Justia Insurance Law Opinion Summaries

In a dispute between Timothy Towne and the Unified School District No. 259, the Supreme Court of the State of Kansas reversed the lower courts' rulings, finding that self-insured school districts are not exempt from regulation under the Kansas Insurance Code. Towne, an employee of the school district, was injured in a car accident and received benefits from the school district's self-funded medical benefit plan. After Towne recovered funds from a third party, the school district required him to reimburse the plan. Towne claimed that the plan's subrogation clause, which allowed for this reimbursement, was unenforceable under Kansas regulations. The district court and Court of Appeals held that the school district's plan was exempt from the Kansas Insurance Code, thereby making the subrogation clause enforceable. However, the Supreme Court reversed, holding that the medical benefit plan offered by the school district is a "health benefit plan" and the school district is a "health insurer" under Kansas law, making the school district subject to the anti-subrogation regulation. The case was remanded for further proceedings. View "Towne v. U.S.D. 259" on Justia Law

In a workers' compensation case, an employee was injured and sought compensation from her employer and its insurance carrier. The employee failed to provide her expert witness's evidence in a timely manner, serving them only two weeks before the arbitration hearing began. The employer and its insurance carrier objected, arguing that this late submission of evidence was unfairly prejudicial. The deputy workers’ compensation commissioner agreed with the employer and excluded the evidence. This decision was affirmed by the commissioner, but was later reversed on judicial review by the district court. The court of appeals affirmed the district court’s ruling. However, the Supreme Court of Iowa held that the commissioner’s decision to exclude untimely evidence was entitled to deference. The court found that the commissioner did not abuse his discretion by excluding the untimely evidence since the employee had disregarded multiple deadlines and submitted the reports only about two weeks before the hearing. Moreover, the reports were not from the employee’s treating physicians and the vocational report reached a conclusion that no other expert in the case shared. Therefore, the supreme court vacated the court of appeals decision, reversed the district court decision, and remanded the case back to the district court to enter a judgment affirming the commissioner's decision to exclude the untimely evidence. View "Hagen v. Serta/National Bedding Co., LLC" on Justia Law

This case involves Jeremy Schulman, a former shareholder at the Maryland law firm Shulman, Rogers, Gandal, Pordy & Ecker. Schulman sued insurance companies AXIS Surplus Insurance Company, Endurance American Specialty Insurance Company, and Prosight Syndicate 1110 at Lloyd’s, for breach of contract, detrimental reliance, and lack of good faith, claiming that they wrongfully denied his claim for coverage under his law firm's professional liability insurance policy. The dispute hinges on whether Schulman's indictment in a criminal case qualifies as a "claim" under his professional liability insurance policy, and whether a letter from the insurance companies promising to cover certain costs relating to a subpoena also covered costs related to the later indictment. Schulman also alleges that the insurers acted in bad faith.The United States Court of Appeals for the Fourth Circuit affirmed the district court's decision, granting summary judgment to the defendants. The court held that Schulman's indictment in the criminal case did not constitute a "claim" under his professional liability insurance policy, and that the insurers' letter did not promise to cover costs related to the indictment. The court also held that Schulman's claim of bad faith could not succeed because he was not entitled to coverage under the policy and the insurers did not breach any tort duty by denying coverage. View "Schulman v. Axis Surplus Ins. Co., Inc." on Justia Law

