Justia Insurance Law Opinion Summaries

In 2015, Zongwei Shen, owner of a massage spa, purchased a commercial insurance policy from Continental Casualty Company, which included an exclusion for abuse or molestation. In 2019, Toiah Gordon, Morganne Mersadie Root, and Karina Carrero sued Shen and his wife, alleging Shen sexually assaulted them during massage sessions. After Continental declined to provide a defense, Shen and Xin stipulated to liability, resulting in a $6.8 million judgment against them. Shen and Xin assigned their rights against Continental to the plaintiffs in exchange for a covenant not to execute the judgment. The plaintiffs then sued Continental for breach of contract and related claims.The Superior Court of Los Angeles County granted Continental's motion for summary judgment, finding that the abuse or molestation exclusion in the insurance policy applied. The court concluded that Shen had care and control of Gordon during the massage, thus the exclusion applied to her injury. The court also found that the claims against Xin for negligent training fell within the exclusion, as negligent training is a form of negligent hiring, retention, or supervision.The California Court of Appeal, Second Appellate District, affirmed the trial court's decision. The appellate court held that the abuse or molestation exclusion applied to Shen's actions because Gordon was under Shen's care and control during the massage. The court also held that the exclusion applied to the claims against Xin, as negligent training is encompassed within negligent employment and supervision. Consequently, Continental had no duty to defend Shen and Xin, and the summary judgment in favor of Continental was affirmed. View "Gordon v. Continental Casualty Co." on Justia Law

Erin Hughes, the plaintiff, obtained two homeowner’s insurance policies for her property in Malibu. One policy, through the California FAIR Plan Association (FAIR Plan), covered fire loss, while the other, issued by Farmers Insurance Exchange (Farmers), did not. After a fire caused significant damage to her property, Hughes filed a lawsuit against Farmers, alleging it was vicariously liable for the negligence of its agent, Maritza Hartnett, who assisted her in obtaining the FAIR Plan policy, resulting in underinsurance for fire loss.The Superior Court of Los Angeles County granted Farmers’ motion for summary judgment, concluding that Hartnett was not acting within the scope of her agency with Farmers when she assisted Hughes in obtaining the FAIR Plan policy. The court also denied Hughes’s motion for leave to amend her complaint.The Court of Appeal of the State of California, Second Appellate District, reviewed the case. The court affirmed the lower court’s decision, holding that Hartnett was not acting as Farmers’ actual or ostensible agent when she helped Hughes obtain the FAIR Plan policy. The court found that Hartnett was acting as an independent broker for the FAIR Plan policy and not on behalf of Farmers. Additionally, the court determined that Hughes failed to present evidence that could establish a triable issue regarding Farmers’ vicarious liability for Hartnett’s actions.The court also upheld the trial court’s denial of Hughes’s motion for leave to amend her complaint, noting that Hughes offered no explanation for the delay in filing the motion and that allowing the amendment would have prejudiced Farmers and Hartnett. The judgment in favor of Farmers was affirmed, and Farmers was entitled to recover its costs on appeal. View "Hughes v. Farmers Insurance Exchange" on Justia Law

Following heavy snowfall in Pine Bluff, Arkansas, the roofs of several chicken houses at ten poultry farms collapsed. Norfolk & Dedham Mutual Fire Insurance Company, which insured the farms, sued Rogers Manufacturing Corporation, the manufacturer of the roof trusses used in the chicken houses, claiming strict product liability, negligence, and breach of warranties. Rogers moved to dismiss the complaint under Federal Rule of Civil Procedure 12(b)(6), arguing that Norfolk’s claims were barred by the Arkansas statute of repose.The United States District Court for the Eastern District of Arkansas agreed with Rogers and dismissed the complaint. Norfolk appealed the dismissal, arguing that the statute of repose did not apply to Rogers because the roof trusses were standardized goods, not custom-designed for the farms.The United States Court of Appeals for the Eighth Circuit reviewed the district court’s dismissal de novo, accepting the allegations in the complaint as true and drawing all reasonable inferences in Norfolk’s favor. The court found that Norfolk’s complaint plausibly supported an inference that the roof trusses were standardized goods, which would not be covered by the Arkansas statute of repose. The court emphasized that at this early stage, the complaint should not be dismissed if it allows for a reasonable inference of liability.The Eighth Circuit reversed the district court’s dismissal of the complaint and remanded the case for further proceedings, noting that the facts and legal arguments could be further developed as the case progresses. View "Norfolk & Dedham Mutual Fire Insurance Company v. Rogers Manufacturing Corporation" on Justia Law

