Justia Insurance Law Opinion Summaries

The Fifth Circuit affirmed the denial of insurance benefits in an action brought by plaintiff, seeking benefits in the amount of $300,000 following her husband's death. The court concluded that plaintiff's estoppel claim failed where her reliance on NOV's statements and deductions were not reasonable because the provision of the group life insurance policy that required her husband to complete an Evidence of Insurability form before coverage could begin was unambiguous. In this case, plaintiff's husband was on notice that coverage applied for during an annual enrollment period began at midnight following the later of two conditions: (1) the first day of the next plan year; and (2) the date Unum approved his evidence of insurability form for life insurance. Furthermore, the Summary of Benefits made clear that this was also the case for changes in coverage, and that NOV's representations were not Unum's. Therefore, the district court did not err in granting summary judgment to NOV on plaintiff's estoppel claim. View "Talasek v. National Oilwell Varco, LP" on Justia Law

The Eighth Circuit affirmed the district court's judgment holding that Safeco was not liable for coverage for a claim stemming from an accident involving an uninsured driver. In this case, the insured was killed when her motorcycle collided with a car driven by the uninsured driver. The court concluded that the district court did not err in determining that coverage for the accident was excluded under the insurance policy's motorcycle exclusion. Therefore, the policy unambiguously excluded coverage for the insured's accident. View "Safeco Insurance Co. of Illinois v. Palazzolo" on Justia Law

Peggy Baltar’s home was destroyed by wildfire in 2014. She had a new house built on the same property. Her insurer, CSAA Insurance Exchange (CSAA), paid the full amount charged by her contractor for construction of the new house. Altar sued for breach of contract and breach of the implied covenant of good faith and fair dealing. According to Baltar, CSAA breached the policy by, among other things, failing to provide her with a complete and accurate estimate for replacing the original house, which would have provided her with a budget for the construction of the new house. Without such a budget, she claimed she was forced to build a cheaper house than the one destroyed by the fire. She claimed this, and other asserted breaches of the policy, amounted to bad faith and entitled her to punitive damages. The trial court granted CSAA’s motion for summary judgment and entered judgment in favor of the company. Baltar appealed, but finding no reversible error, the Court of Appeal affirmed. View "Janney v. CSAA Insurance Exchange" on Justia Law

The Travelers Indemnity Company of Connecticut (Travelers) appealed an order sustaining demurrers filed by Navigators Specialty Insurance Company (Navigators) and Mt. Hawley Insurance Company (Mt. Hawley) to the third amended complaint. Travelers sought to recover from other insurance carriers some or all of the amounts it paid to defend TF McGuckin, Inc. in an underlying construction defect litigation. Travelers contended the trial court incorrectly concluded that the causes of action for equitable contribution and equitable indemnity failed to state a claim. Travelers also argued that, in the event the Court of Appeal contends the trial court properly sustained the demurrers, the appellate court should order that Travelers be given leave to amend its complaint to plead a claim for equitable subrogation. The Court of Appeal concluded the trial court erred in sustaining the demurrers to both the equitable contribution and equitable indemnity causes of action. Accordingly, judgment was reversed and the matter remanded for further proceedings. View "The Travelers Indemnity Co. v. Navigators Specialty Ins. Co." on Justia Law

Plaintiff-appellant Kevin McGrath challenged a superior court’s decision granting summary judgment to appellee Progressive Northern Insurance Company. Specifically, he argued the court erred in concluding that he was not “occupying” a vehicle, as that term is defined in the insurance policy at issue, when he was struck and injured by an underinsured motorist. Plaintiff was driving the vehicle’s owner in the owner’s vehicle to the airport. Plaintiff stopped at a gas station/convenience store on the way; he got out to pump gas and paid for it at the pump. The owner went inside the store for coffee. As the two returned to the car, but before they got inside, a pickup truck struck both plaintiff and the owner. Plaintiff filed for underinsured motorist benefits with the owner’s insurance company, Progressive, asserting he qualified for coverage under the terms of the policy. Progressive denied the claim, contending Plaintiff was not operating or occupying the car at the time of the accident. Plaintiff sued for a declaratory judgment on stipulated facts and no discovery. Summary judgment was entered in favor of the insurer. The Vermont Supreme Court affirmed, finding that while Plaintiff intended to enter the car, he did not, thus he did not occupy it under the terms of the policy at issue. View "Progressive Northern Insurance Company v. McGrath" on Justia Law

The First Circuit affirmed the judgment of the district court ruling against defendant Massachusetts Mutual Life Insurance Company (MassMutual) and against Plaintiff's class action claims in this insurance dispute, holding that the district court did not err.In 2003, MassMutual decided to cut the minimum guaranteed interest rates paid to purchasers of some of its annuities. MassMutual chose to change the interest rate by an endorsement that its staff warned would result in consumer confusion and introduce ambiguity into its annuity certificate. Plaintiff in this case believed that he had bought an annuity that guaranteed him three percent annual interest, but MassMutual claimed that it promised only 1.5 percent annual interest. The district court ruled against MassMutual and against Plaintiff's class action claims. The First Circuit affirmed, holding (1) the annuity did not unambiguously set the minimum guaranteed interest rate at 1.5 percent; (2) the district court did not err in denying Plaintiff's motion for class certification; and (3) MassMutual waived its challenge to prejudgment interest. View "Aronstein v. Massachusetts Mutual Life Insurance Co." on Justia Law

