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Insurance Bad Faith Claim Handling Expert Serving Clients Nationwide

Posts tagged "insurer"

Wisconsin Supreme Court Weighs In On The "Made Whole" Doctrine In Subrogation Cases

The Wisconsin Supreme Court in Dufour v. Progressive Classic Insurance Co., 881 N.W.2d 678 (Wis. 2016) held that insurance companies may retain funds obtained as subrogation for payments that the insurer had previously made, even though the insured may not have been fully compensated for the loss. The court found that it would look to the specific facts and equities in dictating whether the "made whole" doctrine would apply. Under the "made whole" doctrine, insurers are typically prevented from retaining funds received for its subrogation claims in cases where the insured has not been made whole. The court found that the "made whole" doctrine is an equitable doctrine and only applied when the equities favor the policyholder. In cases where there were reasonable reasons why the equities favored the insurance company, the doctrine would not be applied.

Covenant Judgment Settlements In Washington Do Not Automatically Constitute A Waiver Of Attorney-Client Privilege And Work Product Protection When The Insured's Claims For Bad Faith Against The Insurer Are Assigned To The Adverse Party

In Steel v. Philadelphia Indemnity Co., 381 P.3d 111 (2016), a daycare center employee was convicted of child rape and child molestation while working at a daycare center. The parents brought a negligence action against the center. The daycare center had $1 million in coverage. Plaintiffs offered to settle for $4 million, which was rejected by Philadelphia. As trial approached, the insureds entered into a $25 million covenant judgment settlement with the plaintiffs. As part of the settlement the insureds received a covenant not to execute and the plaintiffs received an assignment of the insured's bad faith claims.

7th Circuit Finds that Extrinsic Evidence is Admissible in a Declaratory Judgment Action to Determine the Carrier's Duty to Defend

In Landmark American Insurance Co. v. Hilger, 838 F.3d 821 (7th Cir. 2016) the U.S. Circuit Court of Appeals for the 7th Circuit found that the insurance company was allowed to offer evidence outside the underlying court complaints and that the defendant did not render the professional services in question as an independent contractor. In this case the insured was sued by two credit unions in two different states (Michigan and Tennessee) for allegedly joining with a life insurance agent and a life insurance broker to persuade the credit unions to fund loans based upon life insurance policies with an overstated value that was used as collateral. When the insured and the insurance agent were sued, they tendered their defense to Landmark American under the agent's and the broker's liability policy. The policy provided coverage for claims arising out of any negligent act, error, or omission committed in the agent's rendering of professional services as an agent or broker. However, the tenders were denied.

OREGON SUPREME COURT RULES THAT UNDER ORS §742.061 AN INSURER'S VOLUNTARY PAYMENTS TO THE INSURED AFTER THE INSURED FILED SUIT AND THE APPRAISERS ISSUED AN AWARD WHICH ALSO WAS PAID WAS A "RECOVERY" ENTITLING THE INSURED TO AN AWARD OF ATTORNEYS' FEES

Under ORS §742.061 insurance companies are required to pay their insured's attorneys fees if, in the insured's lawsuit against the insurer, the insured obtains a "recovery" that exceeds the amount of any tender made by the insured within six months from the date that the insured first filed a proof of loss. In Long v. Farmers Insurance Company of Oregon, 360 Or. 791, 388 P.3d 312 (2017), the Oregon Supreme Court held that when an insured files an action against an insurer to recover sums owing on the insurance policy and the insurer subsequently pays the insured more than the amount of any tender made within six months from the insured's proof of loss, the insured obtains a "recovery" that entitles the insured to an award of reasonable attorney's fees notwithstanding the voluntary nature of the insurance company's payment. In essence, the court found that the term "recovery" included any kind of restoration of the loss, including a voluntary payment of a claim made after an action on the insurance policy had been filed. In determining whether a qualifying "recovery" has taken place for purposes of ORS §742.061, all that matters is that, after filing an action on an insurance policy, the insured obtains more from the insurer-irrespective of whether through judgment, settlement, voluntary payment or some other means-than the insurer tendered in the first six months after proof of loss, an award of attorney's fees is appropriate under the statute. The Court found that in the context of the statute, "recovery" was not limited to a money judgment rendered in the action in which attorney's fees were sought. The insured was not required to obtain a money judgment that exceeded any tender within the first six months after the insured submitted the proof of loss.

