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June 17, 2024
Application Wrongfully Stated No Work on Recreational or Playground Equipment

Policy Does Not Cover Damages Caused by In-Ground Trampoline

Read the full article at https://lnkd.in/gjmpqjey, see the full video at https://lnkd.in/grDHyuUn and at https://lnkd.in/gEFU4bXE and at https://zalma.com/blog plus more than 4800 posts.

Post 4824

United Casualty Insurance Company ("United" ) refused to defend James Snell, a landscaper, in a civil lawsuit alleging that Snell had negligently installed a ground-level trampoline in a client's backyard. Snell sued, contending that United had breached its insurance contract with him in bad faith and seeking a declaratory judgment that United had a duty to defend and indemnify Snell. The district court granted summary judgment for United, holding that the accident did not "arise from" Snell's "landscaping" work within the meaning of his commercial general liability policy.

The Eleventh Circuit resolved the dispute in James Snell, d.b.a. Outdoor Expressions v. United Specialty Insurance Company, No. 22-12581, United States Court of Appeals, Eleventh Circuit (May 28, 2024).

BACKGROUND

Snell's landscaping company is named "Outdoor Expressions," and it is located in Fairhope, Alabama. Snell was hired by the Westons to turn an above ground trampoline into a ground level trampoline.

Snell's site work included excavation of a pit, installation of a drain and drainage sand, excavation of a trench to install a drainage pipe, installation of the drainage pipe and of a drain pump, and, most relevant here, construction of concrete block retainer walls and installation of a wood cap on the retainer walls. The retaining walls aimed to prevent erosion and collapse of the structure; the wood cap was for aesthetics. Then, after all that, Snell unboxed the trampoline, assembled it, and lowered it into the pit.

A few years later, Matthew Burton sued the Westons for injuries his daughter suffered on the Westons' trampoline. Burton alleged that Snell "wantonly assembled, constructed and installed the trampoline in the backyard of the Weston[s]'s home," creating "an unreasonably dangerous condition and structure on the property."  Snell's advised his insurer of the lawsuit only to have United that it would not defend him in the lawsuit because it policy’s obligations were limited to the specified operations that Snell, as insured performs landscaping. It concluded that the injury from the assembly and installation of a Trampoline did not arise from Snell's performance of landscaping, and that there was no coverage for such claims.

In addition the application which predated the policy specifically asked Snell: "do you do any recreational or playground equipment construction or erection?" In response, Snell checked the "No" box.

DISCUSSION

Snell Has The Burden To Show Coverage.

Under Alabama law the party seeking coverage under a policy bears the burden of proving that coverage exists.  In short, the Specified Operations provision (fitting into the gap left by the general coverage provision) describes the contours or boundaries of coverage-it does not purport to take away coverage already granted.

Thus, the Specified Operations provision is a limitation of coverage-not an exclusion.

Snell Has Not Shown That United Had A Duty To Defend Him.

Because Snell's insurance application-which Alabama law requires the Eleventh Circuit to consider part of the policy-expressly disclaims the work he did here. Under Alabama law, insurance contracts are subject to the same rules of interpretation as any other contract. It was undisputed that the trampoline is "recreational equipment."

Accordingly, the Eleventh Circuit concluded that the information Snell provided in his insurance application conclusively established he was not entitled to coverage. The Eleventh Circuit concluded that Snell's insurance application forecloses any duty to indemnify for the same reason it forecloses any duty to defend.

Bad Faith

Generally, to prove a claim for bad faith refusal to pay an insurance claim, the plaintiff has the burden to prove

1. the existence of an insurance contract;
2. an intentional refusal to pay the claim; and
3. the absence of any lawful basis for the refusal and the insurer's knowledge of that fact or the insurer's intentional failure to determine whether there is any lawful basis for its refusal.

The District Court, having found that United had a lawful basis for denying Snell's claim and that Snell's breach of contract claim fails, his claim for bad faith denial also fails.  Snell did not show it was error to grant summary judgment on his bad faith claim.

ZALMA OPINION

The Commercial General Liability insurance policy issued to Mr. Snell, insured Snell against many risks of loss as long as they occurred as a result of his occupation as a landscaper that has no act that did not include any recreational or playground equipment construction or erection. Since the trampoline he installed was clearly an item of recreational or playground equipment thee was no potential for coverage to exist to defend or indemnify Snell for the injuries incurred when a child using the trampoline injured herself.

(c) 2024 Barry Zalma & ClaimSchool, Inc.

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00:08:14
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Sovereign Immunity Prevents Suit Against USA

Chutzpah: After Criminal Prosecution Defendant Sues USA
Post 5164

See the full video at https://lnkd.in/g_QAZY-d and at https://lnkd.in/gbF7vMxG and at https://zalma.com/blog plus more than 5150 posts.