Patricia Nicholson filed a garnishment action after her husband was killed in an accident involving Ava Mercer, who was insured by Key Insurance Company. Key provided Mercer with an attorney but did not actively defend her. Nicholson attempted to settle for the policy limit, but Key delayed. Nicholson then filed a wrongful death suit, and Key offered to settle for the policy limit, which Nicholson rejected. Instead, Nicholson and Mercer agreed that Mercer would assign her rights to sue Key for bad faith to Nicholson, and Nicholson would not execute any judgment against Mercer. Mercer waived her right to a jury trial and did not present a defense. Nicholson won a $3 million verdict.The Leavenworth District Court ruled against Key on the merits, finding that Key acted in bad faith and ordered garnishment for the $3 million judgment. Key did not argue that garnishment was statutorily unavailable due to the assignment of rights at the district court level. On appeal, Key raised the issue of subject-matter jurisdiction for the first time, arguing that garnishment was impossible following an assignment of rights, thus the district court lacked jurisdiction.The Kansas Supreme Court reviewed the case and affirmed the lower courts' decisions. The court clarified that subject-matter jurisdiction is the constitutional power of courts to decide disputes and does not disappear due to a flawed claim. The court held that the district court had jurisdiction to hear Nicholson's garnishment action on the merits. The court emphasized that Key's statutory arguments should have been presented as a motion to dismiss at the district court level and could not be raised for the first time on appeal under the guise of a jurisdictional argument. The judgment of the Court of Appeals and the district court was affirmed. View "Nicholson v. Mercer" on Justia Law

Plaintiff's multi-unit apartment building in Staten Island was damaged by fire on August 4, 2014. At the time, she had an insurance policy with Tower Insurance Company of New York, which required any legal action to be brought within two years of the damage and stipulated that replacement costs would only be paid if repairs were made as soon as reasonably possible. Restoration was completed in July 2020, and her claim was denied on September 1, 2020. Plaintiff filed a lawsuit on August 4, 2020, seeking full replacement value and coverage for lost business income, alleging that Tower/AmTrust's bad faith conduct delayed the restoration process.The Supreme Court granted the Tower/AmTrust defendants' motion to dismiss the complaint, citing the policy's two-year suit limitation provision. The court found that the plaintiff failed to demonstrate that she attempted to repair the property within the two-year period or took any action to protect her rights as the limitation period expired. The Appellate Division affirmed the dismissal, holding that the plaintiff did not allege that she reasonably attempted to repair the property within the two-year period but was unable to do so. Consequently, the claims against the broker defendants were also dismissed as the plaintiff's failure to recover was due to her own actions.The New York Court of Appeals affirmed the Appellate Division's order. The court held that the plaintiff did not raise an issue as to whether the suit limitation provision was unreasonable under the circumstances. The plaintiff's allegations were deemed conclusory and lacked specific details about the extent of the damage or efforts to complete repairs within the two-year period. The court concluded that the Tower/AmTrust defendants' motion to dismiss was properly granted, and the claims against the broker defendants were also correctly dismissed. View "Farage v Associated Insurance Management Corp." on Justia Law

National Casualty Company and Nationwide Mutual Insurance Company entered into reinsurance agreements with Continental Insurance Company, which included arbitration clauses. A billing dispute arose, leading Continental to demand arbitration. National Casualty and Nationwide filed a lawsuit in federal court, claiming that prior arbitral awards resolved the billing dispute and precluded new arbitration. They appealed the district court's order compelling arbitration under the Federal Arbitration Act.The United States District Court for the Northern District of Illinois granted Continental's motion to compel arbitration and dismissed the action. National Casualty and Nationwide argued that the prior arbitral awards precluded the new arbitration proceeding, but the district court ruled that the arbitration clauses required the dispute to be arbitrated.The United States Court of Appeals for the Seventh Circuit reviewed the case. The court affirmed the district court's decision, holding that the preclusive effect of prior arbitral awards is an issue for the arbitrator to decide, not the federal court. The court relied on its precedent, which aligns with Supreme Court rulings, stating that procedural questions arising from an arbitrable dispute are for the arbitrator to resolve. The court also rejected Continental's motion to vacate the district court's dismissal order and stay the action pending arbitration, as it was not properly before the court and lacked merit. The court concluded that the district court correctly compelled arbitration and dismissed the case. View "National Casualty Co. v. Continental Insurance Co." on Justia Law

A driver, Safet Miftari, was injured in an accident caused by an uninsured motorist while driving his taxi. He filed a claim for coverage under a policy he had for a different vehicle, which was denied by his insurer, Umialik Insurance Co., because the policy excluded uninsured and underinsured motorist (UIM) coverage for vehicles not insured under the same policy. Miftari then sued the uninsured motorist, who defaulted, and a jury awarded Miftari $1 million in noneconomic damages. Subsequently, Miftari sued Umialik to enforce the judgment.The Superior Court of Alaska, Fourth Judicial District, granted Miftari’s motion for partial summary judgment, holding that Umialik was bound by the prior judgment under the doctrine of res judicata. The court also denied Umialik’s motion to prevent Miftari from pursuing economic damages. In a separate order, the court held that the insurance policy’s exclusion of UIM coverage for injuries sustained in any of the policyholder’s vehicles insured under a separate policy was not authorized by Alaska law.The Supreme Court of the State of Alaska reviewed the case. It held that Alaska law does not authorize excluding UIM coverage for a vehicle not insured under the same insurance policy under which UIM coverage is sought. The court also concluded that res judicata prohibits the parties from relitigating noneconomic damages and litigating economic damages against the insurer. The court affirmed the superior court’s orders on summary judgment, binding Umialik to the jury’s damages verdict and precluding Miftari from seeking economic damages. View "Umialik Insurance Co. v. Miftari" on Justia Law

