Justia Insurance Law Opinion Summaries

The Eighth Circuit affirmed the district court's finding that Selective denied insurance coverage in bad faith and the district court's award of taxable costs and prejudgment interest. In this case, Selective sought a declaration of no coverage for the insured's hailstorm-damaged property, alleging fraud by misrepresentation and breach of contract. The insured counterclaimed and later added a claim for bad faith denial of benefits under Minn. Stat. 604.18, which would entitle him to taxable costs. A jury found in favor of the insured and a panel of appraisers assessed damages. The court concluded that the district court did not err in allowing the insured's section 604.18 claim to proceed; there was no error in awarding taxable costs under section 604.18, subdivision 2(a), based on the district court's determination that no reasonable insurer would have relied on any of Selective's proposed bases to deny defendant's hail claim for fraud; and there was no error in the district court's award of prejudgment interest. View "Selective Insurance Company of South Carolina v. Sela" on Justia Law

In 2006, Moore, an Indiana-based insurance broker, advised Mathis, an Alabama surgeon, to replace his Standard disability insurance policy with a MetLife disability-insurance policy with higher limits that had occupational disability coverage, like the Standard policy. The MetLife policy did not actually provide occupational disability coverage but provided total disability coverage only if Mathis was not gainfully employed and provided residual disability coverage only under various limitations. Mathis became disabled in 2017. Neck and arm problems prevented him from performing some of his duties. He underwent surgery but could no longer work at his usual level; his income decreased. He left his practice in March 2018 and began working for a device manufacturer in a nonsurgical capacity. MetLife paid Mathis residual disability benefits, April-August 2017, then determined he was not entitled to residual disability benefits. The policy lapsed.Mathis sued Moore and Source Brokerage for negligent procurement and brought a breach of contract claim against MetLife. The Seventh Circuit affirmed the dismissal of the claims, applying Alabama law, rather than Indiana law. Mathis’s contributory negligence in failing to read the new policy and the Alabama statute of limitations barred the negligence claims. The court rejected the contract claim because Mathis failed to comply with his contractual obligation to submit proof of loss for any period after September 2017. View "Mathis v. Metropolitan Life Insurance Co" on Justia Law

Plaintiffs filed suit against OSIC after OSIC denied their claim seeking coverage under plaintiffs' policy for damage caused by a hailstorm. The district court ultimately granted OSIC summary judgment.The Fifth Circuit certified the following questions to the Supreme Court of Texas: (1) Whether the concurrent cause doctrine applies where there is any non-covered damage, including "wear and tear" to an insured property, but such damage does not directly cause the particular loss eventually experienced by plaintiffs; (2) If so, whether plaintiffs alleging that their loss was entirely caused by a single, covered peril bear the burden of attributing losses between that peril and other, non-covered or excluded perils that plaintiffs contend did not cause the particular loss; and (3) If so, whether plaintiffs can meet that burden with evidence indicating that the covered peril caused the entirety of the loss (that is, by implicitly attributing one hundred percent of the loss to that peril). View "Frymire Home Services, Inc. v. Ohio Security Insurance Co." on Justia Law

In the underlying action, a citrus grove owner filed suit against defendant in Florida state court, alleging claims for breach of contract, breach of fiduciary duty, and an equitable accounting. Almost a year later, and two days after finding out that defendant had an insurance policy issued by Travelers, the owner moved to amend the complaint to add a claim for negligence. After the motion was granted, Travelers disclaimed coverage. In state court litigation, the owner and defendant entered into a settlement agreement.Travelers filed this declaratory judgment action seeking a declaration that, based on the insurance policy's provision, it had not duty to defend or indemnify defendant against the owner's claims. The Eleventh Circuit affirmed the district court's grant of summary judgment in favor of Travelers. The court concluded that, because the insurance policy excluded coverage for the damages alleged in the owner's amended state court complaint, Travelers had no duty to defend or indemnify, and the Coblentz agreement is unenforceable for that reason. View "The Travelers Indemnity Company of Connecticut v. Richard McKenzie & Sons, Inc." on Justia Law

