Justia Insurance Law Opinion Summaries

Articles Posted in US Court of Appeals for the Eighth Circuit
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Plaintiff sued Reliance Standard Life Insurance Company under 29 U.S.C. Section 1132(a)(1)(B), seeking to recover long-term disability benefits. The district court granted Plaintiff’s motion for summary judgment and denied Reliance’s cross-motion. Reliance appealed, and the Eighth Circuit reversed.   The court explained that the cases cited do not demonstrate that Reliance has a history of biased claims administration. Nor do they show some other systemic flaw in its claims review process that affected Reliance’s review of Plaintiff’s claim. On the other hand, Reliance does not argue that it maintained structural separations to minimize its conflict of interest. Therefore, the conflict of interest, in this case, deserves “some weight,” but the court concluded that it does not indicate that Reliance abused its discretion. The court wrote that substantial evidence supports Reliance’s decision, and neither the decisional delay in this case nor the purported conflict of interest leads us to conclude that Reliance abused its discretion. View "Melissa McIntyre v. Reliance Standard Life" on Justia Law

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Boulevard RE Holdings, LLC (Boulevard) sued Mixon Insurance Agency, Inc. (Mixon), alleging breach of contract and negligent procurement of insurance. Mixon moved for summary judgment. The district court granted Mixon’s motion. Boulevard appealed that order. On appeal, Boulevard challenged the district court’s conclusions that Mixon had no duty to know or discover whether Boulevard was a mortgagee under Missouri law and that Mixon’s actions did not cause Boulevard’s alleged damages.   The Eighth Circuit affirmed. The court reasoned that even assuming that the district court erred in concluding that Mixon did not have a duty to know or discover whether Boulevard was a mortgagee, summary judgment in favor of Mixon was proper because Boulevard cannot show Mixon caused its alleged damages. Noncompliance with the policy, not Mixon’s failure to notify, barred recovery. Therefore, Bell is inapplicable. The district court did not err in granting Mixon’s motion for summary judgment. View "Boulevard RE Holdings, LLC v. Mixon Insurance Agency, Inc." on Justia Law

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In March 2020, Concord Baptist Church of Jefferson City, Inc. (Concord Baptist) sustained damage to its facilities in a severe storm. After disagreements with its insurer, Church Mutual Insurance Company (Church Mutual), regarding the amount of loss, Concord Baptist initiated this action, alleging breach of contract and vexatious refusal to pay. The district court granted summary judgment in favor of Church Mutual, concluding that the undisputed facts demonstrated that Concord Baptist failed to comply with a cooperation clause contained in the insurance policy, which precluded coverage. Concord Baptist appealed.   The Eighth Circuit affirmed. The court explained that because Concord Baptist admits that it materially breached the policy, the court need not address Concord Baptist’s argument regarding whether the failure to submit to an EUO was a material breach. However, the court noted that Missouri courts have found a material breach where an insured failed to submit to an EUO before commencing an action against the insurer. Regarding the second element, whether Church Mutual suffered substantial prejudice from Concord Baptist’s material breach, the court agreed with the district court that the undisputed facts show that it did. Finally, as to the third element, whether Church Mutual exercised reasonable diligence in attempting to procure Concord Baptist’s cooperation, the court again agreed with the district court that the undisputed facts demonstrate Church Mutual’s diligence. View "Concord Baptist Church of Jefferson City v. Church Mutual Insurance Company" on Justia Law

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Plaintiffs brought this action against West Bend Mutual Insurance Company (“West Bend”) after West Bend refused to pay claims for uninsured/underinsured (“UM/UIM”) benefits under an insurance policy that insured Plaintiffs. The district court granted summary judgment in favor of West Bend. Plaintiffs contended the district court erred in concluding that British Columbia law rather than Iowa law determines the extent of Plaintiffs’ recoverable damages under the Policy.   The Eighth Circuit affirmed. The court explained that while Plaintiffs assert contract conflict of laws principles set forth in the Restatement (Second) of Conflict of Laws (“Restatement”) require that Iowa law determine the extent of their recovery, Hall v. Allied Mutual Insurance Co specifically held that no conflict of laws problem exists when the tortfeasor is only subject to personal jurisdiction in courts that would apply identical law. Further, the court wrote that Section 516A.1 only requires that insurance companies offer the type of coverage at issue in this case. The statute does not define what it means for an insured to be “legally entitled to recover” damages from an uninsured or underinsured motorist such that it could abrogate Hall. Finally, the court found that the plain language of this provision provides only that West Bend may “reduce” its otherwise applicable coverage by certain other amounts available. Where, as here, the insurer has no liability under the Policy’s coverage provisions, the Available Insurance Provision does not operate as an affirmative grant of coverage extending to what are otherwise uncovered losses. View "Gregg Geerdes v. West Bend Mutual Insurance Co." on Justia Law

