Justia Insurance Law Opinion Summaries

The U.S. District Court for the District of Colorado certified a question of Colorado law to the Colorado Supreme Court regarding the statute of limitations applicable to section 10-3-1116, C.R.S. (2017), which governed claims for unreasonable delay or denial of insurance benefits. Specifically, the question centered on whether a claim brought pursuant to Colorado Revised Statutes section 10-3-1116 was subject to the one-year statute of limitations found in Colorado Revised Statutes section 13-80-103(1)(d) and applicable to “[a]ll actions for any penalty or forfeiture of any penal statutes.” The Supreme Court held the one-year statute of limitations found in section 13-80-103(1)(d), C.R.S. (2017), did not apply to an action brought under section 10-3-1116(1) because section 10-3-1116(1) was not an “action[] for any penalty or forfeiture of any penal statute[]” within the meaning of section 13-80-103(1)(d). Therefore, the Court answered the certified question in the negative. View "Rooftop Restoration, Inc. v. Am. Family Mut. Ins. Co." on Justia Law

In 2009, a fire started in an apartment building owned by respondents Guillermo and Evelia Barriga and insured by petitioner American Family Mutual Insurance Company (“American Family”). American Family made various payments to the and on behalf of the Barrigas, totaling $209,816.43. However, after a substantial amount of repair work had been completed, the contractor revised its estimate for the cost of the repairs. The revised estimate was higher than American Family’s initial estimate, primarily because of the need for additional repairs and asbestos remediation. In response, American Family initiated a third-party appraisal process outlined in the insurance policy intended to provide an impartial assessment of the needed repair costs. The appraiser fixed the award at $322,141.79. American Family then paid that award, less the $209,816.43 that had been previously paid to the Barrigas, resulting in a payment of $122,325.36. American Family also made an additional payment of $5435.44 for emergency board-up services. The Barrigas sued American Family for breach of contract, common law bad-faith breach of insurance contract, and unreasonable delay and denial of insurance benefits under section 10-3-1116(1), C.R.S. (2017). The jury found for the Barrigas on all claims, awarding damages, as relevant here, of $9270 for breach of contract and $136,930.80 for benefits unreasonably delayed or denied. The issue raised on appeal for the Colorado Supreme Court's review centered on whether an award of damages under section 10-3-1116(1), C.R.S. (2017), had to be reduced by an insurance benefit unreasonably delayed but ultimately recovered by an insured outside of a lawsuit. The Court held that an award under section 10-3-1116(1) must not be reduced by an amount unreasonably delayed but eventually paid by an insurer because the plain text of the statute provided no basis for such a reduction. The Court also concluded that a general rule against double recovery for a single harm did not prohibit a litigant from recovering under claims for both a violation of section 10-3- 1116(1) and breach of contract. View "Am. Family Mut. Ins. Co. v. Barriga" on Justia Law

Nine days after the jury returned its verdict, but before the trial court reduced that verdict to a written and signed judgment, Michael Casper died. Consequently, the defendant, Guarantee Trust Life Insurance Company (“GTL”), moved to substantially reduce the verdict, arguing that the survival statute barred certain damages under the policy that insured Casper. The trial court denied the motion, and the court of appeals affirmed. The Colorado Supreme Court granted GTL’s petition to review the court of appeals’ decision, and concluded that the survival statute did not limit the jury’s verdict in favor of Casper. The Court also concluded that an award of attorney fees and costs under section 10-3-1116(1) was a component of the “actual damages” of a successful claim under that section. Finally, the Court concluded that although the survival statute did not limit the damages awarded by the jury, the trial court abused its discretion by entering a final judgment on October 30, 2014, nunc pro tunc to July 15, 2014. View "Guarantee Trust Life Ins. Co. v. Estate of Casper" on Justia Law

