Justia Insurance Law Opinion Summaries

The Supreme Court affirmed the decision of the district court granting summary judgment in favor of an insurer on the grounds that the plaintiff's contractual assignment was unenforceable, holding that a residential contractor acting as an unlicensed public adjuster cannot enforce its post-loss contractual assignment of insurance benefits against the homeowner's insurer.The contractor in this case represented homeowners as an assignee of their insurance claim for storm damage to their home. The district court concluded that the contractor's contractual assignment was invalid because the contractor acted as an unlicensed public adjuster. The Supreme Court affirmed, holding that the district court did not err in ruling that the contractor acted as an unlicensed public adjuster and that the assignment contract was void and unenforceable under Iowa Code 103A.71(5). View "33 Carpenters Construction, Inc. v. IMT Insurance Co." on Justia Law

The Supreme Court affirmed the district court's grant of summary judgment for an insurer on the grounds that the plaintiff's contractual assignment was unenforceable, holding that a residential contractor acting as an unlicensed public adjuster cannot enforce its postloss contractual assignment of insurance benefits against the homeowner's insurer.Iowa Code 103A.71(5) declares void contracts entered into by residential contractors who perform public adjuster services without the license required under Iowa Code 522C.4. The contractor in this case represented homeowners as an assignee of their insurance claim for hail damage to their home. The district court concluded that the contractor's contractual assignment was invalid under section 103A.71(5) because the contractor acted as an unlicensed public adjuster. The Supreme Court affirmed, holding that the district court did not err in ruling that the contractor acted as an unlicensed public adjuster and that the assignment contract was unenforceable and void under Iowa law. View "33 Carpenters Construction, Inc. v. State Farm Fire & Casualty Co." on Justia Law

The Supreme Court affirmed the decision of the court of appeals affirming the district court's grant of summary judgment in favor of Cincinnati Insurance Company in this insurance dispute, holding that, for the reasons set forth in 33 Carpenters Construction, Inc. v. State Farm Life & Casualty Co., __ N.W.2d __ (Iowa 2020), an assignment contract entered into by a residential contractor acting as an unlicensed public adjuster is void under Iowa Code 103A.71(5).After a hailstorm and windstorm damaged Gregg Whigham's residence, Whigham and 33 Carpenters Construction, Inc. entered into an agreement under which 33 Carpenters would repair the damage in exchange for Wigham's insurance proceeds. A 33 Carpenters representative and Whigham then signed an assignment of claim and benefits. Later, 33 Carpenters sued Whigham's insurer, Cincinnati, claiming that Cincinnati breached the insurance policy by failing to by 33 Carpenters all benefits due and owing under the policy that had been assigned to it. The district court granted summary judgment to Cincinnati, concluding that the purported assignment of Whigham's insurance claim was invalid. The Supreme Court affirmed, holding that because 33 Carpenters was operating as an unlicensed public adjuster, the assignment contract was unenforceable. View "33 Carpenters Construction, Inc. v. Cincinnati Insurance Co." on Justia Law

Travelers won summary judgment in this duty-to-defend insurance dispute with its insured, KLA. The superior court concluded that the language of the commercial liability insurance policies, which covered claims for “malicious prosecution,” could not have created an objectively reasonable expectation that Travelers would defend a “Walker Process claim” against KLA. The Walker Process claim that KLA tendered to Travelers alleged that KLA had fraudulently procured a patent and used that patent to attempt to monopolize the market for a product. KLA argued that it was objectively reasonable for it to expect the “malicious prosecution” coverage in its policies to extend to this Walker Process claim. The court of appeal affirmed. Coverage language is construed as of the time of issuance of the policy, so the construction of that language cannot depend on the precise allegations made in a subsequent complaint. The history of prior litigation between the parties did not change the basis for this claim into one for malicious prosecution because there were no allegations of any legal proceedings involving the patent. View "Travelers Property Casualty Co. of America v. KLA-Tencor Corp." on Justia Law

