Justia Insurance Law Opinion Summaries

In April 2007, Sun Life Assurance Company of Canada received an application for a $5 million insurance policy on the life of Nancy Bergman. The application listed a trust as the sole owner and beneficiary of the policy. Bergman’s grandson signed as trustee; the other members of the trust were all investors, and all strangers to Bergman. The investors paid most if not all of the policy’s premiums. Sun Life issued the policy. About five weeks after the policy was issued, the grandson resigned as trustee and appointed the investors as successor co-trustees. The trust agreement was amended so that most of the policy’s benefits would go to the investors, who were also empowered to sell the policy. More than two years later, the trust sold the policy and the investors received nearly all of the proceeds from the sale. Wells Fargo Bank, N.A. eventually obtained the policy in a bankruptcy settlement and continued to pay the premiums. After Bergman passed away in 2014, Wells Fargo sought to collect the policy’s death benefit. Sun Life investigated the claim, uncovered discrepancies, and declined to pay. Instead, Sun Life sought a declaratory judgment that the policy was void ab initio, or from the beginning. Wells Fargo counterclaimed for breach of contract and sought the policy’s $5 million face value; if the court voided the policy, Wells Fargo sought a refund of the premiums it paid. The United States District Court for the District of New Jersey partially granted Sun Life’s motion for summary judgment, finding New Jersey law applied and concluded “that this was a STOLI [(stranger-originated life insurance)] transaction lacking insurable interest in violation of [the State’s] public policy. . . . As such, it should be declared void ab initio.” The court also granted Wells Fargo’s motion to recover its premium payments, reasoning that “Wells Fargo is not to blame for the fraud here” and that “[a]llowing Sun Life to retain the premiums would be a windfall to the company.” Both parties appealed. Finding no dispositive New Jersey case law, the United States Court of Appeals for the Third Circuit certified two questions of law to the New Jersey Supreme Court regarding the Sun Life policy. In response to the certified questions, the Supreme Court found that STOLI policies were against public policy and void ab initio. The Court also noted that a party may be entitled to a refund of premium payments depending on the circumstances. “Among other relevant factors, courts should consider a later purchaser’s participation in and knowledge of the original illicit scheme.” View "Sun Life Assurance Company of Canada v. Wells Fargo Bank, N.A." on Justia Law

A general contractor was covered as an additional insured on a commercial general liability (CGL) policy issued to its roofing subcontractor. The insurer refused to defend the general contractor after it was sued by homeowners for construction defects concerning roofing, prompting this lawsuit. After a bench trial, the trial court concluded the insurer owed no duty to defend. It believed the exclusion in the additional insured endorsement for damage to "property in the care, custody or control of the additional insured" precluded any duty to defend the general contractor in construction defect litigation. The general contractor disputed the insurer's interpretation of the policy and contended there was a duty to defend. After review, the Court of Appeal agreed and reversed judgment: “the facts indicate only shared control between the general contractor and its roofing subcontractor. Because the insurer did not prove coverage for the underlying construction defect litigation was impossible, it owed the general contractor a duty to defend the homeowner claim.” View "McMillin Homes Construction v. Natl. Fire & Marine Ins. Co." on Justia Law

42 U.S.C. 4072, which provides for original exclusive jurisdiction in district court and a one-year limitations period, is applicable to actions against Write-Your-Own (WYO) carriers. WYO are private insurers which issue flood insurance policies underwritten by the Government in their own names as part of the National Flood Insurance Program created by the National Flood Insurance Act. The Fifth Circuit affirmed the district court's grant of summary judgment for the insured, holding that this WYO action did not arrive in federal court within one-year of the insured's claim denial and was therefore time-barred under section 4072. View "Ekhlassi v. National Lloyds Insurance Co." on Justia Law

