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

New Jersey Trial Court Holds Storm Surge Not Subject to Flood Sublimit Where Policy Expressly Includes “Ensuing Storm Surge” in Named Windstorm Coverage

In recent years, many courts have held that storm surge is a species of excluded flood loss; we reported on a New York example in July.  This week, in Public Serv. Enter. Group, v. ACE Amer. Ins. Co., 2015 WL 1428370, Unpub. LEXIS 620 (N.J.Super., Mar. 23, 2015), a New Jersey trial court granted summary judgment to Public Service Electric & Gas (PSEG) and held that the flood sublimit did not apply to a claim for Superstorm Sandy loss from storm surge where the contracts of insurance specifically recited that coverage for a “named windstorm” – which was not subject to any sublimit  –  included “ensuing storm surge.”

shutterstock_172810640Eight large PSEG generating stations and a number of smaller distribution facilities were damaged when Superstorm Sandy came ashore in New Jersey on October 29, 2012.  The utility’s current estimate of the loss exceeds $500 million.  It was undisputed that a storm surge – which the court described as “a hurricane-generated inundation of water” – of “record-breaking height” caused the lion’s share of the damage.

PSEG had $1 billion in layered property coverage from 11 different insurers, and it made claim for the loss.  The policies had no sublimit for “named windstorms” in New Jersey, but there was a $250 million sublimit for loss occasioned by the peril of “flood” and a $50 million sublimit for flood loss to property “located in Flood Zones A & V.”  The insurers took the position that PSEG’s recovery was capped at $50 million, and the utility brought suit.  On Monday of this week, Judge Thomas Vena granted PSEG’s motion for summary judgment and held that the flood sublimits did not apply to its Superstorm Sandy claims. Read more ›

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Posted in Causation, Efficient Proximate Cause, Ensuing Loss, Flood, Superstorm Sandy, Windstorm

Iowa’s Highest Court: Damage by Rainwater is Damage by Rain

Last July, we posted that an intermediate level appellate court in Iowa had held that a policy excluding loss “caused by rain” did not bar coverage for loss occasioned by the non-excluded peril of “rainwater.”  On Friday, the state’s highest court threw cold water on such nonsense, holding that there was no distinction between rain and rainwater for coverage purposes.  No justice disagreed, though the court split 4-3 on another issue.  The decision can be found at Amish Connection, Inc. v. State Farm Fire & Cas. Co., 2015 WL 1260085, 2015 Iowa Sup. LEXIS 32 (Iowa, Mar. 20, 2015).

shutterstock_13964104(1)The insured operated the Amish Connection Store in Crossroads Shopping Mall in Waterloo, Iowa.  Rooftop drains discharged into a 4” cast-iron drainpipe that ran above the store’s ceiling tiles and then down the back wall of the space and into a storm sewer.  The pipe was leaky and extensively-corroded, and it burst during a rainstorm on June 14, 2010, flooding the store and causing substantial damage to the policyholder’s inventory, office supplies, and records.

Amish Connection had a businessowner’s policy with State Farm that excluded loss “to the interior of any building or structure, or the property inside any building or structure, caused by rain . . . unless . . . the building or structure first sustains damage by an insured loss to its roof or walls through which the rain . . . enters[.]”  It was undisputed that the rainstorm caused no damage to roofs or walls.  State Farm denied, and the insured brought suit. Read more ›

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Posted in Anti-Concurrent Causation, Corrosion, Ensuing Loss, Flood, Water

California Court Holds Product Contamination Insurance Does Not Cover Ingredients Contaminated by Insured’s Supplier

shutterstock_7144888On February 6th, an intermediate level California appellate court held that a product contamination policy only covered contamination that occurs during or after manufacturing operations by the insured, meaning that there was no coverage where the policyholder’s product was found to be adulterated because it used an ingredient that had been contaminated by a third-party supplier.  The decision is Windsor Food Quality Co. v. Underwriters of Lloyds of London, 2015 WL 901867, 2015 Cal. App. LEXIS 195 (Cal.App., Feb. 6, 2015).  One of the three panel members filed a lengthy and convincing dissent that is arguably a more correct interpretation of the language at issue.

The policyholder was Windsor Food Quality Company, a frozen food manufacturer.  Windsor’s ground beef supplier was Westland/Hallmark Meat Company.  In January 2008, the United States Department of Agriculture (USDA) suspended Westland as a federal food supplier, and it subsequently announced a voluntary Class II recall of all of Westland’s products.  This occurred after a USDA investigation discovered that the supplier’s employees were knowingly using disabled or “downer” cattle that may have been infected with “mad cow” disease.  Windsor recalled all of its own products that had been made with Westland beef, and it incurred $3 million in recall costs in doing so.

