Justia Insurance Law Opinion Summaries

Karl Tobien, a door-to-door salesman, was attacked by a dog while working in Ohio. He filed two federal lawsuits: one against the homeowners in the Southern District of Ohio, which was dismissed by agreement, and another against Nationwide General Insurance Company in the Eastern District of Kentucky. Tobien claimed Nationwide violated Kentucky’s Unfair Claims Settlement Practices Act, acted in bad faith, and sought punitive damages after the company denied his insurance claim.The United States District Court for the Eastern District of Kentucky dismissed Tobien’s lawsuit for improper venue, concluding that most relevant events occurred in Ohio. Tobien appealed, arguing that the Eastern District of Kentucky was a proper venue and that the district court should have transferred the case to the Southern District of Ohio instead of dismissing it.The United States Court of Appeals for the Sixth Circuit reviewed the case de novo and upheld the district court’s decision. The court determined that Tobien failed to show that a substantial part of the events giving rise to his claims occurred in the Eastern District of Kentucky. The court also found that transferring the case to the Southern District of Ohio would not be in the interest of justice, as Ohio law would apply and Tobien’s claims would fail under Ohio law. Consequently, the Sixth Circuit affirmed the district court’s dismissal of Tobien’s lawsuit. View "Tobien v. Nationwide Gen. Ins. Co." on Justia Law

Jeremy Woods was injured in a car accident in 2017 and received medical care from Spine Specialists of Michigan PC. Woods assigned his right to payment of personal protection insurance (PIP) benefits to Spine Specialists, but MemberSelect Insurance Company refused to pay. Spine Specialists sued MemberSelect for payment. MemberSelect argued that the claims were barred by the one-year-back rule, which requires claims to be filed within one year of the medical services being rendered. The trial court granted MemberSelect's motion for summary disposition for services rendered before June 11, 2019, but denied it for services rendered between June 11, 2019, and August 12, 2020.The Court of Appeals affirmed the trial court's decision, reasoning that the tolling provision added to the one-year-back rule in 2019 did not apply to claims that accrued before the amendment's effective date. The court held that PIP benefits accrue when the medical services are rendered, not when payment is denied.The Michigan Supreme Court reviewed the case and held that the tolling provision added to MCL 500.3145 in 2019 does not apply retroactively to causes of action that began to accrue before the amendment became effective on June 11, 2019. The court affirmed the judgment of the Court of Appeals, concluding that the claims for services rendered between June 11, 2019, and August 12, 2020, were barred by the one-year-back rule. The court emphasized that the Legislature did not indicate an intent for the tolling provision to apply retroactively and that applying it retroactively would impose new obligations on insurers for past transactions. View "Spine Specialists Of Michigan PC v. Memberselect Insurance Company" on Justia Law

Pamela Siino purchased a life insurance policy from Foresters Life Insurance and Annuity Company (FLIAC) in 2010. In 2014, she moved and failed to successfully update her address with FLIAC. Consequently, she did not receive notices about her premium payments and missed her payment due on January 26, 2018. FLIAC sent a notice on February 26, 2018, stating that her policy had lapsed but could be reinstated if she paid the overdue premium by March 28, 2018. Siino did not receive this notice and did not pay the premium. In 2019, she discovered her policy had lapsed and declined to reinstate it, purchasing a new policy from another provider instead.The United States District Court for the Northern District of California granted summary judgment in favor of Siino, declaring that FLIAC wrongfully terminated her policy and that it would remain valid if she tendered all unpaid premiums. The court found that FLIAC violated California Insurance Code sections 10113.71 and 10113.72 by failing to provide proper pretermination and designee notices. Siino's other claims were dismissed with prejudice.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court affirmed the district court's finding that FLIAC violated the statutory notice requirements, agreeing that FLIAC failed to provide the required pretermination and designee notices. However, the Ninth Circuit reversed the district court's declaration that Siino's policy remained valid, as Siino failed to prove that FLIAC's violations caused her injury. The court noted that even if FLIAC had sent the required notices, they would not have reached Siino due to her failure to update her address. The case was remanded to the district court solely for the purpose of entering final judgment. View "SIINO V. FORESTERS LIFE INSURANCE AND ANNUITY COMPANY" on Justia Law

