Justia Insurance Law Opinion SummariesArticles Posted in Massachusetts Supreme Judicial Court
Commerce Insurance Co. v. Szafarowicz
The Supreme Judicial Court affirmed the orders denying a motor vehicle insurer's motions to stay trial in a wrongful death action until the question of coverage had been determined in a declaratory judgment action but and denying the insurer's Mass. R. Civ. P. 67 motion and vacated the wrongful death judgment, holding that the matter must be remanded for a reasonableness hearing. The Supreme Judicial Court addressed issues that arose where Insurer recognized its duty to defend Insureds in a wrongful death action but did so under a reservation of rights and then brought a separate action seeking a declaratory judgment that it owed no duty to indemnify Insureds for damages arising from the wrongful death action. The parties subsequently settled the wrongful death action. The plaintiff agreed to release the defendants from liability and seek damages only from Insurer. Insurer moved to deposit with the court the policy limit and postjudgment interest under Rule 67. The Supreme Judicial Court held (1) the judge properly denied Insurer's motions to stay; (2) the judge properly denied Insurer's motion to deposit the funds; and (3) where the settlements were executed with no determination of reasonable, the case must be remanded for a hearing on the reasonableness of the settlement/assignment agreements. View "Commerce Insurance Co. v. Szafarowicz" on Justia Law
Holyoke Mutual Insurance Co. in Salem v. Vibram USA, Inc.
In this insurance dispute, the Supreme Judicial Court reversed the superior court’s allowance of the insurers’ motion for summary judgment, holding that the allegations in the underlying complaint were sufficient to trigger the insurers’ duty to defend the insured in the underlying action. The two insurers in this case had issued several general commercial liability policies to the insured. The insured was sued in federal court for improper advertising. The insurers denied coverage on the ground that a provision in the policies covering improper use of another’s advertising idea did not cover the claims raised in the action but, nevertheless, agreed to fund the insured’s defense under a reservation of rights. The insurers then sought a declaration that they were not obligated to defend the insured in the underlying action. The superior court granted summary judgment for the insurers. The Supreme Judicial Court reversed, holding that the policies that the insured purchased, which provided coverage in the event the insured was sued for alleged advertising injuries, covered the insured for the claims at issue in the underlying action. View "Holyoke Mutual Insurance Co. in Salem v. Vibram USA, Inc." on Justia Law
Dental Service of Massachusetts, Inc. v. Commissioner of Revenue
“Covered persons” as used in Mass. Gen. Laws ch. 176I, 11 refers solely to natural persons who, as employees, receive insurance coverage for health care services under a group insurance plan, rather than employer entities. At issue in this case was whether, when an employer purchases insurance on behalf of its employees, the insurer owes tax on premiums paid by on or behalf of only those individuals who live in Massachusetts or whether the insurer owes tax on all premiums received from the Massachusetts-based employer regardless of where its individual employees reside. The Supreme Judicial Court affirmed the judgment of the Appellate Tax Board, holding that the term “covered persons” in section 11 refers to the natural person receiving health care coverage under a preferred provider arrangement policy, including his or her spouse and additional dependents, not the employer-organization with whom the insurer contracts. View "Dental Service of Massachusetts, Inc. v. Commissioner of Revenue" on Justia Law
Great Divide Insurance Co. v. Lexington Insurance Co.
Here the Supreme Court answered a certified question from the United States District Court for the District of Massachusetts concerning the priority of coverage of two automobile insurance policies that both covered a single motor vehicle accident. A portion of the loss was covered by a primary insurance policy from an insurance company not a party to this case. The two policies at issue were triggered, according to the language in each policy, after the exhaustion of the primary policy. Each policy stated that it provided “excess” coverage and also contained an “other insurance” clause. In this opinion, the Supreme Court ultimately concluded that both excess policies covered the accident equally, after exhaustion of the underlying primary policy, to the extent of their respective policy limits. View "Great Divide Insurance Co. v. Lexington Insurance Co." on Justia Law
Mount Vernon Fire Insurance Co. v. Visionaid, Inc.
