“Accident” Includes Continuous or Repeated Exposure to Conditions
Post 5176
“Occurrence” is an Accident & Includes Repeated Damage
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In The Cobblestone Lofts Condominium v. Great American Insurance Company, Admiral Indemnity Company et al., Appeal No. 4265, 2025 NY Slip Op 04749, Index No. 653189/21, Case No. 2024-01860, Supreme Court of New York, First Department (August 21, 2025) the court resolved the issues.
FACTS
The Supreme Court of New York, First Department (trial court) dealt with a declaratory judgment action concerning an insurance coverage dispute. The plaintiff, a condominium association, was being sued for property damage and bodily injury caused by unintended water and moisture infiltration, resulting in toxic contamination of a condominium unit. The infiltration was allegedly caused by the plaintiff’s breaches of its contractual obligations under its bylaws and condominium declarations, as well as violations of statutory duties under the Multiple Dwelling Law and the Administrative Code of the City of New York.
PRIMARY ISSUE
The was asked to resolve whether the Great American Insurance Company was obligated to provide coverage for the plaintiff under its policy. The policy covers liability for bodily injury and property damage caused by an “occurrence,” which includes continuous or repeated exposure to harmful conditions.
Great American argued that the alleged damages were caused by the plaintiff’s breaches of its bylaws and condominium declarations, and not by an accident. However, the term “occurrence” in the policy includes continuous exposure to harmful conditions caused by breaches of contract or statutory violations.
THE ORDER
The Supreme Court, New York County (Louis L. Nock, J.), order granted plaintiff’s motion for summary judgment on its second cause of action declaring that defendant Great American Insurance Company was obligated to provide coverage for plaintiff.
Great American issued a “direct, definitive notice” to plaintiff disclaiming coverage. By letter dated September 17, 2018, Great American notified plaintiff that its policy does not afford coverage because:
1. a breach of contract is not an accident and, therefore, does not constitute an “occurrence” under the Primary Policy or Umbrella Policy and
2. because the Primary Policy excludes coverage for breach of contract.
Contrary to Great American’s argument, the denial letter is a repudiation of plaintiff’s rights. Great American will be obligated to indemnify plaintiff for any liability imposed upon it in the underlying action that is in excess of the policy issued by Admiral Indemnity Company the primary insurer to Great American’s umbrella policy.
The Great American policy covers liability for bodily injury and property damage “that takes place during the Policy Period and is caused by an ‘occurrence’ happening anywhere…” The term “occurrence” is defined, in relevant part, to mean “an accident, including continuous or repeated exposure to substantially the same general harmful conditions.” Under this definition, the term “occurrence” includes within its scope continuous exposure to a harmful condition alleged, as in the underlying action, to have been caused by the insured’s breaches of contract or violations of statutory or regulatory duties.
Great American argued that the alleged “bodily injury” and “property damage” were caused by plaintiff’s breaches of its bylaws and condominium declarations, and not by an accident. The policy defines “accident” to include “continuous or repeated exposure to substantially the same general harmful conditions,” which is exactly what was alleged in the underlying action.
The court declared that Great American is obligated to indemnify the plaintiff for any liability imposed in the underlying action that exceeds the policy issued by Admiral Indemnity Company.
ZALMA OPINION
Fortuity is a required element of every liability insurance policy determined by the definition of “occurrence” in the policy. Since the cause of damage was found by the trial court to be a result of continuous or repeated exposure to harmful conditions, it concluded the loss was due to a fortuitous “occurrence” and Great American must pay damages that could be found against the Plaintiff Condominium.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Private Limitation In Accordance With Statute Defeats a Claim
Post 5204
There is No Good Reason to Delay Filing Suit
In Christian Care Center v. American Alternative Insurance Corporation, Civil Action No. 4:25-CV-00321-O, United States District Court, N.D. Texas, Fort Worth Division (October 6, 2025) a private limitation of action provision effective barred the suit.
KEY FACTS:
Plaintiff and Defendant:
The case involves an insured, the Christian Care Center (Plaintiff) and its insurer American Alternative Insurance (Defendant) in a coverage dispute.
