Justia Insurance Law Opinion SummariesArticles Posted in US Court of Appeals for the Ninth Circuit
California Insurance Guarantee Assoc. v. Azar
The Ninth Circuit reversed the district court's judgment in favor of Medicare in an action brought by CIGA, seeking declaratory relief after Medicare paid for and demanded reimbursement from CIGA for medical expenses of certain individuals whose workers' compensation benefits CIGA was administering. The panel held that Medicare, as a secondary payer, was entitled to seek reimbursement from a beneficiary's primary payer, typically private insurance. However, CIGA was not a primary plan, and specifically was not a workmen's compensation law or plan. Rather, the panel held that CIGA was an insolvency insurer of last resort. The panel explained that insurance regulation was a field traditionally occupied by the states, and it must presume that the Medicare secondary payer provisions do not preempt state insurance laws unless Congress clearly manifested its intent to do so. Furthermore, nothing in the Medicare statute or its implementing regulations suggested that Congress meant to interfere with state schemes to protect against insurer insolvencies. View "California Insurance Guarantee Assoc. v. Azar" on Justia Law
Apollo Education Group, Inc. v. National Union Fire Insurance Co.
The Ninth Circuit certified the following question of state law to the Supreme Court of Arizona: What is the standard for determining whether National Union unreasonably withheld consent to Apollo's settlement with shareholders in breach of contract under a policy where the insurer has no duty to defend? View "Apollo Education Group, Inc. v. National Union Fire Insurance Co." on Justia Law
State Farm Mutual Automobile Insurance, Co. v. Mizuno
The Ninth Circuit certified the following question of state law to the Supreme Court of Hawai'i: Under Hawai'i law, is a permissive user of an insured vehicle, whose connection to the insured vehicle is permission to use the vehicle to run errands and drive to work, entitled to uninsured motorist (UM) benefits under the chain-of-events test because he was injured by an uninsured motorist? View "State Farm Mutual Automobile Insurance, Co. v. Mizuno" on Justia Law
Universal Cable Productions, LLC v. Atlantic Specialty Insurance Co.
After Hamas fired rockets from Gaza into Israel, Universal moved the production of their televisions series out of Jerusalem at significant expense. Universal filed an insurance claim for coverage of those costs under a television production insurance policy and the insurer, Atlantic, denied coverage based on the policy's war exclusions. The Ninth Circuit reversed the district court's grant of summary judgment for Atlantic in part and held that Atlantic breached its contract when it denied coverage by defining Hamas' conduct as "war" or "warlike action by a military force." Because the district court did not address the third war exclusion regarding whether Hamas' actions constituted "insurrection, rebellion, or revolution," the panel remanded for the district court to address that question in the first instance. Consequently, the panel vacated the district court's grant of summary judgment on Universal's bad faith claim because it turned on the district court's erroneous analysis of the first two war exclusions. The panel remanded for further proceedings. View "Universal Cable Productions, LLC v. Atlantic Specialty Insurance Co." on Justia Law
Nautilus Insurance Co. v. Access Medical, LLC
The Ninth Circuit certified the following question of state insurance law to the Nevada Supreme Court: Is an insurer entitled to reimbursement of costs already expended in defense of its insureds where a determination has been made that the insurer owed no duty to defend and the insurer expressly reserved its right to seek reimbursement in writing after defense has been tendered but where the insurance policy contains no reservation of rights? View "Nautilus Insurance Co. v. Access Medical, LLC" on Justia Law
Ingenco Holdings, LLC v. ACE American Insurance Co.
Plaintiffs, operators of a gas purification plant, filed suit against its insurer, Ace, after the insurer denied coverage for damage caused by broken metal brackets that secured crucial components. The Ninth Circuit affirmed the district court's application of Washington law and its discovery sanctions against plaintiffs. However, the panel reversed the district court's grant of summary judgment in favor of the insurer and held that there was a triable issue of fact as to whether the insurer was prejudiced by plaintiffs' remedial actions, whether plaintiffs' loss was fortuitous, whether the policy's Boiler and Machinery endorsement applied to independently confer coverage for plaintiffs' losses, whether the Endorsement's "accident" coverage applied, and whether a 16 month shutdown was consistent with the exercise of due diligence and dispatch. View "Ingenco Holdings, LLC v. ACE American Insurance Co." on Justia Law
Morris v. California Physicians’ Service
The Ninth Circuit affirmed the district court's dismissal of plaintiffs' claim that their insurer, Blue Shield, violated the Medical Loss Ratio (MLR) provision of the Patient Protection and Affordable Care Act (ACA). The MLR is the ratio between what an insurer pays out in claims for medical services and the revenue it takes in. The panel held that there was no basis in the language, history, intent or spirit of the ACA to narrow the MLR by excluding payments for services rendered by out-of-network physicians. In this case, the MLR was properly calculated under federal law by including the settlement reimbursements for medical services by nonnetwork providers. Therefore, the district court correctly recognized the services were covered by the plan and the payments were made. View "Morris v. California Physicians' Service" on Justia Law
Anderson v. State Farm Mutual Automobile Insurance Co.
The Ninth Circuit affirmed the district court's denial of plaintiffs' motion to remand to state court. The panel joined the Fourth Circuit in holding that receipt of an initial pleading by a statutorily designated agent does not begin the thirty-day removal clock under 28 U.S.C. 1446(b)(1), and that it was instead actual receipt by State Farm that started the removal clock. The panel applied this rule and held that State Farm timely removed the case where removal was calculated from when the forwarded copy of the complaint reached State Farm's designated recipient. View "Anderson v. State Farm Mutual Automobile Insurance Co." on Justia Law
Westport Insurance Corp. v. California Casualty Management Co.
The Ninth Circuit affirmed the judgment of the district court in this dispute between two insurance companies that arose after the settlement of certain claims brought against their insureds, holding that Cal. Gov’t Code 825.4 did not preclude Westport Insurance Corporation’s lawsuit against California Casualty Management Company and that the district court did not err in its judgment on all the remaining issues raised on appeal. This diversity insurance coverage action concerned claims for $15.8 million brought by three former students against a school district and three of its school administrators. Westport defended and settled the claims for $15.8 million and sought repayment from California Casualty, the administrators’ insurer. The district court found California Casualty liable for $2.6 million plus prejudgment interest. The Ninth Circuit affirmed, holding (1) section 825.4 did not preclude Westport’s claim; (2) California Casualty’s claim that it was not obligated to contribute to the settlements under its policy was contrary to the plain test of its policy; (3) California Casualty’s challenge to the apportionment of liability with Westport was unavailing; and (4) the district court did not abuse its discretion in awarding prejudgment interest at ten percent from the dates Westport paid the settlements. View "Westport Insurance Corp. v. California Casualty Management Co." on Justia Law
Yahoo! Inc. v. National Union Fire Insurance Co.
The Ninth Circuit certified to the California Supreme Court the following question: Does a commercial liability policy that covers "personal injury," defined as "injury . . . arising out of . . . [o]ral or written publication . . . of material that violates a person's right of privacy," trigger the insurer's duty to defend the insured against a claim that the insured violated the Telephone Consumer Protection Act by sending unsolicited text message advertisements that did not reveal any private information? View "Yahoo! Inc. v. National Union Fire Insurance Co." on Justia Law