Coverage

Context Important in ERISA Dispute Over Unclear Language (PA)

On November 16, 2022 in a lawsuit entitled, Frietas, et al. v. Geisinger Health Plan, et al., No. 4:20-CV-01236, Third Circuit Chief Judge Brann disposed of a proposed class action alleging that Geisinger Health Plan (“GHP”) illegally tried to recoup payments from plan users following their injury settlements, finding that documents uncovered through discovery explicitly gave the company the...Read More

Broad Policy Exclusions Are Vulnerable to Reasonable Expectations (PA)

On November 2, 2022, in Atain Insurance Company v. V2 Properties LLC, the Eastern District of Pennsylvania, Judge Padova issued a memorandum decision denying Atain Insurance Company’s (“Atain”) motion for judgment on the pleadings, arguing that its policy issued to V2 Properties (“V2”) provided no coverage for losses sustained in connection with a personal injury judgment entered against V2....Read More

Third Circuit Upholds Assault Or Battery Exclusion In Sex Trafficking Case (PA)

In Nautilus Insurance Co. v. Motel Management Services, Inc., et al., the Court of Appeals for the Third Circuit analyzed whether the District Court’s judgment declaring that underlying sex trafficking actions fell within the scope of an insurance policy’s assault-or-battery exclusion.  On de novo review, the Court of Appeals affirmed the lower court’s ruling. Nautilus Insurance Company...Read More

Insured Contract Exclusion Requires A Third-Party

In Stevanna Towing, Inc., et al. v. Atlantic Specialty Ins. Co., No. 21-1420, 2022 WL 12241451 (3d Cir. Oct. 21, 2022), a Stevanna employee was injured when the boat he was deckhand on— which was being piloted by an employee of Georgetown Sand & Gravel—bumped into a barge. Stevanna, among others, resolved the suit with the employee and then sought reimbursement for the costs associated...Read More

Duty to Defend Triggered with a “reasonable possibility” of Coverage (NY)

The Appellate Division (4th Dep’t) recently determined that even where a complaint does not include specific claims or allegations bringing it within the scope of a policy’s coverage, an insurer’s duty to defend may still be triggered if the complaint suggests a “reasonable possibility” that the claims may fall within the scope of the policy.  In Main St. Am. Assurance Co. v. Merchants Mut....Read More

Creative Pleading In PA Requires A Duty To Defend

In Siehl v. City of Johnstown, et al., the plaintiff was convicted of murder and was incarcerated for twenty-five years. The plaintiff alleged that, during his period of incarceration, the defendant city and county withheld exculpatory evidence and produced false disclosure statements. After multiple hearings, the Court determined that the defendant officers were untruthful and hid exculpatory...Read More

Uber Eats Not Required By Statute To Maintain $1.5 Million In UIM Coverage (NJ)

On September 27, 2022, raised as an issue of first impression in Malzberg v. Josey, et al., no.: A-2883-20, a New Jersey state appeals court held that insurance coverage requirements under the state’s Transportation Network Company Safety and Regulatory Act (“TNCSRA”) do not apply to Uber Eats’ food delivery services. Specifically, the three-judge panel affirmed summary judgment in favor...Read More

NY Continues Statewide and National Trends Rejecting COVID Business Interruption Claims

Yet another court in New York has ruled against an insured’s lawsuit for breach of contract against the insurer for not covering business losses as a result of the pandemic. In Spirt Airlines v. American Home Assurance Company, Justice Reed of the New York State Supreme Court, New York County, held, as scores of other state and federal courts have held nationwide, that coverage under the...Read More

New Jersey Supreme Court Looks Outside Pleadings in NJ to Deny Duty to Defend

In Norman Int’l, Inc. v. Admiral Ins. Co., No. 086155, 2022 WL 3220868 (N.J. Aug. 10, 2022), the New Jersey Supreme Court ruled on the application of a county-specific exclusionary clause in an Admiral Insurance Company (“Admiral”) policy issued to Richfield Window Coverings, LLC (“Richfield”)—Richfield sells window coverings, blinds, etc., and also provides retailers with cutting machines to...Read More

Non-Parties Cannot Intervene In Insurance Company’s Declaratory Judgment Action

In County Hall Insurance Company, Inc. v. Mountain View Transportation, LLC, the M.D.P.A ruled that non-parties who had a personal injury claim against an insured individual cannot intervene in the insurance’s company’s declaratory judgment action that it filed against the same insured. The underlying state court suit stemmed from a motor vehicle accident in which a number of occupants were...Read More