Justia Insurance Law Opinion Summaries

After he was diagnosed with multiple sclerosis, plaintiff applied for long term disability benefits under his Sun Life policy. The policy required plaintiff to provide written notice of his claim within 30 days of the end of a set period of time (referred to as the elimination period), and to provide proof of his claim no later than 90 days after the end of the elimination period. The policy also included a limitations period requiring any lawsuit regarding benefits to be brought within 3 years of the date that proof of claim was required. In this case, plaintiff did not file his lawsuit until March 2013, well after the contractual limitations period had expired. Therefore, the court concluded that plaintiff's suit is untimely and affirmed the district court's grant of summary judgment in favor of Sun Life. View "Schmitz v. Sun Life Assurance Co." on Justia Law

A1's, packages and sells landscaping materials, filed suit against Decker to recover losses after Decker sold defective plastic bags to A1's. Because Decker failed to manufacture the bags with an ultraviolet inhibitor (UVI), the bags deteriorated in the sunlight, causing small shreds of plastic to commingle with A1’s landscaping materials, sometimes while still in A1’s inventory and sometimes after delivery to its customers. Decker filed a claim with its comprehensive general liability (CGL) insurer, West Bend. After West Bend denied coverage, Decker filed suit and West Bend removed to federal court. The district court granted summary judgment to West Bend. Determining that Iowa law governs the court's interpretation of the West Bend policy, the court concluded that there was an "occurrence" triggering coverage under the terms of West Bend's policy. Accordingly, the court reversed and remanded. View "Decker Plastics Inc. v. West Bend Mut. Ins. Co." on Justia Law

Plaintiff was insured under a group long-term disability policy the county obtained from Hartford. After Hartford denied plaintiff's claim for disability benefits, she filed suit in Minnesota state court for breach of contract. Hartford timely removed to federal court based on diversity jurisdiction. The district court then granted Hartford summary judgment. Under the plain meaning of the statute, the court concluded that plaintiff's suit was time-barred. The court also concluded that the legislative distinction between individual and group policies does not violate the principles of equal protection under the United States and Minnesota constitutions. Accordingly, the court affirmed the district court's conclusion that plaintiff's suit was untimely. View "Walker v. Hartford Life and Accident Ins." on Justia Law

Capson filed suit against MMIC seeking a declaration that MMIC was the primary professional liability insurer for Karl J. Hasik, M.D., and that Capson was the excess insurer. MMIC counterclaimed and filed a third-party complaint against Dr. Hasik and others, seeking rescission of its insurance policy or, in the alternative, a declaration that MMIC had no obligation to defend or indemnify Dr. Hasik for two medical negligence cases that had been filed against him. The district court granted MMIC’s motion for summary judgment. The court concluded that Dr. Hasik’s and the hospital’s nondisclosure of the Wilson lawsuit (a medical malpractice suit filed by a patient against Dr. Hasik) was the equivalent of a false assertion. Therefore, the court held that the elements of equitable rescission were satisfied in this case. Dr. Hasik’s and the hospital’s nondisclosure of the Wilson lawsuit was the equivalent of a material representation that was false. MMIC was entitled to rescind the prior-acts coverage it had agreed to provide. The court further held that Iowa law does not preclude a judgment of rescission in this case. Accordingly, the court affirmed the judgment and dismissed the cross-appeal as moot. View "Capson Physicians Ins. Co. v. MMIC Ins. Inc." on Justia Law

Plaintiffs filed suit against Midwest, alleging that an insurance agent carelessly and negligently failed to designate plaintiffs as owners of the insurance policy at issue. The district court concluded that the complaint failed to state a viable claim and dismissed the case. The court concluded that, under the policy, control over the policy during the lifetime of the insured - including the power to name a new owner - belonged solely to the insured in this case. Therefore, Midwest cannot be liable for negligence for failing to do something it had no power to do. Accordingly, the court affirmed the judgment. View "Carlson v. Midwest Prof'l Planners" on Justia Law