The Supreme Court held that a provision found in just about every commercial and personal-property insurance policy issued in Ohio that bars coverage for damage caused by "water that backs up or overflows from a sewer" includes damage caused by sewage carried into an insured property by a backup or overflow event.Sewage from the local sewer system backed up into the Bank Nightclub, a bar that was insured at the time by United Specialty Insurance Company. The bar subsequently hired Cleantech to clean up the site and submitted a claim to its insurer. United Specialty denied the claim, citing an exclusion in the bar's policy for damage caused by water that backs up or overflows from a sewer. The bar assigned AKC any claims it might have against United Specialty, and AKC then brought this breach of contract claim. The trial court granted summary judgment in favor of United Specialty. The court of appeals reversed. The Supreme Court reversed, holding that the water-backup exclusion in the policy included damage caused by the sewage. View "AKC, Inc. v. United Specialty Insurance Co." on Justia Law

Following a preliminary hearing, petitioner Dr. Sanjoy Banerjee was charged in an information with two counts of presenting a false or fraudulent health care claim to an insurer (a form of insurance fraud, counts 1-2), and three counts of perjury (counts 3-5). The superior court denied Banerjee’s motion to dismiss the information as unsupported by reasonable or probable cause. Banerjee petitioned for a writ of prohibition to direct the superior court to vacate its order denying his Penal Code section 995 motion and to issue an order setting aside the information. The Court of Appeal issued an order to show cause and an order staying further proceedings on the information, pending the Court's resolution of the merits of Banerjee’s petition. The State filed a return, and Banerjee filed a traverse. The State argued the evidence supported a strong suspicion that Banerjee committed two counts of insurance fraud and three counts of perjury, based on his violations of Labor Code section 139.3(a) between 2014 and 2016. During that period, Banerjee billed a workers’ compensation insurer for services he rendered to patients through his professional corporation and through two other legal entities he owned and controlled. The insurance fraud charges are based on Banerjee’s 2014-2016 billings to the insurer through the two other entities. The perjury charges were based on three instances in which Banerjee signed doctor’s reports, certifying under penalty of perjury that he had not violated “section 139.3.” Banerjee argued: (1) the evidence showed he did not violate the statute's referral prohibition; (2) even if he did not comply with section 139.3(e), the “physician’s office” exception to the referral prohibition applied to all of his referrals to his two other legal entities; and (3) the patient disclosure requirement of section 139.3(e), the referral prohibition of section 139.3(a), and the physician’s office exception to the referral prohibition were unconstitutionally vague. The Court of Appeal concluded: (1) Banerjee did not violate section 139.3(a) by referring his patients to his two other legal entities; and (2) the evidence supported a strong suspicion that Banerjee specifically intended to present false and fraudulent claims for health care benefits, in violation of Penal Code section 550(a)(6), by billing the workers’ compensation insurer substantially higher amounts through his two other legal entities than he previously and customarily billed the insurer for the same services he formerly rendered through his professional corporation and his former group practice. Thus, the Court granted the writ as to the perjury charges but denied it as to the insurance fraud charges. View "Banerjee v. Super. Ct." on Justia Law

The Ninth Circuit affirmed the district court's order dismissing Mudpie's claims against its insurer in a putative class action brought by Mudpie, seeking to recover under the insurance policy's "Business Income" and "Extra Expense" coverage after state and local authorities in California issued several public health orders in response to the COVID-19 pandemic. Mudpie claimed that the public health orders prevented it from operating its children's stores. Mudpie sought declaratory relief and asserted claims for breach of contract and breach of the implied covenant of good faith and fair dealing.The panel affirmed the district court's ruling that Mudpie's claimed losses are not covered by the policy and the district court did not err in dismissing the claims for declaratory relief, breach of contract, and breach of the covenant of good faith and fair dealing. The panel explained that California courts would construe the phrase "physical loss of or damage to" as requiring an insured to allege physical alteration of its property. In this case, Mudpie did not identify a distinct, physical alteration of the property. The panel also concluded that the policy's Virus Exclusion bars coverage of Mudpie's claimed losses. View "Mudpie, Inc. v. Travelers Casualty Insurance Co. of America" on Justia Law

The issue on appeal in this case stemmed from an insurance claim filed by Bonbeck Parker, LLC and BonBeck HL, LC (collectively, BonBeck) for hail damage. The Travelers Indemnity Company of America (Travelers) acknowledged that some of the claimed damage to BonBeck’s property was caused by a covered hailstorm, but argued the remaining damage was caused by uncovered events such as wear and tear. BonBeck requested an appraisal to determine how much damage occurred, but Travelers refused this request unless BonBeck agreed the appraisers would not decide whether the hailstorm in fact caused the disputed damage. When BonBeck rejected this condition, Travelers filed suit, seeking a declaration that the appraisal procedure in BonBeck’s policy did not allow appraisers to decide the causation issue. The district court disagreed, ruling that the relevant policy language allowed appraisers to decide causation. After the appraisal occurred, the district court granted summary judgment to BonBeck on its breach of contract counterclaim, concluding that Travelers breached the policy’s appraisal provision. Travelers appealed. Applying Colorado law, the Tenth Circuit Court of Appeals affirmed: the disputed policy provision allowed either party to request an appraisal on “the amount of loss,” a phrase with an ordinary meaning in the insurance context that unambiguously encompassed causation disputes like the one here. "And contrary to Travelers’ view, giving effect to this meaning aligns both with other related policy language and with the appraisal provision’s purpose of avoiding costly litigation. For these reasons, the district court appropriately allowed the appraisers to resolve the parties’ causation dispute and granted summary judgment for BonBeck on its breach of contract claim." View "BonBeck Parker, et al. v. Travelers Indemnity" on Justia Law