Justia Insurance Law Opinion Summaries

Lee Ann Helfrich received benefits through her federal-employee health-insurance plan, the Blue Cross and Blue Shield Service Benefit Plan, for the treatment of injuries she sustained in a car accident. After Helfrich reached a settlement with the other driver’s insurance company, Blue Cross and Blue Shield Association (BCBSA) and Blue Cross and Blue Shield of Kansas City (BCBSKC) sought reimbursement for the benefits paid, as provided in the terms of the Plan. Helfrich appealed the district court’s judgment requiring her to reimburse BCBSA and BCBSKC (together Blue Cross) because the Federal Employees Health Benefits Act of 1959 (FEHBA) preempted a Kansas insurance regulation prohibiting subrogation and reimbursement clauses in insurance contracts. Finding no reversible error in the district court’s judgment, the Tenth Circuit affirmed. View "Helfrich v. Blue Cross & Blue Shield Assoc" on Justia Law

Defendant’s vehicle collided into plaintiff’s vehicle at a busy intersection. Plaintiff sustained spinal injuries in the accident and filed suit against defendant. Eventually, plaintiff had surgery to repair a herniated lumbar disc. The jury found defendant negligent and awarded plaintiff a total of $429,773.71 in damages, including $261,773.71 in past medical expenses, which was the full amount of her medical bills. The trial court then entered judgment on the verdict. Defendant appealed. This case raised an issue regarding the calculation of reasonable medical expenses in economic damages awards. Plaintiff lacked medical insurance and contracted with her medical providers to treat her in exchange for a lien on whatever she might recover from defendant in this lawsuit. A third party assignee, MedFin Managers, LLC (MedFin), purchased the lien from the medical providers for a discounted amount. Plaintiff remained liable on the total bill. Defendant contended that the trial court erred in denying her motion to admit evidence of the amounts MedFin paid to purchase the right to recover the full amounts plaintiff’s medical providers billed plaintiff. Defendant argued that the trial court should have allowed her to introduce evidence of the amounts MedFin paid to the medical providers as evidence of the reasonable cost of treatment provided plaintiff, particularly since the court denied defendant’s motion to exclude evidence of the billed amounts. In the published portion of this opinion, the Court of Appeal concluded that because defendant proffered no evidence to show that the MedFin payments represented the reasonable value of plaintiff’s treatment, the probative value of that evidence was substantially outweighed by the probability that it would create a substantial danger of undue prejudice as well as a danger of confusing and misleading the jury. Consequently, the trial court’s ruling precluding evidence of the MedFin payments was not an abuse of discretion. View "Uspenskaya v. Meline" on Justia Law

David Stoms was killed in an automobile accident by an uninsured driver. David was driving a car belonging to his employer, Diamond Motor Sports, Inc., which had purchased uninsured motorists coverage on its insurance policy only for a limited class of drivers. Under Diamond Motor's insurance policy, only directors, officers, partners, and owners of the corporation had uninsured motorists coverage. David Stoms was a finance manager at Price Toyota, one of Diamond Motor's dealerships. The insurance policy gave all drivers, including David, personal injury protection coverage up to $30,000 per accident. David had purchased no supplemental coverage of his own. Although Federated Insurance paid the entire $30,000 in personal injury protection on David's behalf, it denied Mrs. Stoms benefits for uninsured motorists coverage resulting from David's death. Mrs. Stoms sued Federated Insurance, demanding those benefits. The parties filed cross-motions for summary judgment and the Superior Court granted Federated Insurance's motion. Mrs. Stoms argued that the Superior Court erred in granting Federated Service Insurance Company's motion for summary judgment after concluding that the insurance policy it issued to Diamond Motor was neither contrary to public policy nor ambiguous. Finding no reversible error, the Supreme Court affirmed. View "Stoms v. Federated Service Insurance Company" on Justia Law

