Justia Insurance Law Opinion Summaries

After defendants Frayba and William Tipton pled guilty to committing insurance fraud, they were ordered to pay victim restitution to Nationwide Insurance Company of America (Nationwide). Later, Nationwide petitioned the trial court to convert the criminal restitution orders to civil judgments against both defendants. Defendants opposed. Relying on Penal Code1 section 1214, the trial court granted Nationwide’s petition and entered civil judgments against the defendants. On appeal, defendants argued the trial court erred because (1) Nationwide “failed to provide citation to any . . . authority supporting” conversion of the victim restitution orders to civil judgment; and (2) Nationwide’s petition lacked supporting evidence. The Court of Appeal found no reversible error and affirmed the trial court's judgment. View "Nationwide Ins. Co. of Am. v. Tipton" on Justia Law

Eight South Florida hospitals dutifully provided out-of-network emergency treatment to numerous Cigna customers. When Cigna reimbursed the hospitals just 15% of what they had charged, the hospitals sued, accusing Cigna of paying less than the “community” rate. As proof, the hospitals showed that they normally receive five times as much for the care they provided here. In response, Cigna asserted that the hospitals’ data proved nothing because, it insisted, the relevant “community” necessarily includes more than just the eight plaintiff hospitals. The district court agreed and granted Cigna summary judgment.   The Eleventh Circuit reversed. The court explained that even if the relevant “community” here extends beyond the eight plaintiff hospitals, their receipts alone are enough to create a genuine factual dispute about what the “community” rates are. The court reasoned that to survive summary judgment, a plaintiff needn’t present evidence that compels a single, airtight inference—just evidence that allows a reasonable one. The court explained that the way to rebut an inference allegedly skewed by limited data is to add data. And Cigna can do just that—at trial. If it can show there that most other providers in the “community” charge less than the plaintiff hospitals do, then it may well debunk the hospitals’ estimate. But unless and until that happens, it remains the case that a reasonable jury could conclude that the eight plaintiff hospitals’ rates reflect the prevailing community rate—and thus that Cigna shortchanged them. View "North Shore Medical Center, Inc., et al v. Cigna Health and Life Insurance Company" on Justia Law

Defendant, a reinsurer, appealed from a district court’s ruling granting summary judgment to Plaintiff, its reinsured. On appeal, Defendant argues that the district court erroneously held that its reinsurance obligations to Plaintiff are co-extensive with Appellee’s separate insurance obligations to a third party and that it presented no triable issue of fact on its late-notice defense.   The Second Circuit affirmed. The court wrote that the district court correctly determined that English law, which governs the relevant reinsurance policy, would interpret that policy to provide coverage that is coextensive with Plaintiff’s separate insurance obligations. The district court also correctly rejected Defendant’s late-notice defense because Defendant has not shown the extreme facts necessary under English law to support recognition of that defense where, as here, timely notice is not a condition precedent to coverage. View "The Insurance Company of the State of Pennsylvania v. Equitas Insurance" on Justia Law

The First Circuit affirmed the judgment of the district court granting summary judgment in favor of Triple-S Management Corporation and Triple-S Vida, Inc. (collectively, Triple-S) and dismissing this case brought by Dora Bonner, holding that the district court did not abuse its discretion in denying Bonner's discovery-related motions and did not err in considering the evidence at the summary judgment stage.Bonner brought several claims alleging that Triple-S denied her millions of dollars of proceeds from certain certificates and devised a scheme to defraud her. After denying Bonner's motion to compel discovery and extend the discovery deadline, the district court concluded that Triple-S had established as a matter of law that the persons behind the fraudulent scheme were not related to Triple-S. The First Circuit affirmed, holding that the district court (1) did not abuse its discretion in denying the motion to compel and motion for consideration; and (2) properly granted summary judgment for Triple-S. View "Bonner v. Triple-S Vida, Inc." on Justia Law

Amanda Bryant filed suit against State Farm Automobile Insurance Company (State Farm) and its attorneys, Henley, Lotterhos & Henley, PLLC (HLH), claiming negligence, malicious prosecution, abuse of process, and intentional infliction of emotional distress based on HLH’s actions in a prior subrogation claim. HLH argued in a Motion to Dismiss or, In the Alternative, Motion for Summary Judgment that it was not a proper party to this lawsuit because it was the legal representative of the adverse party in the prior subrogation matter. For this reason, HLH argued it did not owe a duty to Bryant that could give rise to tort liability. The trial court disagreed with HLH and denied its motion. The Mississippi Supreme Court granted HLH’s petition for interlocutory appeal. Based on caselaw, the Supreme Court reversed the trial court’s order and rendered judgment in favor of HLH. Because State Farm was still party to the action, the case was remanded to the trial court for continuation of the proceedings. View "Henley, Lotterhos & Henley, PLLC v. Bryant" on Justia Law

