Justia Insurance Law Opinion Summaries

Nationwide Mutual Insurance Company issued an automobile insurance policy, which included uninsured motorist coverage, to Melvin Briggs. After Nationwide sent Briggs a notice of nonrenewal of the policy, Briggs was involved in a collision with an uninsured motorist. Briggs's children filed a claim under the Nationwide policy for uninsured motorist benefits, which Nationwide denied. Nationwide subsequently sued Briggs’s children, seeking a declaratory judgment that it had nonrenewed Briggs’s policy before the automobile accident. The U.S. district court granted summary judgment for Nationwide, concluding that it had complied with statutory and policy requirements for notice of nonrenewal. On appeal, the Tenth Circuit Court of Appeals certified a question of law to the Kansas Supreme Court, which answered the certified question as follows: Notice to nonrenew an insurance policy that complies with the procedure set out in Kan. Stat. Ann. 40-3118(b) and a consistent provision in the policy itself is sufficient to force a lapse of coverage, regardless of whether a proper substantive basis for nonrenewal exists under Kan. Stat. Ann. 40-276a(a) and consistent policy language. View "Nationwide Mut. Ins. Co. v. Briggs" on Justia Law

Ronald Belding was injured in an accident with an uninsured driver. Belding and his wife had two policies with State Farm Automobile Insurance Company, which provided coverage for their two vehicles, a Ford Ranger, which was involved in the accident, and a Mercury Villager. State Farm paid the Beldings the maximum uninsured motorist coverage under the Ford Ranger policy, and the Beldings sought to collect excess damages through the uninsured motorist coverage in their Mercury Villager policy. The circuit court granted summary judgment for State Farm, concluding that a “drive-other-car exclusion” in the Mercury Villager policy precluded coverage. The court of appeals reversed, determining that Wis. Stat. 632.32(6)(d), which prohibited anti-stacking clauses, barred the drive-other-car exclusion. The Supreme Court affirmed, holding that, pursuant to the prohibition on anti-stacking clauses in section 632.32(6)(d), State Farm could not use the drive-other-car exclusion in the Mercury Villager policy to prevent the Beldings from stacking the uninsured motorist coverage of up to three vehicles owned and insured by them. View "Belding v. Demoulin" on Justia Law

A bank purchased insurance on a commercial property mortgaged to it by a borrower. The policy prohibited an assignment "of this Policy" without the insurer's consent. After the property was damaged, the bank assigned its loss claim to the borrower. The insurer refused to pay the borrower's claim because of the nonassignment provision, and the borrower sued. The district court held that the suit was barred and awarded judgment for the insurer. The issue before the Tenth Circuit in this case centered on whether the nonassignment provision was enforceable. The Court concluded, after review of the provision in question, that the provision did not apply to the assignment of a postloss claim, so the Court did not determine the enforceability of a provision prohibiting such assignments. Accordingly, the Court reversed and remanded for further proceedings. View "City Center West v. American Modern Home Insurance" on Justia Law

ICI Homes, Inc. (ICI) had a general liability insurance policy with General Fidelity Insurance Company. In 2007, Katherine Ferrin, the owner of a residence constructed by ICI, was injured while using stairs installed by Custom Cutting, Inc. Ferrin filed suit against ICI. ICI, in turn, sought indemnification from Custom Cutting. The parties agreed to a $1.6 million settlement of Ferrin’s claim. ICI accepted $1 million from Custom Cutting’s insurer to settle its indemnification claim, which it paid to Ferrin. ICI and General Fidelity then claimed the other was responsible for paying Ferrin the remaining $600,000. Both parties paid $300,000 to Ferrin to settle Ferrin’s claim. ICI then filed suit against General Fidelity seeking return of the $300,000 ICI paid above the $1 million indemnification payment. General Fidelity counterclaimed seeking return of the $300,000 it had paid to Ferrin. The district court entered judgment for General Fidelity. The court of appeals certified two questions to the Supreme Court for resolution. The Supreme Court answered (1) the General Fidelity policy allowed ICI to apply indemnification payments received from Custom Cutting’s insurer towards satisfaction of its $1 million self-insured retention; and (2) the transfer of rights provision in the policy did not abrogate the made whole doctrine. View "Intervest Constr. of Jax, Inc. v Gen. Fidelity Ins. Co." on Justia Law

An employee benefits plan sued a medical college that provides patient care in clinics and hospitals and an affiliated children’s hospital, with which it had provider agreements, alleging ERISA violations and breach of contract under Wisconsin law. The suit was based on the plan’s determination that an employee’s child was not covered by the plan and the hospital’s denial of its subsequent request that the hospital refund about $1.7 million the plan had already paid on behalf of the child. The plan makes no mention of refunds. The district court dismissed and awarded attorneys’ fees to the hospital as a sanction for having filed frivolous claims. The Seventh Circuit affirmed dismissal of the ERISA claims but reversed dismissal of the breach of contract claim, rejecting the district court’s finding of preemption, and imposition of sanctions. On remand of the contract claim, the district court granted summary judgment in favor of the hospital. The Seventh Circuit affirmed, noting that the hospital, having been paid in full by the plan, has no possible claim against Medicaid, that the plan took 11 months to determine that the child was not a beneficiary, and that the hospital has not been unjustly enriched. View "Kolbe & Kolbe Health & Welfare Benefit Plan v. Med. Coll. of WI" on Justia Law

