Justia Insurance Law Opinion Summaries

The First Circuit affirmed the judgment of the district court granting summary judgment in favor of Insurers in this action brought by Appellants claiming that Insurers' refusal to cover certain legal disputes constituted a breach of their insurance contract, holding that the clear and unambiguous language of the specific litigation exclusion barred coverage of the disputed litigation matters.Appellants filed suit against their primary insurance provider and their secondary insurance providers alleging that Insurers breached their contractual duty to reimburse Appellants for defense costs incurred in connection with the disputed matters. The primary insurer argued that the legal disputes fell under a "specific litigation exclusion" clause in the insurance policy that excepted from coverage claims related to prior matters specified therein. The district court granted summary judgment for Insurers, holding that the prior and disputed matters were sufficiently related such that the exclusion clause applied. The First Circuit affirmed, holding that the specific litigation exclusion barred coverage of the disputed matters because they all involved facts, circumstances, or situations alleged in the prior matters. View "UBS Financial Services Inc. v. XL Specialty Insurance Co." on Justia Law

At issue in this case was whether a first-party insurer, after obtaining a partial recovery in a subrogation action, had to reimburse its fault-free insureds for the full amount of their deductibles before any portion of the subrogation proceeds could be allocated to the insurer. Lazuri Daniels brought claims, and sought class action status, in a lawsuit against State Farm Mutual Automobile Insurance Company arguing that by failing to fully reimburse its insureds for their deductibles, State Farm violated both Washington law and the terms of its own insurance policy. The trial court dismissed the claims, and the Court of Appeals affirmed. In addressing conflicts between subrogated insurers and injured insureds, Washington law generally establishes priority for the interests of the insured through the "made whole doctrine." "Out of the recovery from the third party the insured is to be reimbursed first, for the loss not covered by insurance ,and the insurer is entitled to any remaining balance, up to a sum sufficient to reimburse the insurer fully, the insured being entitled to anything beyond that." If the insured still has uncompensated injuries, both the insurer and insured will generally be looking to recover from the same third party, and that party's own insurance and assets are not always sufficient to cover both claims. In such circumstances, there is a high potential for conflict between insureds who wish to be compensated for the full extent of the damages they have suffered, and first-party insurers who expect to be reimbursed for amounts they have advanced to the insured. Daniels argued that insureds' right to be fully compensated for their losses, including full reimbursement for deductibles, takes priority over an insurer's interest in recouping its payments through a direct subrogation action. The Washington Supreme Court concluded Daniels' complaint asserted valid claims for relief under the common law, under Washington insurance regulations, and under State Farm's own policy language. As such, dismissal was improper. The matter was remanded to the trial court for further proceedings. View "Daniels v. State Farm Mut. Auto. Ins. Co." on Justia Law

The Fifth Circuit considered an issue of first impression under Mississippi insurance law: may an insurer rely on a consent-to-settle exclusion in an insurance policy to deny coverage of a claim made by an unnamed additional insured under that policy?The court held that absent evidence that the unnamed insured knew or should have known of the exclusion, the insurer may not enforce its contractual right to deny coverage because it had not consented to the settlement. In this case, there was no evidence that Atlantic attempted to inform plaintiff of the policy terms, and indeed there was testimony that policy was not released to Pearl River County Employees as a matter of county policy. Accordingly, the court affirmed the district court's denial of Atlantic's motion for summary judgment. View "Netto v. Atlantic Specialty Insurance, Co." on Justia Law

Emmis bought a directors-and-officers liability policy covering October 1, 2009 to October 1, 2010, from Chubb Insurance. Emmis later bought, from Illinois National, a policy covering liability from October 1, 2011, to October 1, 2012, with an exclusion for any losses in connection with “Event(s),” which included “[a]ll notices of claim of circumstances as reported” under the Chubb policy. In 2012, Emmis tried to gain control of enough of its shares to go private. Shareholders filed suit to stop Emmis’s effort. Emmis reported the suit to Chubb and also sought coverage under the Illinois National policy. Illinois National refused coverage. Emmis sued, seeking damages for breach of contract and breach of the duty of good faith and fair dealing. The district court granted Emmis summary judgment for breach of contract, rejecting Illinois National’s interpretation of the “as reported” language. The Seventh Circuit reversed. Illinois National’s proposed interpretation is correct. The phrase “as reported” has no discernable temporal limitations. Once Emmis reported a claim to Chubb, at any time, then that claim was “reported” and excluded. View "Emmis Communications Corp. v. Illinois National Insurance Co" on Justia Law

The First Circuit affirmed the judgment of the district court dismissing Plaintiff's action alleging that Defendant, an insurance company, had breached its duty to defend and indemnify Plaintiff against a third-party's claim, holding that Defendant had no duty to defend or indemnify Plaintiff with respect to the third-party's claim.At issue was whether the scope of a so-called intellectual property exclusion to the personal and advertising injury coverage under a commercial general liability policy issued by Defendant to Plaintiff excluded the advertising injury in this case from coverage. The First Circuit held that the advertising injury alleged in the third-party's complaint arose out of the claimed infringement of the third-party's trademark, and therefore, the policy excluded the injury from the scope of coverage. View "Sterngold Dental, LLC v. HDI Global Insurance Co." on Justia Law

