Justia Insurance Law Opinion Summaries

Michael Swanson killed a motorcyclist while driving his parents' car. After a wrongful-death lawsuit settled, Swanson's personal automobile-liability policy paid up to its coverage limits. The remaining question was which insurer should pay next: Hartford Fire Insurance Company, which provided a commercial automobile policy to Swanson's employer, or Chubb Custom Insurance Company, which provided group excess-liability benefits. Both insurers had "excess clauses" requiring the other to pay first, leading to a dispute.The United States District Court for the Western District of Missouri determined that the excess clauses were mutually repugnant, meaning they canceled each other out. The court granted summary judgment to Hartford, denied Chubb's motion for judgment on the pleadings, and ordered both insurers to share the remaining settlement amount pro rata.The United States Court of Appeals for the Eighth Circuit reviewed the case de novo. The court found that Hartford's policy was "excess over any other collectible insurance," while Chubb's policy was "excess over any other insurance," making it a true excess policy. The court concluded that Hartford's policy should pay before Chubb's because Hartford's policy was excess over collectible insurance, which included Swanson's personal automobile-liability policy. Chubb's policy, being a true excess policy, would only come into play after all other insurance was exhausted.The Eighth Circuit vacated the district court's judgment and remanded the case with instructions to grant Chubb's motion for judgment on the pleadings, determining that Hartford should pay before Chubb. View "Hartford Fire Insurance Company v. Chubb Custom Insurance Company" on Justia Law

The case involves the Massachusetts Insurers Insolvency Fund (MIIF) seeking cost-of-living adjustment (COLA) payment reimbursements from the Workers' Compensation Trust Fund (trust fund). MIIF, a nonprofit entity created by statute, administers and pays certain claims against insolvent insurers. Between 1989 and 2013, MIIF paid workers' compensation benefits, including COLA payments, on behalf of several insolvent insurers. MIIF filed claims with the trust fund for reimbursement of these payments, but the trust fund denied the claims, arguing that MIIF is not an "insurer" under the relevant statutes and does not participate in the trust fund.The Department of Industrial Accidents (DIA) administrative judge denied MIIF's claims, and the Industrial Accident Reviewing Board (board) affirmed the decision. The board relied on the Appeals Court's decision in Home Ins. Co. v. Workers' Compensation Trust Fund, concluding that MIIF, like the insolvent insurers, does not collect and transmit assessments to the trust fund and is therefore not entitled to reimbursement.The Supreme Judicial Court of Massachusetts reviewed the case and concluded that MIIF is eligible for COLA-payment reimbursements. The court determined that MIIF, when taking on an insolvent insurer's covered claims, is "deemed the insurer" and has "all rights, duties, and obligations" of the insolvent insurer under G. L. c. 175D, § 5 (1) (b). The court also found that the plain language of the relevant statutes does not exclude MIIF from reimbursement eligibility and that the trust fund's funding mechanism, which is paid for by employers, supports MIIF's entitlement to reimbursement.The Supreme Judicial Court reversed the board's decision and remanded the case for further proceedings consistent with its opinion. View "Massachusetts Insurers Insolvency Fund v. Workers' Compensation Trust Fund" on Justia Law

