Justia Insurance Law Opinion Summaries

In this insurance dispute over whether an insurer's payment of an appraisal award obtained under a unilateral appraisal clause bars an insured's claims under the Texas Prompt Payment of Claims Act (TPPCA), Tex. Ins. Code chapter 542 the Supreme Court reversed the judgment of the court of appeals concluding that Insured's claims were barred, holding that Insured's claims should be considered in light of this Court's recent decisions on these issues.After Insurer declined to pay for damage to Insured's properties Insured asked to invoke the policy's appraisal process. Insurer refused, asserting that it was the only party that could invoke appraisal under the unilateral appraisal clause. Insured sued Insurer alleging claims for breach of contract, bad faith, and violations of the TPPCA. Insurer then obtained an order compelling appraisal. After Insurer paid the appraisal award the trial court granted summary judgment for Insurer. The court of appeals affirmed. The Supreme Court reversed, holding that remand was required for the trial court to consider Insured's claims in light of Barbara Technologies Corp. v. State Farm Lloyds, 589 S.W.3d 806 (Tex. 2019), and Ortiz v. State Farm Lloyds, 589 S.W.3d 127 (Tex. 2019). View "Biasatti v. GuideOne National Insurance Co." on Justia Law

The Supreme Court reversed the judgment of the court of appeals concluding that an insurer's payment of an appraisal award bars an insured's claim under the Texas Prompt Payment of Claims Act (TPPCA), Tex. Ins. Code 542.051-.061, holding that the court of appeals' opinion was inconsistent with this Court's recent decisions on this issue.Insurer issued Insured payment under Insured's insurance policy after Insured's residential property sustained wind and hail damage. Insured later sued, believing that the property damages were undervalued. The trial court compelled appraisal, and the appraisal awarded exceeded Insurer's prior estimates. Insurer paid the award to Insured. The trial court subsequently granted summary judgment on all of Insured's claims. The court of appeals affirmed, concluding that payment of an appraisal award entitles an insurer to summary judgment on all of the insured's claims. The Supreme Court reversed, holding that the court of appeals' conclusion was in error in light of Barbara Technologies Corp. v. State Farm Lloyds, 589 S.W.3d 806 (Tex. 2019), and Ortiz v. State Farm Lloyds, 589 S.W.3d 127 (Tex. 2019). View "Lazos v. State Farm Lloyds" on Justia Law

The Supreme Court reversed the judgment of the court of appeals concluding that an insurer's payment of an appraisal award bars an insured's claim under the Texas Prompt Payment of Claims Act (TPPCA), Tex. Ins. Code 542.051-.061, holding that the court of appeals' opinion was inconsistent with this Court's recent decisions on this issue.Insurer issued Insured payment under Insured's insurance policy after Insured's residential property sustained wind and hail damage. Insured later sued, believing that the property damages were undervalued. The trial court compelled appraisal, and the appraisal awarded exceeded Insurer's prior estimates. Insurer paid the award to Insured. The trial court subsequently granted summary judgment on all of Insured's claims. The court of appeals affirmed, concluding that payment of an appraisal award entitles an insurer to summary judgment on all of the insured's claims. The Supreme Court reversed, holding that the court of appeals' conclusion was in error in light of Barbara Technologies Corp. v. State Farm Lloyds, 589 S.W.3d 806 (Tex. 2019), and Ortiz v. State Farm Lloyds, 589 S.W.3d 127 (Tex. 2019). View "Alvarez v. State Farm Lloyds" on Justia Law

Plaintiff filed suit against defendants after defendants denied plaintiff's claim for damages to its apartment complex caused by a ruptured underground water main.The Court of Appeal affirmed the trial court's judgment following summary adjudication in favor of defendants on plaintiff's claim for breach of the covenant of good faith and fair dealing relating to the parties' insurance contract. The court agreed with the trial court that there is no material dispute whether defendants denied the claim in good faith based on an expert report concluding the damage was not caused by the broken water main. In this case, there is no dispute that defendants based their claim denial on the final expert report, and there is no evidence that the report was contrived or false. View "501 East 51st Street v. Kookmin Best Insurance Co." on Justia Law

The Supreme Court reversed the decision of the court of appeals applying a constructive trust to proceeds Lynnea Landsee-Pulkkila collected from a life insurance policy maintained by her late husband, James Pulkkila, holding that the court of appeals erred in imposing a constructive trust absent findings of fact that would support such an imposition.In 2009, James and Joan Pulkkila divorced. In their marital settlement agreement (MSA) that was incorporated into the judgment of divorce James and Joan were required to maintain life insurance with their children as beneficiaries. In 2013, James and Lynnea were married. The following year, James submitted a beneficiary name change asking that Lynnea be made the sole beneficiary of the life insurance policy. After Lynnea was paid the proceeds of the policy, Joan asserted that James breached the MSA agreement and that a constructive trust should be placed on the proceeds. The circuit court denied Joan's motion for a constructive trust. The court of appeals reversed, concluding that equity required the imposition of a constructive trust. The Supreme Court reversed, holding that the court of appeals erroneously exercised its discretion because it determined that a constructive trust was appropriate in the absence of an evidentiary hearing and resulting relevant factual findings. View "Pulkkila v. Pulkkila" on Justia Law

