Justia Insurance Law Opinion Summaries

The Supreme Court affirmed the judgment of the district court granting summary judgment in favor of Plaintiff's employer's insurance broker and insurer and dismissing Plaintiff's action claiming that the broker had a duty to advise the employer to obtain workers' compensation insurance and that the insurer had a duty to defend the employer in the underlying action, holding that the district court did not err.Plaintiff was injured in an accident during the course and scope of his employement. Plaintiff reached a settlement with his employer and received an assignment of rights against his employer's insurance broker and insurer. Plaintiff then brought this action. The district court concluded that both the broker and the insurer were entitled to judgment as a matter of law. The Supreme Court affirmed, holding that the district court did not err in (1) applying case law applicable to insurance agents rather than insurance brokers; (2) finding that the broker fulfilled its duties as an insurance broker to the employer; and (3) finding that the insurer did not owe a duty to defend the insurer. View "Merrick v. Fischer, Rounds & Associates, Inc." on Justia Law

Guerline Felix’s vehicle collided with Brian Richards’ vehicle in New Jersey. Richards was insured under a New Jersey automobile insurance policy issued by AAA Mid-Atlantic Insurance Company (AAA). The policy provided bodily injury (BI) liability coverage, as well as uninsured and underinsured motorist (UM/UIM) coverage. Felix was insured by the Government Employee Insurance Company (GEICO) under a policy written in Florida. That policy provided up to $10,000 in property liability and personal injury protection (PIP) benefits, but it did not provide any BI liability. Felix sued Richards for personal injuries, and, in a separate action, Richards sued Felix and AAA for personal injuries. AAA then filed a third-party complaint against GEICO, claiming that GEICO’s policy was automatically deemed to include $15,000/$30,000 in BI coverage and that payment would eliminate the claim for UM/UIM coverage by AAA. The motion court determined that the New Jersey "deemer" statute applied to GEICO’s policy, rejecting the argument that the statute created a carve-out for BI coverage based upon the basic policy, as well as GEICO’s constitutional challenge. The Appellate Division affirmed, and the New Jersey Supreme Court granted the petition for certification filed by GEICO. The Supreme Court concluded after review that the deemer statute did not incorporate by reference the basic policy’s BI level for insurers, like GEICO, to which the second sentence of N.J.S.A. 17:28-1.4 applied. From the perspective of the insurers’ obligation, the required compulsory insurance liability limits remained $15,000/$30,000. As to the equal protection claim, New Jersey insureds were the ones who had a choice to purchase less than the presumptive minimum BI amount. The obligation of in-state insurers to offer and provide that minimum was the same as the obligation imposed under the deemer statute’s second sentence on authorized insurers writing an out-of-state policy. "The equal protection claim therefore falls flat," and the Appellate Division's judgment was affirmed. View "Felix v. Richards" on Justia Law

RW Trucking pumped fracking water from frac tanks at oil-well sites and hauled it away for disposal. Jason Metz worked as a driver for RW Trucking. When his trailer reached capacity, Metz turned off the pump and disengaged the hose. According to Metz, he then left a ticket in the truck of another well-site worker, David Garza. Metz testified that as he began walking back to his truck’s cab from its passenger side, and about sixty feet from the frac tanks, he flicked his lighter to light a cigarette. This ignited fumes and caused a flash fire that injured Garza (as well as Metz and another nearby RW Trucking employee). In this appeal and cross-appeal, the issue presented for the Tenth Circuit's review was which of two insurers’ insurance policies covered bodily injuries. Carolina Casualty Insurance Company and Burlington Insurance Company had earlier issued policies to RW Trucking. By design, the two policies dovetailed each other’s coverage. Each insurer contended that the other was solely liable to indemnify the insureds, RW Trucking and Metz, for damages arising from Garza’s bodily injuries suffered in the fire. After Burlington and Carolina jointly settled Garza’s claims, with each reserving its rights against the other, Carolina filed this declaratory-judgment action, contending that it had no duty to defend or indemnify RW Trucking or Metz, and seeking reimbursement of its paid portion of Garza’s settlement. On cross motions for summary judgment, the district court ruled: (1) that Carolina owed a duty to defend but not a duty to indemnify; (2) Burlington owed a duty to indemnify (and so implicitly, also a duty to defend); (3) that Carolina paid its share of the settlement as a volunteer, disabling itself from recovering its portion of the settlement payment from Burlington; and (4) that Carolina owed Burlington for half the total defense costs. After review, the Tenth Circuit reversed the district court as to the duty-to-defend and voluntary-payment issues, and affirmed on the duty-to-indemnify issue. The Court remanded with the instruction that the district court vacate its judgment granting Burlington reimbursement of half its defense costs. View "Carolina Casualty Ins. Co. v. Burlington Ins. Co." on Justia Law

