Justia Insurance Law Opinion Summaries

David Murray purchased used computer equipment worth nearly $40,000, which was damaged by the United Postal Service (UPS) while it was being transported from California to Texas. Murray believed he purchased appropriate insurance to cover this loss, but the insurance company denied his claim. Murray sued his insurance broker, UPS Capital Insurance Agency (UPS Capital), for breach of contract and negligence, claiming UPS Capital owed him a special duty to make the insurance policy language understandable to an ordinary person and to explain the scope of coverage. The court granted UPS Capital’s motion for summary judgment after concluding there was no heightened duty of care and dismissed Murray’s lawsuit. On appeal, Murray asked the Court of Appeal to create a new rule that brokers/agents, specializing in a specific field of insurance, hold themselves out as experts, and are subject to a heightened duty of care towards clients seeking that particular kind of insurance. While the Court declined the invitation to create a per se rule, it concluded Murray raised triable issues of fact as to whether UPS Capital undertook a special duty by holding itself out as having expertise in inland marine insurance, and Murray reasonably relied on its expertise. Therefore, the Court reversed the judgment of dismissal and remanded the matter for further proceedings. View "Murray v. UPS Capital Ins. Agency, Inc." on Justia Law

The House of Blues music studio in Memphis suffered a burglary and arson in 2015. Brown owned House of Blues through TME. He and two tenants, Falls and Mott, submitted insurance claims to Hanover for the loss. Brown submitted fraudulent documents in connection with this claim, resulting in an insurance-fraud lawsuit. Brown was found liable after admitting on the stand that he had forged documents submitted in his insurance claim. Falls prevailed before the jury, only to have the judge set aside the verdict and direct judgment for Hanover under Federal Rule of Civil Procedure 50(b). Rule 50(a) provides for a motion for judgment as a matter of law at trial; Rule 50(b) provides for “Renewing the [50(a)] Motion after Trial.” Hanover failed to make a Rule 50(a) motion at trial. The Sixth Circuit affirmed as to Mott, who failed to raise any issues on appeal, and as to Brown. The court rejected Brown’s arguments that the district court abused its discretion by refusing to allow him to introduce an exhibit that he tried to introduce several times; by intervening excessively to question witnesses; and by imposing a time limit on Brown and not on Hanover. The court reversed as to Falls. Hanover forfeited its ability to “renew” a motion for a directed verdict after trial under Rule 50(b). View "Hanover American Insurance Co. v. Tattooed Millionaire Entertainment, LLC" on Justia Law

A superior court determined State Farm Mutual Auto Insurance Company and State Farm Fire and Casualty Company’s (collectively, “State Farm”) payment practices with Spine Care Delaware, LLC (“SCD”) for medical fees incurred by its Personal Injury Protection (“PIP”) insureds in connection with covered multi-injection spine procedures contravened 21 Del. C. 2118(a)(2). When State Farm received SCD’s charges for a multi-injection procedure performed on one of its PIP insureds, it unilaterally applied a Multiple Payment Reduction (“MPR”) to the charges for injections after the first injection in a manner consistent with Medicare guidelines, paying SCD less than what it charged. SCD sought a declaration that State Farm's application of its MPRs was inconsistent with section 2118(a)(2)’s requirement of reasonable compensation for covered medical expenses, and sought a declaration that State Farm had to pay SCD any reasonable amount charged for PIP-related medical expenses, without applying MPRs. Both parties then moved for summary judgment. The superior court held that State Farm failed to show that the MPR reductions correlated to reasonable charges for the multiple-injection treatments, and thus contravened section 2118(a)(2). On appeal, State Farm contended the superior court incorrectly placed the burden of proof on State Farm to demonstrate that its application of MPRs was reasonable, and that SCD failed to meet its burden of demonstrating that State Farm’s application of MPRs was a failure to pay reasonable and necessary expenses under the statute. Alternatively, State Farm argued that even if it had the burden of proof, it satisfied that burden. The Delaware Supreme Court agreed with State Farm's first premise, that the superior court erred in assigning State Farm the burden of proof. Judgment was reversed and the matter remanded for further proceedings. View "State Farm v. Spine Care Delaware" on Justia Law

