Justia Insurance Law Opinion Summaries
Appeal of Vasquez
Petitioners Javier Vasquez and his employer, Matosantos International Corporation (MIC), appealed a New Hampshire Compensation Appeals Board (CAB) determination that it could not order respondent, The Hartford Insurance Company, to pay workers’ compensation benefits to Vasquez. The CAB concluded that the Department of Labor (DOL), and therefore the CAB, lacked jurisdiction under the New Hampshire Workers’ Compensation Law to interpret the workers’ compensation insurance policy that MIC had purchased from The Hartford. Because the New Hampshire Supreme Court concluded the CAB did have jurisdiction to consider and resolve the coverage dispute between MIC and The Hartford, it vacated the CAB’s decision and remanded for its consideration, in the first instance, of whether the policy purchased by MIC covered Vasquez when he was injured while working in New Hampshire. View "Appeal of Vasquez" on Justia Law
Geist v. State Farm Mutual Automobile Insurance Co.
Geist, seriously injured in an automobile accident, settled a claim against the driver and his insurer, which did not fully compensate her. Geist sought to recover underinsured motorist (UIM) benefits from State Farm under a policy issued to her parents. When State Farm issued the policy in 2010, it provided liability coverage of $100,000 per person / $300,000 per accident for bodily injuries. Geist’s parents elected UIM benefits of up to $50,000 per person / $100,000 per accident. When they added a third vehicle to the policy, her parents did not execute an acknowledgment for UIM-coverage limits below the bodily injury limits. Geist believed that she could recover up to $200,000 in UIM benefits, the stacked total of the $100,000 UIM coverage for each insured vehicle. State Farm paid her $100,000.The Third Circuit affirmed the dismissal of Geist’s purported class action. Under Pennsylvania’s Motor Vehicle Financial Responsibility Law an insurer must seek an election of UIM-coverage limits that are less than the bodily injury coverage limits only when it issues a new policy; the UIM-coverage limits remain in effect as long as the policy does. Geist’s parents executed a written election for lower limits when State Farm issued the policy, and never sought a new policy. View "Geist v. State Farm Mutual Automobile Insurance Co." on Justia Law
Accident Fund Insurance Co. v. Schultheis Insurance Agency, Inc.
Cope, injured on a Kentucky job site, filed a workers’ compensation claim. The subcontractor who hired him for the project, CMC, is based in Southern Indiana, and had an insurance policy with AFICA. Schultheis Insurance Agency procured the policy for CMC, but failed to inform AFICA that CMC did business in Kentucky. AFICA sought a declaration that its policy does not cover Cope’s claim.The district court granted AFICA summary judgment. The Seventh Circuit affirmed. The plain text of the policy is unambiguous: because CMC failed to notify AFICA until after Cope’s accident that it was working in Kentucky, AFICA is not liable for Cope’s workers’ compensation claim. The policy states : “If you have work on the effective date of this policy in any state [other than Indiana], coverage will not be afforded for that state unless we are notified within thirty days.” View "Accident Fund Insurance Co. v. Schultheis Insurance Agency, Inc." on Justia Law
Walker v. Auto-Owners Insurance Co.
The Supreme Court held that while the broad evidence rule is not applicable in Arizona such that that an insurer and/or fact-finder may consider labor depreciation as a pertinent factor in determining the term "actual cash value" in a homeowner's insurance policy, this Court does not categorically preclude application of the broad evidence rule with respect to other homeowners' insurance policies where appropriate.Plaintiffs purchased a homeowners insurance policy from Defendant that did not define the terms "actual cash value" or "depreciation." When Plaintiffs' home received water damage Defendant accepted coverage for the loss. Plaintiffs then filed a complaint alleging that Defendant underpaid them and other similarly situated insureds by depreciating both materials and labor when calculating property damage claims under their respective homeowners' insurance policies. The federal district court certified two questions to the Supreme Court. The Supreme Court answered (1) under the terms of the policy at issue, an insurer may not depreciate the cost of labor when determining actual cash value, and the broad evidence rule does not apply; and (2) there is no bar to application of the broad evidence rule where the terms of the policy do not dictate otherwise in the context of other homeowners' insurance policies in Arizona. View "Walker v. Auto-Owners Insurance Co." on Justia Law
Nitkewicz v. Lincoln Life & Annuity Co. of N.Y.
The United States District Court for the Southern District Court concluded that Lincoln Life & Annuity Company of New York was not obligated under New York Insurance Law Section 3203(a)(2) to refund a payment that Plaintiff had deposited into a policy account associated with her life insurance policy five months before she died. Because no New York court has analyzed this provision of New York insurance law, and because insurance policy implicates significant New York State interests, the Second Circuit deferred a decision on this appeal in order to certify the following question to the New York Court of Appeals: Whether a planned payment into an interest-bearing policy account, as part of a universal life insurance policy, constitutes a “premium actually paid for View "Nitkewicz v. Lincoln Life & Annuity Co. of N.Y." on Justia Law
Huntington Ingalls Industries, Inc. et al. v. Ace American Insurance Company et al.
Insured Huntington Ingalls Industries, Inc. and insurer Huntington Ingalls Industries Risk Management LLC seek a declaratory judgment stating there is coverage under a property insurance policy for certain losses incurred by Huntington Ingalls Industries due to the COVID-19 pandemic. The trial court concluded that the complaint did not allege facts that would trigger coverage under the policy and granted judgment on the pleadings in favor of reinsurers. After review, the Vermont Supreme Court disagreed, reversed the trial court. and remanded for further proceedings. View "Huntington Ingalls Industries, Inc. et al. v. Ace American Insurance Company et al." on Justia Law
Tarrar Enterprises, Inc. v. Associated Indemnity Corp.
