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Vol. 5, Iss. 1
January 13, 2016
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In all of the interviews that I have done of fascinating and famous lawyers there is one question that I have never asked: why did you go to law school? I skip it because the chances of getting anything other than a predictable answer are minimal. I wanted to do justice. The law always fascinated me. My dad was a lawyer. I loved Perry Mason. To be sure, all of these are valid reasons for the three year enlistment -- just not very interesting.
Then I got renowned forensic pathologist Cyril H. Wecht on the phone. Not only did I want to ask him why he went to law school -- but it was at the top of my list of questions. You see, Wecht entered the night program at the University of Pittsburgh Law School in 1957. At that time he was doing a residency in pathology at the Veterans Administration Hospital in Oakland (Pittsburgh). Let me say that again. Wecht graduated from University of Pittsburgh School of Medicine and began the rigors of a residency – known for requiring stretches of insanely long hours on the job. And while that’s all going on he’s dealing with Hadley v. Baxendale and the law against perpetuities. Who in their right mind would do that? The only realistic reason why the words “law school” and “residency” should ever appear in the same sentence is in a discussion of in-state tuition.
Incidentally, as I sometimes enjoy doing with interviewees, I wrote a joke for Wecht -- about this unique combination of degrees. Why did the forensic pathologist go to law school? Because he wanted to be able to determine if someone’s cause of death was reading the tax code.
As a forensic pathologist, 84-year old Cyril Wecht is in a club with few members. Wecht told me that only about 500 people, give or take, call this a profession. But the number of forensic pathologists with a law degree on their resume can be counted on one hand. Indeed, I could hear Wecht counting on his fingers, whispering names to himself, when answering that question.
Wecht has another notch on his resume that few other forensic pathologists have. He is what you would call a celebrity forensic pathologist. In addition to having served as Allegheny County (Pa.) Coroner for 20 years, Wecht has been involved in such high-profile death cases as John F. Kennedy, Robert F. Kennedy, Mary Jo Kopechne, Sharon Tate, Legionnaires’ Disease, Sunny von Bulow, Vincent Forster, Laci Peterson, Daniel and Anna Nicole Smith and lots more people that you’ve heard of. Wecht is also a frequent guest on cable news shows and other television programs.
Wecht’s CV is an astonishing 27 pages, single-spaced – including several devoted to teaching appointments, visiting professorships and guest lectures; as well as lists of governmental and political positions; numerous awards; leadership positions in scores of medical and legal societies; board certifications; and books authored -- ten for the general public on forensics and famous deaths and numerous for professionals. Wecht has authored over 550 professional publications. He is the namesake of the Cyril H. Wecht Institute of Forensic Science and Law at Duquesne University. Wecht has performed about 20,000 autopsies since 1957 and reviewed or supervised about twice that number. He now spends his time as a medical/legal consultant and expert witness. Incidentally, he is the father of Judge, now Justice, David Wecht, very recently elected to the Pennsylvania Supreme Court.
Wecht’s career has not been without controversy. He was twice tried criminally on charges related to allegedly personally benefiting from his work at the Coroner’s office. The cases ended in dropped charges and acquittal and were the subject of federal investigations into whether the charges were politically motivated.
Cyril Wecht was a great interview. Not a good interview. A great interview. He was generous with his time – we spent an hour on the phone on a Saturday afternoon – and provided very thoughtful answers. He was full of fascinating stories, used some words not suitable for a family publication and had an incredible memory for things that happened 60 years ago. But what made my call with Wecht so enjoyable was his passion. For example, he has spent decades railing against the conclusions of the Warren Commission on the death of John F. Kennedy. But despite having discussed this subject a gazillion times, Wecht was still so animated about it that I had to turn down the volume on my phone.
Law School: Why In The World?
Cyril Wecht’s decision to enroll in law school, despite being a doctor at the time, and seemingly all taken care of in the degree department, traces its roots to his younger days. As in really young. Wecht said that, from the day he was born, he was told by his parents that he was going to be a doctor. So that at least explains why he didn’t go to law school first.
As his medical studies went on, Wecht developed an interest in legal medicine. The decision to pull the trigger, and add law to medicine, was made in 1955, during Wecht’s third year of medical school. Wecht had contacted the American Medical Association for assistance with his interest in legal medicine. The AMA put Wecht in touch with the then most prominent M.D./J.D. in the country – Dr. Louis Regan. Fortuitously, at that time, the American Medical Association and the American Bar Association were to hold their first joint conference. Wecht contacted Dr. Regan who invited him to attend the conference in New York City. Despite being besieged, Regan gave Wecht fifteen minutes and provided him an overview of legal medicine. It was there that Wecht made the decision to combine law and medicine – despite that meaning attending law school while a medical resident. And not wanting to be a general practitioner in both fields, Wecht chose to focus on forensic pathology.
Wecht spent two years at the University of Pittsburgh Law School and finished his law degree at the University of Maryland Law School, while serving as a research fellow in forensic pathology in the medical examiner’s office in Baltimore. Wecht described the whole experience in simple terms: “I don’t know how the hell I did it.”
Forensic Pathology: Changes Over The Years
Dr. Cyril Wecht has been figuring out how people died for over a half century. So I’m curious if he ever lays awake at night, thinking about cases, and wondering if his conclusion on cause of death would have been different if he had had the benefit of some technology, now available, that wasn’t at the time.
Wecht surprises me with his answer. It turns out that, with the exception of DNA, “very, very little” has changed over the years in the world of forensic technology. Wecht begins to rattle off the steps in a autopsy and concludes that the basic procedures and questions, to figure out how someone died, are the same as when he started.
But this is not to say that there have been no changes, Wecht tells me. He mentions the attitude of the “things that are expected of you in the legal arena, that are expected of you from the public generally because of what has been portrayed in the world of fiction and what has unfolded in the world of reality vis-à-vis forensic pathology.” Wecht points to certain noted cases, such as J.F.K., O.J. Simpson and Jon Benet Ramsey, as well as television programs, such as CSI, the result of which “lawyers and judges and juries are all looking for things[.]” “I’m not suggesting that forensic pathologists in the past were sloppy, in fact they were giants in the field, but some things maybe you didn’t pay as much attention to and so on given the state of affairs in those years compared to what’s evolved subsequently with the different rules, such as Daubert.”
JFK And The Magic Bullet
Wecht’s involvement in the death of John F. Kennedy goes back 50 years. He is a vocal critic of the Warren Commission’s single (magic) bullet conclusion and Oswald as the lone gunman. Wecht presented a paper in 1965 critiquing the Commission’s findings. Then, in 1978, he testified before the House Select Committee on Assassinations as the sole dissenter, among a nine-member forensic pathology panel, that re-examined JFK’s death and supported the single bullet theory. According to Wikipedia, Wecht is the only pathologist, in four official examinations into the death of JFK, who has disagreed with the single bullet theory.
Wecht told me, in very animated fashion, that the Warren Commission’s conclusion would be “laughed out of court, laughed out of court:” “A single bullet, one bullet, seven wounds and two men leaving pieces of itself in four anatomic locations emerging with a total weight loss of 1.5%, completely intact, turning laterally, horizontally, vertically like a @*&%# rollercoaster ride at a big amusement park. I mean it’s absurd but they went along with it including my colleagues covered it up.”
Wecht wasn’t finished: “[T]here is no @*&%# way Connelly is shot 1½ seconds after Kennedy is hit the first time and the best marksman they can come up with took 2.3 seconds from shot-to-shot with that piece of @*&%# weapon and . . . Arlen Specter says ‘hey what if one bullet produced all of these wounds’ so you gotta give him credit intellectually.”
While it has nothing to do with forensics, I’m curious what Wecht thinks is the story behind the assassination. After all, he hasn’t spent half a century debunking the magic bullet theory without forming opinions on the alternative. Wecht is forceful in his answer: It’s us. As Wecht sees it, the CIA – a government unto itself, he calls it -- was bent on eliminating Russia. Kennedy was not, and, in fact, was bent on eliminating the CIA. The CIA, according to Wecht, couldn’t face the prospect of five more years of JFK, followed by eight years of Robert Kennedy. “Thirteen years is a lifetime, man, in the evolution of a country politically,” Wecht exclaims.
