Missouri Court Clarifies What Constitutes An Ensuing Loss

Last week in Performance Arts Cmty. Improvement Dist. v. ACE Amer. Ins. Co., 2015 WL 3491292, 2015 U.S. Dist. LEXIS 71592 (W.D. Mo., June 3, 2015), a federal court in Missouri shot down an insured’s arguments that a wall collapse caused by the excluded peril of defective design was a covered ensuing loss under a builder’s risk policy.  The developer admittedly erred in calling an for excess amount of concrete slurry to be pumped behind the structure, but the policyholder contended that the collapse that that mistake caused was a separate loss by “excessive lateral pressure.”  The court analogized to that to arguing that the collapse of a defectively-designed building was a separate loss caused by the covered peril of gravity.

shutterstock_160130774The policyholder had contracted for the construction for a parking garage adjacent to a performing arts center in Kansas City, and the project included the installation of a 50’ high concrete retaining wall between the structure and an adjacent limestone rock face.  The original design called for up to 18” of concrete slurry to be poured between the wall and the limestone embankment, but, at the general contractor’s insistence, it was modified to permit up to 36” of the fill material to be installed. While the slurry was being pumped in place, the wall cracked and failed, and it was uncontested that the change to 36” of fill was a design defect.

The insured made claim under its builder’s risk policy, but the carrier denied because the contract of insurance barred coverage for a loss caused by “[e]rror, omission or deficiency in design, plans, specifications, engineering or surveying.”  That exclusion was prefaced by an ensuing loss exception that restored coverage when “direct physical loss or damage by an insured cause of loss ensues,” however.  The policyholder brought suit, contending that excessive pressure caused by the additional fill constituted a covered ensuing loss. Read more ›

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Posted in Builders' Risk, Collapse, Ensuing Loss, Faulty Workmanship or Design

Ninth Circuit: Under Arizona Law Mudslide Can Be Covered as the Direct Result of Fire

Last Friday, a unanimous panel of the Ninth Circuit held that loss from the excluded peril of mudslide occurring one month after a wildfire could be covered as the “direct” result of the blaze.  In Stankova v. Metropolitan Prop. & Cas. Ins. Co., 2015 WL 3429395, 2015 U.S. App. LEXIS 8935 (9th Cir., May 29, 2015),  it reached that result even though Arizona has not adopted the efficient proximate cause rule, saying that it did not need to apply that doctrine to determine that the mudslide “could have been directly and proximately caused by the wildfire.” It also blithely ignored anti-concurrent causation (ACC) language, which is given effect in Arizona, as “inconsistent with Arizona’s standard fire insurance policy, which insures against all direct loss by fire.”

shutterstock_110845709The policyholders owned a home with a detached garage in Alpine, Arizona.  Beginning on May 29, 2011, eastern parts of the state and western New Mexico were devastated by a massive blaze known as the Wallow Fire – we published a post about an Arizona district court decision concerning business interruption loss that stemmed from that conflagration last month.  The fire consumed the detached garage and all of the vegetation on the nearby hillside, but it did not reach the house.  On August 6, 2011, however, one month after the Wallow Fire had been contained, there was a mudslide on the hillside, and mud and runoff water from flooding destroyed the home.

The insureds made claim under their homeowners policy.  The carrier paid for the loss to the garage, but it denied the claim for the house because the contract of insurance expressly excluded loss attributable to:

Water damage, meaning any loss caused by, resulting from, contributed to or aggravated by . . . flood [or] surface water flooding; and

Earth Movement, meaning any loss caused by, resulting from, contributed to or aggravated by events that include, but are not limited to . . . mudslide

These exclusions were prefaced by ACC language reciting that the carrier did not cover loss “which would not have happened in the absence” of the excluded event “regardless of . . . the cause of the excluded event; . . . other causes of the loss; or . . . whether such causes acted at the same time or in any other sequence with the excluded event to produce or contribute to the loss.” Read more ›

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Posted in Anti-Concurrent Causation, Causation, Direct Physical Loss or Damage, Efficient Proximate Cause, Exclusions, Flood, Mudslide, Wildfire

Georgia Court: Policy Does Not Require Insured to Produce Recordings of Her Conversations With the Carrier

