INTRODUCTION

On June 18, 2013, the West Virginia Supreme Court of Appeals issued its opinion in Cherrington v. Erie Insurance Property and Casualty Co., 745 S.E.2d 508 (W. Va. June 18, 2013).  The opinion expressly reversed previous West Virginia jurisprudence through the Court’s holding that defective workmanship causing bodily injury or property damage is an “occurrence” under a commercial general liability (CGL) insurance policy.  

FACTUAL HISTORY

The case originated in 2004 when the underlying plaintiff entered into a “cost plus” contract with a general contractor (“contractor”) for the construction of a home, which included landscaping and interior furnishing.  Several subcontractors were also involved in construction, and their work formed the basis of plaintiff’s damages.  During the construction process, disputes arose between plaintiff and the contractor concerning whether landscaping was included within the contract between the parties.  Plaintiff also felt that she was overcharged for the interior furnishings for the house.  Most importantly, plaintiff alleged that she observed defects in the house following its completion, including an uneven concrete floor, water infiltration, a sagging support beam and cracks in drywall.  

Plaintiff brought suit against the contractor and subcontractors in 2006.  Plaintiff’s complaint and amended complaint alleged that the contractor was negligent through the construction of her home through the following: (1) altering the design; (2) negligently pouring and finishing the concrete floor; (3) finishing and painting the house; (4) placing and securing the foundation.  Plaintiff also alleged that the contractor breached a fiduciary duty through its failure to secure materials and furnishings for the project within the completed contract price.  Plaintiff alleged damages through the contractor’s misrepresentations and negligent acts, which resulted in a reduction in her home’s fair market value.  Plaintiff also alleged emotional distress as a result of the issues with her home.  

Following the filing of plaintiff’s lawsuit, the contractor requested its carrier to provide coverage and a defense through a CGL policy. The carrier denied coverage and a duty to defend.  The contractor subsequently filed a third-party complaint against the carrier seeking a declaration of its rights under the CGL policy. The carrier subsequently filed a motion for summary judgment, contending that the subject policy did not provide coverage for the claims asserted by plaintiff and that a defense was not owed to the contractor.  The trial court granted the carrier’s motion for summary judgment, finding that contractor’s CGL policy did provide coverage for “bodily injury” or “property damage” but plaintiff’s claims of emotional distress without physical manifestation did not constitute a “bodily injury” under the policy’s definition of that term.  The trial court also found that plaintiff failed to establish covered property damage due to the fact that the damages she alleged in her complaint were for economic losses for diminution in value or home or excess charges she was required to pay.  

Importantly, the trial court further found that plaintiff had not established that an “occurrence” or “accident” had caused damages she had sustained because faulty workmanship, standing alone, is not sufficient to give rise to an “occurrence.”  See, Cherrington, at 514.  This finding was premised on the previous holding of West Virginia Court of Appeals in Corder v. William W. Smith Excavating Co., 210 W. Va. 110, 556 S.E.2d 77 (2001); See also, State v. Bancorp, Inc. v. United States Fid. & Guar. Ins. Co., 199 W. Va. 99, 483 S.E.2d 228 (1997). The trial court held that even if plaintiff had sustained covered losses, there was not an “occurrence” pursuant to the contractor’s CGL policy, which would trigger coverage.  Finally, the trial court found that even if it was assumed that coverage existed under CGL policy, coverage would be barred pursuant to the policy’s exclusions.  Citing North American Precast, Inc. v. General Cas. Co. of Wisconsin, 413 Fed. Appx. 574 (4th Cir. 2011) (per curiam) and Groves v. Doe, 333 F.Supp.2d 568 (N.D. W. Va. 2004), the trial court also found that exclusion “M” (“Damage to Impaired Property or Property Not Physically Injured”) would bar coverage because it applies “irrespective of the existence of subcontractors.”  Cherringer, supra., at 515. 

On appeal, the West Virginia Supreme Court of Appeals considered the following assignments of error by the trial court: (1) there was no property damage caused by an “occurrence” under the contractor’s CGL policy; and (2) the CGL policy’s exclusions for “your work” and “impaired property or property not physically injured” precluded coverage.  On appeal, petitioners also advanced the argument that the trial court had refused to interpret the policies consistent with the reasonable expectations of the insured.  

ANALYSIS

The Court’s analysis started by recognizing that it had previously addressed the issue presented on appeal: is defective workmanship a covered “occurrence” under the provisions of a CGL policy of insurance?  Citing Syl. Pt. 2, Erie Insurance Property and Casualty Co. v. Pioneer Home Improvement, Inc., 206 W. Va. 506, 526 S.E.2d 28 (1999), the Court recited its previous holding: 

A lawsuit commenced by a building owner against a building contractor alleging damages caused by faulty workmanship is not within the coverage provided by the contractor's general liability policy of insurance unless such coverage is specifically included in the insurance policy. A commercial general liability policy insurer has no duty to defend a contractor in a lawsuit nor to indemnify a contractor for sums paid to settle the lawsuit or to satisfy a judgment unless the insurance policy specifically requires the insurer to do so.

In its decision of Corder, supra., the Court further found: 

Commercial general liability policies are not designed to cover poor workmanship. Poor workmanship, standing alone, does not constitute an "occurrence" under the standard policy definition of this term as an "accident including continuous or repeated exposure to substantially the same general harmful conditions."

Id., at Syl. Pt. 2.   The final decision by the West Virginia Supreme Court of Appeals within its trilogy of cases addressing coverage for defective workmanship claims was Webster County Solid Waste Authority v. Brackenrich and Associates, Inc. 217 W. Va. 304, 617 S.E.2d 851 (2005). 

The Court then noted that it was “acutely” aware that after rendering the above referenced decisions, many courts considered the same issues.  The Court noted that a majority of other states reached the contrary conclusion through legislative action or judicial decision.  Cherringer, at 517.  Recognizing a “definite trend” in the law that had arisen since its decisions in the late 1990’s and early-to-mid-2000’s, the Court cited to a multitude of decisions from other jurisdictions.  Ultimately, after citing to the holdings throughout the United States that have addressed this issue, the Court held that a defective workmanship claim constitutes an “occurrence” under a CGL policy of insurance.  Id., at 520.  

The Court formally held that “[i]n order for a claim to be covered by the subject CGL policy, it must evidence bodily injury or property damage that has been caused by an ‘occurrence.’”  Id. Citing the definition of “occurrence” to mean “an accident” the Court noted that the policy did not provide a definition for “accident.”  Through a previous holding, the Court defined accident to exclude damages or injuries that were “deliberate, intentional, expected, desired or foreseen” by the insured.  Id., citing Syl. Pt. 1, Casualty Co. v. Westfield Insurance Co., 217 W. Va. 250, 617 S.E.2d 797 (2005). 