Of two people injured in a car wreck in April 2012, one was a Medicare beneficiary who received her benefits from an MAO-Florida Healthcare Plus, which later assigned its claims to appellant MSPA Claims 1, LLC. The other party involved in the accident was insured by appellee Kingsway Amigo Insurance. The Medicare beneficiary obtained medical treatment for her accident-related injuries between April 29, 2012 and July 26, 2012, and Florida Healthcare made $21,965 in payments on her behalf. On March 28, 2013, the beneficiary settled a personal-injury claim with Kingsway and received a $6,667 settlement payment. The issue this case presented for the Eleventh Circuit’s review centered on the timeliness requirement with which the government had to comply as a prerequisite to filing suit to seek reimbursements that it made on behalf of the Medicare beneficiary, and whether filing suit beyond a statutory three-year period beginning on the date on which medical services were rendered was fatal to the government’s claim. The district court held that MSPA’s claim was stale because it didn’t comply with what the court (somewhat confusingly) called “the three-year limitation requirement.” The Eleventh Circuit disagreed and reversed. “The Medicare Secondary Payer Act’s private cause of action, and our cases interpreting it lead us to conclude that the Act’s claims-filing provision, doesn’t erect a separate bar that private plaintiffs must overcome in order to sue. A closer look at the claims-filing provision’s text and the Act’s structure confirms that conclusion. Accordingly, the district court erred in granting Kingsway’s motion for judgment on the pleadings.” View "MSPA Claims 1, LLC v. Kingsway Amigo Insurance Company" on Justia Law

The Office of Personnel Management (OPM), manages the Federal Employees’ Group Life Insurance Act (FEGLIA), 5 U.S.C. 8705(a). Absent a valid beneficiary selection, FEGLIA provides an order of precedence for the proceeds, starting with the policyholder's surviving spouse, followed by the policyholder's descendants. FEGLIA will not follow that order if a “court decree of divorce, annulment, or legal separation, or . . . any court order or court-approved property settlement agreement” “expressly provides” for payment to someone else. The decree, order, or agreement must be “received” by the policyholder’s “employing agency” or OPM before the policyholder’s death. At the time of his death, Miller worked at Tinker Air Force Base and maintained a MetLife policy. Coleman's 27-year marriage to Donna ended in divorce in 2011. Their property settlement agreement states that “[Donna] shall remain the beneficiary of the life insurance policy.” The court ordered Coleman to assign his FEGLI benefits to Donna.Upon Coleman’s death, his only child, Courtenay, was appointed administratrix of his estate. The Air Force informed Courtenay that the court order had not been filed with Coleman’s employing office. Courtenay was paid $172,000 in proceeds and sought a declaration that she is the rightful owner. Citing lack of subject-matter jurisdiction, the district court dismissed the suit. The Sixth Circuit affirmed, noting the lack of a substantial federal question. FEGLIA does not contain an express cause of action for Donna. There is no federal agency involved. View "Miller v. Bruenger" on Justia Law

In this insurance coverage duty-to-defend dispute the Supreme Court affirmed the decision of the court of appeals affirming the circuit court's judgment denying the motion for attorney fees filed by the Germantown School District Board of Education and Germantown School District (collectively, the School District), holding that the School District's insurers (Insurer) did not breach the duty to defend the School District in a lawsuit brought by retired employees.In seeking attorney fees, the School Board argued that its Insurer should pay all of the attorney fees incurred by the School District in the underlying lawsuit as a remedy for its breach of the duty to defend the School District. The Supreme Court held (1) the Insurer's initial denial of the School District's tendered claim did not breach its duty to defend when the Insurer followed a judicially preferred method for determining coverage; (2) a delay in payment of liability attorney fees alone does not mean an insurer breached its duty to defend; and (3) the four-corners rule applies in determining whether a duty to defend exists but does not preclude a court's consideration of certain factors in assessing whether an insurer breached its duty to defend. View "Choinsky v. Germantown School District Board of Education" on Justia Law

