Insurance Industry

Experience

Anonymous Plaintiff v. Insurance Company

Plaintiff filed suit for benefits under a life insurance policy. The carrier denied coverage because the policy terminated and the reinstatement application was still pending when the policyholder passed away. We removed the case to federal court and obtained summary judgment, defeating a cross-motion for summary judgment which attempted under a state supreme court decision to have coverage bound upon tender of the application. After briefing and oral argument, the Third Circuit Court of Appeals affirmed summary judgment for the carrier.

Anonymous Plaintiff v. Self-Insured Large Corporation

We handled multiple Scott-Pontzer claims for Self-Insured Large Corporation, including one lawsuit alleging seven figure damages. All claims were appropriately denied or dismissed based on arguments as to the inapplicability of the Scott-Pontzer line of cases to self-insureds. We also filed an amicus curiae brief in the Ohio Supreme Court arguing the same and urging reversal of Scott-Pontzer. The court then abandoned Scott-Pontzer in a contemporaneous case.

Anonymous Plaintiffs / Claimants v. Insurance Company

Serving as national counsel, we provide coverage opinions and advise carrier as to appropriate and consistent claims handling for multiple property claims, including hurricane, wind, fire, vandalism, water damage, hail, and similar perils. Where applicable, we manage local counsel and help shape strategy for discovery, briefing, trial, and settlement. We have defended depositions, defended subpoenas, and mediated claims on the client's behalf. We also directly defend such claims regionally. We have performed similar functions as national coordinating counsel for mold, Y2K, and liability/casualty claims.

Breach of Contract and Tort Claims Against Insurance Benefits Company

An insurance benefits company acquired the assets of another company operating as third-party administrator. Shortly after acquisition, the third-party administrator was sued, along with the insurance benefits company for various breach of contract and tort claims. The matters at issue include successor liability, enforceability of arbitration clause and indemnification and indemnity claims.

Consumer / Commercial Litigation

Successful defense of financial institutions, loan servicers and finance companies in multiple claims and cases involving borrower allegations of predatory lending and violation of state and federal consumer protection statutes. Our representation also included the resolution of force-placed insurance claims and title defects.

Credit Life Insurance Policy

Represented insurer in U.S. District Court for the Southern District of West Virginia in a case involving a credit life insurance policy. The court granted summary judgment to our client.

Defense of Bad Faith and Breach of Contract Claims

When an insurance company faced allegations of bad faith and breach of contract for denying coverage for fire loss claims made by an insured, they turned to Dinsmore for counsel. A fire occurred at the plaintiff’s residence while he was at work, which resulted in property damage. The plaintiff then filed a claim under their homeowners’ policy. During the investigation, it was determined that the plaintiff misrepresented his financial condition and the value of jewelry and other household items allegedly lost in the fire. Additionally, an independent investigator concluded that the fire was intentionally set. Our client subsequently denied the plaintiff’s claim for breaching the “Concealment or Fraud” provision of the policy. The plaintiff then filed suit against our client for bad faith and breach of contract. Both parties moved for summary judgment and our motion was granted by the U.S. District Court for the Northern District of Ohio. The court found that the plaintiff had made numerous misrepresentations during the investigation, and subsequently had violated the policy. The ruling disposed of the claims without the expense of a trial.

Drafting of Legislation

Assisted in the drafting of West Virginia's comprehensive insurance and civil justice reform legislation in 2005, including the repeal of third-party bad faith. Utilized extensive lobbying experience and training to coordinate and implement grassroots campaign, which included conducting opinion research and polling and a targeted media campaign to promote passage of significant legislation.

Employee Policyholder v. Insurance Agent

I successfully represented an insurance agent who had been sued for misrepresentation in selling an employee benefit plan to a small business. The plan included disability and life insurance benefits. When an employee sought substantial benefits beyond those set forth in the policy, I filed and argued a motion to dismiss, invoking contract law and the ERISA statute, which required benefits to be described in writing, preempting common law misrepresentation claims. I thus obtained a dismissal of claims from state court due to exclusive federal jurisdiction over the alleged claims for benefits beyond those set forth in the written ERISA plan.

