Justia Insurance Law Opinion Summaries

Plaintiffs Russell and Jennifer Johnson blamed Liberty Mutual for failing to hold onto a pair of tail lights that they said would have helped them win a personal injury lawsuit they wanted to bring. Plaintiffs never asked Liberty Mutual to keep the tail lights, never mentioned their intent to sue, and allowed years to pass without a word. In their case against Liberty Mutual, they faulted the company for failing "to divine their hidden (and perhaps not yet formed) intentions." Upon review of the record by the Tenth Circuit, the Court concluded that because Plaintiffs could not identify a statutory or contractual basis for their claim, "they ask[ed the Tenth Circuit] to create one for them in the common law of tort." But the Court held the common law doesnât require such "uncommon foresight," and affirmed the lower court's decision to dismiss their case.

Plaintiffs Aviva Life & Annuity Company and American Investors Life Insurance Company (collectively, "Aviva") contended the Federal Deposit Insurance Corporation (FDIC) acted in an arbitrary and capricious manner in rendering insurance determinations concerning certain of Plaintiffsâ bank deposit accounts. They appealed a district courtâs order upholding the FDICâs determinations. In 2008, the Kansas Bank Commissioner closed Columbian Bank & Trust Company and appointed the FDIC as receiver. At that time, Plaintiffs maintained twelve deposit accounts at Columbian. The bulk of those funds were held in two accounts (the âChallenged Accountsâ). The remaining accounts bore a variety of titles. Shortly after its appointment as receiver, the FDIC determined that each Plaintiffsâ respective accounts identified as âoperatingâ accounts, which included the Challenged Accounts, would be aggregated as corporate accounts. The FDIC further determined that the accounts designated as âbenefitsâ accounts would be separately insured as annuity contract accounts. Upon review of the FDIC's determination and the applicable legal authority, the Tenth Circuit found that the FDIC ultimately concluded the deposit account records clearly and unambiguously indicated the Challenged Accounts were owned in the manner of âcorporate accounts.â Plaintiffsâ extrinsic evidence was not, therefore, ârelevant dataâ for purposes of the FDICâs final insurance determination: "[t]he absence of any discussion pertaining to this evidence in the FDICâs final determination is therefore unsurprising, and in no way arbitrary or capricious." The Court affirmed the FDIC's determination.

This case stems from a fire that destroyed a Michigan apartment building. The owner, Rapid Funding, LLC (a Colorado company), submitted a claim to its insurer James River Insurance Company (an Ohio company). James River denied the claim because it determined that the building's pre-fire value was less than zero. Rapid Funding sued in Colorado federal district court for breach of contract and insurance bad faith and received the full $3 million amount of the policy plus $2.35 million in punitive damages. James River argued on appeal that the damages verdict was based on valuation testimony that should have been excluded at trial. Upon review of the applicable legal authority and briefs submitted by the parties, the Tenth Circuit held that the valuation testimony was erroneously admitted, and the error was not harmless. The Court reversed and remanded the case for a new trial limited to the damages issue.

In one of Plaintiff Leprino Foods Company's warehouses, flavoring compounds derived from nearby-stored fruit products contaminated a large quantity of cheese. Leprino's "all-risk" insurance policy with Defendant Factory Mutual Insurance Company excluded contamination unless with was caused by "other physical damage." When Factory Mutual refused coverage on the basis of the contamination exclusion, Leprino sued. A jury determined that the contamination was caused by other physical damage and therefore was covered by the Factory Mutual insurance policy. On appeal, Factory Mutual contended the verdict was not supported by the evidence presented at trial. Specifically, Factory mutual argued that: (1) expert testimony was not presented to prove causation; (2) the jury instructions pertaining to Leprino's cold-storage guidelines were given in error; and (3) Leprino's damages should have been reduced by its settlement with the warehouse. Upon review of the trial record and applicable legal authority, the Tenth Circuit found that Leprino presented sufficient evidence with regard to expert testimony to prove causation. The Court did not find jury instructions to be erroneous. The Court did agree that Leprino's damages should be reduced by the amount of the settlement received from the warehouse. The Court therefore affirmed part and reversed part of the lower court's decisions and remanded the case for recalculation of damages.

Plaintiff Melissa Qualls appealed a district Court's order that affirmed the Social Security Administration's decision to deny her application for disability insurance benefits. Plaintiff alleged she became disabled in 2004. Her "date last insured" was December 31, 2008, "thus she had the burden of proving that she was totally disabled on that date or before." Though Plaintiff suffered from multiple sclerosis, the Administrative Law Judge (ALJ) found that she was not disabled because "she could make a successful adjustment to other light and sedentary work that exists in significant numbers in the national economy." On appeal, Plaintiff argued that the ALJ failed to perform a proper credibility determination prior to rendering his judgment. Upon review of the Administration's record, the Tenth Circuit found that the Commissioner's decision was supported by substantial evidence, and the the law was properly applied. The Court affirmed the Commission's decision to deny Plaintiff further insurance benefits.