In 2013, the Delaware Supreme Court determined that Matthew Kelty was eligible for personal injury protection (PIP) benefits under an insurance policy between State Farm Mutual Automobile Insurance Company and John and Shirley Lovegrove after Kelty was injured in an accident involving the Lovegroves' vehicle. As a result, the Supreme Court reversed the Superior Court's earlier grant of summary judgment to State Farm and remanded the case for further proceedings. On remand, the parties argued about whether Kelty was entitled to receive only the statutory minimum of $15,000, or $100,000, including excess coverage the Lovegroves opted to pay for but which was expressly limited in the policy to the insureds and their relatives who lived with them. The Superior Court held that Kelty was entitled to receive the full $100,000 because the policy's limitation on who could benefit from the excess coverage was "void as against public policy." The Supreme Court reversed finding that the plain language of the statute, 21 Del. C. 2118, required PIP policies to provide only $15,000 of coverage. Imposing a higher minimum here simply because the Lovegroves chose to pay for additional coverage for themselves and their relatives "thwart[ed] Delaware's public policy to encourage drivers to purchase more than the statutorily-mandated minimum by increasing the cost of excess coverage.[. . .] It is not the role of the judiciary to alter that amount and thus disrupt the incentives that the General Assembly has itself set up for insurers and consumers. Accordingly, we reverse the judgment of the Superior Court." View "State Farm Mutual Automobile Insurance Co. v. Kelty" on Justia Law

Plaintiff was involved in a vehicle collision with another driver, who admitted fault. At the time of the accident, Plaintiff’s vehicle was insured with Farmers Insurance Exchange under a policy that included underinsured motorist (UIM) coverage. After Plaintiff received medical treatment, Plaintiff filed a complaint requesting “all sums due and owing” under her insurance policy with Farmers. During the course of the litigation, Farmers extended settlement offers to Plaintiff, but the case did not settle. The jury returned a verdict in favor of Plaintiff. Thereafter, Plaintiff moved for attorney fees and nontaxable costs under the insurance exception to the American Rule. The district court denied Plaintiff’s motion, concluding that the insurance exception did not apply to Plaintiff’s attorney fees and related costs. The Supreme Court reversed, holding that the district court incorrectly interpreted Montana law when it relied on only the circumstances surrounding the filing of Plaintiff’s complaint to conclude that Plaintiff did not meet the insurance exception. Remanded for further proceedings to determine whether Farmers forced Plaintiff to assume the burden of legal action to obtain the full benefit of her UIM policy, thus entitling her to attorney fees under the insurance exception. View "Mlekush v. Farmers Inc." on Justia Law

Morady sold life insurance policies. Davis, a former lawyer, approached elderly African-Americans and paid them small amounts to become the nominal applicant-buyers of the policies, with Morady as the insurance agent, and to put the policies into an irrevocable trust, with Davis as trustee. The beneficial interest in the trust would be sold to an investor who would pay the remaining premiums and wait for the death of the insured. The insurer would not have sold the policies had it known that the premiums would be paid by an unrelated third party in the expectation that the policy would be transferred to him; its contracts with agents, including Morady, required them to conform to an “absolute prohibition against participation in any type of premium financing scheme involving an unrelated third party,” but the law allows an investor to purchase the beneficial interest in an existing life insurance policy. The net loss to Ohio National (beyond $120,000 commissions paid to Morady) was $605,000 in litigation expenses to void the policies. The total death benefits specified in the illegal policies amounted to $2.8 million. The Seventh Circuit agreed that Morady’s conduct constituted fraud and a breach of her contract and affirmed summary judgment, with damages of $726,000. View "Ohio Nat'l Life Assurance Corp. v. Davis" on Justia Law

Petitioner-claimant Jeanette Ball sought permanent total disability benefits from the Multiple Injury Trust Fund. The Workers' Compensation Court held that a "Crumby" finding of preexisting disability made simultaneously with the adjudication of an on-the-job injury could be combined with the adjudicated injury to render the Claimant a physically impaired person under 85 O.S. Supp. 2005 sec. 171 and awarded Petitioner permanent total disability benefits. The Fund appealed, and a three-judge panel reversed. Claimant then appealed, and the Court of Civil Appeals reversed the panel. After its review, the Supreme Court held that an employee must be a physically impaired person as defined by the applicable statute before he or she can seek benefits from the Fund. A "Crumby" finding of preexisting disability made simultaneously with an adjudication of an on-the-job injury could not be combined with such adjudicated injury to render the Claimant a physically impaired person under 85 O.S. Supp 2005 sec. 171. The Court of Appeals' decision was vacated and the case remanded for further proceedings. View "Ball v. Multiple Injury Trust Fund" on Justia Law

