Justia Insurance Law Opinion Summaries

In a matter of first impression, the Pennsylvania Supreme Court granted review in this case to consider whether Section 310.74(a) of the Insurance Department Act of 1921 prohibited a licensed insurance producer from charging fees in addition to commissions in non-commercial, i.e. personal, insurance transactions. During its investigation, the Department discovered that, between March 2011 and October 2015, appellants charged a non-refundable $60- $70 fee to customers seeking to purchase personal insurance products. These fees were collected from the customers before appellants prepared the insurance policy applications. One consumer complaint indicated appellants kept an “un- refundable broker application fee” when the consumer declined to buy a policy. The Department’s investigation also revealed appellants paid a “one-time” $50 referral fee to car dealership sales personnel when they referred their customers in need of insurance. The Department concluded appellants’ fee practices included improper fees charged to consumers “for the completion of an application for a contract of insurance” and prohibited referral payments to the car dealerships. The Supreme Court held lower tribunals did not err when they determined Section 310.74(a) of the Act did not authorize appellants to charge the $60-$70 non-refundable fee to their customers seeking to purchase personal motor vehicle insurance. The Commonwealth Court’s decision upholding the Commissioner’s Adjudication and Order was affirmed. View "Woodford v. PA Insurance Dept." on Justia Law

After Mark Braswell died when his road bike collided with a stopped truck, his survivors filed suit against the truck's owner, the Brickman Group. Brickman was primarily insured by ACE and secondarily insured by AGLIC. ACE rejected plaintiffs' three settlement offers before and during trial. The jury ultimately awarded plaintiffs nearly $28 million, plaintiffs and Brickman settled for nearly $10 million, and AGLIC paid nearly $8 million of the amount. AGLIC then filed suit against ACE, arguing that because ACE violated its Stowers duty to accept one of the three settlement offers for the primary policy limits, ACE had to cover AGLIC's settlement contribution. The district court agreed.The Fifth Circuit affirmed the district court's judgment and held that ACE's Stowers duty was triggered by plaintiffs' third offer, and that ACE violated this duty. In this case, the offer generated a Stowers duty because it "proposed to release the insured fully" and it was not conditional. Furthermore, the evidence was sufficient to support that ACE violated its Stowers duty by failing to reevaluate the settlement value of the case and accept plaintiffs' reasonable offer. View "American Guarantee & Liability Insurance Co. v. ACE American Insurance Co." on Justia Law

The Supreme held that the trial court did not err in determining that Defendants were not afforded underinsured motorist and medical payments coverage under an insurance policy issued by Plaintiff, an insurance company, to a family member.Defendants argued that they were entitled to medical payments and underinsured motorist coverage under Plaintiff's policy because they were "residents" of the insured's "household." Plaintiff disputed coverage and filed a declaratory judgment action in superior court, arguing that Defendants were not residents of the insured's household at the time of the accident. The trial court entered summary judgment for Plaintiff, concluding as a matter of law that Defendants were not entitled to coverage under the policy. The court of appeals affirmed. The Supreme Court affirmed, holding that the court of appeals did not err in determining that Defendants are not entitled to coverage under the policy and that the trial court appropriately awarded summary judgment in favor of Plaintiff. View "N.C. Farm Bureau Mutual Insurance Co., Inc. v. Martin" on Justia Law

Plaintiff filed suit against Safeco after the insurance company denied her underinsured motorist insurance (UIM) coverage. The district court granted summary judgment to Safeco.The Eighth Circuit affirmed, holding that this case does not involve a set-off within a policy but stacking of separate policies; the anti-stacking provision in the policy unambiguously limits the total of plaintiff's UIM coverage to the highest applicable limit; and Safeco's coverage is not illusory. Therefore, Safeco's anti-stacking provision does not preclude Safeco's excess coverage from ever applying—it simply prevents plaintiff from stacking coverage from different policies when she has already received the highest applicable limit of UIM coverage. View "Johnson v. Safeco Insurance Company of Illinois" on Justia Law

The First Circuit reversed the order of the district court granting summary judgment in favor of General Star Indemnity Company, the excess insurer of Performance Trans., Inc. and Utica Mutual Insurance Company (collectively PTI) in this Massachusetts breach of contract and unfair and deceptive insurance practices action under Mass. Gen. Laws ch. 93A, 11, holding that the district court erred in finding the relevant excess policy provisions unambiguously excluded coverage.In 2019, a PTI tanker-truck spilled approximately 4,300 gallons of gasoline, diesel fuel, and dyed diesel fuel onto the roadway and into a nearby reservoir. After cleanup costs exceeded PTI's primary insurance limit, PTI made a claim with General Star under the excess liability policy. General Star disclaimed any coverage obligation. When this suit was brought, the district court granted summary judgment in favor of General Star on the breach of contract claim and dismissed the chapter 93A, section 11 claim with prejudice. The First Circuit reversed, holding (1) the excess policy was ambiguous; and (2) because ambiguity in the policy must be construed in favor of the insured, coverage was available to PTI. View "Performance Trans., Inc. v. General Star Indemnity Co." on Justia Law

Tokiko Johnson's real property was damaged in a storm and she filed a claim with her insurance company. Johnson also executed an assignment of her insurance claim for the purpose of repairing the property with the execution in favor of Triple Diamond Construction LLC (the construction company). An appraiser retained by the construction company determined storm damage to the property in the amount of $36,346.06. The insurer determined the amount of damage due to the storm was $21,725.36. When sued, the insurer argued the insured property owner was required to obtain written consent from the insurer prior to making the assignment. The Oklahoma Supreme Court determined an insured's post-loss assignment of a property insurance claim was an assignment of a chose in action and not an assignment of the insured's policy. Therefore, the insured's assignment was not prohibited by either the insurance policy or 36 O.S. section 3624. Judgment was reversed and the matter remanded for further proceedings. The insurer's motion to dismiss the appeal was thus denied. View "Johnson v. CSAA General Insurance Co." on Justia Law

