Justia Insurance Law Opinion Summaries

Casey Cotton was involved in a car collision with Caleb and Adriane Crabtree, resulting in severe injuries to Caleb. The Crabtrees filed a lawsuit against Cotton and his insurer, Allstate, alleging that Allstate refused early settlement offers and failed to inform Cotton of these offers. While the claims against Allstate were dismissed, the claims against Cotton proceeded in the Lamar County Circuit Court. During the personal injury suit, Cotton declared bankruptcy, and his bankruptcy estate included a potential bad faith claim against Allstate. The Crabtrees, as unsecured creditors, petitioned the bankruptcy court to allow the personal injury suit to proceed to trial.The bankruptcy court directed that the suit against Cotton be liquidated by jury trial to pursue claims against Allstate for any resulting excess judgment. The Crabtrees sought an assignment of Cotton’s bad faith claim as a settlement of their unsecured claims in Cotton’s bankruptcy estate. Unable to afford the $10,000 up-front cost, they engaged Court Properties, LLC, to assist with financing. Court Properties paid the trustee $10,000 to acquire the bad faith claim, then assigned it to the Crabtrees in exchange for $10,000 plus interest, contingent on successful recovery from Allstate. Cotton was discharged from bankruptcy, and a jury verdict awarded the Crabtrees $4,605,000 in the personal injury suit.The Crabtrees filed an action in the United States District Court for the Southern District of Mississippi, which dismissed the case for lack of subject matter jurisdiction, finding the assignments champertous and void under Mississippi Code Section 97-9-11. The Crabtrees appealed to the United States Court of Appeals for the Fifth Circuit, which certified a question to the Supreme Court of Mississippi.The Supreme Court of Mississippi held that Mississippi Code Section 97-9-11 prohibits a creditor in bankruptcy from engaging a disinterested third party to purchase a cause of action from a debtor. The court clarified that solicitation of a disinterested third party to prosecute a case in which it has no legitimate interest violates the statute. View "Crabtree v. Allstate Property and Casualty Insurance Company" on Justia Law

Brandi Goodwin, a part-time nursing assistant at Fisher Titus Hospital, contracted COVID-19 in December 2020, leading to symptoms such as shortness of breath and chest pain. She filed for short-term disability benefits, which Unum Life Insurance Company approved and extended until June 2021. However, when Goodwin applied for long-term disability benefits, Unum denied her claim, citing a pre-existing condition (vertigo) and normal test results that did not support her continued complaints.The United States District Court for the Southern District of Ohio upheld Unum's denial of long-term disability benefits. Goodwin then appealed the decision, arguing that Unum's denial was procedurally and substantively unreasonable.The United States Court of Appeals for the Sixth Circuit reviewed the case de novo. The court assessed whether Unum's decision-making process was procedurally sound and whether the decision was supported by substantial evidence. The court found that Unum considered all relevant evidence, including new medical opinions and test results, and provided rational reasons for changing its benefits determination from short-term to long-term. The court also noted that Unum's reliance on file reviewers over treating physicians was not unreasonable and that Goodwin did not provide concrete evidence of bias affecting Unum's decision.The Sixth Circuit concluded that Unum's decision to deny Goodwin long-term disability benefits was both procedurally and substantively reasonable. Therefore, the court affirmed the district court's judgment in favor of Unum. View "Goodwin v. Unum Life Ins. Co. of Am." on Justia Law

