Justia Insurance Law Opinion Summaries

A False Claims Act qui tam action was filed under seal against SHH and its nursing facilities, alleging that SHH provided unreasonable and unnecessary services to claim the highest possible Medicare reimbursement. Three co-relators also alleged that SHH retaliated against them for internally reporting fraudulent billing practices. SHH received a Department of Justice notification that it was the subject of a fraudulent claims investigation, requesting information about recent terminations of SHH employees, including the relators. It did not explicitly refer to the retaliation allegations.Two years later, SHH obtained liability coverage. Allied's claims-made policy applies only to claims first made during the policy period. SHH's application checked "none" when asked to “provide full details of all inquiries, investigations, administrative charges, claims, and lawsuits filed” within the last three years. SHH checked “no” to whether “[SHH], any Subsidiary, any Executive or other entity proposed for coverage kn[ew] of any act, error or omission which could give rise to a claim, suit or action.” An application exclusion, incorporated into the policy, stated that if such information existed, any inquiry, investigation, administrative charge, claim, or lawsuit arising therefrom or arising from such violation, knowledge, information, or involvement is excluded from coverage.The qui tam action was unsealed. SHH notified Allied and sought coverage for defense costs. Allied denied coverage. SHH sued. SHH later settled the relators' retaliation claim ($2.2 million) and finalized a $10 million settlement for the claims-submissions violations. The district court granted SHH partial summary judgment, awarding $2,336,786.35. The Sixth Circuit reversed. The plain language of SHH’s policy excluded coverage. View "SHH Holdings, LLC v. Allied World Specialty Ins. Co." on Justia Law

The First Circuit reversed the judgment of the district court ruling that Insured's claim of unfair claim settlement practices in violation of Mass. Gen. Laws ch. 176D and 93A was barred by the choice-of-law provision of the marine insurance policy he purchased from Great Lakes Insurance SE (GLI), holding that the district court erred.Insurer, the insurer of Insured's forty-seven-foot catamaran sailing vessel, brought a declaratory judgment action to determine whether the "constructive total loss" of Insured's vessel was covered under the relevant policy. Insured brought a counterclaim alleging violations of Mass. Gen. Laws ch. 176D, 3(9) and ch. 93A, 9(3A). The district court ruled that pursuant to the policy's choice-of-law provision, New York law barred Insured's Massachusetts counterclaim because New York law does not provide for a chapters 176D and 93A claim. The First Circuit reversed, holding (1) Insured's statutorily-based counterclaim was extra-contractual; (2) the plain language of the choice-of-law provision was not broad enough to unambiguously encompass an extra-contractual claim; and (3) any ambiguity in the policy must be construed in favor of Insured. View "Great Lakes Insurance SE v. Andersson" on Justia Law

The Supreme Court affirmed the decision of the superior court granting summary judgment and final judgment in favor of third-party defendants, Western Surety Company and the Insurance Company of the State of Pennsylvania (collectively, the Sureties) in this case concerning the scope of the sureties' liability under a performance and payment bond issued in conjunction with a public works project, holding that there was no error.The Rhode Island Department of Transportation (RIDOT) was sued by Apex Development Company in this action alleging that RIDOT and its contractors trespassed and damaged Apex's private property. RIDOT filed a third-party complaint against the Sureties and others, seeking full indemnity and contribution. A hearing justice granted summary judgment for the Sureties, and a final judgment was entered. The Supreme Court affirmed, holding that RIDOT was not entitled to relief on its allegations of error on appeal. View "Apex Development Co., LLC v. State of R.I. Dep't of Transportation" on Justia Law

