Appellant sought review of a judgment of the United States District Court for the Central District of California, which granted, sua sponte, summary judgment to appellee insurer, holding that appellee was obligated neither to defend nor indemnify its insureds with respect to appellant’s state court action against appellee’s insureds.
Table of Contents
Overview
Appellant sought review of a trial court judgment which granted, sua sponte, summary judgment to appellee insurer, holding that appellee was obligated neither to defend nor indemnify its insureds with respect to appellant’s state court action against appellee’s insureds. Appellant contended that there was a genuine issue of material fact as to whether appellee insurer timely reserved its rights to assert defenses to coverage under its policy. The court vacated, holding that there was a genuine triable issue over whether appellee timely reserved its rights under the policy because there was evidence showing that no reservation of rights was ever sent to appellee’s insureds and there was also evidence that a timely reservation of rights was sent to appellee’s insureds. The court remanded the case to the trial court for a trial on the question of whether appellee waived its defenses to coverage. Parties’ litigation attorneys Los Angeles appeal.
Outcome
The court vacated, holding that there was a genuine triable issue over whether appellee insurer timely reserved its rights to assert defenses to coverage under its insureds’ policy. The case was remanded for trial on that issue.
Overview
HOLDINGS: [1]-With respect to counter-complaint filed by an insurer against providers, dismissal was not warranted because the insurer adequately alleged that providers made intentional and material misrepresentations in claims to the insurer and the allegations were sufficiently particular, for purposes of Fed. R. Civ. P. 9(b), to provide notice of the types of fraud at issue; [2]-ERISA did not preempt the insurer’s state law claims, as those claims did not interfere with the objects of the federal regulation; [3]-The insurer sufficiently pled claims for equitable relief under ERISA; [4]-Although the insurer had Article III standing and could pursue its ERISA claims and other state law claims, it could not bring an unfair competition law (UCL) claim on behalf of the self-funded plans.
Outcome
Claim seeking to recover on behalf of self-funded plans dismissed. In all other respects, motion to dismiss denied.