Dr. Segun Patrick Adeoye, a medical doctor, filed a lawsuit against the United States of America, seeking damages for alleged violations during his criminal prosecution. He was acquitted by a jury but claims to have suffered significant harm, including financial losses, damage to his professional reputation, and personal distress.

In Dr. Segun Patrick Adeoye v. The United States Of America, Civil Action No. 4:25-cv-83, United States District Court, E.D. Texas, Sherman Division (July 23, 2025) the USDC dismissed Adeoye’s suit.

FACTUAL BACKGROUND

Dr. Adeoye was indicted on charges of conspiracy to commit wire fraud and money laundering. The indictment alleged that he and his co-conspirators obtained at least seventeen million dollars through various fraudulent schemes. Despite being acquitted, Dr. Adeoye claims that his ...

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11 hours ago
Amount of Loss Set by Appraisal Award

Payment of Appraisal Award Defeats Claim of Bad Faith
Post 5163

Read the full article at https://lnkd.in/dNpKKcYx, see the full video at https://lnkd.in/dNgwRP8q and at https://lnkd.in/dA9dvd-D, and at https://zalma.com/blog plus more than 5150 posts.

Hurricane Damage to Dwelling Established by Appraisal Award

In Homeowners Of America Insurance Company v. Emilio Menchaca, No. 01-23-00633-CV, Court of Appeals of Texas, First District (July 31, 2025) after a hurricane Homeowners of America Insurance Company (“HAIC”) estimated that the cost of covered repair to Menchaca’s house was $3,688.54, which was less than his deductible, and therefore no payment would be made.

FACTS

After Menchaca retained counsel HAIC advised that, under the terms of the policy, Menchaca was required to first invoke the appraisal process prior to filing suit, and that HAIC reserved the right to request that Menchaca and any adjuster hired on his behalf submit to an Examination Under Oath (“EUO”).

On August 23, 2018, Menchaca’s counsel ...

00:08:45
August 07, 2025
Amount of Loss Set by Appraisal Award

Payment of Appraisal Award Defeats Claim of Bad Faith
Post 5163

Read the full article at https://lnkd.in/dNpKKcYx, see the full video at https://lnkd.in/dNgwRP8q and at https://lnkd.in/dA9dvd-D, and at https://zalma.com/blog plus more than 5150 posts.

Hurricane Damage to Dwelling Established by Appraisal Award

In Homeowners Of America Insurance Company v. Emilio Menchaca, No. 01-23-00633-CV, Court of Appeals of Texas, First District (July 31, 2025) after a hurricane Homeowners of America Insurance Company (“HAIC”) estimated that the cost of covered repair to Menchaca’s house was $3,688.54, which was less than his deductible, and therefore no payment would be made.

FACTS

After Menchaca retained counsel HAIC advised that, under the terms of the policy, Menchaca was required to first invoke the appraisal process prior to filing suit, and that HAIC reserved the right to request that Menchaca and any adjuster hired on his behalf submit to an Examination Under Oath (“EUO”).

On August 23, 2018, Menchaca’s counsel ...

00:08:45
July 16, 2025
There is no Tort of Negligent Claims handling in Alaska

Rulings on Motions Reduced the Issues to be Presented at Trial

Read the full article at https://lnkd.in/gwJKZnCP and at https://zalma/blog plus more than 5100 posts.

CASE OVERVIEW

In Richard Bernier v. State Farm Mutual Automobile Insurance Company, No. 4:24-cv-00002-GMS, USDC, D. Alaska (May 28, 2025) Richard Bernier made claim under the underinsured motorist (UIM) coverage provided in his State Farm policy, was not satisfied with State Farm's offer and sued. Both parties tried to win by filing motions for summary judgment.

FACTS

Bernier was involved in an auto accident on November 18, 2020, and sought the maximum available UIM coverage under his policy, which was $50,000. State Farm initially offered him $31,342.36, which did not include prejudgment interest or attorney fees.

Prior to trial Bernier had three remaining claims against State Farm:

1. negligent and reckless claims handling;
2. violation of covenant of good faith and fair dealing; and
3. award of punitive damages.

Both Bernier and State Farm dispositive motions before ...

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May 15, 2025
Zalma's Insurance Fraud Letter - May 15, 2025

ZIFL Volume 29, Issue 10
The Source for the Insurance Fraud Professional

See the full video at https://lnkd.in/gK_P4-BK and at https://lnkd.in/g2Q7BHBu, and at https://zalma.com/blog and at https://lnkd.in/gjyMWHff.

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 ...

May 15, 2025
CGL Is Not a Medical Malpractice Policy

Professional Health Care Services Exclusion Effective

Post 5073

See the full video at https://lnkd.in/g-f6Tjm5 and at https://lnkd.in/gx3agRzi, and at https://zalma.com/blog plus more than 5050 posts.

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 ...

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