Justia Insurance Law Opinion Summaries

Douglas Ghee, as the personal representative of the estate of Billy Fleming, appealed a circuit court judgment dismissing Ghee's wrongful-death claim against USAble Mutual Insurance Company d/b/a Blue Cross Blue Shield of Arkansas and Blue Advantage Administrators of Arkansas ("Blue Advantage"). The circuit court correctly dismissed the aspect of Ghee's claim that, on the face of the complaint, was based on an insurance-benefits decision by Blue Advantage. The Alabama Supreme Court found the circuit court erred, however, by dismissing the aspect of Ghee's claim that was based on Blue Advantage's alleged provision of medical advice, because it was not clear from the complaint that that aspect was based on an insurance-benefits decision. Accordingly, the Supreme Court affirmed the judgment in part and reversed it in part. View "Ghee v. USAble Mutual Insurance Company d/b/a Blue Cross Blue Shield of Arkansas, et al." on Justia Law

Secura Supreme Insurance Company appealed a judgment ordering Secura to indemnify Scott Differding for damages awarded against him in a tort case. The district court, deciding cross motions for summary judgment, held Secura’s policy did not insure Differding. The court nonetheless held Secura had to indemnify Differding under theories of waiver and estoppel because it assumed his defense in the tort case without reserving the right to deny coverage. The North Dakota Supreme Court held Differding could not invoke waiver and estoppel to create personal coverage under an insurance policy to which he was not a party and had no right to enforce. The district court’s judgment was therefore reversed. View "Secura Supreme Ins. Co., et al. v. Differding, et al." on Justia Law

Santa Clara Valley Water District was insured by Century. In 2000, the District notified Century that it had been advised by the federal government of potential claims for natural resource damages resulting from mercury contamination in the Guadalupe River Watershed (NRD Claim). Century requested additional information, including the status of negotiations. Century made several similar requests to the District between 2000-2002. In 2001, Century indicated that it had no duties under the primary policies because there was no lawsuit pending, had no duty to indemnify the District under the excess policies until the underlying limits of the policies had been exhausted, and was reserving its rights under the policies. The District subsequently signed a tolling agreement, was sued in federal court, and entered a Consent Decree without notifying Century.In 2008, the District notified Century of the existence of the lawsuit and the Consent Decree and stated that it had incurred $4 million in costs to comply with the Consent Decree. Century cited a No Voluntary Payment (NVP) provision. The District did not contact Century until 2014, when it completed its required Consent Decree work. In 2015, the District sued Century.The court of appeal affirmed summary judgment for Century. The NVP provisions barred the District from seeking indemnification for the expenses it incurred under the Consent Decree, without notifying Century or obtaining its consent. Those provisions apply to the settlement even though it was achieved through a consent decree rather than a traditional settlement agreement. Because the NRD Claim was disposed of by that settlement, there was no “adjudication” that gave rise to an “ultimate net loss” that gave the District the right to pay and seek indemnification. View "Santa Clara Valley Water District v. Century Indemnity Co." on Justia Law

The federal district court for the District of South Carolina certified a question of law to the South Carolina Supreme Court. Garland Denson (the decedent) was killed in an automobile accident allegedly caused by a drunk driver. The complaint alleged the at-fault driver was overserved at Royal Lanes, a bar insured by Defendant National Casualty Company (National Casualty) under a general liability policy with no liquor liability endorsement. During probate of the decedent's estate, his personal representative, Plaintiff Anthony Denson (Denson), discovered Royal Lanes did not have the required liquor liability insurance. Specifically, Denson learned National Casualty previously provided liquor liability coverage to Royal Lanes, but at the time of the accident, the business had failed to renew the liquor liability coverage, leaving only a general liability policy. Liquor liability coverage was statutorily mandated for certain establishments that sell alcoholic beverages, and the failure to maintain this coverage constituted a violation of South Carolina law. The federal court asked whether a person could bring a dram-shop negligence action against a business whose insurer failed to notify the state Department of Revenue of the business’ lapse in liquor liability coverage, and the business did not have coverage at the time of the accident. The Supreme Court responded in the negative: S.C. Code Ann. section 61-2-145(C) did not create a private right of action in favor of an injured party against the business's insurer. View "Denson v. National Casualty" on Justia Law

In 2018, Appellant Nationwide Affinity Insurance Company of America (Nationwide) issued a personal automobile insurance policy to Shameika Clark, Respondent Andrew Green's mother. The policy included $25,000 in UIM property damage coverage for Clark and her family members. The general definition section broadly defined "property damage" as "physical injury to, destruction of[,] or loss of use of tangible property." The UIM endorsement, however, more narrowly defined "property damage" as "injury to or destruction of 'your covered auto.'" In October 2018, Green was hit by a vehicle while walking home from school. Green pursued a claim against Nationwide for UIM bodily injury, but Nationwide refused to pay because the accident did not result in “damage to a “covered auto.” Nationwide filed this declaratory judgment action and requested a declaration that Green was not entitled to UIM property damage. The circuit court reformed Nationwide’s policy rider issued to Clark, finding that under South Carolina case law, insurers could not limit that coverage to vehicles defined in policy as “covered autos.” The South Carolina Supreme Court affirmed the circuit court’s judgment. View "Nationwide v. Green" on Justia Law

