Justia Insurance Law Opinion Summaries

Plaintiff brought a class action in Louisiana state court on behalf of a class of Louisiana medical providers against three Louisiana defendants, alleging that defendants failed to comply with the preferred provider organization (PPO) notice provisions of Louisiana law. Homeland Insurance Company subsequently appealed the district court's class action to Louisiana state court. Because it concluded that the local controversy exception to the Class Action Fairness Act applied, 28 U.S.C. 1332(d)(4), the court affirmed the judgment of the district court.

Plaintiff sued three defendants in Louisiana state court, alleging that there was an enterprise between all three defendants to misappropriate funds using a Texas bill review company's under-calculation of recommended payments to hospitals. Defendants subsequently appealed the judgment of the district court holding that the local controversy exception to federal court jurisdiction under the Class Action Fairness Act (CAFA), 28 U.S.C. 1332(d), applied to this class action suit filed by plaintiffs and remanding this case to Louisiana state court. The court held that, based on its conclusion that plaintiff failed in its burden to establish that the sole local defendant formed a significant basis of the claims of the potential class, the court vacated the remand order and directed that the case be reinstated on the district court's docket.

Plaintiffs (Insured) filed a class action claiming violations of the Texas Insurance Code, alleging insurance discrimination in the non-standard insurance market, which served lower income individuals and those drivers with less than ideal driving records. Defendants (Insurance Companies) each moved to dismiss the case based on the "local controversy" and "home state" mandatory abstention provisions of the Class Action Fairness Act (CAFA), 28 U.S.C. 1332(d). The court concluded that the underlying case presented questions of Texas state law regarding insurance policies issued for automobiles in the state of Texas by Texas County Mutuals to Texas citizens. The Insured's case did not appear to be national litigation, so the spirit and intent of CAFA were not fulfilled. Therefore, the court held that the district court properly applied the "local controversy" and "home state" mandatory abstention provisions of CAFA diversity jurisdiction.

Timothy Hop's automobile was damaged in an accident with a driver insured by Safeco Insurance Company. In addition to the costs of repair, Hop sought "residual diminished value" (RDV) for his vehicle. When Safeco failed to pay RDV, Hop filed a class action complaint for declaratory relief in the district court, seeking a declaration that Safeco was required to investigate and pay class members, people whose vehicles were damaged by a Safeco insured and who were not paid RDV by Safeco, for RDV of their vehicle. The district court granted Hop's motion for class certification. The Supreme Court reversed, holding that the district court abused its discretion in certifying a class action before Hop had satisfied the statutory requirements to bring an individual third party action against Safeco. Remanded with instructions to dismiss Hop's class action without prejudice.

The district court certified a class action and a proposed class in an action under the Employee Retirement Income Security Act, 29 U.S.C. 1001. The suit claimed that Blue Cross breached its fiduciary duty by imposing and failing to disclose an other-than-group subsidy and that the OTG subsidy violated Mich. Comp. Laws 550.1211(2). The state insurance commissioner took the position that state law allows the assessment and that revenue it generates funds Medigap coverage. The Sixth Circuit reversed, holding that the class action is not the superior method of adjudication (Federal Rule of Civil Procedure 23(b)(3)) and prosecuting separate actions does not present the risk of inconsistent adjudications (FRCP 23(b)(1)(A)). ERISA fiduciary status is a crucial threshold factual issue specific to every class member, requiring the court to make individualized determinations. Resolution of the legality of the subsidy before that determination would also mitigate the state's concerns about stopping collection of the fee. Potential awards at stake would not preclude individual class members from seeking relief and there was no evidence that individual litigation would create a risk of inconsistent adjudications that would establish incompatible standards of conduct for the defendant.

This case arose when an ocean-going tanker collided with a barge that was being towed on the Mississippi River, which resulted in the barge splitting in half and spilling its cargo of oil into the river. Following the filing of numerous lawsuits, including personal injury claims by the crew members and class actions by fishermen, the primary insurer filed an interpleader action, depositing its policy limits with the court. At issue was the allocations of the interpleader funds as well as the district court's finding that the maritime insurance policy's liability limit included defense costs. The court affirmed the district court's decision that defense costs eroded policy limits but was persuaded that its orders allocating court-held funds among claimants were tentative and produced no appealable order.