After ASIC denied Waste coverage for all costs associated with a criminal proceeding, Waste filed suit in Texas state court against ASIC and AIG Claims. After ASIC removed to federal court, the district court denied Waste's motion to remand and determined that ASIC had no duty to defend Waste.The Fifth Circuit affirmed the district court's denial of Waste's motion to remand. The court held that, even assuming that an adjuster can be held liable under Texas Insurance Code sections 541.060(a)(2), (a)(4), and (a)(7), Waste did not allege facts that, taken as true, demonstrate a violation of these provisions. In this case, Waste's threadbare factual allegations, along with its conclusory recitation of the elements of a claim under the Texas Insurance Code, are insufficient to state a plausible claim for relief. Therefore, the district court did not err in finding that there was no reasonable probability that Waste would recover against AIG Claims, and the district court did not err in disregarding AIG Claims' citizenship and determining that there was complete diversity.The court also affirmed the district court's summary judgment determination that ASIC had no duty to defend Waste against the criminal allegations. In this case, the district court did not err in finding that there was no claim that triggered ASIC's duty to defend against the criminal allegations. Finally, the district court also did not err in granting summary judgment in favor of ASIC on all remaining claims. View "Waste Management, Inc. v. AIG Specialty Insurance Co." on Justia Law

In 2011, Joshua Martinez was driving a pickup truck when he lost control and crashed into a cabin, injuring the cabin owner Charles Burnett, and causing damage, including a spill of heating fuel. Burnett asked Martinez's insurance company, Government Employees Insurance Company (GEICO) to pay him to do the cleanup himself, but the insurance company refused because the cabin owner did not have the qualifications required by the Alaska Department of Environmental Conservation. Cleanup stalled for over a year while the effects of the spill on the property and the owner’s health allegedly worsened. Martinez and the truck’s owner (his father) Robert Martinez, settled with the Burnett for the maximum limits of the insurance policy, but Burnett sought additional damages from the insurance company for its failure to promptly clean up the property. Following summary judgment for the insurance company and a reversal and remand by the Alaska Supreme Court, the superior court held an evidentiary hearing to decide whether the insurance company had assumed a duty to the cabin owner independent of the duty it owed its insureds. The superior court found there was no such duty. Burnett and the insureds appeal. Burnett contended the superior court erred by finding no actionable duty, and that it deprived him of due process by failing to consider his arguments before entering proposed findings of fact and conclusions of law and awarding attorney’s fees. The insureds argued the superior court erred by deciding that they were precluded from further participation in the litigation once they entered into a settlement and were voluntarily dismissed from the case. The Supreme Court concluded the superior court did not clearly err in its findings of fact about the existence of an independent duty and that it did not violate Burnett’s due process rights. The Court also concluded the insureds were no longer parties to the case at the time they sought to renew their participation in it, and their arguments that they were entitled to either joinder or intervention were waived for lack of briefing. View "Martinez v. Government Employees Insurance Company, et al." on Justia Law

After her claim for coverage under the Public Education Employees' Health Insurance Plan ("PEEHIP") was denied, Marilyn Player sued Blue Cross and Blue Shield of Alabama ("BCBS") at the Macon Circuit Court ("the trial court") asserting claims of breach of contract and bad faith. BCBS sought a writ of mandamus to direct the trial court to transfer Player's case to the Montgomery Circuit Court pursuant to section 16-25A-7(e), Ala. Code 1975. A complaint seeking judicial review of a decision of a PEEHIP claims administrator could be heard only by the Montgomery Circuit Court. Player argued that 16-25A-7(e) did not apply to her complaint because her claims, she contended, did not constitute an action for a dispute over the denial of benefits and her complaint could not be characterized as an appeal of any administrative action. Rather, the breach-of-contract and bad-faith claims, Player argued, were regular tort claims recognized by the common law of Alabama and therefore did not fall within the purview of 16-25A-7(e). The Alabama Supreme Court was not persuaded: "Player cannot avoid the legislature's exclusive-venue provision by recasting her claims using artful labels." The trial court exceeded its discretion in denying BCBS's motion for a change of venue from Macon County to Montgomery County. Despite Player's attempt to cast the issues in her complaint as regular tort claims, Player's breach-of-contract and bad-faith claims are, in essence, disputes over a final decision allegedly made by BCBS regarding Player's insulin medication. Section 16-25A-7(e) controlled in this action; therefore, venue was proper in Montgomery County. The Supreme Court granted the petition and issued the writ. The trial court was ordered to transfer the action to the Montgomery Circuit Court. View "Ex parte Blue Cross & Blue Shield of Alabama." on Justia Law

