Justia Insurance Law Opinion Summaries

North American issued two insurance policies for the life of J.C. On November 9, 2018, it issued a policy that named an irrevocable trust managed by the trustee as beneficiary. It issued a policy that named J.C.’s wife, as beneficiary. Each contained an essentially identical clause that excluded suicide from coverage under the policy. That clause read, “SUICIDE — If the Insured commits suicide, while sane or insane, within two years from the Policy Date, Our liability is limited to an amount equal to the total premiums paid.” In a motion for a judgment on the pleadings, the beneficiaries argued that “the entire lawsuit is predicated on [North American’s] erroneous position that the contract term ‘suicide’ is synonymous with the expression ‘suicide by cop,’ which is a term of art that actually refers to justifiable homicide.” The district court agreed that “[t]he plain meaning of the term ‘suicide’ encompasses the act of killing oneself—not the killing of a person by another” and granted the motion.   The Eleventh Circuit vacated and remanded finding that the ordinary meaning of “suicide” includes suicide-by-cop. The court explained that here, where the beneficiaries agree with the allegations in North American’s complaint due to the procedural posture of the case, no factual question exists. The ordinary meaning of “suicide” certainly covers J.C.’s specific behavior in pointing his gun at police officers to provoke them into shooting and killing him as part of his plan to end his own life. Thus, the district court erred in ruling to the contrary. View "North American Company for Life and Health Insurance v. Michelle Caldwell, et al" on Justia Law

Defendant argued that the district court erroneously held that a life insurance policy issued by Plaintiff Jackson National Life Insurance Company (“Jackson”) to third-party K.C., and subsequently sold by K.C. to Defendant, was void and unenforceable under Georgia law as an illegal human life wagering contract. K.C. acquired the policy, which listed “K.C.” as the insured and named K.C.’s estate as the beneficiary in 1999. At the time, K.C. was HIV positive, and he had a relatively short life expectancy. A few months after he purchased the policy, K.C., with the assistance of a viatical insurance broker, sold the policy to Defendant and named Defendant as its primary beneficiary.   When Defendant learned about K.C.s death, he made a claim for the death benefit under the policy. Jackson declined to pay the benefit and initiated this action seeking a declaration that the policy was void ab initio under Georgia law as an illegal human life wagering contract. The district court concluded that the policy was void and unenforceable under Georgia law, and it entered judgment in favor of Jackson. Defendant appealed, arguing that K.C.’s unilateral intent to sell the policy to a third party without an insurable interest in his life was insufficient to declare the policy void under Georgia law.   The Eleventh Circuit reversed and vacated the judgment entered by the district court and remanded the case for further proceedings, including a determination as to whether Defendant’s claim to benefits under the policy is barred by laches. View "Jackson National Life Insurance Company v. Sterling Crum" on Justia Law

The relevant consolidated appeals constitute the latest chapter of a long-running legal battle over attempts to satisfy a 2010 default judgment of $318 million under the Anti-Terrorism Act, 18 U.S.C. Section 2333, against the Revolutionary Armed Forces of Colombia (the Fuerzas Armadas Revolucionarias de Colombia or FARC) for murder and kidnapping.   In the first appeal (Case No. 20-11736), Appellant appealed the district court’s orders directing certain garnishees to liquidate and/or distribute their assets to Plaintiffs who obtained the $318 million judgment. In the second appeal(Case No. 20-12467) Appellant appealed the denial of their motion for a preliminary injunction to stop the sale of real property located at 325 Leucadendra Drive in Coral Gables, Florida. In the third appeal(Case No. 20-12545) Appellant’s wife appealed the district court’s denial of her motion to intervene in the proceedings concerning the sale of real property located at 325 Leucadendra Drive (and owned by Leucadendra 325, one of the Appellants in Case Nos. 20-11736 and 20-12467).   In Case No. 20-11736, the Eleventh Circuit concluded that a jury must decide whether Appellant and his companies qualify as agencies or instrumentalities of the FARC such that their assets can be garnished by Plaintiffs to satisfy their $318 million judgment. The court, therefore, reversed and remanded that appeal. In Case No. 20-12467, the court dismissed the appeal as moot because 325 Leucadendra has been sold and the court lacks the ability to grant the requested relief. In Case No. 20- 12545, the court affirmed the district court’s order denying Appellant’s wife’s motion to intervene as untimely and therefore dismiss the appeal. View "Keith Stansell, et al v. UBS Financial Services, Inc., et al" on Justia Law

