Justia Insurance Law Opinion Summaries

32nd Street filed suit against the insurers for quantum meruit, unjust enrichment, and vexatious refusal to pay an insurance claim, as well as injunctive relief arising out of medical services provided to the insurers' insureds. The district court granted summary judgment for the insurers and denied 32nd Street's motion to compel discovery. The court concluded that the plain language of the provisions at issue support the district court's conclusion that, in the ancillary-provider agreement, 32nd Street agreed to accept the Blue Traditional rate for services rendered to insureds belonging to all of the insurers’ networks; the district court did not err by finding that the equitable claims were barred by the contracts governing the reimbursement rates paid by the insurers; the district court did not err in granting summary judgment to the insurers on the vexatious-refusal claim where 32nd Street fails to establish any genuine issue of material fact that the insurers refused to pay an amount due under an insurance policy; and the district court did not abuse its discretion by denying 32nd Street's motion to compel. Accordingly, the court affirmed the judgment. View "32nd St. Surgery Ctr. v. Right Choice Managed Care" on Justia Law

American Family filed suit seeking a declaratory judgment as to whether an umbrella insurance policy issued to Todd Patton provided any coverage for an automobile accident in which a passenger in a vehicle driven by Todd's son, Jacob Patton, was seriously injured. The district court granted summary judgment for American Family. The court concluded that the Pattons breached the umbrella policy's cooperation clause by entering into a Miller-Shugart agreement after already being protected from personal liability in the Drake-Ryan settlement, and that such breach was material and prejudicial. Accordingly, the court affirmed the judgment. View "American Family Mutual Ins. v. Donaldson" on Justia Law

After Eric Orloske shot his brother, Brian, to death after Eric tripped and fell down the stairs in his home while holding a loaded shotgun, the trustee for Brian's next of kin filed a wrongful death suit against Eric. At issue in this appeal is whether Country Mutual's homeowner's policy, which covered Eric's home, provided coverage for Brian's death. The court concluded that the district court correctly determined that Minnesota's reasonable-expectations doctrine is inapplicable in this case and correctly granted summary judgment to Country Mutual.The doctrine forces insurers to communicate the coverage and exclusions of their policies clearly; it is not a means of avoiding unambiguous policy language. Here, the policy expressly listed the criminal-acts exclusion - Eric had pleaded guilty to manslaughter for Brian's death - in the exclusion section of the policy between exclusions related to controlled substances and pollution. Accordingly, the court affirmed the judgment. View "Country Mutual Ins. Co. v. Orloske" on Justia Law

Before floodwaters destroyed plaintiffs' property, FEMA issued a flood-in-progress designation. Plaintiffs believed that the FEMA designation rendered their two Standard Flood Insurance Policies (SFIPs) worthless for the pending flood and elected to cancel them. Congress then passed the Biggert-Waters Flood Insurance Reform Act of 2012 (FIRA), Pub. L. No. 112-141, 100227(b), 126 Stat. 405, 943–44, a remedial amendment that would have extended coverage for plaintiffs but for the fact that they had canceled the SFIPs. Plaintiffs filed suit against American Bankers, the issuer of the SFIPs, seeking reinstatement of the SFIPs and payment for their flood loss. The court affirmed the district court's conclusion that plaintiffs were chargeable with knowledge of the terms of the SFIPs and that the FIRA does not reinstate the canceled SFIPs. View "Hodde v. American Bankers Ins. Co." on Justia Law

Plaintiff filed suit against Standard, asserting various claims after Standard determined that plaintiff was no longer disabled and discontinued benefits. The district court granted summary judgment to plaintiff, concluding that Standard abused its discretion in discontinuing long-term disability (LTD) benefits. In this case, Standard's decision was based on its determination that the disabling cognitive impairments suffered by plaintiff in a 2011 car accident had improved to the point that she could return full-time to her Own Occupation. The court concluded that the administrative record more than adequately supports the manner in which Standard addressed the Own Occupation issue in its final decision. The court also concluded that substantial evidence supported Standard's decision to discontinue benefits. Accordingly, the court reversed and remanded. View "Whitley v. Standard Ins. Co." on Justia Law

Plaintiffs filed suit seeking damages from American Family for their individual insurance claims, and the district court later granted American Family's motion to dismiss. The district court denied plaintiffs' motion to amend. Plaintiffs' motion to amend sought to change their theory of the case because the class action petition had challenged the contents of all American Family insurance policies in a declaratory judgment pleading while the proposed second amended petition claimed that American Family breached the contents of the insurance contract. Furthermore, the class action petition sought a class wide injunction, not individual damages, while the proposed second amended petition sought individual damages instead of a class wide injunction. Therefore, the court concluded that the district court did not abuse its discretion because plaintiffs sought to change their theory of liability after their class action petition had been dismissed. Accordingly, the court affirmed the judgment. View "Adams v. American Family Mutual Ins. Co." on Justia Law

Busch filed suit against National Union after National Union denied coverage for Busch's expenditures to remediate mold in the condominium complex that it managed. The court concluded that the district court correctly concluded that Busch's payments for mold remediation are not covered under its policy with National Union because its legal obligation to remediate the mold did not spring from "liability imposed by law." The court also concluded that the district court correctly concluded that Busch's maintenance or consent agreements do not trigger coverage under the 1994 policy because those agreements do not constitute a legal obligation to pay as damages for liability assumed by Busch under contract. Accordingly, the court affirmed the judgment. View "Busch Properties, Inc. v. National Union Fire Ins." on Justia Law

National Union was ordered to pay part of the costs Continental incurred to defend Valspar against several lawsuits. Valspar intervened and now appeals. The court concluded that National Union had a duty to defend Valspar and therefore has an equitable obligation to contribute to paying the costs of the defense. Neither Valspar’s agreement to pay National Union’s costs, Continental’s agreement not to recover defense costs from Valspar, nor Continental’s alleged failure to pay a small fraction of the costs defeats Continental’s right to contribution from National Union. These are distinct obligations. And National Union’s share of the defense costs paid by the insurers is unaffected by amounts paid by Valspar. Accordingly, the court affirmed and remanded for further proceedings. View "Continental Casualty Co. v. The Valspar Corp." on Justia Law

After the parties' dispute over insurance policy liability coverage, plaintiffs and Cincinnati submitted a joint complaint for declaratory judgment. The court concluded that the district court did not err in finding that the Business Owners Package (BOP) and Commercial General Liability (CGL) policies issued by Cincinnati prohibited stacking where both policies cover the same injury, such that the maximum coverage for the injury is $1,000,000. Accordingly, the court affirmed the district court's grant of summary judgment to Cincinnati. View "Gohagan v. The Cincinnati Ins. Co." on Justia Law

Wolfe filed suit against Universal for a declaration of its rights under an insurance policy, as well as for breach of contract and vexatious refusal to pay. Universal counterclaimed for declaratory judgment in its favor. The district court granted Universal's motion for summary judgment. The court concluded that, under the plain language of the policy, the umbrella coverage is not available for the injuries alleged in the underlying complaint. Therefore, Universal is entitled to judgment as a matter of law that it is not under a duty to defend Wolfe from the underlying suit except to the extent such a duty may be provided for in the customer complaint defense provision, and consequently that Universal is not under a duty to indemnify Wolfe should there be an award of damages in the underlying suit. Because Wolfe's claims for breach of contract and vexatious refusal to pay rest on the success of its declaratory judgment action, the court need not address them, nor Universal's remaining arguments. Accordingly, the court affirmed the judgment. View "Wolfe Auto. Grp. v. Universal Underwriters Ins. Co." on Justia Law