Justia Insurance Law Opinion Summaries

Articles Posted in Constitutional Law
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Plaintiff National Rifle Association of America (the "NRA") claims that Defendant, the former Superintendent of the New York State Department of Financial Services ("DFS"), violated its rights to free speech and equal protection when she investigated three insurance companies that had partnered with it to provide coverage for losses resulting from gun use and encouraged banks and insurance companies to consider discontinuing their relationships with gun promotion organizations. The NRA contends that Defendant used her regulatory power to threaten NRA business partners and coerce them into disassociating with the NRA, in violation of its rights.   The district court dismissed the equal protection claim on the basis that Defendant was protected by absolute immunity, but it declined to dismiss the free speech claims, concluding that the NRA plausibly alleged its claims and issues of fact existed as to whether she was protected by qualified immunity.   The Second Circuit reversed and remanded. The court explained that here, the various cases addressing the issue did not provide clear and particularized guidance but involved very different circumstances and much stronger conduct. The cases do not clearly establish that Defendant’s statements, in this case, were unconstitutionally threatening or coercive. Qualified immunity balances the need to hold public officials accountable when they exercise their power irresponsibly with the need to shield officials from harassment, distraction, and liability when they perform their duties responsibly. Here, the Complaint's factual allegations show that, far from acting irresponsibly, Defendant was doing her job in good faith. View "National Rifle Association of America v. Maria T. Vullo" on Justia Law

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Plaintiff Crystal Point Condominium Association, Inc. obtained default judgments against two entities for construction defect claims. Kinsale Insurance Company was alleged to have insured those entities, under the Direct Action Statute, N.J.S.A. 17:28-2. The relevant policies both contained an arbitration agreement providing in part that “[a]ll disputes over coverage or any rights afforded under this Policy . . . shall be submitted to binding Arbitration.” Crystal Point filed a declaratory judgment action against Kinsale, alleging that it was entitled to recover the amounts owed by the entities under the insurance policies issued by Kinsale. Kinsale asserted that Crystal Point’s claims were subject to binding arbitration in accordance with the insurance policies. Kinsale argued that the Direct Action Statute did not apply because Crystal Point had not demonstrated that neither entity was insolvent or bankrupt. In the alternative, Kinsale contended that even if the statute were to apply, it would not preclude enforcement of the arbitration provisions in the policies. The trial court granted Kinsale’s motion to compel arbitration, viewing the Direct Action Statute to be inapplicable because there was no evidence in the record that either insured was insolvent or bankrupt. An appellate court reversed the trial court’s judgment, finding the evidence that the writs of execution were unsatisfied met the Direct Action Statute’s requirement that the claimant present proof of the insured’s insolvency or bankruptcy and determining that the Direct Action Statute authorized Crystal Point’s claims against Kinsale. The appellate court concluded the arbitration clause in Kinsale’s insurance policies did not warrant the arbitration of Crystal Point’s claims, so it reinstated the complaint and remanded for further proceedings. The New Jersey Supreme Court determined Crystal Point could assert direct claims against Kinsale pursuant to the Direct Action Statute in the setting of this case. Based on the plain language of N.J.S.A. 17:28-2, however, Crystal Point’s claims against Kinsale were derivative claims, and were thus subject to the terms of the insurance policies at issue, including the provision in each policy mandating binding arbitration of disputes between Kinsale and its insureds. Crystal Point’s claims against Kinsale were therefore subject to arbitration. View "Crystal Point Condominium Association, Inc. v. Kinsale Insurance Company " on Justia Law

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The Texas Workers' Compensation Act (TWCA), Tex. Lab. Code 401.007–419.007, regulates the prices that insurers must pay to providers for various medical services utilized by their beneficiaries, including air transport services. However, those price restrictions conflict with the federal Airline Deregulation Act (ADA), which makes clear that the states "may not enact or enforce a law, regulation, or other provision . . . related to a price, route, or service of an air carrier that may provide air transportation under this subpart." 49 U.S.C. 41713(b)(1).The Fifth Circuit joined its sister circuits, which have unanimously held that the ADA preempts state price caps on air ambulance reimbursements, and that those state price caps are not saved by the McCarran–Ferguson Act. The court disagreed with the Texas Supreme Court, which has reached contrary conclusions by a divided vote. Therefore, in this case, the court affirmed the judgment and held that the TWCA regulations concerning the reimbursement of air ambulance providers like Air Evac are preempted by the ADA, and are not saved by the McCarran–Ferguson Act. View "Air Evac EMS, Inc. v. Sullivan" on Justia Law

