Justia Insurance Law Opinion Summaries

The Eighth Circuit affirmed the district court's judgment in an insurance coverage dispute over the allocation of a $6 million settlement in an underlying product liability action. The court held that the district court did not err in interpreting the Batch Clause Endorsement and its construction of the term "lot." The court rejected Federal's arguments to the contrary and affirmed the district court's ruling that AIG be paid $500,000 by Donaldson and be reimbursed over $2.76 million by Federal. View "National Union Fire Insurance Co. of Pittsburgh v. Federal Insurance Co." on Justia Law

This case involved an appeal brought by Aerocet, Inc., and its surety, the State Insurance Fund, in which they appealed an Idaho Industrial Commission decision involving two worker’s compensation claims brought by George McGivney. The Commission awarded McGivney benefits for injuries he sustained to his left knee while working for both Aerocet and Quest Aircraft (Quest). The Referee consolidated the two cases and issued a recommendation that attributed the vast majority of liability to Quest. The Commission rejected the bulk of the Referee’s recommendations and apportioned liability equally between Aerocet and Quest. Aerocet appealed, alleging the Commission inappropriately consolidated McGivney’s two injury claims. Aerocet also argued the Commission failed to determine McGivney’s disability in excess of impairment from his 2011 accident at Aerocet prior to his 2014 accident at Quest, and that the Commission erred in its application of Brown v. Home Depot, 272 P.3d 577 (2012). Aerocet also contended the Commission’s decision was not supported by substantial and competent evidence. After review, the Idaho Supreme Court affirmed the Commission’s decisions. The matter was remanded back to the Commission to enable it to calculate the amount due Quest’s surety from Aerocet’s surety for any amounts overpaid by Quest’s surety. View "McGivney v. Aerocet, Inc" on Justia Law

Lacko began working for BKD’s predecessor in 1999 and worked until September 2015, when she was Senior Manager in the Audit Department, with an annual salary of $93,250.04. She applied for benefits under the short term disability (STD) plan, claiming gastroparesis, diabetes, rheumatoid arthritis, congestive heart failure, breathing difficulties, anxiety, musculoskeletal impairments, and cognitive difficulties related to the medication needed to manage the other conditions. Although United approved her claims for STD benefits three times, it denied benefits in June 2016 for the period beyond November 22, 2015, concluding there was no change in Lacko’s medical condition when she stopped working or subsequently. United also denied her claim for long term disability benefits. Lacko sued under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001.. The district court granted United summary judgment. The Seventh Circuit reversed. United failed to adequately address a determination that Lacko was entitled to Social Security disability benefits and failed to recognize the significant distinction between her ability to perform unskilled work and the job of Senior Manager. The court noted that the Plan’s requirement of a “change” in a person’s physical or mental capacity in order to qualify for benefits does not by its terms preclude a degenerative condition from qualifying a claimant for benefits and noted United's conflict of interests, having issued the policies and serving as claims review fiduciary. View "Lacko v. United of Omaha Life Insurance Co." on Justia Law

The United States Court of Appeals for the Fourth Circuit certified a question of South Carolina law to the South Carolina Supreme Court. The underlying case was an insurance bad faith action against an insurance company for its failure to defend its insured in a construction defect action. The insured settled the construction defect action and brought a bad faith tort action. When the insurer asserted it acted in good faith in denying coverage, the insured sought to discover the reasons why the insurer denied coverage. According to the insurer, the discovery requests included communications protected by the attorney-client relationship. The federal district court reviewed the parties' respective positions, determined the insured had established a prima facie case of bad faith, and ordered the questioned documents to be submitted to the court for an in camera inspection. The insurer then sought a writ of mandamus from the Fourth Circuit to vacate the district court's order regarding the discovery dispute. In turn, the Fourth Circuit asked the South Carolina Supreme Court whether state law supported the application of the "at issue" exception to attorney-client privilege such that a party may waive the privilege by denying liability in its answer. The South Carolina Supreme Court found that the parties, especially the insured, contended the certified question did not accurately represent the correct posture of the case. In fact, the insured conceded the narrow question presented required an answer in the negative. The Supreme Court agreed, finding “little authority for the untenable proposition that the mere denial of liability in a pleading constitutes a waiver of the attorney-client privilege.” The Court elected to analyze the issue narrowly in the limited context of a bad faith action against an insurer, and felt constrained to answer the certified question as follows: "No, denying liability and/or asserting good faith in the answer does not, standing alone, place the privileged communications 'at issue' in the case." View "Mt. Hawley Insurance Company v. Contravest Construction" on Justia Law

The Supreme Court reversed the judgment of the district court dismissing the amended complaint filed by Employers Mutual Casualty Company against Continental Resources, Inc., holding that the district court erred as a matter of law when it determined that Employers Mutual must defend Continental as an additional insured under a commercial general liability (CGL) insurance policy it issued to Black Rock Testing, Inc.Employers Mutual filed a declaratory judgment action to determine its obligations to defend and indemnify Continental under the CGL policy it issued to Black Rock. The district court granted Continental's motion for summary judgment and dismissed the complaint, concluding that Continental was entitled to a defense as an additional insured under the insurance policy. The Supreme Court reversed, holding (1) under any reasonable interpretation of the insurance contract and its endorsements, the policy did not cover Continental as an additional insured; and (2) therefore, Employers Mutual owed no duty to defend or indemnify Continental under the policy. View "Employers Mutual Casualty Co. v. Estate of Buckles" on Justia Law

