Justia Insurance Law Opinion Summaries

The Office of Personnel Management (OPM), manages the Federal Employees’ Group Life Insurance Act (FEGLIA), 5 U.S.C. 8705(a). Absent a valid beneficiary selection, FEGLIA provides an order of precedence for the proceeds, starting with the policyholder's surviving spouse, followed by the policyholder's descendants. FEGLIA will not follow that order if a “court decree of divorce, annulment, or legal separation, or . . . any court order or court-approved property settlement agreement” “expressly provides” for payment to someone else. The decree, order, or agreement must be “received” by the policyholder’s “employing agency” or OPM before the policyholder’s death. At the time of his death, Miller worked at Tinker Air Force Base and maintained a MetLife policy. Coleman's 27-year marriage to Donna ended in divorce in 2011. Their property settlement agreement states that “[Donna] shall remain the beneficiary of the life insurance policy.” The court ordered Coleman to assign his FEGLI benefits to Donna.Upon Coleman’s death, his only child, Courtenay, was appointed administratrix of his estate. The Air Force informed Courtenay that the court order had not been filed with Coleman’s employing office. Courtenay was paid $172,000 in proceeds and sought a declaration that she is the rightful owner. Citing lack of subject-matter jurisdiction, the district court dismissed the suit. The Sixth Circuit affirmed, noting the lack of a substantial federal question. FEGLIA does not contain an express cause of action for Donna. There is no federal agency involved. View "Miller v. Bruenger" on Justia Law

In this insurance coverage duty-to-defend dispute the Supreme Court affirmed the decision of the court of appeals affirming the circuit court's judgment denying the motion for attorney fees filed by the Germantown School District Board of Education and Germantown School District (collectively, the School District), holding that the School District's insurers (Insurer) did not breach the duty to defend the School District in a lawsuit brought by retired employees.In seeking attorney fees, the School Board argued that its Insurer should pay all of the attorney fees incurred by the School District in the underlying lawsuit as a remedy for its breach of the duty to defend the School District. The Supreme Court held (1) the Insurer's initial denial of the School District's tendered claim did not breach its duty to defend when the Insurer followed a judicially preferred method for determining coverage; (2) a delay in payment of liability attorney fees alone does not mean an insurer breached its duty to defend; and (3) the four-corners rule applies in determining whether a duty to defend exists but does not preclude a court's consideration of certain factors in assessing whether an insurer breached its duty to defend. View "Choinsky v. Germantown School District Board of Education" on Justia Law

The Supreme Court affirmed the judgment of the district court holding that Appellant, who was injured while she was driving a Pontiac and sought additional primary underinsured motorist (UIM) benefits under an insurance policy that covered a separate vehicle, a Chevrolet, was not entitled to primary UIM benefits under the Chevrolet policy, holding that Appellant could not recover additional primary UIM benefits under the Chevrolet policy.State Farm, Appellant's insurer, paid Appellant the Pontiac policy's UIM benefits limit but denied that the Chevrolet policy applied to Appellant's claim for additional primary UIM benefits. The district court granted summary judgment for State Farm, holding that the Chevrolet policy did not apply under Minn. Stat. 65B.49, subd. 3a(5). The court of appeals affirmed. The Supreme Court affirmed, holding (1) consistent with section 65B.49, subdivision 3a(5) and precedent interpreting that provision, Appellant was limited to primary UIM benefits under the policy that covered the vehicle she occupied at the time of the accident; and (2) even assuming that parties can contract around the priority scheme for primary UIM benefits that the legislature established in section 65B.49, subdivision 3a(5), no explicit language in the State Farm policies actually did so. View "Visser v. State Farm Mutual Automobile Insurance Co." on Justia Law

In this insurance dispute, the Supreme Court reversed the decision of the district court granting summary judgment to Shelter Mutual Insurance Company on its declaratory judgment action, holding that Neb. Rev. Stat. 60-310 does not allow provisions known as partial household exclusion clauses.Larry Freudenburg was injured in an accident where he was the passenger in a car covered by a policy Freudenburg and his wife had purchased from Shelter. Shelter refused to pay Freudenburg's request for reimbursement of expenses in the amount of the policy limit for bodily injury based on a partial household exclusion clause in Freudenburg's policy. Partial household exclusion clauses reduce automobile liability coverage from the policy amount to the state minimum when the injured person is an insured, relative, or resident of the insured's household. The district court concluded that partial household exclusions are not prohibited by section 60-310. The Supreme Court reversed, holding that an automobile liability policy policy in any coverage amount is not permitted to exclude or reduce liability coverage under the policy on the ground that the claimant is a named insured or resident in the named insured's household. View "Shelter Mutual Insurance Co. v. Freudenburg" on Justia Law

