Justia Insurance Law Opinion Summaries

The Court of Appeal reversed the trial court's denial of plaintiff's motion for costs of proof after State Farm denied eight of his requests for admissions. The court held that the trial court incorrectly placed on plaintiff the burden to prove that none of the exceptions to an award of costs as set out in Code of Civil Procedure section 2033.420, subdivision (b) applied. Rather, State Farm should have carried the burden of proof and failed to do so. Therefore, the court remanded to the trial court to determine the reasonable costs of proof. View "Samsky v. State Farm Mutual Automobile Insurance Co." on Justia Law

Fessenden’s employment was terminated after he began receiving short-term disability benefits. He then applied for long‐term disability benefits through his former employer’s benefits plan. The plan administrator, Reliance, denied the claim. Fessenden submitted a request for review with additional evidence supporting his diagnosis of Chronic Fatigue Syndrome. When Reliance failed to issue a decision within the timeline mandated by regulations governing the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132, he filed suit. Eight days later, Reliance finally issued a decision, again denying Fessenden’s claim. The district court granted Reliance summary judgment. The Seventh Circuit vacated. If the decision had been timely, the court would have applied an arbitrary and capricious standard because the plan gave Reliance the discretion to administer it. When a plan administrator commits a procedural violation, however, it loses the benefit of deference and a de novo standard applies. The court rejected Reliance’s argument that it “substantially complied” with the deadline because it was only a little bit late. The “substantial compliance” exception does not apply to blown deadlines. An administrator may be able to “substantially comply” with other procedural requirements, but a deadline is a bright line. View "Fessenden v. Reliance Standard Life Insurance Co." on Justia Law

A condominium association, Dakota Station II Condominium, filed two claims with its insurer, Owners Insurance Company, for weather damage. The parties couldn’t agree on the money owed, so Dakota invoked the appraisal provision of its insurance policy. The parties each selected an appraiser, putting the rest of the provision’s terms into motion. Ultimately, the appraisers submitted conflicting value estimates to an umpire, and the umpire issued a final award, accepting some estimates from each appraiser. Dakota’s appraiser signed onto the award, and Owners paid Dakota. Owners later moved to vacate the award, arguing that Dakota’s appraiser was not “impartial” as required by the insurance policy’s appraisal provision and that she failed to disclose material facts. The trial court disagreed and “dismissed” the motion to vacate. A division of the court of appeals affirmed. In its review, the Colorado Supreme Court interpreted the policy’s impartiality requirement and determined whether a contingent-cap fee agreement between Dakota and its appraiser rendered the appraiser partial as a matter of law. The Court concluded the plain language of the policy required appraisers to be unbiased, disinterested, and unswayed by personal interest, and the contingent-cap fee agreement didn’t render Dakota’s appraiser partial as a matter of law. Accordingly, the Court affirmed the judgment of the court of appeals with respect to the contingent-cap fee agreement, reversed with respect to the impartiality requirement, and remanded for further proceedings. View "Owners Ins. v. Dakota Station II Condo. Ass'n" on Justia Law

John Buckley started working for Labor Ready, Inc., a temporary employment service, in 2009. He was injured on assignment for a shipping company. At the time of injury he was performing a task prohibited by the contract between the temporary employment service and the shipping company. The injury resulted in loss of the worker’s hand and part of his arm. After getting workers’ compensation benefits from the temporary employment service, the worker brought a negligence action against the shipping company and one shipping company employee. The superior court decided on cross-motions for summary judgment that the exclusive liability provision of the Alaska Workers’ Compensation Act (Act) barred the action. The Alaska Supreme Court reverse, finding material issues of fact precluded disposition by summary judgment. View "Buckley v. American Fast Freight, Inc." on Justia Law

Keith Steffes, Kelly Steffes and Tasha (Rohrbach) Steffes appealed a district court order granting Nodak Mutual Insurance Company’s motion for a new trial. The Steffeses argued the district court abused its discretion in vacating the judgment and granting Nodak’s motion for a new trial. The North Dakota Supreme Court dismissed the appeal because the order granting a new trial was not then reviewable. View "Nodak Mutual Insurance Company v. Steffes, et al." on Justia Law

