USDC Dismisses Multiple Counts Against Insurer
Post 5038
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Vincent Cusumano and Vincent Cusumano Architect P.C. (VCA), alleged that the defendants, Berkshire Hathaway issued a professional liability policy with a three-month gap in coverage, which precluded coverage for claims arising from prior work. The plaintiffs asserted thirteen causes of action, including breach of contract, promissory estoppel, and common law fraud.
In Vincent Cusumano Architect P.C. and Vincent Cusumano v. Berkshire Hathaway Direct Insurance Company d/b/a Three By Berkshire Hathaway, Todd Sharpee, John Does 1-10 names being fictitious and unknown, and ABC Corps. 1-10 names being fictitious and unknown, Civil Action No. 23-cv-22970 (JXN)(JSA), United States District Court, D. New Jersey (March 29, 2025) dismissed multiple causes of action.
COUNTS DISMISSED
The court dismissed several counts in the case for the following reasons:
1. Declaratory Judgment (Count 1):
The court found that the declaratory judgment claim was duplicative of the breach of contract claim. Since the breach of contract claim would resolve the same issue, the declaratory judgment was deemed unnecessary.
2. Specific Performance (Count 2):
The court dismissed this claim because specific performance is an equitable remedy, not an independent cause of action. Plaintiffs cannot amend their complaint through opposition briefs.
3. Breach of Contract (Count 3):
The court dismissed this claim because the plaintiffs failed to identify a provision within the insurance contract that the defendants breached. The policy’s terms were clear and did not cover the underlying claim.
4. Quantum Meruit/Unjust Enrichment (Count 5):
The court dismissed this claim because the existence of an express and enforceable contract (the Berkshire Policy) precludes a claim for unjust enrichment.
5. Breach of Covenant of Good Faith and Fair Dealing (Count 6):
The court dismissed this claim as it was duplicative of the breach of contract claim and failed to establish bad faith under New Jersey law.
Common Law Fraud (Count 7):
6. The court dismissed this claim because the plaintiffs could not establish reasonable reliance in the face of clear contradictory language in the insurance policy.
7. Breach of Fiduciary Duty (Count 12):
The court dismissed this claim because the insurance agent owed a fiduciary duty to the insurance company, not to the insured.
The USDC determined that the suit can proceed on the remaining counts but concluded that the 7 counts dismissed were not viable.
ZALMA OPINION
When a person or entity sues an insurance company they often throw in the kitchen sink of causes of action. The architect did just that and found that seven of at least 13 causes of action were not viable and the remaining counts will face either an additional motion for summary judgment or at trial.
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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 ...
