Justia Insurance Law Opinion Summaries

Defendant "L.A." was employed by the Trenton Board of Education as an elementary school security guard. While at work, L.A. allegedly had unlawful sexual contact with two minor students, N.F. and K.O. The allegations were referred to the Institutional Abuse Investigation Unit (IAIU) of the Department of Children and Families (DCF) and defendant was subsequently indicted. In the N.F. indictment, L.A. was charged with third-degree aggravated criminal sexual contact and second-degree endangering the welfare of a minor. In the K.O. indictment, L.A. was charged with two counts of second-degree sexual assault and one count of second-degree endangering the welfare of a minor. L.A. pled guilty to one count of second-degree endangering the welfare of a minor (N.F.) in exchange for dismissal of the remaining charges regarding N.F. and complete dismissal of the K.O. indictment. K.O. s guardian ad litem subsequently filed a civil complaint alleging that L.A. sexually assaulted K.O. and that the Board negligently hired L.A. The Board answered the complaint, taking no position with regard to the allegations against L.A. However, L.A. was assigned counsel by the Horace Mann Insurance Agency, pursuant to a private insurance policy maintained by the New Jersey Education Association. Ultimately, K.O.'s civil action was settled without any admission of wrongdoing by L.A. or the Board. After the settlement, L.A., through counsel provided by Horace Mann, filed a verified petition against the Commissioner of Education seeking reimbursement for the attorney's fees and costs incurred in defending against K.O.'s civil action. The matter was transferred to the Office of Administrative Law and L.A.'s counsel and the Board filed cross motions for summary judgment. The Administrative Law Judge (ALJ) granted L.A.'s motion, denied the Board's, and awarded L.A. attorney's fees and costs pursuant to N.J.S.A.18A:16-6, the statute that addressed the right to indemnification for officers and employees of boards of education in civil actions. The issue this case presented for the Supreme Court's review centered on whether N.J.S.A. 18A:16-6 entitled a school board employee to indemnification for attorney's fees and costs spent in defense of a civil action arising from the same allegations contained in a dismissed criminal indictment. The Court concluded that in such circumstances N.J.S.A. 18A:16-6 requires indemnification unless there was proof by a preponderance of the evidence that the employee's conduct fell outside the course of performance of his or her employment duties. Here, rather than conducting an evidentiary hearing, the ALJ disposed of the matter by way of summary judgment. Because there are disputed issues of material fact regarding whether L.A. was acting within the scope of the responsibilities of his employment, the judgment of the Appellate Division was reversed. The matter was remanded to the Commissioner of Education for a hearing to determine whether L.A.'s conduct fell outside the course of performance of his employment duties. View "L.A. v. Board of Education of the City of Trenton" on Justia Law

Plaintiffs, David Miller and Miller’s Auto Body, alleged that they were subject to a malicious investigation into suspected insurance fraud that Defendants, three insurance companies, believed was taking place at Plaintiffs’ auto-body shop. Miller was charged with, among other charges, four counts of insurance fraud. The criminal information was dismissed by the Attorney General, but the dismissal was conditioned on an agreement between Miller and the Attorney General requiring Miller to execute a general liability release in favor of Defendants. More than one year after executing the release, Plaintiffs filed a complaint against Defendants. The trial court granted pretrial summary judgment for Defendants on the majority of Plaintiffs’ claims. Only Plaintiffs’ abuse-of-process claim went to trial. The jury returned verdicts in favor of Plaintiff against the two remaining defendants. The trial court subsequently granted judgment as a matter of law in favor of one defendant but denied the other defendant’s motion for judgment as a matter of law. The Supreme Court affirmed in part and reversed in part, holding that the release executed by Miller before he initiated suit barred all his claims against the defendants. View "Miller v. Metro. Prop. & Cas. Ins. Co." on Justia Law

Fire Insurance Exchange (FIE) insured Defendant’s home in Clancy, Montana. When Defendant’s home was broken into and robbed, Defendant made a claim under her homeowner’s policy. FIE paid Defendant $22,602, representing property damage and actual cash value for the items Defendant claimed were stolen from the home. Defendant then submitted a supplemental claim in the amount of $23,102 for personal property she asserted she had replaced. When FIE concluded that the receipts Defendant provided to substantiate her replacement claims were fraudulent, FIE made a referral for criminal charges. Defendant subsequently pleaded guilty to felony insurance fraud and theft. The district court ordered Defendant to pay restitution to FIE in the amount of $22,602. The Supreme Court affirmed, holding that the district court did not err when it ordered Defendant to pay restitution to FIE even where Defendant’s initial claim was legitimate because Defendant’s subsequent fraudulent replacement value claim voided her policy, and FIE suffered a pecuniary loss in the amount of Defendant’s initial claim. View "State v. Henderson" on Justia Law

In 2004 Fox was charged with the sexual assault and murder of his three-year-old daughter. Detectives coerced a confession and delayed testing of DNA evidence, leaving Fox imprisoned for eight months, separated from his wife and son. His defense finally obtained the DNA evidence and had it tested at a private lab; the results excluded Fox and charges were dropped. Fox sued under 42 U.S.C. 1983 and state law alleging due process violations, malicious prosecution and intentional infliction of emotional distress. A St. Paul policy required the insurer to defend the detectives to its policy limit, $1 million. Will County also had excess liability policies for $5 million from AAIC (secondary) and Essex (tertiary). Under AAIC’s policy it was not required to assume “settlement or defense” until the underlying policy had been exhausted. None of the policies covered punitive damages. The detectives were represented by a firm retained by St. Paul. The jury awarded $15.5 million, including $6.2 million in punitive damages. Offers to settle for less, before and after the verdict, were rejected. St. Paul exhausted its policy limit; AAIC assumed the defense. The detectives assigned to the Foxes any claims against the insurers in exchange for a covenant not to seek punitive damages from the detectives’ personal assets. The Seventh Circuit upheld $8,166,000 of the damages awarded, including $3.4 million in punitive damages. Fox sought a declaratory judgment that AAIC breached its good faith duties to reasonably settle the claims and inform the detectives of their conflicts of interest. The district court dismissed, reasoning that AAIC, as excess insurer, never had any control over the defense before judgment and therefore had no duty to settle the claims or alert the detectives to any potential conflicts of interest. The Seventh Circuit affirmed View "Fox v. Am. Alt. Ins. Corp." 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

