Justia Insurance Law Opinion Summaries

Tody's Service, Inc. (Tody's), a towing company, billed Liberty Mutual Insurance Company (Liberty) a six-figure storage fee after towing and storing a vehicle involved in a fatal crash at the direction of the police. The vehicle, insured by Liberty, was held as evidence for nearly three years. After obtaining the vehicle's title, Liberty refused to pay the accrued storage charges, leading Tody's to sue Liberty to recover those fees.In the Superior Court, a judge granted summary judgment in favor of Liberty on all of Tody's claims, which included unjust enrichment, promissory estoppel, and failure to pay storage fees under G. L. c. 159B, § 6B. The judge found no evidence of unjust enrichment, ruled that § 6B does not provide a private right of action, and concluded that Tody's failed to demonstrate any actionable promise or reasonable reliance to support promissory estoppel.The Supreme Judicial Court reviewed the case and held that Liberty was not unjustly enriched as a matter of law, as there was no measurable benefit conferred on Liberty by Tody's storage of the vehicle. The court also found no evidence of reliance sufficient to support promissory estoppel, as Tody's stored the vehicle in response to a police directive, not in reliance on any promise by Liberty. Additionally, the court held that § 6B does not create a private right of action against a vehicle owner. Consequently, the Supreme Judicial Court affirmed the judgment in Liberty's favor. View "Tody's Service, Inc. v. Liberty Mutual Insurance Company" on Justia Law

Pamela Edwards, owner of Allure Salon in Starkville, Mississippi, was diagnosed with cancer in 2019 and passed away in 2022. After her death, her husband, Jimmy Edwards, sought payment from her life insurance policy with Guardian Life Insurance. Guardian denied the claim, stating the policy had been canceled because the number of insured employees at Allure dropped to one, triggering their right to cancel the policy. Jimmy Edwards was unaware of the policy until informed by the insurance agent, Debbie Jaudon, who also did not receive a cancellation notice from Guardian.Jimmy Edwards sued Guardian in the Northern District of Mississippi, bringing claims under Mississippi common law and arguing that ERISA entitled him to recover benefits. Guardian moved for partial summary judgment, asserting that ERISA governed the plan and preempted the common-law claims. The district court granted Guardian’s motion, and Jimmy Edwards appealed.The United States Court of Appeals for the Fifth Circuit reviewed the case. The court determined that ERISA applied to the Allure policy, as the salon technicians were considered employees under federal common law. The court found that Guardian had waived its right to cancel the policy by continuing to accept premium payments for 26 months after the right to cancel vested. The court held that Guardian could not avoid its obligation to pay the claim after accepting premiums for such an extended period. Consequently, the Fifth Circuit reversed the district court's judgment and rendered judgment in favor of James Edwards. View "Edwards v. Guardian Life Insurance" on Justia Law

After Hurricane Maria damaged its business, Coco Rico, LLC sued its insurer, Universal Insurance Company, for failing to pay its insurance claim and won. The jury awarded Coco Rico higher damages for its business interruption loss claim than it had requested, plus extra, consequential damages. This appeal centers on the district court's rulings on several post-verdict motions: Universal sought to eliminate or reduce the jury's damages awards, while Coco Rico sought attorneys' fees and prejudgment interest from Universal. After the district court denied the motions, both parties appealed.The United States District Court for the District of Puerto Rico denied Universal's renewed motion for judgment as a matter of law on the consequential damages claim and its motion for a new trial or reduction of the contractual damages award. The court reduced the jury's BI & EE award from $873,000 to $750,000, in line with the insurance policy maximum, but rejected Universal's argument that the award should be further reduced to $686,098. The court also denied Coco Rico's motion to amend the judgment to add attorneys' fees and prejudgment interest.The United States Court of Appeals for the First Circuit reviewed the case. The court agreed with Universal that there was no evidentiary basis for the jury to award consequential damages or higher business interruption loss damages than Coco Rico had established at trial. The court reversed the district court's ruling denying Universal's motions regarding the damages awards and affirmed its ruling denying Coco Rico's motion for attorneys' fees and prejudgment interest. The court held that the jury's award of $873,000 for business interruption loss exceeded the evidence presented, which supported only $686,098, and that there was no evidence to support the $250,000 consequential damages award. The court remanded the case for further proceedings consistent with its opinion. View "Coco Rico, LLC v. Universal Insurance Company" on Justia Law

