Justia Insurance Law Opinion Summaries

Lesley and Fogg presented the Benistar 419 Plan to the Ouwingas, their accountant, and their attorney, providing a legal opinion that contributions were tax-deductible and that the Ouwingas could take money out tax-free. The Ouwingas made substantial contributions, which were used to purchase John Hancock life insurance policies. In 2003, Lesley and Fogg told the Ouwingas that the IRS had changed the rules; that the Ouwingas would need to contribute additional money; and that, while this might signal closing of the “loophole,” there was no concern about tax benefits already claimed. In 2006, the Ouwingas decided to transfer out of the Plans. John Hancock again advised that there would be no taxable consequences and that the Plan met IRS requirements for tax deductible treatment. The Ouwingas signed a purported liability release. In 2008, the IRS notified the Ouwingas that it was disallowing deductions, deeming the Plan an “abusive tax shelter.” The Ouwingas filed a class action against Benistar Defendants, John Hancock entities, lawyers, Lesley, and Fogg, alleging conspiracy to defraud (RICO, 18 U.S.C. 1962(c), (d)), negligent misrepresentation, fraudulent misrepresentation, unjust enrichment, breach of fiduciary duty, breach of contract, and violations of consumer protection laws. The district court dismissed. The Sixth Circuit reversed, View "Ouwinga v. Benistar 419 Plan Servs., Inc." on Justia Law

This case arose from claims asserted by multiple persons against Blue Cross and Blue Shield of Montana (BCBSMT) and Montana Comprehensive Health Association (MCHA). Claimants asserted that while they were fully insured by BCBSMT or MCHA, they submitted claims that the insurers denied based upon exclusions contained in their insurance policies. These exclusions were subsequently disapproved by the Montana Commissioner of Insurance (Commissioner) and the insureds sought the previously-denied benefits. The matter evolved into a class action and three of the claimants, Krista Lucas, Brittany Smith, and Alice Speare, were named class representatives. Subsequently, a settlement was negotiated. Three other claimants, Tyson Pallister, Kevin Budd and Jessica Normandeau, objected to the settlement and sought review by the Second Judicial District Court. The District Court approved the settlement. Pallister, Budd and Normandeau appealed asserting numerous errors by the District Court including but not limited to the court’s error in denying Pallister’s motion to conduct discovery. Upon review, the Supreme Court reversed and remanded on a discrete issue of discovery and vacated the District Court’s approval of the Settlement Agreement. View "Pallister et al v. Blue Cross & Blue Shield of Montana" on Justia Law

Policyholders claimed that their insurers incorrectly taxed their premiums as a result of the insurers’ failure to correctly identify the taxing jurisdiction in which the insured risks of each policyholder were located. Kentucky authorizes local governments to tax insurance premiums, Ky. Rev. Stat. Ann. 91A.080, and to charge a “reasonable collection fee. Insurers pass the tax on to the insureds along with the collection fee. Plaintiffs’ claims were narrowed to illegal dealing in premiums, negligence, conversion, and a declaration of rights; they sought refunds and injunctive and declarative relief. After rejecting an argument that it lacked jurisdiction because Kentucky law allowed an administrative remedy, the district court bifurcated class certification discovery from merits-based discovery, then subdivided plaintiffs into 10 subclasses, one for each insurer, and severed the subclasses into separate actions. The district court found the class ascertainable and administratively feasible, the Rule 23(a) prerequisites (numerosity, commonality, typicality and adequacy of representation) met, and the Rule 23(b)(3) requirements (that class litigation is superior and common questions predominate over individuals ones) satisfied. After settlements, only five appeals remained. The Sixth Circuit affirmed. View "Dyas v. State Farm Fire & Cas. Ins." on Justia Law

Alleging that Appellant Conestoga Title Insurance Company charged more for title insurance than its filed rates permitted, Appellee Nancy A. White asserted three claims against Conestoga in a class action complaint. The Supreme Court granted review to consider whether White was precluded from pursuing all of her claims because Article VII of the Insurance Department Act of 1921 provided her with an exclusive administrative remedy under Section 1504 of the Statutory Construction Act of 1972. Upon review, the Supreme Court reversed in part and affirm in part. Specifically, the Court reversed the Superior Court's order reversing the trial court's dismissal of White's common law claims for money had and received and for unjust enrichment, and the Court affirmed (albeit on different grounds) the Superior Court's order reversing the trial court's dismissal of White's statutory claim brought under Pennsylvania's Unfair Trade Practices and Consumer Protection Law. View "White v. Conestoga Title Insurance Co." on Justia Law

This was an interlocutory appeal from the district court's grant of class certification in a case involving allegations that the defendant title insurance company charged premiums for title policies that exceeded the refinance rates set by the Texas Department of Insurance in Tex. Ins. Code Rate Rule R-8. The Fifth Circuit Court of Appeals reversed the district court's grant of class certification and remanded for further proceedings, holding that the district court abused its discretion in finding that the requirements of Fed. R. Civ. P. 23(a)(2) were satisfied, as none of the four questions identified by the district court was actually common to the class and common questions would not predominate at trial. View "Ahmad v. Old Republic Nat'l Title Ins. Co." on Justia Law

