Justia Insurance Law Opinion Summaries

Plaintiff, a law firm with offices in Dallas, Texas and Atlanta, Georgia, sued to recover lost income and expenses incurred as a result of the COVID-19 pandemic under an insurance policy issued by The Cincinnati Insurance Company. The district court dismissed Plaintiff’s claims and the Fifth Circuit affirmed.   The court explained that under the policy a “Covered Cause of Loss” is a “direct ‘loss’ unless the loss is excluded or limited in this Coverage Part,” and “loss” is an “accidental physical loss or accidental physical damage.” So, to recover under any of the three forms of coverage, there must be a physical loss or physical damage to the Plaintiff’s property. Here, there was no Covered Cause of Loss as there was no underlying physical loss or damage to insured property. Plaintiff was not deprived of its property nor was there a tangible alteration to its property, so there was no underlying “direct ‘loss’” to trigger coverage. View "Ferrer & Poirot v. Cincinnati Ins Company" on Justia Law

Plaintiff appealed the district court’s summary judgment dismissal of the breach of contract claims that he has asserted, as a third-party beneficiary, against Defendant. The district court determined that the insurer’s duty to defend its insured, on which Plaintiff’s claims were based, was never triggered, relative to Plaintiff’s underlying personal injury suit, because the insured, N.F. Painting, Inc., never requested a defense or sought coverage.   The Fifth Circuit affirmed finding no error in the district court’s assessment under Texas law. The court explained that it is well-established, that under Texas law, despite having knowledge and opportunity, an insurer is not required to simply interject itself into a proceeding on its insured’s behalf.   Here, as stated, N.F. Painting did not seek defense or coverage from Defendant when it was served with Plaintiff’s original state court petition. The undisputed facts show that N.F. Painting chose, with the assistance of counsel, to handle Plaintiff’s personal injury claims in its own way, without involving Defendantin its defense, as it was entitled to do. And Plaintiff has put forth no evidence suggesting that Defendant was not entitled to rely on that decision. Having made that decision, it is N.F. Painting, and thus Plaintiff, as third-party beneficiary, not Defendant who must bear responsibility for any resulting adverse consequences. In other words, the law will not permit a third-party beneficiary to simply disregard an insured’s litigation decisions, i.e., essentially re-write history, merely because he has no other means of satisfying his judgment against the insured. View "Moreno v. Sentinel Ins" on Justia Law

Plaintiff bought a home insurance policy from Allstate that covered damage from wind and hail. On June 6, 2018, a wind and hail storm hit the area where Plaintiff lived, allegedly damaging his roof. An Allstate adjuster estimated the value of the loss at less than the deductible and paid Plaintiff nothing. Allstate later moved for summary judgment on Plaintiff’s remaining claims for breach of contract and failure to conduct a reasonable investigation. The district court granted Allstate’s motion finding that Plaintiff’s losses involved concurrent causes and Plaintiff had not carried his burden of proving how much damage came from the June 6, 2018 incident.   The Fifth Circuit explained that Texas’s concurrent causation doctrine instructs leaves questions about when the doctrine applies, and what plaintiffs must prove when it does. The court certified to the Supreme Court three questions:   1. Whether the concurrent cause doctrine applies where there is any non-covered damage, including “wear and tear” to insured property, but such damage does not directly cause the particular loss eventually experienced by plaintiffs;2. If so, whether plaintiffs alleging that their loss was entirely caused by a single, covered peril bear the burden of attributing losses between that peril and other, non-covered or excluded perils that plaintiffs contend did not cause the particular loss; and3. If so, whether plaintiffs can meet that burden with evidence indicating that the covered peril caused the entirety of the loss (that is, by implicitly attributing one hundred percent of the loss to that peril). View "Overstreet v. Allstate" on Justia Law

