Justia Insurance Law Opinion Summaries

Defendant Navigators Specialty Insurance Company (Navigators) appealed a trial court order denying its special motion to strike under California’s anti-SLAPP statute. Plaintiff Trilogy Plumbing, Inc. (Trilogy) alleged that Navigators, as Trilogy’s insurer, gave instructions with which Trilogy did not agree to attorneys Navigators had retained to defend Trilogy and wrongfully negotiated settlements without Trilogy’s consent. Navigators contended the alleged conduct constituted protected activity under Code of Civil Procedure section 425.17 (e)(2) and, therefore, the trial court erred by denying the anti-SLAPP motion. After review, the Court of Appeal affirmed: the allegations challenged by the anti-SLAPP motion described Navigators’ mishandling of the claims process with regard to 33 different lawsuits involving Trilogy. While the alleged acts were generally connected to litigation, they did not include any written or oral statement or writing made in connection with an issue under consideration or review by a judicial body and therefore did not constitute protected activity under section 425.16. View "Trilogy Plumbing, Inc. v. Navigators Specialty Ins. Co." on Justia Law

Travelers Insurance Co. appealed a district court decision to affirm a final order of the Idaho Department of Insurance in favor of Ultimate Logistics, LLC (“Ultimate”). The Department of Insurance’s final order upheld a hearing officer’s determination that two mechanics working for Ultimate were improperly included in a premium-rate calculation made by Travelers. In its petition for review, Travelers argued the Department of Insurance acted outside the scope of its statutory authority in determining that the mechanics could not be included in the premium-rate calculation. The district court rejected this argument. Finding no reversible error in the district court's order, the Idaho Supreme Court affirmed. View "Travelers Insurance v. Ultimate Logistics, LLC" on Justia Law

Rochelle Frett was injured when she slipped and fell at her place of employment during a scheduled lunch break. She filed a claim for benefits under the Workers’ Compensation Act, but the State Board of Workers’ Compensation denied her claim. Frett appealed, and the superior court upheld the denial of her claim. Frett then appealed the decision of the superior court, and the Court of Appeals affirmed. Relying on Ocean Acc. & Guar. Corp. v. Farr, 178 SE 728 (1935), the Court of Appeals held that Frett suffered no injury compensable under the Act because she sustained her injury during a scheduled break, and her injury, therefore, did not arise out of her employment. The Georgia Supreme Court issued a writ of certiorari to reconsider Farr and reviewed the decision of the Court of Appeals in this case. The Supreme Court overruled Farr, and reversed the decision below. View "Frett v. State Farm Employee Workers Compensation" on Justia Law

Defendant ReadyLink Healthcare, Inc. (ReadyLink) was a nurse staffing company that placed nurses in hospitals, typically on a short-term basis. Plaintiff State Compensation Insurance Fund (SCIF) was a public enterprise fund created by statute as a workers' compensation insurer. Premiums that SCIF charged were based in part on the employer's payroll for a particular insurance year. SCIF and ReadyLink disputed the final amount of premium ReadyLink owed to SCIF for the 2005 policy year (September 1, 2005 to September 1, 2006). ReadyLink considered certain payments made to its nurses as per diem payments; SCIF felt those should have been considered as payroll under the relevant workers' compensation regulations. The Insurance Commissioner concurred with SCIF's characterization of the payments. A trial court rejected ReadyLink's petition for a writ of administrative mandamus to prohibit the Insurance Commissioner from enforcing its decision, and an appellate court affirmed the trial court's judgment. SCIF subsequently filed the action underlying this appeal, later moving for a judgment on the pleadings, claiming the issue of the premium ReadyLink owed for the 2005 policy year had been previously determined in the administrative proceedings, which was then affirmed after judicial review. The trial court granted SCIF's motion for judgment on the pleadings. On appeal, ReadyLink conceded it previously litigated and lost its challenge to SCIF's decision to include per diem amounts as payroll for the 2005 insurance year, but argued it never had the opportunity to challenge whether SCIF otherwise properly calculated the premium amount that it claims was due pursuant to the terms of the contract between the parties, or whether SCIF's past conduct, which ReadyLink alleged included SCIF's acceptance of ReadyLink's exclusions of its per diem payments from payroll in prior policy years and SCIF's exclusion of per diem amounts in paying out on workers' compensation claims filed by ReadyLink employees, might bar SCIF from being entitled to collect that premium amount under the contract. To this, the Court of Appeal concurred the trial court erred in granting SCIF's motion for judgment on the pleadings. Judgment was reversed, and the matter remanded for further proceedings. View "State Comp. Ins. Fund v. ReadyLink Healthcare, Inc." on Justia Law

The Supreme Court vacated the order of the superior court granting summary judgment in favor of Liberty Mutual Insurance Company, holding that the trial justice did not err in holding that the statute of limitations barred Plaintiff's claim for personal injuries that arose from a fall on the property of Liberty Mutual's insured.In a second complaint, Plaintiff alleged that he slipped and fell at a Pizza Hut restaurant that was owned and operated by Mita Enterprises, LLC. Plaintiff then moved to substitute Liberty Mutual as a defendant. The motion was granted. Thereafter, Liberty Mutual moved to dismiss the amended complaint, arguing that the three-year statute of limitations barred Plaintiff's action. The trial justice agreed and granted summary judgment for Liberty Mutual. The Supreme Court vacated the superior court's judgment, holding that the trial justice erred in holding that the savings statute did not apply to Plaintiff's claim against Liberty Mutual. View "Frazier v. Liberty Mutual Insurance Co." on Justia Law

