Justia Insurance Law Opinion Summaries

Eight South Florida hospitals dutifully provided out-of-network emergency treatment to numerous Cigna customers. When Cigna reimbursed the hospitals just 15% of what they had charged, the hospitals sued, accusing Cigna of paying less than the “community” rate. As proof, the hospitals showed that they normally receive five times as much for the care they provided here. In response, Cigna asserted that the hospitals’ data proved nothing because, it insisted, the relevant “community” necessarily includes more than just the eight plaintiff hospitals. The district court agreed and granted Cigna summary judgment.   The Eleventh Circuit reversed. The court explained that even if the relevant “community” here extends beyond the eight plaintiff hospitals, their receipts alone are enough to create a genuine factual dispute about what the “community” rates are. The court reasoned that to survive summary judgment, a plaintiff needn’t present evidence that compels a single, airtight inference—just evidence that allows a reasonable one. The court explained that the way to rebut an inference allegedly skewed by limited data is to add data. And Cigna can do just that—at trial. If it can show there that most other providers in the “community” charge less than the plaintiff hospitals do, then it may well debunk the hospitals’ estimate. But unless and until that happens, it remains the case that a reasonable jury could conclude that the eight plaintiff hospitals’ rates reflect the prevailing community rate—and thus that Cigna shortchanged them. View "North Shore Medical Center, Inc., et al v. Cigna Health and Life Insurance Company" on Justia Law

Tessco Technologies Inc. hired Landstar Ranger, Inc. as a transportation broker to secure a motor carrier to transport an expensive load of Tessco’s cargo to a purchaser across state lines. But Landstar mistakenly turned the shipment over to a thief posing as a Landstar-registered carrier, who ran off with Tessco’s shipment. Tessco’s insurer, Aspen American Insurance Company, sued Landstar, claiming Landstar was negligent under Florida law in its selection of the carrier. The district court dismissed Aspen’s negligence claims against Landstar, concluding those claims were expressly preempted by the Federal Aviation Administration Authorization Act (“FAAAA”).   The Eleventh Circuit affirmed. The court explained that just as the phrase “with respect to the transportation of property” “massively limits” the preemption provision, the court reads the phrase “with respect to motor vehicles” to impose a meaningful limit on the exception to the preemption provision. Second, the court found that the phrase “with respect to motor vehicles” has an operative effect only by requiring a direct connection between the state law and motor vehicles. The court reasoned that the specifics of Aspen’s complaint make us even more confident that Aspen’s claims are not “with respect to motor vehicles” within the meaning of the safety exception. Aspen’s complaint says nothing at all about motor vehicles. And Aspen’s negligence and gross negligence counts challenge only Landstar’s “selection of the motor carrier.” The complaint does not purport to enforce any standard or regulation on the ownership, maintenance, or operation of “a vehicle, machine, tractor, trailer, or semitrailer propelled or drawn by mechanical power and used on a highway in transportation.” View "Aspen American Insurance Company v. Landstar Ranger, Inc." on Justia Law

Plaintiff sued Aspen Specialty Insurance Company (“Aspen”) for breach of contract and sought a declaration that its 2016 and 2017 policies (the “Matthew” and “Irma” Policies)—covered damages caused by named windstorms. The parties cross-moved for summary judgment, teeing up a discrete and dispositive question of law: Do the policies cover named-windstorm-related losses? The district court granted summary judgment to Aspen. It held that “no reasonable jury” could find that the parties “intended the policies at issue to exclude named windstorm coverage.”   The Eleventh Circuit reversed. The court held that whatever the evidence of the contracting parties’ subjective intentions and expectations, the Irma Policy’s plain language unambiguously covers losses caused by named windstorms. Further, the court wrote that although potentially ambiguous, the Matthew Policy likewise—and, again, whatever the evidence of the parties’ subjective intentions and expectations—covers losses caused by named windstorms pursuant to the contra proferentem canon, according to which ambiguous insurance contracts are construed in favor of coverage and against the insurer. View "Shiloh Christian Center v. Aspen Specialty Insurance Company" on Justia Law

