Case Summaries

Insurance Law

[03/10] Darvell v. Life Ins. Co. of N. Am.
In an ERISA action regarding defendant-insurer's denial of long-term disability benefits to plaintiff, summary judgment for defendant is affirmed where: 1) it was not an abuse of an ERISA plan administrator's discretion to ignore an opinion when the physician did not provide reliable objective evidence of testing or other proof to support a finding of long term disability; and 2) the plan administrator did not abuse its discretion by using the DOT description of plaintiff's occupation, rather than a description of his actual job duties.

[03/10] Milwaukee Metro. Sewerage Dist. v. American Int'l Specilaty Lines Ins. Co.
In a sewerage district's suit for damages against an environmental liability insurer for denying coverage for costs incurred by the district in removing significant pollution on land it recently purchased, district court's judgment is reversed and remanded as the district court's finding that there was clear and convincing proof that a prior agreement existed between the insurance company and the sewerage district that the parcel would be covered property was clearly erroneous. Therefore, defendant is entitled to judgment on the sewerage district's reformation claim and, as a consequence, judgment in favor of defendant on its indemnity claim is vacated.

[03/10] Fortis Corp. Ins. SA. v. Viken Ship Mgmt. AS
In a maritime shipping case involving a claim for rust damage to steel coils caused by exposure to seawater during a journey from Poland to Ohio, judgment of the district court is affirmed where: 1) a ship manager charged with providing a Master, officers and crew, and performing various other ship-management tasks for the shipping vessel does not qualify as a "carrier" under the Carriage of Goods by Sea Act (COGSA), and thus the COGSA's one year-statute of limitations does not bar the underlying suit; and 2) defendant's claim that the district court's finding of negligence was based on clearly erroneous factual findings is rejected.

[03/09] George's Inc. v. Allianz Global Risks US Ins. Co.
In an action against an insurer claiming that defendant failed to indemnify plaintiff for business expenses and personal property losses as required under the terms of its insurance policy, partial summary judgment for defendant on the personal property claim is affirmed, but a partial denial of summary judgment on the business expenses claim is reversed where the policy unambiguously excludes coverage for plaintiff's claimed losses.

[03/09] HealthEast Bethesda Hosp. v. United Commercial Travelers of Am.
In an action for breach of an insurance settlement contract, summary judgment for plaintiff is affirmed where: 1) defendant was not an unsophisticated party because it had significant experience in handling and negotiating claims with healthcare providers; 2) because defendant bore the risk of mistake, the district court properly denied rescission based on unilateral mistake; and 3) the record of inaction by defendant strongly supported the denial of relief under both unilateral and mutual mistake.

[03/09] Seltzer v. Barnes
Trial court's denial of defendant's anti-SLAPP motion, arising from an underlying suit involving claims against a property management company and homeowners' association, is reversed where: 1) the trial court erred in concluding plaintiff's two causes of action against defendant do not arise from speech or petitioning activity where his alleged conduct was the negotiation of a settlement in the prior case; and 2) because defendant may not be held liable for the alleged conduct under the litigation privilege, plaintiff has failed to show a probability of prevailing on her causes of action for fraud and intentional infliction of emotional distress.

[03/03] City of Laguna Beach v. California Ins. Guarantee Ass'n
In a city's action against an insurance company seeking reimbursement for incurring workers' compensation liability that exceeded its self-insured retention, grant of insurance company's motion for summary judgment is affirmed where: 1) the addition of subdivision (c)(13) to Ins. Code section 1063.1 did not abrogate Denny's Inc. v. Workers' Comp. Appeals Bd., 104 Cal.App.4th 1433 (2003); 2) the trial court properly invoked the Denny's rule when it granted summary judgment and concluded that the city cannot obtain reimbursement from defendant under section 1063.1(c)(13) as, although this provision renders the obligation of an insolvent excess workers' compensation insurer a "covered claim" that defendant must ordinarily reimburse, defendant need not reimburse a permissibly self-insured employer for benefits paid to an employee for cumulative injury if the employer's liability is based in part on a period of time when the employer was self-insured and chose not to buy excess insurance for the particular risk.

[03/03] Fed. Ins. Co. v. Commerce Ins. Co.
In plaintiff-insurance company's subrogation claim, district court's grant of summary judgment in favor of defendants in concluding that the implied coinsured doctrine controlled the outcome in this case and precluded the plaintiff from pursuing a subrogation claim is affirmed as plaintiff has not met its burden of proving that the "Responsibility for Damages" provision of a Residence and Care Agreement (RCA) overcomes the presumption that the landlord's insurance is held for the mutual benefit of both parties.

[02/22] Interstate Fire & Cas. Ins. Co. v. Cleveland Wrecking Co.
In plaintiff's claim for subrogation against defendant, alleging that defendant had breached its contract with a general contractor by failing to defend and indemnify the general contractor in an underlying suit, trial court's judgment in favor of the defendant pursuant to a demurrer is reversed as the allegations of plaintiff's amended complaint establish each of the elements for subrogation.

[02/19] Versai Mgmt. Corp. v. Clarendon Am. Ins. Co.
In an action against an insurer brought after a number of apartment buildings managed by plaintiff sustained damage during Hurricane Katrina, raising contract claims for unpaid insurance proceeds and claims that defendants violated Louisiana law by failing to promptly settle claims and by misrepresenting the terms of their policies, summary judgment for defendants is affirmed in part where, under the policy, plaintiff was not entitled to costs of compliance until after it had incurred the expenses of code compliance. However, the judgment is reversed in part where: 1) the district court was not at liberty to grant summary judgment based on plaintiff's "failure" to support its proofs of loss with additional documentation where the insurance policy created no such obligation; and 2) there was an issue of material fact suggesting that plaintiff was entitled to compensation for business-interruption losses.

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