Justia Insurance Law Opinion Summaries

This case involves a catastrophic wildfire that occurred in 2016 in the Great Smoky Mountains National Park in Eastern Tennessee. The fire spread into Gatlinburg and Sevier County, resulting in the destruction of over 2,500 structures and the death of 14 people. The appellant insurance companies paid claims to policy holders and then filed claims under the Federal Tort Claims Act (FTCA) against the National Park Service (NPS), alleging negligence for failure to follow multiple mandatory fire-management protocols and for the failure to issue mandatory warnings to the public.The government moved to dismiss the case for lack of subject-matter jurisdiction, arguing that it was immune from suit under the discretionary-function exception to the FTCA. The district court granted the motion on all three claims relating to fire-management protocols, but denied the motion on claims relating to the duty to warn. The insurance companies appealed, and the government cross-appealed.The United States Court of Appeals for the Sixth Circuit reversed the district court's order granting the government's motion to dismiss the insurance companies' incident-command claim. The court affirmed the district court's dismissal of the fire-monitoring claim and the Wildland Fire Decision Support System (WFDSS) claim as part of the discretionary fire-suppression decision-making process. The court also affirmed the district court's denial of the government's facial challenge to the insurance companies' duty-to-warn claims, and remanded these claims for further proceedings. View "American Reliable Insurance Co. v. United States" on Justia Law

Ian Simpson purchased a life insurance policy from Transamerica Life Insurance Company and named his then-fiancée, Holly Moore, as the primary beneficiary and his father, Jeffrey Simpson, as the contingent beneficiary. After Ian and Holly married and subsequently divorced, Ian died without changing the policy beneficiaries. The divorce decree stipulated that Holly was divested of all rights to Ian's life insurance policies. After Ian's death, both Holly and Jeffrey claimed the policy proceeds, leading Transamerica to file an interpleader action in federal court.The district court ruled in favor of Holly, holding that Texas Family Code § 9.301, which generally strips an ex-spouse of beneficiary interests in insurance policies after a divorce, only applies if the insured and the beneficiary were married when the insurance policy was purchased. The court reasoned that since the policy was purchased before Ian and Holly's marriage, Holly was not considered "the insured's spouse" at the time of the policy's inception, and therefore, the divorce decree did not divest her of the insurance proceeds.On appeal, the United States Court of Appeals for the Fifth Circuit reversed the district court's judgment. The appellate court interpreted § 9.301 to focus on the marital relationship at the time of the divorce decree's rendition, regardless of when the insurance policy was purchased. The court held that since Holly was Ian's spouse at the time of the divorce decree, § 9.301 divested her of her beneficiary interest in the policy. Therefore, the court ruled in favor of Jeffrey Simpson, the contingent beneficiary. View "Simpson v. Moore" on Justia Law

The case revolves around a dispute between American Compensation Insurance Company (ACIC) and Hector Ruiz, who operates Los Primoz Construction. Ruiz's employee, Raul Aparacio, suffered severe injuries after falling more than fifteen feet at a worksite. ACIC, which provided workers' compensation insurance for Ruiz's company, began paying benefits to Aparacio. However, when the payouts exceeded a quarter of a million dollars, ACIC sought to retroactively void the policy, alleging that Ruiz had materially misrepresented in his application that his company did not perform work more than fifteen feet above ground.The insurer filed for a declaratory judgment in federal court, but the federal district judge dismissed the insurer's lawsuit, concluding that Mississippi’s workers' compensation law does not permit an insurer to rescind a workers' compensation policy. The insurer appealed to the Fifth Circuit, which certified the question to the Supreme Court of Mississippi.The Supreme Court of Mississippi held that the Mississippi Workers’ Compensation Act (MWCA) does not allow insurers to void a workers' compensation policy based on an employer's material misrepresentation. The court reasoned that the MWCA makes no provision for an insurer to void a workers' compensation policy based on a material misrepresentation and exists to ensure injured workers are compensated. The court concluded that allowing rescission would go against the purpose of the MWCA. View "American Compensation Insurance Company v. Ruiz" on Justia Law

