Justia Insurance Law Opinion Summaries

This case arose out of claims asserted by multiple people against Blue Cross and Blue Shield of Montana, now known as Caring for Montanans, Inc. (CFM) and Montana Comprehensive Health Association (MCHA). The claimants asserted that while they were insured by CFM or MCHA, they submitted claims that the insurers denied based upon exclusions contained in their health insurance policies. These exclusions generally provided that the insurer would not pay for health care costs of the injured insureds if the insureds received, or were entitled to receive, benefits from any automobile liability policy. These exclusions were subsequently disapproved by the Montana Commissioner of Insurance, and the insureds sought the previously-denied benefits. The district court certified a class of claimants for settlement purposes only. The court then held a fairness hearing on a proposed settlement agreement and approved the settlement. Several class members objected to the settlement and appealed to the Montana Supreme Court, arguing they should have been allowed to conduct further discovery to ascertain the fairness of the settlement agreement. The Supreme Court agreed with the objectors and remanded the case to the district court for further discovery and a second fairness hearing. The district court allowed further discovery, held a second fairness hearing, and determined that the same settlement agreement was fair, reasonable, and adequate. The Objectors again appealed. Finding no reversible error, the Supreme Court affirmed. View "Pallister v. BCBS" on Justia Law

The Joyce law firm purchased professional liability insurance from Professionals Direct. In 2007 the firm won a large damages award for a class of securities-fraud plaintiffs and hired another law firm to sue to collect the money from the defendant’s insurers. Some class members thought the Joyce firm should have handled enforcement of the judgment itself under the terms of its contingency-fee agreement. They took the firm to arbitration over the extra fees incurred. Professionals Direct paid for the firm’s defense in the arbitration. After the arbitrator found for the clients and ordered the firm to reimburse some of the fees they had paid, the insurer refused a demand for indemnification. The district judge sided with the insurer, concluding that the award was a “sanction” under the policy’s exclusion for “fines, sanctions, penalties, punitive damages or any damages resulting from the multiplication of compensatory damages.” The Seventh Circuit affirmed. While the arbitration award was not functionally a sanction, another provision in the policy excludes “claim[s] for legal fees, costs or disbursements paid or owed to you.” Because the arbitration award adjusted the attorney’s fees owed to the firm in the underlying securities-fraud class action, the “legal fees” exclusion applies. View "Edward T. Joyce & Assocs. v. Prof'ls Direct Ins. Co." on Justia Law

In 2002, Plaintiffs commenced a proposed class action civil rights suit against the County of Rensselaer. The County invoked Selective Insurance Company’s duty to provide a defense under the policies that the company sold to the County. Selective agreed to defend the County in the action, subject to the insurance policy limits and the deductible. Selective’s counsel and the County agreed to settle the actions for $1,000 per plaintiff, determined to be slightly more than 800 individuals in total, with attorney fees also being recoverable. Selective abided by the terms of the settlement. The County, however, refused to pay Selective more than a single deductible payment. Selective then commenced this action for money damages, arguing that each class member was subject to a separate deductible. Supreme Court concluded that a separate deductible payment applied to each class member and that all legal fees should be allocated to one policy. The Appellate Division affirmed. The Court of Appeals affirmed, holding that the class action suit did not constitute one occurrence under the relevant policies’ definition of “occurrence” and that the attorney’s fees generated in defending that suit were properly allocated to the named plaintiff. View "Selective Ins. Co. of Am. v. County of Rensselaer" on Justia Law

