Justia Insurance Law Opinion Summaries

Hospital records state that decedent died of a nonsurvivable head injury following an accidental fall at a casino. An insurer refused to pay, claiming that the fall was likely caused by a stroke, so that death was not "accidental" within the meaning of the policy. The company's expert testified accordingly. The district court entered judgment in favor of the company. The First Circuit affirmed. The district court did not err in admitting the expert's testimony; it fell within the scope of his previously disclosed report. The estate was not prejudiced by any difference between the report and testimony.

Plaintiff Government Employees Insurance Company (GEICO) sought a declaratory judgment against Defendants Jeffery and Tracie Quine and Amanda Watkins. GEICO filed suit following a demand from Defendants' attorney seeking partial advance payment of underinsured motorist benefits available through a policy it issued. GEICO requested the federal court determine whether the subject policy or Oklahoma law obligated the company to unconditionally tender a partial payment of underinsured benefits when (1) a dispute had arisen between the insurer and its insured over the amount of underinsured motorist proceeds due; and (2) the parties had not arrived at a complete settlement agreement. The district court certified the question to the Oklahoma Supreme Court. Upon review, the Supreme Court concluded that an insurer's refusal to unconditionally tender a partial payment of UIM benefits does not amount to a breach of the obligation to act in good faith and deal fairly under Oklahoma law when: (1) the insured's economic/special damages have been fully recovered through payment from the tortfeasor's liability insurance; (2) after receiving notice that the tortfeasor's liability coverage has been exhausted due to multiple claims, the UIM insurer promptly investigates and places a value on the claim; (3) there is a legitimate dispute regarding the amount of noneconomic/general damages suffered by the insured; and (4) the benefits due and payable have not been firmly established by either an agreement of the parties or entry of a judgment substantiating the insured's damages.

A employee made a series of attempts to obtain benefits under the company's long-term disability policy. A copy of the plan, which he obtained during internal appeals, contained no limitation on filing suit to challenge denials, but did reserve the right to make alterations to the plan. The plan was later amended to include a one-year limitation on bringing suit. Employee did not receive notice of the change. In 2005 the plan issued a final written rejection. In 2008 the employee filed suit under the Employee Retirement Income Security Act, 29 U.S.C. 1109 and 1132. The district court dismissed. The First Circuit reversed. While the plan did not engage in deceptive conduct that would implicate equitable estoppel, equitable tolling applies based on the failure to give notice of the change. The employee was reasonably diligent.

Town & Country Property, L.L.C., and Town & Country Ford, L.L.C. (T&C), sued Amerisure Insurance Company and Amerisure Mutual Insurance Company (Amerisure) and its insured, Jones-Williams Construction Company, Inc., alleging that Amerisure was obligated to pay a $650,100 judgment entered in favor of T&C and against Jones-Williams in a separate action pursuant to a commercial general-liability insurance policy Amerisure had issued Jones-Williams. The trial court entered a summary judgment in favor of Amerisure, and T&C appealed. Specifically, the trial court held that Amerisure was not required to indemnify Jones-Williams because there had been no occurrence invoking coverage under the policy. Upon review, the Supreme Court affirmed the trial court's judgment to the extent the awarded damages represented the costs of repairing or replacing faulty work covered under the liability policy. The Court remanded the case to the trial court so that it could consider arguments from the parties to determine if any of the damages awarded represented compensation for damaged property.

At issue before the Supreme Court was whether it was a violation of public policy to exclude from underinsured motorist coverage (UIM) a claim by an individual eligible for workers' compensation benefits. Appellant Frank Heller was severely injured from an automobile accident that happened during the course of his employment as a police officer for Sugarcreek Borough. Workers' Compensation covered his medical expenses and two-thirds of his salary. The Borough paid the remainder of Appellant's salary. Appellant's losses and damages far exceeded the policy limit from the tortfeasor's insurance carrier. Accordingly, Appellant notified his insurer of a potential UIM claim and sought UIM benefits from the Borough pursuant to a policy issued by the Pennsylvania League of Cities and Municipalities. Ultimately, Appellant's claim was denied. Upon review, the Supreme Court concluded that an exclusion in Appellant's workers' compensation policy violated public policy and was therefore unenforceable. The Court reversed the Commonwealth Court which held that the policy considerations favored the insurer: "Invalidating the workers' compensation exclusion would not force [the UIM insurer] to underwrite an unknown risk for which it did not receive compensation. The Borough voluntarily elected to purchase optional UIM coverage. .. [W]e find [Appellant's] assertion that the Borough purchased illusory coverage persuasive… the vast majority of all UIM claims likely will be made by Borough employees who are eligible for workers' compensation. The subject exclusion operates to deny UIM benefits to anyone who is eligible for workers' compensation."