An insurer, Arrowood Indemnity Company, entered run-off in 2003, ceasing to issue new policies but continuing to manage existing claims, including workers' compensation for a Scully Signal Company employee who sustained a second work-related injury in 2001. Arrowood sought second-injury reimbursements from the Massachusetts Workers' Compensation Trust Fund, which reimburses insurers for a portion of workers' compensation benefits paid to employees with exacerbated injuries. Arrowood and the Trust Fund settled in 2009, with Arrowood receiving reimbursements until 2013.The Department of Industrial Accidents (DIA) began denying Arrowood's reimbursement requests in 2015, citing a precedent that insurers in run-off, who no longer collect and transmit employer assessments to the Trust Fund, are ineligible for reimbursements. Arrowood's subsequent complaint in Superior Court was dismissed, and the Appeals Court affirmed the dismissal, directing Arrowood to seek administrative review. The DIA administrative judge and the Industrial Accident Reviewing Board upheld the denial, leading Arrowood to appeal to the Appeals Court.The Appeals Court reversed the Board's decision, ruling that the statutory language of the Massachusetts workers' compensation act does not preclude insurers in run-off from receiving second-injury reimbursements. The Supreme Judicial Court of Massachusetts granted further appellate review and agreed with the Appeals Court. The Court held that the plain language of the act does not exclude insurers in run-off from reimbursement eligibility and that the statutory scheme supports this interpretation. The Court reversed the Board's decision and remanded for further proceedings consistent with its opinion. View "Arrowood Indemnity Company v. Workers' Compensation Trust Fund" on Justia Law

Two hospitals in Tennessee, Saint Francis Hospital and Saint Francis Hospital-Bartlett, sued Cigna Health and Life Insurance Company, claiming that Cigna routinely underpaid them for emergency services provided to Cigna members. The hospitals, which are out-of-network providers for Cigna, argued that Cigna had a quasi-contractual obligation to pay the reasonable value of their services based on federal and state laws requiring hospitals to treat emergency patients and insurers to cover emergency care.The United States District Court for the Western District of Tennessee dismissed the hospitals' claims. The court found that the hospitals' complaint did not meet the pleading standards of Rule 8, that Tennessee common law did not support their claims, and that the Employee Retirement Income Security Act (ERISA) preempted their claims.The United States Court of Appeals for the Sixth Circuit reviewed the case and affirmed the district court's dismissal. The Sixth Circuit held that neither federal law (specifically the Affordable Care Act) nor Tennessee law imposed a duty on Cigna to pay the full value of out-of-network emergency services. The court noted that the ACA's requirement for insurers to provide "coverage" for emergency services did not mean that insurers had to pay the full cost. The court also found that Tennessee common law did not support the hospitals' claims for quantum meruit and unjust enrichment, as there was no contractual or statutory duty for Cigna to pay the full value of the services.The Sixth Circuit concluded that the hospitals' claims failed because they could not establish that Cigna had a legal obligation to pay more than what was stipulated in its contracts with its members. The court did not address the ERISA preemption issue, as the dismissal was affirmed on other grounds. View "AMISUB (SFH), Inc. v. Cigna Health & Life Ins. Co." on Justia Law

A general contractor, Keluco General Contractors, Inc., secured a workers’ compensation and employers’ liability policy through Travelers Property Casualty Company of America. The policy was set to last one year, expiring on March 5, 2017. After the policy expired, a Keluco employee was injured at work. Keluco attempted to make a claim on its workers’ compensation policy and discovered it had expired. Travelers claimed to have sent a notice of nonrenewal to Keluco and its insurance agent, Gretchen Santerre, but Keluco claimed it never received the notice.Keluco sued Santerre and her employer, Country Mutual Insurance Company, for failing to inform it of the nonrenewal notice. Santerre filed a third-party complaint against Travelers. The Superior Court of Alaska granted partial summary judgment against Travelers, ruling that it failed to send the nonrenewal notice in the manner required by statute, specifically by not obtaining a certificate of mailing from the United States Postal Service (USPS). The court found that Travelers breached its contract with Keluco.The Supreme Court of the State of Alaska reviewed the case. The court affirmed the Superior Court’s rulings on summary judgment, agreeing that Travelers violated AS 21.36.260 by not obtaining a certificate of mailing from USPS and thus breached its contract with Keluco. The court also affirmed the dismissal of Travelers’ contribution claim against Santerre, noting that Alaska law allows for the allocation of fault to a party who has settled out of a case.However, the Supreme Court reversed the Superior Court’s determination of when prejudgment interest began to accrue. The Supreme Court held that prejudgment interest should begin to accrue on September 20, 2017, the date the Keluco employee was injured and entitled to workers’ compensation benefits, rather than January 9, 2017. The case was remanded for recalculation of prejudgment interest. View "Travelers Property Casualty Company of America v. Keluco General Contractors" on Justia Law

