Justia Insurance Law Opinion Summaries

In this case, the National Hockey League and associated parties (plaintiffs) sued their insurer, Factory Mutual Insurance Company (defendant), over losses incurred due to the COVID-19 pandemic under a commercial insurance policy. The plaintiffs claimed that their policy covered physical loss or damage to property due to COVID-19 and sought to overturn a lower court order that struck down most of their coverage theories.The Court of Appeal of the State of California, Sixth Appellate District, found that while the plaintiffs had adequately alleged physical loss or damage from the coronavirus, their insurance policy's contamination exclusion unambiguously excluded coverage for losses due to viral contamination. The court concluded that the policy excluded both the physical loss or damage caused by viral contamination and the associated business interruption losses.The plaintiffs had alleged that the virus physically damaged their property by changing the chemical composition of air and altering the molecular structure of physical surfaces. They also claimed that they had to close their hockey arenas, cancel games, limit fan access, and undertake various remedial measures to mitigate the virus's impact. However, under the terms of their insurance policy, the court found that these losses were not covered because they resulted from viral contamination, which was excluded from coverage under their policy. Thus, the court denied the plaintiffs' petition for review. View "San Jose Sharks, LLC v. Super. Ct." on Justia Law

In this case, the plaintiffs, a minor and her parents, sued their health insurer, Premera Blue Cross, for denying coverage for the minor’s stay in a wilderness therapy program, claiming that the denial violates mental health parity laws. The plaintiffs also alleged breach of contract, insurance bad faith, and violation of the Consumer Protection Act.The Supreme Court of the State of Washington held that the plaintiffs’ breach of contract claim based on alleged violation of federal parity laws does not form a viable common law action. The Court found that the plaintiffs failed to show that a violation of federal parity law would give rise to a viable common law action for breach of contract.Furthermore, the Court held that the breach of contract action based on Premera's alleged violation of state parity laws could not succeed based on the statutory language that was in place at the time.However, the Court did affirm the lower court’s finding that the plaintiffs were not required to produce evidence of objective symptomatology to support their insurance bad faith claim for emotional distress damages. Consequently, the case was remanded to the trial court for further proceedings on the bad faith and Consumer Protection Act claims. View "P.E.L. v. Premera Blue Cross" on Justia Law

The United States Court of Appeals for the Eleventh Circuit ruled in a dispute between Travelers Property Casualty Company of America and Talcon Group LLC. Talcon, an underground utility contractor, had an insurance policy with Travelers. Two residential homes under construction and connected to Talcon were destroyed by fire. Talcon filed a claim with Travelers, which was denied on the grounds that the policy only covered their underground utility operations and related site development work, not home construction. Talcon argued that the policy was ambiguous and should cover the homes as they were newly constructed during the policy period. The Court of Appeals, affirming the district court's summary judgment in favor of Travelers, held that the policy unambiguously did not cover the construction of the two homes. The court noted that when viewed together with Talcon's insurance application, the policy clearly restricts coverage to Talcon's underground utility and site development work. The court also stated that the policy's exclusion of pre-existing buildings did not imply coverage for all new construction, only buildings related to Talcon's specified operations. View "Travelers Property Casualty Company of America v. Talcon Group LLC" on Justia Law

In this case, the United States Court of Appeals for the First Circuit had to decide whether rainwater that accumulated on a parapet roof one or more stories above the ground is considered "surface waters" under Massachusetts law for the purposes of the insurance policies in question. This determination was crucial for deciding whether the insureds, Medical Properties Trust, Inc. (MPT) and Steward Health Care System LLC (Steward), were subject to coverage limitations on "Flood" damage in the policies issued by Zurich American Insurance Company (Zurich) and American Guarantee and Liability Insurance Company (AGLIC).The interpretation of "surface waters" posed a novel issue of Massachusetts law that had not been previously addressed by the Massachusetts Supreme Judicial Court (SJC). The court decided to certify the issue to the SJC as the existing case law did not provide a clear answer and the resolution may require policy judgments on applying Massachusetts law to this key insurance coverage issue.The case arose from a situation where Norwood Hospital Facility, a building owned by MPT and leased to Steward, suffered significant damage after severe thunderstorms. Rainwater accumulated on the hospital's roof and a second-floor courtyard, eventually seeping into the hospital's upper floors. Both Zurich and AGLIC, in their initial evaluations, determined that water damage in the hospital's basement was caused by "Flood," and would be subject to the policies' respective coverage limits. However, the insurers later characterized all the water damage, including that from the roof, as "surface water" and subject to the "Flood" coverage limits.The court concluded that whether rainwater pooled on a parapet roof constitutes "surface waters" in the policies' "Flood" definition is determinative of this interlocutory appeal. Therefore, the court certified the issue to the SJC for its consideration. View "Zurich American Insurance Co. v. Medical Properties Trust, Inc." on Justia Law

