Justia Insurance Law Opinion Summaries
State Farm Mutual Automobile Insurance Co. v. Elmore
Kent backed up a grain truck that was owned by his father, Sheldon, to an auger that was being used to move grain to a transport truck. A tractor powered the auger by means of a power take-off shaft. Kent, attempting to open the truck’s gate, wanted to get extra leverage and stepped onto the auger. The auger’s protective shield had been removed. Kent’s foot was exposed to the turning shaft. In the ensuing accident, Kent lost his leg below the knee. Kent settled a negligence action against Sheldon and received $1.9 million from insurers.Kent reserved his right to pursue additional coverage under the auto policy that covered the truck. State Farm sought a declaratory judgment that no coverage was provided because an auger is neither a “car” nor a “trailer,” as defined in the policy but fell under the policy’s “mechanical device” exclusion for damages resulting from "THE MOVEMENT OF PROPERTY BY MEANS OF A MECHANICAL DEVICE, OTHER THAN A HAND TRUCK, THAT IS NOT ATTACHED TO THE VEHICLE.” The circuit court granted State Farm summary judgment. The appellate court construed the exclusion against State Farm.The Illinois Supreme Court reversed. The exclusion was not ambiguous. The auger is a machine or tool designed to move grain from one place to another and is a device that was “operated by a machine or tool” (a tractor) that is not a small hand-propelled truck or wheelbarrow, and was not attached to the insured vehicle. Exclusions are permissible if they do not differentiate between named insureds and permissive users. View "State Farm Mutual Automobile Insurance Co. v. Elmore" on Justia Law
Chen v. Insurance Co. of State of PA
The Court of Appeals affirmed the order of the Appellate Division affirming Supreme Court's conclusion that an excess insurer did not have an obligation to pay interest on an underlying personal injury judgment after the primary policy was voided.Plaintiff was injured at a construction site and sued the general contractor, which maintained an excess liability insurance policy with Defendant. Supreme Court granted partial summary judgment for Plaintiff. Plaintiff then commenced this action asserting that Defendant was obligated to pay the entire underlying damages award. Supreme Court ultimate determined that Defendant was obligated to pay $1.3 million in excess damages, prejudgment interest on those damages and interest that accrued from the date partial summary judgment was granted to Plaintiff until the entry of judgment. The Appellate Division affirmed. The Court of Appeals affirmed. At issue on appeal was whether Defendant was obligated to pay interest on the underlying personal injury judgment after the primary policy was voided. The Court of Appeals affirmed, holding that the excess policy did not provide overlapping coverage for certain interest payments covered in the primary policy. View "Chen v. Insurance Co. of State of PA" on Justia Law
St. Mary & St. John Coptic Orthodox Church v. SBC Insurance Services, Inc.
The Church experienced water damage 57 days after escrow closed on a residence it had purchased; its insurance broker, SBC, had procured commercial property insurance for the residence with Philadelphia Indemnity. Philadelphia denied a claim. The policy states the insurer will not pay for losses if the building where the loss occurs was vacant for more than 60 consecutive days before the loss. The parties entered into an agreement whereby the Church gave Philadelphia the right to control litigation in the Church's name against SBC or third parties in exchange for a loan of money to repair and remediate the residence; the loan was to be repaid out of any recovery.In a suit against SBC for professional negligence, the court found that SBC had breached its duty of care, but that the Church suffered no damages because the loss was covered under the Philadelphia policy. The court found the vacancy provision ambiguous and concluded that it did not include time before the insured owned the residence.The court of appeal reversed. When the vacancy provision is properly interpreted and applied to the undisputed evidence, there was no coverage for the loss. The residence did not contain enough personal property to conduct operations as a residence for the Coptic Pope and visiting clergy or the prior owner. The court rejected an argument that the residence was not vacant under the policy because it was being held out for sale. View "St. Mary & St. John Coptic Orthodox Church v. SBC Insurance Services, Inc." on Justia Law
Benson v. Casa de Capri Enterprises, LLC
