Failure to Name a Party as an Additional Insured Defeats Claim
Post 5104
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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. (Plaintiff).
Venchi 2 LLC is insured by Sentinel Insurance Company, Ltd. (Defendant) through its parent entity Venchi U.S. Inc. .
Claims:
Associated sought a summary judgment declaring that Sentinel has a duty to defend and indemnify CAEA in the underlying action, and that Sentinel’s coverage is primary while Associated’s coverage is excess .
Sentinel opposed this and sought a summary judgment for itself, declaring that CAEA does not qualify as an additional insured under the policy held by Venchi U.S., and therefore, Sentinel does not have a duty to defend and indemnify CAEA.
Court’s Decision:
The court denied Associated’s motion for summary judgment and granted Sentinel’s motion for summary judgment.
The court held that CAEA is not entitled to additional-insured coverage under the Sentinel policy, and therefore, Sentinel does not have a duty to defend and indemnify CAEA in the underlying action.
BACKGROUND
On September 20, 2018, Eduardo Molina, a construction worker, allegedly fell from a scaffold while working on a project at 861 Broadway, New York, NY. Molina sued Venchi 2, CAEA, and Transworld Equities, Inc., asserting claims of common law negligence and failure to provide a safe workplace under New York Labor Law and the Industrial Code.
INSURANCE POLICIES
1. Sentinel Policy: Issued to Venchi U.S. for the period October 13, 2017, to October 13, 2018. Venchi U.S. is the only named insured .
2. Associated Policy: Issued to Transworld Equities, Inc. for the period April 16, 2018, to April 16, 2019. CAEA is identified as a named insured .
CONCLUSION
The court concluded that Sentinel does not have a duty to defend and indemnify CAEA in the underlying action, and Sentinel was not required to reimburse Associated for any costs incurred.
DISCUSSION
Under New York law it is well-established that courts determining a dispute over insurance coverage must first look to the language of the policy. The language of the policy is then to be interpreted according to general rules of contract interpretation. An insurance contract is interpreted to give effect to the intent of the parties as expressed in the clear language of the contract.
If a contract is unambiguous, courts are required to give effect to the contract as written and may not consider extrinsic evidence to alter or interpret its meaning. A contract is not ambiguous if the language it uses has a definite and precise meaning, unattended by danger of misconception in the purport of the agreement itself and concerning which there is no reasonable basis for a difference of opinion. Unambiguous provisions of an insurance policy are to be given their plain and ordinary meaning, and the plain and ordinary meaning of words may not be disregarded to find an ambiguity where none exists.
Given the Court’s holding that CAEA is not entitled to additional-insured coverage, the Court further held that:
1. Sentinel does not have a duty to defend and indemnify CAEA in the Underlying Action, which moots Associated’s further request for relief regarding a declaration that Associated’s coverage is excess; and
2. Sentinel is not required to reimburse for costs incurred or that will be incurred in defending and, if necessary, indemnifying CAEA in the Underlying Action.
For the foregoing reasons, the Court granted Sentinel’s motion for summary judgment and denied Associated’s motion for summary judgment was granted.
ZALMA OPINION
A person can only become an “additional insured” on a liability policy if named on the policy itself as an additional insured or by the terms of the contract – even if unnamed – the person or entity is entitled to additional insured rights. The right to a defense did not exist because the court concluded from the clear and unambiguous language of the policy there was no coverage owed by Sentinel to CAEA.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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ZIFL – Volume 29, Issue 15
Read the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/07/ZIFL-08-01-2025.pdf, at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-august-1-2025-barry-zalma-esq-cfe-eailc, see the full video at and at and at https://zalma.com/blog plus more than 5150 posts.
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Post 5159
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/
Read the full 24 Page August 1, 2025 issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/07/ZIFL-08-01-2025.pdf
The Contents of the August 1, 2025 Issue of ZIFL Includes
No Good Deed Goes Unpunished
GEICO Sued Fraudulent Health Care ...
Unjust Enrichment is an Non-Contract Remedy
Post 5158
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When an Insurer is Defrauded it Should Sue For Fraud Only
MONY Life Insurance Company v. Bernard R. Perez, No. 23-10770, United States Court of Appeals, Eleventh Circuit (July 23, 2025) resulted in a decision that allows an insured of a Disability Insurance policy to successfully defraud his insurer.
The case involved a dispute between MONY Life Insurance Company and Bernard R. Perez, an ophthalmologist, over a disability insurance contract. Perez was diagnosed with throat cancer in 2011 and began receiving monthly disability benefits from MONY. However, MONY later suspected Perez of dishonesty in his disability claims and discontinued payments in 2018.
FACTS
In 1987, ophthalmologist Bernard R. Perez formed a for-profit medical practice in Tampa, Florida. Soon thereafter, in June 1988, Perez applied for, and, in September 1988, was ...
Unjust Enrichment is an Non-Contract Remedy
Post 5158
See the full video at https://lnkd.in/gv2iv_St and at https://lnkd.in/gdqVihMa, and at https://zalma.com/blog plus more than 5150 posts.
When an Insurer is Defrauded it Should Sue For Fraud Only
MONY Life Insurance Company v. Bernard R. Perez, No. 23-10770, United States Court of Appeals, Eleventh Circuit (July 23, 2025) resulted in a decision that allows an insured of a Disability Insurance policy to successfully defraud his insurer.
The case involved a dispute between MONY Life Insurance Company and Bernard R. Perez, an ophthalmologist, over a disability insurance contract. Perez was diagnosed with throat cancer in 2011 and began receiving monthly disability benefits from MONY. However, MONY later suspected Perez of dishonesty in his disability claims and discontinued payments in 2018.
FACTS
In 1987, ophthalmologist Bernard R. Perez formed a for-profit medical practice in Tampa, Florida. Soon thereafter, in June 1988, Perez applied for, and, in September 1988, was ...
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 ...
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
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 ...
