Justia Insurance Law Opinion Summaries

Insurer issued an automobile policy to Philip Laboy as the named insured. The policy provided that Insurer would pay “any negotiated reduced rate accepted by a medical provider.” Three members of Laboy’s family, also insureds under the policy, were involved in an automobile accident. The Laboys submitted some of their medical bills both to Insurer and to their health-insurance provider. The Laboys later reached a settlement with the third-party tortfeasor. When Insurer exercised its contractual right to subrogation against the Laboys, the Laboys objected, arguing that Insurer had overpaid the medical providers. As evidence, the Laboys showed that Insurer had paid discounted rates to medical providers totaling $1,441 in medical expenses but that their own health insurer paid only $648 for those same medical expenses. The Laboys filed a class-action lawsuit against Insurer, alleging claims for breach of contract and breach of good faith and fair dealing. The trial court entered summary judgment for Insurer. The Supreme Court agreed with the trial court’s judgment, holding that the only reasonable interpretation of the policy is that “any negotiated reduced rate accepted by a medical provider” means a negotiated reduced rate that Insurer was contractually entitled to pay and does not include the reduced rates negotiated by the Laboys’ health-insurance provider. View "Laboy v. Grange Indem. Ins. Co." on Justia Law

Castro-Cortes was working for Astro, a subcontractor of JRJ, when he fell through a hole on the jRJ property. He sued JRJ for personal injury in Illinois state court. After being served in that suit, JRJ’s two members, Panfil and Michelon, filed a report with Nautilus under a general commercial liability policy. Nautilus refused to defend, citing three grounds: that the underlying lawsuit was against JRJ, but the named insureds were Panfil and Michelon; the “Contractor-Subcontracted Work Endorsement;” and the “Employee Exclusion.” The JRJ parties filed a federal suit for breach of contract. On summary judgment, the district court determined that Nautilus breached its duty to defend because there was at least the potential for coverage of the underlying lawsuit. The Seventh Circuit affirmed, stating that it is a close case and that the bar to finding a duty to defend is low. The court construed the language of the exclusions in favor of JRJ, noting that the burden of proving that a claim falls within an exclusion rests on the insurer. View "Panfil v. Nautilus Ins. Co." on Justia Law

This case stemmed from alleged acts of pre-leasing housing discrimination that resulted in alleged emotional distress. At the relevant time, the defendants in the underlying case (“Insureds”) were covered under an umbrella insurance policy issued by Insurer. After Insureds settled the underlying case, Insureds sued Insurer for breach of contract for failing to defend Insureds pursuant to the umbrella policy. A federal trial court granted summary judgment in favor of Insurer on its duty to defend and indemnify Insureds under the umbrella policy. The federal court of appeals reversed. At issue before the Supreme Court was whether the umbrella policy’s intentional-acts exclusion - through application of the inferred-intent doctrine - obviated Insurer’s duty to defend in this case. The Supreme Court affirmed, holding (1) the umbrella policy at issue here arguably provides coverage for emotional-distress damages through its coverage for humiliation; and (2) emotional-distress damages are not inherent in a claim for discrimination, and therefore, the inferred-intent doctrine was inapplicable. View "Granger v. Auto-Owners Ins." on Justia Law

Burlington purchased more than $8 million worth of cast vinyl film products from Ritrama to manufacture graphic decals for customers in the recreational vehicle (RV) industry. No later than early 2008, Burlington reported to Ritrama that RV owners were experiencing issues with the graphics. In September, 2008, Burlington sent Ritrama a spreadsheet detailing three claims for monetary damages based on the product failures, which totaled $53,219.37. The companies discussed settlement. In early 2009, Ritrama purchased a commercial general liability insurance policy from Gerling that provided coverage for claims made between March 31, 2009, and March 31, 2010. The policy did not define “claim.” On July 17, 2009, Ritrama advised its insurance agent of its issues with Burlington. The insurance agent sent a "notice of occurrence" to Gerling. Ritrama claims that the notice was not an acknowledgment of a claim, but merely a notification of a "customer having problems." Ritrama failed to meet Burlington's demands. The Eighth Circuit affirmed summary judgment in favor of Gerling. Burlington demanded money in 2008 and, before inception of the Policy, Ritrama attempted to settle existing and future claims for damages based on the RV adhesive issues. Although these communications did not involve an attorney or expressly refer to litigation, Burlington clearly demanded compensation. View "Ritrama, Inc. v. HDI-Gerling Am. Ins. Co." on Justia Law

