Justia Insurance Law Opinion Summaries

A general contractor, Keluco General Contractors, Inc., secured a workers’ compensation and employers’ liability policy through Travelers Property Casualty Company of America. The policy was set to last one year, expiring on March 5, 2017. After the policy expired, a Keluco employee was injured at work. Keluco attempted to make a claim on its workers’ compensation policy and discovered it had expired. Travelers claimed to have sent a notice of nonrenewal to Keluco and its insurance agent, Gretchen Santerre, but Keluco claimed it never received the notice.Keluco sued Santerre and her employer, Country Mutual Insurance Company, for failing to inform it of the nonrenewal notice. Santerre filed a third-party complaint against Travelers. The Superior Court of Alaska granted partial summary judgment against Travelers, ruling that it failed to send the nonrenewal notice in the manner required by statute, specifically by not obtaining a certificate of mailing from the United States Postal Service (USPS). The court found that Travelers breached its contract with Keluco.The Supreme Court of the State of Alaska reviewed the case. The court affirmed the Superior Court’s rulings on summary judgment, agreeing that Travelers violated AS 21.36.260 by not obtaining a certificate of mailing from USPS and thus breached its contract with Keluco. The court also affirmed the dismissal of Travelers’ contribution claim against Santerre, noting that Alaska law allows for the allocation of fault to a party who has settled out of a case.However, the Supreme Court reversed the Superior Court’s determination of when prejudgment interest began to accrue. The Supreme Court held that prejudgment interest should begin to accrue on September 20, 2017, the date the Keluco employee was injured and entitled to workers’ compensation benefits, rather than January 9, 2017. The case was remanded for recalculation of prejudgment interest. View "Travelers Property Casualty Company of America v. Keluco General Contractors" on Justia Law

James Cooper was injured in a car accident in August 2019 while riding as a passenger in a car owned by Rick Huffman. Both Cooper and Huffman were employees of Pison Management, LLC, and were driving to a jobsite for work. Cooper's injuries exceeded the third-party driver's insurance limits, so he sought underinsured motorist (UIM) coverage under Pison's commercial automobile policy issued by Erie Insurance Property & Casualty Company. The policy provided $1 million in liability coverage for two vehicles owned by Pison and a class of non-owned vehicles but only offered UIM coverage for the owned vehicles. Erie denied Cooper's claim for UIM coverage.The United States District Court for the Southern District of West Virginia granted summary judgment in favor of Cooper, holding that West Virginia Code § 33-6-31 required Erie to offer UIM coverage for all vehicles covered by the liability policy, including non-owned vehicles. The court issued a declaratory judgment that Cooper was entitled to $1 million in UIM coverage. Erie appealed the decision.The United States Court of Appeals for the Fourth Circuit reviewed the case and certified a question of law to the West Virginia Supreme Court of Appeals. The West Virginia court concluded that West Virginia Code § 33-6-31 did not require Erie to offer UIM coverage for non-owned vehicles. The court determined that Cooper was not an "insured" under the statute because Pison, the named insured, did not own the vehicle in which Cooper was riding and thus could not consent to its use for UIM purposes.Applying the West Virginia court's interpretation, the Fourth Circuit vacated the district court's judgment in favor of Cooper and remanded the case with instructions to enter judgment in favor of Erie. View "Erie Insurance Property & Casualty Company v. Cooper" on Justia Law

