Justia Insurance Law Opinion Summaries

After sustaining injuries in an auto accident, Tavis McArthur filed this suit in federal district court to recover underinsured motorist (UIM) benefits under his State Farm automobile insurance policy. The district court granted summary judgment in favor of State Farm, concluding that McArthur had failed to exhaust the liability limits of the tortfeasor's insurance, a precondition of his UIM benefits policy. On appeal, the Tenth Circuit Court of Appeals certified two questions to the Utah Supreme Court. The Supreme Court held (1) exhaustion clauses that require the liability insurer to pay out its full policy limits before permitting payment of UIM benefits are generally enforceable in the State of Utah; and (2) because UIM exhaustion provisions are conditions precedent and not covenants capable of being breached, no showing of prejudice is required to sustain their invocation.

Miriam Salazar purchased an insurance policy from United Automobile Insurance Company and El Sol Insurance Agency (collectively, United), rejecting underinsured motorist (UIM) coverage by signing United's waiver. After Salazar was involved in an accident, Lopez sued United, arguing that United must provide her with UIM coverage because the waiver did not provide the required reasonable explanation of UIM coverage. The district court granted summary judgment in favor of United. The court of appeals reversed, holding that the waiver did not contain a reasonable explanation, and Lopez was therefore entitled to UIM coverage of $25,000 under the UIM statute. The court then remanded the case with instructions for the district court to enter judgment in favor of Lopez in the amount of $25,000. The Supreme Court held that the court of appeals (1) did not err in finding that United failed to provide a reasonable explanation of the purpose of UIM coverage and when it would be applicable; but (2) erred in instructing the district court to enter judgment for Lopez in the amount of $25,000. Remanded with instructions to determine the amount of damages Lopez actually sustained.

The parents of a child who suffered an injury during an adult softball game sued the United States Specialty Association (USSSA) and several other defendants. At the time of the accident, USSSA was insured by United States Fidelity and Guarantee Co. (USF&G). USF&G assumed the defense of USSSA, and a jury entered a verdict against USSSA. USF&G posted a bond of $4 million to secure the remainder of the judgment and, simultaneously, filed an action in federal court seeking a judicial declaration that it could not be compelled to pay more than the $2 million policy limit. USSSA later moved for partial summary judgment, contending that USF&G had no right to restitution against its insured for the amounts paid in excess of policy limits. The Supreme Court accepted certification to answer questions of law that controlled the parties' motions, answering (1) an insurer may not seek restitution based on the theory of unjust enrichment where there is an express contract governing the subject matter of the dispute; and (2) an insurer's right to reimbursement from an insured affects the parties' risk relationship and therefore may only arise under the express terms of their insurance contract.

Ohio Casualty insured Cloud Nine from 2001 to 2002. Unigard Insurance insured Cloud Nine from 2002 to 2005. Edizone, LC sued Cloud Nine in federal district court, alleging injuries that began during the last three months of Ohio Casualty's policy period and continued throughout Unigard's policy period. The federal district court ruled that the insurers must equally share the total defense costs they incurred in defending Cloud Nine against the Edizone suit. The Supreme Court accepted certification to answer whether the defense costs in Edizone should be allocated between Ohio Casualty and Unigard under the "equal shares" method set forth in the "other insurance clause" of Ohio Casualty's policy, or, in the alternative, because the policies were issued for successive period, whether those defense costs should be allocated using the time-on-risk method described in Sharon Steel Corp. v. Aetna Casualty and Surety Co. The Court concluded that the "other insurance" clauses did not apply to successive insurers. Accordingly, defense costs should be apportioned using a modified version of the Sharon Steel method that divides responsibility for defense costs between the two insurers in proportion to their time on the risk.

In 2000, a fire destroyed a business location of Stone Flood and Fire Restoration Inc., spurring years of litigation with its insurer, Safeco Insurance Company of America. After Stone Flood and its two shareholders, James and Patrice Stone, sued Safeco in 2007, the district court dismissed all claims against Safeco. The court concluded (1) Stone Flood's claims on the insurance policy were filed three days beyond the applicable statute of limitations and were therefore barred; (2) the Stones were not insureds and lacked standing to bring individual claims under the policy; and (3) the Stones lacked standing to bring a claim of intentional infliction of emotional distress (IIED) because their alleged injuries were merely derivative of the corporation's. The Supreme Court reversed in part and affirmed in part, holding (1) the district court's calculation of the tolling of the limitations period was incorrect and a correct calculation saved Stone Flood's claims under the insurance policy; and (2) the district court properly concluded the Stones were not insureds and lacked standing to sue under the policy, and their claim of IIED failed for lack of a distinct, non-derivative injury. Remanded.

The underlying dispute in this appeal revolved around the issue of who was contractually obligated to pay workers' compensation benefits to an employee of Employer. The Supreme Court found that Employer's Insurer was required to pay workers' compensation benefits for all of Employer's employees and remanded the case. The district court entered a final judgment. Instead of filing a notice of appeal within thirty days of the district court's judgment, Insurer filed an "objection to judgment." Insurer then filed its notice of appeal within thirty days of the district court's order disposing of that motion. The Supreme Court dismissed the appeal, holding that it lacked jurisdiction to address the appeal as (1) Insurer did not file its notice of appeal within thirty days of the district court's final judgment, and (2) Insurer failed to file a postjudgment motion that would toll the time for appeal or one that the Court had jurisdiction to review.

When it was sued by its former president and CEO, the Equine Assisted Growth and Learning Association (EAGALA) requested coverage for the costs of its defense from its insurance carrier, Carolina Casualty. Carolina Casualty denied coverage, contending that the complaint was brought "by, on behalf of, or in the right of" EAGALA, a type of claim excluded from coverage by the insurance policy. EAGALA sued Carolina Casualty to establish coverage for the costs of defending the suit. The district court granted Carolina Casualty's motion for judgment on the pleadings and dismissed EAGALA's complaint after determining that it was unnecessary and improper for the court to consider extrinsic evidence to discern whether Carolina Casualty had a duty to defend EAGALA. The court of appeals reversed, concluding that under the language of the insurance policy, extrinsic evidence was admissible to determined whether the complaint was actually filed by, on behalf of, or in the right of EAGALA. On review, the Supreme Court affirmed the court of appeals' decision, holding that the district court erred when it refused to consider extrinsic evidence as required by the terms of the insurance policy.

Carter and Glenada Iverson were killed in a head-on collision with an underinsured motorist while driving a vehicle covered by their policy with State Farm. The personal representative of the Iversons' estate requested that State Farm provide underinsured motorist (UIM) coverage in an amount equal to the liability policy limits of $100,000. State Farm offered $20,000, the limit under the Iversons' policy for the UIM claims. Iverson sued State Farm in district court. The Supreme Court granted certification to answer whether an insurer may provide lower limits for underinsured motorist coverage than for liability coverage under Utah law. The Court concluded that (1) such coverage may comply with Utah law if the insurer follows the consumer notification requirements contained in the Utah Code; (2) because notification requirements differ depending on when the insured's policy was issued, a court must first determine whether a new policy existed on or after January 1, 2001; and (3) a new policy exists on or after this date when the insurer and the insured enter into a new contractual relationship or if changes are made to the terms of an existing insurance contract that materially alter the levels of risk contained in the contract.