In this case concerning civil liability based on insurer conduct affecting chiropractic services, the Supreme Court affirmed the order of the trial court dismissing all claims in this case, relying on and incorporating its reasoning in a companion case, Sykes v. Health Network Solutions, Inc., __ S.E.2d __ (N.C. 2019)(Sykes I), in holding that the decision in Sykes I met the criteria for collateral estoppel. This case was one of two putative class actions alleging that defendant insurers contracted with Health Network Solutions, Inc. (HNS) to provide or restrict insured chiropractic services in violation of state insurance and antitrust laws. Plaintiffs chose to bring this action against insurers separately from their claims against against HNS and its individual owners in Sykes I, but both actions presented essentially the same claims and relied on the same theories. The trial court dismissed Plaintiffs' claims in this case. The Supreme Court affirmed, holding that collateral estoppel barred Plaintiffs from litigating these matters given the Court's resolution of the issues in Sykes I. View "Sykes v. Blue Cross & Blue Shield of North Carolina" on Justia Law
The Supreme Court remanded this case for further proceedings, holding that the trial court erred by crediting the amount of a payment made to Plaintiff under his own underinsured motorist coverage against the amount of the judgment that Plaintiff obtained against Defendant arising from a motor vehicle collision. Plaintiff filed a negligence complaint against Defendant. The jury returned a verdict finding Defendant to be negligence and awarding Plaintiff $263,000 in compensation for his personal injuries. Thereafter, Plaintiff’s insurer issued a check to Plaintiff in the amount of $145,000, representing the amount of underinsured motorist coverage to which Plaintiff was entitled. The trial court subsequently concluded as a matter of law that Defendant was entitled to credit for the $145,000 payment. The court of appeals affirmed. The Supreme Court reversed, holding that payments received as the result of the purchase of underinsured motorist coverage should not be credited against the amount of the judgment entered against Defendant in this case. View "Hairston v. Harward" on Justia Law
Gervis Sadler owned a house that he insured through a limited-peril policy issued by North Carolina Farm Bureau Mutual Insurance Company (Farm Bureau). Farm Bureau adjusters investigated the home on two separate occasions, but Sadler disagreed with the amount of loss and asked for a disinterested appraisal. In the disinterested appraisal, Farm Bureau's appraiser valued the loss at $31,561. The appraisal award calculated by Sadler's appraiser and the umpire valued the loss at $162,500. Farm Bureau filed a complaint for declaratory relief, alleging the appraisal award failed to itemize the damages so Farm Bureau could determine the covered losses. Sadler moved for partial summary judgment on his breach of contract counterclaim. The trial court granted Sadler's request for partial summary judgment. Farm Bureau appealed. The Supreme Court reversed, holding that the trial court erred in granting partial summary judgment in favor of Sadler because genuine issues of material fact needed to be resolved before the loss covered by the policy could be determined.