Justia Insurance Law Opinion Summaries

An insurer refused to defend its insured against a third party’s tort claims. The third party, standing in the insureds’ shoes, brought a declaratory judgment action against the insurer for indemnification and failure to defend. Prior to the instant suit, an Arizona state court entered default judgment against the insureds that was entered pursuant to a Damron agreement that stipulated facts determinative of both liability and coverage. In the instant case, a federal district court granted summary judgment for the insurer. Applying Arizona law, the district court concluded that the default judgment did not preclude the insurer from litigating the question of whether coverage existed under the policy and that, as a matter of law, the insured did not own the vehicle involved in the accident at the time of the accident. The Supreme Court accepted certification and held (1) insurers are generally not precluded from litigating pure coverage issues in a default judgment action; (2) an insurer in a coverage action may not, in the guise of a coverage defense, litigate what are essentially and solely liability issues resolved by the default judgment; and (3) the insurer here was not precluded from litigating, for coverage purposes, who owned the vehicle at issue at the time of the accident.View "Quihuis v. State Farm Mut. Auto. Ins. Co." on Justia Law

Pennsylvania National Mutual Casualty Insurance Company ("Penn National") was sued by Jacob Walker, an employee of its named insured, seeking underinsured-motorist ("UIM") benefits following an automobile accident. After settling the claims against it, Penn National filed a cross-claim against Michael Bradford, the alleged tortfeasor, asserting a subrogation theory of recovery. The trial court dismissed the cross-claim on the ground that it was barred by the statute of limitations, and Penn National appealed. Finding no reversible error, the Supreme Court affirmed the trial court's judgment. View "Pennsylvania National Mutual Casualty Insurance Company v. Bradford " on Justia Law

Mercury Casualty Company filed an action seeking declaratory relief regarding its obligation to students Hung Chu and his roommate Tu Pham. Mercury issued an automobile policy to Chu insuring his 1995 Honda Accord. Chu was driving, and Pham was a passenger, when Chu collided with a vehicle driven by Krystal Nguyen Hoang. Pham filed a personal injury action against Chu and Hoang and obtained a $333,300 judgment against Chu. Mercury sought a judicial determination confirming Mercury’s decision Chu’s policy excluded coverage for Pham’s judgment under a “resident exclusion.” Mercury also sought an order requiring Chu to reimburse Mercury the fees and costs it incurred in defending him against Pham’s lawsuit. Chu cross-complained against Mercury for breach of contract, bad faith, and general negligence. Mercury prevailed on the issue of whether the policy provided coverage for Pham’s judgment. The court determined Mercury had no duty to indemnify Chu with respect to the judgment. It granted Mercury’s motion for judgment on the pleadings (JOP) on Chu’s cross-complaint but determined Mercury could not seek reimbursement of its attorney fees and costs in defending Chu because such damages were not sought in the JOP. Both parties appealed. Chu and Pham appealed the determination that Mercury’s policy excluded coverage for Pham’s personal injury lawsuit against Chu. Mercury appealed the court’s ruling Chu was not required to reimburse Mercury for the defense fees and costs. After its review of the record, the Court of Appeal reversed, concluding the policy provision excluding Pham from coverage was an overbroad expansion of the statutorily permitted exclusion and was also contrary to public policy. Based on this ruling, the Court did not address the issue raised in Mercury’s cross-appeal regarding its entitlement to defense costs and fees.View "Mercury Casualty v. Chu" on Justia Law

In this case, Gary Walston was exposed to asbestos while working at The Boeing Company and was later diagnosed with mesothelioma. The Court of Appeals held that pursuant to the Industrial Insurance Act (IIA), Boeing was immune from suit because Walston had not raised a material question of fact as to whether Boeing had actual knowledge that injury was certain to occur. The Supreme Court agreed after its review of the matter: Walston has not made such a showing, and therefore, he was limited to the recovery provided by the IIA' s workers' compensation system.View "Walston v. Boeing Co." on Justia Law

