No Coverage if Person Fails to Qualify as an Insured
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Plaintiff CSAA Fire & Casualty Insurance Company (CSAA) sued Roman Ramirez and eventually filed a successful Motion for Summary Judgment on the issue of coverage. In CSAA Fire & Casualty Insurance Company v. Roman Ramirez, No. 2:22-cv-00318-RFB-EJY, United States District Court, D. Nevada (March 10, 2023) the USDC resolved the coverage issue.
Where the record, taken as a whole, could not lead a rational trier of fact to find for the nonmoving party, there is no genuine issue for trial. If a party fails to properly support an assertion of fact or fails to properly address another party’s assertion of fact the court may:
1. give an opportunity to properly support or address the fact;
2. consider the fact undisputed for purposes of the motion;
3. grant summary judgment if the motion and supporting materials – including the facts considered undisputed – show that the movant is entitled to it; or
4. Issue any other appropriate order.
FACTUAL BACKGROUND
The Court accepted the following facts as undisputed, based on Plaintiff’s Motion for Summary Judgment and the supporting materials in the record.
Plaintiff is an insurance company who maintains a homeowner’s insurance policy (“The Policy”) held by the named insured, Maria M. Armendarez.
The policy was in full force and effect on May 4, 2017, and covers the property located at 2421 Old Forge Lane, Unit 104, Las Vegas, Nevada 89121 (“Unit 104”).
While the property covered by the policy was Unit 104, the policy agreement lists Ms. Maria Armendarez’s residence at a different location, namely 219 La Paz Avenue, Henderson, Nevada 89015.
An incident took place on May 4, 2017 (“the Incident”) involving Defendant that resulted in an underlying state court case being filed against him by Mr. Juan Severin. At the time of the Incident, Unit 104 was being rented out by Ms. Maria Armendarez to an unrelated family of three individuals: Loraine Gonzalez, Tony Gonzalez, and their child Luke Gonzalez. At the time of the Incident, certain repairs and remodeling was taking place at Unit 104. In connection with those repairs and remodeling. Ms. Maria M. Armendarez’s daughter, Ms. Carrie Armendarez, hired a handyman, the plaintiff in the underlying action, Mr. Juan Severin, to perform some of the work on Unit 104.
An argument between Ms. Carrie Armendarez and Mr. Servin ensued regarding whether Mr. Servin should perform any additional work and/or receive additional payment. As the argument ensued, Ramirez allegedly punched Mr. Severin in the face, causing him injury. As a result of the Incident, Mr. Servin sued in the underlying state court action, raising claims for injuries and damages against Mr. Ramirez (and others).
Defendant then tendered the defense of the Incident and ensuing underlying action to Plaintiff.
On May 10, 2022, Plaintiff took Defendant’s deposition. In the deposition, Plaintiff asked Defendant whether he had any blood, marital, or domestic relationship with Ms. Maria M. Armendarez and/or whether he had ever lived as a resident of the household of Ms. Maria M. Armendarez. Defendant unequivocally confirmed that he was neither a relative (blood or marriage) of Ms. Maria M. Armendarez, that he never lived with Ms. Maria M. Armendarez, and that he was neither a resident of her household. Defendant further confirmed that he has never lived at 219 La Paz Avenue, Henderson, Nevada, which is the resident household of Ms. Maria M. Armendarez, nor at Unit 104, where the subject Incident occurred. Defendant further confirmed that he has never been married in his entire life, only lived with his girlfriend, Loretta Vargas and not Ms. Maria M. Armendarez, and is not a blood relative of Ms. Maria M. Armendarez or her late husband, Mr. Fernando Armendarez.
DISCUSSION
In Nevada, when the facts are not in dispute, insurance contract interpretation is a question of law that may be decided by the reviewing Court. An insurance policy, like any other contract, must be construed and enforced as written, absent any ambiguity. In this case the four requirements for declaratory relief were met. There is an underlying proceeding between Mr. Severin and Defendant, currently before the Clark County District Court.
Defendant cannot establish that he is covered by the Policy because the Policy is not ambiguous as to defining “insured” and the scope of coverage to “insured” persons. Defendant admitted that at the time of the Incident, he was a resident of 3909 San Andreas Avenue, Las Vegas, NV 89121. He stated that he moved from that residence to a home he purchased, at 4388 Gibraltar Way, Las Vegas, NV, 89121, in 2020 and was not a resident of Unit 104 nor did he reside at Ms. Maria M. Armendarez’s residence.
Through his sworn deposition testimony, Defendant has confirmed that he does not qualify as an “insured” under the Policy.
ZALMA OPINION
Insurance policies must be interpreted as written. When a policy defines “insured” as a person who is named or who resides at the premises and is a relative of the named insured no one else is covered by the policy for defense or indemnity. Since Ramirez failed to fit any variation of the definition of “insured” he was not entitled to coverage for defense or indemnity.