An underinsured motorist struck a car driven by Dale Fisher, causing Fisher injuries requiring over $60,000 in medical care. Fisher was not at fault, and he was covered under multiple State Farm underinsured motorist (“UIM”) insurance policies. State Farm agreed that Fisher’s medical bills were covered under the UIM policies, but it disputed other amounts Fisher sought under the policies, including lost wages. So, State Farm refused to pay Fisher’s medical bills without first resolving his entire claim. Fisher sued, alleging State Farm had unreasonably delayed paying his medical expenses. In response, State Farm argued it had no duty to make piecemeal payments, even for Fisher’s undisputed medical expenses, when it disputed the rest of Fisher’s UIM claim. A jury returned a verdict in Fisher’s favor, finding that State Farm had violated section 10-3-1115, C.R.S. (2017), which provides that an insurer “shall not unreasonably delay or deny payment of a claim for benefits owed to or on behalf of any first-party [insured] claimant.” A division of the court of appeals affirmed. The issue this case presented for the Colorado Supreme Court's review was whether auto insurers have a duty to pay undisputed portions of a UIM claim (like the medical expenses at issue here) even though other portions of the claim remain disputed. The Court held that insurers have a duty not to unreasonably delay or deny payment of covered benefits, even though other components of an insured’s claim may still be reasonably in dispute. Thus, the Court affirmed the judgment of the court of appeals. View "State Farm v. Fisher" on Justia Law

Caroline Burton and Brenda Olivar submitted claims for long-term disability benefits to insurance companies under employee-benefits plans set up by their employers (“the Plans”). The insurance companies denied Burton’s and Olivar’s claims. Burton and Olivar sued the Plans under the Employee Retirement Income Security Act (“ERISA”) for benefits due to them under the insurance policies. But neither served the Plans. Rather, they each served complaints on the United States Department of Labor Secretary, relying on an ERISA provision allowing such service when a plan hasn’t designated “an individual” as an agent for service of process. In both cases, the Labor Secretary never forwarded the complaint to the Plans’ designated agents for service of process, the Plans failed to answer, and Burton and Olivar obtained default judgments in their favor. Eventually, the Plans moved to set aside the default judgments for improper service, which the trial courts granted in both cases. Later, the Plans moved for summary judgment, arguing the insurers, which were obligated to make all eligibility determinations and payments under the Plans’ terms, were the only proper party defendants. The trial courts agreed, granting the Plans summary judgment. A division of the court of appeals affirmed. The issue presented to the Colorado Supreme Court for resolution centered on whether ERISA’s use of the term “individual” provided that service on the Labor Secretary was sufficient when a plan designates a corporation (instead of a natural person) as its administrator and agent for service of process. Finding no reversible error in the district court’s judgment, the Supreme Court affirmed. View "Burton v. Colorado Access & No." on Justia Law

Caroline Burton and Brenda Olivar submitted claims for long-term disability benefits to insurance companies under employee-benefits plans set up by their employers (“the Plans”). The insurance companies denied Burton’s and Olivar’s claims. Burton and Olivar sued the Plans under the Employee Retirement Income Security Act (“ERISA”) for benefits due to them under the insurance policies. But neither served the Plans. Rather, they each served complaints on the United States Department of Labor Secretary, relying on an ERISA provision allowing such service when a plan hasn’t designated “an individual” as an agent for service of process. In both cases, the Labor Secretary never forwarded the complaint to the Plans’ designated agents for service of process, the Plans failed to answer, and Burton and Olivar obtained default judgments in their favor. Eventually, the Plans moved to set aside the default judgments for improper service, which the trial courts granted in both cases. Later, the Plans moved for summary judgment, arguing the insurers, which were obligated to make all eligibility determinations and payments under the Plans’ terms, were the only proper party defendants. The trial courts agreed, granting the Plans summary judgment. A division of the court of appeals affirmed. The issue presented to the Colorado Supreme Court for resolution centered on whether ERISA’s use of the term “individual” provided that service on the Labor Secretary was sufficient when a plan designates a corporation (instead of a natural person) as its administrator and agent for service of process. Finding no reversible error in the district court’s judgment, the Supreme Court affirmed. View "Burton v. Colorado Access & No." on Justia Law

