Justia Insurance Law Opinion Summaries

First American appealed the district court's grant of CNA's motion for summary judgment. First American challenged the district court's conclusion that a claims-made-and-reported policy's requirement that conditioned coverage on CNA's receiving of a written report of a claim within the policy's effective period was enforceable in a Direct Action case under La. Rev. Stat. Ann. 22:1269(B)(1). The policy at issue was a Lawyers Professional Liability Policy. The court concluded, in light of its precedent and the Louisiana Supreme Court's holdings in Anderson v. Ichinose and Hood v. Cotter, that the Direct Action Statute did not trump the reporting provision in CNA's claims-made-and-reported policy's insuring clause, which required that a claim be reported to CNA within the Policy's effective period. Therefore, the court affirmed the district court's summary judgment in CNA's favor. View "First American Title Ins. Co. v. Continental Casualty Co." on Justia Law

Sundown claimed that Mid-Continent prematurely tendered the limits of Sundown's primary and umbrella policies while undercutting Sundown's ability to defend a class action suit for environmental damage following Hurricane Katrina and Rita. The court held that the district court did not err when it held that there was no cause of action under Texas common law for breach of an insurer's duty of good faith and fair dealing in the context of third-party claims; Texas rather than Louisiana law governed Sundown's claims for breach of the duty; and the district court did not err in holding against Sundown on its statutory claims for unfair settlement practices. Accordingly, the court affirmed the judgment. View "Mid-Continent Casualty Co. v. Eland Energy Inc., et al" on Justia Law

Levy Gardens appealed the district court's decision ordering Commonwealth to pay Levy Gardens pursuant to Levy Gardens' title insurance policy with Commonwealth. The court held that the district court did not err in concluding that Levy Gardens had coverage under the insurance policy and that Levy Gardens did not violate the conditions of the policy in a manner prejudicial to Commonwealth. The district court did not err in concluding that the insurance policy provided coverage for only the diminution in value of title to the property resulting from the zoning encumbrance. The district court's findings that Commonwealth's actions were not arbitrary and capricious and Commonwealth made its assertions in good faith were reasonable and supported by the record. Therefore, the court held that the district court did not manifestly err by declining to impose penalties to Commonwealth. Accordingly, the court affirmed the judgment. View "Levy Gardens Partners 2007, LP v. Lewis Title Ins. Co." on Justia Law

Plaintiff appealed the district court's grant of summary judgment to the Plan on his claim under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. Plaintiff asserted that the Plan did not comply with procedures set out by ERISA by changing its basis for denial on administrative appeal and by not identifying the independent physician reviewer who recommended denial on administrative appeal. Because plaintiff did not specify the failure to identify the physician in his amended complaint, the court did not address this issue. The court agreed with plaintiff, however, that the Plan did not substantially comply with ERISA procedures by changing its basis for denying coverage on administrative appeal. The court concluded that remand to the Plan for a full and fair review was appropriate. View "Rossi v. Precision Drilling Oilfield Svcs. Corp. Emp. Benefits Plan" on Justia Law

A third-party administrator of medical benefits plans, IMA, denied claims made on behalf of two patients who received treatment from the same medical provider, LifeCare. The court held that IMA incorrectly interpreted the plans because it categorized LifeCare as a skilled nursing facility (SNF) without finding that LifeCare "fully meets all of" the plans' seven SNF factors. IMA abused its discretion because categorizing LifeCare as an SNF without considering the seven-factors SNF test contradicted the plain language of the plans. The court found that the district court correctly held that LifeCare could maintain an action against IMA pursuant to 29 U.S.C. 1132(a)(1)(B) and that IMA was liable for exercising actual control over the claims process. The court further held that the district court did not abuse its discretion in awarding attorneys' fees. View "Lifecare Mgmt. Svcs., LLC v. Ins. Mgmt. Admins. Inc, et al" on Justia Law

