Justia Insurance Law Opinion Summaries

Michelle and Tony Tweten brought an action against COUNTRY Preferred Insurance Company and American National Property and Casualty Company ("ANPAC"), seeking the full amount of underinsured motorist coverage from both insurance companies. The United States District Court for the District of North Dakota certified a question to the North Dakota Supreme Court that called for an interpretation of the Twetens' policies under North Dakota law. The federal court asked whether the Twetens as a divorced couple with separate insurance policies, were foreclosed from recovering up to the full amount of underinsured motorist benefits from their respective policies under the 'other insurance' clause contained in each policy and the statutory anti-stacking provisions of NDCC Ch. 26.1-40 following the death of their son in a car accident. The North Dakota Supreme Court answered the question "Yes." View "Tweten v. COUNTRY Preferred Insurance Company" on Justia Law

Petitioner Allen Davenport appealed a judgment affirming a Workforce Safety and Insurance ("WSI") decision to terminate benefits on his claim for treatment of his cervical spine and left shoulder and denying his claims for benefits for treatment of his anxiety and depression and lower back condition. He argued his anxiety and depression and his cervical spine, left shoulder and back conditions were "compensable injuries." Upon further review, the Supreme Court concluded Davenport failed to establish by a preponderance of the evidence that work incidents subject to this claim substantially accelerated the progression of, or substantially worsened the severity of, his existing conditions and that his physical injury caused at least 50 percent of his anxiety and depression. View "Davenport v. WSI" on Justia Law

Following Appellant Darren Pollack's injury on the job, his employer accommodated his work restrictions by providing him light duty employment. Later, Appellant was discharged for violating a company policy by failing to report an accident involving an employer vehicle. Appellant filed a claim seeking Temporary Total Disability benefits. The Workers' Compensation Commission denied the claim, holding Appellant's termination and resulting incapacity to earn wages was due to his violation of company policy and not his work-related injury. Finding no error in the Commission's decision, the Supreme Court affirmed. View "Pollack v. Southern Wine & Spirits" on Justia Law

Plaintiff maintained a homeowners insurance policy with Insurer that excluded from coverage any claims for "injury arising out of the business pursuits" of Plaintiff. In 2011, a third party filed a complaint against Plaintiff, contending that Plaintiff published false and defamatory statements regarding the third party. In response to the complaint, Plaintiff tendered defense of the suit to Insurer, which declined to defend Plaintiff. Plaintiff then filed a complaint seeking a declaratory judgment that Insurer had a duty to defend him in the pending action by the third party. The superior court granted Plaintiff's motion for summary judgment. The Supreme Court vacated the judgment and remanded for entry of a summary judgment in favor of Insurer, holding that Insurer had no duty to defend Plaintiff because the third party suit was based entirely on activity falling within the policy's exclusion for Plaintiff's "business pursuits." View "Hardenbergh v. Patrons Oxford Ins. Co." on Justia Law

Plaintiff was withdrawing money from an ATM when Tortfeasor struck her with his car. Tortfeasor was insured under a policy written by Insurer to a limit of $100,000 for bodily injury to one person. Plaintiff and several of her family members brought this action against Tortfeasor and his brother, the named insured on the policy, (collectively, Tortfeasor) and Insurer. The district court originally entered judgment ordering Insurer and Tortfeasor to pay one-and-a-half million dollars to Plaintiffs. Insurer paid into court $75,000, the remainder of its policy limit. The district court later amended its judgment, holding Tortfeasor and Insurer liable for six million dollars in damages. Plaintiffs then unsuccessfully sought to compel Insurer to pay postjudgment interest on the full judgment. The First Circuit Court of Appeals reversed the deniial of Plaintiff's request for postjudgment interest, holding that Insurer was responsible for postjudgment interest from the date of entry of the original judgment and the date of the deposit of the policy limit. View "Vazquez-Filippetti v. Cooperativa de Seguros Multiples de P.R." on Justia Law

Defendant hosted an underage drinking party in which one of the guests known to become belligerent when intoxicated assaulted and seriously injured another guest. The victim sued Defendant and his insurer (Insurer) for damages for his injuries. Insurer disputed coverage, arguing that it had no duty to defend and indemnify Defendant because there was no "accident" or "occurrence" under Defendant's family's homeowner's insurance policy where Defendant's actions were intentional. The circuit court granted summary judgment to Insurer. The court of appeals reversed, concluding that there was an occurrence because the assault was an accident when viewed from the standpoint of the injured person or Defendant, the insured. The Supreme Court reversed, holding (1) viewed from the standpoint of a reasonable insured, Defendant's intentional actions in setting up a drinking party and procuring alcohol for underage guests, including one known to become belligerent when intoxicated, created a direct risk of harm resulting in bodily injury; and (2) thus, the victim's bodily injury was not caused by an "occurrence" within the meaning of the policy, and Insurer was not obligated to provide insurance coverage for Defendant. View "Schinner v. Gundrum" on Justia Law

