Justia Insurance Law Opinion Summaries

Title insurance purchasers, on behalf of themselves and similarly situated consumers, claimed that insurers collectively fixed title insurance rates in violation of the Sherman Act and the New Jersey Antitrust Act. In New Jersey, the Department of Banking and Insurance approves and regulates title insurance rates, N.J. Stat. Ann. 17:1C-19(a)(1). Insurers may collectively file rates for approval through a licensed rating organization, thereby authorizing cooperative action. The district court dismissed, holding that the complaint is barred by the filed-rate doctrine (which precludes antitrust suits based on rates currently filed with federal or state agencies), lack of standing, and federal and state antitrust liability exemptions. The Third Circuit affirmed.

This action arose from practices employed in connection with the handling of claims made under retrocessional reinsurance treaties providing what was known as "non-life" coverage. At issue was the sufficiency and extra-territorial reach of plaintiff's claim under New York State's antitrust statute (Donnelly Act), General Business Law 340 et seq. Plaintiff, a New York branch of a German reinsurance corporation, sued defendants, English based entities engaged in the business of providing retrocessionary reinsurance. The Appellate Division found that the complaint adequately pled a worldwide market. And, while acknowledging that the crucial allegations contained in paragraph 36 of the amended pleading did not separately allege market power, the allegations read together and liberally construed were adequate to that purpose. The Appellate Division granted plaintiff leave to appeal, certifying to the court the question of whether its order reversing the order of Supreme Court was properly made. The court answered in the negative and reversed. Even if the pleading deficiency at issue could be cured and the court perceived no reason to suppose that the formidable hurdle of alleging market power could be surmounted by plaintiff there would remain as an immovable obstacle to the action's maintenance, the circumstance that the Donnelly Act could not be understood to extend to the foreign conspiracy plaintiff purported to described.

The company, an egg producer, was charged in class action suits with conspiring to fix the price of eggs, in violation of section 1 of the Sherman Act. and requested that its liability insurers defend. The company argued that the complaints sought damages for what its policies call "personal and advertising injury," defined as injury. arising out of a list of torts that includes use of another's advertising idea in your advertisement. The insurer refused and the district court granted summary judgment in favor of the insurer. The Seventh Circuit affirmed, noting that the antitrust complaints make no mention of the company's theory that consumers might believe that advertised "free-roaming" chicken management policies are an attempt to justify prices.

Plaintiff, sued by a competitor and by consumers for unfair trade practices, false and misleading advertising, and deceptive labeling, among other claims, sought indemnity and defense costs from its insurer. The insurer claimed that the suit fell within an exclusion for "antitrust violations, price fixing, price discriminations, unfair competition, deceptive trade practices and/or monopolies." The district court ruled in favor of the insurer. The First Circuit affirmed, finding that the policy headings were not determinative and that the paragraph at issue clearly excluded coverage.

Defendant in this case issued health care insurance policies to provide coverage for medical services and entered into contracts with practitioners of the healing arts to provide those services. Plaintiffs, three individual podiatrists and the Connecticut Podiatric Medical Association, brought an action against Defendant, alleging that Defendant's practice of reimbursing individual podiatrists at a lower rate than medical doctors for the same service constituted unfair discrimination in violation of the Connecticut Unfair Insurance Practices Act (CUIPA) and the Connecticut Unfair Trade Practices Act (CUTPA). The trial court granted summary judgment in favor of Defendant. The Supreme Court affirmed, holding that CUIPA, by prohibiting unfair discrimination, bars the denial of reimbursement on the basis of the particular license held by a practitioner of the healing arts, but does not preclude setting different reimbursement rates on the basis of the particular license held by a practitioner of the healing arts.

Trailer Bridge appealed the district court's grant of summary judgment in favor of Illinois National on Trailer Bridge's complaint, alleging that Illinois National failed to defend Trailer Bridge in an underlying antitrust action and thereby breached its commercial general liability insurance policy issued to Trailer Bridge for the year July 2004 to July 2005. The central issue on appeal was whether the CEO's statement triggered the duty to defend under the "personal and advertising injury" provision in the policy. After review and oral argument, the court held that the district court did not err in granting summary judgment for Illinois National for the reasons set forth in the district court's order, which the court adopted as its own. In particular, the court agreed with the district court's rejection of Trailer Bridge's argument that the CEO's statement deployed the advertising idea of "another." The court rejected Trailer Bridge's contention that the use of a co-defendant's idea could qualify as an "offense" under the policy. The underlying plaintiffs sought only antitrust damages; they did not seek to impose any legal obligations upon the insured to pay them damages "because of . . . advertising injury." No facts were alleged in the underlying complaint on the basis of which the underlying plaintiffs might have recovered damages "because of . . advertising injury"; and the underlying plaintiffs could not have recovered such damages because the allegedly misappropriated "advertising idea" was not that of the underlying plaintiffs, but rather was alleged to have been the advertising idea of other parties altogether.

The City of New York sued defendants under federal and New York State antitrust laws, seeking to prevent the companies from merging. The city appealed from a judgment of the district court granting summary judgment to defendants and dismissing the city's complaint without leave to amend. The court agreed with the district court that the alleged relevant market definition, as the "low-cost municipal health benefits market[,]" was legally deficient and concluded that the district court's denial of leave to amend was not an abuse of discretion. Accordingly, the court affirmed the judgement of the district court.

The insured was treated as an outpatient for "mental or nervous disorder" in 2005-2007, allegedly incurring expenses of more than $125,000. In 2006 the company informed her that it had already paid $8,506 and would pay only $1,494 more toward the lifetime cap of $10,000. The district court held that the contract was not ambiguous and that the limit was not prohibited by New Hampshire law. The First Circuit affirmed. The policy limit for mental health benefits, stated as "the amount shown on page 3" is not ambiguous simply because that page refers to both the "Mental and Nervous Disorder Limit" of $10,000, and the "Maximum Benefit Limit Per Covered Person" of $1 million. A state law prohibiting unfair trade practices, including discrimination in insurance does not provide a private right of action until after the claimant obtains a favorable ruling from the insurance commissioner.