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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Posted in Ambiguity, Flood, Superstorm Sandy

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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Posted in Builders' Risk, Delay in Completion, Flood, Superstorm Sandy

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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New York Holds Water Which Backs Up Is Covered If It Originated On The Insured Premises

Last week, in Pichel v. Dryden Mutual Ins. Co., — N.Y.S. 2d —, 2014 WL 1923736 (May 15, 2014), an intermediate level appellate panel in New York brought the state into line with the interpretation of water backup adopted by a number of other jurisdictions.  The decision held that policy references to a “plumbing system” mean the plumbing system on the insured premises itself.  As a result, a loss caused by water which backs up through sewers and drains is covered if the overflow originated within the insured’s property but excluded if the backup originated off site, as from a clogged municipal sewer system for example.

shutterstock_138966689The policyholder owned an apartment complex that was insured by Dryden Mutual.  The structure was damaged when waste water inundated the first floor, entering the units through toilets, bathtubs, and drains.  The insurer denied liability, contending that coverage was barred by two “Water Damage” exclusions.  The first recited that loss caused by “water which backs up through sewers and drains” was excluded, while the second barred coverage for “loss caused by repeated or continuous discharge, or leakage of liquids or steam from within a plumbing … system.”  The second of these exclusions, however, went on to state that Dryden Mutual would pay for “loss caused by the accidental leakage, overflow or discharge of liquids or steam from a plumbing … system.”

The policyholder brought suit state in New York, and the trial court found that the provisions were ambiguous but could be reconciled if read so as to bar coverage for backup that originated off the insured’s property (i.e., in a municipal sewer or drain) while affording coverage for an occurrence originating within the insured’s property (i.e., in the property owner’s own plumbing system).  It therefore granted partial summary judgment to the insured.

On appeal, New York’s Appellate Division agreed.  The issue was one of first impression in New York state, but the appellate court noted that other jurisdictions had interpreted the interplay between these two competing provisions in just that fashion, holding that the term “plumbing system” included the drains that are on the insured’s own premises.  It then adopted a similar rule, holding that “water damage caused by a backup/overflow that originates from a pipe or clogged drain located within the insured’s property line comes from the insured’s plumbing system and is covered by the policy [while] if the cause of the backup/overflow is from outside the insured’s property boundaries – such as a clogged municipal sewer that forces water from outside the insured’s plumbing system to overflow – the sewer or drain exclusion is applicable.”  In the words of the court, such an interpretation “affords full effect to both the exclusion and coverage provisions and is consistent with the … case law of other jurisdictions.”

The case was nonetheless remanded because the Appellate Division held that the policyholder had not met his burden of showing that there were no issues of fact with respect to what happened.

 

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Posted in Flood, Seepage or Leakage, Water

Third Circuit Says No to Insured’s Request for Reserve Information

In a victory for insurers, the United States Court of Appeals for the Third Circuit recently rejected an insured’s discovery request for reserve information in a first-party bad faith action.  In its April 29, 2014 decision in Mirarchi v. Seneca Speciality Insurance Company, — Fed.Appx. —, 2014 WL 1673748 (3d Cir., April 29, 2014), the Court of Appeals upheld the district court’s denial of the policyholder’s request for the reserves and, in doing so, endorsed  the numerous district court decisions that have previously held such information to be non-discoverable.

shutterstock_178839995In Mirarchi, a fire damaged the insured’s property.  The insurer paid the entire undisputed amount, and the parties proceed to appraisal on the remainder of the claim.  An umpire entered an award close to the amount sought by the policyholder, and the carrier paid.  Thereafter, however, the insured filed an action against the insurance company in federal court, asserting that the insurer had delayed payment in bad faith, and he requested discovery of the company’s reserve information.  Seneca Specialty refused to provide the requested information, and the district court held that it was not obligated to so so.  The trial court subsequently dismissed the bad faith claims in their entirety, noting that the insurer had paid the undisputed amount despite the lack of any contractual or legal obligation to do so and further that the insurer, in valuing the claim lower than the appraisal award, had relied on reasonable expert opinions. 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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