The case involves the United States of America, et al. ex rel. Michael Angelo and MSP WB, LLC (Relators-Appellants) against Allstate Insurance Company, et al. (Defendants-Appellees). The relators alleged that Allstate Insurance violated the False Claims Act by avoiding its obligations under the Medicare Secondary Payer Act. They claimed that Allstate failed to report or inaccurately reported to the Centers for Medicare & Medicaid Services (CMS) information regarding its beneficiaries, which led to Allstate failing to reimburse Medicare for auto-accident-related medical costs incurred by beneficiaries insured by Allstate.The United States District Court for the Eastern District of Michigan dismissed the case with prejudice, deeming the relators' second amended complaint deficient in numerous respects. The relators then moved for reconsideration, which the district court denied. They also filed a motion to amend or correct under Rule 59(e), asking the district court to amend its judgment to dismiss the case without prejudice to allow them to file another amended complaint. The district court denied the motion on all grounds.The United States Court of Appeals for the Sixth Circuit affirmed the district court's decision. The court found that the relators failed to state a claim for a violation of the False Claims Act. The court noted that the relators did not provide sufficient facts demonstrating that Allstate had an "established duty" to pay money or property owed to the government. The court also found that the relators did not demonstrate Allstate's understanding that its conduct violated its obligations under federal law. Furthermore, the court found that the relators' claim for conspiracy also failed as they did not provide any specific details regarding the alleged plan or an agreement to execute the plan. The court also affirmed the district court's decision to deny the relators leave to amend their complaint again. View "United States ex rel. Angelo v. Allstate Insurance Co." on Justia Law

The case involves Koppers Performance Chemicals, Inc., a New York-based corporation that manufactures wood preservation chemicals, and Argonaut-Midwest Insurance Company. In 2014, Phillip H. Riley and his wife sued Koppers and other lumber industry entities in South Carolina state court, alleging that Riley developed cancer from exposure to a chemical used in the lumber provided by Koppers. Koppers sought coverage under four commercial general liability policies issued by Argonaut. Argonaut, however, disclaimed any duty to defend or indemnify Koppers, arguing that the policies limited coverage to Koppers' Hawaii operations and did not cover the claims in the Riley lawsuit.The case was initially heard in the District of South Carolina, where the court granted Argonaut's motion for summary judgment and denied Koppers' motion for partial summary judgment. The court found that the insurance policies were limited to Koppers' Hawaii operations and that the original complaint did not allege a potential for coverage under the policies, thus Argonaut had no duty to defend.Upon appeal, the United States Court of Appeals for the Fourth Circuit reversed the lower court's decision. The appellate court found that the insurance policies did not unambiguously limit coverage to Koppers' Hawaii operations. Furthermore, the court held that Argonaut was required to consider extrinsic evidence it specifically requested from Koppers when assessing its duty to defend. The court vacated the district court's order granting Argonaut's summary judgment motion and denying Koppers' partial summary judgment motion on the issue of Argonaut's duty to defend, and remanded the case for further proceedings. View "Koppers Performance Chemicals, Inc. v. Argonaut Midwest Insurance Co." on Justia Law

Baylor Scott & White Holdings (BSW), the largest nonprofit health system in Texas, purchased a specialized commercial property insurance policy from Factory Mutual Insurance Co. (FM) to cover its facilities. The policy covered two types of claims—“Property Damage” and “Time Element” claims, which are synonymous with “business interruption” loss. BSW submitted a claim under the policy for its business interruption losses as a result of COVID-19, totaling over $192 million. FM denied the claim, stating that the only coverage under the policy for losses arising from COVID-19 came from the Communicable Disease Response Extension and the Interruption by Communicable Disease Extension, which had already been exhausted.FM moved to dismiss the amended complaint for failure to state a claim. The district court granted FM’s motion to dismiss, finding that BSW had not plausibly alleged “physical loss or damage” under the policy, and that the Contamination Exclusion and Loss of Use Exclusion barred BSW’s recovery under the policy. BSW appealed the district court’s dismissal order.The United States Court of Appeals for the Fifth Circuit affirmed the decision of the district court. The court held that, in the context of COVID-19 commercial-insurance coverage disputes, COVID-19 does not physically harm property. The court found that the alleged uniqueness of the policy’s language did not change this determination. The court also rejected BSW's contention that its complaint was wrongly dismissed because it included specific factual allegations of demonstratable, measurable, and tangible alteration of property caused by COVID-19. The court concluded that, as a matter of law, COVID-19 does not affect property in a “physical” way. View "Baylor Scott & White v. Factory Mutual" on Justia Law

The case involves First Baptist Church of Iowa, Louisiana (FB Church) and Church Mutual Insurance Company, S.I. (CM Insurance). FB Church sued CM Insurance for failing to pay benefits for property damage caused by Hurricane Laura under an insurance policy. The property included three buildings: the main church, a parsonage, and a vacant building. After the hurricane, FB Church reported the loss to CM Insurance, which then hired a third-party administrator to adjust the loss. The administrator estimated the total loss at $630,000 before deductibles. However, FB Church was dissatisfied with how its claim was being handled and hired a public adjuster, who prepared an estimate of over $1 million in damages. FB Church then sued CM Insurance, alleging claims for additional covered losses and for statutory penalties, costs, and attorney’s fees under Louisiana Revised Statutes § 22:1892.The United States District Court for the Western District of Louisiana found in favor of FB Church, awarding it damages, statutory penalties, attorney’s fees, and costs. CM Insurance appealed the decision to the United States Court of Appeals for the Fifth Circuit.The Fifth Circuit affirmed in part and reversed in part. The court agreed with the district court that CM Insurance failed to adjust the claim and that FB Church was entitled to statutory penalties. However, the court found that the district court erred in calculating damages based on prices in January 2023 instead of at the time of loss, and in awarding any damages for slab repair and damages in excess of $4,500 for the sanctuary’s electrical repair. The case was remanded for recalculation of damages. View "First Baptist Church of Iowa, Louisiana v. Church Mutual Insurance, S.I." on Justia Law

