Justia Insurance Law Opinion SummariesArticles Posted in Supreme Court of Indiana
FMS Nephrology Partners North Central Indiana Dialysis Centers, LLC v. Meritain Health, Inc.
The Supreme Court vacated the trial court's grant of summary judgment for Defendants, holding that the trial court erred by entering summary judgment for defendant health-insurance plans, which were governed by the Employee Retirement Income Security Act of 1974 (ERISA), based on ERISA preemption.Plaintiff, a health-care provider, contracted with two third-party networks. Defendants and its affiliated employee health-insurance plans contacted with both health networks. Seven patients received treatments from Plaintiff, and the patients were covered under Defendants' plans. Plaintiff sued Defendants, alleging that they failed to pay agreed reimbursement rates for covered services under their plans. The trial court granted summary judgment against Plaintiff, concluding that Plaintiff's claims were preempted under ERISA's conflict-preemption provision, 29 U.S.C. 1144(a). The Supreme Court vacated the judgment, holding that genuine issues of disputed fact existed concerning the central issue of whether the provider's claims were denied coverage under the plans or whether the provider's claims necessitated interpreting the plan documents. View "FMS Nephrology Partners North Central Indiana Dialysis Centers, LLC v. Meritain Health, Inc." on Justia Law
Erie Indemnity Co. v. Estate of Brian L. Harris
At issue was whether the term “others we protect” under a decedent’s employer’s commercial auto policy included the decedent.The decedent was killed by an uninsured driver while the decedent was mowing his home’s lawn near the roadside. The decedent’s estate sought uninsured motorist benefits, arguing that the decedent qualified for coverage under the employer’s commercial auto policy’s term “others we protect.” The insurance company denied the claim. The Supreme Court agreed with the insurance policy, holding (1) the term “others we protect” is unambiguous and impervious to judicial construction; and (2) accordingly, as a matter of law, the decedent did not qualify as “others we protect” under the policy when he was struck and killed by the uninsured motorist. View "Erie Indemnity Co. v. Estate of Brian L. Harris" on Justia Law
State Farm Mut. Auto. Ins. Co. v. Jakubowicz
Carol Jakubowicz and her two minor sons were involved in a car accident with Ronald Williams that resulted in injuries to the Jakubowiczs. Jakubowicz filed suit on behalf of herself and her sons against Williams. More than three years after the accident, Jakubowicz filed a motion for leave to amend her complaint and add an underinsured motorist (UIM) claim against State Farm, the Jakubowiczs’ insurer, stating that she believed Williams’ insurance policy would be insufficient to cover her damages. The trial court granted Jakubowicz’s motion for leave to amend. State Farm moved for summary judgment on the UIM claim, claiming it was barred because it was filed after the three-year limitation period in Jakubowicz’s insurance policy. The trial court denied the motion. The Supreme Court affirmed, holding that because the provision in the policy requiring an insured to bring suit within three years is in direct conflict with the policy’s requirement that State Farm will only pay if the underinsured motorist’s insurance has been exhausted, the policy is ambiguous and must be construed in favor of the insured. Remanded. View "State Farm Mut. Auto. Ins. Co. v. Jakubowicz" on Justia Law
Schmidt v. Indiana Insurance Co.
Plaintiff filed an application for insurance on his property, despite his property being vacant and uninhabitable. Based on the application, the insurance company issued a “Dwelling Fire Policy” on the property. Two months later, the property was destroyed by fire. The insurance company denied coverage and rescinded the policy because it contained material misrepresentations and false statements. Plaintiff filed suit against the company that issued the policy, the insurance agency, and the insurance agents, alleging that the agents made false representations as to the occupancy status of the house and committed forgery, deception, and insurance fraud. The trial court granted summary judgment for the agents and directed entry of judgments for all defendants. The Supreme Court (1) reversed in part the trial court’s entry of summary judgment for the agents to the extent that it may apply to Plaintiff’s claim for negligent procurement of insurance, holding that summary judgment was improperly entered on this claim; but (2) directed the entry of partial summary judgment for the agents as to Plaintiff’s claim alleging that the agents failed accurately to report dwelling fire policy information to the insurance company, holding that summary judgment was proper on this claim. View "Schmidt v. Indiana Insurance Co." on Justia Law