Cases
Representative Experience: Duty to Indemnify, Coverage, Property Damage, Insurable Interest, Commercial, L
lord, Tenant
Sonoma County Superior Court
Defendant Insurance Company
Bad Faith, Coverage, Insurance Services
A rain storm damaged part of a strip mall
the improvements that had been made to it that several tenants had leased. When these damages occurred, the owner of the building was an insured under a policy issued by our client, Insurer No. 1. Additionally, the tenants were insured under a policy that a second insurance company, Insurer No. 2, issued to them. Insurer No. 2 paid the tenants for the damages to their improvements. The tenants then vacated the building
sued the owner. Insurer No. 1 defended the owner in this lawsuit until Insurer No. 2 assumed its defense. In response, the owner sued Insurer No. 2 alleging claims for breach of contract
bad faith for withdrawing from its defense in the tenants' lawsuit. While this action was pending, the tenants, the owner, Insurer No. 1
Insurer No. 2 reached a global settlement of any
all claims
causes of action arising out of the events giving rise to the tenants' lawsuit in exchange for Insurer No. 1's contribution to the settlement.
The trial court granted our client's motion for summary adjudication concerning the owner's causes of action for breach of contract
bad faith based on its claim for indemnity for the damaged tenant improvements. The court held the owner had no insurable interest in this property at the time of loss for the same reasons the insurer denied the claim (i.e., the owner did not use, own, or control this property,
did not suffer any direct pecuniary loss when it was damaged.)
ERISA
insurance
bad faith
breach of contract
employee welfare plan
disability
employee benefits
claim determination
Ninth Circuit Court of Appeal
U.S. District Court for the Central District of California
Defendants employee welfare benefit plan,
insurance company
Appellate, ERISA, Insurance Services
This ERISA action arose from the termination of long term disability benefits. The employee welfare benefit plan was insured under a group disability policy issued by Continental Casualty Company. Hartford Life
Accident Insurance Company (Hartford) later acquired the policy,
thereafter assumed responsibility for administering claims under the plan. Following a bench trial, the trial court entered judgment for the plan, concluding that Hartford did not abuse its discretion under the plan in terminating the plaintiff's benefits even though Hartford had a structural conflict in that it both funded
decided claims under the plan.
The trial court entered judgment for the defendants, which is on appeal.
ERISA, employee welfare plan, appeal, arbitration
United States Court of Appeals for the Ninth Circuit, U.S. District Court for the Northern District of California
Appellate, ERISA
A former employee submitted a claim for disability benefits under an employee welfare benefit plan three months after she ceased working for the plan sponsor. The employee did not advise the insurer
claim administrator for the plan that she had been terminated
on a leave of absence since August 28, 2001, or that she had released her claims for disability benefits under the plan pursuant to a severance agreement that she had previously signed. The insurer determined she was not eligible for disability benefits because she was not disabled as of August 29, 2001
throughout the plan's ninety-day elimination period. The employee sued the insurer
plan to recover disability benefits under the Employee Retirement Income Security Act of 1974 (ERISA). The district court granted the employee's petition to dismiss her entire action
compel the binding arbitration of her claims against the insurer under the Federal Arbitration Act
her employment agreement with her former employer. She then submitted all claims to the jurisdiction of the arbitrator.
The arbitrator convened a hearing counsel argued the merits of the parties' claims
defenses. The arbitrator subsequently issued a written ruling in the insurer's favor. In doing so, the arbitrator found that the employee had knowingly
voluntarily released her right to plan benefits under the terms of the severance agreement,
that the agreement barred her claims against the insurer. The district court granted the insurer's petition to confirm the arbitration award,
entered judgment in the insurer's favor. The Ninth Circuit affirmed the judgment on appeal.
ERISA
insurance
bad faith
breach of contract
employee welfare plan
disability
employee benefits
claim determination
Ninth Circuit Court of Appeal
U.S. District Court for the Central District of California
Defendants employee welfare benefit plan,
insurance company
Appellate, ERISA, Insurance Services
This ERISA action arose from the termination of long term disability benefits. The employee welfare benefit plan was insured under a group disability policy issued by Liberty Life Assurance Company of Boston. Following a bench trial, the trial court entered judgment for the plan, concluding that Liberty did not abuse its discretion under the plan in terminating the plaintiff's benefits even though Liberty had a structural conflict in that it both funded
decided claims under the plan.
The Ninth Circuit Court of Appeal affirmed judgment for the defendant.
ERISA
bad faith
breach of contract
employee welfare plan
disability
employee benefits
claim determination
Ninth Circuit Court of Appeal
U.S. District Court for the Northern District of California
Defendant employer
its insurer
Appellate, ERISA
This ERISA action arose from the termination of long term disability benefits. The employee welfare benefit plan was insured under a group disability policy issued by an insurance company. Following a bench trial, the trial court entered judgment for the plan, concluding that the insurer did not abuse its discretion under the plan in terminating the plaintiff's benefits even though the insurer had a structural conflict in that it both funded
decided claims under the plan.
Judgment for employer/insurer affirmed.
ERISA
Insurance
Bad Faith
Breach of Contract
Employee Welfare Plan
Disability
Employee Benefits
Claim Determination
US Court of Appeals for the Ninth Circuit Court
USDC: Northern District of California
Defendants Employee Welfare Benefit Plan
Insurance Carrier
Appellate, Bad Faith, ERISA, Insurance Services
Defended an insurance carrier
an employee welfare benefits plan in an ERISA action which arose from the termination of long term disability benefits. The employee welfare benefit plan was insured under a group disability policy issued by an insurance carrier. Following a bench trial, the trial court rem
ed the case to the claim administrator for further investigation. On rem
, the claim dem
was again upheld
the plaintiff filed suit again.
The trial court entered judgment for our client concluding that the insurer did not abuse its discretion under the plan in terminating the plaintiff's benefits even though they had a structural conflict in that it both funded
decided claims under the plan. The ninth circuit affirmed on appeal.
declaratory relief, covered auto, insurance coverage, bad faith, med-pay, underinsured motorist, rental car,
U.S. District Court, Northern District of California
Plaintiff Automobile Insurance Company
Bad Faith, Coverage
Prosecuted declaratory relief action on behalf plaintiff automobile insurer against claimant arising from the denial of his claim for underinsured motorist (UIM)
medical payments (med-pay) benefits under the insured's policy. The insured submitted his UIM
med-pay claim following an accident in June 2003, in which he was injured while occupying a rental car driven by the insured in Florida. At the time of the accident, the claimant was as neither an insured nor injured in an insured in a covered auto, he did not reside with the insured. The insured alleged that the rental car was a temporary substitute for the insured's Lexus, which was operated
garaged in California, where the insured
the claimant resided. The insurer denied the claims on the grounds that the claimant was not an insured under the policy, because the rental car in which he was injured was not a temporary substitute for the insured vehicle. Thus, the central issue of the case was whether the claimant was entitled to UIM
med-pay benefits even though neither he nor the rental car was covered by the policy.
The district court granted our client's motion for summary judgment
denied the insured's cross motion for partial summary judgment on grounds that the rental car was not a covered auto under the insurance policy. The court concluded that California's uninsured/underinsured motorist statute, California Insurance Code 11580.1
11580.2, did not exp
coverage beyond the terms stated in the policy. The court then held that the rental car was not a temporary substitute for the insured's vehicle under the terms of the policy, because the claimant failed to meet his burden to prove both that the insured vehicle was inoperable,
that the insured vehicle's normal use involved the same use in Florida as the rental car.
