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Defense Digest

Novel Insurance Coverage Issue? File a Declaratory Judgment Action in Federal Court, Right? Well…

Defense Digest, Vol. 29, No. 3, September 2023

September 1, 2023

by Vincent E. Cononico

Key Points:

  • Federal courts are reluctant to consider novel insurance coverage issues.
  • A decision to deny jurisdiction in an insurance coverage action is likely to be affirmed.

The story usually unfolds like this: the facts of the loss suggest that a policyholder may not be entitled to indemnity or a defense under the terms of the insurance policy. However, the law on the particular issue is not well settled in the jurisdiction. Therefore, the prudent decision is to file a declaratory judgment action. The state court venue is not seen as desirable, so the option of filing the case in federal court is suggested. There is diversity of citizenship among the parties and the amount in controversy is sufficient for federal jurisdiction, so there should be no obstacle to filing the action in federal court, right? Well, before charging forward in federal court and incurring the associated expenses, we should take a closer look. 

A scenario similar to the one outlined above was recently considered in Admiral Insurance Co. v. Fire-Dex, LLC, 2023 WL3963623 (6th Cir. June 13, 2023). Fire-Dex is a manufacturer of firefighting products, including clothing worn by firefighters. Many of its materials contain the chemical polyfluoroalkyl, also known as PFAS. There is some evidence suggesting that PFAS causes cancer. A number of lawsuits have been filed against Fire-Dex and similar companies by the end-users of clothing containing PFAS. Fire-Dex turned to its liability insurer, Admiral Insurance, for defense and indemnity. Admiral believed that coverage did not apply under the terms of the policy and filed a declaratory judgment action in the United States District Court for the Northern District of Ohio. 

Specifically, Admiral argued the federal court should declare that it owed no duty to defend or indemnify Fire-Dex because the alleged injuries fell under the policy’s “occupational disease” exclusion. That exclusion states that there is no coverage for a “…disease arising out of any insured’s operation, completed operation or products.” Rather than addressing this issue, the federal district court dismissed the action, declining to exercise jurisdiction over the case. Believing that was an error, Admiral filed a notice of appeal to the United States Court of Appeals for the Sixth Circuit. 

The Court of Appeals began its analysis by explaining that, even when a litigant has satisfied all of the traditional elements establishing federal jurisdiction, a district court’s decision to accept a declaratory judgment action is still discretionary. District courts in the Sixth Circuit are required to apply the factors set forth in Grand Trunk W. R.R. Co. v. Consol. Rail Corp., 746 F.2d 323, 326 (6th Cir. 1984) when deciding whether to keep a declaratory judgment action. These factors are whether:

  • the declaration will settle the controversy;
  • the declaration will serve a useful purpose in clarifying the legal relations in issue;
  • the declaration will be used merely for the purpose of “procedural fencing”;
  • the declaration will improperly encroach upon state jurisdiction; or
  • there is a better alternative remedy.

The parties to the Fire-Dex case agreed that most of these factors were satisfied. The declaratory judgment action would settle the controversy and would be useful in clarifying the legal relations. There was no evidence that the action was filed for an improper motive, or “procedural fencing.” In addition, a declaration of Fire-Dex’s rights under the policy seemed to be the best remedy. 

However, the parties could not agree on the fourth factor, which formed the basis for dismissal by the district court. Specifically, the lower court concluded that retaining the declaratory judgment action would encroach on the jurisdiction of the state courts, because the specific coverage issue had not been decided by the state courts previously. Admiral disagreed and challenged the district court’s ruling on appeal, arguing that similar insurance policy exclusions had been applied in the workers’ compensation setting and that those decisions provided the federal courts with the necessary guidance on state law.