Defendant and his spouse maintained a car insurance policy (the “Policy”) with State Farm Mutual Automobile Insurance Company. While the Policy was in force, Defendant’s wife was involved in an accident in which she was struck and injured by an uninsured driver of an electric motorized scooter. Defendants made a claim for her injuries under the Policy’s Uninsured Motor Vehicle (“UM”) coverage. State Farm denied the claim on the ground that under the Policy, the scooter was neither a “motor vehicle” nor an “uninsured motor vehicle,” which the Policy defined as a “land motor vehicle.” State Farm sued Defendants, seeking a declaratory judgment that the Policy provided no coverage. Both parties moved for summary judgment. The district court denied Defendant’s motion, granting summary judgment in part to State Farm.   Defendants argued that because the Policy defines “uninsured motor vehicle” as a “land motor vehicle,” the plain and ordinary meaning of the term “land motor vehicle” dictates the scope of the Policy, and under the plain and ordinary meaning of the term, the scooter is a covered uninsured motor vehicle. The Eleventh Circuit reversed the district court’s grant of summary judgment to State Farm. The court concluded that the Policy defines “uninsured motor vehicle” more broadly than Florida insurance law requires. Because an insurer can provide more UM coverage than the law requires, we decline to disregard the Policy’s broader definition of uninsured motor vehicle in favor of a more limited statutory definition of motor vehicle. View "State Farm Mutual Automobile Insurance Company v. Anna Bevilacqua Spangler, et al." on Justia Law

S.D. lost control of his van while driving on a divided highway in Pasco County, Florida. The van jumped the center median and landed directly on top of an oncoming car driven by Plaintiff. Plaintiff was seriously injured in the resulting wreck. S.D.’s insurer, USAA General Indemnity Company, immediately began investigating. But despite learning that Plaintiff had suffered grievous injuries so that his damages would almost surely exceed S.D.’s $10,000 policy limit, and despite determining that S.D. was solely at fault for the accident, USAA delayed initiating settlement negotiations for over a month. Then, USAA failed to confirm for Plaintiff’s attorney that S.D. lacked additional insurance coverage with which to satisfy a judgment. Plaintiff then commenced this action to hold USAA responsible for the judgment, bringing a single claim for bad faith under Florida common law. USAA moved for summary judgment, arguing that no reasonable jury could find that its conduct amounted to bad faith.   The Eleventh Circuit reversed and remanded. The court held that the district court improvidently granted summary judgment to USAA. Material issues of fact as to bad faith and causation remain in dispute, and Plaintiff is entitled to have a jury resolve them. The court explained had USAA complied with its “duty to initiate settlement negotiations” sooner or provided Plaintiff’s attorney with a coverage affidavit before Plaintiff filed suit, the case may have settled before rising costs changed the calculus. View "Daniel Ilias v. USAA General Indemnity Company" on Justia Law

The assignees of two Medicare Advantage Organizations seek reimbursements from insurance companies that they allege qualify as primary payers of beneficiaries’ medical expenses. The insurance companies argued, and the district courts agreed, that the assignees’ claims are barred because both assignees failed to satisfy a procedural requirement: a contractual claims-filing deadline in one case and a statutory requirement of a pre-suit demand in the other. The assignees contend that the procedural requirements are preempted by the Medicare Secondary Payer Act.   The Eleventh Circuit affirmed. The court reasoned that Florida’s pre-suit demand requirement does not meet this relatively high bar. The statutory notice requirement and corresponding 30-day cure period are procedural requirements that may result in a brief delay. But the Florida law does not prevent or meaningfully impede the reimbursement of Medicare Advantage Organizations that Congress sought to facilitate. So, the provision does not create an unconstitutional obstacle to the purposes or operation of the Medicare Secondary Payer Act. View "MSP Recovery Claims, Series LLC v. United Automobile Insurance Company" on Justia Law

Life Insurance Company of North America (“LINA”) made multiple determinations that Plaintiff did not qualify for disability benefits under her long-term disability insurance policy and her life insurance policy. Plaintiff sued LINA for breach of contract and bad-faith failure to provide insurance benefits. The district court granted summary judgment for LINA on Plaintiff’s bad-faith claim based on the multiple medical opinions that supported LINA’s determinations. The district court held that, under Alabama law, Plaintiff could not recover mental anguish damages for her breach of contract claim and excluded evidence of such damages. Finally, following a jury verdict in Plaintiff’s favor on the breach of contract claim related to the long-term disability insurance policy, the district court determined that Plaintiff was entitled to simple pre-judgment interest at a rate of 1.5 percent under the policy and simple post-judgment interest at a rate of 0.08 percent pursuant to 28 U.S.C. Section 1961. In determining that the long-term disability insurance policy provided for simple rather than compound interest, the district court struck a document produced by Plaintiff because it was not properly authenticated. On appeal, Plaintiff argued that the district court erred at each of these steps.   The Eleventh Circuit affirmed. The court held that the evidence establishes that LINA had an arguable reason for determining that Plaintiff did not qualify for disability benefits under the disability policy. Further, the court wrote that the Supreme Court of Alabama has made clear that mental anguish damages are unavailable for breach of contract claims related to long-term disability insurance policies. View "Cherri Walker v. Life Insurance Company of North America" on Justia Law

