Justia Insurance Law Opinion Summaries

Articles Posted in Medical Malpractice
by
The Supreme Court of the State of Montana affirmed a lower court decision that granted Dr. Gregory S. Tierney's motion to dismiss a medical malpractice lawsuit filed by Janice M. Dodds for insufficient service of process. Dodds initially filed the suit against Dr. Tierney and Benefis Health System in 2013, alleging medical malpractice related to a knee replacement surgery. She failed to serve the defendants in time. Dr. Tierney later filed for bankruptcy, which invoked an automatic stay, halting the lawsuit. After his bankruptcy discharge, Dodds attempted to serve Dr. Tierney but failed to do so within the required 30-day timeframe following the discharge.Dodds further sought to join Dr. Tierney's malpractice insurance company as the real party in interest, but the court denied the motion. Upon review, the Supreme Court found that Dodds had not proven Dr. Tierney's liability, thus the insurer had no duty to indemnify him. The court also rejected Dodds' argument that Dr. Tierney lacked standing after his Chapter 7 discharge. The court held that Dr. Tierney maintained a personal stake in demonstrating he was not liable for medical malpractice and that his insurer would only have a duty to indemnify him once Dodds proved her malpractice claims. View "Dodds v. Tierney" on Justia Law

by
Banuelos claimed that she was unlawfully charged per-page fees for copies of her UW Hospitals medical records which were provided in an electronic format. UW Hospitals argued that section 146.83(3f) is silent as to fees for electronic copies of patient healthcare records and does not prohibit a healthcare provider from charging fees for providing such copies. Banuelos argued that because fees for electronic copies are not enumerated in the statutory list of permissible fees that a healthcare provider may charge, the fees charged here are unlawful under state law. The court of appeals agreed with Banuelos and determined that Wis. Stat. 146.83(3f) does not permit a healthcare provider to charge fees for providing copies of patient healthcare records in an electronic format.The Wisconsin Supreme Court affirmed. Although section 146.83(3f) provides for the imposition of fees for copies of medical records in certain formats, it does not permit healthcare providers to charge fees for patient records in an electronic format. Although Wisconsin statutes previously permitted a charge for the provision of electronic copies of patient health care records, that language has been repealed. View "Banuelos v. University of Wisconsin Hospitals and Clinics Authority" on Justia Law

by
The Supreme Court reversed the opinion of the court of appeals determining that the prior notice of events exclusion (Exclusion 15) contained in the insurance policies applied to deny the coverage sought by King's Daughters Medical Center (KDMC) for claims made against it and that Insurers were entitled to recoupment of expenses, holding that the court of appeals erred as to both issues.Multiple medical malpractice claims were asserted against KDMC alleging unnecessary cardiac operations and lack of informed consent, among other allegations. Insurers subsequently filed a declaratory action in circuit court to determine their rights and coverage under the relevant policies. The circuit court granted summary judgment in favor of KDMC. The court of appeals reversed, ruling that Exclusion 15 applied to bar professional liability and excess coverage for the underlying litigation and that Insurers were entitled to recoupment of their expenses thus far in defending the litigation. The Supreme Court reversed, holding (1) Exclusion 15 did not bar coverage; and (2) the court of appeals lacked jurisdiction to rule on recoupment. View "Ashland Hospital Corp. v. Darwin Select Insurance Co." on Justia Law

by
Lanclos was born in 1982 at the Keesler Air Force Base Medical Center. During childbirth, she was seriously injured and as a result, suffers from Athetoid cerebral palsy. The settlement agreement for Lanclos’s medical malpractice suit required the government to make lump sum payments to Lanclos’s parents and their attorney; Lanclos would receive a single lump sum payment followed by specific monthly payments for the longer of 30 years or the remainder of her life. The government would purchase an annuity policy to provide the monthly payments. The government selected Executive Insurance to provide the monthly annuity payments. Executive encountered financial difficulties and, in 2014, reduced the amount of the monthly payments by 42%. Lanclos estimates that the reduction will result in a shortfall of $731,288.81 from the amount described in the settlement agreement.The Court of Federal Claims reasoned that the “guarantee” language in the Lanclos agreement applies to the scheduled monthly structure of the payments but not the actual payment of the listed amounts and that the government was not liable for the shortfall. The Federal Circuit reversed. Under the ordinary meaning of the term “guarantee” and consistent with the agreement as a whole, the government agreed to assure fulfillment of the listed monthly payments; there is no reasonable basis to conclude that the parties sought to define “guarantee” or to give the term an alternative meaning. View "Lanclos v. United States" on Justia Law

by
Saltz, a plastic surgeon, was sued by a former patient for releasing her photographs to a news outlet. Saltz submitted his legal defense to his malpractice insurance provider, UMIA, which initially defended Saltz but sought a declaratory judgment, claiming that Saltz lacked insurance coverage for the former patient’s claims. The district court found that Saltz was not covered under the plain language of the policy and dismissed his claim for waiver and his request for punitive damages but denied UMIA’s motion for judgment as a matter of law and allowed Saltz’s promissory estoppel and breach of the duty of good faith claims. Over UMIA’s objections, the court also allowed evidence from a settlement negotiation to be presented to the jury, which found in favor of Saltz on both claims.The Utah Supreme Court affirmed in part, reversed in part, and remanded for further proceedings on Saltz’s requests for punitive damages and for attorney fees incurred on appeal. The district court properly allowed Saltz’s claims for promissory estoppel and breach of the duty of good faith to go to the jury; the court was correct to deny UMIA’s motion for a new trial on the claim for breach of the duty of good faith. The court upheld the admission of evidence from the settlement talks. The district court erred in dismissing Saltz’s claims for waiver and for punitive damages. View "UMIA Insurance, Inc. v. Saltz" on Justia Law