Homeowners, who were represented by the Mostyn Law Firm, filed claims against State Farm in Texas state court after Hurricane Ike. State Farm removed several cases to federal court on diversity grounds. The Firm and State Farm then entered into an agreement whereby the Firm promised to abandon its clients' claims against individual adjusters and forgo suing them in the future in exchange for State Farm's promise not to remove any Hurricane Ike cases to federal court. At issue on appeal was whether the phrase "any Hurricane Ike cases," in a contract covering "all Hurricane Ike cases that either have been filed or will be filed in the future," encompassed class-action lawsuits. The court affirmed and agreed with the district court's conclusion that the negotiated contract covered all past, present, and future lawsuits filed by the Firm against State Farm on behalf of homeowners, as individuals or part of a class, whose properties were damaged during Hurricane Ike. View "Horn, et al v. State Farm Lloyds" on Justia Law

Gallagher provided insurance-related services throughout the country. Its subsidiary, GBSI, handled Gallagher's employee-benefit insurance programs. In November 2003, GBSI purchased Babcock Consulting, a business owned by Clayton L. Babcock. In this diversity suit, Gallagher and GBSI (collectively, "plaintiffs") sought money damages for breach of restrictive employment agreements under Louisiana law. The court affirmed the district court's directed verdict on the breach of competition agreement, but set aside the damages. The court concluded that the district court abused its discretion in admitting certain evidence on the issue of damages. The court vacated the award of attorneys' fees, leaving the ultimate award to be decided on remand. View "Arthur J. Gallagher & Co., et al v. Babcock, et al" on Justia Law

Liberty Mutual insured PPI and PPI was retained by several third parties to assist in planning well-drilling operations. After a well was drilled in the wrong area, PPI was sued by the third parties, PPI then sought defense and indemnification from Liberty Mutual but Liberty Mutual refused. The court affirmed the district court's dismissal of PPI's breach of contract claim because it had no duty to defend. Both parties acknowledged that the duty-to-indemnify issue was now moot. Because the court affirmed the breach of contract claim's dismissal, the court affirmed the breach of the Texas Insurance Code claim and breach of the good faith and fair dealing claims. View "PPI Technology Services, L.P. v. Liberty Mutual Ins. Co." on Justia Law

Plaintiffs were passengers on a chartered fishing boat insured by St. Paul Fire when they were involved in an accident with a utility boat owned by non-party Harvest Oil and insured by Steadfast Insurance Company. Steadfast subsequently appealed from the district court's order denying it summary judgment and granting summary judgment to plaintiffs. The court held that plaintiffs' contention that Steadfast failed to reserve its rights with respect to the watercraft exclusion was without merit. The court also held that, because the automatic stay did apply to plaintiffs' claim against Harvest in the 2008 case, that case had remained stayed since Harvest filed for bankruptcy and the court could not lift the stay until the bankruptcy court closes or dismissed Harvest's bankruptcy case; neither claim preclusion nor issue preclusion would prevent Harvest from litigating the issues decided in this case; and even if plaintiffs had produced sufficient evidence of inconsistent conduct to survive summary judgment, plaintiffs produced no evidence that Steadfast's conduct in this case prejudiced Harvest. Accordingly, the court reversed and rendered summary judgment for Steadfast. View "Sosebee, et al v. Steadfast Ins. Co." on Justia Law

This case stemmed from a dispute over annuity payments. Counter Defendants, RSL, appealed the district court's decision to abstain based on the doctrine of Colorado River Water Conservation District v. United States. Under the Colorado River doctrine, a court could abstain from a case that was part of parallel, duplicative litigation under "exceptional circumstances." The court examined the six relevant factors under Colorado River and reversed and remanded for further proceedings. On remand, the district court should determine whether RSL was entitled to compel arbitration under 9 U.S.C. 3. The district court must determine in the first instance whether any issues or claims decided by the state court were entitled to preclusive effect. View "Saucier v. Aviva Life and Annuity Co." on Justia Law