No Cause of Action for Libel, Slander or any Other Relevant Tort This is not a new case but it is important to everyone in the insurance business in California and any other state that has similar statutes. The principal issue raised is whether the insurer’s report to the Bureau of Fraudulent Claims (hereinafter Bureau) […]
No Insurance Policy Covers Every Risk of Loss In the world of business, corporations obtain commercial insurance to protect their assets, and commercial insurers customarily include exclusion provisions in their policies. Exclusion provisions dispel the notion that insurance coverage is without limits and place the insured on notice about actions or omissions that will trigger […]
Protective Safeguards Endorsement is a Condition Precedent Kinsale Insurance Company (“Kinsale”) sought declaratory relief against Sea Brook Harbor and Marine, et al (collectively “Seabrook”) arguing that Seabrook failed to comply with a condition precedent in the insurance policy it issued to Seabrook and that consequently there was no coverage for a fire occurring at Seabrook’s […]
Injured by an Aircraft Fuselage Arose Out of Ownership of Aircraft A woman was severely injured while moving an inoperable airplane. She now seeks to recover from her husband’s homeowner’s insurance policy. The insurance policy excludes injuries “arising out of” the ownership, maintenance, use, loading or unloading of an aircraft. The policy further defines “aircraft” […]
How to Put Fear of Insolvency Into a Defendant For more than fifty six years working in and about the insurance industry I For more than fifty six years working in and about the insurance industry I have personally seen the fear in the faces of corporate executives faced with a suit claiming wrongful conduct […]
Total Pollution Exclusions The Pollution exclusion often found in policies that are the subject of dispute provides: It is agreed that this policy does not apply to liability for personal injury or property damage arising out of the discharge, dispersal, release, escape, or seepage of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals, liquids or […]
When Appraisers Fail to Agree on Umpire Court Must Appoint One When a claim for damages due to a hurricane was disputed the parties demanded appraisal and appointed their respective appraisers. However, the appraisers could not agree on an umpire for reasons unclear and bad faith litigation ensured. Because of the inability of the appraisers […]
Insurer May Never Subrogate Against its own Insured Zurich American Insurance et al sued their coinsurers – Appellant Certain Underwriters at Lloyd’s, London Subscribing to Policy Number B12630308616 (Lloyd’s) and Defendant Arch Insurance Company (Arch) – seeking a declaratory judgment that Lloyd’s is barred under New York law from bringing a common law indemnification or […]
Fraudster Must Serve Time and Lose His Residence to Pay Restitution Armando Valdes appealed his 60-month sentence for health care fraud after he pleaded guilty. Valdes’s conviction and sentence arose out of his scheme to submit millions of dollars in fraudulent medical claims to United Healthcare and Blue Cross Blue Shield for intravenous infusions of […]
The Christmas Gift of Insurance Fraud The story that follows is fiction based, in part, on a true case worked on by me. Any similarity to real people is unintentional. It is meant only to educate fraud professionals about how some unscrupulous people use the crime of insurance fraud for fun and profit during the […]
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