Justia Insurance Law Opinion Summaries

The decedent had insurance policies with Unum Life. After he died, he was survived by two minor children and his domestic partner. The district court granted a declaratory judgment, holding that Unum Life had adopted an unreasonable interpretation of the plans to support its decision to pay the domestic partner rather than the decedent's estate.The Eighth Circuit reversed, holding that Unum life reasonably interpreted the plan as allowing it to pay a decedent's domestic partner in the absence of a designated beneficiary. In this case, it was reasonable for Unum Life to interpret the word "spouse" in the plan to include domestic partners and to pay the death benefits to the covered person's domestic partner. Accordingly, the court remanded with instructions to enter judgment in defendant's favor. View "Engle v. Land O'Lakes, Inc." on Justia Law

A hotel housekeeper injured her back while lifting a pile of linens. Her employer challenged her application for benefits based on an examining doctor’s opinion that she was medically stable and that the job injury was no longer the substantial cause of any disability or need for medical treatment. After a hearing, the Alaska Workers’ Compensation Board decided that the woman was medically stable as of the date of the doctor’s opinion and therefore not entitled to further disability payments or to benefits for permanent partial impairment. The Board also denied further medical care after the date of medical stability. The Alaska Workers’ Compensation Appeals Commission affirmed the Board’s decision, and the woman appealed. Because the Board’s selected date of medical stability was not supported by substantial evidence in the record, the Alaska Supreme Court vacated the Commission’s decision and remanded the case to the Commission with instructions to remand the case to the Board for further proceedings. View "Tobar v. Remington Holdings LP" on Justia Law

The Supreme Court considered two questions from the federal court of appeals regarding California's common-law notice-prejudice rule and held (1) the notice-prejudice rule is a fundamental public policy of the state in the insurance context, and (2) the rule generally applies to consent provisions in the context of first party liability policy coverage and not to consent provisions in third party liability policies.The insurance policy in this case contained a choice of law provision designating that New York law should govern all matters arising under the policy. Under section 187 of the Restatement Second of Conflict of Laws the parties' choice of law generally governs unless it conflicts with a state's fundamental public policy. The party opposing the application of the choice of law provision sought to establish that California's notice-prejudice rule was a fundamental public policy for the purpose of choice-of-law analysis. The federal court of appeals issued certified questions to the Supreme Court, which answered as set forth above. The Court left it to the federal court of appeals to decide whether the consent provision at issue in this case was a consent provision contemplated first party or third party coverage. View "Pitzer College v. Indian Harbor Insurance Co." on Justia Law

Plaintiffs Malik Hasan, M.D. and Seeme Hasan appealed the entry of summary judgment against them and the denial of their motion for leave to amend their complaint. Plaintiffs sought to recover under an insurance policy with Defendant AIG Property Casualty Co. for the alleged loss of wine bottles that were not delivered to them by a retailer whom they had paid for the wine. The retailer had declared bankruptcy and its principal had pleaded guilty to conducting a Ponzi scheme. The district court held that Plaintiffs were not entitled to recover because they had not shown any physical loss or damage to the wine they had ordered. The Tenth Circuit affirmed summary judgment, although on a different ground: plaintiffs’ loss was not insured because they failed to present adequate evidence that they were the owners of any wine bottles not delivered to them. View "Hasan v. AIG Property" on Justia Law

This case arose from Hurricane Katrina insurance litigation. After the hurricane had destroyed many homes, policyholders and insurance companies began litigating whether the hurricane losses were caused by flood damage or wind damage. The distinction determined whether the insurance companies would pay claims on those polices that did not cover flood damage. This case is before the Court on interlocutory appeal. Safeco Insurance Company (Safeco) and Liberty Mutual Insurance Company individually challenged the circuit court’s reassignment of their respective cases and the appointment of a special master. The Mississippi Supreme Court found no abuse of discretion in reassigning judges, but vacated the order appointing the special master, finding an abuse of the trial court’s discretion. “The order itself acknowledged a blind-billing provision was “unusual.” But the Supreme Court found it was more than that: requiring both parties, one of which is the State of Mississippi, to pay an attorney in Louisiana to act as a judge, allowing either side to meet with him ex parte, and not requiring this special master to mention these meetings or even justify or detail his bill far exceeded the discretionary authority to appoint special masters.” View "Safeco Insurance Company of America v. Mississippi, ex rel. Hood" on Justia Law

