Justia Insurance Law Opinion Summaries

Tony Kourianos worked as a coal miner for more than 27 years before filing a claim for benefits under the Black Lung Benefits Act (“BLBA”). His claim was reviewed through a three-tiered administrative process. Ultimately, the Benefits Review Board (“BRB”) found that he was entitled to benefits. The BRB also found that Kourianos’s last employer, Hidden Splendor Resources, Inc., was the “responsible operator” liable for paying those benefits. Hidden Splendor’s insurer, Rockwood Casualty Insurance Company, petitioned the Tent Circuit Court of Appeal for review of the BRB’s decision: (1) challenging the administrative law judge’s (“ALJ”) decision prohibiting Hidden Splendor from withdrawing its responsible operator stipulation; and (2) contending the BRB incorrectly found that Kourianos was totally disabled and entitled to benefits. Finding no abuse of discretion in the BRB decision, the Tenth Circuit denied Rockwood's petition. View "Rockwood Casualty Insurance v. Director, OWCP" on Justia Law

After plaintiff's insured (a general contractor) secured a default judgment against defendant's insured (a subcontractor), when a homeowner obtained an arbitration award against the general contractor, plaintiff indemnified the general contractor for the arbitration award. Defendant refused to indemnify the subcontractor for the amount of the default judgment and plaintiff then filed suit to recover from defendant under Insurance Code section 11580 the amount of the default judgment against the subcontractor.The Court of Appeal affirmed the trial court's grant of summary judgment for plaintiff, holding that the default judgment was not void. The court also held that it was doubtful that the default judgment was secured in an action based upon property damage, and none of the authorities defendant cited required a contrary conclusion. The court rejected defendant's claims supporting its contention that plaintiff did not prove the default judgment was covered under any of defendant's policies. Finally, the court denied defendant's claim regarding the "per occurrence limits," and NMH's attorney fees and costs claims. View "The Insurance Company of the State of Pennsylvania v. American Safety Indemnity Co." on Justia Law

Gateway filed suit to collect a $900,000 judgment from a contractor's liability insurer, Illinois Union. The Fourth Circuit held that the district court had diversity jurisdiction over the case and rightly refused to remand to state court. On the merits, the court held that Gateway's argument that Illinois waived certain defenses by failing to promptly inform Gateway of its coverage denial under Virginia Code section 38.2-2226 failed, because Illinois Union had not denied coverage because of the contractor's breach. In this case, the relevant policy covered only claims reported to the insurer during the policy period, and the policy expired 19 months before Illinois Union learned about Gateway's claim. Therefore, the court affirmed the district court's grant of summary judgment for Illinois Union. View "Gateway Residences at Exchange, LLC v. Illinois Union Insurance Co." on Justia Law

The Supreme Court affirmed the decision of the court of appeals ruling that the allegations in Abbott Laboratories’ complaint against Ixthus Medical Supply, Inc. alleged a potentially covered advertising injury and, as a result, triggered West Bend Mutual Insurance Company’s duty to defend under the commercial general liability policy West Bend issued to Ixthus, holding that the court of appeals properly concluded that West Bend had a duty to defend Ixthus.The circuit court concluded that, although the allegations in Abbott’s complaint fell within the initial grant of coverage, the “knowing violation” exclusion applied, thereby eliminating any duty West Bend had to defend. The court of appeals reversed, concluding that the knowing violation exclusion did not apply. The Supreme Court affirmed, holding (1) the allegations in the complaint fell within the initial grant of coverage; and (2) neither the knowing violation nor the “criminal acts” exclusions applied to remove West Bend’s duty to defend because the complaint alleged at least one potentially covered claim unaffected by either exclusion. View "West Bend Mutual Insurance Co. v. Ixthus Medical Supply, Inc." on Justia Law

