Justia Insurance Law Opinion Summaries

An employee of High Performance Alloys, Inc. died while working at the company’s facility. The deceased employee’s estate sued the company for wrongful death, alleging gross negligence, willful and wanton conduct, disregard of safety regulations, and actual intent to cause injury. The complaint referenced prior safety violations, knowledge of hazardous conditions, failure to implement available safety measures, and a claim that the employer acted with actual intent to cause injury.The estate’s lawsuit was pending in Indiana state court. High Performance Alloys sought coverage under its Worker’s Compensation and Employers’ Liability Insurance Policy issued by Insurance Company of the West. ICW denied coverage, asserting the claims were excluded by the policy. ICW then filed a federal declaratory judgment action in the United States District Court for the Southern District of Indiana, seeking a determination that it had no duty to defend or indemnify High Performance Alloys. High Performance Alloys counterclaimed for coverage. The district court granted judgment in favor of ICW, holding that the claims were either barred by Indiana’s Workers’ Compensation Act or excluded by the Policy’s intentional acts exclusion.On appeal, the United States Court of Appeals for the Seventh Circuit reviewed the district court’s ruling de novo. The Seventh Circuit held that the estate’s allegations, even if true, either described an accidental injury governed exclusively by Indiana’s Workers’ Compensation Act or an intentional injury excluded from coverage by the policy. The court found the complaint did not allege facts sufficient to plead an intentional tort under Indiana law and denied a request to certify questions to the Indiana Supreme Court. The court affirmed the district court’s judgment, holding that Insurance Company of the West has no duty to defend High Performance Alloys in the underlying lawsuit. View "Insurance Company of the West v High Performance Alloys, Inc." on Justia Law

A surgery center performed a liposuction procedure on April Jenkins, who died during the operation. Her father, Hal Jenkins, engaged in negotiations with the center’s insurer, Prime Insurance Company, regarding liability. The policy had a $50,000 per occurrence limit, which decreased as Prime Insurance paid defense costs. After months of negotiations, Hal Jenkins sued the surgery center, CLJ Healthcare, LLC, and Prime Insurance offered the remaining policy limit. Jenkins rejected the offer. Subsequently, Jenkins learned of a separate $2 million policy through another insurer, Owners Insurance Company, and demanded payment from both insurers. Owners Insurance denied coverage. Jenkins and CLJ Healthcare entered into an agreement where Jenkins would receive an assignment of CLJ’s potential bad faith claim against Prime Insurance and CLJ would not defend itself in Jenkins’s malpractice suit. Jenkins then obtained an uncontested $60 million judgment against CLJ.Jenkins and CLJ sued Prime Insurance in the United States District Court for the District of Utah, alleging bad faith. The district court initially found the claim time-barred, but the United States Court of Appeals for the Tenth Circuit reversed, finding the claim timely and remanded the case. On remand, the district court granted summary judgment for Prime Insurance, concluding the evidence did not show bad faith.The United States Court of Appeals for the Tenth Circuit reviewed the case de novo and affirmed the district court’s summary judgment. The court held that, under Utah law, an insurer generally has no duty to explain policy terms absent ambiguity or fraud, and Prime Insurance’s actions—including offering the policy limit and communicating with the insured—did not constitute bad faith. The Tenth Circuit concluded that Jenkins and CLJ had not provided evidence sufficient to support a claim of bad faith against Prime Insurance. View "Jenkins v. Prime Insurance" on Justia Law

After enduring physical and sexual abuse while in the care of James and Susan McLaurie as a young child, the plaintiff obtained a $150 million judgment against both individuals in Missouri state court. Seeking to collect on this judgment, the plaintiff subsequently filed a new action in state court against the McLauries and their homeowner’s insurer, Liberty Mutual, asserting equitable garnishment claims against all three and additional claims, including bad faith and breach of contract, against Liberty Mutual.Liberty Mutual removed the action to the United States District Court for the Eastern District of Missouri, invoking diversity jurisdiction. At the time of removal, James McLaurie had not yet been served but later entered an appearance. The plaintiff moved to remand, arguing a lack of complete diversity, and James McLaurie joined this motion, expressly refusing to consent to removal. The district court disagreed that diversity was lacking but found that the absence of consent from all defendants rendered removal procedurally defective under the requirement of unanimity in 28 U.S.C. § 1446(b)(2)(A). The court granted remand on this procedural ground.On appeal, the United States Court of Appeals for the Eighth Circuit examined whether it had jurisdiction to review the district court’s remand order. The appellate court held that, under 28 U.S.C. § 1447(d), remand orders based on procedural defects—such as a lack of unanimity among defendants—are not reviewable, so long as the district court’s basis was at least “colorably” procedural. The court determined that the district court’s characterization of its order as resting on a procedural defect was colorable. Accordingly, the Eighth Circuit dismissed the appeal for lack of jurisdiction. View "G.T. v. Liberty Mutual Fire Insurance Company" on Justia Law

