Insurance IndustryExperience
Successful Dismissal of Malpractice Coverage Claims in Fraud and Negligence Case
On behalf of a professional malpractice insurer, we obtained a dismissal of key claims by tort claimants who were seeking professional malpractice coverage from the insurer of a doctor who was found liable for a series of unnecessary surgeries. The jury found both negligence by the doctor and fraudulent misrepresentations about the need for surgeries. Claimants alleged that they were entitled to coverage under Ohio law, noting that the tort verdicts included a negligence component as well as a fraud component. However, by submitting trial transcripts from the tort trials, the jury verdict, jury interrogatories, and pertinent case law involving damages arising from multiple causes, we obtained a dismissal on the merits under Civil Rule 12. The Court agreed with our arguments that negligence damages were not independent of the fraud, and instead were in consequence of the fraud. The Court dismissed the claims for coverage.
Successful Result for a Professional Liability Carrier in a Federal Case Involving Coverage and Bad Faith Claims
Dinsmore obtained a successful result for a professional liability carrier in a federal case involving coverage and bad faith claims. A Kentucky dentist allegedly lied to his patient that he had installed dental implants for her, and after she began to experience increased pain and called the dentist, she learned he had abandoned his practice and moved out of state. After racking up massive dental bills from another provider, her lawyer phoned the dentist’s carrier, but only provided the carrier his client’s name and did not specify damages were being sought or provide any details about the loss. Days later the policy terminated. When that information was provided several months later, the insurer denied the request for coverage, contending that the dentist himself had not reported a “claim” or “potential claim” consistent with the policy terms, nor had the claimant done so consistent with the policy’s reporting requirements. Thereafter, the patient obtained a nearly $500,000 default judgment for negligence against the dentist, and then sued MedPro to cover that judgment as well as for bad faith. Ultimately, a Kentucky federal district judge entered summary judgment in favor of the insurer, ruling that strict compliance with a claims made policy’s reporting policy was required under Kentucky law and that neither a “claim” (a written request for damages during the policy period) or “potential claim” (reporting all “reasonably available information” about the loss during the policy period) had been provided. As a result, the insurer was deemed to have no contractual duty to pay (a required element under Kentucky law for any bad faith claim), a summary judgment on the bad faith claim was also entered. The district court’s orders were recently upheld in a unanimous decision by the Sixth Circuit Court of Appeals.
Counseled Leading ULT Freezer Company through Merger
Client: Stirling Ultracold
We counseled our client, Stirling Ultracold, an innovative developer and manufacturer of ultra-low temperature (ULT) freezers for life science and biopharma research, through its merger with BioLife Solutions, Inc., a developer focused on bioproduction devices used in cell and gene therapies. The all-stock mergers was in excess of $230 million.
Stirling’s CEO saw the potential for increased demand for the company’s freezers during the COVID-19 pandemic as the freezers were a direct competitor to dry ice used in storing the COVID-19 vaccine. Merging with BioLife enabled Stirling to execute an aggressive strategic plan marketing and selling its freezers. Dinsmore served as the company’s general counsel since 2019, and our team of attorneys brought experience in mergers and acquisitions, labor, insurance, and life sciences, all of which was necessary to fully understand and address the company’s specialized needs. We counseled our client through the merger while simultaneously defusing challenges. Our team’s collective experience enabled Stirling’s executives to address the company’s short-term needs while also achieving its long-term goal.
“The entire team at Dinsmore was, by far, the best engagement I have had in the 15-plus strategic transactions I have done throughout my career,” said previous Stirling Ultracold CEO Dusty Tenney, now COO and president at BioLife. “Their responsiveness, engagement, availability and deal leadership were extraordinary from LOI to closing.”
Multi-party Insurance Dispute About Additional Insured Coverage and Indemnity Obligations Related to Construction Lawsuit
Client: An Insurer
At the request of our insurer client, we successfully analyzed the allegations of a multi-party construction-related lawsuit and the tender of defense between parties for purposes of determining coverage and defense obligations. The underlying lawsuit involved construction of a natural gas pipeline for the energy industry. The suit presented allegations of breach of contract, negligence, blasting liability, trespass, emotional distress, and fraud. The insurance issues involved additional insured coverage, property damage coverage, contractual indemnity rights, and anti-indemnity statutes. After presenting our opinion, we assisted the insurer client in obtaining payment from the insurer of another party based upon the indemnity and insurance rights between the parties.
Accidental Death Insurance Policy
Represented insurer in the Circuit Court in Mingo County, West Virginia in a case related to an insurer’s accidental death and disability insurance plan. Plaintiffs claimed that the policy regarding accidental deaths was not explained properly; however, the court stated that the language in the policy was clear and unambiguous. The court granted summary judgment for our client and dismissed the case with prejudice.
Allegations of Breach of Insurance Contract
We represented an insurance company in a suit for breach of insurance contract and bad faith arising out of insurance company’s decision not to pay 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.
Allegations of Breach of Insurance Contract and 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 benefits under an automobile accident insurance policy. The case was removed to federal court and eventually settled at mediation.
Allegations of Breach of Insurance Contract and Bad Faith
We represented a company in a matter where the insurance company refused to defend or indemnify our client in a third-party law-suit arising out of our client’s business operations. We brought claims in federal court for breach of insurance contract and bad faith. The case was resolved prior to mediation for all possible damages awardable under the insurance contract, including attorneys’ fee, costs and interest.
Amicus Curiae Brief
Filed an amicus curiae brief in the Supreme Court of Appeals of West Virginia on behalf of an insurance trade association in support of prevailing party. Client argued that a circuit court had previously erred in granting partial summary judgment in a case related to deliberate intent coverage and a claim that policy language was ambiguous. The Court overruled the circuit court’s decision, resulting in a significant victory for the insurance industry.
Anonymous Department of Insurance v. Big Six Auditing Firm
We represented an insurance liquidator who alleged that the auditor defendant was negligent in auditing the financial statements for the insolvent insurance company and that the negligence caused damage to the company's estate. This case involved complex concepts of insurance, accounting, and auditing. The discovery process included the depositions of over 25 witnesses, including 5 expert witnesses. On the first day of trial, the defendant settled for a multi-million dollar sum. During the case, Dinsmore & Shohl prevailed on nearly every motion. Significantly, the trial court allowed Dinsmore's litigation team to pursue damages against the defendant based upon a deepening of the insolvency theory.
Anonymous Plaintiff v. Insurance Company
Plaintiff filed suit for defense and indemnification under homeowners and personal umbrella policies. The carrier denied coverage because the policyholder engaged in excluded business pursuits and intentional acts. After extensive discovery over contested facts, the carrier obtained summary judgment in a lengthy court opinion on all multiple and independent grounds briefed.
Anonymous Plaintiff v. Insurance Company
Plaintiff filed a class action lawsuit against our client, an insurance company, seeking coverage in excess of $75,000 for moisture intrusion damage due to defects in Plaintiff's home. The case was removed to Federal court, was never certified as a class action and was eventually dismissed.
Anonymous Plaintiff v. Insurance Company
Defended insurance company in multi-million dollar coverage action brought in state court in New Brunswick, N.J. by manufacturing company seeking to recover cleanup costs associated with environmental sites around the country. Among others, the suit included issues of choice of law, trigger of coverage, and allocation. The claims against the client were settled through mediation.
Anonymous Plaintiff v. Insurance Company
Obtained summary judgment for carrier on pollution exclusion. Decision upheld after briefing and oral argument to state court of appeals.
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.
