Tenth Circuit Decides Haunted House’s Insurers Must Share Costs

We in the Bose Insurance Group always appreciate good stories and good writing.  And when you can combine both in law, that’s even better.  Tenth Circuit Judge Gorsuch had some hair-raising fun writing the opinion in Western World Insurance Co. v. Markel American Insurance Co.  Here are the facts [cue the "Psycho" theme]:

Tyler Hodges was working the ticket booth at the Bricktown Haunted House one evening when his flashlight died, so he ventured inside in search of a replacement using his cell phone to light his path.  When an actor complained that the light “dampened the otherworldly atmosphere,” Hodges turned it off and stumbled along.  Upon reaching the freight elevator where the flashlights were stored, he lifted the gate, stepped in, but failed to notice that the elevator was on the floor above him.  Hodges crashed 20 feet down the empty elevator shaft.

Hodges has long since recovered from his injuries and received a settlement in his lawsuit against the haunted house’s operator for various torts.  However, the “lingering specter of a lawsuit” concerns which of the haunted house operator’s two insurance companies (Western World and Markel) must foot the bill.

Western World had excluded a number of ghastly elements from its haunted house coverage (“any claim arising from chutes, ladders . . . naked hangman nooses, . . . trap doors . . . or electric shocks”), but did not think to exclude blind falls down elevator shafts.  Western World admitted coverage and proceeded to defend the claim.  Markel, on the other hand, refused to defend or pay any claim.  Western World sued to have Markel contribute to the costs of defending Hodges’ suit pursuant to the Oklahoma doctrine of equitable contribution.

Markel argued that it was permitted to elude liability through an escape clause.  The trial court agreed and entered summary judgment in its favor. The only issue on appeal was whether the escape clause allowed Markel to escape liability when the escape clause does not appear in Markel’s general commercial liability policy (it was added by a later endorsement).

The Court reversed the grant of summary judgment in Markel’s favor and remanded the case for further proceedings.  It concluded that the applicability of the escape clause in this instance was far from clear, and under Oklahoma contract law, the tie must go to the insured.  The Court found that the insured reasonably expected coverage from Markel and declared:

[W]hen a policy’s escape hatch is less a clearly marked exit than it is a hidden trap door, the reasonable expectations of an insured who has read and become familiar with the policy language supplies the rule of decision.

The lesson: Draft clear and plain escape clauses courts can enforce…or don’t be surprised if the call for coverage…..is coming from INSIDE THE HOUSE!

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Indiana Guaranty Fund Tax Credits Under Legislative Review

It is likely that the Indiana General Assembly will study the basis for, and continued utility of, tax credits allowed for insurance guaranty fund assessments during the 2012 interim.  Currently, both life and health and property & casualty fund assessments may be recouped with a credit of up to 20% of the assessment allowed each year following the assessment for 5 years.  The issues will surely focus on the fairness of all Indiana taxpayers ultimately bearing the burden for insurance insolvencies versus insurance policyholders.

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Indiana Serious About Health Rates

Our recent experience with the Indiana Department of Insurance on behalf of several prominent health insurers makes clear that the department is taking health insurance rate review very seriously.  In addition to retaining a prominent firm to provide actuarial review to the department, it has been steadfast in its commitment to review and approve all health insurance rates since October 2010.  The department is paying particular attention to underlying data purportedly supporting a rate increase and generally following a 10% rule, i.e., if the rate increase exceeds 10%, it is likely suspect.  All portions of a rate increase are considered as a whole.  Trend plus other factors may not be separated and utilized as a means to circumvent an argument over the percentage of increase.

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Indiana Is Again One of the Leaders When It Comes to Credit for Reinsurance

As we’ve previously reported (see our prior post here), in 2011, Indiana joined Florida and New Jersey to become among the first states to enact legislation adopting the NAIC’s Credit for Reinsurance Model Law.  On March 15, 2012–the Ides of March, nonetheless–Indiana took another step forward by adopting accreditation eligibility requirements and suspension/revocation privileges more in line with the NAIC’s current models.  Click here for the complete statute, but (SPOILER ALERT!) you’re going to want to get a fresh cup of coffee beforehand.

The revised statute goes into effect on July 1, 2012.

Man, there's nothing like curling with a brand-new statute and...zzzzzzzzzz.....

