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Occam’s Razor
Exclusion for Work Performed by Insured Defeats Claim for Construction Defects
Post 4935
Read the full article at https://lnkd.in/gT_NsMHv, see the full video at https://lnkd.in/gqkPHYbp and at https://lnkd.in/gEEXkUe3, and at https://zalma.com/blog plus more than 4900 posts.
The question presented to the U.S. First Circuit Court of Appeals was whether a contractor’s CGL insurance policy covers general damage to a non-defective part of the contractor’s project resulting from a subcontractor’s defective work on a different part of that project.
APPLICATION OF OCCAM’S RAZOR
The analysis technique that proposes that the simplest of competing theories be preferred to the more complex.
FACTUAL BACKGROUND
Applying Massachusetts law, the district court concluded that Admiral had no duty to defend Tocci in Admiral Insurance Company, Starr Indemnity & Liability Company, Great American Assurance Company v. Tocci Building Corporation, Tocci Residential LLC, John L. Tocci, Sr., No. 22-1462, United States Court of Appeals, First Circuit (November 8, 2024) and Tocci appealed.
From 2013 to 2016, Tocci was the construction manager for an apartment project owned by Toll JM EB Residential Urban Renewal LLC (“Toll”). There were several work quality issues and delays on the project, and Toll eventually terminated Tocci in March 2016 for alleged mismanagement of the project.
Toll sued with allegations regarding instances of defective work leading to property damage. The allegations included defective work by Tocci’s subcontractors resulting in various instances of property damage to non-defective work on the project, including (1) damage to sheetrock resulting from faulty roof work; (2) mold formation resulting from inadequate sheathing and water getting into the building; and (3) damage to a concrete slab, wood framing, and underground pipes resulting from soil settlement due to improper backfill and soil compaction.
DUTY TO DEFEND
Tocci sought defense and indemnity coverage under the Admiral insurance policies. Admiral denied coverage.
The district court granted Admiral’s motion on duty to defend because the damage alleged in Toll’s complaint did not qualify as “property damage” as defined in the policy because the allegations consisted entirely of damage at Tocci’s own project.
ANALYSIS
The First Circuit considered three steps to the coverage analysis: (1) Do the damages alleged in the action fall within the scope of coverage?; (2) if so, do the exclusions to coverage apply?; and (3) if so, do any exceptions to the exclusions apply?
The First Circuit noted that there is a sharp split of authority on whether damage to non-defective work resulting from a subcontractor’s defective work constitutes “property damage” or is caused by an “occurrence.” The First Circuit decided to avoid the issues of what constitutes “property damage” by focusing on the exclusions which were sufficient to resolve the complete dispute.
THE HOLDING
There are two “Damage to Property” exclusions that provide that there is no coverage for “property damage” to: that particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the ‘property damage’ arises out of those operations; or that particular part of any property that must be restored, repaired or replaced because “your work” was incorrectly performed on it.
The First Circuit, applying Occam’s Razor, focused its analysis on the exclusion it concluded covers the allegations in the Toll complaint. Since the complaint alleges damage resulting from Tocci’s “incorrectly performed” work on the entire project “[t]hat particular part of any property that must be restored, repaired or replaced because ‘[Tocci’s] work’ was incorrectly performed on it” refers to the entirety of the project where Tocci was the general contractor charged with supervising and managing the project as a whole.
Therefore, the First Circuit concluded that Admiral met its burden of establishing that the Toll action only alleges damage falling within the exclusion and that there was no exception to that exclusion that applied.
ZALMA OPINION
This is a case of a court applying Occam’s Razor, by picking an easy and obvious solution – the application of an exclusion – and avoiding the problem of different court rulings on coverage about “property damage” and “occurence.” Since the exclusion clearly applied there was no duty to defend.
(c) 2024 Barry Zalma & ClaimSchool, Inc.
Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.
