In 2012, Dr. Jacobs hired All Green to perform electrical work for Jacobs’s MRI and X-ray facility, including a room in which a mammography unit was to be installed. Hologic installed that unit but discovered it was not operating correctly due to a magnetic field in the room. All Green ran power to another room but the magnetic field persisted; the unit continued to malfunction. The magnetic field continued to interfere with the unit's operation after installation of steel shielding. Jacobs then hired an electromagnetic field expert who determined that the problem was caused by a loose bolt in an electrical cabinet installed by All Green. When the bolt was tightened, the magnetic field instantly disappeared. Jacobs filed suit. All Green tendered defense of the lawsuit to its insurer, SNIC, under policies covering bodily injury and property damage liability. All Green denied the allegations of negligence, stating that all bolts had been properly tightened and that its work had passed two inspections. SNIC denied the claim citing the “impaired property” exclusion. The court of appeal affirmed summary judgment, holding that SNIC had no duty to defend. If Jacobs’s allegations were found true, SNIC would not have to indemnify, nor would SNIC have to indemnify if, as All Green contended, it was not responsible for the loose bolt. View "All Green Electric, Inc. v. Security National Insurance Co." on Justia Law

“Covered persons” as used in Mass. Gen. Laws ch. 176I, 11 refers solely to natural persons who, as employees, receive insurance coverage for health care services under a group insurance plan, rather than employer entities. At issue in this case was whether, when an employer purchases insurance on behalf of its employees, the insurer owes tax on premiums paid by on or behalf of only those individuals who live in Massachusetts or whether the insurer owes tax on all premiums received from the Massachusetts-based employer regardless of where its individual employees reside. The Supreme Judicial Court affirmed the judgment of the Appellate Tax Board, holding that the term “covered persons” in section 11 refers to the natural person receiving health care coverage under a preferred provider arrangement policy, including his or her spouse and additional dependents, not the employer-organization with whom the insurer contracts. View "Dental Service of Massachusetts, Inc. v. Commissioner of Revenue" on Justia Law

Plaintiff Robert Ferrante was involved in an automobile accident in 2006 where the other motorist caused the collision. Without informing his auto insurance carrier, defendant New Jersey Manufacturers Insurance Group (“NJM”), Ferrante initiated a negligence lawsuit against the tortfeasor, who had a liability limit of $100,000 on his insurance policy. The parties participated in mandatory arbitration, which set Ferrante’s damages at $90,000. Again, without informing NJM and allowing it to exercise its subrogation rights, Ferrante rejected the award, and sought a trial de novo. He also refused a $50,000 settlement offer without notifying NJM. Prior to the trial, Ferrante entered into a high-low agreement with the tortfeasor, which set the range of damages between $25,000 and $100,000, notwithstanding a jury verdict. Ferrante did not communicate this agreement or the trial itself to NJM, either. Following the trial, a jury awarded plaintiff $200,000 in damages, but the Law Division entered a judgment of $100,000 based on the high-low agreement. For the first time in 2011, Ferrante sent NJM a letter required by Longworth v. Van Houten, 223 N.J. Super. 174 (App. Div. 1988), stating that he was seeking UIM benefits. In the letter, Ferrante wrote that the other motorist was willing to settle for $100,000. However, Ferrante failed to mention the arbitration, high-low agreement, completed trial, or jury verdict. Based on this information, NJM told Ferrante to accept the offer. NJM and Ferrante proceeded to litigation over UIM coverage; only during a pretrial discovery exchange did Ferrante finally disclose his past dealings. NJM moved to dismiss the complaint, and the Law Division granted the motion, finding that Ferrante violated Longworth by not notifying NJM of any of the proceedings with the other motorist. On appeal, a split panel of the Appellate Division reversed. The majority held that because the trial court did not consider if NJM was actually prejudiced by the lack of notice, a remand was needed to determine if NJM sustained any prejudice. The New Jersey Supreme Court reversed: due to the complete absence of notice by Ferrante to NJM at any point over years of litigation, including the lack of notice about the high-low agreement or completed jury trial during the UIM process, NJM could refuse to pay the UIM benefits. View "Ferrante v. New Jersey Manufacturers Insurance Group" on Justia Law

