Justia Insurance Law Opinion Summaries

The case involves a dispute between an insurer, GEICO, and a windshield repair shop, Glassco, regarding the Florida Motor Vehicle Repair Act. From 2016 to 2019, Glassco performed nearly 1,800 windshield repairs for GEICO’s insureds, who assigned their insurance payment rights to Glassco. GEICO paid these claims at a discounted rate, leading to litigation. GEICO sought to recover payments and claimed that Glassco violated the Repair Act by not providing written estimates and other disclosures.The U.S. District Court for the Middle District of Florida ruled in favor of Glassco, concluding that GEICO did not have a private right of action under the Repair Act because it was not a "customer" as defined by the statute. The court also held that Glassco’s violations did not render its invoices void. GEICO appealed, and the U.S. Court of Appeals for the Eleventh Circuit certified two questions to the Supreme Court of Florida regarding the insurer's rights under the Repair Act.The Supreme Court of Florida answered both certified questions in the negative. First, it held that Fla. Stat. § 559.921(1) does not grant an insurance company a cause of action when a repair shop fails to provide a written repair estimate. The court emphasized that the statute defines a "customer" as the person who signs the repair estimate, and GEICO conceded it did not meet this definition.Second, the court held that the Repair Act violations do not void a repair invoice for completed windshield repairs, nor do they preclude a repair shop from being paid by an insurance company. The court noted that the statute allows for penalties and damages to be adjusted if repairs were authorized and properly performed, indicating that voiding invoices was not intended as a remedy. The court also found that subsequent amendments to the Repair Act rendered previous case law, which might have supported GEICO’s position, obsolete. View "Government Employees Insurance Company v. Glassco Inc." on Justia Law

The case revolves around a dispute over the amount of reimbursements for medical expenses that an insurer, Allstate Insurance Company, was required to pay under a personal injury protection (PIP) policy. The dispute arose when Revival Chiropractic, LLC, a medical provider, submitted charges for services rendered to two of Allstate's policyholders. Allstate paid 80% of the submitted charges, which was less than the amount that would have been reimbursable under the statutory schedule of maximum charges. Revival Chiropractic argued that Allstate was required to pay either 80% of the maximum charge under the schedule or the full amount of the submitted charge.The United States District Court for the Middle District of Florida agreed with Revival Chiropractic, ruling that Allstate violated Florida law by paying only 80% of the submitted charges when the charges were less than the amounts allowed under the statutory schedule of maximum charges. Allstate appealed the decision to the United States Court of Appeals for the Eleventh Circuit, which certified a question to the Supreme Court of Florida due to the lack of controlling precedent.The Supreme Court of Florida, after reviewing the relevant statutory provisions and the terms of Allstate's PIP policy, concluded that Allstate was entitled to pay 80% of the billed charges. The court found that the PIP policy expressly authorized such a payment and that nothing in the statutory scheme stood in the way of that policy provision. The court held that the PIP statute contemplates that an insurer providing notice that it may use the schedule of maximum charges will not thereby be precluded from paying 80% of reasonable charges as otherwise determined under the provisions of the statute. The court also rejected the argument that the statutory provision requiring an insurer to pay the full amount of the charge submitted when that amount is below the reimbursement payable under the schedule was mandatory. The court concluded that the provision was permissive and did not displace the statutory provision limiting reimbursements to 80% of reasonable charges. The court answered the certified question in the affirmative and returned the case to the Eleventh Circuit Court of Appeals. View "Allstate Insurance Company v. Revival Chiropractic, LLC" on Justia Law

This case involves American Coastal Insurance Company ("American Coastal") and San Marco Villas Condominium Association, Inc. ("San Marco"). American Coastal issued San Marco a policy covering the condominium complex against various perils, including hurricanes. When Hurricane Irma struck Marco Island, San Marco's buildings sustained damage and submitted a claim to American Coastal. After an investigation, American Coastal estimated San Marco’s losses to be $356,208.82 and paid $192,629.75, reflecting depreciation and application of policy deductibles. San Marco, however, obtained an estimate showing damages exceeding eight million dollars, leading to a disagreement over the amount of loss, which San Marco sought to resolve by invoking the appraisal provision in the policy.American Coastal refused, arguing that an appraisal was premature since its investigation was ongoing. San Marco subsequently sued American Coastal, seeking the court to compel an appraisal. American Coastal contested, arguing that appraisal was inappropriate because they had completely denied coverage based on a policy condition that voids coverage when the insured commits fraud or makes material misrepresentations about the insurance. The trial court sided with San Marco and ordered an appraisal. The Second District Court of Appeal affirmed the trial court's decision, and the Supreme Court of Florida granted review based on the certified conflict.The Supreme Court of Florida held that a trial court has discretion in determining the order in which coverage and amount-of-loss issues are resolved. It rejected American Coastal’s argument that coverage issues must be resolved before an appraisal can be ordered. The court found that the policy’s retained-rights provision contemplates appraisals occurring prior to resolution of coverage issues. Therefore, the court approved the decision of the Second District Court of Appeal and disapproved the certified conflict cases to the extent they are inconsistent with this opinion. View "American Coastal Insurance Company v. San Marco Villas Condominium Association, Inc." on Justia Law