MSPA Claims 1 LLC—the assignee of a now-defunct Medicare Advantage Organization—sued Tower Hill Prime Insurance Company to recover a reimbursable payment. The district court granted Tower Hill’s motion for summary judgment because it determined that MSPA Claims 1’s suit was untimely.The Eleventh Circuit affirmed. The court explained that because it is at least “plausible” that the term “accrues” in Section 1658(a) incorporates an occurrence rule—in fact, and setting presumptions aside, the court wrote that it thinks that’s the best interpretation—that is how the court interprets it. Therefore, MSPA Claims 1’s cause of action accrued in 2012 when MSPA Claims 1’s assignor, Florida Healthcare, paid D.L.’s medical bills and became entitled to reimbursement through the Medicare Secondary Payer Act. Because that was more than four years before MSPA Claims 1 filed suit in 2018, its suit is not timely under 28 U.S.C. Section 1658(a). View "MSPA Claims 1, LLC. v. Tower Hill Prime Insurance Co." on Justia Law

Plaintiff sued to obtain two insurance benefits that she believes Hartford Insurance Company owes her: (1) long-term disability payments and (2) a waiver of life insurance premiums. Although it concedes that Plaintiff was covered by its policy, Hartford contends that she was ineligible for those benefits.The Eleventh Circuit affirmed the district court’s order granting Hartford summary judgment, concluding that Hartford’s determinations were permissible. The court explained that Plaintiff was not entitled to disability payments because Hartford’s interpretation of the disability exclusion was reasonable, and its conflict of interest didn’t lead it to make an arbitrary or capricious decision. Likewise, Plaintiff was not entitled to a waiver of life insurance premiums because she wasn’t disabled within the meaning of Hartford’s life insurance policy. View "Carol H. Stewart v. Hartford Life and Accident Insurance Company" on Justia Law

Various actors in the Medicare Advantage program assigned claims for failure to pay or reimburse medical expenses owed under the Medicare Secondary Payer Act to Plaintiffs—MSP Recovery Claims, Series LLC; MSPA Claims 1, LLC; and MAO-MSO Recovery II LLC, Series PMPI, (collectively, “MSP Recovery”). MSP Recovery then asserted those claims against Metropolitan General Insurance Company, Metropolitan Casualty Insurance Company, Metropolitan Group Property & Casualty Insurance Company, Metlife Auto & Home Group, and Metropolitan P&C Insurance Company (collectively, “Defendants”).   The district court dismissed MSP Recovery’s claims because the complaint failed to show that Defendants had a “demonstrated responsibility” to reimburse MSP Recovery’s assignors for the medical expenses at issue. The Eleventh Circuit held that at this procedural stage MSP Recovery’s complaint plausibly alleged that Defendants had a demonstrated responsibility to pay the claims, and the court, therefore reversed and remanded this case to the district court for further proceedings consistent with this opinion.   The court explained that the district court found that it would not consider Exhibit A, which was attached to and referenced by incorporation in the factual allegations of MSP Recovery’s complaint. Because “documents attached to a complaint or incorporated in the complaint by reference can generally be considered by a federal court in ruling on a motion to dismiss under Rule 12(b)(6),” the court concluded that the district court erred in failing to consider whether the complaint and Exhibit A, taken together, plausibly alleged that Defendants’ responsibility to pay had been demonstrated prior to suit. View "MSP Recovery Claims, Series LLC, et al v. Metropolitan General Insurance Company, et al" on Justia Law

Plaintiff suffered serious injuries in an automobile accident and won over $12 million in a suit against the other driver. To recover the judgment, Plaintiff sued that driver’s insurance company on the theory that it acted in bad faith toward its insureds. The jury returned a verdict in the insurer’s favor, but Plaintiff argued that the district court abused its discretion by failing to give his proposed jury instruction.   The Eleventh Circuit reversed the district court’s ruling explaining that the district court’s instruction omitted the state law relevant to this theory of liability. The court explained that the district court instructed the jury on bad faith resulting from the failure to settle a claim. But Florida law provides—and Plaintiff argued at trial—that bad faith is also present when an insurance company fails to advise an insured about settlement offers and likely litigation outcomes. Further, Plaintiff’s proposed jury instruction correctly stated the legal basis for his failure-to-advise theory of liability, and the district court’s failure to give that instruction to the jury caused him prejudice. View "Dustin C. Brink v. Direct General Insurance Company" on Justia Law

