Justia Insurance Law Opinion Summaries

A certified nursing assistant employed by a home health provider sustained injuries to her right shoulder and lower back during the course of her employment. She received medical treatment from several providers and was paid mileage reimbursements for traveling between patient homes. Following her injuries, the employer’s insurance carrier denied further payment of temporary disability and medical benefits, including an outstanding medical bill, and ultimately terminated her employment. The worker secured new employment at a higher wage and subsequently filed for workers’ compensation benefits, claiming entitlement to disability benefits and payment of the disputed medical bill. The employer denied liability.The Administrative Law Judge found that the worker had a compensable lower back injury with a 12% impairment rating, entitling her to temporary total and permanent partial disability benefits, but excluded mileage reimbursements from her average weekly wage and denied payment for the outstanding medical bill based on the provider’s failure to submit it within the statutory 45-day deadline. The Workers’ Compensation Board affirmed the ALJ’s findings. The Kentucky Court of Appeals affirmed the exclusion of mileage reimbursements and dismissed the issue of the unpaid medical bill as moot after the employer voluntarily paid it during the appeal. The Court of Appeals also rejected a motion for leave to file an amicus brief, deeming it unauthorized.The Supreme Court of Kentucky affirmed the exclusion of mileage reimbursements from the wage calculation, holding such payments were reimbursements for actual expenses and not “wages.” The Court reversed the dismissal of the medical bill claim as moot, applying the “voluntary cessation” exception, and held that denial of compensability constitutes reasonable grounds to excuse noncompliance with the 45-day rule for submitting medical bills. The Court also found the Court of Appeals erred in rejecting the amicus motion. The decision was affirmed in part and reversed in part. View "HARRIS V. MERCY HOME HEALTH" on Justia Law

Toy Quest Ltd. purchased an insurance policy from General Star Indemnity Company, which covered personal injury claims arising from certain specified torts, including malicious prosecution. When ASI, Inc. sued Toy Quest in federal district court in Minnesota for abuse of process, General Star agreed to defend Toy Quest under a reservation of rights but then filed a separate lawsuit seeking a declaratory judgment that it had no duty to defend against ASI’s claim. Toy Quest and ASI contended that the policy covered abuse of process, that California rather than Minnesota law should apply, and that the court should abstain from deciding the case until the underlying litigation was resolved.The United States District Court for the District of Minnesota granted General Star’s motion for judgment on the pleadings, holding that the policy did not cover abuse of process claims and that Minnesota law applied. The court also declined to abstain from hearing the declaratory judgment action and denied Toy Quest’s motions to certify the coverage issue to the Minnesota Supreme Court and to disqualify ASI’s counsel. Toy Quest and ASI appealed these rulings.The United States Court of Appeals for the Eighth Circuit affirmed the district court’s judgment. The court held that the district court did not abuse its discretion in declining to abstain, as the cases were not parallel and the federal court had jurisdiction. It further held that the insurance policy’s express coverage for malicious prosecution did not extend to abuse of process claims, as these are distinct torts under Minnesota law, and similar reasoning would apply under California law. The court also held that there was no actual conflict of law and denied the motions to certify and to disqualify counsel. View "General Star Indemnity Company v. ASI, Inc." on Justia Law

This case arises from multi-district litigation involving claims that certain aqueous film-forming foam products caused injuries, and that Illinois Union Insurance Company issued excess liability policies to BASF Corporation, which allegedly designed and sold components of those products. Plaintiffs, who originally filed their cases in Wisconsin state court, assert that Illinois Union is directly liable under Wisconsin law for BASF’s conduct. After removal to federal court, the cases were consolidated for pretrial proceedings in the United States District Court for the District of South Carolina under the multi-district litigation statute.The District Court for the District of South Carolina, managing the consolidated proceedings, had entered case management orders requiring motions either to be signed by lead counsel or, if not, to be preceded by a motion for leave of court. Illinois Union sought leave to file a motion to stay the proceedings against it pending arbitration, contending that its insurance policies required arbitration of the dispute. The district court denied Illinois Union’s motion for leave, first citing a failure to consult with lead counsel as required, but then acknowledging that consultation had ultimately occurred. The decisive reason for denial was that lead counsel did not consent to Illinois Union’s motion, and the district court ruled that, absent such consent, the motion could not be filed.The United States Court of Appeals for the Fourth Circuit reviewed the district court’s order. It held that, while district courts have broad discretion to manage multi-district litigation, they may not exercise this authority in a way that prevents a party from asserting its statutory right under the Federal Arbitration Act to seek a stay of litigation pending arbitration. Because the district court’s order effectively barred Illinois Union from filing its stay motion based on lack of lead counsel’s consent, the Fourth Circuit vacated the district court’s order and remanded for further proceedings. View "Bouvet v. Illinois Union Insurance Company" on Justia Law

