Justia Insurance Law Opinion Summaries

Winter wheat farmers could purchase insurance to protect against below-average harvests. The policies at issue here offered yield protection. On July 1, 2014, the Federal Crop Insurance Corporation (“FCIC”) published an interim rule to implement the 2014 Farm Bill. In that interim rule, the FCIC warned that the APH yield exclusion “may not be implemented upon publication” because “[p]roduction data availability and intensive data analysis may limit FCIC’s ability to authorize exclusions of yields for all APH crops in all counties.” Therefore, the FCIC amended the Common Crop Insurance Policy (CCIP) Basic Provisions (the actual terms of the insurance policy offered for sale) “to allow the actuarial documents to specify when insureds may elect to exclude any recorded or appraised yield.” The revised CCIP Basic Provisions stated that farmers “may elect” the APH yield exclusion “[i]f provided in the actuarial documents.” The deadline for winter wheat farmers to purchase insurance for the 2015 crop year was September 30, 2014. When Plaintiffs purchased insurance, they elected to use the APH yield exclusion. But in a letter dated October 31, 2014, the USDA notified insurance providers that the APH Yield Exclusion would not be available for winter wheat for the 2015 crop year. The letter stated that insurance providers could respond to farmers’ elections by pointing them to the USDA’s “actuarial documents,” which did not yet “reflect that such an election is available.” Plaintiffs sought review of this denial through the USDA’s administrative appeals process. An administrative judge determined that she lacked jurisdiction over Plaintiffs’ challenge because the October 2014 letter to insurance providers was not an adverse agency decision. Plaintiffs then appealed to the Director of the National Appeals Division. The Director found that the October 2014 letter was an adverse agency decision, but affirmed the FCIC’s decision not to make the APH yield exclusion available to winter wheat farmers for the 2015 crop year. Plaintiffs appealed the Director’s decision to the United States District Court for the District of Colorado. The district court reversed the Director’s decision and remanded the case to the FCIC with instructions to retroactively apply the APH yield exclusion to Plaintiffs’ 2015 crop year insurance policies, reasoning the applicable statute unambiguously made the APH yield exclusion available to all farmers on the day the 2014 Farm Bill was enacted. Finding no reversible error in the district court’s judgment, the Tenth Circuit affirmed. View "Ausmus v. Perdue" on Justia Law

The Affordable Care Act’s three premium‐stabilization programs were designed to redistribute money among insurance companies and mitigate each company’s exposure to market risks, 42 U.S.C. 18061–18063. The Department of Health and Human Service (HHS) intended to implement these programs in a budget‐neutral way paying out only the funds that each program had taken in from other insurance companies. Land of Lincoln participated in these premium‐stabilization programs and incurred a debt of roughly $32 million but HHS owed Land of Lincoln over $70 million. HHS was not able to pay what it owed because it was taking in far less money than expected, and it refused to dip into its discretionary funds. Like other insurance companies, Land of Lincoln sought the overdue payments in an unsuccessful suit. Land of Lincoln became insolvent and began liquidation. Despite an Illinois court order, HHS began to offset its overdue payments against Land of Lincoln’s debt, as its own regulations permitted. The Director of the Illinois Department of Insurance, Land of Lincoln’s appointed liquidator, asked the state court for a declaration that HHS violated the order, but HHS removed the motion to federal district court arguing that the federal government was not subject to state court jurisdiction. The district court remanded the case back to state court relying on a narrow reading of 28 U.S.C. 1442, and principles of abstention. The Seventh Circuit reversed on both grounds and remanded to the district court. View "Hammer v. United States Department of Health and Human Services" on Justia Law

A taxi driver injured in an accident while working filed a report with the Alaska Workers' Compensation Board. The nature of the relationship between the taxi company and the driver was disputed. The driver retained an attorney for a lawsuit against the other driver, and settled that claim with the other driver's insurance company without his taxi company's approval. Because the taxi company did not have workers' compensation insurance, the Alaska Workers' Compensation Benefits Guaranty Fund assumed responsibility for adjusting the workers' compensation claim. The Fund asked the Board to dismiss the taxi driver's claim because of the unapproved settlement. The Board dismissed the claim, and the Workers' Compensation Appeals Commission ultimately affirmed the Board's decision. The taxi driver appealed, but finding no reversible error, the Alaska Supreme Court affirmed the Commission's decision. View "Atkins v. Inlet Transportation & Taxi Service, Inc." on Justia Law

