Mealey's California Insurance : Mealey's : Legal News & Analysis

Mealey's California Insurance

May 09, 2025
On De Novo Review, Judge Rules That LTD Claimant Is Physically Disabled

LOS ANGELES — Taking issue with numerous aspects of an insurer’s decision to terminate long-term disability (LTD) benefits, a California federal judge concluded that “[a] preponderance of the evidence shows [that the claimant’s] medical symptoms related to spondylolisthesis, lumbar region status post lumbar fusion, and chronic pain render him disabled under the terms of the Plan.”
May 06, 2025
9th Circuit Denies Insurer’s Petition For Rehearing In Contamination Coverage Suit

SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on May 5 denied an insurer’s petition for panel rehearing in an environmental contamination coverage suit, refusing to reconsider its decision that a jury trial is necessary to determine the reasonableness of the defense costs incurred by the insured from the date of the insured’s tender of the underlying complaint through the date of the trial court’s order.
May 06, 2025
Judge Rules On Dismissal Motions In Coverage Suit Over Unlawful Recording Claims

SAN DIEGO — A federal judge in California granted in part and denied in part defendant insurers’ motions to dismiss a cyber liability insurer’s lawsuit seeking equitable contribution and indemnification for an underlying lawsuit alleging their mutual insured intentionally failed to disclose that hidden cameras were installed in operating rooms and recorded patient procedures in an effort to investigate drug theft.
May 05, 2025
Judge: Insurer’s Motion To Amend Judgment Can Be Resolved Without Hearing

SANTA ANA, Calif. — A California federal judge said that a commercial general liability insurer’s motion to amend a $2,186,359.76 judgment in its favor to include $780,360.12 in prejudgment interest is appropriate for resolution without a hearing, vacating a May 2 hearing in the insurer’s equitable contribution and equitable indemnification lawsuit arising from damages to a Hard Rock Hotel location.
May 02, 2025
Magistrate Judge Dismisses Couples’ Suit Over Sale Of Wrong Construction Policy

OAKLAND, Calif. — A California federal magistrate judge granted an insurance company’s motion to dismiss a lawsuit brought against it by a married couple who say the insurer “presented” a policy issued by another insurer that was advertised by a broker as covering their home renovation project, but in fact applied to only new construction and therefore left them uninsured for a $150,000 fire claim, finding that the plaintiffs did not plausibly allege deceptive misconduct by the moving defendant.
April 30, 2025
Residents Sue State-Mandated Insurer ‘Of Last Resort’ Over Los Angeles Wildfires

LOS ANGELES — California residents sued the California Fair Plan Association (CFPA) and its largest members in a state court seeking damages for the defendants’ alleged bad faith breach of their property insurance policies following the Los Angeles wildfires in January.
April 29, 2025
Water Damage Loss Dispute Dismissed After Insureds, Insurer Settle

LOS ANGELES — A federal judge in California on April 28 dismissed with prejudice an insured couple’s suit against their homeowners insurer related to their water damage loss in accordance with a stipulation of voluntary dismissal the parties filed after reaching a settlement.
April 29, 2025
Magistrate: Relator Must Provide All Alleged False Claims In FCA Kickback Suit

SAN DIEGO — A California federal magistrate judge granted Abbott Laboratories’ motion to compel discovery into all the alleged false claims it purportedly submitted to the government in a suit alleging Abbott violated the False Claims Act (FCA) and state false claim laws regarding Abbott’s purported kickback scheme to induce hospitals and physicians to use an Abbott cardiac medical device, finding that Abbott is “entitled to know the specific false claims” against it.
April 28, 2025
Panel Says No Additional Coverage Owed For Underlying Carbon Monoxide Suit

SAN FRANCISCO — An insured landlord is not entitled to additional coverage for the settlement of a tenant’s underlying bodily injury suit arising out of carbon monoxide poisoning because the apartment insurance policy’s liability limit applies only to the year in which the occurrence took place, the Ninth Circuit U.S. Court of Appeals said April 25 in affirming a district court’s finding that the stacking of annual policy limits is prohibited by the policy.
April 25, 2025
Oral Argument Set In Challenge To Rehab Plan For Workers’ Comp Insurer

SAN FRANCISCO — Oral argument is scheduled in the First District California Court of Appealin a workers’ compensation insurance carrier’s challenge to a nonconsensual rehabilitation plan that was approved as part of conservation proceedings brought by California’s insurance regulator and includes resolution of dozens of reinsurance participation agreement (RPA) lawsuits.
April 25, 2025
Watchdog Group Seeks To Invalidate Insurance Bulletins Allowing Policy Surcharges

LOS ANGELES — A consumer research and advocacy organization alleges in a California state court lawsuit that California Insurance Commissioner Ricardo Lara exceeded his statutory authority by issuing two unlawful insurance bulletins that authorize member insurers of the California FAIR Plan to recoup assessments from policyholders and seeks a writ of mandate and injunction commanding Lara not to enforce the bulletins.
April 23, 2025
Jury Trial Should Not Be Limited To Defense Costs, Insurer Tells 9th Circuit

SAN FRANCISCO — An insurer filed a petition for panel rehearing in the Ninth Circuit U.S. Court of Appeals, contending that the panel should modify its recent opinion and remand for a jury trial on all of the damages claimed by an insured in an environmental contamination coverage suit rather than remand only for a jury trial to determine the reasonableness of the defense costs incurred by the insured from the date of the insured’s tender of the underlying complaint through the date of the district court’s order.
April 22, 2025
Homeowners Accuse Insurers Of ‘Nefarious Conspiracy’ In Suit Arising From Wildfires

