Justia Insurance Law Opinion Summaries

In March 2020, in response to the rapidly expanding COVID-19 pandemic, Illinois Governor Pritzker issued an order mandating the temporary closure to the public of restaurants, bars, and movie theaters; a subsequent order required all non-essential businesses to shut down partially and temporarily. Bradley operates a Quality Inn & Suites with a restaurant, bar, and general event space and suspended in-person dining at the restaurant and bar, and canceled previously scheduled weddings and meetings.Bradley’s general business property insurance policy from Aspen requires “direct physical loss of or damage to” covered property; its loss of use exclusion bars coverage for “loss or damage caused by or resulting from … [d]elay, loss of use or loss of market” and another exclusion bars coverage for “loss or damage caused directly or indirectly by … [t]he enforcement of or compliance with any ordinance or law: (1) Regulating the construction, use or repair of any property; or (2) Requiring the tearing down of any property.”Affirming the district court, the Seventh Circuit held that the term “direct physical loss of or damage to” property does not apply to a business’s loss of use of the property without any physical alteration. The loss of use exclusion and the ordinance or law exclusion in this policy provide separate bars to coverage. View "Bradley Hotel Corp. v. Aspen Speciality Insurance Co." on Justia Law

In March 2020, the Dallas County government issued orders restricting the operations of local businesses in light of the COVID-19 pandemic. Hotels were permitted to continue to provide lodging, and delivery and take-out food services, subject to social-distancing rules. Crescent owns the Dallas Ritz-Carlton hotel, which offers guest rooms, a restaurant and bar, general event space, a salon, spa, and fitness center. Crescent alleges that COVID-19 rendered the air in the hotel unsafe and diminished the functional space available, causing significant losses of income. Crescent also alleges that it incurred expenses to install plexiglass partitions and hand sanitizer stations, to display signs throughout the hotel, and to move furniture to permit social distancing. Crescent’s Zurich insurance policy requires “direct physical loss or damage” to covered property and includes an exclusion for losses attributable to any communicable disease, including viruses, and a microorganism exclusion, which bars coverage for losses “directly or indirectly arising out of or relating to mold, mildew, fungus, spores or other microorganisms of any type, nature, or description, including but not limited to any substance whose presence poses an actual or potential threat to human health.”The Seventh Circuit affirmed the dismissal of Crescent’s suit against Zurich. The phrase “direct physical loss or damage” requires either “a permanent [dispossession] of the property due to a physical change … or physical injury to the property requiring repair.” The microorganism exclusion independently bars coverage for the hotel’s claimed losses. View "Crescent Plaza Hotel Owner, L.P. v. Zurich American Insurance Co." on Justia Law

On March 15, 2020, in response to the rapidly expanding COVID-19 pandemic, Illinois Governor Pritzker issued an order mandating the temporary closure to the public of restaurants, bars, and movie theaters. On March 20, another order required all non-essential businesses to shut down partially and temporarily. As a result of these orders, the plaintiffs (businesses) were each required to close or dramatically scale back operations. The businesses held materially identical commercial-property insurance policies, issued by Cincinnati Insurance Company, providing coverage for income losses sustained on account of a suspension of operations caused by “direct physical loss” to covered property. The policies also provided coverage for income losses sustained as a result of an action of civil authority prohibiting access to covered property, when such action was taken in response to “direct physical loss” suffered by other property. Cincinnati denied their claims.The Seventh Circuit affirmed the dismissal of each suit. The businesses did not adequately allege that either the virus that causes COVID-19, SARS-CoV-2, or the resulting closure orders caused “direct physical loss” to property; the loss of use, unaccompanied by any physical alteration to property, does not constitute “direct physical loss” under the relevant insurance policies. View "Sandy Point Dental, P.C. v. Cincinnati Insurance Co." on Justia Law

In this considering the provisions of a personal injury protection (PIP) insurance policy permit permitting the insurer to limit reimbursement payments in accordance with a statutory schedule of maximum charges the Supreme Court held that the PIP policy in this case was effective to authorize the use of the schedule of maximum charges under the pertinent provisions of Fla. Stat. 627.736(5).The certified question in this case related to the Second District Court of Appeal's holding that State Farm's policy provisions permitted State Farm to use the schedule of maximum charges even though the policy also referred to the use of other statutory factors for determining reasonable charges. The Supreme Court affirmed, holding that the PIP policy issued by State Farm was effective to authorize the use of the schedule of maximum charges under the relevant provisions of Fla. Stat. 627.736(5). View "MRI Associates of Tampa, Inc. v. State Farm Mutual Automobile Insurance Co." on Justia Law

The Supreme Court affirmed the order of the superior court denying Defendant's motion to vacate entry of default, holding that the hearing justice did not abuse her discretion in denying Defendant's motion.Plaintiff was injured in a motorcycle accident. Plaintiff brought this complaint against Defendant alleging that he was insured by virtue of his contract with Defendant and that the denial of his uninsured motorist claims was unreasonable and made in bad faith. When Defendant failed timely to answer the complaint, default entered against Defendant. Defendant moved to vacate default, arguing that it had never been Plaintiff's insurer. The hearing justice denied the motion, finding that Defendant had not met the applicable standards to vacate default under Rule 55(c) of the Superior Court Rules of Civil Procedure. The Supreme Court affirmed, holding that Defendant failed to show good cause to excuse its failure to plead or defend. View "Ferris v. Progressive Casualty Insurance Co." on Justia Law

