Justia Insurance Law Opinion Summaries

In this insurance dispute, the Supreme Court answered a question of Texas law in a case certified from the United States Court of Appeals for the Fifth Circuit by stating that a "policy-language exception" to the "eight-corners rule" is not a permissible exception under Texas law.The certified question asked about the "eight-corners rule," which is given its name by the "four corners" of the petition and the "four corners" of the policy. Under the eight-corners rule an insurer's "duty to defend is determined by the claims alleged in the petition and the coverage provided in the policy. The instant case concerned a dispute as to whether State Farm must defend its insureds against personal injury claims. According to one federal district court applying Texas law, the eight-corners rule does not apply unless the policy includes language requiring the insurer to defend all actions against its insured, even if the allegations are groundless, fraudulent, or false. The case made its way to the federal district court, which asked whether the "policy-language exception" to the eight-corners rule was a permissible exception under Texas law. The Supreme Court answered that it was not. View "Richards v. State" on Justia Law

The Fifth Circuit affirmed the district court's adverse judgment against plaintiffs on Employee Retirement Income Security Act (ERISA) claims assigned by Cigna-insured patients. The court held that the law of the case did not require the district court on remand to determine the legal correctness of Cigna's policy interpretation, and under Connecticut General Life Insurance Co. v. Humble Surgical Hospital, L.L.C., 878 F.3d 478, 485 (5th Cir. 2017), a court need not reach legal correctness if the insurer's determination was not an abuse of discretion. Furthermore, Humble moots consideration of the conflicts and inferences of bad faith that plaintiffs assert against Cigna.In this case, the district court correctly applied this court's previous decision in the instant controversy as well as Humble, and thus plaintiffs' exhaustion argument was moot. Plaintiffs' procedural challenge to Cigna's review failed for lack of substantiating evidence, which left the damages issue moot. Finally, plaintiffs failed to establish any right to attorney's fees. View "North Cypress Medical Center Operating Co. v. Cigna Healthcare" on Justia Law

IberiaBank filed suit against the insurers for breach of contract after the insurers denied IberiaBank's claim for coverage in the underlying DOJ Settlement.The Fifth Circuit affirmed the district court's grant of the insurers' motion to dismiss, holding that the government is not IberiaBank's "client" and did not become IberiaBank's "client" as a result of the Direct Endorsement Program. Therefore, IberiaBank's DOJ Settlement claim was not covered by the policies and the district court properly granted the insurers' motions to dismiss. The court need not consider Travelers' alternative argument. View "IberiaBank Corp. v. Illinois Union Insurance Co." on Justia Law

Perry’s home suffered water damage and required extensive repairs. She filed a claim with her insurer, Allstate, which did not dispute that Perry’s home was seriously damaged, or that it was required to pay for repairs or replacement. The parties agreed that the total estimated cost to repair or replace Perry’s home is $32,965.09. After making deductions for “depreciation,” Allstate provided Perry with a net payment of $28,394.74. Perry’s Allstate policy provides, “If you do not repair or replace the damaged, destroyed or stolen property, payment will be on an actual cash value basis. This means there may be a deduction for depreciation.” The policy does not define “depreciation.” Allstate contends that “depreciation” must account for the cost of both materials and labor. Perry claims that “depreciation” is ambiguous with respect to labor costs. The district court reversed the dismissal of Perry’s lawsuit. Under Ohio law, when an insurance policy is ambiguous, courts must interpret the policy strictly against the insurer, so long as the insured’s interpretation is reasonable. Perry’s reading of the term “depreciation” is a reasonable interpretation of an ambiguous policy, so Allstate may not include the cost of labor in calculating depreciation. View "Perry v. Allstate Indemnity Co." on Justia Law

The Fifth Circuit affirmed the district court's dismissal of a complaint brought by two policyholders against their insurance company, claiming that it should pay for the taxes and fees associated with replacing their totaled vehicles, thus making them whole. The court interpreted the relevant policy language under Texas law and held that each of the policyholders was entitled to the fair market value of his pre-loss vehicle. The court also held that the fair market value does not include the taxes and fees payable to purchase a replacement vehicle. View "Singleton v. Elephant Insurance Co." on Justia Law

