Justia Insurance Law Opinion Summaries

In 2007, the Sonoma County project’s owner sued Hearn, the general contractor, Second Generation, the roofer, and other subcontractors for design and construction defects. Hearn cross-complained against Second Generation and others. In 2009, Hearn assigned its interests under its subcontracts to two insurers, North American and RSUI. Hearn then settled with the owner and all but two subcontractors, one of which was Second Generation. Hearn filed an amended cross-complaint, purportedly in the name of the insurers, against those subcontractors, adding breach of a contractual obligation to obtain insurance and seeking equitable contribution for Hearn’s defense costs premised on a breach of that duty. In 2013, the court dismissed the cross-complaint against Second Generation on procedural grounds, awarded $30,256.79 in costs and granted prevailing party attorney fees of $179,119. Second Generation moved to amend the orders to name North American as a judgment debtor owing the amounts awarded against Hearn. The trial court denied the motion, stating: Hearn remains the only proper party and that the subcontractor’s exclusive remedy was to pursue a separate action against Hearn’s insurers. The court of appeal reversed, finding that, after the assignment, Hearn was “out of this case.” View "Hearn Pac. Corp. v. Second Generation Roofing, Inc." on Justia Law

Cummins installed asbestos containing products in California and had received hundreds of asbestos bodily injury claims, including many lawsuits, based on exposure to its asbestos containing materials. Cummins purchased 19 U.S. Fidelity insurance policies 1969-1987, and purchased four U.S. Fire policies, 1988-1992, for “primary, umbrella, and or excess insurance policies,” some of which “may be missing or only partially documented.” Cummins and its parent company (Holding, formed in 2014) sought a “declaratory judgment that defendants are obligated to defend and/or indemnify Cummins [Corp.], in full, including, without limitation, payment of the cost of investigation, defense, settlement and judgment . . . , for past, present and future Asbestos Suits under each of the Policies triggered by the Asbestos Suits.” The trial court dismissed without leave to amend, finding that Holding lacked standing. The court of appeal affirmed. Holding, the controlling shareholder of Cummins, does not have a contractual relationship with the insurers and is not otherwise interested in the insurance contracts. View "D. Cummins Corp. v. U.S. Fid. & Guar. Co." on Justia Law

Sheldon Hathaway became embroiled in a stranger-originated-life-insurance (STOLI) scheme at the involving his neighbor, Jay Sullivan. Here, Intervenor Defendant-Appellant Windsor Securities, LLC (Windsor) loaned Defendant-Appellant the Sheldon Hathaway Family Trust (the Trust) $200,000 to finance the initial premium on a life insurance policy (the policy) for Hathaway. In exchange, Windsor “receive[d] a moderate return on [its] investment” if a trust repaid the loan. Alternatively, Windsor “foreclose[s] on the life insurance policy that was pledged as collateral” when a trust fails to do so. That’s what happened here. But before Windsor could profit from its investment, Plaintiff-Appellee PHL Variable Insurance Company (PHL) sought to rescind the policy based on alleged misrepresentations in Hathaway’s insurance application. The district court ultimately granted PHL’s motion for summary judgment on its rescission claim, and allowed And it allowed PHL to retain the premiums Windsor already paid. On appeal, Windsor and the Trust (collectively, the defendants) argued the district court erred in granting PHL’s motion for summary judgment because there was at least a genuine dispute of material fact as to whether PHL waived its right to rescind the policy. Alternatively, they argued the district court erred in granting summary judgment because, at a minimum, a genuine dispute of material fact existed as to: (1) whether the application contained a misrepresentation; and (2) whether PHL relied on that misrepresentation in issuing the policy. Finally, even assuming summary judgment was appropriate, defendants argued the district court lacked authority to allow PHL to retain the paid premiums. The Tenth Circuit affirmed, concluding no genuine dispute of material fact existed as to whether PHL waived its right to rescind the policy. Nor was there any genuine dispute of material fact as to whether the application contained a misrepresentation or whether PHL relied on that misrepresentation in issuing the policy. Lastly, the Court held the district court had authority to allow PHL to retain the paid premiums. View "PHL Variable Insurance v. Sheldon Hathaway Family Trust" on Justia Law