The Supreme Court affirmed the judgment of the superior court dismissing Plaintiff's breach of contract case against Defendant, her homeowner's insurance carrier, after a hearing justice granted Defendant's motion for summary judgment, holding that summary judgment was properly granted in this case.Plaintiff, who had a homeowner's insurance policy purchased from Defendant, sought coverage for damage done to her residence when her water heater leaked and flooded her basement. When Defendant declined coverage Plaintiff filed a complaint claiming breach of contract. Defendant field a motion for summary judgment, arguing that Plaintiff's breach of contract claim failed as a matter of law because, under the unambiguous language of the policy, the flooding caused by the defective water heater was not a loss covered by the policy. The hearing justice granted the motion for summary judgment. The Supreme Court affirmed, holding that the damage caused by Plaintiff's malfunctioning water heater was clearly not one of the hazards articulated in the policy language. View "Nelson v. Allstate Insurance Co." on Justia Law

The Supreme Judicial Court affirmed the decision of the superior court entering summary judgment in favor of State Farm Fire and Casualty Company on the complaint filed by Plaintiffs seeking to reach and apply the State Farm vehicle insurance coverage of a man found jointly and severally liable to Plaintiffs for damages, holding that the facts did not bring Plaintiffs' damages within the policy's coverage.Grover Bragg was driving a truck insured by State Farm to transport an intoxicated and delusional friend when the friend jumped out of the truck, broke into Plaintiffs' house, damaged property, and assaulted one of the plaintiffs. Plaintiffs brought a complaint against Bragg, alleging negligence, and against Bragg's friend. The court concluded that Bragg and his friend were jointly and severally liable to Plaintiffs and awarded damages. The Supreme Court affirmed. Plaintiffs then commenced the present action seeking to reach and apply Bragg's vehicle insurance policy and to obtain a declaratory judgment that the coverage applied. The court entered summary judgment for State Farm. The Supreme Court affirmed, holding that the injuries and property damage suffered by Plaintiffs were not causally connected to the vehicle use in a way that brought them within the insurance coverage. View "Haskell v. State Farm Fire & Casualty Co." on Justia Law

After defending the general contractor in two construction defect actions, general liability insurer St. Paul Mercury Insurance Company (St. Paul) sought reimbursement of defense costs under an equitable subrogation theory against six subcontractors (defendants) that had worked on the underlying construction projects and whose contracts required them to defend the general contractor in suits involving allegations related to their work. After a bench trial, the court denied St. Paul’s claim. Relying on Patent Scaffolding Co. v. William Simpson Constr. Co., 256 Cal.App.2d 506, 514 (1967), the trial court concluded St. Paul had not demonstrated it was fair to shift all of the defense costs to defendants because their failure to defend the general contractor had not caused the homeowners to bring the construction defect actions. St. Paul argued this conclusion misconstrued the law governing equitable subrogation and therefore constitutes an abuse of discretion. To this, the Court of Appeal agreed: (1) a cause of action based on equitable subrogation allowed an insurer to step into the shoes of its insured and recover only what the insured would be entitled to recover from the defendants; and (2) the appropriate inquiry should have been whether defendants’ failure to defend the general contractor caused St. Paul to incur the defense costs, not whether that failure caused the underlying lawsuits. Judgment was reversed and the matter remanded to the trial court to grant judgment in St. Paul's favor and for a determination of defense costs each defendant owed. View "Pulte Home Corp. v. CBR Electric, Inc." on Justia Law

The 2015 Valley Fire caused smoke damage to the Fadeeffs’ home, insured under a State Farm homeowners’ policy. Linen wall covering inside the home had started to buckle and the Fadeeffs had health concerns. With State Farm’s approval, the Fadeeffs retained ServPro to assist with smoke and soot mitigation and cleaning. State Farm’s independent adjuster (Gannaway) reported that the home was “well maintained” and that “[a]ll damage is related to smoke and soot.” State Farm made payments totaling $50,000. The Fadeeffs hired a public adjuster and submitted supplemental claims, totaling $75,000. State Farm’s independent adjuster (Carpenter), who is not a licensed adjuster in California and not licensed in any building trade reported he could not find smoke damage. State Farm retained FACS, which took only surface samples from the home and determined that no additional cleaning was required. State Farm denied the supplemental claims. The Fadeeffs filed suit, alleging insurance bad faith. The court granted State Farm summary judgment.The court of appeal reversed, concluding that multiple disputed facts made summary judgment inappropriate. It is not possible to conclude that it is indisputable that the basis for denial was reasonable. There are triable issues regarding whether State Farm could have reasonably relied on its experts. A jury should determine the issue of punitive damages. View "Fadeeff v. State Farm General Insurance Co." on Justia Law

The Supreme Court affirmed in part and reversed in part the judgment of the district court holding that a commercial general liability (CGL) policy and a related excess liability declaration do not cover claims brought by the estate and spouse of an employee who was fatally injured while working for Adventureland Amusement Park, holding that the district court erred in granting summary judgment.The decedent was serving as a loading assistant on a river ride when he was fatally injured. The decedent's estate and his widow filed a district court action, later removed to federal court, alleging that the decedent's injuries were a result of grossly negligent acts by the ride's operator, the decedent's coemployee. The insurer filed a declaratory action in state court seeking a declaration that it had no duty to defend or indemnify the coemployee in the federal action. The district court granted summary judgment for the insurer. The Supreme Court reversed in part, holding that there remained a question of fact as to whether the estate has a claim that amounts to gross negligence but is within the scope of the coverage of the CGL policy. View "T.H.E. Insurance Co. v. Estate of Booher" on Justia Law