Justia Insurance Law Opinion Summaries

About four years after a driver, insured by State Farm, collided with Phelps’s car and caused a spine injury that required surgery, Phelps filed suit, alleging that State Farm violated Kentucky’s Unfair Claims Settlement Practices Act. The district court granted summary judgment in favor of State Farm on the ground that Phelps had failed to show that the three years taken to settle her claim raised a genuine dispute as to whether State Farm had acted in bad faith. The Sixth Circuit reversed, noting State Farm’s low initial offer, extensive delays, four transfers to new adjusters, and prolonged refusal to disclose policy limits.

At issue in this appeal was whether Ky. Rev. Stat. 342.730(6) entitled UPS Airlines to receive credit against its liability under section 342.730(1) for the payment of loss of license benefits that were the product of a collective bargaining agreement between UPS Airlines and the Independent Pilots Association (IPA), of which Claimant was a member. Claimant, a UPS pilot, sustained a work-related injury and underwent surgery. UPS paid the entire premium for the loss of license insurance plan. UPS subsequently sought leave to credit Claimant's loss of license benefits against its liability for income benefits. Reversing an ALJ's decision, the workers' compensation board found that section 342.730(6) did not entitle UPS to a dollar-for-dollar credit against Claimant's past due and future income benefits for all benefits paid under the loss of license plan. The Supreme Court (1) affirmed to the extent that UPS was not entitled to a dollar-for-dollar credit; but (2) reversed with respect to the conclusion that loss of license benefits were not funded exclusively by the employer for the purposes of section 342.730(6) because they were bargained-for benefits, holding that section 342.730(6) does not entitle UPS to credit the overpayment of voluntary benefits against future income benefits. Remanded.

LINA appealed the district court's ruling that LINA abused its discretion in denying death benefits to Dawn McClelland based upon her husband's life insurance policy. LINA also appealed the district court's award of attorney's fees. The court found that LINA committed an abuse of discretion in denying benefits because its interpretation was contrary to the language of the plan that it would cover "loss of life" based upon an "accident" and because substantial evidence did not support its decision. The court also found that the total fee awarded should be $85,000 and remanded to the district court to enter an award in that amount. The prejudgment interest award was affirmed.

Plaintiffs were awarded a judgment in August 2006 in a state-court negligence action against TFD, one of whose buses had struck a vehicle operated by one of the plaintiffs. Plaintiffs subsequently appealed the district court's dismissal of their complaint seeking a judgment declaring that defendant Lancer, an insurer of TFD, was obligated to pay each plaintiff $5 million or more in satisfaction of the essentially unpaid Negligence Action Judgment, and ordering Lancer to pay those amounts. The court affirmed the judgment of the district court dismissing the complaint on the ground that the relevant insurance overage was limited to interstate trips and that the TFD bus trip that resulted in the injury at issue was a trip wholly within New York State. The court considered plaintiffs' remaining arguments and found them to be without merit.

OneBeacon and AMICO were insurers of the B.F. Goodrich and, among others, were liable for environmental cleanup at the Goodrich plant in Calvert City, Kentucky. AMICO settled with Goodrich, but OneBeacon’s predecessor went to trial. A state court jury found for Goodrich, and OneBeacon was ordered to pay $42 million in compensatory damages and $12 million in attorney fees. The state court also denied OneBeacon's request for settlement credits to reflect amounts paid by other insurers, such as AMICO, through settlements with Goodrich. OneBeacon sought equitable contribution; AMICO removed to federal court. The district court granted AMICO summary judgment. The Sixth Circuit affirmed. Ohio policy favoring settlements provides that a settled policy is exhausted for purposes of equitable contribution; the court declined to address whether Ohio law permits interclass contribution actions or whether the jury finding of bad faith bars equitable relief.

Plaintiff sued Hartford seeking coverage under his life insurance policy for accidental dismemberment benefits after he suffered serious injuries to his eyes when a can of oven cleaner exploded in his face. The district court dismissed plaintiff's suit, concluding it was untimely because it was brought three years after the loss, outside the policy's time limitations for bringing legal actions against Hartford. Plaintiff appealed, arguing that he brought suit within Arkansas's five-year statute of limitations for breach of contract actions, Ark. Code Ann. 23-79-202(b). The court agreed with plaintiff and held that prior case law was inconsistent with Hartford's contention that the "period prescribed by law" referred to in section 23-79-202 meant something other than the full five-year period set forth in Ark. Code Ann. 16-56-111. Accordingly, the court reversed and remanded.

