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

Texas Supreme Court Enforces Anti-Concurrent Causation, Bars Coverage Where Wind and Flood Combine to Cause the Loss

Last Friday, Texas’ highest court unanimously endorsed lower court and federal court decisions giving effect to anti-concurrent causation (ACC) clauses and held that such provisions bar coverage where a combination of an excluded peril and an included peril operate together to cause the loss.  In JAW The Pointe, LLC v. Lexington Ins. Co., 2015 WL 1870054, 2015 Tex. LEXIS 343 (Tex., Apr. 24, 2015), that meant that the insured could not recover where flood and wind damage triggered the enforcement of city ordinances even though the covered wind damage component was arguably sufficient in and of itself to cause the loss.

shutterstock_119515462The policyholder owned The Pointe Apartments – a complex in Galveston, Texas that was heavily damaged when Hurricane Ike came ashore on September 13, 2008.  Lexington afforded the primary layer of property insurance protection under a $25 million all-risk contract of insurance that covered dozens of local apartment complexes.  Wind was not an excluded peril, and Lexington paid its building consultant’s estimate ($1,278,000) for the wind damage in full.

Galveston City ordinances required that any complexes that were “substantially damaged” – meaning that they sustained damage equal to or exceeding 50% of market value – be raised to a base flood elevation, however, and raising The Pointe 3’ was not feasible.  After the policyholder submitted a repair permit application with a repair estimate of $6,256,887, which was well in excess of the city-determined market value of $2,247,924, Galveston notified the insured that it had determined that the ordinances had been triggered, and the policyholder elected to demolish and rebuild the apartments. Read more ›

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Posted in Anti-Concurrent Causation, Causation, Flood, Hurricane, Hurricane Ike, Ordinance or Law, Windstorm

A New Twist in the California Debate Over Allegedly Inadequate Replacement Cost Limits in Homeowners’ Policies

shutterstock_105910559The April 8, 2015 decision of the California Court of Appeals in Ass’n. of Cal. Insurance Companies v. Jones, 2015 WL 1569669, 2015 Cal. App. LEXIS 298 (Cal.Ct.App., Apr. 8, 2015) held that the state’s Insurance Commissioner overstepped his authority in attempting to regulate the content and format of replacement cost estimates under homeowners’ insurance policies.  Although the legislature may choose to provide such a definition, it has not done so.  While the sufficiency of policy limits remains a concern in the insurance industry and there are other valid statutes in effect that address replacement cost, pending a potential appeal of the decision the Regulation at issue, Title 10, Cal. Code of Regulations, §2695.183, is therefore no longer effective.

Fire victims, whose homes have been lost in any number of Southern California wildfires, have repeatedly argued that their replacement cost limits were insufficient to cover their rebuilding costs.   Historically, many such homeowners filed lawsuits against their brokers or their insurers, alleging negligence and misrepresentation in policy placement.  Insurers, community activists, and others have held numerous public hearings on the subject, and agencies have conducted studies to assess the adequacy of replacement cost limits in homeowners’ policies over the last decade.  Attempting to remedy some of these concerns, effective in June 2011, the Insurance Commissioner issued  §2695.183.  Entitled “Standards for Estimates of Replacement Value,” this elaborate Regulation set forth requirements for establishing replacement cost limits for homeowner’s policies. Read more ›

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Posted in Loss Adjustment, Replacement Cost, Unfair Insurance Practices

Kentucky Court: Depreciating Labor to Get Actual Cash Value Is Like Making the Insured Use a Very Old Roofer With Debilitating Arthritis to Repair the Roof

Surprisingly few states have addressed the question of whether an insurer can depreciate labor – as opposed to materials – to arrive at actual cash value (ACV).  Two weeks ago in Bailey v. State Farm Fire & Cas. Co., 2015 WL 1401640, 2015 U.S. Dist. LEXIS 37568 (E.D.Ky., Mar. 25, 2015), a federal court in Kentucky held that it was impermissible to do so, quoting an Oklahoma opinion that analogized such a step to requiring the policyholder to use “a very old roofer with debilitating arthritis who can barely climb a ladder or hammer a nail” to effect repairs to a roof.