Doe is HIV-positive and takes Genvoya to control his condition. Doe's BlueCross health insurance covers Genvoya. After February 2017, BlueCross required Doe to fill the HIV prescription through mail order or by picking it up at certain brick-and-mortar pharmacies. If Doe used BlueCross's specialty pharmacy network, his co-pay for each monthly batch of Genvoya would be $120. If Doe continued to get the medicine at his local pharmacy, he would have to pay the full cost, thousands of dollars per batch. Doe preferred interacting with his regular pharmacists, who knew his medical history and could spot the effects of harmful drug interactions. He also worried that deliveries to his house might compromise his privacy or risk heat damage to the medicine. Doe filed a putative class action, alleging that BlueCross discriminated against HIV-positive beneficiaries in violation of the Affordable Care Act and the Americans with Disabilities Act (ADA), which breached their insurance contract. The district court dismissed. The Sixth Circuit affirmed. The Affordable Care Act prohibits discrimination against the disabled in the provision of federally supported health programs under section 504 of the Rehabilitation Act. BlueCross did not violate the Rehabilitation Act; it did not exclude Doe from participating in the plan or deny him benefits covered by it. Section 504 does not prohibit disparate-impact discrimination. The ADA claim failed because Doe targets BlueCross’s operation of his health care plan, not its control over his pharmacy (a public accommodation). View "Doe v. BlueCross BlueShield of Tennessee, Inc." on Justia Law

The Supreme Court reversed the judgment of the circuit court entering summary judgment in favor Insured in this insurance coverage dispute, holding that the circuit court erred in finding that Insured was entitled to underinsured motorist (UIM) coverage under three insurance policies Insured maintained with Insurer after the death of her daughter (Decedent).When Driver crashed the vehicle she was driving, Decedent, the passenger, sustained fatal injuries. Insured asserted a wrongful death claim against Driver, and Driver settled the claim for her insurance policy's limits. Thereafter, Insured sought UIM coverage from Insurer. Insurer provided UIM coverage pursuant to one of the insurance policies, but Insurer denied UIM coverage under the other two insurance policies. Insured then brought this suit seeking a declaration that UIM coverage existed for Decedent and alleging breach of contract. The circuit court granted summary judgment for Insured. The Supreme Court reversed, holding that under the plain language of two of the policies at issue, Decedent was not an insured entitled to UIM coverage. View "Seaton v. Shelter Mutual Insurance Co." on Justia Law

The Supreme Court affirmed the judgment of the superior court granting summary judgment in favor of Insurer and Plaintiff's claims alleging that Insurer was contractually obligated to provide insurance coverage to Plaintiff, which was listed as an additional issued on the relevant insurance policy, holding that Insurer had no duty to defend Plaintiff.Plaintiff, the general contractor for a construction project, subcontracted with Insured for structural work on the project. Insured purchased a commercial general liability insurance policy from Insurer, which named Plaintiff as an additional insured. The policy provided for defense and indemnification costs to Insured for its work on the project. Insured's employee (Employee), who sustained injuries while working on the construction project site, filed a complaint against Plaintiff, alleging that Plaintiff's negligent acts were the proximate cause of his injuries. Plaintiff sought a declaratory judgment that Insurer was contractually obligated to indemnify and defend Plaintiff as an additional insured relative to the Employee action. The superior court justice granted summary judgment for Insurer. The Supreme Court affirmed, holding that Employee's complaint was devoid of any allegations that brought the underlying case within the coverage of the policy, and therefore, Insurer had no duty to defend Plaintiff. View "Bacon Construction Co. v. Arbella Protection Insurance Co." on Justia Law

The Supreme Court affirmed in part and reversed in part the decision of the court of appeals reversing the circuit court's order that determined that Plaintiffs' claims against Defendant-insurance company were barred by the doctrine of claim preclusion, holding that claim preclusion barred the claims of certain plaintiffs, but the Court was evenly divided as to whether claim preclusion barred the claims brought by a fourth plaintiff.This case arose from a car accident in which a mother and her three daughters were seriously injured. The father was not in the car. The accident resulted in two separate lawsuits. In the first action, the mother brought a negligence claim against the driver of the other vehicle and her insurer, State Farm. The children were also named as plaintiffs. The action settled. The second lawsuit brought by the family, including the father, alleging that the driver of the car in which they were passengers was negligent. Plaintiffs sued the driver's insurer directly. The circuit court granted summary judgment for Defendant, concluding that the action was barred by claim preclusion. The court of appeals reversed. The Supreme Court held (1) claim preclusion barred the claims brought by the mother and daughters in the second action; but (2) the court of appeals properly allowed the father's claims to proceed. View "Teske v. Wilson Mutual Insurance Co." on Justia Law