In 1971 Milwaukee County provided its employees with health insurance under an ordinance that stated that the “county shall participate in the payment of monthly premiums” and extended coverage to retirees. In 1993, the ordinance was amended to provide that “[t]he County shall pay the full monthly cost of providing such [health insurance] coverage to retired members” as “part of an employee’s vested benefit contract.” Upon her 1991 retirement, Hussey had paid no co‐payments or deductibles for her health care. Her benefit plan booklet explained that with 15 years of service: “the retiree may participate in the health plan in which he/she is currently enrolled on the same basis as … the active employee group. The County will make the full premium contribution.” Until 2012, the plan coordinated benefits so that expenditures not covered by Medicare were paid in full by the County. In 2012 the County increased deductibles, co‐payments, and co‐insurance charges and modified coordination of benefits so that retirees over age 65 would pay the same deductibles, co‐payments, and co‐insurance charges as active employees. Hussey filed a purported class action, alleging that the failure to provide cost‐free health insurance to retirees constituted an unconstitutional taking of property. The Seventh Circuit agreed with the district court that the County only promised retirees the ability to participate in the same health insurance plan as active employees on a “premium‐free” basis.View "Hussey v. Milwaukee County" on Justia Law

Rick Wheeler had two liability insurance policies with American Family Mutual Insurance Company. Both Rick and his son Ryan were insureds under the policies. Both policies provided personal liability coverage and included exclusions for abuse and intentional injury. Both policies also contained a severability clause, which required that the insurance be applied separately to each insured. Joshua and Maren McCrary sued Rick and Ryan for Ryan’s alleged sexual assault of the McCrarys’ minor daughter. American Family filed a complaint for declaratory judgment seeking a judgment that its policies did not provide liability coverage to Rick. The district court granted summary judgment to American Family. At issue on appeal was whether the severability clause changed the effect of, or rendered ambiguous, the exclusions that would otherwise bar coverage for Rick. The Supreme Court affirmed, holding that the severability clause did not affect the unambiguous language of the policies’ exclusions, which barred coverage for Rick. View "Am. Family Mut. Ins. Co. v. Wheeler" on Justia Law

Nationwide Mutual Fire Insurance Company issued a policy to Danny Ludwick insuring his home and its contents. The policy named Citizens Bank & Trust Company as the first mortgagee. The dwelling was subsequently destroyed by fire. However, based on material misrepresentations in Ludwick's application, Nationwide voided the policy back to its inception. Citizens submitted a claim to Nationwide. Nationwide denied the claim on the basis that the policy was void ab initio, allegedly extinguishing not only Ludwick’s interest but also Citizen’s interest as mortgagee. Citizens filed a complaint for wrongful denial of its claim. The circuit court granted summary judgment to Citizens. The Supreme Court affirmed, holding (1) an insurance company is entitled to rescission of its insured’s policy based on the insured’s fraud or misrepresentation, but the rescission of the policy has no effect on an independent contract with the mortgagee; and (2) because the policy at issue contained a standard mortgage cause, which operated as an independent contract between the insurance company and the named mortgagee, the rescission of Nationwide’s policy had no effect on the independent contract with Citizens. View "Nationwide Mut. Ins. Co. v. Citizensbank & Trust Co." on Justia Law

In 2003, multiple residents of Greenwood Health Center, a nursing home, died or were injured when another resident set fire to the facility. Thirteen negligence actions seeking damages for wrongful death or serious bodily injury were filed against Greenwood, the lessee of the property housing Greenwood, the owner and lessor of the property, and the operator of Greenwood. Lexington Insurance Company (Plaintiff) brought this declaratory judgment action against the lessor of the Greenwood property, which was the insured party under a policy issued by Plaintiff, the other Greenwood entities, and the victims’ personal representatives. Following the filing of cross motions for summary judgment, the trial court determined the amount of coverage available under the policy and rendered judgment accordingly. Plaintiff appealed the judgment of the trial court determining available coverage, and four of the individual defendants cross appealed. The Supreme Court reversed in part, holding (1) the trial court improperly interpreted the endorsement relating to the aggregate policy limit, thereby providing more coverage for the individual defendants’ claims than that to which they were entitled; and (2) the trial court improperly applied the self-insured retention endorsement to reduce the available coverage. Remanded. View "Lexington Ins. Co. v. Lexington Healthcare Group, Inc." on Justia Law

In November 2004, Dr. Ashard Yousuf sued Dr. George Cohlmia and Cardiovascular Surgical Specialists Corporation (CVSS) in Oklahoma state court for defamation, tortious interference with business relations/contract, intentional infliction of emotional distress/outrage, negligence, and breach of contract. Dr. Yousuf alleged that Dr. Cohlmia made a series of false statements to local media disparaging Dr. Yousuf's professional reputation. Dr. Cohlmia denied that the statements he made were false. CVSS held a professional liability policy with Physicians Liability Insurance Company (PLICO) and two identical general commercial liability policies with American National Property and Casualty Company (ANPAC, one for each business location), each of which covered Dr. Cohlmia as an additional insured. Dr. Cohlmia demanded that both insurers provide for his defense, pursuant to their respective policies. PLICO agreed to defend the lawsuit under a reservation of rights and requested ANPAC to share in the defense. ANPAC refused, contending its policy did not cover the alleged wrongdoing and that it owed no duty to defend. ANPAC further claimed that even if it erred in refusing to defend Dr. Cohlmia, PLICO had no right to indemnification or contribution for the defense costs it incurred. ANPAC appealed the district court's grant of summary judgment in favor of PLICO in a dispute regarding ANPAC's breach of its duty to defend a co-insured. PLICO cross-appealed the district court's denial of its motion for prejudgment interest. Finding no reversible error, the Tenth Circuit affirmed the district court's decision. View "Yousuf v. Cohlmia" on Justia Law