Justia Insurance Law Opinion Summaries

Under the “individual mandate” within the Patient Protection and Affordable Care Act of 2010, non-exempt individuals must either maintain a minimum level of health insurance or pay a “penalty,” 26 U.S.C. 5000A, the “shared responsibility payment” (SRP). The McPhersons did not maintain health insurance for part of 2017, and Juntoff did not maintain health insurance in any month in 2018. They did not pay their SRP obligations. In each of their Chapter 13 bankruptcy cases, the IRS filed proofs of claim and sought priority treatment as an “excise/income tax”: for Juntoff, $1,042.39, and for the McPhersons, $1,564.The bankruptcy court confirmed their plans, declining to give the IRS claims priority as a tax measured by income. The Bankruptcy Appellate Panel reversed. DIstinguishing the Sebelius decision in which the Supreme Court determined that the SRP constituted a “penalty” for purposes of an Anti-Injunction Act analysis and a “tax” under a constitutionality analysis, the Panel concluded that the SRP is not a penalty but a tax measured by income. It is “calculated as a percentage of household income, subject to a floor based on a specified dollar amount and a ceiling based on the average annual premium the individual would have to pay for qualifying private health insurance.” View "In re: Juntoff" on Justia Law

Wolfe, who was enrolled in VA health care, obtained emergency treatment at a non-VA health care facility, incurring expenses of $22,348.25. Her employer-sponsored healthcare contract covered most of the expenses. She was responsible for a copayment of $202.93 and coinsurance of $2,354.41. The VA denied reimbursement of those expenses; 38 U.S.C. 1725(c)(4(D) bars reimbursement for “any copayment or similar payment.” Wolfe filed a Notice of Disagreement; rather than await the outcome of her appeal, Wolfe also filed a mandamus petition. The Veterans Court certified her requested class and granted her petition, invalidating a VA regulation prohibiting the reimbursement of deductibles and coinsurance for being within the category of “similar payments,” and requiring the VA to re-adjudicate claims denied under the invalidated regulation.The Federal Circuit reversed. Deductibles are excluded from reimbursement under the correct interpretation of the statute and other adequate remedies (appeal) were available with respect to coinsurance, so mandamus was inappropriate. Coinsurance is the type of partial coverage that Congress did not wish to exclude from reimbursement. View "Wolfe v. McDonough" on Justia Law

North Dakota Insurance Reserve Fund (“NDIRF”) appealed a judgment and orders granting Lance Hagen’s amended petition for a writ of mandamus requiring NDIRF to disclose documents under the open records law. NDIRF argued: (1) the amended petition was untimely; (2) NDIRF was not a public entity subject to open records requests; and (3) the documents sought were protected from disclosure under North Dakota court rules. Hagen cross appealed, arguing the district court erred by not requiring NDIRF to disclose all of the documents he sought and by denying him costs and attorney’s fees. After review, the North Dakota Supreme Court affirmed in part, concluding the amended petition was timely, NDIRF was a public entity for purposes of the open records law, and the records sought were not exempt from disclosure. The Court reversed the part of the judgment and orders excluding records from disclosure, and remanded to the district court to review in camera those previously excluded records and those records identified in Appellant’s Brief to determine whether they were exempt from disclosure under the potential liability exception in N.D.C.C. 44-04-19.1(8). The Court affirmed the denial of costs and attorney’s fees. View "Hagen v. North Dakota Insurance Reserve Fund" on Justia Law

In March 2012, First Solar, Inc. stockholders filed a class action lawsuit against the company alleging that it violated federal securities laws by making false or misleading public disclosures ("Smilovits Action"). National Union Fire Insurance Company of Pittsburgh, PA (“National Union”) provided insurance coverage for the Smilovits Action under a 2011–12 $10 million “claims made” directors and officers insurance policy. While the Smilovits Action was pending, First Solar stockholders who opted out of the Smilovits Action filed what has been referred to as the Maverick Action. The Maverick Action alleged violations of the same federal securities laws as the Smilovits Action, as well as violations of Arizona statutes and claims for fraud and negligent misrepresentation. In this appeal the issue presented for the Delaware Supreme Court's review was whether the Smilovits securities class action, and a later Maverick follow-on action were related actions, such that the follow-on action was excluded from insurance coverage under later-issued policies. The Superior Court found that the follow-on action was “fundamentally identical” to the first-filed action and therefore excluded from coverage under the later-issued policies. The Supreme Court found that even though the court applied an incorrect standard to assess the relatedness of the two actions, judgment was affirmed nonetheless because under either the erroneous “fundamentally identical” standard or the correct relatedness standard defined by the policies, the later-issued insurance policies did not cover the follow-on action. View "First Solar, Inc. v. National Union First Insurance Company of Pittsburgh, PA" on Justia Law

The Fourth Circuit affirmed the district court's certification of the class and the approval of the insurance class action settlement. The settlement agreement requires Banner to refund to class members a portion of the money they had paid, with a minimum of $100 per class member, and provides some nonmonetary benefits, with a total value of roughly $40 million.The court concluded that the Allen Trust's argument that the district court improperly placed upon it the burden of overcoming the settlement provides no basis for reversal; the district court did not abuse its discretion in determining that the Dickman class met the requirements of class certification under Federal Rule of Civil Procedure 23(a); and the district court did not abuse its discretion in determining that the settlement was fair, reasonable, and adequate under Rule 23(e)(2). View "1988 Trust For Allen Children v. Banner Life Insurance Co." on Justia Law