Plaintiff filed suit seeking interest and attorney's fees after General American notified plaintiff that the treasury warrant in the amount of his annuity transfer had never cleared. General American reversed the transaction. The court found that, under the terms of plaintiff's annuity, General American promised to make periodic payments to plaintiff at agreed upon dates; plaintiff does not allege that General American failed to make payments or otherwise failed to fulfill an obligation under the terms of the annuity; nor does this action arise from a declaratory judgment action or an effort by General American to cancel or lapse the policy. Accordingly, the court concluded that plaintiff did not suffer a “loss” covered by Ark. Code Ann. Sections 23-79-208 and 23-79-209, and the district court was correct that neither a 12% penalty nor attorney’s fees are owing by American General under these sections. The court also concluded that the district court did not err in finding plaintiff was not entitled to an award of attorney’s fees under section 16-22-308. Finally, the court concluded that the district court did not abuse its discretion in denying attorney’s fees in this case. The court affirmed the judgment. View "Cooper v. General American Life Ins. Co." on Justia Law

Plaintiff filed suit against his insurer, Nationwide, for breach of contract based on Nationwide’s refusal to pay for damages caused by water that leaked from a buried pipe located beneath the garage-floor slab of plaintiff's home. The court affirmed the district court's grant of summary judgment because the exclusion in plaintiff's homeowner's policy is unambiguous on its face and the court agreed with the district court's conclusion that the exclusion's language applied to water below the surface of the ground, regardless of whether that water came from a pipe. View "Bull v. Nationwide Mutual Fire Ins.Co." on Justia Law

After plaintiff was injured in a motor vehicle accident, the Plan paid medical benefits on plaintiff's behalf. Plaintiff also received a payment from a different carrier that insured the party who was allegedly responsible for plaintiff’s injury. The Blue Cross carriers contend that under the terms of plaintiff's benefit plan, she must use any monies obtained from the alleged tortfeasor’s insurer to reimburse the Plan for medical benefits paid by Blue Cross. Blue Cross’s position is that a provision of the Federal Employees Health Benefits Act, 5 U.S.C. 8902(m)(1), expressly preempts plaintiff’s state-law defense, and that the Plan governs the question of reimbursement. The court concluded that federal law preempts the Arkansas state-law defense, and that plaintiff must reimburse the Plan. Accordingly, the court affirmed the judgment of the district court. View "Bell v. Blue Cross & Blue Shield of OK" on Justia Law

In this insurance dispute over the adjusted value of hail-damaged crops in northwest Iowa, Bruhn challenged the district court's grant of summary judgment for Fireman's. The court concluded that there is a factual dispute about whether Fireman's breached its obligations to its insured in this case. Bruhn contends that Fireman's breached the agreement by tendering payment for the loss without first reaching agreement with Bruhn, without entry of a final judgment, and without the filing of any appraisal award. Fireman's contends that the provision merely provides a payment deadline, not a condition precedent to payment issuance. Because there is an issue of fact as to whether Fireman's breached the insurance contract and because the factual issues in the breach claim are relevant to the bad-faith claim, this claim survives summary judgment as well. Accordingly, the court reversed and remanded for further proceedings. View "Bruhn Farms Joint Venture v. Fireman's Fund Ins. Co." on Justia Law

Plaintiff, an insured under a commercial-property insurance policy issued by Country Mutual, was awarded $76,065.50 by the jury for covered hail and wind damage to her property. However, the jury found that the policy did not cover water damage to the interiors of the property. Plaintiff appealed. The court concluded that the district court applied the law correctly under the federal rules and acted within the scope of its discretion in excluding certain portions from the supplemental expert reports; plaintiff was not prejudiced by the exclusion of this evidence to an extent resulting in fundamental unfairness; and the jury instructions fairly and adequately presented the issues in the case to the jury. Accordingly, the court affirmed the district court's denial of plaintiff's motion for new trial and entry of judgment. View "Amplatz v. Country Mutual Ins. Co." on Justia Law