Justia Insurance Law Opinion Summaries

Pruco Life Insurance Company sought rescission of a life insurance policy, owned by the Paul E. L'Archevesque Special Revocable Trust on the life of Paul L'Archevesque, after it discovered that the policy application contained material misrepresentations about the health of Paul. Pruco tendered to Wilmington Trust Company, a co-trustee of the trust, a check in the amount of the policy premiums paid along with a letter stating Pruco was rescinding the policy. Wilmington cashed the check. Pruco subsequently filed a complaint seeking a rescission of the policy and a declaration that the policy was void ab initio. The district court granted summary judgment to Pruco, concluding that, under the circumstances, a mutual rescission had taken place as a matter of law. The First Circuit Court of Appeals affirmed, holding (1) the district court properly interpreted Rhode Island law regarding the standard for mutual rescission; (2) there were no genuine issues of material fact concerning whether Pruco made material misrepresentations in its rescission letter that could have prevented summary judgment; and (3) the district court did not err in finding that the issue of whether Pruco acted in bad faith was irrelevant to the rescission analysis. View "Pruco Life Ins. Co. v. Wilmington Trust Co." on Justia Law

This case involved an insurance-coverage dispute governed by Massachusetts substantive law. Plaintiffs filed a claim with their insurance company after a storm caused a pile of soil to slide down a hill and into and over a retaining wall, damaging one of the buildings on Plaintiffs' property. The insurance company denied coverage. Plaintiffs sued for breach of the insurance contract and violation of the Massachusetts consumer-protection act. The insurance company counterclaimed, seeking a declaration that the policy did not cover the claimed loss. The magistrate judge granted the insurance company's motion for summary judgment, noting that the policy excluded damages from landslides. The First Circuit Court of Appeals affirmed, holding that the insurance company acted well within its rights in denying coverage, and the magistrate judge properly granted summary judgment for the insurance company on all claims. View "Stor/Gard, Inc. v. Strathmore Ins. Co." on Justia Law

Plaintiff, an insurance company, filed an equitable action in the U.S. district court for Rhode Island seeking a declaratory judgment that a life insurance policy was rescinded ab initio due to the fraudulent misrepresentations of Defendant, an irrevocable trust. Plaintiff also sought to retain the premium paid by the trust as an offset against the damages it had suffered in connection with the policy. The district court (1) found that Defendant, by and through its trustee, had made false representations to induce Plaintiff to issue the policy and that this fraud caused Plaintiff damages that would not be fully compensated by rescission alone; and (2) allowed Plaintiff to retain the policy premium paid by Defendant. The First Circuit Court of Appeals affirmed, holding that the district court (1) did not err, under Rhode Island law, in allowing Plaintiff to both rescind the policy and retain the premium; (2) did not err in finding that Plaintiff was a victim of a fraudulent insurance scheme; and (3) appropriately exercised its equity powers. View "PHL Variable Ins. Co. v. Bowie 2008 Irrevocable Trust " on Justia Law

Aetna, Inc. filed a coordinated complaint with Kaiser Foundation Health Plan and Kaiser Foundation Hospitals (together, Kaiser) and Guardian Life Insurance Company (Guardian) against Pfizer, Inc. and Warner-Lambert Company (together, Pfizer). The coordinated plaintiffs asserted that they had suffered injury from the fraudulent marketing of Neurontin for off-label uses, and alleged violations of, inter alia, the Racketeer Influenced and Corrupt Organizations Act (RICO) and the Pennsylvania Insurance Fraud Statute (PIFS). The district court dismissed the claims of Guardian and Aetna but denied summary judgment as to Kaiser's claims. The court then entered judgment against Guardian and Aetna and in favor of Pfizer. The First Circuit Court of Appeals (1) reversed the dismissal of Aetna's RICO claim, as Aetna presented evidence of causation and damages sufficient to survive summary judgment; and (2) vacated the district court's dismissal of Aetna's claim under the PIFS. Remanded. View "Aetna, Inc. v. Pfizer, Inc." on Justia Law

Brothers Thomas and Michael Tessier allegedly swindled brothers Frederick and Thaddeus Jakobiec and the estate of their mother out of millions of dollars. This lawsuit covered the Tessiers' theft of almost $100,000 in life insurance proceeds due to a trust benefitting Thaddeus. Thaddeus and various persons affiliated with the trust and estate (collectively, Plaintiffs) filed this action against Merrill Lynch, the company that issued the life insurance policy, claiming that Merrill Lynch made out the insurance proceeds check to the wrong trust entity in breach of the insurance contract, thus allowing the Tessiers to steal the money. The First Circuit Court of Appeals granted summary judgment for Merrill Lynch, concluding that even if Merrill Lynch did breach the contract, its breach was not the cause of Plaintiffs' losses because the Tessiers would have stolen the money even if the check had been made out correctly. The First Circuit Court of Appeals affirmed, holding (1) because the extensive groundwork laid by the Tessiers for their criminal scheme, they could have and would have stolen the insurance money regardless of how Merrill Lynch made out the check; and (2) therefore, the district court correctly granted summary judgment for Merrill Lynch. View "Jakobiec v. Merrill Lynch Life Ins. Co." on Justia Law

