Justia Insurance Law Opinion Summaries

Plaintiff Greggory Owings sustained an on-the-job injury, for which he received long-term disability benefits by defendant United of Omaha Life Insurance Company (United), under the terms of a group insurance policy issued by United to Owings’ employer. Owings disagreed with, and attempted without success to administratively challenge, the amount of his disability benefits. He then filed suit against United in Kansas state court, but United removed the action to federal district court, asserting that the federal courts had original jurisdiction over the action because the policy was governed by the Employee Retirement Income Security Act of 1974 (ERISA). The district court ultimately granted summary judgment in favor of United. Owings appealed. The Tenth Circuit concluded after review of this matter that United was arbitrary and capricious in determining the date that Owings became disabled and, in turn, in calculating the amount of his disability benefits. Consequently, the Court reversed the district court’s grant of summary judgment in favor of United and remanded with directions to enter summary judgment in favor of Owings. View "Owings v. United of Omaha Life" on Justia Law

Defendant Travelers Indemnity Company of Connecticut ("Travelers") appealed a circuit court’s denial of its post-judgment motion seeking to set aside judgment entered on a jury verdict in favor of plaintiff Angela Worthington. Worthington was a passenger in a vehicle being driven by her husband. A friend of the Worthingtons and the Worthingtons' two minor children were also passengers in the vehicle. While the Worthingtons' vehicle was stopped at a nonfunctioning traffic light, it was struck in the rear by a vehicle being operated by Camille Thomas. Worthington and the other occupants in her vehicle were injured as a result of the accident. At the time of the accident, the company Worthington's husband owned had a comprehensive insurance policy with Travelers that included uninsured-motorist ("UM") and underinsured-motorist ("UIM") coverage. The Worthingtons sued Thomas and Travelers; the complaint included a UM/UIM claim against Travelers. After review of the claims Travelers made on appeal, the Alabama Supreme Court determined Travelers did not establish that the trial court erred in denying the post-judgment motion, and affirmed. View "Travelers Indemnity Company of Connecticut v. Worthington" on Justia Law

This case arose from a motor vehicle accident in 2012. William Taylor was driving a vehicle owned and insured by Guy's Seed Company (Guy's Seed); Appellant Mark Raymond was a passenger in the vehicle driven by Taylor. Both Raymond and Taylor were employees of Guy's Seed. Appellee American Mercury Insurance Company (Mercury) issued a commercial automobile insurance policy to Guy's Seed which provided uninsured/under-insured motorist (UM) coverage of $1,000,000 per accident. Larry Bedell was an employee of BlueKnight Energy Partners (BlueKnight); BlueKnight carried a $1,000,000 primary automobile liability policy and a $40,000,000 excess liability policy. Bedell was driving an oil tanker truck, owned by BlueKnight, and attempted to turn in front of the Guy's Seed vehicle causing a collision. The collision caused an immediate explosion, which resulted in Taylor's death and Raymond suffering significant permanent injuries. Raymond qualified as insured under Mercury's UM coverage. Raymond filed suit against Defendants, Bedell and BlueKnight. Mercury investigated and offered the UM policy limits to Raymond's and Taylor's representatives, paying $500,000 to each. Mercury then intervened in Raymond’s court case seeking subrogation from Defendants for the $500,000 payment made to Raymond under the UM policy. Raymond disputed Mercury's right to subrogation, but Defendants refused to settle unless the settlement amount was inclusive of Mercury's disputed subrogation claim. An agreement was reached where Raymond settled with Defendants for a confidential amount greater than the primary insurance liability limits but less than the excess policy; Defendants paid Raymond the amount of the settlement minus the $500,000 claimed by Mercury. The disputed $500,000 was to be held until there was an agreement or court order as to who was entitled to the funds. The question presented for the Oklahoma Supreme Court’s review centered on whether Mercury was entitled to subrogation for the $500,000 paid. The Supreme Court determined that contrary to Mercury's claims, Raymond was not receiving a windfall here. “Mercury was paid a premium for UM protection and Raymond recovered an amount not covering all of his damages within the limits of the primary liability policy and the UM policy. Raymond has also recovered an amount from the tort-feasor's other assets that, combined with the liability and UM funds, covered his damages. It would be unjust to permit Mercury to avoid its liability with its claim that the tort-feasor's other assets, that happened to be an excess liability policy, removed Mercury's liability thus denying Raymond from receiving that for which Mercury was paid a premium.” View "Raymond v. Taylor" on Justia Law