"Haunted houses may be full of ghosts, goblins, and guillotines, but it’s their more prosaic features that pose the real danger." When the flashlight Tyler Hodges used in connection with taking tickets at an Oklahoma City haunted house began flickering and then died, he ventured inside the house in search of a replacement. To navigate, Mr. Hodges used the light of his cell phone. An actor complained that the light dampened the "otherworldly atmosphere" of the house, Mr. Hodges turned it off and made his way to the freight elevator, where the spare flashlights were stored. When he reached the elevator, Mr. Hodges lifted the wooden gate across the entrance and stepped in, not seeing that the elevator car was not there. Mr. Hodges sued Brewer Entertainment, the haunted house’s operator, for various torts. Brewer held two insurance polities, one with Western World Insurance Company, and the other with Markel American Insurance Company. Brewer quickly looked to them to defend the lawsuit and ultimately pay any award. For its part, Western World had excluded from its haunted house coverage “any claim arising from chutes, ladders, . . . naked hangman nooses, . . . trap doors . . . [or] electric shocks.” Because the policy did not specifically exclude "blind falls down elevator shafts," the company admitted coverage and proceeded to defend Mr. Hodges’s suit. Markel however, balked, refusing to defend or pay any claim. Western World sued to have Markel contribute to the costs of defending Mr. Hodges' suit. The district court agreed with Markel, and entered summary judgment in its favor. Upon review of the record, the Tenth Circuit found that Markel's escape clause was not enough for it to avoid contributing to defending Mr. Hodges' suit. The Court reversed the grant of summary judgment in Markel's favor and remanded the case for further proceedings.

The Workers' Compensation hearing officer terminated Petitioner Gloria Clay's benefits, finding her employer had sufficiently proved the availability of jobs such that Petitioner was capable of earning at least ninety percent of her pre-injury wages. The court of appeal reversed, finding the jobs identified by the vocational rehabilitation counselor were not available to Petitioner. Finding no manifest error in the hearing officer's decision, the Supreme Court reversed the court of appeal and reinstated the hearing officer's ruling terminating Petitioner's benefits.

This insurance-coverage dispute arose after a driver of a leased vehicle struck and seriously injured a pedestrian. The vehicle, a BMW, was owned by BMW Financial Services. The pedestrian and her family sued the driver and BMW Financial for damages. Citizens Insurance Company provided a personal automobile policy listing the driver as an insured and BMW Financial as an additional insured lessor. A separate business auto insurance policy was issued by Empire Fire and Marine Insurance Companies to BMW Financial. The case settled, with Citizens and Empire paying their policy limits. Citizens reimbursed Empire for a portion of the costs Empire expended in legal expenses defending BMW Financial in the civil action but refused to provide Empire with any further reimbursement. Empire subsequently filed a complaint for declaratory judgment seeking a determination that Citizens was liable for reimbursement of all attorneys' fees it incurred. The superior court granted Empire's motion for summary judgment. Citizens appealed, arguing that Empire was entitled only to a pro-rata apportionment of defense costs. The Supreme Court affirmed, holding that it would be improper to resort to a pro-rata apportionment of liability.

IWC appealed the district court's judgment as a matter of law in favor of IDH. Hawaiian, a Florida condominium, contracted with IDH for roof repair. While IDH was conducting the repairs, a large stone veneer wall fell, causing damage to the condominium. Hawaiian's insurer, ICW, sued IDH for negligence. IDH alleged that the wall fell because it was structurally unsound. During trial, at the close of ICW's case, the district court granted IDH's motion for judgment as a matter of law, holding that no reasonable jury could find that IDH was negligent because ICW failed to present any evidence on the standard of care in the roofing industry. Without reaching the issue of whether roofers were "professionals" under Florida law, the court held that ICW was required to put forth some evidence of the standard of care in the roofing industry in order to meet its burden. Because ICW failed to do so, judgment as a matter of law was appropriate. Further, the specificity requirement in Rule 50(a)(2) did not bar the granting of judgment as a matter of law. Accordingly, the court affirmed the judgment.