Plaintiff injured his shoulder while working for his employer, who was insured by the Montana State Fund. The State Fund paid for Plaintiff's two shoulder injuries and paid temporary total disability (TTD) benefits after informing Plaintiff that if he returned to gainful employment without the State Fund's knowledge and continued to receive benefits, he would be subject to legal action or criminal prosecution. After the State Fund discovered that Plaintiff had built and sold furniture and worked at a vacuum cleaner store while receiving TTD benefits, the assistant attorney general charged Plaintiff with theft, a felony. The State Fund subsequently terminated Plaintiff's TTD benefits. Plaintiff filed suit against the State fund and its private investigators, alleging that Defendants violated Montana's Insurance Code regarding unfair claim settlement practices and pleaded a variety of common law causes of action. The district court ruled in favor of Defendants. The Supreme Court affirmed the district court's entry of judgment in favor of the State Fund, holding that the district court did not err in (1) granting the State Fund's motion to dismiss Defendant's claims under the Insurance Code; and (2) granting the State Fund's motion for summary judgment regarding Plaintiff's common law claims. View "White v. State ex rel. Mont. State Fund" on Justia Law

Appellant received treatment at Hospital for injuries she sustained in an automobile accident. Appellant granted two statutory liens to Hospital on settlement proceeds she obtained from the tortfeasor for hospital services rendered. Appellant subsequently settled her case against the tortfeasor, and the tortfeasor's insurer (Insurer) agreed to pay Appellant $1.3 million in exchange for Appellant's agreement to indemnify Insurer from all healthcare provider liens. Hospital subsequently sued Insurer, and Appellant tendered to Hospital all money it asserted was due. Appellant then filed a complaint against Hospital, alleging that Hospital overcharged her pursuant to Nev. Rev. Stat. 439B.260(1), which provides that hospitals must reduce charges by thirty percent to inpatients who lack insurance "or other contractual provision for the payment of the charge by a third party." The district court entered judgment in favor of Hospital, finding that Appellant's settlement agreement with the tortfeasor rendered Appellant ineligible for the thirty percent statutory discount. The Supreme Court reversed in part, holding that a patient's eligibility is determined at the commencement of hospital services, and therefore, a later settlement agreement with a third party for the payment of such services does not disqualify the patient for the statutory discount. View " Bielar v. Washoe Health Sys., Inc." on Justia Law

This case stemmed from a dispute involving a Master Services Agreement (MSA) between BHP and Deep Marine. At issue on appeal was whether Underwriters could enforce BHP's contractual insurance, defense, and indemnity obligations to Deep Marine after Deep Marine's bankruptcy discharge. The court concluded that, even assuming arguendo that the MSA required indemnification against liability and that Deep Marine will eventually be held liable, Underwriters still could not prevail because BHP's indemnification obligation runs only to Deep Marine; Deep Marine would not, and could not, incur any loss in the Duval action, so Underwriters could not seek indemnification from BHP; because BHP had agreed to continue providing Deep Marine with a nominal defense, Underwriters would not have a breach of contract claim against BHP; the additional insured and primary insurance requirements do not apply BHP's self-insurance; BHP's only obligation was an indemnification obligation to Deep Marine; unlike Underwriters, it had no secondary liability to injured tort victims, like Duval; and Duval had no claim against BHP and, therefore, tender under Federal Rule of Civil Procedure 14(c) was improper. Accordingly, the court affirmed the judgment. View "Duval v. Northern Assurance Co." on Justia Law

The Wehrles were struck by drunk-driver Barth. Robert Wehrle’s injury claim exceeded $750,000 and his wife's claim exceeded $1.5 million. Barth’s auto insurance policy included a $100,000 per-person liability limit. Each recovered that amount from Barth’s insurer. The Wehrle’s own policy, issued by Cincinnati, included underinsured-motorist coverage, for up to $1 million. Cincinnati paid $800,000, reasoning that the Wehrles’ policy reduces its $1 million maximum payout “by all sums paid by anyone who is legally responsible,” and that the Wehrles had recovered $200,000 from Barth’s insurer. The Wehrles claimed that the $100,000 that they each received from the drunk-driver’s insurer should reduce their individual claims. The district court ruled in favor of the insurer. The Seventh Circuit affirmed, holding that the policy language unambiguously supported the insurer’s interpretation and was consistent with the gap-filling purpose of underinsured-motorist insurance. View "Wehrle v. Cincinnati Ins. Co." on Justia Law