Justia Insurance Law Opinion Summaries

Nationwide Mutual Insurance Company (Nationwide) appealed a trial courtâs order that denied its "renewed motion for a judgment as a matter of law" in its case against J-Mar Machine & Pump. J-Mar is a repair shop that held a commercial liability and property insurance policy with Nationwide. In 2004, in anticipation of its policy renewal, Nationwide sent an inspector to the shop. In his report, the inspector noted several safety hazards and a messy shop. The insurance policy was renewed in March but several months later Nationwide cancelled the policy. Nationwide cited the inspectorâs report as reason for the cancellation. J-Mar management was not aware of the cancellation until late that year when shop property was stolen. When it tried to file a claim, Nationwide declined J-Marâs claim. A jury trial was held on the disputed policy cancellation and coverage. At the close of J-Marâs case, Nationwide moved the court for a "judgment as a matter of law" which was denied. Nationwide unsuccessfully motioned again at the close of all evidence. Upon review of the trial court record, the Supreme Court found that the evidence J-Mar presented at trial was insufficient to support the jury verdict in its favor. Accordingly, the Court reversed the trial courtâs judgment denying Nationwideâs motion and rendered a judgment in Nationwideâs favor.

Appellant Robert Petty is sole owner of Co-Appellant R.G. Petty Masonry. Appellants contracted with Respondent Blue Cross of Northeastern Pennsylvania (Blue Cross), a nonprofit hospital corporation that provides health insurance coverage for its employees. Appellants are covered under the group policy as subscribers. Appellants filed a four-count class action suit against Blue Cross, alleging that it violated the state Nonprofit Law by accumulating excessive profits and surplus well beyond the "incidental profit" permitted by statute. The second count alleged Blue Cross breached its contract with Appellants by violating the Nonprofit Law. The third count alleged Blue Cross owed appellants a fiduciary duty by virtue of their status as subscribers, and that duty was breached when it accrued the excess surplus. The fourth count requested an inspection of Blue Cross' business records. The trial court found Appellants lacked standing to challenge Blue Cross' alleged violations of the Nonprofit Law and dismissed the suit. The Commonwealth Court affirmed the trial court. Upon careful consideration of the briefs submitted by the parties in addition to the applicable legal authorities, the Supreme Court found that Appellants indeed lacked standing under the Nonprofit Law to challenge Blue Cross by their four-count complaint. Accordingly, the Court affirmed the lower courts' decisions and dismissed Appellants' case.

Respondent optometrist Steven Hobbs sublet space leased by Cole Vision Corporation (Cole Vision) from Sears Roebuck and Company (Sears) for his optometry practice. The sublease agreement between Hobbs and Cole Vision contained indemnity provisions whereby Hobbs agreed to defend Cole Vision and Sears against any and all liabilities arising from events occurring in Hobbs' business location or as a result of Hobbs' activities at the business. The agreement also purportedly required Cole Vision to retain copies of Hobbs' patient records. Pursuant to the agreement, Hobbs obtained professional liability insurance with NCMIC Insurance Company (NCMIC). Mary and John Lewis (the Lewises) sued Hobbs, Cole Vision, and Sears based on Hobbs' alleged malpractice in failing to properly diagnose and treat Mary Lewis. Cole Vision and Sears brought this action for declaratory relief after Hobbs and NCMIC refused to defend them in the malpractice suit. Although the Lewises' case was pending when Cole Vision brought this declaratory judgment action, it eventually settled. Cole Vision and Sears also sought judgment against Hobbs and NCMIC for defense costs and settlement amounts of the malpractice action brought by the Lewises. In response to the complaint, Hobbs filed a defense and counterclaim for negligent spoliation of evidence against Cole Vision and Sears stemming from the loss of Mary Lewis's patient profile sheet. Hobbs contended that Cole Vision lost the profile sheet, which was a key piece of evidence needed to defend the malpractice claim. According to Hobbs, he incurred costs and attorney fees as a result of his inability to adequately defend against the Lewises' claim for malpractice. Cole Vision filed a motion to dismiss on the ground that South Carolina does not recognize a cause of action for spoliation of evidence. The circuit court agreed and granted the motion to dismiss. Hobbs appealed the circuit court's order and the court of appeals reversed the circuit court, finding that Hobbs pled facts sufficient to constitute a general negligence cause of action. The court of appeals did not determine whether South Carolina recognizes a cause of action for negligent spoliation, instead reversing the circuit court based on its characterization of Hobbs' claim as a general negligence claim. Upon review of the record of the courts below, the Supreme Court found that Hobbs' claim that Cole Vision breached a contractual duty to maintain the document at issue remained a viable defense in his action for indemnification. The Court declined to recognize the tort of negligent spoliation of evidence and accordingly found that the circuit court properly dismissed it as a counterclaim. The Court reversed the appellate court's decision and remanded the case for further proceedings.

Stephen O'Bryant, a commercial truckdriver, was killed during the course of his employment as the result of a motor vehicle accident. Sylvia Devese, the representative of his estate, sought to recover under O'Bryant's occupational accident policy with Transguard Insurance Company of America. Transugard denied the claim on the ground that O'Bryant did not have a valid commercial driver's license (CDL) at the time of the accident, and the personal representative brought this action against Transguard for breach of contract and bad faith. The policy stated that no benefits would be paid for any claim resulting from any loss occurring while the insured person was operating a vehicle without a valid CDL. The trial court granted summary judgment in favor of Transguard. On appeal, the Supreme Court reversed and remanded, holding that Neb. Rev. Stat. 44-358 applies so as to require a showing of causation between the breach and the loss, despite the language of the policy.