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Because the Louisiana Supreme Court found in its original opinion that plaintiffs had a right of action under La. C.C. arts. 2315.1 and 2315.2, their constitutional challenge was pretermitted and “that part of the district court judgment declaring [these code articles and La. C.C. art. 199 to be] unconstitutional as applied to children given in adoption” was vacated. Having found on rehearing that the codal analysis of La. C.C. arts. 2315.1, 2315.2 and 199 foreclosed a right of action to the plaintiff children, who were given in adoption, for the death of their biological parent and half-siblings, the Supreme Court was called on to address the propriety of the district court’s declaration that La. C.C. arts. 2315.1, 2315.2, and 199 are “unconstitutional as applied to children given in adoption.” The Court found a rational basis existed for limiting the categories of eligible claimants in La. C.C. arts. 2315.1 and 2315.2 to those who “are likely to be most affected by the death of the deceased.” Children given in adoption “have moved into a new parental relationship, becoming children ‘by adoption,’ who are eligible claimants in the unfortunate occurrence of the tortious death of their adoptive parents. Likewise, the transfer of children into a new parental unit as children ‘by adoption’ terminates, for purposes of wrongful death and survival actions, any connection between the ‘children given in adoption’ and any biological siblings who were not ‘given in adoption.’” For these reasons, the district court legally erred in finding that the fact that Daniel Goins and David Watts were adopted did not prevent them from bringing survival and wrongful death claims for the deaths of their biological father and biological half-siblings and in overruling the defendant’s exception raising the objection of no right of action. The Supreme Court's original decree was vacated and the district court's judgment was reversed. Judgment was entered sustaining the defendant insurance company's peremptory exception raising the objection of no right of action, and dismissing the claims that were the subject of this exception. View "Rismiller et al. v. Gemini Ins. Co." on Justia Law

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This case involved a dispute between Liberty Mutual Insurance Company (Liberty Mutual), Hill Brothers Construction Company (Hill Brothers) and the Mississippi Transportation Commission (the Commission) regarding a fuel-adjustment clause (the FAC) in a highway-construction contract. In 2019, the Commission successfully moved to alter or amend the circuit court's judgment. The circuit court vacated its prior entry of partial summary judgment in favor of Liberty Mutual on the issue of liability, effectively denying Liberty Mutual's motion for summary judgment. The Mississippi Supreme Court granted Liberty Mutual's petition for interlocutory appeal. The company argued the 2019 order was entered in violation of the Supreme Court's mandate in Hill Brothers I. The Supreme Court determined the circuit court erred in denying Liberty Mutual's motion on liability. The circuit court's judgement was thus reversed and summary judgment reinstated in favor of the insurance company on the issue of liability. View "Liberty Mutual Insurance Company v. Mississippi Transportation Commission" on Justia Law

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The United States Court of Appeals for the Eleventh Circuit certified to three questions of law to the Georgia Supreme Court relating to a lawsuit brought in federal district court by Fife Whiteside, the trustee of the bankruptcy estate of Bonnie Winslett. Whiteside sued GEICO to recover the value of Winslett’s failure-to-settle tort claim against GEICO so that the bankruptcy estate could pay creditor Terry Guthrie, who was injured in an accident caused by Winslett. The certified questions certified asked the Supreme Court to analyze how Georgia law applied to an unusual set of circumstances that implicated both Winslett’s duty to give GEICO notice of suit and GEICO’s duty to settle the claim brought against Winslett. The Supreme Court was unable to give unqualified “yes” or “no” answers to two of the certified questions as they were posed; rather, the Court answered the questions only in the context of the circumstances of this particular case. "Winslett remains liable to Guthrie, even if her bankruptcy trustee succeeds on the failure-to-settle claim against GEICO; therefore, if the bankruptcy estate does not recover enough from GEICO to satisfy Guthrie’s judgment, the estate would not be fully compensated for Winslett’s damages, and GEICO would escape responsibility for breaching its settlement duty to Winslett. Such an outcome would deny Winslett the full measure of compensatory damages allowed under Georgia law." View "GEICO Indemnity Co. v. Whiteside" on Justia Law

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Defendant Daniel Clapp plead no contest to concealing the true extent of his physical activities and abilities from his employer, the Department of the California Highway Patrol (CHP), and the State Compensation Insurance Fund (SCIF). Consistent with a resolution negotiated by the parties, the trial court granted defendant three years’ probation, and as a condition of probation, ordered him to pay restitution. Following a hearing, defendant was ordered to pay $30,095.68 to SCIF for temporary disability benefits and $81,768.01 to CHP for benefits wrongfully obtained. He was also ordered to pay $1,350 and $70,159 to SCIF and CHP respectively for investigative costs. Defendant appealed the restitution award as to investigation costs contending that, as public investigative agencies, neither SCIF nor CHP was entitled to reimbursement for the costs of investigating his claim. After review, the Court of Appeal concluded that as direct victims of defendant’s fraud, both CHP and SCIF were indeed entitled to restitution for investigative costs incurred in an effort to justify discontinuance of payments and recoup money defendant fraudulently obtained. View "California v. Clapp" on Justia Law