The Supreme Court withdrew its judgment and opinion issued in this case on April 7, 2017 and, while it reaffirmed the legal principles and rules announced in that opinion, it disagreed as to the procedural effect of those principles in this case. Its disposition remained the same, however, because a majority of the Court agreed to reverse the judgment of the court of appeals and remand the case to the trial court for a new trial. The primary issue in this case was whether Insured could recover policy benefits based on Insurer’s violation of the Texas Insurance Code even where the jury failed to find that Insurer failed to comply with its obligations under the policy. Here, the Court (1) unanimously reaffirmed the five rules it announced in the first opinion addressing the relationship between contract claims under an insurance policy and tort claims under the Insurance Code; (2) reaffirmed the holding in the first opinion that the trial court erred by disregarding the jury’s answer to a jury question; and (3) addressed the procedural effect of the Court’s holdings in this case but reached three different conclusions. The Court then remanded this case for a new trial. View "USAA Texas Lloyds Co. v. Menchaca" on Justia Law

Purnell hired Plaintiffs (Gabarette and Castillo) as independent contractors to deliver furniture in Virginia. Because it was a last-minute request, Plaintiffs did not have a vehicle available, so Purnell permitted them to use a truck that Purnell had rented from Penske. Driving to their destination, Plaintiffs stopped on the side of the interstate so Castillo could check on the security of the furniture load. Another driver struck the rented truck, killing Castillo and injuring Gabarette. Purnell’s motor vehicle insurance policy, issued by Wausau, included an uninsured/underinsured motorists (UIM) endorsement required by Virginia law, with coverage limited “to those autos shown as covered autos.” For UIM coverage—as opposed to liability coverage—the policy restricted coverage to “Owned Autos Only” and listed three vehicles on the “Schedule of Covered Autos You Own,” not including the rented Penske truck. The Declarations Pages provided that Wausau would “pay in accordance with the Virginia Uninsured Motorists Law, all sums the insured is legally entitled to recover as damages from the owner or operator of an uninsured motor vehicle.” For UIM purposes, an insured party is “[a]nyone . . . occupying a covered auto.” The UIM endorsement defines “covered auto” as “a motor vehicle, or a temporary substitute, with respect to which the bodily injury or property damage liability coverage of the policy applies.” The district court granted Wausau summary judgment regarding UIM coverage. The Fourth Circuit affirmed, based on the plain language of the policy. View "Levine v. Employers Insurance Co. of Wausau" on Justia Law

Plaintiffs filed a putative class action, alleging that defendants (insurance providers, banks, and credit card companies) targeted credit card holders with fraudulent solicitations for illegal accidental disability and medical expense insurance policies. Plaintiffs were among the cardholders who purchased those policies, which plaintiffs allege were void ab initio because they violated New York insurance law. Although plaintiffs did not suffer qualifying losses or make claims for coverage, they argued that they are nevertheless entitled to reimbursement of the premiums and fees they paid defendants, plus enhanced damages, based on quasi‐contract, civil fraud, and statutory claims. The district court dismissed the suit, reasoning that plaintiffs could not establish the injury‐in‐fact element of Article III standing. The court concluded the policies were not void ab initio because under a New York savings statute, plaintiffs would have received coverage had they filed claims for qualifying losses, N.Y. Ins. Law 3103. The Second Circuit vacated, stating that an Article III court must resolve the threshold jurisdictional standing inquiry before it addresses the claim's merits. The district court’s analysis conflated the requirement for an injury in fact with the underlying validity of plaintiffs’ arguments, and engaged a question of New York state law that the state courts have yet to answer. View "DuBuisson v. Stonebridge Life Insurance Co." on Justia Law

