Jonathan Kuller

All articles by Jonathan Kuller

 

Feels like a Fraud: Fifth Circuit Rules in Favor of Insurer; Awards $6M in Fraudulent Claims Case

In Allstate Insurance Company et al. v. Michael Kent Plambeck, DC, et al. United States Court of Appeals for the Fifth Circuit, September 17, 2015, an insurer was awarded a $6 million verdict against a group of chiropractors, lawyers and telemarketers that coerced individuals into making fraudulent claims against the insurer. The District Court awarded the verdict based on the Racketeer Influenced and Corrupt Organizations Act (RICO). On September 17, 2015, the Fifth Circuit Court upheld the verdict. The insurer
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Insurer’s Reliance on Prior Unpublished Decision Sufficient To Defeat Bad Faith Claim

In Badiali v. New Jersey Manufacturers Insurance Group, 2015 WL 668206 (N.J. Feb. 18, 2015), the New Jersey Supreme Court found that an uninsured motorist carrier did not commit bad faith by acting in accordance with an unpublished decision from a case it previously litigated. The policyholder was involved in a car accident with an uninsured motorist. He filed an uninsured motorist claim with his employer’s insurer and his personal insurer. The matter was arbitrated, and the policyholder was awarded
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New York Court Reaffirms Limitations on Policy Claims Arising Out of Superstorm Sandy

In Sikarevich Family L.P. v. Nationwide Mutual Insurance Co., No. 13-cv-05564, 2014 U.S. Dist. LEXIS 92254 (E.D.N.Y. July 3, 2014), the United States District Court for the Eastern District of New York addressed a policyholder’s claims for:  (1) breach of the covenant of good faith and fair dealing, (2) unjust enrichment, (3) consequential damages, and (4) punitive damages.  Notably, the policyholder alleged a breach of contract cause of action. The policyholder’s claims arose out of Nationwide’s denial of coverage for
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No Coverage for Improper Building Design

An architectural firm was sued for the improper design of a performing arts center in Louisiana and the Fifth Circuit Court of Appeals found that the firm’s insurer owed no coverage. The architectural firm entered into a design contract with a Louisiana Parish, for the design of a performing arts center. The Parish sued the firm for defective design, asserting breach of warranty, negligence and lack of professional skill as the Parish experienced problems when the project was being constructed.
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No Coverage for Construction Defect After Work Completed

On an underlying claim for negligent construction of a condominium project in south Mississippi, the Fifth Circuit overturned the Southern District of Mississippi’s decision to grant coverage to an additional insured.  The Fifth Circuit overturned on the grounds that the additional insured was temporally barred, by the policy’s limitation and exclusion, from doing so. When initially declining to provide coverage to the additional insured, the insurer cited to language in the policy that limited its coverage “to liability arising out
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Late Night Fiesta Leaves Restaurant Holding the Bag

The plaintiff, Mount Vernon Fire Insurance Company (Mount Vernon), sought a declaration that it was not required to handle or pay a certain insurance claim. The dispositive issue before the court is whether the insured, El Rancho De Pancho LLC (El Rancho De Pancho), violated the terms of its agreement with Mount Vernon on October 9, 2011, giving rise to the injury upon which the insurance claim in question is based. The parties’ dispute in the instant action, is rooted
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Challenge to Regulations on Required Use of Death Master File

United Ins. Co. of Am. v. Boron Cir. Ct.of Cook County, Illinois (Sept. 4, 2013) 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
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State Farm Immune From Policyholder’s False Advertising and Deceptive Trade Practices Claim

Servedio v. State Farm Insurance Co. U.S. Court of Appeals for the Second Circuit. The plaintiff, Dominick Servedio, commenced a class action against the defendant, State Farm Insurance, raising claims of deceptive trade practices and false advertising, in violation of New York General Business Law §§ 349, 350 and common law fraud. The plaintiff’s § 350 and common law fraud claims were dismissed by the district court in September of 2011 with only the § 349 claim allowed to proceed.
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Court Won’t Kick Out Class Action Kickback Claims Against HSBC

Moriba Ba v. HSBC USA, Inc. United States District Court for the Eastern District of Pennsylvania June 26, 2013 The plaintiffs, Moriba Ba, Donald Chipp, Sherrica Chipp, Shawn Hunt, Eugene Murano, and Yolanda Wiggins filed a class action complaint, alleging that HSBC USA Inc. received kickbacks from private mortgage insurers, in violation of the Real Estate Settlement Procedures Act of 1974 (RESPA) and common law unjust enrichment by the defendants. The plaintiffs allege that they obtained home mortgage loans from
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Introducing Our Latest Insurance Newsletter: Insurance Fraud Reporter

The Insurance Fraud Reporter is dedicated to the proposition that fighting insurance fraud is not just a statutory mandate or moral imperative — it is a business imperative. For a free copy, click here. We invite you to subscribe to upcoming editions of the Insurance Fraud Reporter by clicking here. Editors: Anthony J. Golowski II and Jonathan M. Kuller
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Former NFL Linebacker Indicted for Insurance Fraud

United States of America v. Marcus Buckley and Kimberly Jones, United States District Court Eastern District of California, April 10, 2013 Marcus Buckley, a former linebacker for the New York Giants and Atlanta Falcons, was charged his involvement in a $1.5 million insurance fraud scheme. He is alleged to have filed fraudulent claims with the New York Giants’ workers’ compensation program. The adjuster on Buckley’s claims, Kimberly Jones, was also charged with fraud. During the time period Buckley played for
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Number of Occurrences Limited to Just One in Pennsylvania Defective Drywall Litigation

Cincinnati Insurance Co. v. Devon International, Inc. et al. (E.D.Pa) (Index No. 2:11-cv-05930-GP) A federal court in Pennsylvania limited the number of occurrences under a CGL policy for injuries caused by defective drywall. The case involved a sourcing agent for Chinese products who filled an order for drywall by purchasing them from a Chinese drywall manufacturer and shipping them to Florida. The drywall contained an improper amount of sulfur damaging real and personal property. Although there were two separate consecutive
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Food Recall Sufficient to Constitute Property Damage Despite no Actual Contamination

The Netherlands Ins. Co v. Main St. Ingredients et al. (Index No. 11-533) In testing the limits of coverage for recall of food products, the federal district court of Minnesota found in favor of an insured for claims related to “property damage” despite the uncontroverted fact that the recalled product was not contaminated. In The Netherlands Ins. Co v. Main St. Ingredients et al. (Index No. 11-533), insured purchased instant milk from a third-party and subsequently sold it to another
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