Subscribe to my substack at https://barryzalma.substack.com/subscribe
Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg
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Occam’s Razor Exclusion for Work Performed by Insured Defeats Claim for Construction Defects Post 4935 Read the full article at https://lnkd.in/gT_NsMHv, see the full video at https://lnkd.in/gqkPHYbp and at https://lnkd.in/gEEXkUe3, and at https://zalma.com/blog plus more than 4900 posts. The question presented to the U.S. First Circuit Court of Appeals was whether a contractor’s CGL insurance policy covers general damage to a non-defective part of the contractor’s project resulting from a subcontractor’s defective work on a different part of that project. APPLICATION OF OCCAM’S RAZOR The analysis technique that proposes that the simplest of competing theories be preferred to the more complex. FACTUAL BACKGROUND Applying Massachusetts law, the district court concluded that Admiral had no duty to defend Tocci in Admiral Insurance Company, Starr Indemnity & Liability Company, Great American Assurance Company v. Tocci Building Corporation, Tocci Residential LLC, John L. Tocci, Sr., No. 22-1462, United States Court of Appeals, First Circuit (November 8, 2024) and Tocci appealed. From 2013 to 2016, Tocci was the construction manager for an apartment project owned by Toll JM EB Residential Urban Renewal LLC (“Toll”). There were several work quality issues and delays on the project, and Toll eventually terminated Tocci in March 2016 for alleged mismanagement of the project. Toll sued with allegations regarding instances of defective work leading to property damage. The allegations included defective work by Tocci’s subcontractors resulting in various instances of property damage to non-defective work on the project, including (1) damage to sheetrock resulting from faulty roof work; (2) mold formation resulting from inadequate sheathing and water getting into the building; and (3) damage to a concrete slab, wood framing, and underground pipes resulting from soil settlement due to improper backfill and soil compaction. DUTY TO DEFEND Tocci sought defense and indemnity coverage under the Admiral insurance policies. Admiral denied coverage. The district court granted Admiral’s motion on duty to defend because the damage alleged in Toll’s complaint did not qualify as “property damage” as defined in the policy because the allegations consisted entirely of damage at Tocci’s own project. ANALYSIS The First Circuit considered three steps to the coverage analysis: (1) Do the damages alleged in the action fall within the scope of coverage?; (2) if so, do the exclusions to coverage apply?; and (3) if so, do any exceptions to the exclusions apply? The First Circuit noted that there is a sharp split of authority on whether damage to non-defective work resulting from a subcontractor’s defective work constitutes “property damage” or is caused by an “occurrence.” The First Circuit decided to avoid the issues of what constitutes “property damage” by focusing on the exclusions which were sufficient to resolve the complete dispute. THE HOLDING There are two “Damage to Property” exclusions that provide that there is no coverage for “property damage” to: that particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the ‘property damage’ arises out of those operations; or that particular part of any property that must be restored, repaired or replaced because “your work” was incorrectly performed on it. The First Circuit, applying Occam’s Razor, focused its analysis on the exclusion it concluded covers the allegations in the Toll complaint. Since the complaint alleges damage resulting from Tocci’s “incorrectly performed” work on the entire project “[t]hat particular part of any property that must be restored, repaired or replaced because ‘[Tocci’s] work’ was incorrectly performed on it” refers to the entirety of the project where Tocci was the general contractor charged with supervising and managing the project as a whole. Therefore, the First Circuit concluded that Admiral met its burden of establishing that the Toll action only alleges damage falling within the exclusion and that there was no exception to that exclusion that applied. ZALMA OPINION This is a case of a court applying Occam’s Razor, by picking an easy and obvious solution – the application of an exclusion – and avoiding the problem of different court rulings on coverage about “property damage” and “occurence.” Since the exclusion clearly applied there was no duty to defend. