Justia Insurance Law Opinion Summaries

The Eighth Circuit held that an accidental death and dismemberment insurance policy does not qualify as a health plan under Maine law, Me. Rev. Stat. Ann. tit. 24-A, 4303. Therefore, Unum Life's decision to deny benefits is subject to a deferential abuse of discretion standard of review. In this case, substantial evidence supported Unum Life's conclusion that intoxication contributed to the insured's fall down the stairs, which resulted in her death. The court concluded the Unum Life did not abuse its discretion in denying benefits under the policy's intoxication exclusion. View "Williams v. Unum Life Insurance Company of America" on Justia Law

Plaintiff filed suit against State Farm and GEICO for liability coverage after she was injured on her husband's boat. In this case, plaintiff was seriously hurt when she was thrown from the boat.The Eighth Circuit affirmed the district court's grant of summary judgment concluding that the State Farm and GEICO household exclusions bar recovery here. Furthermore, the exclusions do not violate Minnesota law and public policy. The court rejected plaintiff's suggestion that the question of umbrella and boatowner's liability insurance coverage arising from spousal negligence creates a novel question of law that the court should certify to the Minnesota Supreme Court. The court explained that the caselaw plaintiff relies on does not hold that insurance policies must cover household members. Rather, Minnesota consistently enforces household exclusions when the controlling statutes do not prohibit such exclusions, nor do they require homeowner's policies to provide liability coverage for claims made by one resident of a household against another. View "Godfrey v. State Farm Fire and Casualty Co." on Justia Law

In this insurance coverage dispute, at issue is who counts as an "employee" under the Texas Anti-Indemnity Act (TAIA). The Fifth Circuit certified the following question to Supreme Court of Texas: Whether the employee exception to the TAIA, Texas Insurance Code 151.103, allows additional insured coverage when an injured worker brings a personal injury claim against the additional insured (indemnitee), and the worker and the indemnitee are deemed "co-employees" of the indemnitor for purposes of the TWCA. View "Maxim Crane Works, LP v. Zurich American Insurance Co." on Justia Law

A minor was severely injured in an all-terrain vehicle collision in which the other driver was at fault. The minor had medical benefits coverage through a health care plan provided by her father’s employer, the Fairbanks North Star Borough. As allowed by the terms of the plan, the Borough refused to pay the minor’s medical bills until she signed an agreement that included a waiver of certain defenses to the Borough’s subrogation rights, such as the common fund and made-whole doctrines. The minor refused to sign the agreement without reservation and filed suit, seeking a declaration that the Borough could not condition payment of her medical bills on her signature. The superior court decided on summary judgment that the Borough’s health care plan was not a true insurance plan and that, regardless of whether it was interpreted as an insurance policy or an ordinary contract, the parties could lawfully reject subrogation defenses. The minor appealed. The Alaska Supreme Court held that the health care plan was a bargained-for employee benefit rather than a true insurance policy, and that the superior court’s interpretation of it was correct. The Court therefore affirmed the superior court's judgment. View "Best v. Fairbanks North Star Borough" on Justia Law

Dwayne Harris appealed a circuit court order dismissing his counterclaim against Dubai Truck Lines, Inc., pursuant to Rule 12(b)(6), Ala. R. Civ. P. On February 18, 2018, three vehicles were involved in an accident in Jefferson County, Alabama: a vehicle owned by Dubai and driven by Jose Martinez, one of Dubai's employees; a vehicle driven by Harris; and a vehicle driven by Annika Schaefer. Schaefer's vehicle was insured by State Farm Mutual Automobile Insurance Company. On February 28, 2019, Schaefer and State Farm, as subrogee of Schaefer sued Dubai and Martinez. According to Dubai, it was not served with the complaint until June 2020, after the expiration of the applicable two-year statute-of- limitations period. On August 7, 2020, Dubai filed an answer denying all liability for the accident and adding Harris as a third-party defendant pursuant to Rule 14, Ala. R. Civ. P. Dubai specifically impleaded Harris to allege that Harris's negligence was the proximate cause of the accident. On November 13, 2020, Harris filed a counterclaim against Dubai, alleging that Martinez, Dubai's employee, had been negligent and/or wanton in causing the accident, that Harris had suffered injuries as a result of the accident and that Dubai was vicariously liable for those injuries. Dubai then moved to dismiss the counterclaim, alleging Harris' counterclaim was barred by the applicable statute of limitations. The Alabama Supreme Court found Harris's counterclaim was compulsory, and not subject to a statute-of-limitations defense. Thus, there was no basis for the circuit court to dismiss Harris's counterclaim pursuant to Rule 12(b)(6). View "Harris v. Dubai Truck Lines, Inc." on Justia Law

Melvin James appealed a circuit court's grant of summary judgment in favor of Assurance America Insurance Company ("Assurance") on its complaint for a declaratory judgment. In February 2019, Bernardino Mejia and James were involved in a motor-vehicle accident in Montgomery, Alabama. Mejia was driving a 2003 Chrysler Town and Country minivan, and James was driving a 2004 Toyota Camry automobile. As a result of the accident, Mejia's three children were ejected from the Town and Country. One of Mejia's children died, and the other two were seriously injured. James was also injured as a result of the accident. Mejia was arrested, and, on September 23, 2019, he was indicted for one count of reckless murder and four counts of first- degree assault as a result of the accident. He was incarcerated on those charges. In April 2019, James sued Mejia, ALFA Insurance Corporation, USAA Casualty Insurance Company, and various fictitiously named defendants for negligence, negligence per se, wantonness, and breach of contract. Mejia moved to stay the civil proceeding until the accident-related criminal proceedings against him were concluded; this motion was granted. Assurance sought the summary judgment motion at issue here, against Mejia and James. Assurance contended Mejia was not the named insured under the Assurance policy that covered the Town & Country he was driving, and that policy excluded coverage for injury or damage caused by an insured vehicle when driven by a person who was not listed as a driver on the declarations page of the policy and who did not have a valid driver's license. The Alabama Supreme Court reversed and remanded, finding Assurance did not produce substantial, admissible evidence to establish Mejia did not have a valid driver's license at the time of the accident and therefore did not shift the burden of proof to James. Accordingly, the trial court erred in granting Assurance's motion for a summary judgment. View "James v. Assurance America Insurance Company" on Justia Law

