Justia Insurance Law Opinion SummariesArticles Posted in New York Court of Appeals
Brettler v. Allianz Life Insurance Co. of North America
The Court of Appeals answered in the affirmative a certified question asked by the United States Court of Appeals for the Second Circuit asked the Court of Appeals in this case centering around a life insurance policy providing that "assignment will be effective upon Notice" in writing to the insurer.Specifically, the Court of Appeals answered that, when a life insurance policy provides that "assignment will be effective upon Notice" in writing to the insurer, the insured's failure to provide to the insurer written notice of the policy's assignment voids the assignment so that the purported assignee does not have contractual standing to bring a claim under the policy. Accordingly, the Court held that the insured in this case lacked authority under the contract at issue to sue the insurer. View "Brettler v. Allianz Life Insurance Co. of North America" on Justia Law
Nitkewicz v. Lincoln Life & Annuity Co. of N.Y.
The Court of Appeals answered in the negative the question of whether Insurance Law 3203(a)(2), which requires insurers to refund a portion of a life insurance premium "if the death of the insured occurs during a period for which the premium has been paid," holding that the plain language of section 3203(a)(2) does not apply to discretionary payments like those at issue in this case.In this action concerning a contract for a life insurance policy entered into between a family trust with Defendant, Plaintiff, as trustee of the trust, filed this putative class action against Defendant for breach of contract, alleging that its refusal to refund a prorated portion of the final year's planned premium violated section 3203(a)(2). The federal district court granted Defendant's motion to dismiss, concluding that section 3203(a)(2) did not require the refund. The federal court of appeals certified to the Court of Appeals a question of law. The Court of Appeals answered that section 3203(a)(2) did not apply to discretionary payments like those at issue in this case. View "Nitkewicz v. Lincoln Life & Annuity Co. of N.Y." on Justia Law
34-06 73, LLC v. Seneca Insurance Co.
The Court of Appeals held that Plaintiffs' original complaint alleging that Defendant breached the parties' written insurance policy and that Plaintiffs had fully complied with the requirements contained in the policy failed to give Defendant the requisite notice of the "transactions, occurrences, or series of transactions or occurrences, to be proved" in support of Plaintiff's reformation claim, as required under N.Y. C.P.L.R. 203(f).Defendant, an insurance company, issued Plaintiffs, two limited liability companies, a multi-million dollar, written insurance policy covering many of Plaintiffs' vacant commercial properties. Plaintiffs later brought this action for breach of contract seeking damages based on Defendant's failure to cover damages incurred after a fire on the premises. A jury returned a verdict in favor of Plaintiffs on the reformation claim, and the appellate division affirmed. The Court of Appeals reversed, holding that Plaintiffs' complaint failed to give notice to Defendant of the transactions or occurrences on which Plaintiffs based their reformation claim. View "34-06 73, LLC v. Seneca Insurance Co." on Justia Law
Independent Insurance Agents & Brokers of N.Y., Inc. v. New York State Dep’t of Financial Services
The Court of Appeals reversed the order of the appellate division reversing the judgment of Supreme Court concluding that Petitioners did not establish that the recently amended Insurance Regulation 187, 11 N.Y.C.R.R. part 224, which provides protections to consumers engaging in life insurance and annuity transactions, was invalid, holding that there was no basis to invalidate the regulation.Petitioners commenced this N.Y. C.P.L.R. 78 proceeding alleging that the amended regulation was unconstitutionally vague because certain terms did not satisfy the test for constitutional vagueness and that the Department of Financial Services (DFS) exceeded its authority in promulgating the amendment. Supreme Court held that the amendment was a proper exercise of the powers granted to DFS. The appellate division reversed, ruling that the amended regulation was unconstitutionally vague. The Court of Appeals reversed, holding that DFS appropriately exercised its authority "to create a carefully considered and clear regulation." View "Independent Insurance Agents & Brokers of N.Y., Inc. v. New York State Dep't of Financial Services" on Justia Law
Columbia Memorial Hospital v. Hinds
The Court of Appeals held that when an employer pays premiums to a mutual insurance company to obtain a policy for its employee and the insurance company demutualizes, the employee is entitled to the proceeds from demutualization.Medical Liability Mutual Insurance Company (MLMIC) issued professional liability insurance policies to eight medical professionals who were litigants in the cases before the Court of Appeals on appeal. The premiums for the policies were paid by the professionals' employers. After MLMIC demutualized and was acquired by National Indemnity Company, MLMIC sought to distribute $2.502 billion in cash consideration to eligible policyholders pursuant to its plan of conversion. At issue was the employers' claim of legal entitlement to receive the demutualization proceeds. The Supreme Court held that, absent contrary terms in the contract of employment, insurance policy, or separate agreement, the employee, who is the policyholder, is entitled to the proceeds. View "Columbia Memorial Hospital v. Hinds" on Justia Law
J.P. Morgan Securities Inc. v. Vigilant Insurance Co.