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk Subscribe to my substack at https://lnkd.in/gmmzUVByLNKD.INOccam’s RazorExclusion for Work Performed by Insured Defeats Claim for Construction Defects Post 4935 Posted on November 18, 2024 by Barry Zalma See the full video at https://rumble.com/v5po3z8-occams-razor.0 Commentarii 0 Distribuiri 769 Views -
RICK MIRACLE VIDEO LIBRARY #100,
2020 VIDEOS, THE WAR ON THE WORLDS CITIZENS
https://old.bitchute.com/video/1GOOVbPoJIN7/RICK MIRACLE VIDEO LIBRARY #100, 2020 VIDEOS, THE WAR ON THE WORLDS CITIZENS https://old.bitchute.com/video/1GOOVbPoJIN7/OLD.BITCHUTE.COMRick Miracle Video Library #100, 2020 videos, The War on the Worlds CitizensWe are under a multifaceted attack! What do you think? https://gogetfunding.com/2024-fund-to-manufacture-books/ https://www.facebook.com/profile.php?id=100008311954642 http://rickmiracle.com/ e-mail [email protected] Mail suggested …0 Commentarii 0 Distribuiri 148 Views -
EXCLUSIVE: The Globalists Are Not Done Trying To Destroy President Trump, Warns General Flynn
https://www.bitchute.com/video/e1g2GBP6qI0R/?list=notifications&randomize=falseEXCLUSIVE: The Globalists Are Not Done Trying To Destroy President Trump, Warns General Flynn https://www.bitchute.com/video/e1g2GBP6qI0R/?list=notifications&randomize=falseWWW.BITCHUTE.COMEXCLUSIVE: The Globalists Are Not Done Trying To Destroy President Trump, Warns General FlynnAlex Jones speaks with General Michael Flynn about the battle to keep Deep State RINOs from disrupting the incoming Trump administration. **Alex Jones VIP Club Is NOW LIVE! Save 10%-40% off everything at The Alex Jones Store while getting $40.00 FREE store credit every month! Learn more HERE! https://thealexjonesstore.com/products/alex-jones-vip-club-copy?selling_plan=5497979099 **HUGE! The Lost Alex Jones Tapes From 2001-2008 are NOW AVAILABLE at a limited-time -
EXCLUSIVE: The Globalists Are Not Done Trying To Destroy President Trump, Warns General Flynn
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EXCLUSIVE: The Globalists Are Not Done Trying To Destroy President Trump, Warns General Flynn
https://www.bitchute.com/video/e1g2GBP6qI0R/?list=notifications&randomize=false
Alex Jones speaks with General Michael Flynn about the battle to keep Deep State RINOs from disrupting the incoming Trump administration.EXCLUSIVE: The Globalists Are Not Done Trying To Destroy President Trump, Warns General Flynn https://www.bitchute.com/video/e1g2GBP6qI0R/?list=notifications&randomize=false Alex Jones speaks with General Michael Flynn about the battle to keep Deep State RINOs from disrupting the incoming Trump administration.WWW.BITCHUTE.COMEXCLUSIVE: The Globalists Are Not Done Trying To Destroy President Trump, Warns General FlynnAlex Jones speaks with General Michael Flynn about the battle to keep Deep State RINOs from disrupting the incoming Trump administration. **Alex Jones VIP Club Is NOW LIVE! Save 10%-40% off everything at The Alex Jones Store while getting $40.00 FREE store credit every month! Learn more HERE! https://thealexjonesstore.com/products/alex-jones-vip-club-copy?selling_plan=5497979099 **HUGE! The Lost Alex Jones Tapes From 2001-2008 are NOW AVAILABLE at a limited-time -
IMHO: THIS MUST BE PART OF THE "PREPARATIONS" BY NARCO-TERRORISTS, COMMUNIST INVASION FORCES, ALREADY WITHIN OUR NATION... AT SOME POINT, THEY WILL USE THESE "SUPPLIES", AGAINST US ALL!!!.....
SO, WE MUST BE PREPARED TO FIGHT OR DIE!!!!
CBP officials are withholding the arrested man’s identity and information about who he was working for at this time. However, many assume his employer was one of the many Mexican-based drug cartels.