After being injured in a car accident caused by Andrew Clark, who was driving a vehicle owned by his mother Tracy Clark, Nadia Marin sued Andrew for negligence and Tracy for negligent entrustment. Marin suffered multiple injuries and eventually was diagnosed with complex regional pain syndrome after undergoing extensive medical treatment and surgeries. Before trial, Marin made a $2 million offer of judgment, which the Clarks did not accept. At trial, the Clarks conceded liability, and the jury was left to determine damages, ultimately awarding Marin over $2 million.In the Eighth Judicial District Court, the Clarks challenged the outcome on several grounds. They argued that the court did not allocate enough trial time for their defense, improperly allowed Marin to withdraw deemed admissions, and issued an unsupported jury instruction. The Clarks also moved for a new trial on the basis of alleged attorney misconduct. The district court denied their motion for a new trial, upheld the jury verdict, and awarded Marin expert and attorney fees, including the full amount of her contingency fee agreement. The court also granted Marin’s motion to assign the Clarks’ claims against their insurer to her in execution of the judgment.The Supreme Court of Nevada reviewed the case and affirmed the trial court’s judgment, denial of a new trial, award of expert fees, and the assignment of the Clarks’ claims against their insurer. The court concluded that the Clarks had a meaningful opportunity to present their defense and that the district court had not abused its discretion regarding the deemed admissions, jury instructions, or expert fee award. However, the Supreme Court reversed the attorney fee award, holding that post-offer attorney fees under NRCP 68 must be limited to work performed after the offer of judgment, not the entire contingency fee. The court remanded for reconsideration of attorney fees consistent with this clarification and overruled prior precedent to the extent it was inconsistent. View "Clark v. Marin" on Justia Law

In March 2010, a motor vehicle accident occurred on Interstate 95 South in Cranston, Rhode Island, involving Julie DeOliveira, her daughter Maxine, and a truck driven by Greg Trecaso, who was insured by Star Insurance Company. Julie and Maxine claimed that Mr. Trecaso negligently operated his truck, causing their injuries. After Mr. Trecaso and his business were dismissed from the case due to lack of service, Star Insurance remained as defendant. The case proceeded to a jury trial where the key dispute was whether Mr. Trecaso’s actions caused the accident, as described by conflicting accounts from Julie, Maxine, Mr. Trecaso (via deposition), and a police officer.The Providence County Superior Court admitted contested evidence, including Mr. Trecaso’s deposition and a police report, over plaintiffs’ objections. During trial, the jury heard testimony from the plaintiffs, Mr. Trecaso’s deposition, and Trooper Hanley, who investigated the accident. The jury found that neither Julie nor Maxine proved by a preponderance of evidence that Star Insurance’s insured was negligent. Plaintiffs’ motion for a new trial was denied by the Superior Court, as was Star’s motion for judgment as a matter of law.On appeal, the Supreme Court of Rhode Island reviewed several alleged errors, including evidentiary rulings, jury instructions, statements by defense counsel, and the verdict sheet. The Court applied an abuse of discretion standard to evidentiary and procedural rulings and found no error by the trial justice. The Court concluded that the jury instructions were proper, the verdict sheet was not misleading, and the empty chair doctrine was not violated. The Supreme Court affirmed the denial of the plaintiffs’ motion for a new trial and the judgment in favor of Star Insurance Company, declining to address the defendant’s cross-appeal. View "DeOliveira v. Trecaso" on Justia Law

A business owner, who operated an electronics service company, employed a 17-year-old worker whose job included driving duties. One day, during work hours, the employee drove the owner in a personal vehicle owned by the employee’s parents, with their consent. While driving, the employee lost control and crashed, resulting in the owner’s death. The owner had workers’ compensation insurance for employees but opted out of coverage for himself. The owner’s mother, as trustee, sued the employee and the parents in a wrongful death action, alleging negligent driving.The District Court determined that the employee was immune from liability because of the coemployee immunity provision in the Minnesota Workers’ Compensation Act, which protects coemployees from negligence suits for workplace injuries. The court also granted summary judgment to the parents, finding that the owner of a vehicle could not be vicariously liable under the Safety Responsibility Act if the driver was immune. The plaintiff did not appeal the employee’s immunity but challenged the parents’ immunity. The Minnesota Court of Appeals reversed, holding that the parents could still be vicariously liable under the Safety Responsibility Act even if the driver was personally immune.The Supreme Court of Minnesota reviewed the case to resolve whether a motor vehicle owner may be held vicariously liable under the Safety Responsibility Act for the tortious conduct of a permissive driver who is personally immune from liability under the Workers’ Compensation Act. The court held that the Safety Responsibility Act imposes vicarious liability on vehicle owners for a permissive driver’s wrongful conduct even when the driver is personally immune. It further clarified that the coemployee immunity provision is a personal immunity, not a release of liability, and does not extend to protect vehicle owners from vicarious liability. The Supreme Court affirmed the Court of Appeals. View "Niebuhr vs. Sieberg" on Justia Law

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