The Supreme Court answered two certified questions from the United States Court of Appeals for the Fourth Circuit in this dispute between two insurance companies as follows: (1) The Workers’ Compensation Office of Judges does not have jurisdiction over a declaratory judgment action involving a dispute between insurance carriers regarding whether one or both carriers are responsible for contributing toward payment of an employee’s workers’ compensation benefits; and (2) Pursuant to W. Va. Code 33-46A-7(a), parties to a professional employer agreement must designate either the professional employer organization (PEO) or the client-employer as the responsible party for obtaining workers’ compensation insurance coverage for covered employees. Further, when parties to a professional employer agreement designate the PEO as the responsible party for obtaining workers’ compensation insurance coverage for covered employees, the policy obtained by the PEO is primary over a policy obtained by a client-employer. Thus, coverage under a workers’ compensation policy purchased by the client-employer is triggered only if the PEO or its carrier default on their obligation to provide workers’ compensation coverage. View "Brickstreet Mutual Insurance Co. v. Zurich American Insurance Co." on Justia Law

The Supreme Court reversed the judgment of the court of appeals affirming the circuit court’s grant of summary judgment to Plaintiffs’ underinsured motorist (UIM) carrier, Allstate Property and Casualty Co. (Allstate), holding that the court of appeals erred in concluding that Plaintiffs failed to provide Allstate with timely notice of the UIM claim and that they failed to rebut the presumption that Allstate was prejudiced by the untimely notice. Specifically at issue in this case was whether the court of appeals misinterpreted the UIM policy’s “proof of claim” provision as a “notice of accident” provision. The Supreme Court held (1) the operative event triggering the notice requirement in Plaintiffs’ UIM is the tender of the tortfeasor’s underlying policy limit, not the accident itself; (2) Wis. Stat. 631.81(1) does not apply to the UIM policy provision at issue; and (3) therefore, Plaintiffs provided Allstate with timely proof of their UIM claim as required by the policy. The Court remanded the case to the circuit court for further proceedings. View "Shugarts v. Mohr" on Justia Law

Edgar and Laurie Cook owned 200 acres of property in Bonner County, Idaho. The Property included Bloom Lake, a cabin, and a campground. The Cooks allowed people to use the lake and campground without charging a fee, but they solicited voluntary donations to help with the Property’s upkeep. Approximately twenty years ago, Michael Chisholm asked the Cooks if he could stay in the cabin in exchange for maintaining the Property. They agreed, and Chisholm began caring for the Property. In 2015, Joseph Stanczak and his girlfriend were camping at the Property. Chisholm invited them into the cabin, and a dispute later arose between Chisholm and Stanczak. Chisholm shot Stanczak twice with a .45 caliber handgun, then left the scene. Authorities later apprehended Chisholm and charged him with Aggravated Battery and Use of a Deadly Weapon in Commission of a Felony. Chisholm entered an Alford plea, by which he pleaded guilty without admitting guilt as to all the elements of the crimes. He was sentenced to prison. At issue in this was was the interpretation of the insuring clause of a bodily injury liability provision in a property insurance contract. The insurer, Farm Bureau Mutual Insurance Company of Idaho, determined it had no duty to defend or indemnify the Cooks because the shooting was not a covered act under the policy. Farm Bureau filed a declaratory judgment action seeking judicial confirmation of its determination. Farm Bureau then filed a motion for summary judgment, requesting that the district court find as a matter of law that the intentional shooting was not an “occurrence.” The district court granted Farm Bureau’s motion. Finding no reversible error in the district court's decision, the Idaho Supreme Court affirmed judgment in favor of Farm Bureau. View "Farm Bureau Ins v. Cook" on Justia Law

This appeal stemmed from a dispute between Summit Park Townhome Association and its insurer, Auto-Owners Insurance Company, over the value of property damaged in a hail storm. To determine the value, the district court ordered an appraisal and established procedural requirements governing the selection of impartial appraisers. After the appraisal was completed, Auto-Owners paid the appraised amount to Summit Park. But the court found that Summit Park had failed to make required disclosures and had selected a biased appraiser. In light of this finding, the court vacated the appraisal award, dismissed Summit Park’s counterclaims with prejudice, and awarded interest to Auto-Owners on the amount earlier paid to Summit Park. Summit Park appealed, raising six issues of alleged error with the proceedings. The Tenth Circuit affirmed, however, finding that in the absence of a successful appellate challenge to the disclosure order, Summit Park was obligated to comply and did not. The court was thus justified in dismissing Summit Park’s counterclaims. In addition, Summit Park’s failure to select an impartial appraiser compelled vacatur of the appraisal award under the insurance policy. View "Auto-Owners v. Summit Park" on Justia Law