found to have breached the duty to defend will be estopped from later relying upon potentially applicable coverage exclusions to deny coverage for indemnification.  The New York Court of Appeals' 2013 ruling in K2 Inv. Group v. American Guar. & Liab. Ins. Co. ("K2-I") held that an insurer found to have wrongfully failed to defend may be liable to pay up to its policy limits even if the policy contains an exclusion that would otherwise exclude coverage for indemnification.  The K2-I holding represented a significant departure from established New York law which had refused to adopt this minority paradigm often referred to as the "coverage by estoppel" rule.


Bad Faith - Sandy Claims Handling
New York Trial Court Rejects Bad Faith Claims Handling Claim in Superstorm Sandy Litigation 

Orient Overseas Assoc. v. XL Ins. Am., Inc., 2014 N.Y. Misc. LEXIS 867 (N.Y. Sup. Ct. Feb. 26, 2014)

The New York Supreme Court ruled after recognizing a split in New York law that an insurer's alleged misrepresentations and alleged refusal to pay does not give rise to a separate cause of action based on bad faith claims handlng in the context of a Superstorm Sandy first-party coverage dispute.

The owner of a building damaged by Superstorm Sandy sought coverage under multiple policies providing coverage through a quota share program.  The owner alleged that the insurer's misrepresentations during the claims process and refusal to pay gave rise to a separate cause of action for bad faith, particularly since other insurers in the quota share had paid under the same policies.   

Voluntary Parting Exclusion - Fraudulent Conduct
Voluntary Parting Exclusion Bars Coverage for Losses Caused By Voluntarily Parting with Property, Even Where Losses Resulted from Fraudulent Scheme or False Pretense.

Martin, Shudt, Wallace, DiLorenzo & Johnson v. Travelers Indem. Co. of Conn., 2014 U.S. Dist. LEXIS 14323 (N.D.N.Y Feb. 5, 2014)

A New York Federal District Court ruled that a business owner's policy excluded coverage for funds lost after the insured deposited a forged check and forwarded the proceeds to a third party.
The insured brought the declaratory judgment action alleging bad faith and breach of contract after the insurer disclaimed coverage for a loss.  The loss in question arose from a check in the amount of $95,000 made payable to the insured, to be held in escrow, that was subsequently wired to a third-party.  Shortly thereafter, the insured was notified that the check was forged and the insured was charged the amount of the check.  After submitting the loss to the insurer, the insurer denied coverage pursuant to the Voluntary Parting Exclusion which excluded any loss caused by or resulting from "[v]oluntary parting with any property."  

Professional Liability - Direct Action 
Court Finds Injured Party Does Not Have Standing to Pursue Insurer Directly 

Commonwealth Land Title Ins. Co. v. Am. Signature Servs., Inc., 2014 U.S. Dist. LEXIS 22172 (E.D.N.Y. Feb. 20, 2014)

The Eastern District of New York dismissed an injured party's complaint against an insurer on the basis that such a right at common law and the injured party failed to meet the pre-conditions set forth in N.Y. Insurance Law § 3420.

A title insurance business sought coverage under its professional liability carrier for a suit alleging, inter alia, the insured failed to record various real estate documents exposes them to potential liability in excess of $10 million.  The insurer filed suit seeking rescission of the policy and, in the alternative, a declaration that the policy does not provide coverage for the underlying plaintiff's claim.  


NEW JERSEY

Bad Faith - Rescission
Insurer Delay in Seeking Rescission is Not Bad Faith, But May Be Relevant to Estoppel Defense

Nova Cas. Co. v. Col-Mor Apts., Inc., 2014 U.S. Dist. LEXIS 2522 (D.N.J. Jan. 9, 2014)

A policyholder argued that insurer acted in bad faith by pursuing policy rescission after participating in the policyholder's defense for two years. The District Court dismissed the bad faith counterclaim, finding that an insurer who pays its insured's defense costs cannot thereby be prevented from pursuing its due process right to argue for policy rescission.

The insurer sought an injunction rescinding a property and liability insurance policy issued by it to insured, a New Jersey partnership that owned and operated apartment complexes. It argued that the policyholder -- who sought coverage in relation to tenants' claim that it knowingly provided them with tainted drinking water -- secured coverage by concealing knowledge that one of its properties was radioactively contaminated. The insurer's rescission claim occurred after it had paid part of the policyholder's defense costs pursuant to a reservation of rights letter.


