Justia Insurance Law Opinion Summaries

Plaintiff filed suit against Humana, alleging claims for breach of contract and unfair insurance practices. The district court granted summary judgment to Humana. Plaintiff submitted a claim with Humana to cover the cost of her husband's medical services after he overdosed on ecstasy. At issue is the application of an exclusion under the policy that excluded loss due to being intoxicated or under the influence of any narcotic unless administered on the advice of a health care practitioner. The court concluded that the term "narcotic" includes ecstasy and the husband's stroke was due to being under the influence of ecstasy. Accordingly, the court affirmed the judgment. View "Crose v. Humana Ins. Co." on Justia Law

In the underlying lawsuit, Larry Naquin was using an EBI land-based crane to relocate a test block when the pedestal of the crane snapped, causing the crane to topple over and sustaining injuries as result. Naquin subsequently filed suit against EBI and the jury awarded a verdict in Naquin's favor. EBI appealed. EBI then filed a third-party complaint against its insurance companies, SNIC and Certain London Insurers, alleging that the insurers breached their insurance contracts by denying EBI's insurance claims arising from Naquin's accident and by failing to provide EBI with defense and indemnity. In this appeal, EBI challenged the district court's grant of summary judgment for SNIC. The court agreed with SNIC that the terms of the policy does not provide coverage for the land-based incident due to EBI's negligence. Consequently, EBI has no valid underlying claim on which to stand and the district court did not err in dismissing EBI's claim for bad faith. The court affirmed the judgment. View "Naquin, Sr. v. Elevating Boats, LLC" on Justia Law

This dispute arose from injuries sustained by a platform worker employed by Vertex. Continental appealed the district court's final judgment in favor of Tetra and Maritech, requiring Continental and its codefendant insured, Vertex, to indemnify them. The court concluded that the summary judgment record is inadequate to determine whether the Outer Continental Shelf Lands Act (OCSLA), 43 U.S.C. 1333(a)(1), (a)(2)(A), requires the adoption of Louisiana law as surrogate federal law where the court cannot determine whether there is an OCSLA situs, the court cannot determine whether federal maritime law applies, and the Louisiana Oilfield Indemnity Act (LOIA), La. Rev. Stat. Ann. 9:2780, is consistent with federal law. Accordingly, the court concluded that neither party is entitled to summary judgment as to whether LOIA must be adopted as surrogate federal law under OCSLA. The court remanded to the district court to determine the dispositive issue of whether Louisiana law must be adopted as surrogate federal law. View "Tetra Tech. v. Vertex Servs." on Justia Law

Chapter 1301 of the Texas Insurance Code requires healthcare insurers to make coverage determinations and pay claims made by preferred healthcare providers within a specified time or face penalties. HCSC filed suit seeking a declaratory judgment against Methodist, seeking a declaration that Chapter 1301 does not apply to HCSC as the administrator of particular health plans, and the Federal Employee Health Benefits Act of 1959 (FEHBA), 5 U.S.C. 8901, et seq., preempts application of the statute to its administration of claims under the Federal Employees Health Benefits Program (FEHBP). The district court granted summary judgment to HCSC. The court held that Chapter 1301 is not applicable to BCBSTX’s activities as administrator of the self-funded plans or state government plans, nor to those activities that it performs as administrator of claims under the BlueCard program. The court also held that FEHBA preempts Chapter 1301’s application to the claims processed by BCBSTX under FEHBP plans. Accordingly, the court affirmed the judgment. View "Health Care Serv. Corp. v. Methodist Hospitals" on Justia Law

Seahawk filed suit against insurers for proceeds covering the physical damage to a drilling rig and the loss on a drilling contract. The court concluded that, because there were two occurrences, the district court properly denied Seahawk’s claim for the cost of repairs between February and December 2010. That court’s proximate-cause analysis was the correct legal standard for determining the number of occurrences, and the district court did not clearly err in finding that the February storm was not the proximate cause of the sequence of losses following the July storm. The court also concluded that the district court did not err in rejecting Seahawk’s claim under the Contract Provision. The concurrent-cause doctrine applies, and Seahawk could not recover because it failed to comply with the requirements of that doctrine. Accordingly, the court affirmed the district court's judgment for the insurers. View "Seahawk Liquidating Trust v. Certain Underwriters" on Justia Law