One summer night in 2015, at a Louisville nightclub, someone discharged a firearm, shooting eight people. Six of those people sued the nightclub’s owner, Cole’s Place, in state court, arguing that Cole’s Place failed to protect them from foreseeable harm. United Specialty Insurance (USIC) obtained a federal declaratory judgment that it is not obligated to defend or indemnify Cole’s Place in the state court litigation. The Sixth Circuit affirmed. The district court did not abuse its discretion in exercising Declaratory Judgment Act jurisdiction over USIC’s lawsuit and did not err in finding that an assault-and-battery exclusion in Cole’s Place’s insurance policy with USIC applies to the state court litigation. There are no factual issues remaining in the state-court litigation or complex state-law issues that are “important to an informed resolution” of this case. View "United Specialty Ins. Co. v. Cole's Place, Inc." on Justia Law

Group Health Cooperative (GHO) provided health insurance benefits to Nathaniel (Joel) Coon, who suffered a serious fungal infection and amputation following knee surgery at the Everett Clinic (TEC). The Coon family later settled potential negligence claims against TEC, and GHO initiated this lawsuit seeking reimbursement of its payments from the settlement proceeds. At issue before the Washington Supreme Court was whether genuine issues of material fact remained to preclude summary judgment in favor of GHO regarding whether the settlement constituted full compensation to Coon, and whether GHO suffered prejudice from the Coons’ failure to provide notice prior to finalizing the settlement. The Supreme Court concurred with the Court of Appeals’ conclusion that genuine issues of fact still remained, making summary judgment inappropriate. The matter was remanded for further proceedings. View "Grp. Health Coop. v. Coon" on Justia Law

In this insurance dispute, the First Circuit remanded the case for additional factfinding, holding that where the record was conflicted as to whether there was complete diversity of citizenship when the action was commenced, remand was required.Appellants were two affiliated insureds who owned and operated a commercial bakery in Pittsfield, Massachusetts. Appellee, their insurer, had in effect a commercial business insurance policy covering the bakery. When a pipe erupted in the bakery, causing covered losses, the parties were unable to settle the ensuing insurance claims. Appellants commenced a civil action against Appellee in the United States District Court for the District of Massachusetts, invoking federal diversity jurisdiction and alleging that complete diversity existed between the parties. The magistrate judge ultimately granted Appellee's motion for summary judgment. The First Circuit noted a jurisdictional hurdle and remanded the case, holding that remand was required for the district court to determine whether there was complete diversity between the parties at the time the action was commenced. View "Bearbones, Inc. v. Peerless Indemnity Insurance Co." on Justia Law

Bonni Genzer, an Uber driver, contended James River Insurance Company, Uber’s insurer, breached its contractual obligations by declining coverage for injuries she sustained in an accident on the return leg of a lengthy fare. Genzer also contended that, under Oklahoma law, the “mend the hold” doctrine limited James River to the grounds it gave for declining coverage before she sued. The district court granted summary judgment in James River’s favor, first ruling that Oklahoma had not adopted the mend-the-hold doctrine, and next holding that Genzer’s claim falls outside the scope of the governing insurance policy. The Tenth Circuit agreed as to both issues. View "Genzer v. James River Insurance Company" on Justia Law

Due to an unsafe condition on the premises, Osborne suffered a broken arm at the Center, which is owned and operated by Metro Nashville. Osborne obtained a state court judgment against Metro under the Tennessee Governmental Tort Liability Act; the damages included specific medical expenses related to the incident and found Osborne’s comparative fault to be 20 percent. Before the state court suit, Osborne incurred medical expenses for which Metro did not pay at the time. Medicare made conditional payments to Osborne totaling at least $9,453.09. Osborne claims he incurred—in addition to the costs of his state court litigation—the cost of his co-pays, deductibles, and co-insurance for treatments not covered through Medicare. Osborne alleged Metro is a primary payer who failed to pay under the Medicare Secondary Payer Act (MSPA), 42 U.S.C. 1395y(b), and was therefore liable for reimbursement of Medicare’s conditional payments and a double damages penalty under section 1395y(b)(3)(A). Metro claimed it paid the judgment in full, including discretionary costs. The Sixth Circuit affirmed that Osborne lacked statutory standing to sue for his individual losses and the conditional payments made by Medicare because the MSPA does not permit a private cause of action against tortfeasors. Because the MSPA is not a qui tam statute and financial injury suffered by Medicare is not attributed to Osborne, he also lacked Article III standing to sue for Medicare’s conditional payments. View "Osborne v. Metropolitan Government of Nashville and Davidson County" on Justia Law