Forensic Pathology And Insurance
As a medical-legal consultant and expert (about 2/3 plaintiff and 1/3 defense, give or take, he tells me), Wecht’s work varies, including a heavy dose involving medical malpractice, as well as wrongful death of different types, product liability and worker’s compensation.
Of course I ask him about his role in insurance cases and his involvement is substantial – such as, which of several parties is liable for a death, to determine the responsible insurer. He shared with me a recent trip to St. Lucia involving several crew members who died in the engine room of a ship. The big issue was whether they died from fire or intense heat and where did it emanate from. That went to the question of which piece of equipment was responsible and, therefore, which insurer.
As examples of his work involving coverage, Wecht mentioned life insurance and determining what did a person know about their health when they took out a policy. He also pointed to the need in insurance cases to determine if cause of death was accident versus suicide versus homicide.
How To Live Longer
Anyone who has been involved in 60,000 autopsies must also know something about living. In other words, if you’ve seen how that may people have died, then surely you must know how to avoid – well, at least prolong-- that from happening. So I asked Wecht if there was one thing, just one, that I could do to live longer, what should it be? I was expecting a simple answer – like use less salt or don’t eat Twinkies. But the answer was more detailed than that.
Wecht told me that the best thing – if you have the time and money to spend -- would be to obtain the genetic patterns of your parents and grandparents, aunts and uncles, and so on. Then look at what these relatives died from to determine if there is a pattern. If so, correlate that with your diet, find a good internist, have the tests that are appropriate for your age as well as the tests for the diseases for which there is any family history.
Quincy: Does That Really Happen?
One does not speak to Cyril Wecht without asking about the most famous forensic pathologist of them all – Dr. Quincy, of course. Quincy is one of the first television shows about how people died. There is one question about Quincy that I just have to ask. During the opening theme song of the show there is a scene where Jack Klugman, as Quincy, is about to perform an autopsy. There are several police officers standing nearby, there to watch and learn. As soon as Quincy pulls the sheet off the corpse, the officers, one by one, begin to throw up and pass out. So of course I have to ask Wecht the obvious question – does that ever really happen?
Yes it does Wecht says -- although he notes that the scene in Quincy is of course exaggerated. Wecht tells me that he often has people attend autopsies and some throw up or become light-headed. But this is nothing to be ashamed of he is quick to add. Wecht recounted one police officer who attended an autopsy, became light-headed, left the room, tripped and injured himself seriously.
Cyril Wecht, M.D., J.D. summed up his life this way in a 2011 Pittsburgh Quarterly article: “I get involved and I open my mouth. That’s all I can do.” |
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Vol. 5, Iss. 1
January 13, 2016
The Gym, George Jetson and
Insurance Coverage |
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It’s that time of the year – the dreaded New Year’s Resolution. And when it comes to these pledges to fix all of our flaws, surveys show that none is more popular than to resolve to read more insurance coverage cases. OK, that’s probably (definitely) not true. Of course, we all know what the real number one New Year’s Resolution is – loss weight. This means that many of us will be trudging to the gym in January. Indeed, last week my gym was much more crowded than usual. I saw lots of unfamiliar folks bouncing up and down on elliptical machines. I have a love-hate relationship with the gym. I hate going and I love leaving.
A wonderfully entertaining coverage decision came down in late summer. It had all the odd-ball facts that make for a great Open Mic column. But since it involved a gym injury, I made the decision to put it on the shelf until the season of sit-ups and bicep curls. That day is now upon us.
Mt. Fitness v. Capitol Reef Property & Casualty Company, Utah District Court, 2nd Judicial District, No. 14-0136 involves coverage for a unique situation -- to say the least. The coverage case came about when Roger Jenkins was running on a treadmill at Mt. Fitness, a gym located in Ogden, Utah. The machine allegedly sped-up on its own. With no warning of this significant change in the belt speed, Jenkins, not surprisingly, was throw quickly off the back of the machine. He suffered a broken ankle, torn ACL and various other bumps and bruises.
At the time of the incident, Bill Miller, another Mt. Fitness member, was running on an adjacent treadmill. Miller immediately jumped off of his treadmill to assist the injured Jenkins. While doing so, Miller commented that Jenkins’s mishap resembled the famous scene in the opening of the Jetsons television show where George Jetson is walking his dog, Astro, on a treadmill. Astro sees a cat and gives chase. George, still holding onto Astro’s leash, goes flying ‘round and ‘round the treadmill. The scene ends with Jetson pleading for his wife: “Help, Help, Jane, Stop this crazy thing!”
Jenkins filed suit against Mt. Fitness and the manufacturer of the treadmill in Utah state court: Roger Jenkins v. Mt. Fitness, Utah District Court, 2nd Judicial District, No. 15-2436. Jenkins sought damages from Mt. Fitness for bodily injury and emotional injury. Jenkins alleged that Miller’s statement -- made while Jenkins was on the floor, withering in pain -- comparing Jenkins to George Jetson, in what Jenkins described as “the classic Jetson’s treadmill scene,” was defamatory and caused emotional injury and damage to Jenkins’s reputation.
Mt. Fitness sought coverage for the suit from its general liability insurer Capitol Reef Property & Casualty. Capitol Reef P&C undertook Mt. Fitness’s defense and acknowledged a duty to indemnify for any damages for “bodily injury,” but disclaimed coverage for any damages awarded for defamation. Capitol Reef maintained that no coverage was owed for defamation because the complaint in the Jenkins action did not allege “personal and advertising injury,” even on the basis of “[o]ral or written publication, in any manner, of material that slanders or libels a person or organization….” Specifically, the insurer’s argument was that the “publication” requirement was not satisfied because the allegedly defamatory statement – comparing Jenkins to George Jetson – was not made by a Mt. Fitness employee. Rather, it was made by another Mt. Fitness member.
The Jenkins action was settled with Mt. Fitness for $95,000. The parties agreed that $45,000 was for the bodily injury aspect of the claim. That amount was paid by Capitol Reef P&C. The remaining $50,000, for the defamation claim, was paid by Mt. Fitness itself. Mt. Fitness then filed a coverage action against Capitol Reef seeking to recover the $50,000 that it paid.
The court held that Capitol Reef P&C was obligated to provide coverage to Mt. Fitness for the $50,000 that it paid to settle the defamation claim. The court’s conclusion was that it did not matter that the allegedly defamatory statement was not made by a Mt. Fitness employee. As the court saw it, the phrase “in any manner,” modifying the term “publication,” meant that it made no difference who did the oral or written publishing of material that slandered a person.
You see. I wasn’t kidding. Mt. Fitness v. Capitol Reef Property & Casualty Company is a fun one.
Now I want to see a coverage case involving injuries caused when a waitress, at a drive-in restaurant, hands a customer a plate of huge brontosaurus ribs, causing the car to tip over.
Good luck with your New Year’s Resolutions. Careful on the treadmill.
That’s my time. I’m Randy Spencer. Contact Randy Spencer at
Randy.Spencer@coverageopinions.info
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Vol. 5, Iss. 1
January 13, 2016
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Liability insurance is, by definition, a product that provides financial protection when things don’t turn out as planned. Most of the time when this occurs it’s simply a case of bad luck or because, well, stuff just happens. Essentially, some action was taken and the outcome was one that nobody could have seen coming.
But there are other times when liability claims don’t arise simply because stuff just happens. Instead, the claims are the result of peoples’ actions that were so ill-conceived or Tom foolhardy that a liability claim was as predictable as day following night. When you read liability coverage cases you are bound to come across some of these. They are the cases where all you can do is shake your head in disbelief and ask yourself – Wow, did he REALLY do that? You then walk over to a colleague and say you GOTTA see this. Eventually the incredulous behavior leads to a lawsuit, which leads to an insurance claim, which leads to a coverage dispute, which leads to a reported decision, which leads to the final stage of this insurance circle of life -- an appearance in “Coverage For Dummies.”
I am pleased to present my 8th Annual “Coverage For Dummies” -- a review of the best cases, from the year just-concluded, that demonstrate attempts to secure insurance coverage for the frailty and imperfection of the human brain.
