Justia Insurance Law Opinion Summaries

Bridgeview Health Care Center filed a class action complaint against Clark, an Illinois resident who operates Affordable Digital Hearing, a sole proprietorship out of Terre Haute, Indiana. Bridgeview alleged that Clark sent Bridgeview and others unsolicited faxes and claimed violation of the Telephone Consumer Protection Act of 1991, 47 U.S.C. 227; common law conversion of its fax paper and toner; and violation of the Consumer Fraud and Deceptive Business Practices Act, 815 ILCS 505/2. Clark had a comprehensive general liability policy issued by State Farm, an Illinois corporation. The policy was purchased through an Indiana agent and issued to Clark’s Indiana business address. State Farm sought declaratory judgment that it had no duty to defend in Indiana state court. The action was dismissed for lack of personal jurisdiction over Bridgeview. Bridgeview sought a declaration, in Illinois state court that State Farm had a duty to defend and indemnify Clark under the advertising injury and property damage provisions of the policy. State Farm argued that Illinois law conflicts with Indiana law on coverage issues and that Indiana law should apply. The circuit court found that there was no conflict and no need to conduct a choice-of-law analysis. The appellate court reversed, finding that decisions cited by State Farm were sufficient to raise the possibility of a conflict, requiring a choice-of-law analysis The Illinois Supreme Court reversed, finding that State Farm failed to meet its burden of demonstrating that an actual conflict exists between Illinois and Indiana law.View "Bridgeview Health Care Ctr., Ltd. v. State Farm Fire & Cas. Co." on Justia Law

Plaintiffs challenged an insurance company's use of "retained asset accounts" (RAAs) as a method of paying life insurance benefits in the ERISA context. They presented the district court with two basic questions: (1) whether the insurer's method of paying death benefits in the form of RAAs constitute self-dealing in plan assets in violation of ERISA section 406(b); and (2) whether this redemption method offended the insurer's duty of loyalty toward the class of beneficiaries in violation of ERISA section 404(a). The district court answered the first question in favor of the insurer and the second in favor of the plaintiff class. The court then awarded class-wide relief totaling more than $12,000,000. Both sides appealed. Upon review, the First Circuit Court of Appeals agreed with the district court that the insurer's use of RAAs in this case did not constitute self-dealing in plan assets. However, the Court disagreed with the district court's answer to the second question and held that the insurer's use of RAAs did not breach any duty of loyalty owed by the insurer to the plaintiff class. View "Merrimon, et al v. Unum Life Insurance Company" on Justia Law

Nationwide Retirement Solutions, Inc. ("NRS"), appealed a circuit court judgment awarding PEBCO,Inc. over a million dollars in attorney fees and $29,132.01 in expenses. In 2007, participants in the State of Alabama Public Employees Deferred Compensation Plan filed a class action against Nationwide Life Insurance Company ("NL"), NRS, the Alabama State Employees Association ("ASEA"), and PEBCO, Inc., alleging breach of fiduciary duty, conversion, and breach of contract in the administration of the Plan. The parties filed a "Stipulation of Settlement," which the trial court approved in its final order entered in 2011. Pursuant to the settlement, NL and NRS paid $15.5 million to the participants in the Plan and $2.9 million in attorney fees to settle class claims against all defendants, including ASEA and PEBCO. In its findings of fact, the trial court stated: "ASEA is being permitted to retain more than $12 million in sponsorship payments that it allegedly received unlawfully, and ASEA is receiving full release from any liability." A day before the parties filed their "Stipulation of Settlement," Nationwide moved for an order barring ASEA and PEBCO from filing any indemnification claims. The trial court granted the order except for claims for attorney fees and costs. "[I]n light of Nationwide's substantial contributions to the settlement," the court wrote that it was "fair and reasonable that ASEA and PEBCO be barred from pursuing any claims against Nationwide for reimbursement, indemnification, or contribution other than claims for attorney fees and costs ...." A month before entering its final order in the class action, the trial court ordered severance of ASEA and PEBCO's claim for fees and directed the Circuit Court clerk to docket that claim as "a separate and independent action," with ASEA and PEBCO as plaintiffs and NL and NRS as defendants. The trial court found that the indemnification clause in the agreement required that NRS pay the fees and costs incurred by ASEA and PEBCO in defending the class action. Noting that NRS "has contended, and still contends, that indemnification is improper based on the language of the agreement and the attending facts," the trial court stated that it "has held hearings on that issue and by prior order has ruled that indemnification is appropriate. The instant action was filed to enforce indemnification." The court ordered NRS to pay PEBCO $863,988.50 in attorney fees and $15,297.54 in expenses for the class-action litigation, and $210,039 in attorney fees and $13,834.47 in expenses for litigating the severed cross-claim. NRS timely appealed that decision to the Supreme Court. The Supreme Court reversed and remanded: "[b]ecause NRS did not fail to perform those duties under the agreement that ultimately gave rise to the class action, it did not, as a matter of law, breach the indemnification clause in the agreement. . . . Alabama does not permit a party to seek indemnification for defending against its own allegedly wrongful acts." View "Nationwide Retirement Solutions, Inc. v. PEBCO,Inc. " on Justia Law

