Justia Insurance Law Opinion Summaries

In 1998, Appellee Stephen Heim filed a professional liability action against two doctors and their medical practices alleging that their negligent care from 1992 to 1996 caused the death of his wife. In August 2000, Mr. Heim received a jury verdict for over $1 million. The jury attributed a substantial percentage of fault to Mrs. Heim, and apportioned the remaining liability among the defendant doctors, which they bore jointly and severally. At the time of the alleged negligent acts, the doctors each maintained primary professional liability insurance coverage for $200,000 per occurrence under a policy issued by a private insurer. That insurer went bankrupt, and the policy was assumed by the Pennsylvania Property and Casualty Association (PPCIGA). Excess liability protection was provided to health care providers through a government-run contingency fund known as the Medical Professional Liability Catastrophe Loss Fund (CAT Fund). It was determined that the primary insurance policy left a $100,000 shortfall in order to satisfy Mr. Heimâs judgment. The CAT Fund determined it had no responsibility to redress the shortfall from the primary insurerâs bankruptcy. With no insurance money to protect them, Mr. Heim sued against the doctorsâ assets seeking to recover the unpaid portion of the judgment that neither the insurance company nor the CAT Fund would pay. The Commonwealth Court ruled in Mr. Heimâs favor, but in accordance with joint and several liability, applied the order to both PPCIGA and the CAT Fund. The Fund appealed to the Supreme Court. The Supreme Court found that under the statutory scheme that governs the CAT Fund, the facts of this case clearly implicated the Fundâs responsibility to the doctors to pay for the $100,000 shortfall left by their primary insurance policy. Accordingly, the Court affirmed the decision of the Commonwealth Court.

In New Mexico, title insurance is totally regulated by the state. Under its âTitle Insurance Act,â the state superintendent of insurance holds yearly public hearings to establish premium rates insurers can charge for title insurance. At the close of the hearings, a legal or âfiled rateâ is published by the agency. Once set, the filed rate is considered âper se reasonable and unassailable in judicial proceedings brought by ratepayers.â The policy behind the filed rate is to prevent price discrimination, preserve the role of agencies in approving rates and âto keep courts out of the rate-making process.â The New Mexico Insurance Code does not apply to title insurers except to the extent that the Title Insurance Act provides otherwise. Plaintiffs Coll and others brought suit alleging generally that the Title Insurance Act violates numerous New Mexico constitutional and statutory provisions precluding price fixing and creating monopolies. Plaintiffs also allege that the Insurer Defendants conspired with the insurance superintendent to establish a premium rate that is unreasonably high. Based on these theories, Plaintiffs sought declaratory and injunctive relief; compensatory, punitive and statutory damages; Defendantsâ disgorgement of their profits; and attorneysâ fees and costs. The lower court dismissed Plaintiffsâ claims with prejudice and remanded to state court all claims asserted against the state Defendants. The Tenth Circuit District Court agreed with the lower courtâs decision that the âfiled rateâ doctrine precluded Plaintiffsâ claims against the Defendants. The Court affirmed the district courtâs dismissal of Plaintiffs claims and remanded the case to the lower court for review of claims brought on state constitutional and procedural grounds.