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Dr. Robert P. Rothenberg (Rob) tragically suffered a fatal heart attack prior to paying the initial premium on his term life insurance policy issued by Principal National Life Insurance Company (Principal). Principal filed this action in the district court, seeking a declaratory judgment that Appellant— the policy’s intended beneficiary—was not owed death benefits in light of the nonpayment. Appellant filed a counterclaim, asserting claims against Principal for breach of contract, vexatious denial of proceeds, and negligence, as well as claims against Appellee, the couple’s insurance broker and financial planner, for negligence. After the parties filed cross-motions for summary judgment, the district court granted summary judgment in favor of Principal and Appellee, finding, in part, that the policy was not in effect at the time of Rob’s death. Appellant appealed, arguing that the district court erred in concluding (1) that the Policy was not in effect at the time of Rob’s death and (2) that, assuming the Policy was not in effect, neither Principal nor Appellee were negligent because neither owed a duty to Appellant.   The Eighth Circuit affirmed. The court explained that Appellant did not pay the initial premium until after Rob’s death, at which time he was not in a similar state of health as when he applied for the policy. Moreover, any “privileges and rights” Rob (or Appellant) had to retroactively effectuate the Policy were terminated at Rob’s death pursuant to the Policy’s termination provision. Second, Rob’s signature on the EFT Form alone did not render the Policy effective on April 26, 2019, or earlier. View "Principal National Life Insurance Company v. Donna Rothenberg" on Justia Law

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Plaintiff underwent bariatric surgery to lose weight. A few months later, Plaintiff began working for Zimmerman Transfer, Inc. and became a participant in its self-insured employee benefit plan. Zimmerman is the plan administrator, and Benefit Plan Administrators of Eau Claire, LLC (“BPA”) served as the third-party administrator until January 2020. After exhausting his administrative appeals, Plaintiff sued BPA and Zimmerman for benefits under Section 1132(a)(1)(B). He then moved for summary judgment against BPA and Zimmerman. Both Defendants filed cross-motions for summary judgment, which the district court granted.   The Eighth Circuit affirmed. The court explained that because Plaintiff’s plan specifically excludes coverage of treatment for complications of weight-reduction surgery, neither Iowa law nor the ACA requires that his treatment be covered. It is undisputed that Plaintiff’s treatment was due to a complication of his prior bariatric surgery. Thus, Iowa law and the ACA do not require that his treatment be covered. Further, the court wrote that imposing and enforcing coverage limitations, even if it results in a plan participant paying large medical bills, is not inconsistent with the plan’s goal because the plan must allocate limited resources among all plan participants. Accordingly, the court concluded that there was no abuse of discretion in denying Plaintiff’s claim for benefits because the interpretation of the plan was reasonable, and the decision to deny benefits was supported by substantial evidence. View "Darrin Shafer v. Zimmerman Transfer, Inc." on Justia Law

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Two individuals were involved in a car accident in St. Louis, Missouri. One of the cars crashed into White Knight Diner, resulting in property damage to the restaurant. At the time, White Knight was insured by Owners Insurance Company (Owners)pursuant to a policy that provided coverage for property damage and loss of business income (the Policy). After the insurers brought several motions to dismiss, the district court dismissed all parties except for Owners and White Knight. White Knight then filed an amended complaint against Owners only, adding new causes of action, including breach of contract and breach of the implied covenant of good faith and fair dealing. Owners filed a motion for summary judgment on all claims. The district court granted Owners’ motion. White Knight appealed, arguing that disputed material facts remain as to whether Owners’ subrogation efforts were conducted in breach of the Policy.   The Eighth Circuit affirmed. The court explained that even assuming Owners’ actions were taken pursuant to the Policy, White Knight’s claim still fails because it does not establish that it suffered any damages as a result of Owners’ failure to abide by the contracted-for procedures. White Knight, as an insured party under the Policy, contracted for and paid premiums to receive insurance. And Owners settled White Knight’s claim under the Policy when Owners paid White Knight a total of $66,366.27 for property damage and business income loss. White Knight has not shown that it suffered any damages beyond the compensation it received from Owners. Without evidence of damages, a breach of contract claim fails. View "White Knight Diner, LLC v. Owners Insurance Company" on Justia Law