This lawsuit arose from the dispute between the parties about how much appellant was obligated to pay appellee for auto-glass goods and services rendered on behalf of appellant's insureds. Appellants appealed from the district court's orders dismissing its counterclaim that appellee violated Minnesota's anti-incentive statute, Minn. Stat. 325F.783, granting summary judgment in favor of appellee on appellant's counterclaim for breach of contract, and denying appellant's motion to vacate the arbitration award. The court held that, given the plain language of the statute and the ordinary meaning of the terms of rebate and credit, appellee's practice did not violate the anti-incentive statute. The court also held that even if the blast faxes at issue constituted offers to enter into unilateral contracts, appellee rejected the offers when its actions failed to conform to the terms of the offer. The court further held that the arbitration award did not require reversal or new proceedings because the award was based on the finding that appellant failed to pay the competitive price standard set forth in the applicable endorsement and Minnesota law.

After appellant Stephanie Riley, who was insured by State Farm, was involved in a car accident, Riley settled with the tortfeasor's insurer, GEICO. Riley asserted that State Farm filed a lien on her settlement before it knew whether she would be made whole by the settlement. After taking her case to trial court, Riley appealed with a Ark. R. Civ. P. 54(b) certification the dismissal of count one of her amended petition for declaratory judgment and complaint, which sought a declaratory judgment that appellee State Farm had failed to establish a legal lien or right to subrogation under Arkansas law. The Supreme Court reversed and remanded, holding that the circuit court erred in interpreting Ark. Code Ann. 23-89-207 and the state's subrogation law. The subrogation lien cannot arise, or attach, until the insured has received the settlement proceeds or damage award and until there is a judicial determination that the insured has been made whole.

Gervis Sadler owned a house that he insured through a limited-peril policy issued by North Carolina Farm Bureau Mutual Insurance Company (Farm Bureau). Farm Bureau adjusters investigated the home on two separate occasions, but Sadler disagreed with the amount of loss and asked for a disinterested appraisal. In the disinterested appraisal, Farm Bureau's appraiser valued the loss at $31,561. The appraisal award calculated by Sadler's appraiser and the umpire valued the loss at $162,500. Farm Bureau filed a complaint for declaratory relief, alleging the appraisal award failed to itemize the damages so Farm Bureau could determine the covered losses. Sadler moved for partial summary judgment on his breach of contract counterclaim. The trial court granted Sadler's request for partial summary judgment. Farm Bureau appealed. The Supreme Court reversed, holding that the trial court erred in granting partial summary judgment in favor of Sadler because genuine issues of material fact needed to be resolved before the loss covered by the policy could be determined.

Megan Bradley, who was insured by State Farm, was injured in a motor-vehicle accident. State Farm paid $3844 in medical benefits to Bradley. State Farm then pursued a subrogation claim against the tortfeasor's insurer, Farmers Insurance. Bradley responded that the settlement with Farmers Insurance was not sufficient for her to be made whole. State Farm refused to release its subrogation claim. Bradley filed a petition for declaratory judgment and complaint for bad faith against State Farm and later filed an amended declaratory action to invalidate lien and complaint for injunctive relief, deceptive trade practices, bad faith and tortious interference with a contract. The circuit court dismissed count one of Bradley's amended pleading, finding (1) State Farm had a valid but unenforceable lien for sums paid to Bradley, (2) State Farm's right of subrogation arose at the time State Farm paid the medical benefits by operation of law, and (3) State Farm's right of subrogation is not enforceable until a subsequent judicial determination that Bradley was made whole by the settlement. The Supreme Court reversed and remanded for the reasons set forth on the same day in Riley v. State Farm Mutual Automobile Insurance Co.

Gregory Schindler purchased insurance from USAA for a house he owned. The house was destroyed by fire a year and a half later. USAA denied coverage on the basis that Schindler had committed fraud during his application conversation. Specifically, USAA determined that Greg had misrepresented that the house was his primary residence and a single family dwelling when instead it was a rental divided into eight apartment units. Schindler and his wife filed suit against USAA asserting breach of insurance contract and implied obligation of good faith and fair dealing. USAA defended on the basis of fraud. The jury found for USAA and awarded USAA the monies it had advanced to the Schindlers. The Schindlers appealed. The Supreme Court affirmed, holding (1) the district court did not err in denying the Schindlers' motion for summary judgment; (2) the district court did not abuse its discretion in allowing testimony from a USAA employee; (3) the district court did not abuse its discretion in denying the Schindlers' motion in limine to preclude USAA from introducing evidence of fraud; and (4) the district court did not abuse its discretion in requiring the Schindlers to order and pay for additional transcripts.

Wanda Brethorst submitted an uninsured motorist (UM) claim to her insurer, Allstate. Brethorst made a demand for settlement, and Allstate responded with only a partial settlement. Brethorst rejected the offer then filed suit against Allstate for bad faith. Allstate filed a motion asking that Brethorst's contract claim for UM coverage be bifurcated from her bad faith claim and that discovery on the bad faith claim be stayed until the contract claim was resolved. Brethorst opposed the motion on the grounds that she had filed only one claim, and thus no bifurcation or stay of discovery was appropriate. The circuit court agreed with Brethorst and denied Allstate's motion. The Supreme Court affirmed, holding (1) an insured may file a bad faith claim without also filing a breach of contract claim; and (2) Brethorst had supplied the insurer and the court with sufficient evidence of a breach of contract by the insurer to proceed with discovery on her bad faith claim.