Justia Insurance Law Opinion Summaries

During the course of his employment as a police officer for the Town of Abingdon, Kevin Christy suffered injuries from an automobile accident. Christy was insured under an automobile liability insurance policy issued by Mercury Casualty Company (Mercury). Christy submitted a claim to Mercury for payment of the portion of his medical expenses not paid by the Town's workers' compensation carrier. Mercury denied the claim, asserting that an exclusion in the policy barred Christy from receiving any payment for medical expenses because a portion of those expenses had been paid by workers' compensation benefits. Christy filed a warrant in debt against Mercury seeking contract damages. The district court entered judgment in favor of Christy. The circuit court reversed, concluding that, based on the unambiguous language of the exclusion, payment of workers' compensation triggered the exclusion and precluded payment by Mercury. The Supreme Court affirmed, holding that the language of the exclusion was clear and that the exclusion permitted Mercury to deny coverage for any expenses that would have been subject to workers' compensation coverage without regard to whether all of those expenses were actually paid by the workers' compensation carrier.

Auto Owners Insurance, Inc. (Auto Owners) appealed a circuit court's denial of its motion to dismiss or, in the alternative, to compel arbitration in an action against it filed by Blackmon Insurance Agency, Inc. Blackmon and Auto Owners entered into an "agency agreement" authorizing Blackmon to act as an agent for the sale of Auto Owners' insurance in Alabama (the 1995 agreement). A 2005 document entitled "Letter of Instructions" was alleged to be an independent document from the 1995 agreement. Auto Owners contended that the 2005 document was contemplated by and incorporated into the 1995 agreement. The 2005 document contained instructions governing the issuance of a variety of bonds by an agency of Auto Owners. In late 2010, Blackmon filed a complaint in the circuit court seeking a declaratory judgment as to the arbitrability of a dispute between Blackmon and Auto Owners as to which Auto Owners had already initiated arbitration proceedings in its home state of Michigan. Blackmon also alleged that in the Michigan arbitration proceeding Auto Owners based its claims on the 2005 document and a 2009 agreement. Upon review of the matter, the Alabama Supreme Court concluded that the circuit court erred in denying Auto Owners' motion to compel arbitration. The Court therefore reversed that order and remanded the case for the circuit court to grant the motion to compel arbitration and either issue a stay of these proceedings pending arbitration or dismiss the case.

Plaintiffs brought a putative class action under the Employee Retirement Income Security Act, 29 U.S.C. 1001, to recover benefits under long-term disability benefit plans maintained by their former employers. The plans provide for reduction of benefits if the disabled employee also receives benefits under the Social Security Act, as both plaintiffs do. They dispute calculation of the reduction, claiming that the plans do not authorize inclusion in the offset of benefits paid to dependent children. Both plans require offsets for "loss of time disability" benefits. The district court dismissed. The Seventh Circuit affirmed, holding that children's Social Security disability benefits paid based on a parent's disability are "loss of time disability" benefits under the language of the plans.

Miriam Salazar purchased an insurance policy from United Automobile Insurance Company and El Sol Insurance Agency (collectively, United), rejecting underinsured motorist (UIM) coverage by signing United's waiver. After Salazar was involved in an accident, Lopez sued United, arguing that United must provide her with UIM coverage because the waiver did not provide the required reasonable explanation of UIM coverage. The district court granted summary judgment in favor of United. The court of appeals reversed, holding that the waiver did not contain a reasonable explanation, and Lopez was therefore entitled to UIM coverage of $25,000 under the UIM statute. The court then remanded the case with instructions for the district court to enter judgment in favor of Lopez in the amount of $25,000. The Supreme Court held that the court of appeals (1) did not err in finding that United failed to provide a reasonable explanation of the purpose of UIM coverage and when it would be applicable; but (2) erred in instructing the district court to enter judgment for Lopez in the amount of $25,000. Remanded with instructions to determine the amount of damages Lopez actually sustained.