Anthony Burke was a child diagnosed with an autism-spectrum disorder. Throughout the first six months of 2010, Anthony and his family were covered by a group health insurance policy (the “Policy”) with Appellant, Independence Blue Cross (“Insurer”), maintained through Anthony’s father, John Burke’s employer. Initially, Anthony received “applied behavioral analysis” (ABA) treatment at home. In August 2009, before an Autism Coverage Law became effective relative to the Burkes’ coverage, the family requested benefits, under the Policy, for ABA services to be provided at the parochial elementary school attended by Anthony. Insurer denied coverage on account of an express place-of-services exclusion in the Policy delineating that services would not be covered if the care was provided in certain locations, including schools. In a motion for judgment on the pleadings, Mr. Burke argued that the place-of-services exclusion in the Policy was nullified, as it pertained to in-school services, by the Autism Coverage Law. The Pennsylvania Supreme Court found that the Pennsylvania Legislature intended to permit only general exclusions that would not substantially undermine the mandatory coverage requirement: “we simply do not believe that the Legislature intended to permit insurers to exclude coverage in the sensory-laden educational environment where children spend large portions of their days, or to require families to litigate the issue of medical necessity discretely in individual cases to secure such location-specific coverage for the treatment.” The Supreme Court affirmed judgment in favor of the Burkes, and that the Policy’s place-of-services exclusion was ineffective under the Autism Recovery Law. View "Burke v. Independence Blue Cross" on Justia Law

In this discretionary appeal, and in a matter of first impression, the Pennsylvania Supreme Court considered the elements of a bad faith insurance claim brought pursuant to Pennsylvania’s bad faith statute, 42 Pa.C.S. section 8371. In 1992, while working for the United States Postal Service (“USPS”) Appellee LeAnn Rancosky purchased a cancer insurance policy as a supplement to her primary employer-based health insurance. The cancer policy was issued by Appellant Conseco Health Insurance Company (“Conseco”). To pay for the policy, Rancosky’s employer automatically deducted bi-weekly payments of $22.00 from her paycheck. The policy contained a waiver-of premium provision, which excused premium payments in the event Rancosky became disabled due to cancer. In 2003, Rancosky was diagnosed with ovarian cancer and underwent surgery and chemotherapy. Though, Rancosky did not return to her job with USPS following her hospital admission, she remained on her employer’s payroll for several months because she had accrued unused vacation and sick days. Consequently, Conseco continued to receive payroll deducted premiums from Rancosky until June 24, 2003, when Rancosky went on disability retirement. Premium payments were made in arrears; the final premium payment extended coverage under her policy to May 24, 2003. Unbeknownst to Rancosky, her physician statement inaccurately specified her date of disability as beginning on April 21, 2003, rather than on February 4, 2003. 5 Believing that the premiums had been waived and that no further premiums were due on the policy because of her disability from cancer, Rancosky’s final premium payment came from her June 24, 2003, payroll-deducted premium. Over the next two years, as Rancosky experienced several recurrences of her cancer, she continued to submit claims to Conseco. Conseco eventually started denying Rancosky’s claims for further benefits based upon her failure to pay premiums. The Supreme Court adopted the two-part test articulated in Terletsky v. Prudential Property & Cas. Ins. Co., 649 A.2d 680 (Pa. Super. 1994) in order for a plaintiff to recover in a bad faith action; proof of an insurance company’s motive of self-interest or ill-will is not a prerequisite to prevailing in a bad faith claim under Section 8371, as was argued by Appellant. The Court affirmed the superior court, which partially vacated the trial court’s judgment and remanded for further proceedings on Appellee’s bad faith claim. View "Rancosky v. Washington National Ins. Co." on Justia Law

Defendant Arch Specialty Insurance Company (Arch) appealed multiple superior court orders granting summary judgment to defendants Triage Staffing, Inc. (Triage), Exeter Hospital, Inc. (Exeter), and American Healthcare Services Association (AHSA) on their petitions for declaratory judgment, and denying Arch’s cross-motion for summary judgment. The court ruled that Arch was required to defend and indemnify Triage, Exeter, and AHSA, pursuant to two insurance policies that Arch issued to Triage, for claims asserted against the defendants by patients of Exeter who contracted Hepatitis C (Exeter Patients). On appeal, Arch argued the trial court erred in finding inapplicable certain exclusions found in the insurance policies and in determining that the claims involved multiple occurrences under the policies. After review, the New Hampshire Supreme Court reversed the superior court’s grant of summary judgment in favor of Triage and Exeter regarding Arch’s duty to defend and indemnify them pursuant to the general liability coverage forms; the Court reversed the trial court’s grant of summary judgment in favor of Exeter regarding Arch’s duty to defend and indemnify it pursuant to the umbrella coverage forms; reversed in part and vacated in part the trial court’s grant of summary judgment in favor of Triage regarding Arch’s duty to defend and indemnify it pursuant to the umbrella coverage forms, and remanded all matters to the trial court for further proceedings. View "Massachusetts Bay Insurance Company v. American Healthcare Services Association" on Justia Law

