News & Analysis as of

Denial of Insurance Coverage

Wiley Rein LLP

Coverage for Post-Tender Remediation Costs Precluded as Voluntary Payments Where Insured Admitted and Assumed Liability Before...

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A federal district court, applying New York law, has held that a “voluntary payments provision” precluded coverage for an insured’s post-tender costs to remediate its engineering errors because the insured admitted and...more

Rivkin Radler LLP

May 2025 New York Insurance Coverage Law Update

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Utica National Assurance Company issued a liability policy to Bond Painting Company. Bond’s employee was injured working at a construction project at premises leased by Amazon.com Services Inc. and filed a bodily injury...more

Butler Weihmuller Katz Craig LLP

North State Deli: A New Outbreak of COVID-19 Litigation?

Civil-authority “stay-at-home” orders issued in the wake of the COVID-19 pandemic were just one layer of the outbreak’s sweeping impact on people and businesses worldwide. The pandemic has resurfaced in North Carolina in...more

Zelle  LLP

When Coverage Disagreements Are Justified: The Bona Fide Dispute Doctrine in Action

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In Texas, bad faith claims arising under the Texas Insurance Code or the common law are routinely asserted by plaintiffs in first-party insurance disputes. While these causes of action are frequently pled, mere disagreement...more

Zelle  LLP

Court Analyzes “Forces of Nature” in Applying Section 542A of the Texas Insurance Code

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Recently, the United States District Court for the Northern District of Texas, Dallas Division, rejected an insured’s attempt to reframe its claim from a “forces of nature” claim and enforced Section 542A.006 of the Texas...more

Miller Nash LLP

Oregon Supreme Court Reverses Insurance Coverage Denial for Contractor in Twigg v. Admiral Ins. Co.

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In a long-awaited decision that helps contractors obtain coverage for construction defects, the Oregon Supreme Court in Twigg v. Admiral Ins. Co. 371 Or. 308 (2025) ruled that coverage under a commercial general liability...more

Cozen O'Connor

Noncompliance With Policy’s “Duties After Loss” Provision Leads to Denial of Fire Loss Claim

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In Caribe D. Billie v. Plymouth Rock Assurance Corp. et al, the U.S. District Court for the District of Connecticut granted Plymouth Rock Assurance Corp.’s (“Insurer”) motion for summary judgment, holding that the Insurer was...more

Carlton Fields

Third Circuit Holds Harassment Exclusion Bars Coverage for Sexual Assault Suit Under Pennsylvania Law

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In Rice Enterprises LLC v. RSUI Indemnity Co., the Third Circuit Court of Appeals affirmed the district court’s finding that the insured was not entitled to coverage from its employer’s liability insurer or its umbrella...more

Stark & Stark

A Simple Guide: What if My Life Insurance Claim Is Denied?

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How does the life insurance claims process work? Industry surveys contend that life insurance claims are denied less than 5% of the time, while others more skeptical of the life insurance industry believe the denial rate is...more

Ballard Spahr LLP

WA State Court: No COVID-19 Coverage in Tulalip Tribes v. Lexington

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In a recent COVID-19 Washington State insurance bad faith case, Tulalip Tribes of Washington v. Lexington Ins. Co., Division I of the Washington Court of Appeals affirmed Washington’s stance holding lost physical use of...more

Zelle  LLP

Calif. Smoke Claim Ruling Gives Insurers Support On Denials

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In their recent Law360 guest article titled "Reconciling 2 Smoke Coverage Cases From California," the authors described a California appellate court's Feb. 7 opinion in Gharibian v. Wawanesa General Insurance Co. as an...more

Carlton Fields

Divided Ninth Circuit Finds Claimant’s Failure to Provide Medical Records Insulates Insurer From Bad Faith Failure to Settle

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If at first you don’t succeed, try, try again. An age-old adage that now provides critical guidance for insurers seeking to protect themselves in the face of bad faith failure to settle claims....more

Carlton Fields

Litigation Under Construction: Recent Life Insurance and Long-Term Care Developments

