Justia Insurance Law Opinion Summaries

The plaintiff brought a suit under Puerto Rico law after her mother died while residing in an assisted living facility. The plaintiff alleged that the facility's staff, including a licensed practical nurse, incorrectly informed treating physicians that her mother was a Jehovah's Witness. As a result, necessary blood transfusions were not administered, and the mother died from heart failure. The facility’s insurer had denied coverage for the incident under its general liability policy, claiming that the alleged wrongful acts were excluded as “professional services.”The United States District Court for the District of Puerto Rico first granted partial summary judgment for the insurer, finding that certain actions—such as failing to call 911—were excluded as “professional services,” but allowed the case to proceed on claims related to record-keeping and miscommunication, concluding those were not “professional services” under existing precedent. After the case was reassigned, the new district judge reaffirmed that ruling, and a damages trial resulted in a verdict against the facility. Subsequent to a decision by the Puerto Rico Supreme Court in Rivera-Matos v. Commonwealth, which clarified the scope of “professional services” exclusions, the district judge permitted the insurer to relitigate the coverage issue, ultimately finding that the exclusion did apply to the acts in question and entering judgment for the insurer.On appeal, the United States Court of Appeals for the First Circuit held that the plaintiff had forfeited her argument that the Puerto Rico Supreme Court’s decision should not be applied retroactively, as she had not raised it below. The court further found no plain error in the application of the new precedent. The judgment of the district court in favor of the insurer was affirmed. View "Garcia-Navarro v. Universal Insurance Company" on Justia Law

A woman was injured after slipping and falling in the parking lot of an automobile repair shop. She filed a claim with the shop’s insurance provider, which began covering some medical and wage expenses. After the insurance company’s representative informed her that liability for her claim was being accepted, the claimant ceased gathering evidence or seeking legal counsel, believing liability would not be contested. Over two years later, when settlement negotiations failed, she retained an attorney and sued both the repair shop and the insurer. After settling with the shop and dismissing it from the lawsuit, the claimant pursued multiple claims against the insurer, including breach of contract, promissory estoppel, spoliation, and equitable estoppel, contending that the insurer’s communications led her to detrimentally alter her conduct regarding evidence collection.The Fourth Judicial District Court initially indicated from the bench that the insurer was estopped from denying liability, but ultimately denied the claimant’s motion for partial summary judgment and granted summary judgment to the insurer on all claims. The District Court concluded that under Montana law as it existed before a 2023 statutory amendment, a third-party claimant could only bring statutory or common law bad faith claims against an insurer for mishandling a claim, and that the claimant had not sufficiently pled or could not prove the elements of her other asserted causes of action.The Supreme Court of the State of Montana held that, under the pre-2023 version of Montana law, third-party claimants are not restricted to statutory or common law bad faith claims and may assert other causes of action such as breach of contract or torts based on how an insurer handled a claim. The Court affirmed summary judgment for the insurer on promissory estoppel, breach of contract, and insufficiently pled claims, but reversed summary judgment on spoliation and equitable estoppel, remanding those claims for further proceedings. View "D'Hooge v. Cincinnati Insurance Co." on Justia Law

A certified nursing assistant employed by a home health provider sustained injuries to her right shoulder and lower back during the course of her employment. She received medical treatment from several providers and was paid mileage reimbursements for traveling between patient homes. Following her injuries, the employer’s insurance carrier denied further payment of temporary disability and medical benefits, including an outstanding medical bill, and ultimately terminated her employment. The worker secured new employment at a higher wage and subsequently filed for workers’ compensation benefits, claiming entitlement to disability benefits and payment of the disputed medical bill. The employer denied liability.The Administrative Law Judge found that the worker had a compensable lower back injury with a 12% impairment rating, entitling her to temporary total and permanent partial disability benefits, but excluded mileage reimbursements from her average weekly wage and denied payment for the outstanding medical bill based on the provider’s failure to submit it within the statutory 45-day deadline. The Workers’ Compensation Board affirmed the ALJ’s findings. The Kentucky Court of Appeals affirmed the exclusion of mileage reimbursements and dismissed the issue of the unpaid medical bill as moot after the employer voluntarily paid it during the appeal. The Court of Appeals also rejected a motion for leave to file an amicus brief, deeming it unauthorized.The Supreme Court of Kentucky affirmed the exclusion of mileage reimbursements from the wage calculation, holding such payments were reimbursements for actual expenses and not “wages.” The Court reversed the dismissal of the medical bill claim as moot, applying the “voluntary cessation” exception, and held that denial of compensability constitutes reasonable grounds to excuse noncompliance with the 45-day rule for submitting medical bills. The Court also found the Court of Appeals erred in rejecting the amicus motion. The decision was affirmed in part and reversed in part. View "HARRIS V. MERCY HOME HEALTH" on Justia Law

