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Thursday, May 24, 2012

Jessco, Inc. v. Builders Mutual Insurance Co: Part 1 - “Your Work,” Late Notice, and the Duty to Indemnify

Post by Logan Wells
A recent opinion of the United State Court of Appeals for the Fourth Circuit addressed a multitude of issues presented in litigation involving commercial general liability policies – the “your work” exclusion, late notice, and the duty to indemnify.

On March 29, 2012, in Jessco, Inc. v. Builders Mutual Insurance Co., the Fourth Circuit affirmed in part, reversed in part, and remanded by unpublished per curiam opinion the judgment of the United States District Court for the District of South Carolina, thereby finding that Builders Mutual Insurance Co. (“BMIC”) had a duty to defend Jessco, Inc. (“Jessco”) in the underlying construction-defect action, but BMIC was not obligated to indemnify Jessco for the re-grading allowance it paid to the underlying plaintiff homeowners.

In Jessco, Inc., the Mazycks hired Jessco to build a house in a North Charleston subdivision. After moving into the house in 2004, they provided Jessco with a punch list of items to be completed or repaired. These items were not resolved to the Mazycks’ liking, and in 2005, they filed the underlying suit against Jessco, alleging, among other things, that their lot flooded due to improper grading. In 2006, the action was stayed so the claims could be arbitrated. In the fall of 2007, experts for the Mazycks identified water damage to the house caused by the flooding of the property.

In October 2007, after the escalation in the Mazycks' demands, Jessco finally notified BMIC of the underlying claims. BMIC concluded the claims were not covered by the Policy and Jessco failed to promptly notify BMIC of the lawsuit. Accordingly, BMIC refused to defend or indemnify Jessco with regard to the underlying suit. Jessco thereafter filed a declaratory judgment action seeking a declaration that the claims in the underlying action were covered by the Policy. BMIC counterclaimed, seeking a declaration that it was not obligated to defend or indemnify Jessco.

The arbitration hearing on the Mazycks' claims was conducted in late 2008. The arbitrator issued his award in April 2009, ordering Jessco to pay almost $55,000 in damages. As to the flooding issue, the arbitrator concluded the flooding was proximately caused by "the overcapacitation of the wetlands, caused by the overall design and development of the surrounding neighborhood." Although the arbitrator found that Jessco's work was "not the legal proximate cause of the flooding of [the Mazycks'] property," the award included a $10,000 allowance for re-grading of the lot. BMIC appealed, challenging the district court’s determination that (1) BMIC had a duty to defend Jessco in the underlying action; and (2) BMIC had a duty to indemnify Jessco for the re-grading allowance.

Duty to Defend

In asserting it had no duty to defend, BMIC argued (1) coverage for the Mazycks’ claims was excluded by the Policy’s “your work” exclusion; and (2) Jessco failed to notify BMIC of the underlying lawsuit “as soon as practicable” as required by the Policy.

BMIC did not dispute on appeal that the allegations of the underlying complaint raised the possibility of “property damage” caused by an “occurrence,” but instead contended it had no duty to defend because coverage for the claims was excluded under the “your work” exclusion, which excluded coverage for any claims of “’[p]roperty damage’ to ‘your work’ arising out of it or any part of it.” “Your work” was defined as “[w]ork or operations performed by you or on your behalf,” a definition broad enough to encompass and preclude coverage for work done by the insured’s subcontractors. Although the Policy included an exception restoring coverage for damage to work performed by a subcontractor, it also contained an endorsement removing the subcontractor exception.

BMIC argued all the work on the property was done by subcontractors on Jessco’s behalf, and therefore, the “your work” exclusion barred coverage for all underlying claims. The court disagreed, noting “the exclusion does not withdraw coverage for any and all work done by the insured or its subcontractors; it withdraws coverage in cases where the insured causes property damage to work done by the insured or its subcontractors... ‘It does not exclude coverage for a third party’s work.’” (Emphasis in original) (quoting Limbach Co. v. Zurich Am. Ins. Co., 396 F.3d 358, 365 (4th Cir. 2005) (per curiam)). Thus, the court concluded, “the Policy’s elimination of the subcontractor’s exception means that Jessco’s subcontractors will not be viewed as third-parties for purposes of determining whose ‘work’ was damaged, but the elimination of the exception does not, as BMIC contends, preclude coverage if Jessco’s work in fact damages the work of a third party.”

