Justia Insurance Law Opinion Summaries

A taxi driver injured in an accident while working filed a report with the Alaska Workers' Compensation Board. The nature of the relationship between the taxi company and the driver was disputed. The driver retained an attorney for a lawsuit against the other driver, and settled that claim with the other driver's insurance company without his taxi company's approval. Because the taxi company did not have workers' compensation insurance, the Alaska Workers' Compensation Benefits Guaranty Fund assumed responsibility for adjusting the workers' compensation claim. The Fund asked the Board to dismiss the taxi driver's claim because of the unapproved settlement. The Board dismissed the claim, and the Workers' Compensation Appeals Commission ultimately affirmed the Board's decision. The taxi driver appealed, but finding no reversible error, the Alaska Supreme Court affirmed the Commission's decision. View "Atkins v. Inlet Transportation & Taxi Service, Inc." on Justia Law

Dave Jones, in his capacity as Insurance Commissioner of the State of California (the Commissioner), appealed an order enjoining him from enforcing three regulations, adopted in 1992, to implement the unfair claims settlement practices provision of the Unfair Insurance Practices Act (UIPA). The injunction was issued at the conclusion of the first phase of a trial in which PacifiCare Life and Health Insurance Company challenged the Commissioner’s finding that it had committed over 900,000 acts and practices in violation of the Insurance Code. The Court of Appeal reversed the order imposing the injunction in its entirety. The trial court determined the first regulation was inconsistent with the language of section 790.03(h), which it concluded had been interpreted by the California Supreme Court in Moradi-Shalal v. Fireman’s Fund Ins. Companies 46 Cal.3d 287 (1988), and in Zhang v. Superior Court, 57 Cal.4th 364 (2013), to apply only to insurers engaged in a pattern of misconduct. The appellate court determined the Supreme Court’s only binding interpretation of that statutory language was found in Royal Globe Ins. Co. v. Superior Court, 23 Cal.3d. 880 (1979), which held that section 790.03(h) could be violated by an insurer’s single knowing act. Consequently, the Court was bound by that precedent. View "PacifiCare Life & Health Ins. Co. v. Jones" on Justia Law

In 2006, Harvey, the insured, was involved in an automobile accident with Potts. Potts, age 51, died as a result, leaving a wife and three children. Harvey’s vehicle was registered in both his name and his business’s name and was covered under a $100,000 GEICO liability policy. Two days after the accident, GEICO resolved the liability issue adversely to Harvey. GEICO did not communicate a request by the estate’s attorney for a statement. GEICO tendered $100,000 to the estate’s attorney. The estate returned GEICO’s check and filed a wrongful death suit. A jury awarded the estate $8.47 million. Harvey filed a bad faith claim against GEICO. The estate's lawyer testified that he did not receive any communication from GEICO following his initial letter and that had he known that Harvey’s only other asset was a business account worth approximately $85,000, he would not have filed suit. The Fourth District Court of Appeal reversed the judgment entered in favor of Harvey, stating that “the evidence was insufficient as a matter of law to show ... bad faith,” and, “even if the insurer’s conduct were deficient, the insurer’s actions did not cause the excess judgment.” The Supreme Court of Florida reversed. The Fourth District failed to properly apply the directed verdict standard and misapplied precedent setting forth the fiduciary duties of insurance companies. An insurer can be liable for bad faith even “where the insured’s own actions or inactions . . . at least in part” caused the excess judgment. View "Harvey v. Geico General Insurance Co." on Justia Law

The Second Circuit affirmed the district court's judgment that Interstate breached its contractual duty to indemnify the Archdiocese under certain excess insurance policies. The Archdiocese appealed from an amended judgment that Interstate's breach did not violate the Connecticut Unfair Insurance Practices Act (CUIPA). At issue were two contract provisions invoked by Interstate to deny coverage for sexual abuse by priests: the exclusion for assault and battery, and the coverage grant for occurrences that unintentionally and unexpectedly result in personal injury.The court held that the Exclusion applied only to a person "acting within the scope of his duties," and that the assailant priests were not acting within the scope of their duties when they committed sexual assault of children. The court held that Interstate was bound to indemnify the Archdiocese for all sums it was obligated to pay arising out of any occurrences or happening during the period of insurance. The court also held that the Archdiocese failed to demonstrate a violation of CUIPA. View "Hartford Roman Catholic Diocesan Corp. v. Interstate Fire & Casualty Co." on Justia Law

These appeals relate to life insurance policies that were issued by Sun Life to non-parties and that were subsequently acquired by Imperial. The district court dismissed all claims in both cases.The Eleventh Circuit held that Sun Life waived its opportunity to rely on non-forum law to interpret the policies at issue and thus interpreted the relevant policies under Florida law. In regard to Sun Life's complaint, the court affirmed the district court's dismissal of the fraud conspiracy and declaratory judgment counts; and vacated the dismissal of the RICO, RICO conspiracy, fraud, aiding and abetting fraud, and tortious interference with contractual relations counts. In regard to Imperial's complaint, the court affirmed the breach of contract count to the extent it asserted a breach of the rights-and-privileges clause. The court vacated the district court's dismissal of the breach of contract count to the extent it asserted a breach of the incontestability clause. The court remanded for further proceedings. View "Sun Life Assurance Company of Canada v. Imperial Premium Finance, LLC" on Justia Law

