Justia Insurance Law Opinion Summaries

Ramon Vasquez, Jr., sustained injuries while working in a restaurant and subsequently filed a workers' compensation claim, which was accepted by AmTrust North America, Inc. AmTrust paid $177,335.59 in benefits. Vasquez then initiated third-party litigation against several defendants, resulting in a $400,000 settlement. AmTrust, having intervened as subrogee, sought to recover its lien from the settlement proceeds. Vasquez argued that AmTrust was not entitled to any of the settlement proceeds based on prior case law.The Eighth Judicial District Court of Clark County held that AmTrust did not meaningfully participate in the third-party litigation and thus had to bear a portion of the litigation costs and fees under the Breen formula. The court also ruled that AmTrust could not recover from the portion of the settlement allocated to noneconomic damages, as per Poremba. Consequently, the district court adjudicated AmTrust’s lien at $0 and dismissed its complaint.The Supreme Court of Nevada reviewed the case and found that the Breen formula, which required insurers to bear a portion of litigation costs, conflicted with NRS 616C.215(5). The court held that there is no requirement for an insurer to intervene or participate in the third-party claim to recover on its lien. The court also overruled the Breen formula and Poremba to the extent they conflicted with the statute, stating that an insurer's lien applies to the total proceeds of any recovery, including noneconomic damages. The Supreme Court of Nevada reversed the district court’s order and remanded the case for further proceedings consistent with this opinion. View "Amtrust North America, Inc. v. Vasquez" on Justia Law

Zurich American Insurance Company issued a builder’s risk insurance policy for the construction of an academic building for City Colleges of Chicago. Infrastructure Engineering, Inc. (IEI), a subcontractor, designed a rainwater collection system for the project. During construction, a rainstorm caused significant flooding and damage to the building. Zurich paid the claim to CMO, the general contractor, and then sued IEI for breach of contract, alleging that IEI’s design caused the damage.The Cook County circuit court granted summary judgment in favor of IEI, agreeing with IEI’s argument that Zurich was not entitled to subrogation because the payment was made to CMO, not City Colleges, and CMO repaired the damage. Zurich appealed, and the appellate court reversed the circuit court’s decision, holding that Zurich was entitled to subrogation under the policy’s provisions, which allowed Zurich to step into City Colleges’ shoes.The Supreme Court of Illinois reviewed the case and affirmed the appellate court’s judgment. The court held that City Colleges, as the owner of the damaged property, had an insurable interest and sustained a loss when the building was damaged. The court found that Zurich, having paid for the repairs through CMO, was entitled to subrogation rights under the clear terms of the builder’s risk policy. The court rejected IEI’s argument that City Colleges did not sustain a loss or receive payment, emphasizing that CMO acted as City Colleges’ agent in handling the claim and repairs. The case was remanded for further proceedings consistent with this opinion. View "Zurich American Insurance Co. v. Infrastructure Engineering, Inc." on Justia Law

In this case, a primary insurer, Westport Insurance Corporation, and an excess insurer, Pennsylvania National Mutual Casualty Insurance Company, disputed liability for a judgment against their mutual insured, Insurance Alliance (IA). IA was sued by Lake Texoma Highport LLC for failing to procure requested insurance coverage, resulting in significant property damage. IA had a primary insurance policy with Westport and an excess policy with Penn National. Westport controlled the defense and rejected multiple settlement offers from Highport. A jury found IA liable, resulting in a $13.7 million judgment.The United States District Court for the Southern District of Texas determined that Penn National breached its duties to defend and indemnify IA. However, a jury found that Westport violated its Stowers duty by not accepting reasonable settlement offers. The district court ruled that Penn National's breaches occurred after Westport's Stowers violation and thus did not impact the case outcome.The United States Court of Appeals for the Fifth Circuit reviewed the case. The court affirmed that Penn National breached its duties but held that Westport's Stowers duty was triggered by Highport's settlement offers, which Westport unreasonably rejected. The court found that the district court's jury instructions were correct and that Penn National had standing to assert a Stowers claim. The court also concluded that the district court did not err in its jury instructions or in setting aside the jury's verdict regarding the May 2009 demand.Ultimately, the Fifth Circuit affirmed the district court's judgment, holding that Westport was liable for the excess judgment due to its Stowers violation, and Penn National was entitled to reimbursement for the amount it paid on IA's behalf. View "Westport Insurance Corporation v. Pennsylvania National Mutual Casualty Insurance Company" on Justia Law