Chicago awarded a construction contract to a joint venture formed by Gillen and other entities. The joint venture subcontracted some of the work to Gillen, which subcontracted with others for labor and materials. The joint venture obtained over $30 million in Fidelity performance and payment bonds. Fidelity received an indemnity agreement and a net worth retention agreement, both executed by Gillen. Gillen promised to maintain a net worth greater than $7.5 million. During 2012, several subcontractors sued Gillen in state court and named Fidelity as a co-defendant based on its bond obligations. Fidelity sued Gillen in federal court, alleging: breach of the indemnity agreement; a request for an accounting of contract payments; breach of the net worth retention agreement; quia timet; and a demand for access to books and records. Historically, litigants have used bills quia timet to pursue preemptive relief; on that claim, Fidelity sought $2.5 million from Gillen as bond collateral and an order requiring Gillen to satisfy all bond obligations and prohibiting Gillen from disbursing money without court approval. The parties settled all claims in mediation, except for Fidelity’s quia timet claim, agreeing their settlement would not impact the quia timet claim or Gillen’s defenses. The district court granted Gillen summary judgment on the quia timet claim. The Seventh Circuit affirmed. Fidelity negotiated for specific indemnification and collateralization rights, sued on those rights, and settled its breach of contract claims. It may not augment its contractual rights with the ancient equitable doctrine of quia timet. View "Fidelity and Deposit Co. of Maryland v. Edward E. Gillen Co." on Justia Law

Dami Hospitality, LLC (“Dami”) was the owner-operator of a Denver motel that employed between four and ten people at any given time. As an employer of three or more persons, Dami was required by statute to maintain workers’ compensation insurance. Dami allowed its workers’ compensation coverage to lapse on in 2005. Upon receiving notification of the lapse from the Division of Workers’ Compensation (“DWC”), Dami conceded the violation and paid a corresponding settlement in June 2006. Dami again allowed its workers’ compensation coverage to lapse in 2006. From June 2007 to September 2010, Dami carried the proper insurance, but the company’s workers’ compensation coverage again lapsed on September 12, 2010 and went without insurance until July 9, 2014. On February 19, 2014, the DWC discovered that Dami had allowed its workers’ compensation insurance to lapse for these periods of time and issued a notice to Dami regarding this. Dami faxed a copy of workers' compensation insurance for the July 10, 2014 - July 10, 2015 period; Dami offered no such evidence for any other period, nor any explanation for the lapses. Fines accrued for noncompliance, totaling $841,200. The DWC ultimately issued an order upholding the fines. Dami appealed to the Industrial Claim Appeals Office (“ICAO”). The ICAO rejected all but Dami’s excessive fines argument. The ICAO remanded the matter to the DWC, directing it to review the constitutionality of the aggregated per diem fines assessed in accordance with the test established by the court of appeals in Associated Business Products v. Industrial Claim Appeals Office, 126 P.3d 323 (Colo. App. 2005). The ICAO would ultimately affirm the resulting fines, and Dami appealed to the Court of Appeals. The appellate court set aside the fines, assuming, without deciding, the Excessive Fines Clause could be applied to challenge regulatory fees imposed on a corporation. The Colorado Supreme Court concluded the proper test to assess the constitutionality of government fines under the Eighth Amendment required an assessment of whether the fine was grossly disproportional to the offense for which it was imposed. The Supreme Court thus reversed the court of appeals’ ruling and remanded to that court for return to the Division of Workers’ Compensation with instructions to, as appropriate and necessary, develop an evidentiary record sufficient to determine whether the $250–$500 fine that a business was required to pay for each day that it was out of compliance with Colorado’s workers’ compensation law is proportional to the harm or risk of harm caused by each day of noncompliance. View "Colo. Dept. of Labor & Emp. Div. of Workers' Comp. v. Dami Hosp." on Justia Law

Mississippi Code 83-11-101(1) and 83-11-103(c)(vi) of Mississippi's Uninsured Motorist Act are not repugnant. Section 83-11-101(1) requires that automobile insurers provide UM coverage to the extent the insured is "legally entitled to recover" and section 83-11-103(c)(vi) defines "uninsured motor vehicle," as used in the UM Act, to include a vehicle "owned or operated by a person protected by immunity under the Mississippi Tort Claims Act."In this case, the Fifth Circuit held that the insured was not legally entitled to recover from the fireman, the fire department, or the city, and thus was not legally entitled to recover UM benefits from State Farm. Accordingly, the court vacated the district court's grant of summary judgment for the insured and rendered judgment for State Farm. View "McGlothin v. State Farm Mutual Insurance Co." on Justia Law