The federal district court in Washington State certified a question of law to the Washington Supreme Court. Washington law required group life insurance policies to have an incontestability clause providing that “the validity of the policy shall not be contested, except for nonpayment of premiums, after it has been in force for two years from its date of issue.” The certified question in this case asked whether an insurer could invalidate a life insurance policy after this two-year period on grounds that the policies were void ab initio or never “in force.” New York Life Insurance (NY Life) issued two life insurance policies to Lorenzo Mitchell, naming his nephew, Simon Mitchell, as the sole beneficiary. Lorenzo died more than two years after the policies were issued, and Simon sought to collect on the policies. NY Life became aware that Lorenzo had Down syndrome and lived with significant intellectual disabilities. These facts raised questions about the circumstances under which the policies were issued. NY Life sued Simon in federal district court seeking declaratory relief that the policies were void ab initio under three possible theories: imposter fraud, incapacity, and lack of an insurable interest. The Washington Supreme Court concluded NY Life’s first and third claims were not barred by that provision. “In contrast, lack of capacity does not, on its own, render an insurance contract void; it renders it at most voidable. Because a voidable contract is not void ab initio, we hold the incontestability provision bars NY Life’s second claim.” View "New York Life Ins. Co. v. Mitchell" on Justia Law

Allied World Specialty Insurance Company issued a WaterPlus Package Insurance Policy to the Windermere Oaks Water Supply Corporation. That policy includes coverage for Public Officials and Management Liability. But it also includes various exclusions from coverage. At issue in this appeal is the exclusion of contractual liability.   The Fifth Circuit affirmed the district court’s judgment granting summary judgment in favor of the insured. The court held that a claim for breach of fiduciary duty is not a claim for breach of contract and is, therefore, not subject to exclusion from coverage under a contractual liability exclusion. The court explained that under the Texas Prompt Payment of Claims Act, Tex. Ins. Code Section 542.060, an insurer’s breach of the duty to defend constitutes a per se violation View "Windermere Oaks v. Allied World" on Justia Law

Farm Family Casualty Insurance Company (“Farm Family”) appealed after the district court granted summary judgment to Nodak Insurance Company (“Nodak”) and denied, in part, summary judgment to Farm Family. This case arose from an April 6, 2019 motor vehicle accident. Samuel Hamilton was the son of Bruce and Diana Hamilton. At the time of the April 2019 accident at issue, Samuel was a resident of North Dakota, and his parents were residents of Montana. Before the accident, Farm Family issued an automobile insurance policy to Bruce and Diana with an effective policy period of October 19, 2018 to April 19, 2019. The policy insured a 2011 pickup truck. After moving to Montana, the Hamiltons obtained an insurance policy from Mountain West Farm Bureau Mutual Insurance Company (“Mountain West”) that also insured the 2011 pickup truck with a term running from December 2, 2018 to June 2, 2019. In April 2019, Samuel was driving the insured 2011 pickup truck in Williams County, North Dakota. Samuel reportedly ran a stop sign while intoxicated and struck another vehicle; H.W. was seriously injured and A.M. was killed. Nodak insured the vehicle H.W. and A M. occupied at the time of the accident. Nodak filed suit seeking a declaration Farm Family’s automobile policy was in effect at the time of the April 2019 accident, Farm Family’s policy could not be retroactively cancelled, and the vehicle driven by the insureds’ son was not an “underinsured motor vehicle” under North Dakota law. The North Dakota Supreme Court concluded the automobile policy Farm Family issued to its insureds had not “ceased” under the policy language and remained in effect at the time of the April 2019 motor vehicle accident. View "Nodak Ins. Co. v. Farm Family Casualty Ins. Co., et al." on Justia Law

Plaintiff Noble House, L.L.C. (“Noble House”) appealed a judgment of dismissal, without prejudice, based on forum non conveniens, granted in favor of Defendant Certain Underwriters at Lloyd’s, London (“Underwriters”). The district court ruled that the parties’ insurance policy contained an enforceable forum-selection clause requiring litigation in the courts of England and Wales and that a return-jurisdiction clause was not required.   The Fifth Circuit affirmed. The court held that although there are arguably two forum-selection clauses at play, one foreign and one domestic, the district court concluded that the forum-election clause selecting the courts of England and Wales controls. Noble House does not dispute this conclusion in its opening brief. Nor does Noble House dispute that the foreign forum-selection clause is mandatory. Only the foreign forum-selection clause’s enforceability is contested, which is addressed under the “unreasonable under the circumstances” framework – not the usual “available and adequate” framework. Further, the court held that Noble House does not carry its “heavy burden of proof” to show that the clause selecting the courts of England and Wales is unreasonable under the circumstances. Moreover, Noble House offers no compelling reason justifying its filing in Texas or why its action could not be filed timely in the foreign fora. Accordingly, the court held that the district court did not err when it: (1) concluded that the foreign forum-selection clause is enforceable, or (2) failed to include a return-jurisdiction clause and total waiver of any statute-of-limitations defenses. View "Noble House v. Certain Underwriters" on Justia Law

This case involves a rare procedural maneuver called snap removal. Federated Mutual Insurance Company removed an insurance dispute to federal court before Plaintiff, M & B Oil, Inc., “properly joined and served” one of the Defendants, the City of St. Louis. The question is whether this maneuver eliminates the requirement of complete diversity.   The Eighth Circuit answered no, and vacated the order denying remand and sent the case back for a second look. The court explained that from the beginning, M & B sued two Defendants: St. Louis and Federated. One of them is a fellow Missourian, so there has never been complete diversity. And without complete diversity, there is no “original jurisdiction. Further, the court wrote that snap removal cannot cure a lack of complete diversity. Moreover, the court explained that there is reason to doubt that any fraudulent-joinder argument will succeed now that M & B has amended its complaint to include an inverse condemnation claim against St. Louis. View "M & B Oil, Inc. v. Federated Mutual Insurance Co" on Justia Law