LOS ANGELES — California homeowners affected by the Los Angeles wildfires sued insurers in a California court for violations of the state’s Cartwright Act and unfair competition law (UCL), alleging that the insurers participated in a “nefarious conspiracy to eliminate competition between them, and to intentionally and systematically force Plaintiffs to obtain fire insurance from the state’s insurer of last resort.”
April 21, 2025
Insureds, Insurer File Joint Notice Of Settlement In Water Damage Dispute

LOS ANGELES — Insureds and their insurer notified a California federal court that they have reached a settlement in principle of their dispute over the insureds’ water damage loss.
April 17, 2025
9th Circuit Denies Petition For Panel Rehearing In FCA Medicare Fraud Row

SAN JOSE, Calif. — In a one-page order without providing explanation, the Ninth Circuit U.S. Court of Appeals denied a petition for panel rehearing of its ruling affirming a lower court’s dismissal of a qui tam relator’s suit accusing pharmaceutical companies of violating the False Claims Act (FCA) by overcharging the federal government and states under Medicare and Medicaid.
April 17, 2025
$195,000 Class Deal Gets Final OK In Suit Over Allegedly Fraudulent Policies

SANTA ANA, Calif. — Noting the absence of objections and that “the average class member payment will be $467.77, and the highest payment will be $5,204.40,” a California federal judge granted final approval to a $195,000 class settlement that resolves a suit over allegedly counterfeited insurance policies sold through a captive reinsurance arrangement.
April 16, 2025
Insurers Have No Duty To Defend Based On Silica Exclusions, Judge Says

LOS ANGELES — Insurers of an importer and distributor of quartz stone products have no duty to defend their insured in underlying bodily injury suits stemming from exposure to silica dust from the insured’s quartz products because the policies’ silica exclusion clearly bars coverage for the underlying suits.
April 15, 2025
Bad Faith Suit: CFPA Systematically Failed To Investigate, Pay Wildfire Claims

LOS ANGELES — Plaintiffs sued California Fair Plan Association (CFPA) and its “largest” members for breach of contract and bad faith in a California court, seeking compensation for their losses incurred by the January Los Angeles wildfires and to hold CFPA “accountable for its decade-long, systematic failure to properly investigate and pay wildfire claims.”
April 15, 2025
Effective Vindication Rule Is Focus Of ERISA Imprudence Appeal In 9th Circuit

SAN FRANCISCO — In separate briefs, a former 401(k) participant and amicus curiae organization Public Justice urge the Ninth Circuit U.S. Court of Appeals to affirm that a nonseverable arbitration provision is void because it contains a class, collective and representative action waiver that they say prevents effective vindication of plan participants’ substantive right under the Employee Retirement Income Security Act.
April 15, 2025
Skechers Seeks Coverage For Injury Claims Caused By Shoes’ Lack Of Slip-Resistance

LOS ANGELES — Skechers USA Inc. sued its commercial liability insurer in a California court for breach of contract, breach of the implied covenant of good faith and fair dealing and unfair competition, alleging that the insurer has a duty to defend it against an underlying action contending that class members were harmed by actual physical accidents caused by the insured’s shoes’ lack of slip-resistance or by the fact that the shoes were unusable.
April 09, 2025
Bad Faith Claim In Water Damage Coverage Suit To Proceed, Judge Says

LOS ANGELES — An insured’s bad faith claim alleged against a homeowners insurer in a dispute over coverage for water damage in the insured’s home can proceed because dismissal of the bad faith claim would be premature, a California federal judge said in partially denying the insurer’s motion.
April 08, 2025
Panel: Insurer Entitled To Jury Trial On Defense Costs Issue In Contamination Suit

SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on April 7 affirmed a district court’s ruling that an insurer has a duty to defend an insured in an underlying environmental contamination lawsuit, however, the panel said the insurer is entitled to a jury trial to determine the reasonableness of the defense costs incurred by the insured from the date of the insured’s tender of the underlying complaint through the date of the district court’s order.
April 08, 2025
Insurers: ‘Had SCE Acted Responsibly, The Eaton Fire Could Have Been Prevented’

LOS ANGELES — Insurers have filed a subrogation lawsuit alleging negligence and inverse condemnation against Southern California Edison Co. (SCE) in a California court, alleging that the Eaton fire could have been prevented had the defendant acted responsibly.
April 07, 2025
Silica, Pollution Exclusions Bar Coverage For Dust Exposure Suits, Insurer Says

LOS ANGELES — No coverage is owed for underlying bodily injury suits stemming from exposure to silica dust released from an insured’s countertops and stone products because the suits are barred by silica exclusions and total pollution exclusions included in the insured’s commercial general liability insurance policies, an insurer says in a complaint filed in California federal court.
April 04, 2025
California Panel Reverses Judgment For Insurer In HOA’s Suit Over Water Damage

LOS ANGELES — Finding that there are issues of material fact regarding whether the water damage and faulty workmanship exclusions in a condominium homeowners association’s all risks policy preclude coverage for rain damage that occurred during a reroofing project, a California appellate panel reversed a lower court’s grant of summary judgment to the insurer on the association’s breach of contract and bad faith claims.