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2023 | OriginalPaper | Buchkapitel

COVID-19 and Business Interruption Coverage in the United States: An Example of Judicial Regulation

verfasst von : Jeffrey E. Thomas

Erschienen in: Covid-19 and Insurance

Verlag: Springer International Publishing

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Abstract

Insureds in the United States have initiated thousands of lawsuits for business interruption losses caused by the COVID-19 pandemic. This litigation shows the significant regulatory role of the judiciary in the United States. Courts have developed and apply rules for insurance policy interpretation and for good faith behavior of insurers addressing claims. Although in the past the state and Federal courts applying judicial regulation have reached a variety of results, the judicial response to the COVID-19 claims has been surprisingly consistent in favor of insurers. The great majority of decisions have held that pandemic-related closures are not covered because they were not the result of physical damage or loss of property. This chapter describes the current state of the law in the United States for business interruption coverage for losses due to the pandemic. It suggests that the relative uniformity of decisions may reflect judicial concern that pandemic losses could overwhelm the insurance industry and an implicit recognition that the government is already providing substantial relief to businesses. It then identifies some procedural differences between judicial and administrative regulation for these determinations which results in a focus on individual cases rather than historical context and national public policy concerns.

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Fußnoten
1
See generally Insurance Regulation, 2 New Appleman on Insurance Library Edition (2021).
 
2
See Thomas (2021), § 5.02.
 
3
See Thomas (2021), § 5.02[2][c][i]. For an illustrative case, see James River Ins Co v Ground Down Engineering Inc (11th Cir 2008) 540 F3d 1270, p. 1274.
 
4
See Abraham and Baker (2022), pp. 18–21.
 
5
For a summary of proposed legislation, see Newman (2021), pp. 507–513. One example is A.B. A10226B, proposed in the 2019–2020 Legislative Session in New York, which would have provided that property policies that included business interruption coverage “shall be construed to include among the covered perils under that policy, coverage for contingent business interruption during a period of a declared state emergency due to the coronavirus disease 2019 (COVID-19) pandemic.” Section 1(c).
 
6
For example, through the Paycheck Protection Program the government provided more than $600 billion of assistance to small businesses for employee pay and other expenses. See Small Business Administration.
 
7
See, for example, Sassian (2020).
 
8
Keeton (1970). For additional articles on the reasonable expectations doctrine, see Henderson (1990), Thomas (1998) Thomas (2021), Swisher (2000), Randall (2007).
 
9
See Thomas (2021), § 5.05[2]-[3].
 
10
See, for example, Knutson and Stempel (2020), p. 60.
 
11
See Thomas (2002). For an example of the judicial recognition of emotional distress damages for bad faith breach of an insurance contract, see Crisci v Security Ins Co, 426 P2d 173 (Cal 1967).
 
12
See American Law Institute (2019), § 24.
 
13
See Barker (2021), § 2.03[3]-[4].
 
14
See Barker (2021), § 5.03. A leading case finding bad faith liability in the first-party context is Gruenberg v Aetna Ins Co (Cal 1973) 510 P2d 1032.
 
15
See Barker (2021), § 1.07[1]. For an example of a court refusing to recognize a tort remedy for a bad faith breach of a first-party insurance contract, see A & E Supply Co v Nationwide Mut Fire Ins Co (4th Cir 1986) 798 F2d 669.
 
16
See Tennyson and Warfel (2008), p. 3.
 
17
Mo Rev Stat § 375.420.
 
18
Co Rev Stat § 10-3-1116.
 
19
Bad faith allegations were included in 749 cases (or 35%) of the 2136 filed as of February 15, 2022. See Covid Coverage Litigation Tracker, Allegations, https://​cclt.​law.​upenn.​edu/​#allegations, last visited Feb. 15, 2022.
 
20
For an example of a bad faith claim that was dismissed because the court found that the business income claim was not covered, see Ceres Enters LLC v Travelers Ins Co (ND Ohio 2021) 520 F Supp 3d 949, p. 965.
 