Eric Jackson, a commercial tractor-trailer driver, was injured in a motor-vehicle collision in Morgan County, Alabama, on December 20, 2020. Jackson's personal vehicles were insured by State Farm Mutual Automobile Insurance Company under policies issued in Kentucky, which included uninsured/underinsured-motorist (UIM) coverage. In April 2022, Jackson sued the alleged at-fault driver in the Morgan Circuit Court. Later, he sought to amend his complaint to add State Farm as a defendant to recover UIM benefits. State Farm denied the claim, asserting that Jackson failed to file his UIM claim within the two-year period required by Kentucky law, as stipulated in the insurance policies.The Morgan Circuit Court granted State Farm's motion for judgment on the pleadings, concluding that Kentucky law governed the claim and that Jackson did not file his complaint within the required two-year period. Jackson appealed, arguing that Alabama's six-year statute of limitations should apply and that any contractual provision shortening this period was void under Alabama law.The Supreme Court of Alabama reviewed the case de novo. The court noted that Alabama enforces choice-of-law provisions in contracts unless they violate public policy. Jackson's policies explicitly incorporated Kentucky's two-year statute of limitations for filing accident-related tort claims. The court found that the policies were clear and unambiguous in this regard and that Kentucky law, which allows such contractual limitations, applied. The court distinguished this case from others where no specific choice-of-law provision was present or where the provision did not explicitly include procedural laws like statutes of limitations.The Supreme Court of Alabama affirmed the lower court's judgment, holding that the contractual provision incorporating Kentucky's two-year statute of limitations was valid and enforceable, thus barring Jackson's UIM claim. View "Jackson v. State Farm Mutual Automobile Insurance Co." on Justia Law

Emergency air medical providers challenged award determinations made under the No Surprises Act (NSA). The NSA, enacted in 2022, protects patients from surprise bills for emergency services from out-of-network providers by creating an Independent Dispute Resolution (IDR) process for billing disputes between providers and insurers. Guardian Flight transported a patient in Nebraska, and a dispute arose with Aetna over the service value. Similarly, Guardian Flight and its affiliates provided emergency services to patients insured by Kaiser, leading to disputes over payment amounts. Both disputes were submitted to Medical Evaluators of Texas (MET) as the IDR entity, which sided with the insurers.The United States District Court for the Southern District of Texas consolidated the cases. The court dismissed Guardian Flight’s claims against Aetna and Kaiser, ruling that the providers failed to plead sufficient facts to trigger vacatur of the awards. However, the court denied MET’s motion to dismiss based on arbitral immunity, leading to MET’s cross-appeal.The United States Court of Appeals for the Fifth Circuit reviewed the case. The court held that the NSA does not provide a general private right of action to challenge IDR awards, incorporating Federal Arbitration Act (FAA) provisions that allow courts to vacate awards only for specific reasons. The court affirmed the district court’s dismissal of the providers’ claims against Aetna and Kaiser, finding that the providers did not allege facts sufficient to show that the awards were procured by fraud or undue means under the FAA.Additionally, the Fifth Circuit addressed MET’s claim of arbitral immunity. The court concluded that MET, functioning as a neutral arbiter in the IDR process, is entitled to the same immunity from suit typically enjoyed by arbitrators. Consequently, the court reversed the district court’s judgment on this point and remanded with instructions to dismiss the providers’ claims against MET. View "Guardian Flight, L.L.C. v. Aetna Health, Inc." on Justia Law