shutterstock_34430626The case was a proposed class action by a West Liberty, Kentucky dentist whose office was damaged by a tornado and an Owingsville, Kentucky homeowner whose residence was hit by a fire.  In both cases, the State Farm policies afforded replacement cost coverage but authorized the carrier to make its initial payment on an ACV basis.  In the two cases, the insurer calculated ACV by determining replacement costs and then depreciating both materials and labor.  The policyholders argued that labor, unlike construction materials which logically age and wear and tear, was not subject to depreciation.

In his opinion, Judge Henry Wilhoit observed that Kentucky law defined ACV as “replacement cost of property at the time of the loss less depreciation.”  He then observed that the question presented – “whether the installation of materials, i.e. the labor, is subject to depreciation?” – was one of first impression in Kentucky.  He concluded that the answer was no.  In the words of the court: Read more ›

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Posted in Actual Cash Value, Depreciation, Fire, Replacement Cost, Tornado

Squatter’s Warming Fire in Vacant Home Held Not to be Vandalism by Divided California Court

In February, we published a Post about a Florida decision that aligned that state with the clear majority of American courts that have held that the destruction of property by an intentionally set fire is encompassed within the terms “vandalism and malicious mischief.”  Last Friday, in Hung Van Ong v. Fire Ins. Exch., 2015 WL 1524464, 2015 Cal. App. LEXIS 290 (Cal.Ct.App., Apr. 3, 2015), two of the three justices on a California intermediate level appellate court panel rejected that approach, reversing a grant of summary judgment in favor of the insurer in a case in which a vacant dwelling had been damaged when a transient set a fire on the kitchen floor to warm himself because they concluded that there was no evidence of “actual ill-will or intent to injure.”  In a considerably more convincing opinion, the third member of the panel dissented and argued that the trial court should have been affirmed.

shutterstock_113442877The policyholder had a rental property in a “relatively isolated location” that was vacated by the last tenant in February 2010.  On December 20, 2011 the home was damaged by a fire.  Subsequent investigation indicated that it was a “warming fire” set by a transient that got out of hand when he attempted to kick the burning firewood out the back door.

The contract of insurance excluded “direct or indirect loss from . . . Vandalism or Malicious Mischief . . . if the dwelling has been vacant for more than 30 consecutive days.”  The term “vandalism” was not defined in the policy.  The insured’s claim was denied, and the policyholder brought suit in March of 2012.  After the trial court granted Fire Insurance Exchange’s motion for summary judgment, an appeal followed. Read more ›

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Posted in Arson, Exclusions, Fire, Vacant or Unoccupied, Vandalism

Oklahoma Insurance Commissioner: Don’t Deny Earthquake Claims as Man-Made by Linking Them to Fracking

The jury is still out on whether hydraulic fracturing or “fracking” causes earthquakes, but carriers whose policies afford coverage for quakes have recently been denying such claims, asserting that they are excluded because they are attributable to a man-made cause – oil and gas production – rather than to a purely natural one.  Early last month, Oklahoma Insurance Commissioner John Doak cautioned against that, issuing a Bulletin warning earthquake insurers that his office would be forced “to take appropriate action to enforce the law” if they continued to deny quake claims on the basis of what he called “unsettled science.”

shutterstock_239934553Oklahoma has experienced a remarkable rise in earthquake activity in recent years.  According to the Oklahoma Geological Survey, the state had 567 quakes of Magnitude 3.0 or greater in 2014.  That was a five-fold increase over 2013, a 14-fold increase over the 2008-2012 average, and a 100-fold increase over earlier years.  The 2014 number exceeded the total number of earthquakes in Oklahoma during the preceding 30 years combined; no state in the lower 48 states, including California, saw more quakes last year.

