Justia Insurance Law Opinion Summaries

Lejuan Rambin sued Allstate Insurance Company and Titan Insurance Company, seeking payment of personal protection insurance (PIP) benefits under the no-fault act. Rambin had been injured while riding a motorcycle owned by and registered to Scott Hertzog. At the time of the accident, Rambin did not own a motor vehicle. The car involved in the accident was uninsured, but Rambin averred that Hertzog owned a car that Allstate insured. Allstate denied Rambin’s claim for PIP benefits. Rambin alternatively alleged that if Allstate was not the responsible insurer, he was entitled to PIP benefits from Titan, the insurer to which the Michigan Assigned Claims Facility had assigned his claim. Titan and Allstate moved for summary judgment, arguing that Rambin took the motorcycle unlawfully and was therefore barred from recovering PIP benefits. Rambin also moved for summary judgment, arguing: (1) that he had joined a motorcycle club even though he did not own a motorcycle; (2) that Hertzog’s motorcycle was subsequently stolen; (3) that Rambin needed a motorcycle to participate in a club ride; (4) that a colleague offered to loan him a motorcycle; and (5) that during the ride he collided with the uninsured automobile while riding the motorcycle. The trial court granted both insurance companies' motion and Rambin appealed. The Court of Appeals reversed and remanded, holding that Rambin had not taken the motorcycle unlawfully. Allstate appealed. The Supreme Court affirmed the Court of Appeals’ decision insofar as it held that plaintiff was entitled to PIP benefits if the evidence established he did not know the motorcycle he had taken was stolen. The Court disagreed, however, with the Court of Appeals’ conclusion that plaintiff was entitled to a finding as a matter of law that he did not take the motorcycle unlawfully, given the circumstantial evidence presented in this case. "The Court of Appeals improperly made findings in regard to the facts of this case that were still very much in dispute." The Court therefore affirmed in part, reversed in part, and remanded the case to the circuit court for further proceedings. View "Rambin v. Allstate Insurance Co." on Justia Law

In 2009, Plaintiff’s floral shop was destroyed by a fire. State Farm Casualty Insurance Company, with whom Plaintiff had an insurance policy for her business, paid Plaintiff the maximum amount available under her policy, which was approximately $21,105. Plaintiff filed suit against State Farm and insurance agent Shawn Ori, alleging that Ori, acting as State Farm’s agent, had a professional duty to ascertain or advise her of the adequate amount of coverage for her business and that his failure to do so constituted professional negligence. State Farm and Ori jointly moved for summary judgment on the ground that Plaintiff failed to name an expert witness to establish the standard of care applicable to an insurance agent. The district court granted summary judgment in favor of Defendants, concluding that expert testimony was required to establish the standard of care to which Ori was required to conform. The Supreme Court affirmed, holding that Plaintiff’s failure to obtain an expert witness resulted in an insufficiency of proof regarding duty and thus prevented Plaintiff from establishing a prima facie claim of negligence. View "Dulaney v. State Farm Fire & Cas. Ins. Co." on Justia Law

Plaintiff Higby Crane Service, LLC (Higby) entered into a Contract with Defendant DCP Midstream, LP that covered crane work to be done at the gas processing plant of DCP's wholly owned subsidiary National Helium, LLC (collectively, "DCP"). A fire negligently started by DCP damaged Higby's crane. The other Plaintiff, National Interstate Insurance Co. had issued Higby a commercial inland marine (CIM) policy covering direct physical loss to certain property. National paid Higby under the policy, and Plaintiffs then sued DCP for the loss. DCP counterclaimed that Higby had breached the contract by failing to obtain a commercial general liability (CGL) policy that would have indemnified DCP for its negligence and therefore Higby should bear the loss from the damage to the crane. The United States District Court for the District of Kansas granted summary judgment to Plaintiffs, and DCP appealed. Upon review, the Tenth Circuit reversed and remanded for further proceedings to determine whether the required CGL policy would have protected DCP from liability. View "National Interstate Insurance, et al v. National Helium, et al" on Justia Law