Loss Event:
Plaintiff’s property sustained damage due to a storm on April 27, 2020.
Insurance Claim:
Plaintiff submitted a claim to Defendant on February 2, 2022, which was denied on July 29, 2022.
Lawsuit:
Plaintiff sued alleging breach of contract and violations of Chapters 541 ...
Insured May Intervene to Assert Bad Faith Claim Not Assigned
Post 5203
See the full video at https://rumble.com/v7013x8-insured-cant-assign-bad-faith-claim.html and at https://youtu.be/e8OApzn6YZs, and at https://zalma.com/blog plus more than 5200 posts.
Judge Requires Conflict Between Different District Courts in Louisiana Requires Conflict to be Resolved on Appeal
In Allstate Construction, Inc. v. Ohio Security Insurance Company, Civil Action No. 23-01295-BAJ-SDJ, United States District Court, M.D. Louisiana (September 30, 2025) Vina Cleaners, the insured, assigned its claim against Ohio Security to Allstate Construction but did not assign its rights to sue for the tort of bad faith so it intervened in Allstate Construction’s suit.
Background and Procedural History:
In an insurance dispute following damage caused by Hurricane Ida to Vina Cleaners’ property. Vina Cleaners was insured under a commercial policy with the Defendant, Ohio Security Insurance Company. Vina Cleaners assigned its rights ...
Willful and Malicious Injury by the Debtor to Another Entity is Nondischargeable
Intentional Conduct Causing Injury not Dischargeable in Bankruptcy
Post 5202
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In In re Niko T. Irizarry, Mark Riley v. Niko T. Irizarry, No. 2:24-bk-01261-FMD, Adv. No. 2:24-ap-00035-FMD, United States Bankruptcy Court, M.D. Florida, Fort Myers Division (September 30, 2025) established that fraudulent conduct is not dischargeable in Bankruptcy.
Background and Allegations:
Plaintiff Mark Riley filed a lawsuit against Defendant Niko Irizarry in federal district court, alleging claims for civil conspiracy under 42 U.S.C. § 1983, malicious prosecution, violation of his Fourteenth Amendment rights, common law false imprisonment or arrest, and intentional infliction of emotional distress. Riley’s claims are based on allegations with...
How a Need for Profit Led Health Care Providers to Crime
Post 5185
Posted on September 8, 2025 by Barry Zalma
See the full video at https://lnkd.in/gePN7rjm and at https://lnkd.in/gzPwr-9q
This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers.
The Dishonest Chiropractor/Physician
How a Need for Profit Led Health Care Providers to Crime
See the full video at and at
This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help 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.
How Elderly Doctors Fund their ...
How a Need for Profit Led Health Care Providers to Crime
Post 5185
Posted on September 8, 2025 by Barry Zalma
See the full video at https://lnkd.in/gePN7rjm and at https://lnkd.in/gzPwr-9q
This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers.
The Dishonest Chiropractor/Physician
How a Need for Profit Led Health Care Providers to Crime
See the full video at and at
This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help 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.
How Elderly Doctors Fund their ...
Barry Zalma: Insurance Claims Expert Witness
Posted on September 3, 2025 by Barry Zalma
The Need for a Claims Handling Expert to Defend or Prove a Tort of Bad Faith Suit
© 2025 Barry Zalma, Esq., CFE
When I finished my three year enlistment in the US Army as a Special Agent of US Army Intelligence in 1967, I sought employment where I could use the investigative skills I learned in the Army. After some searching I was hired as a claims trainee by the Fireman’s Fund American Insurance Company. For five years, while attending law school at night while working full time as an insurance adjuster I became familiar with every aspect of the commercial insurance industry.
On January 2, 1972 I was admitted to the California Bar. I practiced law, specializing in insurance claims, insurance coverage and defense of claims against people insured and defense of insurance companies sued for breach of contract and breach of the implied covenant of good faith and fair dealing. After 45 years as an active lawyer, I asked that my license to practice law be declared inactive ...