Justia Insurance Law Opinion Summaries

The Supreme Judicial Court reversed the order of the superior court granting summary judgment in favor of Dorchester Mutual with respect to its duty to indemnify the parents of Timothy Krusell, holding that the allowance of summary judgment in favor of Dorchester Mutual was error.Timothy pushed Robert Haufler on a sidewalk, causing him to fall and sustain injuries. Haufler brought a personal injury action against the Krusells. Dorchester Mutual sought a declaratory judgment that it had no duty to indemnify the Krusells under a homeowners' insurance policy for Haufler's personal injury claims because Timothy's conduct was a form of "physical abuse" for which coverage was unavailable. A superior court judge concluded that coverage was precluded. The Supreme Judicial Court reversed, holding (1) the term "physical abuse," as used in the policy, was ambiguous, but a reasonable insured would interpret the term as not precluding coverage for Haufler's claim; and (2) there was no error in the allowance of summary judgment on so much of the Krusell's cross claim as asserted violations of Mass. Gen. Laws ch. 93A and Mass. Gen. Laws ch. 176D. View "Dorchester Mutual Insurance Co. v. Krusell" on Justia Law

The Supreme Judicial Court affirmed the judgment of the superior court in this insurance dispute, holding that deaths caused by the improper use of a portable generator did not arise out of the uninsured premises as defined by an exclusion in the insurance policy.The Insurer in this case sold a homeowner's policy to Mark Wakelin for a property he owned in Braintree. The policy provided Wakelin protection against personal liability and property damage and contained an exclusion for bodily injury arising out of a premises owned by the insured but not insured under the policy. Wakelin owned a cabin without electrical power in Maine, which was uninsured. Two of Wakelin's children and two of their friends died from carbon monoxide poisoning when a portable generator Wakelin left at the cabin was improperly used. The Insurer initiated this action against Wakelin seeking a judgment declaring that coverage for the wrongful death claims against Wakelin was barred under the exclusion. The superior court denied the Insurer's motion for summary judgment. The Supreme Judicial Court affirmed, holding that the generator was not a condition of the uninsured premises, and therefore, the accident did not arise out of the uninsured premises, and the coverage exclusion at issue did not apply. View "Green Mountain Insurance Co. v. Wakelin" on Justia Law

The Supreme Judicial Court affirmed the superior court judge's decision granting in part Plaintiff's motion for partial summary judgment against Insurer, holding that the standard fire insurance policy set by statute imposes several, rather than joint, rights and obligations on the insureds under the circumstances of this case and that Insurer's redrafting of the statutorily defined policy language was in violation of the statute.Plaintiff owned a home as a tenant in common with Kelly Pastrana, and the two were coinsureds on a homeowners' insurance policy. Pastrana intentionally set fire to the home. Despite Plaintiff's lack of involvement, Insurer denied Plaintiff's claim for coverage, relying on an intentional loss exclusion in the policy barring recovery when any coinsured intentionally causes a loss. The superior court concluded that the intentional loss exclusion in the policy violated the standard policy language mandated under Mass. Gen. Laws ch. 175, 99, Twelfth, and allowed Plaintiff to recover only one-half of the coverage limit. The Supreme Judicial Court affirmed, holding (1) the policy not comply with the statute; and (2) the policy proceeds in this case were severable, and Plaintiff was entitled to only one-half of the proceeds. View "Aquino v. United Property & Casualty Co." on Justia Law

In this case involving the indictments of Dr. Frank Stirlacci and his office manager, Jessica Miller, for violations of the Controlled Substances Act and for submitting false health care claims to insurance providers, the Supreme Judicial Court affirmed in part and reversed in part the superior court's judgment dismissing several of the indictments, holding that there was sufficient evidence to indict Shirlacci on twenty-six counts of improper prescribing and to indict both defendants on twenty of the twenty-two counts of submitting false health care claims.The charges against Defendants included twenty-six counts each of improper prescribing, twenty counts each of uttering a false prescription, and twenty-two charges each of submitting a false health care claim. The trial judge dismissed the indictments for improper prescribing and uttering false prescriptions and dismissed six of the indictments against each defendant for submitting false health care claims. The Supreme Judicial Court reversed in part, holding (1) the evidence was sufficient to indict Stirlacci on all counts of improper prescribing, but Miller's status as a nonpractitioner precluded her indictment on improper prescribing; (2) there was insufficient evidence to indict either defendant for uttering false prescriptions; and (3) there was sufficient evidence to indict both defendants on twenty counts of submitting false health care claims. View "Commonwealth v. Stirlacci" on Justia Law

The Supreme Judicial Court affirmed the decision of the superior court allowing Insurer's motion for summary judgment and dismissing Plaintiffs' action claiming that Insurer failed to effectuate a prompt, fair, and equitable settlement, holding that consent-to-settle clauses in professional liability policies do not violate Mass. Gen. Laws ch. 176D, 3(9)(f).Insurer issued a professional liability policy to Insured that contained a consent-to-settle clause. Plaintiffs sued Insured for engineering design errors in their house, and Insured refused to consent to settle. Plaintiffs then brought this action under Mass. Gen. Laws ch. 93A. The motion judge granted summary judgment in favor of Insured, concluding that the consent-to-settle clause in this case limited Insurer's ability to engage in further settlement practices with Plaintiffs once Insured refused to give Insurer consent to settle Plaintiffs' claims. The Supreme Judicial Court affirmed, holding that where Insurer made good faith efforts to investigate the claim and encourage Insured to settle and where Insurer's shortcomings did not proximately cause harm to Plaintiffs the superior court did not err in allowing Insurer's motion for summary judgment. View "Rawan v. Continental Casualty Co." on Justia Law

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

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

“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

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

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