The case involves a billing dispute between a group of emergency room physicians (plaintiff) and an insurance company (defendant). The dispute centers on the interpretation of Connecticut’s surprise billing law, which aims to protect insured individuals from high medical bills when they receive emergency care from out-of-network providers. The plaintiff contends that the law requires the defendant to fully reimburse them for emergency services and then collect any applicable cost-sharing amounts (deductibles, copayments) from the insured. The defendant argues that it can deduct the insured’s cost-sharing amounts from the reimbursement it pays to the plaintiff.The United States District Court for the District of Connecticut dismissed the plaintiff’s stand-alone claims under the surprise billing law, concluding that the law does not create a private right of action. The court then certified three questions to the Connecticut Supreme Court: (1) whether a CUTPA claim can be maintained for conduct that violates the surprise billing law but not CUIPA, (2) whether the surprise billing law requires insurers to fully reimburse providers and then collect cost-sharing amounts from insureds, and (3) whether the defendant’s practice of deducting cost-sharing amounts from reimbursements violates the surprise billing law.The Connecticut Supreme Court held that Connecticut law does not recognize a cause of action under CUTPA for conduct that violates the surprise billing law but is not identified as an unfair insurance practice under CUIPA. The court also held that the surprise billing law does not require insurers to fully reimburse providers and then collect cost-sharing amounts from insureds. Instead, insurers can deduct the insured’s cost-sharing amounts from the reimbursement paid to the provider. Finally, the court concluded that the defendant’s practice of deducting cost-sharing amounts from reimbursements does not violate the surprise billing law. View "NEMS, PLLC v. Harvard Pilgrim Health Care of Connecticut, Inc." on Justia Law

Jon Willis, an employee of Shamrock Management, L.L.C., was injured while working on an offshore oil platform operated by Fieldwood Energy, L.L.C. The injury occurred when a tag line slipped off a grocery box being delivered by a vessel operated by Barry Graham Oil Service, L.L.C. Willis sued Barry Graham for negligence. Barry Graham then sought indemnification, defense, and insurance coverage from Shamrock and its insurer, Aspen, based on a series of contracts linking the parties.The United States District Court for the Western District of Louisiana denied Barry Graham's motion for summary judgment and granted Shamrock and Aspen's motion, ruling that Barry Graham was not covered under the defense, indemnification, and insurance provisions of the Shamrock-Fieldwood Master Services Contract (MSC). Willis's case was settled, and Barry Graham appealed the district court's decision on its third-party complaint.The United States Court of Appeals for the Fifth Circuit reviewed the case de novo. The court concluded that the MSC required Shamrock to defend, indemnify, and insure Barry Graham because Barry Graham was part of a "Third Party Contractor Group" under the MSC. The court also determined that the cross-indemnification provisions in the contracts were satisfied, and that the Louisiana Oilfield Anti-Indemnity Act (LOAIA) did not void Shamrock's obligations because Fieldwood had paid the insurance premium to cover Shamrock's indemnities, thus meeting the Marcel exception.The Fifth Circuit reversed the district court's judgment and remanded the case for further proceedings consistent with its opinion. View "Barry Graham Oil v. Shamrock Mgmt" on Justia Law

In April 2013, Michael Riste applied for a bail bond for his son, Michael Peterson, and signed an Indemnity Agreement and a Premium Agreement with Bad Boys Bail Bonds (Bail Agent). The agreements required Riste to pay a $10,000 premium in installments. Peterson signed identical documents after his release. The Bail Agent executed a $100,000 bail bond on behalf of The North River Insurance Company (Surety), ensuring Peterson's appearance at future court proceedings. Peterson failed to appear, leading to the forfeiture of the bail bond and a summary judgment against the Surety in October 2015.Two panels of the California Court of Appeal previously affirmed the denial of motions by the Surety and Bail Agent to set aside the summary judgment, vacate the forfeiture, and exonerate the bond. In October 2020, a class action cross-claim in Caldwell v. BBBB Bonding Corp. argued that the Bail Agent's premium financing agreements were subject to Civil Code section 1799.91 and were unenforceable without proper notice to cosigners. The trial court and the Court of Appeal agreed, enjoining the Bail Agent from enforcing such agreements without the requisite notice.In September 2022, the Surety and Bail Agent filed a third motion to set aside the summary judgment, citing Caldwell and arguing that the premium was part of the consideration for the bail bond, making the bond void. The trial court denied the motion, and the Surety and Bail Agent appealed.The California Court of Appeal, Second Appellate District, Division Three, affirmed the trial court's order. The court held that the bail bond was not void because the consideration for the bail bond was Peterson's release from custody, not the premium financing agreement. The court concluded that the trial court had jurisdiction over the bond and properly denied the motion to set aside the summary judgment, vacate the forfeiture, and exonerate the bond. View "People v. North River Insurance Co." on Justia Law