Justia Insurance Law Opinion Summaries

After Plaintiff was rear-ended by an underinsured motorist (UM), Plaintiff requested her $100,000 UM policy limits from State Farm. Plaintiff indicated that her damages were estimated to be $3.5 million because she suffered from reflex sympathetic dystrophy syndrome. State Farm responded that Plaintiff must schedule a compulsory medical examination (CME) pursuant to the terms of the policy. Plaintiff refused to attend a CME and instead filed suit against State Farm. The trial court entered judgment against State Farm for the UM policy limits. The court of appeal affirmed, holding (1) Plaintiff breached the contract when she failed to attend the CME; but (2) State Farm must plead and prove prejudice to avoid liability based on noncompliance with the CME clause, and State Farm failed to meet its burden in this case. The Supreme Court approved of the court of appeal’s decision, holding (1) the forfeiture of benefits under a UM policy will not automatically result upon an insured’s breach of a CME provision unless the insurer pleads and proves actual prejudice as an element of its affirmative defense; and (2) the undisputed facts demonstrate that State Farm was not prejudiced in this case. View "State Farm Mut. Auto. Ins. Co. v. Curran" 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

Several insureds filed a class action against the predecessor of Washington National Insurance Corporation concerning insurance policies that provide for reimbursement of certain home health care expenses. The district court granted summary judgment for the insureds, concluding that various provisions in the policy, including a certificate schedule, demonstrated an ambiguity concerning whether an automatic increase applied only to the daily benefit or also applied to the lifetime maximum benefit amount and the per occurrence maximum benefit amount. Because there was ambiguity in the policy, the court of appeal certified questions of law to the Florida Supreme Court, which held (1) because the policy was ambiguous, it must be construed against the insurer and in favor of coverage without consideration of extrinsic evidence; and (2) when so construed, the policy's automatic benefit increase applies to the daily benefit, the lifetime maximum benefit, and the per occurrence maximum benefit. View "Washington Nat'l Ins. Corp. v. Ruderman" on Justia Law

Plaintiff filed a claim with Defendant, his homeowner's insurance company, for fire damage on his home. Plaintiff's insurance policy with Defendant was a replacement cost policy. Defendant made a payment to Plaintiff that included costs of repair even though Defendant had not completed any repairs to the home. Defendant, however, refused to pay for a general contractor's overhead and profit because Plaintiff had not yet incurred those expenses. Plaintiff filed a breach of contract claim against Defendant, contending that, like the other costs of repair Defendant paid, Defendant was required to pay costs for overhead and profit. The trial court granted summary judgment for Defendant, and the court of appeal affirmed. The Supreme Court quashed the court of appeal's decision, holding (1) replacement cost insurance includes overhead and profit where the insured is reasonably likely to need a general contractor for repairs; and (2) the court of appeal erred in determining the Florida law and the insurance policy permitted Defendant to withhold payment of overhead and profit because Plaintiff had not actually incurred those costs. Remanded. View "Trinidad v. Fla. Peninsula Ins. Co." on Justia Law

After Insured sustained injuries in a car accident he sought MRIs from Virtual Imaging Services. Virtual Imaging obtained an assignment of personal injury protection (PIP) benefits under Insured's policy with GEICO and billed GEICO $3600 for the MRIs. GEICO paid the bill but limited its reimbursement to eighty percent of 200 percent of the applicable Medicare fee schedule in accordance with the formula described in Fla. Stat. 627.736(5)(a). This statutory provision became effective on January 1, 2008 as part of Florida's PIP statute. Virtual Imaging subsequently sued GEICO, alleging that GEICO's reimbursement was insufficient. The county court granted Virtual Imaging's motion for summary judgment. The court of appeal affirmed then certified a question of law to the Supreme Court, which answered by holding that GEICO was required to give notice to Insured by electing the permissive Medicare fee schedules in its policy before taking advantage of the Medicare fee schedule to limit reimbursements. View "Geico Gen. Ins. Co. v. Virtual Imaging Servs., Inc." on Justia Law