The insured, Brenda Sandoval, submitted a claim to her insurer, Unum Life Insurance Company of America, which initially paid benefits but then terminated them. The termination of benefits led Sandoval to sue Unum for: (1) a common-law tort (bad faith breach of insurance contract); (2) a statutory tort (unreasonable conduct under Colo. Rev. Stat. sec. 10-3-1115 to 1116); and (3) breach of contract. The district court granted Unum’s motion for partial summary judgment on the tort claims. The contract claim went to trial, where the jury rendered a verdict for Sandoval. The district court later denied Unum’s motion for judgment as a matter of law. Sandoval appealed the grant of Unum’s motion for partial summary judgment, and Unum cross-appealed the denial of its motion for judgment as a matter of law. After review, the Tenth Circuit affirmed the award of partial summary judgment on the tort claims because Unum conducted a reasonable investigation. On the contract claim, the Court also affirmed the denial of Unum’s motion for judgment as a matter of law: the policy contained two alternative tests for a disability, and the evidence permitted a reasonable finding that Sandoval had satisfied at least one of these definitions. View "Sandoval v. UNUM Life Insurance" on Justia Law

The Eighth Circuit affirmed the district court's grant of judgment on the pleadings in favor of the county in a dispute regarding Argonaut's duty to defend the county against a civil rights lawsuit.Under Missouri law, the court held that Argonaut had a duty to defend the county. The court explained that the duty to defend is analyzed by comparing the language of the policy with the allegations in the complaint, and if the complaint alleges facts that merely give rise to a potential claim within coverage, the insurer has a duty to defend. In this case, the county procured insurance to shield itself against, among other things, possible constitutional claims against its officers and agents during the performance of their law enforcement duties. Therefore, there was a covered wrongful act under the policy during the time the policy was in effect. View "Argonaut Great Central Insurance Co. v. Lincoln County" on Justia Law

In this appeal concerning whether a settlement contract under Rhode Island law was formed after a personal injury lawsuit was filed the First Circuit certified to the Rhode Island Supreme Court the question of what is the definition of 'civil action' in R.I. Gen. Laws 27-7-2.2.Horace Johnson was the driver and Carlton Johnson was the sole passenger in a car accident. The accident occurred in Rhode Island. Both men were seriously injured. Horace was insured by Arbella Mutual Insurance Company. Arbella accepted Carlton's demand to settle for the policy limit of $100,000. Thereafter, Carlton filed a lawsuit against Horace, Arbella, and other defendants. A federal district court granted summary judgment for Defendants. The district court rejected Carlton's argument that Rhode Island's Rejected Settlement Offer Interest Statute, section 27-7-2.2, applied to the case. Carlton appealed, arguing that the statute rendered the settlement contract unenforceable because Arbella failed to accept his settlement offer within the timetable set forth by the statute. At issue was whether the court correctly determined that the statute's "[i]n any civil action" language requires that a legal proceeding in court needs to be underway to trigger the statute's application. The First Circuit certified to the Rhode Island Supreme Court a question concerning the definition of "civil action." View "Johnson v. Johnson" on Justia Law

The Supreme Court affirmed the judgment of the district court granting summary judgment in favor of Plaintiff's employer's insurance broker and insurer and dismissing Plaintiff's action claiming that the broker had a duty to advise the employer to obtain workers' compensation insurance and that the insurer had a duty to defend the employer in the underlying action, holding that the district court did not err.Plaintiff was injured in an accident during the course and scope of his employement. Plaintiff reached a settlement with his employer and received an assignment of rights against his employer's insurance broker and insurer. Plaintiff then brought this action. The district court concluded that both the broker and the insurer were entitled to judgment as a matter of law. The Supreme Court affirmed, holding that the district court did not err in (1) applying case law applicable to insurance agents rather than insurance brokers; (2) finding that the broker fulfilled its duties as an insurance broker to the employer; and (3) finding that the insurer did not owe a duty to defend the insurer. View "Merrick v. Fischer, Rounds & Associates, Inc." on Justia Law

The Supreme Court affirmed the decision of the circuit court determining that Insurer's decision to deny coverage for a single-vehicle accident was not in violation of its duty, holding that the court did not err in concluding that the insurance policy did not provide coverage for Defendant's injuries.Appellant suffered serious injuries when a van in which he was a passenger rolled over in a single-vehicle accident. Appellant brought an action against the driver for personal injuries. The driver had purchased a motor vehicle insurance policy from Insurer. Relying upon policy provisions excluding coverage for any vehicle being used to carry people for a fee, Insurer denied coverage and refused to defend the driver. Insurer then brought this declaration action against Appellant and the driver to determine coverage. The circuit court determined that Insurer had no contractual obligation to defend the driver or provide indemnity for the accident. The Supreme Court affirmed, holding the circuit court did not err in concluding that Insurer's policy exclusions were applicable and denying coverage for the accident. View "Western Agricultural Insurance Co. v. Arbab-Azzein" on Justia Law