In this case, the United States Court of Appeals for the Fifth Circuit considered an appeal by Colony Insurance Company against First Mercury Insurance Company related to a settlement agreement for an underlying negligence case. Both companies had consecutively insured DL Phillips Construction, Inc. (DL Phillips) under commercial general liability insurance policies. After the settlement, Colony sued First Mercury, arguing that First Mercury needed to reimburse Colony for the full amount of its settlement contribution, as it contended that First Mercury's policies covered all damages at issue. The district court granted summary judgment in favor of First Mercury, prompting Colony's appeal.In the underlying negligence case, DL Phillips was hired to replace the roof of an outpatient clinic in Texas. Shortly after completion, the roof began leaking, causing damage over several months. The clinic's owner sued DL Phillips for various claims, including breach of contract and negligence. A verdict was entered against DL Phillips for over $3.7 million. Both Colony and First Mercury contributed to a settlement agreement, and then Colony sued First Mercury, arguing it was responsible for all the property damage at issue.The appellate court held that under the plain language of First Mercury's policies and relevant case law, First Mercury was only liable for damages that occurred during its policy period, not all damages resulting from the initial roof defect. The court also found that Colony failed to present sufficient evidence to create a genuine dispute of material fact about whether there was an unfair allocation of damages, which would be necessary for Colony's contribution and subrogation claims. As such, the court affirmed the district court's decision to grant summary judgment in favor of First Mercury and denied summary judgment for Colony. View "Colony Insurance Company v. First Mercury Insurance Company" on Justia Law

In this case, the Supreme Court of North Carolina was asked to determine whether defendant Cassie Herring, who was injured in a car accident, qualifies for benefits under the underinsured motorist (UIM) coverage of her mother and stepfather's automobile insurance policy. The policy defined an "insured" to include any "family member" who is a resident of the named insured’s household. The question was whether Herring was a "resident" of her mother's household.Herring was injured while riding in a car with her father, and the driver of the other car was insured. The other driver's insurance company tendered the limit of its policy to Herring. Herring then sought additional coverage under the UIM provision of her mother and stepfather's policy. The insurer, North Carolina Farm Bureau Mutual Insurance Company (Farm Bureau), filed a declaratory judgment action, claiming that Herring was not a resident of her mother’s household and thus did not qualify for the UIM benefits.The trial court granted summary judgment for Herring and her parents, and the Court of Appeals affirmed. Farm Bureau appealed to the Supreme Court of North Carolina, arguing that there were genuine issues of material fact about Herring’s residency.The Supreme Court of North Carolina agreed with Farm Bureau and reversed the decision of the Court of Appeals. The court held that the evidence, when viewed in the light most favorable to Farm Bureau, raised genuine issues of material fact as to whether Herring was a resident of her mother's household at the time of the accident. The court noted that there were discrepancies between Herring's testimony and the affidavits submitted by her and her parents, which created credibility issues that should be resolved by a jury. Therefore, the court concluded that summary judgment was not appropriate, and the case was remanded for further proceedings. View "N.C. Farm Bureau Mut. Ins. Co. v. Herring" on Justia Law

In this case, the Supreme Court of the State of Delaware reversed the decision of the Superior Court of the State of Delaware. The case centered around an insurance dispute involving Verizon Communications, Inc. and several of its insurers. The dispute arose after Verizon settled a lawsuit brought by a litigation trust, which was pursuing claims against Verizon arising out of a transaction Verizon had made with FairPoint Communications Inc. The litigation trust had alleged that Verizon made fraudulent transfers in the course of the transaction, which harmed FairPoint's creditors. After settling the lawsuit, Verizon sought coverage for the settlement payment and defense costs from its insurers.The insurers denied coverage, arguing that the litigation trust's claims did not qualify as a "Securities Claim" under the relevant insurance policies. The Superior Court disagreed, ruling that the litigation trust's claims were brought derivatively on behalf of FairPoint by a security holder of FairPoint, as required to qualify as a Securities Claim under the policies.The Supreme Court of Delaware reversed this decision, finding that the litigation trust's claims were direct, not derivative. The court reasoned that the trust's claims were brought on behalf of the creditors, not FairPoint or its subsidiary, and the relief sought would benefit the creditors, not the business entity. Therefore, the claims did not meet the definition of a Securities Claim under the insurance policies. Consequently, the Supreme Court held that the insurers were not obligated to cover Verizon's settlement payment and defense costs. View "In re Fairpoint Insurance Coverage Appeals" on Justia Law