The case involves the Boy Scouts of America (BSA) and Delaware BSA, LLC, which filed for bankruptcy in 2020 due to numerous sexual abuse claims. The bankruptcy plan, confirmed by the Bankruptcy Court, includes the creation of a Settlement Trust funded by the sale of certain assets and contributions from BSA and other nondebtors to pay abuse claimants. The plan also includes nonconsensual third-party releases, which release claims against nondebtors without the claimants' consent.The District Court for the District of Delaware affirmed the Bankruptcy Court's confirmation order, and the plan became effective in April 2023. Four groups of appellants, including abuse claimants and insurers, appealed the decision. The Lujan and Dumas & Vaughn (D&V) Claimants, representing 140 abuse victims, sought to reverse the confirmation order and invalidate the plan, arguing that the nonconsensual third-party releases are impermissible under the Bankruptcy Code. The Certain Insurers and Allianz Insurers sought narrower relief, requesting modifications to the plan to preserve their rights and defenses under their insurance policies.The United States Court of Appeals for the Third Circuit reviewed the case. The court dismissed the Lujan and D&V Claimants' appeals as statutorily moot under 11 U.S.C. § 363(m), which protects good-faith purchasers of estate assets from reversal or modification on appeal if the sale was not stayed. The court found that the nonconsensual third-party releases were integral to the insurance policy buyback, and reversing the confirmation order would affect the validity of the sale.The court also considered the appeals of the Certain Insurers and Allianz Insurers. It concluded that the Certain Insurers' rights and defenses under their insurance policies were adequately preserved by the plan and confirmation order. However, the court found that the judgment reduction clause in the confirmation order impermissibly released the Allianz Insurers' claims without their consent, violating the Supreme Court's decision in Purdue Pharma L.P. v. Harrington. The court reversed the District Court's judgment regarding the Allianz Insurers' claims and remanded for further proceedings to modify the judgment reduction clause. View "In re: Boy Scouts of America and Delaware BSA LLC" on Justia Law

Truck Insurance Exchange (Truck) filed a lawsuit against Federal Insurance Company (Federal) alleging fraud, unjust enrichment, and seeking rescission of a settlement agreement. Truck claimed that Federal fraudulently misrepresented and concealed the voluntary nature of its decision to pay defense costs for Moldex-Metric, Inc. (Moldex) under an umbrella policy. Truck argued that it would not have agreed to pay $4.9 million in settlement had it known Federal contributed to Moldex’s defense voluntarily “at its own expense.”The Superior Court of Los Angeles County initially ruled in favor of Federal, granting summary judgment on the basis that Federal had no duty to defend Moldex under its umbrella policy. Truck appealed, and the Court of Appeal affirmed the trial court’s decision, rejecting Truck’s assertion that it reserved the right to recoup defense fees and indemnity costs after the settlement agreement. Truck then filed the current fraud action, alleging that Federal concealed its voluntary business decision to defend Moldex.The Court of Appeal of the State of California, Second Appellate District, reviewed the case. Truck contended that the trial court failed to address its claim for fraudulent concealment and only considered the misrepresentation theory. The appellate court agreed with Truck, finding that the trial court did not consider the fraudulent concealment claim despite Truck’s objection. The appellate court determined that Truck did not unreasonably neglect to protect itself against the alleged fraudulent concealment by Federal, rendering it extrinsic and not barred by the litigation privilege.The Court of Appeal reversed the judgment on Truck’s fraudulent concealment cause of action and remanded the matter to the trial court for a new trial to consider Truck’s fraudulent concealment claim and any other derivative causes of action. The judgment was otherwise affirmed, and Truck was awarded costs on appeal. View "Truck Ins. Exchange v. Fed. Ins. Co." on Justia Law

BlueCross BlueShield of Tennessee (BlueCross) is an insurer and fiduciary for an ERISA-governed group health insurance plan. A plan member in New Hampshire sought coverage for fertility treatments, which BlueCross denied as the plan did not cover such treatments. The Commissioner of the New Hampshire Insurance Department initiated an enforcement action against BlueCross, alleging that the denial violated New Hampshire law, which mandates coverage for fertility treatments. BlueCross sought to enjoin the state regulatory action, arguing it conflicted with its fiduciary duties under ERISA.The United States District Court for the Eastern District of Tennessee denied BlueCross's request for relief and granted summary judgment to the Commissioner. The court found that the Commissioner’s enforcement action was against BlueCross in its capacity as an insurer, not as a fiduciary, and thus was permissible under ERISA’s saving clause, which allows state insurance regulations to apply to insurers.The United States Court of Appeals for the Sixth Circuit reviewed the case and affirmed the district court’s decision. The Sixth Circuit held that the Commissioner’s action was indeed against BlueCross as an insurer, aiming to enforce New Hampshire’s insurance laws. The court noted that ERISA’s saving clause permits such state actions and that BlueCross could not use its fiduciary duties under ERISA to evade state insurance regulations. The court also referenced the Supreme Court’s decision in UNUM Life Insurance Co. of America v. Ward, which established that state insurance regulations are not preempted by ERISA when applied to insurers. Thus, the Sixth Circuit concluded that ERISA did not shield BlueCross from the New Hampshire regulatory action. View "BlueCross BlueShield of Tennessee v. Nicolopoulos" on Justia Law

