Justia New York Court of Appeals Opinion Summaries

Alem Cardenas received treatment for injuries he received during an automobile accident at the office of Plaintiff-medical provider. Cardenas’s automobile liability insurance policy with Defendant-insurer contained a New York State no-fault endorsement. Cardenas assigned his right to receive no-fault benefits to Plaintiff. Plaintiff later commenced this action seeking to recover no-fault insurance benefits, asserting that it timely submitted bills and claims for payment but that Defendant had not made any payments or denied the requests. Defendant asserted as an affirmative defense that payment for Plaintiff’s claims was not overdue because Plaintiff failed to submit “proper proof of the fact and amount of the loss” as required by the Insurance Law. The Appellate Division granted summary judgment for Plaintiff with respect to all the claims that were not timely denied by Defendant, concluding that Plaintiff established prima facie entitlement to summary judgment as a matter of law. The Court of Appeals affirmed, holding that the Appellate Division properly determined that Plaintiff met its prima facie summary judgment burden. View "Viviane Etienne Med. Care v. Country-Wide Ins. Co." on Justia Law

After a subsurface water main abutting Plaintiffs’ property ruptured, causing water to flood into and damage their home’s basement, Plaintiffs made a claim under their homeowners’ insurance policy issued by Defendant, Allstate Indemnity Company. Allstate disclaimed coverage based on a provision in the policy excluding coverage for loss caused by water on or below the surface of the ground, including water that seeps through any part of the residence premises. Plaintiffs commenced this action alleging that Allstate had improperly disclaimed coverage because their claim fell within the exception to the water loss exclusion. Supreme Court declared that Plaintiffs’ loss was covered under the policy and that Allstate was required to pay the claim. The Appellate Division modified the order by vacating the declaration and otherwise affirmed, concluding that the policy was ambiguous and should be construed in favor of Plaintiffs. The Court of Appeals reversed, holding that the policy’s unambiguous language excluded from coverage the water damage to Plaintiffs’ home, and the exception did not nullify the water loss exclusion or render it ambiguous. View "Platek v. Town of Hamberg" on Justia Law

Allstate Insurance Company issued a policy of liability insurance to the landlord of a two-family house. The policy, which was renewed annually for the next two years, stated a $500,000 limit for “each occurrence” and contained a “noncumulation clause.” Felicia Young and her children and, subsequently, Lorenzo Patterson and his children lived in one of the apartments during the years covered by the policy. In 2004, Young, on behalf of her children, and Jannie Nesmith, on behalf of the Patterson children, her grandchildren, brought two separate actions against the landlord for personal injuries allegedly caused by lead paint exposure. Young’s action was settled for $350,000, which Allstate paid. Nesmith’s action was settled for $150,000, which Allstate claimed was the remaining coverage. Nesmith then brought the present action against Allstate seeking a declaration that a separate $500,000 limit applied to each family’s claim, entitling her grandchildren to an additional $350,000. Supreme Court granted Nesmith the declaration she sought. The Appellate Division reversed. The Court of Appeals affirmed, holding that because Young’s children and Nesmith’s grandchildren were injured by exposure to the same general conditions, their injuries were part of a single loss, and only one policy limit was available to the two families. View "Nesmith v Allstate Ins. Co." on Justia Law

The owner and managing agent of an apartment building (collectively, the insureds) were insureds under two different policies: they were named insureds under their own policy and additional insureds under a policy obtained by a contractor they hired. When an employee of the contractor was injured, the contractor’s insurer, seeking to disclaim liability, sent written notice to the insureds’ own carrier but not to the insureds themselves. The insureds brought third party claims against the contractor and the contractor’s insurer, asserting that the contractor’s insurer was required to provide them with a defense and indemnification. Supreme Court granted summary judgment against the contractor’s insurer. The Appellate Division affirmed, concluding that the contractor’s insurer had failed to comply with N.Y. Ins. Law 3420(d)(2) because it had not sent its disclaimer notice to its additional insureds. The Court of Appeals affirmed, holding that the contractor’s insurer failed to comply with section 3430(d)(2) under the circumstances of this case. View "Sierra v. 4401 Sunset Park, LLC" on Justia Law

Strauss Painting, Inc./Creative Finishes, Ltd. contracted with the Metropolitan Opera Association, Inc. to perform work on the Met’s premises. At the time Strauss/Creative contracted with the Met, Strauss had in place a CGL policy issued by Mt. Hawley Insurance Company. Manuel Mayo, a Creative employee, was injured while working at the Met. Mayo sued the Met for negligence. The Met brought a third-party action against Strauss in the Mayo suit. Strauss then commenced this action against Mt. Hawley and the Met, seeking a declaration that Mt. Hawley was obligated to defend and indemnify it in the Met’s third-party action. The Met cross-claimed against Mt. Hawley seeking a declaration that it was an additional insured on Strauss’s CGL policy, thereby requiring Mt. Hawley to defend and indemnify it in the Mayo litigation. The lower courts concluded (1) Mt. Hawley was required to defend the Met in the Mayo lawsuit because the Met was an additional insured on Strauss’s CGL policy; and (2) Strauss’s notice of the accident to Mt. Hawley was untimely, and Mt. Hawley timely disclaimed coverage on that ground. The Court of Appeals modified the order of the Appellate Division by denying the Met’s motion for summary judgment on its first cross-claim, holding (1) the Met was not an additional insured on Strauss’s CGL policy with Mt. Hawley; and (2) Strauss’s notice to Mt. Hawley was untimely as a matter of law. View "Strauss Painting, Inc. v. Mt. Hawley Ins. Co." on Justia Law