Plaintiff sought insurance coverage for gastric lap band surgery. Defendant, a health-care insurer that covered Plaintiff by virtue of Plaintiff’s husband’s employment with the federal government, refused to cover the full cost of the surgery. Plaintiff brought tort and breach of contract claims against Defendant in the Puerto Rico Court of First Instance. Defendant removed the action to the federal district court, asserting, inter alia, that the Federal Employees Health Benefits Act of 1959 (FEHBA) completely preempted Plaintiff’s local-law claims, thus conferring original jurisdiction on the federal court. Defendant then moved to dismiss the case, arguing that the FEHBA demanded exhaustion of administrative remedies. Plaintiff, in the meantime, requested that the district court remand the case to the Court of First Instance. The district court (1) denied Plaintiff’s motion to remand, holding that the FEHBA completely preempted Plaintiff’s claims and, thus, federal jurisdiction attached; and (2) dismissed the action for Plaintiff’s failure to exhaust administrative remedies. The First Circuit Court of Appeals reversed the district court’s judgment of dismissal and its order denying remand, holding that the court erred in concluding that the FEHBA afforded complete preemption. View "Lopez-Munoz v. Triple-S Salud, Inc. " on Justia Law

Alfa Life Insurance Corporation ("Alfa") and Brandon Morris, an agent for Alfa, appealed a judgment entered against them following a jury verdict for Kimberly Colza, the widow of Dante Colza. In 2010, Morris met with Dante to assist him in completing an application for a life-insurance policy. There was disputed evidence as to whether Morris asked Dante whether he had had a moving traffic violation, a driver's license suspended, or an accident in the prior three years, it was undisputed that Morris entered a checkmark in the "No" box by that question. The evidence indicated that Dante applied for the Preferred Tobacco premium rate. Dante named Kimberly as the beneficiary under the policy. At the close of the meeting, Kimberly wrote a check payable to Alfa for $103.70, the monthly Preferred Tobacco premium rate. Kimberly testified at trial that Morris informed them that Dante would be covered as soon as they gave Morris the check. Dante was later examined by the medical examiner. During the examination, Dante informed the examiner that his family had a history of heart disease and that he had had moving traffic violations within the past five years. The day after he had his medical examination, Dante was killed in an accident. Two days later, Alfa received the medical examiner's report, which indicated that Dante's family had a history of heart disease, that Dante's cholesterol was above 255, and that Dante had had moving traffic violations in the past five years. In light of the report, Alfa's underwriters determined that Dante was not eligible for the Preferred Tobacco rate for which he had applied; rather, the proper classification would have been the Standard Tobacco rate (which had a higher premium). Additionally, in light of the moving vehicle violations, Dante was a greater risk to insure and a "rate-up" of $2.50 per $1,000 worth of coverage was required. Alfa notified Kimberly by letter that no life-insurance coverage was available for Dante's death "because no policy was issued and the conditions of coverage under the conditional receipt were not met." Kimberly sued Alfa seeking to recover under the terms of the conditional receipt (an acknowledgment of the policy). She alleged, among other claims, that Alfa had breached the contract and had acted in bad faith when it refused to pay life-insurance benefits on Dante's death. Kimberly also sued Morris, alleging, among other claims, that he had negligently failed to procure insurance coverage for Dante. After a trial, the jury found that Alfa had breached the contract and had in bad faith refused to pay the insurance benefits due, and that Morris had negligently failed to procure insurance. Upon review, the Supreme Court concluded Alfa and Morris were entitled to a judgment as a matter of law on those claims, and the trial court erred by submitting the claims to the jury for consideration. View "Alfa Life Insurance Corporation v. Colza " on Justia Law

The question before the Supreme Court was whether La. R.S. 23:1203.1 applied to requests for medical treatment and/or disputes arising out of requests for medical treatment in cases in which the compensable accident or injury occurred prior to the effective date of the medical treatment schedule. The Office of Workers’ Compensation (OWC) ruled that the medical treatment schedule applied to all requests for medical treatment submitted after its effective date, regardless of the date of injury or accident. The court of appeal reversed, holding that La. R.S. 23:1203.1 was substantive in nature and could not be applied retroactively to rights acquired by a claimant whose work-related accident antedated the promulgation of the medical treatment schedule. The Supreme Court disagreed with the conclusion of the court of appeal and found that La. R.S. 23:1203.1 was a procedural statute and, thus, did not operate retroactively to divest a claimant of vested rights. As a result, the statute applied to all requests for medical treatment and/or all disputes emanating from requests for medical treatment after the effective date of the medical treatment schedule, regardless of the date of the work-related injury or accident. View "Church Mutual Insurance Co. v. Dardar" on Justia Law