The Sixth Circuit did not find Admiral’s argument persuasive and explained that “states…are the masters of their own law, subject to certain federal constitutional and statutory restraints.” The court also stated, “[b]y and large, insurance rules and regulation are reserved to the states for crafting.” Because there are no Ohio state court decisions applying this specific policy exclusion to the same or similar facts, it was concluded that the district court was correct in declining to exercise jurisdiction. The court further explained that it was reluctant to reverse the lower court’s decision absent an abuse of discretion. The court explained, “It is enough that the district court has ‘taken a good look at the issue and engaged in a reasoned analysis of whether issuing a declaration would be useful and fair.’” 

At first glance, the decision in Fire-Dex might seem counterintuitive. After all, in the context of insurance coverage, litigants file declaratory judgment actions for the purpose of seeking clarification of novel coverage questions. If the coverage decision is clear, there is no need to file a declaratory judgment suit. However, the lesson to be taken from Fire-Dex is that if the issue at hand is truly, or even arguably, one of first impression in the state, the federal courts will probably not welcome the case. Further, if the federal court denies jurisdiction, that decision is very likely to be affirmed on appeal. Therefore, litigants should proceed cautiously when considering filing a declaratory judgment action in federal court that involves a novel insurance coverage question.

*Vincent is a shareholder in our Cleveland, Ohio, office. He can be reached at 216.912.3821 or vecononico@mdwcg.com.

 

Defense Digest, Vol. 29, No. 3, September 2023, is prepared by Marshall Dennehey to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. ATTORNEY ADVERTISING pursuant to New York RPC 7.1. © 2023 Marshall Dennehey. All Rights Reserved. This article may not be reprinted without the express written permission of our firm. For reprints, contact tamontemuro@mdwcg.com.

Firm Highlights

Thought Leadership

Supreme Court of Pennsylvania Holds That Public Policy Does Not Prevent Insurance Coverage for Sex Trafficking Claims

