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Allstate Insurance Company denied underinsured motorist (UIM) coverage to Nathan Ball for an accident involving his own vehicle after determining he was not an insured person under his then-fiancée’s parents’ Allstate automobile insurance policy. Ball contended that his fiancée was a “policyholder” for purposes of her parents’ policy, a necessary predicate to his argument for UIM coverage under the policy. But the policy declarations page did not list “policyholders,” it listed only “named insureds” and “drivers.” The superior court granted summary judgment on grounds that the policy language was not ambiguous because “policyholder” referred only to the parents, the “named insureds,” that the fiancée as only a listed driver, had no objectively reasonable expectation that she was a policyholder, and, therefore, that Allstate did not have a duty to provide Ball UIM coverage. The Alaska Supreme Court agreed “policyholder” encompassed only the named insureds, not listed drivers, and therefore affirmed the superior court’s decision. View "Ball v. Allstate Insurance Company" on Justia Law

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Third-party defendant Dr. George Likakis was charged with aggravated arson and insurance fraud after a fire destroyed a building he owned (the Property). Plaintiff RSI Bank held a first-priority mortgage on the Property, and defendant/third-party plaintiff The Providence Mutual Fire Insurance Company (Providence) issued a commercial liability policy that covered the Property. Following the fire, Likakis and RSI Bank submitted insurance claims. Providence denied both sets of claims. Providence’s denial of coverage prompted the filing of two actions in the Law Division: (1) filed by Likakis against Providence; and (2) an action gave rise to this appeal: RSI Bank’s claims against Providence for breach of contract, fraudulent misrepresentation, violations of the Consumer Fraud Act, and bad faith. Providence filed a third-party complaint against Likakis, alleging claims for indemnification. Both civil lawsuits were pending when criminal proceedings commenced against Likakis. Likakis was indicted; Providence did not object to Likakis’ admission to the PTI program, provided he paid restitution, committed to protect/compensate Providence from all claims that might be brought by RSI, and dismissal of Likakis’ suit against Providence. With Likakis’s consent - but no assessment of his ability to pay - the court also imposed the three conditions that Providence had requested. During his PTI term, Likakis paid Providence the specific restitution amount and dismissed with prejudice his lawsuit. Likakis did not make any payment related to the separate indemnification provision. With the prosecutor’s consent, the PTI court terminated Likakis’s PTI supervision and dismissed his indictment. RSI Bank and Providence settled their coverage dispute. Providence agreed to pay RSI Bank to settle all of the bank’s claims based on the insurance policy and moved for summary judgment against Likakis based on the provision of the PTI agreement. The court held that the indemnification provision of the PTI agreement was enforceable against Likakis and ordered Likakis to pay Providence the portion of the settlement funds Providence attributed to fire damage, less the amount Likakis had paid during his PTI supervisory period. Likakis appealed, and an Appellate Division panel affirmed. The New Jersey Supreme Court reversed, finding an open-ended agreement to indemnify the victim of the participant’s alleged offense for unspecified future losses was not an appropriate condition of PTI. Moreover, a restitution condition of PTI was inadmissible as evidence in a subsequent civil proceeding against the PTI participant. The indemnification provision of the PTI agreement at issue should have played no role in this civil litigation. View "RSI Bank v. The Providence Mutual Fire Insurance Company" on Justia Law

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In this insurance dispute, the Supreme Court reversed in part the entry of summary judgment in Plaintiff’s declaratory action regarding underinsured motorist coverage (UIM) in favor of Farmers Insurance Exchange, holding that the district court erred by holding that Farmers could offset its underinsured motorist coverage (UIM) obligation to Plaintiff dollar-for-dollar with GEICO’s entire UIM payment. Plaintiff was one of five passengers injured in an accident. The tortfeasor was underinsured by $48,686 as to Plaintiff’s damages. The vehicle in which Plaintiff was a passenger was insured by GEICO, and Plaintiff carried personal vehicle coverage with Farmers, including medical payment (MedPay) coverage and UIM coverage. GEICO paid Plaintiff its individual UIM coverage limit and Farmers paid Plaintiff under her MedPay coverage. In total, Plaintiff received payments of $2,500 less than her total stipulated damages. Disputes Plaintiff had with Farmers led Plaintiff to file this declaratory action. The district court held in Farmers’ favor on the two contested issues. The Supreme Court held (1) the policy language did not permit Farmers to offset its UIM obligation dollar-for-dollar with the entire GEICO UIM payment; (2) Farmers was entitled to offset its UIM obligation with its MedPay payments to Plaintiff; and (3) Plaintiff was entitled to recover attorney fees. View "Cramer v. Farmers Insurance Exchange" on Justia Law

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United States District Court for the Northern District of Georgia certified a question of Georgia law to the state Supreme Court. At issue in this insurance coverage dispute between plaintiff National Casualty Company, a commercial insurer, and defendant Georgia School Boards Association - Risk Management Fund (“Risk Fund”), an interlocal risk management agency created pursuant to Article 29 of Chapter 2 of Title 20 of the Georgia Code, OCGA 20-2-2001 et seq. The gravamen of the question was whether Georgia law or public policy precluded a commercial insurance policy that was excess to coverage provided under OCGA 20-2-2002; the Supreme Court answered in the negative, there was no such prohibition. View "National Casualty Company v. Georgia School Boards Association Risk Management Fund" on Justia Law

