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Cooper filed suit against National Union after the insurer denied a claim under a commercial-crime insurance policy. The Fifth Circuit affirmed the district court's take-nothing judgment against Cooper. Determining that Texas law governs the court's interpretation of the policy, the court held that Cooper suffered a "loss" only after it loaned the principal to Greenwood and Walsh and that Cooper did not "own" the funds when they were in the fraudsters' possession. Because these holdings were sufficient to preclude coverage, the court need not consider the parties' remaining contentions. Accordingly, the court dismissed National Union's cross-appeal. View "Cooper Industries, Ltd. v. National Union Fire Insurance Co." on Justia Law

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Robert Klem sued Access Insurance Company and Access General Insurance Adjusters, LLC (collectively, "Access") after he was in a car accident and Access administered his claim. Klem alleged Access falsely notified the California Department of Motor Vehicles that his care was a total loss salvage, thereby reducing its value and resulting in a loss of use. Access filed a special motion pursuant to the anti-SLAPP (strategic lawsuit against public participation) statute. The trial court found Access' notice to the DMV was a protected communication, but that Klem met his initial burden of establishing a probability of prevailing on the merits. The trial court denied Access' motion, and Access appealed. Finding the trial court erred with respect to certain evidentiary rulings and by denying the anti-SLAPP motion, the Court of Appeal reversed and remanded for the trial court to enter a new order granting Access' motion. View "Klem v. Access Insurance Co." on Justia Law

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Michael Carlson, individually and in his capacity as administrator of his deceased wife Claudia Carlson’s estate and as assignee of William Porter, brought this action pursuant to N.Y. Ins. Law 3420(a)(2) to collect on certain insurance policies. The policies were issued to DHL Worldwide Express, Inc. (DHL) by National Union Fire Insurance Co. (National Union) and American Alternative Insurance Co. (AAIC), and Plaintiff had previously obtained a judgment against MVP Delivery and Logistics, Inc. (MVP) and William Porter. At issue on appeal was whether Michael sufficiently pleaded that MVP was an “insured” under DHL’s policies and whether the policies fell within the purview of N.Y. Ins. Law 3420 as policies “issued or delivered” in New York. The Court of Appeals held (1) dismissal of Plaintiff’s first cause of action pursuant to N.Y. Ins. Law 3420(a)(2) and (b) to collect on certain insurance policies was improper as to National Union and AAIC; (2) whether MVP was an “insured” under DHL’s policies presents a question of fact to be resolved by the trier of fact; and (3) section 3420 encompasses situations where both insureds and risks are located in the state of New York. View "Carlson v. American International Group, Inc." on Justia Law

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The Supreme Court’s decision in West v. Shelby County Healthcare Corp., 459 S.W.3d 33 (Tenn. 2014), holding that “reasonable charges” for medical services under Tennessee’s Hospital Lien Act are the discounted amounts a hospital accepts as full payment from patients’ private insurer and not the full, undiscounted amounts billed to patients, does not apply in personal injury cases. Further, the collateral source rule applies in this personal injury case, in which the collateral benefit at issue is private insurance. Therefore, Plaintiffs may submit evidence of the injured party’s full, undiscounted medical bills as proof of reasonable medical expenses, and Defendants are precluded from submitting evidence of discounted rates accepted by medical providers from the insurer to rebut Plaintiffs’ proof that the full, undiscounted charges are reasonable. The Supreme Court thus affirmed in part and reversed in part the decision of the court of appeals, which concluded that West did not apply to personal injury cases but that evidence of discounted amounts accepted by the injured’s medical providers may be admissible to rebut Plaintiffs’ expert testimony on the reasonableness of the amount of the full, undiscounted bills. View "Dedmon v. Steelman" on Justia Law

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United Fire & Casualty Company appealed a district court judgment awarding Carol Forsman $249,554.30 in her garnishment action against United Fire, commenced after she settled claims in the underlying suit against Blues, Brews and Bar-B-Ques, Inc., d.b.a. Muddy Rivers. Muddy Rivers was a bar in Grand Forks that was insured by United Fire under a commercial general liability ("CGL") policy. In 2010, Forsman sued Muddy Rivers and Amanda Espinoza seeking damages for injuries to her leg allegedly sustained while a guest at a February 2010 private party at Muddy Rivers. Muddy Rivers notified United Fire of the suit and requested coverage. United Fire denied defense and indemnification based on the policy's exclusions for assault and battery and liquor liability. However, after appeals and reconsideration, the court ruled in Forsman's favor, finding the settlement amount was reasonable. The North Dakota Supreme Court concluded the court erred in granting summary judgment because material fact issues existed on whether exclusions for "assault and battery" and "liquor liability" in the CGL policy excluded coverage of Forsman's negligence claim against Muddy Rivers. Furthermore, the Court concluded further conclude the court properly granted summary judgment to Forsman holding United Fire had a duty to defend Muddy Rivers under the CGL policy in the underlying suit. Therefore, the Court affirmed in part, reversed in part, and remanded for further proceedings. View "Forsman v. Blues, Brews & Bar-B-Ques Inc." on Justia Law

