Justia Insurance Law Opinion Summaries

Plaintiff sued defendant seeking a declaratory judgment to the effect that defendant's liens were not valid, in whole or in part, where plaintiff received a substantial settlement from her insurer when she suffered serious injuries in a car accident and received extensive health care services from defendant. At issue was whether the district court properly granted summary judgment to defendant because it had a right to recover the money spent on plaintiff's medical care under 25 U.S.C. 1621e. The court reversed and held that section 1621e, which allowed healthcare providers to recover expenses from third-party tortfeasors, relevant insureres, or other third parties, did not apply to the action where defendant sought to enforce a right of recovery against plaintiff to whom it provided services.

Appellant Walnut Street Associates (WSA) provides insurance brokerage services and helps employers obtain health insurance for their employees. Appellee Brokerage Concepts, Inc. (BCI) is a third party administrator of employee benefit plans. Procacci retained BCI as administrator of its insurance plans, and BCI paid commissions to WSA based on premiums paid by Procacci. In 2005, Procacci requested BCI reduce its costs, but BCI would not meet Procacciâs proposal. Procacci then notified BCI that it would take its business elsewhere. BCI asked Procacci to reconsider, and in the process, disclosed to Procacci how much it paid to WSA as its broker. The amount was higher than Procacci believed WSA had been earning, but there was no dispute that BCIâs statements about WSAâs compensation were true. As a result of BCIâs letter, Procacci terminated its contract with WSA. WSA sued BCI alleging that BCI tortiously interfered with the WSA/Procacci contract by disclosing the amount of WSAâs compensation. BCI argued that it could not be liable for tortious interference because what it said was true, or otherwise justified and privileged. At trial, the jury found that BCI did interfere in the WSA/Procacci contract. BCI appealed, and the appellate court reversed the trial courtâs judgment. The appellate court adopted a section of the Restatement of Torts, which said that truth is a defense to a claim of tortious interference. WSA maintained that the Restatement was not applicable according to Pennsylvania law. The Supreme Court reviewed the case and adopted the Restatement defense that truth is a defense to claims of tortious interference with contractual relations. The Court affirmed the decision of the appellate court.

Appellants Bruce and Cindy Thompson filed a claim for basic economic loss benefits against their insurer, Respondent Western National Insurance Company (Western National), arising from injuries they sustained in an automobile accident. Western National paid some benefits, but a dispute arose over the Thompsonsâ obligation to submit to examinations requested by Western National. The Thompsons filed for no-fault arbitration, and Western National moved to stay the arbitration in order to seek a declaratory judgment in the district court. The arbitrator entered awards in favor of the Thompsons. In court, Western National moved for summary judgment, and the Thompsons moved to confirm their awards. The district court denied Western Nationalâs motion and confirmed the awards, concluding that the reasonableness of the Thompsonsâ refusal to attend the examinations was an issue handled by the arbitrator. The appellate court reversed, concluding that the examination question was a question of law for the court to decide. The Supreme Court reversed the appellate court, holding that the examination issue was a question of fact for the arbitrator. The Court reinstated the arbitration awards in favor of the Thompsons.

Respondent Lincoln General Insurance Companyâs insured drove a rental car under the influence of methamphetamines, and led police on a high-sped car chase that ended when he struck a vehicle containing Petitioner Julie Bailey and her son. Her son was killed. The insured pled guilty to five felonies, including second-degree murder. The insured assigned his rights to Petitioner to collect on a $1 million excess-insurance policy issued by Lincoln General. Lincoln General denied coverage for damages caused by the insured, relying on an exclusion in the rental agreement that voided coverage if the car was used to commit a crime that could be charged as a felony. The trial court and the court of appeals held that the criminal-acts exclusion of the policy was enforceable. The Supreme Court affirmed the lower courtsâ decisions to uphold the criminal-acts exclusion of the insurance policy, finding that Lincoln Generalâs use of the exclusion was a proper exercise of its freedom to contract and provide coverage or damages caused by fortuitous events instead of for damages caused by intentionally criminal acts.

