Justia Insurance Law Opinion Summaries

Northern, operated by VanDuinen, was a general contractor on public construction projects, legally required to obtain surety bonds. Hanover was Northern’s bonding agent and required Northern to enter into an Indemnity Agreement, which VanDuinen signed in his individual capacity and as Northern’s President. The Midway Airport Project was financed by the FAA and managed by Parsons. In 2008 Northern won the bid and began subcontracting. in 2009 subcontractors complained that Northern failed to pay them in accordance with the bonds and contracts. Work was halted, resulting in a separate complaint, by Parsons, for failure to complete the Project as required. The FAA opted to retain possession of remaining contract funds, $127,086.00, pending resolution of the disputes and completion of the work. Hanover received claims from subcontractors McDaniel ($127,452.78) and Rex Electric ($78,495.00) and a claim for performance from Parsons. Hanover demanded collateral under the Agreement. Northern refused to post collateral or to indemnify Hanover. In 2009 McDaniel filed for bankruptcy; the bankruptcy trustee sued Hanover seeking payment for work performed. In 2012, Hanover paid the trustee $127,452.78 to resolve both McDaniels’s and Rex Electric’s claims. Hanover resolved Parson’s claim by stepping in as general contractor and arranging for completion of the Project. Parsons paid Hanover the $127,086.00 of contract funds the FAA had withheld. Hanover sued Northern and VanDuinen. The district court granted summary judgment in Hanover’s favor. The Seventh Circuit affirmed. The Agreement is unambiguous. Northern breached it, and Hanover is entitled to contractual damages. View "Hanover Ins. Co. v. Northern Bldg. Co." on Justia Law

Plaintiff Ashley Hoffman was insured under an automobile insurance policy issued by defendant Travelers Indemnity Company of America. Following an automobile accident, plaintiff received medical treatment at Baton Rouge General Medical Center and sought reimbursement for the hospital bill under her Travelers' medical payments coverage. The Supreme Court granted certiorari to determine whether the Travelers’ policy, which provided for payment of medical expenses "incurred," allowed plaintiff to be reimbursed for the full, nondiscounted amount of the hospital bill when the charges were contractually reduced pursuant to the hospital’s agreement with plaintiff's health insurer, AETNA Insurance Company. The Court answered that question in the negative and reversed the rulings of the lower courts. View "Hoffman v. Travelers Indemnity Company of America" on Justia Law

The Providers supply outpatient cardiac telemetry (OCT) services, used by doctors to monitor cardiac arrhythmias. The device differs from conventional technology in that it transmits electrocardiographic (EKG) data in real time to certified technicians, who forward the data to a physician. OCT is approved by the FDA, and has long been covered by Medicare and commercial insurers. CIGNA administers employer sponsored health benefit plans. CIGNA pays its in-network providers directly for the services rendered to patients. In 2007, the Providers joined CIGNA’s network by Agreements that set the reimbursement rate and define “Covered Services.” In 2012, CIGNA issued a statement that it would no longer cover OCT “for any indication because it is considered experimental, investigational or unproven.” The 2012 Policy acknowledged that this new position would be trumped by any conflicting language in the coverage policies themselves. In arriving at the new policy, CIGNA relied on the same medical literature it had previously relied upon in concluding that OCT should be covered. The Providers claim that CIGNA indicated that its motive was financial, but refused to reconsider the 2012 Policy. The district court found that the Providers’ claims fell within the arbitration clause of the Agreement. The Third Circuit vacated. The clause at issue is limited in scope to disputes “regarding the performance or interpretation of the Agreement” and the claims at issue do not relate to the performance or interpretation of the Agreement. View "Cardionet Inc v. Cigna Health Corp." on Justia Law

Dozens of suits were filed against Irving Oil Limited (IOL) alleging environmental contamination by methyl tertiary butyl ether (MTBE) occurring from 1979 to the present. At the time of this opinion, all of the MTBE suits against IOL had been settled. In 2009, IOL filed a complaint asking the superior court to declare that ACE INA Insurance (ACE) had a duty to defend and indemnify in the MTBE suits. The superior court granted IOL’s motion for summary judgment in part and denied it in part, concluding that it could not declare that IOL was entitled a judgment on the duty-to-defend count as a matter of law. IOL appealed. The Supreme Court dismissed IOL’s appeal and ACE’s cross-appeal, holding that although a decision that an insurer does not have a duty to defend its insured is ordinarily immediately appealable under the death knell exception to the final judgment rule, the exception did not apply in this case because there were no MTBE cases pending against IOL. View "Irving Oil Ltd. et al. v. ACE INA Ins." on Justia Law

Dennis Hagenow was injured in an automobile accident with Betty Schmidt. Hagenow and his wife (Plaintiffs) filed an uninsured motorist claim with American Family Mutual Insurance Company. American Family denied the claim, determining that Schmidt’s vehicle was not an uninsured motor vehicle under Plaintiffs’ policy. Plaintiffs subsequently filed a breach of contract action against American Family. American Family moved for summary judgment, arguing (1) because Schmidt had automobile insurance at the time of the collision, she was not an uninsured motorist (UM) under the policy; and (2) Plaintiffs were not “legally entitled to recover” under the policy because a jury in Plaintiffs’ underlying action against Schmidt found Schmidt not liable for Plaintiffs’ damages. The district court denied the motion. The Supreme Court reversed, holding (1) Plaintiffs were not “legally entitled to recover” under Iowa law or their UM policy; and (2) Schmidt’s vehicle was not an uninsured motor vehicle under the terms of Plaintiffs’ UM provision. Remanded. View "Hagenow v. Am. Family Mut. Ins. Co." on Justia Law