21
As of December 20, 2021, the tracker had identified and coded 2,120 cases. See Covid Coverage Litigation Tracker, Latest developments, https://​cclt.​law.​upenn.​edu/​#latest, last visited Jan. 26, 2022. This dataset “contains what is believed to be close to a complete set of federal Covid coverage cases” but the state case set “is less complete because of the limits of state court data.” Covid Coverage Litigation Tracker, About, CCLT dataset, https://​cclt.​law.​upenn.​edu/​about/​, last visited Jan. 26, 2022.
 
22
Lost business income was alleged in 1918 cases as of Jan. 26, 2022. Another 1729 cases include allegations of extra expense, and 1652 cases allege civil authority coverage. See Covid Coverage Litigation Tracker, Allegations, https://​cclt.​law.​upenn.​edu/​#allegations, last visited Jan. 26, 2022.
 
23
See Knutsen and Stempel (2020), p. 190. For more current accounting of insurer success, see Covid Coverage Litigation Tracker, https://​cclt.​law.​upenn.​edu/​judicial-rulings/​. Motions to dismiss have been granted in 689 cases and denied in only 64 as of Feb. 15, 2022. Insurers have won summary judgment in full or in part in another 56 cases. Policyholders have only won 11 motions for partial summary judgment. Of the two cases that have been tried, both verdicts were for the insurer.
 
24
For example, see Studio 417 v Cincinnati Ins Co (WD Mo 2020) 478 F Supp 3d 794, p. 800.
 
25
See Knutsen and Stempel (2020), p. 264. For a case example, see Elegant Massage LLC v State Farm Mut Auto Ins Co (ED Va 2020) 506 F Supp 3d 360, pp. 375–376.
 
26
Of the cases included in the Covid Coverage Litigation Tracker (2122 cases as of Dec. 20, 2021), 679 cases (32%) had no virus or broad communicable disease exclusion, 446 (21%) had an explicit virus exclusion without anti-concurrent cause language, 381 (18%) had an explicit virus exclusion with anti-concurrent cause language, and 333 cases (16%) had a “hidden” virus exclusion (such as a pollution exclusion that included contamination). See Policy provisions for communicable disease, Covid Coverage Litigation Tracker, https://​cclt.​law.​upenn.​edu/​, last visited Feb. 8, 2022. Thus, 827 cases out of 2122 had explicit virus exclusions, which amounts to about 39% of cases. If “hidden” virus exclusions are included in that count, the total cases with virus exclusions rises to 1160, or about 55%.
 
27
See Knutsen and Stempel (2020), p. 271. In cases with a virus exclusion, insurers have won motions to dismiss in 462 cases and have only lost them in 32 cases, for a 93% winning rate. Trial Court Rulings on the Merits in Business Interruption Cases, Covid Coverage Litigation Tracker, https://​cclt.​law.​upenn.​edu/​judicial-rulings/​, last visited Feb. 15, 2022. At this point, there have been many fewer summary judgment motions, but Insurers have won summary judgment or partial summary judgment in 36 cases involving a virus exclusion compared to only 5 cases of partial summary judgment by policyholders. The insurers are still winning most of the cases without a virus exclusion, but the success rate is lower. The insurers won 215 motions to dismiss in cases without a virus exclusion, but lost 34 such motions, for a success rate of 86%. Insurers have prevailed on summary judgment or partial summary judgment motions in 20 cases without a virus exclusion, compared to 7 cases in which policyholders have prevailed on motions for partial summary judgment. Only two cases have been resolved by trial so far, and neither involved a virus exclusion, but the insurers won both of them.
 
28
See Knutson and Stempel (2020), p. 273 and n. 199.
 
29
Of the 2122 cases in the database as of December 20, 2021, 1922 seek coverage based on business income provisions. Another 1731 cases seek extra expense coverage, and 1656 seek coverage for an order of civil authority. Allegations, Covid Coverage Litigation Tracker, https://​cclt.​law.​upenn.​edu/​, last visited Feb. 8, 2022.
 
