Justia Insurance Law Opinion Summaries

Several insureds filed a class action against the predecessor of Washington National Insurance Corporation concerning insurance policies that provide for reimbursement of certain home health care expenses. The district court granted summary judgment for the insureds, concluding that various provisions in the policy, including a certificate schedule, demonstrated an ambiguity concerning whether an automatic increase applied only to the daily benefit or also applied to the lifetime maximum benefit amount and the per occurrence maximum benefit amount. Because there was ambiguity in the policy, the court of appeal certified questions of law to the Florida Supreme Court, which held (1) because the policy was ambiguous, it must be construed against the insurer and in favor of coverage without consideration of extrinsic evidence; and (2) when so construed, the policy's automatic benefit increase applies to the daily benefit, the lifetime maximum benefit, and the per occurrence maximum benefit. View "Washington Nat'l Ins. Corp. v. Ruderman" on Justia Law

Plaintiff filed a claim with Defendant, his homeowner's insurance company, for fire damage on his home. Plaintiff's insurance policy with Defendant was a replacement cost policy. Defendant made a payment to Plaintiff that included costs of repair even though Defendant had not completed any repairs to the home. Defendant, however, refused to pay for a general contractor's overhead and profit because Plaintiff had not yet incurred those expenses. Plaintiff filed a breach of contract claim against Defendant, contending that, like the other costs of repair Defendant paid, Defendant was required to pay costs for overhead and profit. The trial court granted summary judgment for Defendant, and the court of appeal affirmed. The Supreme Court quashed the court of appeal's decision, holding (1) replacement cost insurance includes overhead and profit where the insured is reasonably likely to need a general contractor for repairs; and (2) the court of appeal erred in determining the Florida law and the insurance policy permitted Defendant to withhold payment of overhead and profit because Plaintiff had not actually incurred those costs. Remanded. View "Trinidad v. Fla. Peninsula Ins. Co." on Justia Law

The issue on appeal to the Supreme Court in this case stemmed from district court decisions regarding an uninsured motorist claim between Plaintiffs-Appellants Sam and Deva Ferrell and Defendant-Respondent United Financial Casualty Company (United Financial, d.b.a. Progressive Insurance Company). The parties underwent arbitration, and the Ferrells subsequently filed a petition that sought confirmation of the arbitration award and an award of costs and attorney fees. The district court ordered confirmation of the arbitration award and interest based upon an agreement of the parties. On the issue of attorney fees, the district court found that arbitration began five months prior to the amendment of I.C. 41-1839 which explicitly allowed attorney fees in arbitration, and therefore the statute as it existed did not provide for attorney fees in this case. The Supreme Court reversed in part and remanded the case back to the district court. View "Ferrell v. United Financial Casualty Co." on Justia Law

Defendant's employer had insurance through American States Insurance Policy (ASIC). After Defendant was involved in a car accident, Defendant sent ASIC written notice of a potential claim under ASIC's uninsured/underinsured (UM/UIM) coverage. ASIC did not formally deny the claim but, rather, responded with a declaratory-judgment action, asserting that because Defendant had failed to undertake legal action or to make a written demand for arbitration against ASIC within three years from the date of the accident, her UIM claim against ASIC was time-barred. The U.S. district court entered judgment on the pleadings in favor of ASIC, determining that the three-year limitations period set forth in the policy did not violate public policy. On appeal, the court of appeals certified a question of law to the Rhode Island Supreme Court, which answered by holding that Rhode Island would not enforce the contractual limitations clause in this case because it began to run on the date of the accident rather than the date the insurance contract was breached and was shorter than the statutory limitations period. View "Am. States Ins. Co. v. LaFlam" on Justia Law

The Oklahoma Supreme Court accepted a certified question of state law from the Tenth Circuit federal appellate court. Two excess insurers for the Grand River Dame Authority (GRDA) had a dispute concerning the application of equitable subrogation. The question centered on whether a second-level excess insurer could invoke equitable subrogation to recover money it became liable to pay because of an agreement GRDA had with its first-level insurer. GRDA and the first-level insurer agreed to include losses under a policy that was outside that policy's year and that triggered the second-level insurer's coverage for that year. Upon review, the Oklahoma Court held that the second-level insurer could invoke equitable subrogation notwithstanding GRDA's release of the first level insurer. View "Steadfast Insurance Co. v. Agricultural Ins. Co" on Justia Law