The Court of Appeals reversed the decision of the Appellate Division reversing Supreme Court's order granting summary judgment to Bear, Stearns & Co. Inc. and Bear Stearns Securities Corp. (collectively, Bear Stearns) in this action brought by Bear Stearns' successor companies alleging that its insurers (Insurers) had breached insurance contracts, holding that the $140 million disgorgement for which Bear Stearns sought coverage was not a "payment" within the meaning of the relevant policy.When the Securities and Exchange Commission (SEC) censured Bear Stearns for securities law violations, Bear Stearns agreed to a $160 million disgorgement payment and a $90 million payment for civil money penalties. Both payments were to be deposited in a fund to compensate mutual fund investors allegedly harmed by Bear Stearns' improper trading practices. Bear Stearns transferred the payments to the SEC. Plaintiffs then brought this action against Insurers seeking coverage under a "wrongful act" liability for the disgorged funds. Supreme Court granted summary judgment to Bear Stearns. The Appellate Division reversed, concluding that Bear Stearns was not entitled to coverage for the SEC disgorgement payment. The Court of Appeals reversed, holding that Insurers failed to establish that the $140 million disgorgement payment clearly and unambiguously fell within the policy exclusion for "penalties imposed by law." View "J.P. Morgan Securities Inc. v. Vigilant Insurance Co." on Justia Law
Chen v. Insurance Co. of State of PA
The Court of Appeals affirmed the order of the Appellate Division affirming Supreme Court's conclusion that an excess insurer did not have an obligation to pay interest on an underlying personal injury judgment after the primary policy was voided.Plaintiff was injured at a construction site and sued the general contractor, which maintained an excess liability insurance policy with Defendant. Supreme Court granted partial summary judgment for Plaintiff. Plaintiff then commenced this action asserting that Defendant was obligated to pay the entire underlying damages award. Supreme Court ultimate determined that Defendant was obligated to pay $1.3 million in excess damages, prejudgment interest on those damages and interest that accrued from the date partial summary judgment was granted to Plaintiff until the entry of judgment. The Appellate Division affirmed. The Court of Appeals affirmed. At issue on appeal was whether Defendant was obligated to pay interest on the underlying personal injury judgment after the primary policy was voided. The Court of Appeals affirmed, holding that the excess policy did not provide overlapping coverage for certain interest payments covered in the primary policy. View "Chen v. Insurance Co. of State of PA" on Justia Law
American International Specialty Lines Insurance Co. v. Allied Capital Corp.
The Court of Appeals held that an arbitration panel acted within the bounds of its broad authority by reconsidering an initial determination - denominated a "partial final award" - that addressed some, but not all, of the issues submitted for arbitration.Insureds sought payment of their costs resolving through a settlement a federal qui tam action under two insurance policies issued by Insurer. After Insurer denied coverage Insureds demanded arbitration under arbitration clauses contained in the policies. The arbitration panel issued what it called a "partial final award" determining that only one insurance policy was applicable and that one insured was entitled to defense costs but not indemnification. Insureds sought reconsideration, which the arbitration panel granted. The panel then issued a "final award" granting one insured recovery for damages constituting of both the settlement and defense costs. The Appellate Division reversed, vacated the final award, and confirmed the partial final award. The Court of Appeals reversed, holding that the arbitration panel did not exceed its authority by reconsidering the partial final award. View "American International Specialty Lines Insurance Co. v. Allied Capital Corp." on Justia Law
Plavin v. Group Health Inc.
The Court of Appeals accepted questions certified to it by the United States Court of Appeals for the Third Circuit and answered that, in this case, Plaintiff sufficiently alleged consumer-oriented conduct to assert claims under N.Y. Gen. Bus. Law 349 and 350 for damages incurred due to an insurance company's alleged materially misleading representations.Plaintiff brought this action based on Defendant-insurance company's allegedly misleading representations made directly to the City of New York's employees and retirees about the terms of its insurance plan to induce them to select its plan from among the eleven health insurance plans made available to over 600,000 current and former City employees. The district court dismissed the complaint for failure to state a claim, concluding that the claims failed to plead consumer-oriented conduct. On appeal, the federal court of appeals certified questions to the Court of Appeals regarding whether Defendant had engaged in consumer-oriented conduct. The Court of Appeals answered the questions in the affirmative, holding that, under the circumstances, the complaint adequately alleged consumer-oriented conduct. View "Plavin v. Group Health Inc." on Justia Law
Carothers v. Progressive Insurance Co.
In this insurance dispute involving an insurer withholding payments to a medical service corporation improperly controlled by nonphysicans the Court of Appeals ruled that the trial court did not err in declining to give a charge requiring the jury to find fraudulent intent or conduct "tantamount to fraud" in order to reach a verdict in favor of the insurers.Plaintiff Andrew Carothers, M.D., P.C., a professional service corporation, filed multiple collection actions against insurance carriers seeking to recover unpaid claims of assigned first-party no-fault insurance benefits. The jury found that Defendants had proved that Plaintiff was "fraudulently incorporated" and that Carothers did not engage in the practice of medicine. Plaintiff appealed, arguing that the court erred in failing to give a jury instruction on "the traditional elements of common-law fraud and fraudulent intent. The Appellate Division affirmed. The Court of Appeals affirmed, holding that the court's instructions to the jury were proper. View "Carothers v. Progressive Insurance Co." on Justia Law