Justia Insurance Law Opinion Summaries

The Bank of Commerce (Bank) brought an action against SouthGroup Insurance and Financial Services, LLC (SouthGroup) and Norman White, an agent of SouthGroup, for negligent misrepresentations made by White regarding the type of liability insurance coverage they would need to purchase. The trial court granted summary judgment for SouthGroup and White on two grounds: (1) that the Bankâs claims are barred by the statute of limitations; and (2) that the damages sought by the Bank constituted a voluntary payment which may not be recovered under Mississippiâs voluntary payment doctrine. The Bank appealed the trial courtâs decision. Upon review, the Supreme Court concluded that the three-year statute of limitations began to run when the Bank first received notice that it did not have entity coverage on January 18, 2005. When the Bank filed its claim against Defendants on July 17, 2008, the statute of limitations already had run, therefore barring the Bankâs claims against them. The Court affirmed the trial court's grant of summary judgment dismissing the Bank's case.

Dane Shattuck died from injuries after being hit by an automobile. Dane received medical care at Hospital for his injuries. Dane was enrolled in a children's health insurance program (CHIP), administered by the department of public health and human services (DPHHS). Hospital submitted the bill for Dane's care to Blue Cross and Blue Shield (BCBS), which served as third-party administrator of the CHIP program for DPHHS. Hospital then asserted a lien for the full bill amount against recoveries Gail Shattuck, as personal representative of Dane's estate, may obtain against third parties. Shattuck sued Hospital, BCBS, DPHHS, and the State, asserting that Defendants unlawfully acted to avoid application of "made whole" rules and that Hospital could not foreclose the lien because Shattuck had not been made whole. The district court granted partial summary judgment to Shattuck. The Supreme Court reversed in part and affirmed in part, holding (1) the district court erred by determining that CHIP constitutes insurance and was governed by the made whole doctrine, and (2) the district court did not err by determining that BCBS was not an insurer in its role here and, therefore, was not subject to the made whole statute. Remanded.

This case concerned the proper application of stare decisis and required the Supreme Court to decide whether "Collins v. Farmers Ins. Co." was still good law. In "Collins," the Court held that an exclusion in a motor vehicle liability insurance policy that purported to eliminate all coverage for a claim by one insured against another insured under the same policy was unenforceable to the extent that it failed to provide the minimum coverage required by the Financial Responsibility Law (FRL). The exclusion, however, was enforceable as to any coverage beyond that statutory minimum. In this case, Plaintiff Farmers Insurance Company issued an insurance policy to Defendant Tosha Mowry that contained an exclusion identical to the exclusion in "Collins". Defendant was injured in an accident in which her friend -- a permissive user and thus an insured person under the policy -- was driving. Plaintiff brought this action seeking a declaration that Defendant had $25,000 available in coverage under her policy -- the minimum coverage required by the FRL for bodily injury to one person in any one accident. Defendant argued that her coverage was $100,000, the insurance amount stated on the declarations page of her policy. The parties filed cross-motions for summary judgment, and the trial court granted Plaintiff's motion and denied Defendant's. The Court of Appeals affirmed in a per curiam opinion that cited "Collins." The Supreme Court concluded that Defendant "advanced no argument that this court has not previously considered for reaching a different result from that in 'Collins.' Defendant failed to carry the burden for overturning a fully considered precedent of this court."

This case arose because the settlement of a personal-injury suit brought by a recipient of workers' compensation benefits against a third-party tortfeasor did not make any provision to repay the statutory subrogee, the Ohio Bureau of Workers' Compensation. The Bureau brought suit against both the recipient of the workers' compensation benefits and third-party tortfeasor under Ohio Rev. Code 4123.931(G) to recover the full amount of its subrogation interest. The trial court held that a two-year limitations period applied and that it had expired. The court of appeals reversed, holding that a six-year limitations period applied and that it had not yet run out. At issue on appeal was whether a claim under section 4123.931(G) brought by a statutory subrogee to recover its subrogation interest is subject to a two-year statute of limitations, the same period applicable to the injured worker's personal-injury suit against the third party, or to a six-year statute of limitations for an action on a liability created by statute. The Supreme Court affirmed the court of appeals, holding that the claim in this case was an action upon a liability created by statute and that the statute of limitations was six years.

This case stemmed from an Excess Disability Income Reinsurance Agreement (Treaty). At issue was whether a reinsurance agreement between plaintiff and defendant contained a follow-the-settlements provision. The court held that there was no ambiguity in the Treaty and that it contained a follow-the-settlements provision. The court also held that the statute of limitations barred plaintiff's challenges to several claims submitted by defendant and defendant's conduct did not give rise to tolling under Connecticut law. The court further held that the district court properly granted summary judgment on defendant's counterclaims for breach of contract and for breach of the implied covenant of good faith and fair dealing.

