Justia Insurance Law Opinion Summaries

Golden Corral, a buffet restaurant chain, held a commercial property insurance policy issued by Illinois Union Insurance Company, covering losses from physical damage to its property. When state and local governments, including North Carolina, mandated closure of indoor dining facilities in response to the COVID-19 pandemic, Golden Corral suspended its restaurant operations, resulting in significant lost revenue and reduced income from franchisees. Golden Corral submitted a claim to Illinois Union for coverage of these losses, which Illinois Union denied.After the denial, Golden Corral filed suit in North Carolina state court, seeking a declaration that its pandemic-related losses were covered under the policy. The case was removed to the United States District Court for the Eastern District of North Carolina, where Golden Corral amended its complaint to add claims for breach of contract and breach of the implied covenant of good faith and fair dealing. Illinois Union moved for judgment on the pleadings, arguing that COVID-19 did not cause physical loss or damage as required for coverage. The district court granted the motion and dismissed the case with prejudice, a decision affirmed by the United States Court of Appeals for the Fourth Circuit.Over three years later, Golden Corral sought relief from final judgment under Federal Rule of Civil Procedure 60(b)(6), citing a subsequent North Carolina Supreme Court decision in North State Deli v. Cincinnati Insurance Co. that found similar losses covered. The United States Court of Appeals for the Fourth Circuit reviewed the district court’s denial of the Rule 60(b)(6) motion for abuse of discretion. The court held that a change in state decisional law alone does not constitute "extraordinary circumstances" warranting relief under Rule 60(b)(6), especially when the later case involved different parties, policies, and injuries. The Fourth Circuit affirmed the district court’s decision to deny relief. View "Golden Corral Corp. v. Illinois Union Insurance Co." on Justia Law

A roofing contractor was sued in Illinois state court by the estates of two individuals who died when a building façade collapsed. The estates alleged that the contractor had negligently performed repairs on the building after it was damaged by a windstorm in August 2020. The repairs were completed by December 2020, and the fatal collapse occurred in April 2022. The contractor sought defense and indemnification from its commercial general liability insurer under a policy that began on February 8, 2022. The insurance policy included a “Prior Work Exclusion” that barred coverage for claims arising from work completed before the policy’s inception date.The insurer filed suit in the United States District Court for the Northern District of Illinois seeking a declaratory judgment that it had no duty to defend or indemnify the contractor in the underlying state lawsuit. The contractor counterclaimed for breach of contract and argued that the exclusion rendered coverage illusory. Both parties moved for judgment on the pleadings. The district court granted judgment to the insurer, holding that the exclusion applied because the work at issue was completed before the policy period and that the exclusion did not render the coverage illusory, as some coverage for completed operations remained.On appeal, the United States Court of Appeals for the Seventh Circuit affirmed the district court’s judgment. The court held that, under Illinois law, the Prior Work Exclusion clearly barred coverage for claims arising from work completed prior to February 8, 2022. The court further held that the exclusion did not make completed-operations coverage illusory because the policy still provided coverage for work completed during the policy period. The judgment in favor of the insurer was affirmed. View "Nautilus Insurance Company v Bee Quality Inc." on Justia Law

A carpenter who managed his own construction business was involved in a multi-vehicle accident in September 2013, while driving a car owned by another individual. The accident, caused by another driver, resulted in significant injuries and financial losses for the plaintiff, who claimed over $75,000 in medical expenses and more than $250,000 in lost income. The plaintiff had a business insurance policy with Main Street America Assurance Company (MSAA) during the relevant period. The driver and owner of the vehicle that struck the plaintiff were insured by GEICO General Insurance Company.Previously, the plaintiff sued the at-fault driver and owner (the Mathieus) in Kent County Superior Court and later settled that case. In the present suit, the plaintiff brought claims against both GEICO and MSAA for breach of contract, breach of the implied covenant of good faith and fair dealing, and statutory bad faith refusal to settle. Both defendants moved to sever the bad faith and implied covenant claims and to stay discovery on those claims, which the Superior Court granted. The court also denied the plaintiff’s motion to compel additional document production from GEICO, pending resolution of summary judgment motions. Ultimately, the Superior Court granted summary judgment for both defendants.On appeal, the Supreme Court of Rhode Island affirmed the Superior Court’s judgments. The Court held that MSAA’s business insurance policy expressly excluded coverage for injuries arising from automobile use, so the plaintiff’s contract and related claims failed as a matter of law. As to GEICO, the Court found that Rhode Island law prohibits direct actions against an insurer under these circumstances, and the plaintiff had no contractual or third-party rights under the GEICO policy. The Court also concluded that the issues related to severance and discovery were moot given the disposition of the contract claims. View "Menge v. GEICO General Insurance Company" on Justia Law