Evidence produced in discovery indicated that the damage to plaintiff’s residence was caused by subcontractors of the primary contractor.  The Court found that the policy’s express language provided coverage for the acts of subcontractors, contained within policy’s Exclusion “L”, by excepting it from the “your work” exclusion: 

This exclusion does not apply if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. 

The Court’s treatment of the exclusions in the policy deserves special attention because it could significantly mitigate the impact of the Court’s finding concerning what constitutes an “occurrence.”  Examining Exclusion “L” (“Property damage” to “your work”), the Court noted that Exclusion “L” excludes coverage for the work of the contractor but does not operate to preclude coverage under the facts of the case for work performed by the subcontractors.  Id., at 524. Consequently, if the contractor was alleged to have completed the defective work, coverage would have likely been excluded irrespective of whether the defective work constituted an occurrence under the policy. 

Under Exclusion “M” (excluding coverage for (1) a shortcoming in “your product” or “your work” and (2) an issue arising from the insured’s or insured’s agent’s failure to perform contractual obligations), the Court again relied on the fact that the subcontractor performed a significant amount of the work which was defective.  The Court found that Exclusion “M” would act to preclude coverage for the contractor based on the damages caused by the subcontractors.  However, the Court further found that Exclusions “L” and “M” were in conflict and applying Exclusion “M” to preclude coverage for the subcontractor’s work would negate the coverage afforded for subcontractor work in Exclusion “L.”  Id., at 525-526.  The Court found that it was not reasonable to construe two policy exclusions according to their plain language when the operative effect of this exercise results in such an incongruous result.  Id., citing Syl. Pt. 2, D’Annunzio v. Security –Connecticut Life Ins. Co., 186 W. Va. 39, 410 S.E.2d 275 (1991).   The Court disregarded the exclusion contained in Exclusion “M”.  The Court briefly noted that the exclusion for “breach of contract” related actions in Exclusion “M” was also not applicable.   Finally, the Court briefly analyzed the trial court’s conclusory finding that Exclusion N (recall of products) also operated to exclude coverage.  The Court found no support for this finding by the trial court.  

The Court’s opinion also addressed the trial court’s grant of summary judgment in favor of the same carrier in a claim for coverage and defense by a subcontractor/agent (subcontractor) of the contractor pursuant to the subcontractor’s homeowners and umbrella policies of insurance.  Cherrington, supra, at 528. The Supreme Court of Appeals upheld the award of summary judgment in favor the carrier in this instance.  However, the Court did find, consistent with its handling of the CGL policy that the claims against the subcontractor were “occurrences” under the homeowner’s and umbrella policies.  The Court based its affirmation of the denial of coverage based on the business pursuit’s exclusion to the policies.

The effects of the Cherrington decision will likely continue to be felt for the foreseeable future in relation to the interpretation of CGL policies in West Virginia and in other jurisdictions.  Several critical issues will likely need to be addressed in future cases, including the issue of how the West Virginia Supreme Court of Appeals handles the situation when the allegations of defective workmanship are only directed towards work completed by the general contractor.  

Members of DRI’s Insurance Law Committee recognize that they must always be aware of new changes involving insurance coverage.  The recent West Virginia Supreme Court of Appeals decision discussed above demonstrates the importance of membership with DRI and the value that DRI’s seminars provide.  For more information about how the Cherrington decision could affect future coverage decisions in other jurisdictions, please consider attending the DRI’s Insurance Coverage and Practice Symposium on December 12th and 13th, 2013 in New York City.  The program will offer an outstanding opportunity for practitioners to learn about the latest decisions in coverage litigation and how they will shape insurance practice for the foreseeable future.  The Insurance Coverage and Practice Symposium will also present an outstanding opportunity to network with colleagues.  

For more information, please click here. See you in New York!

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In United Ins. Co. of Am. v. Boron in the Circuit Court of Cook County, Illinois, three life insurers have filed an action seeking declaratory and injunctive relief from the Illinois Department of Insurance Regulations that impose an obligation on life insurers to utilize the Social Security Death Master File to ascertain whether its insureds are deceased and benefits owed to their beneficiaries under policies issued in the State of Illinois.

The insurers claim that under the Insurance Code an insurer is required to settle and pay claims only after receipt of due proof of death and upon receipt of a claim by the insured’s estate or beneficiary. The policies issued by the insurers also contain language consistent with the Insurance Code in this respect. Therefore, the insurers argue that the new obligations put in place by the Regulations are unfounded in law and contradict the Insurance Code and the express terms of the policies.

The insurers argue that if no death claim is filed, the insurers have no affirmative obligation to search for proof of death or to take steps to pay benefits under the terms of the policies until the insured has reached the “mortality limiting age.” According to the NAIC approved mortality table incorporated into the insurer’s policy forms, that age is 99. Currently, if no claim is filed, benefits under the policy will be paid when the insured reaches the age of 99.

The state of Illinois has taken the lead in the mufti-state market conduct examination in this area joined by five other states (California, Florida, Pennsylvania, New Hampshire, and North Dakota). Recently, these investigations have resulted in multi-million dollar settlements for life insurers who have been found to affirmatively use the Death Master File for their benefit in terminating annuity payments, but also did not utilize the Death Master File to search for deceased policyholders whose beneficiaries were owed life insurance proceeds. The insurer’s in this action claim that they do not use the Death Master File for any purpose.

This blog was posted on September 11 on Goldberg Segalla LLP’s Insurance and Reinsurance Report Blog. Click here to view the original post. 
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Not Every Reservation of Rights Raises a Conflict

Posted on September 11, 2013 03:11 by Barry Zalma

An insurer that reserves its rights under a policy of insurance will usually raise a request by the insured for independent counsel. However, unless the reservation actually raises the need for the application of the ethical duty of an attorney to avoid representing conflicting interests. If that duty exists independent counsel is required. If not, the insurer may assert its right to control the defense of the insured with counsel of its choice.

In Federal Insurance Company v. MBL, Inc., H036296, H036578 (Cal.App. Dist.6 08/26/2013) the California Court of Appeal explained the purpose of independent counsel as first stated in San Diego Federal Credit Union v. Cumis Ins. Society, Inc. (1984) 162 Cal.App.3d 358 as modified by California statutes.

