COLUMBUS, Ohio - The denial of a claim for long-term disability (LTD) benefits was not arbitrary and capricious because the claimant was provided with a fair review procedure and substantial evidence supports the denial of benefits, an Ohio federal judge said Feb. 14 in granting the plan's motion for judgment on the administrative record (Angela Schofield v. Nationwide Insurance Cos., et al., No. 16-371, S.D. Ohio, 2017 U.S. Dist. LEXIS 20687).
SAN FRANCISCO - Claims against a mutually insured subcontractor for damage caused by "subsidence" are excluded under an insurance policy, the Ninth Circuit U.S. Court of Appeals ruled Feb. 14, finding that an insurer had no duty to defend and thus was not responsible to share in costs incurred by a defending insurer (St. Paul Mercury Insurance Co. v. Navigators Specialty Insurance Co., No. 14-56723, 9th Cir., 2017 U.S. App. LEXIS 2586).
ALBUQUERQUE, N.M. - Unable to determine from the evidence provided whether an insured's disability benefits plan is governed by the Employee Retirement Income Security Act of 1974 (ERISA), a federal judge in New Mexico on Feb. 14 converted the insurer's motion to dismiss to a motion for summary judgment and ordered supplemental briefing (Sherry Evans-Carmichael v. Liberty Mutual Group Inc., No. 16-276, D. N.M., 2017 U.S. Dist. LEXIS 20599).
ATLANTA - A disability claimant is not entitled to benefits under a policy's lifetime sickness rider because the claimant is residually disabled and not totally disabled as required for benefits under the rider, a Georgia federal judge said Feb. 15 (William F. Nefsky v. Unum Life Insurance Company of America, No. 15-2119, N.D. Ga., 2017 U.S. Dist. LEXIS 21152).
DENVER - Because an insured failed to establish that it suffered water damage to "covered property" at a renovation project under a builders risk policy, the 10th Circuit U.S. Court of Appeals on Feb. 16 affirmed a Colorado federal judge's finding that the insurer properly denied coverage and did not breach its contract (Gerald H. Phipps, Inc. d/b/a GH Phipps Construction Co. v. Travelers Property Casualty Company of America, No. 16-1039, 10th Cir.).
AUSTIN, Texas - The Texas Supreme Court refused to revisit its ruling in a hailstorm coverage dispute that directed a lower court to vacate the part of its discovery order compelling production of management reports and emails and to re-evaluate the issue of sanctions against the insurer, according to its Feb. 17 orders pronounced (In Re National Lloyds Insurance Co., No. 15-0452, Texas Sup.).
SEATTLE - A Washington federal judge on Feb. 13 denied an insurer's motion for summary judgment on an insured's claims for bad faith in an environmental coverage dispute because the judge previously found that the insurer breached it duty to defend and any estoppel argument is now irrelevant to the disposal of the insured's bad faith claims (King County v. Travelers Indemnity Co., et al., No. C14-1957, W.D. Wash.).
DALLAS - Finding that an insured improperly joined an insurance adjuster in a dispute over coverage for storm damage, a Texas federal judge on Feb. 14 denied the insured's motion to remand and dismissed the claims against the adjuster without prejudice (Hutchins Warehouse Limited Partners v. American Automobile Insurance Co., et al., No. 16-3336, N.D. Texas, 2017 U.S. Dist. LEXIS 20417).
SAN FRANCISCO - A disability claimant's suit alleging wrongful termination of benefits was timely filed, a California federal judge said Feb. 13 after determining that the plan's three-year limitations period did not begin to run until after the 180-day deadline to appeal the termination of benefits ended (Nancy Hart v. UNUM Life Insurance Company of America, No. 15-5392, N.D. Calif., 2017 U.S. Dist. LEXIS 20198).
NEW YORK - A federal magistrate judge in New York on Feb. 13 recommended that a federal judge enter default judgment against a doctor and the clinics he owned for common-law fraud and violation of the Racketeer Influenced and Corrupt Organizations Act for his role involving the submission of fraudulent bills and kickbacks for referring patients to doctors for medical procedures that were not necessary (Government Employee Insurance Company v. Roger Jacques, M.D., et al., No. 14 Civ. 5299, E.D. N.Y., 2017 U.S. Dist. LEXIS 20195).
LOS ANGELES - Because insureds seeking coverage for damages to their home caused by a sewage backup did not file their lawsuit against their insurers until well after the policy's one-year limitation period expired, a California federal judge on Feb. 13 granted the insurers' motion for summary judgment and dismissed the insureds' complaint in its entirety (Jacqueline Keller. et al. v. Federal Insurance Co., et al., No. 16-3946, C.D. Calif., 2017 U.S. Dist. LEXIS 20820).
MIAMI - A Florida appeals panel on Feb. 15 reversed a lower court's ruling compelling appraisal against an insurer in a Hurricane Wilma coverage dispute, finding that the insureds failed to comply with their post-loss duties under their insurance policy (State Farm Florida Insurance Co. v. Jose R. Fernandez and Sandra Fernandez, No. 3D16-1441, Fla. App., 3rd Dist., 2017 Fla. App. LEXIS 2004).
LOS ANGELES - A California federal judge on Feb. 10 denied a plaintiff's motion to remand a disability suit to state court because the disability plan at issue is not a "church plan" and is governed by the Employee Retirement Income Security Act (Melvyn L. Durham v. The Prudential Insurance Company of America et al., No. 16-8202, C.D. Calif., 2017 U.S. Dist. LEXIS 19402).