Elizabeth Holt, a former insurance agent for Medicare Medicaid Advisors, Inc. (MMA), alleged that MMA and several insurance carriers (Aetna, Humana, and UnitedHealthcare) violated the False Claims Act (FCA). Holt claimed that MMA engaged in fraudulent practices, including falsifying agent certifications and violating Medicare marketing regulations, which led to the submission of false claims to the Centers for Medicare and Medicaid Services (CMS).The United States District Court for the Western District of Missouri dismissed Holt's complaint. The court found that no claims were submitted to the government, the alleged regulatory violations were not material to CMS’s contract with the carriers, and the complaint did not meet the particularity standard required by Federal Rule of Civil Procedure 9(b). The court also denied Holt's motion for reconsideration, which introduced a fraudulent inducement theory and requested leave to amend the complaint.The United States Court of Appeals for the Eighth Circuit reviewed the case. The court affirmed the district court's dismissal, agreeing that Holt's allegations did not meet the materiality requirement under the FCA. The court applied the materiality standard from Universal Health Services, Inc. v. United States ex rel. Escobar, considering factors such as whether the government designated compliance as a condition of payment, whether the violations were minor or substantial, and whether the government continued to pay claims despite knowing of the violations. The court found that the alleged violations did not go to the essence of CMS’s contract with the carriers and were not material to the government's payment decisions.The Eighth Circuit also upheld the district court's denial of Holt's motion for reconsideration and request to amend the complaint, concluding that adding a fraudulent inducement claim would be futile given the immateriality of the alleged violations. View "United States ex rel. Holt v. Medicare Medicaid Advisors" on Justia Law

The case involves a dispute between Century Surety Company, acting as a subrogee of Triangle Engineering, L.P., and Colgate Operating, L.L.C. over the interpretation of a Master Services/Sales Agreement (MSA) and the insurance policies of the parties. Colgate, an oil well operator, and Triangle, an oilfield consultancy, entered into the MSA in April 2017, which included mutual indemnity provisions supported by liability insurance. Both parties purchased insurance, but Colgate's coverage was significantly higher than Triangle's. Following an accident involving a worker, Century, as Triangle’s subrogee, sought reimbursement from Colgate for a settlement payment.The United States District Court for the Western District of Texas granted summary judgment in favor of Colgate. The court rejected affidavits from Colgate’s vice president and Triangle’s sole member, which were intended to clarify the parties' intentions at the time of the MSA signing. The district court concluded that the MSA did not specify a ceiling for insurance coverage and applied the "lowest common denominator rule" from the Texas Supreme Court’s decision in Ken Petroleum Corp. v. Questor Drilling Corp., limiting Colgate’s indemnity obligation to $6 million, the amount of coverage Triangle had purchased.The United States Court of Appeals for the Fifth Circuit reviewed the case de novo and affirmed the district court’s judgment but on different grounds. The appellate court agreed that the district court correctly excluded the extrinsic evidence but found that the MSA itself provided both a floor and a ceiling of $5 million for mutual indemnity coverage. The court held that Colgate’s insurance policies did not alter this limit and that Colgate was not liable to Century beyond the $5 million specified in the MSA. Thus, the court affirmed the district court’s judgment in favor of Colgate. View "Century Surety Co. v. Colgate Operating" on Justia Law

