Justia Insurance Law Opinion Summaries

Five years after Homeowners contracted for the construction of their home, Homeonwers sued Elite Homes, the construction company that built their home, and Motorists Mutual Insurance, the insurance company that provided commercial general liability (CGL) insurance to the construction company while the home was under construction, claiming the house was so poorly built it was beyond repair. Motorists settled Homeonwers' claims against itself and Elite. Under the terms of the settlement, Homeowners and Elite assigned to Motorists all claims they may have had against Cincinnati Insurance, which was a successor to Motorists as Elite's CGL insurer. Motorists then filed a third-party complaint against Cincinnati. The trial court granted summary judgment to Cincinnati, holding that Homeowners' claims of intangible economic loss did not qualify as an "occurrence" causing property damage under Cincinnati's CGL policy. The court of appeals vacated the grant of summary judgment. At issue on appeal was whether faulty construction-related workmanship, standing alone, qualifies as an "occurrence" under a CGL policy. The Supreme Court reversed the court of appeals and reinstated the judgment of the trial court, holding that the trial court's conclusion that the claims were not an "occurrence" was correct.

Plaintiff was injured while driving his employer's tow truck. Plaintiff filed suit against the driver of the other car involved in the accident, and later sought to invoke his employer's uninsured motorist policy in an amount equal to the liability coverage for bodily injury. The employer's insurer filed a motion for partial summary judgment, seeking to limit uninsured motorist coverage to the amount listed in the policy rather than the amount fixed by statute. The trial court denied the motion. The court of appeals reversed, directing that the insurer's motion for partial summary judgment be granted. The Supreme Court affirmed, holding that when the insured signs an application indicating the selection of uninsured motorist coverage lower than the liability limits but neglects to initial a provision designed to confirm the selection of coverage less than the standard provided by statute, the requirement under Tenn. Code Ann. 56-7-1201(a)(2) that the selection be in writing has been satisfied.

State Farm petitioned for review of the Third District's determination that the household exclusion in its policy issued to respondents was ambiguous and therefore could not be enforced to eliminate coverage for bodily injuries suffered by members of the household of a permissive-driver insured. The court held that the plain language of the household exclusion precluded coverage for bodily injuries suffered by members of the household of a permissive-driver insured, such as the parents in this case. Therefore, the court quashed the Third District's decision, approved Linehan v. Alkhabbaz, and remanded for further proceedings.

Insured submitted a claim to Insurer after his house was damaged by a storm. Insured returned the payment tendered to him by Insurer, deeming the amount insufficient to cover the damage to his home. Almost two years after the house was damaged, Insured filed suit against Insurer. Insurer argued the lawsuit was barred by a clause in the insurance contract that stated that any action must be started within one year after the date of loss or damage. The trial court granted Insurer's motion for summary judgment. The court of appeals reversed, concluding the policy language was ambiguous and that Insurer, by its actions, had waived its right to enforce the one-year limitation clause. The Supreme Court reversed the judgment of the court of appeals and reinstated the trial court's grant of summary judgment, holding that Insurer could enforce the limitation-of-action clause contained in its contract because (1) the policy language was not ambiguous, and (2) Insurer did not waive its right to enforce the clause.

Eric Walters was a federal employee covered by a Standard Option health insurance plan (the Plan) administered by Blue Cross Blue Shield of Kansas City (Blue Cross). In November 2007 he went to Weight Loss Healthcare Centers of America, Inc. (Weight Loss) to inquire about surgical treatment for obesity. Because Weight Loss had no contractual arrangement with Blue Cross as either a preferred provider or a participating provider, Walters would expect to pay more than if he used a provider that had a contract. Nevertheless, Walters had outpatient laparoscopic surgery at Weight Loss to help him better control his weight. Although Walters obtained preauthorization from Blue Cross for the surgery, there was no indication in the record that he requested or received information about his out-of-pocket costs. Weight Loss billed Blue Cross for the procedure. The Blue Cross Plan paid $2,300 according to the Planâs benefit for out-of-network providers. Weight Loss appealed the payment to the federal Office of Personnel Management (OPM), which held that Blue Crossâs interpretation of Waltersâs Plan was correct and it had paid the proper amount. The district court affirmed OPMâs decision. Upon review, the Tenth Circuit determined that OPM reasonably interpreted the Plan language. However, the Court reversed the district courtâs decision because OPM neither (1) reviewed the evidence that would show whether Blue Cross had correctly calculated the Plan allowance, nor (2) explained why such review was unnecessary.