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Federal Court Orders Production of Loss Reserve and Reinsurance Information

Parties in insurance disputes sometimes seek production of information regarding loss reserves and reinsurance.  But when should such information be produced?  The Western District of Washington recently addressed this issue in Isilon Systems, Inc. v. Twin City Fire Ins. Co., and the result isn’t necessarily good news for insurers and reinsurers.

The case arises in the bad faith context.  Isilon, the plaintiff, filed a motion to compel challenging Twin City’s claim that loss reserve and reinsurance information was not discoverable.  Twin Cities argued that information about loss reserves is generally not discoverable in bad faith claims, except in narrow circumstances, because such information is irrelevant.  Further, Twin City argued that loss reserves information is not relevant because the reserves represent nothing more than an accounting decision made by persons without actual knowledge of the policies involved.

The court, however, felt otherwise.  Since Twin City’s loss reserves decisions were made by members of its upper management with knowledge of the actual policies involved, the court applied the general rule that the relevancy of insurance reserves was applicable and ordered Twin City to turn over all materials relating to loss reserves.  The court noted, however, that while aggregate reserve information is not protected as attorney work product, individual case reserves calculated by defendant’s attorney may be.

As to reinsurance, the court stated that reinsurance polices themselves are discoverable, regardless of relevance.  This rule does not extend to communications between the insured and the reinsurer regarding the reinsurance policies unless the plaintiff demonstrates relevance to the bad faith claim.  The court held that Twin City must produce all reinsurance policies, but recognized that Twin City did not have to produce other reinsurance documents unless Isilon presents a basis for the relevance of such documents.

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Indiana Supreme Court Thrice Finds “Absolute Pollution Exclusion” Is Ambiguous

The Indiana Supreme Court has held, for the third time, that the “absolute pollution exclusion” is ambiguous, affirming summary judgment in favor of coverage.

In State Auto. Mut. Ins. Co. v. Flexdar, Inc., the insured discovered a chemical called TCE (trichloroethylene) in the soil and groundwater both on and off the site of its manufacturing plant.  The Indiana Department of Environmental Management informed Flexdar that Flexdar would be liable for the costs of cleanup.  Flexdar then sought defense and indemnification from State Auto under its CGL policy.  State Auto defended under a reservation of rights and filed a DJ action to determine its obligations, contending that the TCE cleanup fell under the “absolute pollution excluison.”  The trial court granted summary judgment in favor of Flexdar on the grounds that the exclusion was ambiguous, and the Court of Appeals affirmed.

Here’s the exclusion language in issue:

This insurance does not apply to:
. . . .
f. Pollution
(1) “Bodily injury” or “property damage” arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of pollutants:
(a) At or from any premises, site or location which is or was at any time owned or occupied by, or rented or loaned to, any insured;
. . . .
(2) Any loss, cost or expense arising out of any:
(a) Request, demand or order that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of pollutants; or
(b) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of pollutants.
Pollutants means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed.

The Supreme Court noted that it had twice previously found the same or similar language to be ambiguous, first in 1996 and then again in 2002.  The Court pointed out that “this clause cannot be read literally as it would negate virtually all coverage…In other words, practically every substance would qualify as a ‘pollutant’ under this definition, rendering the exclusion meaningless.”  The Court noted that while some courts have developed “literal” and “situational” approaches to analyzing whether a substance was a “pollutant,” Indiana instead focuses on the contract language itself.  The question was therefore “whether the language in State Auto’s policy is sufficiently unambiguous to identify TCE as a pollutant.”  The Court concluded it was not.

So, what will be the outcome?  At a minimum, Indiana pollution exclusions are probably going to get a lot longer.

And here's your Indiana pollution exclusion...

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The Status of “Manifest Disregard of the Law,” Now in Chart Form!

Following Hall Street and Stolt-Nielsen, there’s been an “open” question as to whether a party can still challenge arbitrators’ rulings for “manifest disregard of the law” under the FAA.  (I say “open” because I thought Hall Street made it pretty clear that “manifest disregard” challenges weren’t viable under the FAA.)  Some circuits have held that “manifest disregard” challenges are still viable, while others say no deal.

Last month, in Wachovia Secs., LLC v. Brandthe Fourth Circuit joined the fray, holding that “manifest disregard” challenges are still viable.  So, where do things stand now?  Well, I could write it all out for you, but that would get boring, so instead I’ll show you!  Here is our handy chart showing where “manifest disregard” challenges are and aren’t viable (click here for a printable PDF version).

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