Justia Insurance Law Opinion Summaries

Krista Peoples and Joel Stedman filed Washington Consumer Protection Act ("CPA") suits against their insurance carriers for violating Washington claims-handling regulations and wrongfully denying them personal injury protection (PIP) benefits. The federal district court for the Western District of Washington certified a question of law relating to whether Peoples and Stedman alleged an injury to "business or property" to invoke their respective policies' PIP benefits. Peoples alleged her insurance carrier refused, without any individualized assessment, to pay medical provider bills whenever a computerized review process determined the bill exceeded a predetermined limit, and that the insurance company's failure to investigate or make individualized determinations violated WAC 284-30-330(4) and WAC 284-30-395(1). Due to this practice of algorithmic review, the insurance carrier failed to pay all reasonable medical expenses arising from a covered event, in violation or RCW 48.22.005(7). Stedman alleged his carrier terminate PIP benefits whenever an insured reached "Maximum Medical Improvement," which he alleged violated WAC 284-30-395(1). The Washington Supreme Court held an insurance carrier's wrongful withholding of PIP benefits injures the insured in their "business or property." An insured in these circumstances may recover actual damages, if proved, including out-of-pocket medical expenses that should have been covered, and could seek injunctive relief, such as compelling payment of the benefits to medical providers. Other business or property injuries, apart from wrongful denial of benefits, that are caused by an insurer's mishandling of PIP claims are also cognizable under the CPA. View "Peoples v. United Servs. Auto. Ass'n" on Justia Law

This matter came from two separate lawsuits commenced in the Pennsylvania courts of common pleas which were subsequently removed to federal district courts on the basis of diversity jurisdiction, and thereafter consolidated for disposition by the United States Court of Appeals for the Third Circuit. Appellee William Scott was covered by an automobile insurance policy issued by Appellant Travelers Commercial Insurance Company. Appellee Samantha Sayles was covered by an automobile policy issued by Appellant Allstate Insurance Company. Allstate’s policy contained a clause, similar to the one in Scott’s policy, providing that, in order to receive first-party medical benefits, the insured had to submit to mental and physical examinations by physicians selected by the insurance company at the company’s behest before medical benefits were paid. Both appellees were injured in separate car accidents, and their respective insurance companies refused to pay their medical bills. The United States Court of Appeals for the Third Circuit certified a question of Pennsylvania law to the Pennsylvania Supreme Court: Does an automobile insurance policy provision, which required an insured seeking first-party medical benefits under the policy to submit to an independent medical exam whenever the insurer requires and with a doctor selected by the insurer, conflict with 75 Pa.C.S. Section 1796(a) of the Pennsylvania Motor Vehicle Financial Responsibility Law (“MVFRL”), such that the requirement was void as against public policy? After review, the Supreme Court concluded that the provision indeed conflicted with Section 1796(a), and was void as against public policy. View "Sayles. v. Allstate Ins Co." on Justia Law

Allstate Insurance Company ("Allstate") petitioned the Alabama Supreme Court for a writ of mandamus to direct the Perry Circuit Court ("the trial court") to vacate its order denying Allstate's motion to transfer an action filed against it by Devin Harrison in Perry County to Shelby or Bibb County. Harrison, a resident of Bibb County, was driving an automobile in Perry County. The automobile was owned by Thomas Hobson, a resident of Bibb County ("Hobson"), and was insured by Allstate, whose principal place of business is in Shelby County. Dylan Gardner and Alexander Hobson, Hobson's grandson, were passengers in the vehicle Harrison was driving. While Harrison was driving, the automobile was involved in a single-vehicle accident. Gardner died as a result of injuries sustained in the accident, and Alexander Hobson was injured. Gardner's estate filed a wrongful-death action against Harrison and obtained a $2 million dollar judgment. At some point, Alexander Hobson also filed an action in the trial court against Harrison and Allstate seeking damages for injuries relating to the accident. In May 2018, Harrison filed the action underlying this petition in the trial court against Allstate in which he asserted claims of breach of contract and bad faith based on Allstate's alleged refusal to defend or indemnify him in the wrongful-death action. Allstate removed the action to the United States District Court for the Southern District of Alabama. After that court remanded the case to the trial court, Allstate filed a motion to transfer the action to Shelby County or Bibb County, arguing that venue in Perry County was improper. The Alabama Supreme Court concluded after review of the trial court record that Allstate demonstrated venue was improper in Perry County, and was proper in Shelby or Bibb County. The trial court was directed to vacate its order denying Allstate’s motion for a change of venue and to transfer the action. View "Ex parte Allstate Insurance Company." on Justia Law