The case centers on a legal-malpractice insurance dispute arising from a failed medical-malpractice lawsuit. Lauren Bridges, acting as guardian for her minor daughter, initially filed suit in Alaska state court, alleging negligence by healthcare providers that resulted in her child’s disabilities. The case was dismissed when Bridges’s attorney, McKeen & Associates, failed to respond to summary judgment motions. Bridges subsequently brought a legal-malpractice claim against McKeen. At the relevant times, McKeen held legal-malpractice policies from Maxum Indemnity Company, StarStone Specialty Insurance Company, and Landmark American Insurance Company. All insurers declined to defend or indemnify McKeen. McKeen settled with Bridges, assigning her its rights under the policies.Bridges filed suit in the United States District Court for the Eastern District of Michigan against all three insurers, seeking a declaratory judgment and damages for breach of contract. Maxum and Landmark moved to dismiss, and the district court granted their motions, finding the policies unambiguously excluded coverage. The district court also denied Bridges’s motion to amend her complaint to add bad-faith claims and, after Bridges and StarStone stipulated to dismissal, entered final judgment regarding Maxum and Landmark. Bridges appealed only the dismissal of her claims against Maxum and Landmark.The United States Court of Appeals for the Sixth Circuit reviewed the district court’s dismissal de novo. The court held that Maxum’s policy unambiguously required notification of potential malpractice claims during the policy period, which McKeen failed to do, precluding coverage. As to Landmark, the court found that the relevant “wrongful act” occurred before the retroactive date specified in the follow-form policy, excluding coverage. Bridges’s arguments regarding policy ambiguity and procedural fairness were rejected. The Sixth Circuit affirmed the district court’s dismissal of Bridges’s claims against both Maxum and Landmark. View "Bridges v. Maxum Indemnity Company" on Justia Law

The Office of the Special Deputy Receiver (OSD), an Illinois non-profit that manages receiverships for insolvent insurance companies, purchased a Financial Institution Bond from Hartford Fire Insurance Company. The bond included coverage for computer systems fraud and for electronic mail initiated transfer fraud, subject to certain exclusions. Hackers infiltrated OSD’s Chief Financial Officer’s email account via a spear phishing attack, impersonated the CFO, and sent fraudulent instructions to other OSD employees, resulting in unauthorized wire transfers and a loss of nearly $4 million.OSD filed claims with both Hartford and another insurer. Hartford denied coverage, asserting that an exclusion in the bond applied to the loss. OSD sued both insurers in the United States District Court for the Northern District of Illinois, seeking declaratory relief and alleging breach of contract. The district court granted Hartford’s motion to dismiss under Rule 12(b)(6), finding that the policy’s exclusion for losses resulting from fraudulent instructions sent to OSD by email applied, and denied the other insurer’s motion. OSD later voluntarily dismissed its claims against the second company, and judgment was entered.On appeal, the United States Court of Appeals for the Seventh Circuit reviewed the dismissal de novo. The court held that the exclusion in Rider 17 of the Hartford bond unambiguously barred coverage for losses resulting from fraudulent email instructions sent to OSD—even if the sender was impersonating an internal employee—because the exclusion focused on the recipient, not the sender. The court found no ambiguity or conflict between the exclusion and other coverage provisions, and concluded that OSD’s losses fell outside the scope of coverage. The Seventh Circuit affirmed the district court’s dismissal of OSD’s claims against Hartford. View "Office of the Special Deputy Receiver v Hartford Fire Insurance Company" on Justia Law

