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Breach of Contract › Contract Terms › Insurance Litigation

Polsinelli

Sixth Circuit Holds TPAs Do Not Get a Free Pass from ERISA’s Fiduciary Duties

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In a decision about ERISA’s fiduciary duties and transparency, the Sixth Circuit in Tiara Yachts, Inc. v. Blue Cross Blue Shield of Michigan held that Blue Cross Blue Shield of Michigan (BCBSM), a third-party administrator...more

Wiley Rein LLP

Fifth Circuit Holds Carve-Back Provision Could Not Overcome Breach of Contract Exclusion for Louisiana Wage Payment Act Claim

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The United States Court of Appeals for the Fifth Circuit, applying Louisiana law, has held that a breach of contract exclusion barred coverage for a judgment awarded to two employees who were not paid severance as required...more

Fuerst Ittleman David & Joseph

Subrogees Beware—You Can Be Compelled to Arbitrate as Third-Party Beneficiaries to an Arbitration Agreement

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Cases requiring non-signatories to an arbitration agreement to arbitrate are not uncommon. Cases compelling subrogees to arbitrate, not because of an insurance policy but because of another contract, are less common. In...more

Gray Reed

Marcel Exception to Louisiana Oilfield Anti-Indemnity Act Clarified

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An understanding of Willis v. Barry Graham Oil Service LLC requires knowledge of two principles underlying the Louisiana Anti-Oilfield Indemnity Act: The LOAIA bars an oilfield agreement to the extent that the agreement...more

Carlton Fields

Eleventh Circuit Holds Course of Construction Exclusion Applies to Water Damage as Project Was Not Fully Complete

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In Liberty Surplus Insurance Corp. v. Kaufman Lynn Construction Inc., the Eleventh Circuit Court of Appeals held that a “course of construction exclusion” in a commercial general liability precluded coverage for water damage...more

Marshall Dennehey

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

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

ArentFox Schiff

Federal Court Holds That Pathology Group States Viable Claims Against Multiplan and Cigna for Failing to Ensure In-Network Payment

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A federal court recently rejected arguments by MultiPlan, Inc. and Cigna Health and Life Insurance Company that they had no obligation to ensure payments at the contractually negotiated, in-network rate to Anatomic and...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

Fifth District Court of Appeal Rules Insurance Benefit Assignment to Roofing Contractor Invalid Under Florida Statute § 627.7152.

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Holding Insurance Companies Accountable, LLC v. Leonard Caruso v. American Integrity Insurance Company of Florida, Fla. 5th DCA, No. 5D2023-2810, January 3, 2025 - The homeowner reported roof damage to his homeowners...more

Marshall Dennehey

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

Marshall Dennehey on

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

Pillsbury - Policyholder Pulse blog

The Ninth Circuit Wants Everyone to Stop Forgetting About the Appraisal Provision

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Policyholders, don’t lose track of the appraisal provision in your insurance policies. At least that is what the panel in 50 Exch. Terrace LLC v. Mt. Vernon Specialty Ins. Co. seemed to be saying. There, the Ninth Circuit...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

Cozen O'Connor

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

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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

Rivkin Radler LLP

February 2025 New York Insurance Coverage Law Update

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The insured is a Texas-based hotel operator. A windstorm damaged one of its hotels in Texas and three months later the insured reported the loss to Mt. Hawley Insurance Company, its commercial property insurer. The policy...more

Carlton Fields

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

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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

Carlton Fields

California Appellate Court Rules Wildfire Debris Does Not Qualify as “Direct Physical Loss” Under Homeowners Insurance Policy

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The Second Appellate District of the California Court of Appeal recently affirmed a lower court ruling that wildfire debris on an insured’s property did not qualify as “direct physical loss” within the meaning of a homeowners...more

Mayer Brown

English Court Rules on Conflicting Jurisdiction and Arbitration Clauses

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The English Commercial Court has handed down an important decision highlighting the approach adopted by the English court when there are competing jurisdiction and arbitration clauses (“Competing Clauses”) and the effect of a...more

Bradley Arant Boult Cummings LLP

Insurance in the Know (Part 3): Recoupment of Defense Costs Is Not a “Right” in a Standard CGL Policy

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The foundation of a policyholder’s agreement to pay premiums for a standard commercial general liability policy (CGL) is the insurer’s agreement to defend the policyholder against lawsuits and shoulder the costs of the...more

Carlton Fields

Illinois Federal Court Denies Motion to Dismiss Complaint Alleging Breach of Reinsurance Agreement Between Parties

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In PMC Casualty Corp. v. Virginia Surety Co., the U.S. District Court for the Northern District of Illinois, Eastern Division, addressed a motion to dismiss a complaint filed by a party to a reinsurance agreement alleging...more

Zelle LLP

The Southern District of Texas Reaffirms That an Insured has the Burden to Identify a Covered Loss During the Policy Period and...

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This seems like a simple concept; however, this is the exact question that the Honorable Judge Lee Rosenthal was asked to address in Cutchall v. Chubb Lloyd’s Ins. Co. of Texas, CIVIL ACTION NO. 23-3745, 2024 WL 5264707,...more

Carlton Fields

Insurer Must Consider “Expectations of Future Mortality Experience” When Reassessing, Redetermining, and Changing COI Rates

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In Advance Trust & Life Escrow Services, LTA v. Protective Life Insurance Co. (Mar. 2, 2024), the Eleventh Circuit Court of Appeals affirmed in part and reversed in part the district court’s dismissal of breach of contract...more

Robins Kaplan LLP

Don’t Stop the Music: The Intersection Between Insurance and The Music Industry in the Era of COVID-19

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As More Live Performances Are Cancelled, Limited In Size Or Postponed, Venues, Festival Organizers, Artists And Others Are Looking For Relief From The Financial Impact Caused By The Coronavirus Crisis....more

Carlton Fields

Trial Court Denies Post-Trial Motions in Asbestos Reinsurance Saga Involving Claims That Reinsurer Failed to “Follow the Fortunes”...

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We previously posted about the yearslong reinsurance dispute between Utica Mutual Insurance Co. (the cedent) and Century Indemnity Co. (the reinsurer), involving Utica’s claims that Century breached two reinsurance...more

Carlton Fields

Court Denies Motion to Reconsider Order Compelling Arbitration

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Plaintiffs Kevin Struss, Struss Farms LLC, and Struss & Cook Farms brought certain tort and breach of contract claims against Rural Community Insurance Co. (RCIC) and Scott Laaveg, RCIC’s claims representative. The claims...more

Carlton Fields

Class Action Roundup

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McClendon v. North Carolina Mutual Life Insurance Co. (M.D. Tenn. 2019) - In McClendon, the plaintiff’s mother purchased a whole life insurance policy to insure the plaintiff’s brother, and subsequently took out a loan on...more

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