by
Jackson, injured in an accident, taken to University Hospital, where she stated that she had health insurance coverage through United. Jackson received treatment from PRI, which uses MDB for billing services. PRI did not submit charges to United but sent Jackson a letter seeking payment of $1,066 and requesting that Jackson’s attorney sign a letter of protection against any settlement to prevent Jackson’s account from being sent to collections. Jackson did not pay. Her account was submitted to CCC, which sent Jackson a collection letter. Jackson’s attorney negotiated a $852 payment to CCC as final settlement of the charges. PRI or MDB later contacted Jackson, stating that she still owed $3.49. Jackson paid that amount. She brought a class action against CCC, PRI, and MDB for violation of Ohio Rev. Code 1751.60(A), which prohibits directly billing patients who have health insurance when the healthcare provider has a contract with the patient’s insurer to accept that insurance. The complaint also alleged breach of contract, breach of third-party beneficiary contract, violation of the Ohio Consumer Sales Practices Act, violation of the Fair Debt Collection Practices Act, fraud, conversion, unjust enrichment, and punitive damages. The Sixth Circuit reversed dismissal of the claims under section 1751.60 against PRI and MDB, but affirmed as to CCC, which is not subject to the section. View "Jackson v. Professional Radiology, Inc." on Justia Law

by
The Supreme Court affirmed the district court’s summary judgment for the County of Lancaster in this complaint filed by the City of Lincoln seeking reimbursement of expenses paid on its employee’s behalf after a deputy sheriff with the County made contact with the employee, injuring the employee’s shoulder. The district court concluded (1) the County’s procurement of liability insurance did not constitute a waiver of its sovereign immunity for claims less than the policy’s retained insurance limit; and (2) because the amount in controversy was $63,418, the County did not waive its sovereign immunity by obtaining insurance for claims exceeding $250,000. The Supreme Court affirmed for reasons different from those stated by the district court, holding (1) the County’s procurement of insurance did not constitute a waiver of immunity as to a claim arising out of a battery; and (2) therefore, the County’s policy did not cover the underlying event, and there was no waiver of immunity regardless of the retained insurance limit. View "City of Lincoln v. County of Lancaster" on Justia Law

by
After a commercial warehouse sustained substantial fire damage, the owner of the warehouse (Emerald), filed suit against the lessee (Sunrise), the insurance agent, and the insurer. The Fifth Circuit affirmed the district court's grant of summary judgment to the insurance defendants, holding that Emerald's claims failed under Florida and Mississippi law. In this case, no Mississippi case recognizes a duty owed by an agent to a party in Emerald's position when the agent procures insurance for its insured. Emerald's claims under Florida law failed because it had never claimed status as a third-party beneficiary to the contract to procure insurance. View "Emerald Coast Finest Produce Co. v. Alterra American Insurance Co." on Justia Law

by
At issue in this case was the permissibility of preaward interest on an insurance appraisal award under the preaward interest statute, Minn. Stat. 549.09, subd. 1(b). Cincinnati Insurance Company issued James Poehler a homeowner’s insurance policy that provided replacement cost coverage for Poehler’s home and personal property. After a fire damaged Poehler’s property, Poehler demanded an appraisal under the appraisal clause of the policy. The appraisers issued an award, determining that Poehler’s total loss was more than what Cincinnati had paid by the time of the appraisal hearing. The district court confirmed the appraisal award and granted Poehler preaward interest. The court of appeals reversed, concluding that the preaward interest statute does not apply to appraisal awards pursuant to an insurance policy in the absence of “an underlying breach of contract or actionable wrongdoing.” The Supreme Court reversed, holding (1) section 549.09 does not require a finding of wrongdoing for the recovery of a reward interest on appraisal awards; (2) the loss payment provision in Cincinnati’s insurance policy did not preclude Poehler from recovering preaward interest on the appraisal award; and (3) the loss payment provision in Minn. Stat. 65A.01, the Minnesota standard fire insurance policy, did not apply in this case. View "Poehler v. Cincinnati Insurance Co." on Justia Law

by
Olin, a large chemical manufacturing company, filed suit against its insurers, including OneBeacon, seeking indemnification for environmental contamination at its manufacturing sites. On appeal, OneBeacon challenged two judgments entered pursuant to Federal Rule of Civil Procedure 54(b) in favor of Olin, awarding it over $80 million in indemnification costs. The Second Circuit held that, because it was not disputed that the damages at each site far exceed OneBeacon's attachment point of $300,000 when apportioned to a single policy year, OneBeacon's policies have been triggered. The court affirmed the denial of summary judgment with respect to the McIntosh site; affirmed the district court's ruling as to the special verdict form; vacated and remanded for entry of a new damages judgment on the basis of the methodology dictated by In re Viking Pump, Inc., 52 N.E.3d 1144 (N.Y. 2016); remanded for further proceedings on the prior insurance provision issue; and remanded as to the issue of prejudgment interest. In regard to Olin's cross-appeal, the court affirmed and held that summary judgment in its favor on Olin's Chapter 93A claim was proper because Olin's Chapter 93A claim was barred by the applicable statute of limitations. View "Olin Corp. v. OneBeacon American Insurance Co." on Justia Law

