California Limits Causes of Action Against Life Insurers

In Fairbanks v. Superior Court of Los Angeles County (Farmers New World Life Insurance Co.) 46 Cal.4th 56 [2009 WL 1035264] (2009), the California Supreme Court held life insurance is not a service subject to the protections of California’s Consumer Legal Remedies Act (“CLRA”). The decision provides life insurance companies with a solid defense against CLRA lawsuits alleging unfair or deceptive acts and practices in the marketing or sale of life insurance policies.

The CLRA (Calif. Civ. Code § 1750 et seq.) provides a nonexclusive statutory remedy for unfair methods of competition and unfair or deceptive acts undertaken by any person in a transaction intended to result or which results in the sale or lease of goods or services to any consumer.  The Act provided a means to recover damages, punitive damages, and attorneys fees.

Absence of this remedy does not preclude other causes of action, namely under California’s Business & Professions Code Section 17200 for unfair competition (limited to injunctive relief and restitution), or a “bad faith” claim (if there has been a breach of contract).

In reaching its decision in Fairbanks, the California Court rejected decisions from other jurisdictions (namely Texas and Colorado), which held life insurance does come within the meaning of services under similar consumer protection statutes. The California Court determined that, unlike the broadly worded statutes in other states, the CLRA “contains a restrictive definition of ‘services’ that excludes life insurance.”

No Coverage For Mold

Although winter storms may bring another round of mold claims, California appellate courts again have upheld the right of insurers to exclude coverage for damage caused by mold. De Bruyn v. Superior Court (Fire Ins. Exchg.) (2007) 07 C.D.O.S. 5019. The efficient proximate doctrine, which in California (unlike many states) constrains insurers in how they communicate what they want to cover and not cover, did not prevent the insurer in this case from excluding mold, even where the insurer agreed to cover water damage from sudden and accidental discharge of water from plumbing and household appliances.

In De Bruyn, the California appellate court (Second Appellate District [Los Angeles]) ruled that a water damage exclusion that excepted out coverage for sudden and accidental release of water, did not cover the resulting mold. That is because the exclusion “plainly and precisely” indicated that: “We never, under any circumstances, cover rust, mold, fungus, or wet or dry rot, even if resulting from exceptions . . .” In addition, the policy had a specific exclusion for rust, mold, fungus, or wet or dry rot.

The court held that Fire Insurance Exchange’s exclusion of coverage for mold did not violate Insurance Code § 530 or the efficient proximate cause doctrine in California. The efficient cause doctrine provides that if there is both a covered and non-covered cause of the loss for which the insured seeks coverage, there is coverage for the claim. Calif. Ins. Code § 530; Garvey v. State Farm Fire & Cas. Co. (1989) 48 Cal.3d 395, 403. In California, insurers are not permitted to “contract around” this rule. See, e.g., Howell v. State Farm Fire & Cas. Co. (1990) 218 Cal.App.3d 1446. In other states, courts recognize that an insurer can, if it does so clearly and explicitly, contract that despite the fact that one cause of the loss may be covered, if the other cause is not covered, there is no coverage. See, e.g., Arizona: Millar v. State Farm Fire & Cas. Co., 804 P.2d 822 (Ariz. Ct. App. 1991), review denied, 811 P.2d 1081 (Ariz. 1991); Utah: Alf v. State Farmer Fire & Cas. Co., 850 P.2d 1272 (Utah 1993).) See, also, the De Bruyn court’s footnote 3.

In De Bruyn, the California appellate court again confirms that an insurance company is permitted to provide coverage for some but not all manifestations of a loss, as long as the company does so in manner that communicates the information and does not violate public policy. Accord, Julian v. Hartford Und. Ins. Co. (2005) 35 Cal.4th 747 (insurer can exclude coverage for certain perils, i.e., weather conditions and landslides, even if the policy provides that it will cover the results of other weather conditions; the policy clearly communicated that the insurer intended to exclude coverage for rain that induced a landslide).

In De Bruyn, the California appellate court (Second Appellate District [Los Angeles]) ruled that a water damage exclusion that excepted out coverage for sudden and accidental release of water, did not cover the resulting mold. That is because the exclusion “plainly and precisely” indicated that: “We never, under any circumstances, cover rust, mold, fungus, or wet or dry rot, even if resulting from exceptions . . .” In addition, the policy had a specific exclusion for rust, mold, fungus, or wet or dry rot.

The court held that Fire Insurance Exchange’s exclusion of coverage for mold did not violate Insurance Code § 530 or the efficient proximate cause doctrine in California. The efficient cause doctrine provides that if there is both a covered and non-covered cause of the loss for which the insured seeks coverage, there is coverage for the claim. Calif. Ins. Code § 530; Garvey v. State Farm Fire & Cas. Co. (1989) 48 Cal.3d 395, 403. In California, insurers are not permitted to “contract around” this rule. See, e.g., Howell v. State Farm Fire & Cas. Co. (1990) 218 Cal.App.3d 1446. In other states, courts recognize that an insurer can, if it does so clearly and explicitly, contract that despite the fact that one cause of the loss may be covered, if the other cause is not covered, there is no coverage. See, e.g., Arizona: Millar v. State Farm Fire & Cas. Co., 804 P.2d 822 (Ariz. Ct. App. 1991), review denied, 811 P.2d 1081 (Ariz. 1991); Utah: Alf v. State Farmer Fire & Cas. Co., 850 P.2d 1272 (Utah 1993).) See, also, the De Bruyn court’s footnote 3.

In De Bruyn, the California appellate court again confirms that an insurance company is permitted to provide coverage for some but not all manifestations of a loss, as long as the company does so in manner that communicates the information and does not violate public policy. Accord, Julian v. Hartford Und. Ins. Co. (2005) 35 Cal.4th 747 (insurer can exclude coverage for certain perils, i.e., weather conditions and landslides, even if the policy provides that it will cover the results of other weather conditions; the policy clearly communicated that the insurer intended to exclude coverage for rain that induced a landslide).