The Ninth Circuit certified to the Arizona Supreme Court the following questions: 1. In a garnishment action by a judgment creditor against the judgment debtor's insurer claiming that coverage is owed under an insurance policy, where the judgment creditor is not proceeding on an assignment of rights, can the insurer invoke the doctrine of direct benefits estoppel to bind the judgment creditor to the terms of the insurance contract? 2. If yes, does direct benefits estoppel also bind the judgment creditor to the arbitration clause contained in the insurance policy? View "Benson v. Casa de Capri Enterprises, LLC" on Justia Law
State Farm Mutual Automobile Insurance Co. v. Mizuno
The Supreme Court answered a certified question by concluding that, under Hawai'i law, a permissive user of an insured vehicle, whose connection to the vehicle is permission to use the vehicle to run errands and drive to work, was entitled to uninsured motorist (UM) benefits under the chain-of-events test because he was injured by an uninsured motorist.The Supreme Court determined that the proper inquiry under the chain of events test was whether a permissive user has retained a sufficient connection to the insured vehicle. The Court then held that, under the chain of events test, the driver at issue was entitled to UM benefits because he was a permissive user of the insured vehicle during the chain of events resulting in his injury caused by an uninsured motor vehicle. View "State Farm Mutual Automobile Insurance Co. v. Mizuno" on Justia Law
State ex rel. Blue Cross & Blue Shield of Kansas, Inc. v. Honorable Shawn D. Nines
In this original jurisdiction proceeding, the Supreme Court granted a writ of prohibition sought by Petitioners, out-of-state Blue Cross Blue Shield Plans, to prevent the enforcement of the circuit court's order concluding that it had jurisdiction over Petitioners in this action, holding that jurisdiction over Petitioners was clearly not appropriate in this case.Respondent alleged that the circuit court had jurisdiction over Petitioners for several reasons. Petitioners filed a motion to dismiss for lack of jurisdiction, asserting that they had no relevant jurisdictional contacts with West Virginia. The circuit court denied the motion, concluding that Petitioners purposefully availed themselves of the privilege of conducting business in West Virginia. Petitioners then filed the instant writ, arguing that any attempt to exercise specific jurisdiction over them violated due process because there was no allegation or evidence showing that they developed or maintained a substantial relationship with West Virginia or purposefully engaged in forum-related conduct that gave rise to Respondent's claims. The Supreme Court granted the writ, holding that Petitioners were entitled to the writ of prohibition. View "State ex rel. Blue Cross & Blue Shield of Kansas, Inc. v. Honorable Shawn D. Nines" on Justia Law
Cleveland v. Advance Auto Parts
After suffering two work-related injuries, Sheree Cleveland settled her workers’ compensation claims with Advance Auto Parts and its workers’ compensation insurance carrier, Indemnity Insurance Company of North America. The Workers’ Compensation Commission approved the settlement. Approximately one month later, the Employer/Carrier filed a Form B-31 indicating the last payment had been made. More than a year after that, Cleveland filed a motion asserting that the Employer/Carrier had not paid all compensation due under the settlement and that two medical bills remained outstanding. The Commission found that, because a one-year statute of limitations had expired, it lacked jurisdiction to enforce its order approving the settlement agreement. Cleveland appealed, and the Court of Appeals reversed, questioning whether the one-year statute of limitations applied to the claim. But instead of answering that question, the Court of Appeals found that the Employer/Carrier had been estopped from asserting a statute of limitations defense because it had agreed to pay the outstanding bills and had represented to the administrative law judge that it would do so. Further, the Court of Appeals also found Cleveland's contact with the Employer/Carrier within the limitations period tolled the statute of limitations, if, in fact, it applied. The Mississippi Supreme Court affirmed, but for different reasons than the appellate court. The Supreme Court determined the statute of limitations did not apply to Cleveland's motion for enforcement of the settlement order, therefore, her motion was timely filed. View "Cleveland v. Advance Auto Parts" on Justia Law
Davis v. Hartford Life & Accident Insurance Co.