Plaintiffs, collection agencies, appealed the district court's dismissals with prejudice of their claims against defendants, seeking double damages against defendants under the Medicare Secondary Payer Act and alleging that actors within the Medicare Advantage system, including Medicare Advantage Organizations (MAOs) and various "downstream actors" that contracted with MAOs, had assigned their Medicare Secondary Payer Act claims to plaintiffs for collection.The Eleventh Circuit vacated the dismissals of plaintiffs' claims based on assignments from downstream actors, holding that the district court erred by narrowly construing 42 U.S.C. 1395y(b)(3)(A) to categorically exclude claims by downstream actors. The court explained that both the text and the objective of section 1395y(b)(3)(A) support allowing downstream actors to bring suit, or assign their right to bring suit, against primary payers. Therefore, the court remanded these claims for further proceedings.The court found that the district court erred insofar as it dismissed MSPRC's HFAP claims with prejudice, and ordered that the district court's dismissal be without prejudice. The court also found that the district court erred in dismissing MSPA's FHCP and IMC claims based on the purported cancellation and validity of MSPA's assignments. Finally, defendants' alternative claims are without merit. The court vacated the dismissal of plaintiffs' remaining claims in case number 18-12149. In case number 18-13049, the court affirmed the dismissal of plaintiffs' claims but modified the dismissal of these claims to be without prejudice. View "MSP Recovery Claims, Series LLC v. Ace American Insurance Co." on Justia Law

Todd and Melissa Muller appealed a superior court decision granting summary judgment to their insurer, Progressive Northern Insurance Company. The Mullers challenged the court’s conclusions on how the setoff provision of their insurance policy should have been applied when there were multiple claimants. The Vermont Supreme Court agreed with the trial court that, construing the insurance policy as a whole, the setoff provision is unambiguous: It clearly provided that Progressive was entitled to reduce “all sums . . . paid” regardless of the number of claims made. View "Progressive Northern Insurance Company v. Muller" on Justia Law

The Supreme Court affirmed the order of the district court granting in part judgment notwithstanding a jury verdict (JNOV) in favor of American Family Insurance Company on Valley Boys, Inc.'s complaint alleging that American Family failed to pay the full amounts due under postloss assignments of insurance proceeds, holding that the district court did not err in finding that eight of Valley Boys' nine assignments were unenforceable.In 2014, nine homeowners sustained property damage in a hailstorm. The properties were insured under a homeowner's insurance policy issued by American Family. The homeowners assigned their proceeds under the insurance policies to Valley Boys, a roofing company. Eight of the assignments incorporated a Customer Service Agreement (CSA). Valley Boys, as assignee, later filed suit against American Family for failing to pay the full amount of repair and/or replacement costs due under the policies. The jury returned a verdict for Valley Boys. American Family moved for JNOV, arguing that the assignments were unenforceable. The court granted the motion as to the claims based on the eight assignments that incorporated the CSA. The Supreme Court affirmed, holding that the assignments were unenforceable under general contract principles. View "Valley Boys, Inc. v. American Family Insurance Co." on Justia Law

TDH’s contract to provide HVAC services at a Chicago construction site contained provisions agreeing to indemnify Rockwell, the owner. TDH provided a Certificate of Liability Insurance, identifying Columbia as the commercial general liability insurer, TDH as the insured, and Rockwell and Prairie (the manager) as additional insureds. While working at the site, TDH’s employee Guzman fell 22 feet through an unguarded opening in the second floor, sustaining serious injuries.Guzman sued Rockwell, Prairie, and others. Guzman did not sue TDH. Several defendants filed third-party complaints against TDH for contribution. Scottsdale insured Rockwell and has defended Rockwell and Prairie. Scottsdale filed suit, wanting Columbia to take over their defense.The district court declared that Columbia owes a duty to defend Prairie and Rockwell, ordered Columbia to pay Scottsdale $50,000 for defense costs through August 2019, and left the issue of indemnity for another day. The Seventh Circuit affirmed. The Columbia policy limitation that another organization would only be an additional insured with respect to liability arising out of TDH’s ongoing operations performed for that other organization does not eliminate Columbia’s duty to defend. Prairie’s and Rockwell’s liability for the fall potentially arises in part out of TDH’s then-ongoing operations performed for Prairie and Rockwell. It does not matter that the underlying suit does not name TDH. The underlying allegations do not preclude the possibility of coverage. View "Scottsdale Insurance Co. v. Columbia Insurance Group, Inc" on Justia Law