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Labor Day: Office Hours & the Evolution of Workers’ Insurance

As Labor Day approaches, we at Lether Law Group want to take a moment to recognize and celebrate the hard work and dedication that you and countless others demonstrate every day. Labor Day, observed on the first Monday of September, is a time to honor the achievements and contributions of workers across the country.

In observance of this National Holiday, our offices will be closed on Monday, September 2, 2024, to allow our team to enjoy some well-deserved rest and relaxation. We will resume our normal business hours on Tuesday, September 3, 2024.

Fun Fact: Labor Day is not just a day off—it is also a significant marker in the history of workers’ rights and the development of modern-day insurance practices. As the industrial revolution transformed the American workforce, the risks associated with labor grew, leading to the establishment of workers' compensation laws and the expansion of insurance coverage to protect both employers and employees. These laws were designed to provide financial protection for employees injured on the job, paving the way for modern-day insurance practices related to workplace safety and employee benefits.

Today, these protections have evolved into the complex and sophisticated insurance landscape we know, where coverage disputes, liability concerns, and regulatory challenges are common.

At Lether Law Group, we understand the vital role that labor plays in our society and the importance of ensuring that workers are protected. As we take this time to reflect on the importance of labor and the protections that have been established over the years, we remain dedicated to serving the needs of our clients in this ever-evolving field.

We hope you have a safe and enjoyable Labor Day weekend. Should you need any assistance before or after the holiday, please do not hesitate to reach out.

Thank you for your continued trust in Lether Law Group.

Ninth Circuit Partially Revise Class Action Claims Against State Farm

On Monday, August 19, 2024, the Ninth Circuit Court of Appeals issued a published opinion in Jama, et al. v. State Farm Mutual Auto. Ins. Co., et al, No. 22-35499, 2024 U.S. App. LEXIS 20881, __ F.4th___ (9th Cir. 2024) reversing in part a Western District of Washington summary judgment ruling decertifying class action claims against two State Farm entities.

At the trial court level, the insureds asserted class action claims against State Farm based on how State Farm compensated vehicle owners for actual cash value (ACV) after accidents that involved the total loss of the insured vehicle. The insureds initially sought class certification for two classes: 1) the negotiation class; and 2) the condition class.

To determine ACV, State Farm would use an Autosource report from a third-party vendor which reported information regarding advertised price of comparable vehicles and then would make adjustments including adjustments for the condition of a vehicle and adjustments for “negotiation.”  The condition adjustment was based on the assumption that vehicles were in different conditions than those on the market and would adjust the value of the car accordingly. The negotiation adjustment was based on an assumption that a customer would negotiate with a dealer and buy a car for less than advertised price.

The District Court decertified the classes and dismissed claims against State Farm on summary judgment based on the court’s reading of Lara v. First National Ins. Co. of Amer., 25 F.4th 1134 (9th Cir. 2022) finding that just because the insureds could establish an illegal adjustment was not sufficient to establish injury on a class-wide basis “by relying class members’ car value as calculated in the Autosource reports less the amount of the challenged negotiation or condition adjustments.” 

The Ninth Circuit affirmed with respect to the condition class because it was undisputed that an insurer could take condition into account and adjust ACV accordingly and because any injury would be individualized based upon the condition of each individual’s vehicle.  However, it reversed with respect to the negotiation class.

With respect to the negotiation class, the insureds argued that Washington law did not allow an insurer to reduce ACV payments by a “typical negotiation discount”. The Court of Appeals agreed with the trial court’s  finding that applicable Administrative Code (WAC) provision (WAC 284-30-391) did not allow for such discounts and only provided for discounts specifically set forth in the WAC. See WAC 284-30-391(4)(b).  Accordingly, any reduction in ACV payment for a negotiation discount was unlawful.

The insureds asserted that class certification for the negotiation class was appropriate because it could be determined on a class wide scale for those who were paid according to the Autosource report and had their payment reduced by a uniformly applied negotiation discount. State Farm argued that measuring injury that way would effectively allow the class to establish injury just based upon the illegality of the act, which was prohibited by the Lara decision.

The trial court effectively agreed with this argument when it decertified the class and entered summary judgment for State Farm. The Ninth Circuit, however, reversed. In doing so, it clarified that its holding in Lara was distinguishable because in Lara the proposed class was broader than the proposed class in Jama.  In Lara, the proposed class included those who received a report containing an unlawful adjustment but nevertheless received ACV for other reasons. The class Jama was not as broad.