Star, a mine staffing company, bought workers’ compensation insurance from Granite. Early in each policy year, Star gave Granite an estimate of its total payroll, which Granite used to calculate an estimated premium. Star paid the preliminary installment. After each year, Granite audited Star’s records to produce an exact payroll number, then charged additional premiums or made reconciliation payments. A 2018 audit revealed that Star had significantly underestimated its 2017 payroll, as it had for 2016. To avoid a similar situation with the 2018 policy, Granite adjusted its estimated premium for Star halfway through the year. In accordance with industry guidelines, Granite increased Star’s 2018 estimated premium to reflect 2017’s actual payroll numbers, giving Star four weeks to pay the difference. Star never paid. Granite canceled the policy three months early. Star closed its business. To determine Star’s final premium—and whether it owed a reconciliation payment—Granite needed to complete its year-end audit. Star would not comply. Granite’s final bill, including the updated estimated premium, prorated for early cancellation, was $1,485,323, including an “audit noncompliance charge” (double 2018’s total estimated premium).Granite sued for breach of contract. The Sixth Circuit affirmed summary judgment for Granite, rejecting Star’s argument that the noncompliance charge is an unenforceable penalty. Kentucky’s insurance regulator approved the rates that Kentucky insurance companies charge, barring their review. View "Granite State Insurance Co. v. Star Mine Services, Inc." on Justia Law

Robinson submitted an “uninsured driver” claim to State Farm for injuries sustained in an accident involving her car and an unidentified vehicle. Coverage was available only if the two cars came into contact. (Ins. Code 11580.2(b)(1).) In arbitration, State Farm propounded requests for admissions that there was either no contact between the two cars or that no damage resulted from any contact. Robinson failed to respond by the due date. After finding that Robinson had not “substantially complied” with Code of Civil Procedure sections 2033.220 or 2015.5, the court deemed the requests admitted and awarded sanctions. Robinson unsuccessfully moved to withdraw or amend the deemed admissions, citing inadvertence. The arbitrator entered an award in favor of State Farm, relying on the established admissions.The trial court confirmed the award. The court of appeal affirmed. In typical arbitration proceedings, discovery disputes are resolved by the arbitrator but in uninsured-motorist arbitration proceedings, discovery disputes are resolved by a trial court. Trial court discovery orders in these proceedings are not reviewable on appeal from a judgment confirming the arbitration award. A party’s recourse to challenge an allegedly improper discovery ruling in an uninsured-motorist arbitration proceeding is through a timely petition for a writ of mandamus. View "State Farm Mutual Automobile Insurance Co. v. Robinson" on Justia Law

The federal district court for the District of Colorado certified a question of law to the Colorado Supreme Court. In July 2020, Alexis Skillett was involved in a car accident. At the time of the accident, Allstate Fire and Casualty Insurance Company (“Allstate”) insured Skillett under a policy that included underinsured motorist coverage. Skillett settled with the at-fault driver and his insurer and also filed a claim with Allstate for underinsured motorist benefits. Allstate assigned one of its employees, Collin Draine, to handle Skillett’s claim. Draine concluded Skillett was not entitled to underinsured motorist benefits. Skillett filed suit in Denver District Court, naming both Allstate and Draine as defendants. Her claims against Allstate included breach of contract, statutory bad faith, and common law bad faith. As to Draine, she alleged that he had personally violated section 10-3-1116, which creates a cause of action for insureds whose insurance benefits have been unreasonably delayed or denied. The certified question asked the Supreme Court whether an employee of an insurance company who adjusts an insured’s claim in the course of employment could, for that reason, be liable personally for statutory bad faith under Colorado Revised Statutes Sections 10-3-1115 and -1116. Given the plain statutory language, the Supreme Court answered that question in the negative: "An action for unreasonably delayed or denied insurance benefits under Colorado law may be brought against an insurer, not against an individual adjuster acting solely as an employee of the insurer." View "Skillet v. Allstate" on Justia Law

The Fourth Circuit held that, under West Virginia law, the insurance policy language requiring a "physical loss" or "physical damage" unambiguously covers only losses caused by, or relating to, material destruction or material harm to the covered property. In this case, the insured seeks coverage for lost business income and other expenses resulting from the Covid-19 virus and a related, state government order temporarily halting non-essential business activities. Although the court, like the district court, recognized that the insured and other businesses suffered severe losses during the period that the closure order was in effect, the court concluded that under the unambiguous terms of the policy, coverage is not available for the insured's loss of business income and related expenses absent material destruction or material harm to the covered property. Accordingly, the court affirmed the district court's dismissal of the complaint. View "Uncork and Create LLC v. The Cincinnati Insurance Co." on Justia Law

In an interlocutory appeal, the issue this case presented for the Vermont Supreme Court's review was whether Vermont or Georgia law applied to a coverage dispute between claimant Bestwall LLC and insurer Ambassador Insurance Company. Bestwall contended that the trial court erred in concluding that Vermont law applied following the special master’s prediction that Georgia courts would adopt the same loss-allocation method as Vermont. But because Georgia law was unsettled on this issue, the Vermont Supreme Court concluded there was no conflict with Vermont law and accordingly, Vermont law applied. The Court therefore affirmed the trial court’s grant of partial summary judgment to Ambassador. View "In re Ambassador Insurance Company (Bestwall LLC, Appellant)" on Justia Law