News & Analysis as of

Denial of Insurance Coverage Insurance Claims Appeals

Zelle  LLP

Calif. Smoke Claim Ruling Gives Insurers Support On Denials

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In their recent Law360 guest article titled "Reconciling 2 Smoke Coverage Cases From California," the authors described a California appellate court's Feb. 7 opinion in Gharibian v. Wawanesa General Insurance Co. as an...more

Carlton Fields

Divided Ninth Circuit Finds Claimant’s Failure to Provide Medical Records Insulates Insurer From Bad Faith Failure to Settle

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If at first you don’t succeed, try, try again. An age-old adage that now provides critical guidance for insurers seeking to protect themselves in the face of bad faith failure to settle claims....more

Carlton Fields

Litigation Under Construction: Recent Life Insurance and Long-Term Care Developments

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In Potovsky v. Lincoln Benefit Life Co., the Ninth Circuit Court of Appeals affirmed the dismissal of the insureds’ complaint for failure to sufficiently allege damages regarding the denial of a long-term care claim....more

Marshall Dennehey

Court Denies UIM Coverage to Woman, Claiming ‘Family Member’ Status Through Daughter

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Miller v. USAA General Indemnity Company, No. 23-1934 (3d Cir. Jan. 7, 2025) - The plaintiff, who resided with her daughter in the home of her daughter’s paternal grandmother, sought UIM benefits under an auto insurance...more

Carlton Fields

Eighth Circuit Finds No Coverage Under “Ensuing Loss” Provision Under Arkansas Law

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“Ensuing loss” provisions have long been the subject of nuanced arguments in insurance litigation. The provisions, which sometimes afford coverage for a “covered loss” stemming from an expressly excluded peril, serve as...more

Carlton Fields

Texas Appeals Court Finds Project Owner Excluded From Coverage as Claimants’ Statutory Employer

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On April 3, 2025, a Texas state appeals court reversed a trial court order awarding Exxon Mobil $25 million under an umbrella insurance policy issued by Lexington Insurance Co. to Brock Services Ltd. The appeals court found...more

Marshall Dennehey

Third District Court of Appeal Rules Affidavit Lacks Evidence Linking Damage to Tropical Storm Eta

Marshall Dennehey on

Thomas A. Bouchard, Jr. v. Citizens Prop. Ins. Corp., Fla. 3d DCA, No. 3D12-2202, February 19, 2025 - Thomas Bouchard, the appellant, appealed a final summary judgment order entered in favor of Citizens Property Insurance...more

Marshall Dennehey

Fourth District Court of Appeal: Noncompliance with Post-Loss Requirements Is a Contract Breach, No Prejudice to Insurer Needed

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Alton Forbes v. People’s Trust Ins. Co., Fla. 4th DCA, No. 4D2023-2375, January 8, 2025 - The Fourth District Court of Appeals ruled that the final judgment against the appellant stands because the appellant failed to comply...more

Rivkin Radler LLP

March 2025 New York Insurance Coverage Law Update

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The owners of a warehouse leased it to a commercial tenant to operate a photography studio. The lease required the tenant to procure insurance for the owners and to indemnify them for the negligent acts of the tenant’s...more

Marshall Dennehey

Court Reverses Summary Judgment, Finding Insurer Failed to Prove Policy Exclusion

Marshall Dennehey on

Ronald and Lovelie Belizaire v. Citizens Prop. Ins. Corp., Fla. 4th DCA, No. 4D2023-2488, February 12, 2025 - The Fourth District Court of Appeal reversed the trial court’s order granting summary judgment in favor of the...more

Zelle  LLP

Balancing Discovery and Protecting the Attorney-Client Privilege In the Insurance Coverage Context

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A recent case out of Colorado highlights the continued attack on the attorney-client privilege during the claim adjustment process. In In re: Hill Hotel Owner, LLC v. Hanover Insurance Company, 557 P.3d 798 (Colo. Oct. 29,...more

Quarles & Brady LLP

2024 Wisconsin Insurance Case Law Update

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Every year, Quarles & Brady LLP's Insurance Recovery Team compiles a list of important decisions by Wisconsin state and federal courts addressing insurance issues. Our goal is to keep you informed of developments and help you...more

Goldberg Segalla

Fraud Doesn’t Pay in New York – February 2025 Update

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As a part of our Quarterly Practice Group Update, we are pleased to produce another installment with examples of our continued success in the area of fraud litigation. The New York State Workers’ Compensation Board has...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Ninth Circuit Affirms ERISA Plan Administrator’s Decision, Validates Use of Industry Guidelines and Medical Evidence

On March 5, 2019, Magistrate Judge Joseph C. Spero of the U.S. District Court for the Northern District of California issued his opinion in Wit v. United Behavioral Health, in which he attempted to significantly change how...more

Conn Kavanaugh

First Circuit Rules on Important Coverage Issue for Contractors.