Incidentally, last year I suggested that “Coverage for Dummies” may be over since I suspected that there could never be a “Dummies” case as great as Davler v. Arch Ins. Co. (Cal. Ct. App. Aug. 25, 2014), where the court held that no coverage was owed to a cosmetics manufacturer when a (female) manager, determined to figure out who left a sanitary napkin in the bathroom and blood around the toilet seat, forced female employees to pull down their underwear so that another (female) employee could inspect whether they were wearing a sanitary napkin. The employment related practices exclusion precluded coverage.
But, alas, “Dummies” was saved from extinction by Blank-Greer v. Tannerite Sports, LLC, No. 13-1266 (N.D. Ohio Apr. 21, 2015), which rivals Davler v. Arch. In Blank-Greer, two nimrods, as part of a celebration of the upcoming birth of a child of one of the nimrods, held a party – a “diaper shootout” -- where guests could bring diapers for the new baby and enjoy an afternoon shooting guns. As a grand finale they decided to blow up an old refrigerator. Guests stood behind tables fifty meters away from the refrigerator -- with explosives placed inside. Upon firing at the refrigerator it immediately blew apart and sent shrapnel flying across the yard. A piece of shrapnel hit a guest’s hand, nearly severing it. I know. It takes your breath away. In case you’re wondering, the court held that no coverage was owed because the incident did not arise with respect to the conduct of the insured’s business.
Incidentally, 2015 was a down year for “Dummies.” For whatever reason, it was slim pickins for good “Dummies” cases. That’s just the way it goes sometimes. However, this could be prevented in some way. “Dummies” cases often involve such things as fights, people doing stupid stuff in bars, the use of an automobile for something other than getting from A to B, feuding neighbors and the use of guns. The incidents at issue in these cases generally just don’t happen out of the blue. They often have back stories explaining what led up to them. But so many courts leave these facts out of their opinions. As a result, what could be a great “Dummies” case will never be known, since it reads as a detail-less “assault and battery” or “liquor liability” or “expected or intended” case.
The following additional “Dummies” 2015 cases are in no particular order.
Evanston Insurance Co. v. Haven South Beach, LLC (S.D. Fla. Dec. 28, 2015): Pollution Exclusion precluded coverage to insured food and beverage vender for injuries sustained by a customer who was served an alcoholic beverage infused with liquid nitrogen to create a “smoky effect.”
Minden v. Atain Specialty Ins. Co. (8th Cir. May 26, 2015): Neither auto exclusion nor assault and battery exclusion precluded coverage to insured driver, for striking and killing an individual with his car, possibly motivated by the decedent yelling unflattering remarks at the insured-driver, when he could not figure out how to turn off a car alarm with a key fob.
Auto Club Property Casualty Ins. Co. v. B.T. (W.D. Ky. Jan. 12, 2015): No coverage owed to a dad for this father of the year performance. Dad’s 8 year old son was playing with friends and wanted to get some sparklers out of the car. Dad used his keyless remote to open the door but did not follow his son to the car – nor check up on him for the next few hours. It turns out that his son didn’t retrieve just sparklers from the car (as if that would have been OK) but bottle rockets too. One of the kids lit a bottle rocket that hit another in the eye. Coverage for dad denied based on the criminal act exclusion. Nobody will confuse this guy for Ward Cleaver. [This case was featured in “Dummies” 2014. In 2015 the Sixth Circuit reversed – not the dummy-ness; but the lower court’s decision that the criminal act exclusion barred coverage.]
Parler v. North Sea Insurance Co. (N.Y. Sup. Ct. June 17, 2015): Not enough factual details to be a “Dummies” case. However, the underlying action involved a bar patron being struck in the face with a bar stool. As frequent as that happens in the movies, you just don’t see it very often in real life coverage cases. Take my word. I did some research on that.
Ford v. Standard Fire Ins. Co. (N.D. Ohio Apr. 30, 2015): Expected or intended exclusion barred coverage to insured for striking his brother-in-law with a ceramic pot. [Insured also alleged that his brother-in-law once stole Christmas presents intended for insured’s children.]
Canon v. Palisades Insurance Company (N.J. Super. Ct. App. Div. Mar. 25, 2015): You know an opinion is going to be good when it starts out with this gem: “This case involves a street fight between two groups of combatants, some of whom were employed as telemarketers with two local companies. Not surprisingly, the challenge to fight, the acceptance of that challenge, and negotiations over the combat site were all done telephonically.” Following the rejection of numerous fight locations one was finally agreed upon. However, the fight didn’t take place as scheduled. One group arrived in a car with the occupants carrying baseball bats. The other group, expecting a traditional fist fight, was unarmed, and hurriedly left. However, the court noted that the parties were willing to continue settlement efforts: “The two cars drove to the Skytop Gardens Complex while their occupants made phone calls trying to reschedule the fight.” Sadly, the opinion does not mention what caused these two groups to want to kill each other. Maybe each one tele-marketed the other.
To make a long story short, someone was eventually shot in the head. He filed suit against some of the individuals on the other side. A default judgment was entered in the amount of $65,000. Seeking to satisfy the judgment, the victim then filed an action against the auto insurer for one of the assailant’s parents. The substantive coverage issues were “expected or intended” and “use of an auto.”
State Farm Fire and Casualty Co. v. Powell (N.D. Okla. Sept. 11, 2015): Intentional act exclusion barred coverage to insured for striking a fellow gambler in the face while playing cards in a casino. I mentioned in the introduction that most assaults have a back story explaining what led up to the altercation. Well, not here. Casino surveillance showed that, three minutes after the victim sat down at the table, the insured stood up, walked around the table, and struck him in the face with his fist. I guess when you saw “hit me” at a blackjack table there’s more than just the risk of going over 21. |
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Vol. 5, Iss. 1
January 13, 2016
Top 10 Coverage Cases Of The Year: CliffsNotes Version
My Letter To Cliff Hillegass -- Founder of Cliff’s Notes
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You may have missed my 15th edition of the “Ten Most Significant Coverage Decisions of the Year” in the last issue of CO. Perhaps you just had something better to do or perhaps you didn’t feel like reading 47,000 words. Well, your decision to ignore the article has paid off. Below is the CliffsNotes version.
By the way, in the interesting factoid category, there really is (or was) a Cliff at CliffsNotes. According to the all-knowing Wikipedia – which we all love to use but don’t donate the requested $3 to the funding campaign – CliffsNotes (originally Cliff’s Notes) was started by Cliff Hillegass in his Lincoln, Nebraska basement in 1958. I bet you didn’t know that.
When I was in college I sent a letter to Cliff Hillegass thanking him for all he did and letting him know that he was my favorite author. I asked him for his autograph and he kindly sent back the photo that you see nearby. It’s been nearly 30 years since Cliff sent me that photo and I still keep it, along with the cool envelope that it came in, in a safe place.
Cliff Hillegass died in 2001. I assume someone wrote a 50 page eulogy and then read a one-page summary. I dedicate this CliffsNotes Version of the Top 10 Coverage Cases Of The Year to the memory of Cliff Hillegass.
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For the fifteenth year in a row I have taken a crack at listing the ten most significant liability insurance coverage cases of the year. Admittedly, it is a highly subjective exercise and in no way scientific. The list is subject to as much debate and disagreement as that of the ten best pizza places in New York City.
But that the list is not unscientific, and devoid of any checks and balances, is not to say that the selection process is without serious consideration, criteria and hand-wringing. The cases are chosen based on numerous selection factors that I have developed over the years. In general, the selected cases (i) involve a frequently occurring claim scenario that has not been the subject of many, or clear-cut, decisions; (ii) alter a previously held view on an issue; (iii) are part of a new trend; (iv) involve a burgeoning or novel issue; or (v) provide a novel policy interpretation. Putting aside all of the details of how this operates, including why seemingly important cases are not chosen, the most important consideration for selecting a case as one of the year’s ten most significant is its potential ability to influence other courts nationally.
One curiosity of this year’s list is that five of the cases involve an issue, in some manner, concerning an insurer’s handling of the settlement of an underlying action. In fifteen years of creating the list there has never been one issue that so predominated the ten selections.
The following cases are listed in the order that they were decided.
