Justia U.S. 9th Circuit Court of Appeals Opinion Summaries

Articles Posted in Insurance Law

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Plaintiffs, elderly Oregonians or their successors who purchased long-term healthcare insurance policies sold by Bankers, filed suit alleging that Bankers developed onerous procedures to delay and deny insurance claims. The court certified the following question to the Oregon Supreme Court, pursuant to Oregon Revised Statues 28.200: Does a plaintiff state a claim under Oregon Revised Statutes 124.110(1)(b) for wrongful withholding of money or property where it is alleged that an insurance company has in bad faith delayed the processing of claims and refused to pay benefits owed under an insurance contract? View "Bates v. Bankers Life & Casualty" on Justia Law
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The court certified the following questions of state law to the California Supreme Court: 1. Is California’s common law notice-prejudice rule a fundamental public policy for the purpose of choice-of-law analysis? May common law rules other than unconscionability not enshrined in statute, regulation, or the constitution, be fundamental public policies for the purpose of choice-of-law analysis? 2. If the notice-prejudice rule is a fundamental public policy for the purpose of choice-of-law analysis, can a consent provision in a first-party claim insurance policy be interpreted as a notice provision such that the notice-prejudice rule applies? View "Pitzer College v. Indian Harbor Insurance Co." on Justia Law
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Plaintiffs filed suit against Lincoln seeking to recover damages for the injuries they incurred from the insured. The court certified the following question to the Supreme Court of California: When determining whether an injury arises out of the “use” of a vehicle for purposes of determining coverage under an automobile insurance policy and an insurance company’s duty to defend, is the appropriate test whether the vehicle was a “predominating cause/substantial factor” or whether there was a “minimal causal connection” between the vehicle and the injury? View "Gradillas v. Lincoln General Ins." on Justia Law
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Kaady, a mason, filed suit against Mid-Continent after Mid-Continent denied Kaady's claim for indemnification under its commercial liability insurance policy. The district court granted summary judgment to Mid-Continent based on the ground that Kaady's claim was barred by the policy's known-loss provision. The court concluded that MidContinent has offered no reason to treat the insured’s work and the work of others as different property in every provision of the policy except the known-loss provision. Thus, the known-loss provision also distinguishes between them. The insured’s knowledge of damage to his own work doesn’t automatically constitute knowledge of damage to the components of the structure furnished by others. Further, an insured’s knowledge of one type of damage to property doesn’t automatically constitute knowledge of any and all damage to the property; the claimed damage must be related to the known damage. In this case, Kaady’s knowledge of the cracks in the masonry before he bought the policy doesn’t constitute knowledge of the claimed “property damage” to the structural components. The court concluded that the correct inquiry is whether the claimed damage to the structural components was a “continuation, change or resumption” of the cracks. If it was, Kaady’s knowledge of the cracks would bar coverage of the claimed damage; if not, his knowledge of the cracks wouldn’t bar coverage. In this case, without any record evidence connecting the cracks in the masonry that Kaady observed before he bought the policy to the damage to the wooden components for which Kaady claims coverage, summary judgment was inappropriate. Accordingly, the court reversed and remanded. View "Kaady v. Mid-Continent Cas. Co." on Justia Law
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Guam Industrial owned a dry dock that sunk during a typhoon in Guam. Guam Industrial filed a claim under two insurance policies to cover the cost of damage to the dock and the clean up of oil barrels. The district court granted summary judgment in favor of the insurers. Whether derived from federal admiralty law or state law, the court concluded that the law requires strict compliance with marine insurance policy warranties, even when the breach of the warranty did not cause the loss. In this case, the policies required Guam Industrial to obtain and maintain Navy Certification and Guam Industrial breached the warranty because the dry dock was never Navy Certified. The court concluded that the district court correctly ruled that since there was no actual discharge of pollutants, even though the containers of oil were submerged after the sinking, Guam Industrial’s costs of retrieving the containers from the sea were not covered by the policy’s allowance of coverage for cleanup after the “discharge, dispersal, release, or escape” of pollutants. Accordingly, the court affirmed the judgment. View "Guam Indus. Servs. V. Zurich Am. Ins. Co." on Justia Law
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Plaintiff filed suit against Metropolitan after the insurance company denied coverage for the loss of her home. After a wildfire swept through Northern Arizona in 2011, flooding and mudslides in the area destroyed plaintiff's house. Plaintiff had a homeowner’s policy with Metropolitan which covered direct loss caused by fire but excluded coverage for loss caused by either water damage or earth movement, including mudslides. Under the Appleman definition of direct and proximate cause as adopted by Arizona, it is possible that the fire directly caused plaintiff's loss in “an unbroken sequence and connection between” the wildfire and the destruction of the house. In this case, a reasonable factfinder could conclude that the destruction of the house was caused by the fire, which likely caused the mudslide, “the operation and influence of which could not be avoided.” Therefore, although an efficient proximate cause analysis is not appropriate under Arizona law, the court need not apply that doctrine in order to find that the damage here could have been directly and proximately caused by the wildfire. The court concluded that the district court erred in determining that, under Arizona law, Metropolitan was entitled to summary judgment because there is a triable issue as to whether the fire directly caused the destruction of plaintiff's home. Accordingly, the court reversed and remanded. View "Stankova v. Metro. Prop. & Cas. Ins. Co." on Justia Law
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Plaintiff filed a putative class action against EquiTrust, alleging that EquiTrust's marketing of the sale of annuities violated the Racketeer Influenced and Corrupt Organizations (RICO) Act, 18 U.S.C. 1962(c), and Arizona law. The district court granted EquiTrust's motion for summary judgment but declined to award costs. In this case, plaintiff's complaint is based entirely on the language of the annuity contract and the EquiTrust marketing materials. The district court found, and the court agreed, that there were no actionable predicate acts regarding the premium bonus, the market value adjustment, nor the nonforfeiture law. The court concluded, however, that the district court must explain a denial of an award of costs to the prevailing party. Because the district court failed to do so here, the court vacated the order denying costs and remanded for further proceedings. The court affirmed the grant of summary judgment. View "Harrington v. EquiTrust Life Ins." on Justia Law
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Encompass filed suit against Mid-Century and Coast National seeking contribution or subrogation for the expenses Encompass incurred in its defense and indemnification of its insured, Lisa Torti, in an underlying lawsuit. Alexandra Van Horn was a passenger in a wrecked car and, Torti, fearing that Van Horn might be in danger, grabbed Van Horn and physically removed her from the car. Van Horn suffered severe spinal injuries after the accident and became a paraplegic. Van Horn sued Torti, alleging that Torti caused her injuries when she removed her from the wrecked car. At issue on appeal was whether unloading an injured passenger from a motor vehicle constitutes "use" of that motor vehicle under California law. The court concluded that it does. As used in Mid-Century's and Coast National's insurance policies, the term "use" is defined by California Insurance Code 11580.06(g). As defined by California Insurance Code 11580.06(g), "use" of an automobile includes unloading that automobile. In this case, Torti "used" the vehicle when she unloaded Van Horn from that car. Accordingly, the court reversed the judgment of the district court in favor of Mid-Century and Coast National and remanded for further proceedings. View "Encompass Ins. Co. v. Coast Nat'l Ins. Co." on Justia Law

