Justia Insurance Law Opinion Summaries
QBE Seguros v. Morales-Vazquez
In this dispute between a boat owner and his insurance company, the First Circuit affirmed the judgment of the district court in favor of the insurer, holding that the district court properly applied the doctrine of uberrimae fidei in this case.When Defendant applied for an insurance policy for his yacht from an entity later acquired by Plaintiff he failed to disclose that he had grounded a forty-foot yacht in Puerto Rico. Plaintiff later sought a declaratory judgment voiding the policy on the grounds that Defendant had failed to honor his duty of utmost good faith, known as uberrimae fidei in maritime law, in acquiring the policy and had therefore breached the warranty of truthfulness contained in the policy. The district court concluded that Plaintiff was entitled to void the policy. The First Circuit affirmed, holding that the district court correctly concluded that the uberrimae fidei doctrine entitled Plaintiff to a declaration that the policy was void. View "QBE Seguros v. Morales-Vazquez" on Justia Law
The Health Care Authority for Baptist Health v. Dickson
The Health Care Authority for Baptist Health, an affiliate of UAB Health System ("HCA"), and The Health Care Authority for Baptist Health, an affiliate of UAB Health System d/b/a Prattville Baptist Hospital (collectively, "the HCA entities"), appealed a circuit court order denying their motion to compel arbitration in an action brought by Leonidas Dickson, II. In 2015, Dickson sustained injuries as a result of an automobile accident. Following the accident, Dickson was taken to Prattville Baptist Hospital ("PBH"), where he was treated and discharged. Dickson was partially covered by a health-insurance policy issued by Blue Cross and Blue Shield of Alabama, Inc. ("BCBS"). PBH was a party to a "Preferred Outpatient Facility Contract" ("the provider agreement") with BCBS, under which the medical care rendered to Dickson in the emergency department at PBH was reimbursable. In 2017, Dickson filed a complaint to challenge a reimbursement that PBH had received in exchange for Dickson's medical treatment. Dickson's complaint also sought to certify a class of people who were insured by BCBS and who had received care at any hospital operated by HCA's predecessor, Baptist Health, Inc. ("BHI"). After the HCA entities' motion to dismiss was denied, the HCA entities filed an answer to the lawsuit, but the answer did not raise arbitration as a defense. After a year of extensive discovery (including class certification and class-related discovery), the HCA entities moved to compel arbitration on grounds that Dickson's health-insurance policy with BCBS required all claims related to the policy to be arbitrated and that the provider agreement also provided for arbitration, contingent upon the arbitration requirements of the BCBS policy. The trial court denied the motion to compel without providing a reason for the denial. After a request for reconsideration was also denied, the HCA entities appealed. The Alabama Supreme Court concluded the HCA entities waived their right to arbitration, thus affirming the trial court order. View "The Health Care Authority for Baptist Health v. Dickson" on Justia Law
IDS Property Casualty Insurance Co. v. Government Employees Insurance Co.
In this insurance dispute, the First Circuit affirmed the district court's grant of summary judgment to Ameriprise Auto & Home Insurance, holding that the arguments on appeal brought by Government Employees Insurance Company (GEICO) were unavailing.An accident that occurred in Florida damaged a Toyota Highlander insured by Ameriprise and a Lamborghini insured by GEICO and injured the driver of the Highlander. Ameriprise rescinded coverage, alleging that its insureds breached their obligations under the policy. Ameriprise brought this suit seeking declaratory relief in federal district court to approve the company's rescission and to confirm that Ameriprise had satisfied its compulsory coverage requirements under Massachusetts law. The district court granted summary judgment in favor of Ameriprise. The First Circuit affirmed, holding (1) the district court did not err in finding that Ameriprise could rescind the insureds' coverage as a matter of law because the insureds' misrepresentation of certain information breached the insureds' duty to inform Ameriprise about about dates to the Highlander's principal place of garaging and customary drivers; and (2) Ameriprise was not estopped from rescinding the insureds' coverage, and GEICO's waiver arguments failed as a matter of law. View "IDS Property Casualty Insurance Co. v. Government Employees Insurance Co." on Justia Law
Associated Risk Management, Inc. v. Ibanez
The Supreme Court reaffirmed in this case that undocumented aliens who are injured while working for a Nevada employer may be eligible for monetary disability benefits, holding that these monetary benefits, paid by the insurer, do not conflict with federal law or undermine the Legislature's intent.Respondent, an undocumented Nevadan, was severely injured while working for High Point Construction and applied for permanent total disability (PTD) status. Associated Risk Management (ARM), High Point's insurance administrator, denied the request. An appeals officer reversed and granted Respondent PTD status pursuant to the "odd-lot doctrine." ARM petitioned for judicial review, arguing that the appeals officer committed legal error by granting PTD to an undocumented alien. The Supreme Court affirmed, holding (1) undocumented aliens are not precluded from receiving disability benefits under Nevada's workers' compensation laws; (2) although federal law prohibits employers from knowingly employing an undocumented alien, it does not prohibit insurers from compensating undocumented aliens for injuries they sustain while working; and (3) the appeals officer's decision was based on substantial evidence. View "Associated Risk Management, Inc. v. Ibanez" on Justia Law
Alpert v. NationStar Mortgage LLC
The Ninth Circuit filed an order deferring submission and certifying the following questions to the Washington State Supreme Court: 1. Should the filed rate doctrine apply to claims by a Washington homeowner against a loan servicer arising from the placement of lender placed insurance on the Washington homeowner's property where the servicer purchased the insurance from a separate insurance company who filed the insurance product with the Washington State Office of the Insurance Commissioner? 2. In the event the filed rate doctrine does apply to this type of transaction, do the damages requested by plaintiff fall outside the scope of the filed rate doctrine, or rather do they "directly attack agency-approved rates," such that they are barred under McCarthy Finance, Inc. v. Premera, 347 P.3d 872, 875 (Wash. 2015)? View "Alpert v. NationStar Mortgage LLC" on Justia Law
Pine Bluff School District v. Ace American Insurance Co.