The court determined the Mazycks’ claims against Jessco created a possibility that a third-party’s work or property was damaged by the faulty workmanship of Jessco or its subcontractors, noting the contract between Jessco and the Mazycks specifically contemplated that Mr. Mazyck would perform some of the work, and that Mr. Mazyck himself installed (or hired a subcontractor to install) the flooring and landscaping. Accordingly, the court found the “your work” exclusion did not bar coverage for the underlying claims.

With regard to “late notice,” BMIC argued even if the Policy otherwise provided coverage, Jessco lost its right to coverage by waiting more than two years to give notice of the underlying suit. Assuming for purposes of the opinion that notice was untimely, the court noted that under South Carolina law, “recovery under the Policy is barred only if BMIC proves that it was substantially prejudiced by the late notice.” See Vermont Mut. Ins. Co. v. Singleton, 446 S.E.2d 417, 421 (S.C. 1994) (“Where the rights of innocent parties are jeopardized by a failure of the insured to comply with the notice requirements of an insurance policy, the insurer must show substantial prejudice to the insurer’s rights.”); Squires v. National Grange Mut. Ins. Co., 145 S.E.2d 673, 677 (S.C. 1965) (“The burden of proof is upon the insurer to show not only that the insured has failed to perform the terms and conditions invoked upon him by the policy contract but in addition that it was substantially prejudiced thereby.”) Therefore, because BMIC failed to present any evidence of prejudice and “prejudice to the insurer may not be presumed,” the court rejected BMIC’s assertion that Jessco’s delay in notification precluded recovery under the Policy.

            BMIC also challenged the attorney fee award; however, it failed to substantively address the issue in its brief. Accordingly, the court found BMIC had abandoned the issue. See Wahi v. Charleston Area Med. Ctr., Inc., 562 F.3d 599, 607 (4th Cir. 2009) (“Federal Rule of Appellate Procedure 28(a)(9)(A) requires that the argument section of an appellant’s opening brief must contain the ‘appellant’s contentions and the reasons for them, with citations to the authorities and parts of the record on which the appellant relies.’ Because Wahi has failed to comply with the specific dictates of Rule 28(a)(9)(A), we conclude that he has waived his claims . . . .”).

Duty to Indemnify

BMIC also contended that the $10,000 re-grading allowance was not compensation for loss caused by a covered risk. Recognizing the Mazycks asserted contract and negligence based claims against Jessco in the underlying action, the Court determined that if the re-grading allowance was awarded by the arbitrator as compensation for negligence by Jessco in grading the property, Jessco’s negligence would constitute an “occurrence,” and the policy would provide coverage. Thus, the court first determined the legal basis for the re-grading allowance ordered by the arbitrator:

Although the arbitrator stated that Jessco and the Mazycks both “b[ore] some responsibility for the flooding,” the arbitrator ultimately determined that the flooding was caused by “the overcapacitation of the wetlands, caused by the overall design and development of the surrounding neighborhood.” The arbitrator concluded that the development and overcapacitation was “an unforeseen intervening cause,” and Jessco’s work was “not the legal proximate cause of the flooding of [the] property.”
The arbitrator’s determination that Jessco’s work was not the proximate cause of the flooding necessarily amounted to a rejection of any negligence-based claim asserted against Jessco. See, e.g., Hurd v. Williamsburg Cnty., 579 S.E.2d 136, 144 (S.C. Ct. App. 2003) (“It is apodictic that a plaintiff may only recover for injuries proximately caused by the defendant’s negligence.”). While there may have been some negligent conduct by Jessco, the proximate-cause determination means that Jessco could not have been held accountable to a third-party for that negligence. See, e.g., Howard v. Riddle, 221 S.E.2d 865, 866 (S.C. 1976) (“Plaintiff must show, as a matter of law, not only that defendant was negligent but also that his negligence was a contributing or proximate cause of the injury . . . .” (internal quotation marks omitted)).
Having established the arbitrator determined there was no actionable negligence on the part of Jessco, the court reasoned the re-grading allowance could only have been awarded as compensation for a breach of contract. Therefore, because the Policy unambiguously excluded coverage for breach of contract damages, the court found BMIC had no obligation to indemnify Jessco for the re-grading allowance paid to the Mazycks.