The Fourth Circuit affirmed the district court's decision to vacate an arbitration award that the Farm won against a private insurance company that sold federal crop insurance policies to the Farm. The court held that, despite the strong presumption in favor of confirming arbitration awards pursuant to the Federal Arbitration Act (FAA), the insurance company met its heavy burden to prove that the arbitrator exceeded her powers by awarding extra-contractual damages, contrary to both the policy and binding authority from the Federal Crop Insurance Corporation (FCIC). In this case, the arbitrator exceeded her powers by both interpreting the policy herself without obtaining an FCIC interpretation for the disputed policy provisions, and awarding extra-contractual damages, which the FCIC has conclusively stated in multiple Final Agency Determinations could not be awarded in arbitration and can only be sought through judicial review. View "Williamson Farm v. Diversified Crop Insurance Services" on Justia Law

Mid-Continent filed a declaratory judgment action seeking a declaration that it did not owe coverage for a judgment assessed against its insured, PSI. The district court ruled that the Cooperation Clause in the policy applied to PSI's third-party claim in the underlying lawsuit and that only parts of the judgment were covered.The Fifth Circuit affirmed in part and held that, regardless of whether the Cooperation Clause applied to affirmative claims, the Cooperation-Clause jury instruction was not an abuse of discretion. The court reversed the district court's conclusion that the Professional Liability Endorsement did not cover the entire judgment and held that it did. View "Mid-Continent Casualty Co. v. Petroleum Solutions, Inc." on Justia Law

Numerous claims were filed in various jurisdictions against Deere for personal injuries arising from alleged exposure to asbestos-containing brakes, clutch assemblies, and gaskets used in Deere machines. Deere sought declaratory relief, alleging breach of contract with respect to more than 100 umbrella and excess general liability policies issued to Deere from 1958-1986. In the third phase of litigation, the trial court ruled in favor of the insurers. The court of appeal reversed, in favor of Deere. Once the first-layer excess policy’s annual aggregate limit for products liability has been exhausted, the higher-layer excess insurers’ policies are not subject to a self-insured retention per occurrence for subsequent claims. The insurers’ indemnity obligation extended to Deere’s defense costs incurred in asbestos claims that had been dismissed. View "Deere & Co. v. Allstate Insurance Co." on Justia Law

The Eighth Circuit affirmed the district court's order finding that Prudential did not abuse its discretion when it terminated plaintiff's long term disability benefits. The court held that, although plaintiff presented some evidence that he was disabled, Prudential's decision to deny benefits was supported by substantial evidence. In this case, Prudential had evidence that plaintiff was deliberately exaggerating his symptoms, making it impossible to determine whether he had cognitive deficiencies that rendered him disabled. View "Johnston v. Prudential Insurance Co." on Justia Law

The First Circuit affirmed the district court’s grant of summary judgment in favor of a Church on its lawsuit seeking a declaratory judgment that its claim filed pursuant to its property insurance policy with an Insurance Company was improperly denied, holding that ambiguities in the policy resulted in coverage for the collapse of a ceiling in one section of the church.The Insurance Company denied the Church’s claim, citing the “faulty construction” exclusion in the policy. In its complaint, the church argued that the collapse was caused by hidden decay such that the “additional coverage - collapse” provision applied. The First Circuit affirmed, holding that the meaning of “decay” was ambiguous and that ambiguity must be resolved in the Church’s favor. View "Easthampton Congregational Church v. Church Mutual Insurance Co." on Justia Law

The First Circuit affirmed the district court’s grant of summary judgment in favor of Liberty Mutual Insurance Corporation on Brendan Kelly’s claim that Liberty was bound to provide uninsured motorist coverage for his benefit, holding that no uninsured motorist coverage was provided under the policy.The insurance contract was an umbrella policy issued to Kelly’s employer and the named insured and was issued in New Hampshire. The named insured rejected uninsured motorist coverage in writing, but the writing was not incorporated into the policy. Kelly argued that that the lack of an explicit reference to the named insured’s written rejection rendered that rejection inoperative against an additional insured like himself, and that provision of uninsured motorist coverage was therefore required under state law. The First Circuit disagreed, holding that Kelly’s position was not implicit in the statute. View "Kelly v. Liberty Insurance Corp." on Justia Law