The Supreme Court approved the decision of the Second District Court of Appeal in the proceedings below, holding that an appraiser cannot be "disinterested" if he or she, or a firm in which he or she has an interest, is to be compensated for services as a public adjuster with a contingency fee.At issue was whether George Keys, the president of Keys Claims Consultants, Inc. (KCC), a homeowner's public adjusting firm, which was to be compensated on a contingency basis for its adjusting services, could subsequently serve as a "disinterested" appraiser for Jon Parrish under the language of the relevant insurance policy with State Farm. The trial court concluded that Keys could serve as Parrish's disinterested appraiser because the two had disclosed their arrangement to State Farm. The Second District reversed, concluding that Keys could not serve as Parrish's disinterested appraiser. The Supreme Court affirmed, holding that because Keys’s company, KCC, was to be compensated via contingency fee, Keys had a pecuniary interest in the outcome of the claim and could not qualify as a “disinterested” appraiser. View "Parrish v. State Farm Fla. Insurance Co." on Justia Law

The Supreme Court quashed the decision of the court of appeal issuing a writ of prohibition to prevent the circuit court from exercising jurisdiction over certain claims, holding that the court of appeal erred in issuing the writ.Plaintiff brought this lawsuit against an insurance company and the law firm representing the company in the underlying suit Plaintiff brought against the insurer, arguing that Defendants violated confidentiality requirements applicable to a mediation. After the circuit court denied Defendants' motions to dismiss Defendants petitioned the Third District relief. The Third District granted a writ of prohibition, concluding that the circuit court had exceeded its jurisdiction by entertaining Defendants' collateral estoppel affirmative defense. The Supreme Court quashed the decision below, holding that the writ of prohibition was used in an improper manner here. View "Mintz Truppman, P.A. v. Cozen O'Connor, PLC" on Justia Law

In this considering the provisions of a personal injury protection (PIP) insurance policy permit permitting the insurer to limit reimbursement payments in accordance with a statutory schedule of maximum charges the Supreme Court held that the PIP policy in this case was effective to authorize the use of the schedule of maximum charges under the pertinent provisions of Fla. Stat. 627.736(5).The certified question in this case related to the Second District Court of Appeal's holding that State Farm's policy provisions permitted State Farm to use the schedule of maximum charges even though the policy also referred to the use of other statutory factors for determining reasonable charges. The Supreme Court affirmed, holding that the PIP policy issued by State Farm was effective to authorize the use of the schedule of maximum charges under the relevant provisions of Fla. Stat. 627.736(5). View "MRI Associates of Tampa, Inc. v. State Farm Mutual Automobile Insurance Co." on Justia Law

In this legal malpractice action by an insurer against a law firm retained to represent its insured in a separate prior litigation, the Supreme Court held that, where the insurer had a duty to defend, the insurer had standing through its contractual subrogation provision to maintain the malpractice action against counsel hired to represent the insured.The trial court granted summary judgment in favor of the law firm, concluding that the insurer lacked standing to directly pursue a legal malpractice action because there was no privity between the law firm and the insurer. The Fourth District Court of Appeal affirmed, concluding that the insurer lacked standing to pursue the professional negligence action. The Supreme Court quashed the decision below, holding that the insurer had standing to maintain this legal malpractice action because the insurer was contractually surrogated to the insured's rights under the insurance policy. View "Arch Insurance Co. v. Kubicki Draper, LLP" on Justia Law

The Supreme Court answered in the negative a question certified by the Fifth District Court of Appeal, holding that in a first-party breach of insurance contract action brought by an insured against its insurer not involving suit under Fla. Stat. 624.155, Florida law does not allow the insured to recover extra-contractual, consequential damages.The insureds in this case sought to recover from the insurer extra-contractual, consequential damages for lost rental income. The trial court granted the insurer's motion for partial summary judgment regarding the breach of contract claim for lost rental income. The Fifth District reversed the partial summary judgment regarding the consequential damages claim, concluding that the insurer was not statutorily immune from this aspect of the insureds' claim. The Supreme Court quashed the Fifth District's decision and remanded the case, concluding that extra-contractual, consequential damages are not available in a first-party breach of insurance contract action. View "Citizens Property Insurance Corp. v. Manor House, LLC" on Justia Law

The Supreme Court approved the decision of the Fifth District Court of Appeal in this insurance dispute, holding that an insurer that issues a reduced premium collector vehicle policy may not limit uninsured motorist coverage under the specialty policy to accidents involving the occupancy or use of the collector vehicle.The Estate of Michael Lentini, who was operating his motorcycle when he was involved in a fatal accident, sought uninsured motorist benefits under a policy issued on a collector vehicle. The policy limited uninsured motorist coverage to accidents involving the covered collector vehicle. The Insurer denied coverage, and the Estate sued. The trial court entered summary judgment for the Insurer. The Fifth District reversed, concluding that the collector vehicle policy must and did not comply with the statutory requirements of Fla. Stat. 627.727. The Supreme Court affirmed, holding that the requirements of section 627.727 prohibited the limitations placed on uninsured motorist coverage in the collector vehicle policy at issue in this case. View "American Southern Home Insurance Co. v. Lentini" on Justia Law

In this case involving the proper method of applying a personal injury protection (PIP) insurance policy deductible to a medical provider’s bill for hospital emergency services and care, the Supreme Court approved the Fifth District Court of Appeal’s decision, holding that the deductible should be subtracted from the total charges prior to application of the reimbursement limitation in Fla. Stat. 627.736(5)(a)1.b.While this case was pending in the Court, the Fourth District Court of Appeal issued an opinion in State Farm Mutual Automobile Insurance Co. v. Care Wellness Center, LLC (Care Wellness), 240 So. 3d 22 (Fla. 4th DCA 2018), holding that the deductible should be applied after charges are reduced under any fee schedule found in section 627.736. The Supreme Court approved the Fifth District’s decision in the instant case and disapproved the Fourth District’s decision in Care Wellness, holding that, under Fla. Stat. 627.739(2), the deductible should be applied to the total medical charges prior to reduction under the reimbursement limitation. View "Progressive Select Insurance Co. v. Florida Hospital Medical Center" on Justia Law