The First Circuit affirmed the district court's dismissal of Appellants' claims in this putative class action against Lexington Insurance Company and other insurers alleging fraudulent misrepresentation and violation of the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C. 1961 et seq., holding that the facts Appellants pleaded demonstrated the absence of any circumstances constituting fraud.Appellants entered into structured settlement agreements with Lexington Insurance Company pursuant to which Lexington agreed that Appellants would receive specific periodic payments from annuities that Lexington would purchase. Appellants later brought this action alleging that Lexington and other affiliated insurers misrepresented the amount Appellants would receive from the settlements. The district court dismissed Appellants' claims with prejudice. The First Circuit affirmed, holding that Appellants failed to state with particularity the circumstances constituting fraud under Fed. R. Civ. P. 9(b). View "Ezell v. Lexington Insurance Co." on Justia Law

Two cases consolidated for review by the Delaware Supreme Court involved automobile accidents. John Henry and Charles Fritz sustained injuries in accidents while operating employer-owned vehicles during the course of their employment. In both cases, the accidents were allegedly caused by a third-party tortfeasor. Both employees received workers’ compensation from their respective employers’ insurance carriers. In each case, the vehicle was covered by an automobile liability insurance policy issued to the employer by Cincinnati Insurance Company. The superior court issued an order in Henry’s case first, finding the exclusive-remedy provision in the Delaware Workers’ Compensation Act in effect at the time of his accident precluded Henry from receiving underinsured motorist benefits under the Cincinnati policy. Following that decision, the Fritz court granted Cincinnati’s motion for summary judgment on the same ground. Henry and Fritz argued on appeal to the Delaware Supreme Court that the superior court erred in finding the Act’s exclusivity provision precluded them from receiving underinsured motorist benefits through the automobile liability policies their respective employers purchased from Cincinnati. The Supreme Court agreed both trial courts erred in finding the Act’s exclusivity provision prevented underinsured motorist benefits. The Court reversed and remanded for further proceedings. View "Henry v. Cincinnati Insurance Co." on Justia Law

In this insurance dispute involving an insurer withholding payments to a medical service corporation improperly controlled by nonphysicans the Court of Appeals ruled that the trial court did not err in declining to give a charge requiring the jury to find fraudulent intent or conduct "tantamount to fraud" in order to reach a verdict in favor of the insurers.Plaintiff Andrew Carothers, M.D., P.C., a professional service corporation, filed multiple collection actions against insurance carriers seeking to recover unpaid claims of assigned first-party no-fault insurance benefits. The jury found that Defendants had proved that Plaintiff was "fraudulently incorporated" and that Carothers did not engage in the practice of medicine. Plaintiff appealed, arguing that the court erred in failing to give a jury instruction on "the traditional elements of common-law fraud and fraudulent intent. The Appellate Division affirmed. The Court of Appeals affirmed, holding that the court's instructions to the jury were proper. View "Carothers v. Progressive Insurance Co." on Justia Law

The Court of Appeals affirmed the decision of the Appellate Division affirming the judgment of Supreme Court granting Defendant summary judgment in this insurance dispute, holding that a general business practice of failing promptly to disclose coverage within the meaning of N.Y. Ins. Law 2601(a)(6) does not include violations of the timely liability disclaimer requirement of N.Y. Ins. Law 3420(d)(2).This dispute arose between Plaintiff, the general contractor in an underlying personal injury action by an employee of Plaintiff's subcontractor, and Defendant, the subcontractor's general liability insurer. Defendant's policy named Plaintiff as an additional insured, extending coverage to Plaintiff for liability related to the "ongoing operations" of the subcontractor and other members of the risk retention group. After Defendant disclaimed coverage Plaintiff sought a declaratory judgment that the policy obligated Defendant to defend and indemnify Plaintiff in the employee's personal injury action. Supreme Court granted summary judgment for Defendant, and the Appellate Division affirmed. The Court of Appeals affirmed, holding that section 2601(a)(6) does not encompass the liability disclaimer requirement of section 3420(d)(2). View "Nadkos, Inc. v. Preferred Contractors Insurance Co. Risk Retention Group LLC" on Justia Law

The insurer appealed from the district court's judgment in favor of the adjuster. At issue was whether the district court erred in overturning the jury verdict and granting judgment as a matter of law in favor of the adjuster on the basis of insufficiency of the evidence to support the jury's conclusion that the statute of limitations was tolled such that the insurer's claim was timely filed.The Second Circuit certified a question of law to the Connecticut Supreme Court regarding the contours of the doctrine that tolls a limitation period because of a continuing course of conduct. The state court responded that the evidence was not legally sufficient to toll the statute of limitations on this factual record. Accordingly, because the state court's decision resolved the controlling question of Connecticut law, the court affirmed the judgment. View "Evanston Insurance Co. v. William Kramer & Associates, LLC" on Justia Law