A family visiting Arkansas stopped at the Lydalisk Bridge, a low-water crossing over the Middle Fork of the Little Red River. The bridge, owned by The Nature Conservancy, created a pool upstream where water flowed through narrow culverts beneath the bridge. There were no warning signs posted. A seven-year-old child swam in the pool and was pulled by the river’s current into a culvert, becoming trapped and subsequently dying. The Nature Conservancy had commissioned engineering reports about this and a similar nearby bridge, but received the report warning of risks at the Lydalisk Bridge only after the incident.The United States District Court for the Eastern District of Arkansas reviewed the parents’ negligence and malicious failure-to-warn claims against The Nature Conservancy and its insurers. The district court granted the defendants’ motions to dismiss. The court found that the Arkansas Recreational Use Statute (ARUS) generally relieves landowners from a duty of care to recreational users, unless there is a malicious failure to warn of an ultra-hazardous condition actually known to the owner. The court held that the complaint’s allegations did not plausibly show malice, only recklessness. The court also found that the Arkansas Direct-Action Statute (DAS) did not allow direct suit against the insurers, because The Nature Conservancy was not immune from suit—only from liability.On appeal, the United States Court of Appeals for the Eighth Circuit affirmed. The Eighth Circuit held that, under ARUS, Allen’s allegations did not satisfy the requirement for malicious conduct, and thus he failed to state a claim for breach of duty. The court further held that ARUS provides immunity from liability but not from suit, making DAS inapplicable to the insurers. The dismissal by the district court was affirmed. View "Allen v. Nature Conservancy" on Justia Law

The dispute centers on an injury suffered by Catherine Dudley at a property owned by Michel Kanyambo and Speciose Mahirwe, which was insured under a general liability policy issued by Hudson Specialty Insurance Company. The policy, procured through intermediaries, was in effect from September 14, 2017, to September 14, 2018. Before the expiration, a renewal quote was relayed from Hudson’s intermediary to Kanyambo via their insurance agent, but Kanyambo and Mahirwe never received a written quote nor communicated directly with Hudson or its intermediary. They took no steps to renew, and no written notice of nonrenewal was sent to them. Dudley was injured on the property nine days after the policy’s expiration and, after settling her claims against the owners, she initiated a statutory “reach-and-apply” action against Hudson.In the Androscoggin County Superior Court, both Dudley and Hudson sought summary judgment on whether the policy was effective at the time of the injury. The Superior Court granted summary judgment to Hudson, reasoning that the owners’ receipt of the renewal quote via their agent meant Hudson was not required to provide written notice of nonrenewal. The court found there was no material fact in dispute and held the policy was not in effect, barring Dudley’s claims against Hudson.The Maine Supreme Judicial Court reviewed the case de novo. It concluded that under the plain language of Maine’s statutes, an insurer must send a written notice of nonrenewal before a policy terminates at its expiration, regardless of whether the insurer offered to renew. The statutory definition of “nonrenewal” encompasses any termination at the expiration date, and failure to provide the required notice means the policy does not terminate. The Court vacated the summary judgment in favor of Hudson and remanded for further proceedings, holding that Hudson was obligated to send notice and its failure to do so meant coverage remained in effect. View "Dudley v. Hudson Specialty Insurance Company" on Justia Law