Conn Kavanaugh on

First Circuit Court of Appeals Rules That Standard Commercial General Liability Policy Excludes Coverage for Downstream Property Damage When General Contractor’s Scope of Work Covers Entire Building - It is well-accepted...more

Marshall Dennehey

The Sixth District Court of Appeals Rules in Favor of the Insurance Carrier, Finding That Ensuing Water Damage is Not Covered...

Marshall Dennehey on

State Farm Florida Ins. Co. v. Feltes, Fla. 6th DCA, No. 6D2023-0991, November 27, 2024 - This case arose out of the policyholder’s ongoing plumbing issues in her home. The insured property was built in the early 1960s, and...more

Zelle  LLP

Homeowners Did Not Substantially Meet Policy’s Condition Precedent to Recover Replacement Cost Value

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Property Insurance/Replacement Cost - Homeowners Did Not Substantially Meet Policy’s Condition Precedent to Recover Replacement Cost Value - Insurer Did Not Waive Conditions - Henderson v. State Farm Fire and...more

Wiley Rein LLP

Second Circuit Finds Pre-Suit Letter Was a “Claim” and Remands for Determination of Whether Notice of Claim Was Timely

Wiley Rein LLP on

The United States Court of Appeals for the Second Circuit, applying New York law, has held that a pre-suit letter sent to an insured constituted a “Claim” under a liability policy. Match Group, LLC v. Beazley Underwriting...more

BCLP

English Court Decides COVID-19 is a “Catastrophe”

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The English Court has, for the first time, considered the meaning of a “catastrophe”, as well as how Hours Clauses work in the context of non-damage business interruption losses claimed under two Property Catastrophe Excess...more

Carlton Fields

Alabama Federal Court Finds No Duty to Defend Lawsuit Alleging Concealment of Defects in Sale of Home

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In Nationwide Mutual Fire Insurance Co. v. Carmichael, the U.S. District Court for the Northern District of Alabama, applying Alabama law, entered summary judgment ruling that Nationwide Fire Insurance Co. had no duty to...more

Ervin Cohen & Jessup LLP

Ninth Circuit Deals Another Blow to Restaurants in COVID-19 Insurance Coverage Case

On June 26, 2023, a panel of judges for the United States Court of Appeals for the Ninth Circuit affirmed an insurance company’s win over a restaurant group seeking insurance coverage for pandemic-related claims in Team 44...more

Sheppard Mullin Richter & Hampton LLP

The Commercial Division Rejects Yet Another Insured’s Claim for Coverage for Covid-Related Revenues Losses

Does the business harm caused by COVID-19 qualify as “direct physical loss” for insurance purposes? In Spirit Airlines, Inc. v. American Home Assurance Company, Index No. 655755/2021, Commercial Division Justice Robert R....more

Proskauer - Employee Benefits & Executive...

Ninth Circuit Defers to Plan Design and Administrative Discretion on Bounds of Mental Health Coverage

A recent decision by the U.S. Court of Appeals for the Ninth Circuit (Wit et al. v. United Behavioral Health and Alexander et al. v. United Behavioral Health) exemplifies the challenge in balancing a desire to cover evolving...more

Steptoe & Johnson PLLC

Fourth Circuit Upholds Dismissal of Insurance Claim for Pandemic Related Business Losses

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In a published decision filed March 7, 2022, the U.S. Court of Appeals for the Fourth Circuit in Uncork and Create LLC v. The Cincinnati Insurance Company, affirmed the U.S. District Court for the Southern District of West...more

Butler Snow LLP

The Fifth Circuit Court of Appeals Just Slammed the Door on Texas Businesses Seeking Insurance Coverage for Lost Revenue Due to...

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In a pair of opinions issued last month, the Fifth Circuit Court of Appeals held that Texas businesses’ COVID-19 related income loss was not covered by standard business income and extra expense (“BI/EE”) endorsement in...more

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