News & Analysis as of

Insurance Claims Fraud Insurance Litigation

Zelle  LLP

Court Grants Insurer’s Motion for Summary Judgment on Nearly All of Insureds’ Causes of Action

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Schnatzmeyer v. State Farm Ins. Co., No. 3:23-CV-02820-K, 2025 WL 1697505, at *1 (N.D. Tex. June 17, 2025). In a case involving two overlapping freeze claims—and a substantial array of legal issues affecting insurers in...more

JUSTICENTER

How Long Is an Insurance Check Good For?

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If you’ve received a settlement check from an insurance company after a car accident, property damage claim, or injury settlement, you might be wondering: how long is an insurance check good for? While holding onto it for a...more

Carlton Fields

Iowa Supreme Court Reaffirms Rule That Faulty Workmanship Is Not an Occurrence, Leaving Question of Statutory Fraud for Another...

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In Dostart v. Columbia Insurance Group, the Iowa Supreme Court reaffirmed the rule — in Iowa, and many other jurisdictions — that faulty workmanship by a contractor does not constitute an “occurrence” as defined in a standard...more

Zelle  LLP

N.M. Cyber Ruling Will Spur Litigation As Coverage Remedy

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A June 16 appellate decision involving the construction of a cyberinsurance policy demonstrates a concerning lack of judicial understanding about the nature and scope of cyber liability coverage and implicitly incentivizes...more

Wiley Rein LLP

For the Record: Cyber Coverage “For” a Security Breach is Ambiguous under New Mexico Law

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The New Mexico Court of Appeals has held that cyber policy language affording coverage “for” a security breach was ambiguous and must be construed broadly to provide coverage for a breach of contract claim “because of,”...more

Zelle  LLP

Invoking ‘Our Option’ and Preferred Contractor Network Endorsements

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Increasing abuses in the claims process have caused insurance companies to rethink the traditional model of sending out cash to pay claims. Far too often, that cash is used for purposes other than fixing damage, with a...more

Wiley Rein LLP

No Second Bite at the Apple: New Emails Can’t Undo a False Application Response

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The United States District Court for the Central District of California, applying California law, has held that an insurer could rescind liability insurance policies based on misrepresentations in the application, even though...more

Wiley Rein LLP

Coverage Barred by Prior Acts Exclusion Under First Policy; No Coverage Under Second Policy Because Defendant did not Qualify as...

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The United States District Court for the District of New Mexico, applying New Mexico law, has held that a prior acts exclusion in a directors and officers policy barred coverage for an investor lawsuit alleging a scheme to...more

Goldberg Segalla

Fraud Doesn’t Pay in New York – May 2025 Update

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As a part of our quarterly practice group update, we are pleased to produce our latest installation with examples of our continued success in fraud litigation. This is our fourth year of this publication, and in February...more

Sheppard Mullin Richter & Hampton LLP

Umbrella Insurer’s “Business Decision” to Pick Up an Insured’s Defense Leads to a Multi-Million Dollar Fraudulent Concealment...

A primary insurer (Truck Insurance Exchange) and an umbrella insurer (Federal Insurance Company) have been involved in a series of lawsuits dating back to 2007. The California Court of Appeal recently ruled that their...more

Zelle  LLP

Further Clarity Regarding Coverage for Funds Transfer Fraud

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At this point, your IT department has almost certainly warned you to approach your e-mail inbox with skepticism--for good reason. Cybercriminals regularly and effectively impersonate our legitimate contacts for illegitimate...more

Goldberg Segalla

Fraud Doesn’t Pay in New York – February 2025 Update

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As a part of our Quarterly Practice Group Update, we are pleased to produce another installment with examples of our continued success in the area of fraud litigation. The New York State Workers’ Compensation Board has...more

Carlton Fields

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

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

Miller Nash LLP

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

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

Wiley Rein LLP

New Jersey Appellate Court Affirms Rescission of Policies Based on Law Firm’s Misrepresentation in Applications

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In a win for Wiley’s client, a New Jersey appellate court, applying New Jersey law, affirmed a trial court’s decision rescinding four lawyer’s professional liability policies because of material misrepresentations made in the...more

Wiley Rein LLP

Lending Exclusion in Bankers Professional Liability Policy Bars Coverage For Claim Alleging Financing a Ponzi Scheme

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The United States District Court for the Central District of California, applying California law, has held that a lending exclusion in a bankers professional liability policy barred coverage for underlying lawsuits alleging...more

Marshall Dennehey

Appellate Court Affirms Ruling a Sworn Proof of Loss and Estimate Related to Later Claim Was Inadmissible as Hearsay and...

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Universal Property & Casualty Insurance Company v. Luis Nacimiento, Fla. 3rd DCA, 3D23-0301, Apr. 3, 2024 - The insured reported a claim to Universal Casualty & Property Insurance Company in February 2016 for water damage...more

Faegre Drinker Biddle & Reath LLP

Court Sides with Long-Term Care Insurer Over Claim Denial and Potential Fraud

A judge from the District of Colorado recently issued an opinion that might leave the door open for long-term care insurers to void policies after the contestability period expires if an insured commits fraud. See Meyer v....more

Ervin Cohen & Jessup LLP

Companies That Pay Hackers May Be Able to Recoup Their Losses

Where companies are victimized by ransomware or email scams, their losses arise from payments made by an officer or employee of the company. In the case of ransomware, a company’s files are held hostage pending payment...more

Bennett Jones LLP

Court of Appeal Endorses Draconian Deterrent to Insurance Fraud

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In Abbas v Esurance Insurance Company of Canada, 2023 ABCA 36 [Abbas], the Alberta Court of Appeal endorsed what it described as draconian consequences for insurance fraud as consistent with the Insurance Act, RSA 2000 c I-3...more

Carlton Fields

Federal Court Rejects Computer Fraud Coverage for Social Engineering Loss

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In SJ Computers LLC v. Travelers Casualty and Surety Company of America, the U.S. District Court for the District of Minnesota recently addressed the scope of insurance available for a phishing scheme under the terms of a...more

Wiley Rein LLP

Texas Court Holds Late Notice Bars Coverage

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The United States District Court for the Northern District of Texas, applying Texas law, has held that an insured’s late notice of a claim bars coverage, rejecting arguments that (i) the initial complaint did not constitute a...more

Robinson+Cole Property Insurance Coverage...

Computer Fraud Policy: Eleventh Circuit Affirms District Court’s Finding Of No Coverage For $11M Fraud Claim

In Interactive Communities Int’l v. Great Am. Ins. Co., 2018 U.S. App. LEXIS 12410 (11th Cir. May 10, 2018), the insured sold “chits,” which have a specific monetary value and can be redeemed by loading their monetary value...more

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