PHILADELPHIA - Although insureds did not exercise reasonable care in maintaining heat to prevent pipes from freezing in their home while they were away, a question of fact exists as to whether the insureds' home was unoccupied when the loss occurred, a Pennsylvania federal judge said July 7 (Joseph Jugan, et al. v. Economy Premier Assurance Co., No. 15-4272, E.D. Pa.; 2016 U.S. Dist. LEXIS 87876).
PHILADELPHIA - A federal judge in Pennsylvania on July 11 awarded summary judgment to two lawyers accused of civil conspiracy, finding that Church Mutual Insurance Co. failed to present sufficient evidence that the attorneys agreed with other defendants to pursue fraudulent claims and that they acted with malice (Church Mutual Insurance Company v. Alliance Adjustment Group, et al., No. 15-461, E.D. Pa.; 2016 U.S. Dist. LEXIS 89194).
CINCINNATI - The Sixth Circuit U.S. Court of Appeals on July 11 affirmed that there is no coverage for an insured's $1 million check theft loss caused by an employee because the insured discovered wire fraud by the same employee before the policy's inception and the check theft and wire fraud constitute a single loss under the policy (Construction Contractors Employer Group, LLC v. Federal Insurance Co., No. 15-4352, 6th Cir.; 2016 U.S. App. LEXIS 12710).
LAKELAND, Fla. - A Florida appeals panel held July 6 that a lower court erred in awarding $233,610.02 in damages payable directly to insureds without regard for an insurance policy's loss settlement provision as to subsurface repair, reversing the lower court's ruling in part (Citizens Property Insurance Corp. v. James Stieben, et al., No. 2D14-4412, Fla. App., 2nd Dist.; 2016 Fla. App. LEXIS 10296).
ELIZABETH CITY, N.C. - A North Carolina federal judge on July 7 denied an insurer's motion to stay enforcement of a $700,194 total judgment against it in a Hurricane Irene coverage dispute (Gary Woodson, et al. v. Allstate Insurance Co., No. 13-21, E.D. N.C., Northern Div.; 2016 U.S. Dist. LEXIS 87971).
HARRISBURG, Pa. - The liquidator of an insolvent insurer asked a Pennsylvania court on July 6 for approval of an agreement under which a reinsurer will make direct payments of claims to the insolvent insurer's insured (In re: Reliance Insurance Company in Liquidation, No. 1 REL 2001, Pa. Cmwlth.).
SALT LAKE CITY - An insured failed to show that an underlying breach of contract action involved the same parties and issues as its insurer's coverage action regarding the duty to defend and indemnify the insured, a Utah federal judge ruled July 8 (Acuity, a mutual insurance company v. McGinnis Homes, LLC, No. 16-58, D. Utah; 2016 U.S. Dist. LEXIS 88974).
SEATTLE - Under Washington law, an insurer is not liable for damage to apartments from hidden decay under its policies' "collapse" provisions, a Washington federal judge ruled July 7, finding that the insurer's coverage decision and claims handling were reasonable (American Economy Insurance Co. v. CHL, LLC, No. 15-899, W.D. Wash.; 2016 U.S. Dist. LEXIS 88286).
PHILADELPHIA - The Third Circuit U.S. Court of Appeals on July 7 affirmed a district court's finding that there is no ambiguity in a residual disability policy regarding the policy's use of the term "occupation" and the policy rider's use of the term "insured's occupation" (Daniel S. Bowerman, D.C. v. National Life Insurance Co., No. 15-1129, 3rd Cir.; 2016 U.S. App. LEXIS 12503).
NEW ORLEANS - A panel of the Fifth Circuit U.S. Court of Appeals on July 8 affirmed that the Employee Retirement Income Security Act governs a case in which a laid-off employee was denied severance compensation for failing to return all company property as required by a severance agreement (Mark Gomez v. Ericsson Inc., No. 15-41479, 5th Cir.; 2016 U.S. App. LEXIS 12604).
PHILADELPHIA - The Third Circuit U.S. Court of Appeals on July 7 determined that summary judgment in favor of a disability insurer was not appropriate because issues of material fact exist regarding whether the medical evidence supports the insurer's termination of benefits and whether the termination was arbitrary and capricious (Frank Reed v. Citigroup Inc., et al., No. 15-2094, 3rd Cir.; 2016 U.S. App. LEXIS 12523).
SYRACUSE, N.Y. - An insurer told a federal court in New York on July 5 that a non-party reinsurer involved in a similar asbestos reinsurance dispute does not have the right to see documents sealed in the instant action (Utica Mutual Insurance Company v. Munich Reinsurance America, Inc., No. 12-cv-00196, N.D. N.Y.).
JACKSON, Miss. - A Mississippi federal judge on July 1 dismissed an insured's claims for waiver and estoppel and for vicarious liability but allowed breach of contract and bad faith claims to proceed in a homeowners insurance coverage action (Brooke T. Martin v. Shelter Mutual Insurance Co., No. 15-675, S.D. Miss.; 2016 U.S. Dist. LEXIS 86112).