Tarrar operated “a utility consultant business” in Contra Costa County. Associated issued Tarrar a comprehensive commercial liability and property insurance policy to “pay for direct physical loss of or damage to Covered Property,” and in particular to “pay for the actual loss of Business Income you sustain due to the necessary suspension of your operations during the period of restoration." The suspension must be caused by direct physical loss of or damage to property at the described premises. The loss or damage must be caused by or result from a Covered Cause of Loss.Based on the 2020 “shelter-in-place orders,” Tarrar made an unsuccessful claim for “business income loss.” The trial court dismissed Tarrar’s subsequent suit without leave to amend. While several California courts of appeal have resolved this issue against the insureds, one court held for the insured on the basis it had pled the element missing from earlier cases: it “adequately alleged direct physical loss or damage.” While Tarrar’s complaint did not allege the necessary “direct physical loss of or damage to property,” Tarrar should be permitted to amend. A plaintiff need not even request leave to amend an original complaint. Unless the complaint shows on its face that it is incapable of amendment, denial of leave to amend constitutes an abuse of discretion. View "Tarrar Enterprises, Inc. v. Associated Indemnity Corp." on Justia Law
National Rifle Association of America v. Maria T. Vullo
Plaintiff National Rifle Association of America (the "NRA") claims that Defendant, the former Superintendent of the New York State Department of Financial Services ("DFS"), violated its rights to free speech and equal protection when she investigated three insurance companies that had partnered with it to provide coverage for losses resulting from gun use and encouraged banks and insurance companies to consider discontinuing their relationships with gun promotion organizations. The NRA contends that Defendant used her regulatory power to threaten NRA business partners and coerce them into disassociating with the NRA, in violation of its rights. The district court dismissed the equal protection claim on the basis that Defendant was protected by absolute immunity, but it declined to dismiss the free speech claims, concluding that the NRA plausibly alleged its claims and issues of fact existed as to whether she was protected by qualified immunity. The Second Circuit reversed and remanded. The court explained that here, the various cases addressing the issue did not provide clear and particularized guidance but involved very different circumstances and much stronger conduct. The cases do not clearly establish that Defendant’s statements, in this case, were unconstitutionally threatening or coercive. Qualified immunity balances the need to hold public officials accountable when they exercise their power irresponsibly with the need to shield officials from harassment, distraction, and liability when they perform their duties responsibly. Here, the Complaint's factual allegations show that, far from acting irresponsibly, Defendant was doing her job in good faith. View "National Rifle Association of America v. Maria T. Vullo" on Justia Law
Progressive Direct v. Groves
Jimi Redman shot and killed Lynn Harrison with a rifle while both were in their vehicles at a stoplight. Immediately before the shooting, Redman, who was driving a Ford Escape, approached Harrison's GMC in the lane to her right. A witness, who was directly behind Harrison in the left lane, saw Redman make hand gestures and blow kisses toward Harrison. There is no evidence that Harrison attempted to evade Redman or that she even saw his gestures. Instead, as the two vehicles stopped at the red light, Redman pulled out a rifle and fired one shot which traveled through Harrison's passenger side window, killing her. Redman subsequently sped away, while Harrison's vehicle, which was still in drive, crept forward until coming to rest in the median. Redman was arrested a few blocks away. The issue this case presented for the South Carolina Supreme Court's review was whether uninsured or underinsured benefits could be recovered when an individual was shot and killed by another motorist as both cars were stopped at a traffic light. In deciding this question, the Court revisited and attempted to clarify conflicting jurisprudence as to whether such injuries arise out of the "ownership, maintenance, or use" of an automobile. To this, the Court held that gunshot injuries do not arise out of the use of an automobile. Therefore, it reversed the court of appeals and reinstated the judgment of the circuit court. View "Progressive Direct v. Groves" on Justia Law
Adler & Sons v. Axis Surplus Ins Co
During the covid-19 pandemic, state and local authorities in Louisiana ordered nonessential businesses to close for a time. This required Plaintiff to temporarily shut his jewelry stores and event spaces in New Orleans. To recoup income lost during the closure, Plaintiff claimed reimbursement under his insurance policy’s coverage for “direct physical loss of or damage to” his property. Plaintiff’s insurer, Axis, denied the claim. Plaintiff sued Axis along with his insurance agent and broker. The district court dismissed Plaintiff’s claims, concluding that Plaintiff suffered no covered loss or damages and that his agent and broker violated no duty to advise Plaintiff about pandemic-related coverage. The Fifth Circuit affirmed. The court explained that what denied Plaintiff use of his property was the government’s closure orders. Such losses do not involve a “tangible alteration to, injury to, or deprivation of property.” The district court therefore correctly dismissed Plaintiff’s claims against Axis. Further, contrary to Plaintiff’s arguments, what creates a Louisiana insurance agent’s duty to procure particular coverage is not a “close relationship” with the insured but an insured’s “specific” request for “the type of insurance coverage . . . needed.” Here, Plaintiff did not allege he specifically requested pandemic-related coverage from either the wholesale broker or insurance agent, therefore Plaintiff’s claims against those Defendants were properly dismissed. View "Adler & Sons v. Axis Surplus Ins Co" on Justia Law