Justia Insurance Law Opinion Summaries

The Supreme Court vacated the judgment of the superior court granting Insurer's motion for summary judgment in this insurance dispute, holding that Insured was entitled to judgment as to counts one, four, and five of its complaint.Insured, a company that sold and serviced residential heating and air-conditioning systems, was sued by a former customer who alleged negligence and demanded remediation from property damaged by 170 gallons of home heating oil that leaked into his basement. Insured demanded that Insurer defend and indemnify against the claim. The hearing justice granted summary judgment in favor of Insurer. The Supreme Court vacated the judgment below, holding (1) the relevant insurance policy's definition of "pollution" was ambiguous as applied to Insured's claims; and (2) the hearing justice erred in granting summary judgment in favor of Insurer and in denying Insured's motion for summary judgment as to certain counts of the complaint. View "Regan Heating & Air Conditioning, Inc. v. Arbella Protection Insurance Co., Inc." on Justia Law

The Supreme Court affirmed the decision of the court of appeals panel reversing the judgment of the district court against Key Insurance Company in this garnishment action brought by Nancy Granados seeking pay under the liability insurance policy Key had issued to John Wilson, holding the court of appeals made the correct conclusion.John Wilson struck a car while he was driving under the influence and killed the driver. The driver's wife, Granados, brought a wrongful death lawsuit against Wilson. The district court entered a judgment against Wilson for nearly $3.5 million. Granados then filed this garnishment action seeking payment from Key under the automobile liability insurance policy it had issued to Wilson and under which Key limited tis coverage for bodily injuries caused by Wilson to $50,000 in the aggregate. Granados argued that, despite the policy limits, Key's negligent and bad-faith handling of Wilson's claim rendered it liable for the entire judgment. The trial court agreed and entered judgment against Key. The court of appeals reversed. The Supreme Court affirmed, holding that Granados failed to meet her burden to prove that Key's handling of the claim caused the judgment exceeding policy limits. View "Granados v. Wilson " on Justia Law

The Supreme Court reversed the decision of the court of appeals affirming the circuit court's grant of summary and declaratory judgment in favor of State Farm in this insurance dispute, holding that issue preclusion did not bar Lindsey Dostal from seeking insurance coverage for her claims against Curtis Strand.The daughter of Dostal and Strand died as a result of head trauma that occurred while she was in Strand's care. Strand was convicted of second-degree reckless homicide. Dostal subsequently brought this civil action against Strand for negligence and wrongful death. Strand tendered the matter to his homeowner's insurer, State Farm, seeking defense and indemnification. The circuit court granted summary and declaratory judgment in favor of State Farm. The court of appeals affirmed, determining that Strand's conduct did not constitute an "occurrence" covered by the policy at issue because Defendant's criminal conviction established that the death was not the result of an accident. The Supreme Court reversed, holding (1) the issue of whether Strand's conduct was an "accident" was not actually litigated in the prior criminal proceeding; and (2) there were genuine issues of material fact such that summary judgment was inappropriate. View "Dostal v. Strand" on Justia Law

Joy Global and Komatsu agreed to merge. Joy sent its investors disclosures required under the Securities Exchange Act, 15 U.S.C. 78n. Subsequent suits contended that Joy violated the Act by not disclosing some internal projections of Joy’s future growth that could have been used to negotiate a higher price, rendering the proxy statements fraudulent, and that Joy’s directors violated their state law duties by not maximizing the price for the shareholders. The suits settled for $21 million.The district court held that the $21 million loss is not covered by insurance. The policies do not require indemnification for “any amount of any judgment or settlement of any Inadequate Consideration Claim other than Defense Costs.” An “inadequate consideration claim” is that part of any Claim alleging that the price or consideration paid or proposed to be paid for the acquisition or completion of the acquisition of all or substantially all the ownership interest in or assets of an entity is inadequate.The Seventh Circuit affirmed. The suits assert the wrongful act of failing to disclose documents that could have been used to seek a higher price and are within the definition of “inadequate consideration claim.” The claims do not identify any false or deficient disclosures about anything other than the price. The only objection to this merger was that Joy should have held out for more money, and that revealing this would have induced the investors to vote “no.” View "Joy Global Inc. v. Columbia Casualty Co." on Justia Law