Southern Natural Gas Company (Sonat) sued Certain Underwriters at Lloyd's London and Certain London Marketing Insurance Companies (Phase III), alleging breach of numerous umbrella and excess liability policies. Sonat contended the insurance companies failed to pay certain environmental-remediation costs. The trial court granted summary judgment in favor of the insurers based on prior trials in Phases I and II of the case; Sonat appealed, and the insurers cross-appealed Phase III's outcome. Finding no abuse of the trial court's discretion, the Supreme Court affirmed. View "Certain Underwriters at Lloyd's, London v. Southern Natural Gas Company " on Justia Law

Plaintiff Mary Soileau was injured while working for the Town of Mamou when a front-end loader detached from a tractor and struck her in the leg. She named the tractor manufacturer, the Town, Smith's Hardware (where the Town rented the tractor for employees' use), the hardware store's owners and their insurance company. Trial began with only the owners and their insurer as the remaining defendants in the suit. On the third day, Plaintiff moved to dismiss the owners and their company in the presence of the jury, stating that she did not seek any damages personally against them. Hearing no objections, the trial court granted the request, but made no written (and therefore signed) judgment of dismissal. On day four, the insurer moved for a directed verdict, based on contract language that it was obligated to pay only if its insureds were legally obligated to pay. The insurer's motion was denied, and ultimately over $9 million in damages were awarded to Plaintiff. Concluding that the trial court erred in denying the insurer's motion, the appellate court reversed, dismissing the insurance company. The issue before the Supreme Court centered on the effect Plaintiff's in-court dismissal of the insured parties was during her personal injury action. Upon review, the Supreme Court concluded that the appellate court erred in its analysis, reversed and remanded the case for further proceedings. View "Solieau v. Smith True Value & Rental" on Justia Law

Appellant Tommie Patterson was involved in a motor vehicle accident. His insurance company paid his medical providers to the policy limit. Two years later, Appellant sued the insurance company, arguing it had shown bad faith following the accident. The company moved for summary judgment, which was granted. A month after that decision, Appellant filed a second lawsuit, alleging the company falsely advertised its services, breached his insurance contract, embezzled money from him, falsified documents and threatened to make him at fault for the accident. The company moved for summary judgment again, which was granted. After review, the Supreme Court concluded that because Appellant's embezzlement claim in the second lawsuit alleged a different cause of action than in the first, the trial court improperly granted summary judgment with regards to that claim. All other claims were barred by res judicata. Therefore the Supreme Court affirmed the trial court in all other respects. View "Patterson v. Infinity Insurance Co." on Justia Law

Pruco Life Insurance Company sought rescission of a life insurance policy, owned by the Paul E. L'Archevesque Special Revocable Trust on the life of Paul L'Archevesque, after it discovered that the policy application contained material misrepresentations about the health of Paul. Pruco tendered to Wilmington Trust Company, a co-trustee of the trust, a check in the amount of the policy premiums paid along with a letter stating Pruco was rescinding the policy. Wilmington cashed the check. Pruco subsequently filed a complaint seeking a rescission of the policy and a declaration that the policy was void ab initio. The district court granted summary judgment to Pruco, concluding that, under the circumstances, a mutual rescission had taken place as a matter of law. The First Circuit Court of Appeals affirmed, holding (1) the district court properly interpreted Rhode Island law regarding the standard for mutual rescission; (2) there were no genuine issues of material fact concerning whether Pruco made material misrepresentations in its rescission letter that could have prevented summary judgment; and (3) the district court did not err in finding that the issue of whether Pruco acted in bad faith was irrelevant to the rescission analysis. View "Pruco Life Ins. Co. v. Wilmington Trust Co." on Justia Law

Plaintiff's automobile insurance policy with Geico included a condition that Plaintiff submit to examination under oath (EUO) before recovering personal injury protection (PIP) benefits. Geico denied Plaintiff's PIP claim due to her failure to satisfy this condition after she was injured in a car accident. Plaintiff filed a class action complaint alleging that Geico had violated Florida's PIP statute. The federal district court dismissed the case, concluding that the PIP statute did not prohibit an insured from requiring an EUO. On appeal, the Eleventh Circuit certified a question of law to the Florida Supreme Court, which answered by holding that, under Fla. Stat. 627.736, an insurer cannot require an insured to attend an EUO as a condition precedent to recovery of PIP benefits. View "Nunez v. GEICO Gen. Ins. Co." on Justia Law