Hershel Easterling, both individually and as the personal representative of the estate of Charlotte Easterling, appealed the grant of a summary judgment in favor of Progressive Specialty Insurance Company ("Progressive") on his claims seeking uninsured/underinsured-motorist ("UIM") benefits. In December 2014, Hershel and his wife, Charlotte Easterling, were injured when their vehicle was rear-ended by a vehicle driven by Ashley McCartney. In April 2015, the Easterlings sued McCartney, alleging she behaved negligently and/or wantonly at the time of the accident. The Easterlings' complaint also named Progressive, their insurer, as a defendant and included a count seeking to recover UIM benefits from Progressive. The Alabama Supreme Court reversed and remanded for further proceedings, finding that by virtue of her bankruptcy filing, McCartney was not been relieved of legal liability for the harm she caused Hershel; instead, Hershel could prove the merits of his claim but was merely prevented by law from seeking to collect damages from McCartney for that harm even after his legal entitlement to recover those damages has been established. Any injunction against proceeding directly against the debtor, therefore, in no way extends to Hershel's own insurer. The trial court erred in entering a summary judgment in favor of Progressive on Hershel's UIM claim. View "Easterling v. Progressive Specialty Insurance Co." on Justia Law

This case presented for the Washington Supreme Court's review claims of breaches of fiduciary duty and legal malpractice against lawyers hired to defend insureds in a civil action where the insurance company provided the defense. The insureds claimed the lawyers failed to disclose potential conflicts of interest based on long-standing relationships the law firm had with the insurance company in not only accepting cases representing insureds in other civil cases, but also representing the insurance company itself in coverage disputes. The insureds also claimed the attorneys failed to advise them of settlement negotiations, and by taking settlement directions from the insurer. The trial court granted summary judgment in favor of the lawyers, finding the insureds failed to establish an actionable breach. The Court of Appeals affirmed. While the Supreme Court disagreed with portions of the appellate court's analysis, it affirmed the result. View "Arden v. Forsberg & Umlauf, PS" on Justia Law

Pharmacist Joseph McNamara, Jr. appealed the grant of summary judgment in favor of Benchmark Insurance Company ("Benchmark") in Benchmark's indemnity action against McNamara. Benchmark commenced the indemnity action in an effort to recover funds expended to settle a medical-malpractice action brought against Southern Medical, Inc., Benchmark's insured and McNamara's employer. The medical-malpractice action was brought against Southern Medical by Ricky Avant and Kim Avant and was based, at least in part, on the alleged tortious acts and omissions of McNamara. Because the act complained of occurred in January 2010 and Benchmark sued McNamara in February 2014, the Alabama Supreme Court concluded Benchmark's indemnity action was time-barred under section 6-5-482, Ala. Code 1975. Thus, the trial court erred in entering a summary judgment in favor of Benchmark and in denying McNamara's motion for a summary judgment. View "McNamara v. Benchmark Insurance Co." on Justia Law

Defendant Horizon Healthcare Services, Inc., New Jersey’s largest health insurer, maintained a two-tiered provider-hospital system. Plaintiff Saint Peter’s University Hospital, Inc., and plaintiff Capital Health System, Inc. and others, commenced separate lawsuits claiming Horizon treated them unfairly and in a manner that contravened their agreements when they were placed in the less advantageous Tier 2. Plaintiffs assert Horizon’s tiering procedures were pre-fitted or wrongfully adjusted to guarantee selection of certain larger hospitals for the preferential Tier 1. The New Jersey Supreme Court was asked, by way of interlocutory appeal, to settle multiple discovery disputes that arose in the course of the litigation. The Supreme Court concluded the Appellate Division exceeded the limits imposed by the standard of appellate review both by assessing the disputed information’s relevance against the panel’s own disapproving view of the merits and by giving no apparent weight or consideration to the protections afforded by confidentiality orders. Having closely examined the record, the Supreme Court rejected the Appellate Division’s determination that the chancery judges encharged with these matters abused their discretion. It was not an abuse of discretion for the chancery judges to find the information sought was relevant to plaintiffs’ claims that Horizon violated either the network hospital agreements’ contractual terms, or the overarching implied covenant of good faith and fair dealing, when they were relegated to the less desirable Tier 2. View "Capital Health System, Inc. v. Horizon Healthcare Services, Inc." on Justia Law