INSURANCE SUBBROKER HELD TO NOT OWE DUTY TO WARN OF AN INSURANCE COMPANY FRAUD DURING THE PLACEMENT OF INSURANCE

Under Illinois statutory and common law an insurance broker owes a duty only to the named insured who has purchased insurance from the broker. Recently, the question arose under Illinois law regarding whether a sub broker, who played an administrative role in the placement of a large and complex risk involving a chain of brokers and subcontractors, but did not place any insurance on the behalf of the named insured or received commissions from the placement owed any type of duty to warn the named insured of potential "red flags" suggesting that the insurance company under which the program was placed was untrustworthy and that its polices issued might be worthless.

INDIANA COURT OF APPEALS HOLDS THAT POLICY SIR EXHAUSTION REQUIREMENT APPLIES TO ADDITIONAL INSURED AND NOT JUST THE NAMED INSURED

The Indiana Court of Appeals in Walsh Construction Co. v. Zurich American Insurance Co. 2017 WL 1151033 (IN Ct App March 28th 2017) acknowledged that under Indiana law in situations that arise between the insurer and the named insured, the insurer's responsibility is to defend and indemnify the named insured only after the SIR has been satisfied and exhausted. However, the question of whether a SIR endorsement applied only to the insurers relationship to the named insured or whether it also applied to an additional insured was resolved in the Walsh case as a question of first impression.

CALIFORNIA COURT OF APPEALS HOLDS THAT AUTOMOBILE POLICY'S COLLISION COVERAGE DID NOT REQUIRE THE INSURANCE COMPANY TO PAY FOR THE CAR'S LOST MARKET VALUE

In Baldwin v. AAA Northern California, Nevada & Utah, 204 Cal.Rptr 3d 433 (1st Dist. 2016), the Court held that an automobile insurer had no obligation to pay the "pre-accident value" of the insured vehicle under the policy's collision coverage provision which gave the insurer the option to repair the vehicle and which expressly excluded diminution in value damages. The Court held that the insurer did not breach the policy's implied covenant of good faith and fair dealing by not compensating its insured for the diminished value of the vehicle.

THE ELEVENTH CIRCUIT COURT OF APPEALS CONSIDERS EXHAUSTION REQUIREMENT IN EXCESS UM LIABILITY POLICIES UNDER GEORGIA LAW. THE ELEVENTH CIRCUIT UPHELD THE POLICY EXHAUSTION REQUIREMENTS

Recently, the Eleventh Circuit Court of Appeals in Coker v. American Guar. & Liab. Ins. Co., 825 F.3d 1287 (11th Cir. 2016) (applying Georgia law) held that UM policy exhaustion requirements were enforceable under Georgia law. The Court found that Georgia's UM statute did not transform excess policies into primary policies.

IN THE STATE OF WASHINGTON INSUREDS DO NOT WAIVE ATTORNEY-CLIENT AND WORK-PRODUCT PRIVILEGES WHEN THEY SEEK THE COURT'S APPROVAL OF A COVENANT JUDGMENT SETTLEMENT WHICH ASSIGNS TO THE ADVERSE PARTY THE INSURED'S BAD FAITH CLAIM AGAINST THE INSURER

In Steel v. Philadelphia Indemnity Ins. Co., 195 Wash.App. 811, 381 P.3d 111 (Wash. App. 2016), the Washington Court of Appeals held that insurance companies do not waive attorney-client privilege or work product protection when their insured enters into a covenant judgment settlement that is subject to judicial determination as to reasonableness. In Steel, a day care center's employee was convicted of child rape and child molestation of two children at the day care center. At the time, the defendants were insured under a Philadelphia Indemnity policy providing $1M in coverage. Plaintiffs offered to settle their claims for $4M which was rejected by Philadelphia. Shortly before trial was scheduled to begin, the insureds entered into a $25M covenant judgment settlement with the plaintiffs, receiving a covenant not to execute in return, for an assignment of the insureds' bad faith claims against Philadelphia.

THE 10TH CIRCUIT COURT OF APPEALS FINDS THAT COLORADO'S "FAIRLY DEBATABLE" DEFENSE IS NOT ABSOLUTE

In The Home Loan Investment Co. v. St. Paul Mercury Ins. Co., 827 F.3d 1256 (10th Cir. 2016), the Tenth Circuit Court of Appeals held that a property insurance company's denial of a fairly debatable claim was not per se reasonable. The insurer, St. Paul Mercury Ins. Co., argued that because its coverage decision was "fairly debatable," it was, as a matter of law, not unreasonable. St. Paul argued that a claim's fair debatability was outcome determinative because, under Colorado law, an insurance company could not act unreasonably in denying a fairly debatable claim. In response, the insured argued that a claim's "fair debatability" was merely one factor in the overall analysis of whether the insurer acted reasonably in delaying or denying coverage. The Tenth Circuit rejected St. Paul's argument.

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