The plaintiffs both have policies with State Farm Mutual Automobile Insurance Company and both submitted claims that State Farm failed to pay within the statutory thirty-day period. The plaintiffs earlier alleged that State Farm had failed to make the required statutory interest payments to them and other claimants whose PIP claims had not been processed within thirty days. When that theory did not pan out and they faced summary judgment, the plaintiffs reformulated their pursuit of class-wide relief by proposing to file an amended complaint seeking a declaratory judgment from the Superior Court that State Farm must process all PIP claims within thirty days. The Superior Court denied the motion for leave to amend, reasoning that amending the complaint would be futile because no case or controversy existed because the plaintiffs had been paid the required statutory interest. The court then granted summary judgment to State Farm. In this appeal, the plaintiffs alleged that the Superior Court was wrong to dismiss their claim, arguing that they have a ripe disagreement with State Farm over its failure to comply invariably with the thirty-day deadline set forth in 21 Del. C. 2118B(c). After review, the Supreme Court affirmed the Superior Court, but on a somewhat different ground. The plaintiffs were correct that absent declaratory (or injunctive) relief, it may be that they and other class members will have a claim in the future processed by State Farm in more than thirty days. But, the Court agreed with the Superior Court that the amended complaint is futile because as plainly written, section 2118B(c) did not impose an invariable standard that every PIP claim must be processed within thirty days and, in fact, contemplated that will not be the case by establishing a statutory consequence for the failure to do so. View "Clark v. State Farm Mutual Automobile Insurance Co." on Justia Law

Plaintiffs Delbert Soseeah, Maxine Soseeah and John Borrego filed this action against defendants Sentry Insurance, Dairyland Insurance Company, Peak Property and Casualty Insurance Company, and Viking Insurance Company of Wisconsin (collectively Sentry) claiming, in part, that Sentry failed to timely and properly notify them and other Sentry automobile insurance policyholders of the impact of two New Mexico Supreme Court decisions regarding the availability of uninsured and underinsured motorist coverage under their respective policies. The complaint alleged that Delbert Soseeah, after being injured in a motor vehicle accident, made a claim for UM/UIM benefits under two policies of automobile insurance issued by Sentry to Mrs. Soseeah. According to the complaint, Mrs. Soseeah “never executed a valid waiver of UM/UIM coverage under the” two policies and, consequently, Mr. Soseeah “demanded that . . . Sentry reform” the two policies “to provide stacked uninsured/underinsured motorist coverage limits equal to the limits of the liability coverage on each of the vehicles covered by the” policies pursuant to the two New Mexico Supreme Court decisions. Sentry purportedly refused to reform the policies and rejected Mr. Soseeah’s claim for UM/UIM benefits. The complaint alleged that Sentry, by doing so, violated New Mexico’s Unfair Practices Act (UPA), violated a portion of New Mexico’s Insurance Code known as the Trade Practices and Frauds Act (TPFA), breached the implied covenant of good faith and fair dealing, and breached the terms of the two policies. The district court granted plaintiffs’ motion for class certification. Sentry subsequently sought and was granted permission to appeal the district court’s class certification ruling. Because plaintiffs failed to establish that all members of the general certified class suffered the common injury required by Rule of Civil Procedure 23(a)(2), the Tenth Circuit concluded that the district court abused its discretion in certifying the general class. Because the district court’s certification ruling did not expressly address the Rule 23 factors as they applied to each of the identified subclasses, the Court did not have enough information to determine whether the district court abused its discretion in certifying two subclasses. Consequently, the Court directed the district court on remand to address these issues. View "Soseeah v. Sentry Insurance" on Justia Law

When Kent Roose was injured in an automobile crash his wife was an employee of Lincoln County, which provided health benefits via a group health plan (the Plan) that was part of Joint Powers Trust (JPT). Employee Benefit Management Services, Inc. (EBMS administered the Plan. The Plan contained an exclusion stating that medical benefits would not be paid when any automobile or third-party liability insurance was available to pay medical costs. EBMS denied Roose’s request for reimbursement for medical expenses he paid out of the liability insurance payment he received from the tortfeasors’ insurer. Roose subsequently brought suit against EBMS and JPT. The Supreme Court held that the exclusion violated Mont. Code Ann. 2- 18-902(4). Appellants subsequently reimbursed Roose the requested amount. In 2014, Roose filed a motion for partial summary judgment and class certification, arguing that Appellants violated section 2-18-902 through systematic practices that amounted to seeking subrogation against the tortfeasor’s liability carrier before Roose was made whole. Roose also sought class certification on behalf of every member of Appellants’ plans subject to Montana law that contained the coverage exclusion. The district court granted Roose’s motion. The Supreme Court affirmed, holding that the district court did not abuse its discretion in certifying the class or in defining the class. View "Roose v. Lincoln County Employee Group Health Plan" on Justia Law