Brian Prahl filed a petition to compel arbitration of an uninsured motorist claim, alleging he was involved in a multiple vehicle accident in March 2016 while insured by Allstate Northbrook Indemnity Company. The insurance proceeds from the at-fault drivers were insufficient to cover his damages, leading him to seek arbitration for his underinsured motorist claim. Allstate agreed to arbitration in May 2018, but the arbitration was delayed and not concluded within the five-year deadline set by Insurance Code section 11580.2, subdivision (i). Prahl argued that Judicial Council Emergency Rule 10 extended this deadline by six months due to the COVID-19 pandemic.The Superior Court of Sacramento County denied Prahl's petition, concluding that the five-year deadline had expired and that Emergency Rule 10 did not apply to extend the deadline for arbitration. Prahl also contended that the court should have granted his petition because Allstate's opposition was not filed timely. However, the court found good cause to consider the late opposition, noting that Prahl had filed a reply on the merits.The California Court of Appeal, Third Appellate District, reviewed the case de novo and affirmed the lower court's decision. The appellate court held that Emergency Rule 10, which extends the time to bring a civil action to trial by six months, did not apply to arbitration proceedings. The court reasoned that the term "civil action" refers to court actions and does not include arbitration, which is an alternative to a civil action. Consequently, Prahl's failure to conclude the arbitration within the statutory five-year period resulted in the loss of his right to compel arbitration. The appellate court also upheld the lower court's decision to consider Allstate's late opposition, finding no undue prejudice to Prahl. View "Prahl v. Allstate Northbrook Indemnity Co." on Justia Law

In 2021, the 11640 Woodbridge Condominium Homeowners’ Association (HOA) experienced significant interior damage to their building due to two rainstorms while the roof was being replaced. The HOA filed a claim under their condominium policy with Farmers Insurance Exchange (Farmers), which was denied on the grounds that the damage resulted from nonaccidental faulty workmanship, not covered by the policy. The HOA then sued Farmers for breach of contract and breach of the implied covenant of good faith and fair dealing.The Superior Court of Los Angeles County granted summary judgment in favor of Farmers, concluding that the policy did not cover the HOA’s losses due to the water damage exclusion and the faulty workmanship exclusion. The HOA appealed the decision.The California Court of Appeal, Second Appellate District, Division Three, reviewed the case and reversed the summary judgment. The court found that the condominium policy was an “all-risks” policy, covering all damage unless specifically excluded. The court determined that there were triable issues of material fact regarding whether the exclusions cited by Farmers—the water damage exclusion and the faulty workmanship exclusion—precluded coverage. The court noted that the property had a “roof” during the repairs and that the damage could have been caused by both the rain and the alleged faulty workmanship. Therefore, the court concluded that Farmers did not establish that the damage was solely caused by faulty workmanship and that the HOA’s losses might be covered under the policy.The court reversed the summary judgment and remanded the case for further proceedings, allowing the HOA to pursue its claims against Farmers. The HOA was awarded its appellate costs. View "11640 Woodbridge Condominium Homeowners' Assn. v. Farmers Ins. Exchange" on Justia Law

David and Marcia Earll's daughter, Rebecca, was killed in a car accident caused by an underinsured motorist. The Earlls sought underinsured motorist (UIM) benefits under their motor vehicle liability policy with Farmers Mutual Insurance Company of Nebraska. Farmers Mutual denied the claim based on an "owned but not insured" exclusion in the policy. The Earlls filed for a declaratory judgment, arguing that the exclusion was against public policy and that they were entitled to UIM benefits. Both parties filed motions for summary judgment. The circuit court ruled in favor of Farmers Mutual, and the Earlls appealed.The circuit court granted summary judgment to Farmers Mutual, relying on a previous decision in De Smet Insurance Company of South Dakota v. Pourier, which upheld the validity of an "owned but not insured" exclusion for UIM coverage. The Earlls argued that this decision should be overruled or distinguished, emphasizing that similar exclusions had been found to violate public policy in the context of uninsured motorist (UM) coverage.The Supreme Court of South Dakota reviewed the case and reversed the circuit court's decision. The court held that the "owned but not insured" exclusion to UIM coverage violated South Dakota public policy. The court noted that UIM coverage is intended to protect insured individuals from underinsured motorists and that such coverage follows the insured rather than the vehicle. The court overruled its previous decision in Pourier, finding it inconsistent with the statutory purpose of UIM coverage and other related decisions. The case was remanded for the circuit court to enter summary judgment in favor of the Earlls. View "Earll v. Farmers Mutual Insurance" on Justia Law

Ellen Williams purchased a residential property in Houma, Louisiana, which was mortgaged by Flagstar Bank. Since Williams did not insure the home, Flagstar obtained a lender-placed hazard insurance policy from Integon National Insurance Company at Williams's expense. The policy named Flagstar as the "Insured" and Williams as the "Borrower." Williams paid all premiums and complied with all policy requirements. The policy included a provision stating that if the loss amount exceeded Flagstar's insurable interest, Integon would pay Williams any residual amount due for the loss, not exceeding the policy limit.In August 2021, Williams's home was damaged by Hurricane Ida. Although Integon inspected the property and exchanged repair estimates with Williams, it ultimately refused to pay for the full property repairs. Williams sued Integon in the 32nd Judicial District Court for the Parish of Terrebonne, asserting breach-of-contract and bad-faith claims under Louisiana law. Integon removed the case to the United States District Court for the Eastern District of Louisiana and filed a Rule 12(b)(6) motion to dismiss, arguing that Williams lacked standing to sue under the policy. The district court agreed with Integon, ruling that Williams was not a named insured, additional insured, or third-party beneficiary, and dismissed the case without allowing Williams to amend her complaint.The United States Court of Appeals for the Fifth Circuit reviewed the case. The court found that the policy's loss payment provision clearly manifested an intent to benefit Williams, provided a certain benefit when the loss amount exceeded Flagstar's insurable interest, and that this benefit was not merely incidental. The court held that Williams might be able to plead plausible facts supporting her status as a third-party beneficiary. Consequently, the Fifth Circuit reversed the district court's decision and remanded the case with instructions to allow Williams to amend her complaint. View "Williams v. Integon National Insurance" on Justia Law