The Schmidts operate a farm Worthington, Minnesota. Madison hosted a sleepover party at the family farm to celebrate her twelfth birthday. A guest, 10-year old Alyssa, was driving the Schmidts' ATV around the property when the ATV struck a tree. Alyssa died as a result of the accident. The Schmidts tendered defense of a wrongful death action to Grinnell under their farm policy, which provided $300,000 in coverage. Grinnell initially informed the Schmidts the policy appeared to provide coverage, but reserved its right to dispute coverage and sought a declaratory judgment. The wrongful death action settled for $462,500. Both parties agree the coverage dispute turns on whether Jerome or Kelly – the named insureds – gave Alyssa "express permission" to operate the ATV within the meaning of an exclusion contained in the Select Recreational Vehicle Limited Liability Coverage endorsement. The Eight Circuit affirmed summary judgment in favor of the Schmidts. While the Schmidts observed the girls on the ATV and did not object, Alyssa never “expressly” sought permission, so her conduct did not fall within the exclusion. View "Grinnell Mut. Reinsurance v. Schmidt" on Justia Law

Defendant-Appellants Carl McCaffree, Jimmy Helvey, and Sam McCaffree (director-defendants) and the Federal Deposit Insurance Corporation (FDIC) appealed the district court's grant of summary judgment to BancInsure, Inc. BancInsure issued a Directors and Officers Liability Insurance Policy to Columbian and its parent Columbian Financial Corporation (CFC). the Kansas State Bank Commissioner declared Columbian insolvent and appointed the FDIC as receiver. By operation of law, the FDIC-R succeeded to "all rights, titles, powers, and privileges of [Columbian], and of any stockholder, member, accountholder, depositor, officer, or director" of Columbian. BancInsure received notice of potential claims the FDIC-R intended to file against the bank's officers and directors. In anticipation of such a suit, CFC and director-defendant Carl McCaffree brought suit against BancInsure seeking a declaratory judgment that the policy covered claims made after the date Columbian was declared insolvent, but before the expiration of the policy. The district court ultimately held that the policy remained in effect until May 11, 2010, relying in part on its finding that a regulatory endorsement in the policy "provide[d] coverage for actions brought by deposit insurance organizations as receivers during the policy year," which would have been meaningless if the policy terminated upon appointment of a receiver. On appeal, the Tenth Circuit sua sponte determined that no case or controversy existed at the time of the district court's judgment and remanded with instructions to vacate the judgment for lack of jurisdiction. BancInsure filed the instant action against the director-defendants in Kansas state court seeking a declaratory judgment that it owed no duty of coverage to the director-defendants for claims brought against them by the FDIC-R. The FDIC-R joined and removed the action to the federal district court in Kansas. At approximately the same time, the FDIC-R brought claims against several of Columbian's former directors and officers alleging negligence, gross negligence, and breach of fiduciary duty. The district court held that claims by the FDIC-R were unambiguously excluded by the policy's "insured v. insured" exclusion and that BancInsure was not judicially estopped from denying coverage. Finding no reversible error in that judgment, the Tenth Circuit affirmed. View "BancInsure v. FDIC" on Justia Law

In 2009, Carol McClue was involved in a serious car accident. At the time of the accident, Carol had underinsured motorist (UIM) insurance coverage through Safeco Insurance Company of Illinois. In 2011, Carol was diagnosed with bulbar ALS. In 2013, Carol died from the illness. After the diagnosis, Dan McClue, Carol’s husband, submitted claims to Safeco for UIM benefits for damages associated with Carol’s ALS. Safeco denied the claims. Dan subsequently filed suit against Safeco, asserting that Safeco breached the insurance contract by failing to provide UIM benefits for Carol’s ALS. Before trial, the district court granted Safeco’s motions in limine to exclude expert testimony from two doctors - Dr. John Sabow and Dr. Decontee Jimmeh-Fletcher. The district court subsequently granted summary judgment to Safeco on the grounds that, without the expert testimony, Dan did not have admissible evidence to establish that the car accident caused Carol’s ALS. The Supreme Court (1) affirmed the district court’s ruling barring Dan from using Dr. Jimmeh-Fletcher’s testimony to establish causation in this case; but (2) reversed the district court’s ruling that Dr. Sabow was not qualified to present expert testimony during trial. View "McClue v. Safeco Ins. Co. of Ill." on Justia Law

