Mack truck’s primary insurer refused to contribute more than $1 million toward the settlements of the final three auto collisions, claiming that they were part of a single "accident" under its policy and that $1 million was the primary insurer's limit of liability per accident. The Fifth Circuit applied Texas law and held that there was one accident under the policy. In this case, the chain of causation remained unbroken and the ongoing negligence of the runaway Mack truck was the single proximate, uninterrupted, and continuing cause of all the collisions. Therefore, the court reversed the district court's decision that there were two accidents and rendered judgment in favor of the primary insurer. View "Evanston Insurance Co. v. Mid-Continent Casual" on Justia Law

Winter wheat farmers could purchase insurance to protect against below-average harvests. The policies at issue here offered yield protection. On July 1, 2014, the Federal Crop Insurance Corporation (“FCIC”) published an interim rule to implement the 2014 Farm Bill. In that interim rule, the FCIC warned that the APH yield exclusion “may not be implemented upon publication” because “[p]roduction data availability and intensive data analysis may limit FCIC’s ability to authorize exclusions of yields for all APH crops in all counties.” Therefore, the FCIC amended the Common Crop Insurance Policy (CCIP) Basic Provisions (the actual terms of the insurance policy offered for sale) “to allow the actuarial documents to specify when insureds may elect to exclude any recorded or appraised yield.” The revised CCIP Basic Provisions stated that farmers “may elect” the APH yield exclusion “[i]f provided in the actuarial documents.” The deadline for winter wheat farmers to purchase insurance for the 2015 crop year was September 30, 2014. When Plaintiffs purchased insurance, they elected to use the APH yield exclusion. But in a letter dated October 31, 2014, the USDA notified insurance providers that the APH Yield Exclusion would not be available for winter wheat for the 2015 crop year. The letter stated that insurance providers could respond to farmers’ elections by pointing them to the USDA’s “actuarial documents,” which did not yet “reflect that such an election is available.” Plaintiffs sought review of this denial through the USDA’s administrative appeals process. An administrative judge determined that she lacked jurisdiction over Plaintiffs’ challenge because the October 2014 letter to insurance providers was not an adverse agency decision. Plaintiffs then appealed to the Director of the National Appeals Division. The Director found that the October 2014 letter was an adverse agency decision, but affirmed the FCIC’s decision not to make the APH yield exclusion available to winter wheat farmers for the 2015 crop year. Plaintiffs appealed the Director’s decision to the United States District Court for the District of Colorado. The district court reversed the Director’s decision and remanded the case to the FCIC with instructions to retroactively apply the APH yield exclusion to Plaintiffs’ 2015 crop year insurance policies, reasoning the applicable statute unambiguously made the APH yield exclusion available to all farmers on the day the 2014 Farm Bill was enacted. Finding no reversible error in the district court’s judgment, the Tenth Circuit affirmed. View "Ausmus v. Perdue" on Justia Law

The Supreme Court denied the defendant hospital’s petition for a writ of mandamus challenging a trial court’s order requiring the hospital to produce information regarding its reimbursement rates from private insurers and public payers for the services provided to the plaintiff, holding that the trial court did not abuse its discretion in compelling production of the information. The plaintiff, who was uninsured, was treated by the hospital, which billed the plaintiff and filed a hospital lien for the cost of its services. The plaintiff sought a declaratory judgment that the hospital’s charges were unreasonable and its lien invalid to the extent it exceeded a reasonable and regular rate for services rendered. The plaintiff served requests for production and interrogatories on the hospital, including information about reimbursement rates from insurers and government payers. The hospital objected to the discovery requests, but the trial court ordered the hospital to produce the information. The hospital then filed a petition for a writ of mandamus, which the court of appeals denied. The Supreme Court affirmed, holding that the requested reimbursement rates were relevant to whether the hospital’s charges to the uninsured plaintiff were reasonable. View "In re North Cypress Medical Center Operating Co., Ltd." on Justia Law

Favero’s car struck Alpizar-Fallas's car, causing Alpizar-Fallas serious injuries. Both drivers were insured by Progressive. The next day, Barbosa, a Progressive claims adjuster, went to Alpizar-Fallas's home to inspect her car and have her sign “paperwork” that would “expedite the processing of the property damage claim.” Alpizar-Fallas alleges that he stated that her signature was “necessary” for Progressive to advance her payment. Alpizar-Fallas signed the document. The document was actually a broadly written comprehensive general release of all claims. Barbosa failed to advise Alpizar-Fallas to seek legal counsel and did not communicate with her in Spanish, her native language. Alpizar-Fallas sought damages for the personal injuries she sustained in the accident and amended her complaint to include a class action claim against Progressive and Barbosa under the New Jersey Unfair Claims Settlement Practices Regulations (UCSPR) and the Consumer Fraud Act (CFA). The district court dismissed Alpizar-Fallas’s class action claim to the extent it alleged a violation of the UCSPR because those regulations do not provide a private right of action, then dismissed Alpizar-Fallas’s CFA claim, as a claim for denial of insurance benefits, and construing the CFA to only apply to the “sale or marketing” of insurance policies. The Third Circuit vacated, finding that Alpizar-Fallas’s complaint alleged deception that would be covered by the CFA. View "Alpizar-Fallas v. Favero" on Justia Law

