News & Analysis as of

Denial of Insurance Coverage Policy Terms Insurance Claims

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

Wiley Rein LLP

Notice Prejudice Rule Applies to Claim Not Reported “As Soon As Practicable” But Within Policy Period

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The United States District Court for the District of Kansas, applying Kansas law, has held that an insurer must show prejudice to deny coverage when an insured provided notice of a claim within the policy’s three-year policy...more

Wiley Rein LLP

No Coverage for Lawsuit Where “Claim” First Made at Time of Pre-Inception Tolling Agreement

Wiley Rein LLP on

In a win for Wiley’s client, a New York intermediate appellate court, applying New York law, has affirmed that no coverage is available for a legal malpractice lawsuit because the “claim” was first made before the policy’s...more

Morris, Manning & Martin, LLP

Policyholder Concerns after Georgia Federal Court Takes Broad Reading of Pollution Exclusion

In Citizens Ins. Co. of Am., et al. v. Augusta Chiller Service, Inc., et al., the Southern District of Georgia granted insurers' motions for summary judgment in part on their duty to defend under a primary and excess policy...more

Lathrop GPM

California Courts Continue to Grapple with What Constitutes Wildfire “Direct Physical Loss or Damage”

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In Gharibian et al., v. Wawanesa General Insurance Company, the California Second District Court of Appeal found that, under California law, the insureds failed to prove smoke, soot, ash and fire debris on covered property...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

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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

Marshall Dennehey

Fourth District Court of Appeal Rules Policy Endorsement Prevails Over Main Policy in Case of Conflict

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Colony Insurance Company v. Titan Restoration Construction, Inc., Fla. 4th DCA, No. 4D2023-2908, January 8, 2025 - Colony Insurance Company’s insurance policy with the general contracting company, Titan Restoration...more

Maynard Nexsen

Lessons in Limitation – Contractual Limitations Provisions as a Basis for Summary Judgment

Maynard Nexsen on

In recent weeks, our firm obtained summary judgment under a contractual limitations provision that the plaintiff-insured argued had been equitably tolled due to the insurance carrier’s conduct. Although the good guys won, the...more

Carlton Fields

Recent Denial of Business Interruption Coverage to Cannabis Manufacturer Highlights Importance of Diving Into the Weeds of...

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In Theraplant LLC v. National Fire & Marine Insurance Co., the U.S. District Court for the District of Connecticut denied the insured cannabis cultivator’s claim for business interruption coverage because the insured failed...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

Carlton Fields

A Bridge Too Far: Pennsylvania Federal Court Declines to Extend Coverage Beyond Policy’s Plain and Unambiguous Terms

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It’s apt to name a blog post after one of history’s great action movies when the case involves a “conceptual artillery duel” that “ends in a draw,” and that is exactly how U.S. District Judge Gerald Austin McHugh Jr. of the...more

Cozen O'Connor

Jackson v. Spinnaker: Court Rules a Thorough Investigation is Just Good Business, Not Bad Faith

Cozen O'Connor on

In Jackson v. Spinnaker Insurance Company, the United States District Court for the Western District of Pennsylvania considered a homeowners insurance coverage dispute, ultimately finding that questions of residency and...more

Marshall Dennehey

Adequate Notice Requires More Than Delivery of a Policy

Marshall Dennehey on

A December 31, 2024, decision from the Supreme Court of Idaho found that adequate notice to an insured required more than the delivery of a policy and, due to the insurer’s failure to do so, coverage under a pre-existing...more

Carlton Fields

Square Peg, Round Hole: 6th Circuit Affirms Finding That Cyber Claims Are Not Covered by CGL Policies

Carlton Fields on

In Home Depot Inc. v. Steadfast Insurance Co., Home Depot learned the hard way a rule every DIY enthusiast knows: measure twice, cut once. It appears Home Depot’s measurements were off when it sized up its insurance needs,...more

Miller Nash LLP

The Northwest Policyholder | When the Application is the Risk: Application-Based Insurance Policy Rescission

Miller Nash LLP on

Surprised insurers are unhappy insurers. And unhappy insurers are more likely to resist paying claims. As are insurers who fail to heed their good faith and other obligations to their policyholders. So if you seek coverage...more

Snell & Wilmer

After the Fire: Assessing Coverage for Lingering Smoke Damage

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Insurance is designed to relieve financial strain and provide peace of mind — a contractual promise that when a catastrophe strikes, a policyholder will receive the financial support to rebuild and recover. Unprecedented...more

Segal McCambridge

New York Appellate Court Clarifies Insurer Obligations Under the Child Victims Act

Segal McCambridge on

The New York Appellate Division Fourth Department recently issued a decision affirming in part and reversing in part summary judgment motions against GuideOne Mutual Insurance Company (“GuideOne”) in a case brought by The...more

Bradley Arant Boult Cummings LLP

North Carolina Supreme Court: Government-ordered business closures during COVID-19 lockdowns constitute 'direct physical loss'...

Steven Hix and G. Benjamin Milam of Bradley discuss a pair of recent North Carolina Supreme Court rulings on coverage for pandemic-related losses, one of which gave policyholders a rare win. On December 13, the North...more

Allen Matkins

What You Need to Know about the California Fair Access to Insurance Requirements Plan (FAIR Plan)

Allen Matkins on

This alert begins our series discussing legal issues related to the Southern California wildfires. We will continue to provide updates as more information becomes available. Due to the high risk of wildfires in California,...more

Rivkin Radler LLP

January 2025 New York Insurance Coverage Law Update

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The insured owned premises located in Huntington Station, NY. The Claimant was allegedly injured when she slipped and fell at the premises. The Claimant sued the insured and the insured sought coverage under her homeowners...more

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