Appellants Robert and Kelly Franks sought automobile insurance from Appellee, State Farm Mutual Automobile Insurance Company in 2013 for their two vehicles. Appellants included underinsured motorist coverage (“UIM”) in their policy but completed a form rejecting stacked UIM coverage in compliance with Section 1738(d)(2) of the Motor Vehicle Financial Responsibility Law (“MVFRL”). Absent such waiver, stacked coverage would be the default. Appellants removed one of the original vehicles and added a third vehicle to the policy effective 2014, and again rejected stacked UIM coverage. They made another change to the policy in 2015, removing the other of the original insured vehicles with a different car. No additional form rejecting stacked UIM coverage was offered or sought to be completed on the occasion of the removal of the last vehicle, and the ongoing premiums paid by Appellants reflected the lower rate for non-stacked UIM overage on two vehicles. Robert was injured in an accident caused by the negligence of a third party. That party had insufficient liability coverage to cover Robert's injuries. Appellants initiated a claim for UIM benefits under their policy with State Farm, but the parties disagreed on the limit to their benefits. Appellants contended with the last change to the policy, there was no valid waiver of stacked UIM coverage, resulting in a default stacked coverage mandated by statute. The issue presented for the Pennsylvania Supreme Court's review in this matter was whether the Superior Court erred as a matter of law by holding that removal of a vehicle from a multiple motor vehicle insurance policy, in which stacked coverage had previously been waived, did not require a renewed express waiver of stacked coverage pursuant to Section 1738(c). The Supreme Court concluded the Superior Court did not err and affirmed its judgment. View "Franks, et al. v. State Farm Mutual" on Justia Law

Plaintiff, MSP Recovery Claims, Series LLC (“MSP”) appealed from the district court’s judgment dismissing for lack of standing its putative class action against Defendant Hereford Insurance Company (“Hereford”) and denying leave to amend. MSP has brought several lawsuits around the country seeking to recover from insurance companies that allegedly owe payments to Medicare Advantage Organizations (“MAOs”) under the Medicare Secondary Payer Act (the “MSP Act”). In the putative class action brought here, MSP charges Hereford with “deliberate and systematic avoidance” of Hereford’s reimbursement obligations under the MSP Act.   The Second Circuit affirmed. The court concluded that MSP lacked standing because its allegations do not support an inference that it has suffered a cognizable injury or that the injury it claims is traceable to Hereford. The court also concluded that the district court did not abuse its discretion when it denied MSP leave to amend based on MSP’s repeated failures to cure. The court explained that the plain language of Section 111 provides that when a no-fault insurance provider such as Hereford reports a claim pursuant to Section 111, it does not thereby admit that it is liable for the claim. The statutory context of the section’s reporting obligation and the purpose of the reporting obligation confirms the correctness of this interpretation. Because MSP’s argument that the payments made by EmblemHealth are reimbursable by Hereford rests entirely on its proposed interpretation of Section 111, MSP has not adequately alleged a “concrete” or “actual” injury or that the injury it alleges is fairly traceable to Hereford. View "MSP v. Hereford" on Justia Law

Plaintiffs own a large ten-thousand-square-foot house in Austin, Texas. They insured their home with Crestbrook Insurance Company. Their policy included “Biological Deterioration or Damage Clean Up and Removal” coverage (“mold coverage”). In April 2019, Plaintiffs discovered a widespread mold infestation in their home. Although Crestbrook covered many of their losses, it denied a generalized claim for mold growing in Plaintiffs’ walls and heating, ventilation, and air conditioning system. On cross-motions for summary judgment, a magistrate judge issued a report and recommendation in favor of Crestbrook, and the district court adopted the magistrate judge’s conclusions. At issue on appeal is whether the optional mold coverage Plaintiffs purchased in their Crestbrook policy, which provided $1.6 million in mold damage insurance in exchange for $4,554.53 in additional premiums, covers a generalized mold loss.   The Fifth Circuit affirmed. The court held that the district court incorrectly applied the Texas insurance coverage burden-shifting framework. However, Crestbrook is entitled to summary judgment regardless. The court wrote that the insurance company has demonstrated that a generalized mold claim is excluded under the policy. Plaintiffs have not met their burden of showing that an exception to the exclusion in their insurance contract brings their claim back within coverage View "Buchholz v. Crestbrook" on Justia Law

The Supreme Court reversed the judgment of the court of appeals in this insurance dispute, holding that an insurance policy does not incorporate by reference the payout limits in an underlying service agreement.Two employees that were severely burned in a workplace accident at an ExxonMobil Corporation refinery sought compensation for their injuries and settled for a collective amount over $24 million. When two of Exxon's insurers, National Union Fire Insurance Company and Starr Indemnity & Liability Insurance Company, denied Exxon coverage under their umbrella policies Exxon sued both insurers for breach of contract. The trial court sided with Exxon, ruling that National Union was obligated to reimburse Exxon. The court of appeals reversed, concluding that Exxon was not insured under National Union's umbrella policy. The Supreme Court reversed, holding (1) Exxon was an insured under National Union's umbrella policy, and the court of appeals erred in ruling otherwise; and (2) because the court of appeals' holding with respect to Starr's policy was predicated on a similar error, judgment in favor of Starr must also be reversed. View "ExxonMobil Corp. v. Nat'l Union Fire Ins. Co. of Pittsburgh, PA" on Justia Law