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In Potovsky v. Lincoln Benefit Life Co., the Ninth Circuit Court of Appeals affirmed the dismissal of the insureds’ complaint for failure to sufficiently allege damages regarding the denial of a long-term care claim....more

Marshall Dennehey

Court Denies UIM Coverage to Woman, Claiming ‘Family Member’ Status Through Daughter

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Miller v. USAA General Indemnity Company, No. 23-1934 (3d Cir. Jan. 7, 2025) - The plaintiff, who resided with her daughter in the home of her daughter’s paternal grandmother, sought UIM benefits under an auto insurance...more

Paul Hastings LLP

Antitrust Lawsuits Accuse Insurers of Conspiring to Deny Fire Insurance to California Homeowners

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On April 18, 2025, law firms representing California homeowners filed a pair of lawsuits accusing dozens of insurance companies of conspiring to deny property insurance to homeowners in fire-prone areas of California,...more

Rivkin Radler LLP

April 2025 New York Insurance Coverage Law Update

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John H. Fisher and his P.C. represented a client in a medical malpractice action filed on February 15, 2019, alleging that the defendant medical providers failed to provide proper prenatal care to the client, causing the...more

Carlton Fields

Eighth Circuit Finds No Coverage Under “Ensuing Loss” Provision Under Arkansas Law

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“Ensuing loss” provisions have long been the subject of nuanced arguments in insurance litigation. The provisions, which sometimes afford coverage for a “covered loss” stemming from an expressly excluded peril, serve as...more

Carlton Fields

Texas Appeals Court Finds Project Owner Excluded From Coverage as Claimants’ Statutory Employer

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On April 3, 2025, a Texas state appeals court reversed a trial court order awarding Exxon Mobil $25 million under an umbrella insurance policy issued by Lexington Insurance Co. to Brock Services Ltd. The appeals court found...more

American Conference Institute (ACI)

[Event] 16th Annual Advanced Forum on Managed Care Disputes and Litigation - May 1st - 2nd, Chicago, IL

Join the industry’s top litigators and leading plan counsel at ACI’s 16th Annual Advanced Forum on Managed Care Disputes and Litigation, for two days of discussions designed to address emerging areas of concern for MCOs in...more

Wiley Rein LLP

Notice Prejudice Rule Applies to Claim Not Reported “As Soon As Practicable” But Within Policy Period

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The United States District Court for the District of Kansas, applying Kansas law, has held that an insurer must show prejudice to deny coverage when an insured provided notice of a claim within the policy’s three-year policy...more

Venable LLP

[Webinar] Insurance Coverage for PFAS Under Historical CGL, Modern Environmental and Other Insurance Policies - April 3rd, 1:00 pm...

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This program will address insurance coverage for the potential environmental impacts of PFAS, such as the costs of testing or remediation required by the government, as well as other potential non-environmental PFAS claims....more

Wiley Rein LLP

No Coverage for Lawsuit Where “Claim” First Made at Time of Pre-Inception Tolling Agreement

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In a win for Wiley’s client, a New York intermediate appellate court, applying New York law, has affirmed that no coverage is available for a legal malpractice lawsuit because the “claim” was first made before the policy’s...more

Wiley Rein LLP

Third Circuit: Changes in Exposure Provision Bars Coverage for Pre-Merger Liabilities

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In a win for Wiley’s client, the United States Court of Appeals for the Third Circuit, applying Pennsylvania law, affirmed judgment on the pleadings in favor of a group of insurers on the ground that a Changes in Exposure...more

Marshall Dennehey

Second District Court of Appeal Reinstates Homeowner’s Lawsuit, Assigns New Judge Over Bias Concerns

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Montes v. Universal Property & Casualty Insurance Co., Fla. 2d DCA, No. 2D2023-1200, February 12, 2025 - The Second District Court of Appeal revived an insurance coverage suit a homeowner brought against his insurance...more

Morris, Manning & Martin, LLP

Policyholder Concerns after Georgia Federal Court Takes Broad Reading of Pollution Exclusion

In Citizens Ins. Co. of Am., et al. v. Augusta Chiller Service, Inc., et al., the Southern District of Georgia granted insurers' motions for summary judgment in part on their duty to defend under a primary and excess policy...more

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