In the State of Oregon, a woman whose husband was accidentally shot and killed during a camping trip filed a lawsuit against her husband's life insurance company. The woman claimed that the insurance company negligently failed to investigate and pay her claim for policy benefits, causing her economic harm and emotional distress. The trial court granted the insurance company's motions to dismiss the woman's negligence claim and to strike her claim for emotional distress damages. The Court of Appeals reversed the trial court's decision, and the insurance company appealed the case to the Supreme Court of Oregon.The Supreme Court of Oregon affirmed the decision of the Court of Appeals. The court held that the woman had pleaded facts sufficient to give rise to a legally cognizable common-law negligence claim for emotional distress damages. The court reasoned that the woman, as the surviving spouse of a deceased breadwinner, had a legally protected interest sufficient to support a common-law negligence claim for emotional distress damages against her husband's life insurance company for failure to reasonably investigate and promptly pay her claim for insurance benefits. The court concluded that the insurance claim practices that Oregon law requires and the emotional harm that foreseeably may occur if that law is violated are sufficiently weighty to merit imposition of liability for common-law negligence and recovery of emotional distress damages. Therefore, the Supreme Court of Oregon reversed the judgment of the trial court and remanded the case back to the trial court for further proceedings. View "Moody v. Oregon Community Credit Union" on Justia Law

This is a coverage dispute between Pep Boys and their insurers, Old Republic Insurance, Executive Risk Indemnity, and Fireman’s Fund Insurance, over the interpretation of their insurance policies' annual aggregate limits. The policies were for terms longer than 12 months. The core issue was whether the policies contained two separate annual periods for the purposes of the annual aggregate limits of liability.The Court of Appeal of the State of California, First Appellate District, Division Four, held that for Old Republic and Fireman’s Fund's policies, which had similar language, the phrase "each annual period" within the policy term created two separate aggregate limits of liability, one for the first 12 months and another for the remaining period. The court reasoned that both the language of the policies and the parties' reasonable expectations supported this interpretation. The court noted that the policies' language could not be applied literally because it would either dilute the benefits or create a gap in coverage, neither of which were the insured's intention when extending the policies.However, the court agreed with the trial court that the American Excess policy, which had different language, had only one period for the purpose of that policy’s annual aggregate limits. The court noted that American Excess's policy unambiguously set its limits for the entire duration of the policy, not based on annual periods within the policy term.In conclusion, the court reversed the trial court's judgment in part, ruling in favor of Pep Boys for Old Republic and Fireman’s Fund's policies, and in favor of American Excess regarding its policy. View "The Pep Boys v. Old Republic Ins. Co." on Justia Law

The United States Court of Appeals for the Eighth Circuit affirmed a district court's ruling that BITCO General Insurance Corporation ("BITCO") had no obligation under its policy to cover damages from an accident involving a truck driven by a contractor engaged by the insured, KAT Excavation Company ("KAT"). KAT had arranged for E&S Quarry ("E&S") to supply rock for a construction project and had engaged other hauling companies, including Chris White Construction ("CWC"), to transport the rock. An accident occurred on a trip to the construction site by Clayton Hamlin, a driver used by CWC. The court held that for a vehicle to be considered a "hired auto" under the insurance policy, there must be a separate contract by which the vehicle is hired or leased to the named insured for their exclusive use or control. The court found that KAT did not exercise the requisite level of control over the dump truck and thus, the driver, Hamlin, was not covered under KAT's insurance policy. View "BITCO General Insurance Corporation v. Smith" on Justia Law

In this case, the United States Court of Appeals for the Second Circuit heard an appeal from Ezrasons, Inc., a company engaged in the garment trade, against The Travelers Indemnity Company. Ezrasons suffered a loss of insured goods exceeding $600,000 due to a fire at a warehouse owned by Chamad Warehouse, Inc., in Marion, North Carolina. Travelers paid $250,000, but declined to pay more, asserting that the policy's coverage was limited to $250,000 because the warehouse where the goods were destroyed was not an "Approved Location" under the policy. The district court ruled in favor of Travelers, finding that the warehouse was unambiguously not an "Approved Location" under the policy.On appeal, the Second Circuit Court found that the policy was ambiguous as to whether the warehouse where the destruction occurred was an "Approved Location." It further held that the district court erroneously excluded admissible evidence by which Ezrasons sought to prove that the warehouse was an "Approved Location." As the extrinsic evidence did not provide a basis for favoring either possible meaning of "Approved Location," the ambiguity should be resolved in favor of Ezrasons under New York law. Accordingly, the judgment was vacated and the case remanded with instructions to enter judgment in favor of Ezrasons. View "Ezrasons, Inc. v. Travelers Indemnity Co." on Justia Law