American Western Home Insurance Co. v. Donnelly Distribution, No. 14–797, 2015 WL 505407 (E.D. Pa. Feb. 6, 2015)
It is one of the toughest issues of them all for insurers, not to mention one sorely lacking in guidance. The insurer is defending its insured under a reservation of rights. There are strong coverage defenses. The underlying case is getting close to trial. There is a demand to settle within limits. It is a settlement that should be accepted based on liability and damages considerations. But the insurer does not believe that coverage is owed. So it is not pleased at the prospect of settling. But if it accepts the demand, it could lose its coverage defenses. If it does not accept the demand, because of the coverage defenses, it may be liable for the verdict – excess or otherwise. And, of course, a declaratory judgment is unlikely to solve the problem as trial is probably approaching and it could never be resolved in time.
An issue along these lines played out in the Eastern District of Pennsylvania in American Western Home Insurance Co. v. Donnelly Distribution, Inc. and the court provided real guidance to an insurer confronting this challenge. The take-away here is that an insurer that is undertaking its insured’s defense, under a reservation of rights, and has filed a coverage action, but that is not resolved before a demand to settle is made, has an argument that any settlement it makes is one for which it is entitled to reimbursement, following any judicial determination that no coverage was owed for such settlement.
Mid-Continent Casualty Co. v. Kipp Flores Architects, LLC, 602 Fed. Appx. 985 (5th Cir. 2015)
By Joshua Mooney – White and Williams, LLP
In Mid-Continental Cas. Co. v. Kipp Flores Architects, LLC, the United States Court of Appeals for the Fifth Circuit held that a house is an “advertisement” for purposes of the duty to indemnify under Coverage Part B of a commercial general liability policy. The insured, a builder, built homes using an architect’s design, but without a license. The architect sued for copyright infringement.
The Court concluded that the underlying action alleged infringement of copyright in the insured’s advertisement. Traditionally, courts recognized that advertising injury coverage only covered copyright infringement in an advertisement, not in the product itself. Here, because the homes in question were deemed to be the best means to market the builder’s work, the homes – the infringing products themselves – were converted into advertisements for purposes of insurance coverage. By logical extension, an insured need only contend that an infringing product sells itself in order to qualify for “personal and advertising injury” coverage.
C. Brewer and Co., Ltd. v. Marine Indemnity Ins. Co., 347 P.3d 163 (Hawaii 2015)
The Hawaii Supreme Court’s decision in C. Brewer and Co., Ltd. v. Marine Indemnity Ins. Co. provides a very broad interpretation of a Designated Premises Endorsement. A large portion of a dam in Hawaii collapsed, releasing over three million gallons of water. The insured was the seller of the dam and the purchaser alleged that the insured was aware of the dam’s questionable structural stability. The insured’s commercial general liability policy had a Designated Premises Endorsement that limited coverage to liability “arising out of the ownership, maintenance, and use of the [designated] premises.” And, most importantly, the dam site was not listed as a designated premises.
The court concluded that the “policy provides coverage for injury and damage arising out of [the insured’s] ‘use’ of its corporate headquarters to make negligent corporate decisions [the headquarters was a designated premise] even though the resulting damage happened at the unlisted Dam site.” C. Brewer provides an important policy drafting lesson for insurers that seek to limit their CGL coverage to liability on designated premises.
Erie Insurance Exchange v. Lobenthal, 114 A.3d 832 (Pa. Super. Ct. 2015)
The Pennsylvania Superior Court held in Erie Insurance Exchange v. Lobenthal that a reservation of rights letter was never provided to an adult-defendant, who was a resident in her parents’ home, because the letter -- that was intended to be a reservation of rights -- was addressed to her parents. The court held: “[W]e refuse to attribute notice to Michaela based on the fact that she was living with her parents at the time. Michaela was an adult at the time the lawsuit was filed, and there is no evidence that she actually read the letter. Michaela was the defendant in the underlying tort action, and the letter should have been addressed in her name.”
Thus, despite that the insurer should have owed no coverage to the insured, on account of an exclusion, such was not to be the case, as no reservation of rights letter was ever sent to her. The overarching take-away from Lobenthal is that, when an insurer sends a reservation of rights letter, no matter how well-drafted it is, it must address coverage for all insureds and be sent to or on behalf of them.
Kelly v. State Farm Fire & Casualty Co. 169 So. 3d 328 (La. 2015)
Insurers generally see themselves as relieved of any risk of exposure for an excess verdict if there is no demand to settle within limits. After all, even if the insured has a legitimate risk of personal liability for a verdict above its policy limit, the opportunity to settle just isn’t there.
The Louisiana Supreme Court held in Kelly v. State Farm Fire & Casualty Co. that an insurer can be found liable for a bad-faith failure-to-settle claim, under Louisiana’s version of the Unfair Claims Settlement Practices Act, notwithstanding that the insurer never received a firm settlement offer. The court pointed to the statute’s language that an “insurer has an affirmative duty to adjust claims fairly and promptly and to make a reasonable effort to settle claims with the insured or the claimant, or both.”
By relying on this Louisiana statute to reach its decision it sounds like Kelly may not be felt outside the Pelican State. But here’s the rub. The Louisiana statute is in fact based on the National Association of Insurance Commissioner’s Unfair Claims Settlement Practices Act. And just about every state in the country has adopted some version of the NAIC’s Act. Therefore, the Kelly court’s rationale may be there for the talking by courts in other states. If so, insurers may not be able to consider themselves without risk of exposure for an excess verdict because a demand to settle within the insured’s limit of liability was never made.
Wolfe v. Allstate Property & Casualty Company, 790 F.3d 487 (3rd Cir. 2015)
When considering whether an insurer is obligated to settle a case, based on the possibility of a verdict in excess of limits, it may be the potential for a punitive damages award that has a lot to do with pushing the case into that category – especially one that is relatively small or has fixed damages that do not exceed the policy limit.
The Third Circuit held in Wolfe v. Allstate that, if punitive damages are uninsurable, then an insurer does not have to consider the potential for the jury to award punitive damages, when confronted with a settlement demand within policy limits, and assessing whether a verdict can potentially exceed such limits. Thus, the Wolfe court has given insurers justification for taking cases to trial, and then avoiding liability for a verdict in excess of limits, if that’s how it turns out.
The Babcock & Wilcox Company v. American Nuclear Insurers, 2015 WL 4430352, -- A.3d -- (Pa. 2015)
The Pennsylvania Supreme Court held in Babcock & Wilcox Company v. American Nuclear Insurers that an insured did not forfeit “insurance coverage by settling a tort claim without the consent of its insurer [for $80 million], when the insurer defended the insured subject to a reservation of rights [to the tune of $40 million], asserting that the claims may not be covered by the policy.”
The story of B&W is that the Pennsylvania high court adopted a variation of the Arizona Supreme Court’s decision in United States Auto Ass’n. v. Morris, 741 P.2d 246 (Ariz. 1987). In general, under Morris, the insured will not be deemed to have violated the cooperation clause’s prohibition against the insured settling a case without the insurer’s consent. The insurer must be made aware that it may waive its reservation of rights and provide an unqualified defense. If the insurer declines, it can defend against the judgment resulting from the Morris agreement on the basis that it is unreasonable and/or not covered.
As discussed above in Donnelly Distribution, there may be no harder issue than an insurer confronted with a settlement demand but which has defenses to coverage for any verdict against the insured. The Pennsylvania Supreme Court’s decision in Babcock & Wilcox Company may find an important place in addressing this complex situation. This challenging issue is also sorely lacking in guidance. For that reason, B&W’s reach may extend beyond The Keystone State.
[Disclosure: White and Williams filed an amicus brief, on behalf of an insurance industry trade association, in support of ANI’s position.]
United States Liability Insurance Company v. Benchmark Insurance Services, 797 F.3d 116 (1st Cir. 2015)
Insurers have been attempting to reduce their exposure for bodily injuries at construction sites. The effort has come about in the form of endorsements that preclude coverage for bodily injury sustained by an employee of a contractor or subcontractor. However, under some of these endorsements, the injured party need not have been working for a subcontractor that was retained by the insured. Rather, the exclusion applies if the injured party was employed by any contractor or subcontractor on the project.