Davis, insured under a Hartford long-term disability policy, began missing work due to chronic back pain, neuropathy, and fatigue caused by multiple myeloma. Relying on the opinion of Davis’s oncologist, Dr. Reddy, Hartford approved Davis’s claim for short-term disability benefits through April 17, 2012. In June, Hartford approved Davis for long-term disability benefits, retroactive to April, for 24 months. Davis could continue to receive benefits beyond that time if he was unable to perform one or more of the essential duties of “Any Occupation” for which he was qualified by education, training, or experience and that has comparable “earnings potential.” Reddy's subsequent reports were inconsistent. An investigator found “discrepancies" based on surveillance. Davis’s primary care physician and neurologist both concluded that Davis could work full-time under described conditions. Reddy disagreed, but would not answer follow-up questions. An orthopedic surgeon conducted an independent review and performed an examination, and reported that Davis was physically capable of “light duty or sedentary work” within certain restrictions. Other doctors agreed. Hartford notified Davis that he would be ineligible for benefits after April 17, 2014.Davis filed suit under the Employee Retirement Income Security Act, 29 U.S.C. 1132(a). The Sixth Circuit affirmed summary judgment in favor of Hartford. Hartford reasonably concluded that Davis could work full-time, under certain limitations; the decision was not arbitrary. View "Davis v. Hartford Life & Accident Insurance Co." on Justia Law
Ewing v. Westport Ins. Co., et al.
The Louisiana Supreme Court granted this writ application to determine whether “collectibility” was a relevant consideration in a legal malpractice action. Specifically, the issue presented was whether plaintiff’s damages in this legal malpractice action were limited to the amount she could have actually collected on a judgment against the tortfeasor in the underlying lawsuit. Elaine Ewing was injured in an automobile accident in 2015, when her vehicle was hit by a vehicle driven by Marc Melancon. Her counsel failed to forward the original petition for damages within seven days as required by La. R.S. 13:850. The original petition was filed on April 22, 2016, after the one-year prescriptive period had passed. Ms. Ewing’s suit was dismissed on an exception of prescription. Ms. Ewing subsequently filed a legal malpractice action against her attorney and Westport Insurance Corporation, counsel's malpractice insurer. Defendants filed a motion for partial summary judgment asserting the court should apply the “collectibility rule.” Defendants alleged Ms. Ewing’s recovery could be no greater than her potential recovery in the underlying personal injury lawsuit, and recovery in this case should have been capped at Mr. Melancon’s insurance policy limits. The Supreme Court held that proof of collectibility of an underlying judgment was not an element necessary for a plaintiff to establish a claim for legal malpractice, nor could collectibility be asserted by an attorney as an affirmative defense in a legal malpractice action. View "Ewing v. Westport Ins. Co., et al." on Justia Law
Leibowitz v. Family Vision Care, LLC
Cahill was the office administrator for the Family Vision optometry practice and handled insurance billings. She left her employment and filed for bankruptcy protection. About 90% of Family’s revenue came from claims submitted to VSP, which covers claims from optometrists only if they have “majority ownership and complete control” of their medical practices. VSP disburses payments after the provider signs an agreement certifying itself as “fully controlled and majority-owned” by an optometrist. At the time Cahill was submitting Family’s claims, the practice was actually owned by a practice management company with more than 150 surgery centers and other medical practices.About a year after Cahill left Family, the trustee of Cahill’s bankruptcy estate sued under the Insurance Claims Fraud Prevention Act, 740 ILCS 92/1, which added civil penalties to existing criminal remedies for fraud against private insurance companies and allows a claim to be raised on the state’s behalf by a private person (relator), in a qui tam action. The relator becomes entitled to remuneration if the lawsuit succeeds. A relator must be an “interested person” but the Act does not define that term.The Illinois Supreme Court affirmed the reinstatement of the case. A former employee-whistleblower with personal, nonpublic information of possible wrongdoing qualifies as an “interested person” under the Act and need not allege a personal claim, status, or right related to the proceeding. The state need not suffer money damages to partially assign its claim to a relator. The Act is intended to remedy fraud against private insurers, where the only injury to the state is to its sovereignty, based on a violation of criminal law. View "Leibowitz v. Family Vision Care, LLC" on Justia Law