Manuel Lainez had been independently driving commercial vehicles for eight and a half years. He owned his own truck and his own business, Lainez Trucking. He purchased a trucker’s liability policy from Scottsdale Indemnity Company with a $1 million liability limit. Lainez entered into a motor carrier agreement with Western Transportation Services. Western did not own tractors or trailers, but contracted with owner/operators or drivers. The agreement provided that Lainez was an independent contractor and was responsible for all costs and expenses incidental to the performance of transportation services. He agreed to maintain liability insurance and to name Western Transport as an additional insured. Western Transport, through the California Automobile Assigned Risk Plan (CAARP), purchased a commercial assigned risk policy from National Continental Insurance Company (NCI), which stated "'Named Insured’s Business: 1 Trucker for Hire-Excess'" and named Lainez as a driver. It did not list, describe, or rate any vehicle. It was rated on an excess cost of hire basis at a premium that was 4 to 10 percent of the cost of a policy rated on a primary cost of hire basis. The issue this case presented for the Court of Appeal's review was whether the two insurance companies were coprimary insurers or whether NCI was an excess insurer for an underlying fatality involving Lainez. The trial court granted NCI’s motion for a summary judgment, concluding that Scottsdale was the primary insurer pursuant to California Insurance Code section 11580.9, subdivisions (d) and (h). The Court of Appeal agreed that Scottsdale was the primary insurer and NCI was the excess insurer and affirmed the judgment. View "Scottsdale Indemnity v. National Continental Insurance Co." on Justia Law

State farm Fire & Casualty Company issued a rental dwelling policy to Jerry Dantzler. The tenants of Dantzler’s rental property sued Dantzler for personal injuries allegedly sustained by a Dantzler’s tenant as a result of exposure to lead-based paint. Dantzler tendered the claim to State Farm. State Farm subsequently filed an action for declaratory judgment against Dantzler and the tenants asking for a determination of whether its policy precluded coverage for the tenants’ personal injury claim. The district court granted summary judgment for State Farm, concluding as a matter of law that the pollution exclusion barred coverage under State Farm’s policy. The court of appeals reversed, concluding that a genuine issue of material fact existed as to whether the tenant’s injuries were the result of a “discharge, dispersal, spill, release or escape of pollutants” as described in the pollution exclusion. The Supreme Court reversed, holding that all manners of exposure to lead-based paint involve discharge, dispersal, spill, release, or escape, and therefore, the manner of exposure was not a material fact that prevented summary judgment. Remanded.View "State Farm Fire & Cas. Co. v. Dantzler" on Justia Law

Kaiser Permanente covered three patients who received care at an emergency room operated by Dameron Hospital Association. The patients were injured due to the negligence of third party tortfeasors who had automobile liability insurance with California Automobile Association Inter-insurance Bureau (AAA) and Allstate Insurance Company. Unlike Kaiser, neither AAA nor Allstate had contracts with Dameron. In the absence of an agreement for negotiated billing rates, Dameron sought to collect from AAA and Allstate its customary billing rates by asserting liens filed under the Hospital Lien Act (HLA). AAA and Allstate ignored Dameron’s HLA liens when paying settlements to the three Kaiser patients. Upon learning of the settlements, Dameron sued AAA and Allstate to recover on its liens. The trial court granted the automobile liability insurers’ motions for summary judgment on grounds the patients’ debts had already been fully satisfied by their health care service plans. Reasoning the HLA liens were extinguished for lack of any underlying debt, the trial court dismissed the case. The trial court further found dismissal was warranted because Dameron failed to timely file some of its HLA liens against AAA. The issue this case presented for the Court of Appeal was whether a heath care service plan’s payment of a previously negotiated rate for emergency room services insulate the tortfeasor’s automobile liability insurer from having to pay the customary rate for medical care rendered? AAA and Allstate contended they were not responsible for any amount after Kaiser paid in full the bill for the emergency room services provided by Dameron. Dameron contended that it contracted with Kaiser to preserve its rights to recover the customary billing rates from tortfeasors and their automobile liability insurers. Dameron argued the tortfeasors and their liability insurers were responsible for the entire bill for medical services at the customary rate, not just the difference between the reimbursement received from Kaiser and the customary billing rate. Although Dameron claimed it should benefit from the California Supreme Court’s holding that it may avoid extinguishment of its HLA liens upon receiving payments from health insurers, the contract in this case preceded that case by 10 years. The Court of Appeal concluded that the Dameron/Kaiser contract did not preserve the right to recover the customary billing rate for emergency room services from third party tortfeasors: "[I]f Dameron wishes to preserve its right to recover its customary billing rates through an HLA lien, it is free to contract for this right. But Dameron must actually contract for this right. A history of voluntary cooperation with Kaiser does not suffice to avail Dameron of the [Supreme Court's] guidance on reservation of contractual rights under the HLA." Consequently, the trial court properly granted summary judgment in favor of AAA and Allstate. As to Dameron’s argument that it filed a timely claim relating to patient Rita H.’s HLA lien, the Court of Appeal affirmed the trial court’s dismissal based on the statute of limitations. Dameron has not made a sufficient showing of diligence to toll the claim under the discovery rule. View "Dameron Hospital Assn. v. AAA etc. Ins. Exchange" on Justia Law