In a previous opinion, the district court affirmed a $34.3 million jury verdict in favor of the class represented by plaintiff and reversed the district court's denial of prejudgment interest. The court then remanded the matter for the district court to reconsider plaintiff's motion for prejudgment interest. State Farm appealed.The Eighth Circuit affirmed the district court's award of prejudgment interest, concluding that plaintiff was entitled to prejudgment interest at the 4% rate contained in the contract, and the district court did not err in calculating the amount of interest due and awarding plaintiff $4,521,674 in prejudgment interest. View "Vogt v. State Farm Life Insurance Co." on Justia Law

In 2003, Shupe was an Executive Sous Chef for Hyatt when he began experiencing symptoms of osteomyelitis, an infection in his spinal cord. He was 37 years old. After rounds of antibiotics and surgery, he was unable to maintain his employment and left his position in July 2004 due to pain from chronic osteomyelitis, degenerative disc disease in the lumbar spine, and spinal stenosis that was so severe that he could not stand for an extended period of time. Hyatt’s long-term disability plan, a “qualified” plan under the Employee Retirement Income Security Act of 1974, paid Shupe disability benefit for 11 years. Hartford then terminated his benefits, finding that there were alternative occupations that Shupe could physically perform, was qualified for, and pay greater than 60% of his prior salary, so that he did not meet the plan’s definition of “disabled.”The district court rejected Shupe’s 29 U.S.C. 1132(a)(1)(B) suit on summary judgment. The Fourth Circuit reversed, in favor of Shupe. His post-termination evaluations, coupled with Shupe’s contemporaneous medical history, all uniformly conclude that Shupe was incapable of full-time sedentary employment. Hartford’s assessment was an “outlier.” View "Shupe v. Hartford Life & Accident Insurance Co." on Justia Law

Under Minnesota law, when the insurance policy in question refers disputes as to amount of loss to an appraiser, when the question presented by the dispute involves separating loss due to a covered event from a property's preexisting condition, the question of what caused the loss is one for the appraiser to resolve.The Eighth Circuit affirmed the district court's grant of Condor's motion to compel an appraisal. In this case, Condor filed a claim for benefits with its insurer, Axis. Condor then demanded an appraisal because the parties could not agree on the amount of loss. After Axis filed suit for a declaratory judgment that there was no coverage and that the parties' coverage dispute precluded appraisal, Condor filed a motion to compel one, which the district court granted. View "Axis Surplus Insurance Co. v. Condor Corp." on Justia Law

Hodroj, a passenger, was injured in a single-car collision. The driver was insured by CSAA. Hodroj’s attorney wrote to CSAA offering that Hodroj would settle his claim for bodily injuries in exchange for payment of the driver’s insurance policy limits if CSAA provided a sworn declaration confirming the policy limits and delivered a check within 21 days of acceptance. CSAA could condition its acceptance on Hodroj signing a written release of all bodily injury claims. CSAA responded: “We accept ... [and] are tendering ... $100,000[.]” Enclosed were a sworn declaration attesting to the policy limits, and a written release to be signed by Hodroj. A $100,000 check was sent separately, providing that it should not be presented until the release was signed. Hodroj reneged on the settlement because the release included a release of claims for property damage. Hodroj sued the driver. CSAA sued Hodroj for breach of contract.The court of appeal affirmed judgment in favor of CSAA. An objective observer would conclude that the parties intended to settle Hodroj’s bodily injury claim for the policy limits. That the proposed document contained terms materially different from what had been agreed did not change the binding effect of the agreement. Hodroj was not obliged to sign a release that was inconsistent with what he agreed to but a proposal that does not accurately reflect the agreement does not unwind the entire deal. Hodroj breached the contract by filing suit. View "CSAA Insurance Exchange v. Hodroj" on Justia Law

After a tractor manufactured by CNH caught fire, Floyd filed suit against CNH in federal court under a theory of product liability, claiming that its insureds owned the tractor and other property on the tractor, both of which were damaged in the fire, and that Floyd was subrogated to its insureds' claims against CNH because Floyd had paid its insureds' claim for the damage. The district court dismissed the case for lack of subject matter jurisdiction under 28 U.S.C. 1332.The Eighth Circuit affirmed and concluded that section 1332's amount-in-controversy requirement was not satisfied in this case. The court concluded that the Iowa Supreme Court would hold that the economic-loss doctrine permits recovery only for the other property and not for the product itself. Accordingly, the Iowa Supreme Court would bar recovery in tort for damage that a defective product causes to itself, even if the plaintiff also seeks recovery for damage to other property. Here, Floyd's recovery is limited as a matter of law to the alleged $22,787.81 in damage to property other than the tractor. The court denied the motion to certify a question of law to the Iowa Supreme Court and upheld the district court's dismissal based on lack of subject matter jurisdiction. View "Floyd County Mutual Insurance Ass'n v. CNH Industrial America LLC" on Justia Law