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Plaintiffs suffer from asbestos disease as a result of exposure to Grace's Montana mining and processing operations and sought to hold Grace’s insurers (CNA), liable for negligence. CNA sought to enforce a third-party claims channeling injunction entered under Grace’s confirmed plan of reorganization to bar the claims. Bankruptcy Code section 524(g) allows an injunction that channels asbestos mass-tort liability to a trust set up to compensate persons injured by the debtor’s asbestos; channeling injunctions can also protect the interests of non-debtors, such as insurers. The Third Circuit rejected the Plaintiffs’ argument that the Plan and Settlement Agreement’s terms preserved all of CNA’s duties as a workers’ compensation insurer in order to avoid preempting the state’s workers’ compensation laws. The court then applied a three-part analysis: Section 524(g)(4)(A)(ii) allows injunctions to “bar any action directed against a third party who is identifiable . . . and is alleged to be directly or indirectly liable for the conduct of, claims against, or demands on the debtor [that] . . . arises by reason of one of four statutory relationships between the third party and the debtor.” CNA is identified in the Injunction, satisfying the first requirement. Analysis of the second factor requires review of the law to determine whether the third-party’s liability is wholly separate from the debtor’s liability or instead depends on it. The Bankruptcy Court must make that determination, and, with respect to the “statutory relationship” factor, should review the law and determine whether CNA’s provision of insurance to Grace is relevant legally to the Montana Claims. View "W.R. Grace & Co. v. Carr" on Justia Law

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Springer, a Utah physician, began a fellowship at the Cleveland Clinic and enrolled his family in its employee benefit plan, administered by Antares. During the enrollment period, Springer had his 14-month-old son, J.S., transported from a Utah hospital to the Cleveland Clinic by Angel Jet’s air ambulance service. J.S. had been hospitalized since birth for multiple congenital abnormalities. He required a mechanical ventilator. J.S.’s physician prepared a letter of medical necessity for the service. Before the flight, Angel Jet contacted Antares, which was unable to confirm that Springer and his son were members of the plan and did not precertify the service. Angel Jet proceeded with the transportation and submitted a bill to Antares for $340,100. Antares denied it for failure to obtain precertification. The Plan affirmed the denial but paid $34,451.75, reflecting the amount their preferred provider would have charged. Angel Jet brought suit under the Employee Retirement Security Act. The district court dismissed the suit, finding that Springer had not properly assigned his rights under the plan to Angel Jet. Springer then brought his own claim under ERISA Section 502(a)(1)(B). The Sixth Circuit affirmed, first finding that Springer had standing despite having received the service and not being billed. The denial was not arbitrary and capricious because J.S.’s transportation was not an emergency or precertified as required for a nonemergency. View "Springer v. Cleveland Clinic Employee Health Plan Total Care" on Justia Law

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In this declaratory judgment action filed by a professional liability insurer seeking to establish that it had no duty to defend its insured in two state court proceedings, the First Circuit affirmed the judgment of the district court granting the declaratory judgment for the insurer, holding that the district court correctly determined that the claims against the insured in both lawsuits fell outside the professional liability coverage provided by the insurance policy. The insured, a physician, was the defendant in two civil suits filed in state courts in Maine and Maryland. The insured’s ex-wife claimed that the insured used his status as a doctor to obtain her medical records during their deteriorating marriage so that he could harass and embarrass her. The district court concluded that the insurer had no duty to defend the insured in either lawsuit. The First Circuit affirmed after a close review of the policy at issue, holding that the insurer had no duty to defend the insured in either the Maryland or the Maine proceedings. View "Medical Mutual Insurance Co. of Maine v. Burka" on Justia Law

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At issue in this appeal was a statutory scheme that dictates how to calculate farmers' crop insurance policies. Determining that it had jurisdiction over the appeal, the Fifth Circuit held that farmers were permitted to exclude the historical data for the 2015 crop year, even though the FCIC had not completed its data compilation. In this case, the FCIC has not provided any textual or contextual clues that would cast doubt on the plain language of the Federal Crop Insurance Act, 7 U.S.C. 1508(g)(4). Therefore, the farmers prevailed at Chevron step one. View "Adkins v. USDA" on Justia Law

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The Supreme Court affirmed in part and reversed and remanded in part the district court’s grant of summary judgment in favor of ALPS Property & Casualty Insurance Company (ALPS) in this declaratory action, holding that the district court erred when it determined that ALPS properly rescinded an insurance policy, which the court rendered void from the inception of the coverage period for Michael McLean and McLean & McLean, PLLP (M&M), but the court did not err in concluding that no coverage existed as to third-party claimants Miantae McConnell and Joseph and Marilyn Micheletti. Specifically, the Court held (1) the district court erred in concluding that Mont. Code Ann. 33-15-403 provided for a right to rescind the policy; and (2) the district court did not err when it concluded that the third-party claims were barred because they were lodged after ALPS had cancelled the policy or were excluded from coverage under other policy provisions. View "ALPS Property & Casualty Insurance Co. v. McLean & McLean" on Justia Law

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At issue was whether section 38a-334-6(c)(2)(B) of the Regulations of Connecticut State Agencies, which authorizes exclusions in insurance policies when the owner of the underinsured vehicle is a rental car company designated as a “self-insurer” by the Insurance Commissioner pursuant to Conn. Gen. Stat. 38a-371(c), remains valid as applied to rental car companies in light of development in federal law. The insureds in this case, who were injured by an underinsured lessee driving a rental car owned by a self-insured rental car company, were denied underinsured motorist benefits under their policies because those policies contained a self-insurer exclusion. The Supreme Court reversed, holding that section 38a-334-6(c)(2)(B) of the regulations is invalid as applied because it conflicts with the public policy manifested in Conn. Gen. Stat. 38a-336(a)(1) that requires insurance policies to provide underinsured motorist coverage. View "Tannone v. Amica Mutual Insurance Co." on Justia Law