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The First Circuit affirmed the district court’s denial of Plaintiffs’ motion for reconsideration of the district court’s grant of summary judgment dismissing all of their claims against various insurance companies and certain of those companies’ employees under 42 U.S.C. 1981 and Puerto Rico law. The complaint alleged that Defendants unlawfully interfered with Plaintiffs’ right to “make or enforce” existing and prospective contracts with Defendants’ insureds or third-party claimants. The district court granted summary judgment on all claims against Defendants. The First Circuit affirmed, largely on waiver grounds, holding (1) Plaintiffs expressly waived certain issues on appeal by failing to raise them in their opening brief; and (2) Plaintiffs’ remaining claims on appeal were unavailing. View "Best Auto Repair Shop, Inc. v. Universal Insurance Group" on Justia Law

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Plaintiffs filed suit against Allstate after the insurance company denied their homeowner's insurance claim. The Eighth Circuit affirmed the district court's grant of Allstate's motion for judgment as a matter of law. In regard to the breach of contract claim, the court held that plaintiffs failed to present sufficient evidence of the home's value and the personal property's value before or after the fire. Furthermore, a bankruptcy filing was insufficient to establish value. In this case, plaintiffs could have submitted an estimate of the personal property's value immediately before the fire, but they did not. Values on their proof-of-loss list were estimates of original purchase prices and it did not account for deterioration, obsolescence, or other depreciation as required by the policy and under Missouri law. Because plaintiff's vexatious refusal claim was derivative of their breach of contract claim, the court affirmed as to that claim. View "Aziz v. Allstate Insurance Co." on Justia Law

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This case was once again before the First Circuit after the court certified to the Massachusetts Supreme Judicial Court (SJC) some state-law questions arising from this diversity-based declaratory-judgment action governed by Massachusetts substantive law. The case was brought by Mount Vernon Fire Insurance Company, the employment-practices liability insurer of VisionAid, Inc., seeking a declaratory judgment that it had no duty to prosecute VisionAid’s embezzlement counterclaim in litigation brought against VisionAid alleging age discrimination. The federal district court ruled that Mount Vernon did not have to foot the bill for VisionAid’s affirmative counterclaim. On appeal, the First Circuit certified three questions to the SJC, two on the duty-to-defend issue and one on a conflict-of-interest issue, which was the only question left for the court to decide in the instant appeal. At issue was whether a conflict of interest existed between the parties that permitted VisionAid to choose the attorney to defend the suit brought against it by the ex-employee, with Mount Vernon paying for that defense. The First Circuit answered in the negative, holding that the presence of the embezzlement counterclaim did not generate a conflict of interest entitling VisionAid to separate counsel to defend against the ex-employee’s suit at Mount Vernon’s expense. View "Mount Vernon Fire Insurance Co v. VisionAid, Inc." on Justia Law

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Homeowner-plaintiffs Michelle and Robert Russell appealed a superior court order denying their summary judgment motion and granting that of insurer-defendant NGM Insurance Company. On appeal, the homeowners argued the trial court erred when it determined that their homeowners’ insurance policy provided no coverage for the additional living expenses they incurred when they were unable to live in their home because of mold contamination. Finding no reversible error, the New Hampshire Supreme Court affirmed. View "Russell NGM Insurance Co." on Justia Law

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An injured first party insured who is compelled to sue for underinsured motorist (UIM) benefits and recovers more at trial than the last insurance company offer, the insurer must pay the first party insured’s attorney fees in an amount determined by the district court to be reasonable. Plaintiff in this case filed suit against Farmers Insurance Exchange, demanding her UIM policy limits. After Farmers extended its final offer of $77,500 to settle the claim, the jury returned a verdict in the amount of $450,000 in favor of Plaintiff. Judgment was entered for the policy limit amount of $200,000. The district court denied Plaintiff’s motion for attorney fees. The Supreme Court reversed, holding that Farmers was required to pay Plaintiff’s attorney fees because Plaintiff was compelled to sue and the jury returned a verdict higher than the amount of the last offer made by Farmers to settle her UIM claim. View "Mlekush v. Farmers Insurance Exchange" on Justia Law