Justia Insurance Law Opinion Summaries

Appellees Floyd Demaray and James Hagemann were sued for repeated tortious activity in discharging of pollutants into lakes and streams of a nearby property. Appellees, who owned separate but identical insurance policies with De Smet Farm Mutual Insurance, notified De Smet of the lawsuit. De Smet declined defense of the suit, asserting it owed no duty to defend under the insurance contract. Appellees obtained their own defense counsel and defended the matter through trial, where a jury ruled in their favor. Appellees then sued De Smet, alleging that the company breached its duty to defend them in the previous lawsuit and seeking indemnification for all costs and fees incurred as a result. The trial court granted Appellees' motion for summary judgment, holding that De Smet owed Appellees a duty to defend because the alleged claim, if true, fell within policy coverage. On appeal, the Supreme Court reversed, holding that the policy language was unambiguous and the complaint asserted no claim that would arguably invoke coverage. Remanded with directions to grant summary judgment for De Smet.

This case involved a type of insurance fraud known as "Stranger Originated Life Insurance" (STOLI), "whereby," as plaintiff described, "high face amount insurance polices insuring senior citizens are obtained for the benefit of investors with no insurable interest in the life of the insured." At issue was whether the district court erred in applying the procured-by-fraud exception to the general rule that "rescission required the return of unearned premiums." The court held that, based on Minnesota Supreme Court precedents, the court affirmed the district court's decision recognizing plaintiff's right under the Minnesota law to retain the premiums paid on a fraudulently procured insurance policy. Accordingly, the judgment of the district court was affirmed.

After meeting with Robert Swendra, an insurance agent selling American Family Insurance products, Curtis Graff purchased an automobile policy and an umbrella policy. Based on Swendra's representations, Graff wrongfully believed the umbrella policy contained $1 million in underinsured motorist (UIM) coverage. Later, Graff injured his back in a car accident with an underinsured motorist. Graff filed a complaint alleging breach of contract against American Family and negligent procurement of insurance coverage against the Swendra Agency. After Graff entered into a settlement agreement with American Family Graff's contract claim against American Family was dismissed, and the negligence claim against the Swendra Agency proceeded to trial. The jury found Swendra Agency liable and awarded damages. Pursuant to the collateral source statute, the district court reduced the damages award by $200,260. The court of appeals affirmed. The Supreme Court affirmed, holding (1) the court of appeals did not err in finding that Graff's release of American Family did not extinguish Graff's claim against the Swendra Agency, and (2) the district court properly excluded the attorney fees paid to Graff's counsel from the collateral source calculation.

In 1999, four employees of a Domino Sugar refinery sued parent company Tate & Lyle North America Sugars, Inc. (T&L) for damages from noise exposure during their employment with T&L between 1947 and 1994. Continental Casualty Insurance Company insured T&L with eight general liability policies. Each of the policies contained exclusions for bodily injury to employees arising out of the course and scope of their employees. In one of the eight policies, the exclusion was deleted by a special endorsement effective in 1975. After T&L notified Continental of the lawsuit, Continental retained defense counsel to defend T&L. In 2001, 125 new plaintiffs were added to the suit, and the complaint was amended to allege noise exposure from 1947 to 2001. At some point, trial was continued to allow for settlement. In 2003, without Continental's consent, T&L settled with 1 of 15 "flights" of plaintiffs for $35,000 per plaintiff. After that settlement, Continental was notified. One month later, Continental withdrew from the defense, disclaiming its liability based on a mistaken belief that all of its policies contained the exclusions for injuries to employees. In the subsequent years following the first settlement, additional plaintiffs were added. In 2004, the trial court granted partial summary judgment to T&L, finding that Continental had waived its right to rely on its policy exclusion defenses for "first flight" plaintiffs. The issue before the Supreme Court centered on Continental's exclusions and its disclaiming liability for subsequent plaintiffs. Upon careful consideration of the trial court record, the Court held that an insurer's breach of the duty to defend does not result in a waiver of all coverage defenses when the insured seeks indemnity under the policy. In this case, Continental had disclaimed coverage at the time more plaintiffs were added to the lawsuit, and did not provide a defense to those claims. Therefore, waiver principles did not apply. Continental was only liable to T&L in indemnity on a pro rata basis for the exposures that took place during the coverage period. The Court remanded the case for a determination of whether twelve remaining plaintiff-flights met the settlement criteria.

After being diagnosed with fibromyalgia, chronic pain, anxiety, and depression, plaintiff was awarded long-term disability benefits under an employee benefit plan issued and administered by defendant. Benefits were discontinued about 24 months later, when defendant determined that plaintiff had received all to which she was entitled under the planâs self-reported symptoms limitation. Because plaintiff had retroactively received social security benefits, defendant also sought to recoup equivalent overpayments as provided by the plan. The district court dismissed. The Seventh Circuit reversed in part and remanded for reinstatement. The self-reported symptom limitation violates ERISA, 29 U.S.C., 1022; the policy sets out that long-term benefits will be discontinued after 24 months if disability is due to mental illness or substance abuse, but does not mention that the time limitation applies if a participantâs disability is based primarily on self-reported symptoms. The Social Security Act does not bar recovery of overpayments occasioned by receipt of social security benefits.

