Seber v. General Fire and Cas. Co. et al
Year: 2014
Court: Indiana Supreme Court
Case Number: Appeal from 53A01-1405-PL-00208
Issue:
  • Ambiguity and Omission
  • Replacement Cost Value
State:
  • Indiana

Policyholders pay higher premiums for replacement cost value policies in order to recoup additional insurance proceeds necessary to rebuild or purchase substitute property. Insurers should be prohibited from attempting to pay only actual cash value (i.e., depreciated value) based on semantic discussions of undefined or…
Kerrigan v. Metropolitan Life Insurance Company
Year: 2014
Court: New York Court of Appeals
Case Number: 111775/2003
Issue:
  • Post Claims Underwriting
State:
  • New York

“Post-claims underwriting” describes the scenario where an insurer waits until after the insured makes a claim to investigate whether the insured is eligible for coverage based on the risk he or she presents. Post-claims underwriting (also referred to as “post-loss underwriting” or “retroactive underwriting” in…
Universal American Corp. v. National Union Fire Ins. Co.
Year: 2014
Court: New York Court of Appeals
Case Number: APL-2014-00133
Issue:
  • Cyber Liability
State:
  • New York

The carrier denied coverage for payments incurred as losses for fraudulent use of the insured’s computer systems (bogus medicare payments). However, the insured had purchased a “Computer Systems Fraud” rider which the insured argued would cover such losses. Fraudulent conduct, as defined in the rider,…
Advance Cable, Inc. v. Cincinnati Ins. Co.
Year: 2014
Court: U.S. Court of Appeals, 7th Circuit
Case Number: 14-02620
Issue:
  • Direct Physical Loss - Cosmetic Damage
  • Reasonable Expectations of Coverage
State:
  • Wisconsin

Insurance contracts are to be construed in accordance with the plain meaning of terms and the reasonable expectations of the policyholder. Doing so not only ensures that parties to a contract of insurance receive the benefit of the bargain, but is also good public policy.…
Liberty Mut. Ins. Co. v. Ash Grove Cement Co.
Year: 2014
Court: U.S Court of Appeals, 9th Circuit
Case Number: 13-35900; 13-35905; 14-35298
Issue:
  • Duty to Defend - 104(e) Letters
  • Environmental Liabilities
State:
  • Oregon

UP, joined by co-amici The Marine Group, LLC, MMGL Corp. and Schnitzer Steel Industries, Inc. urged the Court to uphold a correct ruling by an Oregon District Court that a 104(e) Request for Information Letter triggers the duty to defend under a commercial general liability…
Mut. Benefit Ins. Co. v. Politopoulos et al.
Year: 2014
Court: Pennsylvania Supreme Court
Case Number: 60 MAP 2014
Issue:
  • Employer's Liability
  • Separation of Insureds
State:
  • Pennsylvania

Under a correct reading of an Umbrella Policy, an Employer’s Liability exclusion only applies where an insured is sued by its own employee (e.g., damages for bodily injury in a suit brought by a co-insured). Pennsylvania law supports this interpretation. An Umbrella policy’s provisions are…
Russell v. Catholic Healthcare, UNUM et al.
Year: 2014
Court: U.S, Court of Appeals, 6th Circuit
Case Number: 13-4084
Issue:
  • ERISA
  • Statute of Limitations
State:
  • Ohio

ERISA plan administrators must include a time limit for judicial review (i.e., a statute of limitations to file suit) in a letter denying disability benefits. In the absence of such a notification, contractual limitations cannot be enforced against the participant, as required by federal regulations.…
Peoples Insurance Counsel Division v. State Farm
Year: 2014
Court: Maryland Court of Appeals
Case Number: 21 - September Term 2014
Issue:
  • Contract Interpretation
State:
  • Maryland

Maryland law does not apply the rule of contra proferentem, accepted by a majority of states – that ambiguous terms in insurance contracts are to be construed strictly against the insurer-drafter; instead, Maryland law treats an insurance contract like any other contract, drafted by parties…
Vandana Upadhyay v. Aetna Life Ins. Co.
Year: 2014
Court: U.S. Court of Appeals, 9th Circuit
Case Number: 14-15420
Issue:
  • ERISA
State:
  • California

