Justia Insurance Law Opinion Summaries

Plaintiffs, domestic entities, entered into an insurance contract providing coverage for a Texas townhome complex that they own and operate. The Policy was underwritten by Lloyd’s, members of a foreign organization, and contains a mandatory arbitration provision, providing that the seat of the Arbitration shall be in New York and the Arbitration Tribunal shall apply the law of New York. In 2017, Hurricane Harvey caused an estimated $5,660,000 in damages to the townhome complex. A third-party claims administrator for Lloyd’s concluded that the Policy’s deductible was $3,600,000.Plaintiffs filed a complaint in the Western District of Washington asserting breach of contract, failure to communicate policy changes, and unfair claims handling practices in violation of Washington law, asserting that the deductible should be $600,000. Lloyd’s moved to compel arbitration and stay proceedings, arguing that the Policy’s arbitration provision falls within the scope of the Convention on the Recognition and Enforcement of Foreign Arbitral Awards. Plaintiffs did not contest that the arbitration provision falls within the Convention’s scope but argued the provision is unenforceable because Washington law specifically prohibits the enforcement of arbitration clauses in insurance contracts. Plaintiffs cited the McCarran-Ferguson Act, 15 U.S.C. 1011–15, which provides that state insurance law preempts conflicting federal law. On interlocutory review, the Ninth Circuit upheld an order granting Lloyd’s motion. Article II, Section 3 of the Convention is self-executing, and therefore is not an “Act of Congress” subject to reverse-preemption under the McCarran-Ferguson Act. View "CLMS Management Services Limited Partnership v, Amwins Brokerage of Georgia" on Justia Law

The Second Circuit affirmed the district court's judgment sustaining the final determination of Hartford Life with respect to plaintiff's disability benefits under the terms of the long term disability plan.The court held that California Insurance Code 10110.6(a) applies only to the claims of California residents. It does not apply to plaintiff because he was a New York resident at all relevant times. The court also held that "full and fair review" under the Employee Retirement Income Security Act's (ERISA) claims-procedure regulations does not require the claims administrator to produce documents developed or considered during the appeal from the initial determination while the claim is still under review and before a final benefits determination. Therefore, plaintiff cannot establish that Hartford Life did not provide his claim a full and fair review. In this case, the district court correctly reviewed Hartford Life's determination under the arbitrary-and-capricious standard and correctly concluded that the final determination was reasonable and supported by substantial evidence in the record. View "Mayer v. Ringler Associates Inc. and Af." on Justia Law

Maryam Hedayati appealed the grant of summary judgment in favor of Interinsurance Exchange of the Automobile Club (Auto Club or the Club) on Hedayati’s breach of good faith and fair dealing claim. Hedayati suffered catastrophic injuries in October 2012 when Auto Club’s insured ran a red light and struck her in a pedestrian crosswalk. The insured driver immediately notified Auto Club of the accident and authorized the Club to disclose his policy limits ($25,000); he also informed Auto Club he had no other insurance or assets. Auto Club’s policy with its insured required him to relinquish to the Club his right to negotiate settlement of potential tort claims falling within the policy. When he inquired about a release, Auto Club inaccurately told its insured driver Hedayati was not willing to sign one. Despite repeated requests during settlement negotiations from Hedayati’s attorney, Auto Club initially declined to disclose the insured’s policy limits; eventually it acquiesced, but Auto Club still declined to provide written proof of those limits, which the Club knew was common practice to facilitate a settlement. Auto Club then withheld from Hedayati’s counsel the insured’s written declaration which indicated he had no other insurance, which the Club had confirmed, and the insured’s statements that he had no assets. Auto Club also, despite multiple requests from Hedayati’s lawyer, failed to provide a copy of its insured’s policy which Hedayati’s lawyer needed to verify its terms. Hedayati’s counsel had demanded a hard copy of the policy as a settlement condition. Auto Club ultimately failed to settle the matter within its $25,000 policy limits. Hedayati subsequently obtained a $26 million judgment against the insured driver, along with assignment of the insured’s claim against the Club for breach of the covenant of good faith and fair dealing implicit in its policy with him. The trial court concluded the evidence presented by Hedayati was insufficient as a matter of law. After its de novo review, the Court of Appeal disagreed with the trial court’s evaluation of the evidence. It therefore reversed the summary judgment ruling and remanded for further proceedings. View "Hedayati v. Interinsurance Exchange of the Auto. Club" on Justia Law

