CAMDEN, N.J. - Questions of fact exist as to whether an insurer breached its contract by denying coverage for water damage sustained by homeowners, a New Jersey federal judge ruled Feb. 18; however, the judge granted summary judgment on the homeowners' bad faith claim (Joseph Dooley and Elizabeth Dooley v. Scottsdale Insurance Co., No. 12-1838, D. N.J.; 2015 U.S. Dist. LEXIS 19140).
MIAMI - A federal magistrate judge in Florida on Feb. 17 recommended accepting a home health care clinic owner's guilty plea in a $13 million Medicare fraud scheme, finding that the defendant was capable and competent in entering an informed plea (United States of America v. Alexander Lara, No. 15-cr-20029-KMM, S.D. Fla.).
SAN FRANCISCO - Because there is more than one occurrence for the purposes of a primary commercial general liability insurance policy's "per occurrence" limit, excess coverage is triggered for an underlying construction defects lawsuit, the Ninth Circuit U.S. Court of Appeals affirmed Feb. 18 (Insurance Company of the State of Pennsylvania v. National Fire & Marine Insurance Co., No. 12-17383, 9th Cir.; 2015 U.S. App. LEXIS 2448).
MIAMI - The 11th Circuit U.S. Court of Appeals on Feb. 13 declined to rehear a Patient Protection and Affordable Care Act (ACA) case, leaving stand a divided panel's conclusion that an orthodontist lacked standing to challenge delayed implementation of the law's employer mandate (Kawa Orthodontics LLP v. Secretary, U.S. Department of the Treasury, et al., No. 14-10296, 11th Cir.).
GRAND RAPIDS, Mich. - Right to Life Michigan's action challenging implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate will proceed after a federal judge lifted his stay of the case on Feb. 17 (Right to Life of Michigan v. Sylvia Mathews Burwell, et al., No. 13-1202, W.D. Mich.).
HOUSTON - A Texas federal judge on Feb. 17 held that an insurer has no duty to defend its insured against false representation, monopolization and unfair and deceptive trade practices counterclaims in an infringement dispute over the '831 patent that protected a particular pavement-lifting process, granting the insurer's motion for summary judgment (Uretek [Usa] Inc. v. Continental Casualty Co., No. 4:13-cv-3746, S.D. Texas; 2015 U.S. Dist. LEXIS 18610).
ATLANTA - Finding that a commercial general liability insurer failed to demonstrate the existence of a mutual mistake, the 11th Circuit U.S. Court of Appeals on Feb. 13 affirmed a lower federal court's refusal to reform the policy to include "restaurant and bars" and "assault and battery sublimit" endorsements (Essex Insurance Co. v. Tina Marie Entertainment LLC, d/b/a Scene Premium Night Club, No. 14-11861, 11th Cir.; 2015 U.S. App. LEXIS 2277).
SPRINGFIELD, Mo. - A federal judge in Missouri on Feb. 12 ruled that the heightened pleading requirement of Federal Rule of Civil Procedure (FRCP) 9(b) applies to Allstate Indemnity Co.'s allegations that a couple misrepresented or concealed information when submitting a claim over a fire that occurred at their home and ordered the company to provide a more definite statement in its complaint (Allstate Indemnity Company v. Joseph Dixon, et al., No. 14-cv-03489-MDH, W.D. Mo.; 2015 U.S. Dist. LEXIS 17201).
CINCINNATI - An insurer did not act in bad faith in denying an insured's claim under a homeowners insurance policy for a fire because the cause of the fire was "fairly debatable," a federal judge in Ohio ruled Feb. 12 (Jeffrey Blevins, et al. v. Allstate Property & Casualty Insurance Co., No. 13-0440, S.D. Ohio; 2015 U.S. Dist. LEXIS 17979).
RENO, Nev. - According to a docket entry, Everest Indemnity Insurance Co. on Feb. 17 settled with a class of homeowners after a jury in the Washoe County, Nev., Second Judicial District Court found that the insurer had breached its duty of good faith and fair dealing in declining a defense and indemnity for property damage sustained by the class (Elizabeth Reimers, et al. v. Everest Indemnity Insurance Co., No. CV13-00737, Nev. Dist., 2nd Dist., Washoe Co.).
DENVER - Reframing two certified questions from the 10th Circuit U.S. Court of Appeals in a directors and officers liability coverage dispute, the Colorado Supreme Court on Feb. 17 held that the notice-prejudice rule does not apply to the date-certain notice requirement of claims-made insurance policies (Dean Craft v. Philadelphia Indemnity Insurance Co., No. 14SA43, Colo. Sup.; 2015 Colo. LEXIS 139).
PASADENA, Calif. - An insurer did not act in bad faith by failing to accept a policy limit settlement offer because the offer did not release all insureds involved, a Ninth Circuit U.S. Court of Appeals panel ruled Feb. 13 (Douglas Harp, et al. v. Converium Insurance [North America] Inc., No. 13-55282, 9th Cir.; 2015 U.S. App. LEXIS 2304).
NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals on Feb. 12 held that underlying negligence and conspiracy claims in a wrongful death lawsuit fail to allege that certain defendants were employees of the named insured, affirming a lower federal court's ruling that the defendants are not additional insureds under a commercial general liability insurance policy (Colony Insurance Co. v. Marty D. Price, et al., No. 14-10317, 5th Cir.; 2015 U.S. App. LEXIS 2249).