11,000 Rounds of 7.62×39 Seized at Mexican Border https://www.ammoland.com/2024/11/11000-rounds-of-7-62x39-seized-at-mexican-border/?utm_source=twitter&utm_medium=website&utm_campaign=SocialSnap via @AmmoLandIMHO: THIS MUST BE PART OF THE "PREPARATIONS" BY NARCO-TERRORISTS, COMMUNIST INVASION FORCES, ALREADY WITHIN OUR NATION... AT SOME POINT, THEY WILL USE THESE "SUPPLIES", AGAINST US ALL!!!..... SO, WE MUST BE PREPARED TO FIGHT OR DIE!!!! 💩💥 CBP officials are withholding the arrested man’s identity and information about who he was working for at this time. However, many assume his employer was one of the many Mexican-based drug cartels. 11,000 Rounds of 7.62×39 Seized at Mexican Border https://www.ammoland.com/2024/11/11000-rounds-of-7-62x39-seized-at-mexican-border/?utm_source=twitter&utm_medium=website&utm_campaign=SocialSnap via @AmmoLandWWW.AMMOLAND.COM11,000 Rounds of 7.62x39 Seized at Mexican BorderA Mexican man was arrested trying to smuggle 11,100 rounds of 7.62x39 into the United States from Mexico. -
DON'T BE DECEIVED THIS WHOLE CATASTROPHE IS A JEW SCRIPTED PLAY!
https://old.bitchute.com/video/aUBFiOBPkOAy/DON'T BE DECEIVED THIS WHOLE CATASTROPHE IS A JEW SCRIPTED PLAY! https://old.bitchute.com/video/aUBFiOBPkOAy/OLD.BITCHUTE.COMDon't be deceived this Whole Catastrophe is a Jew Scripted Play!Who created Hollyweird the Synagogue of Satan thats who the Revelation 2:9, 3:9 fake jews WTFU Don't be deceived. You are under mind control. Your thoughts are not your own. You are being herded into a pre-planned narrative.0 Commentarii 0 Distribuiri 134 Views -
#5 BP Cartel Policy won the 2024 #LosAlamitosSuperDerby as an even-odd favorite. https://www.shishonsports.com/shish-on-horse-racing/live-blogging-2024-los-alamitos-super-derby#5 BP Cartel Policy won the 2024 #LosAlamitosSuperDerby as an even-odd favorite. https://www.shishonsports.com/shish-on-horse-racing/live-blogging-2024-los-alamitos-super-derbyWWW.SHISHONSPORTS.COMLive-Blogging: 2024 Los Alamitos Super DerbyPaul Shishkoff, Junior will live blog Los Alamitos Racecourse's Late Pick 4 including 2024 Los Alamitos Super Derby.0 Commentarii 0 Distribuiri 300 Views
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Declaring a Policy Void
When a Policy Is Void
For Subscribers to Excellence in Claims Handling
You can Subscribe for only $5 a month to Excellence in Claims Handling at
https://barryzalma.substack.com/subscribe
A small portion of what was provided to subscribers.
In almost every policy of insurance, there is a clause declaring the policy void if the insured misrepresents or conceals material facts or commits fraud. For example:
We do not pay for bodily injury or property damage which is expected by, directed by, or intended by an insured. This exclusion does not apply to bodily injury that arises out of the use of reasonable force to protect people or property. (AAIS Form BP-200, (c) 1987 AAIS).
or:
This Coverage Form is void in any case of fraud by you at any time as it relates to this Coverage Form. It is also void if you or any other “insured,” at any time, intentionally conceal or misrepresent a material fact concerning: a. This Coverage Form; b. The covered “auto”; c. Your interest in the covered “auto”; or d. A claim under this Coverage Form. (Insurance Services Office form CA 00 01 01 87).
The policy wording requires that the insurer prove, not only that the insured misrepresented or concealed a material fact but must also prove that the insured did so with the intent to deceive.
