Justia Insurance Law Opinion Summaries

ECE's movie theaters lost money after North Carolina's Governor imposed statewide closures in response to COVID-19. ECE’s insurance policy with HCC provides: We will pay the actual loss of Business Income you sustain due to the necessary “suspension” of your “operations” during the “period of restoration.” The “suspension” must be caused by direct physical loss of or damage to property at premises that are described in the Declarations and for which a Business Income Limit of Insurance is shown in the Declarations. The loss or damages must be caused by or result from a Covered Cause of Loss. A “Civil Authority” provision covers “the actual loss of Business Income you sustain and necessary Extra Expense caused by action of civil authority that prohibits access to the described premises due to direct physical loss of or damage to property, other than at the described premises, caused by or resulting from any Covered Cause of Loss.”After HCC denied ECE’s claim, the district court dismissed ECE’s suit. ECE argued that the policy covered losses due to COVID-related closures because the virus rendered ECE’s property unsafe. The Seventh Circuit affirmed the dismissal. ECE alleged neither a physical alteration to property nor an accessor use-deprivation so substantial as to constitute physical dispossession. View "East Coast Entertainment of Durham, LLC v. Houston Casualty Co." on Justia Law

Relator Gilbert Ellinger brought a qui tam suit on behalf of the People of the State of California against Zurich American Insurance Company (Zurich), ESIS, Inc. (ESIS), and Stephanie Ann Magill, under Insurance Code section 1871.7, a provision of the Insurance Frauds Prevention Act (IFPA). In January 2016, Ellinger injured his back while working, and he immediately informed his supervisor. The following month, Ellinger reported to his employer’s human resources manager that he had sustained a work-related injury and had told his supervisor about it. The human resources manager created a “time line memorandum” summarizing the conversations she had with Ellinger about the injury. She placed the memorandum in Ellinger’s personnel file. Ellinger filed a workers’ compensation claim. Magill worked as a senior claims examiner for ESIS and was the adjuster assigned to investigate Ellinger’s claim. ESIS denied Ellinger’s claim on an unspecified date. Magill later testified that she denied the claim because of a written statement from Ellinger’s supervisor in which the supervisor claimed that Ellinger had not reported the injury to him. When the human resources manager was deposed in November 2016, she produced the time line memorandum, which Ellinger’s counsel in the workers’ compensation action did not know about until then. Nearly eight months after that disclosure, in July 2017, ESIS reversed its denial of the claim and stipulated that Ellinger was injured while working, as he had alleged. Contrary to Magill’s testimony, her email messages showed that the human resources manager had emailed Magill the time line memorandum in March and April 2016, and Magill thanked the manager for sending it. Ellinger alleged that Magill’s concealment of or failure to disclose the time line memorandum violated Penal Code section 550 (b)(1) to (3). On the basis of those alleged violations, Ellinger alleged that defendants were liable under section 1871.7. Against each defendant, Ellington sought a civil penalty and an assessment of no greater than three times the amount of his workers’ compensation claim. The trial court sustained defendants’ demurrers without leave to amend, concluding defendants could not be held liable under section 1871.7 for any failures of Magill in the claims handling or review process. Finding no reversible error in sustaining the demurrers, the Court of Appeal affirmed. View "California ex rel. Ellinger v. Magill" on Justia Law

This appeal involved a challenge to how Geico General Insurance Company (“GEICO”) processed insurance claims under 21 Del. C. 2118. Section 2118 provided that certain motor vehicle owners had to obtain personal injury protection (“PIP”) insurance. Plaintiffs, all of whose claims for medical expense reimbursement under a PIP policy were denied in whole or in part, were either GEICO PIP policyholders who were injured in automobile accidents or their treatment providers. Plaintiffs alleged GEICO used two automated processing rules that arbitrarily denied or reduced payments without consideration of the reasonableness or necessity of submitted claims and without any human involvement. Plaintiffs argued GEICO’s use of the automated rules to deny or reduce payments: (1) breached the applicable insurance contract; (2) amounted to bad faith breach of contract; and (3) violated Section 2118. Having reviewed the parties’ briefs and the record on appeal, and after oral argument, the Delaware Supreme Court affirmed the Superior Court’s ruling that the judiciary had the authority to issue a declaratory judgment that GEICO’s use of the automated rules violated Section 2118. The Supreme Court also affirmed the Superior Court’s judgment as to the breach of contract and bad faith breach of contract claims. The Court concluded, however, that the issuance of the declaratory judgment was improper. View "GEICO General Insurance Company v. Green" on Justia Law