A car dealership, Broadway Ford Truck Sales, Inc., in St. Louis, Missouri, suffered a significant fire damage to its business premises and filed claims under its insurance policy provided by Depositors Insurance Company. However, disputes arose over the coverage and Broadway Ford sued Depositors for breach of contract and vexatious refusal to pay. The United States District Court for the Eastern District of Missouri granted summary judgment favoring Depositors.At the time of the fire, Broadway Ford had an insurance policy that covered loss or damage to its Building and Business Personal Property (Building/Property) and loss of Business Income and Extra Expenses (BI/EE) due to a suspension of operations. Broadway Ford and Depositors later entered into a Limited Settlement Agreement and Release of Disputed Property Damage Claims (LSA), in which Depositors agreed to pay a certain amount for the fire damage and Broadway Ford released Depositors from any claims related to the property damage. BI/EE claims were not included in this agreement and remained open.Broadway Ford’s complaint against Depositors alleged that Depositors breached the policy's implied covenant of good faith and fair dealing and that Depositors’ conduct amounted to vexatious refusal under Missouri law. The district court granted Depositors' motion for summary judgment, finding that Broadway Ford’s complaint was foreclosed by the LSA. On appeal, the United States Court of Appeals for the Eighth Circuit reviewed the grant of summary judgment de novo.The appellate court affirmed the judgment of the district court. The court found that Broadway Ford had released its claims related to the Building/Property coverage in the LSA and could not pursue litigation for additional compensatory damages in the form of the “business income” it lost and the “extra expenses” it incurred due to Depositors’ alleged mishandling of its Building/Property coverage claim. View "Broadway Ford Truck Sales, Inc. v. Depositors Insurance Company" on Justia Law

In the United States Court of Appeals for the Fourth Circuit, the case involved defendant Glenda Taylor-Sanders, a licensed insurance agent, who pleaded guilty to one count of wire fraud. Taylor-Sanders had used her position to defraud several trucking companies and an insurance finance company, BankDirect Capital Finance, by misappropriating funds meant for insurance premiums and obtaining loans under the guise of non-existent insurance policies. She used the funds for personal expenditures, leading to the lapse of some of the trucking companies' insurance policies.In her plea agreement, Taylor-Sanders agreed to pay full restitution to all victims harmed by her relevant conduct, and she waived all rights to contest the conviction and sentence in any appeal, unless it was due to ineffective assistance of counsel or prosecutorial misconduct. However, she later attempted to withdraw her guilty plea, arguing that she didn't fully understand the implications of her plea and that she never acted with the requisite intent to defraud. The district court denied her motion to withdraw the plea, concluding that her claim was not credible and that she had not provided a fair and just reason to withdraw her guilty plea.After being sentenced to 66 months' imprisonment and ordered to pay over $700,000 in restitution, Taylor-Sanders appealed her conviction, sentence, and the restitution order. She argued that her guilty plea wasn’t knowing and voluntary, that the district court miscalculated her offense level, and that the district court made several errors when awarding restitution.The Court of Appeals found that Taylor-Sanders's guilty plea and plea waiver were valid and the issues she raised on appeal fell within the scope of her appeal waiver. The court distinguished between claims that a sentence is "illegal" because the district court lacked the authority to issue the sentence (which remain reviewable despite an appeal waiver) and claims that a sentence was "imposed in violation of law" because it has otherwise merely "been touched by a legal error" (in which case the court will enforce the appeal waiver). The court dismissed Taylor-Sanders's appeal in its entirety. View "US v. Taylor-Sanders" on Justia Law

In this case, the United States Court of Appeals for the Eighth Circuit heard an appeal by Armory Hospitality, LLC, an event venue in Minneapolis, Minnesota. Armory had an insurance policy with Philadelphia Indemnity Insurance Company and filed a claim to recover its business losses due to the closure of bars, restaurants, and performance venues for over a year by Minnesota’s Governor in response to the COVID-19 pandemic. The insurer denied the claim, leading to Armory suing. However, the district court dismissed Armory’s complaint, holding that the policy did not cover the losses, a decision which Armory appealed.The Court of Appeals affirmed the district court’s decision. The court interpreted the insurance policy under Minnesota law, which requires unambiguous policy language to be given its plain and ordinary meaning. Armory sought coverage under three clauses in its policy: the Building Coverage clause, the Business Income clause, and the Civil Authority clause. The first two clauses required “direct physical loss of or damage to” Armory’s property, which the court decided had not been met since the closure of the venue due to the pandemic did not satisfy the physicality requirement. The court disregarded Armory's argument that the "loss of" property included its inability to use its venue, citing previous precedent requiring physicality for both "loss of" and "damage to" property.As for the Civil Authority clause, the court found that Armory could not prove a causal link between the contamination of nearby properties (a hospital and a jail) by COVID-19 and the Governor’s orders to close venues. Hence, the court concluded that Armory could not recover under any of the clauses in its policy, and therefore affirmed the district court's dismissal of Armory's complaint. View "Armory Hospitality, LLC v. Philadelphia Indemnity Ins. Co." on Justia Law