Dave Jones, in his capacity as Insurance Commissioner of the State of California (the Commissioner), appealed an order enjoining him from enforcing three regulations, adopted in 1992, to implement the unfair claims settlement practices provision of the Unfair Insurance Practices Act (UIPA). The injunction was issued at the conclusion of the first phase of a trial in which PacifiCare Life and Health Insurance Company challenged the Commissioner’s finding that it had committed over 900,000 acts and practices in violation of the Insurance Code. The Court of Appeal reversed the order imposing the injunction in its entirety. The trial court determined the first regulation was inconsistent with the language of section 790.03(h), which it concluded had been interpreted by the California Supreme Court in Moradi-Shalal v. Fireman’s Fund Ins. Companies 46 Cal.3d 287 (1988), and in Zhang v. Superior Court, 57 Cal.4th 364 (2013), to apply only to insurers engaged in a pattern of misconduct. The appellate court determined the Supreme Court’s only binding interpretation of that statutory language was found in Royal Globe Ins. Co. v. Superior Court, 23 Cal.3d. 880 (1979), which held that section 790.03(h) could be violated by an insurer’s single knowing act. Consequently, the Court was bound by that precedent. View "PacifiCare Life & Health Ins. Co. v. Jones" on Justia Law

The Eighth Circuit affirmed the district court's grant of summary judgment deferring to an insurance policy interpretation made by the FCIC and a determination regarding the FCIC's authority made by the RMA. The court held that the clear language of the Federal Crop Insurance Act indicated that Congress intended the Corporation to have extensive and broad authority; given the FCIA's broad grant of authority to the Corporation, and the specific authority over the provisions of insurance and insurance contracts found in 5 U.S.C. 1505 and 1506, substantial deference was given to the FCIC's interpretation of the special provision; and, considering the plain language of the insurance contract and the deference given to the RMA in its role of supervisor of the FCIC, the RMA's determination that the FCIC was required to provide an interpretation of the special provision to the arbitrating parties was not clearly erroneous. View "Bottoms Farm Partnership v. Perdue" on Justia Law

The Supreme Court reversed the district court’s deemed denial of Scottsdale Insurance Company’s motion to set aside the default judgment entered against it, holding that Scottsdale satisfied its burden of establishing that doubt existed concerning whether service was properly effectuated.National Parks Reservations (NPR) filed a complaint and demand for jury trial, naming Scottsdale. Because Scottsdale was a foreign insurer, NPR was statutorily required to serve Scottsdale through the Office of the Montana State Auditor, Commissioner of Securities and Insurance (the Commissioner). The Commissioner, in turn, was statutorily required to forward the complaint and summons to Scottsdale. After Scottsdale failed to appear the district court entered a partial default judgment against Scottsdale. Scottsdale moved to set aside the default judgment, arguing that both NPR and the Commissioner had failed strictly to comply with foreign insurer service requirements under Mont. Code Ann. 33-1-603(1), and, thus, the default judgment was void. Scottsdale’s motion was deemed denied. The Supreme Court reversed, holding that Scottsdale established that doubt existed regarding whether service was properly completed by the Commissioner. View "Reservation Operations Center LLC v. Scottsdale Insurance Co." on Justia Law

Migliaro purchased a Standard Flood Insurance Policy (SFIP) under the National Flood Insurance Program, 42 U.S.C. 4011(a), from Fidelity for his property, which sustained flood damage in October 2012's Hurricane Sandy. Fidelity’s adjuster recommended a payment of $90,499.11, which Fidelity paid. Five months later, Migliaro submitted a proof of loss, claiming an additional $236,702.57. On July 15, 2013, Fidelity sent Migliaro a letter titled “Rejection of Proof of Loss,” stating: This is not a denial of your claim. Your field adjuster provided you with an estimate and Proof of Loss regarding covered damages. If there are additional covered damages identified, please forward documentation and they will be considered. Migliaro did not provide additional documentation or submit a second proof of loss but filed suit. Migliaro's July 2015 complaint was dismissed as untimely. Because SFIP claims are ultimately paid by the government, SFIPs are identical and state: You may not sue ... unless you have complied with all the requirements of the policy. If you do sue, you must start the suit within one year after the date of the written denial of all or part of the claim. The Third Circuit affirmed. Although the rejection of a proof of loss is not per se a denial of the claim, it does constitute a denial if the policyholder treats it as such by filing suit against the carrier. View "Migliaro v. Fidelity National Indemnity Insurance Co." on Justia Law

