Justia Insurance Law Opinion Summaries

MMG Insurance Company (MMG) appealed a summary judgment entered in Superior Court in favor of Jennifer Jacobi. Ms. Jacobi rented a home from MMG's insured, Barbara Bennett. Ms. Bennett left Maine to live in New Mexico, but her seventeen-year-old son remained in Maine in an "in-law" apartment attached to the home. The son repeatedly sexually assaulted Ms. Jacobi's seven-year-old daughter. Ms. Jacobi reported the incidents to the police, and informed Ms. Bennett. Ms. Jacobi filed suit against Ms. Bennett on multiple grounds. In particular, her claim for "negligent infliction of emotional distress" served as one of the grounds for review by the Supreme Court. Ms. Bennett and her son were insured by a homeowner's policy issued by MMG. The policy that covered Ms. Bennett had a $300,000 limit per occurrence for "bodily injury." MMG notified Ms. Bennett that it would not participate in Ms. Jacobi's action because the policy contained an exclusion for claims arising from sexual abuse. Ms. Bennett failed to file an answer to Ms. Jacobi's complaint, and a default was entered against her. Ms. Jacobi sought enforcement of her default judgment against MMG, and eventually won at trial. MMG appealed, arguing that the court misinterpreted its insurance policy. The Supreme Court found there was no basis for recovery of damages under the MMG homeowner's policy. The Court reversed the judgment in favor of Ms. Jacobi from the lower court, and remanded the case for further proceedings.

Anthem Health Plans of Maine, Inc., appealed a judgment that affirmed a decision by the Superintendent of Insurance. The Superintendent determined that Anthemâs proposed average rate increase of 18.5% applicable to its individual health insurance products containing a built-in 3% profit margin was excessive and discriminatory. The Superintendent then indicated that an average 10.9% rate increase containing a 0% projected profit margin would be approved by his agency. Anthem contends that in setting a profit margin at 0%, the Superintendentâs decision eliminated Anthemâs opportunity to earn a reasonable profit. Anthem brought suit alleging the superintendentâs decision violates state law and the U.S. Constitution. The Supreme Court held (1) that because the year in which the challenged rates were effective has passed and new rates went into effect; (2) a favorable decision on the merits would not give Anthem any relief; and (3) because federal and state laws are in transition, there is no basis for the Court to address Anthemâs appeal from the Superintendent. The Court dismissed Anthemâs appeal as moot.