Justia Insurance Law Opinion Summaries

In a consolidated appeal each of the insured businesses, SA Palm Beach, LLC, Emerald Coast Restaurants, Inc., Rococo Steak, LLC, and R.T.G. Furniture, Corporation, were denied after seeking coverage under an all-risk insurance policy that provides compensation for losses and expenses incurred in connection with “direct physical loss of or damage to” the covered property or “direct physical loss or damage to” the covered property. The Eleventh Circuit addressed the question of whether under Florida law, all-risk commercial insurance policies provide coverage for “direct physical loss of or damage to” property or “direct physical loss or damage to” property insure against losses and expenses incurred by businesses as a result of COVID-19. The court affirmed in part and vacated in part, the district court’s dismissal of the complaints. The court held that under Florida law there is no coverage because COVID-19 did not cause a tangible alteration of the insured property. The court reasoned that under Florida law, an insurance policy should be read “as a whole, endeavoring to give every provision its full meaning and operative effect.” Further, Florida Supreme Court has explained, that an “all-risk policy” does not extend coverage to “every conceivable loss.” Thus, the court found that it believes that the Florida Supreme Court would hold that, under the allegations in the complaints before the court, there is no coverage. The court vacated in part the dismissal of Emerald Coast’s complaint finding that the district court did not address the Plaintiff’s Spoilage provision claim. View "SA Palm Beach, LLC v. Certain Underwriters at Lloyd's London, et al." on Justia Law

Plaintiff sued Aegis Security Insurance Company (Aegis) for breach of contract, insurance bad faith, and declaratory relief after Aegis denied her tender of a lawsuit brought against her by her neighbors. The underlying lawsuit alleged Plaintiff graded land and cut down trees on her neighbors’ property. The trial court granted Aegis’s motion for summary judgment, holding Aegis had no duty to defend because Plaintiff’s homeowner’s policy did not provide coverage for nonaccidental occurrences. The Second Appellate District affirmed the Superior Court’s judgment granting summary judgment to Defendant. The court held that the evidence established that Defendant did not have a duty to defend. The court reasoned that the policy at issue covers property damage resulting from an occurrence, which is defined as an accident. Here, the complaint in the underlying action alleges harm from Plaintiff’s intentional conduct and these events were not unforeseen or accidental. Thus, Plaintiff failed to carry her burden to show the neighbors’ claims may fall within the scope of the policy. View "Ghukasian v. Aegis Security Ins. Co." on Justia Law

In March 2020, to prevent the spread of Covid-19, Illinois Governor Pritzker ordered all persons living in the state to stay at home except to perform specified “essential activities” and ordered “non-essential” businesses to cease all but minimum basic operations. Childcare providers were permitted to continue operating only with an emergency license to care for the children of essential workers. Michigan’s Governor Whitmer issued a similar order. Both states lifted those restrictions by June 2020. West Bend denied claims by childcare centers under their all-risk commercial property insurance policies.The policies cover the actual loss of income and expense due to the suspension of an insured’s operations “caused by direct physical loss of or damage to property”. The loss or damage must be caused by “[d]irect physical loss.” Lost income and extra expenses are covered when a civil authority prohibits access to insured premises because of damage at nearby property. The policies cover income lost and expenses incurred when an insured’s operations are temporarily suspended by government order "due to an outbreak of a ‘communicable disease’ … at the insured premises.”The district court concluded that the Centers had not plausibly alleged that COVID-19 caused physical loss of or damage to their property—or to nearby property— or that government shutdown orders were due to an outbreak at their premises. The Seventh Circuit affirmed, noting that other circuits have reached the same conclusion. View "Paradigm Care & Enrichment Center, L.L.C. v. West Bend Mutual Insurance Co." on Justia Law

Plaintiff-appellant John Coates brought an action for breach of contract and breach of the duty of good faith and fair dealing against defendant-appellee Progressive Direct Insurance Company. Plaintiff was injured after a motorcycle collision; he was insured by Progressive under a motorcycle policy, an auto policy, and a policy providing UM coverage. Coates moved for partial summary judgment regarding his entitlement to uninsured/underinsured motorist benefits. Progressive moved for summary judgment regarding Coates' bad faith claim. Coates sought more time to conduct discovery to address Progressive's counterclaim on bad faith. The trial court granted Coates' Motion for Partial Summary Judgment, allowing his UM claim against Progressive. The trial court also granted Progressive's Motion for Summary Judgment, denying Coates' claim for breach of duty of good faith and fair dealing. The trial court denied Coates' Motion for Additional Time to Respond. After review of the parties’ arguments on appeal, the Oklahoma Supreme Court affirmed the trial court’s grant of partial summary judgment on Coates' UM claim. The Court reversed, however, the decisions granting Progressive's Motion for Summary Judgment and denying Coates additional time to respond to that motion. View "Coates v. Progressive Direct Ins. Co." 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