The First Circuit in United States Liability Insurance Company v. Benchmark Insurance Services declined to uphold an exclusion where the injured person was employed by a contractor that had no relationship to the insured. The court’s rationale was that the term “contractor” is ambiguous: “Anyone with a contract is surely a reasonable definition of the word ‘contractor,’ as the district court found, but so is a more narrow definition focused on the contractual relationship of the injured party and the insured.”
Benchmark does not mean that insurers are never going to win cases based on exclusions that apply if an injured party was employed by any contractor or subcontractor on the project – even ones with no relationship to the insured. But the thoroughness of the opinion is likely to give more courts pause before applying such exclusions – no matter how clearly they may apply on their face.
SRM, Inc. v. Great American Insurance Co., 798 F.3d 1322 (10th Cir. 2015)
As discussed above, in the context of the Louisiana Supreme Court’s decision in Kelly v. State Farm, when a demand to settle within the insured’s limit of liability is never made, insurers generally see themselves as relieved of any risk of exposure for an excess verdict. Granted, that’s not always true. In some states, such as Oklahoma, “if an insured’s liability is clear and the injuries of a claimant are so severe that a judgment in excess of policy limits is likely, a primary insurer has an affirmative duty to initiate settlement negotiations.” SRM, Inc. v. Great American Insurance Co., 798 F.3d 1322 (10th Cir. 2015).
In SRM, Inc. v. Great American, the Tenth Circuit held that Oklahoma’s rule, applicable to primary policies, does not require excess insurers to take that same affirmative step. The court place strong reliance on the language in the excess policy, noting that the excess insurer’s contractual duties to investigate, settle, or defend claims did not arise until the primary insurer exhausted its policy limits by actually paying claims.
The SRM court’s decision is entirely justifiable based on the policy language rationale. However, it is not difficult to imagine a court, in a state that imposes an affirmative duty on a primary insurer to initiate settlement negotiations, when an insured’s liability is clear, and a judgment in excess of policy limits is likely, to turn around and impose the same affirmative duty on an excess insurer. A court may conclude that, to have the duty apply to the primary insurer, but not the excess insurer, may not achieve the objective being sought.
U.S. Metals, Inc. v. Liberty Mutual Group, No. 14-0753 (Tex. Dec. 4, 2015)
In U.S. Metals, Inc. v. Liberty Mutual, the Texas Supreme Court addressed the applicability of the “impaired property” exclusion for damages for loss of use of refinery units on account of the insured’s defective flanges that had been installed in them. Most significantly, the process of replacing the flanges damaged the units. In other words, the replacement process did not involve simply unscrewing the defective flanges and screwing in new ones. U.S. Metals argued that, for this reason, the impaired property exclusion did not apply. Texas’s top court was not persuaded, noting that the policy definition of “impaired property” does not restrict how the defective product is to be replaced.
Insurers have sometimes shied away from asserting the “impaired property” exclusion for the very reason that U.S. Metals provided: since the flanges had to be cut out and welded back in, the diesel units could not be restored to use simply by replacement of the flanges. U.S. Metals is likely to cause some insurers to take another look at the impaired property exclusion in these types of product liability situations. |
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Congratulations To John Grisham: Who Says Proximate Cause Is So Hard To Understand?
I had the privilege of interviewing John Grisham for the November 11, 2015 issue of Coverage Opinions. At the time, his new book, Rogue Lawyer, was #1 on The New York Times Best Seller List. It is now eight weeks later and Rogue Lawyer is still on the NYT list – having slipped only to the #3 spot. Look what happens when John Grisham gives an interview to Coverage Opinions.
Coverage Decision Written In Spanish
I read a lot of coverage decisions. However, I have never seen one like the Tribunal Supremo de Puerto Rico’s in Candelaria v. City of Angels, Inc., No. 2014-163 (P.R. Dec. 4, 2015). It is written entirely in Spanish.
Despite having lived in Spain for four years I do not speak Spanish. It’s a long story. But it looks like the decision has something to do with a “professional services” exclusion in a CGL Policy. The opinion states near the top: “Este recurso nos brinda la oportunidad de expresarnos sobre el alcance de una cláusula de exclusión de servicios profesionales incluida en una póliza de Responsabilidad General Comercial.”
The now and then coverage decisions that I see from the U.S. District Court in Puerto Rico are written in English. Anyway, just thought this was unusual enough to mention here.
Rutgers Law Review Devoted To ALI Restatement Of The Law Of Liability Insurance
Those of you following the ALI’s drafting of the Restatement Of The Law Of Liability Insurance will be interested to know that the Rutgers Law Review recently published an issue dedicated to the project. It is a compilation of various articles that were prepared for the law school’s February 27, 2015 conference on the liability insurance Restatement. A copy of the issue can be found at the Rutgers Law Review’s website.
In Remembrance: Joe Jamail – “King of Torts” (Coverage Opinions Interviewee)
Joe Jamail, dubbed the “King of Torts” by many, died on December 23. Jamail was the richest practicing lawyer in America. But that has nothing to do with the fact that Forbes recently listed his net worth at $1.6 billion. There’s more than one definition of the word “rich.” It can also mean deep in color. And there may be no lawyer – ever – who had more color than Joe Jamail.
I had the honor (and fun) of interviewing Jamail last year for Coverage Opinions. I asked him where does a person sit when they are in football stadium (University of Texas) that bares their name. It was a funny exchange. Here’s the article (which was picked up by Above the Law as part of its coverage of Jamail’s death):
http://www.coverageopinions.info/Vol3Issue6/CurrentIssue.html
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Vol. 5, Iss. 1
January 13, 2016
Amazon Nearly Sells Out Of Insurance Key Issues
The Black Friday Door Buster Continues: Insurance Key Issues 3rd Edition For Half Price!
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The Black Friday Door Buster for Insurance Key Issues (3rd Edition), announced in the last issue of Coverage Opinions, lives on.
Use Discount Code NTP238LF at the following “Create Space” site to get a 50% discount: www.createspace.com/5242805.
Amazon – despite providing NO discount (nada, zip, zilch) – came within 3 copies of selling out of Key Issues just before Christmas. I really wish those Amazon shoppers had known that they could have gotten 2 for the price of 1. The last thing I want to see is anyone paying full retail for the book.
See for yourself why so many find it useful to have, at their fingertips, a nearly 800-page book with just one single objective -- Providing the rule of law, clearly and in detail, in every state (and D.C.), on the liability coverage issues that matter most.
http://www.InsuranceKeyIssues.com
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Vol. 5, Iss. 1
January 13, 2016
Insurers Must Initiate Settlement Negotiations – Even With No Demand Within Limits
Guest Author Lee Archer, Claimant’s Co-Appeal Counsel In “Top 10’s” Kelly v. State Farm, Addresses What She Sees As The “Modern View”
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The last issue of Coverage Opinions featured the 15th Annual “Ten Most Significant Coverage Decisions of the Year” article. The article lists the cases in the order that they were decided and not in terms of relative significance. After all, the whole thing is subjective enough without adding that on top. But, if the list were put in order of most most-significant decision to least most-significant, at or near the top would have been the Louisiana Supreme Court’s in Kelly v. State Farm Fire & Casualty Co., holding that an insurer can be found liable for a bad-faith failure-to-settle claim, under Louisiana’s version of the Unfair Claims Settlement Practices Act, notwithstanding that the insurer never received a firm settlement offer. The decision made the “Top 10” list because the Louisiana statute, on which the court relied, is based on the National Association of Insurance Commissioner’s Unfair Claims Settlement Practices Act. And just about every state in the country has adopted some version of the NAIC’s Act. Therefore, as I saw it, the Kelly court’s rationale may be there for the taking by courts in other states. If so, insurers may not be able to consider themselves without risk of exposure for an excess verdict because a demand to settle within the insured’s limit of liability was never made.
It turns out that I’m not alone in my belief that the Kelly decision could be felt outside of the Pelican State. In fact, according to Lee Archer, claimant’s appeal counsel in the case, that an insurer can be liable for a bad-faith failure-to-settle claim, notwithstanding that the insurer never received a firm settlement offer, is already the “modern view” on this issue. Lee was kind enough to discuss this in the commentary just below.