Great Lakes Insurance SE (“Great Lakes”) and Wave Cruiser LLC (“Wave Cruiser”) were involved in an insurance dispute. Wave Cruiser purchased an “all risks” insurance policy from Great Lakes covering a vessel that Wave Cruiser had recently acquired. The policy did not cover engine damage unless an accidental external event caused the damage. After Wave Cruiser purchased the policy, the vessel suffered catastrophic engine failure. Wave Cruiser submitted a claim on its policy. Great Lakes denied the claim, explaining that Wave Cruiser had not shown that an external event caused the engine damage.   Great Lakes filed suit for a declaratory judgment that Wave Cruiser’s policy did not afford coverage for the loss. Wave Cruiser filed counterclaims for breach of contract and breach of the duty of good faith and fair dealing. The district court granted summary judgment to Great Lakes. The district court concluded that Wave Cruiser failed to come forward with evidence that an external event caused the engine damage.   The Eleventh Circuit agreed with the district court that Wave Cruiser had the burden to come forward with evidence that an external event caused the engine failure. The court held that (1) the district court did not err by placing the burden on Wave Cruiser to provide evidence that an external event caused the vessel’s port engine to fail, and (2) the district court committed harmless error by considering inadmissible expert opinion testimony. View "Great Lakes Insurance SE v. Wave Cruiser LLC" on Justia Law

Dukes Clothing, LLC (“Dukes”) operated two clothing stores. As a result of the state orders and a customer’s exposure to COVID-19, Dukes was forced to close its doors. These closures resulted in lost business income for Dukes. Dukes’s insurer, The Cincinnati Insurance Company (“Cincinnati”), had issued an all-risk commercial insurance policy to Dukes. Dukes submitted a claim under its policy to recover its loss of business income due to its store closures caused by COVID-19. Cincinnati denied the claim on the basis that Dukes’s income loss was not caused by a direct physical loss or damage to the insured’s property.   The Eleventh Circuit affirmed the district court’s dismissal of Plaintiff’s claims holding that Plaintiff’s income loss was not caused by a direct physical loss or damage to the insured’s property. The court explained that when examining insurance policies, Alabama courts consider the language of the policy as a whole, not in isolation. There are no Alabama appellate court decisions interpreting the relevant terms here—physical loss or damage—or interpreting these types of all-risk policies in the COVID-19 context so the court looked to its’ decisions interpreting nearly identical terms under Florida and Georgia law. Ultimately, the court found that since COVID-19 does not cause a “tangible alteration of the property” such that the property could not be used in the future or needed repairs to be used, lost business income resulting from COVID-19 could not constitute a “physical loss of or damage to” the property necessary for insurance coverage. View "Dukes Clothing, LLC v. The Cincinnati Insurance Company" on Justia Law

When the first Covid-19 cases appeared in Georgia, the governor declared a public state of emergency. Plaintiff’s restaurant played its part by suspending dine-in service. To recover the income, it was losing by closing its doors, Plaintiff quickly filed a claim with its insurer, Allied Insurance Company of America. Under Plaintiff’s “Premier Businessowners Property Coverage” policy, Allied agreed to “pay for direct physical loss of or damage to Covered Property” if it was “caused by or resulting from any Covered Cause of Loss.”   Allied denied coverage. It found that Plaintiff’s closure was not caused by any “direct physical loss or damage.” And under the policy’s Virus or Bacteria exclusion, Allied refused to “pay for loss or damage caused directly or indirectly” by any “virus.” The district court dismissed Plaintiff’s complaint for failure to state a claim. It held that no “direct physical loss of or damage to” property occurred because the restaurant and its dining room “underwent no physical change.”   The Eleventh Circuit affirmed the district court’s ruling, holding that the harm does not extend to the intangible harm caused by Covid-19 or by a declaration of public emergency issued in its wake. Plaintiff alleged no actual change to its property. Even if the court assumed that the governor’s Covid-19 order caused loss because it deprived the restaurant of the use of its property, that does not result in a win for Plainitff. Allied agreed to provide for only one manner of loss—the physical loss of Henry’s property and to be physical it must be “tangible or concrete.” View "Henry's Louisiana Grill, Inc., et al v. Allied Insurance Company of America" on Justia Law