Having determined that BMIC owed a duty to defend Jessco in the underlying action, but did not owe a duty to indemnify Jessco for the re-grading allowance, the court vacated the district court’s judgment and remanded for further proceedings consistent with the opinion.
Part II of this blog post will discuss the decision of the district court on remand. We will post it on Tuesday.

Until then - have a wonderful Memorial Day. 
Logan

Health Wonk Review: In-Depth edition

Dr Jaan Siderov hosts an outstanding edition of the Health Wonk Review. Great posts, and lots of 'em, all deftly edited with Dr Siderov's insight and gentle humor.

Wednesday, May 23, 2012

Health Insurance – A Necessity of Todays Life.


Health Insurance is the only solution for increasing health care cost in today's world. It is an absolute necessity to have yourself insured as it will help keep you and your family safe and insure that you do not get engulfed with health care bills if one of you should have an accident or have grave health issues.





Many people do not get insured because they think that it is a waste of money and consider medical insurances to be very costly. But the fact is that it is not that costly and you can get it for a fair amount of money.





The simplest and cheapest way of getting a good health care insurance is through your employer. But you must understand that when you leave that job you may lose the coverage. Other way of getting health care insurance is through a personal plan. Entrepreneurs & people whose employers do no offer coverage, acquire this kind of insurance. This kind of insurance policy will come out of your pocket, but the cost of insurance is much cheaper than bearing your own medical costs.





If you have to go with a personal health insurance then be sure to shop around to ensure you get the best coverage for the really best price. There are numerous insurance companies offering different health/medical insurance plans but before you choose one, you need to think of few important things like general state of your health, your age, any medical problem history, your boozing and smoking habit etc. If you are going for family cover, then your will need to find these details for each member and then think carefully what kind of coverage you want. Do not conceal any medical problem from insurance company as bearing a claim denied later because you had failed to disclose medical truth to the insurance company would be far more displeasing - and very expensive.





A careful study of above mentioned factors will help you decide the kind of coverage you need and where you can cut the expenses of premium. This might appear like a boring process, but it will assist you considerably in ascertaining appropriate and affordable health insurance and making sure your health care needs can be met by the medical insurance you select.


It Depends...

No, no, no.

Ever heard of the "Dependency Ratio?" Me either, but it's important, and it's scary:

"The U.S. Census Bureau recently reported that the dependency ratio, or the number of people 65 and older to every 100 people of traditional working ages, is projected to climb rapidly from 22 in 2010 to 35 in 2030"

Right now, about 1 in 5 of us is 65 or older. So what, you ask? Well, let's look at that number. It means that about 8 out of ten are working age. But with real unemployment at almost 15%, there are less than 7 working people supporting every 10 retirees. And that number's likely to go even lower as the Boomers continue reaching retirement age.

Why is this scary? Glad you asked:

"A Pennsylvania state appeals court has ruled that the adult son of a nursing home resident is responsible for her unpaid $93,000 bill. And the decision has some elder care lawyers wondering if this is just the beginning of a trend."

The Keystone State is just one of the 30 states which currently have "filial responsibility statutes" on the books. These regs impose an affirmative duty on "adult children to care for their indigent parents;" providers like nursing homes can seek restitution from them. And as the situation continues to deteriorate, how long will it be before the other 28 states follow suit?

So why bring it up?

Well, this is InsureBlog - perhaps there's a clue. How many of us have seriously considered Long Term Care insurance for ourselves? How many fewer have considered it for their parents? Well, LTCi can cost some decent bucks. But with the potential for a $93,000 (or more!) "filial financial burden" it may turn out to be very cheap indeed.