In an interlocutory appeal, Pekin Insurance Company challenged the denial of its motion to dismiss for lack of personal jurisdiction. Pekin was an Illinois company not licensed to sell insurance in Mississippi. Pekin asserted it had not entered into a contract with a Mississippi Resident, had not committed a tort in Mississippi and had not done any business in Mississippi-- making in ineligible to be subject to the jurisdiction of Mississippi courts under the Mississippi long-arm statute. The Mississippi Supreme Court, after review of the facts of this case, found that Pekin voluntarily submitted itself to Mississippi's jurisdiction in federal court when it asked that court to resolve the same coverage dispute over which it claimed here that Mississippi courts had no jurisdiction. The Court accordingly affirmed the trial court here in denying Pekin's motion to dismiss, and remanded the case for further proceedings. View "Pekin Insurance Company v. Hinton" on Justia Law

A group of New York-based third party payor health insurers (“TPPs”) that provided prescription drug benefits to union members appealed a Superior Court judgment dismissing with prejudice their second amended complaint. At issue were claims brought by the TPPs under various state consumer fraud laws against AstraZeneca Pharmaceuticals LP, and Zeneca Inc. (collectively “AstraZeneca”). The TPPs alleged that AstraZeneca falsely advertised its more expensive patented prescription drug "Nexium" as superior to the less expensive generic drug "Prilosec," causing the TPPs to overpay for Nexium when generic Prilosec would have sufficed. After conducting an extensive choice of law analysis, the Superior Court determined that New York law controlled the TPPs’ claims. The court then held that the TPPs failed to state a claim under New York’s consumer fraud statute for failure to allege legally sufficient causation. The TPPs appealed, arguing the Superior Court's choice of law analysis was flawed, and that the Superior Court's causation analysis was equally flawed. After a careful review of the record on appeal, the Delaware Supreme Court affirmed the ultimate judgment of the Superior Court, finding it not necessary to discuss whether the Superior Court correctly analyzed the choice of law issue, because under either state consumer fraud statute the TPPs could not recover damages as a matter of law. View "Teamsters Local 237 Welfare Fund, et al. v. AstraZeneca Pharmaceuticals LP" on Justia Law

Stacey and Mark Bent sued USAA for breach of their homeowners’ policy and violations of the Texas Insurance Code. The Bents subsequently stopped making mortgage payments, and their lender foreclosed on their home. The Bents’ case against USAA, however, proceeded to trial. The jury concluded that USAA had not breached the homeowner’s policy but did violate chapter 541 of the Insurance Code. The trial court entered judgment on the jury’s verdict but later granted the Bents’ motion for new trial. The court of appeals conditionally granted a writ of mandamus directing the trial court to vacate its order and render judgment on the jury’s verdict, concluding that the trial court abused its discretion on each of its bases for ordering a new trial. The Bents sought relief in mandamus from the Supreme Court. The Supreme Court denied the Bents’ mandamus petition, holding (1) three of the trial court’s bases for ordering a new trial failed to satisfy the facial requirements set forth in In re Columbia Med. Ctr. of Las Colinas, Subsidiary, L.P. and In re United Scaffolding, Inc.; and (2) on the remaining basis at issue on appeal, the court of appeals correctly found that the record did not support the trial court’s stated rationale. View "In re Bent" on Justia Law

Stacey and Mark Bent sued USAA for breach of their homeowners’ policy and violations of the Texas Insurance Code. The Bents subsequently stopped making mortgage payments, and their lender foreclosed on their home. The Bents’ case against USAA, however, proceeded to trial. The jury concluded that USAA had not breached the homeowner’s policy but did violate chapter 541 of the Insurance Code. The trial court entered judgment on the jury’s verdict but later granted the Bents’ motion for new trial. The court of appeals conditionally granted a writ of mandamus directing the trial court to vacate its order and render judgment on the jury’s verdict, concluding that the trial court abused its discretion on each of its bases for ordering a new trial. The Bents sought relief in mandamus from the Supreme Court. The Supreme Court denied the Bents’ mandamus petition, holding (1) three of the trial court’s bases for ordering a new trial failed to satisfy the facial requirements set forth in In re Columbia Med. Ctr. of Las Colinas, Subsidiary, L.P. and In re United Scaffolding, Inc.; and (2) on the remaining basis at issue on appeal, the court of appeals correctly found that the record did not support the trial court’s stated rationale. View "In re Bent" on Justia Law

