Insurance Law

Declaratory judgment action filed in insurance policy coverage dispute. Restoration company entered into rental agreement with equipment company, where equipment company leased scaffolding materials to restoration company. Plaintiff insurer provided commercial general liability to restoration company,  which included endorsements and exclusions. Employee of restoration company was injured on 2 occasions at jobsite, and filed 2 personal injury suits against equipment company. Court properly entered summary judgment in favor of Plaintiff insurer, as policy had an additional insured endorsement that would not cover rental contract at issue. The indemnity provision of lease between 2 companies is an insured contract. Construction Contract Indemnification for Negligence Act applies, as lease agreement involves work dealing with construction. (CUNNINGHAM and HARRIS, concurring.)

Defendant was passenger in car that collided with another car, and suffered significant, permanent injuries that she valued in millions of dollars. On remand, court to enter summary judgment for Defendant on question of liability. On question of damages, Defendant is entitled to no more than $500,000 policy limit from her own underinsured motorist coverage. Because Defendant's actual damages have not been determined, and to prevent her from obtaining double recovery, court must conduct hearing to determine extent of her damages and whether they exceed what the 2 drivers have already paid her. To the extent they do, Defendant will be entitled to recovery from her own underinsured motorist coverage up to $500,000 combined single limit.(HOWSE and COBBS, concurring.)

Van driver employed by SCR to drive a Pace paramedical transport vehicle sustained personal injuries in collision with motorist he contends was underinsured. Plaintiff received $50,000 limit of other motorist's insurance coverage and $28,608 settlement in workers' compensation benefits from SCR, and requested UIM coverage from SCR's business auto liability insurer. Plaintiff is not a 3rd-party beneficiary of the SCR-Pace contract, and thus court properly dismissed Pace. Plaintiff has no valid cause of action against his employer's business auto liability insurer, as his receipt of $50,000 from other driver means Plaintiff did not have an accident with an "underinsured motor vehicle" as it is defined in that auto policy, and there is no public policy justification for reforming that policy. Thus, court properly dismissed auto insurer.(HOWSE and COBBS, concurring.)

Court properly granted summary judgment for insurer and against insured, finding that insured's underinsured motorist (UIM) claim was barred because insured failed to execute HIPAA authorizations requested by insurer, and failed to appear for examination under oath. American Arbitration Association (AAA) rules did not prohibit compliance with terms of insurance policy. Review of UIM claim had not yet been completed as insured failed to comply with terms of claim submittsion, and thus there was no "disagreement" upon which to institute arbitration proceedings. (REYES and GORDON, concurring.)

Plaintiff, an outpatient surgical facility, sued Defendant, a third-party administrator for an insurance company, under a promissory estoppel theory after Defendant did not pay Plaintiff the full amount Plaintiff billed for a patient’s surgery. Court properly granted Defendant’s motion for summary judgment. Plaintiff did not establish that Defendant made a clear and unambiguous promise regarding the reimbursement. The parties agreed that the reimbursement rate would be 60%, but there was no agreement regarding the basis for calculating the reimbursement amount. Plaintiff also did not demonstrate that its reliance on any alleged promise was reasonable. Plaintiff failed to provide any compelling reason why an insurance company would agree to pay a provider based on the provider’s unilaterally determined charges. (NEVILLE and SIMON, concurring.)

Court properly ruled in favor of insurance company in coverage dispute with additional insured (developer), to contended that insurance company had duty to defend it in underlying suit. Insurer had no duty to defend developer in condo association's underlying action. Policy requires accidental event to trigger coverage, yet nothing accidental is alleged in complaint. Allegations of complaint do not fall within definition of property damage under policy's plain language. Allegations that construction defects damaged something other than project itself do not constitute occurrence and property damage, but were meant to bolster contention that water infiltration occurred and caused damages. (MASON, concurring; PUCINSKI, dissenting.)