On May 20th, a federal court in Georgia held that the standard “requirements in case of loss” language compelling the insured to turn over her books and records during the adjustment process did not require the production of recordings that she had secretly made of her telephone calls with the insurer’s representatives.  In Armstead v. Allstate Prop. & Cas. Ins. Co., 2015 WL 2408049, 2015 U.S. Dist. LEXIS 66030 (N.D. Ga., May 20, 2015), the court rejected arguments that the policyholder’s refusal to disgorge the tapes was a violation of the “no action” clause that precluded her breach of contract and bad faith action because it held that the carrier had not shown that they were material to the adjustment of the claim.

shutterstock_146114156Instead of contending that the “requirements in case of loss” language mandated the tapes’ production, of course, the insurer should have sought them through regular discovery and moved to compel if they weren’t forthcoming.  It is hard to see how the policyholder could have resisted that motion given her allegations of bad faith.

The policyholder owned a home in Powder Springs, Georgia that sustained fire and smoke damage from an accidental grease fire on December 7, 2011.  The insured submitted a proof of loss seeking $75,909.43, but her homeowners carrier contended that the repairs could be effected for far less, and it ultimately made payments totaling approximately $20,000. Read more ›

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Posted in Cooperation, Discovery, Examinations Under Oath, Fire, Homeowners Coverage, Investigation, Loss Adjustment

Indiana Court Nixes Requests for Reinsurance and Reserves

shutterstock_182629457Early last month a federal court in Indianapolis barred a policyholder from seeking the claims and underwriting files of the defendant carrier’s reinsurer in Indianapolis Airport Auth. v. Travelers Property Cas. Co. of Amer., 2015 WL 1548959, 2015 U.S. Dist. LEXIS 45123 (S.D. Ind., Apr. 7 2015).  Several months ago, the same court also shot down the policyholder’s requests for the insurer’s reserves.

The insured operated the Indianapolis International Airport, and it began construction on the $1 billion Midfield Terminal Project in 2005 and secured a builder’s risk policy from Travelers to cover the work.  On January 24, 2007, temporary shoring towers collapsed, damaging the building, disrupting the original construction schedule, and generating claims by consultants and contractors.  The policyholder made claim for $13.4 million, but the carrier refused to pay more than $4.19 million.  The insured then brought suit, alleging breach of contract and seeking declaratory judgment.

During discovery, the policyholder issued a non-party subpoena to Travelers’ reinsurer, Gen Re, seeking Gen Re’s claims and underwriting files.  The insurer responded with a motion to quash and also requested a protective order barring the insured from discovery of any reinsurance documents from any source.  On April 7th, Magistrate Judge Tim Baker granted the motion. Read more ›

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Posted in Builders' Risk, Collapse, Discovery, Reinsurance, Reserves

Oklahoma Court Holds the Policyholder Can Also Be the Vandal

Earlier this week an Oklahoma federal court addressed a mortgagee’s claim for vandalism loss – a topic we also discussed in Wednesday’s post.  In American Modern Home Ins. Co. v. Tulsa Fed. Credit Union, 2015 WL 2372549, 2015 U.S. Dist. LEXIS 64491 (E.D.Okla., May 18, 2015), the court rejected an insurer’s argument that because the vandalism was done by the insured, it could not constitute the covered peril of “vandalism” in a situation in which the policy neglected to define that term.

shutterstock_118758637The insured owned a house and secured a homeowners policy that also extended coverage to his mortgagee.  The mortgage company instituted foreclosure proceedings and the policyholder vacated the dwelling, but only after removing fixtures and damaging property to the tune of $246,025.  The mortgagee’s subsequent insurance claim was denied, and litigation ensued.

