ST. LOUIS - A m0ultiemployer health fund is not entitled to equitable relief in the amount it paid in medical benefits to students who were also covered by student accidental medical insurance under the fund's coordination-of-benefits provision pursuant to the Employee Retirement Income Security Act, the Eighth Circuit U.S. Court of Appeals affirmed Aug. 10 (Central States, Southeast and Southwest Areas Health and Welfare Fund v. Student Assurance Services, Inc., et al., No. 14-2376, 8th Cir.; 2015 U.S. App. LEXIS 13941).
NEW YORK - A New York federal judge on Aug. 11 clarified a prior ruling to ensure that a disability claimant is able to present additional evidence supporting her disability on remand and awarded the claimant 50 percent of the attorney fees she incurred since suing the disability insurer (Pamela Wallace v. Group Long Term Disability Plan for Employees of TDAmeritrade Holding Corp. et al., No. 13-6759, S.D. N.Y.; 2015 U.S. Dist. LEXIS 105390).
SEATTLE - An insurance policy's three-year limitation clause precludes an insured's breach of contract claim for denial of coverage for earthquake damage, a Washington federal judge held Aug. 9; however, the judge allowed the bad faith claim to proceed (Larry Andrews v. St. Paul Guardian Insurance Co., No. 15-676, W.D. Wash.; 2015 U.S. Dist. LEXIS 104712).
SALT LAKE CITY - An insurer had a duty to defend at least some of the underlying allegations in a construction defects case against an insured, a Utah federal judge ruled Aug. 10, granting summary judgment to another insurer that defended the insured (Maryland Casualty Co. v. Mid-Continent Casualty Co., No. 14-522, D. Utah; 2015 U.S. Dist. LEXIS 105064).
NEW HAVEN, Conn. - A commercial general liability insurer has a duty to indemnify its insured for damages caused by its defectively produced shotcrete in the construction of swimming pools, a Connecticut federal judge ruled Aug. 7, finding that the expected or intended injury exclusion injury does not bar coverage (Harleysville Worcester Insurance Co. v. Paramount Concrete, et al., No. 11-578, D. Conn.; 2015 U.S. Dist. LEXIS 104869).
HUNTINGTON, W.Va. - A limitation provision in a disability insurance policy is not enforceable under West Virginia law because the claimant was not afforded a full two years from the accrual of her legal action to file suit against the insurer, a West Virginia federal judge said Aug. 10 (Mary R. Caldwell v. Standard Insurance Co., et al., No. 14-25242, S.D. W.Va.; 2015 U.S. Dist. LEXIS 104253).
PHILADELPHIA - A federal district court did not err in dismissing an insured's breach of contract and insurance bad faith claims because his claims were barred by their respective statutes of limitations, a Third Circuit U.S. Court of Appeals panel ruled Aug. 10 (Ralph Leporace v. New York Life and Annuity, et al., No. 14-3821, 3rd Cir.; 2015 U.S. App. LEXIS 13970).
ST. PAUL, Minn. - The Eighth Circuit U.S. Court of Appeals on Aug. 11 affirmed a lower federal court's ruling that there is no coverage under a general liability insurance policy for a $5 million lawsuit alleging that a manufacturer insured's vinyl adhesive product was defective, finding that a 2008 spreadsheet between the insured and the underlying claimant "cannot reasonably be understood as anything other than a demand for relief" (Ritrama, Inc. v. HDI-Gerling America Insurance Co., No. 14-3392, 8th Cir.; 2015 U.S. App. LEXIS 14018).
SANTA ANA, Calif. - Summary judgment in an insurance bad faith lawsuit was proper because insureds failed to submit to an examination under oath with their insurer and failed to bring their claims within the one-year statute of limitations, a California appellate panel ruled Aug. 6 (Shauna S. Callison, et al. v. Liberty Mutual Fire Insurance Co., No. G050633, Calif. App., 4th Dist., Div. 3; 2015 Calif. App. Unpub. LEXIS 5633).
TRENTON, N.J. - The majority of the New Jersey Supreme Court on Aug. 6 affirmed a trial court's dismissal of bad faith and breach of contract claims against two insurers because the claimants have no standing, without an assignment of rights, to assert a direct claim against the insurers (John Ross, et al. v. Karen A. Lowitz, et al., No. 074200, N.J. Sup.; 2015 N.J. LEXIS 819).
TAMPA, Fla. - An insurer failed to establish that exclusions for "that particular part" of the real property on which the insured is operating at the time of the accident applied to bar coverage for damage that a fire caused to a cell tower, a Florida federal judge ruled Aug. 10 (Essex Insurance Co. v. Kart Construction Inc., et al., No. 14-356, M.D. Fla.; 2015 U.S. Dist. LEXIS 104514).
NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals on Aug. 10 affirmed a lower federal court's dismissal of an insured's breach of contract and bad faith suit arising from alleged property damage to its apartment buildings caused by Tropical Storm Hermine (Arlington Apartment Investors v. Allied World Assurance Company [U.S.] Inc., No. 14-11109, 5th Cir.).
SAN FRANCISCO - A majority of the California Supreme Court on Aug. 10 found that a commercial general liability insurer can maintain a direct suit against its insureds' independent counsel for reimbursement of allegedly unreasonable or unnecessary underlying defense costs, reversing an appeals court in part (Hartford Casualty Insurance Co. v. J.R. Marketing, L.L.C., et al., No. S211645, Calif. Sup.; 2015 Cal. LEXIS 5405).