In an earlier appeal, the Tenth Circuit Court of Appeals ruled that Wyoming’s anti-indemnity statute would not defeat possible insurance coverage to an additional insured. In this second appeal and cross-appeal, the issue presented for the Court's review centered on whether the district court correctly ruled that additional-insured coverage existed under the applicable insurance policies; whether the district court entered judgment for the additional insured in an amount greater than the policy limits; and whether the district court correctly ruled that the additional insured was not entitled to prejudgment interest and attorneys’ fees. Ultra Resources, Inc. held a lease for a Wyoming well site. In January 2007, Ultra contracted with Upstream International, LLC under a Master Service Agreement to manage the well site. The Ultra-Upstream contract required Upstream to obtain insurance policies with a stated minimum amount of coverage for Ultra and Ultra’s contractors and subcontractors. To do so, Upstream obtained two policies from Lexington Insurance Company - a General Liability Policy (“General Policy”) and a Commercial Umbrella Policy (“Umbrella Policy”). Lexington issued and delivered the two policies in Texas. Ultra contracted with Precision Drilling (“Precision”) to operate a drilling rig at the well site. Precision maintained a separate insurance policy with Lloyd’s of London (“Lloyd’s”), covering Precision for primary and excess liability. Upstream employed Darrell Jent as a contract management of some Ultra well sites. Jent assumed that Precision employees had already attached and tightened all A-leg bolts on a rig platform. In fact, Precision employees had loosened the A-leg bolts (which attach the A-legs to the derrick) and had not properly secured these bolts. After supervising the pin removal, Jent had just left the rig floor and reached “the top step leading down from the rig floor” when the derrick fell because of the “defectively bolted ‘A- legs’ attaching the derrick to the rig floor.” Jent was seriously injured after being thrown from the steps, and sued Precision for negligence. Precision demanded that Ultra defend and indemnify it as required by the Ultra-Precision drilling contract. Ultra, in turn, demanded that Upstream defend Precision under the insurance policies required by the Ultra-Upstream Contract. The Tenth Circuit concluded the district court ruled correctly on each issue presented, so it affirmed. View "Lexington Insurance Company v. Precision Drilling Company" on Justia Law

In this insurance dispute, the First Circuit directed entry of summary judgment for Zurich American Insurance Company, holding that Zurich's decision to deny the insured's claim was supported by substantial evidence.Denise Arruda filed a claim for death benefits following the death of her husband, Joseph Arruda, in a car accident. Zurich denied the claim, concluding that Joseph's death was not within the coverage clause of the policy because the death was not independent of all other causes and that it was caused or contributed to by his pre-existing health conditions. Denise brought this action under 29 U.S.C. 1132(a)(1)(B) alleging that Zurich violated ERISA by denying the insurance benefits. The district court entered summary judgment in favor of Denise, concluding that substantial evidence did not support Zurich's decision. The First Circuit reversed, holding that Zurich's conclusion that Joseph's death was caused or contributed to by pre-existing medical conditions was not arbitrary or capricious and was supported by substantial evidence. View "Arruda v. Zurich American Insurance Co." on Justia Law

Of two people injured in a car wreck in April 2012, one was a Medicare beneficiary who received her benefits from an MAO-Florida Healthcare Plus, which later assigned its claims to appellant MSPA Claims 1, LLC. The other party involved in the accident was insured by appellee Kingsway Amigo Insurance. The Medicare beneficiary obtained medical treatment for her accident-related injuries between April 29, 2012 and July 26, 2012, and Florida Healthcare made $21,965 in payments on her behalf. On March 28, 2013, the beneficiary settled a personal-injury claim with Kingsway and received a $6,667 settlement payment. The issue this case presented for the Eleventh Circuit’s review centered on the timeliness requirement with which the government had to comply as a prerequisite to filing suit to seek reimbursements that it made on behalf of the Medicare beneficiary, and whether filing suit beyond a statutory three-year period beginning on the date on which medical services were rendered was fatal to the government’s claim. The district court held that MSPA’s claim was stale because it didn’t comply with what the court (somewhat confusingly) called “the three-year limitation requirement.” The Eleventh Circuit disagreed and reversed. “The Medicare Secondary Payer Act’s private cause of action, and our cases interpreting it lead us to conclude that the Act’s claims-filing provision, doesn’t erect a separate bar that private plaintiffs must overcome in order to sue. A closer look at the claims-filing provision’s text and the Act’s structure confirms that conclusion. Accordingly, the district court erred in granting Kingsway’s motion for judgment on the pleadings.” View "MSPA Claims 1, LLC v. Kingsway Amigo Insurance Company" on Justia Law