The Colorado Supreme Court concluded here that nothing in the language of the Colorado uninsured/underinsured motorist statute, 10-4-609 C.R.S. (2016) precluded an agent from exercising either apparent or implied authority to reject UM/UIM coverage on behalf of a principal. In line with this reasoning, the agent’s rejection of UM/UIM coverage was indeed binding on the principal. Respondent Brian Johnson tasked a friend with purchasing automobile insurance for the new car that he and the friend had purchased together. The friend did so, and in the course of that transaction, she chose to reject uninsured/underinsured motorist (UM/UIM) coverage on the new car. After an accident in that car with an underinsured motorist, Johnson contended that his friend’s rejection of UM/UIM coverage was not binding on him. View "State Farm v. Johnson" on Justia Law

A provision of the mandatory form settlement document promulgated by the Director of the Division of Workers’ Compensation (“Director”) did not waive an injured employee’s statutory right under section 8-43-204(1), C.R.S. (2016), to reopen a settlement based on a mutual mistake of material fact. Petitioner Victor England was a truck driver for Amerigas Propane. He filed a workers’ compensation claim after sustaining a serious injury to his shoulder in December 2012 while making a delivery for Amerigas. England’s claim was governed by the Colorado Workers’ Compensation Act, which required that settlements between employer and employee must be written, signed by both sides, and approved by the Director or an administrative law judge (“ALJ”). Pursuant to section 8-43-204, the Director promulgated a form settlement agreement (“Form”), which the parties are required to use to settle all claims. In this case, the parties’ settlement agreement was consistent with the Form. England’s pain continued after the settlement agreement was signed and approved. In October 2013, he sought further medical evaluation, which revealed a previously undiagnosed stress fracture in the scapula (shoulder blade) of England’s injured shoulder. Up to this point, no one was aware that this fracture existed. England claims that if he had been aware of this fracture, he would not have settled his claim. England filed a motion to reopen the settlement on the ground that the newly discovered fracture justified reopening his workers’ compensation claim. An ALJ agreed, and the Industrial Claim Appeals Office (ICAO) affirmed. The court of appeals reversed, concluding that the Form waived England’s right to reopen. The Colorado Supreme Court held that because provisions of the form document must yield to statutory rights, the court of appeals erred in its conclusion. View "England v. Amerigas Propane" on Justia Law

The issue this matter presented for the Supreme Court's review centered on a discovery dispute between plaintiff Stephen Rumnock and defendant American Family Mutual Insurance Company. After being ordered to produce documents that Rumnock requested, American Family disclosed some and simultaneously moved for a protective order. The motion sought to preclude Rumnock from using or disclosing the documents (alleged to be trade secrets) outside of this litigation. The trial court granted in part and denied in part, ordering that the alleged trade secrets not be shared with American Family's competitors, but declining to further limit their use. American Family petitioned the Colorado Supreme Court to direct the trial court to enter the protective order. The Supreme Court declined to do so, finding that American Family failed to present to the trial court evidence demonstrating the documents were trade secrets or otherwise confidential commercial information. View "In re Rumnock v. Anschutz" on Justia Law

Petitioner Arnold Calderon was injured in a vehicle accident with an uninsured motorist. At the time, petitioner was insured with respondent American Family Mutual Insurance. American Family paid the policy limit to petitioner's medical providers; it denied payment with respect to his uninsured/underinsured (UM/UIM), disputing the amount of petitioner's damages. A jury returned an award in petitioner's favor. The trial court offset the amount of the jury award by the amount already paid to the medical providers. Petitioner argued on appeal of that offset, that the "MedPay" coverage was separate from the UM/UIM coverage, and that the MedPay amount should not have been deducted. The Supreme Court reversed, finding that the amount of UM/UIM coverage, as listed in petitioner's policy, in this case should not have been reduced by the MedPay amount. View "Calderon v. American Family Mutual Insurance Company" on Justia Law