Lee Archer is a Louisiana appellate lawyer who has spent the past 25 years providing other lawyers with appellate consulting and brief writing services at all levels of state and federal courts. For lawyers who find appellate courts to be unfamiliar territory, or want the benefit of an appellate expert on their team, the former law clerk to the Chief Justice of the Louisiana Supreme Court, provides the necessary assistance. Lee Archer is a lawyer’s lawyer. he served as co-appeal counsel to the claimant in Kelly v. State Farm. For more information about Lee Archer visit www.leeaarcher.com. |
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The “Modern View:”
Insurers Owe a Duty to Initiate Settlement Negotiations to Protect Insureds from Excess Judgments |
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The insurance defense and coverage bars have reacted with shock to the Louisiana Supreme Court’s recent decision in Kelly v. State Farm Fire & Cas. Co., 169 So. 3d 328 (La. 2015). The Kelly Court held: “A firm settlement offer is unnecessary for an insured to sustain a cause of action against an insurer for a bad-faith failure-to-settle claim, because the insurer's duties to the insured can be triggered by information other than the mere fact that a third party has made a settlement offer.” 169 So. 3d at 338.
But if insurers believe the sky is now falling, they have not been looking up. In Kelly, the Court in fact adopted the “modern view,” which imposes an affirmative duty upon the insurer, not the insured or claimant, to initiate settlement negotiations.
“The modern view is that absence of a third party’s settlement demand will not insulate a liability insurer from exposure to liability to pay sums beyond its policy limits as a result of its bad faith and unfair dealing in settlement.” Dennis J. Wall, Litigating & Preventing Insurance Bad Faith § 3:14 (3rd ed. 2012), citing, inter alia, Badillo v. Mid Century Ins. Co., 2005 OK 48, 121 P.3d 1080, 1095 (2005); Dennis J. Wall, “The Era of Initiating Settlement Negotiations: What Is a Liability Insurance Company to Do?” 32 Ins. Lit. Rptr. 1 (2010). Further, “the originally accepted proposition that only a demand within or at policy limits would activate the liability insurer's duty of good faith and fair dealing in settlement has been modified to require the insurer to enter into settlement arrangements using its policy limits whenever … The reasonable insurer would offer that sum if its own liability had no policy limit…” Id., at p.1
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An increasing number of courts have “rejected the original reliance on reception of the third party's settlement demand as being the operative factor in a liability insurer's duty of good faith and fair dealing in settlement.” Litig. & Prev. Ins. Bad Faith, supra, § 3:14. Indeed, many state and federal courts have imposed upon insurers an affirmative duty to initiate settlement negotiations. See, Allan D. Windt, 1 Insurance Claims and Disputes 5th § 5:2 (2012), collecting cases.
Comparing numerous cases, Professor Windt notes: “The better rule, therefore, is that the insurance company has an affirmative duty to explore settlement possibilities under circumstances in which the company would have initiated settlement negotiations on its own behalf were its potential liability equal to that of the insured. The absence of a formal request by the plaintiff to settle within the policy limits should merely be one factor to be considered in determining causation.” Id., (emphasis added) citing, inter alia, Roberts v. Printup, 422 F.3d 1211, 1215 (10th Cir. 2005) (“The duty to consider the insured’s interest arises because of a claim for damages in excess of the policy limits, not because a settlement offer had been made.”)
Other state supreme courts agree. See, e.g., Alt v. American Fam. Mut. Ins. Co., 237 N.W.2d 706, 711 (Wis. 1976) (“the submission of a legally binding offer from a claimant is not a necessary condition antecedent to the maintenance of a bad-faith excess-liability action”); Rova Farms Resort, Inc. v. Investors Ins. Co. of Amer. 323 A.2d 495 (N.J. 1974) (insurers have an affirmative duty to explore settlement possibilities. “At most, the absence of a formal request to settle within the policy is merely one factor to be considered on the issue of good faith”); Farmers Ins. Exch. v. Schropp, 567 P.2d 1359, 1366 (Kan. 1977) (“the duty to settle does not hinge on the existence of a settlement offer from the plaintiff”).
Thus, the decision in Kelly imposing an affirmative duty to settle was not unprecedented. The decision brings Louisiana in line with the “modern view” that an insurer owes an affirmative duty to initiate settlement negotiations in order to protect the insured from an excess judgment and that absence of a third party’s “firm settlement offer” will not insulate an insurer from liability for bad faith. For insurers, the rule they should be following is “we’ll call you, don’t call us.” |
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Vol. 5, Iss. 1
January 13, 2016
MUST READ CASE: Court Provides Roadmap For Policyholders To Navigate Around Numerous Exclusions
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Skolnik v. Allied Property and Casualty Ins. Co., No. 1-14-2438 (Ill. Ct. App. Dec. 22, 2015) was a Christmas week gift for policyholders. It provides a lesson that could have an impact felt far and wide. Indeed, I would have given this coverage case serious consideration, as one of the ten most significant of the year, had it been decided two weeks earlier.
Haley Johnson died of methadone intoxication in the bedroom of Joshua Skolnik, who lived with his parents. The night before, Johnson and Skolniok, and others, had been out drinking. Skolnik had a prescription for methadone. I’ll let the court take over the facts from here. Be sure you are sitting down. “After Johnson had another drink that Skolnik provided, she told him that she thought ‘something’ had been put into it, and needed assistance to walk. Skolnik took Johnson to his parents’ home where they had sex in his bedroom. Skolnik had abused drugs in the past and used methadone; Skolnik’s parents knew of his drug history and of the methadone in the house. Skolnik’s parents heard voices in his bedroom at 4 a.m. Around 9 a.m., Skolnik’s mother checked on Skolnik and he told her that Johnson passed out in the bedroom. Between 11:30 a.m. and 1 p.m., two of Johnson’s friends came to the Skolniks’ home to check on her but Skolnik did not let them see her, telling them that Johnson was passed out naked in his bedroom. At 3:30 p.m., Skolnik told his parents Johnson was unconscious. Three hours later, his parents left for dinner and another six-and-a-half hours later, Skolnik pulled Johnson off his bed and called his parents who had not yet returned. He told them Johnson felt cold to the touch. The Skolniks instructed their son to dress Johnson and call 911. At 10:11 p.m., Skolnik called 911. When the police arrived at 10:14 p.m., Johnson was not breathing. She was pronounced dead at the Skolniks’ home at 11:31 p.m.”
Johnson’s father sued Joshua Skolnik and his parents for wrongful death, false imprisonment and a host of other causes of action. Coverage was sought under homeowner’s and personal and umbrella policies issued by Allied Property and Casualty. The policies contained an exclusion for bodily injury “arising out of the use” of controlled substances, with an exception for “the legitimate use of prescription drugs by a person following the orders of a licensed physician.”
The applicability of this exclusion, for purposes of a duty to defend, was the crux of the case before the Illinois Court of Appeals. Allied argued that the complaint alleged that Johnson’s death resulted from controlled substances. This is not an unreasonable argument, especially when you consider that the term “arising out of,” as contained in an exclusion, is usually interpreted broadly. The trial court concluded that the exclusion applied to relieve Allied from a duty to defend.
But as the appeals court saw it, there was more to it. In addition to allegations that Skolnik caused Johnson’s death, the complaint also alleged that “Skolnik and his parents negligently, carelessly, and improperly failed to request emergency medical assistance for Johnson within a reasonable period of time after knowing she was physically incapacitated or unconscious or both; and knowing or discovering she ingested or unknowingly consumed methadone or other illegal substances in the Skolnik home. Further, count I alleges that Skolnik and his parents refused to allow Johnson’s two friends to check on, talk to, see, or render aid to Johnson upon their request; and that they ‘took affirmative actions to Johnson’s detriment and acted in concert’ after discovering she was ‘dead, unconscious, and/or unresponsive in their home.’”
