In Amherst Country Club, Inc. v. Harleysville Worcester Ins. Co., 2008 U.S. Dist. LEXIS 48481 (D. N.H. June 24, 2008), the District Court determined there was no coverage when the loss was caused by both a covered event and an excluded event. The court analyzed the efficient proximate cause doctrine, but found
Hawaii Supreme Court Finds Auto Policies Ambiguous
By Tred R. Eyerly on
The Supreme Court’s recent decision in Allstate Ins. Co. v. Pruett, No. 26830 (Haw. Sup. Ct. June 25, 2008), addressed several issues regarding auto policies issued by AIG and Allstate.
The facts revolved around a household consisting of a mother insured by Allstate, a daughter insured by AIG, and a…
Doctrine of Efficient Proximate Cause Alive and Well in Washington
By Tred R. Eyerly on
Under the doctrine of proximate cause, where a peril specifically insured against sets in motion other causes which, in an unbroken sequence between the act and final loss, produces the result for which recovery is sought, the insured peril is regarded as the "proximate cause" of the entire loss and coverage exists. The…
Hawaii Supreme Court Grants Certiorari in Auto Policy Case
By Tred R. Eyerly on
The Hawaii Supreme Court has granted a writ of certiorari in Gillan v. Gov’t Employees Ins. Co., 184 P.3d 780 (Haw. Ct. App. 2008). Moreover, the Supreme Court ordered that oral argument will be conducted in the case. See Gillan v. Gov’t Employees Ins. Co., No. 28075 (Haw. June 23, 2008).
…
New Rate Models
By Tred R. Eyerly on
A recent Wall Street Journal article critiques insurers for the recent use of computerized risk projection models to take global warming into account. Previously, insurers relied primarily on historical data to set rates. After the severe hurricanes in 2004, insurers started using new computer models to project natural catastrophes over the next several years (a…
Duty to Cooperate – How Far Does it Extend?
By Tred R. Eyerly on
A liability policy typically requires the insured to cooperate with the insurer. Under the provision, the insured must, among other things, cooperate with the insurer in investigating or settling of the claim. Breach of the cooperation clause by the insured relieves the insurer of liability under the policy. But the insurer must show…
Liability Policy for Professional Services Does Not Cover Alleged Violations Under False Claims Act.
By Tred R. Eyerly on
Coverage for a suit involving false billing claims submitted in violation of the False Claims Act is generally not recognized under a liability policy. This was the result reached in a recent case decided by the Tenth Circuit. See Zurich Am. Ins. Co. v. O’Hara Regional Center for Rehabilitation, Nos. 06-1357 and…
Supreme Court Overturns Insurer’s Denial of Disability Benefits Based in Part on Conflict of Interest
By Tred R. Eyerly on
The United States Supreme Court decided an insurance-related case last week involving the insurer’s potential conflict of interest in its dual role in administering and paying benefits under an ERISA plan. Metropolitan Life Ins. Co. v. Glenn, No. 06-923 (U.S. Supreme Ct. June 19, 2008). MetLife was the administrator and insurer of…
When Does the Duty to Defend Start?
By Tred R. Eyerly on
The question "when does the duty to defend start?" arises quite frequently. Succinctly, it starts immediately upon the filing of a covered lawsuit and tender to the insurer. "The defense duty is a continuing one, arising on tender of defense and lasting until the underlying lawsuit is concluded, or until it has been shown that…
Hawaii Appellate Court Again Addresses Payment of No-fault Benefits
By Tred R. Eyerly on
In a prior post, we discussed two appeals by Dr. Emerson Jou to the Hawai`i Intermediate Court of Appeals regarding notice requirements for reimbursement from no-fault policies. In a recent, third case pursued by Dr. Jou, the ICA agreed notice of denial of benefits was required pursuant to Haw. Rev. Stat. 431:10C-304…