When Buying a House with a Flooding History, Let the Buyer Beware

Primary insurance policies include the duty to defend aninsured in connection with a covered loss. The insurer is sometimes presentedwith the question of whether a defense is owed when many of the allegations arenot apparently covered by a particular policy. In this circumstance, how doesan insurer determine its obligation? The law provides the answer: the “eightcorners” rule—do the four corners of the policy unambiguously exclude coveragein all respects when viewed within the context of the four corners of thepetition? If the answer is “no,” the duty to defend arises. Mossy Motors,Inc. v. Cameras America, 2004-0726 (La. App. 4 Cir. 3/2/05), 898 So.2d 602,606.

Courts generally hold that the duty to defend the caseextends to ALL claims, not just the covered claims. This duty can often provequite costly, especially when non-covered claims are high-value or involveextensive factual development or testimony to defend. In some instances, theanswer under the eight corners analysis is not so clear. The safe choice forthe insurer is to provide a defense and hire separate counsel to handle thecoverage side of the case.

In this scenario, where an insurer has serious coveragedefenses, but agrees to provide the defense, when does the duty to defend terminate?The Louisiana First Circuit Court of Appeal recently ruled on this issue againin Ponchartrain Natural Gas System, K/D/S Promix, L.L.C. and Acadian GasPipeline System v. Texas Brine Company, L.L.C., No. 2018 CA 0254 (La. App.12/12/19), stating:

“Our previous decisions in the related sinkhole appeals clearly set out the well-established rule of law that an insurer' s duty to defend terminates once the undisputed facts establish, or a judicial determination is made, that the claims asserted are not covered under the policy. See Florida Gas, 272 So. 3d at 551; Pontchartrain, 264 So.3d at 553- 54; Crosstex, 240 So.3d at 1032.”

So, the duty to defend ends when undisputed facts establishOR a judicial determination is made that the asserted claims are not covered.Of course, who is to say that the facts are “undisputed” without a judicialdetermination that confirms this conclusion. An insurer couldunilaterally determine that facts are undisputed and terminate the defensebefore a judicial determination, but if the court does not agree, the insurermay have issues. Accordingly, the safe course is to await a judicialdetermination before an insurer terminates the defense.

It is important to distinguish the duty of an excess carrierbecause such policies generally do not provide an obligation to defend.Instead, the excess carrier may exercise its “right to defend.”

In South Alexander Development I, LLC v. Markel American Insurance Co., the U.S. District Court for the Middle District of Louisiana granted an insurer’s motion for summary judgment finding that the insured’s failure to cooperate violated the policy’s coverage terms and voided coverage.

The dispute arose from a commercial first-party property loss following Hurricane Ida. The insurer moved quickly to adjust the claim by retaining an independent adjuster and engineers to evaluate the damage to and value of the insured property. It also asked the insured to produce documentation needed to complete the adjustment, including records of installation costs, monthly revenues, and repair estimates. The insured did not respond.

Additionally, the insurer sent numerous emails over the course of the claim requesting information about (1) the costs the insured had incurred; (2) documentation supporting the income loss claim, along with quotes, estimates, and proposals for repairs; and (3) the scope of work for testing and repairs. However, most of these requests went unanswered.

Based on this evidence, the court determined that the insured violated the terms of the policy because it failed to cooperate with the insurer’s investigation. Most notably, the insured obtained repair estimates and proposals from its own contractor and withheld them from the insurer until after suit was filed. The insured also never submitted a completed proof of loss, even though the policy required submission of such a document that included estimates and “other reasonable information” the insurer needed to settle the loss. These acts showed the insured failed to “cooperate with [the insurer] in performing all acts required by this policy.”

The insurer showed that it pursued the information diligently and that the insured’s breach was both material and prejudicial. The court found (1) the insurer had documented repeated, specific requests for nearly a year, (2) the withheld documents went directly to quantifying the loss, and (3) the insured’s noncompliance deprived the insurer of its right to investigate the insured’s claim.

As a result, the court granted summary judgment finding no genuine issue of material fact relating to the insured’s breach of the policy’s cooperation clause. The insured was precluded from bringing a breach of insurance contract claim and therefore, without a valid contractual claim, the insured also could not pursue a bad faith claim against the insurer.

References:

South Alexander Development I, LLC v. Markel American Insurance Co., CV 23-1436-JWD-SDJ, 2026 WL 1819120 (M.D. La. June 24, 2026).

The COVID-19 pandemic had a profound impact on the global economy. Louisiana was not spared, and many businesses had to close as sales to their customers slowed or stopped altogether. Not surprisingly, the question arose regarding whether business interruption insurance would provide coverage to businesses in this situation. The Louisiana Supreme Court recently was asked this question in Cajun Conti, LLC v. Certain Underwriters at Lloyd’s, London and found that the policy at issue did not provide such coverage.

The mayor of New Orleans issued a proclamation on March 16, 2020, that prohibited most public and private gatherings. This applied to restaurants, whose business initially was limited to takeout and delivery services. Before the pandemic, Oceana Grill, a restaurant located in the French Quarter, could serve up to 500 customers at one time. However, it had to limit its business to takeout and delivery services when the mayor’s proclamation was announced. Because of social distancing guidelines, it remained at 60% or less capacity throughout the pandemic.

Oceana maintained a commercial insurance policy with loss of business income coverage and filed suit to request a declaratory judgment that the “policy provides business income coverage from the contamination of the insured premises by COVID-19.” Oceana’s insurer argued that there was no coverage under the policy because COVID-19 did not cause “direct physical loss of or damage to property” under the policy’s terms.

The trial court denied Oceana’s request for declaratory relief at trial. The appellate court reversed and found the policy’s terms ambiguous because it held “direct physical loss” could mean loss of use of the property. Because the pandemic prevented the full use of the property due to capacity limitations, the appellate court found coverage was triggered.

The Supreme Court disagreed and reversed the appellate court’s decision, finding its focus on the use of the property to be misguided. The Court found that suspension of operations “caused by direct physical loss of or damage to property,” as defined by the policy, required “the insured’s property to sustain a physical, meaning tangible or corporeal, loss or damage.” The Court noted that the restaurant’s physical structure was not lost or damaged because of the pandemic. COVID-19 restrictions did not cause damage or loss that was physical in nature. Therefore, the policy did not provide coverage for loss of business income.

Whether a policy affords coverage depends on the terms and conditions of each policy and the facts of each case. However, in light of this decision, businesses with insurance policies that include provisions with language like that at issue in Cajun Conti should not anticipate coverage for loss of business income allegedly caused by the COVID-19 pandemic.

Case References:

Cajun Conti LLC v. Certain Underwriters at Lloyd's, London, 2022-01349 (La. 3/17/23), 2023 WL 2549132.