Two individuals were involved in a car accident in 2020 and received a payment from the other driver’s insurer. Seeking further compensation, they pursued a claim against their own underinsured motorist policy with their insurance company. After the insurer offered less than the policy limit, the insureds initiated a breach of contract lawsuit. Ultimately, the insurer settled by paying the full policy limit, and that litigation was dismissed. Subsequently, the insureds filed a second lawsuit alleging that the insurer acted in bad faith by delaying settlement, leading to emotional and financial distress.During discovery in the bad-faith action, the insureds requested the insurer’s claims file, including documents generated after the prior litigation began. The insurer withheld certain documents, citing attorney-client privilege and the work-product doctrine, and provided a privilege log. The Hamilton County Court of Common Pleas ordered production of the entire unredacted claims file up to the date of payment, without conducting an in camera review. The insurer appealed, arguing that the trial court erred by not applying statutory requirements for privilege and failing to conduct an in camera inspection.The First District Court of Appeals affirmed the trial court’s order, relying on Boone v. Vanliner Insurance Co., holding that in bad-faith claims, materials created prior to denial of coverage are discoverable. The appellate court reasoned that the insureds’ allegations of bad faith were sufficient to override privilege protections and rejected the insurer’s arguments about statutory requirements and the need for an in camera review, concluding that the insurer had not asserted privilege with sufficient detail.The Supreme Court of Ohio reversed the appellate court’s judgment. It held that the Boone decision had been superseded by statute: attorney-client communications are subject to discovery only after a prima facie showing of bad faith and an in camera review under R.C. 2317.02(A)(2). The work-product doctrine is governed by Civil Rule 26(B)(4) and allows disclosure only upon a showing of good cause. The case was remanded to the trial court for compliance with these standards. View "Eddy v. Farmers Property Cas. Ins. Co." on Justia Law

A tornado struck Tennessee, damaging two properties owned by a church that held property insurance with an insurer. The church filed a claim, and the insurer made a payment, but the church alleged that the insurer improperly calculated the amount by subtracting depreciation for non-material costs (such as labor) from the "actual cash value" (ACV) payment, leading to a lower payout. The insurance policy did not specify whether labor should be depreciated. The church then brought a putative class action, asserting similar claims under the laws of ten states, seeking class certification for policyholders who received reduced ACV payments because of the insurer’s practice.The United States District Court for the Middle District of Tennessee addressed several motions. It rejected the insurer’s argument that the church lacked Article III standing to assert claims under other states' laws, and denied the insurer’s motion for judgment on the pleadings as to Texas law. When considering class certification, the district court found the plaintiff satisfied Rule 23(a)’s requirements but limited class certification to four states (Arizona, California, Illinois, and Tennessee), citing unsettled law in the remaining six states. The court reasoned that the uncertain nature of laws in Kentucky, Ohio, Missouri, Mississippi, Texas, and Vermont would make a ten-state class action unwieldy, and thus declined to certify a class for those states.On appeal, the United States Court of Appeals for the Sixth Circuit reviewed the district court’s decisions. It held that the plaintiff had Article III standing to represent the class because the alleged injuries were substantially similar across the proposed class members. The appellate court found that the district court abused its discretion by not conducting an Erie analysis for five of the six excluded states and vacated the class-certification order in part, remanding for further proceedings. However, it affirmed the denial of class certification for Vermont due to insufficient authority on Vermont law. View "Generation Changers Church v. Church Mutual Ins. Co." on Justia Law