The court used these allegations to conclude that, at least for purposes of the duty to defend, the controlled substances exclusion did not apply: “Here, despite the autopsy notation regarding cause of death [methadone intoxication], a genuine issue of material fact exists as to whether Johnson’s death was caused solely by her methadone ingestion. The four corners of the complaint contain details that, if true, describe a lengthy and protracted period of time during which Skolnik could have sought assistance. The unknown is whether Johnson would have died if he had allowed Johnson’s friends to see her, or called 911, or truthfully informed his parents earlier about Johnson’s condition. Other potential causes include a genetic predisposition and a prior history of drug abuse.”
Thus, the court held that Allied had a duty to defend. But whether Allied would have a duty to indemnify was still an open issue. It was tied to a determination whether, in fact, there was “an independent basis for liability in that Skolnik could have saved Johnson but he did not summon help?”
There are a host of exclusions that preclude coverage for injury arising out of some specified conduct on the part of an insured: assault and battery, furnishing alcohol, criminal acts, etc. These exclusions are often interpreted broadly on account of being expressed in “arising out of” language. Skolnik demonstrates that a plaintiff may be able to trigger a defense obligation, in a case that would otherwise be subject to a broad “specified conduct exclusion,” by simply alleging (provable or not) that, after the insured committed the excluded conduct, it failed to summon help for the victim. And such failure was also a cause of the plaintiff’s injuries.
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Vol. 5, Iss. 1
January 13, 2016
Impressive Example Of A Plaintiff “Pleading Into Coverage”
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We all know that plaintiffs’ attorneys sometimes draft a complaint in an effort to so-called “plead into coverage.” It often looks like this. The plaintiff is suing the defendant for personal injuries, on account of some type of physical assault or wrongful conduct on the part of the defendant. The plaintiff’s attorney is well aware that his or her best hope for collecting a judgment is from the defendant’s homeowner’s insurer. So, despite how intentional the defendant’s conduct may have in fact been, the plaintiff’s attorney includes an allegation in the complaint that it was negligent. The purpose here is obvious. It is an effort to trigger the liability section of the defendant’s homeowner’s policy – something that would be very difficult to do if all of the allegations in the complaint were that the defendant acted intentionally. In other words, the negligence allegation in the complaint is a ploy in an effort to avoid a disclaimer from the defendant’s insurer on the basis of no “occurrence” or the “expected or intended” exclusion.
I know this. You know this. The defendant knows this. And, thankfully for insurers, so does the judge. Courts are often times not fooled by this so-called “artful drafting” in an effort to trigger coverage. Courts often look at the complaint (defendant stabbed the plaintiff 17 times), understand that it’s all about an intentional act that would surely be known to cause the injuries, give no credence to the “negligence” label attached to a count (defendant was negligent in that he should have known not to place the knife into the plaintiff’s chest 17 times), and conclude that no defense is owed based on no “occurrence” or the “expected or intended” exclusion.
But sometimes plaintiffs succeed in using artful drafting to trigger the defendant’s policy. And you’d be hard-pressed to find a more impressive example of this than Allstate Ins. Co. v. Neleber, No. 14-629 (D. Conn. Sept. 15, 2015). Not only is it impressive, but the plaintiff (maybe purposely; maybe by accident) provided a lesson how others can achieve such success. [The case, from September, is a little old for a CO write-up. I just missed it at the time it came out.]
The facts are not out of the ordinary (actually, they are very out of the ordinary, but not when it comes discussing these types of situations): “On or about June 9, 2013, Astram and Neleber were both guests at the home of George and Susan Kulp in North Haven, Connecticut. On that occasion Neleber struck Astram about the face and head causing Astram injuries and damages including, but not limited to, a fractured jaw, broken and missing teeth, difficulty eating and sleeping, and psychological pain and suffering.”
The causes of action are what you would expect to see—Assault and Battery and Negligence. Negligence you say. How can this be negligent?, you ask. Easy. The plaintiff alleged that defendant “swung his arms when he was inattentive to the presence of individuals around him.” I know, it’s breathtaking.
The court concluded that Allstate owed a defense to its insured under a homeowner’s policy. The trouble for Allstate was that, even though Count One alleged Assault and Battery, the complaint contained a scarcity of factual allegations concerning the incident in question. Specifically, Count I simply alleged that Neleber did commit an Assault & Battery upon the plaintiff by striking him about the head and face. Based on these limited allegations, the court concluded that even the Assault & Battery count did not clearly implicate intentional acts. From there, it wasn’t even necessary to determine whether the incredible “negligence” allegations (defendant “swung his arms when he was inattentive to the presence of individuals around him”) should be ignored based on being artfully pleaded.
The court noted that “the meager factual allegations contained in the Astram Complaint are not sufficient to demonstrate the applicability of the policy’s intentional or criminal acts exclusion. It is, of course, entirely possible that the paucity of factual allegations in the Astram Complaint is by design, and that Neleber’s actions were indeed intentional. In deciding whether to grant Allstate’s motion, however, the Court is limited to a review of the policy and the factual allegations contained in the Astram Complaint.”
On one hand, Neleber is not in fact an “artful pleading”/“plead into coverage” case. The court never actually needed to address whether the negligence count was hogwash since even the cause of action with an intentional label (A&B) wasn’t necessarily intentional. However, the case still belongs in the “plead into coverage” category (and a masterful one at that) on the basis that it was the scarcity of allegations in the complaint (possibly by design, as the court noted) that dictated the outcome. The lesson here for would-be pleaders into coverage is obvious.
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Vol. 5, Iss. 1
January 13, 2016
Federal Court Demonstrates Insurers’ Challenge In Applying “Montrose Endorsement”
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In general, insurers have had mixed results in construction defect cases when it comes to enforcing the Montrose (known loss) endorsement. Some courts have interpreted them narrowly and applied a strict “sameness” test (my term) between the “property damage” that existed pre-policy inception date and that which took place during the policy period, for which coverage was being sought. Further, it is the “property damage” itself that must be known by the insured prior to the policy period and not the cause of the “property damage.” You could put it this way – if it looks like a mallard duck, and quacks like a mallard duck, it’s only a mallard duck and not a perching duck.
[Of course, construction defect cases are not what ISO had in mind when it put pen to paper on the Montrose endorsement.]
This insurer challenge is the story of Scottsdale Ins. Co. v. Kaplan Family Trust, No. 15-538 (N.D. Calif. Nov. 23, 2015). Residents of a hotel in San Francisco brought suit against the hotel owners for an array of habitability issues. This was known as the Toliver action and involved 78 plaintiffs (keep that name in mind). The hotel owners had been sued earlier by residents – represented by the same plaintiffs’ firm – over habitability issues.
The hotel owners sought coverage from Scottsdale under a commercial general liability policy. The insurer defended under a reservation of rights and filed a declaratory judgment action. Scottsdale’s argument was that, based on the existence of these prior habitability lawsuits and the owners’ knowledge of them, the policy’s “known loss” provisions (i.e., Montrose language) precluded coverage. The court set out the specific policy language, but summarized it this way: “Essentially, the policy creates a coverage exclusion if the insured had been put on notice, before inception of the policy, by receiving a demand for damages or by other means, of the injury claimed during the policy period.”
The court concluded that, despite these earlier habitability suits, summary judgment for Scottsdale was not warranted: “Many of the defects alleged in the previous actions overlap with the Toliver allegations. Many of the same units are involved and all allege violations in common areas. The existence of the prior lawsuits likely put landlord defendants on notice of at least some violations alleged in Toliver. This is especially true in regards to the claims of the seventeen plaintiffs in Toliver who were also plaintiffs in the previous Santa-Iglesias action. Nevertheless, Scottsdale has not established beyond ‘any doubt’ that the known-loss provisions in the policy apply to all of the claims in Toliver.” (emphasis in original).
Here is the take-away/money language from the case: “An insured being on notice of general habitability allegations in certain parts of a building does not negate any future insurance coverage for allegations relating to other partially overlapping, partially different habitability issues. . . . [T]he Toliver action involves twenty-five separate units not implicated in prior suits. Based on the differences between the underlying action and the previously settled actions, factual issues remain to be decided as to the scope of landlord defendants’ knowledge of the alleged Toliver violations.”
Essentially, Kaplan Family Trust is another court applying a strict “sameness” test for purposes of denying coverage based on Montrose language. The “property damage” that existed pre-policy inception date, and that which took place during the policy period, for which coverage is now being sought, must be the same. The insured’s knowledge of prior property damage in general, or the cause of property damage, may not be enough.
