Justia Insurance Law Opinion Summaries

Due to an unsafe condition on the premises, Osborne suffered a broken arm at the Center, which is owned and operated by Metro Nashville. Osborne obtained a state court judgment against Metro under the Tennessee Governmental Tort Liability Act; the damages included specific medical expenses related to the incident and found Osborne’s comparative fault to be 20 percent. Before the state court suit, Osborne incurred medical expenses for which Metro did not pay at the time. Medicare made conditional payments to Osborne totaling at least $9,453.09. Osborne claims he incurred—in addition to the costs of his state court litigation—the cost of his co-pays, deductibles, and co-insurance for treatments not covered through Medicare. Osborne alleged Metro is a primary payer who failed to pay under the Medicare Secondary Payer Act (MSPA), 42 U.S.C. 1395y(b), and was therefore liable for reimbursement of Medicare’s conditional payments and a double damages penalty under section 1395y(b)(3)(A). Metro claimed it paid the judgment in full, including discretionary costs. The Sixth Circuit affirmed that Osborne lacked statutory standing to sue for his individual losses and the conditional payments made by Medicare because the MSPA does not permit a private cause of action against tortfeasors. Because the MSPA is not a qui tam statute and financial injury suffered by Medicare is not attributed to Osborne, he also lacked Article III standing to sue for Medicare’s conditional payments. View "Osborne v. Metropolitan Government of Nashville and Davidson County" on Justia Law

In 2013, Rachel Dixon was driving a car owned by her boyfriend, Rene Oriental-Guillermo (“Policyholder”), when she was involved in an accident with a vehicle in which Priscila Jimenez was a passenger, and which was owned by Iris Velazquez, and operated by Alli Licona-Avila. At the time of the accident, Dixon resided with Policyholder, who had purchased a personal automobile insurance policy (“Policy”) for his vehicle through Safe Auto Insurance Company (“Safe Auto”). The Policy contained an unlisted resident driver exclusion (“URDE”), which excluded from coverage any individuals who lived with, but were not related to, the policyholder, and whom the policyholder did not specifically list as an additional driver on the insurance policy. Jimenez and her husband Luis (collectively, “Appellants”) filed a personal injury lawsuit against Dixon, Policyholder, and Licona-Avila. On May 13, 2015, Safe Auto filed a complaint against Dixon, Policyholder, and Appellants, seeking a declaratory judgment regarding the enforceability of the URDE with respect to Dixon. The trial court granted summary judgment in favor of Safe Auto, finding the URDE unambiguous, valid, and enforceable, and concluding that Safe Auto had no duty under the Policy to defend or indemnify Dixon in the underlying personal injury lawsuit. Appellants timely appealed to the Superior Court, arguing: (1) the trial court erred in holding the URDE was valid and enforceable; (2) that the URDE violated the provisions of the Pennsylvania Motor Vehicle Financial Responsibility Law (“MVFRL”); and (3) that the URDE violated public policy. The Superior Court affirmed the order of the trial court in a divided, published opinion. The Pennsylvania Supreme Court concurred the URDE at issue in this case was enforceable, and affirmed the Superior Court. View "Safe Auto v. Oriental-Guillermo" on Justia Law

The Supreme Court affirmed the judgment of the circuit court holding that a settlement agreement between Plaintiff and her underinsured motorist carrier did not entitle the underinsured defendant (Defendant) to a statutory reduction of the jury verdict rendered against her pursuant to the offset provision of Va. Code 8.01-35.1, holding that the tortfeasor remains primarily responsible for fully compensating the plaintiff for the injury the tortfeasor has caused.Plaintiff sustained injuries when her vehicle was struck by Defendant's vehicle. Plaintiff sued Defendant, asking for compensatory and punitive damages. Prior to trial, Plaintiff settled her underinsured motorist (UIM) claims against her insurance provider. The jury returned a verdict awarding Plaintiff damages against Defendant. Defendant moved to reduce the verdict against her because of the amount paid to Plaintiff by Plaintiff's insurer. The circuit court denied the motion. The Supreme Court affirmed, holding that the circuit court did not err in refusing to reduce the judgment Plaintiff obtained against Defendant by the amount of the proceeds Plaintiff received from her UIM policy. View "Llewellyn v. White" on Justia Law

The Supreme Court affirmed the circuit court's order denying State Farm Mutual Auto Insurance Company's motion for a new trial after a jury returned a general verdict in favor of Giyo Miranda and denying State Farm's request for subrogation recovery against Miranda, holding that State Farm was not prejudiced by the court's instructions to the jury on the sudden emergency doctrine.Giyo Miranda was involved in a head-on collision with another vehicle driven by Loyd Nielson after Miranda lost control of his vehicle. State Farm, Nielson's insurer, pursued subrogation recovery against Miranda, but the jury returned a general verdict in favor of Miranda. State Farm filed a motion for a new trial, which the circuit court denied. The Supreme Court affirmed, holding that State Farm failed to establish any prejudice from the circuit court's instructions and that the court was unable to exercise meaningful appellate review on the merits of State Farm's claims. View "State Farm Mutual Automobile Insurance Co. v. Miranda" on Justia Law