CAMDEN, N.J. - A New Jersey federal judge on Feb. 14 granted a federal flood insurer's motion for summary judgment in a lawsuit brought by insureds seeking a declaration that they are entitled to coverage and compensatory damages stemming from the insurer's purported mishandling of their Superstorm Sandy flood claim (Herbert Ruth and Danna Ruth v. Selective Insurance Company of America, No. 15-2616, D. N.J., 2017 U.S. Dist. LEXIS 20534).
SALT LAKE CITY - A federal judge in Utah on Feb. 13 denied an insolvent insurer's objection to a magistrate judge's order compelling discovery of certain categories of information sought by a group of the insolvent insurer's former directors and officers (Western Insurance Company v. Dick L. Rottman, et al., No. 13-cv-00436, D. Utah, 2017 U.S. Dist. LEXIS 20709).
DENVER - A two-year statute of limitations precludes an insured's breach of contract claim against its insurer for denied coverage for property damage to commercial properties, a Colorado federal judge ruled Feb. 13 (The Pinewood Townhome Association Inc. v. Auto-Owners Insurance Co., No. 15-01604, D. Colo.; 2017 U.S. Dist. LEXIS 19999).
ORLANDO, Fla. - Judgment was entered in favor of insurers on Feb. 15, one day after a Florida federal judge found that there is no further coverage owed to insureds for lawsuits alleging that they have intentionally engaged in wrongful antitrust and monopolizing conduct in an effort to dominate the health care service industry (Health First Inc., et al. v. Capitol Specialty Insurance Corporation, et al., No. 15-718, M.D. Fla., 2017 U.S. Dist. LEXIS 20320).
NEW YORK - A federal judge in New York on Feb. 9 denied as moot errors and omissions insurers' motion for leave to appeal a temporary restraining order (TRO) issued in a bankruptcy court in a coverage dispute with their insured MF Global Holdings Ltd. (MFGH) (MF Global Holdings Ltd., et al. v. Allied World Assurance Co. Ltd., et al., Nos. 17-106 and 17-113, S.D. N.Y., 2017 U.S. Dist. LEXIS 19328).
HOUSTON - A federal judge in Texas on Feb. 9 held that a third-party holding corporate stock cannot seek coverage under an insurance policy's plain language that limits coverage to "direct" losses when a corporate officer committed fraud that caused the devaluation of the corporation's stock (HC4, Inc. Employee Stock Ownership Plan v. Travelers Casualty and Surety Company of America, No. 16-00090, S.D. Texas, 2017 U.S. Dist. LEXIS 19605).
SHREVEPORT, La. - A Louisiana federal magistrate judge on Feb. 10 ordered an insured seeking coverage for damages caused by a sewage backup that occurred during the insured's work in a neighborhood to file a motion to remand its suit if it contests the insurer's notice of removal to Louisiana federal court (Eagle Water LLC v. Arch Insurance Co., et al., No. 17-250, W.D. La., 2017 U.S. Dist. LEXIS 19317).
SHREVEPORT, La. - A federal jury in Louisiana on Feb. 10 found a mental health care facility administrator guilty of organizing a kickback scheme that resulted in the submission of $6.7 million in fraudulent bills to Medicare, the U.S. Attorney's Office announced (United States of America v. Tom McCardell, No. 16-cr-212, W.D. La.).
SACRAMENTO, Calif. - An insured's claims for insurance breach of contract and bad faith against his insurer were not timely filed within the contractual limitations period and the insured failed to show that the insurer engaged in any outrageous conduct to support a claim for intentional infliction of emotional distress in failing to provide coverage under a comprehensive long-term care policy, a federal judge in California ruled Feb. 9 in granting the insurer's motion to dismiss (Donald Mann v. Mutual of Omaha, et al., No. 16-2560, E.D. Calif., 2017 U.S. Dist. LEXIS 18732).
SAN FRANCISCO - An insurer owes no additional coverage for water damages to an insured's condominium, the First District California Court of Appeal, Division Four, said Feb. 10 after determining that substantial evidence supports a jury's verdict in favor of the insurer (Greg Kawai v. State Farm Fire and Casualty Co., et al., No. A136569, Calif. App., 1st Dist., Div. 4, 2017 Cal. App. Unpub. LEXIS 1006).
ROCHESTER, N.Y. - Because an insurance policy limits coverage to $25,000 for water damage and an insured property was damaged by water that entered the basement through a broken conduit, a trial court erred in denying the insurer's motion for summary judgment, a Fourth Department New York Supreme Court Appellate Division majority said Feb. 10 (Ronald J. Papa, et al., v. Associated Indemnity Corp., et al., No. 16-01136, N.Y. Sup., App. Div., 4th Dept., 2017 N.Y. App. Div. LEXIS 1132).
HOUSTON - A Texas appeals panel held Feb. 9 that a take-nothing judgment against insureds is proper because a commercial insurer overpaid the actual cash value of Hurricane Ike property damage by more than $1.5 million based on the jury's findings as to actual cash value (Triyar Companies, LLC, et al. v. Fireman's Fund Insurance Co., No. 14-14-00160, Texas. App., 14th Dist., 2017 Tex. App. LEXIS 1126).