The Supreme Court vacated the judgment of the superior court that granted a preliminary injunction in favor of Plaintiffs restraining the City of Woonsocket from changing the terms of Plaintiffs' retiree health insurance, holding that the City had the statutory authority to make changes to Plaintiffs' health care benefits.Plaintiffs, several retried Woonsocket police officers, brought this action against the City and the Woonsocket Budget Commission (the WBC). The superior court granted a preliminary injunction for Plaintiffs and reinstated Plaintiffs' previous postretirement health care benefits. The Supreme Court vacated the judgment, holding that the trial justice (1) did not err when he found that Plaintiffs had a vested contractual right to free lifetime health care benefits; (2) erred when he found that the WBC lacked statutory authority when it adopted the Retiree Resolutions that required Plaintiffs to contribute to their health care expenses; and (3) erred in finding that the WBC violated the Contract Clause of the Rhode Island Constitution when it required Plaintiffs to pay for their health insurance under a new uniform health care plan applicable to all retirees and employees. The Court remanded the case to the trial justice for additional findings. View "Hebert v. City of Woonsocket" on Justia Law

The district court granted summary judgment to Cincinnati in an insurance coverage dispute action, concluding that the insured's intentional decision to drive while intoxicated meant that the collision was not an "accident" under Texas law.The Fifth Circuit reversed, holding that, as a matter of plain meaning and common usage, the term "accident" plainly includes the drunk driving collision that gave rise to this dispute. The court rejected Cincinnati's arguments to the contrary and held that Texas Supreme Court precedent did not command a different result. Accordingly, the court remanded for further consideration. View "Frederking v. Cincinnati Insurance Co." on Justia Law

The Ninth Circuit certified the following question of state insurance law to the Nevada Supreme Court: Is an insurer entitled to reimbursement of costs already expended in defense of its insureds where a determination has been made that the insurer owed no duty to defend and the insurer expressly reserved its right to seek reimbursement in writing after defense has been tendered but where the insurance policy contains no reservation of rights? View "Nautilus Insurance Co. v. Access Medical, LLC" on Justia Law

laintiff was a car repair business in Rutland, Vermont. Defendant insured the vehicles of dozens of plaintiff’s customers (“the insureds”) who hired plaintiff to repair damage to their vehicles between 2009 and 2014. Over seventy insurance claims, which all arose under identical insurance policies, were combined in this breach-of- contract case. In each instance, defendant paid less than what plaintiff had billed to complete the repair, a "short pay." Plaintiff submitted to defendant a final invoice and a “supplemental report” itemizing each of the repairs performed. For each claim involved in this case, although defendant did not pay a portion of what the repair shop believed was owed under the policy, defendant did pay significant sums. Defendant initially paid what its claims adjuster believed to be covered by the insurance policy after having conducted a visual inspection of the damage. Defendant generally would make at least one additional payment based on information provided by plaintiff after plaintiff disassembled the damaged vehicle in preparation to repair it, a "supplemental payment." After an adjuster’s initial estimate was paid to plaintiff and any supplemental payments were made, there was still an outstanding balance for the repair bill on each claim involved in this case. Plaintiff believed these were covered by the insurance policy yet had been unpaid by the insurer. However, defendant maintained that these unpaid portions of the repair bill between plaintiff and each insured were not covered under the policy. A jury ultimately awarded plaintiff $41,737.89 in damages. After the trial, the court concluded that plaintiff could not show that his assignors were damaged by a breach of contract by defendant and granted defendant's motion for judgment as a matter of law. The Vermont Supreme Court reversed this determination, vacated the judgment that was entered in favor of defendant, and remanded with direction to the superior court to reinstate the jury’s verdict and its award of damages. View "Parker's Classic Auto Works, Ltd. v. Nationwide Mutual Insurance Company" on Justia Law

The Supreme Court affirmed in part and reversed in part the judgment of the court of appeals in this insurance dispute, holding that an insurer's payment of an appraisal award bars an insured's breach of contract claim and bad faith claims but that an insured may proceed on his claim under the Texas Prompt Payment of Claims Act, Tex. Ins. Code chapter 542.Insured sued Insurer for breach of contract, violations of the Prompt Payment Act, and statutory and common law bad faith insurance practices. Insurer filed a motion to compel appraisal, which the trial court granted. Insurer then filed a motion for summary judgment, arguing that its payment of the appraisal award resolved all claims in the lawsuit. The trial court granted the motion. The court of appeals affirmed. The Supreme Court affirmed, holding (1) the payment barred Insured's breach of contract claim premised on failure to pay the amount of the covered loss; (2) the payment barred Insured's bad faith insurance practices claims to the extent the only actual damages sought were lost policy benefits; and (3) in accordance with today's decision in Barbara Technologies Corp. v. State Farm Lloyds, __ S.W.3d __ (Tex. 2019), Insured may proceed on his claim under the Prompt Payment Act. View "Ortiz v. State Farm Lloyds" on Justia Law