The contract of insurance covered fire and also the perils of vandalism, malicious mischief, and burglary.  The terms “vandalism” and “malicious mischief” were not further defined, but the policy excluded burglary loss if it was “committed by an insured.”  In addition, there was an exclusion for “Intentional Loss” which was defined to mean “any loss arising out of any act committed . . . by or at the direction of an insured.”  Finally, there was a mortgage clause that informed the policyholder that “[i]f we deny your claim, that denial will not apply to a valid claim of the mortgagee” so long as the mortgage company has notified the insurer of any change in the ownership,  occupancy, or risk, paid any premium due, and submitted a sworn proof of loss in a timely manner. Read more ›

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Posted in Ambiguity, Homeowners Coverage, Loss Payees, Mortgagees, Theft or Dishonesty, Vandalism

Pennsylvania Joins Oklahoma, Bans Homeowners Insurers From Attributing Earthquakes to Fracking

Last month we reported that the Oklahoma Insurance Commissioner had issued a bulletin cautioning earthquake insurers against denying claims on the basis that the quake was attributable to a man-made cause, which is to say oil and gas production, rather than to a purely natural one.  Recently, Pennsylvania’s Acting Insurance Commissioner Teresa Miller followed suit, “instructing” homeowners carriers that earthquake endorsements “should cover all earthquakes, whether believed to be ‘naturally occurring’ or caused by ‘human activity.’ ”

shutterstock_248308744The Keystone State has not seen the dramatic uptick in earthquake activity that has shattered both nerves and property in Oklahoma in recent years.  Because of the hydrocarbon-rich Marcellus Shale formation, however, it remains a jurisdiction with more oil and gas drilling than all but a handful of other states, and many homeowners have purchased earthquake endorsements in view of the widely-publicized rise in seismic activity in many such places. Read more ›

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Posted in Causation, Earthquake, Homeowners Coverage, Regulation

Illinois Court Holds Vacancy Clause Does Not Bar Vandalism and Theft Claim by Mortgagee

In a case of first impression in Illinois, a unanimous panel of the state’s Appellate Court recently addressed the interplay between a vacancy clause and a mortgagee provision and held that the insured’s failure to comply with the former did not preclude recovery by the mortgage company after vandals did over $2 million in damage.  In Old Second Nat’l Bank v. Indiana Ins. Co., 2015 IL App. (1st) 140265, — N.E.3d –, 2015 WL 1283867, 2015 Ill. App. LEXIS 185 (Mar. 20, 2015), it held that the vacancy clause was a condition subsequent to coverage and that its violation therefore only operated to bar the policyholder’s claim even though the structure – unbeknownst to the insurer — had been vacant since the policy’s inception.

shutterstock_268384877The property at issue was a former slaughterhouse in Askum that had been vacant since 2005.  The policyholder (Brothers Future Holdings) acquired it in 2007 intending to use it for a contract cooking venture, but that business turned out to be stillborn.  Property insurance was duly procured, based on an application reciting the structure was “100% owner-occupied.”  The mortgagee came on board in August of 2007, and the insurer’s agent was contacted by the mortgage company and issued an “Evidence of Property Insurance” document to the mortgagee indicating that coverage was in place.

The insurer never inspected the facility and was unaware that it was vacant.  The mortgagee’s loan officer did inspect the building in 2007, however, and the mortgagee knew that the structure was unoccupied. Read more ›

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Posted in Conditions, Loss Payees, Mortgagees, Theft or Dishonesty, Vacant or Unoccupied, Vandalism

Iowa Court: Anti-Concurrent Causation Language Mandates That the Jury Determine Whether an Excluded Peril Was One Cause of the Loss

shutterstock_118990687Last month, we discussed a recent Texas Supreme Court decision that enforced an anti-concurrent causation (ACC) clause.  The month of April also saw a unanimous panel on Iowa’s intermediate level appellate court do the same thing.  In Salem United Methodist Church v. Church Mut. Ins. Co., 2015 WL 1546431, 2015 Iowa App. LEXIS 308 (Iowa Ct. App., Apr. 8, 2015), the judges held that ACC provisions unambiguously exclude loss caused by a concurrent combination of excluded perils and included perils and that the question of whether an excluded peril played any causative role must therefore be put to the finder of fact.