In this appeal, accounting firm Bryan Brothers sought coverage under a professional liability insurance policy issued by Continental Casualty Company for liability arising from illegal acts of a former Bryan Brother's employee. Under the policy, it was a condition precedent to coverage that no insured had knowledge, prior to the inception of the policy, of an act that was reasonably likely to become the basis for a claim. The court held that because Bryan Brothers had such knowledge, the claims at issue were not covered. Therefore, the court affirmed the district court's grant of summary judgment to Continental Casualty Company.

In attempting to enroll his infant daughter, a covered employee failed to complete parts of the form indicating whether the child resided with employee, was dependent upon employee for more than 50 percent support and maintenance, and whether the child qualified to be claimed as a tax exemption on employee's federal tax return. The plan made several inquiries before sending a notice that coverage was denied. The employee did not appeal. The plan sued under the Employee Retirement Income Security Act , 29 U.S.C. 1001, to recover $472,357.84 paid to the medical college and $1,199,538.58 paid to the hospital on behalf of the child. The district court dismissed. The Seventh Circuit affirmed dismissal of the ERISA claim. The plan reserves the right to recover against "covered persons" if it has paid them or any other party on their behalf. Neither the treating entities nor the child are covered persons. Because the plan is not implicated, state law claims were not preempted; the court reversed dismissal of those claims. Plaintiffs' position was not unreasonable; the district court abused its discretion in awarding attorney fees.

This dispute emerged from state and federal litigation over liability for damages and defense costs in certain environmental tort suits. At issue was an action for damages that appellants brought in federal court and a declaratory judgment action that appellee brought in state court, which appellants later removed to federal court. The district court dismissed the former and remanded the latter in light of a related third action that had been pending for several years in state court. The court held that the district court did not abuse its discretion by deciding that the parties' claims should be resolved in a more comprehensive action (Vulcan Action). The court also held that the district court had discretion under Wilton v. Seven Falls Co. and Brillhart v. Excess Ins. Co. of Am. to remand the removed action. The court further held that the district court's concerns about piecemeal litigation and interfering with the progress made in the Vulcan Action supported dismissal under Colorado River Water Conservation Dist. v. United States. Therefore, the court affirmed the judgment of the district court.

Claimant Patrick Williams appealed the Industrial Commission's determination that I.C. 72-802 does not prohibit Respondent Blue cross of Idaho from seeking to exercise its contractual right of subrogation against his lump sum settlement proceeds. Claimant's insurance contract with Blue Cross contained several subrogation and reimbursement provisions. In addition to seeking payment from Blue Cross, Williams filed a complaint with the Industrial Commission seeking workersâ compensation for the medical expenses incurred as a result of two shoulder surgeries, as well as benefits for temporary and permanent disability as a result of such injuries. Claimant entered into a lump sum settlement agreement with the State Insurance Fund. After the agreement was finalized before the Commission, Blue Cross sent a letter to counsel for Williams demanding that, pursuant to Blue Crossâ right of subrogation, he withhold money from the workersâ compensation proceeds for payment to Blue Cross. The Commission ultimately concluded that I.C. 72-802 did not prohibit Blue Cross from seeking to exercise a contractual right of subrogation because Blue Cross is a subrogee, and not a creditor, within the meaning of the statute. However, the Commission found it did not have jurisdiction to consider a breach of contract claim by Blue Cross against Williams and, therefore, determined that Blue Cross must pursue its remedy in district court. Upon review of the applicable legal authority and the Commission's record, the Supreme Court affirmed the Commissionâs determination that Blue Cross was a subrogee under I.C. 72-802.

The South Dakota Public Assurance Alliance (SDPAA), a local government risk pool, negotiated with Aurora County to provide what was essentially insurance coverage. After coverage was finalized, a local dairy farm sued the County over a pre-existing zoning dispute. The County was found liable for damages. SDPAA then sought a declaration that it did not have a duty to defend or indemnify, arguing, inter alia, that the County failed to disclose material facts relating to the claim. In a jury trial, the circuit court excluded as parol evidence the parties' pre-contract communications regarding coverage for zoning issues, including communications that could be interpreted as having disclosed the dairy farm zoning dispute. The jury found for SDPAA. The Supreme Court reversed and remanded for a new trial, holding that because the excluded coverage communications were not offered to alter or contradict any written terms of the agreement, their admission would not have violated the parol evidence rule.