DEFINITION OF “CONTRACTOR” CONTROLLED CONTRACT INTERPRETATION
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The Eleventh Circuit was asked to resolve who was responsible for a workers’ compensation claim filed by Steven Brock, who was injured while driving a truck for Stafford Transport of Michigan, Inc., while Brock, an authorized driver for Kenneth Carver Trucking Company, LLC, was not covered by workers’ compensation insurance at the time of his accident. However, Stafford had three insurance policies, including a contingent-liability policy issued by Crum.
In Stafford Transport Of Michigan, Inc., d.b.a CEI, d.b.a. Custom Ecology, Great American Alliance Insurance Company v. Crum & Forster Specialty Insurance Company, No. 24-12058, United States Court of Appeals, Eleventh Circuit (February 4, 2025) the Eleventh Circuit was asked to provide coverage for Mr. Brock who had become a paraplegic as a result of the accident.
The district court ruled in favor of Stafford and Great American, stating that Brock was a covered person under the contingent-liability policy. Crum appealed, arguing that Brock was not a covered person and that exclusions applied.
ANALYSIS
On September 9, 2021, Brock filed a claim against Stafford and Great American before the Georgia State Board of Workers’ Compensation seeking payment of workers’ compensation benefits as Stafford’s statutory employee. Great American demanded that Crum defend Stafford against the claim.
Stafford entered into a consent agreement with Brock stating that he was a statutory employee of Stafford. Crum then confirmed that it would not extend coverage under the contingent-liability policy because Brock was not a covered person under the contract as an “Owner/Operator” or “Contractor” of Stafford and did not have a fully executed contract with Stafford.
A contractor is defined as someone who is a party to a contract or a person or company that agrees to do work or provide goods for another company. And contrary to Crum’s argument, the district court was allowed to look at the contract as a whole to determine the reasonable interpretation of that term.
Brock had a covered contract with Stafford through the Kenneth Carver Trucking agreement. The policy states that owner/operators and contractors must “[h]ave a written covered contract with” Stafford. A “Covered Contract means a fully executed contract between a Covered Person” and Stafford. As the Eleventh Circuit explained, a covered person includes owner/operators and contract drivers. And the use of the plural “Covered Person(s)” that “[h]ave a written covered contract,” in contrast to the other three requirements, which use singular verbs, means members of the owner/operator and contract driver group can collectively have a single contract, while the other conditions must be satisfied by one individual. So, Brock had a written covered contract with Stafford based on the Kenneth Carver Trucking agreement, even without an individual contract.
The Eleventh Circuit concluded that the district court correctly rejected Crum’s argument that the Kenneth Carver Trucking agreement was not fully executed even though Stafford did not sign the agreement. Kenneth Carver Trucking signed the agreement, and Stafford’s acceptance could be inferred.
The summary judgment in favor of Stafford and Great American was affirmed.
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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 ....
Failure to Name a Party as an Additional Insured Defeats Claim
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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:
CAEA is insured by Associated Industries Insurance Company, Inc. ...
Exclusion Establishes that There is No Duty to Defend Off Site Injuries
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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
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 ...
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
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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...