In this putative class action, Plaintiffs were doctors of chiropractic who alleged they had been victimized by the discriminatory practices of Iowa's largest health insurer, Wellmark, Inc. The district court (1) granted Wellmark's motion to dismiss claims brought under Iowa's insurance regulatory statutes because no private cause of action was provided therein; (2) granted Wellmark's motion for summary judgment on Plaintiffs' antitrust claims based on the "state action" exemption found in Iowa Code 553.6(4); (3) granted summary judgment on claims alleging Wellmark breached its obligations under a judicially approved national class action settlement in Love v. Blue Cross Blue Shield Ass'n; and (4) granted summary judgment on several specific antitrust claims. The Supreme Court (1) reversed in part, holding that the district court erred in granting summary judgment on Plaintiffs' antitrust claims based on the state action exemption, as the record failed to establish the challenged conduct fell within the exemption; and (2) otherwise affirmed. Remanded. View "Mueller v. Wellmark, Inc." on Justia Law

Travelers sought a declaratory judgment that they had no duty to defend their insured, Rogan Shoes, in an Illinois state court class action for violations of the federal Fair and Accurate Credit Transactions Act, 15 U.S.C. 1681c(g), which prohibits businesses from including on sales receipts the expiration date or more than the last five digits of the purchaser’s credit or debit card and authorizes damages of up to $1,000 per unlawful receipt. The suit sought statutory damages of $387 million. Rogan settled for $16 million; the settlement specified that the judgment would be satisfied only through proceeds from Travelers’ policies, with the exception of $50,000 to cover legal costs. Rogan assigned its claims and rights to payments under the policies. The state court approved the settlement. A state court citation to discover assets was served on Travelers’ agent. The district court dismissed the declaratory judgment action on the ground that parallel state proceedings were pending. The Seventh Circuit affirmed, finding that the case did not satisfy the amount-in-controversy requirement for diversity jurisdiction, 28 U.S.C. 1332(a), because Rogan had assigned its interests in its policies to class members, none of whom individually claim a share of more than $75,000. View "Travelers Prop. Cas. & Travelers Indem. Co. v. Good" on Justia Law

Plaintiffs sought to recover on behalf of themselves and similarly-situated employees and retirees of the City of Cincinnati the current value of the 870,021 shares of Anthem stock that the City received from Anthem’s demutualization. Plaintiffs asserted eight claims for breach of contract and four tort claims against Anthem and three breach of contract claims and four tort claims against the City. The district court certified the class: 2,536 people named as insureds, or former members of a group of insured persons, covered under a health care group policy from June 18 through November 2, 2001. The class included “Class A” members, who had an insurance policy with Anthem prior to its merger with Community in 1995 and “Class B” members who received a health insurance group policy after the merger. The court later dismissed. The Sixth Circuit, exercising jurisdiction under the Class Action Fairness Act of 2005, 28 U.S.C. 1332(d), affirmed. Plaintiffs cannot recover any demutualization compensation; the City was the policyholder before the merger and maintained its policyholder rights post-merger through a grandfather clause, including any rights to demutualization proceeds. The 2001 demutualization process did not disrupt the City’s membership interests or confer any equity rights to Plaintiffs. View "Mell v. Anthem, Inc." on Justia Law

Plaintiff-Appellee Larry Frederick brought a putative class action suit against Hartford Underwriters Insurance Company (Hartford) in Colorado state court; Hartford removed the case to federal court. Looking to the face of Plaintiff’s complaint, the district court concluded that the amount in controversy did not exceed $5,000,000 (which was required for federal jurisdiction under the Class Action Fairness Act (CAFA)). Accordingly, the district court remanded the case to state court. In reaching its decision, the district court acknowledged that the Tenth Circuit had not defined the burden a defendant must carry to prevent a remand in a CAFA suit. Faced with this question, the Tenth Circuit held that a defendant in these circumstances is entitled to present his own estimate of the amount at stake and must show by a preponderance of the evidence that the amount in controversy exceeds the amount in 28 U.S.C. 1332(d)(2) (currently $5,000,000). The Court emphasized that the preponderance standard applies to punitive damages as well, and that such damages cannot be assumed when calculating the amount in controversy. Accordingly, the Court reversed the district court and remanded the case for further proceedings. View "Frederick v. Hartford" on Justia Law

OneBeacon and AMICO were insurers of the B.F. Goodrich and, among others, were liable for environmental cleanup at the Goodrich plant in Calvert City, Kentucky. AMICO settled with Goodrich, but OneBeacon’s predecessor went to trial. A state court jury found for Goodrich, and OneBeacon was ordered to pay $42 million in compensatory damages and $12 million in attorney fees. The state court also denied OneBeacon's request for settlement credits to reflect amounts paid by other insurers, such as AMICO, through settlements with Goodrich. OneBeacon sought equitable contribution; AMICO removed to federal court. The district court granted AMICO summary judgment. The Sixth Circuit affirmed. Ohio policy favoring settlements provides that a settled policy is exhausted for purposes of equitable contribution; the court declined to address whether Ohio law permits interclass contribution actions or whether the jury finding of bad faith bars equitable relief.