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Vol. 5, Iss. 1
January 13, 2016
Construction Defect: Court Applies “Cause Test” And Finds Multiple Occurrences
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Number of occurrences is the “money issue.” A court finds that damage was caused by multiple occurrences and poof, in a heartbeat, an insurer’s exposure for a claim can double or triple or more. It is also one of the more predictable issues. Number of occurrences, more than some others, enables the parties to make some educated guesses. For example, in a state that applies the “cause test” for determining number of occurrences, a court is more likely to find that injury or damage was caused by a single occurrence, and, hence, one limit of liability applies. In a state that applies the “effect test” for determining number of occurrences, a court is more likely to find that injury or that damage was caused by more than one occurrence, and, hence, more than one limit of liability applies.
This is why I always pay more attention to number of occurrences decisions that buck this general rule. United National Ins. Co. v. Assurance Company of America, No. 10-1086 (D. Nev. Nov. 12, 2015) is one such case. Not to mention that it is a construction defect case. In other words it does not involve some obscure fact pattern that is unlikely to be replicated.
At issue was coverage for R.B. Petersen & Sons Construction Co., a grading and paving contractor that worked on a project called Seneca Falls. “Petersen’s work on this project was governed by six written proposals, which delineated several different types of work: over-excavation, grading, sub-grading for curbs and streets, fine grading, compacting, filling, curb construction, paving, importing soil, importing gravel, and placing gravel.”
The facts are described by the court like this: “R.B. Petersen was added as a third-party defendant in the underlying construction-defect litigation in October 2006. After amendments, the complaint alleged claims of 124 homeowners in 122 Seneca Falls homes purchased between August 22, 2000, and May 15, 2003. In their third amended complaint, the homeowners alleged that R.B. Petersen ‘provided rough grading and earthwork services’ and that ‘the nature and scope of construction defects include but may not be limited to, improperly placed or compacted soils, improperly designed or constructed walkways, driveways, slabs, pads, foundations, exterior masonry site retaining/fence walls, and landscape.’ Throughout that litigation, there were allegations that R.B. Petersen caused damages by (1) failing to over-excavate to a proper depth, (2) failing to provide a gravel base at home sites, (3) using expansive and/or corrosive soils in its fill material, (4) improperly compacting slab sites, and (5) using oversized fill materials.”
Putting aside how the issue arose, it became necessary for the court to determine how many occurrences caused the damage at issue in a settlement. [There was also a question concerning the applicability of an “anti-stacking” provision but I’ll take a pass on that.] As you would expect, the court started its analysis by addressing how Nevada law treats number of occurrences. The answer – like the majority of jurisdictions – is the causal approach (i.e., the cause test). “Under this analysis, the inquiry is focused on whether there was one or more than one cause [that] resulted in all of the injuries or damages.’ ‘[T]he focus of the inquiry should not be on the number, magnitude or time of the injuries, but rather on the cause or causes of the injury.... As long as the injuries stem from one proximate cause there is a single occurrence.” The court went on to discuss three examples of the Nevada Supreme Court’s application of the casual test.
The primary insurer argued (in a dispute with the excess insurer, as is often the case) that all of the insured’s grading work, as a whole, at the Seneca Falls development was the single cause of the damage, and, thus, constituted one occurrence under its policies. On one hand, the court saw this point: “Zurich is correct that rough grading, over-excavation, importing fill materials, paving, filling, and compacting soils is an interconnected series of acts or omissions by R.B. Petersen that are attendant to or part of the grading and paving work it performed at the Seneca Falls development. Zurich is also correct that the record reflects that those series of acts and omissions are what caused damage to the homes in the Seneca Falls development and created R.B. Petersen’s liability for the ‘scaling and corrosion of various elements of the homes, ponding and drainage problems surrounding the homes[,] and moisture intrusion into the homes.’”
However, that was not the end of the analysis. The court took note of the fact that the insured’s “negligence was directed toward separate groups of homeowners and can be separated into several discrete series of acts or omissions.” And this became the basis for the court’s determination that the property damage was caused by four “independent causes:” “the grading and paving work that R.B. Petersen performed in each of the four units of that development.” More specifically, “R.B. Petersen performed grading and paving work in all four units of the Seneca Falls development and that its work was performed in four or five distinct phases over several years. Moreover, that R.B. Petersen’s grading and paving work at the Seneca Falls development was subject to different soils reports and recommendations for each unit of that development.”
United National v. Assurance is not going to change my opinion that, in a state that applies the “cause test” for determining number of occurrences, a court is more likely to find that damage was caused by a single occurrence. But the moral of the story is don’t judge an issue by its label. Damage that looks like it has one single, general cause – as Zurich argued and the court acknowledged was not an unreasonable position – can in fact be parsed into separate, single causes. So the court complies with its obligation to follow the requisite cause test, yet issues an opinion that resembles the effect test.
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Coverage And The Insured’s Violation Of A Law That Nobody Has Heard Of
The court’s decision in Parker v. Farm Bureau Property & Casualty Co., No. 15-1204 (D. Kan. Nov. 16, 2015) starts out like this: “If you have never heard of the Plant Variety Protection Act (PVPA), you are not alone.” It turns out that the owner of a farm also never heard of it either, until he sold a variety of wheat seed “to an undercover investigator who represented the holder of an exclusive license under the PVPA to sell that variety of seed.” The farm owner was sued for damages under the PVPA and sought coverage under a liability policy issued by Farm Bureau. The insurer denied “because the insurance policy excluded coverage for ‘intentional acts,’ and plaintiffs’ sale of Fuller wheat was an intentional act.” The court wasn’t convinced. Like, not even close. Following a review of the policy’s “intentional act” exclusion and Kansas law on the issue, the court held: “Parker [insured] did these acts without knowledge of an obscure federal law and without knowledge of an exclusive federal license pertaining to a particular variety of wheat. Farm Bureau cites nothing to show that a reasonable person would have expected advertising and selling wheat seed to result in injury or damage. Only with knowledge of the exclusive license would a person expect a sale to result in damage.”
Insurer Entitled To Reimbursement Of Defense Costs
I have long maintained that an insurer’s right to reimbursement of defense costs is an over-rated issue. The stars need to be perfectly aligned: a state that affords insurers the right (about half don’t); a judicial determination that there was no duty to defend (not a situation where a duty to defend existed followed by a determination of no indemnity coverage); and an insured with the resources to pay the defense costs back.
Nonetheless, the issue gets litigated, as was the case in American Economy Insurance Company v. Aspen Way Enterprises, Inc., No. 14-09 (D. Mont. Dec. 4, 2015), where the Montana federal court held that, based on two theories, the insurer was entitled to reimbursement of defense costs. "Under the theory of unjust enrichment, Aspen Way has received the benefit of representation on claims that were not covered by the policies and for which it did not pay premiums. Aspen Way’s objection does not change the fact that Aspen Way would be unjustly enriched by forcing Liberty Mutual to bear unbargained-for defense costs.” The court also held that, “[u]nder the implied contract theory, Aspen Way accepted Liberty Mutual’s reservation of rights letter by not objecting to it until nearly three years later. Under Montana law, a ‘party is not allowed to take the benefit of a contract and then later repudiate its existence.’”
Duty To Defend And Websites
In Shanze Enterprises, Inc. v. American Casualty Company of Reading, No. 15-0756 (N.D. Tex. Dec. 15, 2015), the Texas federal court held that, if it will consider web page exhibits attached to a complaint, for purposes of determining a duty to defend under the eight corners rule, it will only consider the exhibits themselves, and not the contents of the entire website. The policyholder argued that “the court must consider Baja’s entire website because, ‘[l]ike a hyperlink, [Baja’s] attachment of the website attaches the entire website,’ since ‘[n]o one truly expects a plaintiff to print out each and every page of the website and attach it to the complaint.’” The court declined do so: “The court has found no authority to support the proposition that, when ruling on the duty to defend, the court must consider an entire website when only part of the website is included in a printout that is attached as an exhibit to the complaint in the underlying lawsuit.”
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