Javonne Hunt appealed a district court order requiring him to pay $27,501.86 in restitution to Blue Cross Blue Shield (“BCBS”). In 2017, Hunt was playing basketball at the YMCA in Bismarck, North Dakota when he was involved in an altercation with an opposing player. Hunt intentionally struck the opposing player in the jaw causing a bone fracture. Hunt was charged and subsequently found guilty by a jury of aggravated assault. Following his conviction, Hunt agreed to pay as restitution the out-of-pocket medical expenses incurred by the injured individual in the amount of $3,233.07. BCBS provided evidence that it had paid an additional $27,501.86 for the medical treatment of the injured individual under the injured individual’s policy of insurance. The district court applied N.D.C.C. 12.1-32-08(1) in granting restitution to BCBS and ordered Hunt to pay a total of $30,734.93; $3,233.07 for the conceded out-of-pocket costs plus the $27,501.86 claimed by BCBS. Hunt argued BCBS is precluded from recovery of its expenditures in the criminal proceedings because the definition of “victim” under N.D. Const. art. I, section 25 was incompatible with a recovery by a corporation under the criminal restitution statute, N.D.C.C. 12.1-32-08(1). The North Dakota Supreme Court found no reversible error in the district court’s judgment and affirmed the order. View "North Dakota v. Hunt" on Justia Law

The Supreme Court affirmed the decision of the court of appeals affirming the judgment of the circuit court granting summary judgment dismissing Rural Mutual Insurance Company's subrogation claims pursuant to a subrogation waiver, holding that the subrogation waiver was valid and enforceable.Rural Mutual brought this action against Lester Buildings, LLC, Phoenix Insurance Company, Van Wyks, Inc., and West Bend Mutual Insurance Company after a barn collapsed due to strong winds and Rural Mutual paid more than $650,000 to the barn owner, Jim Herman, Inc. (Herman). The circuit court concluded that the claims were barred pursuant to a subrogation waiver contained in Lester Buildings' contract with Herman, Rural Mutual's insured, and further concluded that Wis. Stat. 895.447 did not void that subrogation waiver. The Supreme Court affirmed, holding (1) section 895.447 did not void the subrogation waiver in the contract because the waiver did not limit or eliminate tort liability; and (2) the subrogation waiver was not an unenforceable exculpatory contract contrary to public policy. View "Rural Mutual Insurance Co. v. Lester Buildings, LLC" on Justia Law

Appellants challenged the approval of a global settlement between the receiver for Stanford International Bank and related entities, and various insurance company underwriters, who issued policies providing coverage for fidelity breaches, professional indemnity, directors and officers protection, and excess losses.The Fifth Circuit vacated the district court's order approving the settlement and bar orders, holding that the district court lacked authority to approve the receiver's settlement to the extent it nullified the coinsureds' claims to the policy proceeds without an alternative compensation scheme; released claims the estate did not possess; and barred suits that could not result in judgments against proceeds of the underwriters' policies or other receivership assets. Accordingly, the court remanded for further proceedings. View "SEC v. Stanford International Bank, Ltd." on Justia Law

The First Circuit affirmed the judgment of the district court granting summary judgment for Insured on Insurer's complaint seeking a declaratory judgment that it had no duty to defend Insured against an underlying class action alleging that Insured had engaged in misconduct that resulted in customers receiving higher bills than Insured had represented that they would be, holding that summary judgment was properly granted.The complaint sought class-wide damages for a variety of Maine common law claims and for claims under the federal Rackeeter Influenced and Corrupt Organizations Act (RICO), 18 U.S.C. 1962, 1964; and the Maine Unfair Trade Practices Act, Me. Rev. Stat. Ann. tit. 5, 207. In its complaint, Insurer argued that the complaint in the underlying action failed to allege that Insurer engaged in conduct that qualified as an "occurrence" or that caused any "bodily injury" under the relevant policy. The district court entered judgment for Insured. The First Circuit affirmed, holding that there was no genuine issue of material fact in dispute and that the district court's conclusions were correct as a matter of law. View "Zurich American Insurance Co. v. Electricity Maine, LLC" on Justia Law

In this case concerning civil liability based on insurer conduct affecting chiropractic services, the Supreme Court affirmed the order of the trial court dismissing all claims in this case, relying on and incorporating its reasoning in a companion case, Sykes v. Health Network Solutions, Inc., __ S.E.2d __ (N.C. 2019)(Sykes I), in holding that the decision in Sykes I met the criteria for collateral estoppel.This case was one of two putative class actions alleging that defendant insurers contracted with Health Network Solutions, Inc. (HNS) to provide or restrict insured chiropractic services in violation of state insurance and antitrust laws. Plaintiffs chose to bring this action against insurers separately from their claims against against HNS and its individual owners in Sykes I, but both actions presented essentially the same claims and relied on the same theories. The trial court dismissed Plaintiffs' claims in this case. The Supreme Court affirmed, holding that collateral estoppel barred Plaintiffs from litigating these matters given the Court's resolution of the issues in Sykes I. View "Sykes v. Blue Cross & Blue Shield of North Carolina" on Justia Law