FACTUAL BACKGROUND

After soil and groundwater contamination in the City of Modesto was traced back to a dry cleaning facility known as Halford’s Cleaner’s (Halford’s), the federal government brought a Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) action against the owners of the property on which Halford’s was located, as well as the lessees who owned and/or operated the facility, to recover the costs of monitoring and remediating the contamination. The defendants in the Lyon action subsequently filed third-party actions against, among others, appellant MBL, Inc. (MBL), a supplier of dry cleaning products including perchloroethylene (PCE), seeking indemnity, contribution and declaratory relief.

MBL tendered the defense of these third-party actions to its insurers, Federal Insurance Company (Federal), Centennial Insurance Company (Centennial), Atlantic Mutual Insurance Company (Atlantic), Nationwide Indemnity Company (Nationwide), Utica Mutual Insurance Company (Utica) and Great American Insurance Company (Great American) (hereafter collectively referred to as Insurers). The Insurers accepted the tender of defense, subject to reservations of various rights, and retained counsel to provide MBL with a defense. MBL refused to accept retained counsel, arguing the Insurers’ reservations of rights created a conflict of interest and demanding the Insurers instead pay for counsel of MBL’s choosing. The Insurers denied there was any such conflict of interest and filed declaratory relief actions. The trial court granted summary judgment in favor of the Insurers, finding there was no actual conflict of interest.

In a related appeal, Great American sought to preserve its right to equitable contribution from the other Insurers in the event MBL’s appeal is successful. Alone among the Insurers, Great American paid MBL’s independent counsel for the costs of defending the third-party actions, subject to a reservation of the right to reimbursement from MBL if it succeeded in its declaratory relief action.

MBL supplies PCE, and other dry cleaning products, to dry cleaning facilities, and has done so for a number of years. In 2007, MBL was named as a defendant in a number of third-party complaints and cross-complaints filed in the Lyon action. According to the allegations of the Lyon action, wastewater containing PCE was discharged into the sewer system as part of Halford’s dry cleaning operations until the mid-1980s. PCE was also leaking from an old dry cleaning machine through the floor of the facility into the soil and groundwater. In 1989, the site was placed on the National Priorities List of hazardous waste sites.

MBL retained defense counsel, who tendered the defense of the Lyon action to the Insurers, requesting they appoint Cumis counsel. The Insurers accepted the tender of defense subject to various reservations of rights, detailed below, and appointed counsel to defend MBL. MBL refused to allow the Insurers’ appointed counsel to associate as defense counsel, asserting it was entitled to independent counsel of its own choosing pursuant to Civil Code section 2860. The Insurers advised MBL it was only entitled to Cumis counsel if their reservations of rights created a conflict of interest and, with the exception of Great American, refused to pay the defense costs incurred by MBL’s counsel.

INSURERS’ COMPLAINTS FOR DECLARATORY RELIEF

The Insurers moved for summary adjudication of the causes of action for declaratory relief regarding their duty to provide independent counsel to represent MBL. The Insurers argued that the limited reservations of rights asserted by these insurers did not create a conflict of interest under California Civil Code section 2860 which modified the Cumis decision.

In June 2009, after the matter was briefed and argued, the trial court granted the Insurers’ motions. In its order, the court noted that the specific reservations of rights by [the] insurers did not present a conflict which would require the appointment of independent counsel. The court further found the general reservation of rights to deny coverage does not present a conflict which would require the appointment of independent counsel.

After amending its complaint to add a cause of action for reimbursement against MBL, Great American filed a motion for summary adjudication and summary judgment against MBL. The motion further sought summary judgment on MBL’s cross-complaint against Great American. The trial court granted Great American’s motion in its entirety and entered a declaratory and money judgment on October 27, 2010, in favor of Great American and against MBL.

DISCUSSION

Entitlement to Independent Counsel – Statutory and Case Law

In San Diego Federal Credit Union v. Cumis Ins. Society, Inc., supra, 162 Cal.App.3d 358, the court held that if a conflict of interest exists between an insurer and its insured, based on possible noncoverage under the insurance policy, the insured is entitled to retain its own independent counsel at the insurer’s expense.

The Cumis opinion was codified in 1987 by the enactment of section 2860, which clarifies and limits the rights and responsibilities of insurer and insured as set forth in Cumis.

As statutory and case laws make clear, not every conflict of interest triggers an obligation on the part of the insurer to provide the insured with independent counsel at the insurer’s expense. For example, the mere fact the insurer disputes coverage does not entitle the insured to Cumis counsel; nor does the fact the complaint seeks punitive damages or damages in excess of policy limits. The insurer owes no duty to provide independent counsel in these situations because the Cumis rule is not based on insurance law but on the ethical duty of an attorney to avoid representing conflicting interests. For independent counsel to be required, the conflict of interest must be significant, not merely theoretical, actual, and not merely potential. The insured’s right to independent counsel depends upon the nature of the coverage issue, as it relates to the issues in the underlying case.

An insurer that reserves its rights under a policy of insurance will usually raise a request by the insured for independent counsel. However, unless the reservation actually raises the need for the application of the ethical duty of an attorney to avoid representing conflicting interests. If that duty exists independent counsel is required. If not, the insurer may assert its right to control the defense of the insured with counsel of its choice.

In Federal Insurance Company v. MBL, Inc., H036296, H036578 (Cal.App. Dist.6 08/26/2013) the California Court of Appeal explained the purpose of independent counsel as first stated in San Diego Federal Credit Union v. Cumis Ins. Society, Inc. (1984) 162 Cal.App.3d 358 as modified by California statutes.

FACTUAL BACKGROUND

After soil and groundwater contamination in the City of Modesto was traced back to a dry cleaning facility known as Halford’s Cleaner’s (Halford’s), the federal government brought a Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) action against the owners of the property on which Halford’s was located, as well as the lessees who owned and/or operated the facility, to recover the costs of monitoring and remediating the contamination. The defendants in the Lyon action subsequently filed third-party actions against, among others, appellant MBL, Inc. (MBL), a supplier of dry cleaning products including perchloroethylene (PCE), seeking indemnity, contribution and declaratory relief.

MBL tendered the defense of these third-party actions to its insurers, Federal Insurance Company (Federal), Centennial Insurance Company (Centennial), Atlantic Mutual Insurance Company (Atlantic), Nationwide Indemnity Company (Nationwide), Utica Mutual Insurance Company (Utica) and Great American Insurance Company (Great American) (hereafter collectively referred to as Insurers). The Insurers accepted the tender of defense, subject to reservations of various rights, and retained counsel to provide MBL with a defense. MBL refused to accept retained counsel, arguing the Insurers’ reservations of rights created a conflict of interest and demanding the Insurers instead pay for counsel of MBL’s choosing. The Insurers denied there was any such conflict of interest and filed declaratory relief actions. The trial court granted summary judgment in favor of the Insurers, finding there was no actual conflict of interest.