Dorris, a company president, had Unum long-term disability insurance. Her endometriosis became disabling; Unum started paying her benefits in 2002. Later, Dorris was diagnosed with Lyme disease. By 2007, the Social Security Administration granted her disability benefits. To maintain Unum benefits after two years, an employee had to prove that she “cannot perform each of the material duties of any gainful occupation for which [she is] reasonably fitted” or that she is “[p]erforming at least one of the material duties" of any occupation and “[c]urrently earning at least 20% less" due to the disability. In 2015, Dorris told Unum that she was improving and had started golfing and volunteering. Dorris’s Lyme disease specialist indicated that Dorris still had major symptoms and could not work. Unum’s consulting physicians found no evidence of limitations that would preclude sedentary work nor of an active Lyme infection. Unum ended her benefits.In her Employee Retirement Income Security Act (29 U.S.C. 1132(a)(1)(B)) lawsuit, Dorris was denied permission to depose witnesses to clarify the administrative record. Dorris never sought further discovery; nor objected to the ruling. Unum rested on its physician’s conclusions that Dorris could perform the duties of a president. Dorris asserted, without evidence, that such jobs required “55–70 hours a week,” and focused on how little she did as a volunteer. The court limited its review to the administrative record and found that Dorris could not perform the duties of her regular occupation, but nonetheless ruled in Unum's favor, because Dorris's arguments based on the "20% less" option were conclusory. The Seventh Circuit affirmed. The plaintiff bears the burden of proving that she is entitled to benefits. The court did not abuse its discretion in denying Dorris the opportunity to supplement the record after judgment nor were its factual findings in error. View "Dorris v. Unum Life Insurance Co. of America" on Justia Law

State Farm Fire and Casualty Company ("State Farm"), a defendant below, petitioned the Alabama Supreme Court for a writ of mandamus to challenge Clarke Circuit Court's failure to dismiss the underlying action or to enter a judgment in its favor on the claims of the plaintiffs, Samuel Boykin, Lucretia Boykin, Reginald Berry, and Ida Berry (collectively referred to as "the respondents"). Specifically, State Farm contended respondents' claims were barred by section 27-23-2, Ala. Code 1975 ("the direct-action statute). In denying the writ, the Supreme Court found it “never recognized an exception to the general rule that would permit interlocutory review of a trial court's denial of a motion to dismiss or for a judgment on the pleadings for cases that turn on whether the plaintiff has stated a cognizable claim under the applicable law. We will not make an exception here. Accordingly, the petition is denied.” View "Ex parte State Farm Fire & Casualty Company." on Justia Law

Allstate Property and Casualty Insurance Company ("Allstate") petitioned the Alabama Supreme Court for a writ of mandamus to direct the Macon Circuit Court to grant Allstate’s request for a jury trial in a pending action there. In August 2013, a vehicle occupied by Danielle Carter was involved in an accident with a vehicle being driven by Alvin Lee Walker. Carter sued Walker, alleging negligence and wantonness in the operation of his vehicle. In the same action, Carter also sued her underinsured-motorist carrier, Allstate, seeking underinsured-motorist benefits. In her complaint, Carter demanded a jury trial. Likewise, Allstate demanded a jury in its answer to the complaint. Pursuant to Lowe v. Nationwide Insurance Co., 521 So. 2d 1309 (Ala. 1988), Allstate opted out of active participation in the litigation. Opting out under Lowe keeps the jury in a vehicle-accident action from learning that insurance coverage might be available to pay damages. As the trial date approached, Carter and Walker decided that they would rather try the case without a jury. Allstate, however, demanded a jury trial. The trial court denied Allstate's demand and set the case for a nonjury trial. The Supreme Court determined that Lowe demonstrated there was a strong policy in Alabama against tainting a jury with knowledge of the possible availability of insurance to cover a party's damages. “There is also a strong policy of preserving the right to have a jury determine the extent of a party's liability.” Accordingly, the Court held Allstate could insist that a jury determine liability and damages and, at the same time, keep its involvement from the jury pursuant to the opt-out procedure adopted in Lowe. View "Ex parte Allstate Property & Casualty Insurance Company." on Justia Law

