Justia Insurance Law Opinion Summaries

The parents of a child who suffered an injury during an adult softball game sued the United States Specialty Association (USSSA) and several other defendants. At the time of the accident, USSSA was insured by United States Fidelity and Guarantee Co. (USF&G). USF&G assumed the defense of USSSA, and a jury entered a verdict against USSSA. USF&G posted a bond of $4 million to secure the remainder of the judgment and, simultaneously, filed an action in federal court seeking a judicial declaration that it could not be compelled to pay more than the $2 million policy limit. USSSA later moved for partial summary judgment, contending that USF&G had no right to restitution against its insured for the amounts paid in excess of policy limits. The Supreme Court accepted certification to answer questions of law that controlled the parties' motions, answering (1) an insurer may not seek restitution based on the theory of unjust enrichment where there is an express contract governing the subject matter of the dispute; and (2) an insurer's right to reimbursement from an insured affects the parties' risk relationship and therefore may only arise under the express terms of their insurance contract.

Appellant James Grace suffered permanent brain injuries when his helmet failed after he braked to avoid hitting a dog and was thrown over the handlebars of his motorcycle. Appellant and his wife, Kathleen, filed personal injury and loss of consortium claims against the helmet retailer and manufacturer. The Graces received disbursements from the receiver of one of the manufacturer's second-tier insurance providers that had filed for bankruptcy and gone into liquidation, and entered a settlement agreement with the third-tier insurance carrier. Appellant and his wife separated at some point after the accident, divorced for a month, and remarried. Except for a partial disbursement of funds that occurred while their final divorce hearing was pending, the Graces were unable to agree upon how the remaining settlement and insurance proceeds should be divided. The Graces' lawyer filed an action for interpleader asking the superior court to determine how to divide the remaining funds. After a one-day trial, the superior court concluded that: (1) based on the "analytic" approach in "Bandow v. Bandow," the portion of the recovery from the receiver for the manufacturer's second-tier insurance carrier that was allocated for past economic loss, past medical loss, and rehabilitation services was marital property and should have been divided equally; and (2) the recovery from the third-tier insurance carrier was the result of a jointly-assigned bad faith insurance claim and belonged to both parties. Upon review, the Supreme Court affirmed the superior court's division of the proceeds from the second-tier insurance carrier, but reversed its division of the proceeds from the third-tier insurance carrier.

Samuel Pietropaolo Sr. (Sam Sr.)directed a substantial portion of his retirement benefits to the upkeep of a life insurance policy that he purchased in 1998 through his nephew, an insurance agent. The nephew assured Sam Sr. and the other plaintiffs that the policy provided death benefits of $500,000 but, in fact, the policy provided only $200,000 in benefits. Although plaintiffs regularly received accurate policy statements from the insurer that issued the policy, they relied on the nephew's assurances as to the policy's value for almost six years, only bringing this action in July 2004. The court concluded that plaintiffs' claims were properly pleaded in tort under G.L.c. 93A. Their claims were therefore subject to the limitations periods in G.L.c. 260, section 2A, and 5A, respectively, which were susceptible to tolling. The court further concluded that the nephew's fraudulent concealment of these claims tolled the limitation period as to claims against the nephew himself, but did not toll the limitation period with regard to the remaining defendants. However, because the limitation period for claims brought under G.L.c. 93A was longer than the limitation period for tort claims, the nationwide defendants have not shown that plaintiffs' G.L.c. 93A claim against Nationwide was time barred. The court finally concluded that the trial judge did not err in deciding that the economic loss doctrine did not bar plaintiffs' common-law claims; determining that it was not unreasonable as a matter of law for plaintiffs to have relied on the nephew's misrepresentations; dismissing plaintiffs' G.L.c. 93A claim against Barry G. Armstrong; determining the amount of the damages on plaintiffs' G.L.c. 93A claim against the nephew; or calculating the award of attorney's fees against the nephew.

Plaintiff, a professional limousine driver, was injured when he was struck by a car while unloading luggage from a limousine at an airport. Plaintiff reached settlements with his employer's insurance company and the driver whose car struck him but remained less-than-fully compensated for his injuries. Plaintiff subsequently filed an underinsured-motorist claim with his Insurer under the terms of his personal automobile policy. Insurer denied the claim, citing two exclusions from the policy's provisions for uninsured-motorist coverage. Plaintiff filed suit, and the superior court ruled that the exclusions were void on grounds of public policy. The Supreme Court vacated the judgment of the superior court, holding that Insurer's denial of coverage was both lawful and not inconsistent with public policy. Remanded.