Absent the rare confession it is often difficult to prove intentional deceit. The insured will usually claim that he or she was mistaken and had no intent to deceive. In more than 50 years of investigation of fraudulent insurance claims I only once received from an insured an under oath statement that the insured intentionally deceived the insurer and then, not in person, but by correcting false testimony in the transcript of an examination under oath.
If fraud or mutual mistake is an issue, insurers and insureds doing business in Oklahoma must resort to courts of general jurisdiction for a determination of contractual rights.[1] In Oklahoma, the Workers’ Compensation court does not have the right to rescind or declare a policy of Workers’ Compensation insurance void. However, where there is a misrepresentation with intent to deceive and the putative insured recognized the materiality of the misrepresentation the insurance policy is void from its inception.[2]
In Florida, Florida Statutes (2006), state in pertinent part:
any insurance fraud shall void all coverage arising from the claim related to such fraud under the personal injury protection coverage of the insured person who committed the fraud.
In harmony with this statutory provision, the fraud provision in an insurance policy set forth: “any insurance fraud shall void all personal injury protection coverage arising from the claim with respect to the insured who committed the fraud” is appropriate and enforceable. [Bosem v. Commerce & Indus. Ins. Co., 35 So.3d 944 (Fla. App., 2010)]
Declaring a Policy Void When a Policy Is Void For Subscribers to Excellence in Claims Handling You can Subscribe for only $5 a month to Excellence in Claims Handling at https://barryzalma.substack.com/subscribe A small portion of what was provided to subscribers. In almost every policy of insurance, there is a clause declaring the policy void if the insured misrepresents or conceals material facts or commits fraud. For example: We do not pay for bodily injury or property damage which is expected by, directed by, or intended by an insured. This exclusion does not apply to bodily injury that arises out of the use of reasonable force to protect people or property. (AAIS Form BP-200, (c) 1987 AAIS). or: This Coverage Form is void in any case of fraud by you at any time as it relates to this Coverage Form. It is also void if you or any other “insured,” at any time, intentionally conceal or misrepresent a material fact concerning: a. This Coverage Form; b. The covered “auto”; c. Your interest in the covered “auto”; or d. A claim under this Coverage Form. (Insurance Services Office form CA 00 01 01 87). The policy wording requires that the insurer prove, not only that the insured misrepresented or concealed a material fact but must also prove that the insured did so with the intent to deceive. Absent the rare confession it is often difficult to prove intentional deceit. The insured will usually claim that he or she was mistaken and had no intent to deceive. In more than 50 years of investigation of fraudulent insurance claims I only once received from an insured an under oath statement that the insured intentionally deceived the insurer and then, not in person, but by correcting false testimony in the transcript of an examination under oath. If fraud or mutual mistake is an issue, insurers and insureds doing business in Oklahoma must resort to courts of general jurisdiction for a determination of contractual rights.[1] In Oklahoma, the Workers’ Compensation court does not have the right to rescind or declare a policy of Workers’ Compensation insurance void. However, where there is a misrepresentation with intent to deceive and the putative insured recognized the materiality of the misrepresentation the insurance policy is void from its inception.[2] In Florida, Florida Statutes (2006), state in pertinent part: any insurance fraud shall void all coverage arising from the claim related to such fraud under the personal injury protection coverage of the insured person who committed the fraud. In harmony with this statutory provision, the fraud provision in an insurance policy set forth: “any insurance fraud shall void all personal injury protection coverage arising from the claim with respect to the insured who committed the fraud” is appropriate and enforceable. [Bosem v. Commerce & Indus. Ins. Co., 35 So.3d 944 (Fla. App., 2010)]BARRYZALMA.SUBSTACK.COMSubscribe to Excellence in Claims HandlingA series of writings and/or videos to help understand insurance, insurance claims, and becoming an insurance claims professional and who need to provide or receive competent and Excellence in Claims Handling. Click to read Excellence in Claims Handling, by Barry Zalma, a Substack publication with thousands of subscribers.0 Commentarii 0 Distribuiri 915 Views
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