In this case involving the In-Home Supportive Services (IHSS) program the Supreme Court affirmed the judgment of the court of appeal concluding that sections 631 and 683 of the Unemployment Insurance Code exclude from coverage a provider who is the recipient's minor child, parent, or spouse under the state's unemployment insurance program, holding that the court of appeal did not err.The IHSS program authorized certain Californias, who were disabled or elderly, to receive in-home services from third parties or family members paid for with public funds. Under one program option, service recipients hire their own providers and the providers are paid either by a public entity or by the recipients with funds they have received from a public entity. At issue was whether such a provider qualified for unemployment benefits. The Supreme Court answered the question in the negative, holding that provider who is the recipient's minor child, parent, or spouse is not covered by the state's unemployment insurance program. View "Skidgel v. California Unemployment Insurance Appeals Board" on Justia Law

The three restaurants in these consolidated appeals each brought its own action in state court seeking a declaration that its respective Insurer was obligated to provide coverage for COVID-19-related losses under an insurance policy. Each Insurer removed its case to federal court invoking diversity jurisdiction; each district court exercised its discretion under the Declaratory Judgment Act (DJA), 28 U.S.C. 2201–02, to abstain from hearing the case and ordered the matter be remanded to state court. The Third Circuit vacated the orders, concluding that the District Courts erred in weighing factors relevant to the exercise of discretion under the DJA: the likelihood that a federal court declaration will resolve the uncertainty of obligation which gave rise to the controversy, the general policy of restraint when the same issues are pending in a state court, and the public interest in settlement of the uncertainty of obligation. In this case, a declaratory judgment would be sufficient to afford relief and settle their respective controversies. View "Dianoias Eatery LLC v. Motorists Mutual Insurance Co" on Justia Law

Before filing for bankruptcy, the Debtors provided general contracting services for large construction projects, including many projects for departments of the federal government. To enter into contracts with the United States, contractors are generally required to post both a performance bond and a payment bond signed by the contractor and a qualified surety (such as ICSP), 40 U.S.C. 3131. When the Debtors defaulted on the contract at issue, ICSP stepped in to make sure that the work was completed. ICSP claims that it is subrogated to the United States’ rights to set off a tax refund (owed to one or more of the Debtors) against the losses that ICSP covered. However, to settle various claims in the Debtors’ Chapter 7 bankruptcy proceedings, the United States and the Trustee agreed that the United States would waive its setoff rights.The Bankruptcy Court, district court, and Third Circuit held that ICSP is not entitled to the tax refund. The United States had not yet been “paid in full,” within the meaning of 11 U.S.C. 509(c), when the Bankruptcy Court approved the settlement, so ICSP’s subrogation rights were subordinate to the remaining and superior claims of the United States at the time of the settlement. The United States was entitled to waive its setoff rights in order to settle its remaining and superior claims; the waiver of its setoff rights extinguished ICSP’s ability to be subrogated to those rights. View "Insurance Co of the State of Pennsylania v. Giuliano" on Justia Law

The United States Third Circuit Court of Appeals certified a question of law to the Pennsylvania Supreme Court involving the state's Motor Vehicle Financial Responsibility Law (“MVFRL”). In July 2015, Corey Donovan (“Corey”) suffered significant injuries due to a collision between a motorcycle, which he owned and was operating, and an underinsured vehicle. He recovered the $25,000 limit of coverage available under the policy insuring the underinsured vehicle as well as the $50,000 per person limit of UIM coverage available under Corey’s policy insuring the motorcycle, issued by State Farm Automobile Insurance Company. Corey then sought coverage under a policy issued by State Farm to his mother, Linda Donovan (“Linda”), under which he was insured as a resident relative. Linda’s Auto Policy insured three automobiles but not Corey’s motorcycle. Linda’s policy had a UIM coverage limit of $100,000 per person, and Linda signed a waiver of stacked UIM coverage on her policy which complied with the waiver form mandated by Section 1738(d) of the MVFRL. First, the Pennsylvania Court considered whether an insured’s signature on the waiver form mandated by 75 Pa.C.S. 1738(d) resulted in the insured’s waiver of inter-policy stacking of UIM coverage where the relevant policy insured multiple vehicles. To this, the Supreme Court held the waiver invalid as applied to inter-policy stacking for multi-vehicle policies in light of its decision in Craley v. State Farm Fire and Casualty Co., 895 A.2d 530 (Pa. 2006). The Court then determined whether the policy’s household vehicle exclusion was enforceable following its decision in Gallagher v. GEICO Indemnity Company, 201 A.3d 131 (Pa. 2019). Finally, after concluding that the household vehicle exclusion was unenforceable absent a valid waiver of inter-policy stacking, the Court addressed the third question posed by the Court of Appeals regarding the applicability of the policy’s coordination of benefits provision for unstacked UIM coverage. After review, the Supreme Court held that the policy’s coordination of benefits provision for unstacked UIM coverage did not apply absent a valid waiver of inter-policy stacking. Having answered these questions of law, the matter was returned to the Third Circuit. View "Donovan, et al. v. State Farm Mutual Ins. Co." on Justia Law