Justia Insurance Law Opinion Summaries

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.

The company and its affiliates filed for Chapter 11 bankruptcy and sought to resolve asbestos-related liability through the creation of a personal-injury trust under 11 U.S.C. 524(g). As part of its reorganization plan, it sought to transfer rights under insurance liability policies to the trust. The Insurers had provided liability policies to the debtors prior to bankruptcy and objected that the transfer violated the policies' anti-assignment provisions. The bankruptcy and district courts held that 11 U.S.C. 1123(a)(5)(B) preempts those provisions. The Third Circuit affirmed. Section 524 trusts are the only national statutory scheme available to resolve asbestos litigation through a quasi-administrative process. The plain language of 11 U.S.C. 1123(a) evinces clear intent for a preemptive scope that includes transfer of property to a 524 trust; that preemption reaches private contracts enforced by state common law.

The attorney represented more than 400 plaintiffs in a class action related to the diet drug Fen-Phen. Lawyers’ fees were to be limited to 30 percent of the clients' gross recovery. The case settled for almost $200 million. Plaintiffs together received $74 million, 37 percent of the settlement; $20 million was used to establish Kentucky Fund for Healthy Living. The attorney served on the Fund’s board, for which he received $5,350 monthly. The attorney knew that the Kentucky Bar Association was investigating fee division in the case and possible unauthorized practice of law by his paralegal. The attorney subsequently applied to renew his malpractice insurance and answered "no" to questions about possible pending claims and investigations. The policy excluded coverage for dishonest acts and omissions. Members of the class subsequently filed malpractice claims and were awarded $42 million. The insurer sought a declaration that it was entitled to rescind the policy. The district court granted the insurer summary judgment and awarded $233,674.49 for its outlay on defense costs. Class members intervened to protect their ability to recover. The Sixth Circuit affirmed. Disbarment constituted a sufficient "regulatory ruling" under the dishonesty exclusion clause and there were material misrepresentations on the application.

Plaintiff, a class representative, appealed the district court's dismissal of her complaint for failure to state a claim and its order denying her motion for reconsideration. Plaintiff argued that examinations under oath (EUOs) were impermissible conditions precedent to personal injury protection (PIP) coverage under Florida law and the Florida No-Fault automobile insurance statute based on the Florida Supreme Court's decision in Custer Med. Ctr. v. United Auto. Ins. Co. As a result of varying interpretations of Custer in the lower Florida state courts, the court concluded that Florida law was unclear in the context of statutorily mandated insurance and the Florida No-Fault Statute and certified this question to the Florida Supreme Court.

Main & Associates, Inc., d/b/a Southern Springs Healthcare Facility, filed an action in the Bullock Circuit Court, on behalf of itself and a putative class of Alabama nursing homes, against Blue Cross and Blue Shield of Alabama (BCBS), asserting claims of breach of contract, intentional interference with business relations, negligence and/or wantonness, and unjust enrichment and seeking injunctive relief. BCBS removed the case to the the federal court, arguing among other things, that Southern Springs' claims arose under the Medicare Act and that the Medicare Act, as amended by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the MMA) completely preempted Southern Springs' state-law claims. Southern Springs moved the federal court to remand the case to the circuit court, arguing that the federal court did not have jurisdiction over its claims. The federal court granted the motion and remanded the case to the Bullock Circuit Court. After remand, BCBS moved the circuit court for a judgment on the pleadings, arguing that Southern Springs had not exhausted its administrative remedies and that the circuit court did not have subject-matter jurisdiction over the case. The circuit court denied BCBS's motion, and BCBS petitioned the Supreme Court for a writ of mandamus to direct the circuit court to dismiss Southern Springs' claims. Upon review, the Court concluded that Southern Springs' claims were inextricably intertwined with claims for coverage and benefits under the Medicare Act and that they were subject to the Act's mandatory administrative procedures and limited judicial review. Southern Springs did not exhaust its administrative remedies, and the circuit court did not have jurisdiction over its claims. Therefore, the Court granted BCBS's petition and issue a writ of mandamus directing the circuit court to dismiss the claims against BCBS.

Plaintiff filed a class-action lawsuit against the insurance company, claiming breach of contract because the company began interpreting the "actual charges" provision of his cancer-insurance policy to mean the charges that the medical provider accepts as full payment from the primary insurer and the insured. Plaintiff claims that the policy entitles him to be paid the higher "list prices" that appear on his hospital bills before the primary insurer negotiates a lower rate. The company made payments to the insured, not directly to hospitals. The district court certified the class and issued a preliminary injunction, requiring the company to pay plaintiff according to his interpretation. Meanwhile, an Arkansas state court certified a nearly identical class, and the Arkansas Supreme Court affirmed a settlement in that action. The Sixth Circuit vacated class certification, based on the intervening Arkansas case. The court dismissed appeal of the injunction for lack of jurisdiction because was not a decision on the merits.

Insureds, Minnesota residents, filed class action complaints against their automobile insurers alleging violations of a Minnesota statute, Minn. Stat. 65B.285, requiring insurers to provide a discount for cars which have antitheft devices and breach of contract claims based on the failure to apply the statutory discount. The court affirmed the district court's dismissal of the insureds' amended complaints, rejecting their attempts here, particularly in the absence of any indication that Minnesota's administrative remedies were inadequate, to circumvent Minnesota's administrative remedies in order to create a private right of action.