Steidl and Whitlock were convicted of 1987 murders, largely based on testimony by two supposed eyewitnesses. Long after the convictions, an investigation revealed that much of the testimony was perjured and that exculpatory evidence had been withheld. The revelations led to the release of the men and dismissal of all charges. Steidl had spent almost 17 years in prison; Whitlock had spent close to 21 years. They sued. By 2013, both had settled with all defendants. Because the defendants were public officials and public entities, disputes arose over responsibility for defense costs. National Casualty sought a declaratory judgment that it was not liable for the defense of former State’s Attorney, McFatridge, or Edgar County, agreeing to pay their costs under a reservation of rights until the issue was resolved. The Seventh Circuit ruled in favor of National Casualty. In another case McFatridge sought a state court order that the Illinois Attorney General approve his reasonable expenses and fees; the Illinois Supreme Court rejected the claim. In a third case, National Casualty sought a declaratory judgment that another insurer was liable for costs it had advanced. The Seventh Circuit affirmed that the other company is liable. It would be inequitable for that company to benefit from National’s attempt to do the right thing, especially since it did not do the right thing and contribute to the defense costs under a reservation of rights. View "Nat'l Cas. Co. v. White Mountains Reinsurance Co." on Justia Law

Petitioner Jennifer Mau was convicted of making false insurance claims. She challenged the sufficiency of the evidence presented against her at trial. Upon review, the Supreme Court found that the State failed to prove the existence of any "contract of insurance" underlying Petitioner's claim. Therefore the Court reversed her conviction. View "Washington v. Mau" on Justia Law

Plaintiff injured his shoulder while working for his employer, who was insured by the Montana State Fund. The State Fund paid for Plaintiff's two shoulder injuries and paid temporary total disability (TTD) benefits after informing Plaintiff that if he returned to gainful employment without the State Fund's knowledge and continued to receive benefits, he would be subject to legal action or criminal prosecution. After the State Fund discovered that Plaintiff had built and sold furniture and worked at a vacuum cleaner store while receiving TTD benefits, the assistant attorney general charged Plaintiff with theft, a felony. The State Fund subsequently terminated Plaintiff's TTD benefits. Plaintiff filed suit against the State fund and its private investigators, alleging that Defendants violated Montana's Insurance Code regarding unfair claim settlement practices and pleaded a variety of common law causes of action. The district court ruled in favor of Defendants. The Supreme Court affirmed the district court's entry of judgment in favor of the State Fund, holding that the district court did not err in (1) granting the State Fund's motion to dismiss Defendant's claims under the Insurance Code; and (2) granting the State Fund's motion for summary judgment regarding Plaintiff's common law claims. View "White v. State ex rel. Mont. State Fund" on Justia Law

Appellees, the Rubins, requested that the district court issue a Writ of Garnishment against the assets of Hamas and HLF after obtaining a judgment against Hamas for damages resulting from a terrorist attack in an outdoor pedestrian mall in Jerusalem. The district court executed the writ but the Rubins could not execute against HLF's assets because those assets had been restrained under 21 U.S.C. 853 to preserve their availability for criminal forfeiture proceedings. The district court subsequently denied the government's motion to dismiss the Rubins' third-party petition under section 853(n) to assert their interests in the restrained assets and vacated the preliminary order of forfeiture. The district court held that the Terrorism Risk Insurance Act of 2002 (TRIA), Pub. L. No. 107-297, title II, 201, 116 Stat. 2337, allowed the Rubins to execute against HLF's assets not withstanding the government's forfeiture proceedings. The court reversed, holding that section 853(n) did not provide the Rubins with a basis to prevail in the ancillary proceeding; TRIA did not provide the Rubins a basis to assert their interest in the forfeited property; TRIA did not trump the criminal forfeiture statute; and the in custodia legis doctrine did not preclude the district court's in personam jurisdiction over HLF. View "United States v. Holy Land Foundation for Relief, et al." on Justia Law

In 2005, Curtis McGhee and another individual brought claims against the City alleging violations of civil rights sounding in malicious prosecution. The City sought coverage under insurance policies issued by CIC and Columbia. On appeal, the City and McGhee challenged the district court's order granting summary judgment to CIC and Columbia, on CIC's and Columbia's declaratory judgment claims concerning coverage under the various insurance policies. The court concluded that the district court correctly refused to consider and correctly denied additional discovery of extrinsic evidence. The court also concluded that the alleged malicious prosecution and resulting personal injuries occurred when the underlying charges were filed against McGhee in 1977. Therefore, the court affirmed the district court's judgment that the following policies did not afford coverage to the City for the malicious prosecution claims: the two excess liability policies issued by CIC; four of the special excess liability policies issued by Columbia; and the commercial umbrella liability policy issued by Columbia. As to the 1977-78 special excess liability policy issued by Columbia, the court reversed the district court's judgment regarding the applicability of the reasonable expectations doctrine. The court remanded for further proceedings. View "Chicago Ins. Co., et al v. City of Council Bluffs, et al" on Justia Law