UPDATE: Courtesy of Bob, here's a list of the 30 states with "Filial Responsibility" statutes.

About Those Exchanges

The folks in la-la land are at it again, doing everything in their power to make sure no one in the Republik of Kalifornia has affordable health insurance. In an attempt to get the jump on health insurance exchanges the gummint is using "focus groups" to get an idea of what Kalifornian's want and expect from a health insurance exchange.
Many uninsured California residents think buying health coverage through a new health insurance exchange, or Web-based insurance market, would be cheaper than buying coverage through a broker.
Asking uninsured folks their opinion on something they don't own and perhaps have never bought is about like asking a man to describe childbirth.                 


Apparently the participants in this focus group never considered that an exchange will have overhead, salaries and probably benefits that are factored in to the cost of health insurance. These are the same folks that believe they can get a lower rate by purchasing direct from a carrier.
Researchers talked to a total of 36 uninsured California residents ages 18 to 44 who intend to use the California exchange.
Well that is certainly a large sample. I would think it would be fairly easy to find considerably more than 36 folks living on the dole that would be glad to participate in a survey. Just this last weekend while riding on mass transit to the airport I overheard a couple of people who were comparing notes on how to get paid by focus groups. One person said she got $75 just for tasting chocolate.


How hard is that?


And, "You don't have to report it to the government so they won't reduce your check".
"Some participants reported having shopped for insurance in the past either through their employer or by using a broker, insurance company website, or going to a local social service office," Bye writes in the focus group report. "Most preferred to shop on the Web as opposed to through brokers (who they viewed as expensive middlemen) or social service offices."
Expensive middlemen. Of course Social Workers not only volunteer their time and services (so no need to pay them) but they are infinitely well versed in insurance contracts.

Participants said they think the exchange will encourage plans to lower their prices and help consumers avoid paying broker fees, and decrease the amount of paperwork consumers must fill out.
The participants said they want to shop "at their own pace without pressure from salespeople."
There are those expensive broker fee's again . . .
I have a website and offer visitors the chance to run their own rates and even apply "direct" with the carrier if they choose. After several years of doing this, I can tell you about half never get around to completing the application. Roughly 70% of those that do submit an application are rejected due to health issues.
Quite a few pick plans that do not cover prescription drugs.
When asked about coverage affordability, the focus group participants said they might be able to afford $25 to $50 per month for individual coverage and $100 to $150 per month for family coverage.
I think it is becoming quite clear why these folks are uninsured. They seem to think you can buy health insurance for less than you pay your cable company each month.

Collins & Lacy to Present CLE "Managing Your Risks: A 2012 Perspective on Business, Social Media & Litigation Risks" to Association of Corporate Counsel

Post by Pete Dworjanyn
In June, I will be part of the Collins & Lacy team presenting a Continuing Legal Education (CLE) to the Association of Corporate Counsel entitled "Managing Your Risks: A 2012 Perspective on Business, Social Media and Litigation Risks." The presentation is Thursday, June 7, 2012 from 2:00 p.m. to 5:00 p.m. at EdVenture Children's Museum in Columbia, S.C.   

My section will address how to best manage business risk from an insurance perspective, including issues regarding Certificates of Insurance, Additional Insured status and Indemnity Agreements. 


Other parts of the three-part presentation include:
  • Products Liability Practice Group Chair Brian Comer will offer best practices learned in litigation.
  • Employment Law Practice Group Chair Christian Boesl and employment law attorney Charles Appleby will address the management of social media risks in the workplace. The presentation will draw upon emergent issues raised by the National Labor Relations Board, as well as general risks involving social media and employers.
  • Public Policy & Governmental Consulting Practice Group Chair Jon Ozmint will lead a panel discussion on how to manage risk in litigation from several different business perspectives.
This presentation is free to in-house counsel, but they must register to attend. For more information and to RSVP, please contact Kathleen Yarborough at kathleen@amchouston.com.

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