Justia Insurance Law Opinion Summaries

The United States Court of Appeals for the Third Circuit certified a question of law to the Pennsylvania Supreme Court regarding whether an increase to the limits of underinsured motorist (“UIM”) coverage for multiple vehicles that are insured under an existing policy constitutes a “purchase” for purposes of Subsection 1738(c) of the Pennsylvania Motor Vehicle Financial Responsibility Law (“MVFRL”). Michelle Barnard purchased a personal automobile policy from Travelers Home and Marine Insurance Company (“Travelers”) to insure her two vehicles. As part of this policy, Barnard purchased UIM coverage in the amount of $50,000 per vehicle. Barnard waived stacking of her UIM coverage limits. Two years later, Barnard increased the UIM coverage limit on each of her vehicles to $100,000. Barnard did not execute a new stacking waiver at that time. Then several more years later, Barnard was involved in a motor vehicle accident with an underinsured motorist. When Barnard sought UIM benefits from Travelers, Travelers offered her $100,000 based upon the UIM coverage limit on one of her vehicles. Barnard filed a complaint for declaratory judgment, seeking $200,000 in stacked UIM benefits. Travelers removed the case to the United States District Court for the Eastern District of Pennsylvania, where the parties filed cross-motions for summary judgment. Based upon the plain language of Subsection 1738(c), the Pennsylvania Supreme Court answered the Third Circuit's question in the affirmative: therefore, an increase of UIM coverage under circumstances as was presented here triggered an insurance company’s statutory obligation to offer an insured the opportunity to waive stacking of the new, aggregate amount of UIM coverage. View "Barnard v. Travelers Home, et al" on Justia Law

In this insurance dispute the Supreme Court reversed in part the district court's determination that Carla King was not entitled to her taxable costs and her claimed nontaxable costs after a jury found in favor of King, holding that the district court erred in concluding that King was not entitled to her claimed nontaxable costs.King was injured when her vehicle was hit by a drunk driver. King sought underinsured motorist coverage from State Farm, but King and State Farm did not agree on the value of King's claim. State Farm had offered to settle the claim for $20,000. The jury found that King had suffered damages in the amount of $410,000. The district court entered judgment against State Farm in the amount of the policy limit of $50,000. The district court awarded King $20,000 in attorney fees and denied King's claimed litigation expenses and costs. The Supreme Court held (1) the district court correctly held that King was not entitled to her taxable costs as provided by Mont. Code Ann. 25-10-201 because they were not timely filed; and (2) the district court erred in concluding that King was not entitled to her claimed nontaxable costs because those litigation costs were part of the insurance exception to the American Rule. View "King v. State Farm Mutual Automobile Insurance Co." on Justia Law

A hotel housekeeper injured her back while lifting a pile of linens. Her employer challenged her application for benefits based on an examining doctor’s opinion that she was medically stable and that the job injury was no longer the substantial cause of any disability or need for medical treatment. After a hearing, the Alaska Workers’ Compensation Board decided that the woman was medically stable as of the date of the doctor’s opinion and therefore not entitled to further disability payments or to benefits for permanent partial impairment. The Board also denied further medical care after the date of medical stability. The Alaska Workers’ Compensation Appeals Commission affirmed the Board’s decision, and the woman appealed. Because the Board’s selected date of medical stability was not supported by substantial evidence in the record, the Alaska Supreme Court vacated the Commission’s decision and remanded the case to the Commission with instructions to remand the case to the Board for further proceedings. View "Tobar v. Remington Holdings LP" on Justia Law

One summer night in 2015, at a Louisville nightclub, someone discharged a firearm, shooting eight people. Six of those people sued the nightclub’s owner, Cole’s Place, in state court, arguing that Cole’s Place failed to protect them from foreseeable harm. United Specialty Insurance (USIC) obtained a federal declaratory judgment that it is not obligated to defend or indemnify Cole’s Place in the state court litigation. The Sixth Circuit affirmed. The district court did not abuse its discretion in exercising Declaratory Judgment Act jurisdiction over USIC’s lawsuit and did not err in finding that an assault-and-battery exclusion in Cole’s Place’s insurance policy with USIC applies to the state court litigation. There are no factual issues remaining in the state-court litigation or complex state-law issues that are “important to an informed resolution” of this case. View "United Specialty Ins. Co. v. Cole's Place, Inc." on Justia Law

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