Instead, the proposed negotiation class was limited only to:

…those class members who (1) were paid based on the Autosource report, excluding those who negotiated or pursued an appraisal; and (2) were paid a negotiation adjustment that, according to the Plaintiffs, can never measure a lawful deduction.

The Ninth Circuit concluded that narrowing the class avoided the issues raised in Lara. It further summarized that the Plaintiff’s arguments were that the ACV was originally calculated based on permissible factors, but then reduced by a factor that was not allowed under Washington law. The Court went on to state that “[n]othing in Lara precludes common proof of injury as the amount of State Farm’s estimates less the impermissible deduction as to the class of owners who were paid the Autosource valuation.” Accordingly, the Court reversed the trial court’s decertification and dismissal. This included reversing summary judgment against the individual class representatives and remanding the case for consideration in light of the Court’s holding. 

Lether Law Group has represented and advised auto insurers on all aspects of coverage including valuation disputes for over 30 years. If you would like to discuss the implications of the Jama decision or coverage issues involving these types of claims, please feel free to contact our offices.

Understanding the Impact of OFAC Advisory Notices on Insurance Policies

One of the most unusual notices that exists in many policies is the OFAC Advisory Notice. This notice, which can function to freeze or block an insurance contract, is rarely considered by claims professionals or insureds. So, what is OFAC?

OFAC stands for the Office of Foreign Assets Control, which is a financial intelligence and enforcement agency operating under the U.S. Treasury Department. The Division of Foreign Assets Control (DFAC), the precursor to OFAC, was created in the 1950s, when China entered the Korean War. DFAC blocked Chinese and North Korean assets that were subject to US jurisdiction. Thereafter, following a 1962 Treasury Department Order, DFAC officially became OFAC. Yet, despite OFACs presence as a governmental entity for over 70 years, little is known about it. Even less is known about OFAC’s relationship to the insurance industry.

In 2018, OFAC mandated an advisory notice restricting claims activities and payments when any person or entity benefiting from the subject insurance policy has violated US sanctions law or is a Specially Designated National and Blocked Person under OFAC. Included in the Specially Designated National and Blocked Persons list are various foreign agents, front organizations, terrorists, terrorist organizations, and narcotics traffickers.

In essence, the advisory mandates that insurers are restricted from issuing payments on claims where a designated entity is involved. Per the terms of the advisory this could include entities that are subject to foreign trade embargoes or sanctions.

Based upon our research, the OFAC advisory has been construed only a few times in the insurance industry. However, there has been increased discussions regarding this notice due to heightened worldwide tensions and international sanctions placed on certain countries, such as Russia, as a result of military activity. Further, the advisory notice would apply to any business or entity that is in violation of human rights, is subject to trade embargoes or sanctions, or is engaged in narcotics trafficking.

Although the advisory notice provides that the insured’s policy can be frozen or blocked if they are found to be in violation of OFAC regulations, neither OFAC nor case law provides clear direction as to what those exact ramifications are. This issue, however, should be considered in regard to any claim where such a designated entity may be involved, either as an insured or as the beneficiary of insurance payment.

Insurers who issue cyber coverage likely face the largest impact from the OFAC advisory notice. In fact, in 2020 the OFAC issued an Advisory on Potential Sanctions Risks for Facilitating Ransomware Payments and issued an updated Advisory regarding same on September 21, 2021. That advisory, a copy of which is also linked to this newsletter, provides that facilitating ransomware payments demanded as a result of malicious cyber attacks may violate the OFAC advisory with respect to payments to those who have violated U.S. sanctions law or are Specially Dedicated national and Blocked Persons. The 2021 Advisory further provides as follows:

OFAC may impose civil penalties for sanctions violations based on strict liability, meaning that a person subject to U.S. jurisdiction may be held civilly liable even if such person did not know or have reason to know that it was engaging in a transaction that was prohibited under sanctions laws and regulations administered by OFAC.

In other words, an insurer who issues cyber coverage runs the very real risk of running afoul of OFAC regulations by issuing payment for any cyber ransom attack without first getting permission from the OFAC. As a result of these risks, insurers offering this type of coverage would benefit significantly by putting into place policies and protocols to ensure compliance with OFAC regulations and to ensure that proper reporting and communication with OFAC take place prior to issuing payment for any cyber ransom attack.

The attorneys at Lether Law Group have been providing insurers with coverage advice and recommendations for more than 30 years. Our experience includes addressing cyber claims and coverage issues under cyber policies.  If you'd like to discuss this particular coverage issue or other insurance related issues arising in the ever-changing world of insurance, please feel free to contact our office.