Justia Insurance Law Opinion Summaries

Two former customers of an insurance company filed suit after their vehicles were declared total losses and the insurer paid out claims based on the vehicles’ “actual cash value” (ACV). The insurance policy defined ACV as the “market value, age, and condition of the vehicle at the time the loss occurs.” The insurer calculated market value using a system that included a “projected sold adjustment” (PSA), which reduced the list prices of comparable vehicles to reflect typical consumer negotiation. The plaintiffs alleged that the PSA always resulted in an artificially low valuation, breaching the policy’s requirement to pay true market value.The United States District Court for the District of Arizona found that the plaintiffs met the requirements of numerosity, commonality, typicality, and adequacy under Federal Rule of Civil Procedure 23(a). However, the court determined that individual questions about how each vehicle’s ACV was calculated predominated over common questions, as required by Rule 23(b)(3), and therefore denied class certification. The plaintiffs appealed this decision.The United States Court of Appeals for the Ninth Circuit reviewed the district court’s denial of class certification for abuse of discretion. The appellate court held that the PSA was not facially unlawful and that determining whether each class member was harmed would require individualized inquiries into each person’s vehicle valuation. Because liability and injury could not be established through common evidence, individual issues would predominate over common ones. The Ninth Circuit therefore affirmed the district court’s order denying class certification, holding that class certification was inappropriate under Rule 23(b)(3) due to the predominance of individualized questions. View "AMBROSIO V. PROGRESSIVE PREFERRED INSURANCE COMPANY" on Justia Law

The plaintiff purchased a life insurance policy for her son and consistently paid the required premiums. She alleges that the insurer failed to provide the statutory notices and protections mandated by California law before terminating her policy for nonpayment. After missing a payment in 2016, her policy lapsed, and following reinstatement, it was terminated again in 2018 after another missed payment. The plaintiff contends that the insurer’s failure to comply with statutory notice requirements rendered the termination ineffective and that her experience was representative of many other policyholders in California.The United States District Court for the Eastern District of California granted in part the plaintiff’s motion for class certification. The court found that the prerequisites of Federal Rule of Civil Procedure 23(a) were met and certified a class under Rule 23(b)(2) for declaratory and injunctive relief. The certified class included all policy owners or beneficiaries whose policies lapsed for nonpayment without the required statutory notice. The court appointed the plaintiff as class representative but denied, without prejudice, certification for monetary relief under Rule 23(b)(3).The United States Court of Appeals for the Ninth Circuit reviewed the district court’s class-certification order. Relying on its intervening decision in Small v. Allianz Life Insurance Co. of North America, the Ninth Circuit held that to recover for violations of the relevant California statutes, plaintiffs must show not only a statutory violation but also that the violation caused them harm. The court found that the plaintiff was not an adequate class representative for beneficiaries and that her claims were not typical of class members who intentionally allowed their policies to lapse. The Ninth Circuit reversed the district court’s class-certification order and remanded the case for further proceedings. View "Farley v. Lincoln Benefit Life Co." on Justia Law

Pamela Siino purchased a life insurance policy from Foresters Life Insurance and Annuity Company (FLIAC) in 2010. In 2014, she moved and failed to successfully update her address with FLIAC. Consequently, she did not receive notices about her premium payments and missed her payment due on January 26, 2018. FLIAC sent a notice on February 26, 2018, stating that her policy had lapsed but could be reinstated if she paid the overdue premium by March 28, 2018. Siino did not receive this notice and did not pay the premium. In 2019, she discovered her policy had lapsed and declined to reinstate it, purchasing a new policy from another provider instead.The United States District Court for the Northern District of California granted summary judgment in favor of Siino, declaring that FLIAC wrongfully terminated her policy and that it would remain valid if she tendered all unpaid premiums. The court found that FLIAC violated California Insurance Code sections 10113.71 and 10113.72 by failing to provide proper pretermination and designee notices. Siino's other claims were dismissed with prejudice.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court affirmed the district court's finding that FLIAC violated the statutory notice requirements, agreeing that FLIAC failed to provide the required pretermination and designee notices. However, the Ninth Circuit reversed the district court's declaration that Siino's policy remained valid, as Siino failed to prove that FLIAC's violations caused her injury. The court noted that even if FLIAC had sent the required notices, they would not have reached Siino due to her failure to update her address. The case was remanded to the district court solely for the purpose of entering final judgment. View "SIINO V. FORESTERS LIFE INSURANCE AND ANNUITY COMPANY" on Justia Law