On July 21, 2026, the Supreme Court of Pennsylvania issued an opinion emphasizing the limited circumstances in which courts may invoke public policy to bar insurance coverage, holding in Samsung Fire & Marine Insurance Co., Ltd. (U.S. Branch) v. RI Settlement Trust that Pennsylvania public policy does not preclude coverage for claims alleging that insureds enabled or profited from human sex trafficking. The decision rejects a line of federal district court decisions predicting otherwise and reinforces that Pennsylvania courts will invoke the public policy doctrine only in the clearest of circumstances. RI Settlement is particularly significant because it arose on certified questions from the United States Court of Appeals for the Third Circuit, giving the Supreme Court the opportunity to resolve an issue on which federal courts had predicted Pennsylvania law differently. RI Settlement arose out of four separate civil complaints in which the underlying plaintiffs alleged that, as minors, they were the victims of human sex trafficking at various hotels in Philadelphia. The plaintiffs claimed that the hotel owners were negligent in failing to stop the sex trafficking from happening at their hotels. After the filing of the lawsuits, the hotel owners sought coverage under their Commercial General Liability policies. The insurers initially defended the hotels under Reservation of Rights letters, though the carriers later filed Declaratory Judgment actions seeking declarations that they did not owe a duty to defend or indemnify. In short, the insurers argued in the alternative that they did not owe any obligation to provide coverage based upon Pennsylvania public policy (because the claims violated the Human Trafficking Law – 18 Pa.C.S. § 3011) and the terms and conditions of the policy. On motions for judgment on the pleadings, the District Court found for the insurers on the basis of public policy: There is no duty to defend or indemnify against actions arising out of an insured's criminal conduct related to the sex trafficking of minors. The Court appreciates that it may make public policy the basis of a judicial decision only in “the clearest of cases.” See Minnesota Fire & Cas. Co. v. Greenfield, 589 A.2d 854, 868 (Pa. 2004) (quoting Hall v. Amica Mut. Ins. Co., 648 A.2d 755, 760 (Pa. 1994)). Yet, the Court strains to imagine a clearer case than the one presented here in which the facts alleged indicate that Policyholders engaged in criminal conduct in violation of Pennsylvania's Human Trafficking Law. The hotel owners appealed the matter to the Third Circuit, which petitioned the Supreme Court of Pennsylvania to grant review of two certified questions of law: (1) whether Pennsylvania law had an “overriding public policy” against sex trafficking, such that an insurer’s duty to defend and/or indemnify is abrogated when an insured is alleged to have enabled or profited from such trafficking; and (2) if yes, is that duty abrogated whenever the insured’s alleged conduct would constitute a violation of the Pennsylvania Human Trafficking statute. Importantly, the certified questions did not ask the Supreme Court to determine whether the policies afforded coverage under their terms. Rather, the court was asked only whether Pennsylvania public policy independently barred coverage. As a result, the court assumed for purposes of answering the certified questions that the insurers otherwise owed a duty to defend and addressed only the public policy issue, leaving all policy-based coverage defenses for further proceedings. Because the court concluded that the answer to the first certified question was “no”, it did not reach the second issue. In reaching its determination that Pennsylvania public policy does not prohibit insurance coverage for sex trafficking claims, the court limited the impact of its decision in Minnesota Fire & Cas. Co. v. Greenfield, 855 A. 2d 854, 855 (Pa. 2004), which the RI Settlement opinion emphasized as having been an “Opinion Announcing Judgment of the Court” – or a plurality opinion. In Greenfield, the insured homeowner was sued by the estate of his houseguest who overdosed from heroin that he sold to her. The matter wound its way to the Supreme Court, which determined that the insurer did not owe a duty to defend or indemnify based upon Pennsylvania public policy, which criminalized the sale and use of heroin as a Schedule I narcotic. In RI Settlement, the court “decline[d] the invitation” to extend the rationale of the three-justice plurality in Greenfield beyond cases involving Schedule I controlled substances. In so holding, the justices in RI Settlement refused to “divine an overriding public policy pronouncement by the General Assembly by virtue of its enactment of the Human Trafficking Law.” The opinion further states that it is not “within the purview of this Court to rank the magnitude of the public policy underlying the various crimes defined in the Crimes Code. It is sufficient for the work of the courts to know that the General Assembly has identified conduct it deems harmful and dangerous to the maintenance of an orderly society and criminalized it.” While the court declined to declare that Pennsylvania public policy prohibits coverage for sex trafficking claims, the opinion in RI Settlement expressly states that insurers are free to include appropriate exclusionary language for such causes of actions in their policies if they desire to do so. It will certainly be interesting to see whether the insurance industry accepts the court’s invitation, or perhaps whether the Pennsylvania legislature steps in to clarify that sex trafficking claims are indeed of the type or magnitude that they should not be covered by insurance. In any event, we will, of course, continue to monitor this and other insurance coverage issues that arise before courts in Pennsylvania, New Jersey and throughout our firm’s geographic footprint and around the country.

Thought Leadership

New Jersey Appellate Division Affirms Exclusion of Legal Malpractice Expert as Impermissible Net Opinion