In 2011, a tornado struck and substantially damaged Midwest’s building and its contents. After the tornado, the medical practice was to relocate, which required substantial work. Until construction was complete, Midwest operated out of a temporary location, but was unable to operate at its normal capacity. Moving the repaired MRI machine to the new building required a crane; it was necessary to reinforce floors; replace exterior brick; and install pipe, specialized heating and air conditioning equipment, and copper shielding. The new location opened about a year after the tornado. Cincinnati Insurance paid Midwest the policy limit of $2,414,161.26 for the building; the policy limit of $388,000 for business personal property; and $828,081.75 for business income interruption and extra expenses. . Midwest requested “Extra Expense” reimbursement for the costs to repair and relocate the MRI machine and to replace the other specialty equipment necessary for normal operations. Cincinnati denied payment, contending the expenditures were covered under the Building or Business Personal Property provisions, for which it had paid the policy limits. The district court found the claimed expenses were recoverable under the Extra Expense provision. The Eighth Circuit affirmed, noting that the language of the Policy does not specifically exclude coverage under the Extra Expense provision if the expenses happen to fall under another coverage in the Policy. View "Midwest Reg'l Allergy Ctr., P.C. v. Cincinnati Ins. Co." on Justia Law

In 2012, a fire destroyed three buildings and related equipment that were owned by Jackson Hop, LLC, and were used to dry hops, to process and bale hops, and to store hop bales. The buildings were insured by Farm Bureau Mutual Insurance Company of Idaho for the actual cash value of the buildings and equipment, not to exceed the policy limit. Farm Bureau’s appraisers determined that the actual cash value of the buildings was $295,000 and the value of the equipment was $85,909. Farm Bureau paid Jackson Hop $380,909. Jackson Hop disagreed with that figure, and it hired its own appraiser, who concluded that the actual cash value of the buildings and equipment totaled $1,410,000. Farm Bureau retained another appraiser to review the report of Jackson Hop’s appraiser, and that appraiser concluded that the value of $1,410,000 was unrealistically high. Jackson Hop filed this action to recover the balance of what it contended was owing under the insurance policy, plus prejudgment interest. The parties agreed to submit the matter to arbitration as provided in the policy. During that process, Jackson Hop presented additional opinions regarding the actual cash values, ranging from $800,000 to $1,167,000 for the buildings and $379,108 to $399,000 for the equipment. Farm Bureau’s experts revised their opinions upward, although only from $295,000 to $333,239 for the buildings and from $85,909 to $133,000 for the equipment. Before completion of the arbitration, Farm Bureau paid an additional sum of $85,330. Arbitrators determined that the actual cash value of the buildings and the equipment was $740,000 and $315,000, respectively, for a total of $1,055,000. Within seven days of the arbitrators’ decision, Farm Bureau paid Jackson Hop $588,761, which was the amount of the arbitrators’ award less the prior payments. Jackson Hop filed a motion asking the district court to confirm the arbitrators’ award and to award Jackson Hop prejudgment interest, court costs, and attorney fees. Farm Bureau filed an objection to the request for court costs, attorney fees, and prejudgment interest. The court awarded Jackson Hop attorney fees, but denied the request for court costs because the parties’ arbitration agreement stated that both parties would pay their own costs, and the court denied the request for prejudgment interest because the amount of damages was unliquidated and unascertainable by a mathematical process until the arbitrators’ award. Jackson Hop then appealed. Finding no reversible error in the trial court's judgment, the Supreme Court affirmed. View "Jackson Hop v. Farm Bureau Insurance" on Justia Law

The Cleveland Indians hired National to produce Kids Day events at baseball games, with attractions, including an inflatable bouncy castle and inflatable slide. The contract required National to secure a five-million-dollar comprehensive liability policy. National submitted an Application to Doodson Insurance Brokerage, stating on the application that the Kids Day events would include inflatable attractions. Doodson arranged for National to obtain a policy, but it excluded from coverage injuries caused by inflatable slides. Johnson admiring a display at a 2010 Indians game, was crushed by an inflatable slide that collapsed onto him. He died of his injuries. Johnson’s estate won a $3.5 million state court default judgment against National. The Sixth Circuit held that the insurance policy did not cover Johnson’s injuries. National and the Indians sued Doodson and obtained settlements. Johnson’s estate, which has not collected on the default judgment against National, sued Doodson, alleging negligence and breach of contract. The Sixth Circuit affirmed dismissal. Under Michigan law, the broker’s contractual duty to its client to protect the client from negligence suits, without more, does not create a tort duty to an injured party who brings such suits and Johnson was neither a party to nor an intended third-party beneficiary of the contract between the broker and National. View "Johnson v. Doodson Ins. Brokerage" on Justia Law