Plaintiff Geral Brown appealed a district court's order that granted summary judgment to Defendant Hartford Insurance Company (Hartford). Plaintiff sued Hartford under the Employee Retirement Income Security Act (ERISA) for the company's termination of his long-term disability benefits. Following his injury, Plaintiff filed for Social Security Disability benefits as required by his benefit plan, and the Social Security Administration awarded him benefits. The plan then offset the monthly benefit it paid to Plaintiff by the amount of the Social Security benefit. The Hartford denied Plaintiff's administrative appeal. After examining and weighing the evidence, the trial court granted summary judgment to the Hartford. The Tenth Circuit concluded that the plan administrator's decision was supported by substantial evidence. Accordingly, the Court affirmed the decision of the district court.

BancInsure, Inc. appealed a declaratory judgment in favor of Columbian Financial Corporation and a former director, Carl McCaffree (collectively the Insureds). The insurance policy at issue here was a "claims-made" policy covered any claim made to BancInsure against any Columbian officer or director for a "Wrongful Act" as defined by the policy. A disputed provision of the policy pertained to the scope of coverage if Columbian was placed in receivership or otherwise ceased to engage in active banking business. The parties interpreted the provision differently. The Insureds contended that if Columbian went into receivership, the policy covered all claims made through the end of the original policy period, although only for Wrongful Acts committed before the receivership. BancInsure contended that the policy covered only claims made before the receivership. The operation of the disputed provision became relevant in August 2008 when the Kansas State Bank Commissioner declared Columbian insolvent and appointed the FDIC as its receiver. Soon thereafter, Columbianâs management sent BancInsure a letter to notify it of potential claims by the FDIC and others. The parties disputed many of the claims against Columbian which led to Columbian filing suit to the district court to determine which claims were covered under the policy. The sole issue on appeal to the Tenth Circuit was whether the district court had jurisdiction. Though no party disputed jurisdiction, the Tenth Circuit found that there was no actual controversy between the parties when the district court below rendered its judgment. The court therefore lacked jurisdiction. The Tenth Circuit reversed the lower courtâs decision and remanded to case with instructions to the court to vacate its judgment.

After a jury trial, Defendant David Hillman was convicted on several money laundering charges arising from a scheme to steal hundreds of thousands of dollars from the insurance company for which he worked. Defendant's defense at trial was that he was duped by his then-girlfriend and co-worker, Hillary Shaffer, as to the source of the money. Defendant maintained that Ms. Shaffer told him the money they deposited in their joint bank account came from her grandmother's trust. The trial record revealed that the source of the money came from inactive annuities of the company's clients. On appeal to the Tenth Circuit, Defendant argued multiple errors at trial: prosecutorial misconduct, a violation of his due process rights, and misguided jury instructions all denied him a fair trial. Upon review of Defendant's arguments against the trial record, the Tenth Circuit concluded that none of his claims fundamentally affected the fairness of his trial or were otherwise an abuse of discretion by the trial court. Accordingly, the Court affirmed Defendant's conviction.

Defendants-Appellants Farmers Insurance Exchange (Farmers) and Mid-Century Insurance Company (Mid-Century) removed a putative class action suit from state court to federal district court. Upon motion of Plaintiff-Appellee Lawrence Countryman, the federal court remanded the case back to the state court based on a procedural defect in the Defendantsâ notice of removal. Specifically, Defendants were required to attach copies of all process, pleadings and orders for both Farmers and Mid-Century. The copies served to all parties in this case only contained those pertaining to Farmers, not Mid-Century. Defendants supplemented their joint notice or removal to include the missing Mid Century documents. Defendants challenged the lower courtâs remand of the case to state court. Upon review, the Tenth Circuit found that the Defendantsâ omission was an inadvertent, procedural defect that was timely cured, and caused no prejudice to Plaintiffs. The Court vacated the district courtâs decision, and remanded the case back to federal court.

In New Mexico, title insurance is totally regulated by the state. Under its âTitle Insurance Act,â the state superintendent of insurance holds yearly public hearings to establish premium rates insurers can charge for title insurance. At the close of the hearings, a legal or âfiled rateâ is published by the agency. Once set, the filed rate is considered âper se reasonable and unassailable in judicial proceedings brought by ratepayers.â The policy behind the filed rate is to prevent price discrimination, preserve the role of agencies in approving rates and âto keep courts out of the rate-making process.â The New Mexico Insurance Code does not apply to title insurers except to the extent that the Title Insurance Act provides otherwise. Plaintiffs Coll and others brought suit alleging generally that the Title Insurance Act violates numerous New Mexico constitutional and statutory provisions precluding price fixing and creating monopolies. Plaintiffs also allege that the Insurer Defendants conspired with the insurance superintendent to establish a premium rate that is unreasonably high. Based on these theories, Plaintiffs sought declaratory and injunctive relief; compensatory, punitive and statutory damages; Defendantsâ disgorgement of their profits; and attorneysâ fees and costs. The lower court dismissed Plaintiffsâ claims with prejudice and remanded to state court all claims asserted against the state Defendants. The Tenth Circuit District Court agreed with the lower courtâs decision that the âfiled rateâ doctrine precluded Plaintiffsâ claims against the Defendants. The Court affirmed the district courtâs dismissal of Plaintiffs claims and remanded the case to the lower court for review of claims brought on state constitutional and procedural grounds.