The Fourth Circuit vacated the district court's declaratory judgment in favor of the insurer, holding that the district court abused its discretion when it assumed jurisdiction under the Declaratory Judgment Act. In this case, without addressing the decision to exercise its discretionary jurisdiction, the district court reached the merits despite a thin and ambiguous record. The court held that the district court created both a substantial question about whether Article III jurisdiction existed and a serious potential to interfere with ongoing state proceedings. Therefore, the court remanded with instructions to dismiss the action without prejudice. View "Trustgard Insurance Co. v. Collins" on Justia Law

In 2006, Verizon divested its print and electronic directories business to its stockholders in a tax-free “spin-off” transaction. As part of the transaction, Verizon created Idearc, Inc. and appointed John Diercksen, a Verizon executive, to serve as Idearc’s sole director. Verizon then distributed Idearc common stock to Verizon shareholders. Idearc launched as a separate business with $9.1 billion in debt. In connection with the Idearc spinoff, Verizon and Idearc purchased primary and excess Executive and Organizational Liability Policies (“Idearc Runoff Policies"). The Idearc Runoff Policies covered certain claims made against defined insureds during the six-year policy period that exceeded a $7.5 million retention. Relevant here, Endorsement No. 7 to the policies stated that “[i]n connection with any Securities Claim,” and “for any Loss . . . incurred while a Securities Claim is jointly made and maintained against both the Organization and one or more Insured Person(s), this policy shall pay 100% of such Loss up to the Limit of Liability of the policy.” “Securities Claim” was defined in pertinent part as a “Claim” against an “Insured Person” “[a]lleging a violation of any federal, state, local or foreign regulation, rule or statute regulating securities (including, but not limited to, the purchase or sale or offer or solicitation of an offer to purchase or sell securities).” Under the policy, Verizon could recover its “Defense Costs” when a Securities Claim was brought against it and covered directors and officers, and Verizon indemnified those directors and officers. Idearc operated as an independent, publicly traded company until it filed for bankruptcy in 2009; a litigation trust was set up to pursue claims against Verizon on behalf of creditors. Primary amongst the allegations was Dickersen and Verizon saddled Idearc with excessive debt at the time of the spin-off. This appeal turned on the definition of a "Securities Claim;" the Superior Court found the definition ambiguous. Using extrinsic evidence, the court held that fiduciary duty, unlawful dividend, and fraudulent transfer claims brought by a bankruptcy trustee against Verizon Communications Inc. and others were Securities Claims covered under the policy. The Delaware Supreme Court disagreed, finding that, applying the plain meaning of the Securities Claim definition in the policy, the litigation trustee’s complaint did not allege any violations of regulations, rules, or statutes regulating securities. Thus, the Superior Court’s grant of summary judgment to Verizon was reversed and that court directed to enter summary judgment in favor of the Insurers. View "In Re Verizon Insurance Coverage Appeals" on Justia Law