The insured had a $4 million Contamination Products Insurance Policy issued by Lloyds.  Windsor sought coverage under two of the policy’s three “Insured Event” definitions – “Accidental Product Contamination” and “Malicious Product Tampering.”  Lloyds denied, and Windsor placed the matter in suit.  The carrier’s motion for summary judgment was subsequently granted by the trial court. Read more ›

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Posted in Contamination, Contamination and Product Recall

Silica Dust Damage Held Barred by Pollution and Faulty Workmanship Exclusions in New York

Building construction frequently generates silica dust, a substance that can cause lung disease and other respiratory problems.  Abrasive sand-blasting or jack hammering as well as concrete drilling and block cutting can lead to its release.  In Broome Cty. v. Travelers Indem. Co., – N.Y.S.2d –, 125 A.D.3d 1241, 2015 WL 790256, 2015 N.Y.App.Div. LEXIS 1706 (N.Y.App.Div., Feb. 26, 2015), a unanimous panel from New York’s intermediate level appellate court held that the pollution and faulty workmanship exclusions in a first-party policy barred coverage for the property damage when silica dust spread throughout an office building due to construction activities nearby.

shutterstock_92081126The insured was Broome County, the owner of a building in a government complex.  During the construction of a parking garage below the structure, silica dust migrated up an elevator shaft and disbursed throughout all floors of the building.  It was undisputed that inadequate dust barriers were what allowed the silica to infiltrate the shaft – it was “a flawed process on the part of the contractors that led to the loss at issue.”  Broome County made claim for the resulting property damage, but its insurer, Travelers Indemnity, denied the claim, invoking the two exclusions discussed above.

After litigation ensued, the trial court denied Travelers’ motion to dismiss, finding that the pollution exclusion did not operate to bar coverage and that there were factual issues with respect to whether the faulty workmanship exclusion did so.  An appeal followed. Read more ›

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Posted in Ambiguity, Contamination, Faulty Workmanship or Design, Particulates, Pollution

New York’s Highest Court Enforces a Water Damage Exclusion Despite an Ensuing Loss Exception

In Platek v. Town of Hamberg, et al., 2015 WL 685726, 2015 N.Y. LEXIS 252 (N.Y., Feb. 19, 2015), the New York Court of Appeals held that an exclusion for water below the surface of the ground was unambiguous and operated to bar coverage when a subsurface water main burst and flooded the insureds’ basement.  The policyholders’ attempt to invoke an ensuing loss exception to the exclusion was also rejected in an opinion that surveys the historical genesis of ensuing loss provisions and explains the limited circumstances under which they operate to restore coverage.

shutterstock_98719718The insureds, Frederick and Mary Platek, owned a home in Hamberg, New York.  On September 7, 2010, a subsurface water main abutting their property ruptured, flooding the house’s finished basement and causing $110,000 in damages.  The Platek’s insurance claim was denied by Allstate, their homeowner’s insurer, because the policy contained an exclusion reciting that Allstate “does not cover loss to the property . . . consisting of or caused by . . . 4. Water . . . on or below the surface of the ground, regardless of its source[, including] water . . .  which exerts pressure on, or flows, seeps or leaks through any part of the residents premises.”

The insureds brought suit, contending that their loss was covered because it fit within an exception to the exclusion that recited as follows:  “We do cover sudden and accidental direct physical loss caused by fire, explosion or theft resulting from items 1 through 4 listed above.”  To support that position, they submitted an engineer’s affidavit stating that the water main “suddenly exploded from the internal water pressure being exerted on the pipe walls [and hence] the explosion resulted from internally pressurized water that was supposed to be contained in a buried underground pipe.”  The trial court granted the Plateks’ motion for summary judgment, and a panel of the Appellate Division subsequently affirmed the finding of liability in a 3-2 decision.  An appeal to New York’s highest court followed. Read more ›

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Posted in Ambiguity, Burden of Proof, Ensuing Loss, Explosion, Flood, Water

Sixth Circuit: Growing Marijuana is Not the Same as Buying a Houseplant or Entertaining Visitors

Half of the states in this country have now legalized marijuana for medical use, and that has led to a number of small-scale growing operations in policyholders’ homes.  While not nearly as dangerous as cooking meth on the kitchen stove, such activities can nonetheless pose unacceptable risks of loss.  On Tuesday in Nationwide Mut. Fire Ins. Co. v. McDermott, 2015 WL 756206, 2015 U.S. App. LEXIS 3012 (6th Cir., Feb. 24, 2015), a unanimous panel of the Court of Appeals roundly rejected policyholder arguments that starting up such an operation did not represent a change in use or occupancy that the insured was required to bring to the insurer’s attention.

shutterstock_114904339In 2005, Kasey McDermott purchased a home in Bay City, Michigan and secured homeowner’s coverage from Nationwide.  Five years later in 2010, her then-husband Brien Matthews became a licensed medical marijuana patient and caregiver pursuant to Michigan law, and he set up a marijuana growing and processing operation in two rooms in the basement.  The area was previously used only for storage and for the couple’s washer and dryer.  By January of 2012, Matthews was servicing the needs of four patients, including himself.