Alan Jesperson was injured in a motor vehicle accident when his motorcycle was struck from behind by a vehicle owned by Mary Basha and driven by Matthew Badelalla while Badelalla was making deliveries for Jet’s Pizza. Auto Club Insurance Association (ACIA) was notified of Jesperson’s injuries and that it was the highest-priority no-fault insurer. It began making payments to Jesperson shortly after it received that notice. Jesperson brought an action against Basha, Badelalla, and Jet’s seeking damages for the injuries he had sustained. He later moved to amend his complaint to add a claim against ACIA after it stopped paying him no-fault benefits. The trial court entered a default judgment against Badelalla and Basha, entered an order allowing Jesperson to amend the complaint, and entered an order severing Jesperson’s claims for trial. A jury returned a verdict of no cause of action with regard to Jesperson’s claims against Jet’s. Before trial on the remaining claim, ACIA moved for summary judgment, arguing that Jesperson’s claim against it was barred by the statute of limitations in MCL 500.3145(1). The court agreed that the statute of limitations barred Jesperson’s claim and granted ACIA’s motion for summary disposition. On appeal, the Court of Appeals affirmed, holding that the exception in MCL 500.3145(1) to the one-year limitations period when the insurer has previously made a payment applied only if the insurer has made a payment within one year after the date of the accident. Jesperson appealed, and the Supreme Court reversed. The Supreme Court found that the insurer's payment of no-fault benefits more than a year after the date of the accident satisfied the second exception to the one-year statute of limitations in MCL 500.3145(1). The Court vacated the trial court's order granting summary judgment in favor of the insurer and the case was remanded for further proceedings. View "Jesperson v. Auto Club Insurance Association" on Justia Law

Plaintiff Tenet Healthsystem Desert, Inc. (Hospital) appealed a judgment entered in favor of defendants Blue Cross of California, doing business as Anthem Blue Cross (Blue Cross), Anthem Blue Cross Life and Health Insurance Company (BC Life), and Anthem UM Services, Inc. (Anthem UM). Hospital sued Anthem, as well as Eisenhower Medical Center (Eisenhower) and Keenan & Associates (Keenan), when the defendants refused to pay approximately $1.9 million the cost of medical services that Hospital provided to an insured patient following extensive communications with Anthem over a period of approximately 50 days regarding "authorization" for the services. The defendants ultimately denied coverage for the medical services based on an exclusion in the patient's policy for injuries sustained as a result of having a blood alcohol level over the legal limit. Hospital alleged that Anthem's continuing to "authorize" medical services during the patient's stay at Hospital, even after Anthem was made aware that the patient was admitted with a blood alcohol level far exceeding the legal limit, constituted a misrepresentation as to coverage, on which Hospital relied in providing care to the patient. The trial court determined that the Hospital's third amended complaint (TAC) lacked the necessary specificity to survive a demurrer, and entered judgment for Anthem. The Court of Appeal, however, reversed, concluding the TAC alleged facts with sufficient particularity to overcome a demurrer. The Court therefore reversed and remanded the matter to the trial court for further proceedings. View "Tenet Healthsystem Desert v. Blue Cross of Cal." on Justia Law

Arthur Murdock, then a lieutenant with the Maine State Police, was injured when his cruiser was struck by another vehicle after Martin Thorne indicated that Murdock could turn in front of him into an intersection. Murdock filed a four-count complaint alleging negligence against Castigliola and Thorne and seeking uninsured motorist coverage from the Maine Department of Public Safety (DPS). The superior court granted the motions for summary judgment filed by both DPS and Thorne. Murdock appealed, and DPS cross-appealed. The Supreme Judicial Court dismissed the appeals, holding that the superior court improvidently granted Murdock’s motion to enter final judgment on Murdock’s claims against Thorne and DPS pursuant to Me. R. Civ. P. 54(b)(1). View "Murdock v. Thorne" on Justia Law