Justia Insurance Law Opinion Summaries

Claimant Mark Pilling filed a claim for workers' compensation benefits which insurer Travelers Insurance denied. An administrative law judge (ALJ) reversed insurer’s denial, but the Workers’ Compensation Board reversed the ALJ’s order and reinstated insurer’s denial on the ground that claimant was a nonsubject worker because he was a partner in the business for which he worked and he had not applied for coverage as a nonsubject worker. The Court of Appeals affirmed the board’s order. On claimant’s petition, the Oregon Supreme Court granted certiorari review and concluded that, even assuming claimant was a nonsubject worker, he was entitled to coverage because the business for which he worked made a specific written application for workers’ compensation coverage for him, which insurer accepted. Therefore, the Court reversed the decisions of the Court of Appeals and the Workers’ Compensation Board and remanded to the board for further proceedings. View "Pilling v. Travelers Ins. Co." on Justia Law

In this equitable contribution action brought by Nationwide Mutual Fire Insurance Company and Nationwide Mutual Insurance Company (collectively, Nationwide) against Erie Insurance Exchange the Supreme Court vacated the final judgment of the circuit court granting Erie's demurrer and dismissing Nationwide's claim for equitable contribution, holding that the circuit court erred as a matter of law.In Nationwide Mutual Fire Insurance v. Erie Insurance Exchange, 293 Va. 331 (Nationwide I), the Supreme Court resolved an insurance coverage dispute between Nationwide and Erie. Thereafter, Nationwide brought this action seeking reimbursement for Erie's share of a monetary settlement that Nationwide had paid to a tort claimant while the case was on appeal. The circuit court sustained Erie's demurrer to the claim. The Supreme Court reversed, holding that the circuit court should have denied Erie's demurrer to the claim of equitable contribution based upon the coverage allocation that the Court had determined in Nationwide I. The Court remanded the case to the circuit court to enter an order awarding contribution to Nationwide consistent with the Court's allocation of coverage liability in Nationwide I and with the views expressed in this opinion. View "Nationwide Mut. Fire Insurance Co. v. Erie Insurance Exchange" on Justia Law

In this appeal from the circuit court's distribution of proceeds from Nicklaus Macke's wrongful death settlement the Supreme Court affirmed the judgment of the circuit court overruling Appellant's motion for a second continuance and in apportioning only a small percent of the wrongful death settlement to Appellant, holding that the circuit court did not err or abuse its discretion.Nicklaus, the son of Pamela Eden and Loren Macke (Macke), suffered fatal injuries in a motor vehicle collision with Austin Patton. Macke negotiated a settlement with Patton's insurance company, which offered to pay its policy limit in satisfaction of Macke's wrongful death claim against Patton. The circuit court apportioned ninety-eight percent of the settlement to Nicklaus' father and two percent to Eden, who played little to no role in Nicklaus' childhood and upbringing. The Supreme Court affirmed, holding (1) the circuit court did not err in overruling Appellant's motion for continuance; and (2) the circuit court did not erroneously apply the law in making its apportionment judgment, and the apportionment was not against the weight of the evidence. View "Macke v. Patton" on Justia Law

After Hamas fired rockets from Gaza into Israel, Universal moved the production of their televisions series out of Jerusalem at significant expense. Universal filed an insurance claim for coverage of those costs under a television production insurance policy and the insurer, Atlantic, denied coverage based on the policy's war exclusions.The Ninth Circuit reversed the district court's grant of summary judgment for Atlantic in part and held that Atlantic breached its contract when it denied coverage by defining Hamas' conduct as "war" or "warlike action by a military force." Because the district court did not address the third war exclusion regarding whether Hamas' actions constituted "insurrection, rebellion, or revolution," the panel remanded for the district court to address that question in the first instance. Consequently, the panel vacated the district court's grant of summary judgment on Universal's bad faith claim because it turned on the district court's erroneous analysis of the first two war exclusions. The panel remanded for further proceedings. View "Universal Cable Productions, LLC v. Atlantic Specialty Insurance Co." on Justia Law

The Eighth Circuit affirmed the district court's orders requiring it to deposit $21 million in disputed insurance proceeds to maintain its federal statutory interpleader claim and dismissing Ronald Gean and the Estate of Jean Carol Gean for lack of personal jurisdiction in its declaratory judgment claims. The Geans are citizens of Michigan and were injured in an automobile accident in Illinois by a truck operated by Rex, a Missouri company.The court agreed with the district court that subject matter jurisdiction was lacking because Acuity did not deposit the disputed amount into the court's registry. The court rejected Acuity's argument that the district court had personal jurisdiction over the Geans. Rather, the court held that the district court lacked personal jurisdiction over the Geans in the remaining declaratory judgment action. View "Acuity v. Rex, LLC" on Justia Law

Matthew Dye brought an action against Esurance Property and Casualty Insurance Company and GEICO Indemnity Company, seeking personal protection insurance (PIP) benefits under the no-fault act, MCL 500.3101 et seq., for injuries he sustained in a motor vehicle accident while driving a vehicle he had recently purchased. At plaintiff’s request, plaintiff’s father had registered the vehicle in plaintiff’s name and obtained a no-fault insurance policy from Esurance. The declarations page of the policy identified only plaintiff’s father as the named insured. At the time of the accident, plaintiff was living with his wife, who owned a vehicle that was insured by GEICO. After Esurance and GEICO refused to cover plaintiff’s claim, plaintiff filed a breach-of-contract claim against both insurers along with a declaratory action, alleging that either Esurance or GEICO was obligated to pay his no-fault PIP benefits and requesting that the trial court determine the parties’ respective rights and duties. The issue this case presented for the Michigan Supreme Court’s review centered on whether an owner or registrant of a motor vehicle involved in an accident was excluded from receiving statutory no-fault insurance benefits under the no-fault act when someone other than an owner or registrant purchased no-fault insurance for that vehicle. The Court of Appeals concluded that “[a]t least one owner or registrant must have the insurance required by MCL 500.3101(1), and ‘when none of the owners maintains the requisite coverage, no owner may recover [personal injury protection (PIP)] benefits.’ ” The Supreme Court concluded an owner or registrant of a motor vehicle was not required to personally purchase no-fault insurance for his or her vehicle in order to avoid the statutory bar to PIP benefits. Rather, MCL 500.3101(1) only requires that the owner or registrant “maintain” no-fault insurance. The Court reversed in part the judgment of the Court of Appeals and remanded this case to the circuit court for further proceedings. View "Dye v. Esurance Property & Casualty Ins. Co." on Justia Law

Allstate filed suit under Insurance Code section 1871.7 on behalf of the People against defendant, her mother, and others for insurance fraud in violation of Penal Code section 550, which makes it unlawful to submit false or fraudulent claims to an insurance company. The jury found in favor of Allstate.The Court of Appeal affirmed, holding that the trial court did not abuse its discretion in denying defendant's ex parte application for a stay. The court also held that unlawful conduct under section 550 does not require a misstatement of fact in the insurance claim. In this case, defendant and her mother committed insurance fraud in violation of section 550 where they perpetrated a deceitful insurance scheme designed to acquire insurance proceeds illegally for personal gain. View "People ex rel. Allstate Insurance Co. v. Suh" on Justia Law

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