Farmers Direct Property and Casualty Insurance Company filed a declaratory judgment action against Dennis Perez, seeking a declaration that it no longer had a duty to defend or indemnify Perez under an auto insurance policy in connection with an automobile accident involving Victor Montez. Perez had been uncooperative in his defense in the underlying state court tort action filed by the Montezes, leading Farmers Direct to claim that Perez breached the policy's cooperation clause. The Montezes intervened and moved to set aside the default judgment entered against Perez, arguing that the district court lacked subject matter jurisdiction because the amount in controversy did not meet the statutory requirement.The United States District Court for the Central District of California granted the Montezes' motion, vacating the default judgment on the grounds that the amount in controversy was limited to the policy's $25,000 face amount, which did not satisfy the jurisdictional threshold of over $75,000. Farmers Direct appealed this decision.The United States Court of Appeals for the Ninth Circuit reviewed the case and reversed the district court's order. The appellate court held that the district court erred in determining that the value of the declaratory judgment action was limited to the policy's $25,000 maximum liability. The Ninth Circuit found that there was at least an arguable basis that the amount in controversy was satisfied by considering either the potential excess liability of the underlying tort claim or Farmers Direct's anticipated future defense fees and costs, or both. The appellate court concluded that the judgment was not void for lack of subject matter jurisdiction and remanded the case for further proceedings. View "FARMERS DIRECT PROPERTY AND CASUALTY INSURANCE COMPANY V. MONTEZ" on Justia Law

50 Exchange Terrace LLC sought to collect under a property insurance policy with Mount Vernon Specialty Insurance Company for damage to its property in Rhode Island. The insurance policy required an appraisal if the parties disagreed on the amount of loss. After frozen pipes caused water damage, Mount Vernon paid its estimated value but demanded an appraisal. 50 Exchange filed a lawsuit in California state court, alleging wrongful withholding of compensation by Mount Vernon while awaiting the appraisal outcome.The case was removed to the United States District Court for the Central District of California, where Mount Vernon moved to dismiss based on forum non conveniens. The district court requested supplemental briefing on ripeness and Article III standing and subsequently dismissed the action for lack of both. 50 Exchange appealed the dismissal.The United States Court of Appeals for the Ninth Circuit reviewed the case and affirmed the district court's dismissal. The court held that the injuries asserted by 50 Exchange were not actual or imminent because the extent of any loss could not be determined until the appraisal process was completed. The court concluded that any alleged injury before the appraisal was too speculative to create an actionable claim, thus failing to meet the requirements for ripeness and Article III standing. The court did not address the parties' arguments under the doctrine of forum non conveniens. View "50 EXCHANGE TERRACE LLC V. MOUNT VERNON SPECIALTY INSURANCE CO." on Justia Law

Julian Omidi and his business, Surgery Center Management, LLC (SCM), were involved in a fraudulent scheme called "Get Thin," which promised weight loss through Lap-Band surgery and other medical procedures. Omidi and SCM defrauded insurance companies by submitting false claims for reimbursement, including fabricated patient data and misrepresented physician involvement. The scheme recruited patients through a call center, pushing them towards expensive medical tests and procedures regardless of medical necessity.A grand jury indicted Omidi and SCM for mail fraud, wire fraud, money laundering, and related charges. After extensive pretrial litigation and a lengthy jury trial, both were convicted on all charges. The district court sentenced Omidi to 84 months in prison and fined SCM over $22 million. The government sought forfeiture of nearly $100 million, arguing that all proceeds from the Get Thin scheme were derived from fraud. The district court agreed, finding that even proceeds from legitimate procedures were indirectly the result of the fraudulent scheme.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court affirmed the district court's forfeiture judgment, holding that under 18 U.S.C. § 981(a)(1)(C), all proceeds directly or indirectly derived from a health care fraud scheme must be forfeited. The court rejected the argument that only proceeds from fraudulent transactions should be forfeited, noting that the entire business was permeated with fraud. The court concluded that there is no "100% Fraud Rule" in forfeiture cases seeking proceeds of a fraud scheme, and all proceeds from the Get Thin scheme were subject to forfeiture. View "United States V. Surgery Center Management, LLC" on Justia Law