Plaintiff and his son’s mother met with the insurance company’s producer seeking insurance covering the life of their adult son. The producer filled out the application, as well as a temporary insurance agreement (the “TIA”) to cover the son’s life while the application was pending. After completing the application and the TIA, the producer gave Plaintiff the opportunity to review. The producer subsequently submitted the application and authorized the TIA. After receiving notice of the death, Defendant sent Plaintiff a letter notifying him that the application had not been processed. Defendant subsequently denied coverage. Its basis for doing so was the misrepresentation and omission of key parts of the son’s medical history. Plaintiff then filed suit in state court against the producer and insurance company. The district court determined that Defendant denied coverage without just cause.The Fifth Circuit affirmed the district court’s ruling holding that the life insurance company was bound by its producer’s errors and omissions. The court reasoned that the district court acted within its discretion to deny Defendant’s pretrial motion in limine. Further, Defendant forfeited its argument related to the contractual element of “cause,” by not first presenting it to the district court. As for the insured’s “consent” to the contracts, the producer’s actions, errors and omissions in completing the insurance application and TIA were properly imputed to Defendant such that Defendant was estopped from raising the son’s lack of consent. Finally, the district court acted within its discretion in assessing penalty interest against Defendant. View "Thomas v. Ameritas Life Insurance" on Justia Law

Plaintiff filed a petition for damages in the 19th Judicial District Court in East Baton Rouge Parish. Plaintiff totaled his car in an accident and alleged that GoAuto, his car insurance carrier, paid less in policy benefits than his policy and Louisiana law required. GoAuto filed its notice of removal, Plaintiff received permission from the Louisiana court to amend his complaint again and, as accepted on appeal, filed the amended complaint. This amendment changed the definition of the class from class “residents of Louisiana” to class “citizens of Louisiana.” After removal, the parties filed several competing motions disputing which complaint controlled and the sufficiency of GoAuto’s notice of removal.   The Fifth Circuit affirmed the district court’s order remanding the case to state court, finding that Defendant is a citizen of Louisiana and thus the suit lacks the minimal diversity necessary to vest a federal court with jurisdiction. The court declined Defendant’s request to disregard the Louisiana state court’s pre-removal procedural rulings applying Louisiana law and substituted its own Erie guesses at how a Louisiana court ought to rule on a motion to amend a pleading.   Further, in regards to Defendant’s argument that it is plausible that some class members are not citizens of Louisiana, the court held that none of these individuals, assuming they had relocated to Colorado, Texas, or Florida before the filing of the complaint, qualify as citizens of Louisiana. Finally, the court held that Defendant points to nothing in the text of the statute that would bar Plaintiff’s class definition. View "Turner v. GoAuto Insurance" on Justia Law

Vista Health Plan, Inc., a small health insurance company in Texas, was assessed risk-adjustment fees that exceeded its premium revenue, causing the company to cease operations. The company and its parent, Vista Service Corporation, (collectively, Vista) sued HHS, HHS Secretary, the Centers for Medicare and Medicaid Services (CMS), and CMS Administrator Seema Verma (collectively, the HHS Defendants), challenging the risk-adjustment program and two rules promulgated pursuant to the program.The Fifth Circuit explained that determining whether the district court’s “final judgment” was truly an appealable judgment is necessary to establish whether the court has jurisdiction. The court explained that it has recognized an exception to the general rule and determined it had jurisdiction “when the agency would be unable to later appeal the issue that is the subject of the remand order,” such as when “all that is left for remand is a ministerial accounting.”Here, though the district court denied summary judgment as to Vista’s procedural due process claim, the court then explicitly entered a “Final Judgment” stating “nothing remains to resolve ... the case is hereby CLOSED”— suggesting the court “end[ed] the litigation on the merits.” The court held that the district court, in denying summary judgment on Vista’s procedural due process claim and then remanding it for further proceedings, did not yet fully dispose of the case., Thus, there was no appealable final judgment, and the court lacks jurisdiction to reach the substance of Vista’s appeal. View "Vista Health Plan v. HHS" on Justia Law