Plaintiffs, alleging to be putative class members of multiple class actions, have filed their own individual suits against the defendant, Louisiana Citizens Property Insurance Corporation (Citizens). Plaintiffs were residents of, and owned homes in, St. Bernard Parish at the time Hurricane Katrina. Their properties were insured under policies of all-risk or homeowners insurance by defendant. Plaintiffs originally filed suit against Citizens on December 3, 2009, seeking contractual and bad faith damages arising out of Citizens’ handling of their property damage claims related to Hurricane Katrina. Citizens excepted on grounds of prescription and lis pendens. At issue is whether the doctrine of lis pendens barred plaintiffs’ suits where the plaintiffs were not named parties in the first-filed class actions. The Supreme Court found the trial court erred in overruling the defendant’s exception of lis pendens. View "Aisola v. Louisiana Citizens Property Insurance Corp." on Justia Law

Insured filed a complaint alleging that Insured had breached a title insurance policy. Insured also alleged that Insurer had acted in bad faith and requested an award of attorney’s fees and costs pursuant to Va. Code Ann. 38.2-209. Insured demanded a jury trial “on all counts so triable.” Insurer sought to have the trial judge, rather than the jury, consider the issues of bad faith and attorney’s fees. The jury was permitted to award attorney’s fees. The jury found in favor of Insured and awarded $442,000 in attorneys’ fees and costs. The trial court judge vacated the jury’s award of attorney’s fees and costs, ruling that section 38.2-209(A) requires a judge, not a jury, to determine whether an insurer committed a bad faith breach of an insurance contract warranting an award of attorney’s fees. Reconsidering the evidence de novo, the judge then concluded that the evidence was insufficient to prove that Insurer had acted in bad faith. The Supreme Court affirmed, holding (1) a judge, not a jury, must determine whether an insurer has acted in bad faith under the policy; and (2) section 38.2.209(A) does not implicate the right to a jury trial under Va. Const. art. I, 11. View "REVI, LLC v. Chicago Title Ins. Co." on Justia Law

In 2009, CE filed a class action suit under the Telephone Consumer Protection Act, 47 U.S.C. 227, against King. King had commercial general liability and umbrella policies from three insurance companies, but all three disclaimed any obligation to defend or indemnify, based on provisions in the policies that appeared to exempt liability under the Telephone Consumer Protection Act from coverage. The district court certified the class. On remand, CE and King agreed to settle the case for $20 million, the limit of the insurance policies. Their agreement, approved by the district court, provided that only one percent of the judgment ($200,000) could be executed against King. Upon learning of the proposed settlement, the insurers sought a state court declaratory judgment. A state court ruled that the insurance policies do not cover liability under the Act, but CE is appealing that decision. After the settlement agreement in the federal case, but before its approval, the insurers moved to intervene under Fed.R.Civ.P. 24(a), (b), hoping to delay approval of the settlement until there was a state-court determination. The Seventh Circuit affirmed denial of the motion to intervene as untimely. View "Valley Forge Ins. Co. v. King Supply Co., LLC" on Justia Law

Across the state, plaintiffs were filing complaints against health care providers from whom they sought treatment following automobile accidents and with whom their health care insurers had contracted reimbursement rates for the services rendered. At issue was the legality of these providers' policy of collecting or attempting to collect the undiscounted rate from the insured if a liability insurer may be liable, implemented through the filing of medical liens against plaintiffs' lawsuits and settlements pursuant to the health care provider lien statute. The Supreme Court granted certiorari to resolve a conflict among the appellate courts of this state on the issue of whether a class action is the superior method for adjudicating actions brought pursuant to the Health Care Consumer Billing and Disclosure Protection Act ("Balance Billing Act"). After review, the Court found plaintiffs in the Third Circuit Court of Appeal proceeded as a class, while plaintiffs in the Second Circuit Court of Appeal were denied class certification. After reviewing the record and the applicable law, the Supreme Court found the class action was superior to any other available method for a fair and efficient adjudication of the common controversy over the disputed billing and lien practices. Accordingly, the Court reversed the judgment of the Second Circuit. Finding all other requirements for class certification properly met, the Court reinstated the judgment of the trial court. View "Baker v. PHC-Minden, L.P." on Justia Law