Executive Spouse v. ERISA Benefit Plan for Large Corporation

I successfully represented an ERISA plan and plan administrator in a suit where a participant's spouse, during the course of a divorce, sought a share of the participant's retirement benefits via a qualified domestic relations order (QDRO). The QDRO that she sought was contrary to the plan's terms and it was denied by the plan administrator. Unhappy with the plan administrator's actions, the spouse sued in federal court to force a particular apportionment of the retirement benefits. Invoking the discretion conferred upon administrators, and highlighting some related procedural shortcomings in the spouse's efforts, I was able to obtain a dismissal of the suit.

Geneva Hager v. Large National Insurance Company

Our firm defended a large national insurance company on claims that it violated the Kentucky Unfair Claims Settlement Practices Act in implementing claim handling processes for casualty claims involving soft tissue injuries arising from minor impact automobile accidents which the plaintiff contended were improper. Class certification was denied, and thereafter the insurance company won a defense verdict in a highly publicized trial of the bad faith claim of the individual plaintiff who had sought $1.45 billion in damages.

Group of Employees v. Employee Leasing Company

We successfully negotiated a dismissal of our client from a suit involving alleged failure to provide health insurance. Certain employees claimed that our client was liable as the successor to a prior company which had experienced problems in setting up a self-insured ERISA plan. The prior company had utilized a third party administrator (TPA) to procure excess insurance coverage and to handle medical claims, but the TPA failed to procure the insurance or pay the claims. After investigating the claims for coverage under the ERISA plan, and analyzing the issues of successor liability, we obtained a dismissal of our client from the litigation.

Insurance Coverage Dispute Involving Allegations of Bad Faith

We represented an insurance company in a suit for breach of insurance contract and bad faith arising out of the client’s decision not to pay death benefits under an occupational accident insurance policy. The case was removed to federal court and summary judgment was granted in favor of the insurance company.

Insurance Coverage Dispute Involving Allegations of Bad Faith, Breach of Contract

We represented an insurance company in a suit for breach of insurance contract and bad faith arising out of the client’s decision not to pay disability benefits under an occupational accident insurance policy. The case was removed to federal court and the matter was resolved at mediation.

Insurance Coverage Opinion

I provided coverage opinions to a large insurance company on complex issues arising out of an alleged scheme by alcohol manufacturers to market and sell to underage consumers. The underlying plaintiffs sought to pursue a class action on behalf of the underage consumers and their parents, alleging intentional actions and certain negligent actions by the alcohol manufacturers. The manufacturers, in turn, sought insurance coverage. The coverage opinion addressed a number of issues, including the alleged marketing plans of these consumer products manufacturers and whether these could form the basis for a duty to defend or duty to indemnify under the insurance policies.

Insurance Defense Litigation

Retained by insurance company to defend its insureds in a variety of personal injury and property damage cases pending in Ohio and Kentucky.

Insurance Premium Tax Class Action Litigation

We defended a national insurance company in a putative class action case regarding the application of an insurance premium tax in the state of Kentucky. Kentucky statutes authorize Kentucky cities and counties to impose and collect a tax on insurance premiums. The statute permits insurance companies to collect the tax and keep a portion of the amount they have collected upon remittance of the appropriate amount to the taxing body. The proposed class consisted of all persons or entities in the state who paid a surcharge on their insurance premiums pursuant to a tax imposed by a local government. The proposed class definition contained no time limit as to the claims asserted.

The plaintiffs argued that the insurance premium tax should have been paid by the insurance companies, and not the policyholders. They also alleged that the tax had been miscalculated by the insurance company in some jurisdictions. The plaintiffs sought both declaratory and injunctive relief that the insurance companies be prohibited from collecting the tax from the policyholders. Alternatively, if it was determined that the companies were permitted to collect the tax from policyholders, the plaintiffs sought an accounting to determine if the tax had been properly calculated for each policyholder, with the cost of the accounting to be paid by the insurance companies.

We removed the case to federal court pursuant to the Class Action Fairness Act. The plaintiffs’ motion to remand was denied. We also filed a motion to dismiss asserting that under the applicable state statutes the insurance premium tax was properly charged to the policyholders. We also argued that the plaintiffs had failed to exhaust administrative remedies before the appropriate state agency prior to filing suit, as required by state statute. The motion to dismiss was granted.

Insured v. National Insurance Company

Represented a national insurance company in coverage and bad faith matter. Plaintiff had purchased comprehensive coverage but not collision coverage. Plaintiff was involved in a car accident, alleging that a bird struck his vehicle, which caused him to collide with a culvert. The Campbell Circuit Court (Kentucky) held that our client was entitled to summary judgment on the coverage claim because there was no “direct” damage to his vehicle caused by the bird strike. The court further held that our client was entitled to summary judgment on the bad faith claim because there was no coverage under the terms of the policy.