Edna Banco filed a claim for workers' compensation benefits for an occupational disease (OD) in her right shoulder. Banco worked concurrently at 4B's Restaurant and the Child Development Center on Malmstrom Air Force Base (CDC). 4B's was insured by Liberty Northwest Insurance Corporation (Liberty). Liberty denied Banco's claim for workers' compensation benefits. The Workers' Compensation Court (WCC) found (1) Banco was last exposed to work of the same type and kind that gave rise to her shoulder condition while she was working at CDC; and (2) thus, since Banco was not last exposed at 4B's, Liberty was not liable under the "last injurious exposure" rule set forth in In re Mitchell. The Supreme Court affirmed, holding that the WCC had substantial credible evidence upon which to find Banco was last injuriously exposed at CDC to working conditions of the type and kind that led to her OD, and thus, Liberty was not liable for Banco's OD.

Players on a local youth soccer team sought to recover under the state youth soccer governing association's business auto-insurance policy for injuries sustained when the van in which they were riding was involved in an accident. The trial court granted summary judgment in favor of the association's insurance carrier. The court of appeals affirmed, holding that under the relevant insurance policy language, the rented van was not being used in the business of the association at the time of the accident. The Supreme Court granted transfer and affirmed the trial court, holding that because Castro was not using the automobile "in the business" of the association, a condition for coverage under the insurance policy at issue, the policy provided no coverage to the injured players.

Mack Downey and his wife sued Western Community College area, which operates Western Nebraska Community College, after Downey suffered injuries from a fall that occurred while he was replacing a scoreboard at the College. Downey's employer, Ferguson Signs, was named as a plaintiff to preserve a subrogation interest for workers' compensation benefits. The trial court found that the College was liable for a portion of Downey's injuries and apportioned liability to Downey and Ferguson Signs. The Supreme Court affirmed in part and in part reversed and remanded, holding (1) the court did not err in finding the College liable; (2) the court correctly denied the College's claim for indemnity; but (3) the court erred in apportioning negligence to Ferguson Signs where Ferguson Signs was not a "released person" within the meaning of Neb. Rev. Stat. 25-21,185.11. Remanded for the court to reapportion Ferguson Signs' share of the negligence to Downey and the College.

In 2000, a fire destroyed a business location of Stone Flood and Fire Restoration Inc., spurring years of litigation with its insurer, Safeco Insurance Company of America. After Stone Flood and its two shareholders, James and Patrice Stone, sued Safeco in 2007, the district court dismissed all claims against Safeco. The court concluded (1) Stone Flood's claims on the insurance policy were filed three days beyond the applicable statute of limitations and were therefore barred; (2) the Stones were not insureds and lacked standing to bring individual claims under the policy; and (3) the Stones lacked standing to bring a claim of intentional infliction of emotional distress (IIED) because their alleged injuries were merely derivative of the corporation's. The Supreme Court reversed in part and affirmed in part, holding (1) the district court's calculation of the tolling of the limitations period was incorrect and a correct calculation saved Stone Flood's claims under the insurance policy; and (2) the district court properly concluded the Stones were not insureds and lacked standing to sue under the policy, and their claim of IIED failed for lack of a distinct, non-derivative injury. Remanded.

This lawsuit arose from an insurance contract between Plaintiff, who had cancer, and Defendants, two insurance companies. In May 2007, Plaintiff applied for long-term care benefits under her policy. Defendants found her eligible for benefits and paid her caregiver for services beginning in October 2007. Defendants provided coverage for Plaintiff for almost a year, then terminated her benefits on August 25, 2008. Nearly five months later, on January 23, 2009, Defendants reinstated her benefits retroactively. After Defendants terminated Plaintiff's benefits, she attempted suicide. On July 9, 2009, Plaintiff sued Defendants, alleging, inter alia, insurer bad faith and negligent and intentional infliction of emotional distress. The Supreme Court subsequently accepted a question certified to it by the district court and answered it by holding that if a first-party insurer commits bad faith, an insured need not prove the insured suffered economic or physical loss caused by the bad faith in order to recover emotional distress damages caused by the bad faith.

Respondent, an insurer/managed care organization, contracted with an endoscopy center and gastroenterology center (collectively, the Clinic) to provide health care services to its insureds. After the Nevada Health District found that the Clinic engaged in a number of unsafe medical practices, Respondent terminated its contract with the Clinic. Janice Munda was insured by Respondent through her employer's health plan, which was governed by ERISA. Munda was diagnosed with hepatitis C, which the Health District determined she contracted as a result of being treated at the Clinic. Janise and her husband (collectively, Appellants) sued Respondent for negligence, negligence per se, breach of implied covenant of good faith and fair dealing, and loss of consortium. The district court granted Respondent's motion to dismiss, finding that Appellants' claims were preempted by ERISA. The Supreme Court reversed, holding that under the facts, there was no preemption because Respondent's alleged actions were independent of the administration of the ERISA plan.