Migliaro purchased a Standard Flood Insurance Policy (SFIP) under the National Flood Insurance Program, 42 U.S.C. 4011(a), from Fidelity for his property, which sustained flood damage in October 2012's Hurricane Sandy. Fidelity’s adjuster recommended a payment of $90,499.11, which Fidelity paid. Five months later, Migliaro submitted a proof of loss, claiming an additional $236,702.57. On July 15, 2013, Fidelity sent Migliaro a letter titled “Rejection of Proof of Loss,” stating: This is not a denial of your claim. Your field adjuster provided you with an estimate and Proof of Loss regarding covered damages. If there are additional covered damages identified, please forward documentation and they will be considered. Migliaro did not provide additional documentation or submit a second proof of loss but filed suit. Migliaro's July 2015 complaint was dismissed as untimely. Because SFIP claims are ultimately paid by the government, SFIPs are identical and state: You may not sue ... unless you have complied with all the requirements of the policy. If you do sue, you must start the suit within one year after the date of the written denial of all or part of the claim. The Third Circuit affirmed. Although the rejection of a proof of loss is not per se a denial of the claim, it does constitute a denial if the policyholder treats it as such by filing suit against the carrier. View "Migliaro v. Fidelity National Indemnity Insurance Co." on Justia Law

Christita Moreau appealed a Workers’ Compensation Court (WCC) order denying her motion for summary judgment and granting summary judgment to Transportation Insurance Company. Moreau’s husband Edwin worked at the W.R. Grace mine near Libby. In 2009, he died from asbestos-related lung cancer. In 2010 Moreau, as personal representative of Edwin’s estate, filed a workers’ compensation claim for occupational disease benefits. Transportation Insurance Company (Transportation) was W.R. Grace’s workers’ compensation insurer, and it denied liability for the claim. Edwin’s employer, W.R. Grace, established and funded the Libby Medical Plan (LMP) to pay the medical expenses of its employees who were injured by exposure to asbestos. LMP paid approximately $95,000 of Edwin’s medical expenses. In 2012, as part of Grace’s bankruptcy, “certain rights and duties of the LMP” were transferred to the Libby Medical Plan Trust. Grace remained responsible for LMP’s “ongoing payment obligations” incurred before that time. In 2013, Transportation accepted liability for the workers’ compensation claim and entered a settlement with Moreau. Transportation agreed to reimburse Medicaid, other providers, and Moreau personally for medical expenses each had paid for Edwin’s care. The parties stipulated that Transportation paid all of Edwin’s medical bills or reimbursed the other persons or entities that had paid them. Transportation did not reimburse the LMP for the $95,846 of Edwin’s medical bills it had previously paid because the LMP refused to accept it. After the LMP refused to accept reimbursement from Transportation, Moreau demanded that Transportation pay the $95,000 either to Edwin’s Estate, to the LMP or its successor, or to a charity selected by the Estate. Transportation refused and Moreau filed a second petition with the WCC to resolve the issue. The WCC determined that all of Edwin’s medical care costs had been paid; that Edwin had no liability to any health care provider; and that he had no right to claim any further payment from Transportation. The WCC determined that if the Estate were to receive the $95,000 from Transportation it would represent a double recovery because Edwin had already received the medical benefits themselves. The Court concluded that Moreau therefore lacked standing to proceed Moreau’s petition. The WCC also found that Moreau’s attorneys also represented the LMP Trust “for purposes of recovering the disputed $95,846” for the LMP Trust. At the time of the WCC order, the LMP Trust was not a party to this action and had not advanced a claim in the WCC for reimbursement of the amount paid by its predecessor LMP. The WCC therefore granted summary judgment to Transportation. Finding no reversible error in that WCC decision, the Montana Supreme Court affirmed. View "Moreau v. Transportation Ins." on Justia Law

This was the second time this dispute related to benefits provided under the Public Education Employees' Health Insurance Plan ("PEEHIP") went before the Alabama Supreme Court. In the present case, the remaining defendants below, David Bronner, as secretary-treasurer of PEEHIP, and the current members of the PEEHIP Board, petitioned for permission to appeal the trial court's denial of their motion seeking a summary judgment. "When a trial court fails to correctly identify the controlling question of law, a Rule 5 permissive appeal is due to be dismissed." After thoroughly reviewing the record and the arguments presented by the parties, the Supreme Court concluded the permission to appeal under Rule 5, Ala. R. App. P., was improvidently granted, and the Court dismissed the appeal. View "Bronner v. Burks" on Justia Law