In April 2018, Le’Onsha Scott was severely injured in a car accident caused by Ellen Cahill, who admitted fault. Cahill was insured under two policies: her own Hartford policy and a Nationwide policy as a "resident relative" of her son, John Duggan. The Nationwide policy covered liability for vehicles listed in its declarations, which did not include Cahill's 2018 Hyundai Ioniq, the car she was driving during the accident. Nationwide denied coverage for the accident, leading Scott to seek indemnification for the balance of a $424,140.26 judgment awarded after arbitration.The United States District Court for the District of Colorado granted summary judgment in favor of Nationwide, ruling that the policy's limitation to specified vehicles did not violate Colorado public policy. The court found that Colorado statutes and case law allowed insurers to exclude liability coverage based on whether a vehicle is specifically named in the policy. Scott's cross-motion for summary judgment, which argued that the policy's vehicle-based coverage limitation was void against Colorado public policy, was denied.The United States Court of Appeals for the Tenth Circuit reviewed the case and affirmed the district court's decision. The appellate court held that the Nationwide policy's limitation to specified vehicles did not violate Colorado public policy. The court noted that Colorado's motor vehicle insurance statutes and case law support the practice of limiting liability coverage to vehicles explicitly named in the policy. The court also distinguished this case from Pacheco v. Shelter Mutual Insurance Co., which involved uninsured/underinsured motorist coverage, a different context with person-oriented statutes. The appellate court denied Scott's request for appellate costs. View "Scott v. Nationwide Agribusiness Insurance" on Justia Law

James Cooper was injured in a car accident in August 2019 while riding as a passenger in a car owned by Rick Huffman. Both Cooper and Huffman were employees of Pison Management, LLC, and were driving to a jobsite for work. Cooper's injuries exceeded the third-party driver's insurance limits, so he sought underinsured motorist (UIM) coverage under Pison's commercial automobile policy issued by Erie Insurance Property & Casualty Company. The policy provided $1 million in liability coverage for two vehicles owned by Pison and a class of non-owned vehicles but only offered UIM coverage for the owned vehicles. Erie denied Cooper's claim for UIM coverage.The United States District Court for the Southern District of West Virginia granted summary judgment in favor of Cooper, holding that West Virginia Code § 33-6-31 required Erie to offer UIM coverage for all vehicles covered by the liability policy, including non-owned vehicles. The court issued a declaratory judgment that Cooper was entitled to $1 million in UIM coverage. Erie appealed the decision.The United States Court of Appeals for the Fourth Circuit reviewed the case and certified a question of law to the West Virginia Supreme Court of Appeals. The West Virginia court concluded that West Virginia Code § 33-6-31 did not require Erie to offer UIM coverage for non-owned vehicles. The court determined that Cooper was not an "insured" under the statute because Pison, the named insured, did not own the vehicle in which Cooper was riding and thus could not consent to its use for UIM purposes.Applying the West Virginia court's interpretation, the Fourth Circuit vacated the district court's judgment in favor of Cooper and remanded the case with instructions to enter judgment in favor of Erie. View "Erie Insurance Property & Casualty Company v. Cooper" on Justia Law