A fire damaged a hotel owned by Shri Ganesai, LLC, which had an insurance policy with AmGuard Insurance Company. The policy also covered the mortgagee, Academy Bank, N.A. AmGuard denied Shri's claim, suspecting arson by Shri's principal, Alex Patel. During the investigation, the building suffered additional damage from vandalism and frozen pipes. Shri and Academy sued AmGuard for breach of contract and vexatious refusal to pay. The jury found in favor of the plaintiffs, awarding damages for the fire, vandalism, and freeze damage.The United States District Court for the Western District of Missouri denied AmGuard's motions for judgment as a matter of law and a new trial. AmGuard appealed, challenging the viability of Academy's vexatious-refusal claim, the exclusion of certain evidence, and the sufficiency of the evidence regarding damages from vandalism and frozen pipes. The district court had granted summary judgment to AmGuard on Shri's vexatious-refusal claim but allowed the remaining claims to proceed to trial.The United States Court of Appeals for the Eighth Circuit affirmed the district court's decisions. The court held that Academy's vexatious-refusal claim was viable despite the settlement of the underlying breach-of-contract claim, as AmGuard's delay in payment constituted vexatious conduct. The court also found no abuse of discretion in the district court's exclusion of certain evidence, including the testimony of a witness and parts of Patel's deposition. Additionally, the court ruled that sufficient evidence supported the jury's findings on the timing and extent of the vandalism and freeze damage, and that the expert testimony admitted was reliable. The court concluded that the district court did not err in denying AmGuard's motions for judgment as a matter of law or a new trial. View "Academy Bank, N.A. v. Amguard Insurance Company" on Justia Law

On August 10, 2020, a derecho caused significant damage to the plaintiffs' property in Cedar Rapids, Iowa. The plaintiffs filed a claim with their insurer, State Farm, which initially paid $2,297.26 for the damage. After further submissions and inspections, State Farm increased the payment by $3,822.68. The plaintiffs' contractor estimated the repair costs at $21,537.45, but State Farm disagreed, leading to further disputes and inspections. Eventually, the plaintiffs requested an appraisal, which set the actual cash value (ACV) at $16,155.48 and the replacement cost value (RCV) at $21,069.59. State Farm paid the plaintiffs the difference between the initial payments and the new ACV but required documentation of repairs for the RCV.The plaintiffs filed a lawsuit in state court for breach of contract and bad faith, which was removed to federal court. The district court granted summary judgment to State Farm, holding that the insurer had not breached the contract because it had paid the ACV and the plaintiffs had not completed repairs within the two-year policy deadline to claim the RCV. The court also found that State Farm had an objectively reasonable basis for its payment decisions, negating the bad-faith claim.The United States Court of Appeals for the Eighth Circuit reviewed the case. The court affirmed the district court's decision, holding that State Farm did not breach the contract as the plaintiffs failed to complete repairs within the required two-year period. The court also held that State Farm had a reasonable basis for its initial payment decisions and did not act in bad faith. The court concluded that the plaintiffs were not entitled to further payments under the policy and that State Farm's actions were justified. View "Henderson v. State Farm Fire & Casualty Co." on Justia Law

In 2017, five plaintiffs sued three excess insurers, alleging breach of contract, declaratory relief, breach of the covenant of good faith and fair dealing, and aiding and abetting breaches of fiduciary duty. The plaintiffs claimed that the insurers failed to cover litigation costs related to a series of disputes between the plaintiffs and another party, Paine. The insurance policies in question provided $40 million in excess coverage, divided into four layers of $10 million each.The San Francisco County Superior Court sustained the demurrers of two excess insurers, St. Paul and Liberty Mutual, without leave to amend, on the grounds that the plaintiffs failed to allege exhaustion of the underlying insurance policies. The court overruled the demurrer of the first-level excess insurer, Twin City, allowing the claims against Twin City to proceed.The California Court of Appeal, First Appellate District, Division Two, affirmed the trial court's decision. The appellate court held that the plaintiffs did not sufficiently allege exhaustion of the underlying insurance policies, which is a prerequisite for triggering the excess coverage. The court also found that the plaintiffs' claims for declaratory relief, bad faith, and aiding and abetting breaches of fiduciary duty were properly dismissed. The court concluded that the plaintiffs failed to demonstrate a reasonable possibility of curing the defects in their complaint through further amendment. The judgments in favor of St. Paul and Liberty Mutual were affirmed, and the plaintiffs' appeal was denied. View "Fox Paine & Co., LLC v. Twin City Fire Insurance Co." on Justia Law