The culprit is believed by many to be the disposal process associated with fracking.  Fracking itself involves injecting a slurry of water, sand, and chemicals into wells to fracture oil- and gas-bearing rock strata and thereby permit the oil and gas to escape to the surface.  The suspicion is not that fracking itself is the malefactor but rather the subsequent disposal of its principal byproduct – millions and millions of gallons of toxic fluid that travels back to the surface with the extracted oil and gas and is then injected deep underground. Read more ›

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Posted in Causation, Earthquake, Earthquake Insurance, Regulation

Eleventh Circuit: Sinkhole Loss in Florida Must Impair the Property’s Structural Integrity to be Covered

shutterstock_126855287Effective in 2005, Florida statutes defined “sinkhole loss” to mean “structural damage to the building, including the foundation, caused by sinkhole activity,” and they left the all-important term “structural damage” undefined.  Homeowner’s policies issued in the state employed that formulation until May 17, 2011, when Florida adopted a much narrower five-part definition of structural damage that applied to policies affording coverage for sinkhole loss, and many courts construing the 2005 language held that the term “structural damage” meant nothing more than “damage to the structure.”  Several weeks ago in Hegel v. First Liberty Ins. Corp., 778 F.3d 1214 (11th Cir., Feb. 27, 2015), a unanimous Eleventh Circuit panel held: (1) that defining structural damage to mean any “damage to the structure” was “facially unreasonable” and “untenable;” and (2) that the term was properly understood to mean “damage that impairs the structural integrity of the building.”  It also refused, however, to look to the narrow 2011 formulation when dealing with a policy and a loss that preceded its effective date.

The Hegels owned a home in Spring Hills, Florida, and they made an insurance claim after discovering damage to the walls and floors on March 1, 2011.  Their homeowner’s carrier, First Liberty, denied the claim after its engineering expert concluded that the damage could be attributable to differential settlement and ordinary concrete shrinkage as opposed to sinkhole activity and that, in any case, it did not rise to the level of structural damage as defined in the 2011 statute.  The Hegels then secured several engineers of their own, who concluded that the home had suffered “widespread minor cracking” as a result of sinkholes and recommended $145,775 in subsurface grouting and $20,743.17 in cosmetic damage repairs. Read more ›

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Posted in Direct Physical Loss or Damage, Homeowners Coverage, Sinkhole

Order of Civil Authority Claim for Superstorm Sandy Barred by Flooding Exclusion in New York

On Thursday of last week, a federal court in New York City tossed an Order of Civil Authority (OCA) claim by a New York City law firm in Bamundo, Zwal & Schermerhorn, LLP v. Sentinel Ins. Co., 2015 WL 1408873, 2015 U.S. Dist. LEXIS 39409 (S.D.N.Y., Mar. 26, 2016).  The policy extended coverage to loss of business income caused by an OCA issued “as the result of a Covered Cause of Loss,” but it excluded flooding from the definition of that term.

shutterstock_186026504The insured was a law firm with offices on John Street in lower Manhattan.  On October 28, 2012, the Mayor of New York City issued an executive order evacuating all homes and business located in the area.  Superstorm Sandy made landfall the next day, and parts of lower Manhattan – though not the area around the policyholder’s offices – quickly experienced “never-before-seen flood levels.”  On October 31st, a second executive order continued the evacuation and directed that buildings could only be reoccupied after being inspected and declared safe; 14 more orders were subsequently issued extending those restrictions.  The law firm’s offices were ultimately declared available for occupancy on Christmas Eve, and the policyholder moved back in on January 4, 2013.

The policy afforded coverage for

the actual loss of Business Income you sustain when access to your scheduled premises is specifically prohibited by order of a civil authority as the direct result of a Covered Cause of Loss to property in the immediate area of your scheduled premises.

This extension of coverage was subject to a 72-hour waiting period deductible and limited to a period of 30 consecutive days.  In addition, the contract of insurance excluded loss caused by water, including flooding, from the definition of what constituted a covered cause of loss.  The insured made claim for loss of business income for the entire evacuation period (October 30th through January 4th), and it filed suit for breach of contract and bad faith after the insurer denied. Read more ›

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Posted in Bad Faith, Flood, Order of Civil Authority, Superstorm Sandy
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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