The federal district court for the District of South Carolina certified a question of law to the South Carolina Supreme Court. In 2019, USAA issued a personal automobile policy to Megan Jenkins. The policy defined "your covered auto" as any vehicle shown on the policy's declaration, any newly acquired vehicle, and any trailer owned by the insured. While riding her bicycle, Jenkins was struck and killed by an underinsured motorist. Defendant Vincent Rafferty—Jenkins' personal representative—made a claim under Jenkins' policy for UIM property damage arising from damage to the bicycle. USAA Casualty Insurance Company (USAA) denied the claim and commenced this action in federal court, asserting Jenkins' bicycle did not fall within the definition of "your covered auto." Whether USAA prevailed depended upon whether automobile insurers were required to offer UIM property damage coverage at all. If insurers were not required to offer UIM property damage coverage, they were free to restrict such coverage to an insured's "covered auto." The federal court asked the Supreme Court whether, under South Carolina Law, an auto insurer could validly limit underinsured motorist property damage coverage to property damage to vehicles defined in the policy as a “covered auto.” In their briefs and during oral argument, the parties did not directly address the question as framed by the district court. Instead, the parties briefed and argued the broader question of whether an automobile insurer's offer of underinsured motorist (UIM) coverage had to include property damage coverage. Because the answer to the broader question yielded the answer to the certified question, the Supreme Court addressed the parties’ question. USAA rightly conceded that if the Supreme Court held an insurer was required to offer UIM property damage coverage, the Court had to answer the certified question "no." The Court indeed held insurers were required to offer UIM property damage coverage, and therefore answered the certified question "no." View "USAA Casualty v. Rafferty" on Justia Law

Plaintiffs wereconsumers who sued Defendant Security Benefit Life Insurance Company under the Racketeer Influenced and Corrupt Organizations Act (“RICO”), and state law, alleging Security Benefit developed a fraudulent scheme to design and market certain annuity products. The issue this case presented for the Tenth Circuit’s review centered on whether the district court properly dismissed Plaintiffs’ first amended complaint without prejudice for lack of particularity and plausibility in pleading fraud. Because the Tenth Circuit concluded Plaintiffs alleged facially plausible fraud claims with the particularity required under Federal Rule of Civil Procedure 9(b), the district court erred in granting Security Benefit’s motion to dismiss under Federal Rule of Civil Procedure 12(b)(6). View "Clinton, et al. v. Security Benefit Life" on Justia Law

The Supreme Court reversed the judgment of the circuit court affirming the rules of the West Virginia Health Care Authority (WVHCA) denying War Memorial Hospital, Inc.'s (Hospital) certificate of need exemption application that would have allowed Hospital to acquire and utilize a fixed magnetic resonance imagining (MRI) scanner at its medical office building, holding that the circuit court erred.The WVHCA denied the Hospital's exemption application on the grounds that the MRI device would not be used in the Hospital's facility but, rather, that the Hospital intended to place the MRI device in a building in another country that was owned by the Hospital's parent corporation. The circuit court affirmed. The Supreme Court reversed, holding that there is no location-specific requirement in W. Va. Code 16-2D-11(c)(27) that the MRI the Hospital sought to acquire be utilized at its "primary hospital location." View "War Memorial Hospital v. W. Va. Health Care Authority" on Justia Law

In this case arising the death of James Savage after he was thrown from his motorcycle and run over by Oscar Ramos, the Supreme Court affirmed in part and reversed in part the judgment of the court of appeals remanding this case back to the circuit court for a new trial, holding that remand was required under the circumstances.Specifically, the Supreme Court held (1) Property & Casualty Insurance Company of Hartford was not the owner of the Jeep Wrangler at issue according to Ky. Rev. Stat. 186A.530(3), and Co-part of Connecticut, Inc. was required to obtain proof of insurance pursuant to sections 186A.215 and 186A.220; (2) the court of appeals improperly engaged in fact-finding that affected its judgment on other issues; (3) the court of appeals erred in ruling that the trial court abused its discretion by allowing Co-part to withdraw an admission; (4) strict liability does not apply as a matter of law for violations of Ky. Rev. Stat. 186A.500; and (5) Aull v. Houston, 345 S.W.3d 232 (Ky. App. 2010) is hereby abrogated to the extent that it can be read to hold that Social Security Disability benefits are inadmissible in a damages calculation in a wrongful death suit. View "Savage v. Co-Part of Connecticut, Inc." on Justia Law

Ron and Lorrie Meier investigated the purchase of a life insurance policy for Ron through Monarch Solutions. While they considered a policy offered by Lincoln, a nurse assessed Ron’s health and prepared a “Medical Supplement” and “Examiner’s Report.” Ron ultimately applied for a policy with Pacific. In June 2018, Pacific received a copy of the medical forms previously submitted to Lincoln. On July 26, Ron completed his Pacific application, referencing the Lincoln “medical examination.” Ron agreed to several terms, including a provision requiring him to update Pacific “in writing of any changes” to his health. Pacific accepted Ron’s application on July 30 and began the underwriting process. On August 6, Ron learned he had stage IV lung cancer and immediately began treatment. Ron and Lorrie orally disclosed Ron’s cancer diagnosis to their Monarch representative but did not inform Pacific. On September 6, Pacific delivered Ron's policy. A year later Ron died from lung cancer.After learning that Ron had failed to disclose his terminal cancer before the policy’s issuance date, Pacific rejected Lorrie’s claim. Pursuant to the Illinois Insurance Code, Pacific rescinded the policy and returned the premiums. The district court and Seventh Circuit ruled in favor of Pacific. Ron’s failure to inform Pacific of the diagnosis constituted a material misrepresentation allowing for the policy's rescission. View "Meier v. Pacific Life Insurance Co." on Justia Law