Justia Insurance Law Opinion Summaries

In 2014, Michael Messier and Kay Bushman were involved in an auto accident. Both were the drivers of their respective vehicles and were then-alleged to be Vermont residents. In 2017, shortly before the statute of limitations was to expire, Messier filed suit against Bushman and her auto insurer, Travelers, for damages he claimed to have sustained in the accident. The claim against Bushman sounded in negligence, the claim against Travelers asserted breach of the Vermont Consumer Protection Act (CPA). The trial court granted a motion for judgment on the pleadings filed by Bushman and a motion to dismiss filed by Travelers. Messier appeals both decisions. The Vermont Supreme Court determined the motion filed by Bushman was one that challenged the sufficiency of service of process: the trial court, without holding an evidentiary hearing, found that Messier did not send a copy of the return of service on the Commissioner to Bushman as required by 12 V.S.A. 892(a). The Supreme Court reversed as to Bushman's motion because the issues concerning what was included in the mailing and whether the affidavit contained sufficient specificity to comply with section 892(a) were contested and needed to be resolved through factual determination by the trial court. Regarding Messier's claim against Travelers, the Supreme Court found his claim was brought under the CPA, but references unfair claims settlement practices which were part of Vermont Insurance Trade Practices Acts (ITPA). The Court found Messier did not purchase anything from Travelers- his only connection was that Bushman was insured by Travelers. Thus, Messier was not a consumer with respect to Bushman's Travelers insurance policy, and therefore had to CPA claim against them. The case was remanded for further proceedings with respect to the claim against Bushman; dismissal of the claim against Travelers was affirmed. View "Messier v. Bushman" on Justia Law

In December 2009, defendant Randell Blake was convicted of filing a false insurance claim in connection with a 2007 fire at his house. Subsequent to his criminal convictions, the trial court ordered defendant to pay restitution to his insurer, Safeco Insurance Company of America (Safeco). Defendant appealed the trial court’s restitution order, arguing the order should be vacated because a general release, signed by Safeco in a related civil case, relieved him of any duty to pay it restitution. He also argued the order should be vacated because the trial court failed to make findings regarding his ability to pay restitution. The Vermont Supreme Court found that restitution and civil damages originated within separate systems, were not substitutes for each other; a civil court’s award of damages to a plaintiff did not discharge the criminal court’s duty or authority to consider and order restitution. Therefore, a civil settlement or release cannot entirely preclude a criminal restitution order because: (1) the statutory obligation to impose restitution when necessary leaves no room for private parties to preclude a court from ordering it; (2) a release does not address the underlying purposes of restitution; and (3) the victim has no standing and is not a party in the restitution proceeding, and may seek a separate remedy in an action for civil damages. Here, defendant initiated a civil suit against Safeco for payment he claimed it owed him relating to the house fire and Safeco counterclaimed. The exchange of releases extinguished these competing civil claims. The release Safeco signed did not, however, preclude an order of restitution in the related criminal proceeding. The Supreme Court therefore affirmed the trial court’s determination on this matter; but reversed because the trial court by not considering his ability to pay. View "Vermont v. Blake" on Justia Law

Wilbur Shriner, the holder of a homeowner’s insurance policy from Amica Mutual Insurance Company (Amica), appealed the trial court’s grant of summary judgment to Amica and denial of his cross-motion for summary judgment. Shriner owned a glassblowing studio in Burlington until he sold the property in December 2007 and moved the glassblowing equipment to his home in Charlotte. He and his friend set up the equipment in the garage at Shriner’s property and began making glass in late 2008 or early 2009. From 2009 to 2012, Shriner and his friend “sometimes made glass for a week or two, and then would shut down for weeks due to lack of money.” During that three-year period, they made glassware approximately one time per week on average, and glassmaking was never more than an occasional or part-time activity for him. Throughout those three years, Shriner earned income from glassblowing, as well as from the redevelopment and rental of investment properties and from an organic honey and vegetable operation. In early 2012, the furnace exhaust system in a piece of glassmaking equipment malfunctioned and caused a fire that destroyed the garage and all of the property and equipment inside it. At the time, Shriner’s home was covered by his homeowner’s policy with Amica, which covered losses from fire and provided replacement coverage for buildings and personal property. The policy carried a $25,000 deductible and contained an exclusion from coverage for structures from which a business was conducted. Shriner submitted a personal property inventory for the property destroyed in the fire, with a replacement cost totaling $88,354.91. Amica accepted Shriner’s fire-loss claim and determined the replacement cost of the garage to be $42,422.97. Amica applied the policy’s $25,000 deductible and made an actual cash-value payment of $1460.53 as an advance partial payment to Shriner for the garage. Amica then changed positions and, asserting that Shriner’s glassblowing activities constituted a “business” for the purposes of the policy’s exclusion, refused to make any further payments to replace the garage. Amica paid Shriner $11,613 for nonbusiness property that was destroyed in the garage but capped its payment for other property in the inventory at $2500, which was the maximum reimbursement permitted under the policy for “business” personal property. Shriner brought suit to recover the full amount of his claim, and the court granted summary judgment to Amica. This appeal followed. Finding no reversible error, the Vermont Supreme Court affirmed. View "Shriner v. Amica Mutual Ins. Co." on Justia Law