The Supreme Court affirmed the judgment of the district court holding that Appellant, who was injured while she was driving a Pontiac and sought additional primary underinsured motorist (UIM) benefits under an insurance policy that covered a separate vehicle, a Chevrolet, was not entitled to primary UIM benefits under the Chevrolet policy, holding that Appellant could not recover additional primary UIM benefits under the Chevrolet policy.State Farm, Appellant's insurer, paid Appellant the Pontiac policy's UIM benefits limit but denied that the Chevrolet policy applied to Appellant's claim for additional primary UIM benefits. The district court granted summary judgment for State Farm, holding that the Chevrolet policy did not apply under Minn. Stat. 65B.49, subd. 3a(5). The court of appeals affirmed. The Supreme Court affirmed, holding (1) consistent with section 65B.49, subdivision 3a(5) and precedent interpreting that provision, Appellant was limited to primary UIM benefits under the policy that covered the vehicle she occupied at the time of the accident; and (2) even assuming that parties can contract around the priority scheme for primary UIM benefits that the legislature established in section 65B.49, subdivision 3a(5), no explicit language in the State Farm policies actually did so. View "Visser v. State Farm Mutual Automobile Insurance Co." on Justia Law

In this insurance dispute, the Supreme Court reversed the decision of the district court granting summary judgment to Shelter Mutual Insurance Company on its declaratory judgment action, holding that Neb. Rev. Stat. 60-310 does not allow provisions known as partial household exclusion clauses.Larry Freudenburg was injured in an accident where he was the passenger in a car covered by a policy Freudenburg and his wife had purchased from Shelter. Shelter refused to pay Freudenburg's request for reimbursement of expenses in the amount of the policy limit for bodily injury based on a partial household exclusion clause in Freudenburg's policy. Partial household exclusion clauses reduce automobile liability coverage from the policy amount to the state minimum when the injured person is an insured, relative, or resident of the insured's household. The district court concluded that partial household exclusions are not prohibited by section 60-310. The Supreme Court reversed, holding that an automobile liability policy policy in any coverage amount is not permitted to exclude or reduce liability coverage under the policy on the ground that the claimant is a named insured or resident in the named insured's household. View "Shelter Mutual Insurance Co. v. Freudenburg" on Justia Law

Dorris, a company president, had Unum long-term disability insurance. Her endometriosis became disabling; Unum started paying her benefits in 2002. Later, Dorris was diagnosed with Lyme disease. By 2007, the Social Security Administration granted her disability benefits. To maintain Unum benefits after two years, an employee had to prove that she “cannot perform each of the material duties of any gainful occupation for which [she is] reasonably fitted” or that she is “[p]erforming at least one of the material duties" of any occupation and “[c]urrently earning at least 20% less" due to the disability. In 2015, Dorris told Unum that she was improving and had started golfing and volunteering. Dorris’s Lyme disease specialist indicated that Dorris still had major symptoms and could not work. Unum’s consulting physicians found no evidence of limitations that would preclude sedentary work nor of an active Lyme infection. Unum ended her benefits.In her Employee Retirement Income Security Act (29 U.S.C. 1132(a)(1)(B)) lawsuit, Dorris was denied permission to depose witnesses to clarify the administrative record. Dorris never sought further discovery; nor objected to the ruling. Unum rested on its physician’s conclusions that Dorris could perform the duties of a president. Dorris asserted, without evidence, that such jobs required “55–70 hours a week,” and focused on how little she did as a volunteer. The court limited its review to the administrative record and found that Dorris could not perform the duties of her regular occupation, but nonetheless ruled in Unum's favor, because Dorris's arguments based on the "20% less" option were conclusory. The Seventh Circuit affirmed. The plaintiff bears the burden of proving that she is entitled to benefits. The court did not abuse its discretion in denying Dorris the opportunity to supplement the record after judgment nor were its factual findings in error. View "Dorris v. Unum Life Insurance Co. of America" on Justia Law