Justia Insurance Law Opinion Summaries

In a workers' compensation case, an employee was injured and sought compensation from her employer and its insurance carrier. The employee failed to provide her expert witness's evidence in a timely manner, serving them only two weeks before the arbitration hearing began. The employer and its insurance carrier objected, arguing that this late submission of evidence was unfairly prejudicial. The deputy workers’ compensation commissioner agreed with the employer and excluded the evidence. This decision was affirmed by the commissioner, but was later reversed on judicial review by the district court. The court of appeals affirmed the district court’s ruling. However, the Supreme Court of Iowa held that the commissioner’s decision to exclude untimely evidence was entitled to deference. The court found that the commissioner did not abuse his discretion by excluding the untimely evidence since the employee had disregarded multiple deadlines and submitted the reports only about two weeks before the hearing. Moreover, the reports were not from the employee’s treating physicians and the vocational report reached a conclusion that no other expert in the case shared. Therefore, the supreme court vacated the court of appeals decision, reversed the district court decision, and remanded the case back to the district court to enter a judgment affirming the commissioner's decision to exclude the untimely evidence. View "Hagen v. Serta/National Bedding Co., LLC" on Justia Law

In this case, the United States Court of Appeals for the Second Circuit heard an appeal from Ezrasons, Inc., a company engaged in the garment trade, against The Travelers Indemnity Company. Ezrasons suffered a loss of insured goods exceeding $600,000 due to a fire at a warehouse owned by Chamad Warehouse, Inc., in Marion, North Carolina. Travelers paid $250,000, but declined to pay more, asserting that the policy's coverage was limited to $250,000 because the warehouse where the goods were destroyed was not an "Approved Location" under the policy. The district court ruled in favor of Travelers, finding that the warehouse was unambiguously not an "Approved Location" under the policy.On appeal, the Second Circuit Court found that the policy was ambiguous as to whether the warehouse where the destruction occurred was an "Approved Location." It further held that the district court erroneously excluded admissible evidence by which Ezrasons sought to prove that the warehouse was an "Approved Location." As the extrinsic evidence did not provide a basis for favoring either possible meaning of "Approved Location," the ambiguity should be resolved in favor of Ezrasons under New York law. Accordingly, the judgment was vacated and the case remanded with instructions to enter judgment in favor of Ezrasons. View "Ezrasons, Inc. v. Travelers Indemnity Co." on Justia Law

In this case, the Supreme Court of North Carolina was asked to determine whether defendant Cassie Herring, who was injured in a car accident, qualifies for benefits under the underinsured motorist (UIM) coverage of her mother and stepfather's automobile insurance policy. The policy defined an "insured" to include any "family member" who is a resident of the named insured’s household. The question was whether Herring was a "resident" of her mother's household.Herring was injured while riding in a car with her father, and the driver of the other car was insured. The other driver's insurance company tendered the limit of its policy to Herring. Herring then sought additional coverage under the UIM provision of her mother and stepfather's policy. The insurer, North Carolina Farm Bureau Mutual Insurance Company (Farm Bureau), filed a declaratory judgment action, claiming that Herring was not a resident of her mother’s household and thus did not qualify for the UIM benefits.The trial court granted summary judgment for Herring and her parents, and the Court of Appeals affirmed. Farm Bureau appealed to the Supreme Court of North Carolina, arguing that there were genuine issues of material fact about Herring’s residency.The Supreme Court of North Carolina agreed with Farm Bureau and reversed the decision of the Court of Appeals. The court held that the evidence, when viewed in the light most favorable to Farm Bureau, raised genuine issues of material fact as to whether Herring was a resident of her mother's household at the time of the accident. The court noted that there were discrepancies between Herring's testimony and the affidavits submitted by her and her parents, which created credibility issues that should be resolved by a jury. Therefore, the court concluded that summary judgment was not appropriate, and the case was remanded for further proceedings. View "N.C. Farm Bureau Mut. Ins. Co. v. Herring" on Justia Law

