Justia Insurance Law Opinion Summaries

The case involves the Massachusetts Insurers Insolvency Fund (MIIF) seeking cost-of-living adjustment (COLA) payment reimbursements from the Workers' Compensation Trust Fund (trust fund). MIIF, a nonprofit entity created by statute, administers and pays certain claims against insolvent insurers. Between 1989 and 2013, MIIF paid workers' compensation benefits, including COLA payments, on behalf of several insolvent insurers. MIIF filed claims with the trust fund for reimbursement of these payments, but the trust fund denied the claims, arguing that MIIF is not an "insurer" under the relevant statutes and does not participate in the trust fund.The Department of Industrial Accidents (DIA) administrative judge denied MIIF's claims, and the Industrial Accident Reviewing Board (board) affirmed the decision. The board relied on the Appeals Court's decision in Home Ins. Co. v. Workers' Compensation Trust Fund, concluding that MIIF, like the insolvent insurers, does not collect and transmit assessments to the trust fund and is therefore not entitled to reimbursement.The Supreme Judicial Court of Massachusetts reviewed the case and concluded that MIIF is eligible for COLA-payment reimbursements. The court determined that MIIF, when taking on an insolvent insurer's covered claims, is "deemed the insurer" and has "all rights, duties, and obligations" of the insolvent insurer under G. L. c. 175D, § 5 (1) (b). The court also found that the plain language of the relevant statutes does not exclude MIIF from reimbursement eligibility and that the trust fund's funding mechanism, which is paid for by employers, supports MIIF's entitlement to reimbursement.The Supreme Judicial Court reversed the board's decision and remanded the case for further proceedings consistent with its opinion. View "Massachusetts Insurers Insolvency Fund v. Workers' Compensation Trust Fund" on Justia Law

An insurer, Arrowood Indemnity Company, entered run-off in 2003, ceasing to issue new policies but continuing to manage existing claims, including workers' compensation for a Scully Signal Company employee who sustained a second work-related injury in 2001. Arrowood sought second-injury reimbursements from the Massachusetts Workers' Compensation Trust Fund, which reimburses insurers for a portion of workers' compensation benefits paid to employees with exacerbated injuries. Arrowood and the Trust Fund settled in 2009, with Arrowood receiving reimbursements until 2013.The Department of Industrial Accidents (DIA) began denying Arrowood's reimbursement requests in 2015, citing a precedent that insurers in run-off, who no longer collect and transmit employer assessments to the Trust Fund, are ineligible for reimbursements. Arrowood's subsequent complaint in Superior Court was dismissed, and the Appeals Court affirmed the dismissal, directing Arrowood to seek administrative review. The DIA administrative judge and the Industrial Accident Reviewing Board upheld the denial, leading Arrowood to appeal to the Appeals Court.The Appeals Court reversed the Board's decision, ruling that the statutory language of the Massachusetts workers' compensation act does not preclude insurers in run-off from receiving second-injury reimbursements. The Supreme Judicial Court of Massachusetts granted further appellate review and agreed with the Appeals Court. The Court held that the plain language of the act does not exclude insurers in run-off from reimbursement eligibility and that the statutory scheme supports this interpretation. The Court reversed the Board's decision and remanded for further proceedings consistent with its opinion. View "Arrowood Indemnity Company v. Workers' Compensation Trust Fund" on Justia Law

Tody's Service, Inc. (Tody's), a towing company, billed Liberty Mutual Insurance Company (Liberty) a six-figure storage fee after towing and storing a vehicle involved in a fatal crash at the direction of the police. The vehicle, insured by Liberty, was held as evidence for nearly three years. After obtaining the vehicle's title, Liberty refused to pay the accrued storage charges, leading Tody's to sue Liberty to recover those fees.In the Superior Court, a judge granted summary judgment in favor of Liberty on all of Tody's claims, which included unjust enrichment, promissory estoppel, and failure to pay storage fees under G. L. c. 159B, § 6B. The judge found no evidence of unjust enrichment, ruled that § 6B does not provide a private right of action, and concluded that Tody's failed to demonstrate any actionable promise or reasonable reliance to support promissory estoppel.The Supreme Judicial Court reviewed the case and held that Liberty was not unjustly enriched as a matter of law, as there was no measurable benefit conferred on Liberty by Tody's storage of the vehicle. The court also found no evidence of reliance sufficient to support promissory estoppel, as Tody's stored the vehicle in response to a police directive, not in reliance on any promise by Liberty. Additionally, the court held that § 6B does not create a private right of action against a vehicle owner. Consequently, the Supreme Judicial Court affirmed the judgment in Liberty's favor. View "Tody's Service, Inc. v. Liberty Mutual Insurance Company" on Justia Law