30
Of the 2122 cases in the database as of December 20, 2021, 187 cases (about 9%) seek to enforce specific coverage for communicable disease. Allegations, Covid Coverage Litigation Tracker, https://​cclt.​law.​upenn.​edu/​, last visited Feb. 8, 2022.
 
31
The Covid Coverage Litigation Tracker refers to these exclusions as “hidden” virus exclusions that are included in 333 cases. See Allegations, Covid Coverage Litigation Tracker, https://​cclt.​law.​upenn.​edu/​, last visited Feb. 8, 2022.
 
32
See Garaffa et al. (2021), § 42.02 [3] (2021).
 
33
See Knutsen and Stempel (2020), pp. 212–214; Kitchen (2021).
 
34
See Knutsen and Stempel (2020) p. 249. For a case example, see Sandy Point Dental PC v Cin Ins Co (7th Cir) 2021 US App LEXIS 36399, p. *13, finding that “the overwhelming majority of courts, including the four circuits that have so far spoken on the issue, have adopted this interpretation” that a physical alteration is required.
 
35
Sandy Point Dental PC v Cin Ins Co (7th Cir) 2021 US App LEXIS 36399, p. *9, quoting Travelers Ins Co v Eljer Mfg (Ill 2001) 757 N.E.2d 481, p. 502.
 
36
Sandy Point Dental PC v Cin Ins Co (7th Cir) 2021 US App LEXIS 36399, pp. *9–*10.
 
37
Sandy Point Dental PC v Cin Ins Co (7th Cir) 2021 US App LEXIS 36399, p. *10.
 
38
Sandy Point Dental PC v Cin Ins Co (7th Cir) 2021 US App LEXIS 36399, p. *11.
 
39
Sandy Point Dental PC v Cin Ins Co (7th Cir) 2021 US App LEXIS 36399, p. *15.
 
40
See Sandy Point Dental PC v Cin Ins Co (7th Cir) 2021 US App LEXIS 36399, p. *13.
 
41
Studio 417 v Cincinnati Ins Co (WD Mo 2020) 478 F Supp 3d 794, p. 800.
 
42
Studio 417 v Cincinnati Ins Co (WD Mo 2020) 478 F Supp 3d 794, p. 800, quoting Merriam-Webster online dictionary.
 
43
Studio 417 v Cincinnati Ins Co (WD Mo 2020) 478 F Supp 3d 794, p. 800, quoting the complaint.
 
44
See Knutsen and Stempel (2020) pp. 242–243; see also French (2020), pp. 21–22.
 
45
(DNJ) 2014 US Dist LEXIS 165232.
 
46
Gregory Packaging Inc v Travelers Prop Cas Co (DNJ) 2014 US Dist LEXIS 165232, pp. *3–*4.
 
47
Gregory Packaging Inc v Travelers Prop Cas Co (DNJ) 2014 US Dist LEXIS 165232, pp. *16–*17.
 
48
Gregory Packaging Inc v Travelers Prop Cas Co (DNJ) 2014 US Dist LEXIS 165232, pp. *18–*19.
 
49
See French (2020), pp. 21–22. For an example, see Studio 417 v Cincinnati Ins Co (WD Mo 2020) 478 F Supp 3d 794, p. 800.
 
50
Sandy Point Dental PC v Cin Ins Co (7th Cir) 2021 US App LEXIS 36399, p. *14.
 
51
Sandy Point Dental PC v Cin Ins Co (7th Cir) 2021 US App LEXIS 36399, p. *14.
 
52
Sandy Point Dental PC v Cin Ins Co (7th Cir) 2021 US App LEXIS 36399, p. *15.
 
53
Sandy Point Dental PC v Cin Ins Co (7th Cir) 2021 US App LEXIS 36399, p. *15.
 
54
See, for example, Studio 417 v Cincinnati Ins Co (WD Mo 2020) 478 F Supp 3d 794, p. at 803 n.6, citing Gregory Packaging to support the argument that “a physical loss has been adequately alleged insofar as the presence of COVID-19 ad the Closure Orders prohibited or significantly restricted access to Plaintiffs’ premises.”
 