When it was sued by its former president and CEO, the Equine Assisted Growth and Learning Association (EAGALA) requested coverage for the costs of its defense from its insurance carrier, Carolina Casualty. Carolina Casualty denied coverage, contending that the complaint was brought "by, on behalf of, or in the right of" EAGALA, a type of claim excluded from coverage by the insurance policy. EAGALA sued Carolina Casualty to establish coverage for the costs of defending the suit. The district court granted Carolina Casualty's motion for judgment on the pleadings and dismissed EAGALA's complaint after determining that it was unnecessary and improper for the court to consider extrinsic evidence to discern whether Carolina Casualty had a duty to defend EAGALA. The court of appeals reversed, concluding that under the language of the insurance policy, extrinsic evidence was admissible to determined whether the complaint was actually filed by, on behalf of, or in the right of EAGALA. On review, the Supreme Court affirmed the court of appeals' decision, holding that the district court erred when it refused to consider extrinsic evidence as required by the terms of the insurance policy.

Appellant/Respondent Harleysville Mutual Insurance Company ("Harleysville") issued a series of standard CGL policies to the Respondent developers or their predecessors (collectively "Crossmann") for a series of condominium projects in the Myrtle Beach area of South Carolina. The exterior components of the condominium projects were negligently constructed, which resulted in water penetration and progressive damage to otherwise nondefective components of the projects. The homeowners settled their lawsuits against Respondents. Crossmann then filed this declaratory judgment action to determine coverage under Harleysville's policies. Upon review of the lower courtâs order, the Supreme Court reversed a finding of joint and several liability against the developers and its insurer, and found the scope of Harleysville's liability was limited to damages accrued during its "time on the risk." In so ruling, the Court adhered to its holding in âJoe Harden Builders, Inc. v. Aetna Casualty & Surety Co.â: â[u]sing our âtime on riskâ framework, the allocation of the damage award against Crossmann must conform to the actual distribution of property damage across the progressive damage period. Where proof of the actual property damage distribution is not available, the allocation formula adopted herein will serve as an appropriate default method for dividing the loss among Crossmann's insurers.â The Court remanded the case to the trial court for further consideration of the "time on risk" allocation.

Appellant Zebuleon Whitney collided with a bicyclist in his pick-up truck, seriously injuring the bicyclist. The bicyclist sought a settlement agreement in excess of the maximum coverage of the driverâs insurance policy. Appellee State Farm Mutual Automobile Insurance Company (State Farm) responded with an offer to tender policy limits, which the bicyclist refused. After a series of court proceedings in both state and federal court, Appellant sued his insurance company, complaining in part that his insurance company had breached its duty to settle. State Farm moved for partial summary judgment on a portion of the duty to settle claims. The superior court granted the motion. The parties then entered a stipulation by which Appellant dismissed all remaining claims, preserving his right to appeal, and final judgment was entered in the insurance companyâs favor. Because State Farmâs rejection of the bicyclistâs settlement demand and its responsive tender of a policy limits offer was not a breach of the duty to settle, the Supreme Court affirmed the superior courtâs grant of summary judgment to that extent. But because the superior courtâs order exceeded the scope of the insurance companyâs motion for partial summary judgment, The Court reversed the superior courtâs order to the extent it exceeded the narrow issue upon which summary judgment was appropriate. The Court remanded the case for further proceedings concerning the surviving duty to settle claims.

Liberty Mutual sued Pella in the district court for declaratory judgment where the suit was sought to determine the scope of Liberty Mutual's obligation, under general commercial liability (GCL) policies issued to Pella, to reimburse Pella's defense costs in two underlying lawsuits. Both parties appealed the judgment of the district court. The court held that the district court did not err in concluding that Liberty Mutual's duty to reimburse Pella's defense costs should be determined by looking at the allegations in the complaint to determine if they stated a covered claim where Liberty Mutual would still have no duty to defend even if it had to reimburse defense costs in a suit where an "occurrence" was alleged but not yet an established fact. The court also held that because the underlying suits did not allege an "occurrence," Liberty Mutual did not owe Pella a duty to reimburse its costs in defending either action. Therefore, the court need not address Liberty Mutual's alternative argument. The court further held that the district court did not commit reversible error in granting summary judgment to Liberty Mutual. The court finally held that, in light of its conclusion that Liberty Mutual had no duty to reimburse Pella's defense costs in the underlying suits, the court need not address the issue of defense costs. Accordingly, the court affirmed the district court's grant of summary judgment to Liberty Mutual on Pella's bad-faith counterclaim. The court reversed the district court's order granting summary judgment to Pella on Liberty Mutual's claim for declaratory judgment and remanded with instructions to enter declaratory judgment in favor of Liberty Mutual.

Appellants Samantha Young and Rebekah Alley were injured while riding in a vehicle driven by Joshua Weeks. Appellants appealed from a judgment entered in the superior court in which the court held Weeks liable but permitted North East Insurance Company to rescind its automobile insurance policy on the vehicle Weeks was driving. Specifically, Young and Alley challenged the court's entry of summary judgment in favor of North East on its complaint seeking a declaratory judgment that it had no duty to defend or indemnify the driver because Weeks' mother had made material, fraudulent misrepresentations in applying for the automobile insurance. The Court of Appeals vacated the judgment, holding that genuine issues of material fact existed regarding whether Weeks' mother made a material, fraudulent misrepresentation to North East in obtaining the insurance policy. Remanded.