Wadette Cothran incurred approximately $40,000 in medical expenses from injuries she received in an automobile accident. Her employer's workers' compensation carrier paid all of her medical expenses. She was also covered by her automobile insurance policy issued to her and her husband Chris by State Farm Mutual Automobile Insurance Company. The State Farm policy provided PIP coverage with a limit of $5,000. However, State Farm refused to pay her any PIP benefits for medical expenses based on a "Workers' Compensation Coordination" provision in the policy. This appeal requires presented for the South Carolina Supreme Court's consideration whether Section 38-77-144 of the South Carolina Code (2015) prohibited an automobile insurance carrier from reducing its obligation to pay PIP benefits to its insured by the amount of workers' compensation benefits the insured received for medical expenses. The Court held that it did: "[w]hen an insurer seeks to reduce its obligation to pay benefits based on a third party's previous payment for the same claim, it is a setoff. Because that is the precise effect of State Farm's "Coordination" provision, section 38-77-144 prohibits the provision from reducing State Farm's obligation to pay PIP benefits to the Cothrans." the Court reversed the court of appeals and reinstated the summary judgment in the Cothrans' favor. View "Cothran v. State Farm" on Justia Law

After a child fell 50 ft. from a zipline at Bible camp, the parties dispute who potentially bears financial responsibility for her injuries. The Eighth Circuit held that, under the plain language of the insurance policy, the camp's insurer was not responsible for the conference center's alleged negligence. In this case, the insurer's potential liability for the child's injuries could not possibly have arisen out of the use of the premises leased to the insured. Accordingly, the court reversed and remanded for the entry of summary judgment for the insurer. View "Great American Alliance Insurance Co. v. Windermere Baptist Conference, Inc." on Justia Law

The federal district court for the District of South Carolina certified a question of law to the South Carolina Supreme Court. The Supreme Court was asked to construe section 38-77-350(C) of the South Carolina Code (2015) and determine whether, under the facts presented, an insurance company was required to make a new offer of underinsured motorist (UIM) coverage when an additional named insured is added to an existing policy. In 2012, Wayne Reeves acquired an insurance policy from Progressive Direct Insurance Company (Progressive) covering his motorcycle. When the policy was issued, Wayne declined optional UIM coverage. In 2015, Wayne's wife (Jennifer) and son (Bryan) were added to the policy as "drivers and household residents," because they also drove motorcycles. In 2017, Bryan sold his motorcycle and purchased another motorcycle, a 2016 Harley Davidson, which was added to the policy. At the time, Wayne had Bryan added as named insured to the policy. Progressive did not offer Bryan any optional coverages. Later in 2017, Bryan was involved in an accident while driving his 2016 Harley Davidson. Bryan ultimately made a claim against Progressive to reform the policy to include UIM coverage based on Progressive's failure to offer him the optional coverage. Progressive contended that adding Bryan as a named insured was a change to an existing policy, and as a result, Progressive was not required to offer Bryan UIM coverage. Based on the undisputed facts, the parties filed cross motions for summary judgment. The Supreme Court concluded under South Carolina law, Progressive was not required to make an additional offer of UIM coverage to Bryan. View "Progressive Direct v. Reeves" on Justia Law

Plaintiff filed suit against AUIC, alleging that the release it procured from the insured was fraudulent conveyance under statutory and common law. In this case, the insured was involved in a car accident that injured plaintiff. AUIC paid the insured to release any bad faith claim he had against the company for AUIC's failure to accept an earlier settlement offer.The Court of Appeal held that California's Uniform Voidable Transactions Act (UVTA) filing deadlines did not pose a bar to plaintiff's UVTA cause of action; the operative complaint stated a valid UVTA claim against the insured; and plaintiff waived any challenge to the demurrer ruling on the common law cause of action. Accordingly, the court reversed the judgment of dismissal and remanded for further proceedings. View "Potter v. Alliance United Insurance Co." on Justia Law

Claimant Mark Pilling filed a claim for workers' compensation benefits which insurer Travelers Insurance denied. An administrative law judge (ALJ) reversed insurer’s denial, but the Workers’ Compensation Board reversed the ALJ’s order and reinstated insurer’s denial on the ground that claimant was a nonsubject worker because he was a partner in the business for which he worked and he had not applied for coverage as a nonsubject worker. The Court of Appeals affirmed the board’s order. On claimant’s petition, the Oregon Supreme Court granted certiorari review and concluded that, even assuming claimant was a nonsubject worker, he was entitled to coverage because the business for which he worked made a specific written application for workers’ compensation coverage for him, which insurer accepted. Therefore, the Court reversed the decisions of the Court of Appeals and the Workers’ Compensation Board and remanded to the board for further proceedings. View "Pilling v. Travelers Ins. Co." on Justia Law

In this equitable contribution action brought by Nationwide Mutual Fire Insurance Company and Nationwide Mutual Insurance Company (collectively, Nationwide) against Erie Insurance Exchange the Supreme Court vacated the final judgment of the circuit court granting Erie's demurrer and dismissing Nationwide's claim for equitable contribution, holding that the circuit court erred as a matter of law.In Nationwide Mutual Fire Insurance v. Erie Insurance Exchange, 293 Va. 331 (Nationwide I), the Supreme Court resolved an insurance coverage dispute between Nationwide and Erie. Thereafter, Nationwide brought this action seeking reimbursement for Erie's share of a monetary settlement that Nationwide had paid to a tort claimant while the case was on appeal. The circuit court sustained Erie's demurrer to the claim. The Supreme Court reversed, holding that the circuit court should have denied Erie's demurrer to the claim of equitable contribution based upon the coverage allocation that the Court had determined in Nationwide I. The Court remanded the case to the circuit court to enter an order awarding contribution to Nationwide consistent with the Court's allocation of coverage liability in Nationwide I and with the views expressed in this opinion. View "Nationwide Mut. Fire Insurance Co. v. Erie Insurance Exchange" on Justia Law