After Hurricane Maria damaged its business, Coco Rico, LLC sued its insurer, Universal Insurance Company, for failing to pay its insurance claim and won. The jury awarded Coco Rico higher damages for its business interruption loss claim than it had requested, plus extra, consequential damages. This appeal centers on the district court's rulings on several post-verdict motions: Universal sought to eliminate or reduce the jury's damages awards, while Coco Rico sought attorneys' fees and prejudgment interest from Universal. After the district court denied the motions, both parties appealed.The United States District Court for the District of Puerto Rico denied Universal's renewed motion for judgment as a matter of law on the consequential damages claim and its motion for a new trial or reduction of the contractual damages award. The court reduced the jury's BI & EE award from $873,000 to $750,000, in line with the insurance policy maximum, but rejected Universal's argument that the award should be further reduced to $686,098. The court also denied Coco Rico's motion to amend the judgment to add attorneys' fees and prejudgment interest.The United States Court of Appeals for the First Circuit reviewed the case. The court agreed with Universal that there was no evidentiary basis for the jury to award consequential damages or higher business interruption loss damages than Coco Rico had established at trial. The court reversed the district court's ruling denying Universal's motions regarding the damages awards and affirmed its ruling denying Coco Rico's motion for attorneys' fees and prejudgment interest. The court held that the jury's award of $873,000 for business interruption loss exceeded the evidence presented, which supported only $686,098, and that there was no evidence to support the $250,000 consequential damages award. The court remanded the case for further proceedings consistent with its opinion. View "Coco Rico, LLC v. Universal Insurance Company" on Justia Law

Eric Jackson, a commercial tractor-trailer driver, was injured in a motor-vehicle collision in Morgan County, Alabama, on December 20, 2020. Jackson's personal vehicles were insured by State Farm Mutual Automobile Insurance Company under policies issued in Kentucky, which included uninsured/underinsured-motorist (UIM) coverage. In April 2022, Jackson sued the alleged at-fault driver in the Morgan Circuit Court. Later, he sought to amend his complaint to add State Farm as a defendant to recover UIM benefits. State Farm denied the claim, asserting that Jackson failed to file his UIM claim within the two-year period required by Kentucky law, as stipulated in the insurance policies.The Morgan Circuit Court granted State Farm's motion for judgment on the pleadings, concluding that Kentucky law governed the claim and that Jackson did not file his complaint within the required two-year period. Jackson appealed, arguing that Alabama's six-year statute of limitations should apply and that any contractual provision shortening this period was void under Alabama law.The Supreme Court of Alabama reviewed the case de novo. The court noted that Alabama enforces choice-of-law provisions in contracts unless they violate public policy. Jackson's policies explicitly incorporated Kentucky's two-year statute of limitations for filing accident-related tort claims. The court found that the policies were clear and unambiguous in this regard and that Kentucky law, which allows such contractual limitations, applied. The court distinguished this case from others where no specific choice-of-law provision was present or where the provision did not explicitly include procedural laws like statutes of limitations.The Supreme Court of Alabama affirmed the lower court's judgment, holding that the contractual provision incorporating Kentucky's two-year statute of limitations was valid and enforceable, thus barring Jackson's UIM claim. View "Jackson v. State Farm Mutual Automobile Insurance Co." on Justia Law

Casey Cotton rear-ended Caleb Crabtree, causing significant injuries. Cotton, insured by Allstate, faced potential liability exceeding his policy limit. Allstate allegedly refused to settle with Crabtree and failed to inform Cotton of the settlement negotiations or his potential liability, giving Cotton a potential bad-faith claim against Allstate. The Crabtrees sued Cotton, who declared bankruptcy. The bankruptcy court allowed the personal-injury action to proceed, resulting in a $4 million judgment for the Crabtrees, making them judgment creditors in the bankruptcy proceeding. Cotton’s bad-faith claim was classified as an asset of the bankruptcy estate. The bankruptcy court allowed the Crabtrees to purchase Cotton’s bad-faith claim for $10,000, which they financed through Court Properties, Inc.The Crabtrees sued Allstate, asserting Cotton’s bad-faith claim. The United States District Court for the Southern District of Mississippi dismissed the action for lack of subject matter jurisdiction, holding that the assignments of Cotton’s claim to Court Properties and then to the Crabtrees were champertous and void under Mississippi law. Consequently, the court found that the Crabtrees lacked Article III standing as they had not suffered any injury from Allstate.The United States Court of Appeals for the Fifth Circuit reviewed the case. The court certified a question to the Supreme Court of Mississippi regarding the validity of the assignments under Mississippi’s champerty statute. The Supreme Court of Mississippi held that the statute prohibits a disinterested third party engaged by a bankruptcy creditor from purchasing a cause of action from a debtor’s estate. Based on this ruling, the Fifth Circuit held that the assignment of Cotton’s claim to Court Properties was void, and thus, the Crabtrees did not possess Cotton’s bad-faith claim. Therefore, the Crabtrees lacked standing to sue Allstate, and the district court’s dismissal was affirmed. View "Crabtree v. Allstate Property" on Justia Law