A devastating fire occurred in Lahaina on August 8, 2023, resulting in over one hundred deaths and widespread property and economic damage. Following the fire, individually represented plaintiffs and class action plaintiffs filed lawsuits in state and federal courts against entities including Hawaiian Electric, Kamehameha Schools, the State of Hawaiʻi, and the County of Maui. These class actions were eventually consolidated and refiled as a single case in the Circuit Court of the Second Circuit. Through court-ordered mediation, parties reached a “global settlement” in August 2024, resolving all claims for a total of $4.037 billion, with a portion allocated to a class settlement fund.Prior to the present appeal, the Circuit Court of the Second Circuit coordinated complex proceedings, including appointment of a special settlement master and consolidation of cases. The court issued an order establishing exclusive jurisdiction over subrogation claims related to the settlement. After the settlement was publicized and the Hawaiʻi Supreme Court issued its opinion in In re Maui Fire Cases, which clarified that insurers’ exclusive remedy after settlement is a statutory lien under HRS § 663-10, Subrogating Insurers moved to intervene in the class action, claiming protectable equitable subrogation rights if some class members did not file claims.The Supreme Court of the State of Hawaiʻi held that Subrogating Insurers do not possess a protectable interest that justifies intervention by right or permissive intervention in the class action settlement under Hawaiʻi Rules of Civil Procedure Rule 24. The court found that the statutory lien process under HRS § 663-10 is the exclusive remedy for insurers, and settlement extinguishes subrogation rights, even if some class members do not claim settlement funds. The court affirmed the Circuit Court’s order denying intervention. View "Burnes v. Hawaiian Electric Company, Inc." on Justia Law

Daevieon Towns purchased a new Hyundai Elantra in 2016, and over the next 19 months, the car required multiple repairs for alleged electrical and engine defects. In March 2018, either Towns or his wife, Lashona Johnson, requested that Hyundai buy back the defective vehicle. Before Hyundai acted, the car was involved in a collision, declared a total loss, and Johnson’s insurance paid her $14,710.91.Towns initially sued Hyundai Motor America in the Superior Court of Los Angeles County for breach of express warranty under the Song-Beverly Consumer Warranty Act. As trial approached, Towns amended his complaint to add Johnson as a plaintiff, arguing she was the primary driver and responsible for the vehicle. The trial court allowed the amendment, finding Johnson was not a buyer but permitted her to proceed based on its interpretation of Patel v. Mercedes-Benz USA, LLC. At trial, the jury found for Towns and Johnson, awarding damages and civil penalties. However, the court reduced the damages by the insurance payout and adjusted the prejudgment interest accordingly. Both parties challenged the judgment and costs in post-trial motions.The California Court of Appeal, Second Appellate District, Division Four, reviewed the case. It held that only a buyer has standing under the Act, so Johnson could not be a plaintiff. The court also held that third-party insurance payments do not reduce statutory damages under the Act, following the Supreme Court’s reasoning in Niedermeier v. FCA US LLC. Furthermore, prejudgment interest is available under Civil Code section 3288 because Hyundai’s statutory obligations do not arise from contract. The court affirmed in part, reversed in part, and remanded for the trial court to enter a modified judgment and reconsider costs. View "Towns v. Hyundai Motor America" on Justia Law