FORT WORTH, Texas - A federal judge in Texas on July 5 granted an insurer's motion for summary judgment in an insurance breach of contract and bad faith lawsuit, ruling that an insured can no longer bring her claims because the appraisal process has been completed and the insurer timely paid her the appraisal award (Yolanda Aguilar v. State Farm Lloyds, et al., No. 15-565, N.D. Texas; 2016 U.S. Dist. LEXIS 87600).
FRESNO, Calif. - A California federal judge on July 5 determined that a disability claims administrator did not abuse its discretion in terminating a claimant's benefits because the administrator identified two reasonable jobs within the proper zone that could be performed by the claimant (William Barnett v. Southern California Edison Company Long Term Disability Plan, No. 12-130, E.D. Calif.; 2016 U.S. Dist. LEXIS 86828).
FRESNO, Calif. - Summary judgment is not warranted in an insurance breach of contract and bad faith lawsuit because an insurer has failed to show that the doctrine of judicial estoppel should be invoked and has failed to show that no genuine issue of material fact exists related to claims made by insureds in suing the insurer, a federal magistrate judge in California ruled July 5 (Halonda Naff, et al. v. State Farm General Insurance Co., No. 15-0515, E.D. Calif.; 2016 U.S. Dist. LEXIS 86854).
SEATTLE - A federal judge in Washington on July 5 denied an insurer's motions for summary judgment and to dismiss in an insurance breach of contract and bad faith lawsuit, ruling that insureds have sufficiently pleaded their claims for relief against their health insurance provider (Lori Patnode, et al. v. HCC Life Insurance Co., d/b/a HCC Medical Insurance Services LLC, No. 15-0824, W.D. Wash.; 2016 U.S. Dist. LEXIS 86872).
HARRISBURG, Pa. - Finding that genuine issues of fact remain as to the cause of homeowners' water damage, a Pennsylvania federal judge on July 7 declined to grant summary judgment to an insurer based on exclusions for defective construction, seepage, neglect or known loss doctrine (The Cincinnati Insurance Co. v. Jonathan Drenocky and Deborah Drenocky, No. 15-762, M.D. Pa.; 2016 U.S. Dist. LEXIS 87711).
BOSTON - A subrogated insurer's rights to recover insurance proceeds paid for a condominium unit's water damage were not waived based on a clause in the bylaws of the insured's condominium trust that unit owners "shall carry insurance" and that "all such policies shall contain waivers of subrogation," the First Circuit U.S. Court of Appeals held July 5 (Pacific Indemnity Co. v. John Deming, No. 15-2386, 1st Cir.; 2016 U.S. App. LEXIS 12374).
CINCINNATI - The Sixth Circuit U.S. Court of Appeals on July 5 affirmed a lower federal court's finding that because underlying claims were based on an associate pastor's sexual acts, the victims and their parents cannot recover a $4.35 million award against the pastor from his church's insurer because the policy does not cover an individual's sexual misconduct and because Ohio public policy prohibits insurance for the sexual abuse of a minor (Jacquin Clifford, et al. v. Church Mutual Insurance Co., No. 15-4154, 6th Cir.; 2016 U.S. App. LEXIS 12541).
NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals on July 7 affirmed a lower court's ruling in favor of a commercial property insurer in a breach of contract and bad faith dispute arising from Hurricane Ike damage to the insured's daycare center and warehouse (Steve Quibodeaux and the Kids Safari Inc., d/b/a Wee Care Childcare and Preschool v. Nautilus Insurance Co., No. 15-40567, 5th Cir.).
HARRISBURG, Pa. - The liquidator of an insolvent insurer asked a Pennsylvania court on July 6 to approve the liquidator's recommendation that a reinsurer be allowed to make direct payments to one of the insolvent insurer's insureds (In re: Reliance Insurance Company in Liquidation, No. 1 REL 2001, Pa. Cmwlth.).
SAN JOSE, Calif. - A plan administrator abused its discretion by failing to consider a disability claimant's functional capacity evaluation and an award of Social Security disability benefits before terminating the claimant's long-term disability benefits, a California federal judge said June 30 in remanding the benefits claim to the plan administrator (Olga Gorbacheva v. Abbott Laboratories Extended Disability Plan et al., No. 14-2524, N.D. Calif.; 2016 U.S. Dist. LEXIS 85702).
ROCHESTER, N.Y. - A New York federal judge on June 30 ordered a disability insurer to reinstate a claimant's disability benefits and pay past due benefits because the insurer's termination of benefits was arbitrary and capricious (Randi Dunda v. Aetna Life Insurance Co., No. 15-6232, W.D. N.Y.; 2016 U.S. Dist. LEXIS 85549).
ST. LOUIS - A disability claimant's complaint was dismissed July 1 because the claims administrator did not abuse its discretion in terminating the claimant's benefits, a Missouri federal judge said, noting that the claims administrator consulted with a number of independent physician advisers before terminating the benefits (Maria Domenica Moore v. Ascension Long-Term Disability Plan, No. 15-328, E.D. Mo.; 2016 U.S. Dist. LEXIS 85900).