It is Inappropriate to Argue a Win Was Wrong and a New Result is Required
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Post 4829
Defendant, Bankers Insurance Company (“Bankers Insurance”), moved to vacate the Panel Appraisal Award Amendment & Clarification (“Amended Award”) based on three alleged “significant errors” or “clear mistakes of fact” only to see an unfavorable response in St. Joseph Medical Clinic AMC v. Bankers Insurance Company, Civil Action No. 22-4521, United States District Court, E.D. Louisiana (June 17, 2024)
BACKGROUND
This case concerns an insurance coverage dispute arising from damages sustained during Hurricane Ida. At the parties’ request, an appraisal panel provided an award in September 2022 (the “Initial Award”). The Initial Award provided for $1,066,798.39 (RCV) under the policy’s Building coverage and $12,729.86 under the policy’s Business Property coverage. Bankers Insurance disagreed with the Initial Award’s inclusion of a $61,485.00 expense for “Rose Office Systems, Inc.” (“Rose Systems”) within the Building coverage. Bankers Insurance took the position in its correspondence that the Rose Systems expense should be categorized within the Extra Expense coverage, yet Bankers Insurance chose not to pursue this objection and filed an unconditional motion to confirm in May 2023.
The Honorable Donna Currault presiding, denied the motion. The Court identified the possibility of double counting as a potential significant error that required clarification by the panel. The matter was remanded for that clarification. The Court identified no other errors in the award.
The panel issued an Amended Award in January 2024. The Amended Award explained that the panel had included the Rose Systems expense within the Building coverage and provided its reasoning for doing so. The Amended Award further provided a complete calculation of damages for all the other coverages, including Extra Expense coverage ($0.00 awarded) and Business Income Loss ($270,409.96 awarded). The Amended Award confirms there was no double-counting.
Bankers Insurance waited until May 2024 to move to vacate based on the same alleged Rose Systems error of which it was aware when it filed its prior motion to confirm in October 2022.
ANALYSIS
Appraisal clauses are enforceable under Louisiana law. The burden of demonstrating that the award should not be confirmed must fall upon the party challenging it. Contractually specified appraisal awards are presumed accurate. Although appraisal awards are presumed correct, a court is not bound to confirm an award that contains clear mistakes of fact. When an award reflects accidental double-counting that duplicates certain items or categories, that is the type of clear error that cannot stand.
Bankers Insurance’s Belated Objection To The Panel’s Treatment Of The Rose Systems Expense Is Subject To Judicial Estoppel And Lacks Merit.
If Bankers Insurance were to prevail on its first argument and its second argument, the Rose Systems expense would be subject to a lower policy limit. Bankers Insurance’s first two arguments collapse under the weight of its prior litigation strategy.
Bankers Insurance moved to confirm the Initial Award, which concluded that the Rose Office Systems expense fell within the Building coverage. Bankers Insurance made a strategy decision to abandon this objection when moving to confirm the Initial Award.
The USDC concluded that Bankers Insurance’s prior litigation conduct subjected it to judicial estoppel. Courts can invoke judicial estoppel to prevent a party from asserting a position in a legal proceeding that is inconsistent with a position taken in a previous proceeding.
Bankers Insurance asked the Court to rule that the Initial Award set the total amount of damages in this matter, including relative to an award of $1,046,255.76 under building coverage. In this motion Bankers Insurance asks the Court to vacate the Initial Award because, it contends, the Initial Award’s Building coverage determination was error. The two positions were irreconcilable.
Bankers Insurance’s Argument Relative To Lost Business Income Misstates The Panel’s Position And Lacks Merit.
Bankers Insurance’s argument does not refer to any actual calculation error-merely an alleged error in terminology-and the mischaracterization of the panel’s reasoning renders this argument confusing, at best.
CONCLUSION
Now, Bankers Insurance seeks to prevail by arguing that the Initial Appraisal suffered from a separate significant error, which has carried over into the Amended Appraisal and requires its vacatur. This attempt to “prevail, twice, on opposite theories,” renders Bankers Insurance the “quintessential ‘chameleonic litigant’ against whom judicial estoppel is usually appropriate.”
ZALMA OPINION
Appraisals often raise disputes over the finding of the appraisers. Bankers, although it disagreed with some findings of the appraisers, moved the court to affirm the award. The court sent the dispute back to the appraisers who submitted an amended award only for Bankers, to try to have the court apply the argument it originally abandoned. Judicial estoppel disposed of Bankers’ argument and the amended award was affirmed. Parties to appraisal awards should stick to their position and never change their position first accepted by the court only to ask it to do something different.
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Concurrent Cause Doctrine Does Not Apply When all Causes are Excluded
Post 5119
Death by Drug Overdose is Excluded
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Southern Insurance Company Of Virginia v. Justin D. Mitchell, et al., No. 3:24-cv-00198, United States District Court, M.D. Tennessee, Nashville Division (October 10, 2024) Southern Insurance Company of Virginia sought a declaratory judgment regarding its duty to defend William Mitchell in a wrongful death case pending in California state court.
KEY POINTS
1. Motion for Judgment on the Pleadings: The Plaintiff moved for judgment on the pleadings, which was granted in part and denied in part.
2. Duty to Defend: The court found that the Plaintiff has no duty to defend William Mitchell in the California case due to a specific exclusion in the insurance policy.
3. Duty to Indemnify: The court could not determine at this stage whether the Plaintiff had a duty to ...
GEICO Sued Fraudulent Health Care Providers Under RICO and Settled with the Defendants Who Failed to Pay Settlement
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Post 5119
Default of Settlement Agreement Reduced to Judgment
In Government Employees Insurance Company, Geico Indemnity Company, Geico General Insurance Company, and Geico Casualty Company v. Dominic Emeka Onyema, M.D., DEO Medical Services, P.C., and Healthwise Medical Associates, P.C., No. 24-CV-5287 (PKC) (JAM), United States District Court, E.D. New York (July 9, 2025)
Plaintiffs Government Employees Insurance Company and other GEICO companies (“GEICO”) sued Defendants Dominic Emeka Onyema, M.D. (“Onyema”), et al (collectively, “Defendants”) alleging breach of a settlement agreement entered into by the parties to resolve a previous, fraud-related lawsuit (the “Settlement Agreement”). GEICO moved the court for default judgment against ...
ZIFL – Volume 29, Issue 14
Post 5118
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You can read the full 20 page issue of the July 15, 2025 issue at https://lnkd.in/giaSdH29
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
This issue contains the following articles about insurance fraud:
The Historical Basis of Punitive Damages
It is axiomatic that when a claim is denied for fraud that the fraudster will sue for breach of contract and the tort of bad faith and seek punitive damages.
The award of punitive-type damages was common in early legal systems and was mentioned in religious law as early as the Book of Exodus. Punitive-type damages were provided for in Babylonian law nearly 4000 years ago in the Code of Hammurabi.
You can read this article and the full 20 page issue of the July 15, 2025 issue at https://zalma.com/blog/wp-content/uploads/2025/07/ZIFL-07-15-2025.pdf
Insurer Refuses to Submit to No Fault Insurance Fraud
...
Rulings on Motions Reduced the Issues to be Presented at Trial
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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 ...
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
Post 5073
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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 ...