UnitedHealthCare Insurance Company and its affiliates (collectively, United) were sued by Fremont Emergency Services and other emergency medical providers (collectively, TeamHealth) for underpaying claims for emergency medical services provided to United’s members. TeamHealth alleged that United failed to adequately reimburse them for services rendered under the Emergency Medical Treatment and Labor Act (EMTALA) after their contract with United expired, leaving them as out-of-network providers. TeamHealth claimed United was unjustly enriched and breached an implied-in-fact contract, also asserting statutory claims under the Prompt Pay and Unfair Claims Practices Acts.The case was initially removed to federal court, which found no ERISA preemption and remanded it to state court. The Eighth Judicial District Court of Nevada ruled in favor of TeamHealth, awarding them compensatory and punitive damages, prejudgment interest, and attorney fees. United appealed the judgment and petitioned to seal certain court documents.The Supreme Court of Nevada reviewed the case and found substantial evidence supporting the jury’s verdict on unjust enrichment but not on the implied-in-fact contract or statutory claims. The court held that ERISA did not preempt TeamHealth’s claims and that United was entitled to judgment as a matter of law on the Unfair Claims Practices Act claim, as the statute did not provide a private right of action for medical providers. The court affirmed the compensatory damages for unjust enrichment but vacated the punitive damages award, remanding for recalculation to a 1:1 ratio of compensatory to punitive damages. The court also reversed the prejudgment interest and attorney fees awards under the Prompt Pay Act and remanded for a new determination of prejudgment interest.Additionally, the court denied United’s petition to seal certain documents, finding that United failed to meet its burden to demonstrate the necessity of sealing. The court concluded that the district court did not abuse its discretion in refusing to seal parts of the record. View "UnitedHealthCare Insurance Company v. Fremont Emergency Services" on Justia Law

Union Pacific Railroad Company, as the corporate successor to a dissolved coal mining company, periodically received mine subsidence claims from the Illinois Mine Subsidence Insurance Fund. The Fund, acting as a reinsurer for primary insurers offering mine subsidence coverage, sought to recover its reinsurance payments from Union Pacific. After years of litigation, Union Pacific sued the Fund for declaratory and injunctive relief to preclude future cases. The Fund moved to dismiss, and the district court allowed the complaint seeking injunctive relief to proceed on certain theories but not others. Union Pacific brought an interlocutory appeal.The United States District Court for the Central District of Illinois had previously ruled that Union Pacific could seek declaratory and injunctive relief for subsidence claims acquired by the Fund before the Gillespie case and the 2019 Opinion but not for future claims. Union Pacific amended its complaint, and the district court reiterated its earlier decision, dismissing the request for future injunctive relief while allowing the case to proceed on the earlier claims.The United States Court of Appeals for the Seventh Circuit reviewed the case and concluded that it lacked appellate jurisdiction. The court determined that the district court's order was a narrowing of the injunctive relief rather than a definitive refusal. The court also found that the injunctive relief sought on appeal was not substantially different from the relief still pending in the district court. As a result, the appeal was dismissed. View "Union Pacific Railroad Co. v. Illinois Mine Subsidence Insurance Fund" on Justia Law