by
Plaintiff, Medical Mutual Insurance Company (“Med Mutual”) was the insurance carrier for numerous defendants in medical malpractice suit. Med Mutual provided the defense for the state case but, during discovery, alleged that one of the insureds had made a material modification to the Decedent’s medical records. Med Mutual brought the federal action seeking a declaratory judgment concluding that it has no obligation to provide insurance coverage for the defense of the state case. The district court declined to exercise jurisdiction over a declaratory judgment action while a parallel action was pending in state court.   The Fourth Circuit affirmed the district court’s decision. The court explained when a Section 2201 action is filed in federal court while a parallel state case is pending, the court has recognized that “courts have broad discretion to abstain from deciding declaratory judgment actions.” When deciding whether to hear such a declaratory judgment action, the court considers four factors: (1) whether the state has a strong interest in having the issues decided in its courts; (2) whether the state courts could resolve the issues more efficiently than the federal courts; (3) whether the presence of “overlapping issues of fact or law” might create unnecessary “entanglement” between the state and federal courts; and (4) whether the federal action is mere “procedural fencing”. Here, the factors favoring abstention are at least as strong, if not stronger, than those favoring retention and Med Mutual has not demonstrated an abuse by the district court of its broad discretion. View "Medical Mutual Insurance Co NC v. Rebecca Littaua" on Justia Law

by
Plaintiff State Farm Mutual Automobile Insurance Company (State Farm) filed an Insurance Fraud Protection Act (IFPA) action alleging defendants Sonny Rubin, M.D., Sonny Rubin, M.D., Inc., and Newport Institute of Minimally Invasive Surgery (collectively, defendants) fraudulently billed insurers for various services performed in connection with epidural steroid injections. A month prior, however, another insurer, Allstate, filed a separate IFPA lawsuit against the same defendants, alleging they were perpetrating a similar fraud on Allstate. The trial court sustained defendants’ demurrer to State Farm’s complaint under the IFPA’s first-to-file rule, finding it alleged the same fraud as Allstate’s complaint. State Farm appealed, arguing its complaint alleged a distinct fraud. After review, the Court of Appeal agreed the demurrer was incorrectly sustained, but for another reason. The Court found the trial court and both parties only focused on whether the two complaints alleged the same fraudulent scheme, but in this matter of first impression, the Court found the IFPA’s first-to-file rule required an additional inquiry. "Courts must also review the specific insurer-victims underlying each complaint’s request for penalties. If each complaint seeks penalties for false insurance claims relating to different groups of insurer-victims, the first-to-file rule does not apply. A subsequent complaint is only barred under the first-to-file rule if the prior complaint alleges the same fraud and seeks penalties arising from the false claims, submitted to the same insurer-victims." Judgment was reversed and the matter remanded for further proceedings. View "California ex rel. State Farm Mutual Automobile Ins. Co. v. Rubin" on Justia Law

by
The Supreme Court granted a writ of prohibition sought by West Virginia Mutual Insurance Company (Mutual) from the order of the circuit court denying Mutual's motion for summary judgment on common law bad faith claims brought by Michael Covelli, M.D., holding that Mutual demonstrated that the writ of prohibition was appropriate.A jury awarded Dominique Adkins almost $5.8 million on her medical malpractice claim against Dr. Covelli, which was above the limits of his medical malpractice insurance. However, Mutual, Covelli's insurer, settled Adkins's suit within policy limits before the circuit court reduced the verdict to judgment. When a second patient of Dr. Covelli learned of Adkins's large jury award, that patient too sued Dr. Covelli for malpractice. Mutual also settled that claim within policy limits. Thereafter, Dr. Covellie sued Mutual for common law bad faith. At issue was the order of the circuit court denying Mutual's motion for summary judgment on Dr. Covelli's claims. The Supreme Court granted the writ, holding that the circuit court clearly erred by denying Mutual's motion for summary judgment. View "State ex rel. W. Va. Mutual Insurance Co. v. Honorable Salango" on Justia Law

by
The Supreme Court affirmed the judgment of the court of appeals affirming the trial court's grant of summary judgment for the defendants in this insurance dispute, holding that the Legislature has clearly and unequivocally excluded captive insurers from the requirements of the Kentucky Unfair Claims Settlement Practices Act (USCPA), Ky. Rev. Stat. 304.12-230.Plaintiff brought this action against various healthcare defendants. The medical negligence claims were eventually settled. Thereafter, the circuit court denied Plaintiff's motion for declaratory relief as to his bad faith insurance claim against First Initiatives Insurance, Ltd., a foreign captive insurance entity that provides self-insurance for Catholic Health Initiatives, Inc. The court granted summary judgment for Catholic Health and First Initiatives. The court of appeals affirmed. The Supreme Court affirmed, holding that First Initiatives, as a captive insurer, is not subject to the USCPA. View "Merritt v. Catholic Health Initiatives, Inc." on Justia Law

by
Group Health Cooperative (GHO) provided health insurance benefits to Nathaniel (Joel) Coon, who suffered a serious fungal infection and amputation following knee surgery at the Everett Clinic (TEC). The Coon family later settled potential negligence claims against TEC, and GHO initiated this lawsuit seeking reimbursement of its payments from the settlement proceeds. At issue before the Washington Supreme Court was whether genuine issues of material fact remained to preclude summary judgment in favor of GHO regarding whether the settlement constituted full compensation to Coon, and whether GHO suffered prejudice from the Coons’ failure to provide notice prior to finalizing the settlement. The Supreme Court concurred with the Court of Appeals’ conclusion that genuine issues of fact still remained, making summary judgment inappropriate. The matter was remanded for further proceedings. View "Grp. Health Coop. v. Coon" on Justia Law