Samantha Pinto was involved in a car accident in December 2020, after which she claimed to have suffered various physical and cognitive injuries, including a concussion and related mental health issues. At the time, she was employed by United Services Automobile Association (USAA), her insurer, and asserted a claim for uninsured motorist (UM) benefits. Pinto alleged significant lost wages and benefits following her termination from USAA, which she attributed to her accident-related health issues. She received $500,000 from the other driver’s insurer but claimed that her damages exceeded that amount, seeking additional recovery from USAA under her UM policy.After USAA denied her UM claim, valuing it at less than what she had already recovered, Pinto filed a breach of contract lawsuit against the company. During discovery in the El Paso County District Court, USAA requested Pinto’s unredacted medical records, documents relating to a subsequent 2022 accident, and required her to submit to an independent medical examination (IME). Pinto objected, arguing that under Schultz v. GEICO Casualty Co., USAA should be limited to the evidence available at the time of its coverage decision. The district court distinguished Schultz, finding the requested information relevant and discoverable for the contract claim, and ordered Pinto to comply.The Supreme Court of Colorado reviewed the district court’s order under its original jurisdiction. It held that the rule from Schultz, which limits review to evidence available when the insurer made its decision, applies only to bad faith claims, not to breach of contract claims. The court further held that the district court did not abuse its discretion in compelling production of Pinto’s medical records and insurance documents, and in ordering her to undergo an IME. The order to show cause was discharged. View "Pinto v. United Servs. Auto. Ass'n" on Justia Law

This case centers on a car accident between an insured driver, Ortiz, and an uninsured motorist, Camacho, in Colorado. At the time of the collision, Camacho lacked insurance, drove with only a learner’s permit, and was unsupervised. Ortiz, insured by Progressive Direct Insurance Company, sought uninsured motorist (UM) benefits from Progressive after the accident. Progressive denied the claim, asserting Ortiz was more than 50% at fault. Ortiz then sued both Camacho for negligence and Progressive for breach of contract, insurance bad faith, and unreasonable delay and denial of benefits.Camacho did not respond to the lawsuit, leading the District Court for Garfield County to enter a clerk’s default against her. Progressive had been served but did not object at that time. Progressive’s answer to Ortiz’s complaint included general affirmative defenses but did not specifically assert comparative fault. After Ortiz moved for partial summary judgment, Progressive, for the first time, sought to participate in the liability and damages components of the default judgment hearing. The district court permitted Progressive to contest damages but barred it from contesting liability, finding Progressive had not timely or specifically pleaded its legitimate defenses as required under State Farm Mutual Automobile Insurance Co. v. Brekke, 105 P.3d 177 (Colo. 2004). Progressive paid the damages awarded in the default judgment and then proceeded to trial on Ortiz’s bad faith claims, where Ortiz prevailed.On appeal, the Colorado Court of Appeals affirmed the district court’s decision, holding Progressive failed to meet the Brekke standards for timely and particularized pleading of its legitimate defenses. The Supreme Court of Colorado reviewed whether Brekke’s requirements should be reconsidered. The Court clarified that pleading with particularity under Rule 9(b) is only necessary if fraud or mistake is asserted, and otherwise, insurers must plead legitimate defenses specifically and as soon as practicable. The Court affirmed the appellate judgment, reaffirming Brekke and declining to overrule it. View "Progressive Direct Ins. Co. v. Ortiz" on Justia Law