Matthews employed a process known as butane extraction to produce a smokable substance called “honey oil.”  Honey oil is rich in tetrahydrocannabinol or THC, the principal active ingredient in the plant.  It sells for four to eight times as much as raw marijuana.  Butane extraction involved drawing liquid butane – a highly flammable chemical – through chopped marijuana leaves to extract the THC. Read more ›

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Posted in Co-Insureds, Fire, Increase in Hazard

Florida Court Holds Arson is a Type of Excluded Vandalism and Malicious Mischief

shutterstock_112847098Earlier this month a unanimous Florida appellate court joined a number of other states that have held that an all-risk policy exclusion for vandalism and malicious mischief operates to bar coverage for an arson loss.  The opinion can be found at Botee v. Southern Fid. Ins. Co., 2015 WL 477836, 2015 Fla. App. LEXIS 1566 (Fla.Dist.Ct.App., Feb. 6, 2015).

The insured, Raziya Botee, owned a single-family home that was destroyed by an arsonist on October 10, 2012.  It was undisputed that the structure had been vacant for over a month when the fire broke out.  Her homeowner’s insurer, Southern Fidelity (SFIC), denied liability because the contract of insurance excluded coverage for losses caused by “vandalism and malicious mischief, theft or attempted theft” if the dwelling had been vacant or unoccupied for more than thirty consecutive days immediately before the loss.  Ms. Botee responded by filing a declaratory judgment action against the carrier.  The trial granted summary judgment to SFIC, and an appeal followed.

The policyholder argued that the contract of insurance was ambiguous.  SFIC’s policy afforded all-risk coverage for loss to the structure under Coverage A and named perils coverage for loss to the contents under Coverage C.  The vandalism and malicious mischief exclusion was found only in the former, and the latter expressly recited that both “fire or lightning” and “vandalism or malicious mischief” were covered causes of loss.  Though the fire had resulted in no contents loss, Ms. Botee looked to the fact that the policy identified both fire and vandalism as “separate covered perils” without defining either one.  According to the insured: Read more ›

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Posted in All Risk, Ambiguity, Arson, Exclusions, Fire, Vacancy and Unoccupancy, Vandalism

California: Service of Suit Endorsement Trumps Forum Selection Clause in Case Involving Product Recall Due to Contamination.

On February 5th in a case involving the recall of over $500,000 worth of oyster products made from Korean shellfish, the Southern District of California held: (1) that the policy’s service of suit clause, which gave the insured the choice of forum, trumped a forum selection clause that provided for suit in a New York state court; (2) that California law, as opposed to New York law, applied, and (3) that for purposes of a 12(b)(6) motion, plaintiff’s complaint, which alleged potential contamination, was sufficient to state a claim.  The decision is Tri-Union Seafoods, LLC v. Starr Surplus Lines Ins. Co., 2015 WL 728477, 2015 U.S. Dist. LEXIS 23441 (S.D.Cal., Feb. 5, 2015).

shutterstock_105419966The case arose after Tri-Union Seafoods initiated a recall in response to the U.S. Food and Drug Administration (FDA) warning about potential contamination.  The policyholder’s claim was denied by its product contamination carrier, Starr Surplus Lines, and Tri-Union then filed suit in federal court in California, where it was headquartered and incorporated.  Starr’s response was a motion to dismiss based on the contract of insurance’s forum selection clause and/or to transfer to New York pursuant to 28 U.S.C. § 1404(a).

The body of the insurance contract included a forum selection clause establishing New York as the proper forum and source of applicable law.  New York was Starr’s principal place of business.  Importantly, New York law does not recognize either a cause of action for the tort of breach of the covenant of good faith and fair dealing or an action based on unfair competition, as alleged by Tri-Union under California Business and Professions Code section 17200, et. seq.   Starr argued that the service of suit endorsement was not inconsistent with the policy’s forum selection clause and that the two provisions should be read in conjunction with one another.  Contrary to Starr’s argument, however, Judge Michael M. Anello held that the service of suit clause modified the policy to permit plaintiff to choose a forum in which to file suit.  He noted that the fact that Starr reserved the right to seek removal or transfer of the case to a different forum after plaintiff filed suit in its chosen forum did not alter or change Tri-Union’s ability to select the forum in the first place.  Read more ›

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Posted in Bad Faith, Contamination, Contamination and Product Recall
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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