Joshuah Farrington struck a moose while driving a vehicle loaned to him by Darling's Rent-a-Car, causing damages. Philadelphia Indemnity, Darling's insurer, compensated Darling's pursuant to the property damage provision of its commercial insurance policy. Philadelphia Indemnity, as Darling' subrogee, subsequently filed a complaint against Farrington, asserting that he breached the rental contract by damaging the vehicle. The Business and Consumer Docket entered judgment in Philadelphia Indemnity's favor. Farrington appealed, contending that he was insured by Darling's insurance policy with Philadelphia Indemnity and that Maine's anti-subrogation rule prohibited Philadelphia Indemnity to bring a claim against him. The Supreme Court affirmed, holding that the district court did not err in concluding that Farrington was not included as an insured within the meaning of the property damage portion of the contract Darling's made with Philadelphia Indemnity.

In this appeal the Supreme Court was asked to determine whether the parties' indemnity agreement clearly and unequivocally indemnified the Snohomish County Public Transportation Benefit Area Corporation (doing business as Community Transit) for losses resulting from its own negligence. Upon review, the Court concluded that the language of the agreement, and in particular language providing that indemnity would not be triggered if losses resulted from the sole negligence of Community Transit, clearly and unequivocally evidenced the parties' intent that the indemnitor, FirstGroup America, Inc. (doing business as First Transit) indemnify Community Transit for losses that resulted from Community Transit's own negligence. The Court reversed the Court of Appeals' decision to the contrary and remanded the case to the trial court for further proceedings.

Insurer commenced the instant suit against insureds, alleging eight causes of action and requesting a declaration that the insurer's policy provided no coverage or duty to indemnify any amount paid or payable by insured and the plan in an underlying class action suit. At issue was whether the disputed language in an insurance policy extended coverage to alleged violations of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., by insureds. The court reaffirmed fundamental principles of insurance contract interpretation and held that the plain language of the policy did not cover such acts and, therefore, the Appellate Division correctly held that insurer was entitled to summary judgment and a declaration that was not required to indemnify insured in the manner requested.

This case involved a dispute between plaintiff and other class members (insureds) and Pioneer, which was succeeded in this action by Washington National. The controversy was over the proper interpretation of certain similar insurance contracts under Florida law. Washington National appealed the district court's grant of summary judgment for the insureds. The court agreed with the district court and held that the policies in question were ambiguous, but concluded that Florida law was unsettled on the proper way to resolve the ambiguity. To establish the proper approach to take under Florida law in interpreting ambiguity, the court certified the following question to the Supreme Court of Florida: In this case, does the Policy's "Automatic Benefit Increase Percentage" apply to the dollar values of the "Lifetime Maximum Benefit Amount" and the "Per Occurrence Maximum Benefit"?

Defendant was injured in 2007 while driving an automobile insured under an ASIC policy that indemnifies against injuries caused by negligent uninsured or underinsured motorists. After determining that the tortfeasors were underinsured, defendant received authorization from ASIC to settle pursuant to Rhode Island's UM/UIM insurance statute, R.I. Gen. Laws 27-7-2.1. Within three months, defendant and the tortfeasors agreed to a settlement of $1 million. ASIC refused to pay under the UM/UIM provisions and sought a declaratory judgment that the claim did not comply with a policy requirement that a claim be made within three years after the date of the accident. The district court granted ASIC judgment on the pleadings. The First Circuit certified to the state supreme court the question of whether the policy limitation is enforceable under state law. The court noted that, by requiring the three-year limitations period to run from the date of the accident, the policy may require some insureds to file suit before their claims are ripe--before the insurer determines whether it will cover the claim. The limitations period may even require some insureds to file suit before it becomes clear that the tortfeasor is underinsured.

Appellant was physically injured as a result of an accident caused by an underinsured motorist. Prior to the accident, Appellant purchased a Dairyland Insurance Policy through his insurance agent, Jonathan Schrack. Although Appellant requested full coverage, the policy did not include underinsured motorist coverage. When the other driver's insurance did not fully cover Appellant's damages, Appellant sued Dairyland and Schrack (Defendants), raising numerous theories as to why he should recover under the Dairyland policy. The district court granted Defendants' motions for summary judgment. The Supreme Court affirmed, holding, inter alia, (1) Wyoming's uninsured motorist statutes unambiguously do not require insurers to provide underinsured motorist liability coverage; (2) Appellant's failure to read the policy was available as a defense to Defendants as to Appellant's negligence and contract claims against them and barred application of the doctrine of promissory estoppel; and (3) the doctrine of reasonable expectations was not available to alter the unambiguous terms of the policy.