In this case, a joint venture between Watershed Ventures, LLC and Patrick M. McGrath failed, leading to bankruptcy and litigation. McGrath and two investment vehicles he controlled sought coverage from Watershed's insurer, Scottsdale Insurance Company, under a directors and officers liability policy. Scottsdale denied coverage and sought a declaratory judgment as to its coverage obligations. McGrath countered with claims against Scottsdale and third-party claims against Watershed. The district court issued two summary judgment decisions. The first ruled that McGrath is an insured under the policy, while the second dismissed one of McGrath's counterclaims. The parties agreed to a "Stipulated Conditional Final Judgment Subject to Reservation of Rights of Appeal," which would become void if either of the district court’s two summary judgment rulings were partly vacated or reversed on appeal. The parties appealed, but the U.S. Court of Appeals for the Second Circuit dismissed both Scottsdale's appeal and McGrath's cross-appeal for lack of appellate jurisdiction, concluding that the Stipulated Conditional Final Judgment was not a "final decision" under 28 U.S.C. § 1291. The court reasoned that the Stipulated Conditional Final Judgment did not resolve all claims of all parties, was not entered under Federal Rule of Civil Procedure 54(b), and did not finally resolve whether Scottsdale breached its duty to defend under the policy. View "Scottsdale Ins. Co. v. McGrath" on Justia Law

In this case before the Supreme Court of Pennsylvania, Joseph Tambellini, Inc. and HTR Restaurants, Inc., along with other businesses, had their business interruption insurance claims related to the COVID-19 pandemic denied by their insurer, Erie Insurance Exchange. The businesses had sued Erie in various courts across Pennsylvania. Due to the factual and legal overlap among these claims, the businesses moved for all state-wide litigation to be coordinated in Allegheny County for all pre-trial and trial purposes under Rule of Civil Procedure 213.1.Erie appealed to the Superior Court, which affirmed in part and reversed in part. According to the Superior Court, the trial court exceeded the authority of Rule 213.1 by ordering the coordination of similar actions against Erie that had not yet been filed. The Superior Court further held that the businesses were parties who were empowered by Rule 213.1 to file the motion for coordination.Upon the parties’ cross-appeals, the Supreme Court of Pennsylvania granted review of both holdings. The Supreme Court of Pennsylvania agreed with the Superior Court that the trial court lacked authority to coordinate actions that had not yet been filed. Furthermore, the Supreme Court found that Erie had waived any argument that the businesses could not seek coordination when it failed to raise this issue in the trial court. Therefore, the Supreme Court affirmed the Superior Court’s order. View "Tambellini v. Erie Insurance" on Justia Law

In a dispute arising from insurance coverage for business interruption losses during the COVID-19 pandemic in the Supreme Court of Pennsylvania, various businesses, including Joseph Tambellini, Inc. and HTR Restaurants, Inc., had sued their insurer, Erie Insurance Exchange, for denial of their claims. The businesses moved for the coordination of all state-wide litigation, including future filings, in Allegheny County under Rule 213.1 of the Pennsylvania Rules of Civil Procedure, which allows for the coordination of actions in different counties that involve a common question of law or fact. The motion was granted by the trial court, but on appeal, the Superior Court held that the trial court exceeded the authority of Rule 213.1 by ordering the coordination of similar actions against Erie that had not yet been filed.On further appeal, the Supreme Court of Pennsylvania agreed with the Superior Court. The court found that the term "pending" in Rule 213.1 clearly refers to cases that have already been filed, and does not include cases that are imminent or impending. The court further noted that Erie had waived the argument that the plaintiffs were not entitled to seek coordination as it had not raised this issue in the trial court. The Superior Court's order was affirmed, holding that Rule 213.1 does not permit the coordination of actions that have not been filed at the time of the coordination motion and Erie had waived its argument that the plaintiffs were not entitled to seek coordination. View "HTR Restaurants v. Erie Insurance" on Justia Law