55
Of cases included in the Covid Coverage Litigation Tracker, 827 cases (about 39%) include allegations regarding an explicit virus or communicable disease exclusion. See Policy provisions for communicable disease, Covid Coverage Litigation Tracker, https://​cclt.​law.​upenn.​edu/​, last visited Feb. 8, 2022.
 
56
Knutsen and Stempel (2020), pp. 270–271, quoting the Insurance Services Office virus exclusion Form CP 01 40 07 06 (July 6, 2006).
 
57
Of the cases included in the Covid Coverage Litigation Tracker (2122 cases as of Dec. 20, 2021), 381 included an explicit virus exclusion with anti-concurrent cause language and 446 had an explicit virus exclusion without anti-concurrent cause language. See Policy provisions for communicable disease, Covid Coverage Litigation Tracker, https://​cclt.​law.​upenn.​edu/​, last visited Feb. 8, 2022.
 
58
See Knutsen and Stempel (2020), pp. 272–273. Insurers have prevailed on a motion to dismiss in 462 cases involving a virus exclusion, and lost only 32 of those motions for a 93% success rate. Trial Court Rulings on the Merits in Business Interruption Cases, Covid Coverage Litigation Tracker, https://​cclt.​law.​upenn.​edu/​judicial-rulings/​, last visited Feb. 15, 2022. See also Kitchen (2021), § 17.03[1].
 
59
Knutsen and Stempel (2020), p. 272.
 
60
(7th Cir 2021) 20 F4th 311.
 
61
Mashallah Inc v West Bend Mut Ins Co (7th Cir 2021), 20 F4th 311, p. *10, quoting Founders Ins. Co. v. Munoz (Ill 2010) 930 NE2d 999, p. 1006.
 
62
The exclusion in one policy was identical to the ISO exclusion quoted above. The other exclusion was somewhat broader as it excluded “loss or damage caused directly or indirectly” by any “virus . . . that induces or is capable of inducing physical distress, illness or disease.” Mashallah Inc v West Bend Mut Ins Co (7th Cir 2021), 20 F4th 311, p. *4 (emphasis supplied).
 
63
Mashallah Inc v West Bend Mut Ins Co (7th Cir 2021), 20 F4th 311, p. *10.
 
64
Mashallah Inc v West Bend Mut Ins Co (7th Cir 2021), 20 F4th 311, p. *10.
 
65
Mashallah Inc v West Bend Mut Ins Co (7th Cir 2021), 20 F4th 311, pp. *11–*12.
 
66
Mashallah Inc v West Bend Mut Ins Co (7th Cir 2021), 20 F4th 311, p. *12, quoting Exec. Order No. 2020-10.
 
67
Mashallah Inc v West Bend Mut Ins Co (7th Cir 2021), 20 F4th 311, p. *13, quoting Mudpie Inc v Travelers Cas Ins Co for the “not debatable” language.
 
68
Mashallah Inc v West Bend Mut Ins Co (7th Cir 2021), 20 F4th 311, pp. *13–*14.
 
69
Mashallah Inc v West Bend Mut Ins Co (7th Cir 2021), 20 F4th 311, p. *14.
 
70
See, for example, Mudpie Inc v Travelers Cas In Co (9th Cir 2021) 15 F4th 885, pp. 889–893.
 
71
See MacGregor (2021), § II[B], citing ISO Form BG 00 01 01 97 (emphasis in the original).
 
72
See, for example, Sanzo Enterprises LLC v Erie Ins Exch. (Ct of App) 2021 Ohio 4269, p. *P59.
 
73
See MacGregor (2021), § II[D], citing ISO Form BG 00 01 01 97.
 
74
See Knutsen and Stempel (2020), p. 200.
 
75
See, for example, Sanzo Enterprises LLC v Erie Ins Exch. (Ct of App) 2021 Ohio 4269, p.*P63.
 
76
See Kitchen (2021) Insurance Coverage Disputes § 17.02[2].
 
77
See MacGregor (2021), § II[E].
 
78
Specific coverage for communicable diseases was alleged in 190 out of the 2,130 cases, so a little less than 9% of cases being tracked by the Covid Coverage Litigation Tracker. See Allegations, Covid Coverage Litigation Tracker, https://​cclt.​law.​upenn.​edu/​, last visited Feb. 24, 2022.
 