The Ninth Circuit certified the following questions of state law to the Arizona Supreme Court: 1. Whether Arizona equitable indemnity law incorporates Section 78 of the Restatement (First) of Restitution; and if so, 2. Whether equitable indemnity under Section 78 requires that the indemnity plaintiff's liability to the underlying plaintiff have been coextensive with the indemnity defendant's liability to the underlying plaintiff. View "KnightBrook Insurance v. Payless Car Rental System" on Justia Law

The Ninth Circuit reversed the dismissal of plaintiff's putative class action filed under California's Unfair Competition Law (UCL), Cal. Bus. & Prof. Code 17200–17210, and common law, alleging that AARP, through its arrangement with Medigap, transacts insurance without a license in violation of the California Insurance Code. The Ninth Circuit held that plaintiff stated a plausible claim at the motion to dismiss stage that AARP "solicits" insurance without a license, and consequently committed an unlawful act in violation of the UCL. Plaintiff also adequately alleged that AARP violated the UCL's "fraudulent" and "unfair" prongs where plaintiff plausibly alleged that members of the public are likely to be deceived into paying AARP's additional 4.95% fee because AARP collects and labels the the fee as a "royalty" rather than a "commission." View "Friedman v. AARP" on Justia Law

LMA filed suit against its excess insurance carrier, National Union, based on National Union's refusal to either contribute $3.75 million toward the settlement of claims brought by a third party or take over the defense. At issue was whether the district court erred in applying the rule in Diamond Heights Homeowners Association v. National American Insurance Co., instructing the jury, denying National Union's motion for judgment as a matter of law (JMOL), and awarding fees and costs. In Diamond Heights, a California appellate court ruled that an excess liability insurer has three options when presented with a proposed settlement of a covered claim that has met the approval of the insured and the primary insurer. The excess insurer must (1) approve the proposed settlement, (2) reject it and take over the defense, or (3) reject it, decline to take over the defense, and face a potential lawsuit by the insured seeking contribution toward the settlement. The court held that the district court did not err in applying the rule in Diamond Heights where National Union has not presented convincing evidence that the California Supreme Court would not follow Diamond Heights, and Diamond Heights is not distinguishable on its facts. The court also concluded that the district court did not commit prejudicial error in defining the standard of proof applicable to LMA's breach of contract claim; National Union's challenge to the bad faith claim failed because a jury could rationally conclude based on these facts that National Union acted unreasonably by refusing to take over the defense or approve the reasonable settlement, knowing full well of its obligations under California law; and the court affirmed the district court's award of fees and costs. Accordingly, the court affirmed the judgment and denied National Union's motion for certification. View "Teleflex Medical Inc. v. National Union Fire Insurance Co." on Justia Law

Plaintiffs, elderly Oregonians or their successors who purchased long-term healthcare insurance policies sold by Bankers, filed suit alleging that Bankers developed onerous procedures to delay and deny insurance claims. The court certified the following question to the Oregon Supreme Court, pursuant to Oregon Revised Statues 28.200: Does a plaintiff state a claim under Oregon Revised Statutes 124.110(1)(b) for wrongful withholding of money or property where it is alleged that an insurance company has in bad faith delayed the processing of claims and refused to pay benefits owed under an insurance contract? View "Bates v. Bankers Life & Casualty" on Justia Law