The plaintiff was involved in a car accident with the defendant, after which he sought damages for the diminished value and loss of use of his vehicle, alleging the accident was caused by the defendant’s negligence. The defendant’s insurer paid the full property damage coverage limit to the plaintiff’s insurer, based on the assertion that the plaintiff had been made whole. The plaintiff then amended his complaint to allege that his insurer was unjustly enriched for accepting the payment and exhausting the defendant’s coverage before the plaintiff was fully compensated, in violation of the make whole doctrine.The case was brought in the Superior Court for the judicial district of Hartford, which dismissed the unjust enrichment claim against the insurer, finding it was not ripe for adjudication. The court reasoned that the plaintiff’s claim depended on the outcome of his negligence action against the defendant. The plaintiff appealed, and the Connecticut Appellate Court affirmed the dismissal, concluding the unjust enrichment claim would only become ripe after the plaintiff obtained a judgment against the defendant and exhausted collection efforts, because the injury was contingent on whether and to what extent the plaintiff could recover and on the defendant’s ability to satisfy a judgment.On review, the Supreme Court of Connecticut held that the Appellate Court incorrectly affirmed the dismissal on ripeness grounds. The Supreme Court ruled that a claim based on premature subrogation in violation of the make whole doctrine is ripe for adjudication even before a judgment against the tortfeasor is obtained, because the alleged injury—violation of the plaintiff’s priority right to the defendant’s insurance coverage—had already occurred. The court also found the plaintiff had standing to assert his claim. The Supreme Court reversed the Appellate Court’s judgment and remanded for further proceedings. View "Orlando v. Liburd" on Justia Law

A mass shooting occurred at a Florida high school in 2018, resulting in numerous deaths and injuries. The Sheriff’s Office, which employed a school resource officer at the school, faced 60 lawsuits from victims alleging negligence in failing to secure the premises. The Sheriff’s Office held an excess liability insurance policy with Evanston Insurance Company, which required the Sheriff to pay a $500,000 self-insured retention (SIR) per “occurrence” and a $500,000 annual aggregate deductible before coverage would be triggered. The central dispute was whether the shooting constituted a single “occurrence” under the policy, or multiple occurrences—one for each victim or gunshot.The United States District Court for the Southern District of Florida reviewed the case after the Sheriff filed a declaratory judgment action. The district court denied Evanston’s motion to dismiss, finding that the policy’s definition of “occurrence” was ambiguous under Florida law, and that ambiguity should be construed in favor of the insured. The court determined that the Parkland shooting was a single occurrence, meaning only one SIR applied. The court also found that the Sheriff had satisfied both the SIR and the deductible through legal expenses and other covered claims, and awarded attorney’s fees and costs to the Sheriff.The United States Court of Appeals for the Eleventh Circuit affirmed the district court’s rulings. The Eleventh Circuit held that a justiciable controversy existed, as the Sheriff had demonstrated a substantial likelihood of future injury and had satisfied the policy’s prerequisites for coverage. The court further held that, under controlling Florida law, the term “occurrence” was ambiguous and must be construed in favor of the insured, resulting in the Parkland shooting being treated as a single occurrence. The court also upheld the award of attorney’s fees and costs to the Sheriff. View "Sheriff of Broward County v. Evanston Insurance Company" on Justia Law