Vermont Mutual Insurance Company issued a homeowners insurance policy to Joanne St. Vil for property in Rumford, Rhode Island. St. Vil filed a claim for windstorm damage, which Vermont Mutual paid after an inspection. St. Vil later engaged New England Property Services Group, LLC (NEPSG) for additional repairs, leading to a dispute over the scope of damages. St. Vil assigned her insurance claim to NEPSG, which demanded an appraisal. Vermont Mutual objected to NEPSG's appraiser, Steven Ceceri, due to his financial interest but proceeded with the appraisal, reserving the right to dispute the award. The appraisal resulted in a final award of $144,855.37, which Vermont Mutual contested.The Superior Court denied Vermont Mutual's petition to vacate the appraisal award and granted NEPSG's cross-petition to confirm it. The court ruled that the policy did not require the appraiser to be disinterested, referencing a similar case it had previously decided.The Rhode Island Supreme Court reviewed the case and held that the appraisal process in Vermont Mutual's policy constituted arbitration under the Arbitration Act. The Court found that Steven Ceceri had a direct financial interest in the award, establishing evident partiality. The Court also determined a causal nexus between Ceceri's conduct and the final award, as the award was not unanimous and significantly higher than Vermont Mutual's appraiser's estimate. Consequently, the Supreme Court vacated the Superior Court's order and remanded the case for a new appraisal. View "Vermont Mutual Insurance Company v. New England Property Services Group, LLC" on Justia Law

Heartland Co-op, an agricultural cooperative, purchased a property and casualty insurance policy from Nationwide Agribusiness Insurance Company. The policy included earnings and extra expense coverage with a $3 million limit for "any one loss" at "all covered locations." In August 2020, a derecho caused significant damage to Heartland's operations across 48 locations. Nationwide paid Heartland approximately $131 million for the losses, including $3 million for earnings and extra expense coverage. Heartland claimed that the $3 million limit should apply to each location individually, while Nationwide argued that the limit applied to the total loss across all locations.The Iowa District Court for Polk County granted Nationwide's motion for summary judgment, concluding that the policy unambiguously limited the earnings and extra expense coverage to $3 million in total for the derecho-related loss. The Iowa Court of Appeals affirmed the district court's decision, agreeing that the policy language was clear and that the $3 million limit applied to the aggregate loss across all covered locations.The Iowa Supreme Court reviewed the case and affirmed the decisions of the lower courts. The court held that the insurance policy was unambiguous and provided coverage for the total loss of net income and extra expense to Heartland as an entity, not on a per-location basis. The $3 million limit applied to the total loss resulting from the derecho at all covered locations. The court emphasized that the policy's plain language and the premium paid supported this interpretation, and it declined to rewrite the contract to provide the coverage Heartland sought. View "Heartland Co-Op v. Nationwide Agribusiness Insurance Company" on Justia Law

JohnsonKreis Construction Company, Inc. ("JohnsonKreis") served as the general contractor on a hotel-construction project in Birmingham, with Howard Painting, Inc. ("Howard") as a subcontractor. The subcontract agreement included an indemnity provision requiring Howard to indemnify JohnsonKreis for personal injury or death arising from Howard's negligence. Domingo Rosales-Herrera, an employee of a subcontractor working for Howard, died after falling from a window while attempting to load equipment into a trash box on a telehandler owned by JohnsonKreis. The personal representative of Rosales-Herrera's estate filed a wrongful-death lawsuit against both JohnsonKreis and Howard.The Jefferson Circuit Court granted summary judgment in favor of Howard and its insurers, Auto-Owners Insurance Company and Owners Insurance Company (collectively "Owners"), determining that the indemnity provision in the subcontract agreement was legally unenforceable. The court held that Alabama law does not allow for the apportionment of damages in a wrongful-death case, thus precluding proportional indemnification.The Supreme Court of Alabama reviewed the case and reversed the trial court's decision. The Supreme Court held that the subcontract agreement's proportional indemnity provision was legally enforceable under Alabama law. The court noted that parties may enter into agreements allowing for indemnification even for claims resulting solely from the negligence of the indemnitee. The court emphasized that such agreements are valid and enforceable if expressed in clear and unequivocal language.The Supreme Court remanded the case for further proceedings consistent with its opinion, instructing the trial court to consider the parties' evidentiary submissions and arguments regarding the interpretation and application of the disputed provisions of the subcontract agreement and the additional-insured endorsement. View "JohnsonKreis Construction Company, Inc. v. Howard Painting, Inc." on Justia Law