Plaintiff here was Boston Gas Company and Defendant was Century Indemnity Company, one of Boston Gas's insurers. Environmental contamination was later found at many of Boston Gas's former gas plant sites. Boston Gas filed this action seeking a declaratory judgment as to Century's obligations under policies issued to Boston Gas. Jury trials were held with respect to two sites included in the cleanup, the Everett and Commercial Point sites. The Everett site litigation first went to trial. Before the parties reached a settlement, the supreme judicial court (SJC) found a pro rata allocation method applied for allocating liability for the contamination where Century had provided coverage for the risk for only a portion of the time during which the contamination took place. Meanwhile, the jury found Century liable for $1,699,145 in the Commercial Point litigation. The trial judge deferred entry of final judgment pending the outcome of the Everett appeal. The district court ultimately (1) concluded that in the wake of the SJC ruling in the Everett litigation, by allocating damages across a 121-year span in the case of the Commercial Point site, this reduced Century's share of damages from 100 percent to less than fifteen percent; and (2) vacated the damages award and ordered a new trial on the issue of which of the costs were subject to an exclusion in the GCL policy. The First Circuit Court of Appeals affirmed. View "Boston Gas Com. v. Century Indem. Co." on Justia Law

Plaintiff was a partner in a medical practice where she served as a staff anesthesiologist. When Plaintiff's dependence on opioids came to light, her employer had in force a group employee benefit plan, underwritten and administered by Union Security Insurance Company & Management Company for Merrimack Anesthesia Associates Long Term Disability Plan (USIC), which included long-term disability (LTD) benefits. When Plaintiff applied for those benefits, USIC refused to pay benefits past the point when Plaintiff was discharged from a treatment center, finding that Plaintiff's risk for relapse was not the same as a current disability. Plaintiff brought suit in the federal district court. The district court ultimately awarded Plaintiff LTD benefits for the maximum time available under the plan, concluding that categorically excluding the risk of drug abuse relapse was an unreasonable interpretation of the plan. The First Circuit Court of Appeals affirmed, holding that, in an addiction context, a risk of relapse can be so significant as to constitute a current disability. View "Colby v. Union Sec. Ins. Co." on Justia Law

This case involved an insurance coverage dispute arising from charges of sexual harassment brought by a former employee (Employee) against the one-time president (President) of Jasmine Company, Inc. After President filed an action against Jasmine's liability insurance provider (Insurer), seeking defense and indemnification for the harassment charges, Insurer filed a third-party complaint against Jasmine itself, requesting a declaratory judgment that it had not duty to defend or indemnify Jasmine for the harassment claims. The district court granted summary judgment on the third-party claims for Jasmine, holding that Insurer had to defend and indemnify Jasmine. At issue on appeal was whether a finder of fact must conclude that the conduct underlying the sexual harassment charges did or did not begin before Jasmine's insurance policy took effect. The First Circuit Court of Appeals vacated the judgment and remanded, holding that neither party was entitled to summary judgment, as the question of when the harassing conduct that gave rise to Employee's claims began was a quintessential question for a factfinder. View "Manganella v. Evanston Ins. Co." on Justia Law

This insurance coverage dispute arose from charges of sexual harassment brought by a one-time employee against Appellant, the former president of Jasmine Company, Inc. Appellant sought a defense to and indemnity for the harassment claims from Appellee, Jasmine's liability insurance provider. The district court ruled that Appellant was not entitled to coverage from Appellee because, under the doctrine of issue preclusion, a prior arbitration between Appellant and the purchaser of his business conclusively established that Appellant's conduct fell within an exclusion to Appellee's insurance policy. The First Circuit Court of Appeals affirmed, holding (1) the arbitration presented Appellant with the full and fair opportunity for adjudication on the issue at hand; and (2) therefore, the district court was correct to bar Appellant from disputing the applicability of the exclusion based on the doctrine of issue preclusion. View "Manganella v. Evanston Ins. Co." on Justia Law

The State enacted an Act in 2011 pursuant to which health insurers were required to disclose, upon written request from a public school district, aggregate loss information pertaining to any group policies held by the district's employees. Maine Education Association Benefits Trust, which managed a statewide health insurance plan for a substantial segment of Maine's public school work force, subsequently filed suit in the district court, seeking to permanently enjoin the law prior to its enforcement. The Trust alleged that because its information constituted a confidential trade secret, the Act's disclosure requirement resulted in an uncompensated taking proscribed by the Fifth Amendment. The district court denied the Trust's motion for a preliminary injunction. The Supreme Court affirmed, holding that the Trust did not have a reasonable likelihood of success on the merits of its takings claim. View "Me. Educ. Ass'n Benefits Trust v. Cioppa" on Justia Law