The case revolves around an insurance dispute between the Bradshaw Family Trust Inc., operating as Hunton Office Supply Inc. (Hunton), and Twin City Fire Insurance Company (Twin City). In June 2019, Hunton renewed a business owner’s policy on its office supply store building, which included a building replacement cost of $1,378,000. In April 2020, the building sustained wind damage from a storm. Hunton sought an insurance payout for the building’s repairs, but Twin City only paid a fraction of what was expected. A dispute arose surrounding the effective date of proposed policy changes, leading Hunton to sue Twin City.Twin City moved for summary judgment in the United States District Court for the Eastern District of Arkansas, arguing that it did not breach the insurance contract. The district court granted Twin City’s motion for summary judgment. Hunton appealed the decision, arguing that the policy endorsement was invalid because there was no meeting of the minds, the endorsement was never delivered to him, and the extent of the insurance agent's authority was a material fact question precluding summary judgment.The United States Court of Appeals for the Eighth Circuit affirmed the district court's decision. The court found that the insurance agent had apparent authority to bind Hunton to the policy endorsement. It also concluded that based on the record, the only reasonable conclusion was that Hunton intended the policy changes to take effect immediately. Lastly, the court ruled that under Arkansas law, Hunton did not have to receive or sign the endorsement because it had requested the policy change. View "Bradshaw Family Trust Inc. v. Twin City Fire Insurance Co." on Justia Law

The case involves a dispute between Great American Insurance Company (Great American) and State Farm Fire and Casualty Company (State Farm) over who was responsible for paying the defense costs in a lawsuit against board members at the College of DuPage. The lawsuit was filed by Robert Breuder, the former president of the college, who alleged defamation and other claims after his employment was terminated. The board members were insured under a policy issued by the Illinois Community College Risk Management Consortium (Consortium), which was assigned to Great American, and a personal liability umbrella policy issued by State Farm. Great American sued State Farm to recoup losses from defense costs that it claimed State Farm had the duty to provide on behalf of one board member.The district court dismissed Great American's claims, finding that the language of the State Farm insurance contract was unambiguous and that State Farm had no duty to provide defense costs because the primary policy provided by Great American’s assignor covered the underlying loss. Great American appealed the decision.The United States Court of Appeals for the Seventh Circuit affirmed the district court's decision. The court found that the language of the State Farm policy was clear that it would only provide a defense if the loss was not covered by any other insurance policy. Since the Consortium policy covered the loss, State Farm had no duty to provide defense costs. The court rejected Great American's arguments that the language of the State Farm insurance contract was ambiguous and that State Farm's coverage was primary as it related to the board member's liability for conduct committed in her individual capacity. View "Great American Insurance Co. v. State Farm Fire and Casualty Co." on Justia Law

A real estate developer, 3534 East Cap Venture, LLC, and a construction company, McCullough Construction, LLC, were involved in a dispute with their insurers, Westchester Fire Insurance Company and Endurance American Insurance Company. The dispute centered around the coverage of two identical builders’ risk insurance policies for a residential and retail complex under construction in the District of Columbia. During construction, the absence of a vapor barrier in the architect's plans led to the condensation of vapor into water during cold weather, causing nearly $1.5 million in damages. The insurers denied the claims, arguing that the policies excluded losses caused by atmospheric dampness or temperature changes.The case was initially brought to the Superior Court of the District of Columbia, but was moved to federal district court due to diversity of citizenship. The district court ruled in favor of the insurers, holding that the exclusions for losses caused by "dampness of atmosphere" or "changes in temperature" applied. The court also held that the ensuing-loss exception to the exclusions did not apply because losses from "water damage" to the building were "inextricably intertwined" with—and indeed were "one and the same" as—losses covered by the dampness and temperature exclusions.The United States Court of Appeals for the District of Columbia Circuit reversed the district court's decision. The appellate court held that the ensuing-loss clause in the insurance policies applied to losses from water damage caused by the excluded perils of dampness and temperature changes. Therefore, the policies covered the losses at issue. The court remanded the case with instructions to enter summary judgment for the insureds on the question of liability. View "3534 East Cap Venture, LLC v. Westchester Fire Insurance Company" on Justia Law