Geico General Insurance Company (Geico) asserted eight claims against Glassco, Inc.: a declaratory judgment claim seeking a declaration that Glassco violated the Repair Act and that Geico had no duty to pay pending claims (count one); a federal racketeering claim (count two); a federal racketeering conspiracy claim (count three); a Florida Deceptive and Unfair Trade Practices Act claim (count four); a Florida racketeering claim (count five); a common law fraud claim (count six); an unjust enrichment claim (count seven); and a Repair Act claim (count eight). The district court denied summary judgment to the extent that Geico alleged that Glassco, Inc. made misrepresentations that amounted to fraud “independent of” Glassco’s violations of the Florida Motor Vehicle Repair Act. Geico tried to convert this nonfinal decision into a final decision by filing an amended complaint that removed the fraud allegations that were independent of the Repair Act violations.   The Eleventh Circuit dismissed the appeal explaining that because the district court denied summary judgment as to these fraud allegations, there is no final decision for Geico to appeal. The court held that it can’t exercise jurisdiction over this appeal simply because the alternative—sending this case back to the district court—may be inconvenient or inefficient. The court wrote that by dismissing this appeal today, it vindicates finality as the historic characteristic of federal appellate procedure, serves the important interests of judicial efficiency, and promotes the sensible policy of avoiding piecemeal appeals. View "Government Employees Insurance Company, et al. v. Jason Wilemon, et al." on Justia Law

An insured fell from a roof and became paralyzed from the waist down, never to walk again. Within months, his medical bills climbed past $400,000, and future costs were projected into the millions. Three insurance companies potentially provided coverage for the insured. This appeal is a battle between the two of them. The primary insurer was Southern Owners Insurance Company. At the time of the accident, the insured was performing subcontracting work for Beck Construction, which had a policy with American Builders Insurance Company and an excess policy with Evanston Insurance Company. American Builders investigated the accident, assessed Beck Construction’s liability, and evaluated the claim. Southern-Owners did little to nothing for months. American Builders then sued Southern-Owners for common law bad faith under Florida’s doctrine of equitable subrogation. Southern-Owners moved for summary judgment, but the district court denied the motion. A federal trial jury heard the case and found in favor of American Builders. After the entry of final judgment, Southern-Owners sought judgment matter of law or, in the alternative, a new trial. On appeal, Southern-Owners challenges the denials of its summary judgment and post-trial motions.   The Eleventh Circuit affirmed. The court held that taking the evidence in the light most favorable to American Builders, a reasonable jury could have found (as it did) both that Southern-Owners acted in bad faith and that its bad faith caused American Builders to pay its policy. Moreover, American Builders did not breach Southern-Owners’ contract and relieve Southern-Owners of its good-faith duties. The district court did not err in denying Southern-Owners’ Rule 50(b) motion. View "American Builders Insurance Company v. Southern-Owners Insurance Company" on Justia Law

This appeal arises out of an insurance dispute involving a yacht, the Serendipity, that was destroyed by Hurricane Dorian, a Category 5 storm, that slammed into Great Abaco Island in the Bahamas. Serendipity at Sea, LLC (“Serendipity, LLC”), a holding company created by M.S. and J.E. (“the Managers”) to manage the Serendipity, sued Underwriters at Lloyd’s of London Subscribing to Policy Number 187581 (“Lloyd’s”) for breach of contract after Lloyd’s denied the the Managers insurance claim for the damage Hurricane Dorian caused to the Serendipity. In denying that it had breached the contract, Lloyd’s argued that it was not liable because Serendipity, LLC did not employ a full-time licensed captain in violation of the policy’s Captain Warranty, and that the breach increased the hazard to the yacht because a licensed captain would have operated the vessel back to Florida when Hurricane Dorian formed and was forecast to hit the Bahamas.   The district court granted summary judgment in favor of Lloyd’s. It found that the Captain Warranty was unambiguous; that Serendipity, LLC breached the agreement by failing to hire a full-time licensed captain; and that the breach increased the hazard posed to the Serendipity based on the purportedly undisputed testimony of an expert hired by Lloyd’s. The Eleventh Circuit reversed the district court’s grant of summary judgment in favor of Lloyd’s and remanded. The court explained that while it agreed with the district court’s conclusion that Serendipity, LLC breached the Captain Warranty, a disputed question of material fact remains about whether the breach increased the hazard posed to the vessel. View "Serendipity at Sea, LLC v. Underwriters at Lloyd's of London Subscribing to Policy Number 187581" on Justia Law