Tody's Service, Inc. (Tody's), a towing company, billed Liberty Mutual Insurance Company (Liberty) a six-figure storage fee after towing and storing a vehicle involved in a fatal crash at the direction of the police. The vehicle, insured by Liberty, was held as evidence for nearly three years. After obtaining the vehicle's title, Liberty refused to pay the accrued storage charges, leading Tody's to sue Liberty to recover those fees.In the Superior Court, a judge granted summary judgment in favor of Liberty on all of Tody's claims, which included unjust enrichment, promissory estoppel, and failure to pay storage fees under G. L. c. 159B, § 6B. The judge found no evidence of unjust enrichment, ruled that § 6B does not provide a private right of action, and concluded that Tody's failed to demonstrate any actionable promise or reasonable reliance to support promissory estoppel.The Supreme Judicial Court reviewed the case and held that Liberty was not unjustly enriched as a matter of law, as there was no measurable benefit conferred on Liberty by Tody's storage of the vehicle. The court also found no evidence of reliance sufficient to support promissory estoppel, as Tody's stored the vehicle in response to a police directive, not in reliance on any promise by Liberty. Additionally, the court held that § 6B does not create a private right of action against a vehicle owner. Consequently, the Supreme Judicial Court affirmed the judgment in Liberty's favor. View "Tody's Service, Inc. v. Liberty Mutual Insurance Company" on Justia Law

Pamela Edwards, owner of Allure Salon in Starkville, Mississippi, was diagnosed with cancer in 2019 and passed away in 2022. After her death, her husband, Jimmy Edwards, sought payment from her life insurance policy with Guardian Life Insurance. Guardian denied the claim, stating the policy had been canceled because the number of insured employees at Allure dropped to one, triggering their right to cancel the policy. Jimmy Edwards was unaware of the policy until informed by the insurance agent, Debbie Jaudon, who also did not receive a cancellation notice from Guardian.Jimmy Edwards sued Guardian in the Northern District of Mississippi, bringing claims under Mississippi common law and arguing that ERISA entitled him to recover benefits. Guardian moved for partial summary judgment, asserting that ERISA governed the plan and preempted the common-law claims. The district court granted Guardian’s motion, and Jimmy Edwards appealed.The United States Court of Appeals for the Fifth Circuit reviewed the case. The court determined that ERISA applied to the Allure policy, as the salon technicians were considered employees under federal common law. The court found that Guardian had waived its right to cancel the policy by continuing to accept premium payments for 26 months after the right to cancel vested. The court held that Guardian could not avoid its obligation to pay the claim after accepting premiums for such an extended period. Consequently, the Fifth Circuit reversed the district court's judgment and rendered judgment in favor of James Edwards. View "Edwards v. Guardian Life Insurance" on Justia Law

After Hurricane Maria damaged its business, Coco Rico, LLC sued its insurer, Universal Insurance Company, for failing to pay its insurance claim and won. The jury awarded Coco Rico higher damages for its business interruption loss claim than it had requested, plus extra, consequential damages. This appeal centers on the district court's rulings on several post-verdict motions: Universal sought to eliminate or reduce the jury's damages awards, while Coco Rico sought attorneys' fees and prejudgment interest from Universal. After the district court denied the motions, both parties appealed.The United States District Court for the District of Puerto Rico denied Universal's renewed motion for judgment as a matter of law on the consequential damages claim and its motion for a new trial or reduction of the contractual damages award. The court reduced the jury's BI & EE award from $873,000 to $750,000, in line with the insurance policy maximum, but rejected Universal's argument that the award should be further reduced to $686,098. The court also denied Coco Rico's motion to amend the judgment to add attorneys' fees and prejudgment interest.The United States Court of Appeals for the First Circuit reviewed the case. The court agreed with Universal that there was no evidentiary basis for the jury to award consequential damages or higher business interruption loss damages than Coco Rico had established at trial. The court reversed the district court's ruling denying Universal's motions regarding the damages awards and affirmed its ruling denying Coco Rico's motion for attorneys' fees and prejudgment interest. The court held that the jury's award of $873,000 for business interruption loss exceeded the evidence presented, which supported only $686,098, and that there was no evidence to support the $250,000 consequential damages award. The court remanded the case for further proceedings consistent with its opinion. View "Coco Rico, LLC v. Universal Insurance Company" on Justia Law