Plaintiff Barbara Orientale brought a personal-injury lawsuit against defendant Darrin Jennings for allegedly setting off an automobile accident that caused her to suffer permanent injuries. The trial court entered partial summary judgment against Jennings, finding that he was at fault for causing the accident. Orientale and Jennings then settled the lawsuit for $100,000, the full amount of liability coverage on Jennings’s vehicle. Orientale maintained an underinsured motorist policy with defendant Allstate New Jersey Insurance Company (Allstate) that provided coverage for damages up to $250,000. Orientale initiated a claim for her personal-injury damages in excess of $100,000 allegedly caused by the accident. Although the jury returned a verdict finding that Orientale suffered a permanent injury, it awarded damages in the amount of only $200. Because the jury award did not exceed Orientale’s $100,000 settlement with Jennings, Allstate’s underinsured motorist coverage policy was not triggered. Orientale moved for a new damages trial or an additur. The judge vacated the damages award, finding that it constituted a miscarriage of justice, and granted an additur in the amount of $47,500, the lowest award in his estimation that a reasonable jury could have returned in light of the evidence presented at trial. Plaintiff challenged the constitutionality of additur on the basis that the judge acts as a “super jury” in setting a damages award in violation of the right to a jury trial. The New Jersey Supreme Court held that when a damages award is deemed a miscarriage of justice requiring the grant of a new trial, the acceptance of a damages award fixed by the judge must be based on the mutual consent of the parties. "Going forward, in those rare instances when a trial judge determines that a damages award is either so grossly excessive or grossly inadequate that the grant of a new damages trial is justified, the judge has the option of setting a remittitur or an additur at an amount that a reasonable jury would award given the evidence in the case. Setting the figure at an amount a reasonable jury would award -- an amount that favors neither side -- is intended to give the competing parties the greatest incentive to reach agreement. If both parties accept the remittitur or additur, then the case is settled; if not, a new trial on damages must proceed before a jury." View "Orientale v. Jennings" on Justia Law

Zachariah Cowart ("Zachariah") accidentally ran over his wife Misty Cowart ("Misty"). Misty was partially compensated for her injuries under one provision of her automobile-insurance policy, and she sought to use the uninsured-motorist provision of the policy to make up the difference. The trial court entered a summary judgment in favor of the insurer and upheld its denial of uninsured-motorist benefits to Misty. The Alabama Supreme Court determined that judgment, however, was not supported by the language of the policy. For that reason, and because there wer key factual questions that were unresolved, the Supreme Court reversed summary judgment and remanded for further proceedings. View "Cowart v. GEICO Casualty Company" on Justia Law

D.P.T. sought a writ of mandamus to direct the Circuit Court to rescind a discovery order that, D.P.T. asserted, required him to execute written authorizations allowing the respondents, D.P.T.'s insurers--United States Automobile Association, American Bankers Insurance of Florida, Inc., and American Collectors Insurance, LLC, to obtain records containing communications that he alleged were privileged under the psychotherapist-patient privilege. The insurers represented to the Alabama Supreme Court that they sought only D.P.T.'s "employment" records. In a rare move, the trial court itself filed a brief in response to the mandamus petition, in which it represented to the Supreme Court that it directed D.P.T. to execute an authorization allowing only the release of "employment" records. After review, the Supreme Court found D.P.T., who, as the petitioner, had the burden of establishing a clear legal right to the issuance of the writ of mandamus, did not demonstrate his "employment" records contained privileged communications. Thus, the Court denied the petition for mandamus relief. View "Ex parte D. P. T." on Justia Law

Maria Thompson filed sued Dennis Holliman and Allstate Property and Casualty Insurance Company (“Allstate”) alleging that Holliman had negligently operated his motor vehicle while pulling a trailer in a gas-station parking lot, resulting in a collision in which she was injured. A jury returned a verdict in favor of Holliman, and the circuit court entered a judgment consistent with the jury verdict. Aggrieved, Thompson appealed, alleging that the trial court had abused its discretion by excluding her expert witness. Finding no abuse of the trial court's discretion, the Mississippi Supreme Court affirmed judgment in Holliman's favor. View "Thompson v. Holliman" on Justia Law

While driving his truck, Moun Keodalah and an uninsured motorcyclist collided. After Keodalah stopped at a stop sign and began to cross the street, the motorcyclist struck Keodalah's truck. The collision killed the motorcyclist and injured Keodalah. Keodalah's insurance policy with Allstate Insurance Company included underinsured motorist (UIM) coverage. Keodalah requested Allstate pay him his UIM policy limit of $25,000. Allstate refused, offering $1,600 based on its assessment Keodalah was 70% at fault for the accident. After Keodalah asked Allstate to explain its evaluation, Allstate increased its offer to $5,000. Keodalah sued Allstate asserting a UIM claim. The ultimate issue before the Washington Supreme Court in this case was whether RCW 48.01.030 provided a basis for an insured's bad faith and Consumer Protection Act claims against an insurance company's claims adjuster. The Supreme Court held that such claims were not available, and reversed the Court of Appeals. View "Keodalah v. Allstate Ins. Co." on Justia Law