In this insurance dispute, the Supreme Court reversed the decision of the district court granting summary judgment to Shelter Mutual Insurance Company on its declaratory judgment action, holding that Neb. Rev. Stat. 60-310 does not allow provisions known as partial household exclusion clauses.Larry Freudenburg was injured in an accident where he was the passenger in a car covered by a policy Freudenburg and his wife had purchased from Shelter. Shelter refused to pay Freudenburg's request for reimbursement of expenses in the amount of the policy limit for bodily injury based on a partial household exclusion clause in Freudenburg's policy. Partial household exclusion clauses reduce automobile liability coverage from the policy amount to the state minimum when the injured person is an insured, relative, or resident of the insured's household. The district court concluded that partial household exclusions are not prohibited by section 60-310. The Supreme Court reversed, holding that an automobile liability policy policy in any coverage amount is not permitted to exclude or reduce liability coverage under the policy on the ground that the claimant is a named insured or resident in the named insured's household. View "Shelter Mutual Insurance Co. v. Freudenburg" on Justia Law

USAA Casualty Insurance Company (“USAA”) sought a declaratory judgment that it was not obligated to defend, indemnify, or provide insurance coverage for claims made in two lawsuits against Trinity Carr, the daughter of a USAA homeowner’s-insurance policyholder. The plaintiffs in the underlying lawsuits sought money damages from Carr and others for personal injuries and wrongful death suffered by Amy Joyner-Francis in a physical altercation - described in both complaints as a “brutal, senseless, forseeable [sic] and preventable attack” - between Joyner-Francis and Carr and her friends. USAA argued at trial, as it did before the Delaware Supreme Court, that the incident - whether it be labeled an altercation, an attack, or otherwise - was not an “accident” and therefore not a covered occurrence under the policy and that, even if it were, the purported liability was excluded from coverage. The Superior Court disagreed and entered summary judgment in favor of Carr. The Delaware Supreme Court agreed with USAA’s interpretation of the relevant policy provisions and therefore reversed the Superior Court’s judgment. "To label an intentional assault, as the parties agree occurred here, an accident is to disregard the ordinary, everyday meaning of 'accident.' We thus hold that whether an assault is an 'accident' is determined by the intent of the insured, and not by the viewpoint of the victim. ... even though Carr may not have intended to cause [the victim's] death, she certainly intended to cause injury to her." View "USAA Casualty Ins. Co. v. Carr" on Justia Law

The Supreme Court reinstated the district court's award granting Plaintiff substitution benefits after a court of appeals panel held that married persons cannot be a provider or recipient of substitution services to each other, holding that Plaintiff was entitled to substitution benefits for the amount he promised to pay his wife for what she did resulting from Plaintiff's automobile accident.Insurer insured Plaintiff when he was injured in an automobile accident. When Plaintiff returned from the rehabilitation hospital, he and his wife agreed she would provide caregiver services for $25 a day. Plaintiff sought payment for personal injury protection (PIP) substitution benefits available to him under his policy, but Insurer refused. Litigation ensued, and the district court granted judgment for Plaintiff. The court of appeals reversed, concluding that an injured person's spouse is excluded from providing substitution services. The Supreme Court reversed, holding (1) Kan. Stat. Ann. 40-3103(w) does not expressly preclude Plaintiff's wife from providing substitution services simply because of her marital relationship with Plaintiff; (2) Plaintiff incurred an obligation to pay his wife by entering into a contract with her to perform specific services for him that she would not otherwise have performed while Plaintiff convalesced; and (3) Plaintiff was entitled to PIP substitution benefits. View "Williams v. Geico General Insurance Co." on Justia Law

While driving a car insured by Arizona Automobile Insurance Company, Marlena Whicker rear-ended a taxi and injured its passenger, Georgiana Chavez. Chavez sued Whicker in Colorado state court and won a default judgment when neither Whicker nor Arizona entered a defense. Whicker, unable to satisfy the judgment from the lawsuit, assigned her rights against Arizona to Chavez, who then filed this diversity suit against Arizona in federal court for failure to defend Whicker in the underlying state court action. Her theory was that Arizona had a duty to defend Whicker under Colorado law because Arizona knew that she was a driver covered under its policy. The district court disagreed with Chavez and granted Arizona’s motion to dismiss. The Tenth Circuit determined that under Colorado law, Arizona was only required to defend Whicker if Chavez’s complaint plausibly alleged Whicker was insured under the Arizona policy. It therefore reached the same conclusion as the district court and, affirmed its dismissal of Chavez’s case. View "Chavez v. Arizona Automobile Ins. Co." on Justia Law