Plaintiff filed suit against Allstate and its agent for breach of contract after Allstate refused to pay a claim for flood damage. The Fifth Circuit affirmed the district court's judgment in favor of Allstate, holding that the district court did not err in granting summary judgment on the breach of contract claim because the claim was time-barred. The court also held that the district court did not abuse its discretion in denying petitioner's Federal Rule of Civil Procedure 59(e) motion. View "Cohen v. Allstate Insurance Co." on Justia Law

GEICO appealed a judgment awarding punitive damages to plaintiff for GEICO's bad faith breach of an insurance contract. The Court of Appeal affirmed the punitive damages award and held that there was sufficient evidence in the record to show that GEICO's managing agent ratified conduct warranting punitive damages. In this case, GEICO concluded that plaintiff's claim was worth far less than the policy limits by disregarding information provided by plaintiff showing that he had a permanent, painful injury, and instead selectively relied on portions of medical records that supported GEICO's position that plaintiff had fully recovered. Furthermore, the $1 million in punitive damages was within the constitutionally permitted range in view of the degree of reprehensibility of GEICO's conduct. View "Mazik v. GEICO General Insurance Co." on Justia Law

In this insurance coverage dispute, the Supreme Court reversed the judgment of the circuit court ruling in favor of Doswell Truck Stop, LLC (DTS) on DTS's declaratory judgment action against James River Insurance Company and entered final judgment declaring that an auto exclusion precluded coverage of James Smith's injuries under the policy at issue, holding that the trial court erred in ruling in favor of DTS. Smith filed a personal injury lawsuit against DTS for injuries he allegedly suffered as a result of a tire explosion that occurred when DTS was repairing a tire on Smith's tractor-trailer. DTS filed an insurance claim with James River, which had issued a commercial general liability policy to DTS. James River denied coverage on the basis that DTS's claim was precluded by the auto exclusion. DTS then filed this action seeking a determination of whether the policy covered Smith's injury. The circuit court ruled in favor of DTS. The Supreme Court reversed, holding (1) the circuit court erred determining that the auto exclusion was ambiguous with respect to the meaning of "maintenance" of an auto; and (2) the circuit court erred in ruling that an independent basis existed for coverage under the policy. View "James River Insurance Co. v. Doswell Truck Stop, LLC" on Justia Law

After a fire seriously damaged the insureds' home, the insurer paid for their total property damage and then brought a diversity action against Entergy, alleging that the utility's equipment caused the fire. The insurer alleged subrogation claims for damages in excess of the amount paid for the damage. Although the district court erred in determining that the insurer did not have standing, the Eighth Circuit affirmed the district court's grant of Entergy's motion for judgment as a matter of law because the insurer failed to prove that the insureds were made whole either before or during this lawsuit. Therefore, a reasonable jury could not have found that the insurer proved an essential element of its subrogation claim. View "EMC Insurance v. Entergy Arkansas" on Justia Law

After insurers denied McDonnel's claim, McDonnel initiated a declaratory and breach of contract action. The Fifth Circuit affirmed the district court's dismissal of the action in favor of arbitration and held that the insurance policy's conformity provision did not negate the agreement to arbitrate. The court held that the state statute, La. Rev. Stat. Ann. 22:868, was preempted by the Convention on the Recognition and Enforcement of Foreign Arbitral Awards, and thus the statute did not and could not apply to McDonnel's policy. Consequently, there was no conflict between the policy and the state statute. Therefore, the court held that the conformity provision was not triggered, and its inapplicability leads only to the conclusion that the arbitration provision survives, undiminished by state law. View "McDonnel Group, LLC v. Great Lakes Insurance SE" on Justia Law

Defendant-appellant Ricardo Lara, the California Insurance Commissioner, filed a notice of noncompliance against plaintiffs-respondents Mercury Insurance Company, Mercury Casualty Company, and California Automobile Insurance Company (collectively Mercury) alleging Mercury charged rates not approved by the California Department of Insurance (CDI) and that the rates were unfairly discriminatory in violation of Insurance Code sections 1861.01 (c) and 1861.05 (b). The allegedly unapproved rates were in the form of broker fees charged by Mercury agents, which should have been disclosed as premium. After prevailing at an administrative hearing, the Commissioner imposed civil penalties against Mercury totaling $27,593,550 for almost 184,000 unlawful acts. Mercury filed a petition for writ of mandate, which the court granted, reversing the Commissioner’s decision. The court found the “broker fees” were not premium because they were charged for separate services. The court also rejected the Commissioner’s interpretation of the term premium under the Insurance Code and regulations. In addition, the court ruled Mercury did not have proper notice it was subject to penalties, in violation of due process, and the action was barred by laches because CDI had unduly delayed in bringing the action. Commissioner and intervener-appellant, Consumer Watchdog (CWD), appealed on several grounds, among them: (1) the trial court did not use the proper standard of review; (2) failed to give the Commissioner’s findings a strong presumption of correctness and failed to put the burden of proof on Mercury to show the findings were against the weight of the evidence; (3) the trial court’s finding the fees were charged for separate services was precluded by collateral estoppel; (4) Mercury received proper notice of the potential imposition of a penalty; and (5) laches did not bar the action. The Court of Appeal agreed with Commissioner and CWD the writ was issued in error and reversed the judgment. View "Mercury Insurance Co. v. Lara" on Justia Law