After suffering a car accident more than 40 years ago, the plaintiff lost the use of her arms and legs and required substantial assistance with daily activities. She worked for a regional education agency for over three decades, during which her employer began offering group long-term care insurance through the defendant insurer. The policy was “guaranteed issue,” so preexisting conditions were not a barrier to enrollment, but it contained an “existing-loss provision” excluding coverage for losses of daily living activities that already existed on the policy’s effective date. The plaintiff, after consulting with both agency specialists and the insurer—without fully disclosing her limitations—enrolled in the policy and paid premiums for nearly 20 years. Upon retiring, she filed a claim for benefits based on her longstanding impairments. Her claim was denied, as her limitations predated the policy’s effective date.The plaintiff sued in state court, alleging breach of contract, fraudulent misrepresentation, and bad faith. After the case was removed to the United States District Court for the Northern District of Iowa, the defendant moved for summary judgment. The district court granted summary judgment to the insurer and dismissed the case, finding that the policy’s plain language did not cover losses existing before coverage began and that the plaintiff could not rely on the reasonable-expectations doctrine or statutory protections for preexisting conditions to obtain coverage.On appeal, the United States Court of Appeals for the Eighth Circuit affirmed the district court’s judgment. The Eighth Circuit held that under the unambiguous terms of the policy and applicable Iowa law, the insurer was not required to cover losses that predated the effective date of coverage. The court also rejected the plaintiff’s arguments based on Iowa statutes, administrative rules, and the reasonable-expectations doctrine, as well as her claims for bad faith and fraudulent misrepresentation, concluding that the insurer had a reasonable basis for denial. View "Child v. Unum Life Insurance Co. of America" on Justia Law

After being injured in a car accident while riding in a vehicle insured by Progressive, the respondent received medical treatment from several providers. The total amount billed for her treatment was $27,786.17. However, as a Medicaid recipient, her providers agreed to accept $1,323.60—paid by Medicaid—as full satisfaction for her medical expenses. The respondent demanded payment of the full $10,000 policy limit under the "Medpay" provision of her Progressive auto insurance policy, but Progressive paid only the $1,323.60 Medicaid had paid, arguing that this was the only amount the respondent actually "incurred."The Circuit Court for Chester County denied Progressive’s motion to dismiss the breach of contract claim and, after a bench trial, found for the respondent. The court determined the term "incurred" was ambiguous and should be interpreted in favor of the insured, entitling the respondent to the full amount charged for her medical care. The South Carolina Court of Appeals affirmed, holding that the full amount billed constituted expenses "incurred," even though the providers accepted less due to Medicaid.The Supreme Court of South Carolina granted certiorari and reversed. It held that the term "expenses incurred" in the policy is unambiguous and means the amount for which the insured is legally obligated to pay. The Court determined the respondent incurred only the amount Medicaid paid, as she had no obligation to pay the providers more. Accordingly, Progressive was required to pay only $1,323.60, and not the higher amounts billed or the policy limit. The Court remanded for entry of judgment in favor of Progressive. View "Jones v. Progressive Northern Insurance Company" on Justia Law

A public entity contracted with a general contractor to construct a major rail line project. The general contractor, in turn, subcontracted a significant portion of the work to a subcontractor. As the project progressed, it experienced numerous delays and disruptions, which the subcontractor claimed increased its costs. After completing its performance, the subcontractor, relying on expert analysis of its additional costs, filed a verified statement of claim under the Colorado Public Works Act, asserting it was owed additional millions for labor, materials, and other costs, including those stemming from delay and disruption.Following the filing, the general contractor substituted a surety bond for the retained project funds and the subcontractor initiated litigation in Denver District Court. After a bench trial, the trial court found in favor of the subcontractor, concluding that its verified statement of claim was not excessive and that there was a reasonable possibility the claimed amount was due. The court awarded the subcontractor damages for delay, disruption, and unpaid funds. The general contractor appealed, contending the claim was excessive and should result in forfeiture of all rights to the claimed amount. The Colorado Court of Appeals reversed in relevant part, holding that the verified statement of claim was excessive as a matter of law and that the subcontractor forfeited all rights to the amount claimed. This disposition left certain issues raised by the subcontractor on cross-appeal unaddressed.The Supreme Court of Colorado granted review and held that, under the Public Works Act, disputed or unliquidated amounts—including delay and disruption damages—may be included in a verified statement of claim if they represent the specified categories of costs and the claim is not excessive under the statute. The court also held that filing an excessive claim results only in forfeiture of statutory remedies under the Act, not all legal remedies. The Supreme Court reversed the Court of Appeals’ judgment and remanded for further proceedings. View "Ralph L. Wadsworth Constr. Co. v. Reg'l Rail Partners" on Justia Law