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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Breach of Contract is not a Tort
It Doesn’t Pay to Over Charge a Suit Against an Insurer
Post 5116
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In Kole Westwood and Keeley Westwood v. The Travelers Home And Marine Insurance Company and Aaron Harrigfeld, No. 2:24-cv-00719-JNP-DBP, United States District Court, D. Utah (June 30, 2025) the case against the engineer failed completely and the case against Travelers was limited to the claim that the insurance contract was breached.
CASE BACKGROUND
Plaintiffs Kole and Keeley Westwood are homeowners in Utah whose home was damaged in a severe winter storm. The roof buckled under the weight of snow and ice, causing water damage to the house.
Their insurer, Travelers, denied their claim based on an engineering inspection report prepared by Defendant Aaron Harrigfeld. The Westwoods allege that the report contained false representations about the history ...
Motions in Limine Used to Limit Trial and Expert Testimony
Post 5116
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Trial Judge Must Limit Experts to Testimony that will Aid the Jury
The case brought by Plaintiff Gary Cawley and others against American Financial Security Life Insurance Company and others was before United States District Court for the District of Arizona’s Honorable Steven P. Logan, United States District Judge.
In Gary Cawley, et al. v. American Financial Security Life Insurance Company, et al., No. CV-22-00823-PHX-SPL, United States District Court, D. Arizona (July 2, 2025) Judge Logan resolved dozens of motions in limine filed by the parties.
Motions in Limine
Judge Logan issued orders relating to various motions in limine filed by both Plaintiffs and Defendant recognizing that a motion in limine is a procedural mechanism to limit testimony or evidence in a particular area and the practice has developed ...
A Court Will Never Accept Legal Conclusions in a Suit
Post 5115
A Contract Cannot Legally Bind A Person Or Entity Which Is Not A Party To The Contract.
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The plaintiff, Nataly Gasova, claimed a breach of contract related to an insurance policy which IISS sold to her. IISS moved to dismiss the complaint, arguing inter alia that there was no contract between these parties. Gasova moved to amend her complaint to abandon her breach of contract claim and instead bring claims related to the advertising and sale of the insurance policy.
In Nataly V. Gasova v. Intact Insurance Specialty Solutions, Civ. No. 1:24-CV-2279, United States District Court, M.D. Pennsylvania (June 26, 2025) Intact Insurance Specialty Solutions (“IISS”) moved the court to dismiss the suit.
Background
On November 4, 2023, Gasova was involved in an automobile accident while working as a rideshare driver. ...
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 ...
A Heads I Win, Tails You Lose Story
Post 5062
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...