In this declaratory judgment action, the Supreme Court reversed the district court's decision entering summary judgment in favor of Gage County's insurer, Employers Mutual Casualty Company (EMC), and dismissing Gage County's claim that EMC had defense and indemnity obligations for federal court judgments entered against Gage County in 2016, holding that it was error to grant summary judgment for EMC.The district court granted EMC's summary judgment motion and denied Gage County's partial summary judgment motion, ruling that a commercial general liability policy's professional services exclusion barred coverage under the CGL policy for all claims brought against Gage County in the earlier litigation and that there was no coverage under either a linebacker policy or an umbrella policy. The Supreme Court reversed and remanded the cause with directions to sustain Gage County's motion for partial summary judgment, holding that the professional services exclusion in the CGL policy did not preclude coverage for Gage County's insurance claims. View "Gage County v. Employers Mutual Casualty Co." on Justia Law

The issue this case presented for the Court of Appeal's review centered on whether a binding arbitration clause in an insurance policy issued by plaintiff Philadelphia Indemnity Ins. Co., applied to a third party, defendant SMG Holdings, Inc. The policy had been issued to Future Farmers of America, which was holding an event inside the Fresno Convention Center. Future Farmers had licensed the use of the convention center from its property manager, SMG. As part of the license, Future Farmers agreed to obtain coverage for itself and to name SMG as an additional insured. Thereafter, Future Farmers obtained a policy from Philadelphia Indemnity, which provided coverage for “managers, landlords, or lessors of premises” as well as for any organization “as required by contract.” The policy also contained an arbitration clause for coverage disputes. During the Future Farmers event, an attendee was injured in the convention center parking lot. When the injured man sued SMG, which also managed the parking lot, SMG tendered its defense to Philadelphia under the policy. Philadelphia refused, believing SMG was not covered under the policy for an injury occurring in the parking lot. After two years, Philadelphia petitioned the trial court to compel arbitration against SMG. The trial court denied the petition, concluding no evidence was presented that the parties to the policy intended to benefit SMG, and Philadelphia was equitably estopped from claiming SMG was required to arbitrate the dispute. Philadelphia contended: (1) the trial court erred in determining SMG was neither a third party beneficiary of the policy, nor equitably estopped from avoiding the policy’s arbitration clause; (2) alternatively, the court erred in finding Philadelphia estopped from compelling SMG to arbitrate; and (3) the coverage dispute was encompassed by the arbitration clause and arbitration should be ordered. The Court of Appeal agreed SMG could be compelled to arbitrate. Judgment was reversed, the trial court's order vacated, and the trial court directed to order arbitration of the coverage dispute. View "Philadelphia Indemnity Ins. Co. v. SMG Holdings, Inc." on Justia Law

In a case of first impression, the Court of Appeal was asked to determine whether insurers have the right to appeal a small claims default judgment entered against their insureds. Vanessa Gonzalez sued Jonathan Johnson in small claims court after an auto accident in Orange, California. Johnson did not show up for the small claims hearing, and the small claims court entered a default judgment against him for $10,000, plus $140 in costs. Johnson’s auto insurer was Pacific Pioneer Insurance Company. Pacific Pioneer filed a timely notice of appeal. The trial court struck the notice of appeal, and Pacific Pioneer sought to set aside that order. This prompted the trial court to compose a minute order explaining why it had struck the notice: Code of Civil Procedure 116.710(d) precluded a non-appearing “defendant” - which the court equated with Pacific Pioneer - from appealing a small claims judgment. Pacific Pioneer then filed this writ petition, challenging the trial court’s reading of the relevant statutes. The Court of Appeal concluded the insured’s failure to appear in small claims court did not annul the appeal right conferred upon the insurer by Code of Civil Procedure section 116.710(c). The trial court thus erred in striking Pacific Pioneer’s notice of appeal. The Court issued a writ to direct the trial court to vacate its order striking Pacific Pioneer’s notice of appeal, and to reinstate its appeal of the small claims judgment in favor of Gonzalez. View "Pacific Pioneer Ins. Co. v. Super. Ct." on Justia Law