Insurance

For purposes of ERISA plan insurance policies, the Ninth Circuit defines "accident" or "accidental" to mean that the insured did not subjectively expect injury or death to result from his actions--so long as those subjective expectations were reasonable from the insured's perspective.  If the insured's subjective expectation cannot be ascertained, then the court asks whether a reasonable person with a… Read More

Ins. Code 1063.2(c)(2) is more specific than, and prevails over Ins. Code 1063.1(c)(5), barring a claimant or its subrogated insurer from suing the at-fault driver for damages the driver caused to the claimant's property if the driver's insurer was a member of CIGA and went insolvent after the accident. Read More

Plaintiff sued insurer #1, claiming it owed a duty to defend him against a suit by a conservation land trust that he had violated the trust's conservation easement over his land by various development activities he undertook on the property.  That suit resulted in a judgment for the insurer, affirmed on appeal, denying coverage on the ground that the suit… Read More

Bucking the trend and disagreeing with United Talent Agency v. Vigilant Ins. Co. (2022) 77 Cal.App.5th 821, this decision holds that the trial court erred in sustaining the insurer's motion to dismiss this suit seeking coverage under a CGL policy's business interruption coverage for losses sustained by reason of COVID-19.  It reasons that however improbable it may now seem, on… Read More

The trial court did not abuse its discretion in staying this case under CCP 410.30 on the ground of forum non conveniens.  The complaint sought a declaration regarding the plaintiffs' duty to defend and indemnify defendants under various insurance policies for opioid litigation brought against defendants throughout the country.  There was already an on-going coverage action involving plaintiff and defendant… Read More

An insurer is not required to appoint Cumis counsel when it accepts its insured's defense without a reservation of rights but, for premium purposes only, decides that the insured is the at-fault driver in the accident and so increases his premium for future years' coverage. Read More

This decision holds that an insurer's allegedly wrongful denial of an insurance claim or its claim handling leading to that denial cannot be the basis of a viable claim under the Insurance Fraud Pevention Act (Ins. Code 1871.7).  The Act was designed to prevent fraudulent insurance claims not impose added duties on or create new remedies against insurers in connection… Read More

This decision holds that losses due to COVID closures are not covered by the business income and extra expense coverage of a business insurance policy since to trigger coverage the loss must be due to an impairment of operations caused by direct physical loss or damage to property.  For there to be coverage under this policy language, some external force… Read More

Following Mudpie, Inc. v. Travelers Casualty Ins. Co. (9th Cir. 2021) 15 F.4th 885 and Inns-by-the-Sea v. California Mutual Ins. Co. (2021) 71 Cal.App.5th 688, this decision holds that business interruption insurance providing coverage for interruption due to physical loss or damage to property does not cover losses caused by the COVID pandemic or associated government-ordered shut downs of business… Read More

This decision affirms a judgment holding that Ins. Code 533 bars insurance coverage for a judgment against Conagra for the public nuisance caused by Fuller Paint's pre-1950 advertising promoting the use of lead-based paint for interior paint on residential units.  In the liability trial, the trial court found that Fuller had kwown at the time it made the advertisements that… Read More

The Court of Appeal initially reversed a judgment in the plaintiff's favor, finding that the insurance agent who fraudulently induced plaintiff to enter into unsuitable annuities rather than the life insurance he had requested was an insurance broker, not a true agent, and that the insurer defendant therefore was not liable for the agent's fraud.  The Supreme Court granted review… Read More

Hill's umbrella insurance did not provide coverage for bodily injuries Gardineer sustained in a car accident caused by Hill's niece while she was driving Hill's car with his permission.  The umbrella policy extended coverage only to "insureds" a term it defined to include only the named insured, his wife and other relative who resided in the named insured's house.  The… Read More

A hospital cannot recover more for its emergency care of patients injured in car accidents than the amounts it has agreed with the patients' medical insurers to charge for those services.  Here, the hospital tried to collect more by requiring the patients to sign conditions of admissions that contained assignments of the patients' underinsured motorist coverage and medical benefits coverage… Read More

Tricked by a hacker's sending emails purportedly from her boss, Ernst's accounts payable clerk wire transferred $200,000 to banks from which the money was swiftly withdrawn.  Ernst sued its insurer to recoup its losses.  This decision holds that the loss fell within the computer fraud coverage of loss “resulting directly from the use of any computer to fraudulently cause a… Read More

Under former Ins. Code 2051.5, an insurer's liability under a replacement cost policy was the lesser of (a) the amount it would cost to replace the damaged structure at the insured location (without regard to depreciation), or (b) the policy's limits.  If the insurer requires the insured to repair the structure before claiming replacement cost, the insurer must first pay… Read More

Mountain Lakes church affiliated itself with the Church of God, a hierarchical church.  Mountain Lakes was a separately incorporated religious corporation and a separate entity from the national Church of God corporation.  However, the Mountain Lakes church held its church property as the national body's agent.  Mountain Lakes obtained a fire insurance policy from GuideOne on the church property, but… Read More

The Insurance Fraud Prevention Act (IFPA; Ins. Code 1871, et seq.) allows qui tam plaintiffs to file lawsuits on the government’s behalf and seek monetary penalties against perpetrators of insurance fraud.  To prevent duplicative lawsuits, the IFPA contains a “first-to-file rule” (Ins. Code 1871.7(e)(5)) that bars parties from filing subsequent actions related to an already pending lawsuit.  This decision holds… Read More

Plaintiff insured's losses due to COVID-19-related restrictions on its business were not covered by the business interruption insurance policy defendant had issued to it.  To be covered, the business interruption had to result from physical loss of or damage to property at the insured location. Instead, the business interruption resulted from county closure orders that were issued due to the… Read More

In this attorney malpractice case, the trial court properly ruled against plaintiff on the case-within-a-case, establishing that the underlying insurance claim had no merit, so the attorney's negligence in not filing suit in a timely manner did not cause plaintiff's loss.  The insurance claim arose under a contractor's CGL policy, and the policy's own work exclusion clearly barred insurance coverage… Read More

Under the prior approval of rates scheme enacted by Prop. 103 (Ins. Code 1861.05; Cal. Code Regs., titl 10, 2644.20), the Insurance Commissioner must consider the insurer's investment income as against losses, costs and reserves in determining whether the rate is reasonable.  This decision holds that the Commissioner must use only the investment income earned by the insurance company seeking… Read More