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May 23, 2024
Who’s on First?

Insurers Dispute Who Must Defend Additional Insured

Read the full article at https://lnkd.in/ghfcpVQv, see the full video at https://lnkd.in/gXhwbZjK and at https://lnkd.in/gvJHghHt, and https://zalma.com/blog plus more than 4800 posts.

Post 4806

Other Insurance Clauses Control who Defends Whom

The Travelers and Defendant Ohio Security Insurance Company (“Ohio Security”) moved for summary judgment. In The Travelers v. Ohio Security No. 23-cv-3451 (AS), United States District Court, S.D. New York (May 10, 2024) the USDC resolved the disputes.

BACKGROUND

Ohio Security issued an insurance policy to Sutega USA Corp. (“Sutega”). Travelers sued seeking a declaratory judgment that, under the policy, Ohio Security has a duty to defend and indemnify Shawmut Design and Construction (“Shawmut”), Zara USA, Inc. (“Zara”), Eklecco Newco LLC (“Eklecco”), and Pyramid Management Group, LLC (“Pyramid”) in a state court lawsuit.

Construction Contracts

In 2015, Zara, Shawmut, and Sutega entered into several contracts related to the construction of a new Zara store in Palisades, New York. The contract states that Shawmut “shall supervise and direct the Work” and all parties included additional insured provisions and other insurance provisions.

Insurance Policies

The Travelers policy provided commercial general liability coverage subject to certain terms, conditions, and exclusions. The Travelers policy contains an amendment to the “other insurance” provision stating: “This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is added as an additional insured under any other policy, including umbrella or excess policy.”

The Travelers Policy provides coverage to Zara, Eklecco, and Pyramid as additional insureds subject to certain terms and conditions. Ohio Security issued a commercial general liability policy to Sutega. The Ohio Security policy applied Sutega’s place of business is listed as an address in Miami, Florida. As relevant here, the policy states that Ohio Security has “the right and duty to defend the insured against any ‘suit’ seeking” damages for bodily injury.

The policy contains a Commercial General Liability Extension Endorsement that defines “insured” to include: “any person or organization whom you have agreed to add as an additional insured in a written contract.

The Ohio Security policy also contains an “other insurance” provision.

Underlying State Court Lawsuit

John Autenrieth was injured while using a table saw during the construction. Autenrieth sued Eklecco, Shawmut, Apollo, Pyramid, Zara, and Palisades Center, LLC in New York state court. Autenrieth alleges that the defendants breached their non-delegable duties under New York law to maintain a safe work environment.

Shawmut’s insurer, Travelers, alleged that Sutega’s insurer, Ohio Security, has a duty to defend and to indemnify Shawmut, Zara, Eklecco, and Pyramid in the state court action. Ohio Security denied that its policy covers these entities. The only disputed issue for the Court is whether Shawmut is covered by the Ohio Security policy. The answer is yes, at least as to Ohio Security’s duty to defend Shawmut.

DISCUSSION

For purposes of these motions, the Court found that no actual conflict exists. The only disputed issue is whether the Ohio Security policy covers Shawmut. Under both Florida and New York law, an insurer’s duty to defend is broad. The parties do not dispute that there is a written contract between Sutega and Shawmut. Therefore, Ohio Security has a duty to defend Shawmut in the underlying state court action pursuant to the policy issued to Sutega.

Primary Coverage

Shawmut is an additional insured under the Ohio Security policy in the underlying state court litigation. Neither party disputes that Shawmut also has insurance coverage as the named insured under the Travelers policy. The Travelers argued that Ohio Security is required to provide Shawmut coverage on a primary and non-contributory basis. Given the plain language of the insurance contracts and Ohio Security’s failure to respond, the Court agrees with Travelers.

ZALMA OPINION

The “other insurance” clauses in insurance policies often results in unnecessary disputes between insurers as to who, between multiple insurers who insure against the same risk of loss, must be first in line to defend or indemnify an insured. The court resolved one of those disputes in this case and told the various insurers and insureds to resolve any remaining issued. To answer the question as to Shawmut, Ohio is on first.

(c) 2024 Barry Zalma & ClaimSchool, Inc.

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00:06:28
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Post 5434

Posted on August 26, 2026 by Barry Zalma

See the full video at https://lnkd.in/g-ZtsSgK and at https://lnkd.in/ghMBdYWR
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In Farmers Insurance Exchange, a California Reciprocal Insurance Exchange,  The Superior Court For The County Of San Bernardino, Kathleen Ann Wood, E087128, California Court of Appeals, (July 9, 2026) Farmers Insurance Exchange insured Doyle Archer under an automobile policy with bodily injury limits of $15,000 per person and $30,000 per accident.

FACTUAL BACKGROUND

Archer rear-ended Kathleen Ann Wood at a red light, causing Wood to assert a bodily injury claim against him. Wood’s counsel sent Farmers a pre-litigation settlement demand offering to resolve Wood’s claim for the available policy limits, stating that if the $100,000 demand exceeded the policy, the offer was for the policy limits.