This case arose when plaintiffs filed a nationwide consumer class action against Life of the South Insurance Company (Life of the South). At issue was whether Life of the South had a right to enforce against plaintiffs the arbitration clause in the loan agreement, between plaintiffs and the car dealership where they purchased their vehicle, where the loan agreement lead plaintiffs to enter into a separate credit life insurance contract with Life of the South. The court held that the loan agreement did not show, on its face or elsewhere, an intent to allow anyone other than plaintiffs, the car dealership, and Chase Manhattan, and the assignees of the dealership of Chase Manhattan, to compel arbitration of a dispute and Life of the South was none of those. The court also held that because the only claims plaintiffs asserted were based on the terms of their credit life insurance policy with Life of the South, which did not contain an arbitration clause, equitable estoppel did not allow Life of the South to compel plaintiffs to arbitrate. Accordingly, the court affirmed the district court's denial of Life of the South's motion to compel arbitration.

Plaintiffs appealed from a judgment of the district court dismissing their class-action complaint, which asserted a single claim against MetLife under ERISA, 29 U.S.C. 1001 et seq. Plaintiffs alleged that through the use of "retained asset accounts" (RAAs), MetLife breached fiduciary duties imposed by ERISA by retaining and investing for its own profit life insurance proceeds due them under employee benefit plans that MetLife administered. The court held that the district court correctly determined that plaintiffs failed to state a claim, since MetLife discharged its fiduciary obligations under ERISA when it established the RAAs in accordance with the plans at issue, and did not misuse "plan assets" by holding and investing the funds backing the accounts. Accordingly, the court affirmed the judgment of the district court.

Plaintiff filed suit against Liberty Mutual, both personally and on behalf of a putative class of similarly situated individuals, alleging that the company's failure to disburse "medical payments" coverage (MedPay) benefits to her constituted a breach of contract, a breach of implied covenant of good faith and fair dealing, and a violation of G.L.c. 93A, 2. At issue was whether a claimant could seek medical expense benefits under the MedPay of a standard Massachusetts automobile insurance policy where she had already recovered for those expenses under a separate policy of health insurance. The court held that plaintiff's complaint and the extrinsic materials submitted by Liberty Mutual contained alleged facts sufficient to "raise a right to relief above the speculative level." The court also held that Liberty Mutual had not demonstrated as a matter of law that plaintiff could not receive MedPay benefits when she already had received medical expense benefits under her policy of health insurance. Accordingly, the order allowing Liberty Mutual's motion to dismiss was reversed and the matter remanded.

In 1999, four employees of a Domino Sugar refinery sued parent company Tate & Lyle North America Sugars, Inc. (T&L) for damages from noise exposure during their employment with T&L between 1947 and 1994. Continental Casualty Insurance Company insured T&L with eight general liability policies. Each of the policies contained exclusions for bodily injury to employees arising out of the course and scope of their employees. In one of the eight policies, the exclusion was deleted by a special endorsement effective in 1975. After T&L notified Continental of the lawsuit, Continental retained defense counsel to defend T&L. In 2001, 125 new plaintiffs were added to the suit, and the complaint was amended to allege noise exposure from 1947 to 2001. At some point, trial was continued to allow for settlement. In 2003, without Continental's consent, T&L settled with 1 of 15 "flights" of plaintiffs for $35,000 per plaintiff. After that settlement, Continental was notified. One month later, Continental withdrew from the defense, disclaiming its liability based on a mistaken belief that all of its policies contained the exclusions for injuries to employees. In the subsequent years following the first settlement, additional plaintiffs were added. In 2004, the trial court granted partial summary judgment to T&L, finding that Continental had waived its right to rely on its policy exclusion defenses for "first flight" plaintiffs. The issue before the Supreme Court centered on Continental's exclusions and its disclaiming liability for subsequent plaintiffs. Upon careful consideration of the trial court record, the Court held that an insurer's breach of the duty to defend does not result in a waiver of all coverage defenses when the insured seeks indemnity under the policy. In this case, Continental had disclaimed coverage at the time more plaintiffs were added to the lawsuit, and did not provide a defense to those claims. Therefore, waiver principles did not apply. Continental was only liable to T&L in indemnity on a pro rata basis for the exposures that took place during the coverage period. The Court remanded the case for a determination of whether twelve remaining plaintiff-flights met the settlement criteria.