The Supreme Court affirmed the order of the district court denying Appellant's motion for summary judgment and granting summary judgment in favor of United Services Automobile Association (USAA) in this insurance dispute, holding that the district court did not err.Appellants filed a complaint alleging that USAA violated its duty to defend Shawn Conrad, one of USAA's insured policy-holders against whom Appellants had obtained a judgment. The district court granted summary judgment for USAA, concluding that USAA had no duty to defend Conrad because his conduct against Appellants did not fall within the scope of the policy's coverage. The Supreme Court affirmed, holding (1) Appellants' claims against Conrad were beyond the scope of coverage in USAA's policy; and (2) therefore, USAA did not have a duty to defend Conrad. View "R.S. v. United Services Automobile Ass'n" on Justia Law

While driving the co-plaintiffs car, the plaintiff negligently changed lanes and caused a collision, seriously injuring another driver. At the time of the incident at-fault car’s owner had a GEICO insurance policy that provided bodily-injury coverage up to $100,000 per person. The victim and Geico assert they made offers to settle, but the parties never agreed. After the conclusion of the victim's lawsuit, plaintiffs sued GEICO for bad faith, seeking to recover the amounts of the final judgments entered against them that exceeded the $100,000 policy limit. They contended that GEICO had breached its fiduciary duty to them by failing to settle the victim’s case within the policy limit. Plaintiffs challenge Cawthorn v. Auto-Owners Insurance Co 791 F. App’x 60, 65 (11th Cir. 2019), arguing that Florida law doesn’t require that a verdict precede an excess judgment as a prerequisite to proving the causation element of an insurer-bad-faith claim. The court reasoned that plaintiffs' available coverage and final judgments entered against them constituted excess judgments. Thus, plaintiffs could prove causation in their bad-faith case because they were subject to excess judgments. Finally, the court declined to follow Cawthorn because that court incorrectly analyzed Florida's bad-faith law and is unpersuasive. View "Erika L. McNamara v. Government Employees Insurance Company" on Justia Law

The Court of Chancery granted a motion sought by the Insurance Commissioner of the State of Delaware (the Commissioner) asking the Court of Chancery to permit Scottish Re (U.S.) Inc. (the Company), a delinquent insurer, to make payments to a subset of primary insurers (cedents) for a portion of their losses, holding that the Commissioner was authorized to cause the Company to make the payments.The Company, a reinsurer, entered into reinsurance agreements with cedents in which the Company agreed to pay a portion of the losses that their insurers suffered. The Company was later placed in receivership, and the Commissioner was appointed as receiver. The Company stopped paying its cedents for the losses they incurred while the cedents continued to make premium payments to the Company. The Commissioner asked the Court to permit the company to make the payments tissue before the approval of a rehabilitation plan. The Court of Chancery granted the motion, holding that the Commissioner established a prima facie case sufficient for the Court to grant the motion. View "In re Rehabilitation of Scottish RE (U.S.), Inc." on Justia Law