John Zeverino owned a semi-tractor that was leased to Taylor Truck Line. In 2009, the tractor was involved in a multi-vehicle accident that occurred while Zeverino was on his way to a maintenance facility for repairs to the tractor. Acceptance Casualty Insurance Company and Great West Casualty Company both issued liability insurance policies for the semi-tractor. Acceptance provided a non-trucking use policy, and Great West provided a commercial truckers’ policy. Each insurer filed a motion for summary judgment asserting the other was responsible for coverage for the accident. The circuit court concluded that the Acceptance policy provided coverage. The court of appeals affirmed. The Supreme Court affirmed, holding that Acceptance’s non-trucking use policy provided coverage for the accident, and neither of the two exclusions in Acceptance’s policy precluded coverage. View "Casey v. Smith" on Justia Law

Steven Thomas & Sons (T&S), LLC did excavation and soil compaction work for an addition to a school building in the Kimball School District. The School District was later informed that problems in the building caused by settling issues were due to negligently performed work by T&S. The School District brought suit against T&S and other defendants. T&S’s commercial general liability insurer, Employers Mutual Casualty Company (EMC) withdrew from contributing to T&S's defense, asserting that the policy excluded coverage for continuous or progressive property damage that occurred before the effective date of the policy, and the problems to the building were observed before the 2007 policy date. In 2005 and 2006, T&S was insured by AMCO Insurance Company. Ultimately, AMCO paid defense costs and indemnified T&S for its share of the arbitration award in favor of the School District. AMCO subsequently brought a declaratory judgment action against EMC seeking a ruling that EMC had a joint duty to defend T&S and a declaration that EMC’s policy exclusion was void as against public policy. The circuit court granted summary judgment in favor of EMC. The Supreme Court affirmed, holding that EMC’s exclusion did not violate public policy. View "AMCO Ins. Co. v. Employers Mut. Cas. Co." on Justia Law

Plaintiffs purchased a home that a pre-closing inspection revealed had corrosion on the oil heating system in the basement. Although the boiler and oil tank were replaced prior to the sale of the home, the oil feed line buried beneath the concrete floor in the basement was not replaced. After Plaintiffs discovered an oil leak at the feed line, they initiated claims under their homeowners’ insurance policy issued by Defendant. Defendant denied Plaintiffs’ claim. Plaintiffs filed a complaint against Defendant for breach of contract. The trial justice granted summary judgment in favor of Defendant, concluding that Plaintiffs’ claim was caused by gradual corrosion of an oil fuel feed line, not by a sudden or accidental loss, and the claim was therefore barred by the clear and unambiguous terms of the policy. The Supreme Court affirmed, holding that because the undisputed evidence indicated that the damage to Plaintiffs’ property was caused by corrosion, which was not covered by their insurance policy, there were no genuine issues of material fact, and Defendant was entitled to judgment as a matter of law. View "Nunez v. Merrimack Mut. Fire Ins. Co." on Justia Law

Plaintiffs, property owners, filed a quiet title action against owners of adjacent lots, seeking a declaration that express easements granted in favor of the adjacent lots were invalid. The defendants filed counterclaims asserting that the express easements were valid. Plaintiffs submitted to Commonwealth Land Title Insurance Company ("Commonwealth") a claim for defense pursuant to a policy of title insurance issued by Commonwealth insuring Plaintiffs’ property, but Commonwealth denied the claim. In the quiet title action, the district court extinguished the express easements and denied the counterclaims but concluded that the defendants possessed implied easements. While the quiet title action was pending, Plaintiffs filed the instant action against Commonwealth, seeking a determination that Commonwealth breached its duty under the policy by refusing to provide a defense to the counterclaims. The district court granted summary judgment in favor of Commonwealth. The Supreme Court affirmed, holding that the district court did not err in sustaining Commonwealth’s motion for summary judgment because Commonwealth did not violate its contract with Plaintiffs by denying coverage or indemnification. View "Woodle v. Commonwealth Land Title Ins. Co." on Justia Law

Petitioner was injured in a car accident while riding as a passenger in a vehicle driven by a co-employee. The liability limits of the at-fault driver were tendered, and there was no underinsured motorist (UIM) coverage on the vehicle in which he was riding. Therefore, Petitioner submitted a claim for UIM benefits under a Progressive insurance policy, issued to Sarah Severn. At the time of the accident, Petitioner resided with Severn and their child. He described Severn as "his on again off again fiancé." Both Petitioner's and Severn's names appear on the Declarations Page of the Policy under the heading "Drivers and household residents." Under the heading "Additional information," Severn is listed as the "Named insured." Progressive denied UIM coverage to Petitioner under Part III of the Policy. According to the affidavit filed by Progressive's Claims Injury Operations Manager, "[t]he claim was denied because [Petitioner] did not fall within the terms, provisions and conditions of [the Policy] to qualify for benefits under the [UIM] provisions," as Petitioner "was only listed as a 'driver' on the policy and not a named insured, nor was he a resident relative of the named insured." The Supreme Court granted Bell's petition for review of the court of appeals' decision affirming the circuit court's grant of summary judgment in favor of Progressive Direct Insurance Company. Finding no reversible error, the Supreme Court affirmed. View "Bell v. Progressive Direct Insurance" on Justia Law