Casey Cotton rear-ended Caleb Crabtree, causing significant injuries. Cotton, insured by Allstate, faced potential liability exceeding his policy limit. Allstate allegedly refused to settle with Crabtree and failed to inform Cotton of the settlement negotiations or his potential liability, giving Cotton a potential bad-faith claim against Allstate. The Crabtrees sued Cotton, who declared bankruptcy. The bankruptcy court allowed the personal-injury action to proceed, resulting in a $4 million judgment for the Crabtrees, making them judgment creditors in the bankruptcy proceeding. Cotton’s bad-faith claim was classified as an asset of the bankruptcy estate. The bankruptcy court allowed the Crabtrees to purchase Cotton’s bad-faith claim for $10,000, which they financed through Court Properties, Inc.The Crabtrees sued Allstate, asserting Cotton’s bad-faith claim. The United States District Court for the Southern District of Mississippi dismissed the action for lack of subject matter jurisdiction, holding that the assignments of Cotton’s claim to Court Properties and then to the Crabtrees were champertous and void under Mississippi law. Consequently, the court found that the Crabtrees lacked Article III standing as they had not suffered any injury from Allstate.The United States Court of Appeals for the Fifth Circuit reviewed the case. The court certified a question to the Supreme Court of Mississippi regarding the validity of the assignments under Mississippi’s champerty statute. The Supreme Court of Mississippi held that the statute prohibits a disinterested third party engaged by a bankruptcy creditor from purchasing a cause of action from a debtor’s estate. Based on this ruling, the Fifth Circuit held that the assignment of Cotton’s claim to Court Properties was void, and thus, the Crabtrees did not possess Cotton’s bad-faith claim. Therefore, the Crabtrees lacked standing to sue Allstate, and the district court’s dismissal was affirmed. View "Crabtree v. Allstate Property" on Justia Law

UnitedHealthCare Insurance Company and its affiliates (collectively, United) were sued by Fremont Emergency Services and other emergency medical providers (collectively, TeamHealth) for underpaying claims for emergency medical services provided to United’s members. TeamHealth alleged that United failed to adequately reimburse them for services rendered under the Emergency Medical Treatment and Labor Act (EMTALA) after their contract with United expired, leaving them as out-of-network providers. TeamHealth claimed United was unjustly enriched and breached an implied-in-fact contract, also asserting statutory claims under the Prompt Pay and Unfair Claims Practices Acts.The case was initially removed to federal court, which found no ERISA preemption and remanded it to state court. The Eighth Judicial District Court of Nevada ruled in favor of TeamHealth, awarding them compensatory and punitive damages, prejudgment interest, and attorney fees. United appealed the judgment and petitioned to seal certain court documents.The Supreme Court of Nevada reviewed the case and found substantial evidence supporting the jury’s verdict on unjust enrichment but not on the implied-in-fact contract or statutory claims. The court held that ERISA did not preempt TeamHealth’s claims and that United was entitled to judgment as a matter of law on the Unfair Claims Practices Act claim, as the statute did not provide a private right of action for medical providers. The court affirmed the compensatory damages for unjust enrichment but vacated the punitive damages award, remanding for recalculation to a 1:1 ratio of compensatory to punitive damages. The court also reversed the prejudgment interest and attorney fees awards under the Prompt Pay Act and remanded for a new determination of prejudgment interest.Additionally, the court denied United’s petition to seal certain documents, finding that United failed to meet its burden to demonstrate the necessity of sealing. The court concluded that the district court did not abuse its discretion in refusing to seal parts of the record. View "UnitedHealthCare Insurance Company v. Fremont Emergency Services" on Justia Law