In a related appeal, Great American sought to preserve its right to equitable contribution from the other Insurers in the event MBL’s appeal is successful. Alone among the Insurers, Great American paid MBL’s independent counsel for the costs of defending the third-party actions, subject to a reservation of the right to reimbursement from MBL if it succeeded in its declaratory relief action.

MBL supplies PCE, and other dry cleaning products, to dry cleaning facilities, and has done so for a number of years. In 2007, MBL was named as a defendant in a number of third-party complaints and cross-complaints filed in the Lyon action. According to the allegations of the Lyon action, wastewater containing PCE was discharged into the sewer system as part of Halford’s dry cleaning operations until the mid-1980s. PCE was also leaking from an old dry cleaning machine through the floor of the facility into the soil and groundwater. In 1989, the site was placed on the National Priorities List of hazardous waste sites.

MBL retained defense counsel, who tendered the defense of the Lyon action to the Insurers, requesting they appoint Cumis counsel. The Insurers accepted the tender of defense subject to various reservations of rights, detailed below, and appointed counsel to defend MBL. MBL refused to allow the Insurers’ appointed counsel to associate as defense counsel, asserting it was entitled to independent counsel of its own choosing pursuant to Civil Code section 2860. The Insurers advised MBL it was only entitled to Cumis counsel if their reservations of rights created a conflict of interest and, with the exception of Great American, refused to pay the defense costs incurred by MBL’s counsel.

INSURERS’ COMPLAINTS FOR DECLARATORY RELIEF
The Insurers moved for summary adjudication of the causes of action for declaratory relief regarding their duty to provide independent counsel to represent MBL. The Insurers argued that the limited reservations of rights asserted by these insurers did not create a conflict of interest under California Civil Code section 2860 which modified the Cumis decision.
In June 2009, after the matter was briefed and argued, the trial court granted the Insurers’ motions. In its order, the court noted that the specific reservations of rights by [the] insurers did not present a conflict which would require the appointment of independent counsel. The court further found the general reservation of rights to deny coverage does not present a conflict which would require the appointment of independent counsel.

After amending its complaint to add a cause of action for reimbursement against MBL, Great American filed a motion for summary adjudication and summary judgment against MBL. The motion further sought summary judgment on MBL’s cross-complaint against Great American. The trial court granted Great American’s motion in its entirety and entered a declaratory and money judgment on October 27, 2010, in favor of Great American and against MBL.

DISCUSSION

Entitlement to Independent Counsel – Statutory and Case Law

In San Diego Federal Credit Union v. Cumis Ins. Society, Inc., supra, 162 Cal.App.3d 358, the court held that if a conflict of interest exists between an insurer and its insured, based on possible noncoverage under the insurance policy, the insured is entitled to retain its own independent counsel at the insurer’s expense.

The Cumis opinion was codified in 1987 by the enactment of section 2860, which clarifies and limits the rights and responsibilities of insurer and insured as set forth in Cumis.

As statutory and case laws make clear, not every conflict of interest triggers an obligation on the part of the insurer to provide the insured with independent counsel at the insurer’s expense. For example, the mere fact the insurer disputes coverage does not entitle the insured to Cumis counsel; nor does the fact the complaint seeks punitive damages or damages in excess of policy limits. The insurer owes no duty to provide independent counsel in these situations because the Cumis rule is not based on insurance law but on the ethical duty of an attorney to avoid representing conflicting interests. For independent counsel to be required, the conflict of interest must be significant, not merely theoretical, actual, and not merely potential. The insured’s right to independent counsel depends upon the nature of the coverage issue, as it relates to the issues in the underlying case.

Not every reservation of rights entitles an insured to select Cumis counsel. There is no such entitlement, for example, where the coverage issue is independent of, or extrinsic to, the issues in the underlying action or where the damages are only partially covered by the policy. Independent counsel is required where there is a reservation of rights and the outcome of that coverage issue can be controlled by counsel first retained by the insurer for the defense of the claim.

The court of appeal agreed with the Insurers. There was no evidence to show that the Insurers’ representation of other parties in the Lyon action gave rise to a “significant, not merely theoretical, actual, not merely potential” conflict of interest. General reservations of rights do not raise a conflict because they are just that: general reservations. At most, they create a theoretical, potential conflict of interest – nothing more.

Because it decided that judgment was properly entered in favor of the other Insurers, the trial court also properly entered judgment in favor of the other Insurers on Great American’s declaratory relief action.  At the heart of this dispute is the question whether MBL was entitled to independent counsel; since it was not, the other Insurers were not obligated to contribute to payment of MBL’s counsel and Great American is not entitled to equitable contribution from the other Insurers.

Equitable contribution is a loss-sharing mechanism intended to accomplish ultimate justice among coinsurers of the same insured.  The fundamental prerequisite to equitable contribution is shared responsibility for the loss.

None of the Insurers disputed their duty to defend MBL. They all acknowledged that duty and agreed to defend MBL, subject to their reservations of various rights. MBL, however, insisted on retaining independent counsel, rather than allowing counsel appointed by the Insurers to conduct its defense. As discussed above, MBL was not entitled to independent counsel, thus none of the Insurers (including Great American) were ever obligated to reimburse MBL for the fees generated by that counsel. Great American, as it happens, did reimburse MBL for those fees, but because there was no obligation to pay, Great American can only seek reimbursement for those fees from MBL, not the other Insurers.

ZALMA OPINION

The Cumis decision – regardless of the opinion of counsel and the public – is not an insurance decision. It is, rather, a decision regarding the ethical duty of an attorney to avoid representing conflicting interests. If there is a real conflict of interest between the lawyer retained by the insurer and the insured the lawyer was retained to defend the insured has the right to seek independent counsel. If, however, in a case like this one, the reservation of rights do not raise an inference that counsel is representing conflicting interests there is no obligation to provide the insured with independent counsel.

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On July 24th, the California Appellate Court ruled on what distinguishes an “employee” from a “volunteer” for purposes of FEHA discrimination claims in Estrada v. City of Los Angeles (2013) — Cal.App.4th–. The trial court held held that Estrada, a former volunteer Reserve Police Officer for the City, was not an employee, but merely a volunteer. The Appellate Court affirmed.

Estrada became a reserve officer for the Los Angeles Police Department (LAPD) in 1990. While reserve officers are volunteers who are not compensated for their time, the City deems such officers “employees” for the limited purpose of extending workers’ compensation benefits to them in the event they are injured while performing their duties. This exception is codified in the Los Angeles Administrative Code, which states that such volunteer officers shall not be deemed an employee but for this one purpose- to receive workers’ compensation benefits. In his application, Estrada acknowledged that he was not a regular salaried officer and was not entitled to compensation.