The plaintiffs, Jeffrey Cubberley and Philip Seaver, filed a lawsuit against The Commerce Insurance Company, seeking declaratory relief and compensation for alleged breach of contract. They claimed that Commerce was obligated to cover "inherent diminished value" (IDV) damages to their vehicles, which were damaged in collisions caused by Commerce's insured drivers. Commerce paid for the repairs but refused to compensate for IDV damages, leading the plaintiffs to argue that their vehicles were worth less in the resale market post-repair.The plaintiffs initially filed their lawsuit in the Superior Court, which was later transferred to the business litigation session. The case was stayed pending the outcome of McGilloway v. Safety Ins. Co., which held that IDV damages were recoverable under the 2008 standard Massachusetts automobile policy. After the stay was lifted, the plaintiffs filed a second amended complaint. Commerce moved to dismiss the claims, arguing that the 2016 standard policy excluded IDV damages. The motion judge granted the dismissal, concluding that the policy did not cover IDV damages and that the plaintiffs failed to allege facts suggesting an entitlement to relief. The plaintiffs appealed, and the Supreme Judicial Court granted direct appellate review.The Supreme Judicial Court affirmed the dismissal, holding that the plaintiffs lacked standing to pursue their breach of contract claims because they had not obtained final judgments against the insureds, as required by G. L. c. 175, § 113, and G. L. c. 214, § 3 (9). Additionally, the court found that part 4 of the 2016 standard policy explicitly excluded coverage for IDV damages to third-party vehicles. The court also determined that neither G. L. c. 90, § 34O, nor the decision in McGilloway provided a legal basis requiring insurers to cover IDV damages under the 2016 standard policy. Thus, the plaintiffs' complaint did not plausibly establish an entitlement to relief. View "Cubberley v. The Commerce Insurance Company" on Justia Law

A severe thunderstorm caused significant damage to Norwood Hospital, owned by Medical Properties Trust, Inc. (MPT) and leased to Steward Health Care System LLC (Steward). The storm led to extensive flooding in the hospital's basements and rainwater accumulation on the rooftop courtyard and parapet roofs, which then seeped into the building, causing further damage. MPT and Steward sought coverage from their insurers, Zurich American Insurance Company (Zurich) and American Guarantee and Liability Insurance Company (AGLIC), respectively. Both policies had high overall coverage limits but lower sublimits for flood damage. The insurers argued that all the damage was due to "Flood" as defined in the policies, which included "surface waters," and thus subject to the lower sublimits.The United States District Court for the District of Massachusetts granted partial summary judgment to the insurers, interpreting "surface waters" to include rainwater accumulated on the roofs. The court allowed an interlocutory appeal, recognizing the substantial ground for difference of opinion on this legal issue. The United States Court of Appeals for the First Circuit then certified the question to the Supreme Judicial Court of Massachusetts, asking whether rainwater accumulating on a building's rooftop courtyard or parapet roof constitutes "surface waters" under Massachusetts law.The Supreme Judicial Court of Massachusetts concluded that the term "surface waters" is ambiguous in this context. The court noted the lack of a clear definition in the policies and the divided case law on the issue. Given this ambiguity, the court ruled in favor of the insureds, determining that rainwater accumulating on the rooftop courtyard and parapet roofs does not unambiguously constitute "surface waters" under the policies. Therefore, the damage from such water infiltration is not subject to the flood sublimits. View "Zurich American Insurance Company v. Medical Properties Trust, Inc." on Justia Law