Van Dermark served in the Navy from 1963 until his 1976 honorable discharge. The VA found Van Dermark to be totally and permanently disabled due to service-connected injuries. Van Dermark received treatment in Thailand (where he lived) at non-VA facilities, from physicians and others not affiliated with VA, in 2016 and in 2018, both times for cardiac conditions not related to his service-connected disability. For each of the two instances of treatment abroad, Van Dermark filed a claim with VA under 38 U.S.C 1728 and 1725 seeking VA payment—to him or his medical creditors—for the surgical or other heart-related treatment he received abroad.VA Community Care denied both claims. The Board of Veterans’ Appeals maintained the denials. The Veterans Court and Federal Circuit affirmed. Section 1724(a) prohibits the VA from “furnish[ing] hospital . . . care or medical services” abroad, where the care or services are unrelated to the service-connected disability. The “furnishing” phrase encompasses the payment for a veteran’s hospital care or medical expenses abroad at issue here; sections 1728 and 1725 do not override that prohibition. View "Van Dermark v. McDonough" on Justia Law

This case arose out of a qui tam action against Prime Healthcare Services—Encino Hospital, LLC (Encino Hospital) and others to impose civil penalties for violation of the Insurance Fraud Prevention Act (IFPA), Insurance Code section 1871 et seq. The State of California and relator (Plaintiffs) appealed from a judgment entered after a bench trial in which the court found insufficient evidence to support their allegations that Defendants engaged in insurance fraud by billing insurers for services performed in a detox center for which they had no appropriate license, and by employing a referral agency to steer patients to the center.   The Second Appellate District affirmed the judgment. The court explained that, CDI alleged that Encino Hospital misrepresented to insurers that it was properly licensed to provide detox services when it was not. The trial court found no evidence suggesting that Defendants presented a false claim to any insurer. The court agreed, reasoning that no authority of which it is aware or to which it has been directed obligates Encino Hospital to hold any license other than its license as a general acute care hospital. Because Encino Hospital needed no separate license or approval, and no evidence showed it concealed any provider, the CDI’s cause of action for false claims failed for lack of a predicate. View "State of Cal. v. Encino Hospital Medical Center" on Justia Law

Plaintiff appealed the district court’s post-trial dismissal of his case for lack of subject-matter jurisdiction. A jury found that AXA Equitable Life Insurance Company negligently reported false medical information about Plaintiff to an information clearinghouse used by insurance companies, causing him to become uninsurable. Despite the fact that the parties satisfied the requirements for federal diversity jurisdiction, and the fact that both parties litigated the entire case through trial under North Carolina law, the district court decided that Connecticut law applied and found itself deprived of subject-matter jurisdiction by virtue of a Connecticut statute.   The Fourth Circuit found that the district court erred and concluded that choice of law is waivable and was waived here. And even if Connecticut’s law applied, it would not have ousted federal jurisdiction. Further, the court held that the district court also erred by concluding that Connecticut’s CIIPPA divested it of subject-matter jurisdiction despite that statute affecting only choice of law rather than choice of forum. AXA’s alternative argument for affirmance based on the nature of Plaintiff’s s injury and its causation was thoroughly briefed and argued before the court, and the court found it to be without merit. But because AXA’s argument for post-trial relief challenging the number of damages was neither raised nor briefed before this court, the court remanded to the district court to consider that issue in the first instance. View "Malcolm Wiener v. AXA Equitable Life Insurance Company" on Justia Law