BITCO General Insurance Corporation (“BITCO”) and Monroe Guaranty Insurance Company (“Monroe”) issued general liability insurance policies to 5D Drilling & Pump Service Inc. (“5D”). A property owner sued 5D for breach of contract and negligence. BITCO sought a declaratory judgment that Monroe also owed a duty to defend 5D.The parties dispute whether any “property damage” alleged could have occurred during Monroe’s policy period. The magistrate found that damage must have occurred during a period when Monroe’s policy was in force.The court reasoned that under Texas law, courts determine whether an insurer’s duty to defend has been triggered by using the “eight corners” rule. The party seeking coverage has the initial burden of establishing that the underlying claims potentially state a cause of action. When pleadings in the underlying lawsuit have been amended, the court analyzes the duty to defend by examining the “latest, and only the latest, amended pleadings.”Typically, the eight-corners rule prevents courts from considering any extrinsic evidence. Texas law recognizes a limited exception to the eight-corners rule when it is impossible to discern whether coverage is potentially implicated and when the extrinsic evidence goes solely to a fundamental issue of coverage.Monroe contends that even if the owner’s pleading alleges damage within its policy period, it still has no duty to defend because all the damage falls within policy exclusions. The court found that Monroe cannot carry its burden because it cannot show that either exception unambiguously applies. Thus, the court affirmed the district court’s order. View "BITCO Gen Ins v. Monroe Guar Ins" on Justia Law

A water control and improvement district in Harris County, Texas ("the District"), wanted a new headquarters, so it contracted with a construction company to build one. The District required the company to post a performance bond. The company engaged Philadelphia Indemnity Insurance Co. (“Philadelphia”) to provide that bond, which explicitly stated that changes to the construction contract would not void Philadelphia’s obligations. However, the District’s project manager backed out, which led the District to execute a new agreement without Philadelphia’s knowledge or consent. The District sought what was owed under the performance bond and sued for breach of contract.At issue is whether a 2016 Agreement created a new contract between the District and the construction company or merely amended their 2015 Agreement. The court concluded that the 2016 Agreement was an amendment under Texas law. The court reasoned that the Supreme Court of Texas would examine the text of both agreements to identify the parties' objective intent. The court concluded the 2016 Agreement amended—instead of replaced—the 2015 Agreement. Thus, the court reversed and remanded the case, placing no limits on the matters that the district court may address on remand. View "Harris Cty v. Philadelphia Indem" on Justia Law

Tarango Trucking, L.L.C. (“Tarango”) appeals from a judgment declaring that its insurer, Penn-America Insurance Company (“PennAmerica”), owes neither defense nor indemnity concerning third-party claims against Tarango concerning a fatal accident on its property.At the time of the accident, Tarango was insured under a commercial general liability policy issued by Penn-America (“the Policy”). Penn-America defended Tarango but reserved its right to contest coverage. Texas law governs the insurance issues in this diversity case. The Policy contains both a duty to defend and a duty to indemnify. PennAmerica must show that the plain language of an exclusion avoids coverage of all claims within the confines of the eight-corners rule. Penn-America argues that the Policy’s Auto Exclusion satisfies this burden. Because the Parking Exception is an exception to the Auto Exclusion, it is reasonable to interpret it as employing the same “arising-out-of” nexus as the Auto Exclusion.The Fifth Circuit held that the Parking Exception applies to bodily injury and property damage arising out of parking. Because the petition alleges some claims that arise out of parking and are potentially covered by the Policy, Penn-America must defend Tarango. The court also held that it was premature for the district court to decide the indemnity issue. View "Penn-America Ins v. Tarango Trucking" on Justia Law

Q, which operates nine men’s clothing stores, purchased insurance to cover the stores for “direct physical loss of or physical damage to Covered Property at the premises described in the Declarations . . . caused by or resulting from a Covered Cause of Loss.” “Covered Causes of Loss” are defined as “risks of direct physical loss” unless excluded or limited. A Business Income Extension covers loss due to the necessary suspension of operations during a “period of restoration” caused by the direct physical loss of or physical damage to property “caused by or resulting from a Covered Cause of Loss.” A Civil Authority Extension covers “the actual loss of Business Income” sustained when access to the scheduled premises “is specifically prohibited by order of a civil authority as the direct result of a Covered Cause of Loss to property in the immediate area of [the] ‘scheduled premises.’” The policy contains a “Virus Exclusion."Q complied with pandemic shutdown orders, lost business income, and submitted claims, which were denied. The Fifth Circuit affirmed judgment on the pleadings in favor of the insurer. The orders closing nonessential businesses did not qualify as a direct physical loss of or damage to property and no other coverage applied. View "Q Clothier New Orleans, L.L.C. v. Twin City Fire Insurance Co." on Justia Law