In Iowa, Rain is What Gene Kelly Sang In – Not Water From a Burst Drain Pipe

Earlier this year, an Iowa court recognized that rain becomes rainwater once it has fallen, and it held that policy language excluding loss caused by “rain” – without more – will not operate to bar coverage for water from a burst drain pipe that ruptured during a rainstorm.  The decision is reported at Amish Connection, Inc. v. State Farm Fire & Cas. Co., 847 N.W.2d 237, 2014 WL 1234161 (Iowa Ct. App., March 26, 2014).

shutterstock_170611241The insured, Amish Connection, Inc., leased space in a mall in Waterloo, Iowa, and its merchandise was damaged after a 4” cast iron drain pipe above the ceiling burst during a rainstorm.  The pipe carried water from the roof drains to a storm sewer.  The policyholder reported the loss on the day after the storm, and its commercial property insurer, State Farm Fire & Casualty Company, denied by letter on the same afternoon, stating that the loss was “caused by rain.”  The contract of insurance excluded loss “to the interior of any building or structure, or the property inside any building or structure, caused by rain, snow, sleet, ice, sand or dust, whether driven by wind or not[.]”  Rain itself was not a defined term.

Amish Connection brought suit.  The district court granted summary judgment to State Farm, ruling that the exclusion applied because the water that cascaded from the burst pipe was “rainwater.”  On appeal, a unanimous panel of the state’s intermediate level appellate court reversed, and they did so for exactly that reason – the loss was caused by rainwater and not the excluded peril of rain. Read more ›

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Posted in Flood, Water

Insurers Say “Over My Dead Body” to Claims for Damage From Decomposition

Last April saw decisions handed down in Pennsylvania and Florida that addressed the ghoulish question of whether first-party policies cover property damage from a decomposing body, and the courts in both jurisdictions held that the answer in no.  A word of warning – the balance of this post is not for the squeamish.

shutterstock_10128775The first decision was Certain Underwriters at Lloyds of London v. Creagh, — Fed.Appx. —, 2014 WL 1408868 (3rd Cir. , April 14, 2014).  The insured owned a building in Philadelphia where a tenant died in the bathroom of a second floor apartment.  The body went undiscovered for two weeks, by which time bodily fluids had seeped through the floor, contaminating both the apartment itself and parts of the first floor unit below, and there was “a powerful foul odor” in the entire structure.  The policyholder spent $180,000 to sanitize, remediate, and even rebuild portions of the building, and he then sought coverage from his property insurance carrier, Certain Underwriters at Lloyds of London.

Lloyds denied, and the matter went into suit.  The Eastern District of Pennsylvania granted summary judgment to the insurer, and the Third Circuit affirmed earlier this year, holding that coverage was barred by two exclusions in the Lloyds policy.  The first was a “Microorganism Exclusion” that recited as follows: Read more ›

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Posted in Decomposition, Explosion, Microorganisms, Seepage or Leakage

Sixth Circuit Holds That Declines in Market Value are Not a Factor in Determining Actual Cash Value

In a case of first impression in Michigan, the federal Court of Appeals determined last month that general market conditions could not be considered when calculating actual cash value.  In Whitehouse Condominium Group, LLC v. Cincinnati Ins. Co., — Fed.Appx. —, 2014 WL 2743480 (6th Cir., June 17, 2014), the contract of insurance defined ACV as replacement cost less a number of factors including “obsolescence .”  The Sixth Circuit held that the word connoted only functional obsolescence as opposed to both functional and economic obsolescence.

shutterstock_179118050The policyholder owned a condominium building in Flint, Michigan that was heavily damaged by fire in November of 2010.  The policy afforded coverage for ACV, which was defined in the contract of insurance to mean “replacement cost less a deduction that reflects depreciation, age, condition and obsolescence.”  The insurance carrier, Cincinnati Insurance Company, determined that the value of the structure was $1,187,660.38, and it paid that amount to the insured.  The policyholder contended that the building was actually worth $1.6 million more, however, and it demanded appraisal.

The sole issue was the meaning of the word “obsolescence.”  The insured contended that it meant only functional obsolescence, which the Court of Appeals defined as “a loss in value due to something inherent in the building itself such as old technology (think an electric panel that is no longer acceptable under current codes) or bad design (think a five bedroom house that only has one bathroom).”  Cincinnati, on the other hand, argued that it meant both functional and economic obsolescence – “a reduction in value due to market factors entirely external to the building, such as neighborhood factors (this might occur if the neighborhood were suddenly under a noisy flight path) or the general market (the real estate market crash appears to be the factor in this case);”  The decline in property values in Flint was the reason for the difference between the two parties’ ACV numbers. Read more ›

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Posted in Actual Cash Value, Depreciation, Fire, Loss Adjustment

Argument That Rain Alone Can’t Cause a Flood “Would be News to Noah” Says a California Court

Last month an appellate court in California looked to the Bible, citing the Book of Genesis when rejecting the argument that an inundation caused solely by heavy rain was not an excluded flood.  The opinion was handed down in Horvath v. State Farm General Ins. Co., 2014 WL 2931049 (Cal.App., June 30, 2014).

shutterstock_25651162The insureds, Peter and Susan Horvath, owned a home at the end of a cul-de-sac at the bottom of Bell Canyon Drive.  On December 22, 2010, severe rainstorms led to what the husband described as a “river of water coming down the street.”  The town’s drainage systems were overwhelmed, and the cul-de-sac quickly filled up, ultimately inundating the first floor of the insureds’ home with 18” of water.  The couple were evacuated by firefighters, and the local municipality yellow-tagged the structure as unfit to live in.