In this case, the District Court held that the insured’s ERISA action was untimely under the provisions of the Long-Term Disability Plan because the contractual deadline for filing suit ended on July 1, 2010, even though the insured had a right to file her claim…
Pistorese v. Transamerica Life Insurance Company
Year: 2014
Court: U.S. Court of Appeals, 9th Circuit
Case Number: 14-35027
Issue:
  • Contract Interpretation
  • Long Term Care Insurance
State:
  • Washington

Under Washington law, insurance contracts are to be interpreted based on the principle of contra preferentem – ambigious terms must be strictly construed against the drafter-insurer and in favor of the insured as to effectuate coverage. UP argued in its brief, that in the long-term-care…
Thomson, Inc. et al. v. XL Insurance, Inc. et al.
Year: 2014
Court: Indiana Supreme Court
Case Number: 49A05-1109-PL-470
Issue:
  • Allocation
  • Contract Interpretation
State:
  • Indiana

On appeal from a decision in error by the Indiana Court of Appeal, UP argued in its brief that the presumptive rule in determining the scope of coverage under a Commercial General Liability Policy (“CGL”) should be “all-sums” or joint and several liability. For “long-tail”…
Allstate Property and Casualty Co. v. Jared Wolfe
Year: 2014
Court: Pennsylvania Supreme Court
Case Number: 39 MAP 2014
Issue:
  • Assignment of Bad Faith Claims
  • Public Policy and Tort Remedies
State:
  • Pennsylvania

On certified question from the U.S. Court of Appeals for the Third Circuit, the Pennsylvania Supreme Court confronted the issue of whether statutory bad faith claims may be assigned to an injured third party when the insured settles its claim and/or chooses not to pursue…
Street Surfing, LLC v. Great American E&S Ins. Co.
Year: 2014
Court: U.S. Court of Appeals, 9th Circuit
Case Number: 12-5531
Issue:
  • Commercial General Liability
  • Duty to Defend
State:
  • California

Under California law, the duty to defend is broader than the duty to indemnify. In fact, under Montrose Chem. Corp. v. Superior Court, 6 Cal. 4th 287, 300 (1993), “the insured must prove the existence of a potential for coverage, while the insurer must establish…
Thomas Nickerson v. Stonebridge Life Ins. Co.
Year: 2014
Court: California Supreme Court
Case Number: S213873
Issue:
  • Punitive Damages
State:
  • California

Punitive damages awards are subject to heightened Due Process scrutiny after the U.S. Supreme Court’s decision in State Farm v. Campbell. While the Campbell ruling did not establish a bright-line rule, many state and federal courts, including California, have announced that no more than a…
Recall Total Information Management Inc., et al. v. Federal Insurance Co.
Year: 2014
Court: Connecticut Supreme Court
Case Number: S.C. 19291
Issue:
  • Advertising Injury
  • Data Breaches
  • Duty to Defend
  • Reasonable Expectations
State:
  • Connecticut

Under Commercial General Liability policies (“CGL”) and Umbrella policies, “publication” of usually defamatory statements to a third person will trigger coverage for “advertising injury” and a carrier’s duty to defend. Here, the Court of Appeal erroneously found that loading confidential personal employee data onto encrypted…
Cedar Bluff Townhome Condominium Assn. v. American Family Mut. Ins. Co.
Year: 2014
Court: Minnesota Supreme Court
Case Number: A13-0124
Issue:
  • Like Kind Replacement
  • Uniform Appearance/spot-repairs
  • Unjustfied Premiums
State:
  • Minnesota

Under Minnesota law, insurers are required to replace damage and undamaged property with the same “like kind construction and similar use” to ensure uniform appearance and prevent decreased property values resulting from mismatched repairs. UP urged the Court to estop insurers from conducting “spot-repairs” and…
In re: Deepwater Horizon
Year: 2014
Court: Texas Supreme Court
Case Number: 13-0670
Issue:
  • Interpretation
  • Sophisticated Policyholders
State:
  • Texas
Wellpoint Inc., Anthem Ins. Co v. Nat. Union. Fire Ins. Co.
Year: 2014
Court: Indiana Supreme Court
Case Number: 49A05-1202-PL-92
Issue:
  • Errors and Omissions
State:
  • Indiana

This case arises from a class-action lawsuit alleging that the insurer unlawfully conspired to systematically delay, deny, and diminish payments to doctors under a health plan. The insuring agreement in the policy at issue provided coverage for “errors and omissions” (E&O) arising out of “professional…