Lewis & Clark LTC Risk Retention Group, Inc. was placed into receivership and liquidation by the Nevada Commissioner of Insurance after financial distress. The Commissioner, acting as receiver, sued the company’s directors, alleging gross negligence and breaches of fiduciary duty relating to their management of the insurer. The allegations included knowingly relying on an unlicensed reinsurance broker, approving projects outside guidelines, operating the company in a hazardous condition, and violating Nevada statutes and regulations.After the directors moved for judgment on the pleadings, the Eighth Judicial District Court stayed proceedings while the directors petitioned for a writ of mandamus. The Supreme Court of Nevada, in Chur v. Eighth Judicial District Court, held that directors and officers can only be held personally liable for intentional misconduct, fraud, or knowing violations of the law, not gross negligence. The district court then denied the Commissioner leave to amend the complaint to meet this clarified standard, finding the amendment untimely, prejudicial, and futile, and entered judgment for the directors. The directors also moved for attorney fees and costs, which the district court denied, citing statutory immunity for the Commissioner.On appeal, the Supreme Court of Nevada found that Chur I represented a significant change in law and that, under Nevada Rules of Civil Procedure and in the interest of justice, leave to amend should have been granted. The district court abused its discretion by denying the amendment, as the proposed changes were not made in bad faith, were not unduly prejudicial, and were not futile. The Supreme Court reversed the judgment in favor of the directors, vacated the denial of attorney fees, and remanded for further proceedings consistent with these holdings. View "Commissioner of Insurance v. Chur" on Justia Law

A New Mexico insurance company initiated a lawsuit in Nebraska against two insurance companies, asserting claims for contribution and indemnity. One defendant, a New York insurance company, moved to dismiss for lack of personal jurisdiction, while the other defendant, a surplus insurance company, challenged a default judgment and sought to file a responsive pleading. The district court in Douglas County issued separate orders: it dismissed the New York insurer with prejudice and set aside the default judgment against the other defendant, allowing additional proceedings.After the dismissal order concerning the New York insurer, the plaintiff appealed to the Nebraska Court of Appeals, which summarily dismissed the appeal for lack of jurisdiction. The case returned to the district court, where the plaintiff voluntarily dismissed its claims against the remaining defendant without prejudice. This second dismissal order did not reference the prior dismissal of the New York insurer. The plaintiff then filed another appeal, again challenging the earlier dismissal order. The Court of Appeals dismissed this second appeal for lack of appellate jurisdiction, citing the absence of a single judgment resolving all claims against all parties as required by Nebraska statutes and referencing the Nebraska Supreme Court’s decision in Elbert v. Keating, O’Gara. The plaintiff petitioned for further review.The Nebraska Supreme Court reviewed the case and held that, because the district court had not entered a single written judgment adjudicating all claims and all parties, nor certified any order as final under the applicable statute, there was no final, appealable order. Therefore, the Supreme Court determined it lacked appellate jurisdiction and affirmed the dismissal of the appeal by the Court of Appeals. The court emphasized that jurisdiction cannot be created by voluntary dismissal without prejudice of unresolved claims or parties in the absence of a final judgment. View "Continental Indem. Co. v. Starr Indem. & Liab. Co." on Justia Law

A passenger, after being injured in a hit-and-run rear-end collision while riding in a vehicle arranged through a rideshare application, sought damages for bodily injuries. The passenger alleged that the rideshare company, its subsidiary, and its insurer either provided or were required by law to provide uninsured motorist (UM) coverage, and that their rejection of such coverage violated Louisiana law.The action began in Louisiana state court, initially naming only the insurer as a defendant. The passenger later amended the complaint to add the rideshare company and its subsidiary, arguing that they were not permitted to reject UM coverage. With all defendants’ consent, the insurer removed the case to the United States District Court for the Eastern District of Louisiana, citing diversity jurisdiction. Multiple motions followed, including motions to dismiss by the rideshare entities and a motion for summary judgment by the insurer. The district court found that Louisiana statutes allow transportation network companies to reject UM coverage and that the defendants had properly done so. Accordingly, the district court dismissed all claims with prejudice and denied the passenger’s request to certify a question to the Louisiana Supreme Court.On appeal, the United States Court of Appeals for the Fifth Circuit reviewed the statutory interpretation de novo. The court concluded that Louisiana Revised Statute § 45:201.6 incorporates, by general reference, the provisions of § 22:1295, including the right to reject UM coverage. The court found support for this interpretation in state appellate decisions and statutory context. The Fifth Circuit affirmed the district court’s judgment and denied the motion to certify the question to the Louisiana Supreme Court. The holding is that transportation network companies in Louisiana may reject uninsured motorist coverage if they follow the procedures in § 22:1295. View "Guerrera v. United Financial Casualty Co." on Justia Law