Hon. MARY FINGAL SCHULTE

TYPES OF INSURANCE CASES HANDLED:

  • Title insurance
  • Scope of Additional Insured’s coverage and endorsement
  • Exclusions from coverage
  • Subrogation claims
  • Defense/indemnity claims between and among insurers and contractors
  • Bad faith: denial of defense/indemnity/withdrawal of defense
  • Broker liability
  • Duty to defend


REPRESENTATIVE CASES:

  • Insurance coverage dispute involving homeowner’s policy and issues of whether loss was covered for water damage to a dwelling, and if so, whether a tree root exclusion applied.  Cause of action for breach of contract and bad faith denial of coverage were asserted.

  • Bad faith claim re: denial of coverage for corporate theft.

  • Complex title insurance claim arising from protracted litigation between sophisticated, institutional real estate lenders over the priority of multi-million dollar loans they made to the same borrower and secured by the same property.  The underlying dispute was largely resolved when the Court of Appeal confirmed that the lien of plaintiff and its assignee/successor plaintiff was in first priority ahead of the lien of another entity.
    Title insurance company determined it had no duty under the title policy to defend a lawsuit where the claim against the insured was that it had breached the contract by which it acquired title, and not that there was a pre-existing defect in the title. The insurer withdrew from defense after accepting tender subject to a reservation of rights and defending the action for two years at its sole expense while investigating the claim.  Insured claimed breaches of express and implied duties under the policy.   Case involved issues of priority of trust deeds.
    The insurer asserted it had no duty to defend an action not based on title defects but which sought a determination that the subordination agreement was unenforceable based on allegations of insured’s breaches of contract and post-policy wrongful conduct. Case involved issues of reasonable investigation of claims and coverage determinations. Court conducted an analysis of risks covered by title policies as compared to other forms of insurance, which indemnify against conduct of the insured, while title insurance indemnifies against existing title defects and other title impediments to real property interests that exist in the record title and can normally be found through an examination of title. Court conducted an analysis of exclusion from coverage clauses, reservations of rights, waivers of coverage.  Case also involved California Fair Claims Regulations, bad faith.

  • Plaintiff acted as a third party administrator that contracts with numerous hospitals in Mexico providing various services, including confirming medical insurance coverage for American citizens admitted to Mexican facilities, translation of medical records, billing and invoicing.  Additionally, as part of the contractual agreements between Plaintiff and hospitals in Mexico, upon admission to a Mexican facility, patients who are American citizens execute an assignment of benefit agreement, assigning their benefits in the insurance policies to Plaintiff. 
    Third-Party patient was an insured of Defendant under health insurance policy.  Patient had a medical emergency while in Mexico and was admitted to a hospital.  At the time of admission, Plaintiff contacted Defendant and advised of patient’s admission, and Defendant’s agent acknowledged that patient’s health insurance policy was active and that Defendant would cover the benefits for the medical services provided to patient upon admission to the hospital.
    After patient was stabilized in the emergency room, Plaintiff contacted Defendant to request an air ambulance or other medical transportation to transport patient to a medical facility of Defendant’s choosing in the United States.  Defendant’s representative advised and directed Plaintiff to make arrangements for patient to remain at a hospital in Mexico rather than being transported to the United States.  Plaintiff relied on Defendant’s assurances that the insurance policy would cover the medical services provided to patient, and continued to provide patient with non-emergency medical treatment at a hospital in Mexico. Complaint alleged: Promissory estoppel; Breach of Contract – Tortious Breach of Insurance Contract (Bad faith); Breach of implied covenant of good faith and fair dealing.

  • Breach of contract action by medical center against defendant, arising from an Agreement for Health Care Services entered into in 2009 between Plaintiff, and defendant. Pursuant to the Agreement, medical center  contracted to provide medically necessary emergency room services to defendant patients. Medical center  alleged it provided medically necessary services to certain individuals in the amount of $215,995, submitted invoices to defendant, and was not paid.

  • Involved issues of duty to defend, and interpretation of policy exclusions for intentional and unlawful acts, as well as definitions of “occurrence”, “personal injury” and “bodily injury.”  In an underlying case, ex-husband/father alleged that plaintiff (among others) abducted, or aided and abetted the abduction of, his infant son and hid him from his father for almost 18 years, with the knowledge and help of others.  Plaintiff tendered defense to insurance company, which declined to defend. Underlying case where Wife took infant from Orange County to parents’ home in India.  Husband sued several family members and acquaintances over 19 years later, accusing them of conspiring with ex-wife.  Trial court granted nonsuit as to two defendants, jury found against other defendants.  In a second suit filed by policyholders who had been sued in Matter #1 and found by jury not to have had knowledge that mom planned to leave the U.S., court granted carrier’s MSJ on grounds that abduction claims were not covered claims.  Policyholders had tendered claim under condo/homeowner policies covering them during period in which acts alleged in Matter #1 had occurred.  Both trial court decisions were affirmed on appeal. 

  • Plaintiff was an Insurance agent who was insured through an “Insurance Agents Error and Omissions Liability Policy” issued by Defendant Insurance Company.
    Plaintiff was sued for professional negligence in another action wherein it was alleged that Plaintiff provided a “sham” 419 plan to the individual who brought suit (i.e. a plan which was not a 419 plan). Plaintiff asserted that, based on the allegations, insurance company had a duty to defend and indemnify Plaintiff. Further, Plaintiff asserted Defendant wrongly denied coverage, on the basis 419 plans were excluded from Plaintiff’s policy.
    Plaintiff alleges that co-Defendant was hired by insurance company to review the claim and falsely concluded that coverage should be denied.

  • Insurance coverage matter: breach of contract and breach of warranty, alleging failure to properly investigate and adjust a claim for partial submergence of insured’s yacht.  Claims for breach of the implied covenant of good faith and fair dealing; breach of contract; fraud in the performance; negligent misrepresentation; and intentional interference with contractual relations

  • Claims for: (1) Declaratory Relief; (2) Breach of Implied Covenant of Good Faith and Fair Dealing; and (3) Breach of Contract.

  • Defendant insurance company issued a Homeowner’s Policy of Title Insurance to Plaintiff.  Plaintiff sought a determination from the Court that damage to the property, due to a damaged and defective sewage system, was covered by this policy. 

  • Suit by residual trust beneficiaries over what was owed under a professional liability policy issued by a bankrupt insurer; issues of covered claims, single claim policy limits and self- liquidating policies, what is restitution versus covered damages. Underlying case involved voiding of a trust wherein attorney designated himself as a beneficiary,  resulting in imposition of constructive trusts, and judgments in probate  proceedings of close to $4 million against the lawyers representing value of stocks sold; the second underlying petition was for accounting and review of attorney’s exercise of discretionary trustee powers, and an additionally award for premature stock distributions causing tax losses. Insurance carriers made partial satisfaction of judgments, but there remained an unsatisfied portion of over $4 million. Liability carrier became insolvent.  Issue was whether the 2 probate petitions were a single claim under the policy.  Interpretation of insurance policy was required to determine potential for coverage, as to what part of damage award was covered versus restitution, and what remained under the policy limit. Involved issues of what constituted separate transactions for purposes of coverage limits.

Insurance

Representative Cases


Judge, Orange County Superior Court (Ret.)