Petitioner Theodore Morrison had surgery on his right knee in 2004 after injuring it at work. He returned to work after the surgery and did not consult a doctor about that knee for almost ten years, until he again injured it in 2014 while working for a different employer. Following the 2014 injury he sought to have arthroscopic surgery as his doctor recommended. His 2014 employer disputed its liability for continued medical care, and the worker filed a written claim against the 2014 employer. The Alaska Workers’ Compensation Board joined the earlier employer to the claim and decided, after a hearing, that the 2014 work injury was the substantial cause of the worker’s current need for medical care, requiring the 2014 employer to pay the cost of treatment for the right knee. The 2014 employer appealed to the Alaska Workers’ Compensation Appeals Commission, which decided the Board misapplied the new compensability standard and remanded the case to the Board for further proceedings. Morrison petitioned the Alaska Supreme Court for review of the Commission’s decision, and the Supreme Court reversed the Commission’s decision and reinstated the Board’s award. Based on the medical testimony, the Court found the Board identified two possible causes of Morrison’s need for medical treatment at the time of the hearing. It then considered the extent to which the two causes contributed to that need and decided the 2014 injury was the more important cause of the need for treatment then. "The legislature gave the Board discretion to assign a cause based on the evidence before it. The Board did here what the statute directs." View "Morrison v. Alaska Interstate Construction Inc." on Justia Law

The Alaska Workers’ Compensation Board denied a Bryce Warnke-Green's request that his employer pay for a van modified to accommodate his work-related disability. On appeal, the Alaska Workers’ Compensation Appeals Commission decided that a modifiable van was a compensable medical benefit. Warnke-Green moved for attorney’s fees. The Commission reduced the attorney’s hourly rate, deducted a few time entries, and awarded him less than half of what was requested. Warnke-Green asked the Commission to reconsider its award, but the Commission declined to do so because of its view that the Alaska Workers’ Compensation Act (the Act) allowed it to reconsider only the final decision on the merits of an appeal. The Alaska Supreme Court granted Warnke-Green's petition for review, and held that the Commission had the necessarily incidental authority to reconsider its non-final decisions. The Court also reversed the Commission’s award of attorney’s fees and remanded for an award that was fully compensable and reasonable. View "Warnke-Green v. Pro-West Contractors, LLC" on Justia Law

The Eighth Circuit affirmed the district court's grant of summary judgment for LM General in an uninsured motorists (UM) coverage dispute. The district court concluded that there was no UM coverage because any liability of the uninsured motorist and his occupants to plaintiff did not arise out of the use of the uninsured motor vehicle. The court held that Missouri law requires UM coverage whenever an uninsured motorist is liable for injury to the insured arising out of the motorist's use of his uninsured auto. In this case, the injuries inflicted on a victim of a drive-by shooting by the occupant of a motor vehicle were not injuries which arise out of the "use" of the motor vehicle because the motor vehicle was merely the "situs" or "locus" of the cause of the victim's injuries and the discharge of the gun was unconnected to the inherent use of the motor vehicle. View "Patel v. LM General Insurance Co." on Justia Law

In a consolidated appeal, the New Jersey Supreme Court considered one central issue: whether the New Jersey Legislature intended to deviate from its highly regulated no-fault system of first-party self-insurance to cover medical expenses arising from automobile accidents when it amended the statutory scheme to allow an insured to elect smaller amounts of personal injury protection (PIP) under a standard policy. Each plaintiff in this appeal was injured in a car accident. Each was insured under a standard policy with insurance that provided for $15,000 in PIP coverage instead of the default amount of $250,000. Neither was able to sustain a claim for bodily injury (noneconomic loss) due to each policy’s limitation-on-lawsuit option. Each sued for outstanding medical bills in excess of their elected PIP coverage ($28,000 and $10,000, respectively). The trial courts ruled against plaintiffs in each matter and prohibited plaintiffs from admitting evidence of their medical expenses that exceeded their $15,000 PIP limits. The Appellate Division consolidated the cases on appeal, and, in a published opinion, reversed both trial court orders. After its review, the Supreme Court could not concluded there was evidence of a clear intention on the part of the Legislature to deviate from the carefully constructed no-fault first-party PIP system of regulated coverage of contained medical expenses and return to fault-based suits consisting solely of economic damages claims for medical expenses in excess of an elected lesser amount of available PIP coverage. "Unless the Legislature makes such an intent clearly known, the Court will not assume that such a change was intended by the Legislature through its amendments to the no-fault system in the Automobile Insurance Cost Reduction Act." View "Haines v. Taft" on Justia Law