Haney rented a car from Enterprise. While being driven by Artley, the vehicle collided with an oncoming car operated by Nelson. Nelson sued Artley, who was uninsured, and obtained a default judgment. Nelson brought a supplementary action against Enterprise. Enterprise denied that it was in possession of any property of Artley and raised affirmative defenses to recovery: that Artley was not its customer, was not listed on its rental agreement with Haney and did not have Haney’s permission to use the vehicle. Haney had reported the vehicle as stolen. Enterprise contended in the alternative that it was self-insured, that its total financial responsibility for the liability of any authorized driver was $100,000 per occurrence, and that it had paid $50,000 to settle another claim from the same accident and had tendered $50,000 to the court to allocate between Nelson and a third injured party, exhausting its liability limits. Enterprise also argued that there was nothing in its rental agreement nor in Illinois statutes to obligate Enterprise to pay costs or post-judgment interest connected with the default judgment. The Illinois Supreme Court agreed with the trial court that, under a 2005 appellate court decision, Enterprise’s liability was limited to the minimum coverage provisions applicable to rental car companies that meet their financial responsibility obligations through the purchase of an insurance policy and not the full amount of the default judgment. View "Nelson v. Artley" on Justia Law

In October 2010, Eddie Hoffman was injured when his vehicle was rear-ended by a vehicle driven by Carolyn Elzy. Hoffman filed suit against Ms. Elzy and her insurer, 21st Century North America Insurance Company for damages allegedly resulting from the accident. This case presented with a question of first impression for the Louisiana Supreme Court's review as to whether a write-off from a medical provider, negotiated by plaintiff's attorney, could be considered a collateral source from which the tortfeasor receives no set-off. Applying Louisiana law and the principles set forth in our Civil Code, the Court found that such a write-off did not fall within the scope of the collateral source rule. View "Hoffman v. 21st Century North America Insurance Co." on Justia Law

Defendant Cy Tapia, a teenager living with his aunt and grandmother, was driving a vehicle which crashed, inflicting severe and eventually fatal injuries on his passenger, Cory Driscoll. Before his death Driscoll and his mother filed an action for damages. The parties established that the vehicle driven by Tapia was owned by his grandfather and that Tapia was entitled to $100,000 in liability coverage under an auto policy issued to Melissa McGuire (Tapia’s sister), which listed the vehicle as an insured vehicle and listed Tapia as the driver of the vehicle. The policy was issued by petitioner-defendant 21st Century Insurance Company. 21st Century offered to settle the action for the policy limits of the McGuire policy ($100,000). However, plaintiff1 also believed that Tapia might be covered under policies issued to his aunt and grandmother, each offering $25,000 in coverage and also issued by 21st Century. Plaintiff communicated an offer to settle for $150,000 to Tapia’s counsel; 21st Century contended that it never received this offer (although there was certainly evidence to the contrary). Inferrably having realized the seriousness of its position, 21st Century affirmatively offered the “full” $150,000 to settle the case against Tapia. Plaintiff did not accept this offer, but a month later plaintiff’s counsel served a statutory offer to compromise seeking $3,000,000 for Cory Driscoll and $1,150,000 for his mother Jenny Driscoll. Shortly before the expiration of this offer, 21st Century sent Tapia a letter warning him that it would not agree to be bound if Tapia personally elected to accept the offer. Nonetheless, Tapia agreed to the entry of a stipulated judgment in the amounts demanded by plaintiff. 21st Century paid $150,000 plus interest to the plaintiff. Tapia then assigned any rights he had against 21st Century to plaintiff. This assignment and agreement included plaintiff’s promise not to execute on the judgment against Tapia so long as he complied with his obligations, e.g., to testify to certain facts concerning the original litigation and 21st Century’s actions. This bad faith action followed. Petitioner's unsuccessfully moved for summary judgment, and petitioned the Court of Appeal for a writ of mandate to overturn the trial court's denial. Upon review, the Court of Appeal found that plaintiff’s efforts to pursue essentially a “bad faith” action as assignee of the insured was misguided. Accordingly, petitioner was entitled to summary judgment. View "21st Century Ins. v. Super. Ct." on Justia Law