A district court may abstain under the Colorado River doctrine only in extraordinary circumstances, not in an ordinary diversity action seeking damages and rescission under settled principles of state law. Read More
Gas station’s insurance policy, which insured against collapse but not settling, cracking, shrinkage or expansion, did not cover needed repairs after the outer shell of the insured’s underground gas storage tank split open but inner steel lining remained intact. Read More
An insurer was not entitled to summary judgment on its rescission defense based on false answers to its insurance application questions, since the questions were ambiguously worded and the answers were arguably accurate under one reasonable interpretation of the questions; also, a defendant gives sufficient notice of its intent to rescind a contract on which the plaintiff sues by alleging… Read More
Summary judgment for insurer on bad faith claim is reversed due to a triable issue as to whether insurer’s dispute about the claim amount was genuine since the insurer had not updated its medical expert’s opinion based on new evidence of the extent of the insured’s injuries. Read More
Under the Knox-Keene Health Care Services Act, an out-of-network provider who gave substance abuse treatment to PPO subscribers was entitled to be paid by the PPO only the amount shown on its explanation of benefits form, since the treatment was not an emergency medical service and the provider had no contract with the PPO. Read More
Under a homeowner's policy providing “open actual cash value coverage,” the insurer must pay, on a partial loss claim, the lesser of (a) the policy limits or (b) the actual cost of repair, even if the repair cost exceeds the property’s pre-loss market value. Read More
Insured company misrepresented in its worker’s compensation insurance application that its workers traveled only within a 200 mile radius of its headquarters in California, so appeals board needed to determine whether insurer’s resulting rescission was effective. Read More
Plaintiff stated a viable unfair competition law claim by alleging that the insurer paid almost 5% of his Medicare gap insurance premiums to the American Association of Retired People as a disguised commission even though it was not a licensed California insurance agent. Read More
At least when a directors and officers liability policy provides a defense on appeal, its provision requiring reimbursement of defense costs upon a “final determination” the insured was guilty of willful misconduct applies only after completion of the appeal. Read More
If an excess insurer rejects a settlement proposed by the primary insurer and insured and does not assume the insured’s defense, it cannot avoid liability for paying its share of the settlement (if a court later finds the settlement reasonable) by relying on the excess policy’s no-action clause. Read More
It was not an abuse of discretion to deny plaintiff’s request to raise its auto insurance rates, since its advertising expenses were properly excluded from rate calculation. Read More
A van the driver’s employer gave her for business and personal use was a non-owned vehicle furnished for the driver’s regular use and thus was excluded from coverage under the driver’s personal auto policy. Read More
The California Insurance Commissioner did not exceed his powers in promulgating regulations governing an insurer’s communicating an estimate of replacement costs to an insured. Read More
Insurer owed no duty to indemnify an insured construction contractor under a CGL policy for damages it paid the owner of a building for injury to the building's flooring, since the injury occurred because the insured performed a deliberate, non-accidental act—ordering the subcontractor to lay the flooring over wet concrete—and there was no additional, unexpected, unforeseen or independent event that… Read More
In this litigation between excess insurers of a prime contractor and a subcontractor whose employee was badly injured on the job and recovered a $10 million settlement, the prime contractor's insurer failed to introduce evidence on summary judgment proving that the sub or the employee was at fault and thus that the loss was actually covered by the sub’s policy. Read More
CGL insurer owed its insured, a contractor, a duty of defense against claim that the insured’s mis-installation of a chimney caused a fire that destroyed the house; even though the fire occurred outside the policy period, the wood surrounding the chimney may have suffered progressive deterioration starting in the policy period and ultimately leading to the fire. Read More
In an insurance bad faith case, the trial court properly remitted punitive damages from the $19 million awarded by the jury to $475,000, which was ten times the actual damages awarded. Read More
Insurers owe emergency service providers a duty of care not to delegate responsibility to pay for emergency services to a medical provider that the insurer knows or should know is insolvent and unable to pay the providers' claims. Read More
Insurer is entitled to summary judgment against a claim under an auto insurance policy which the insurer had canceled before an accident, due to the insured's failure to respond within 30 days to written inquiry whether the insured wanted his driving age son to be included as an insured under the policy, since that information was reasonably necessary to underwrite… Read More
If the state does not intervene in an insurance false claims case, the plaintiff insurer may enforce the entire judgment against the defendants without first having the court determine the insurer’s share of the proceeds of the action. Read More