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After the Diocese settled four lawsuits for alleged sexual abuse by its priests, the Diocese filed a declaratory judgment action seeking entitlement to indemnification under IFC's excess liability indemnity policies. The policy provided by IFC to the Diocese excludes "liability of any Assured for assault and battery committed by or at the direction of such Assured..." The court concluded that, based on the ordinary meaning of this exclusion and consistent with Arizona law, "the language 'any insured'... express[es] a contractual intent to prohibit recovery by innocent co-insureds." In this case, the assault and battery exclusions applied to innocent co-insureds. Accordingly, the court reversed the district court's judgment in favor of the Diocese, and vacated and remanded its grant of attorneys' fees and taxable costs. View "IFC v. Roman Catholic Church" on Justia Law

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This case arose from general liability insurance policies, including advertising injury coverage, that Great American issued to Street Surfing. At issue was whether those policies obligated Great American to defend Street Surfing in an action alleging trademark infringement, unfair competition, and unfair business practices under federal and California law (Noll action). The court accepted Great American's concession that the Noll action potentially falls within coverage for use of another's advertising idea, but rejected Street Surfing's argument that the action would also fall within the policies' coverage for slogan infringement. The court held that the prior publication exclusion relieves Great American of its duty to defend Street Surfing in the Noll action because the extrinsic evidence available to Great American at the time of tender conclusively establishes: (1) that Street Surfing published at least one advertisement using Noll's advertising idea before coverage began; and (2) that the new advertisements Street Surfing published during the coverage period were substantially similar to that pre-coverage advertisement. Accordingly, the court affirmed the district court's grant of summary judgment in favor of Great American. View "Street Surfing v. Great Am. E&S Ins. Co." on Justia Law