Cases consolidated cases for appellate review stemmed from alleged injuries suffered by plaintiff Faye Ainsworth while she was at defendant Charles Chandler’s business, Chandler Electric. Plaintiff sued claiming she was injured when she tripped on a coil of wires that had been placed in the stairway. Defendant sued his insurer, Concord Insurance Group, arguing that insurer had wrongfully and in bad faith failed to provide adequate coverage for the claim. The insurer filed a counterclaim seeking a declaration of noncoverage. The trial court granted summary judgment to defendant, concluding that plaintiff was a social guest of defendant at the time of her visit, that the duty of care defendant owed her was the lesser duty applicable to licensees under Vermont law (as opposed to that which is owed to business invitees), and that defendant did not breach this duty. The trial court also granted summary judgment to the insurer, on the basis that the underlying personal injury action had been dismissed and therefore no coverage was owed. Plaintiff and defendant both appealed, contesting the court’s order granting summary judgment in favor of defendant. Defendant contested the order granting summary judgment in favor of insurer. Upon review of the cases, the Supreme Court affirmed with respect to defendant’s motion to disqualify the trial judge, but reversed with respect to plaintiff’s suit and reversed and remanded for further proceedings with respect to defendant’s claim against the insurer and the insurer’s counterclaim for declaration of noncoverage. View "Ainsworth v. Chandler" on Justia Law

Plaintiff Helena Murphy appealed a superior court judgment in favor of defendant, Patriot Insurance Company, her homeowner’s insurer. The dispute between the parties stemmed from storm damage done to plaintiff's house in 2007, and the subsequent claims she made on her insurance policy. On appeal of the superior court's ruling in Patriot's favor, plaintiff argued: (1) Patriot was estopped from denying coverage for the removal and replacement of a chimney on her home; and (2) the trial court erred in dismissing claims for negligence and bad faith. Finding no reversible error, the Supreme Court affirmed. View "Murphy v. Patriot Insurance Company" on Justia Law

Plaintiff Progressive Casualty Insurance Company insured the vehicle involved in the accident at issue in this case. Given the number of victims, the policy’s liability coverage did not fully compensate at least one of the injured passengers. The parties disputed whether the injured passenger was therefore entitled to UIM benefits under Progressive’s policy. Progressive argued that coverage was barred by certain exclusions in its policy. The trial court found Progressive’s exclusions unenforceable as inconsistent with the definition of an "underinsured vehicle" set forth in 23 V.S.A. 941(f). Progressive appealed, arguing that its exclusions should be enforced, and that it should not have to provide both liability and UIM benefits to the injured passenger. The Supreme Court agreed with Progressive after its review of the case, and therefore, reversed the trial court’s decision.View "Progressive Casuality Insurance Co. v. MMG Insurnace Co." on Justia Law