In 1995 and 1996, Estrada was involved in a traffic collision and sustained leg, back, and shoulder injuries. In both cases he obtained workers’ compensation benefits. In 2004, the Food and Drug Administration (FDA) served a search warrant on Estrada’s personal nutritional supplement company which was followed by the filing of a complaint by the Department’s Internal Affairs Division. The complaint alleged that Estrada illegally sold certain products. Pending an outcome of the complaint, Estrada was suspended from his duties with the LAPD. Following the administrative proceedings, the LAPD terminated Estrada in 2007.

In 2009, Estrada filed suit against the City alleging disability discrimination under FEHA. The primary issue to be determined was whether Estrada was an employee or a volunteer for purposes of FEHA.

The Court of Appeals held that an uncompensated volunteer is not an employee. While only employees have the right to bring action under FEHA against their employers, the statutory definition of “employee” is not clear in determining who is an employee, as it merely excludes certain classes of individuals from employee status. The Court then looked at the definition of “employee” contained in the Department of Fair Employment and Housing regulations which defines an employee as “[a]ny individual under the direction and control of an employer under any appointment or contract of hire or apprenticeship, express or implied, oral or written.” (Cal.Code Regs., tit. 2, § 7286.5, subd. (b).) The Court went on to analyze other California cases, as well as out of state cases, and determined that Estrada’s status as an uncompensated volunteer officer did not render him an employee for purposes of FEHA.

Furthermore, the Court determined that Estrada’s receipt of workers’ compensation coverage and benefits did not alter his status as a volunteer. Pursuant to the terms of the Los Angeles Administrative Code, reserve officers were expressly designated as volunteers and would not be deemed employees for any purpose other than to receive workers’ compensation benefits. This provision was provided by the City despite the fact that the Workers’ Compensation Act excludes from the definition of employee “[a]ny person performing voluntary service for a public agency or a private, nonprofit organization who receives no remuneration for the services other than meals, transportation, lodging, or reimbursement for incidental expenses.” (Lab.Code, § 3352, subd. (i).) The City’s decision to provide such benefits to its volunteers in the event they sustained an injury did not convert the volunteers to employees.

The Court held that Estrada was not an employee, but merely a volunteer, for purposes of FEHA and affirmed the trial court’s decision.

This case is beneficial to employers, as it clarifies the differences between a volunteer and employee, as well as the rule that some benefits may be provided to a volunteer without elevating the volunteer’s status to that of employee. However, it is important that employers act within the legal limitations to ensure their volunteers are properly classified and not inadvertently converted to employee status.

*This article was originally posted on August 15, 2013, on the Jampol Zimet LLP Insurance Defense blog. Click here to read the original article. 

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In spite of the increasing number of spoliation claims crossing our desks, plaintiffs are not automatically entitled to sanctions every time a piece of evidence once in defendant’s control is no longer available. In Georgia, a party asserting that evidence has been spoliated must prove: (1) the destruction or failure to preserve evidence, and (2) that the evidence is necessary, (3) to contemplated or pending litigation, before they are entitled to the any sanctions against the spoliator. Baxley v. Hakiel Industries, Inc., et al., 282 Ga. 312, 313 (2007).

In determining whether spoliation sanctions are warranted, Georgia courts consider the following factors: (1) whether the non-spoliating party was prejudiced as a result of the destruction of the evidence; (2) whether the prejudice could be cured; (3) the practical importance of the evidence; (4) whether the spoliator acted in good or bad faith; and (5) the potential for abuse if expert testimony regarding the evidence is not excluded. Nat'l Grange Mut. Ins. Co. v. Hearth & Home, Inc., 2006 U.S. Dist. LEXIS 97675, *10,*11 (2006) Then, if the court has determined that there has been spoliation, and that sanctions are warranted, the court can decide what sanction to impose. Id.

By now you have probably heard of a recent spoliation case that strikes fear in the heart of every defense lawyer, insurance adjuster, and our clients. For those of you who have not, you can read the decision at Kroger v. Walters, 319 Ga. App. 52 (2012). In Walters, a slip and fall case involving a banana, the trial court struck Kroger's answer on the grounds that Kroger had spoliated evidence (a surveillance video) and acted in bad faith, thereby precluding Kroger from introducing evidence at trial to contest its negligence. While the Court partially reversed the $2.3 million verdict and remanded for a new trial on causation, damages and the claim for attorneys’ fees, it upheld the trial court’s order on spoliation based on the following:

[Evidence that] Kroger had destroyed the video from the date and time of the incident by not preserving it; that the video might have established either actual or constructive knowledge by Kroger of a foreign substance on the floor; that the Customer Incident report states that it was made in anticipation of litigation; . . .that the camera was ‘centered on the exact location of Walters' fall and not the location shown in the prior images produced by Kroger and could have clearly shown the exact conditions at the time of Walters' fall and whether Kroger employees knew or should have known of the dangerous condition in that area.’ Walters, 319 Ga. App. at 55.

Most of our cases, thankfully, do not involve conduct as egregious as was alleged in Walters and Georgia courts have shown a willingness to deny plaintiffs’ spoliation motions. For example, in the more recent Court of Appeals decision in Powers v. Piggly Wiggly, 2013 Ga. App. LEXIS 212 (March 18, 2013), Plaintiff fell while exiting the store and later filed a motion for spoliation after the store had taped over the incident in the ordinary course of business. The Court affirmed the trial court’s refusal to impose sanctions for spoliation, relying on the store manager’s timely response and follow-through, and his understandable reliance on Plaintiff’s initial indications that she was uninjured.

The Court in Powers also relied on previous decisions, noting that “[s]poliation refers to the destruction or failure to preserve evidence that is necessary to contemplated or pending litigation. …We have held that [the mere] contemplation of potential liability is not notice of potential litigation. . . . The simple fact that someone is injured in an accident, without more, is not notice that the injured party is contemplating litigation sufficient to automatically trigger the rules of spoliation.” Powers at *5.

My two cents: remind our insureds to take good care to preserve all evidence that they anticipate could be relevant to a future claim. Often, video surveillance evidence will ultimately be more helpful to us than to plaintiffs! If evidence is lost and spoliation motions are filed, vigorously defend them and know that Georgia courts will most often make the right decision. And finally, what’s good for the goose is good for the gander. I recently filed a motion for sanctions against plaintiffs who had “lost” a video taken just minutes after a catastrophic crash. Suffice it to say that they not only found the video (and abandoned their claim that certain traffic signs were not in place) but are now going to have to defend against my motion for costs and fees.