Where an insurance policy provides that the insurer has the “duty to defend any claim” initiated against the insured, the insurer’s duty to defend does not require it to prosecute affirmative counterclaims on behalf of its insured. In this case, a policy imposed two duties on Insurer with respect to any wrongful termination claim brought against Insured. When a wrongful termination claim was commenced against Insured, Insurer filed a complaint for declaratory judgment seeking a ruling that its duty to Insured did not require that it prosecute or pay for the prosecution of a counterclaim for misappropriation of funds. A federal district court issued a judgment in favor of Insurer. On appeal, the United States Court of Appeals for the First Circuit certified three questions to the Massachusetts Supreme Judicial Court. The court answered the first two certified questions and did not reach the third. View "Mount Vernon Fire Insurance Co. v. Visionaid, Inc." on Justia Law
Caira v. Zurich American Insurance Co.
Plaintiff filed a complaint alleging that Zurich American Insurance Co. committed unfair claim settlement practices in violation of Mass. Gen. Laws ch. 176D, 3(9)(f) and Mass. Gen. Laws ch. 93A, 2. Specifically, Plaintiff claimed that Zurich violated these statutory provisions when it conditioned the payment of its primary insurance policy limit on a release of all claims against its insureds, notwithstanding the availability of excess insurance. The superior court judge concluded that Zurich was entitled to judgment as a matter of law because it did not engage in unfair claim settlement practices. The Supreme Judicial Court affirmed, holding that Zurich did not engage in unfair claim settlement practices in violation of Mass. Gen. Laws ch. 176D, 3(9)(f) and Mass. Gen. Laws ch. 93A, 2. View "Caira v. Zurich American Insurance Co." on Justia Law
Massachusetts Insurers Insolvency Fund v. Berkshire Bank
The Massachusetts Insurers Insolvency Fund (Fund) is statutorily authorized to recover from “high net worth insureds” certain amounts paid by the Fund “on behalf of” such insureds. There was no dispute that defendant Berkshire Bank met the definition of “high net worth insured.” The Fund brought this action seeking to recover from Berkshire workers’ compensation benefits the Fund had paid to a Berkshire employee. The superior court allowed Berkshire’s motion for summary judgment, concluding that any amounts paid by the Fund would not be “on behalf of” the insured employer, and therefore, recoupment was not available. The Supreme Court reversed, holding that the Fund was authorized to recoup the sums in question because they were paid by the Fund “on behalf of” Berkshire within the meaning of Mass. Gen. Laws ch. 175D, 17(3). View "Massachusetts Insurers Insolvency Fund v. Berkshire Bank" on Justia Law
Ins. Co. of State of Penn. v. Great N. Ins. Co.
Employee was severely injured while traveling abroad on a business trip. Employer had purchased two workers’ compensation policies from two different insurers, the Insurance Company of the State of Pennsylvania (ISOP) and Great Northern Insurance Company (Great Northern). Both policies provided primary coverage. Employee pursued a workers’ compensation claim. Employer gave notice of the claim only to ISOP. ISOP began making payments pursuant to the policy and defended the claim. When ISOP learned that Employer also had workers’ compensation coverage under its Great Northern policy, ISOP filed a complaint against Great Northern seeking a judgment declaring that the doctrine of equitable contribution required Great Northern to pay one-half of the past and future defense costs and indemnity payments related to Employer’s claim. A federal district court granted summary judgment for Great Northern. ISOP appealed, and the United States Court of Appeals for the First Circuit certified a question to the Supreme Court. The Court answered that, where two primary workers’ compensation insurance policies provide coverage for the same loss arising from an injury to an employee, the insurance company that pays that loss has a right of equitable contribution from the coinsurer, regardless of whether the insured gives notice of the injury only to one insurer. View "Ins. Co. of State of Penn. v. Great N. Ins. Co." on Justia Law
Posted in: Government & Administrative Law, Insurance Law, Labor & Employment Law, Massachusetts Supreme Judicial Court
DiCarlo v. Suffolk Constr. Co., Inc. v. Angelini Plastering, Inc.
Two employees were injured in the course of their employment, collected workers’ compensation benefits and then reached settlement agreements with third parties including damages for their pain and suffering. The same insurer insured by employers and sought reimbursement from the employees’ recoveries. In one employee’s case, the superior court judge rejected a settlement agreement providing that the insurer would not have a lien on the damages for pain and suffering. In the second employee’s case, a superior court judge approved a settlement agreement similar to the agreement rejected by the judge in the first employee’s case. The Appeals Court determined that the employees’ awards for pain and suffering were exempt from the insurer’s liens. The Supreme Judicial Court combined the two cases for argument and held that an insurer’s lien does not extend to damages allocated to an employee’s pain and suffering. View "DiCarlo v. Suffolk Constr. Co., Inc. v. Angelini Plastering, Inc." on Justia Law