Greenwich filed suit after paying an assessment imposed by MWUA. The court held that the FCIC did not intend to preclude MWUA from imposing and enforcing its true-up deadline. The court concluded that the true-up deadline did not directly or indirectly affect MPCI because the deadline did not trigger an assessment improperly based on MPCI premiums. Even Greenwich’s failure to abide by the deadline did not trigger the improper assessment. Rather, Greenwich’s independent actions - specifically, its repeated affirmative statements that the 2003 premium data was correct - triggered the assessment. Thus, “in reality,” Greenwich’s complaint “is directed at the actions of private parties, not the operation of” MWUA deadlines. Because the fault lies not with any law or rule but rather with the acts of a private third party, the court cannot say that the true-up deadline affects MPCI. The court further concluded that the source of Greenwich's trouble is not the acts of just any private parties; Greenwich’s own acts are to blame. And, the actions themselves are not just any actions; they are acts of unjustifiable incompetence. View "Greenwich Ins. C. v. MS Windstorm Underwriting" on Justia Law

JSI appealed the district court's grant of summary judgment for Travelers on JSI's payment bond and bad faith claims. The court concluded that Travelers remains liable to JSI on the payment bond, requiring reversal of the summary judgment granted to Travelers on this claim; JSI is entitled to recovery under the bond and summary judgment on liability for the invoiced amount should have been granted in the amount of $36,346.09; the court remanded for the district court to consider the other fees and costs relevant to JSI’s bond claim; and the court vacated the summary judgment on the bad faith claim and remanded for reconsideration. View "JSI Commc'n v. Travelers Cas. & Surety Co." on Justia Law

Liberty insured Cameron, the manufacturer of the blowout preventer used on Deepwater Horizon, for potential losses associated with the blowout preventer. After Cameron settled with BP, Cameron sought coverage from Liberty but Liberty refused to pay. The court affirmed the district court's grant of summary judgment for Cameron on its breach of contract claim; reversed the district court's denial of Cameron's motion for attorney's fees; and remanded for a determination of the proper amount of those fees. The court certified the following question to the Supreme Court of Texas: Whether, to maintain a cause of action under Chapter 541 of the Texas Insurance Code against an insurer that wrongfully withheld policy benefits, an insured must allege and prove an injury independent from the denied policy benefits? View "Cameron Int'l Corp. v. Liberty Ins. Underwriters, Inc." on Justia Law

Plaintiffs filed suit seeking additional coverage under their flood insurance policy after their home was damaged during Hurricane Ike. The district court denied plaintiffs' claim for additional building coverage on the ground that the total recovery they had already received from insurers exceeded their total loss. As for contents coverage, the district court awarded $2,500 for some car parts damaged in the storm. Both parties appealed. The court concluded that federal common law governing the National Flood Insurance Program recognizes the rule against double recovery and affirmed the ruling that plaintiffs' are not entitled to additional building coverage. However, the court vacated the personal property award to plaintiffs because they concede it was in error. View "Pye v. Fidelity Nat'l Prop. & Cas. Ins." on Justia Law

MRMC purchased a primary-insurance policy from Zurich and excess insurance from AXIS. MRMC filed suit to recover under its primary- and excess-insurance policies after suffering losses in a state lawsuit. The trial court granted AXIS summary judgment. The court held that the AXIS policy unambiguously precludes exhaustion by below-limit settlement. In this case, the AXIS policy is not triggered where MRMC pays the difference between Zurich’s liability limit and a below-limit settlement releasing Zurich of any further obligations. Accordingly, the court affirmed the judgment. View "Martin Resource Mgmt. Corp. v. Zurich Am. Ins." on Justia Law