This case arises from a 2004 automobile accident in which one driver, LaMoin Larkin, died. Larkin’s insurer paid benefits to his estate and then sued the surviving driver, Jared Weston, for negligence, also seeking a declaratory judgment that Weston was insured by Farmers Insurance Exchange at the time of the accident. Farmers Insurance Exchange denied coverage, claiming the policy had been cancelled prior to the accident. Weston filed a crossclaim against Farmers, alleging breach of the duty to defend. Weston and Larkin’s insurer arbitrated the negligence claim, resulting in a finding of liability against Weston and a judgment entered in 2009.The Third District Court, Salt Lake County, confirmed the arbitration award and entered judgment. It later held a bench trial to resolve whether Farmers had properly cancelled Weston’s policy, ultimately finding the cancellation was valid and that Weston was not insured at the time of the accident. The court also granted summary judgment that Farmers had breached its duty to defend Weston, as the complaint raised a genuine issue regarding cancellation. Subsequent proceedings addressed damages, including emotional distress and attorney fees. The district court found Weston failed to prove emotional distress caused by the breach and reduced damages to zero. The court also ruled that the 2009 judgment had not expired, allowing it to be amended to include interest and costs.The Utah Court of Appeals affirmed the district court’s findings on cancellation, breach of duty to defend, and emotional distress, but reversed on consequential damages, holding Farmers liable for the arbitration judgment and related attorney fees. On certiorari, the Supreme Court of the State of Utah held that the 2009 judgment expired in 2017 under Utah law, reversing the court of appeals on that issue and vacating the award of damages and attorney fees based on the expired judgment. The Supreme Court affirmed that Farmers breached its duty to defend but found no basis for damages or attorney fees due to the expiration of the judgment. View "Farm Bureau v. Weston" on Justia Law

Curtis Diblin and Monee Gagliardo were housemates when Diblin attacked Gagliardo with a rubber mallet, causing significant injuries. Diblin was criminally prosecuted and pled guilty to assault with intent to commit a sexual crime. Gagliardo then filed a civil suit against Diblin, alleging several intentional torts and negligence, all based on the attack. The operative complaint at trial did not allege any facts suggesting accidental conduct or negligence unrelated to the assault. Diblin’s homeowners insurance policy with State Farm covered injuries arising from an “occurrence,” defined as an “accident,” and excluded coverage for intentional or willful acts.In the San Diego County Superior Court, a jury found Diblin liable for gender violence (an intentional tort) and negligence, awarding Gagliardo over $2.5 million in compensatory damages. The jury also found Diblin acted with malice and oppression, supporting punitive damages, though Gagliardo later waived her right to punitive damages. State Farm, having defended Diblin under a reservation of rights, filed a declaratory relief action seeking a determination that it owed no duty to indemnify Diblin for the judgment.The California Court of Appeal, Fourth Appellate District, Division One, reviewed the trial court’s judgment in favor of State Farm. The appellate court held that the jury’s findings in the underlying action established Diblin’s conduct was intentional, not accidental, and therefore not a covered “occurrence” under the policy. The court rejected arguments that the negligence finding mandated coverage or that the concurrent independent causes doctrine applied, finding the injury-producing conduct was not independent of the intentional act. The court also found no need for a new jury to determine intent for exclusion purposes. The judgment in favor of State Farm was affirmed. View "State Farm Fire and Casualty Co. v. Diblin" on Justia Law

A woman was injured while visiting a property owned by a couple who were seeking tenants for a mobile home located on their land. The injury occurred when she stepped into a gap between the entryway stairs and the mobile home, a gap created during ongoing repairs. The couple had a homeowners insurance policy with State Mutual Insurance Company, but the policy’s declarations page listed a different property as the covered premises. The injured woman sued the couple for negligence, and the parties later entered into a settlement and stipulated judgment, with the couple paying part of the judgment and the woman seeking the remainder from the insurer under Maine’s reach-and-apply statute.The Superior Court of Waldo County granted summary judgment in favor of the insurer, finding that the insurance policy did not cover the property where the injury occurred. The court determined that the property was not an “insured location” under the policy and that the injury arose out of a condition of the uninsured premises, thus falling within a policy exclusion. The woman appealed this decision.The Maine Supreme Judicial Court reviewed the case de novo, considering both the interpretation of the insurance policy and the application of the reach-and-apply statute. The court held that the policy unambiguously excluded coverage for bodily injury arising out of a premises owned by the insured but not listed as an insured location. The court also found that the property in question was not an “insured location” because the insureds did not reside there and it was not listed in the policy declarations. Accordingly, the court affirmed the grant of summary judgment in favor of the insurer, holding that the policy did not provide coverage for the injury. View "Rowe v. State Mutual Insurance Company" on Justia Law