The policyholders made claim under a homeowners policy issued by State Farm General Insurance Company.  The carrier denied liability because “flood” was an excluded peril under the contract of insurance.  Specifically, the language at issue recited as follows:

We do not insure under any coverage for any loss which is caused by . . . Water Damage, meaning flood, surface water, waves, tidal water, tsunami[.]

The term “flood” was not further defined in the policy. Read more ›

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Posted in Ambiguity, Flood, Water

New York Court: Storm Surge is a Species of Excluded Flood

One of the most litigated issues in the Gulf States in the wake of Hurricane Katrina was whether flood exclusions bar coverage for loss by storm surge.  The courts ultimately decided that the answer was yes.  The Superstorm Sandy jurisdictions have yet to address that question, but a recent federal case in New York suggests that the matter will ultimately be resolved in the same fashion in the Empire State.  The decision is New Sea Crest Healthcare Center, LLC, et al. v. Lexington Ins. Co., — F.Supp.2d —, 2014 WL 2879839 (E.D.N.Y., June 24, 2014).

shutterstock_126359603At present, the issue will not crop up nearly as frequently as it did in the wake of the 2005 storm because Katrina taught a lesson to underwriters everywhere; virtually all of today’s policies make it crystal clear that storm surge is a type of flood.  The policy at issue in this case is a good example, but the Eastern District nonetheless implied that it would have barred coverage even if that were not the case.

The policyholder owned a nursing home in Brooklyn, and it procured a property policy with Lexington Insurance Company.  The contract of insurance had a $1 million flood sublimit, and “flood” was defined as follows:

whether natural or manmade, Flood waters, surface water, waves, tide or tidal water, overflow or rupture of a dam, levy [sic], dike, or other surface containment structure, storm surge, the rising, overflowing or breaking of boundaries of natural or manmade bodies of water, or the spray from any of the foregoing, all whether driven by wind or not.

There was also a named storm provision with a sublimit of $36,650,000 for loss occasioned by the perils of “Flood, (however caused) wind, wind gusts, storm surges, tornadoes, cyclones, hail or rain.”  The named storm provision recited that damage by flood during a named storm was capped at the flood sublimit. Read more ›

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New York Court: All Sandy Losses, Including “Downstream” Financial Ones, Capped By Annual Aggregate Limit For Flood

Superstorm Sandy jurisprudence is starting to shed light on some unresolved issues in the effected states.  In El-Ad 250 West LLC v. Zurich American Ins. Co., — N.Y.S.2d —, 2014 WL 2931058 (N.Y.Cty., June 27, 2014), a New York court held last week that a $5 million annual aggregate limit of liability for losses caused by flood capped any recovery for all such loss, without regard to whether it was physical damage to property or a “downstream” financial loss such as delay in completion.  It was a case of first impression in New York.

shutterstock_120132568On October 29, 2012, the policyholder, El-Ad 250 West LLC, was converting an 11-story office building into a 12-story luxury condominium complex in lower Manhattan.  Superstorm Sandy damaged the project to the tune of more than $20 million according to the insured.  El-Ad had a builder’s risk insurance policy issued by Zurich American Insurance Company.  The contract of insurance had a $115 million overall limit of liability, but delay in completion coverage was sub-limited to $7 million.  In addition, there was a $5 million annual aggregate limit for flood loss, which was defined as follows:

As respects the peril of FLOOD, OCCURRENCE shall mean all losses or damages arising during a continuous condition as defined in the definition of FLOOD.

El-Ad sustained both property damage and delay in completion losses, and it contended that the latter were subject to the contract of insurance’s $7 million sub-limit rather than the $5 million annual aggregate for flood.  Zurich disagreed, and the policyholder filed suit in state court in New York County in August of law year as a result. Read more ›

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Waiver of Attorney-Client and Work-Product – You Can’t Be Just a Little Bit Pregnant

A recent Mississippi opinion dramatically underscores the dangers of an advice-of-counsel defense.  In Willis v. Allstate Ins. Co., — F.Supp.2d —, 2014 WL 1882387 (S.D.Miss., May 12, 2014), the court held that the insurer had waived both the attorney-client privilege and the work-product doctrine with respect to coverage counsel’s entire file – and not just that portion of it that the carrier was willing to produce – when its representatives testified that they relied on the attorney’s advice to deny liability.  As the saying goes, in for a penny, in for a pound.

shutterstock_178587218The policyholder Sandra Willis’ home was damaged by a fire on June 14, 2012, and she made a claim under her homeowner’s policy with Allstate Insurance Company.  The insurer then hired an attorney, David Waldrop, to provide an opinion on coverage.  Waldrop did so in a letter dated February 19, 2013, and Allstate subsequently denied liability.  The insured responded by filing suit for breach of contract and bad faith.