-This blog was originally posted on the Georgia Insurance Defense Lawyer blog by Susan J. Levy on May 10. Click here to read the original post. 

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When an insurer sues for rescission, the insured is generally responsible for omissions and misrepresentations on insurance applications. That being said, when a third party brokers the deal between the insurer and the insured, he too is potentially liable. A recent District Court case out of Northern California case illustrates how a broker can be held liable to the insured for those same omissions and misrepresentations in rescission actions.

In James River Ins. Co. v. DCMI, Inc., 2012 WL 2873763 (N.D. Cal. July 12, 2012), James River Insurance Company brought suit against DCMI, a construction contractor, to rescind the insurance contract taken out. The insurer alleged that DCMI made material omissions and/or misrepresentations about prior claims or threatened litigation against them. DCMI, who used a broker, Powers & Company, to find James River Insurance Company, argued that they were not responsible for the omissions.
 
DCMI cross-filed to include Powers & Company as a defendant in the suit. Powers & Company filed out the insurance application on behalf of DCMI. DCMI alleged that in doing so the broker neglected to explain material terms and used a pre-filled form. The cross-filing complained of breach of contract, negligence, and breach of duty. Powers & Company moved to dismiss the suit against them for a failure to state a claim regarding all three counts. The trial court denied the motion in relevant part.
 
The court held that the breach of contract and negligence cause of actions were proper. In doing so, the court explained that under California law, an insurance broker has the general duties found in any agency relationship. This includes the duty to use reasonable care, diligence, and judgment in procuring the requested insurance coverage. Failing to properly fill out an application and explain material terms is a breach of said duty—a breach that can be an element within either cause of action.
 
In ruling on the first claim, the court held that the use of a pre-filed form and then failing to explain key terms to a client could amount to breach of contract in a broker-relationship. The court explained that a breach of contract claim requires the showing of four elements:  (1) the existence of a contract; (2) the plaintiff’s performance under the contract; (3) that the defendant breached the contract; and (4) the breach resulted in damage to the plaintiff. DCMI’s allegation of an arrangement and then the incorrectly completion of the forms was enough to survive a motion to dismiss.
 
On the second claim, the court held that although an insured bears the responsibility of omissions in application as to an insurer, the broker can still be liable to the insured. A negligence claim requires the showing of three elements: (1) breach of duty; (2) causation; and (3) damages. The court acknowledged that when an insurer seeks to rescind the insured bears the responsibility of the application. However, the court explained that nothing prevents the insured from then recovering from the broker where the broker is liable. In this case, the use of a pre-filled application and then failing to explain key terms could amount to negligence.
 
This case is significant because it shows just how far insurance broker liability can go. Even where the law already holds the insured responsible for rescission actions, a broker may be joined to the suit for his own negligence or breach arising out of the contract.

This was originally posted on the Jampol Zimet LLP’s Insurance Defense blog. Read the original post here.



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We previously discussed the troubling issues of:  a)whether your company’s insurance policy(ies) actually provides coverage for claims of IP infringement, and b)which of your policies is the one(s) you should be looking to for possible coverage when you get sued for infringement.

And for a great discussion of insurance coverage for IP infringement claims generally under the “Advertising Injury” clause of a standard commercial general liability policy, see Dan Graham’s article in the DRI insurance coverage newsletter.

This week we’ll get more specific:  a claim that was found by one California appeals court to be covered under a standard commercial general liability policy, and one that was found by a different division of the same appeals court not to be covered – both under the very same “advertising injury” clause of the policy.

Background
In Travelers Property Casualty Co. of America v. Charlotte Russe Holding, Inc., Charlotte Russe, a clothing retailer, requested its insurance company, Travelers, to defend it in a lawsuit brought by Versatile Entertainment, Inc. (Versatile v. Charlotte Russe – the “underlying lawsuit”).  Versatile is a manufacturer of “premium” clothing marketed under the brand “People’s Liberation.”  In the underlying lawsuit, Versatile alleged that Charlotte Russe had harmed the People’s Liberation “brand” of “high-end” and high-priced clothing by offering Versatile’s clothing for sale at deep discounts and at “close-out” prices, amounting to a “fire sale.”

Charlotte Russe’s request that Travelers defend it in the underlying lawsuit was based on the “Advertising Injury” clause in the Travelers’ policy issued to Charlotte Russe.  Travelers denied Charlotte Russe’s request.  Because of the disagreement between Charlotte Russe and Travelers, Travelers filed a separate lawsuit requesting a judicial determination of whether it was required to provide coverage to Charlotte Russe (Travelers v. Charlotte Russe – the “coverage lawsuit”).

Travelers Policy Defines Advertising Injury
In the Travelers policy, “Advertising Injury” was defined in several ways.  One of the definition of “Advertising injury” was, “injury . . . arising out of . . . material that . . . disparages a person’s or organization’s goods, products, or services.” In the coverage lawsuit, Travelers contended that Versatile’s allegations against Charlotte Russe in the underlying lawsuit did not amount to a claim that Charlotte Russe had “disparaged” the People’s Liberation brand.  A retailer’s mere reduction of a product’s price is not, argued Travelers, a disparagement of that product.  In order to satisfy the definition of “disparagement” under the policy, Travelers argued, Versatile would have to be alleging the elements of the tort of trade libel under California law against Charlotte Russe.

Trade Libel Not A Requirement for Committing Disparagement
Trade libel, in turn, requires the publication of an injurious false statement about a company or its goods or services.  The trial court in the coverage lawsuit agreed with Travelers’ position on the meaning of the term “disparagement” and granted summary judgment in its favor – meaning that Travelers had no obligation to defend Charlotte Russe in the underlying lawsuit.  Charlotte Russe appealed from this decision.

The California appeals court reversed, holding that Company A’s publication of an injurious false statement against Company B or Company B’s goods or services (i.e., the definition of trade libel) is not a requirement for establishing that Company A may have committed “disparagement” under the insurance policy.  In other words, reading the allegations in the underlying lawsuit, Charlotte Russe may have “disparaged” the People’s Liberation brand of clothing by implication, by selling the clothing at “fire sale” prices.  The gist of the underlying lawsuit, said the court, is that Versatile was accusing Charlotte Russe of impliedly telling the world that the People’s Liberation brand of clothing is not a premium, high-end line, which, according to Versatile, is false. According to the court, that is disparagement.  Lastly, the court said that there was nothing in the language of Travelers’ policy that said the definition of “disparagement” is equal to the legal definition of trade libel.  Accordingly, the appeals court reversed the trial court, and held that Travelers was required to defend Charlotte Russe in the underlying lawsuit.  Travelers appealed this decision to the California Supreme Court, but its petition for appeal was denied.