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Defendant Gemini Insurance Company appealed a district court's holding La. C.C. arts. 2315.1, 2315.2 and 199 were “unconstitutional as applied to children given in adoption” and overruling the defendants’ peremptory exceptions of no right of action. At issue was whether plaintiffs Daniel Goins and David Watts, two adult children who were given in adoption as minors, had a right to bring wrongful death and survival actions stemming from the deaths of their biological father and his two minor children, who were not given in adoption, and were plaintiffs’ biological half-siblings. After a de novo review, based on the clear and unambiguous wording of La. C.C. arts. 2315.1 and 2315.2, the Louisiana Supreme Court concluded Goins and Watts were “children of the deceased” and “brothers of the deceased” who were permitted to bring wrongful death and survival actions arising from the death of their biological father and half-siblings. In view of the Court's holding that plaintiffs had a right to assert survival and wrongful death actions, the Court declined to address their argument that La. C.C. arts. 2315.1, 2315.2 and 199 were unconstitutional as applied to children given in adoption. View "Rismiller v. Gemini Insurance Co." on Justia Law

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The Patient Protection and Affordable Care Act of 2010 (ACA) requires covered employers to provide women with “preventive care and screenings” without cost-sharing requirements and relies on Preventive Care Guidelines “supported by the Health Resources and Services Administration” (HRSA) to define “preventive care and screenings,” 42 U.S.C. 300gg–13(a)(4). Those Guidelines mandate that health plans cover all FDA-approved contraceptive methods. When the Federal Departments incorporated the Guidelines, they gave HRSA the discretion to exempt religious employers from providing contraceptive coverage. Later, the Departments promulgated a rule accommodating qualifying religious organizations, allowing them to opt out of coverage by self-certifying that they met certain criteria to their health insurance issuer, which would then exclude contraceptive coverage from the employer’s plan and provide participants with separate payments for contraceptive services without any cost-sharing requirements.In its 2014 “Hobby Lobby” decision, the Supreme Court held that the contraceptive mandate substantially burdened the free exercise of closely-held corporations with sincerely held religious objections. In a later decision, the Court remanded challenges to the self-certification accommodation so that the parties could develop an approach that would accommodate employers’ concerns while providing women full and equal coverage.The Departments then promulgated interim final rules. One significantly expanded the church exemption to include an employer that objects, based on its sincerely held religious beliefs, to coverage or payments for contraceptive services. Another created an exemption for employers with sincerely held moral objections to providing contraceptive coverage. The Third Circuit affirmed a preliminary nationwide injunction against the implementation of the rules.The Supreme Court reversed. The Departments had the authority under the ACA to promulgate the exemptions. Section 300gg–13(a)(4) states that group health plans must provide preventive care and screenings “as provided for” in comprehensive guidelines, granting HRSA sweeping authority to define that preventive care and to create exemptions from its Guidelines. Concerns that the exemptions thwart Congress’ intent by making it significantly harder for women to obtain seamless access to contraception without cost-sharing cannot justify supplanting that plain meaning. “It is clear ... that the contraceptive mandate is capable of violating the Religious Freedom Restoration Act.” The rules promulgating the exemptions are free from procedural defects. View "Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania" on Justia Law

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GEICO Insurance Company appealed a trial court judgment entered in favor of plaintiffs Johnson Evans, Jimmy Smith, and Bernard Smith on plaintiffs' claims for damages resulting from an automobile accident caused by GEICO's insured, Bernard Grey. GEICO argued that the April 17, 2019, judgment entered against it was void because it did not receive notice of plaintiffs' claims against it or notice of the hearing on plaintiffs' claims. For their part, plaintiffs did not dispute that GEICO never received actual notice of any action pending against it in the present case. Instead, they argued GEICO had "constructive notice of potential litigation" because it had actual notice of Grey's accident involving plaintiffs -- which occurred in 2010 -- and that GEICO was aware that plaintiffs claimed to be injured by Grey's actions. The Alabama Supreme Court agreed with GEIDO that "constructive notice of potential litigation" clearly fell short of "even the most basic requirements of due process." Because it was undisputed GEICO never received notice of any claim pending against it, the April 17 judgment violated due process, and was therefore void. Because a void judgment would not support an appeal, the trial court was instructed to vacate its judgment, and GEICO's appeal was thus dismissed. View "GEICO Insurance Co. v. Evans" on Justia Law