Justia Insurance Law Opinion Summaries

Chapter 1301 of the Texas Insurance Code requires healthcare insurers to make coverage determinations and pay claims made by preferred healthcare providers within a specified time or face penalties. HCSC filed suit seeking a declaratory judgment against Methodist, seeking a declaration that Chapter 1301 does not apply to HCSC as the administrator of particular health plans, and the Federal Employee Health Benefits Act of 1959 (FEHBA), 5 U.S.C. 8901, et seq., preempts application of the statute to its administration of claims under the Federal Employees Health Benefits Program (FEHBP). The district court granted summary judgment to HCSC. The court held that Chapter 1301 is not applicable to BCBSTX’s activities as administrator of the self-funded plans or state government plans, nor to those activities that it performs as administrator of claims under the BlueCard program. The court also held that FEHBA preempts Chapter 1301’s application to the claims processed by BCBSTX under FEHBP plans. Accordingly, the court affirmed the judgment. View "Health Care Serv. Corp. v. Methodist Hospitals" 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

The Departments of Health and Human Services (HHS), Labor (DOL), and Treasury appealed a preliminary injunction that enjoins the government from enforcing the contraceptive mandate provisions of the Patient Protection and Affordable Care Act (ACA), 42 U.S.C. 300gg-13(a)(4), and its implementing regulations against nonprofit religious organizations that offer healthcare coverage to their employees. The district court’s order also enjoined the government from enforcing the challenged provisions against “any insurance provider (including insurance issuers and third-party administrators) offering health insurance to” the organizations. The Eighth Circuit affirmed, stating that by coercing the organizations to participate in the contraceptive mandate and accommodation process under threat ofsevere monetary penalty, the government has substantially burdened their exercise of religion. Even assuming that the government’s interests in safeguarding public health and ensuring equal access to health care for women are compelling,the contraceptive mandate and accommodation process likely are not the least restrictive means of furthering those interests. View "Dordt College v. Burwell" on Justia Law

Religious, not-for-profit organizations challenged the “contraceptive mandate” of the Patient Protection and Affordable Care Act of 2010 (ACA), 42 U.S.C. 300gg-13(a)(4), arguing that the ACA’s accommodations for religious organizations impose a substantial burden on their free exercise of religion, and that the ACA and accompanying regulations are not the least restrictive means of furthering a compelling government interest, in violation of the plaintiffs’ rights under the Religious Freedom Restoration Act of 1993 (RFRA), 42 U.S.C. 2000bb. The district court entered a preliminary injunction. The Seventh Circuit reversed, stating: It is the operation of federal law, not any actions that the plaintiffs must take, that causes the provisions of services that the plaintiffs find morally objectionable. The accommodation has the legal effect of removing from objectors any connection to the provision of contraceptive services. View "Grace Schools v. Burwell" on Justia Law

In Sprint Commc’ns, Inc. v. Jacobs, the Supreme Court revisited the doctrine of abstention enunciated in Younger v. Harris. That doctrine requires federal courts, in the absence of extraordinary circumstances, to refrain from interfering with certain state proceedings. In this case, David Knight, an employee of Sirva Relocation, LLC, filed a charge of discrimination with the Massachusetts Commission Against Discrimination (MCAD) alleging that Sirva and Aetna Life Insurance Company (together, Appellants) had discriminated against him on the basis of disability in violation of Mass. Gen. Laws ch. 151B and the Americans with Disabilities Act (ADA). Appellants filed a federal complaint against the Commonwealth of Massachusetts, the MCAD, its commissioners, and Knight, asking the court to enjoin the MCAD proceeding on the basis that ERISA preempted the chapter 151B claim. The MCAD and Knight moved to dismiss the complaint, entreating the district court to abstain. While the case was pending, the Supreme Court decided Sprint. The district court dismissed the federal court action, concluding that Younger abstention was appropriate in this case. The First Circuit affirmed the district court’s decision to abstain and further clarified its own case law concerning the exception to the Younger doctrine for facially conclusive claims of preemption. View "Sirva Relocation, LLC v. Golar Richie" on Justia Law

Wieland is a member of the Missouri House of Representatives and obtains healthcare coverage for his family through the Missouri Consolidated Health Care Plan (MCHCP), a plan made available to him by his employer, the state. Until August 1, 2013, MCHCP offered an opportunity to opt out of contraceptive coverage under state law. The state and MCHCP discontinued offering that opportunity when the state opt-out was found to be preempted by the Patient Protection and Affordable Care Act (ACA), 42 U.S.C. 300gg, and its implementing regulation. The Wielands sued the U.S. Departments of Health and Human Services, Treasury, and Labor, challenging the ACA, as requiring them to obtain, and provide to their daughters, healthcare coverage for contraceptives, sterilization, and abortifacients in violation of their sincerely held religious beliefs. The district court dismissed for lack of standing. The Eighth Circuit reversed, stating that it is more than merely speculative that the Wielands’ injury would be redressed if they were granted the injunctive relief they seek. If the Supreme Court’s decision in Hobby Lobby overruled the case under which the opt-out was eliminated, the state law opt-out provision would likely again be available. View "Wieland v. Dep't of Health & Human Servs." on Justia Law