Farmers timely responded in writing, agreed to pay Wood the $15,000 per-person policy limit, and provided the requested ...

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August 26, 2026
Offer Made and Accepted Creates Enforceable Contract

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Post 5434

Posted on August 26, 2026 by Barry Zalma

See the full video at https://lnkd.in/g-ZtsSgK and at https://lnkd.in/ghMBdYWR
A Contingent Offer Accepted Ends the Dispute

In Farmers Insurance Exchange, a California Reciprocal Insurance Exchange,  The Superior Court For The County Of San Bernardino, Kathleen Ann Wood, E087128, California Court of Appeals, (July 9, 2026) Farmers Insurance Exchange insured Doyle Archer under an automobile policy with bodily injury limits of $15,000 per person and $30,000 per accident.

FACTUAL BACKGROUND

Archer rear-ended Kathleen Ann Wood at a red light, causing Wood to assert a bodily injury claim against him. Wood’s counsel sent Farmers a pre-litigation settlement demand offering to resolve Wood’s claim for the available policy limits, stating that if the $100,000 demand exceeded the policy, the offer was for the policy limits.

Farmers timely responded in writing, agreed to pay Wood the $15,000 per-person policy limit, and provided the requested ...

00:08:28
July 22, 2026
The Real Cost of Fraud

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Post 5407

Fraud & the Fear of Bad Faith Suits
Posted on July 22, 2026 by Barry Zalma

See the full video at https://lnkd.in/gWQQEySW and at https://lnkd.in/gyhdK6wv

This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help 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.

This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help 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.

After ...

00:12:33
September 04, 2026

Qui Tam Relators are not officers of the United States

Posted on September 4, 2026 by Barry Zalma

Attempt to use Constitution to Stop a Qui Tam False Claims Act Case

Post 5486

FCA’s Qui Tam Provisions do not Violate the Appointments Clause.

In United States Of America, Clarissa Zafirov, ex rel; Dr. v. Florida Medical Associates, LLC, d.b.a. Vipcare, Physician Partners, LLC, Anion Technologies, LLC, Freedom Health, Inc., Optimum Healthcare, Inc., Physician Partners Specialty Services, LLC, et al., No. 24-13581, United States Court of Appeals, Eleventh Circuit (September 1, 2026).

The False Claims Act (“FCA”) allows the Attorney General to bring civil suits against perpetrators of fraud against the government. This case involves another portion of the FCA-the qui tam provisions-which allow people, called relators, who have knowledge about fraud against the government to pursue a case against the perpetrator of the fraud.

Dr. Clarissa Zafirov filed a qui tam action under the False Claims Act on behalf of...

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September 03, 2026
Res Judicata Produces Certainty

Posted on September 3, 2026 by Barry Zalma

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Post 5484

In David Cromp v. Johnny Harkrider, Monique Harkrider, and their Marital Community, dba Able Plumbing Plus, No. 61678-5-II, Court of Appeals of Washington, Division 2 (August 25, 2026) David Cromp hired Able Plumbing Plus in 2018 to install plumbing, including two toilets, at his residence. In 2019, both toilets allegedly leaked, causing damage. Insurance claims were submitted through Able’s contractor policy, but the insurer eventually denied the claims.

Cromp sued Able in 2022 for breach of contract based on the allegedly defective toilet installation. During that case, Cromp attempted to add claims related to Able’s conduct during the insurance claim process, including fraud, bad faith, tortious conduct, and bond-related claims, but the superior court denied leave to amend. The 2022 breach-of-contract claim was later dismissed with prejudice on summary judgment as time-barred.

On the same day the 2022 case was dismissed, Cromp filed a ...

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September 02, 2026
A Charge of Insurance Fraud is not Grounds for Deportation

Habeas Corpus Petition Granted

Post 5483

Posted on September 2, 2026 by Barry Zalma

Over Staying Visa & Charge of Insurance Fraud Still Entitled to Habeas Relief and a Bond Hearing

In Hernan Guillermo Palomino-Crespo v. Warden, Glades County Detention Center et al., No. 2:26-cv-02322-SPC-NPM, United States District Court, M.D. Florida, Fort Myers Division (August 26, 2026) Hernan Guillermo Palomino-Crespo’s Amended Petition for Writ of Habeas Corpus, the government’s response and Palomino-Crespo’s reply.

FACTUAL BACKGROUND

Palomino-Crespo is a native and citizen of Colombia who lawfully entered the United States on a B-2 non-immigrant visa on February 24, 2017. He resides in Miami, Florida with his wife and two minor children, owns and operates a residential restoration and remodeling business, and files U.S. tax returns.
On June 4, 2026, the State of Florida charged Palomino-Crespo with insurance fraud.

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