Plaintiff Chase Wisness appealed the district court's grant of summary judgment in favor of Nodak Mutual Insurance Company (Nodak), finding its Farm and Ranch Excess Liability Policy did not provide coverage for his claim. Plaintiff argued on appeal that the district court erred by finding the insurance policy did not provide underinsured motorist coverage. In 2007, Plaintiff was a passenger in a vehicle driven by an unrelated third party. An accident occurred, and Plaintiff was injured and is now a paraplegic. At the time of the accident, Milo Wisness, Plaintiff's father, owned a Nodak Mutual automobile insurance policy with underinsured motorist limits of $500,000. Milo Wisness also owned a Farm and Ranch Excess Liability Policy issued by Nodak. Plaintiff settled with Nodak for underinsured limits on the automobile policy and reserved the right to pursue a claim under the excess liability policy. Plaintiff then sued alleging that Nodak wrongfully denied his claim under his excess liability policy because the policy provided underinsured motorist coverage, that Nodak used bad faith when denying the claim and that his father's insurance agent negligently counseled Milo Wisness about what insurance policy to buy. Nodak and the agent denied the allegations. Plaintiff moved for partial summary judgment, asking the court to declare coverage existed for his claim. Judgment was entered awarding Nodak its costs and dismissing Wisness's claim with prejudice. Upon review, the Supreme Court agreed with the district court's conclusion that the excess liability policy did not cover Plaintiff's claim, and affirmed the court's decision.

This action came before the court following the insolvency and proposed rehabilitation of a Delaware insurance company. At issue was whether the arbitration clause in the reinsurance agreements between the insolvent insurance company and the reinsurer were enforceable against the receiver under Delaware law. If so, the question became whether this court should, in its discretion, require the parties to honor their agreement to arbitrate in light of the ongoing rehabilitation of the insurer. The court held that Delaware law permitted enforcement of the arbitration clause of the reinsurance agreements against the receiver and that the parties should be required to arbitrate their competing claims to the disputed cash. In addition, the court ordered a partial stay of the proceedings pending resolution of the arbitration.

This case arose from an automobile collision in which a police officer employed by the City of Newman was driving a City police car when it was struck by a motor vehicle owned and operated by the insured, who had $25,000 of motor vehicle liability coverage. The City had a Member Coverage Agreement (Agreement) with the Georgia Interlocal Risk Management Agency (GIRMA), established under OCGA 36-85-1 et seq. The officer subsequently sued the insured in tort and served a copy of the complaint on GIRMA to notify GIRMA that it might be held responsible as an uninsured motorist carrier pursuant to OCGA 33-7-11. The court subsequently granted a writ of certiorari to the court of appeals to consider whether that court properly determined that a municipality's motor vehicle liability coverage secured through an interlocal risk management agency was not statutorily obligated to satisfy the requirements for uninsured and underinsured motorist coverage that were applied to commercial insurance policies and private self-insurance plans. The court held that the district court reached the correct conclusion when it determined that there was no authority for the conclusion that an interlocal risk management program such as that offered by GIRMA must include uninsured motorist coverage pursuant to OCGA 33-7-11. Therefore, the Agreement was limited to its express terms and did not include the underinsured motorist protection that the police officer sought. Accordingly, the judgment was affirmed.

This case arose when Cat Tech sought indemnification from its insurers after Cat Tech damaged several components of a hyrotreating reactor owned by Ergon Refining, Inc. and arbitrators entered an award against Cat Tech for the damage. Insurers subsequently denied the claim, contending, inter alia, that the "your work" exclusion found in the policies precluded coverage for damage to the reactor. The district court found that insurers had no duty to indemnify Cat Tech. The court held that the information contained in the arbitration award was insufficient to properly apply the "your work" exclusion. As such, the court concluded that the district court erred when it relied on the award in granting insurer's summary judgment motion. On remand, the district court should conduct any additional fact-finding necessary to determine whether the damage suffered by Ergon's reactor was limited only to those components upon which Cat Tech worked, or instead included other components unrelated to Cat Tech's operations. Accordingly, the judgment was reversed and the case remanded for further proceedings.

The underlying dispute in this appeal revolved around the issue of who was contractually obligated to pay workers' compensation benefits to an employee of Employer. The Supreme Court found that Employer's Insurer was required to pay workers' compensation benefits for all of Employer's employees and remanded the case. The district court entered a final judgment. Instead of filing a notice of appeal within thirty days of the district court's judgment, Insurer filed an "objection to judgment." Insurer then filed its notice of appeal within thirty days of the district court's order disposing of that motion. The Supreme Court dismissed the appeal, holding that it lacked jurisdiction to address the appeal as (1) Insurer did not file its notice of appeal within thirty days of the district court's final judgment, and (2) Insurer failed to file a postjudgment motion that would toll the time for appeal or one that the Court had jurisdiction to review.