DETROIT - The Michigan Court of Appeals on Aug. 6 affirmed a trial court's ruling that insureds are entitled to a maximum of only $5,000 in coverage for mold remediation after finding no support for the insureds' argument that a claims adjuster orally agreed to waive the policy's $5,000 mold coverage limit (Steven DuBuc, et al. v. Auto Club Group Insurance Co., et al., No. 320331, Mich. App.; 2015 Mich. App. LEXIS 1559).
HARRISBURG, Pa. - A subrogated insurer sufficiently alleges a claim for recklessness against contractors for their alleged failure to properly install piping that led to water damage on the insured's property, a Pennsylvania federal judge ruled Aug. 7 (The Cincinnati Insurance Co. v. Markey Builders Inc. and Susquehanna Automatic Sprinklers Inc., No. 15-00062, M.D. Pa.; 2015 U.S. Dist. LEXIS 103492).
INDIANAPOLIS - An insured failed to establish a genuine issue of material fact regarding whether the collapse of its roof was caused by decay, an Indiana appeals panel ruled Aug. 6, affirming summary judgment to an insurer on breach of contract and bad faith claims (Greater New Jerusalem Temple of Truth, Inc. v. Sentinel Insurance Company Ltd., No. 49A02-1501-PL-61, Ind. App.; 2015 Ind. App. Unpub. LEXIS 893).
BATON ROUGE, La. - A Louisiana federal judge on Aug. 5 determined that an insured is owed coverage for mitigation projects undertaken to address alleged violations of the Clean Air Act (CAA) and said the insured's costs incurred during the mitigation were reasonable (Louisiana Generating LLC, et al. v. Illinois Union Insurance Co., et al., No. 10-516, M.D. La.; 2015 U.S. Dist. LEXIS 102422).
COLUMBIA, S.C. - A South Carolina appeals panel on Aug. 5 vacated a lower court's ruling that an insured has no viable individual claim against insurers but affirmed the lower court's finding that the insured could not adequately represent the proposed class in her suit alleging that the insurers' practices regarding medical payments coverage and personal injury protection violated state law and their own procedures (Stephanie A. Smith v. Progressive Halcyon Insurance Company, n/k/a Progressive Direct Insurance Co., et al., No. 2015-UP-392, S.C. App.; 2015 S.C. App. Unpub. LEXIS 473).
ATLANTA - The 11th Circuit U.S. Court of Appeals on Aug. 6 affirmed a lower federal court's dismissal of an insured's breach of contract and bad faith suit seeking damages for missing inventory of 82,510 bottles of 5-Hour Energy drinks, holding that employee dishonesty coverage is barred by the policy's inventory shortage exclusion (W. L. Petrey Wholesale Co., Inc. v. Great American Ins. Co., No. 15-10629, 11th Cir.; 2015 U.S. App. LEXIS 13738).
NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals on Aug. 6 held that a second sworn proof of loss was necessary for Louisiana insureds to perfect their claim for Hurricane Isaac damage, affirming a lower federal court's ruling in favor of a federal flood insurer (Ron Ferraro, et al. v. Liberty Mutual Fire Insurance Co., No. 14-30944. 5th Cir.; 2015 U.S. App. LEXIS 13762).
DENVER - The 10th Circuit U.S. Court of Appeals on Aug. 6 affirmed a lower federal court's finding that a directors and officers insurance policy's "insured vs. insured" exclusion unambiguously precludes coverage for the Federal Deposit Insurance Corp.'s gross mismanagement claims against a bank's former directors (BancInsure Inc., et al. v. Federal Deposit Insurance Corporation, et al., Nos. 14-3063 and No. 14-3064, 10th Cir.; 2015 U.S. App. LEXIS 13764).
GREENBELT, Md. - An insured was required to bring its insurance bad faith claim first to the Maryland Insurance Administration because the applicable limit of liability of its insurance policy does not exceed $1 million for two radio towers that were destroyed by a storm, a Maryland federal judge ruled Aug. 3, dismissing the insured's bad faith claim (Somar Communications Inc. v. The Cincinnati Insurance Co., No. 14-3399, D. Md., Southern Div.; 2015 U.S. Dist. LEXIS 100797).
OKLAHOMA CITY - An Oklahoma federal judge on Aug. 4 granted a disability insurer's motion to set aside a default judgment entered by an Oklahoma state court because the insurer did nothing to warrant the default judgment and the claimant will not be prejudiced if the judgment is set aside (Chris I. Robison v. Reliance Standard Life Insurance Co., No. 14-1262, W.D. Okla.; 2015 U.S. Dist. LEXIS 101656).
CHICAGO - A federal judge in Illinois on Aug. 5 dismissed without prejudice an office manager's allegations that two doctors violated the False Claims Act (FCA) by conspiring to unlawfully refer patients between two clinics and submitting fraudulent bills to Medicare, ruling that the pleadings did not satisfy the heightened pleading requirement of Federal Rule of Civil Procedure 9(b) (United States of America, ex rel. Deborah Radke v. Sinha Clinic Corp., et al, No. 12 cv 6238, N.D. Ill.; 2015 U.S. Dist. LEXIS 102699).
INDIANAPOLIS - An Indiana federal judge on Aug. 5 ordered an insurer to file a second amended complaint to properly allege a basis for diversity jurisdiction in a coverage lawsuit involving claims for an insured's alleged failed installation of exterior balconies and balcony beam supports (Celina Mutual Insurance Co. v. Custom Touch Builders Inc., et al., No. 15-01144, S.D. Ind.; 2015 U.S. Dist. LEXIS 102341).