The Supreme Court affirmed the decision of the court of appeals affirming the judgment of the district court dismissing the claims filed by Depositors Insurance Company against Craig Dollansky after concluding that Depositors was barred by Minn. Stat. 60A.41(a) from proceeding against Dollansky in a subrogation action, holding that the statute indeed barred Depositors from proceeding in this action. Depositors insured a motor vehicle home owned by Karavan Trailers, Inc., which rented the motor home to Dollansky. The rental agreement provided that Dollansky was responsible for all damages to the RV during the term of the agreement. The motor vehicle caught fire while Dollansky was driving it. Karavan submitted a claim to its insurer, Depositors, which paid the full amount of the damages. Depositors then filed a complaint against Dollansky, alleging that Depositors was surrogated to the rights of Karavan in the same amount. The district court dismissed the claims, concluding that Depositors was barred by section 60A.41(a) from proceeding against Dollansky in a subrogation action. The court of appeals affirmed. The Supreme Court affirmed, holding that where Depositors provided insurance coverage to Dollansky as a permissive-use driver and the loss was caused by the nonintentional acts of Dollansky, section 60A.41(a) barred Depositors from proceeding against Dollansky in a subrogation action. View "Depositors Insurance Co. v. Dollansky" on Justia Law

The panel certified the following question to the Washington Supreme Court: Under Washington law, is an insurer bound by representations made by its authorized agent in a certificate of insurance with respect to a party's status as an additional insured under a policy issued by the insurer, when the certificate includes language disclaiming its authority and ability to expand coverage? View "T-Mobile USA Inc. v. Selective Insurance Company of America" on Justia Law

The Eighth Circuit affirmed the district court's entry of judgment for the insured in a dispute over property coverage of a building that was destroyed by fire. The court held that the district court correctly entered judgment for the insured on the bad faith claim where Met could not prove misrepresentation or deception by the insured, or any reliance thereupon by Met. The court also held that the district court properly calculated the economic damages the insured suffered as a result of Met's bad faith refusal to pay pursuant to the provisions of the improperly rescinded contract. Furthermore, the district court did not abuse its discretion in awarding reasonable attorney fees. View "Hayes v. Metropolitan Property & Casualty Insurance" on Justia Law

Plaintiff-petitioner Charissa Schultz was injured in a 2015 car accident in which the other driver failed to stop at a stop sign. The other driver’s insurance company settled for its $25,000 policy limit, and Schultz made a demand on her own uninsured/underinsured motorist benefits under her GEICO policy, which also had a $25,000 limit. In April 2017, after months of correspondence and apparent review of an MRI performed on Schultz in April 2015, GEICO offered Schultz its full policy limit, and it did so without requesting that she undergo an independent medical examination (“IME”). Indeed, GEICO’s claim logs reveal that at the time GEICO decided to offer Schultz its policy limits, it “concede[d] peer review wouldn’t be necessary,” indicating an affirmative decision not to request an IME. A few months later, Schultz filed the present lawsuit asserting claims for bad faith breach of an insurance contract and unreasonable delay in the payment of covered benefits. GEICO denied liability, disputing the extent and cause of Schultz’s claimed injuries and asserting that causation surrounding the knee replacement surgeries was “fairly debatable” because Schultz had preexisting arthritis, which GEICO claimed may independently have necessitated her surgeries. To establish its defense, GEICO ordered the IME and the district court granted that request. The Colorado Supreme Court concluded GEICO’s conduct had to be evaluated based on the evidence before it when it made its coverage decision and that, therefore, GEICO was not entitled to create new evidence in order to try to support its earlier coverage decision. The Court also concluded the district court abused its discretion when it ordered Schultz to undergo an IME over three years after the original accident that precipitated this case and a year and a half after GEICO had made the coverage decision at issue. View "Schultz v. GEICO Casualty Company" on Justia Law

At issue was the implications of the statutory language found in Ky. Rev. Stat. 186A.220 to the sale of a vehicle that was involved in an accident that killed both Jonathan Elmore and Craig Armstrong. Charles Armstrong sued Martin Cadillac, Inc.; The Travelers Indemnity Company, Martin’s insurer; Elmore’s estate, and other parties for the wrongful death of his son, Craig. Elmore was driving the vehicle, and Craig was a passenger when the vehicle was involved in the accident. This litigation centered around who owned, operated, or was financially responsible for the vehicle Elmore was driving. The circuit court found that Elmore was the owner of the vehicle, and therefore, that Martin and Travelers were not financially liable for the loss. The Supreme Court affirmed the circuit court’s order granting summary judgment on all claims against Martin and Travelers, holding that, pursuant to section 186A. 220, Martin was not the “owner” of the vehicle, and therefore, Martin and Travelers were not responsible for coverage of the vehicle. View "Travelers Indemnity Co. v. Armstrong" on Justia Law

The Supreme Court affirmed the decision of the court of appeals reversing the trial court’s grant of summary judgment against Plaintiffs in this insurance dispute, holding that summary judgment was improper. Plaintiffs sought chiropractic treatment for injuries sustained in an automobile accident. The bills were submitted to GEICO for payment under Plaintiffs’ basic reparations benefits (BRB). GEICO denied coverage and refused to pay for certain medical treatments Plaintiffs had already received. Plaintiffs then brought suit alleging that GEICO improperly denied coverage under their BRB based upon a medical records review and arguing that Ky. Rev. Stat. 304.39-270 requires an independent medical examination before GEICO can deny them BRB. In entering summary judgment against Plaintiffs, the trial court ruled that section 304.39-270 was permissive. The court of appeals reversed and remanded the case to the trial court for further proceedings. The Supreme Court affirmed, holding (1) section 304.39-270 fails to address when and how GEICO could deny BRB; and (2) because the trial court based its decision to grant summary judgment on the implications of section 304.39-270 rather than examining the remaining parts of the Motor Vehicle Reparations Act, Ky. Rev. Stat. 304.39-020(2), it was improper for the trial court to grant summary judgment without further review of the statutes. View "Government Employees Insurance Co. v. Sanders" on Justia Law