During their 30(b)(6) depositions, the carrier’s  representatives testified that Allstate’s denial was based, in part, on Waldrop’s coverage opinion, and the carrier then provided the policyholder with a copy of the February 19 letter from counsel.   It withheld the balance of his file, however, and it scheduled the contents of that file on a privilege log.

The insured subsequently issued a subpoena requesting production of Waldrop’s “entire claim file of Sandra Willis, including any correspondence to and from Allstate and any reports to and from Allstate.”  Allstate moved to quash, citing the attorney-client privilege and the work-product doctrine. Read more ›

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California Court: An Insurance Claim for Feng Shui Is Not Harmonious Qi

Feng shui is a Chinese philosophical system that supposedly orients buildings and their contents in an auspicious manner.  Last month in Patel v. American Economy Ins. Co., — F.Supp.2d —, 2014 WL 1862211 (N.D. Cal., May 8, 2014), however, a California court rejected the notion that it was compensable under a first-party property insurance policy as either a legitimate expense to repair direct physical loss or damage or a necessary extra expense to avoid additional business income loss.

On October 14, 2009, a fire filled the dental offices of Dr. Namrata Patel with smoke.  Dental and electronic equipment was damaged, and she incurred costs for cleaning and repair, inventory replacement, and lost business income during a one-month closure after the blaze.  Dr. Patel was insured by American Economic Insurance Company, and she made claim for her loss.  The insurer paid portions of her claim, but it denied liability for other components, and the dentist subsequently brought suit in federal court in California, alleging breach of contract and bad faith.

shutterstock_141641554One of the two principal bones of contention was a claim for over $50,000 for a feng shui consultant.  Dr. Patel utilized feng shui when she initially opened her dental practice.  Prior to reopening after the fire, she did so once again, and the claim included a “Five Elements Feng Shui Invoice” in the amount of $50,275.  According to her affidavits, the feng shui consultant was retained “to come in and change crystals and perform additional cures to help to restore the location to its original condition,” to “restore energy balance,” and to determine “placement of furniture and dealing with forces of Qi.”  The policy insured against “direct physical loss of or damage to Covered Property,” an0d Dr. Patel contended that the consultant’s services fit within that definition because she had used him when she had originally set the office up.  She also sought to invoke coverage under the contract of insurance’s extra expense provision. Read more ›

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Posted in Direct Physical Loss or Damage, Extra Expense, Fire

Connecticut Holds that When a Lapsed Policy is Reinstated, Coverage is Only Restored Prospectively

In a case of first impression in the Nutmeg State, an intermediate level court in Connecticut recently held that reinstatement of coverage after a lapse for non-payment of premiums does not operate to restore coverage retroactively.  In Brown v. State Farm Fire & Casualty Co., 150 Conn.App. 405 (May 27, 2014), the court held that coverage is only restored on a prospective basis, and it barred the insured from recovering for a fire loss that took place between the time of the lapse and the reinstatement.

The insured, Ralston Brown, owned a home in Bridgeport, and he purchased a homeowner’s insurance policy from State Farm on September 16, 2004.  One year later, the policyholder secured a business policy from the same insurer, and he arranged for both contracts of insurance to be billed quarterly on the same date.

shutterstock_1391724On February 16, 2006, State Farm submitted a quarterly bill for the two policies, payable on or before April 6th.  No payment was forthcoming.  On March 22nd, the insurer sent a notice of cancellation, reciting that the two contracts of insurance would be cancelled on April 6th if Brown failed to pay the full amount due by that date.  It was uncontested that no payment was made. Read more ›

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Failure to File a Proof of Loss is Fatal, and the Defense Does Not Require a Showing of Prejudice

On June 3, Connecticut’s intermediate level appellate court held that the failure of a policyholder to file a sworn statement in proof of loss was fatal to his claim.  Palkimas v. State Farm Fire & Casualty Co., 150 Conn.App. 655, 2014 Conn.App. LEXIS 244 (June 3, 2014) rejected the insured’s arguments that prejudice need be shown, holding that while the insurance company may well need to make a showing of prejudice in cases involving the belated submission of a proof, its burden to make such a showing never arises in cases in which the insured has never submitted such a document.

shutterstock_153125888Richard Palkimas was insured under a homeowner’s policy issued by State Farm Fire & Casualty Company, and he sustained two losses.  The first occurred in September 2006, “when workers negligently used a toilet that had been blocked off resulting in a buildup of sewage, and the breaking and rupturing of a sanitary pipe, as well as the spreading of sewage and fecal matter throughout the home.”  Then in January of the following year, the policyholder discovered that “freezing temperatures caused substantial damage to [his] home, including fracturing of the plaster walls and building structure.”

The insured made claim for both events, and he hired a public adjuster to negotiate with State Farm on his behalf.  It was undisputed, however, that he never filed a sworn statement in proof of loss in connection with either claim.  The insurer ultimately denied coverage for both, contending that the policyholder’s failure to submit a proof meant that he had failed to satisfy a condition precedent to coverage under the contract of insurance. Read more ›

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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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