An underinsured motorist struck a car driven by Dale Fisher, causing Fisher injuries requiring over $60,000 in medical care. Fisher was not at fault, and he was covered under multiple State Farm underinsured motorist (“UIM”) insurance policies. State Farm agreed that Fisher’s medical bills were covered under the UIM policies, but it disputed other amounts Fisher sought under the policies, including lost wages. So, State Farm refused to pay Fisher’s medical bills without first resolving his entire claim. Fisher sued, alleging State Farm had unreasonably delayed paying his medical expenses. In response, State Farm argued it had no duty to make piecemeal payments, even for Fisher’s undisputed medical expenses, when it disputed the rest of Fisher’s UIM claim. A jury returned a verdict in Fisher’s favor, finding that State Farm had violated section 10-3-1115, C.R.S. (2017), which provides that an insurer “shall not unreasonably delay or deny payment of a claim for benefits owed to or on behalf of any first-party [insured] claimant.” A division of the court of appeals affirmed. The issue this case presented for the Colorado Supreme Court's review was whether auto insurers have a duty to pay undisputed portions of a UIM claim (like the medical expenses at issue here) even though other portions of the claim remain disputed. The Court held that insurers have a duty not to unreasonably delay or deny payment of covered benefits, even though other components of an insured’s claim may still be reasonably in dispute. Thus, the Court affirmed the judgment of the court of appeals. View "State Farm v. Fisher" on Justia Law

The Fifth Circuit affirmed the district court's grant of summary judgment for Axis and grant of Axis's motion to strike an affidavit submitted in support of its motion for summary judgment as untimely. The court held that this case presented no unusual or exceptional circumstances and the district court did not abuse is discretion in striking the affidavit where Hartford did not not seek modification of the scheduling order so that it may apprise the district court of its intent to offer another witness's testimony so as to give Axis an opportunity to depose the witness, nor did Hartford provide any valid justification for its failure to secure the affidavit before all discovery deadlines had passed. The court held that the policy unambiguously provided coverage in this case because the Hartford policy provided liability coverage for any auto and because the CRB Endorsement did not conflict with the liability coverage provision of the policy. Finally, the court declined to take judicial notice of Dana Transport's "admission." View "Bennett v. Hartford Insurance Company of the West" on Justia Law

Sports Medicine performed shoulder surgery on “Joshua,” who was covered by a health insurance plan, and charged Joshua for the procedure. Because it did not participate in the insurers’ network, Sports Medicine was not limited to the insurer’s fee schedule and charged Joshua $58,400, submitting a claim in that amount to the insurers on Joshua’s behalf. The claim form indicated that Joshua had “authorize[d] payment of medical benefits.” The insurer processed Joshua’s claim according to its out-of-network cap of $2,633, applying his deductible of $2,000 and his 50% coinsurance of $316, issuing him a reimbursement check for the remaining $316, and informing him that he would still owe Sports Medicine the remaining $58,083. Sports Medicine appealed through the insurers’ internal administrative process and had Joshua sign an “Assignment of Benefits & Ltd. Power of Attorney.” Sports Medicine later sued for violations of the Employee Retirement Income Security Act (ERISA), and breach of contract, citing public policy. The district court dismissed for lack of standing because Joshua’s insurance plan included an anti-assignment clause. The Third Circuit affirmed, holding that the anti-assignment clause is not inconsistent with ERISA and is enforceable. View "American Orthopedic & Sports Medicine v. Independence Blue Cross Blue Shield" on Justia Law

The term "invasion of the right of private occupancy" is ambiguous and may include non-physical invasions of rights in real property. The Court of Appeal reversed the trial court's grant of summary judgment for the umbrella insurer in an action alleging claims for breach of contract and breach of the implied covenant of good faith and fair dealing. In this case, the personal injury provision of plaintiff's umbrella policy potentially covered the allegations in the underlying action and the umbrella insurer breached its duty to defend by not providing plaintiff with a defense. Accordingly, the court vacated the trial court's order and directed the trial court to enter a new order granting the motion. View "Albert v. Truck Insurance Exchange" on Justia Law

The Fourth Circuit affirmed the district court's grant of summary judgment for the insurance company that insured Steven Gordon. After Steven died, his wife filed suit seeking the full coverage amount for the insurance policy he had been paying for through his company. The court held that no reasonable jury could find that either of the CIGNA Defendants had a fiduciary duty toward the Gordons with respect to soliciting supporting materials for coverage beyond the guaranteed issue amount or notifying new employees that they had not completed the evidence of insurability requirement; even assuming without deciding, that the cause of action for breach of trust by a fiduciary under the Employee Retirement Income Security Act (ERISA) was cognizable, her claim would fail because there was no evidence that the CIGNA Defendants knowingly participated in any breach; and the district court did not err by granting summary judgment before allowing plaintiff to conduct discovery. View "Gordon v. Cigna Corp." on Justia Law