The State filed a class action suit against several insurers to recover on the homeowner insurance policies purchased by individual Louisiana citizens but assigned by the respective policy holders to the State in return for State financial assistance in repairing and rebuilding their homes in the wake of the hurricanes. Defendants removed to federal court. The State eventually dropped its class allegations and severed this individual action from the original class action case. At issue was whether there was federal jurisdiction over these individual cases, once part of the Class Action Fairness Act (CAFA), 28 U.S.C. 1332(d)(2), class action. The court held that the general rule regarding federal jurisdiction over a removed case controlled; jurisdictional facts were determined at the time of removal, not by subsequent events; because at the time of removal CAFA supplied federal subject matter jurisdiction over these cases, the court held that CAFA continued to provide jurisdiction over these individual cases notwithstanding their severance from the class. View "State of Louisiana v. American National Property and Casualty Co., et al." on Justia Law

Plaintiff was injured in an accident while driving a business vehicle owned by Mattress King, Inc. and insured by Mountain West Farm Bureau. Plaintiff, whose personal vehicles were insured by Safeco Insurance Company of Illinois, filed a claim with Safeco for medical payment benefits. Plaintiff received medical payment benefits from Safeco and an undisclosed amount of underinsured motorist benefits from Mountain West. Believing Safeco wrongfully refused to pay additional claimed benefits, Plaintiff brought a class action suit against Safeco. The district court ultimately ruled in favor of Safeco. The Supreme Court affirmed, holding that the “other insurance” clauses in Plaintiff’s automobile liability policy were valid and, as applied in this case, did not constitute de facto subrogation. View "Scheafer v. Safeco Ins. Co. of Ill." on Justia Law

Plaintiff was involved in a motor vehicle accident caused by another driver. As a result of the accident, Plaintiff sustained both bodily injury and property damage. Plaintiff carried an automobile insurance policy through United Services Automobile Association General Indemnity Company (USAA). USAA paid vehicle repair and car rental costs, after which it sought subrogation for the property damage expenses from the tortfeasor’s automobile liability insurer. Plaintiff subsequently filed an action on behalf of himself and a putative class of plaintiffs, alleging that USAA violated Montana law by seeking subrogation for property damage loss before its insured had been made whole with respect to related personal injuries. The U.S. district court certified a question to the Montana Supreme Court, which answered by holding that Montana law does not prohibit an insurer from exercising its right of subrogation under the limited, specific circumstances presented in the certified question. View "Orden v. United Servs. Auto. Ass'n" on Justia Law

