Justia Insurance Law Opinion Summaries

Two insurers disputed whether their respective insurance policies required them to defend the insured against allegations regarding an accidental death. Both insurers sought a declaratory judgment from the district court that their policies did not cover the underlying lawsuit. Alma Batie, daughter of Darline Rigsby, sued Preferred Ambulance in Texas state court on behalf of herself and as a representative of Rigsby's estate (the underlying lawsuit). After the district court ruled that each insurer must provide primary coverage for the accident, both insurers appealed. The court held that, for purposes of defining the scope of each insurer's duty to defendant, both Western World and National Casualty must provide primary coverage of the underlying lawsuit. Neither the exclusions in their respective policies nor the "other insurance" provision in the Western World policy limited either insurer's duty to defendant. Accordingly, to the extent that National Casualty had paid more than half of the defense costs in the underlying lawsuit to this point, it was entitled to contribution from Western World.

SLM appealed the district court's grant of summary judgment in favor of IFIC, a surety, against SLM, the principal on a bond pursuant to which IFIC paid Customs import duties assessed against SLM. The court held that the district court had jurisdiction to adjudicate IFIC's claims against SLM; exclusive jurisdiction over these claims did not lie in the Court of International Trade (CIT). The court also held that the district court did not abuse its discretion in refusing to dismiss or abate IFIC's action until the proceedings in the CIT have concluded. With regard to the merits of IFIC's claims against SLM, the court affirmed the district court's grant of summary judgment in favor of IFIC, concluding that SLM was required to pay IFIC the amounts that IFIC had paid to Customs pursuant to its bond obligations.

This insurance coverage case arose out of an underlying personal injury lawsuit brought by Michael Parr against Gilbane Building Company. Gilbane, a general contractor, sought defense and indemnification from Admiral Insurance Company based on an insurance policy held by Empire Steel Erectors, a subcontractor. On cross-motions for summary judgment, the district court determined that Admiral owed a duty to defend and indemnify. As a preliminary matter, the court held that Gilbane qualified as an additional insured. The court held that, pursuant to the strict eight-corners rule, Admiral had no duty to defend where the petition did not affirmatively allege any facts implicating the negligence of either Empire or Parr. Therefore, the district court erred in granting summary judgment in favor of Gilbane on the duty to defend. The court held, however, that the district court did not clearly err in determining that Admiral owed Gilbane a duty to indemnify for the cost of its settlement with Parr and the district court's summary judgment on that matter was affirmed.

Appellant appealed the district court's grant of summary judgment in favor of Zurich, SRS, and an insurance adjuster on his claim for wrongful denial and delay of workers' compensation benefits under Texas state and common law. At issue on appeal was whether appellees complied with the duty of good faith and fair dealing in resolving appellant's claim. The court affirmed summary judgment and held that appellant failed to raise a material fact issue with respect to his common-law bad faith cause of action.

Amerisure appealed the district court's summary judgment ruling determining that Louisiana law prohibited the consideration of extrinsic evidence to prove mutual mistake; ranking Amerisure as the primary insurer; and allowing another third-party insurer to bring a cross-claim for defense fees. The court held that because the district court erred in refusing to consider extrinsic evidence to prove the theory of mutual mistake, the court reversed and remanded without considering ranking or standing.

Plaintiff's lawsuit arose from defendant's refusal to pay some or all of plaintiff's claims for reimbursement for medical-device procurement and financing services provided in connection with over 2,000 patients insured under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., plans administered by defendant. Plaintiff subsequently appealed a summary judgment for defendant. At issue was whether plaintiff's state-law claims of promissory estoppel, quantum meruit, unjust enrichment, negligent misrepresentation, and violations of the Texas Insurance Code, 541.051(A) & (B) and 541.061(1) & (2), were preempted by ERISA. The court reversed with respect to plaintiff's promissory estoppel, negligent misrepresentation, and Texas Insurance Code claims because these claims were premised on allegations and evidence that plaintiff provided the services in reliance on defendant's representations that it would pay reasonable charges for plaintiff's services. The court affirmed with respect to plaintiff's quantum meruit and unjust enrichment claims because these claims depended on plaintiff's assertion that without its services the patients' ERISA plans would have obligated defendant to reimburse a different provider for the same services.

This case arose when Cat Tech sought indemnification from its insurers after Cat Tech damaged several components of a hyrotreating reactor owned by Ergon Refining, Inc. and arbitrators entered an award against Cat Tech for the damage. Insurers subsequently denied the claim, contending, inter alia, that the "your work" exclusion found in the policies precluded coverage for damage to the reactor. The district court found that insurers had no duty to indemnify Cat Tech. The court held that the information contained in the arbitration award was insufficient to properly apply the "your work" exclusion. As such, the court concluded that the district court erred when it relied on the award in granting insurer's summary judgment motion. On remand, the district court should conduct any additional fact-finding necessary to determine whether the damage suffered by Ergon's reactor was limited only to those components upon which Cat Tech worked, or instead included other components unrelated to Cat Tech's operations. Accordingly, the judgment was reversed and the case remanded for further proceedings.

This case stemmed from allegations of improprieties at the Brownsville Independent School District (BISD), including allegations that appellants were manipulating the bidding process for the BISD's Stop Loss Insurance Coverage. Appellants, all members of the BISD Board of Trustees (Board), argued that the district court should have granted their motion for summary judgment because they were entitled to qualified immunity. The court found no error in the district court's holding that genuine issues of material fact existed with respect to whether appellants violated appellee's First Amendment rights. The court also held that the district court did not err when it denied summary judgment on appellants' qualified immunity defense.

Plaintiff brought a class action in Louisiana state court on behalf of a class of Louisiana medical providers against three Louisiana defendants, alleging that defendants failed to comply with the preferred provider organization (PPO) notice provisions of Louisiana law. Homeland Insurance Company subsequently appealed the district court's class action to Louisiana state court. Because it concluded that the local controversy exception to the Class Action Fairness Act applied, 28 U.S.C. 1332(d)(4), the court affirmed the judgment of the district court.

Plaintiff appealed from the district court's grant of summary judgment to National Union with respect to his claims under the Texas Insurance Code (Insurance Code), Tex. Ins. Code Ann. 541.003, 541.051, 541.052, 541.061, and the Texas Deceptive Trade Practices Act (DTPA), Tex. Bus. & Com. Code Ann. 17.46, 17.50, asserting misrepresentation and unconscionability. At issue was the Description of Coverage documents that National Union sent to plaintiff regarding eligibility for permanent total disability benefits under two insurance policies. The court held that plaintiff's contention that he had insufficient notice of National Union's basis for seeking summary judgment on his misrepresentation claims was unsustainable. The court also held that the definition of permanent total disability in the Descriptions of Coverage was ambiguous. The court held, however, that the ambiguity did not rise to the level of a misrepresentation within the meaning of the Insurance Code or the DTPA. To the extent that the Insurance Code required additional information to clarify an ambiguity, the reference to the master policy as controlling adequately informed a reasonable person that an ambiguity in the Description of Coverage was not binding if it conflicted with the policy. The court further held that plaintiff's unconscionability claims failed where he had not offered any reasoning as to the relevance of certain evidence regarding allegations of unconscionable conduct and where the claims were premised on conduct that had occurred after his injury and well after the inception of coverage under the policies. Accordingly, the court affirmed the district court's grant of summary judgment.