| Q&A of the Week |
Defense Costs for an Indemnitee
An Indiana subscriber recently asked the following question:
How does the CGL form apply when it comes to extending defense cost coverage to indemnitees, that is, those entities whose liability has been assumed by the insured under an insured contract?
ANSWER: The current CGL form states that "reasonable attorneys' fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages". This answers the question about defense cost coverage in the affirmative since the word "damages" is the key word. The exception to the contractual liability exclusion in the CGL form states that the exclusion does not apply to liability for damages assumed under an insured contract; therefore, if the defense costs for the entity other than the insured are damages, the CGL form will cover them.
Note that there are some conditions to be met before the defense costs are deemed to be damages, namely, liability for the defense costs has to be assumed in the insured contract and the defense costs have to be for defense against alleged damages that are covered by the insured's policy. And, note that one would have to look to the supplementary payments section of the CGL form to see whether these defense costs for the indemnitee are included within the limits of insurance. In the supplementary payments section, the insurer declares that payments for attorneys' fees and litigation expenses for a party other than an insured will not reduce the limits of insurance provided that the enumerated conditions are met. |
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| Litigation Watch |
Uninsured Motorists Coverage and Use of an Auto
The estate of Yong Suk Chong sues National Continental Insurance Company seeking compensation from an automobile insurance policy's uninsured motorists coverage (UM). This case is Chong v. National Continental Insurance Company, 2016 WL 3014613.
Chong and Yun Yi were domestic partners living in Alaska where Yi owned and operated a taxi business, with Chong employed as a cab driver. In January 2012, Motgin called for a cab and Chong responded. Motgin wanted to go to Napakiak, but the only way to get there by auto was on the frozen Kuskokwim River, which required a permit. Chong did not have such a permit and told Motgin she could not drive him to Napakiak. Motgin was angered by this refusal and he pulled a knife on Chong and cut her. Motgin then proceeded to push Chong out of the driver's seat and shove her in the back seat of the cab. Motgin then drove off. In February 2012, the taxi was found in Napakiak and Chong's dead body was found in the backseat of the cab.
The estate of Chong eventually brought this case seeking UM coverage under the policy issued by National Continental for the cab. The policy provided compensatory damages an insured is entitled to recover from the driver of an uninsured motor vehicle for injury or death when the liability for these damages results from the use of a vehicle. The insurer denied coverage.
The United States District Court, Alaska, noted the argument put forth by the insurer that the estate was not entitled to UM benefits because language in the policy provided that an uninsured motor vehicle means a vehicle for which no liability policy applies at the time of the accident, and the taxi was insured, so the definition of uninsured motor vehicle was not met. The estate countered that because Motgin's use of the taxi was unauthorized, liability coverage would not apply and so, the cab should be considered an uninsured motor vehicle.
The court said that in order to provide coverage, the uninsured party must also have been a motorist. Because Chong remained in the driver's seat during the initial assault, the court found that it could not say that Motgin was a motorist at the time of the knife assault. The court found no indication that Motgin was a motorist or operator of any vehicle during the assault, and accordingly, the taxi was not an uninsured vehicle and Motgin was not an uninsured motorist at the time the bodily injury occurred.
The court also noted that even if Motgin was found to be an uninsured motorist and the taxi was an uninsured vehicle at the time of Chong's injuries, the injuries must result from the use of the taxi for the policy to provide coverage. The court recognized that there are three factors that a court should consider when deciding whether an injury arises from the use of a vehicle: the extent of causation between the auto and the injury; whether an act of independent significance occurred, breaking the causal link between use of the auto and the injuries inflicted; and, what type of use of the auto was involved.
In Alaska, the vehicle must be an active accessory for there to be an adequate causal relationship. Where the vehicle was only the subject of a fight, for example, and played no part in the fight itself, there is insufficient causation to say that the injuries have arisen out of the use of the vehicle. In this instance the court said that the taxi and its use were only the subject of the assault and the taxi was not an active accessory to Chong's injuries. This weighs against coverage.
As for the act of independent significance breaking the causal link, the court said that an act of violence can break the causal nexus between the use of the vehicle and the injuries inflicted, and Motgin's violent actions during the assault were independent from the transportation intended by Chong. The court found that Motgin's actions were of sufficient independent significance to disrupt any causal link that may be found between Chong's injuries and the use of the taxi.
The court noted that the parties to this action agreed that coverage should exist only if the injuries resulted from the taxi being used for transportation purposes. The insurer argued that the taxi was not used for transportation when Motgin attacked Chong because her vehicle was parked and not moving. The estate countered that the taxi was being used for transportation purposes since Motgin entered the taxi to be transported, stabbed Chong over a disagreement on transportation, and then used the taxi to drive Chong and himself to Napakiak. The court decided that the use of the taxi in this instance was akin to a case decided by the Alaska Supreme Court wherein that court ruled that there was no coverage where the vehicle was the mere situs of the accident. The court said that the negotiation of transportation is not a type of use of an auto that is sufficient to support coverage under the policy.
The District Court ruled that the taxi was not uninsured, Motgin was not an uninsured motorist, and Chong's injuries did not arise out of the use of the taxi. Summary judgment for the insurer was granted.
Editor's Note: This case is presented to show another court's opinion on what it takes to show that injuries, and coverage for those injuries, arise from the use of a vehicle. |
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| Fraud of the Week |
Fraudulent Life Insurance and Death Benefit Claims – New Jersey
AMOUNT: $2,157
A Mercer County insurance agent has been charged with knowingly submitting fraudulent life insurance applications and death benefit claims for applicants who did not meet U.S. residency requirements along with other policy conditions.The agent has been indicted on second-degree insurance fraud and third-degree theft by deception for issuing policies to three unqualified applicants who did not reside in the U.S. for more than twelve months, did not carry valid social security numbers, and did not sign the necessary applications under the proper circumstances. Using his ties to the African immigrant community, the agent received over $2,000 in commission for the policies, and pocketed the money.
He also convinced clients that life insurance for their family members outside of the country, in Liberia, was necessary, and procured the necessary information to create those policies. Later those three relatives allegedly passed away, leaving benefits of $85,000. Since the deaths of the insured individuals could not be confirmed, that claim money was not paid out. The charge is an accusation, and the agent is presumed innocent until proven guilty. A deputy attorney general presented the case to the grand jury.
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