The Supreme Court granted certiorari in this case to consider whether La. R.S. 23:1203.1 applied to a dispute arising out of a request for medical treatment where the request for treatment was submitted after the effective date of the statute and the medical treatment schedule, but the compensable accident and injury that necessitated the request occurred prior to that date. Both the Office of Workers’ Compensation (OWC) and the court of appeal ruled that La. R.S. 23:1203.1 applied to all requests for medical treatment submitted after the statute’s effective date, regardless of the date of accident and injury. Finding no reversible error, the Supreme Court affirmed. View "Cook v. Family Care Services, Inc." on Justia Law

The issue this case presented to the Supreme Court centered on whether the Patient’s Compensation Fund (PCF) could be bound by summary judgment rendered solely against a defendant physician in the underlying malpractice proceeding on the issue of causation. Plaintiffs, Majdi Khammash and his wife and children, filed suit against various defendants, including Dr. Gray Barrow. After approving plaintiff’s settlement with Dr. Barrow for the $100,000 Medical Malpractice Act (MMA) cap, the District Court granted partial summary judgment, finding plaintiff’s injuries were caused by the fault of Dr. Barrow. The case then proceeded to jury trial against the PCF for the remaining $400,000 MMA cap. The jury returned a verdict in the PCF’s favor, finding Dr. Barrow’s malpractice did not cause plaintiff damage. The Court of Appeal reversed, finding as a result of the partial summary judgment, the issue of causation was not properly before the jury, and remanded for a new trial on damages only. The Supreme Court granted certiorari to address the extent, if any, the PCF was bound by the partial summary judgment on causation. The Court found, in accordance with La. Rev. Stat. 40:1299.44(C)(5)(a) and its holding in "Graham v. Willis-Knighton Med. Ctr.," (699 So.2d 365), the partial summary judgment against Dr. Barrow on the issue of causation was not binding on the PCF in plaintiff’s claim for damages exceeding the $100,000 MMA cap. Furthermore, the Court found no manifest error in the jury’s factual findings on causation. The Court therefore reversed the judgment of the Court of Appeal and reinstated the District Court’s judgment in its entirety. View "Khammash v. Clark" on Justia Law

Plaintiff Ashley Hoffman was insured under an automobile insurance policy issued by defendant Travelers Indemnity Company of America. Following an automobile accident, plaintiff received medical treatment at Baton Rouge General Medical Center and sought reimbursement for the hospital bill under her Travelers' medical payments coverage. The Supreme Court granted certiorari to determine whether the Travelers’ policy, which provided for payment of medical expenses "incurred," allowed plaintiff to be reimbursed for the full, nondiscounted amount of the hospital bill when the charges were contractually reduced pursuant to the hospital’s agreement with plaintiff's health insurer, AETNA Insurance Company. The Court answered that question in the negative and reversed the rulings of the lower courts. View "Hoffman v. Travelers Indemnity Company of America" on Justia Law

A guest (“Guest”) at an apartment complex fell of a third-story apartment’s balcony, rendering him quadriplegic. Guest sued the apartment complex’s ownership (“Owner”) and management (“Manager”) under theories of joint and several liability. American Family Mutual Insurance Company held liability policies covering both Owner and Manager. Regent Insurance Company held liability policies covering Manager, but the parties disputed whether the policies also covered the “same risk” for Owner as an additional insured. American Family settled with Guest and sued Regent for equitable contribution toward the payment it made to Guest under the settlement agreement. The district court granted summary judgment in favor of American Family. The Supreme Court affirmed, holding that the district court did not err in its apportionment of the common obligation toward Guest’s settlement. View "Am. Family Mut. Ins. Co. v. Regent Ins. Co." on Justia Law