After sustaining injuries in a vehicle driven by her son, Kevin Simms, Petitioner Belinda Pickens sought UM coverage through her policy with Respondent United Services Automobile Association (USAA). At the time of the accident, Pickens's policy covered five vehicles, including the 1997 Chevrolet involved in the accident. The policy included liability, personal injury protection (PIP), UM, and underinsured motorist (UIM) coverage. Pickens also executed a named driver exclusion. Pickens's declarations page also contained a provision that stated, "***COVERAGES EXCLUDED WHEN ANY VEHICLE OPERATED BY KEVIN SIMMS***." USAA denied Pickens's claim and initiated a declaratory judgment action asserting she was not entitled to UM coverage because Simms, the excluded driver, was operating the vehicle at the time of the accident. Pickens sued USAA and lost. The issue this case presented for the South Carolina Supreme Court's review centered on whether Section 38-77-340 of the South Carolina Code (2015) permitted a named driver exclusion that precluded uninsured motorist (UM) coverage to a passenger injured in an accident involving an unknown driver. The Court held that it did. "As the circuit court noted, no liability coverage would have been afforded to a third party had Simms been at fault, and thus, it would violate public policy to allow Pickens to recover UM when she was the person who executed the exclusion yet knowingly allowed Simms to drive her vehicle." View "United Services Automobile Association v. Pickens" on Justia Law

Two female students brought claims under Title IX, 20 U.S.C. 1681–88, alleging that the School District failed to prevent and inappropriately responded to sexual misconduct by a male student. The incidents occurred while the District did not have insurance coverage for sexual misconduct and molestation. After the District settled the suit for $1.5 million, its insurers sought a declaration of their rights and obligations under the District’s errors-and-omissions coverage. The district court held that the errors and omissions coverage applies although the policy contains a sexual misconduct exclusion. The judge stated that the exclusion was ambiguous and could be read to exclude only sexual misconduct by a school employee and might not bar coverage for “reactions to” a student’s sexual misconduct.The Seventh Circuit reversed. The sexual-misconduct exclusion is not ambiguous in precluding coverage for “[a]ny” sexual misconduct or molestation of “any person” and related allegations. Even if the sexual-misconduct exclusion barred only coverage for employees’ actions, the exclusion still applies. The District is not directly liable for misconduct by students. A school district can be liable for discrimination in cases of student-on-student sexual misconduct under Title IX only if the district has notice and is deliberately indifferent. By excluding coverage for “allegations relating” to sexual misconduct, the exclusion necessarily bars coverage for “reactions to” sexual misconduct. View "Netherlands Insurance Co. v. Macomb Community Unit School District" on Justia Law

Nationwide Mutual Insurance Company issued two public-official bonds as surety for Eddie Carthan, a member of the Holmes County, Mississippi Board of Supervisors. On appeal, the State Auditor claimed Nationwide was liable under both bonds. The undisputed facts showed the Board never paid the premium for the first bond, which was only for a year. Instead, the Board asked if the first bond could be “converted” to a four-year bond that would cover Carthan’s entire term. Nationwide complied with the Board’s request. It cancelled the first bond and issued a second bond covering Carthan’s entire term for which the Board paid the premium. After review, the Mississippi Supreme Court found no evidence that Carthan was actually secured simultaneously by two separate bonds. Rather, the Court found the undisputed facts showed the Board intended to procure and did in fact obtain one public-official bond in the amount of $100,000 as surety for Carthan. Because Nationwide paid $100,000 under the second, paid-for bond, the chancellor did not err by granting Nationwide summary judgment on all claims based on the first bond. View "White v. Nationwide Mutual Insurance Company" on Justia Law