In this case concerning the term "physical abuse" as used in an "abuse and molestation" policy exclusion the Supreme Judicial Court reversed the order of the superior court granting summary judgment in favor of Insurer on its action for declaratory relief, holding that the abuse and molestation exclusion did not exempt coverage under the circumstances of this case.The homeowners' insurance policy at issue precluded coverage under a policy exclusion exempting coverage for "[b]odily injury...arising out of sexual molestation, corporal punishment or physical or mental abuse." Insured initiated an unprovoked attack on Leonard Miville by punching and kicking him repeatedly. When Insurer denied coverage Miville commenced an action against Insured. Insurer brought this action seeking a judgment declaring that it had no duty to defend or indemnify Insured for the personal injury claims. The judge granted summary judgment for Insurer. The Supreme Judicial Court reversed, holding that a reasonable insured would not expect the abuse and molestation exclusion to preclude coverage for the incident. View "Dorchester Mutual Insurance Co. v. Miville" on Justia Law

The Supreme Judicial Court reversed the order of the superior court allowing Plaintiff's motion for summary judgment in this lawsuit brought against the Executive Office of Health and Human Services and Nationwide Life Insurance Company in this dispute over the remainder of an annuity issued by Nationwide, holding that the superior court erred.Robert Hamel purchased the annuity at issue to help Joan Hamel, his wife, become eligible for Medicaid benefits, which was necessary to pay for her long-term care. Robert named the Commonwealth as the primary remainder beneficiary to the "extent benefits paid" and Plaintiff, his daughter, as the contingent remainder beneficiary. Before the end of the annuity period Robert died. Plaintiff filed this lawsuit alleging that she was entitled to the remainder. The superior court entered summary judgment in favor of Plaintiff and denied the Commonwealth's motion for summary judgment as to Plaintiff's claim for declaratory judgment. The Supreme Judicial Court vacated and reversed the judgment below, holding that, upon Robert's passing, the remainder of the annuity properly belonged to the Commonwealth up to the amount it paid for Joan's care. View "Dermody v. Executive Office of Health & Human Services" on Justia Law

The Supreme Judicial Court held that there is no common-law duty for insurers to cover costs incurred by an insured to prevent imminent covered loss when the plain, unambiguous terms of the insurance policy speak directly to the question of mitigation and reimbursement and do not provide coverage and the costs are otherwise excluded by other policy provisions.Insured sought recovery from Insurer for various costs it incurred after a wastewater treatment system at its manufacturing facility malfunctioned, claiming coverage under its pollution liability policy. In dispute were costs incurred that were not cleanup costs or costs necessary to avoid imminent endangerment to public health or welfare but necessary to avoid a business interruption. The district court held that the costs at issue were not recoverable and that there was no basis to impose a common-law duty that was inconsistent with the policy's coverages and exclusions. View "Ken's Foods, Inc. v. Steadfast Insurance Co." on Justia Law

The Supreme Judicial Court reversed the judgment of the superior court in favor of Insureds in this insurance dispute over attorney's fees, holding that attorney's fees under Mass. Gen. Laws ch. 93A are not awarded as "damages because of 'bodily injury' and are not 'costs taxed against the insured.'"At issue was whether Insureds' insurance policy, which covered "sums that the insured becomes legally obligated to pay as damages because of 'bodily injury,'"included Insureds' liability for attorney's fees under chapter 93A, section 9(4) in an action for breach of warranty resulting in bodily injury. After paying the substantive damages on the claim, Insurer brought this declaratory judgment action to determine whether it was also responsible for attorney's fees. The superior court concluded that the policy did cover attorney's fees. The Supreme Judicial Court reversed, holding that Insureds' policy did not cover the award of attorney's fees under chapter 93A. View "Vermont Mutual Insurance Co. v. Poirier" on Justia Law

The Supreme Judicial Court affirmed the judgment of the superior court concluding that the insurance policies of three restaurants (Plaintiffs), which suffered reductions in revenues during the COVID-19 pandemic and the resulting government restrictions on public gatherings, did not unambiguously cover Plaintiffs' losses, holding that there was no error.Plaintiffs brought a declaratory judgment action to determine the scope of their policies. The superior court granted judgment against Plaintiffs, finding that there was no "direct physical loss or damage" resulting from the COVID-19 virus. The Supreme Judicial Court affirmed, holding that Plaintiffs' claims were properly dismissed. View "Verveine Corp. v. Strathmore Insurance Co." on Justia Law