Department of Labor regulations required the administrator of an employee benefit plan to give a claimant, “upon request,” copies of “all documents, records, and other information” that the administrator considered in making an adverse benefit determination. In 2018, the regulations were amended to eliminate “upon request” and require an administrator to provide such information “sufficiently in advance” of an adverse determination “to give the claimant a reasonable opportunity to respond.”Zall, a dentist for 20 years, sought long-term disability benefits in 2013 after pain and numbness forced him to stop working. His insurer, Standard denied the claim. In 2014, after considering additional medical information and consulting an orthopedic surgeon, Standard approved Zall’s claim, including retroactive payments. Less than a year later, Standard began reviewing his case to see if his condition was subject to a 24-month benefit limit applicable to any disability “caused or contributed to by … carpal tunnel or repetitive motion syndrome” or “diseases or disorders of the cervical, thoracic, or lumbosacral back and its surrounding soft tissue.” Standard ultimately terminated Zall’s benefits.Zall filed suit under the Employee Retirement Income Security Act, 29 U.S.C. 1001, arguing that the decision was arbitrary and capricious and that Standard violated ERISA’s procedural requirements by failing to afford him “a full and fair review.” The district court granted Standard summary judgment. The Seventh Circuit reversed and remanded. The plain language shows that the amended regulation applies; Standard failed to comply. View "Zall v. Standard Insurance Co." on Justia Law

When the ACA’s mandate and SRP were still in effect, a husband and wife (“Taxpayers”) did not maintain the minimum insurance coverage required by the ACA. The taxpayers did not include their $2409 SRP when they filed their 2018 federal tax return. The Taxpayers filed for Chapter 13 bankruptcy protection in the Eastern District of North Carolina. The IRS filed a proof of claim for the unpaid SRP and asserted that its claim was entitled to priority as an income or excise tax under Section 507 of the Bankruptcy Code. The Taxpayers objected to the government’s claim of priority. The bankruptcy court granted the objection, concluding that, for purposes of the Bankruptcy Code, the SRP is a penalty, not a tax, and therefore is not entitled to priority under Section 507(a)(8). The government appealed to the district court, which affirmed the bankruptcy court’s decision. The district court held that even if the SRP was generally a tax, it did not qualify as a tax measured by income or an excise tax and thus was not entitled to priority. The government thereafter appealed.   The Fourth Circuit reversed and remanded. The court concluded that that the SRP qualifies as a tax under the functional approach that has consistently been applied in bankruptcy cases and that nothing in the Supreme Court’s decision in NFIB requires the court to abandon that functional approach. Because the SRP is a tax that is measured by income, the government’s claim is entitled to priority under 11 U.S.C. Section 507(a)(8)(A). View "US v. Fabio Alicea" on Justia Law

Five months after being sued in Oregon for trademark infringement, Jacob Rieger & Co., LLC provided notice to its liability insurer, Cincinnati Insurance Company. Due to Rieger’s delay, Cincinnati refused to reimburse Rieger’s legal fees for the five months that Cincinnati was unaware of the lawsuit. The Oregon case was ultimately dismissed for lack of jurisdiction. Instead of waiting to be sued in a court that did have jurisdiction, Rieger’s parent company, GSP Licensing LLC, filed a new suit in Missouri as the plaintiff. GSP was not named under Rieger’s insurance policy, so Cincinnati denied coverage for the Missouri case. Cincinnati then filed this lawsuit, seeking a declaration of coverage. The district court granted summary judgment to Cincinnati.   The Eighth Circuit reversed in part the district court’s grant of summary judgment to Cincinnati. The court affirmed the dismissal of Rieger’s tort claims and the imposition of sanctions. The court explained that under Missouri law, a tort claim is independent of a contract claim if the tort claim can succeed without regard to the outcome of the contract claim. In other words, the tort claim could succeed regardless of the outcome of the contract claim. Here, Rieger admits that its tort claims would fail if its contract claim succeeded. By Rieger’s own admission, the court found that the district court properly dismissed Rieger’s tort claims. View "Cincinnati Insurance Company v. Jacob Rieger & Co., LLC" on Justia Law