MMG Insurance Company (MMG) appealed a summary judgment entered in Superior Court in favor of Jennifer Jacobi. Ms. Jacobi rented a home from MMG's insured, Barbara Bennett. Ms. Bennett left Maine to live in New Mexico, but her seventeen-year-old son remained in Maine in an "in-law" apartment attached to the home. The son repeatedly sexually assaulted Ms. Jacobi's seven-year-old daughter. Ms. Jacobi reported the incidents to the police, and informed Ms. Bennett. Ms. Jacobi filed suit against Ms. Bennett on multiple grounds. In particular, her claim for "negligent infliction of emotional distress" served as one of the grounds for review by the Supreme Court. Ms. Bennett and her son were insured by a homeowner's policy issued by MMG. The policy that covered Ms. Bennett had a $300,000 limit per occurrence for "bodily injury." MMG notified Ms. Bennett that it would not participate in Ms. Jacobi's action because the policy contained an exclusion for claims arising from sexual abuse. Ms. Bennett failed to file an answer to Ms. Jacobi's complaint, and a default was entered against her. Ms. Jacobi sought enforcement of her default judgment against MMG, and eventually won at trial. MMG appealed, arguing that the court misinterpreted its insurance policy. The Supreme Court found there was no basis for recovery of damages under the MMG homeowner's policy. The Court reversed the judgment in favor of Ms. Jacobi from the lower court, and remanded the case for further proceedings.

Plaintiff filed a petition for equitable garnishment against State Farm Mutual Automobile Insurance Company ("State Farm") after she was injured at a crosswalk from a truck driver, the insured under State Farm's policies, who negligently struck and injured her. At issue was whether plaintiff could recover additional amounts from State Farm where State Farm's policy contained an "anti-stacking" clause and an "excess coverage" clause. The court reversed the district court's ruling that plaintiff could stack State Farm's liability limits in each of its four policies where Paragraph 3 of the policy did not create an ambiguity that permitted a court to ignore the unambiguous anti-stacking clause in Paragraph I. The court also remanded to the district court to decide whether a single insurer, having issued four policies to the owner of four vehicles who then negligently caused an accident while driving a non-owned vehicle, may enforce its anti-stacking clause after it satisfied the minimum Missouri's Motor Vehicle Financial Responsibility Law's, State. 303.010 et seq., coverage requirement.

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.

Homeowners Kenneth and Larissa Trinder filed a declaratory judgment action to establish Defendant Connecticut Attorneys Title Insurance Companyâs (Company) obligation to defend or indemnify them regarding an encroachment of their septic system onto their neighborâs property. The Trinders purchased the land in question in 2005. In conjunction with the sale, they purchased title insurance from the Company to defend themselves against situations that might make their title unmarketable or where they would be forced to remove an existing structure on their property because it extends onto someone elseâs. The Trindersâ neighbor was the Mount Holly Community Historical Museum. The Museum called the Trinders to inform them that the Museum intended to expand its facility, and it wanted to reach a settlement with the Trinders that implicated the use of their septic system. The Trinders perceived the Museumâs call (and subsequent letter) as a threat to their title, and contacted their real estate closing attorney, who filed a claim to the Company on their behalf. The Company responded that the matter didnât impact their title. In September, 2008, the Trinders filed suit against the Company seeking to protect its right to have the septic system on the museumâs land, based on the âforced removal and marketabilityâ provisions of the title insurance. Following a bench trial, the court ordered judgment in favor of the Company. The court concluded a plain reading of the insurance policy showed there was no coverage under the forced removal clause, and that the marketability provision did not apply. The Supreme Court agreed with the lower courtâs reasoning and affirmed its order on appeal.

Plaintiff appealed a grant of summary judgment in favor of Allstate Indemnity Company ("Allstate") where plaintiff's claims for coverage stemmed from the death of plaintiff's eight-year-old daughter at her ex-husband's home. At issue was whether plaintiff's claim for wrongful death was covered under the terms of a homeowner's insurance policy Allstate issued to plaintiff's ex-husband. The court held that summary judgment in favor of Allstate was improper where Allstate failed to meet its burden of demonstrating that the family exclusion unambiguously precluded coverage.

A young woman died from injuries she sustained after falling from a portable rock climbing wall at a minor league baseball game. Her parents sued the team's owner, who had an excess insurance policy with Respondent Great American Assurance Company (Great American). To protect himself from additional liability, the team owner entered into an agreement with the parents that limited collection of any judgment to the limits of both primary and excess insurance policies. The trial court entered judgment against the team owner, finding him liable, and awarded $4 million in damages. The parents then brought an equitable garnishment suit to collect against the primary and excess policies. The primary insurers settled for less than their policy limit. However, the parents entered a release of judgment for the full policy limit. The excess insurer, Great American, disputed its obligation to pay under its policy because the primary insurance limit had not been exhausted. The appellate court agreed with Great American, and denied the parents equitable garnishment. The parents appealed, arguing that the excess insurance policy did not require exhaustion before it was obligated to pay. The Supreme Court reviewed the policy and found it had no provisions requiring exhaustion. The Court reversed the appellate court on the exhaustion issue, and affirmed the lower court's decision on all other matters brought on appeal.