This action stemmed from property damage and the resulting business interruption sustained by Plaintiffs as a result of water damages that occurred following three separate roof breaches. Plaintiffs were Deborah Voss and three business entities owned and controlled by her. Plaintiffs sued CH Insurance Brokerage Services Co. (CHI), their insurance broker, arguing that a special relationship existed with CHI and that CHI had negligently secured inadequate levels of business interruption insurance for the three losses. Supreme Court granted summary judgment for CHI, and the Appellate Division affirmed. The Court of Appeals reversed, holding that CHI did not satisfy its initial burden of establishing the absence of a material issue of fact as to the existence of a special relationship.View "Voss v. Netherlands Ins. Co." on Justia Law

Plaintiffs brought legal malpractice claims against Jeffrey Daniels, American Guarantee & Liability Insurance Company’s insured. American Guarantee wrongly refused to defend the claims. A default judgment was entered against Daniels, who assigned his rights against American Guarantee to Plaintiffs. Plaintiffs then brought the present action seeking to enforce American Guarantee’s duty to indemnify Daniels for the judgment. Summary judgment was awarded in favor of Plaintiffs. The Appellate Division affirmed. The Court of Appeals affirmed, concluding that American Guarantee’s breach of its duty to defend barred it from relying on policy exclusions as a defense to the present lawsuit. The Court later granted reargument, vacated its prior decision, and reversed the Appellate Division’s order, holding (1) under controlling precedent, American Guarantee was not barred from relying on policy exclusions as a defense; and (2) the applicability of the exclusions American Guarantee relied on presented an issue of fact sufficient to defeat summary judgment.View "K2 Inv. Group, LLC v. Am. Guar. & Liab. Ins. Co." on Justia Law

Filippo Gallina and his wife (Plaintiffs) commenced a personal injury action against Preferred Trucking Services Corp. Preferred Trucking was insured by County-Wide Insurance Company under a policy that required insureds to cooperate with Country-Wide in its investigation of a claim or defense against a lawsuit. The next year, Country-Wide disclaimed its obligation to defend and indemnify Preferred Trucking based upon Preferred Trucking’s refusal to cooperate in the defense. Supreme Court subsequently awarded judgment to Plaintiffs. Thereafter, Country-Wide filed this action against Preferred Trucking and Plaintiffs seeking a declaration that it was not obligated to defend and indemnify Preferred Trucking in the underlying action. Supreme Court concluded that Country-Wide was obligated to defend and indemnify Preferred Trucking. At issue on appeal was whether Country-Wide’s disclaimer was timely as a matter of law. The Appellate Court affirmed, concluding that Country-Wide’s disclaimer was untimely because it came four months after Country-Wide learned of the ground for the disclaimer. The Court of Appeals reversed, holding that Country-Wide was not obligated to defend and indemnify Preferred Trucking, as Country-Wide established as a matter of law that its delay was reasonable. View "Country-Wide Ins. Co. v. Preferred Trucking Servs. Corp. " on Justia Law

Plaintiff had a $1 million insurance policy from Defendant on an office building. On February 23, 2007, the building was severely damaged in a fire. Defendant paid Plaintiff the actual cash value of the destroyed building in the amount of $757,812 but withheld the cost of replacing the destroyed property until Plaintiff could replace the property. The replacement building was completed in October 2010. Plaintiff brought an action against Defendant seeking payment of the unpaid portion of the policy limits. The U.S. district court granted Defendant’s motion to dismiss, concluding that the policy barred any suits commenced more than two years after the date of the damage and that the two-year limitation period was reasonable. The Court of Appeals answered a question from the Second Circuit Court of Appeals and held that such a contractual limitation period, applied to this case in which the property could not reasonably be replaced in two years, was unreasonable and unenforceable.View "Executive Plaza, LLC v. Peerless Ins. Co." on Justia Law

Defendants issued excess insurance policies to Plaintiff that required, as a threshold condition for coverage, Plaintiff to provide timely notice of any occurrence that potentially implicated Defendants’ duty of indemnification. This case concerned the investigation and remediation of environmental damage at manufactured gas plant (MGP) sites owned by Plaintiff. When Defendants denied coverage, Plaintiff commenced a declaratory judgment action. The Appellate Division concluded that Plaintiff failed to provide timely notice under the policies of environmental contamination at the MGP sites but denied summary judgment to Defendants, determining that material issues of fact remained as to whether Defendants waived their right to disclaim coverage of Plaintiff’s claims. The Court of Appeals reversed, holding that the Appellate Division erred in considering the waiver issue under N.Y. Ins. Law 3420(d)(2) because Plaintiff never relied on the statute and instead asserted a common-law waiver defense. View "KeySpan Gas E. Corp. v. Munich Reins. Am., Inc." on Justia Law