Justia Insurance Law Opinion SummariesArticles Posted in Florida Supreme Court
Progressive Select Insurance Co. v. Florida Hospital Medical Center
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
Harvey v. Geico General Insurance Co.
In 2006, Harvey, the insured, was involved in an automobile accident with Potts. Potts, age 51, died as a result, leaving a wife and three children. Harvey’s vehicle was registered in both his name and his business’s name and was covered under a $100,000 GEICO liability policy. Two days after the accident, GEICO resolved the liability issue adversely to Harvey. GEICO did not communicate a request by the estate’s attorney for a statement. GEICO tendered $100,000 to the estate’s attorney. The estate returned GEICO’s check and filed a wrongful death suit. A jury awarded the estate $8.47 million. Harvey filed a bad faith claim against GEICO. The estate's lawyer testified that he did not receive any communication from GEICO following his initial letter and that had he known that Harvey’s only other asset was a business account worth approximately $85,000, he would not have filed suit. The Fourth District Court of Appeal reversed the judgment entered in favor of Harvey, stating that “the evidence was insufficient as a matter of law to show ... bad faith,” and, “even if the insurer’s conduct were deficient, the insurer’s actions did not cause the excess judgment.” The Supreme Court of Florida reversed. The Fourth District failed to properly apply the directed verdict standard and misapplied precedent setting forth the fiduciary duties of insurance companies. An insurer can be liable for bad faith even “where the insured’s own actions or inactions . . . at least in part” caused the excess judgment. View "Harvey v. Geico General Insurance Co." on Justia Law
Altman Contractors, Inc. v. Crum & Forster Specialty Insurance Co.
The notice and repair process set forth in Fla. Stat. 558 is a “suit” within the meaning of the commercial general liability policy issued in this case by Crum & Forster Speciality Insurance Company (C&F) to Altman Contractors, Inc. According to the policy, C&F had a duty to defend Altman in any “suit” arising from the construction of a condominium. Altman claimed that this duty to defend was invoked when the property owner served it with several notices under chapter 558 cumulatively claiming over 800 construction defects in the project. Altman filed a declaratory judgment action seeking a declaration that C&F owed a duty to defend and to indemnify it under the policy. The federal district court granted summary judgment for C&F, concluding that nothing about the chapter 558 process satisfied the definition of “civil proceeding.” Altman appealed, and the United States Circuit Court of Appeals for the Eleventh Circuit certified the legal issue to the Supreme Court. The Supreme Court answered the certified question in the affirmative because the chapter 558 presuit process is an “alternative dispute resolution proceeding” as included in the policy’s definition of “suit.” View "Altman Contractors, Inc. v. Crum & Forster Specialty Insurance Co." on Justia Law
Joyce v. Federated National Insurance Co.
The Supreme Court quashed the decision of the Fifth District Court of Appeals, which held on appeal in this case that trial courts may apply a contingency fee multiplier to an award of attorney’s fees to a prevailing party only in “rare” and “exceptional” circumstances. Petitioners, the insureds in a successful dispute with their homeowners’ insurance carrier, argued before the Supreme Court that the Fifth District’s decision misapplied Supreme Court precedent from Florida Patient’s Compensation Fund v. Rowe, 472 So. 2d 1145 (Fla. 1985), and its progeny. The Supreme Court agreed with Petitioners, holding that there is no “rare” and “exceptional” circumstances requirement before a trial court may apply a contingency fee multiplier. View "Joyce v. Federated National Insurance Co." on Justia Law
Government Employees Insurance Co. v. Macedo
The ambiguous section of the insurance policy at issue in this case must be construed in favor of coverage for the costs and attorneys’ fees awarded against the insured pursuant to the offer of judgment statute, Fla. Stat. 768.79. Alysia Macedo sued Zackery Lombardo for damages resulting from injuries she sustained in an automobile collision.The jury returned a verdict in favor of Macedo in the amount of $243,954.55. Macedo joined to the judgment GEICO, which provided bodily injury liability coverage to Lombardo. The trial court awarded taxable fees and costs against GEICO jointly and severally with its insured pursuant to section 768.79. The First District Court of Appeal affirmed. The Supreme Court approved the First District’s decision, holding that the key provision in the insurance policy was ambiguous and must be construed in favor of coverage. View "Government Employees Insurance Co. v. Macedo" on Justia Law
State Farm Mutual Automobile Insurance Co. v. Shands Jacksonville Medical Center, Inc.