Fraud Prevention Act - Duplicative Payments
Insurer Allowed to Pursue Fraud Prevention Act Claim; Policyholder Ordered to Repay Insurer for Duplicative Sums Recouped from Third Party

AIG Cas. Co. of N.Y. v. Walsh, 2014 N.J. Super. Unpub. LEXIS 283 (App. Div. Feb. 12, 2014)

The New Jersey Appellate Division found that an insurer was entitled to reimbursement of indemnification payments made to policyholders who received independent payment for their losses from a third party. Since the insureds allegedly concealed the third party payment, the appellate panel reversed a trial court ruling and allowed the insurer to pursue a claim under the Fraud Prevention Act claim.

The insurer issued a policy covering the insureds' yacht. Damage to the yacht's engine occurred within the policy period, and the insurer provided the insureds with an indemnification payment pursuant to the policy. The insureds subsequently learned that the engine manufacturer would pick up the entire cost of the replacement engine and its installation. The insurer eventually learned of the third party payment and demanded that the insureds refund the money they received under the policy. The insureds refused. 


Applicability of Policy Exclusions
Insurer Policy Reformation Claim Survives Summary Judgment Motion 

Indian Harbor Ins. Co. v. NL Envtl. Mgmt. Servs., 2014 U.S. Dist. LEXIS 23240 (D.N.J. Feb. 25, 2014)

An insurer filed this declaratory judgment action seeking a ruling that an entity claiming additional insured status is not entitled to coverage and the policy should be reformed to reflect the same.  The issue before the Court was whether the relevant policy exclusions applied to the additional insured even though the exclusions did not identify the additional insured entity by name.  Applying New York law, a New Jersey Federal District Court ruled that summary judgment was premature since more evidence was needed to evaluate the legitimacy of the insurer's policy reformation claim.


Bad Faith - Attorney's Feels
Policyholder's Claims for Bad Faith and Counsel Fees Rejected

Johnson v. Plasser Am. Corp., 2014 N.J. Super. Unpub. LEXIS 372 (App. Div. Feb. 26, 2014)

A policyholder claimed bad faith and sought attorney's fees from its insurer after an excess insurer contributed to a settlement resolving an underlying matter. In rejecting both claims, the New Jersey Appellate Division ruled that a bad faith claim requires more than simple negligence, and that an excess insurer cannot be required to pay attorney's fees where its policy had not been triggered prior to settlement of the underlying claim.

An employee of the insured was injured while working. He sued the insured, arguing that the company committed an intentional wrong in refusing to maintain its equipment in proper working order. One of the policyholder's insurers, who provided workers' compensation coverage and $1 million in employment liability coverage, defended against the suit. The insured also was covered by a $4 million umbrella liability policy from an excess insurer. 
   

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. 

Insurance Coverage Update January 2014

insurance

NEW YORK                                                                                           January 2014

Pollution Liability - Policy Sublimit
Court Upholds "Dedicated UST Sublimit Endorsement" to Cap Insurer's Exposure Under Pollution Liability Policy

Two Farms, Inc. v. Greenwich Ins. Co., 2014 U.S. Dist. LEXIS 1629 (S.D.N.Y. Jan. 6, 2014)

The United States District Court for the Southern District of New York ruled that an Underground Storage Tank Sublimit Endorsement unambiguously limits coverage available under a Pollution and Remediation Legal Liability Policy.

The insured sought coverage for losses and expenses related to a discharge of thousands of gallons of gasoline at its facility. The discharge was allegedly caused by a defective "O-Ring" that allowed gasoline to leak from an underground storage tank ("UST").  The Policy at issue covered losses from pollution and remediation expenses but contained two endorsements relevant to the claim for coverage. First, the "UST Exclusion" excluded coverage for losses "based upon or arising out of the existence of any underground storage tank(s) and associated piping."  The UST Exclusion, however, contained an applicable exception, providing that the exclusion did not apply if the UST was listed on the policy schedule. The second endorsement, the "UST Sublimit Endorsement," provided that all loss applicable to the scheduled USTs was limited to $1,000,000 for each loss.  


Occurrence - Business Risks
Under CGL Policy, No Coverage for Economic Damages Stemming from Breach of Contract

Fed. Ins. Co. v. Marlyn Nutraceuticals, Inc., 2013 U.S. Dist. LEXIS 178565 (E.D.N.Y. Dec. 19, 2013)

Following a detailed analysis of various policy provisions, the Court granted summary judgment in favor of the insurer on the grounds that the causes of action in a Verified Complaint sought solely economic damages for breach of contract and are not covered by an occurrence based policy.