Jack Slimm and Jeremy Zacharias obtained a favorable decision on behalf of their client in a case centering on the admissibility of expert testimony in legal malpractice actions. In Martin v. Loury, the New Jersey Appellate Division affirmed the exclusion of a plaintiff's legal malpractice expert, holding that the expert's opinions on causation and damages were too speculative to support the malpractice claim. The legal malpractice action arose from an underlying employment dispute involving claims for damages stemming from the breach of an employment agreement. The plaintiff alleged that defense counsel committed malpractice during a second trial by failing to recall the plaintiff as a rebuttal witness after the employer's CEO testified. According to the plaintiff's expert, additional rebuttal testimony would have bolstered the plaintiff's damages claims and led to a more favorable result. Both the trial court and the Appellate Division rejected that theory. The courts found that the expert could not explain how the proposed rebuttal testimony would have altered the outcome of the underlying case or resulted in any additional recoverable damages. Notably, the trial judge in the underlying employment matter had already rejected the CEO's testimony as not credible and had accepted the damages analysis advanced by the plaintiff. The court had also determined that the amount of damages was not genuinely disputed. As a result, the expert's opinion that additional rebuttal testimony would have produced a better outcome was unsupported by the record and based on speculation rather than evidence. The Appellate Division agreed that neither the plaintiff nor the expert could identify any actual damages attributable to the alleged malpractice or demonstrate the required element of proximate causation. The court further upheld the trial court's application of New Jersey's net opinion doctrine, finding that the expert failed to provide the necessary "why and wherefore" supporting his conclusion that the attorney's conduct caused a compensable loss. Because the opinions rested on unquantified possibilities rather than demonstrable facts, they were inadmissible. Key Takeaway for Legal Malpractice Defendants For attorneys and firms defending legal malpractice claims, Martin v. Loury underscores the importance of closely scrutinizing an opponent's expert report on the critical elements of proximate causation and damages. The decision demonstrates that a malpractice claim cannot survive where an expert merely speculates that different litigation tactics might have produced a better result. Instead, the plaintiff must present admissible expert testimony grounded in the record that explains how the alleged attorney error probably changed the outcome of the underlying matter and resulted in measurable damages.

Thought Leadership

Court Allows Recklessness and Punitive Damages Claims to Proceed After Work‑Zone Crash

In a case where a defendant filed preliminary objections against allegations of recklessness and punitive damages, the Susquehanna County Court of Common Pleas denied these preliminary objections. This case stems from a motor vehicle accident, where the defendants car struck the plaintiffs car after the defendant allegedly fell asleep at the wheel, going at a high rate of speed, through a construction work zone. Defendant first objected to the general allegations throughout the plaintiff’s complaint pertaining to “reckless” conduct contending that there were insufficient factual allegations to support the claim of reckless conduct. Defendant next objected to the plaintiffs claim for punitive damages, as punitive damages may only be assessed against a motorist for falling asleep while driving if there is further evidence to prove driver was aware of their drowsiness and risk of falling asleep. Lastly, defendant objected to plaintiffs complaint, claiming it lacked specificity. The court here found that the plaintiff had included in the complaint specific allegations related to the defendant’s alleged recklessness, including allegations regarding speeding in a work zone, almost striking the flagger, falling asleep at the wheel, and striking the plaintiffs vehicle which was stopped. Additionally, the court noted that falling asleep does not come without warning. The court found that these allegations were sufficient to support an allegation of recklessness at the pleadings stage.

Result

No-Cause Jury Verdict Secured in Wrongful Death Trial

We successfully obtained a no-cause jury verdict in a 13-day wrongful death trial. The decedent, a 59-year-old man, was admitted to the emergency room on February 15, 2019, with complaints of abdominal pain, decreased appetite, and constipation, despite the use of laxatives. The patient did not complain of any nausea, vomiting, or diarrhea. He had a significant medical history including diabetes, hypertension, prior coronary artery stenting, morbid obesity (with past gastric bypass surgery), longstanding ventral hernia, and back pain. A CT scan revealed multiple hernias and a potential closed-loop bowel obstruction, leading to a surgery consultation. Our client, an emergency general surgeon, interpreted that the patient did not have a closed loop or any significant obstruction and recommended non-surgical management. The patient was approved to have clear liquids, and had a vomiting incident shortly after, but our client was not notified. The patient was returned to NPO status, and after improving overnight, he was returned to “clears” and additional medical and renal consults were ordered. Our client did not receive any communications from the residents/nurses of any changes in the patient’s condition. On February 18, 2019, two rapid responses were called due to increased heart rate and vomiting. It is believed that the vomiting resulted in aspiration, causing sepsis, ultimately leading to the patient’s death. During the trial, the plaintiff’s sole medical expert highlighted imaging on the wrong hernia, which called into question all of his opinions in the case. We made key objections related to the expert testimony, limiting what the allegations were, and preventing new allegations from being made. After approximately two and a half hours of deliberating, the jury returned a no-cause verdict.