by
Streit set fire to the house where he lived with his parents, which was insured by Metropolitan. Under the Streits’ policy, the act of arson triggered a contractual exclusion of coverage. The Streits still submitted a claim, but Metropolitan refused to cover the fire damage.The Streits sued, claiming that the exclusion was inconsistent with the Illinois Standard Fire Policy. The Streits and Metropolitan then stipulated that the Streits were innocent of any wrongdoing related to the fire. The district court granted the Steits partial summary judgment, awarding $235,000. The Seventh Circuit affirmed. The Illinois Standard Fire Policy sets a minimum threshold for what fire-insurance policies must cover, and Metropolitan failed to provide that coverage. Under the Metropolitan policy, an intentional loss caused by any insured party suspends coverage for all insured parties—even those who were innocent of any wrongdoing. By contrast, the Standard Fire Policy suspends coverage if “the hazard is increased by any means within the control or knowledge of the insured.” View "Streit v. Metropolitan Casualty Insurance Co." on Justia Law

by
A newly-constructed multi‐story condominium building suffered water damage, allegedly caused by the painting subcontractor, National, failing to apply an adequate coat of sealant to the exterior. In Illinois state court, the condominium association sued the general contractor, developer, and subcontractors. The defendants tendered the defense to Westfield, National’s insurer, Westfield filed a federal action seeking a declaration that it owed no duty to defend in the underlying action. The district court determined that the complaint triggered Westfield’s duty to defend. The Seventh Circuit affirmed the grant of summary judgment, rejecting an argument that failure to apply an adequate amount of paint cannot be considered an “accident” that would constitute a covered “occurrence” under the policy. Westfield also argued that because the damage is to the building itself, which was a new construction and not an existing structure, the association has not demonstrated that there was property damage that is subject to its policy. The policy defines “occurrence” to include the “continuous or repeated exposure to substantially the same harmful conditions,” so the allegation that National acted negligently was sufficient under Illinois law to constitute an “occurrence.” National’s actions allegedly damaged parts of the building that were outside of the scope of its work, so the complaint alleges potentially covered property damage sufficient to invoke the duty to defend. View "Westfield Insurance Co. v. National Decorating Service, Inc." on Justia Law

by
The ambiguous section of the insurance policy at issue in this case must be construed in favor of coverage for the costs and attorneys’ fees awarded against the insured pursuant to the offer of judgment statute, Fla. Stat. 768.79. Alysia Macedo sued Zackery Lombardo for damages resulting from injuries she sustained in an automobile collision.The jury returned a verdict in favor of Macedo in the amount of $243,954.55. Macedo joined to the judgment GEICO, which provided bodily injury liability coverage to Lombardo. The trial court awarded taxable fees and costs against GEICO jointly and severally with its insured pursuant to section 768.79. The First District Court of Appeal affirmed. The Supreme Court approved the First District’s decision, holding that the key provision in the insurance policy was ambiguous and must be construed in favor of coverage. View "Government Employees Insurance Co. v. Macedo" on Justia Law

by
This appeal arose out of an agent contract dispute between Bret Kunz (“Bret”) and Nield, Inc. (“N.I.”) authorizing Bret to sell insurance on behalf of N.I. N.I. is owned by two brothers, Bryan Nield (“Bryan”) and Benjamin Nield. A dispute arose concerning the method and type of compensation available to Bret under the Contract. Bret filed a complaint seeking, inter alia, a declaratory judgment interpreting the Contract. The district court held the 2009 Contract did not provide for profit sharing as Bret claimed. Bret and his wife, Marti, (collectively, the “Kunzes”) appealed. Finding no reversible errors with respect to how the district court interpreted the Contract, the Idaho Supreme Court affirmed. View "Kunz v. Nield, Inc." on Justia Law

by
Nevils was a federal employee insured through a plan governed by the Federal Employee Health Benefits Act (FEHBA) when she was injured in an automobile accident. Coventry paid her medical expenses and asserted a subrogation lien against a settlement Nevils received from the party responsible for the accident. Nevils filed a class action, arguing Missouri law does not permit subrogation of personal injury claims. Coventry obtained summary judgment, based on FEHBA’s preemption clause: The terms of any contract under this chapter which relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any State or local law, ... which relates to health insurance, 5 U.S.C. 8902(m)(1). Initially, the Missouri Supreme Court concluded Congress did not manifest a clear intent to preempt state anti-subrogation laws. The Office of Personnel Management subsequently promulgated a rule providing that an insurer’s rights to subrogation and reimbursement under federal employee health benefits contracts “relate to the nature, provision, and extent of coverage or benefits” under FEHBA. On remand, the Missouri Supreme Court held the rule did not alter its analysis. The U.S. Supreme Court then held an insurer’s subrogation rights “relate to . . . payments with respect to benefits” and that FEHBA “manifests the same intent to preempt state law” as other federal preemption statutes despite the different “linguistic formulation” of section 8902(m)(1). In light of that holding, the Missouri Supreme Court affirmed the trial court’s judgment. View "Nevils v. Group Health Plan, Inc." on Justia Law