79
See MacGregor (2021), § II[E].
 
80
See, for example, Dakota Girls LLC v Philadelphia Indem Ins Co (6th Cir) 2021 US App LEXIS 33002, pp. *13–*14.
 
81
See, for example, Monarch Casino & Resort v Affiliated FM Ins Co (D Colo) 2021 US Dist LEXIS 179812.
 
82
See MacGregor (2021), § II[E].
 
83
See French (2020), p. 26.
 
84
See, for example, Circus Circus LV v AIG Specialty Ins Co (D Nev 2021) 525 F Supp 3d 1269, pp. 1277–1278.
 
85
See Kitchen (2021). § 17.03[2].
 
86
See, for example, Zwillo V Corp v Lexington Ins Co (WD Mo 2020) 504 F Supp 3d 1034, p. 1041.
 
87
See Kitchen (2021), § 17.03[2].
 
88
See, for example, Mohawk Gaming Enterprises LLC v Affiliated FM Ins Co (NDNY 2021) 534 F Supp 3d 216, p. 221 & n. 4.
 
89
See, for example, Mohawk Gaming Enterprises LLC v Affiliated FM Ins Co (NDNY 2021) 534 F Supp 3d 216, p. 221 & n. 4.
 
90
See, for example, Bradley Hotel Corp v Aspen Specialty Ins Co (7th Cir) 2021 US App LEXIS 36398, pp. *6–*7.
 
91
Mudpie Inc v Travelers Cas Ins Co (ND Cal 2020) 487 F Supp 3d 834, p. 842.
 
92
See, for example, Ceres Enters LLC v. Travelers Ins Co (ND Ohio 2021) 520 F Supp 3d 949, p. 953, quoting the exclusion.
 
93
See, for example, Ceres Enters LLC v. Travelers Ins Co (ND Ohio 2021) 520 F Supp 3d 949, p. 953, quoting the exclusion.
 
94
See, for example, Ceres Enters LLC v. Travelers Ins Co (ND Ohio 2021) 520 F Supp 3d 949, p. 953.
 
95
Bradley Hotel Corp v Aspen Specialty Ins Co (7th Cir) 2021 US App LEXIS 36398, p. *3, quoting exclusion from the policy.
 
96
Bradley Hotel Corp v Aspen Specialty Ins Co (7th Cir) 2021 US App LEXIS 36398, pp. *9–*14.
 
97
See Abraham and Baker (2022), p. 22.
 
98
See Knutsen and Stempel (2020), pp. 230–248, analyzing the legal arguments that support coverage.
 
99
See Knutsen and Stempel (2020).
 
100
See Gron and Tsvetkov (2020).
 
101
Gron and Tsvetkov (2020).
 
102
Gron and Tsvetkov (2020).
 
103
Swiss Re (2022).
 
104
Swiss Re (2022).
 
105
Gron and Tsvetkov (2020).
 
106
Gron and Tsvetkov (2020).
 
107
Gron and Tsvetkov (2020).
 
108
See Insurance Information Institute (2020) noting that when “industry surplus drops below $400 billion, dozens, perhaps hundreds, of insurers will be imperiled.”
 
109
See Gron and Tsvetkov (2020).
 
110
Gron and Tsvetkov (2020).
 
111
The argument has been raised in the press and in some cases through amicus briefing. See Rice (2022).
 
112
Rice (2022).
 
113
See Levmore and Logue (2003), p. 278.
 
114
DataLab, The Federal Response to COVID-19, available at https://​datalab.​usaspending.​gov/​federal-covid-funding/​, last visited Mar. 8, 2022.
 