The Fifth Circuit withdrew its prior opinion and substituted the following opinion.In this insurance coverage dispute, at issue is who counts as an "employee" under the Texas Anti-Indemnity Act (TAIA). The Fifth Circuit concluded that Zurich was not required to file a cross-appeal and thus dismissed the cross-appeal. The court also concluded that the Maxim Policy does not assign Maxim's rights to Zurich, and thus Maxim can pursue this claim against Zurich under the Berkel Policy.The court certified the following question to the Supreme Court of Texas: Whether the employee exception to the TAIA, Texas Insurance Code 151.103, allows additional insured coverage when an injured worker brings a personal injury claim against the additional insured (indemnitee), and the worker and the indemnitee are deemed "co-employees" of the indemnitor for purposes of the TWCA. View "Maxim Crane Works, LP v. Zurich American Insurance Co." on Justia Law

Rodenburg purchased a Commercial Umbrella Liability Policy from Cincinnati. In the underlying action, a plaintiff filed suit against Rodenburg, asserting several theories including wrongful garnishment, tort-based claims, and violations of the Fair Debt Collection Practices Act (FDCPA). Rodenburg filed a claim under the policy for coverage of the underlying lawsuit, but Cincinnati denied coverage.The Eighth Circuit affirmed the district court's grant of summary judgment in favor of Cincinnati, concluding that the policy did not provide coverage for the underlying lawsuit and Cincinnati had no duty to defend Rodenburg under the policy. In this case, the underlying complaint alleged "personal and advertising injury" that was not "caused by an 'occurrence.'" The court explained that any potential liability arose either directly or indirectly from conduct that was alleged to violate the FDCPA, however, and was thus excluded from coverage by the Violation of Statutes Exclusion. Therefore, Cincinnati did not breach its contractual duty to defend Rodenburg. View "Rodenburg LLP v. Cincinnati Insurance Co." on Justia Law

The Eighth Circuit held that an accidental death and dismemberment insurance policy does not qualify as a health plan under Maine law, Me. Rev. Stat. Ann. tit. 24-A, 4303. Therefore, Unum Life's decision to deny benefits is subject to a deferential abuse of discretion standard of review. In this case, substantial evidence supported Unum Life's conclusion that intoxication contributed to the insured's fall down the stairs, which resulted in her death. The court concluded the Unum Life did not abuse its discretion in denying benefits under the policy's intoxication exclusion. View "Williams v. Unum Life Insurance Company of America" on Justia Law

Plaintiff filed suit against State Farm and GEICO for liability coverage after she was injured on her husband's boat. In this case, plaintiff was seriously hurt when she was thrown from the boat.The Eighth Circuit affirmed the district court's grant of summary judgment concluding that the State Farm and GEICO household exclusions bar recovery here. Furthermore, the exclusions do not violate Minnesota law and public policy. The court rejected plaintiff's suggestion that the question of umbrella and boatowner's liability insurance coverage arising from spousal negligence creates a novel question of law that the court should certify to the Minnesota Supreme Court. The court explained that the caselaw plaintiff relies on does not hold that insurance policies must cover household members. Rather, Minnesota consistently enforces household exclusions when the controlling statutes do not prohibit such exclusions, nor do they require homeowner's policies to provide liability coverage for claims made by one resident of a household against another. View "Godfrey v. State Farm Fire and Casualty Co." on Justia Law

In this insurance coverage dispute, at issue is who counts as an "employee" under the Texas Anti-Indemnity Act (TAIA). The Fifth Circuit certified the following question to Supreme Court of Texas: Whether the employee exception to the TAIA, Texas Insurance Code 151.103, allows additional insured coverage when an injured worker brings a personal injury claim against the additional insured (indemnitee), and the worker and the indemnitee are deemed "co-employees" of the indemnitor for purposes of the TWCA. View "Maxim Crane Works, LP v. Zurich American Insurance Co." on Justia Law

A minor was severely injured in an all-terrain vehicle collision in which the other driver was at fault. The minor had medical benefits coverage through a health care plan provided by her father’s employer, the Fairbanks North Star Borough. As allowed by the terms of the plan, the Borough refused to pay the minor’s medical bills until she signed an agreement that included a waiver of certain defenses to the Borough’s subrogation rights, such as the common fund and made-whole doctrines. The minor refused to sign the agreement without reservation and filed suit, seeking a declaration that the Borough could not condition payment of her medical bills on her signature. The superior court decided on summary judgment that the Borough’s health care plan was not a true insurance plan and that, regardless of whether it was interpreted as an insurance policy or an ordinary contract, the parties could lawfully reject subrogation defenses. The minor appealed. The Alaska Supreme Court held that the health care plan was a bargained-for employee benefit rather than a true insurance policy, and that the superior court’s interpretation of it was correct. The Court therefore affirmed the superior court's judgment. View "Best v. Fairbanks North Star Borough" on Justia Law