This case stems from the rate filing submitted to the Green Mountain Care Board (GMCB) by MVP Health Insurance Company (MVP) with respect to the Agri-Services health insurance plan. The State of Vermont, GMCB found that the 2015 Agri-Services rate filing would not promote access to quality health care and denied it for that reason. MVP appealed, arguing: (1) that GMCB’s disapproval was an arbitrary use of discretion based on vague standards that unconstitutionally delegated authority to GMCB; (2) that GMCB’s decision was not supported by the record; and (3) that GMCB’s statutory interpretation of its authority was compelling error. After review, the Supreme Court held that 8 V.S.A. 4062 was constitutional, but found that GMCB’s conclusions were not supported by specific findings on the statutory criteria required for approval of health insurance rates and, accordingly, reversed and remanded for new findings. View "In re MVP Health Insurance Company" on Justia Law

Defendant Dylan Stinson appealed a judgment finding him liable to plaintiffs Kevin and Linda Flanagan for damage to their vacation home from a fire started in an outdoor fireplace on their deck by a group of teenagers who were there without their permission. Stinson contended that: (1) there was insufficient evidence to find him liable for the damage under a concerted-action theory; (2) it was improper for the trial court to admit and rely on evidence of the actual cash value of the lost personal property; and (3) the pre and postjudgment interest rate awarded by the trial court was unconstitutional under the U.S. and Vermont Constitutions. Finding no reversible error, the Supreme Court affirmed. View "Concord General Mutual Insurance Company v. Gritman" on Justia Law

Plaintiffs Neil and Patricia Whitney asserted that damage to their home and personal property resulting from the spraying within their home of a pesticide known as chlorpyrifos was covered by their homeowners policy. Defendant Vermont Mutual Insurance Company argued that the pollution exclusion in the policy barred the Whitneys’ claim. The superior court granted the Whitneys’ summary judgment motion on the question of coverage, concluding that the exclusion in question was ambiguous, and construing the ambiguous provision in favor of coverage. After review of the policy at issue, the Supreme Court concluded that the property damage to the Whitneys’ home was an excluded risk in the policy and reversed. View "Whitney v. Vermont Mutual Insurance Company" on Justia Law

Plaintiff Nicholas Bonnano appealed the superior court’s grant of summary judgment against him and in favor of his employer, Verizon, and Verizon’s third-party claims administrator, Sedgwick Claims Management. Plaintiff’s claims stemmed from an alleged breach of a settlement agreement with employer regarding his workers’ compensation claim. On appeal, plaintiff argued that the trial court erred because there was a dispute of material fact as to the voluntariness of employer’s temporary total disability (TTD) payments made to plaintiff after the TTD termination date indicated in the settlement. Finding no reversible error, the Supreme Court affirmed the superior court in all respects. View "Bonanno v. Verizon Business Network Systems" on Justia Law

In consolidated appeals, petitioners, both recipients of home-based long-term care benefits through Vermont's Medicaid-funded Choices for Care (Choices) program, appealed decisions of the Human Services Board disallowing deductions for personal care services from their patient-share obligation under federal and state Medicaid laws. Upon review of the cases, the Supreme Court concluded that to the extent the services in question were medically necessary, expenses for those services must be deducted from petitioners’ patient-share obligation even if they are of a type generally covered by Medicaid. Furthermore, the Court rejected the State’s claim that the decision of the Department of Disabilities, Aging and Independent Living not to provide the personal care services in question under the Choices program constituted a conclusive finding that the services were not medically necessary. View "In re Brett" on Justia Law

Appellant Windham County Sheriff’s Department (WCSD) appealed a decision of the Employment Security Board that held it liable for reimbursement of unemployment compensation benefits as a base-period employer of a former employee. WCSD argued that because the employee was terminated for gross misconduct, and because an amendment to the statute governing reimbursement of unemployment compensation benefits that would have removed its liability for payments for employees terminated for gross misconduct took effect before the employee became eligible to receive any benefits, it should not have been held liable for reimbursement payments. Finding no error in the Board's decision, the Supreme Court affirmed. View "Windham County Sheriffs Department v. Department of Labor" on Justia Law

At issue in this case was whether the omnibus clause in a automobile insurance policy provided coverage to a permittee to whom the insured owner loans the car when that first permittee was subject to a negligent entrustment claim for loaning the car to a second permittee. A vehicle owner gave her car keys to defendant, who in turned passed them to another driver. The driver was involved in a fatal, single-car accident and the driver's estate sued defendant for negligent entrustment. Defendant sought coverage under the vehicle owner's automobile insurance policy. Defendant appealed the trial court's order granting summary judgment in favor of the insurer and finding that, as a matter of law, defendant did not qualify for coverage under the policy. Upon review of the trial court record, the Supreme Court concluded that defendant’s entrustment of the vehicle to the driver constituted "use" under the omnibus clause of the policy and that the undisputed evidence supported the conclusion that the insured did not consent to defendant's allowing the driver to drive the car, but that a material issue of fact existed with respect to whether defendant entrusted the car keys to driver reasonably believing that driver would not drive the car. Accordingly, the Court reversed and remanded the case for further proceedings. View "State Farm Mutual Automobile Co. v. Colby" on Justia Law