The issue central to this appeal centered on a “covenant judgment” arrangement: an insured defendant, facing suit by a plaintiff, settles claims without the insurer’s consent in exchange for a release from liability and assignment of potential bad faith claims against the insurer to the plaintiff. If the trial court deems the settlement reasonable, that settlement amount becomes the presumptive measure of damages in the later bad faith action brought by the plaintiff against the insurer. Insurer Cincinnati Specialty Underwriters (Cincinnati), challenged the trial court’s order approving as reasonable a $1.7 million settlement between plaintiffs, Anna and Jeffrey Wood (Woods), and Cincinnati’s insureds, Milionis Construction Inc. (MCI) and Stephen Milionis. A divided Court of Appeals held the trial court abused its discretion because the reasonableness finding credited a defense expert’s evaluation of contract damages at $1.2 million despite other evidence in the record suggesting the defense’s evaluation of damages never rose above $399,000. The Washington Supreme Court reversed and reinstated the trial court’s order. The Supreme Court found the trial court properly conducted the reasonableness hearing and evaluated the varied and conflicting evidence of contract damages. In addition, the court appropriately considered damages for plaintiffs’ extracontractual claims as well as allowable attorney fees. "In finding an abuse of discretion, the Court of Appeals majority misapprehended parts of the record and substituted its assessment of the competing damages evaluations for the trial court’s assessment." View "Wood v. Milionis Constr., Inc." on Justia Law

The Texas Workers' Compensation Act (TWCA), Tex. Lab. Code 401.007–419.007, regulates the prices that insurers must pay to providers for various medical services utilized by their beneficiaries, including air transport services. However, those price restrictions conflict with the federal Airline Deregulation Act (ADA), which makes clear that the states "may not enact or enforce a law, regulation, or other provision . . . related to a price, route, or service of an air carrier that may provide air transportation under this subpart." 49 U.S.C. 41713(b)(1).The Fifth Circuit joined its sister circuits, which have unanimously held that the ADA preempts state price caps on air ambulance reimbursements, and that those state price caps are not saved by the McCarran–Ferguson Act. The court disagreed with the Texas Supreme Court, which has reached contrary conclusions by a divided vote. Therefore, in this case, the court affirmed the judgment and held that the TWCA regulations concerning the reimbursement of air ambulance providers like Air Evac are preempted by the ADA, and are not saved by the McCarran–Ferguson Act. View "Air Evac EMS, Inc. v. Sullivan" on Justia Law

CNI owed IPFS the unearned premium from an insurance policy that was cancelled prematurely, but the parties disputed the value of the unearned premium. The district court granted partial summary judgment to IPFS but denied IPFS's request for prejudgment interest. IPFS filed a motion to amend under Federal Rule of Civil Procedure 59(e), requesting prejudgment interest, which the district court granted. CNI appeals.The Eighth Circuit affirmed, concluding that the district court did not abuse its discretion in granting IPFS's Rule 59(e) motion. The court explained that the fact that IPFS did not request prejudgment interest in its initial summary judgment briefing does not mean that the district court was prohibited from considering the request in a post-judgment Rule 59(e) motion. The court also concluded that the district court did not miscalculate the amount of prejudgment interest owed by CNI under Nebraska law. In this case, because the district court could readily determine the amount based on the premium finance agreement and no reasonable controversy existed as to the amount, the district court did not abuse its discretion by concluding that the entire claim was liquidated and subject to prejudgment interest. View "Continental Indemnity Co. v. IPFS of New York, LLC" on Justia Law

All Seasons inspected SparrowHawk's warehouse roofs and discovered hail damage. Because All Seasons did not hold an Illinois roofing license, it arranged for Prate to serve as general contractor with All Seasons as subcontractor. All Seasons was to provide materials and labor, maintain safety, and supervise the project. All Seasons purchased a commercial general liability policy and general liability extension endorsement from United, listing Prate as an “additional insured” in a “vicarious liability endorsement.” All Seasons then subcontracted with Century. Ayala, a Century employee was working on a SparrowHawk warehouse when he fell to his death.The Illinois workers’ compensation system provided limited death benefits but precluded tort remedies against his direct employer, Century. Ayala’s estate sued Prate, All Seasons, and SparrowHawk. Prate tendered the defense to United, which declined to defend and sought a declaratory judgment. All Seasons and United reached a settlement with the estate, paying the policy limits.The district court granted Prate summary judgment. The Seventh Circuit affirmed, rejecting United’s argument that because its named insured was an independent contractor, Illinois law would not impose any liability on the additional insured and there was no risk of covered liability. The duty to defend depends on the claims the plaintiff asserts, not on their prospects for success. The settlement of the underlying claims against the named insured, however, removed any possibility that the additional insured might be held vicariously liable for actions of the named insured; the duty to defend ended when that settlement was consummated. View "United Fire & Casualty Co. v. Prate Roofing & Installations LLC" on Justia Law