Sister Appeals Court Comes to Opposite Conclusion
A little more than three months later, a different panel of the same California appeals court came to exactly the opposite conclusion in the case of Hartford Casualty Ins. Co. v. Swift Distribution, Inc.  In this case, the issue was whether Hartford had to defend its insured, Swift, in a lawsuit brought by Gary-Michael Dahl.  Dahl sells an item called the “Multi-Cart.”  Swift started advertising and selling an item called the “Ulti-Cart.”  Swift’s advertisements made no mention of Dahl or the “Multi-Cart.”  Dahl sued Swift for patent infringement, trademark infringement, unfair competition, trademark dilution, and misleading advertising (Dahl v. Swift – the “underlying lawsuit”).  Among other things, Dahl alleged that Swift’s advertisements for the Ulti-Cart “disparaged” Dahl’s Multi-Cart by implication.  Swift requested that its insurance company, Hartford, defend it in the lawsuit brought by Dahl.  Swift requested coverage under the “Advertising Injury” clause of the policy.

The definition of “Advertising Injury” in the Hartford policy was exactly the same as the definition in the Travelers policy in the Travelers v. Charlotte Russe case, above.  Hartford refused Swift’s request, arguing that Dahl’s allegations in the underlying lawsuit against Swift weren’t covered under the policy.  To settle the dispute – just as Travelers had done against Charlotte Russe – Hartford filed a coverage lawsuit against Swift.  That is, it sued Swift for a judicial determination of whether it had a duty to defend Swift in the underlying lawsuit.  While Hartford’s coverage lawsuit against Swift was pending, Dahl and Swift settled the underlying lawsuit.

In Hartford’s coverage lawsuit, Swift alleged that Dahl’s claims in the underlying lawsuit came within the definition of “Advertising Injury.”  The trial court ruled in Hartford’s favor, finding that, on the undisputed facts, which, in this case, were:
a) the allegations in Dahl’s complaint against Swift in the underlying lawsuit, and
b) the terms of the Hartford policy issued to Swift, there was no “disparagement” by Swift.  Swift appealed.

Insurer Does Not Have to Provide Coverage
This time, the California appeals court – again, a different division of the very same appeals court that found coverage in the Travelers v. Charlotte Russe case – affirmed the trial court’s decision of no insurance coverage.  The appeals court here found that Dahl’s underlying lawsuit did make a variety of allegations that Dahl and its product, the Multi-Cart, were harmed by Swift’s infringements, by its unfair competition, and by its false and misleading advertising.  Nevertheless, the court found that Swift’s advertisements did not actually disparage – i.e., express an “injurious falsehood” about – Dahl or the Multi-Cart because the advertisements never mentioned Dahl or the Multi-Cart.

Swift then argued that in the underlying lawsuit Dahl had alleged that Swift’s advertisements referred to Dahl’s Multi-Cart by implication.  The court found that even if this were true, Swift’s advertisements mentioned only its own product, the Ulti-Cart.  Regardless of whether Swift’s conduct might constitute trademark infringement and unfair competition against Dahl and the Multi-cart, Swift’s advertisements did not disparage Dahl or the Multi-Cart.

Therefore, the appeals court held that, because Swift’s advertisements had not disparaged Dahl or the Multi-Cart, Dahl’s underlying lawsuit did not come within the Advertising Injury coverage clause of Hartford’s policy issued to Swift, and Hartford was not required to defend Swift in the underlying lawsuit.

Notably, the appeals court in Hartford v. Swift said that its sister court’s decision in Travelers v. Charlotte Russe was wrong.  It said that discounted pricing (which was the operative allegation in the Versatile v. Charlotte Russe lawsuit) is not “disparagement.”  It said that discounted pricing is not the same thing as the publication of an injurious false statement.  The language used by the Hartford v. Swift court in expressing its disagreement with its sister court is about as clear and strong as one finds in court opinions.

Swift has appealed the coverage case to the California Supreme Court, which has not yet decided whether it will hear the case.  I’m guessing the Supreme Court will take the case now that two California appeals courts have come to opposite results in interpreting the same clause in a standard insurance policy.

Takeaway
The lesson here is that claims against you or your client of patent infringement, trademark infringement, unfair competition, trademark dilution, and/or misleading advertising might not constitute “disparagement” under your insurance policy.  If you sell a product, especially one that competes with other similar products on the market, you need to purchase your insurance carefully, and look for policies that will cover you for the types of claims you might face:  infringement- and unfair competition-type claims by your competitors, and products liability-type claims by the purchasers of your product(s).

In the coming weeks and months, we’ll check the status of the appeal in the Hartford v. Swift case and have more to say on insurance coverage issues for intellectual property infringement claims.

Walter Judge is a litigation partner at Downs Rachlin Martin PLLC who blogs on intellectual property litigation topics. You can find his original post here

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Harvard University and the National Football League Players Association (“NFLPA”) are negotiating a deal with the NFL seeking a $100 million grant for the purpose of studying, diagnosing, and treating injuries and ailments suffered by players as a result of their football careers.

Dr. Lee Nadler, the Harvard Medical School Dean for clinical and translational research, attested to the groundbreaking nature of the proposed project, noting “[n]o one has ever studied the players [themselves] before.  There have been postmortem studies looking at the brains of previous players but not the players today.”

One has to wonder how generous the NFL will continue to be – after all, the league just donated $30 million to the National Institutes of Health last year to study brain injuries in NFL alumni.  Still, proponents of the Harvard study made sure to stress that this would not be simply another concussion study; instead, it would consider a whole host of health ailments potentially facing former NFL players  including chronic pain, depression, heart problems, and diabetes.  The scope of the proposed research is beyond anything that has been conducted to this point – preliminary estimates called for a nation-wide group of 200 NFL alumni drawn from a 1,000 person study group, with all participants being subject a wide array of medical tests.

Dr. Herman Taylor, one of the non-Harvard medical professionals retained for the study, stated, “Typically, when we do a test or medical study, we’re taking a snapshot.  What we want to do is see the full-length movie of what happens to a player over time.”

On the issue of funding, NFLPA Executive George Atallah noted, “Given the scope of health issues that NFL players are subject to, we are committed to making sure that enough money is allocated to get answers.”  However, because the research will be funded by a portion of league revenues, the actual amount the NFL is willing to put towards the study will likely not be determined until after the Super Bowl.