Plaintiff's automobile insurance policy with Geico included a condition that Plaintiff submit to examination under oath (EUO) before recovering personal injury protection (PIP) benefits. Geico denied Plaintiff's PIP claim due to her failure to satisfy this condition after she was injured in a car accident. Plaintiff filed a class action complaint alleging that Geico had violated Florida's PIP statute. The federal district court dismissed the case, concluding that the PIP statute did not prohibit an insured from requiring an EUO. On appeal, the Eleventh Circuit certified a question of law to the Florida Supreme Court, which answered by holding that, under Fla. Stat. 627.736, an insurer cannot require an insured to attend an EUO as a condition precedent to recovery of PIP benefits. View "Nunez v. GEICO Gen. Ins. Co." on Justia Law

Tiara Condominium Association (Tiara) retained Marsh & McLennan (Marsh) as its insurance broker. Marsh secured windstorm coverage through Citizens Property Insurance Corporation (Citizens), which issued a policy that contained a loss limit in an amount close to $50 million. Tiara's condominium subsequently sustained damages caused by two hurricanes. After being assured by Marsh that the loss limits coverage was per occurrence, Tiara spent more than $100 million in remediation efforts. However, when Tiara sought payment from Citizens, Citizens claimed that the loss limit was $50 million in the aggregate, not per occurrence. Tiara filed suit against Marsh, alleging, inter alia, breach of contract, breach of fiduciary duty, and negligence. The trial court granted summary judgment for Marsh on all claims. The appeals affirmed with the exception of the negligence and breach of fiduciary claims, as to which it certified a question to the Supreme Court to determine whether the economic loss rule prohibits recovery, or whether an insurance broker falls within the professional services exception that would allow Tiara to proceed with the claims. The Court answered by holding that the application of the economic loss rule is limited to products liability cases. View "Tiara Condo. Ass'n, Inc. v. Marsh & McLennan Cos. " on Justia Law

Plaintiff filed a medical malpractice action against a dentist (Dentist) and his dental practice, alleging that Dentist's failure to diagnose and treat his dental conditions resulted in a bone infection and a worsening of his dental problems, which caused severe and permanent physical and emotional damage. In preparation for trial, there was an ex parte predeposition conference conducted between Plaintiff's nonparty treating physician and counsel provided by Defendant's insurance company. Plaintiff contended that the ex parte meeting violated the State's physician-patient confidentiality statute as delineated in Fla. Stat. 456.057(8). The Supreme Court held that section 456.057 prohibits such meetings and quashed the decision of the Fourth District holding otherwise. In particular, the Court held that an ex parte meeting such as the one attempted here is prohibited irrespective of whether the attorney and physician claim they will discuss only non-privileged matters. View "Hasan v. Garvar" on Justia Law

The issue in this case was whether an appellate court should review a non-final order denying a claim of sovereign immunity by Citizens Property Insurance Corporation (Citizens), a state-created entity that provides property insurance, in a bad faith action stemming from the entity's handling of a property damage claim. The issue arose in the context of the broader question of when appellate courts should use common law writs to review non-final orders involving claims of immunity prior to the entry of a final judgment and when the Supreme Court should expand the list of non-final appealable orders. While the Court did not resolve the broader issue in this case, it determined that Citizens' claim of immunity was not reviewable by the appellate courts either through the writ of certiorari or the writ of prohibition, and the Court declined to expand the list of non-final orders reviewable on appeal to include the discrete legal issue presented in this case. View "Citizens Prop. Ins. Corp. v. San Perdido Ass'n, Inc." on Justia Law

Based on unethical actions during the 2004-2005 hurricane season, the Legislature enacted Section 626.854(6), Florida Statutes: A public adjuster may not directly or indirectly through any other person or entity initiate contact or engage in face-to-face or telephonic solicitation or enter into a contract with any insured or claimant under an insurance policy until at least 48 hours after the occurrence of an event that may be the subject of a claim under the insurance policy unless contact is initiated by the insured or claimant. An adjuster sued. The trial court upheld the law, accepting an interpretation that it prohibited only in-person or telephonic communication, that it primarily regulates conduct, not speech, and furthers an important governmental interest. The appeals court reversed, finding that the section regulates commercial speech and that the Department failed to demonstrate that prohibiting property owners from receiving information from public adjusters for 48 hours is justified by the possibility that some public adjuster may unduly pressure traumatized victims or otherwise engage in unethical behavior. The Florida Supreme Court affirmed, holding that the statute unconstitutionally restricts commercial speech and was not narrowly tailored to serve interests in ensuring ethical conduct by public adjusters and protecting homeowners. View "Atwater v. Kortum" on Justia Law