A hospital provided medical services to twenty-nine insureds who were injured in motor vehicle accidents. After paying the hospital, the insurer requested certain documentation relating to the reasonableness of the charges pursuant to Fla. Stat. 627.736(6)(b). The hospital provided the insurer with various documents but refused to furnish copies of third-party contracts containing negotiated discount rates between the hospital and other insurers and payers, arguing that the information was not covered by subsection (6)(b). The insurer filed a petition pursuant to Fla. Stat. 627.736(6)(c) asking the trial court to compel discovery of the withheld information. The trial court ordered the hospital to produce the requested discovery. The court of appeal reversed, concluding that the trial court’s order exceeded the scope of discovery permissible under sections 627.736(6)(b) and (c). Specifically, the court ruled that discovery of facts under section 627.736(6)(c) is limited to the production of the documents described in section 627.736(6)(b). The Supreme Court approved the court of appeal’s interpretation of the scope of discovery under section 627.736(6)(c), holding that the scope of permissible discovery under subsection (6)(c) is limited to the production of documents described in subsection (6)(b). View "State Farm Mutual Automobile Insurance Co. v. Shands Jacksonville Medical Center, Inc." on Justia Law
Allstate Insurance Co. v. Orthopedic Specialists
Orthopedic Specialists and various medical service providers challenged reimbursements made by Allstate Insurance Company under personal injury protection no-fault insurance policies issued to Allstate’s insureds, arguing that Allstate’s policy was ambiguous as to whether Allstate had elected to reimburse the Providers in accordance with the Medicare fee schedules provided for in Fla. Stat. 627.736(5)(a)2. The Fourth District held that the policy language was not legally sufficient to authorize Allstate to apply the Medicare fee schedules. The Supreme Court quashed the decision of the Fourth District and approved the decision of the First District in Allstate Fire & Casualty Insurance v. Stand-Up MRI of Tallahassee, P.A., holding that Allstate’s insurance policy provides legally sufficient notice of Allstate’s election to use the permissive Medicare fee schedules identified in section 627.736(5)(a)2 to limit reimbursements. View "Allstate Insurance Co. v. Orthopedic Specialists" on Justia Law
Sebo v. American Home Assurance Co.
In 2005, John Sebo purchased a home. American Home Assurance Company (AHAC) provided homeowners insurance as of the date of the purchase. It later became clear that the house suffered from major design and construction defects when water began to intrude during rainstorms. Hurricane Wilma further damaged the residence. AHAC denied coverage for most of the claimed losses. Sebo sued AHAC seeking a declaration that the policy provided coverage for his damages. The jury found in favor of Sebo, and the trial court entered judgment against AHAC. The Second District Court of Appeal reversed and remanded for a new trial, concluding that coverage did not exist under Sebo’s all-risk policy when multiple perils combined to create a loss and at least one of the perils was excluded by the terms of the policy. The Supreme Court quashed the Second District’s opinion, holding that the plain language of the policy did not preclude recovery in this case. View "Sebo v. American Home Assurance Co." on Justia Law
de la Fuente v. Florida Insurance Guaranty Ass’n
Insureds, who owned a policy from Insurer, alleged that Insurer failed to pay them for damage to their home from sinkhole loss, thus breaching the terms of the insurance policy. When Insurer became insolvent, Florida Insurance Guaranty Association (FIGA) was activated to handle the “covered claims.” The circuit court ordered appraisal, and the appraisers determined the amount of loss to be $130,600. FIGA objected to the confirmation of the appraisal award, arguing that the statutory definition of “covered claim” in effect when Insurer was adjudicated insolvent should govern any payments made on the claim, thus prohibiting any direct payment to Insureds for their sinkhole loss. The circuit court confirmed the appraisal award and entered judgment in favor of Insureds in the amount of $130,600, concluding that Insureds’ rights to recover against FIGA for sinkhole loss were established when Insurer issued the insurance policy. The Second District Court of Appeal reversed. The Supreme Court affirmed, holding (1) the definition of “covered claim” in effect on the date that Insurer was adjudicated to be insolvent governed the scope of FIGA’s liability to Insureds for the sinkhole loss at their property; and (2) Insureds were precluded from obtaining an appraisal award for their sinkhole loss directly from FIGA under the terms of the policy. View "de la Fuente v. Florida Insurance Guaranty Ass’n" on Justia Law
Johnson v. Omega Ins. Co.
Johnson was covered under a homeowner’s insurance policy issued by Omega when she filed a claim to recover damages resulting from conditions which she believed to be sinkhole activity. After an initial sinkhole investigation determining that there was no sinkhole activity present on Johnson’s property, Omega denied Johnson’s claim. Johnson filed suit against Omega for breach of contract. In response, Omega hired another expert to perform an additional evaluation. The expert agreed that sinkhole activity was present on Johnson’s property. Omega accepted the evaluation report and provided payment for the damages. At issue before the trial court was whether Johnson was entitled to attorney’s fees. The trial court concluded that Omega’s agreement to pay money to Johnson amounted to a confession of judgment and awarded Johnson attorney’s fees under Fla. Stat. 627.428. The Fifth District Court of Appeal reversed, concluding that Omega did not act wrongfully or in bad faith, and therefore, section 627.428 and the confession of judgment doctrine did not apply. The Supreme Court quashed the decision below, holding that a recovery for attorney’s fees under section 627.428 requires an incorrect denial of benefits by the insurance company, not a bad faith denial. View "Johnson v. Omega Ins. Co." on Justia Law