Hennen worked as a sales specialist for NCR, 2010-2012, and was covered by long-term disability insurance under a group policy provided by MetLife. She sought treatment for a back injury. When physical therapy and surgery failed to resolve her injury, Hennen applied for long-term disability benefits. Acting as plan administrator, MetLife agreed that Hennen was disabled and paid benefits for two years. The plan has a two-year limit for neuromusculoskeletal disorders, subject to exceptions, including on for radiculopathy, a “Disease of the peripheral nerve roots supported by objective clinical findings of nerve pathology.” After MetLife terminated Hennen’s benefits, she sued under the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1001 (ERISA), arguing that MetLife’s determination that she did not have radiculopathy was arbitrary and capricious. The district court granted MetLife summary judgment. The Seventh Circuit reversed. MetLife acted arbitrarily when it discounted the opinions of four doctors who diagnosed Hennen with radiculopathy in favor of the opinion of one physician who ultimately disagreed, but only while recommending additional testing that MetLife declined to pursue. View "Hennen v. Metropolitan Life Insurance Co." on Justia Law

In this insurance dispute, the Supreme Judicial Court reversed the superior court’s allowance of the insurers’ motion for summary judgment, holding that the allegations in the underlying complaint were sufficient to trigger the insurers’ duty to defend the insured in the underlying action.The two insurers in this case had issued several general commercial liability policies to the insured. The insured was sued in federal court for improper advertising. The insurers denied coverage on the ground that a provision in the policies covering improper use of another’s advertising idea did not cover the claims raised in the action but, nevertheless, agreed to fund the insured’s defense under a reservation of rights. The insurers then sought a declaration that they were not obligated to defend the insured in the underlying action. The superior court granted summary judgment for the insurers. The Supreme Judicial Court reversed, holding that the policies that the insured purchased, which provided coverage in the event the insured was sued for alleged advertising injuries, covered the insured for the claims at issue in the underlying action. View "Holyoke Mutual Insurance Co. in Salem v. Vibram USA, Inc." on Justia Law

Dissatisfied with NYCM’s handling of his insurance claim related to a serious car accident, Clemens filed suit, asserting a contractual underinsured motorist (UIM) claim and a claim under the Bad Faith Statute, 42 Pa. Cons. Stat. 8371. After NYCM removed the case to federal court, the parties settled the UIM claim for $25,000. The bad faith claim proceeded to trial. A jury awarded Clemens $100,000 in punitive damages. As the prevailing party under the Bad Faith Statute, Clemens then sought $946,526.43 in attorneys’ fees and costs. The district court reviewed every time entry submitted, performed a traditional lodestar analysis, and concluded that 87 percent of the hours billed had to be disallowed as vague, duplicative, unnecessary, or inadequately supported by documentary evidence. In light of that substantial reduction, the court deemed Clemens’s request “outrageously excessive” and exercised its discretion to award no fee. Represented by new counsel, Clemens appealed. The Third Circuit affirmed, formally endorsing a view adopted by several other circuits: where a fee-shifting statute provides a court discretion to award attorney’s fees, such discretion includes the ability to deny a fee request altogether when, under the circumstances, the amount requested is “outrageously excessive.” View "Clemens v. New York Central Mutual Fire Insurance Co." on Justia Law

At issue before the Colorado Supreme Court in this matter was the issue of whether an insured was entitled to collect prejudgment interest when he settles an uninsured motorist claim (“UM claim”) with his insurer in lieu of filing a lawsuit and proceeding to judgment. The Court held that under the plain language of the prejudgment interest statute, 13-21-101, C.R.S (2017), an insured is entitled to prejudgment interest only after: (1) an action is brought; (2) the plaintiff claims damages and interest in the complaint; (3) there is a finding of damages by a jury or court; and (4) judgment is entered. Because the plaintiff in this case did not meet all of these conditions, he was not entitled to prejudgment interest. View "Munoz v. Am. Fam. Ins. Co." on Justia Law

The Eighth Circuit reversed the district court's grant of summary judgment to plaintiffs, holding that St. Paul Insurance's policy expressly precluded indemnification of intentional criminal acts and that David Kofoed's act of evidence tampering did not fall within the malicious prosecution exception. Kofoed was criminally convicted for evidence tampering while investigating two murders and eventually charging plaintiffs with the murders.The court held that St. Paul's policy coverage was not illusory where it excluded coverage for acts with specific intent, but did not cover general intent acts; the policy did not provide some exceptions to the exclusions to cover certain intentional acts such as malicious prosecution; and Kofoed's evidence-tampering crime was analogous to civil malicious prosecution. Because plaintiffs failed to sufficiently plead the malicious prosecution cause of action in their complaints, the district court's entry of default judgment against Kofoed did not include malicious prosecution. Because Kofoed's judgment did not include malicious prosecution, plaintiffs failed in their burden to show that an exception to the insurance exclusion applied. Therefore, St. Paul had no duty to indemnify Kofoed. View "Sampson v. St. Paul Fire and Marine Insurance Co." on Justia Law