Insured v. National Insurance Company

Represented a national insurance company against claims of bad faith, breach of contract and negligence. Plaintiff’s home suffered wind damage and water loss in October 2007, but the plaintiff failed to file suit against her insurer until March 2009. The Southern District of Ohio held that the plaintiff’s claims for coverage and negligence were barred by the policy’s one-year suit limitations provision, and the insurer had not waived the limitations period. The U.S. Court of Appeals for the Sixth Circuit affirmed summary judgment for our client.

Insured v. National Insurance Company

Represented a national insurance company against claims of breach of contract and bad faith. The plaintiff, an owner of a barbershop, purchased two identical business insurance policies prior to a robbery, which plaintiff claimed resulted in damage to property, loss of income and loss of inventory. The Northern District of Ohio granted summary judgment to our client on all claims, holding that the plaintiff failed to cooperate during the insurer’s investigation of his loss.

Insured v. National Insurance Company

Represented a national insurance company against claims of breach of contract and bad faith. Plaintiff was the owner of apartment complex, which suffered a roof collapse, causing exterior and interior damage, as well as multiple uninhabitable living units. Both plaintiff and defendant hired roof inspectors to determine cause of collapse, although interpretations of reports were disputed by both sides. Our client eventually paid out for a new roof and repair of interior damages; however, plaintiff alleged that our client did not fully pay out for loss of income as dictated on policy. The Northern District of Ohio granted summary judgment to our client on grounds that our client was reasonably justified in withholding payment throughout the course of its investigation.

Policyholder-Attorney v. Legal Malpractice Insurer, U.S. District Court

I served as lead, local trial counsel for insurer in successfully obtaining summary judgment in 2011 in a claim for coverage and bad faith involving underlying allegations of legal malpractice. In the only oral hearing in the case, I presented our position to the federal judge in a related-discovery motion that ultimately formed the basis for the summary judgment.

President of Insurance Trade Association

Ongoing service as President of West Virginia Insurance Federation since 2004. Conduct a number of administrative duties, including day-to-day operations, reviewing and monitoring applicable legislation, lobbying on behalf of or in opposition to legislation, drafting and introducing legislation, drafting amendments and providing testimony regarding legislation. Duties also include distributing regular reports on legislation, meeting regularly with company representatives and lobbyists, monitoring interim committees, scheduling committee and board meetings, working with the Insurance Commissioner’s Office and other regulatory agencies, and assisting in distribution of materials, such as media releases and editorials.

Regional Insurance Company v. Local Manufacturer

I obtained favorable rulings from the trial and appellate courts on the insurer's duty to defend certain underlying intellectual property claims. The underlying claims involved trade dress infringement, patent infringement, and unfair competition. The coverage issue arose because one of our client's insurance policies provided coverage for certain trade dress claims, among other types of advertising injury. I obtained summary judgment on the duty to defend, served as co-counsel in conducting a trial on damages issues, and then was the lead author of the brief that prevailed in the First District Court of Appeals.

Steadfast Insurance Company v. Eon Lab (KY)

Dinsmore & Shohl represented the Plaintiff, a British based plc, in insurance coverage litigation relating to the MDL Phen-Fen litigation. The case was settled.

Superintendent of Insurance v. Insurance Company

Served as principal outside counsel to the Superintendent of Insurance as statutory liquidator of a failed property and casualty insurance company. Work has mainly consisted of assisting the Liquidator's assets collection efforts and the prosecution of litigation on behalf of the Liquidator against various debtors of the insolvent insurer and parties responsible for the failure of the insurer. The litigation has included suits against the insurer's: directors and officers, insurance liability carrier for the directors and officers, employee theft insurance carrier, parent and affiliated companies, financial auditor, and various of the insurer's agents and high deductible insureds. In addition to assisting the Liquidator in prosecuting claims against others, we have assisted the Liquidator in defending claims against the liquidation estate, including lawsuits and claims filed by the Bankruptcy Trustee of the insurer's parent company, claims filed by another insurance company, and assessments made by the IRS. Also have assisted the Liquidator in running out the affairs of the insurance company, such as terminating the insurance company's pension plan, and in administering the liquidation proceeding, such as developing the statutorily required early distribution plan for state insurance guaranty funds.