The appeals before the Tenth Circuit in this opinion concerned the regulations (as a part of the Affordable Care Act ("ACA")) that required group health plans to cover contraceptive services for women as a form of preventive care ("Mandate"). In response to religious concerns, the Departments implementing the ACA (Health and Human Services ("HHS"), Labor, and Treasury) adopted a regulation that exempted religious employers (churches and their integrated auxiliaries) from covering contraceptives. When religious non-profit organizations complained about their omission from this exemption, the Departments adopted a regulation that allowed them to opt out of providing, paying for, or facilitating contraceptive coverage. Under this regulation, a religious non-profit organization could opt out by delivering a form to their group health plan’s health insurance issuer or third-party administrator or by sending a notification to HHS. The Plaintiffs in the cases here were religious non-profit organizations. They argued that complying with the Mandate or the accommodation scheme imposed a substantial burden on their religious exercise. The Plaintiffs argued the Mandate and the accommodation scheme violated the Religious Freedom Restoration Act (“RFRA”) and the Religion and Speech Clauses of the First Amendment. While Tenth Circuit recognized the sincerity of Plaintiffs’ beliefs and arguments, it concluded the accommodation scheme relieved Plaintiffs of their obligations under the Mandate and did not substantially burden their religious exercise under RFRA or infringe upon their First Amendment rights. The Court affirmed the district court’s denial of a preliminary injunction to the plaintiffs in Little Sisters of the Poor Home for the Aged v. Sebelius, (6 F.Supp. 3d 1225 (D. Colo. 2013)), and reversed the district courts’ grants of a preliminary injunction to the plaintiffs in "Southern Nazarene University v. Sebelius," (No. CIV-13-1015-F, 2013 WL 6804265 (W.D. Okla. Dec. 23, 2013)), and "Reaching Souls International, Inc. v. Burwell," (No. CIV-13-1092-D, 2013 WL 6804259 (W.D. Okla. Dec. 20, 2013)). View "Little Sisters of the Poor v. Burwell" on Justia Law

Wheaton College, a nondenominational Illinois college, hires from a various Christian traditions and admits students of varied faiths, but requires all to sign a “Covenant” that requires them to “uphold the God-given worth of human beings, from conception to death.” The Covenant does not mention contraception, but Wheaton believes that “emergency contraception” is forbidden on religious grounds if it can destroy a fertilized ovum. Wheaton also opposes intrauterine devices (IUDs) that prevent implantation of a fertilized ovum. Wheaton excludes coverage of emergency contraception and IUDs from its health plans, but covers “traditional contraception.” Of the 20 types of FDA-approved female contraceptives, Wheaton disapproves only emergency contraceptives and certain IUDs. Wheaton challenged the Affordable Care Act as violating the Religious Freedom Restoration Act, 42 U.S.C. 2000bb-1, and the First Amendment, by making it complicit in the provision of emergency-contraception. The district court denied a preliminary injunction. The Seventh Circuit affirmed, stating: What had been Wheaton’s plan, concerning emergency contraception, the Affordable Care Act made the government’s plan when Wheaton refused to comply with the Act’s provision on contraception coverage. When notified that a health insurance provider has religious objections to providing coverage for some government-approved medical procedure, the government directs the insurer to provide the coverage itself. View "Wheaton College v. Burwell" on Justia Law

Plaintiffs, former police officers and firefighters employed by local public agencies, filed suit alleging that CalPERS's failure to pay enhanced retirement benefits under the Public Employees' Retirement Law (PERL), Gov. Code section 20000 et seq., gave rise to a variety of causes of action. In these consolidated appeals, the court affirmed in part and concluded that neither the PERL nor plaintiffs' contracts entitle plaintiffs to the additional retirement benefits they seek and therefore, their causes of action for breach of statutory duty and breach of contract fail as a matter of law. Further, plaintiffs' causes of action for constitutional torts also fail because, as a matter of law, CalPERS's interpretation of the applicable statutory provisions does not deny plaintiffs due process or equal protection of law and does not effect an unconstitutional impairment of contract. The court reversed, however, as to the causes of action for rescission and breach of fiduciary duty where plaintiffs' pleading was sufficient to survive demurrer and therefore demurrer should have been overruled as to these causes of action. In this case, plaintiffs alleged that CalPERS failed to disclose the potential loss of the value of purchased service credit if plaintiffs suffered disability - a disclosure that CalPERS, as a fiduciary, is alleged to have been required to make. View "Marzec v. CalPERS" on Justia Law

In 1994, Investors Equity Life Insurance Company of Hawaii, Ltd. (IEL) was liquidated. The State Insurance Commission was appointed as IEL’s liquidator (Liquidator). In 1996, Investors Equity Life Holding Company (IELHC), the former parent company and sole shareholder of IEL, surrendered all of its shares in IEL to the Commissioner as part of a settlement agreement to resolve claims relating to IEL’s insolvency. The Liquidator proceeded to administer IEL’s estate. In 2008, IELHC wrote to the Liquidator claiming that it held legal or equitable title to all of IEL’s stock and demanding that the Liquidator turn over to IELHC all shares and assets remaining in IEL’s estate. The Liquidator denied the claim. The circuit court affirmed. The Supreme Court affirmed, holding (1) the circuit court did not err in concluding that IELHC asserted a claim against IEL’s estate and that the claim was time barred; (2) the circuit court had subject matter jurisdiction over IELHC’s claim and personal jurisdiction over IELHC; (3) there were no grounds for abating the adjudication of IELHC’s claim; and (4) the circuit court’s procedures met due process requirements. View "Ito v. Investors Equity Life Holding Co." on Justia Law