115
DataLab, The Federal Response to COVID-19, available at https://​datalab.​usaspending.​gov/​federal-covid-funding/​, last visited Mar. 8, 2022.
 
116
Small Business Administration, Paycheck Protection Program Loans – How it Works (Round 1), available at https://​www.​sba.​com/​funding-a-business/​government-small-business-loans/​ppp/​how-it-works/​, last visited Mar. 8, 2022.
 
117
U.S. Bureau of Economic Analysis, How does the Paycheck Protection Program impact the national income and product accounts (NIPAs), available at https://​www.​bea.​gov/​help/​faq/​1408, last visited Mar. 8, 2022.
 
118
U.S. Bureau of Economic Analysis, How does the Paycheck Protection Program impact the national income and product accounts (NIPAs), available at https://​www.​bea.​gov/​help/​faq/​1408, last visited Mar. 8, 2022.
 
119
U.S. Bureau of Economic Analysis, How does the Paycheck Protection Program impact the national income and product accounts (NIPAs), available at https://​www.​bea.​gov/​help/​faq/​1408, last visited Mar. 8, 2022.
 
120
See Bell (2021), § 46.08[3].
 
121
Parlapiano et al. (2022)
 
122
See Levmore and Logue (2003), pp. 280–281.
 
123
See Abraham and Baker (2022), pp. 18–20.
 
124
See Abraham and Baker (2022), pp. 16–17.
 
125
See Abraham and Baker (2022), pp. 16–17 & n.33, citing as “the most influential historical treatment of internalist views” the work of Gordon (1984), p. 57.
 
126
See Abraham and Baker (2022), pp. 17, citing to Friedman (1973) as an example of the externalist point of view.
 
127
See Abraham and Baker (2022), p. 20.
 
128
See Abraham and Baker (2022), pp. 22–23, describing judicial decisions on some environmental coverage issues as a “mixed bag” where “insurer were winners about as often as they were losers.”
 
129
See Knutsen and Stempel (2020), pp. 224–226.
 
130
See Knutsen and Stempel (2020), p. 225.
 
131
Of the coverage cases being tracked by the Covid Coverage Litigation Tracker, 39% involve a virus exclusion. See Policy provisions for communicable disease, Covid Coverage Litigation Tracker, https://​cclt.​law.​upenn.​edu/​, last visited Feb. 8, 2022. Cases with a virus exclusion, however, are less likely to be litigated as the policyholder is more likely to view the prospects of recovery as much less likely. Although good data on the number of policies with virus exclusions is difficult to find, it could be much higher than 39%. See Rice (2022), quoting a policyholder lawyer stating that “83% of property policies have virus exclusions.”
 
132
Johnson (2019), p. 98.
 
133
Love and Knapp (2014), p. 12.
 
134
See, for example, Nail Nook Inc v Hiscox Ins Co (Ct App) 2021-Ohio-4211.
 
135
See, for example, Studio 417 v Cincinnati Ins Co (WD Mo 2020) 478 F Supp 3d 794, p. 801.
 
136
For an example of a case addressing (and rejecting) this argument, see Kim-Chee LLC v Phila Indem Ins Co (2nd Cir) 2022 US App LEXIS 2655, pp. *5–*6.
 
137
Insurance Services Office (2006), p. 2.
 
138
Insurance Services Office (2006), p. 1.
 
139
Insurance Services Office (2006), p. 2.
 
140
In cases with a virus exclusion, insurers have won motions to dismiss in 462 cases and have only lost them in 32 cases, for a 93% winning rate. Trial Court Rulings on the Merits in Business Interruption Cases, Covid Coverage Litigation Tracker, https://​cclt.​law.​upenn.​edu/​judicial-rulings/​, last visited Feb. 15, 2022.
 
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Metadaten
Titel
COVID-19 and Business Interruption Coverage in the United States: An Example of Judicial Regulation
verfasst von
Jeffrey E. Thomas
Copyright-Jahr
2023
DOI
https://doi.org/10.1007/978-3-031-13753-2_4

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