The school district filed suit against ACE, seeking a declaratory judgment stating that the school district's legal liability insurance policy provided coverage for a teacher's retaliatory discharge lawsuit filed against the school district and the principal of Pine Bluff High School. The school district argued that coverage existed for the underlying lawsuit or, alternatively, ACE waived all defenses to coverage and was estopped from claiming no coverage.The Eighth Circuit affirmed the district court's grant of summary judgment in favor of ACE, holding that the single claim provision unambiguously applies and that neither the 2015 Policy nor the 2016 Policy provide coverage for the school district's claim based on the teacher's September 22, 2016 lawsuit. The court applied Arkansas law and held that the doctrines of waiver and estoppel are inapplicable here. View "Pine Bluff School District v. Ace American Insurance Co." on Justia Law
Merritt v. Catholic Health Initiatives, Inc.
The Supreme Court affirmed the judgment of the court of appeals affirming the trial court's grant of summary judgment for the defendants in this insurance dispute, holding that the Legislature has clearly and unequivocally excluded captive insurers from the requirements of the Kentucky Unfair Claims Settlement Practices Act (USCPA), Ky. Rev. Stat. 304.12-230.Plaintiff brought this action against various healthcare defendants. The medical negligence claims were eventually settled. Thereafter, the circuit court denied Plaintiff's motion for declaratory relief as to his bad faith insurance claim against First Initiatives Insurance, Ltd., a foreign captive insurance entity that provides self-insurance for Catholic Health Initiatives, Inc. The court granted summary judgment for Catholic Health and First Initiatives. The court of appeals affirmed. The Supreme Court affirmed, holding that First Initiatives, as a captive insurer, is not subject to the USCPA. View "Merritt v. Catholic Health Initiatives, Inc." on Justia Law
Farmers Insurance Exchange v. Wessel
The Supreme Court reversed the holding of the district court that Farmers Insurance Exchange had no duty to defend the Insureds in this case but reversed the district court's holding that the duty to indemnify was not justiciable, holding that when there is no duty to defend there cannot be a duty to indemnify.Defendants in two underlying lawsuits (together, the Insureds) tendered the claims to Farmers, with whom they had a homeowners insurance policy. Farmers concluded that coverage was not available because the claims asserted intentional conduct by the Insureds and filed the instant declaratory judgment action to confirm that it did not have a duty to defend or indemnify. The district court granted summary judgment to Farmers, concluding that there was no coverage under the policy and that the issue of indemnification was not justiciable. The Supreme Court affirmed in part and reversed in part, holding that the district court (1) correctly concluded there was no coverage under the policy; (2) did not abuse its discretion in denying the Insureds more time for discovery; but (3) erred in concluding that the issue of whether Farmers had a duty to indemnify was not justiciable. View "Farmers Insurance Exchange v. Wessel" on Justia Law
Shepard v. Farmers Insurance Exchange
The Supreme Court affirmed the judgment of the district court granting motions to dismiss filed by Farmers Insurance Exchange and State Farm Fire and Casualty Company, holding that the district court did not err in granting the motions to dismiss.Plaintiffs filed a complaint against State Farm and Farmers alleging, among other claims, common law bad faith and violation of the Unfair Trade Practices Act. The insurers filed motions to dismiss. The district court granted the motions to dismiss. The Supreme Court affirmed, holding that the district court did not err in dismissing Plaintiffs' bad faith claims on the basis that the liability of State Farm and Farmers was not reasonably clear. View "Shepard v. Farmers Insurance Exchange" on Justia Law
Federated Mutual Insurance Co. v. Coyle Mechanical Supply Inc.
Prairie sued Coyle in Illinois state court concerning the replacement of valves purchased by Prairie. Coyle's insurer, Federated, sought a declaration that it had no duty to defend or indemnify Coyle in that suit. After Coyle answered Federated’s complaint, Federated moved for judgment on the pleadings. Coyle opposed the motion and later moved for leave to file supplemental briefs to show that the state-court action potentially fell within Federated’s coverage obligations. The district court denied Coyle’s motions to file supplemental briefs and granted Federated judgment on the pleadings. The court ruled that Prairie’s complaint did not allege “property damage” or an “occurrence” because Prairie only sought damages for the repair and replacement of defective products—purely economic losses. Prairie’s counsel had clarified at a discovery hearing that “Prairie was not making a claim for loss of use but rather for the costs of replacing the allegedly defective valves and the associate piping” and the defectiveness of the valves was foreseeable.The Seventh Circuit reversed. In granting Federated’s motion, the court relied on some of the new facts that Coyle had unsuccessfully moved to introduce through supplemental briefs while ignoring other facts. The court’s handling of the case ran afoul of local rules and the Federal Rules of Civil Procedure and deprived Coyle of its right to present material factual evidence bearing on the central issue in the case. View "Federated Mutual Insurance Co. v. Coyle Mechanical Supply Inc." on Justia Law