Defendant Gemini Insurance Company appealed a district court's holding La. C.C. arts. 2315.1, 2315.2 and 199 were “unconstitutional as applied to children given in adoption” and overruling the defendants’ peremptory exceptions of no right of action. At issue was whether plaintiffs Daniel Goins and David Watts, two adult children who were given in adoption as minors, had a right to bring wrongful death and survival actions stemming from the deaths of their biological father and his two minor children, who were not given in adoption, and were plaintiffs’ biological half-siblings. After a de novo review, based on the clear and unambiguous wording of La. C.C. arts. 2315.1 and 2315.2, the Louisiana Supreme Court concluded Goins and Watts were “children of the deceased” and “brothers of the deceased” who were permitted to bring wrongful death and survival actions arising from the death of their biological father and half-siblings. In view of the Court's holding that plaintiffs had a right to assert survival and wrongful death actions, the Court declined to address their argument that La. C.C. arts. 2315.1, 2315.2 and 199 were unconstitutional as applied to children given in adoption. View "Rismiller v. Gemini Insurance Co." on Justia Law

Pharmacy benefit managers (PBMs) reimburse pharmacies for the cost of drugs covered by prescription-drug plans by administering maximum allowable cost (MAC) lists. In 2015, Arkansas passed Act 900, which requires PBMs to reimburse Arkansas pharmacies at a price at least equal to the pharmacy’s wholesale cost, to update their MAC lists when drug wholesale prices increase, and to provide pharmacies an appeal procedure to challenge MAC reimbursement rates, Ark. Code 17–92–507(c). Arkansas pharmacies may refuse to sell a drug if the reimbursement rate is lower than its acquisition cost. PCMA, representing PBMs, sued, alleging that Act 900 is preempted by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1144(a).Reversing the Eighth Circuit, the Supreme Court held that Act 900 is not preempted by ERISA. ERISA preempts state laws that “relate to” a covered employee benefit plan. A state law relates to an ERISA plan if it has a connection with or reference to such a plan. State rate regulations that merely increase costs or alter incentives for ERISA plans without forcing plans to adopt any particular scheme of substantive coverage are not preempted. Act 900 is a form of cost regulation that does not dictate plan choices. Act 900 does not “refer to” ERISA; it regulates PBMs whether or not the plans they service fall within ERISA’s coverage. Allowing pharmacies to decline to dispense a prescription if the PBM’s reimbursement will be less than the pharmacy’s cost of acquisition does not interfere with central matters of plan administration. The responsibility for offering the pharmacy a below-acquisition reimbursement lies first with the PBM. Any “operational inefficiencies” caused by Act 900 are insufficient to trigger ERISA preemption, even if they cause plans to limit benefits or charge higher rates. View "Rutledge v. Pharmaceutical Care Management Association" on Justia Law

Todd McLaughlin was riding his bicycle on a Seattle street when the door of a parked vehicle opened right into him. McLaughlin fell, suffered injuries, and sought insurance coverage for various losses, including his medical expenses. McLaughlin’s insurance policy covered those expenses if McLaughlin was a “pedestrian” at the time of the accident. McLaughlin argued a bicyclist was a pedestrian, relying on the definition of “pedestrian” found in the Washington laws governing casualty insurance. The trial court held a bicyclist was not a pedestrian, reasoning that the plain meaning of "pedestrian" excluded bicyclists. The Court of Appeals affirmed, relying largely on its view that the Washington statute defined pedestrian for purposes of casualty insurance, excluded bicyclists. The Washington Supreme Court reversed. The Washington legislature defined “pedestrian” for purposes of casualty insurance in Washington broadly in RCW 48.22.005(11). The Supreme Court found that definition included bicyclists and applied to the insurance contract at issue here. "Even if we were to hold otherwise, at the very least, the undefined term 'pedestrian' in the insurance contract at issue must be considered ambiguous in light of the various definitions of 'pedestrian' discussed in this opinion. Being ambiguous, we must construe the insurance term favorably to the insured. Accordingly, we reverse the Court of Appeals and remand for further proceedings." View "McLaughlin v. Travelers Commercial Ins. Co." on Justia Law

In this insurance dispute arising from an employee's death, the Supreme Court remanded the determination that the employer's insurer providing underinsured motorist coverage and workers' compensation insurance was entitled to a lien on a portion of settlement proceeds received by the estate, holding that, given a lack of factual findings, there was no way to evaluate whether the court clearly erred in its assessment of the various factors impacting an equitable allocation.Charles Luze died in a work-related accident. His employer paid his wife, Jeanette Luze, workers' compensation benefits. Jeanette, as the representative of Charles's estate, then brought suit against the negligent driver and settled the claim. The estate also settled a claim against the New FB's insurer providing underinsured motorist coverage, Zurich American Insurance Company, which was also New FB's workers' compensation carrier. The circuit court determined that Zurich was entitled to a statutory workers' compensation lien on fifty percent of the settlement proceeds received by the estate and was able to subrogate against its own settlement payment of underinsured benefits. The Supreme Court remanded in part, holding (1) this Court was unable meaningfully to review the circuit court's allocation determination; and (2) the circuit court properly allowed Zurich to subrogate against the amount it paid in underinsured motorist benefits. View "Luze v. New FB Co." on Justia Law