Connie Bourque, a Louisiana resident insured by State Farm Mutual Automobile Insurance Co., filed a class-action lawsuit, alleging that State Farm breached its insurance contract and violated its duty of good faith and fair dealing under Louisiana Law. The claim was based on the method State Farm used to calculate the actual cash value (ACV) of vehicles in the event of a total loss. State Farm used the Autosource MarketDriven Valuation, which Bourque alleged provided a valuation less than the true ACV.The United States District Court for the Western District of Louisiana certified a class of all persons insured by State Farm in Louisiana whose vehicle's Autosource valuation was less than the value according to the National Automobile Dealers Association (NADA) Official Used Car Guide. State Farm appealed this decision to the United States Court of Appeals for the Fifth Circuit.The Fifth Circuit, citing a similar case (Sampson v. United Services Automobile Ass’n), held that the district court's class certification was error. The Fifth Circuit noted that to establish a breach of contract under Louisiana law, proof of injury is required—proof that Bourque failed to establish can be made on a class-wide basis. The court also noted that the NADA value was just one of many statutorily acceptable methods for calculating ACV, and therefore pinning ACV to NADA value constituted an impermissibly arbitrary choice of a liability model.As a result, the Fifth Circuit vacated the district court’s grant of class certification and remanded the case for further proceedings. View "Bourque v. State Farm Mtl Auto Ins" on Justia Law

In this case, Defendant-Appellee Martin Andersson purchased an insurance policy for his vessel from Plaintiff-Appellant Great Lakes Insurance SE. The vessel ran aground off the coast of the Dominican Republic, and Great Lakes brought a declaratory judgment action to determine coverage under the policy. Andersson filed counterclaims for breach of contract and equitable estoppel. Great Lakes' motion for summary judgment was denied, and Andersson was granted partial summary judgment on his breach of contract claim. Great Lakes appealed, claiming the district court erred in refusing to apply the policy's definition of seaworthiness.The United States Court of Appeals for the First Circuit held that under the absolute implied warranty of seaworthiness, the insured vessel must be seaworthy at the policy's inception, and if not, the policy is void. The court affirmed the district court's ruling, stating that Great Lakes' argument that the absolute implied warranty required the vessel to carry up-to-date charts for all geographic areas covered by the policy in order to be considered seaworthy was unsupported by admiralty case law and was unreasonable.Additionally, the court held that Great Lakes' argument that the express terms of the policy required updated paper charts for every location that could be navigated under the entirety of the policy coverage area was unsupported by the express language of the policy itself. The court found no precedent supporting the claim that updated paper charts for every location covered by the policy were required to be onboard the vessel at the inception of the policy. As a result, the Court of Appeals affirmed the district court's decision in favor of Andersson. View "Great Lakes Insurance SE v. Andersson" on Justia Law

The Supreme Court of Alabama dismissed an appeal by the Great American Insurance Company. The insurance company had appealed a lower court's decision denying its motion to invoke the appraisal procedure in a dispute with the Crystal Shores Owners Association, Inc. The dispute arose following damage to the Crystal Shores Condominium complex due to Hurricane Sally and a subsequent bathtub overflow in one of the units. The insurance company argued that the dispute over the amount of loss was subject to an appraisal procedure described in the insurance policy, which it contended was a form of arbitration. The Supreme Court of Alabama held that, regardless of whether federal law or Alabama law controlled the definition of "arbitration" in the Federal Arbitration Act, the appraisal clause in the insurance contract did not qualify as a clause calling for "arbitration". As such, the lower court's denial of Great American's motion did not constitute an order denying a motion to compel arbitration, and the Supreme Court of Alabama dismissed the appeal as one stemming from a nonfinal judgment. View "Great American Insurance Company v. Crystal Shores Owners Association, Inc." on Justia Law