Levi Werley was seriously injured while riding an uninsured dirt bike. After the insurance of the driver who struck him did not fully compensate for his injuries, Levi’s parents sought underinsured motorist (UIM) benefits under their own automobile insurance policies. Their insurer, Mid-Century Insurance Company, paid $250,000 under one policy but denied an additional $250,000 under another policy, citing a household vehicle exclusion. The Werleys argued that this exclusion was invalid and unenforceable.The United States District Court for the Eastern District of Pennsylvania agreed with the Werleys, ruling that the household vehicle exclusion was invalid under Pennsylvania’s Motor Vehicle Financial Responsibility Law (MVFRL). The court held that the exclusion acted as a de facto waiver of stacking, which is not permissible under the MVFRL. Consequently, the court granted summary judgment in favor of the Werleys, entitling them to the additional UIM benefits.The United States Court of Appeals for the Third Circuit reviewed the case and vacated the District Court’s order. The Third Circuit held that the household vehicle exclusion in the Multi-Vehicle Policy was valid and enforceable. The court distinguished this case from precedents like Gallagher v. GEICO Indemnification Co. and Donovan v. State Farm Mut. Auto. Ins. Co., noting that the Werleys had never paid premiums for UIM coverage on the dirt bike. The court emphasized that exclusions limiting UIM coverage are generally enforceable unless they act as impermissible de facto waivers of stacking, which was not the case here. The Third Circuit remanded the case with instructions to enter judgment in favor of Mid-Century. View "Mid-Century Insurance Co v. Werley" on Justia Law

A fire damaged a malt beverage store owned by A Maxon Company, LLC (AMC). Acuity Insurance Company sought a declaratory judgment to determine coverage under an insurance policy listing Greg and Tammy Weatherspoon as additional loss payees. The Weatherspoons counterclaimed for breach of contract. The circuit court granted Acuity’s motion for judgment as a matter of law on the Weatherspoons’ counterclaim, determining that the insurance policy terms prevented the Weatherspoons from recovering damages unless AMC successfully asserted a claim. The jury found that AMC principal, Russel Maxon, had intentionally started the fire, excluding coverage under AMC’s policy. The Weatherspoons appealed.The Circuit Court of the Fourth Judicial Circuit, Corson County, South Dakota, initially denied the Weatherspoons’ motion for summary judgment, ruling that the insurance contract was unambiguous and that the Weatherspoons’ claim was dependent on AMC’s claim. The court also denied Acuity’s motion for summary judgment, finding that there were factual disputes suitable for a jury. At trial, the court granted Acuity’s motion for judgment as a matter of law, concluding that the Weatherspoons could not recover under the policy because AMC’s claim was excluded due to Russel’s intentional act.The Supreme Court of the State of South Dakota affirmed the circuit court’s decision. The court held that the insurance policy’s Loss Payable Clause only allowed the Weatherspoons to collect if AMC could collect, and since the jury found that Russel intentionally started the fire, AMC was precluded from recovering. The court also found no abuse of discretion in admitting expert testimony from Special Agent Derek Hill and allowing the impeachment of Tracy Maxon with prior inconsistent statements. The court concluded that the Weatherspoons’ arguments regarding ambiguity and third-party beneficiary status were unavailing. View "Acuity Insurance V. A Maxon Company" on Justia Law