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No Second Chances: New Jersey Appellate Division Prohibits Alleged Insurance Fraudster From Re-Litigating Issue Of Whether There Was An Underlying Auto Accident

The New Jersey Appellate Division held that an individual alleged to have submitted a fraudulent insurance claim as a result of an auto accident was collaterally estopped from litigating for a second time the issue of whether there was in fact an auto accident. In Badolato v. McMillan, No. A-5474-16, 2018 WL 5091799 (App. Div. Oct. 19, 2018) an individual, Charyse McMillan, filed a claim with New Jersey Manufacturers Insurance Company (NJM) for personal injury protection (PIP) benefits as a

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Florida’s Statutory Sovereign Immunity Language Inserted Into Any Government Liability Policy Takes Precedence Over the Policy’s Definition of “Occurrence”

In Florida, as in most jurisdictions, government agencies may be subject to liability for tortious acts, with the recovery limit capped by law. A recent decision, State of Florida v. Barnett, explores the recent conflict regarding the limit of recovery against a state agency for an “occurrence” involving multiple claimants. Section 768.28(5), Florida Statutes (2010), states in relevant part as follows: Neither the state nor its agencies or subdivisions shall be liable to pay a claim or a judgment by

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Years Later, Hurricane Sandy Claims Still Present Unique Coverage Questions

The Second Circuit’s recent reversal of summary judgment involving a coverage dispute over a $50M Hurricane Sandy storm surge claim is an important reminder to always closely read the policy. At first blush, the policy in question was a seemingly standard all-risk commercial property policy that featured a flood exclusion and a separate windstorm or hail deductible endorsement. The coverage analysis in this case should have been straightforward – storm surge falls within the scope of the flood exclusion vitiating

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What on Earth? Court Finds Ambiguous Property Appraisal Award for Earthquake Damage

The U.S. District Court for the Southern District of Illinois recently held that outstanding coverage issues and an ambiguous notation in an appraisal award precluded a finding that an insurer satisfied its coverage obligations. Windsor Oaks, LLC v. Cincinnati Ins. Co., No. 17-CV-689-SMY-SCW, 2018 WL 4303141 (S.D. Ill. Sept. 10, 2018). The insured, a hotel owner, submitted to its insurer a property claim for earthquake damage. The insurer retained an engineering expert, who determined the hotel did not sustain earthquake damage.

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Insured Can’t Claim Damages in Proof of Loss Were “Puffed” Up to Avoid Federal Jurisdiction: Federal Court Deems Damages Demand in Sworn Proof of Loss Submitted to Insurer More Credible than Complaint’s Unsworn Estimate

On October 10, 2018, a Florida federal court ruled that an insured’s precise damages estimate, set out in an exhibit to his complaint against his insurer, of $73,963.19, was less credible than his pre-suit demand in his proof of loss form of $100,709.34. The insured, Roger Ulloa, sued his insurer, Integon National Insurance Company, alleging it failed to fully pay his property damage claim in the wake of Hurricane Irma. Integon removed the case to federal court on the basis

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GEICO Lost a UM Battle But May Yet Win the War

In GEICO Indem. Co. v Perez, 2018 WL 4495557 (Fla. Dist. Ct. App. 2018), not only was Geico Indemnity Company and Geico General Insurance Company (collectively GEICO) forced to go to trial against their insured because the trial court denied GEICO’s motion for summary judgment on the issue of whether the insured was entitled to uninsured/underinsured motorist (UM) coverage but the jury also found that the insured had been severely injured due to the negligence of an un insured motorist, entitling him to

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This is No “Accident”: Ohio Court Rules CGL Policy Doesn’t Cover Shoddy Subcontractor Work

One of the ongoing battles in construction defect coverage law around the country is whether a general contractor’s commercial general liability (“CGL”) policy obligates the insurer to defend and indemnify the general contractor in a lawsuit based on faulty work performed—not by the general contractor—but on its behalf by a subcontractor. Yesterday, Ohio joined a small minority of states when its high court ruled that damage from a subcontractor’s faulty work is not an accident triggering an insurer’s defense obligation.

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