Fire-Dex, a manufacturer of personal protective equipment for firefighters, faced lawsuits from firefighters and their spouses alleging exposure to carcinogens from Fire-Dex's products. These lawsuits were consolidated in multidistrict litigation in South Carolina. Fire-Dex had general commercial liability insurance policies with Admiral Insurance Company and requested Admiral to defend and indemnify it against the lawsuits. Admiral refused, leading to a declaratory judgment action in federal court in Ohio, where the district court declined to exercise jurisdiction.The United States District Court for the Northern District of Ohio initially had diversity jurisdiction over Admiral's declaratory judgment action but chose to abstain from exercising it, a decision affirmed by the Sixth Circuit. Subsequently, Fire-Dex filed a lawsuit in Ohio state court seeking a declaration that Admiral must defend and indemnify it, along with compensatory and punitive damages for breach of contract and bad faith. Admiral removed the case to federal court and filed counterclaims for declaratory judgment. Fire-Dex moved to remand the case to state court.The United States Court of Appeals for the Sixth Circuit reviewed the district court's decision to remand the declaratory claims and stay the damages claims. The Sixth Circuit held that the district court erred in abstaining from the declaratory claims under Thibodaux abstention, as the case did not involve unsettled questions of state law intimately involved with state sovereignty. The court also found that abstaining from the declaratory claims was an abuse of discretion because the declaratory and damages claims were closely intertwined, and no traditional abstention doctrine applied to the damages claims. The Sixth Circuit vacated the district court's order and remanded for further proceedings. View "Fire-Dex, LLC v. Admiral Insurance Co." on Justia Law

J.H. participated in an employee welfare-benefit plan insured by Anthem Blue Cross Life and Health Insurance Company, with her son, A.H., as a beneficiary. After seeking benefits for A.H.'s yearlong stay at a mental-health treatment center, Anthem denied coverage, and Plaintiffs' appeal to Anthem was unsuccessful. Over a year after their final appeal through Anthem was decided, Plaintiffs filed a lawsuit to recover benefits under § 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (ERISA).The United States District Court for the District of Utah dismissed the action, concluding it was time-barred under a provision of the Plan that required civil actions under ERISA § 502(a) to be brought within one year of the grievance or appeal decision. Plaintiffs argued that another sentence in the Plan set a three-year limitations period, creating an ambiguity that should be interpreted in their favor.The United States Court of Appeals for the Tenth Circuit reviewed the case and held that the two provisions were not inconsistent and both applied. The court explained that the one-year limitations period for § 502(a) actions and the three-year limitations period for other actions were distinct and could both be applicable. The court affirmed the district court's dismissal, concluding that Plaintiffs' action was time-barred as it was filed beyond the one-year limitations period specified in the Plan. View "J.H. v. Anthem Blue Cross Life and Health Insurance" on Justia Law

Melvin G. Welch died in 2023 from mesothelioma caused by asbestos exposure. His widow, Donna B. Welch, sued Atlas Turner, Inc. and other defendants, alleging their products caused his death. Atlas Turner, a Canadian company, produced and sold asbestos insulation, which was shipped to South Carolina. Welch was likely exposed to these products while working in Greenwood, South Carolina. The case was brought in Richland County and assigned to Judge Jean H. Toal, who oversees the South Carolina asbestos docket.Atlas Turner moved to dismiss the claims for lack of personal jurisdiction, but the trial court denied the motion and ordered Atlas Turner to participate in discovery. Atlas Turner ignored deposition notices and refused to comply with discovery orders, claiming it had no knowledgeable witnesses and that the Québec Business Concerns Records Act (QBCRA) prohibited it from disclosing information. The trial court held Atlas Turner in contempt, struck its answer, and placed it in default. The court also appointed a Receiver over Atlas Turner's Insurance Assets.The South Carolina Supreme Court reviewed the case and affirmed the trial court's sanctions and the appointment of the Receiver over Atlas Turner's Insurance Assets. The court found that Atlas Turner's refusal to comply with discovery was willful and that the QBCRA did not excuse its non-compliance. The court also held that the trial court had the authority to appoint a Receiver before judgment due to Atlas Turner's conduct, which indicated an intent to evade responsibility. However, the Supreme Court reversed the portion of the Receivership order that granted the Receiver authority beyond investigating and collecting Atlas Turner's Insurance Assets. View "Welch v. Atlas Turner, Inc." on Justia Law