INSURANCE POLICY TERMINATED BEFORE LOSSES
Barry Zalma
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In re: United Specialty Insurance Company Ski Pass Insurance Litigation, Ann C. Hoak; et al. v. United Specialty Insurance Company, and American Claims Management; Beecher Carlson Insurance, LLC, No. 21-16986, United States Court of Appeals, Ninth Circuit (November 22, 2022)
Plaintiffs attempted to recover for their lost ski days, relying on the “quarantine” provision of their insurance policy, but USIC denied their claims. The district court dismissed the complaint without leave to amend holding that Plaintiffs’ allegations did not support that they had been “quarantined” within the meaning of the insurance policy.
The Ninth Circuit, believing it found a better reason to rule in favor of USIC reviewed the “effective date of coverage” provision of the insurance policy. Plaintiffs’ insurance coverage terminated on March 15, 2020, the “effective date of coverage” provision made clear that coverage terminated on “the date upon which ski operations are ceased due to an unforeseen event” if that date is earlier than the scheduled end of the season, April 15, 2020.
Since ski operations ceased for the 2019-2020 season on March 15 when Vail Resorts closed all of its resorts and never reopened for that season. Operations ceased due to the spread of COVID-19, which was clearly an “unforeseen event” under the “ordinary and popular sense” of the term. The “effective date of coverage” provision thus makes plain that Plaintiffs cannot recover for any losses on or after March 15, 2020. Since the loss – the inability to ski at Vail – happened after March 15, 2020, there was no loss when the policy was in effect.
Contrary to Plaintiffs’ contentions, the separate “termination” provision, which automatically terminates coverage on the last day of the season, does not suggest that coverage could not end earlier under the “effective date of coverage” provision.
The Plaintiffs claimed that the policy’s “natural disaster” provision was rendered a nullity; it would allow for coverage in instances when all the resorts in a state closed indefinitely for a natural disaster but reopened one month later thus not ceasing ski operations altogether for the season which is not what eliminated the Plaintiffs desire to ski.
The trial court’s decision was affirmed.
ZALMA OPINION
The Ninth Circuit, unlike the Plaintiffs, the lawyers for the Plaintiffs, and the District Court, read the full policy and found that it did not matter whether the Plaintiffs were quarantined because their loss happened after the policy, by its terms, had expired.
(c) 2022 Barry Zalma & ClaimSchool, Inc.
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Barry Zalma, Esq., CFE, is available at http://www.zalma.com and [email protected]
Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and [email protected].
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Insured Must Give Prompt Notice of Loss
Post 5256
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Once The Insured Knows There is Damage It is Obligated to Report the Loss to the Insurer
In Greater St. Stephen Ministries, Inc. v. Mt. Hawley Insurance Company, No. 24-cv-3130 (AS), United States District Court, S.D. New York (January 2, 2026) resolved a case brought by a church against an insurance company for denying coverage after Hurricane Ida. After discovery, the insurance company moved for summary judgment because it claimed the insured breached a material condition of the policy.
BACKGROUND
Greater St. Stephen Ministries, Inc., a church located in Louisiana, owned property that suffered damage from Hurricane Ida on August 29, 2021. The property was insured under a policy with Mt. Hawley Insurance Company, which required the insured to provide “prompt notice” of any loss or damage, ...
Insured Must Give Prompt Notice of Loss
Post 5256
Read the full article at https://lnkd.in/gBXRbKXD, see the video at https://lnkd.in/g4DKfUDz and at https://lnkd.in/g65V_RQ7 and at https://zalma.com/blog plus more than 5250 posts.
Once The Insured Knows There is Damage It is Obligated to Report the Loss to the Insurer
In Greater St. Stephen Ministries, Inc. v. Mt. Hawley Insurance Company, No. 24-cv-3130 (AS), United States District Court, S.D. New York (January 2, 2026) resolved a case brought by a church against an insurance company for denying coverage after Hurricane Ida. After discovery, the insurance company moved for summary judgment because it claimed the insured breached a material condition of the policy.
BACKGROUND
Greater St. Stephen Ministries, Inc., a church located in Louisiana, owned property that suffered damage from Hurricane Ida on August 29, 2021. The property was insured under a policy with Mt. Hawley Insurance Company, which required the insured to provide “prompt notice” of any loss or damage, ...
New Trial Because Jury Used Policy That Provides No Coverage to Assess Damages
Post 5255
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In Brown & Brown of Florida, Inc. v. Houligan’s Pub & Club, Inc., and Ormond Wine Company, LLC, Nos. 5D2024-2352, 5D2024-2458, Florida Court of Appeals (January 2, 2026) the Court of Appeals was faced with a case of first impression that involved damages from a hurricane that hit the East Coast of Florida almost a decade ago and the extent to which an insurance broker is responsible for paying for such damages.
The jury entered a verdict in favor of the insurance broker on the insured’s claim that it was negligent in failing to procure insurance, but it found in favor of the insured on claims of breach of fiduciary duty and negligent misrepresentation.
The insurance broker does not contest it breached its duties on these two claims, only ...
Court Must Follow Judicial Precedent
Post 5252
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Insurance Policy Interpretation Requires Application of the Judicial Construction Doctrine
In Montrose Chemical Corporation Of California v. The Superior Court Of Los Angeles County, Canadian Universal Insurance Company, Inc., et al., B335073, Court of Appeal, 337 Cal.Rptr.3d 222 (9/30/2025) the Court of Appeal refused to allow extrinsic evidence to interpret the word “sudden” in qualified pollution exclusions (QPEs) as including gradual but unexpected pollution. The court held that, under controlling California appellate precedent, the term “sudden” in these standard-form exclusions unambiguously includes a temporal element (abruptness) and cannot reasonably be construed to mean ...
Lack of Jurisdiction Defeats Suit for Defamation
Post 5250
Posted on December 29, 2025 by Barry Zalma
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He Who Represents Himself in a Lawsuit has a Fool for a Client
In Pankaj Merchia v. United Healthcare Services, Inc., Civil Action No. 24-2700 (RC), United States District Court, District of Columbia (December 22, 2025)
FACTUAL BACKGROUND
Parties & Claims:
The plaintiff, Pankaj Merchia, is a physician, scientist, engineer, and entrepreneur, proceeding pro se. Merchia sued United Healthcare Services, Inc., a Minnesota-based medical insurance company, for defamation and related claims. The core allegation is that United Healthcare falsely accused Merchia of healthcare fraud, which led to his indictment and arrest in Massachusetts, causing reputational and business harm in the District of Columbia and nationwide.
Underlying Events:
The alleged defamation occurred when United ...
Zalma’s Insurance Fraud Letter
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ZIFL Volume 29, Issue 24
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Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/
Zalma’s Insurance Fraud Letter
Merry Christmas & Happy Hannukah
Read the following Articles from the December 15, 2025 issue:
Read the full 19 page issue of ZIFL at ...
