Justia Insurance Law Opinion Summaries

This appeal raised the issue of whether a district court can order a child support obligor to cooperate with a child support obligee in the obligee's efforts to obtain insurance on the obligor's life if the obligor objects to the issuance of the life insurance policy. Here, despite the obligor's objection, the district court ordered the obligor to cooperate with the obligee's attempts to obtain insurance on the obligor's life at the obligee's own expense. The court of appeals affirmed. The Supreme Court reversed, holding that a district court cannot issue such an order because the order would be contrary to public policy as expressed by the Kansas Legislature in Kan. Stat. Ann. 40-453(a), which provides that an insurable interest does not exist if a person whose life is insured makes a written request for the termination or nonrenewal of the policy. View "In re Marriage of Hall" on Justia Law

Appellee, as executrix of the estate of her father, and her sister, brought a breach of contract action in which they asserted that their father's second wife, appellant, contractually waived her right to retain the proceeds of their deceased father's employer-provided 401K plan and life insurance policy by entering a settlement agreement incorporated into an order of separate maintenance executed approximately a year prior to the father's death. At issue was whether the court of appeals erred in finding that decedent's children could maintain a state law action against the decedent's surviving spouse to recover proceeds distributed to the spouse as the beneficiary of the decedent's ERISA-governed benefits plans, 29 U.S.C. 1001 et seq., where the state law claims were based on a contention that the spouse waived her rights to such proceeds. The court answered in the negative, concluding that, in this case, since the proceeds of the ERISA-covered plans were paid out to appellant and were no longer in the control of the plan administrator, the trial court erred when it dismissed appellees' breach of contract claim against appellant.

Appellant filed a declaratory judgment action seeking a declaration that AHCCCS had no right to recover from her father's annuity at all or, alternatively, had no right to recover for any costs incurred for the care of her mother received after her father's death. Appellant subsequently appealed the district court's judgment granting summary judgment to AHCCCS. The court held that the 2006 amendment to 42 U.S.C. 1396p(c)(1)(F)(i) created a right in the State to recover as a remainder beneficiary against a community spouses' annuity for an institutionalized spouse's medical costs. The court further held that the State's recovery was not limited to the amount it paid for the institutionalized spouse's medical costs as of the date of the community spouse's death. Accordingly, the court affirmed the judgment, concluding that AHCCCS could be reimbursed as the primary remainder beneficiary from the father's annuity for the cost of the medical assistance it paid on the mother's behalf after the father's death.

Appellant James Grace suffered permanent brain injuries when his helmet failed after he braked to avoid hitting a dog and was thrown over the handlebars of his motorcycle. Appellant and his wife, Kathleen, filed personal injury and loss of consortium claims against the helmet retailer and manufacturer. The Graces received disbursements from the receiver of one of the manufacturer's second-tier insurance providers that had filed for bankruptcy and gone into liquidation, and entered a settlement agreement with the third-tier insurance carrier. Appellant and his wife separated at some point after the accident, divorced for a month, and remarried. Except for a partial disbursement of funds that occurred while their final divorce hearing was pending, the Graces were unable to agree upon how the remaining settlement and insurance proceeds should be divided. The Graces' lawyer filed an action for interpleader asking the superior court to determine how to divide the remaining funds. After a one-day trial, the superior court concluded that: (1) based on the "analytic" approach in "Bandow v. Bandow," the portion of the recovery from the receiver for the manufacturer's second-tier insurance carrier that was allocated for past economic loss, past medical loss, and rehabilitation services was marital property and should have been divided equally; and (2) the recovery from the third-tier insurance carrier was the result of a jointly-assigned bad faith insurance claim and belonged to both parties. Upon review, the Supreme Court affirmed the superior court's division of the proceeds from the second-tier insurance carrier, but reversed its division of the proceeds from the third-tier insurance carrier.

A father and his sixteen-year-old son were sued after the son was involved in an accident while driving a vehicle owned, insured, and provided to him by his father. The basis for the suit against the father was the family purpose doctrine, which imposes vicarious liability on the owner of a vehicle for the negligent operation of the vehicle by a family member. The trial court granted summary judgment to the father, finding that the family purpose doctrine did not apply. The court of appeals reversed and granted partial summary judgment in favor of the plaintiff, ruling that the family purpose doctrine applied as a matter of law. The Supreme Court vacated the decision of the court of appeals, holding that while two of the essential elements of the family purpose doctrine were met in this case, a genuine issue of material fact remained as to the last element. Remanded for trial.

Appellant, the named beneficiary of an accident benefits plan that her husband obtained through his employer, brought suit under ERISA, 29 U.S.C. 1001 et seq., alleging that the plan administrator, Metropolitan Life Insurance (Metlife), abused its discretion in determining that her husband was intoxicated at the time of the accident and denying coverage. At issue was whether the district court properly granted summary judgment to Metlife because Metlife's interpretation of the relevant policies was arbitrary and capricious and not supported by substantial evidence. The court held that Metlife did not abuse its discretion as plan administrator when it denied benefits based on the general exclusion for intoxication that appeared in the certificate of insurance. The court also held that the toxicology report, which concluded that the husband's blood alcohol level was above the state limit, constituted evidence that a reasonable mind might accept as adequate to support a conclusion and therefore, satisfied the substantial evidence standard. The court also held that because it agreed with the district court's conclusion that the denial of benefits was justified in light of the intoxication conclusion, it need not address Metlife's assertion that the husband's death was not accidental because it was reasonably foreseeable or, alternatively, the result of intentional self-inflicted injury. Accordingly, summary judgment was affirmed.

Appellants filed suit against nine pilots and their spouses asserting claims for equitable relief under 29 U.S.C. 1132(a)(3) of ERISA where appellants alleged that the pilots and their spouses obtained "sham" divorces for the purpose of obtaining lump sum pension distributions from the Continental Pilots Retirement Plan. At issue was whether ERISA, 29 U.S.C. 1056(d)(1), allowed a retirement plan administrator to seek restitution of benefits that were paid to a plan participant's ex-spouse pursuant to a domestic relations order such as a divorce decree, if the administrator subsequently determined that the domestic relations order was based on a "sham" divorce. The court agreed with the district court's holding that subsection 1056(d)(3)(D)(i) did not authorize an administrator to consider or investigate the subjective intentions or good faith underlying a divorce. Therefore, the court affirmed the district court's dismissal of appellants' claims.

Plaintiff, the father of decedent, commenced an action seeking to recover from defendants, decedent's grandparents, for decedent's wrongful death and for her conscious pain and suffering where she accidentally drowned in defendants' pool. At issue was an exclusion in defendants' homeowner's insurance policy excluding coverage for bodily injury to an insured where an insured would receive "any benefit" under the policy. The court held that judgment should have been granted in plaintiff's favor where the exclusion did not operate to bar coverage for the noninsured plaintiff's wrongful death claim for the death of the insured decedent. Accordingly, the court reversed the Appellate Division's judgment and remanded for further proceedings.

The biological mother of three children lived with the children and their adoptive mother and named the adoptive mother as beneficiary on one of her life insurance policies through her employer. She did not name beneficiaries on other policies and, after she died, the insurers rejected claims on behalf of the children. The district court dismissed claims under the Employee Income Security Act (ERISA), 29 U.S.C. 1001, which lists children as default beneficiaries. The Third Circuit vacated and remanded. ERISA grants standing to participants and beneficiaries; whether the term "children," as used in the insurance contracts, includes biological children who have been adopted by a non-participant is ambiguous. There was evidence of the insured's intent to benefit the children, sufficient to create a colorable claim adequate to support standing.