Defendant Russell Blodgett appealed a superior court order granting summary judgment in favor of plaintiff Cincinnati Specialty Underwriters Insurance Company (CSU). Blodgett argued the trial court erred by concluding that the terms of a commercial general liability policy issued by CSU clearly and unambiguously excluded coverage for Blodgett’s damages in a separate personal injury action against CSU’s insured resulting from Blodgett’s fall from an alleged negligently constructed staircase. The New Hampshire Supreme Court concluded that, pursuant to the policy’s clear and unambiguous language, CSU had no duty or obligation to defend or indemnify its insured in the underlying litigation. View "Cincinnati Specialty Underwriters Insurance Company v. Best Way Homes, Inc. & a." on Justia Law

Hospitals provided emergency medical services to members of the county’s health plan, which is licensed and regulated by the state Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act, Health & Saf. Code 1340. The county reimbursed the Hospitals for $28,500 of a claimed $144,000. The Hospitals sued, alleging breach of an implied-in-fact or implied-in-law contract. The trial court rejected the county’s argument that it is immune from the Hospitals’ suit under the Government Claims Act (Gov. Code 810).The court of appeal reversed. The county is immune from common law claims under the Government Claims Act and the Hospitals did not state a claim for breach of an implied-in-fact contract. The county does not contest its obligation to reimburse the Hospitals for the reasonable and customary value of the services; the issue is what remedies may be pursued against the county when the reasonableness of the reimbursement is disputed. The Knox-Keene Act provides alternative mechanisms to challenge the amount of emergency medical services reimbursements. A health care service plan has greater remedies against a private health care service plan than it does against a public entity health care service plan, a result driven by the Legislature broadly immunizing public entities from common law claims and electing not to abrogate that immunity in this context. View "County of Santa Clara v. Superior Court" on Justia Law

Appellant Dameron Hospital Association (Dameron) required patients or their family members sign Conditions of Admissions (COAs) when Dameron provides the patients’ medical care. The COAs at issue here contained language assigning to Dameron direct payment of uninsured and underinsured motorist (UM) benefits and medical payment (MP) benefits that would otherwise be payable to those patients under their automobile insurance policies. Dameron treated five of AAA Northern California, Nevada & Utah Insurance Exchange’s (CSAA) insureds for injuries following automobile accidents. Those patients had UM and/or MP coverage as part of their CSAA coverage, and Dameron sought to collect payment for those services from the patients’ UM and/or MP benefits at Dameron’s full rates. Instead of paying to Dameron the lesser of either all benefits due to the patients under their UM and MP coverage, or Dameron’s full charges, CSAA paid portions of those benefits directly to the patients which left balances owing on some of Dameron’s bills. Dameron sued CSAA to collect UM and MP benefits it contended CSAA owed Dameron under the assignments contained in the COAs. The trial court concluded that Dameron could not enforce any of the assignments contained in the COAs and entered summary judgment in CSAA’s favor. After its review, the Court of Appeal held Dameron could not collect payment for emergency services from the UM or MP benefits due to patients that were covered under health insurance policies. Additionally, the Court found: (1) the COA forms were contracts of adhesion; (2) it was not within the reasonable possible expectations of patients that a hospital would collect payments for emergency care directly out of their UM benefits; and (3) a trier of fact might find it is within the reasonable expectations of patients that a hospital would collect payments for emergency care directly out of their MP benefits. Accordingly, the Court concluded Dameron could not maintain causes of action to collect MP or UM benefits due to four of the five patients directly from CSAA. However, consistent with its opinion, the trial court could consider whether an enforceable assignment of MP benefits was made by one adult patient. View "Dameron Hospital Assn. v. AAA Northern Cal., Nevada etc." on Justia Law

The Supreme Court vacated the order of the circuit court entering summary judgment in favor of Alexis Still in this dispute over whether there was a settlement agreement between the parties, holding that there was no settlement agreement between the parties.Clifton Jameson and Still were involved in an automobile accident. Jameson sent MetLife, Still's insurer, an offer to settle. MetLife made a counteroffer. Jameson took the counteroffer as a rejection of his offer to settle and sued Still for damages arising from the accident. MetLife then attempted to accept Jameson's original settlement offer. The circuit court granted summary judgment for Still, concluding that MetLife's counteroffer did not terminate the settlement offer and that its subsequent letter of acceptance created a settlement agreement between the two parties. The Supreme Court vacated the judgment, holding that that the circuit court erred in granting summary judgment on the basis of settlement because no settlement agreement was reached. View "Jameson v. Still" on Justia Law

In this insurance dispute, the Supreme Court affirmed the orders of the circuit court granting partial summary judgment to Insured, denying summary judgment to Insurer, and awarding Insured her attorney's fees, holding that there was no error.At issue in this case was the "medical payments coverage" provision in Insured's automobile insurance contract that required that Insurer reimburse Insured for any medical expenses she "incurred" in an accident. The circuit court concluded that the contract obligated Insurer to reimburse Insured the full amount of Insured's medical bill she received after an automobile accident and further concluded that Insurer was required to reimburse Insured for her attorney's fees. The Supreme Court affirmed, holding (1) there was no error in the circuit court's interpretation of the medical payments provision in the insurance contract; and (2) there was no error in the circuit court's rulings on costs and attorney's fees. View "Auto Club Property Casualty Insurance Co. v. Moser" on Justia Law