Wellness filed a putative class action in state court seeking a declaration that the form language Allstate used in the class members' personal injury protection insurance policies did not clearly and unambiguously indicate that payments would be limited to the levels provided for in Fla. Stat. 627.736(5)(a). The district court subsequently granted Wellness' motion to remand, concluding that the value of the declaratory relief was too speculative for purposes of satisfying the Class Action Fairness Act's (CAFA), 28 U.S.C. 1332(d)(2), amount-in-controversy requirement because Allstate had failed to show that declaratory judgment in this case necessarily triggered a flow of money to plaintiffs. The court concluded, however, that Allstate had carried its burden of establishing an amount in controversy that exceeded $5 million and Wellness did not provide any evidence to rebut Allstate's affidavit or controvert its calculations. Here, the amount that would be put at issue is the amount that the putative class members could be eligible to recover from Allstate in the event that they obtain declaratory relief. Accordingly, the court reversed and remanded. View "South Florida Wellness, Inc. v. Allstate Ins. Co." on Justia Law

Plaintiff was injured in an automobile accident. Group Health Plan, Inc. (GHP) paid Plaintiff’s medical bills. Plaintiff subsequently recovered a personal injury settlement from the tortfeasor. GHP, through its agent, ACS Recovery Services, Inc. (ACS), asserted a lien against Plaintiff’s settlement, seeking reimbursement or subrogation for its payment of Plaintiff’s medical bills. Plaintiff filed a class action petition against GHP asserting several claims based on the premise that Missouri law does not permit the subrogation of tort claims. ACS intervened. The trial court entered summary judgment for GHP and ACS, concluding that the Federal Employee Health Benefits Act (FEHBA) preempts Missouri’s anti-subrogation law. The Supreme Court reversed, holding that FEHBA does not preempt Missouri law barring subrogation of personal injury claims. Remanded. View "Nevils v. Group Health Plan, Inc." on Justia Law

Steve Sangwin, a State employee, was a qualified subscriber and beneficiary of the State of Montana Employee Benefits Plan (Plan), which was administered by Blue Cross and Blue Shield of Montana (BCBS). Steve's daughter, McKinley, was also a beneficiary under the Plan. This case arose after BCBS denied a preauthorization request for a medical procedure for McKinley on the grounds that the procedure was "experimental for research." Steve and his wife (collectively, the Sangwins) initiated this action by filing an amended complaint setting forth five counts, including a request for certification of a class action. The Sangwins defined class members as other beneficiaries of the Plan who had their employee benefits denied by the State based on the experimental exclusion for research in the past eight years. The district court granted the Sangwins' motion for class certification. The State appealed. The Supreme Court (1) affirmed the district court's order defining the class; but (2) reversed and remanded with respect to the question certified for class treatment, holding that the district court abused its discretion in specifying for class treatment the question of whether the State breached its contract of insurance with the plaintiffs. View "Sangwin v. State" on Justia Law

In 1994, Norem purchased a “Flexible Premium Variable Life Insurance Policy” from Lincoln Benefit. With variable life insurance, part of the premium is allocated to the insurer’s investment funds, called subaccounts. Policyholders may move their investments within the subaccounts and the death benefit, which is guaranteed not to fall below a certain amount. With variable universal life, the policyholder may easily invest and alter insurance coverage. The policy is comprised of the policy value, which represents the investment component, and its net amount at risk, which represents the insurance component. Norem purchased his policy because he wanted both life insurance and an investment vehicle for the proceeds from the sale of his ownership of a medical business. The policy has a “cost of insurance” (COI) charge deducted monthly from the policy. The policy explains how the COI rate is calculated. Norem filed a putative class action on behalf of himself and other similarly situated policyholders, claiming that Lincoln Benefit breached the terms of its policies in its method of calculating the COI rate.Before deciding on class certification, the district court granted summary judgment to Lincoln Benefit, concluding that its calculation of COI rates did not breach the contract. The Seventh Circuit affirmed. View "Norem v. Lincoln Benefit Life Co." on Justia Law