(c) 2023 Barry Zalma & ClaimSchool, Inc.
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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]
Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.
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Jury’s Findings Interpreting Insurance Contract Affirmed
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Madelaine Chocolate Novelties, Inc. (“Madelaine Chocolate”) appealed the district court’s judgment following a jury verdict in favor of Great Northern Insurance Company (“Great Northern”) concerning storm-surge damage caused by “Superstorm Sandy” to Madelaine Chocolate’s production facilities.
In Madelaine Chocolate Novelties, Inc., d.b.a. The Madelaine Chocolate Company v. Great Northern Insurance Company, No. 23-212, United States Court of Appeals, Second Circuit (June 20, 2025) affirmed the trial court ruling in favor of the insurer.
BACKGROUND
Great Northern refused to pay the full claim amount and paid Madelaine Chocolate only about $4 million. In disclaiming coverage, Great Northern invoked the Policy’s flood-exclusion provision, which excludes, in relevant part, “loss or damage caused by ....
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Contract Interpretation is Based on the Clear and Unambiguous Language of the Policy
In Associated Industries Insurance Company, Inc. v. Sentinel Insurance Company, Ltd., No. 23-CV-10400 (MMG), United States District Court, S.D. New York (June 16, 2025) an insurance coverage dispute arising from a personal injury action in New York State Supreme Court.
The underlying action, Eduardo Molina v. Venchi 2, LLC, et al., concerned injuries allegedly resulting from a construction accident at premises owned by Central Area Equities Associates LLC (CAEA) and leased by Venchi 2 LLC with the USDC required to determine who was entitled to a defense from which insurer.
KEY POINTS
Parties Involved:
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Attack by Vicious Dog Excluded
In Foremost Insurance Company, Grand Rapids, Michigan v. Michael B. Steele and Sarah Brown and Kevin Lee Price, Civil Action No. 3:24-CV-00684, United States District Court, M.D. Pennsylvania (June 16, 2025)
Foremost Insurance Company (“Foremost”) sued Michael B. Steele (“Steele”), Sarah Brown (“Brown”), and Kevin Lee Price (“Price”) (collectively, “Defendants”). Foremost sought declaratory relief in the form of a declaration that
1. it owes no insurance coverage to Steele and has no duty to defend or indemnify Steele in an underlying tort action and
2. defense counsel that Foremost has assigned to Steele in the underlying action may withdraw his appearance.
Presently before the Court are two ...
ZIFL Volume 29, Issue 10
The Source for the Insurance Fraud Professional
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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/ You can read the full issue of the May 15, 2025 issue at http://zalma.com/blog/wp-content/uploads/2025/05/ZIFL-05-15-2025.pdf
This issue contains the following articles about insurance fraud:
Health Care Fraud Trial Results in Murder for Hire of Witness
To Avoid Conviction for Insurance Fraud Defendants Murder Witness
In United States of America v. Louis Age, Jr.; Stanton Guillory; Louis Age, III; Ronald Wilson, Jr., No. 22-30656, United States Court of Appeals, Fifth Circuit (April 25, 2025) the Fifth Circuit dealt with the ...
Professional Health Care Services Exclusion Effective
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This opinion is the recommendation of a Magistrate Judge to the District Court Judge and involves Travelers Casualty Insurance Company and its duty to defend the New Mexico Bone and Joint Institute (NMBJI) and its physicians in a medical negligence lawsuit brought by Tervon Dorsey.
In Travelers Casualty Insurance Company Of America v. New Mexico Bone And Joint Institute, P.C.; American Foundation Of Lower Extremity Surgery And Research, Inc., a New Mexico Corporation; Riley Rampton, DPM; Loren K. Spencer, DPM; Tervon Dorsey, individually; Kimberly Dorsey, individually; and Kate Ferlic as Guardian Ad Litem for K.D. and J.D., minors, No. 2:24-cv-0027 MV/DLM, United States District Court, D. New Mexico (May 8, 2025) the Magistrate Judge Recommended:
Insurance Coverage Dispute:
Travelers issued a Commercial General Liability ...
A Heads I Win, Tails You Lose Story
Post 5062
Posted on April 30, 2025 by Barry Zalma
"This is a Fictionalized True Crime Story of Insurance Fraud that explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help everyone to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime."
Immigrant Criminals Attempt to Profit From Insurance Fraud
People who commit insurance fraud as a profession do so because it is easy. It requires no capital investment. The risk is low and the profits are high. The ease with which large amounts of money can be made from insurance fraud removes whatever moral hesitation might stop the perpetrator from committing the crime.
The temptation to do everything outside the law was the downfall of the brothers Karamazov. The brothers had escaped prison in the old Soviet Union by immigrating to the United...