Brian Smith, a Rhode Island resident, sued Prudential Insurance Company of America for breach of fiduciary duty after the company terminated his long-term disability benefits under an insurance policy. The policy stated a three-year limitations period to file a lawsuit, which began on the date Smith was required to submit proof of his disability, not on the date Prudential allegedly breached the policy by stopping payment. Consequently, by the time Smith filed his lawsuit, the limitations period had expired. Smith appealed to the United States Court of Appeals for the First Circuit after the United States District Court for the District of Rhode Island granted summary judgment in favor of Prudential on the grounds that Smith's lawsuit was filed too late.Smith argued that enforcing the limitations scheme would violate Rhode Island public policy. While the Court of Appeals found compelling reasons to believe that the limitations scheme might indeed contravene Rhode Island public policy, they also recognized that reversing and remanding on that ground would potentially expand Rhode Island law. Consequently, the Court of Appeals decided to certify the public policy question to the Rhode Island Supreme Court. The certified question is whether, in light of specific state laws and Rhode Island public policy, Rhode Island would enforce the limitations scheme in this case to bar Smith's lawsuit against Prudential. View "Smith v. Prudential Insurance Company of America" on Justia Law

The First Circuit reversed the order of the district court dismissing this case at the pleading stage for lack of standing, holding that Malcom Wiener had Article III standing to sue Defendants, MIB Group, Inc. and its executive vice president, based on additional attorney's fees and costs Wiener insured to respond to Defendants' actions in a separate lawsuit.In 2018, Wiener sued AXA Equitable Life Insurance Company, his former life insurance company, for negligence. After the jury returned a verdict in favor of Wiener the district court granted AXA's motion to dismiss for lack of subject matter jurisdiction. The court of appeals reversed the decision granting AXA's motion to dismiss. Meanwhile, Wiener brought this suit against Defendants, alleging that he incurred out-of-pocket loss in the form of attorney's fees and costs and to respond to Defendants' actions in the related lawsuit. The district court dismissed the action, concluding that Wiener lacked Article III standing. The First Circuit reversed, holding that a past, out-of-pocket loss is a basis for Article III standing, and therefore, Wiener had standing to bring this suit. View "Wiener v. MIB Group, Inc." on Justia Law

The Eleventh Circuit certified the following two questions to the Florida Supreme Court:(1) does Fla. Stat. § 559.921(1) grant an insurance company a cause of action when a repair shop does not provide any written repair estimate?(2) Do the violations here under the repair act void a repair invoice for completed windshield repairs and preclude a repair shop from being paid any of its invoiced amounts by an insurance company? View "Government Employees Insurance Company, et al v. Glassco, Inc., et al" on Justia Law

Medical providers sued insurance company to enforce their perfected medical liens for professional services rendered to a person injured in a car accident. Insurance company disputed the: (1) reasonableness of the charges; and (2) necessity of the services. The providers argued the insurance company had no legal standing to dispute these issues, absent an assignment from the injured party. Although Insurance company prepared the "Release" with the injured person, it failed to include such an assignment. Insurance company argued that in spite of this omission, there was an "implied" assignment from the injured party as evidenced by precontract settlement discussions. The trial court ruled that there was no assignment in the executed written release and that insurance company was barred by the Parol Evidence Rule from presenting evidence to establish an implied assignment. The Oklahoma Court of Civil Appeals reversed the trial court holding that summary judgment was not proper when there was a question of fact surrounding the issue of an assignment. The Oklahoma Supreme Court found there was no assignment in the executed release and there was no question of fact on material issues. Without evidence of fraud, the Court found precontract negotiations and all discussions were merged into and superseded by the terms of an executed written release. The decision of the Court of Civil Appeals was vacated; and this matter was remanded to the trial court for proceedings. View "Accident Care & Treatment Center v. CSAA General Insurance Co." on Justia Law