The policyholder had a church in Cedar Rapids.  On June 11-12, 2008, the Cedar River overflowed its banks, and the basement of the church sustained damage from sewer backup.  The insurer denied the claim, and the insured put the matter in suit.  After a jury trial, the district court awarded $705,765.07 to the policyholder, and an appeal followed. Read more ›

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Posted in Anti-Concurrent Causation, Flood, Water

Arizona Court: Argument that All Business Income Loss Caused by a Wildfire is Covered is “Off Base”

Several weeks ago in White Mt. Communities Hosp., Inc. v. Hartford Cas. Ins. Co., 2015 WL 1755372, 2015 U.S. Dist. LEXIS 50900 (D. Ariz., Apr. 17, 2015), an Arizona federal court underscored that business interruption losses flowing from a wildfire are only covered to the extent that they stem directly from physical loss or damage to the policyholder’s property.  In other words, loss of income due to the fire in general is beyond the scope of such coverage absent a causal nexus with repairs necessitated by the blaze.

shutterstock_152341301The policyholder White Mountain owned a hospital in Springerville, Arizona.  On May 29, 2011, a blaze was started by an abandoned campfire in the nearby Bear Wallow Wilderness Area.  The wildfire ultimately burned 841 square miles in eastern Arizona and western New Mexico, and it led to the temporary evacuation of Springerville.  Residents weren’t allowed to return until June 13th, and the hospital itself was closed until the following day.

The policy afforded both property damage and business interruption coverage.  The hospital sustained soot and smoke damage that required cleaning, and some air conditioning units and carpeting had to be replaced as well.  The insurer ultimately paid approximately $40,000 for property damage claims and $683,520 for business interruption through August 6, 2011 after determining that 60 days was a reasonable period of time for effecting repairs.  The hospital contended that it had suffered additional business income losses after August 6th, however, and it brought suit when the insurer denied the claim. Read more ›

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Posted in Business Interuption, Causation, Contamination, Direct Physical Loss or Damage, Fire, Smoke and Soot, Wildfire

Smelly Cat – Closely-Divided New Hampshire Supreme Court Addresses Whether Cat Urine Is a Pollutant

Last Friday, New Hampshire’s highest court unanimously held that the pungent aroma of cat urine could constitute physical loss or damage under a property policy.  In Mellin v. Northern Security Ins. Co., 2015 WL 1869572, 2015 N.H. LEXIS 32 (N.H., Apr. 24, 2015), it split on whether such a loss was barred by standard pollution exclusion language, however.  Three of the five justices (including a specially-appointed retiree) held that the exclusion was ambiguous in nature.  The Chief Justice and another member of the court disagreed, labeling the provision “plain and unambiguous” and clearly applicable to preclude coverage for a pervasive cat odor problem.

shutterstock_171186704On the TV show “Friends,” Phoebe Buffay used to entertain patrons at the Central Perk coffee shop with her song “Smelly Cat” (“Smelly cat, smelly cat, what are they feeding you, . . . “).  The lyrics would have resonated with Doug and Gayle Mellin, the owners of a condominium in Epping, New Hampshire.  After they moved in, the Mellins noticed a cat urine odor coming from a downstairs neighbor’s unit through an open plumbing chase in the kitchen wall.  The stench was so severe that the town building inspector directed the couple to relocate temporarily and have the unit professionally remediated, but efforts to do that were unsuccessful.  The policyholders vacated permanently after living there only three months.

The insureds made claim under their homeowner’s policy in December of 2010.  The carrier denied, and they then brought suit.  The trial court granted summary judgment to Northern Security, and an appeal followed.  On April 24th, a divided state Supreme Court reversed and remanded the matter.  The contract of insurance “insure[d] against risk of direct loss to property . . . only if that loss is a physical loss to property,” and the threshold question was thus whether the odor was physical loss or damage.  Speaking for all five members of the court, Justice Carol Conboy concluded that it could be.  The court held “that physical loss may include not only tangible changes to the insured property, but also changes that are perceived by the sense of smell and that exist in the absence of structural damage” so long as those changes were “distinct and demonstrable.”  In the words of the opinion, “[e]vidence that a change rendered the insured property temporarily or permanently unusable or uninhabitable may support a finding that the loss was a physical loss[.]”  The justices therefore remanded the matter to the trial court for application of the legal standard that they had adopted. Read more ›

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Posted in Ambiguity, Direct Physical Loss or Damage, Homeowners Coverage, Odors, Pollution
About The Property Insurance Law Observer

For more than five decades, Cozen O’Connor has represented all types of property insurers in jurisdictions throughout the United States, and it is dedicated to keeping its clients abreast of developments that impact the insurance industry. The Property Insurance Law Observer will survey court decisions, enacted or proposed legislation, and regulatory activities from all 50 states. We will also include commentary on current issues and developing trends of interest to first-party insurers.

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