PASADENA, Calif. - The Ninth Circuit U.S. Court of Appeals on Feb. 12 held that there was no genuine issue of material fact that an insured was not entitled to independent counsel because it failed to provide evidence of a conflict between its interests and its insurer's interests, affirming a lower federal court's ruling in favor of the insurer in an employment practices liability coverage dispute (Argonaut Insurance Co. v. Elite Home Medical Respiratory Inc., et al., No. 12-57146, 9th Cir.; 2015 U.S. App. LEXIS 2243).
ST. LOUIS - A Missouri federal judge on Feb. 13 dismissed an insurer's suit with prejudice after determining that the lack of action by the insured in the past nine months indicates that the insured abandoned the suit (United Fire & Casualty Co. v. Titan Contractors Service Inc., No. 10-2076, E.D. Mo.; 2015 U.S. Dist. LEXIS 17666).
SIOUX FALLS, S.D. - Claims for breach of contract, breach of warranty and negligence against an insured encompass some acts that are not excluded from coverage under the professional services exclusion in a commercial general liability insurance policy, a South Dakota federal judge ruled Feb. 13, finding that material issues of fact remain with regard to resolution of the insurer's duty to indemnify (General Casualty Company of Wisconsin v. Nelson Engineering Consulting LLC, No. 13-4075, D. S.D.; 2015 U.S. Dist. LEXIS 17705).
ANN ARBOR, Mich. - A federal judge in Michigan on Feb. 13 refused to dismiss a lawsuit brought by State Farm Mutual Insurance Co. against a chiropractor and his practice claiming that the defendants submitted fraudulent bills under Michigan's No-Fault Automobile Act, finding that the insurance company sufficiently stated claims under the Racketeer Influenced and Corrupt Organizations (RICO) Act and for common-law fraud and unjust enrichment (State Farm Mutual Automobile Insurance Company v. Louis N. Radden, D.O., et al., No. 14-13299, E.D. Mich.; 2015 U.S. Dist. LEXIS 17788).
DAYTONA BEACH, Fla. - A Florida appellate panel on Feb. 13 reversed and remanded a lower court opinion regarding what definition of "covered claim" controls a sinkhole damage suit brought by homeowners against the state's insurance guarantor standing in for an insolvent insurer (Florida Insurance Guaranty Association, Inc. v. William Simmons and Sylvia Simmons, No. 5D13-4095, Fla. App., 5th Dist.).
NEW YORK - A New York justice on Feb. 11 found that a foundation insured's action seeking coverage for water damage to a renowned work of art was timely, refusing to dismiss the complaint (Richard Avedon Foundation v. AXA Art Insurance Corp., No. 151435/2014, N.Y. Sup., New York Co.).
RENO, Nev. - A jury in the Washoe County, Nev., Second Judicial District Court on Feb. 13 awarded $4.5 million in compensatory damages for a commercial general liability insurer's breach of its duty of good faith and fair dealing in declining a defense and indemnity for property damage sustained to a class of homeowners (Elizabeth Reimers, et al. v. Everest Indemnity Insurance Co., No. CV13-00737, Nev. Dist., 2nd Dist., Washoe Co.).
PHILADELPHIA - An estate's executor failed to produce evidence of the existence of a valid and paid-for policy of voluntary life insurance with the estate's former employer and insurer, a Pennsylvania federal judge ruled Feb. 10, granting summary judgment on breach of contract and breach of fiduciary duty claims (Seth J. Diener, guardian ad litem of Estate of Joseph Thomas Mancuso IV, et al. v. The Renfrew Centers Inc. and Life Insurance Company of North America, No. 11-4404, E.D. Pa.; 2015 U.S. Dist. LEXIS 16421).
PHILADELPHIA - The accommodation through which those who object to the contraceptive mandate of the Patient Protection and Affordable Care Act (ACA) can avoid providing or paying for the insurance coverage does not burden religious practice, a Third Circuit U.S. Court of Appeals panel held Feb. 11 (Geneva College, et al. v. HHS, et al., 13-3536, Geneva College, Wayne L. Hepler, et al. v. HHS, et al., No. 14-1374, Most Reverend Lawrence T. Persico, et al. v. HHS, et al., No. 14-1376, Most Reverend David A. Zubik, et al. v. HHS, et al., No. 14-1377, 3rd Cir.).
DAYTONA BEACH, Fla. - A Florida appeals panel on Feb. 13 held that damage to insureds' pool deck, rock garden and waterfall resulted directly or indirectly from subsurface water pressure, reversing and remanding a lower court's ruling in favor of insureds in a breach of contract dispute arising from a tropical storm (Liberty Mutual Fire Insurance Co. Nigel Martinez, et al., No. 5D13-2683, Fla. App., 5th Dist.; 2015 Fla. App. LEXIS 1918).
AUSTIN, Texas - The majority of the Texas Supreme Court on Feb. 13 determined that BP Exploration & Production and its affiliates are covered as additional insureds only for above-surface pollution arising out of the Deepwater Horizon drilling rig explosion because the rig owner did not assume any liability for sub-surface pollution (In re: Deepwater Horizon, No. 13-0670, Texas Sup.).
FORT WORTH, Texas - A subrogated insurer did not need a certificate of merit under Texas Civil Practice and Remedies Code Section 150.002 to file its lawsuit against a contractor regarding damages incurred from settlement of an underlying homeowner's lawsuit arising from a defective foundation, a Texas appeals panel affirmed Feb. 12 (Childress Engineering Services Inc. v. Nationwide Mutual Insurance Co., as subrogee to Meritage Homes of Texas LLC, No. 02-14-00332-CV, Texas App., 2nd Dist.; 2015 Tex. App. LEXIS 1425).