In this case, a construction financer, Mortgages Ltd. (ML), collapsed, leading to numerous mechanics' liens on unfinished projects. ML had loaned $165 million to Tempe Land Company (TLC) for a condominium project, securing the loan with a deed of trust and purchasing a title insurance policy from Fidelity National Title Insurance Company. Contractors began recording mechanics' liens against the property, and ML entered involuntary bankruptcy. The Loan LLCs, created to hold ML's assets, foreclosed on the property but did not extinguish the liens. Universal and VRCP provided loans to ML Manager and the Loan LLCs, securing their loans with deeds of trust and obtaining title insurance policies from Commonwealth Land Title Insurance Co.The trial court granted summary judgment to Commonwealth on CMLC's breach of contract claim, finding that the loans were fully repaid, thus precluding coverage under the policy. The case proceeded to trial on CMLC's bad faith claim, where the jury awarded $5 million in damages. Both parties appealed. The court of appeals vacated the trial court's summary judgment on the breach of contract claim, directing the trial court to enter summary judgment for CMLC, and affirmed the denial of Commonwealth's motion for judgment as a matter of law on the bad faith claim.The Supreme Court of Arizona reviewed the case and held that Commonwealth could contest coverage based on policy provisions limiting liability to the unpaid indebtedness. The court found that the loans were fully repaid, thus no covered loss occurred. The court also held that the diminution in lien value did not constitute actual pecuniary damage to support a bad faith claim. Additionally, the court ruled that the collateral source rule did not preclude evidence of loan repayments. The court vacated the court of appeals' opinion, affirmed the trial court's summary judgment for Commonwealth on the breach of contract claim, and remanded to enter summary judgment for Commonwealth on the bad faith claim. View "CENTERPOINT v COMMONWEALTH" on Justia Law

BCC Partners, LLC ("BCC") contracted with Ben F. Blanton Construction, Inc. ("Blanton") to build an apartment complex in Creve Coeur, Missouri. Blanton obtained an insurance policy from Travelers Property Casualty Company of America ("Travelers"), naming Blanton as the "Named Insured" and BCC as an "Additional Named Insured." A retaining wall failure during construction led to damage and delays, resulting in multiple insurance claims. Travelers paid $1.3 million into an escrow account, which was divided among claimants. BCC later sought coverage for loss of rental income and soft costs due to the delays, but Travelers denied the claim after an initial advance payment of $200,000.The United States District Court for the Eastern District of Missouri granted summary judgment to Travelers, concluding that BCC was not entitled to the demanded payments under the Policy. BCC appealed the decision.The United States Court of Appeals for the Eighth Circuit reviewed the case de novo. The court held that under the plain meaning of the Policy, only a "Named Insured" is covered for losses of rental income and soft costs. BCC, as an "Additional Named Insured," did not qualify for such coverage. The court found that the Policy's language was clear and unambiguous, and BCC's arguments to the contrary were unavailing. Consequently, the court affirmed the district court's judgment, ruling that Travelers did not breach the Policy and that BCC's claim for vexatious refusal to pay also failed. View "BCC Partners, LLC v. Travelers Property Casualty Co. of America" on Justia Law

Adam and Lydia Duffy were severely injured in a motorcycle accident, resulting in damages of nearly $2,000,000. The at-fault motorist's insurance coverage was insufficient, so the Duffys sought compensation through their underinsured motorist (UIM) policies, including one from Selective Insurance Company of South Carolina. Selective paid $300,000, arguing that North Carolina law did not require stacking of the Duffys' multiple insurance policies because the vehicles covered were not "nonfleet private passenger vehicles."The United States District Court for the Western District of North Carolina granted summary judgment in favor of Selective. The court found that the Duffys' policy covered seven vehicles used for their landscaping business, classifying it as fleet coverage under North Carolina law. The court also determined that the vehicles were not "private passenger vehicles" because they were used for commercial purposes. Consequently, the anti-stacking provisions of North Carolina law did not apply.The United States Court of Appeals for the Fourth Circuit reviewed the case and affirmed the district court's decision. The appellate court agreed that the policy was fleet coverage and that the vehicles were not private passenger vehicles. The court also found that the insurance contract clearly limited coverage to $1,000,000 per accident, regardless of the number of insureds. Therefore, Selective's payment of $300,000, after accounting for the contributions from other insurers, was appropriate. The court held that the policy's terms were unambiguous and did not allow for stacking of coverage limits across multiple policies. View "Selective Insurance Company of South Carolina v. Duffy" on Justia Law