Justia Insurance Law Opinion Summaries

Claimant Elvia Garcia-Solis was injured in a work-related accident. Farmers Insurance Company and Yeaun Corporation (collectively, “Insurer”) accepted a workers’ compensation claim and certain specified medical conditions associated with the accident. Because claimant also showed psychological symptoms, her doctor recommended a psychological referral to diagnose her for possible post-traumatic stress disorder (PTSD). Insurer argued, and the Court of Appeals agreed, that the cost of the psychological referral was not covered by workers’ compensation because claimant had failed to prove that it was related to any of the medical conditions that insurer had accepted. The Oregon Supreme Court reversed both the Court of Appeals and the Workers’ Compensation Board: “’injury’ means work accident is context-specific to exactly two uses in the first and second sentences of ORS 656.245(1)(a). It does not apply to the second use in the first sentence of ORS 656.245(1)(a). We do not decide or suggest that it applies to any other statute in the workers’ compensation system.” View "Garcia-Solis v. Farmers Ins. Co." on Justia Law

The Supreme Court affirmed the judgment of the court of appeals affirming the decision of the circuit court granting summary judgment in favor of Hiscox Insurance Company on Leicht Transfer & Storage Company's complaint seeking coverage for its losses under a commercial crime insurance policy issued to it by Hiscox, holding that Leicht's losses were not covered under the policy.Pallet Central Enterprises, Inc. forged delivery tickets and used them to bill Leicht for the sale and delivery of pallets that Pallet Central never sold or delivered. Leicht sought coverage for its losses under the policy issued to it by Hiscox. Hiscox denied coverage. Leicht sued for breach of contract, arguing that the forged delivery tickets comprised "directions to pay" within the meaning of the "forgery or alteration" insuring agreement of the Hiscox policy. The circuit court granted summary judgment for Hiscox, and the court of appeals affirmed. The Supreme Court affirmed, holding (1) the delivery tickets did not qualify as "written...directions to pay a sum certain in money"; and (2) the policy did not provide coverage for forged documents that were not themselves "directions to pay," but which were used as proxies for such documents. View "Leicht Transfer & Storage Co. v. Pallet Central Enterprises, Inc." on Justia Law

The Eleventh Circuit granted Gerber's petition for panel rehearing and vacated its prior opinion, substituting the following opinion.In this insurance dispute case, the court held that Gerber, as assignee, lacked Article III standing to bring a declaratory judgment class action against GEICO in the absence of a claim for money damages or substantial likelihood that the insured would suffer a future injury. Accordingly, the court vacated the district court's judgment because it had no jurisdiction to entertain this suit. The court instructed the district court to remand the case to the circuit court. View "A&M Gerber Chiropractic LLC v. GEICO General Insurance Co." on Justia Law

In this declaratory relief proceeding, the Supreme Court affirmed the circuit court's denial of State Farm's motion for summary judgment and entered a judgment in favor of LeRoy James on his complaint alleging that State Farm had no right to reimbursement or subrogation for paying James's medical expenses under his policy, holding that State Farm had no contractual right to reimbursement for the $5,000 paid to James for medical expenses under the policy.State Farm insured both James and Melissa Rivers, who rear-ended James and caused him personal injury. State Farm paid a portion of James's medical expenses under his policy and then, acting on behalf of Rivers, settled with James. Once James released Rivers from liability, State Farm demanded that James use his settlement proceeds to reimburse State Farm for paying his medical expenses. James then brought this action. The circuit court entered a judgment in favor of James. The Supreme Court affirmed, holding that the text of the reimbursement provision of the policy was ambiguous, and therefore, State Farm had no contractual right to reimbursement from James. View "James v. State Farm Mutual Automobile Insurance Co." on Justia Law

After DNA evidence exonerated Phillip Bivens, Bobby Ray Dixon, and Larry Ruffin, who spent a collective 83 years in prison for the rape and murder of a woman in Forrest County, their estates filed a civil rights law suit against the County. At issue in this appeal was whether two of the County's law enforcement liability policies require the insurers to defend the civil rights suit.The Fifth Circuit affirmed the district court's holding that there is a duty to defend, because the policies are triggered when injuries occur during the policy period, even though the wrongful acts that caused the injuries occurred before the policy period. In this case, the provisions of the Travelers and Scottsdale policies cover bodily injuries occurring during the policy period, and the estates' complaint alleges those injuries during the relevant time periods. Therefore, both insurers have a duty to defend the County and its officers. View "Travelers Indemnity Co. v. Mitchell" on Justia Law