The insured, a manufacturer and seller of customized vitamin and nutritional supplement products, sought coverage for a lawsuit brought by a company that purchased tablets that were later found to be contaminated.  Upon receipt of the claim, the insurer agreed to defend but reserved its right to withdraw, indicating the allegations as alleged may constitute "property damage caused by an occurrence" and invoking the "your product" and "your work" exclusions.  Shortly thereafter, an Amended Verified Complaint and Verified Bill of Particulars specified the categories of damages: "Credit to Customer For Product Returned or Destroyed," "Inventory Cost-Inventory on Hand," "Storage Cost," "Cost of Recall," and "Legal Fees."


Timely Disclaimer -- Waiver 
Court Determines "Classification Limitation Endorsement" Is Not an Exclusion and Cannot be Waived

Black Bull Contr., LLC v Indian Harbor Ins. Co., 2013 N.Y. Misc. LEXIS 6339 (N.Y. Misc. 2013)

New York court finds that insurer's 55 day delay in disclaiming coverage based on a Classification Limitation Endorsement was untimely as a matter of law but nonetheless finds the policy language does not operate as exclusion and cannot be waived.

An insured, after receiving notice of a claim regarding an injury to any employee, promptly provided notice to its insurer.  Fifty-five days later, the insurer disclaimed coverage based on a Classification Limitation Endorsement, which "applied only to operations that are classified or shown on the Declarations or specifically added by endorsement to this Policy."  Shortly thereafter, the insurer reiterated its coverage denial and further explained the policy covered four specific types of work and the demolition work it was engaged in at the time of the accident was not classified, and therefore, not covered. 


Late Notice -- Additional Insureds
Court Finds Additional Insureds Entitled to Coverage After Establishing Reasonable Excuse for Failing to Provide Timely Notice

Petrillo Stone Corp. v QBE Ins. Corp., 2014 N.Y. Misc. LEXIS 9 (N.Y. Sup. Ct. Jan. 3, 2014)

New York court finds that additional insureds established reasonable excuse for failing to provide timely notice based on good faith belief on the identity of an injured employee's employer.

The owner and construction manager sought defense and indemnity from a contractor and its subcontractor stemming from any injury to an employee of the subcontractor.  The contract between the construction manager and contractor required the contractor to provide additional insured coverage on a primary basis for the owner and construction manager.  The contract between the contractor and subcontractor incorporated by reference the contract between the contractor and construction manager and required the subcontractor to name the owner, construction manager, and contractor as additional insured. The construction manager maintained that it was unaware of the contractor-subcontractor arrangement.


NEW JERSEY

Claims-Made - Definition of Claim
Absence of "Claim" Against Policyholder Precludes Coverage Under Claims-Made Policy 

Seltzer v. Chiesa, 2014 N.J. Super. Unpub. LEXIS 37 (App. Div. Jan. 9, 2014)

New Jersey's Appellate Division considered the scope of the term "claim" in the context of interpreting two claims-made policies. Coverage was denied under both policies because the policyholder could not prove potential adverse actions against him were anything more than speculative. Policy exclusions also applied.

The policyholder had purchased a townhome pursuant to a contract that stated that there "was/were underground fuel tank(s) [UST] which was/were properly removed" from the property. The sellers did not disclose that the property had previously "been impacted by a fuel oil release" on an adjacent property; nor did they inform the plaintiff-buyer of the likelihood that a potentially hazardous underground storage tank still lurked beneath the townhome's property. When the plaintiff discovered the contamination, he sued his real estate agent and her employer and notified his insurers of potential environmental problems.

                                                          Read the full summary... 

Equitable Estoppel 
Court Rejects Insured's Equitable Estoppel Argument in UIM Dispute

Owens v. Am. Hardware Mut. Ins. Co., 2013 U.S. Dist. LEXIS 181708 (D.N.J. Dec. 30, 2013)

A New Jersey Federal District Court Judge refused to award UIM benefits to an injured party based upon the doctrine of equitable estoppel.  The plaintiff was involved in a traffic accident while driving to his daughter's school in a van issued to him by his employer for work use. He settled with the other driver's insurer for $50,000 (the counterpart driver's policy limit) and sought uninsured motorist coverage from the insurer whose policy covered the van. Although the van's insurer agreed to waive its subrogation rights, it refused to administer plaintiff's UIM benefits claim or allow it to be arbitrated.

The plaintiff sought an order stating that he is entitled to UIM coverage and that the van's insurer must arbitrate the amount of the claim. More specifically, plaintiff contended that the insurer should be equitably estopped from refusing to arbitrate the claim. Plaintiff argued that he settled his case against the other driver for a fraction of the appropriate damages in reliance on the UIM carrier's statement that up to $500,000 would be available under its policy. In opposition, the insurer argued that UIM coverage was not available because the plaintiff, in violation of the terms of his employment, was using the van for a personal purpose when the accident occurred. 



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.