Defendants Farmers Insurance Company of Oregon, Mid-Century Insurance Company and Truck Insurance Exchange (Farmers) petitioned the Supreme Court to reconsider an opinion that affirmed a trial court's judgment against it for approximately $8.9 million in compensatory and punitive damages. Farmers contended that the Court's resolution of certain state law issues violated its federal due process rights. Farmers was required by statute and contract to provide personal injury protection to its insureds by covering all reasonable and necessary medical expenses within a year of the insured's injury. Plaintiff Mark Strawn filed a class action suit against Farmers, alleging that Farmers' claims handling process breached its contractual obligations to its insureds. According to Farmers, the Court, in its prior decision, created an "irrebuttable presumption" that altered what was required under state law to prove a fraud claim in a class action in a way that violated due process. The Court held that "Farmers's argument misses the mark" by characterizing the Court's conclusion in its prior holding as "novel" by "assuming the answer to one of the legal questions that [the] Court had to resolve." The Court concluded that Farmers' premises on appeal were incorrect, and that "Farmers's legal arguments therefore fail."

After a fire damaged Oscar Batiz's residential rental property, Batiz filed a claim with his carrier, Fire Insurance Exchange. Exchange initially tendered to Batiz $33,182 representing the actual cash value of the damaged property, later raising that amount to $8,415 after both parties chose an impartial appraiser and an umpire determined the cost to repair the property was $43,921. Batiz did not cash the payment and brought a declaratory action against Exchange. Both parties filed cross motions for summary judgment. The circuit court granted Exchange's motion for summary judgment, dismissing Batiz's action without prejudice. On appeal, the Supreme Court affirmed, holding that (1) the circuit court did not err in determining that a declaratory judgment against Exchange was unwarranted because the insurance policy unambiguously provided what rights and obligations the parties had; and (2) the circuit court was correct in ruling that Batiz's assertion that the vast difference between his appraiser's and the umpire's valuations presented a justiciable issue requiring the court to determine the amount of loss was premature as Batiz had not yet repaired or replaced the damaged property. Remanded.

Gulf Underwriters Insurance issued a general liability policy to United Foundries with an endorsement for employer's liability coverage, known as a stop-gap endorsement. David Ward filed a complaint against his employer, United, alleging claims for employer intentional tort and seeking damages. While the case was pending, United filed an action against Gulf for a declaration that Gulf had a duty to defend and indemnify United for the claims asserted by Ward. The trial court granted summary judgment to United. The court of appeals reversed. The Supreme Court affirmed the judgment of the court of appeals, holding (1) an exclusion in a stop-gap endorsement stating that the insurance does not apply to bodily injury resulting from an act that is determined to have been committed by an insured with the belief that an injury is substantially certain to occur does not require a final determination by either a judge or jury before the insurer can refuse to defend a claim alleging a substantial-certainty employer intentional tort: and (2) that the claims stated in the underlying complaint were neither potentially nor arguably covered under the terms of the policy, and thus, Gulf had no duty under the policy to defend United.

Respondent, on behalf of the estate of her deceased sister, filed suit against petitioner, a nursing home, alleging that while the sister was being cared for by petitioner, she was bitten by a brown recluse spider and died. At issue was whether the claims were healthcare liability claims that required an expert report to be served. The court held that the claims fell within the statutory definition of a health care liability claim and therefore, the statute required the suit to be dismissed unless respondent timely filed an expert report. Accordingly, the court granted the petition for review and reversed and remanded.

Plaintiff Mark Peak broke his leg while helping Ellis and Rachel Adams move furniture using a rented U-Haul truck. The liability insurer for U-Haul paid its policy limits of $20,000 to Peak in exchange for a release that specifically named Ellis and arguably covered Rachel. When Peak sought additional compensation from another of insurer for the Adamses, the insurer denied coverage based on the release. Peak filed a negligence action against Adamses, alleging they were liable for negligence in their operation of the rental truck and their failure to remove snow from their driveway. The district court granted defendants' motion for summary judgment, concluding the release barred Peak's claims against both Ellis and Rachel. The court of appeals reversed. At issue was whether the release covered Ellis and Rachel as well as U-Haul and its insurer. On further review, the Supreme Court held that the district court correctly granted summary judgment for Ellis based on the release, while fact questions precluded summary judgment for Rachel. The Court vacated the decision of the court of appeals and affirmed in part and reversed in part the district court judgment.