A water control and improvement district in Harris County, Texas ("the District"), wanted a new headquarters, so it contracted with a construction company to build one. The District required the company to post a performance bond. The company engaged Philadelphia Indemnity Insurance Co. (“Philadelphia”) to provide that bond, which explicitly stated that changes to the construction contract would not void Philadelphia’s obligations. However, the District’s project manager backed out, which led the District to execute a new agreement without Philadelphia’s knowledge or consent. The District sought what was owed under the performance bond and sued for breach of contract.At issue is whether a 2016 Agreement created a new contract between the District and the construction company or merely amended their 2015 Agreement. The court concluded that the 2016 Agreement was an amendment under Texas law. The court reasoned that the Supreme Court of Texas would examine the text of both agreements to identify the parties' objective intent. The court concluded the 2016 Agreement amended—instead of replaced—the 2015 Agreement. Thus, the court reversed and remanded the case, placing no limits on the matters that the district court may address on remand. View "Harris Cty v. Philadelphia Indem" on Justia Law

Tarango Trucking, L.L.C. (“Tarango”) appeals from a judgment declaring that its insurer, Penn-America Insurance Company (“PennAmerica”), owes neither defense nor indemnity concerning third-party claims against Tarango concerning a fatal accident on its property.At the time of the accident, Tarango was insured under a commercial general liability policy issued by Penn-America (“the Policy”). Penn-America defended Tarango but reserved its right to contest coverage. Texas law governs the insurance issues in this diversity case. The Policy contains both a duty to defend and a duty to indemnify. PennAmerica must show that the plain language of an exclusion avoids coverage of all claims within the confines of the eight-corners rule. Penn-America argues that the Policy’s Auto Exclusion satisfies this burden. Because the Parking Exception is an exception to the Auto Exclusion, it is reasonable to interpret it as employing the same “arising-out-of” nexus as the Auto Exclusion.The Fifth Circuit held that the Parking Exception applies to bodily injury and property damage arising out of parking. Because the petition alleges some claims that arise out of parking and are potentially covered by the Policy, Penn-America must defend Tarango. The court also held that it was premature for the district court to decide the indemnity issue. View "Penn-America Ins v. Tarango Trucking" on Justia Law

Cardinal, a distributor of wholesale pharmaceutical products, purchased commercial umbrella insurance policies from National Union. Various plaintiffs have filed more than 3,000 lawsuits against Cardinal and other manufacturers, distributors, and dispensers of prescription opioids. The majority of federal cases are consolidated in coordinated, multi-district proceedings in the Northern District of Ohio. Plaintiffs “assert a wide variety of federal and state causes of action, many seeking to recover for increased payments, services, treatment, and/or care allegedly necessitated by the opiate-related addictions, overdoses, and deaths of those they serve.”National Union has reserved its right to deny coverage for opioid litigation claims. Cardinal sought a declaratory judgment in the Franklin County, Ohio Court of Common Pleas. National Union removed the suit to the Southern District of Ohio. The district court granted Cardinal’s motion and remanded the case to state court. The Sixth Circuit affirmed. The district court found no evidence of procedural fencing and properly declined to weigh that factor in favor of federal jurisdiction. The court noted a preference to allow state courts to answer questions of insurance contract interpretation and the actively developing nature of insurance coverage claims related to opioid litigation in Ohio state courts. The district court adhered to the principles of federalism and comity and engaged in a reasoned analysis of each factor in declining jurisdiction. View "Cardinal Health, Inc. v. National Union Fire Insurance Co. of Pittsburgh" on Justia Law

The Supreme Court vacated the order of the superior court granting the motion for judgment on the pleadings filed by Defendant in this insurance dispute, holding that the grant of judgment on the pleadings for Defendant was erroneous.The roof at Plaintiffs' home collapsed due to accumulating ice and snow. The property was insured through a policy issued by Defendant. Plaintiffs invoked the appraisal provision of the policy and later brought a second amended complaint alleging that Defendant had breached the terms of the policy by not performing a complete investigation and had acted in bad faith in the handling of their claim. The motion justice granted Defendant's motion for judgment on the pleadings, concluding that Plaintiffs could not maintain an action for breach of contract against Defendant. The Supreme Court vacated the judgment below, holding that the allegations, as pled, could support a claim for breach of contract or breach of the implied covenant of good faith and fair dealing. View "Houle v. Liberty Insurance Corp." on Justia Law