As originally published at Sportslawinsider.com on January 31, 2013
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A Pennsylvania district court in CAMICO Mutual Insurance Co. v. Heffler, Radetich & Saitta, LLP (E.D. Pa. Jan. 28, 2013), refused to allow an insurer access to its insured’s defense file, holding that that the insurer was not a client of the insured’s defense counsel.  There, CAMICO Mutual Insurance Co. insured Heffler, Radetich & Saitta, L.L.P. (“Heffler”) which was sued for misappropriating class action settlement proceeds.  In response to the suit, Heffler selected its defense counsel, and CAMICO agreed to pay defense counsel’s fees.  

CAMICO filed this declaratory judgment action seeking a finding apparently regarding the available policy limits.  In connection therewith, CAMICO sought production of certain documents related to the underlying lawsuit.  Heffler refused, and CAMICO moved to compel.  CAMICO argued the application of exceptions to the attorney-client privilege, which the parties agreed would have otherwise protected the documents from production.

CAMICO relied on the co-client exception, which concerns where two or more clients share the same attorney.  CAMICO argued that the exception applied because defense counsel represented the joint interests of Heffler and CAMICO with respect to the underlying lawsuit.  The district court disagreed, relying on several authorities for the proposition that the insurer is not automatically a client of defense counsel, even when it funds its insured’s defense.  Further, the district court found that based on the factual record, CAMICO was not a client of defense counsel.  Therefore, the district court denied CAMICO’s motion.

Notably, the district court glossed over three important issues, which merit a brief discussion here:  (1) Heffler’s choice of its own defense counsel, (2) the common interest exception as an exception to the attorney-client privilege, and (3) CAMICO’s providing a defense to Heffler in the underlying lawsuit while seeking to litigate the extent of coverage.  

First, that Heffler chose its own defense counsel made the arguments in favor of the co-client exception peculiar.  If CAMICO had appointed defense counsel for Heffler, there probably would have been a better argument for a co-client exception.  

Second, several courts recognize the common interest doctrine as an exception to the attorney-client privilege.  E.g., Waste Management, Inc. v. Int’l Surplus Lines Ins. Co., 144 Ill. 2d 178, 579 N.E.2d 322 (1991).   Although the district court asserted, without more, that CAMICO’s counsel did not share information with Heffler’s defense counsel, that is the point—CAMICO desired that defense counsel provide its counsel with otherwise privileged information.  This may have been a legitimate exception to the attorney-client privilege.   And, the Third Circuit and the Supreme Court of Pennsylvania have not taken a position on whether they will follow the Illinois Supreme Court’s interpretation of the common interest exception as set forth in Waste Management. 

Third and finally, that CAMICO was not seeking a declaration that it had no duty to defend or indemnify suggests that CAMICO and Heffler could have a common interest with respect to the underlying lawsuit.  Most courts that have criticized the Waste Management reject, in pertinent part, the concept that the insurer can seek to vindicate its disclaimer of coverage in a declaratory judgment action, yet have a common interest with its abandoned insured in the underlying tort action.  While subject to debate, that CAMICO was merely seeking to litigate the available limits suggests that the common interest exception may be available here.

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The Zhang case is a dispute following a fire at the plaintiff’s commercial property wherein the uninsured Zhang accuses the defendant-insurer of misconduct. The first two actions in the plaintiff’s complaint consist of 88 paragraphs arguing common law allegations of misconduct by the insurance company. Then, in her third cause of action, the plaintiff incorporates these paragraphs and alleges that the defendant engaged in false advertising. That last allegation starts the case down its controversial path.

The Zhang trial court sustained the insurer’s demurrer on the grounds that an earlier Court of Appeal case, Trexton Financial Corp. v. National Union Fire Insurance Company of Pittsburgh, precluded suit under Insurance Code section 790.03 (a.k.a. Fair Claims Handling Act, FCHA). On review, the appellate court disapproved of the Textron holding and held that the allegations of false advertising permitted suit under the Business and Professions Code section 17200 et seq (a.k.a. Unfair Competition Law, UCL).

To address the appellate court’s ruling in Zhang and the difference between it and Textron, we need to understand the current law. The UCL is a set of statutory codes that allow private persons to sue businesses for five types of conduct: (1) an unlawful business practice; (2) an unfair business practice; (3) a fraudulent business act (4) unfair, deceptive, untrue or misleading advertising; or (5) other acts prohibited by later sections of the code. Insurance companies are businesses within this law. A UCL cause of action requires some “predicate” violation, meaning that the plaintiff must complain of some conduct by a business-defendant in order to bring the claim.

As for the FCHA, it too is a set of statutory codes and it too sets out to stop unfair business practices; acts such as disseminating false insurance statements, making false entries into insurance reports, improperly disclosing private financial information. Unlike the UCL, the Legislature wrote the FCHA to apply specifically to insurance companies—almost exhaustively. The  California Supreme Court previously ruled in Moradi-Shalal v. Fireman’s Fund Insurance Companies that private plaintiffs cannot bring actions under FCHA. The Supreme Court has not held the same when it comes to the UCL. And that is the issue at the heart of Zhang when it comes before the supreme court this year.

Like in Zhang, in Textron, the plaintiff also alleged that the insurer engaged in misconduct that violated the FCHA and brought a UCL claim. The Textron appellate court upheld the defendant’s demurrer dismissing the case and pointed out that the conduct the plaintiff complained of was similar to the conduct covered by the FCHA and therefore the plaintiff could not bring a private cause of action. The appellate court in Textron held that, because in Moradi-Shalal the Supreme Court held that FCHA does not allow a private cause of action, FCHA violations cannot be the predicate violation for a UCL claim.

The differences between Textron and the appellate decision in Zhang is FCHA violations can serve as the predicate for a UCL cause of action. Textron unequivocally disfavored such a practice, holding that a plaintiff cannot use the UCL to avoid the Moradi holding. Zhang is holding otherwise. In Zhang, the UCL claim remained even though it was an FCHA violation. Now that we have two courts of equal standing handing down opposite rulings, the California Supreme Court must make a ruling to determine which way the law goes.

There is no evidence to suggest that the California Supreme Court will alter Moradi as to the holding denying a private right of action for violations of the FCHA. However, good public policy indicates that the Zhang approach—allowing UCL claims for FCHA violations—is the right approach. As a general matter, the UCL acts to empower private citizens to enforce fair business practices when the attorney general cannot or chooses not to do so. By extending the right to cover citizens aggrieved by insurance companies, the system can better protect those that are wronged. Moreover, because a successful plaintiff recovers restitution and not damages, the results will be equitable. Essentially, private citizens will be able to file claims to force an insurer to comply with the FCHA and then recover any money or property wrongfully taken.

Posted on January 21, 2013 by jampolzimetlaw
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