Justia Insurance Law Opinion Summaries

Insurer issued Insured a commercial general liability policy. After a third party sued Insured, Insured rejected the representation offered by Insurer under the policy on the ground that Insurer's reservation-of-rights letter had created a conflict of interest. Insured hired its own independent counsel, and when Insurer refused to reimburse Insured for the cost of its independent counsel, Insured filed an action seeking a declaratory judgment that Insurer had a contractual duty to defend and indemnify Insured in the third party lawsuit. The magistrate judge rejected Insured's claim, ruling that Insurer was not required to reimburse Insured for the cost of independent counsel. The Fifth Circuit Court of Appeals affirmed, holding (1) because the facts to be adjudicated in the third party lawsuit were not the same facts upon which coverage depended, the potential conflict in this case did not disqualify the attorney offered by Insurer to represent Insured; and (2) therefore, Insured was not entitled to reimbursement from Insurer for the cost of hiring independent counsel. View "Downhole Navigator, LLC v. Nautilus Ins. Co." on Justia Law

This case arose from a contract entered into by the parties where Ewing agreed to construct tennis courts for the school district. At issue was the interpretation of a Commercial General Liability (CGL) insurance policy under Texas law. The district court held that a CGL policy's contractual liability exclusion applied in this case and that no exception restored coverage. The insured construction company faced liability, if at all, because it contracted to construct usable tennis courts for the school district and it had allegedly failed to perform. The court held that the district court correctly interpreted the contractual liability exclusion and correctly applied that exclusion with respect to the insurer's duty to defend the construction company. The court held, however, that the district court was premature in applying the exclusion to the insurer's duty to indemnify.

LINA appealed the decision of the district court holding that it abused its discretion in its denial of benefits to plaintiff under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. Plaintiff alleged that LINA wrongly denied her the benefits of her common-law husband's ERISA-governed Group Accident Policies where her husband participated in two accidental death and dismemberment policies. The court affirmed the district court's holding that the common law definition of "accident" adopted in Todd v. AIG Life Insurance Co., was controlling in all ERISA accidental death and dismemberment plans where the term "accident" was undefined, irrespective of whether the plan administrator was given discretion to interpret the plan.

Mid-Continent appealed the district court's final judgment that it had a duty to indemnify Davis Construction in the underlying wrongful death action brought by the family of decedent Jorge Serrato. The court affirmed the district court's ruling, finding that the district court did not abuse its discretion in determining that Serrato was an independent contractor and not an employee of Davis Construction.

Plaintiff appealed the district court's summary judgment dismissing her suit to recover health insurance benefits under an employee plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001-1461. Aetna, a Texas health maintenance organization (HMO), provided and administered the plan's health insurance benefits under an agreement giving Aetna discretion to interpret the plan's terms. Aetna refused to reimburse plaintiff for care she received from a specialist outside of the Aetna HMO to whom she had been referred by a physician in the HMO. Aetna denied her claim because the referral was not pre-authorized by Aetna. The district court found as a matter of law that Aetna did not abuse its discretion in denying coverage. The court found, however, that the plan was ambiguous and the need for pre-authorization was not clearly stated in Aetna's summary description of the plan. And under the circumstances of the case, it could not be said as a matter of law that Aetna did not abuse its discretion in denying coverage.

Three primary insurers and one excess carrier appealed the district court's determination on summary judgment of their duties to defend a contractor who allegedly was responsible for a fire that occurred during construction. The district court held that the three primary insurers must split the costs initially spent by one of them defending the insured, while the excess insurer could not recover any of its defense costs from the primary insurers. The court concluded that National Union could seek reimbursement for its defense costs from Continental, Columbia, and North American through contractual subrogation. The district court did not err in its allocation of Continental's defense costs among Continental, Columbia, and North American. Therefore, the court affirmed the district court's judgment in part and reversed in part, and the court remanded for further proceedings.

Following the destruction of his home in Hurricane Katrina, plaintiff sued Liberty Mutual for negligent misrepresentation to recover the difference between his flood insurance coverage he had and the coverage he could have purchased under the preferred riskier insurance policy. The district court concluded that plaintiff's claim was not preempted by federal law and sent the case to the jury which awarded plaintiff in compensatory damages. Because plaintiff's dispute with Liberty Mutual related to his renewal of a policy already in place, Campo v. Allstate Ins. Co. did not control and the court held that plaintiff's state law claim was preempted. Because the Federal Emergency Management Agency (FEMA) was presumed to be paying both the litigation expenses and any resulting damage award, the district court erred in submitting this case to the jury. Because Liberty Mutual was not offering insurance advice, was not a fiduciary of plaintiff, and did not offer any statement to plaintiff to imply the lack of alternative insurance options, Mississippi law would not recognize negligent misrepresentation as a cause of action against Liberty Mutual and the submission of negligent misrepresentation to the jury was error. Accordingly, the court reversed with instructions to dismiss plaintiff's claim

LRK, an architect firm, brought this action for copyright infringement against a former client and his affiliated building companies (collectively, Bryan defendants). Lafayette and State Farm, insurers of Bryan's Cypress Lake Development, sought declaratory judgments that, by virtue of exclusions set forth in their respective insurance policies, they have no obligation to provide coverage or duty to defend in LRK's suit. LRK appealed the district court's summary judgment ruling that Lafayette and State Farm have no duty to provide coverage, and Lafayette and State Farm appealed the district court's summary judgment ruling that they have a duty to defend. The court concluded that the exclusions relied upon by the insurers did not preclude coverage of LRK's copyright infringement claim and therefore, that the insurers owed both coverage and defense under their respective policies. Accordingly, the court reversed in part and affirmed in part.

In 2008, BEPCO sued Santa Fe in Louisiana state court, alleging claims for indemnity and contribution in an attempt to recover money it had paid out in a settlement. Santa Fe and a group of subsequently named defendants then filed cross-claims and third-party claims against a multitude of insurers and underwriters, including Lloyd's London. Among the Lloyd's London insurers named by defendants was ICAROM. In January 2011, ICAROM exercised its right to removal under the Foreign Sovereign Immunities Act (FSIA), 28 U.S.C. 1441(d), 1447(c). After BEPCO objected to removal, the district court remanded the case to state court. ICAROM appealed the district court's remand order. The court held that BEPCO's timely motion to remand, combined with a remand order based on permissible section 1447(c) grounds, denied the court jurisdiction to review the district court's order on appeal or on petition for writ of mandamus. Accordingly, the court dismissed the appeal for want of appellate jurisdiction.

Liberty appealed the summary judgment awarded to its insured, Technical Automation, holding that Liberty had a duty to defend Technical Automation in an underlying lawsuit. The court held that, notwithstanding Stern v. Marshall, the magistrate had jurisdictional authority under Article III to try and enter judgment in the state law counterclaim. The court also held that the magistrate judge erred in not resolving whether a mutual mistake existed as to coverage and whether the policy should be reformed to expunge the disputed provision. Therefore, the court reversed and vacated the summary judgment in favor of Technical Automation and remanded for further proceedings.