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This case involves a rare procedural maneuver called snap removal. Federated Mutual Insurance Company removed an insurance dispute to federal court before Plaintiff, M & B Oil, Inc., “properly joined and served” one of the Defendants, the City of St. Louis. The question is whether this maneuver eliminates the requirement of complete diversity.   The Eighth Circuit answered no, and vacated the order denying remand and sent the case back for a second look. The court explained that from the beginning, M & B sued two Defendants: St. Louis and Federated. One of them is a fellow Missourian, so there has never been complete diversity. And without complete diversity, there is no “original jurisdiction. Further, the court wrote that snap removal cannot cure a lack of complete diversity. Moreover, the court explained that there is reason to doubt that any fraudulent-joinder argument will succeed now that M & B has amended its complaint to include an inverse condemnation claim against St. Louis. View "M & B Oil, Inc. v. Federated Mutual Insurance Co" on Justia Law

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Olmsted Medical Center (“Olmsted”) provides preventive, primary, and specialty healthcare in southeastern Minnesota. Olmsted purchased a business property insurance policy from Continental Casualty Company (“Continental”) for the period from January 1, 2020, to January 1, 2021. The “Coverage” section of the policy states that it “insures against risks of direct physical loss of or damage to property and/or interests described herein at” Olmsted’s premises. Olmsted submitted a claim for losses it sustained due to the COVID-19 pandemic under the insurance policy it held with Continental. Continental denied the claim two days later. Olmsted filed suit in Minnesota state court, alleging Continental breached the insurance contract when it refused to pay the claim. Olmsted requested damages and declaratory relief. After Olmsted filed its amended complaint, Continental filed a motion to dismiss. Continental argued, among other things, that Olmsted’s allegations did not implicate a “direct physical loss of or damage to” property; therefore, its claim for coverage did not fall within the policy’s language under any of the above provisions.   The Eighth Circuit affirmed. The court explained that although SARS-CoV-2 may have a “physical” element, it does not have a physical effect on real or personal property. Moreover, the business-interruption provision, however, expressly limits coverage to the “length of time as would be required . . . to rebuild, repair or replace” the affected property. Due to the fact that SARS-CoV-2 does not have an effect on the underlying property, the court did not see how to square Olmsted’s broader interpretation of the provision with the express time limitation. View "Olmsted Medical Center v. Continental Casualty Company" on Justia Law

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Zurich American Insurance Company (“Defendant”) insured St. Joe Minerals Corporation (“St. Joe”) and its sole shareholder Fluor Corporation (“Plaintiff”) from 1981 to 1985. St. Joe operated a lead smelting plant in Herculaneum, Missouri. Residents of the town sued Fluor and St. Joe in the early 2000s, claiming that they had been injured by the plant’s release of lead and other toxins.Defendant agreed to defend the companies and paid out $9.87 million. Defendant also contributed more than $25 million to a settlement between St. Joe and the remaining plaintiffs. Plaintiff went to trial, lost in a jury trial, and then settled the claims for $300 million.Defendant filed for declaratory judgment against Plaintiff, who filed a counterclaim alleging bad faith failure to settle. The district court granted summary judgment to Defendant, concluding that the policy limited Defendant’s liability on a per-occurrence basis and that the $3.5 million per-occurrence limit had been exhausted by Defendant’s initial payments. The court also concluded that Defendant did not act in bad faith when it elected not to settle the claims against Plaintiff.The Eighth Circuit reversed the district court’s policy-limits determination and remanded for further proceedings. The court found that an endorsement modified the limits of liability for comprehensive general liability, including bodily injury liability, to be on a per-claim basis. View "Fluor Corporation v. Zurich American Insurance Co." on Justia Law