The case involves insurance policies issued by certain surplus lines insurers at Lloyd’s, London, which contain identical arbitration clauses. The insured parties, 3131 Veterans Blvd LLC and Mpire Properties LLC, attempted to sue the insurers in Louisiana state court. The insurers then sued in New York federal court to enforce the arbitration clauses under the Federal Arbitration Act (FAA) and the New York Convention on the Recognition and Enforcement of Foreign Arbitral Awards. The insured parties argued that the arbitration clauses were unenforceable under Louisiana law, which prohibits such clauses in insurance contracts, and that the McCarran-Ferguson Act (MFA) allows state insurance laws to reverse preempt federal legislation and non-self-executing treaty provisions.The United States District Court for the Southern District of New York ruled in favor of the insured parties, holding that Louisiana law prohibits arbitration clauses in insurance contracts and that the FAA and the New York Convention were reverse-preempted under the MFA, based on the Second Circuit’s previous decision in Stephens v. American International Insurance (Stephens I).The United States Court of Appeals for the Second Circuit reviewed the case. The court concluded that its reasoning in Stephens I had been undermined by the Supreme Court’s decision in Medellín v. Texas, which established a different test for determining whether a treaty provision is self-executing. Applying the Medellín test, the court found that Article II Section 3 of the New York Convention is self-executing. As a result, the court abrogated Stephens I to the extent that it held that Article II Section 3 is not self-executing, reversed the district court decisions, and remanded the matters for further proceedings consistent with its opinion. View "Certain Underwriters at Lloyds, London, v. 3131 Veterans Blvd LLC" on Justia Law

Mullins Food Products, Inc. was sued in Illinois state court for violating the Biometric Information Privacy Act (BIPA). Mullins requested its liability insurer, Citizens Insurance Company of America, to defend the suit, but Citizens declined and instead filed a federal suit seeking a declaratory judgment that it had no duty to defend or indemnify Mullins based on exclusions in the commercial liability insurance policies issued to Mullins in 2015, 2016, and 2017. While the federal suit was pending, Mullins settled the state-court action.The United States District Court for the Northern District of Illinois agreed with Citizens that the policy exclusions relieved Citizens of the duty to defend or indemnify Mullins. Specifically, the court found that the Access or Disclosure of Confidential or Personal Information exclusion and the Recording and Distribution of Material or Information in Violation of Law exclusion barred coverage for BIPA claims. The district court also ruled against Mullins on its counterclaim for breach of contract, reasoning that Citizens' timely filing of the declaratory judgment action precluded a finding of breach.The United States Court of Appeals for the Seventh Circuit reviewed the case and vacated the district court's decision. The appellate court concluded that the Access or Disclosure exclusion in the 2016 and 2017 policies barred coverage for BIPA claims, but the Statutory Violations exclusion did not. Therefore, Citizens had a duty to defend and indemnify Mullins under the 2015 policy, assuming Mullins provided timely notice of the state-court action. The appellate court remanded the case for further proceedings to determine the timeliness of Mullins' notice and to address Mullins' claim for reimbursement of defense costs. View "Citizens Insurance Company of America v Mullins Food Products, Inc." on Justia Law