The First Circuit affirmed the judgment of the district court dismissing Plaintiffs' breach of contract action against Defendant, their insurer, holding that the district court properly dismissed for failure to state a claim Plaintiffs' claim that Defendant failed to defend and indemnify them in a state court action.Newton Covenant Church (NCC) was comprised of members of the Newton Presbyterian Church (NPC) who withdrew from the Presbyterian Church (USA) and affiliated with a non-Presbyterian organization. NPC and the Presbytery of Boston sued the NCC in the state superior court seeking, among other things, a declaratory judgment that NPC owned church property at 75 Vernon Street in Newton, Massachusetts. NCC submitted a notice to the Great American Insurance Company (GAIC) requesting a defense in the state court action under a Director and Officers insurance policy. GAIC denied coverage on the grounds that the named insured under the policy was NPC, not NCC. After the parties reached a settlement NCC and its individual officers (collectively, Plaintiffs) brought this action against GAIC for breach of contract. The district court dismissed the complaint. The First Circuit affirmed, holding that Plaintiffs' allegations were not reasonably susceptible of an interpretation that would state a claim covered under the policy. View "Newton Covenant Church v. Great American Insurance Co." on Justia Law

United owns a fleet of ambulances. In 2016, Stofko was driving his car when a United ambulance crashed into it; Stofko’s injuries were fatal. United was insured by Markel but the particular ambulance that crashed was not listed on the policy. Rau, the representative of Stofko’s estate, argued that it was nevertheless covered by the policy because before the crash United sent Markel’s agent, Insurance Service Center, an email requesting that the vehicle be added to the policy. The Center denied seeing the email and United acknowledged that it had not received a response as was customary. Markel argued that even if United had sent an email, it never endorsed the change, which the policy requires, and has no duty to indemnify United or the driver and no duty to defend in Rau’s suit. The Seventh Circuit affirmed summary judgment in favor of Markel. It is not necessary to resolve what happened to the email request to add the vehicle to the policy; under Indiana law courts may not rewrite an insurance contract. Neither Center nor Markel accepted or responded in any way to United’s request, so the ambulance was not covered. View "Markel Insurance Co. v. Rau" on Justia Law

The Second Circuit certified a question of insurance law to the New York Court of Appeals: Must a general liability insurance carrier defend an insured in an action alleging discrimination under a failure-to-accommodate theory? View "Brooklyn Center for Psychotherapy, Inc. v. Philadelphia Indemnity Insurance Co." on Justia Law

The Supreme Court affirmed the judgment of the circuit court concluding that coverage did not exist under an automobile insurance policy issued to Shelby Olsons' parents or an automobile policy issued to the shooter for injuries sustained by Shelby when she was struck by a bullet while riding in the backseat of her parents' vehicle, holding that the circuit court did not err.Shelby was struck by a bullet when the driver of another vehicle fired a handgun at the Olsons' vehicle. At issue was whether coverage for Shelby's injuries existed under the automobile policy issued to her parents or under the automobile policy issued to the shooter. The circuit court concluded that coverage did not exist under either policy because the injuries did not arise out of the use of a vehicle and, alternatively, were not caused by an accident. The Supreme Court affirmed, holding that the circuit court did not err in granting summary judgment in favor of the insurance companies. View "Olson v. Slattery" on Justia Law

The Supreme Court affirmed the judgment of the trial court declaring that the School the City of Richmond's School Board's UM/UIM motorist coverage was $1 million, as provided in the contract between the School Board and the Virginia Association of Counties Group Self-Insurance Risk Pool (VACORP), holding that the $1 million in UM/UIM coverage the School Board contracted for was the amount of available UM/UIM coverage.Maisia Young was injured while riding a school bus. Young filed suit against the School Board seeking damages for her personal injuries. The School Board was self-insured through a self-insurance risk pool managed by VACORP. Young filed a declaratory judgment action to determine the extent of the coverage available to the School Board under the UM/UIM provisions of its contract. VACORP argued that $50,000 was the maximum amount of coverage available, as set by statute. In response, Young argued that the statutes set a minimum, not a cap, and that the maximum available was what was specified in the contract. The circuit court agreed with Young. The Supreme Court affirmed, holding that the School Board's UM/UIM coverage was $1 million, as provided in the contract between the School Board and VACORP. View "VACORP v. Young" on Justia Law