In the Fifth Circuit's previous ruling, Aldous v. Darwin Nat'l Assurance Co., 851 F.3d 473, 485 (5th Cir. 2017), the court determined that plaintiff's claims under the Texas Insurance Code Chapter 541 were barred because she did not claim damages beyond the loss of policy benefits. Since that ruling, the Supreme Court of Texas decided USAA Texas Lloyds Co. v. Menchaca, No. 14-0721, 2018 WL 1866041, at 10 (Tex. Apr. 13, 2018), and repudiated the independent-injury rule. Therefore, the court granted plaintiff's motion for leave to file her petition out of time because the court retained jurisdiction over the appeal and because plaintiff had good cause for her late filing. View "Charla Aldous, P.C. v. Darwin National Assurance Co." on Justia Law

While sitting on his motorcycle at a stop light, Chad Hahn was thrown backwards when Franklin Townsend’s car failed to stop in time and struck the motorcycle. During settlement negotiations in the suit that followed, Hahn sought payment under Townsend’s underinsured motorist(UIM) insurance policy. Hahn argued that he was an insured occupant of Townsend’s car because he landed on the car after the impact and that Townsend’s liability insurance would not cover the full extent of his damages, rendering Townsend underinsured. Townsend’s insurer, GEICO Choice Insurance Company (GEICO), sued for a declaratory judgment that no UIM coverage was available. Hahn answered, raising a number of affirmative defenses including that GEICO’s declaratory judgment action was not ripe and that the court therefore lacked subject matter jurisdiction. Hahn also filed a counterclaim for a declaratory judgment that UIM coverage was available to him, and asserted third-party claims against Townsend, seeking to join him as a necessary party and a real party in interest. The superior court concluded that it had subject matter jurisdiction, granted summary judgment and a declaratory judgment in GEICO’s favor, and dismissed the third-party claims against Townsend. Hahn appealed; finding no reversible error, the Alaska Supreme Court affirmed. View "Hahn v. GEICO Choice Insurance Company" on Justia Law

The lower courts in this case erred by requiring a signatory to arbitrate its non-contractual claims against non-signatories. Jody James Farms, JV purchased a crop revenue coverage insurance policy from Rain & Hail, LLC through the Altman Group. The insurance policy contained an arbitration clause. Neither the Altman Group nor any of its employees signed the agreement. After Rain & Hail denied coverage for a grain sorghum crop loss suffered by Jody James and the parties arbitrated the dispute, Jody James sued the Altman Group and its agent (collectively, the Agency) for breach of fiduciary duty and deceptive trade practices. The Agency successfully moved to compel arbitration under the insurance policy. At arbitration, Jody James asserted that it had a right to proceed in court against the Agency because the Agency was a non-signatory to the arbitration agreement. The arbitrator resolved that issue and the merits of the dispute in the Agency’s favor. The trial court confirmed the award. The court of appeals affirmed. The Supreme Court reversed because (1) Jody James and the Agency did not agree to arbitrate any matter; and (2) Jody James may not be compelled to arbitrate under agency, third-party-beneficiary, or estoppel theories. View "Jody James Farms, JV v. Altman Group, Inc." on Justia Law

The business-owners liability insurance policy in this case did not provide coverage for a negligent supervision claim arising out of an alleged employee’s intentional act of physically punching a customer in the face. The circuit court granted summary judgment in favor of the Insurer, concluding that there was no coverage under the policy for either the employee’s intentional act or the negligent supervision claim against the employer arising out of the employee’s intentional act. The court of appeals reversed. The Supreme Court reversed, holding that where the negligent supervision claim pled rested solely on the employee’s intentional and unlawful act without any separate bais for a negligence claim against the employer, no coverage existed. View "Talley v. Mustafa" on Justia Law

At issue in this case was whether the record contained sufficient evidence to support the jury's verdict that a continuing course of conduct tolled the statute of limitations, Connecticut General Statutes 52‐577. The Second Circuit certified the following question to the Connecticut Supreme Court: Is the trial evidence legally sufficient to support the jury's finding that the statute of limitations was tolled at least through October 21, 2010, rendering the Insurer's claim timely? View "Evanston Insurance Co. v. William Kramer & Associates, LLC" on Justia Law