Zurich American Insurance Company (“Defendant”) insured St. Joe Minerals Corporation (“St. Joe”) and its sole shareholder Fluor Corporation (“Plaintiff”) from 1981 to 1985. St. Joe operated a lead smelting plant in Herculaneum, Missouri. Residents of the town sued Fluor and St. Joe in the early 2000s, claiming that they had been injured by the plant’s release of lead and other toxins.Defendant agreed to defend the companies and paid out $9.87 million. Defendant also contributed more than $25 million to a settlement between St. Joe and the remaining plaintiffs. Plaintiff went to trial, lost in a jury trial, and then settled the claims for $300 million.Defendant filed for declaratory judgment against Plaintiff, who filed a counterclaim alleging bad faith failure to settle. The district court granted summary judgment to Defendant, concluding that the policy limited Defendant’s liability on a per-occurrence basis and that the $3.5 million per-occurrence limit had been exhausted by Defendant’s initial payments. The court also concluded that Defendant did not act in bad faith when it elected not to settle the claims against Plaintiff.The Eighth Circuit reversed the district court’s policy-limits determination and remanded for further proceedings. The court found that an endorsement modified the limits of liability for comprehensive general liability, including bodily injury liability, to be on a per-claim basis. View "Fluor Corporation v. Zurich American Insurance Co." on Justia Law

Tessco Technologies Inc. hired Landstar Ranger, Inc. as a transportation broker to secure a motor carrier to transport an expensive load of Tessco’s cargo to a purchaser across state lines. But Landstar mistakenly turned the shipment over to a thief posing as a Landstar-registered carrier, who ran off with Tessco’s shipment. Tessco’s insurer, Aspen American Insurance Company, sued Landstar, claiming Landstar was negligent under Florida law in its selection of the carrier. The district court dismissed Aspen’s negligence claims against Landstar, concluding those claims were expressly preempted by the Federal Aviation Administration Authorization Act (“FAAAA”).   The Eleventh Circuit affirmed. The court explained that just as the phrase “with respect to the transportation of property” “massively limits” the preemption provision, the court reads the phrase “with respect to motor vehicles” to impose a meaningful limit on the exception to the preemption provision. Second, the court found that the phrase “with respect to motor vehicles” has an operative effect only by requiring a direct connection between the state law and motor vehicles. The court reasoned that the specifics of Aspen’s complaint make us even more confident that Aspen’s claims are not “with respect to motor vehicles” within the meaning of the safety exception. Aspen’s complaint says nothing at all about motor vehicles. And Aspen’s negligence and gross negligence counts challenge only Landstar’s “selection of the motor carrier.” The complaint does not purport to enforce any standard or regulation on the ownership, maintenance, or operation of “a vehicle, machine, tractor, trailer, or semitrailer propelled or drawn by mechanical power and used on a highway in transportation.” View "Aspen American Insurance Company v. Landstar Ranger, Inc." on Justia Law

Plaintiff sued Aspen Specialty Insurance Company (“Aspen”) for breach of contract and sought a declaration that its 2016 and 2017 policies (the “Matthew” and “Irma” Policies)—covered damages caused by named windstorms. The parties cross-moved for summary judgment, teeing up a discrete and dispositive question of law: Do the policies cover named-windstorm-related losses? The district court granted summary judgment to Aspen. It held that “no reasonable jury” could find that the parties “intended the policies at issue to exclude named windstorm coverage.”   The Eleventh Circuit reversed. The court held that whatever the evidence of the contracting parties’ subjective intentions and expectations, the Irma Policy’s plain language unambiguously covers losses caused by named windstorms. Further, the court wrote that although potentially ambiguous, the Matthew Policy likewise—and, again, whatever the evidence of the parties’ subjective intentions and expectations—covers losses caused by named windstorms pursuant to the contra proferentem canon, according to which ambiguous insurance contracts are construed in favor of coverage and against the insurer. View "Shiloh Christian Center v. Aspen Specialty Insurance Company" on Justia Law