PorterCare Adventist Health Systems had inadequate surgical-sterilization procedures for about two years, leading to over $40 million in liability from thousands of patients' claims. PorterCare sought coverage from AdHealth, its excess-liability insurer, for the full $40 million policy limit, arguing that the claims arose from one medical incident. AdHealth refused coverage, asserting that a medical incident covers injuries to a single person, not multiple people, and filed a complaint seeking a declaratory judgment. PorterCare counterclaimed for declaratory judgment and breach of contract.The United States District Court for the District of Colorado granted summary judgment to AdHealth, agreeing with its interpretation that a medical incident is limited to the acts or omissions causing injury to one person. The court found that AdHealth owed coverage only for the claims of a single patient that trigger the excess policy’s liability threshold, not for multiple patients' claims grouped together.The United States Court of Appeals for the Tenth Circuit reviewed the case and affirmed the district court's decision. The appellate court held that the policy’s definition of “medical incident” unambiguously applies to the injuries of a single person. Therefore, AdHealth is liable only for individual claims exceeding PorterCare’s $2 million self-insurance retention, not for the aggregated claims of multiple patients. View "Adhealth, Limited v. PorterCare Adventist Health Systems" on Justia Law

Kepali Group procured insurance for its fleet of vehicles through an agent at Brown & Brown of Florida, with Prime Property & Casualty Insurance Company issuing a commercial automobile policy for the period from January 23, 2019, to January 23, 2020. The policy included a provision for after-acquired vehicles, requiring notification within 30 days of acquisition for coverage. On December 6, 2019, a 2009 Toyota Sienna owned by Kepali was involved in an accident. Kepali had acquired the vehicle on September 30, 2019, and notified Brown to add it to the Prime policy. Prime issued a quote for the additional premium, but Kepali did not pay it, and Prime did not issue an endorsement for the vehicle.The United States District Court for the Southern District of Florida ruled that Brown was acting as Kepali’s agent, not Prime’s, when attempting to procure insurance for the 3985 Toyota. However, the court concluded that the vehicle was covered under the policy’s after-acquired auto provision because Kepali met the two conditions: Prime covered all of Kepali’s vehicles, and Kepali notified Prime within 30 days of acquiring the vehicle. The court ruled that Prime had a duty to defend Kepali and Mr. Rodriguez but deferred ruling on the duty to indemnify until the underlying suit was resolved. The court granted summary judgment against Kepali and Mr. Rodriguez on their reformation and promissory estoppel claims and dismissed the remaining claims as moot.The United States Court of Appeals for the Eleventh Circuit affirmed the district court’s ruling. The court held that the after-acquired auto provision did not require payment of an additional premium within 30 days for coverage to continue. The court also found that the premium audit provision allowed Prime to compute the final premium and bill Kepali, and that Prime failed to perform this audit or send a bill. Therefore, Prime could not terminate coverage for non-payment without following the policy’s cancellation procedures. The court concluded that Prime had a duty to defend Kepali and Mr. Rodriguez in the underlying state court action. View "Prime Property and Casualty Insurance Company v. Kepali Group, Inc." on Justia Law

Two former police officers, Mark Zukowski and Joshua Ruggiero, were injured in the line of duty and subsequently awarded both accidental disability retirement (ADR) benefits and workers' compensation benefits under Maryland's Workers' Compensation Act. The ADR benefits exceeded the workers' compensation benefits, resulting in an offset that left the officers with only a small portion of the workers' compensation benefits. The officers' attorney sought fees based on the total workers' compensation award before the offset was applied.The Maryland Workers' Compensation Commission awarded attorney's fees based on the reduced amount of workers' compensation benefits after applying the statutory offset. The Circuit Court for Anne Arundel County affirmed the Commission's decision, holding that attorney's fees should be calculated after the offset.The Supreme Court of Maryland reviewed the case and affirmed the lower courts' decisions. The Court held that the terms "benefits" and "compensation" are interchangeable in this context, meaning that attorney's fees should be calculated based on the amount of compensation actually payable to the claimant after applying the statutory offset. The Court emphasized that the attorney's fees are a lien on the compensation awarded, which is defined as the money payable to the injured employee. Therefore, the offset must be applied before calculating the attorney's fees. The Court also rejected the argument that this interpretation was unconstitutional, stating that the attorney voluntarily agreed to the fee arrangement and was aware of the statutory provisions governing attorney's fees. View "Zukowski v. Anne Arundel Cnty." on Justia Law