On October 30, 2013, Consuelo Prieto Mariscal was driving her minivan in Pasco, Washington, with her daughter. There were vehicles, including an orange, pickup truck and a van, on the right side of the road. As Prieto passed the orange pickup truck, she heard a noise, felt her van jump a little, and saw a boy, Brayan, lying on the ground. Realizing Brayan was seriously hurt, her daughter called 911. Brayan was taken to a nearby hospital. Prieto and her daughter both told the police they did not see how the accident happened. There were no other eyewitnesses, and though the officer only spoke to Prieto and her daughter, he noted in his report the "bicyclist pulled into the roadway [and] was stuck on the left side and fell to the ground. The passenger side front tire drove over the child['s] right front leg." Brayan gave a number of statements, the most detailed of which related his right shoelace got stuck in the spokes of his bicycle and his right leg was run over when he leaned over to untangle the lace. Monica Diaz Barriga Figueroa, Brayan's mother, retained counsel, and signed a blank personal injury protection (PIP) application form. The English-speaking legal assistant completed the form for the Spanish-speaking Diaz, pulling language of the accident from the police report. The significant difference between the PIP form and Brayan's testimony became a central issue at trial. Prieto's counsel stressed the differences between Diaz's and Brayan's testimony and the PIP form; Diaz's counsel stress the PIP form was based on accounts from people who did not see the accident. At trial, and over Diaz's counsel's objection, Prieto's counsel referenced the PIP form as a statement against interest. Diaz's counsel moved to exclude the PIP form as privileged. The issue before the Washington Supreme Court was whether the form could be considered work product entitled to protection from disclosure. The Court determined that in this instance, where the insured gained the status of insured by statute, rather than contract, the form at issue was privileged. The Court affirmed the Court of Appeals and remanded this matter back to the trial court for a new trial. View "Figueroa v. Mariscal" on Justia Law

The longstanding dispute between UPMC; UPE, a/k/a Highmark Health and Highmark, Inc. (collectively, “Highmark”); and the Commonwealth of Pennsylvania's Office of the Attorney General (“OAG”) is again before the Pennsylvania Supreme Court. This time, the issue centered on the parties’ rights and obligations under a pair of Consent Decrees that, since 2014, governed the relationship between UPMC and Highmark with regard to the provision and financing of certain healthcare services to their respective insurance subscribers. The Consent Decrees were scheduled to terminate on June 30, 2019. Following the Supreme Court's decision in "Shapiro I," on February 7, 2019, OAG filed a four-count petition at Commonwealth Court to Modify Consent Decrees (“Petition”), thus commencing the underlying litigation. OAG argued the Commonwealth Court erred in concluding that Shapiro I controlled this case, and in so doing, misapplied the applicable principles of contract law. Highmark argued the Commonwealth Court erred in imposing a “materiality” limitation upon the Modification Provision, observing that nothing therein precluded modification of “unambiguous” and “material” terms of the Consent Decrees, as the Supreme Court characterized the termination date in Shapiro I. UPMC counters that OAG’s proposed use of the Modification Provision is contrary to the parties’ intent, in that the intent of the Consent Decrees, UPMC contends, was to establish a five-year transition period for UPMC and Highmark to wind down their contractual relationships, and thereby to minimize disturbance to the health care industry and to avoid sudden disruption of health care consumers’ expectations. The Supreme Court agreed with OAG and Highmark that the Commonwealth Court erred in concluding this case was controlled by Shapiro I. Further, the Court determined OAG and Highmark have set forth a plausible construction of the Modification Provision. The Court remanded this matter back to the Commonwealth Court to interpret the contested provision, and to reconsider the question of extension of the Consent Decrees. View "Pennsylvania v. UPMC, et al." on Justia Law

Plaintiff Stanley Jozefowicz owned a mobilehome that was damaged in a fire. At the time, Jozefowicz’s mobilehome was insured under an Allstate homeowners policy. Jozefowicz submitted a claim to Allstate for the fire damage and retained Sunny Hills Restoration (Sunny Hills) to perform cleanup, repairs, and remediation of the mobile home. He told his insurer, defendant Allstate Insurance Company (Allstate), that Sunny Hills was to be named on all reimbursement checks and was permitted to deposit checks into its own account. The contractor then contacted Allstate for a check, Allstate sent it, and the contractor deposited it. At some point, Jozefowicz and the contractor were having a dispute over the scope and quality of the work. Jozefowicz sued Allstate under California Uniform Commercial Code section 3309, which provided a cause of action on a negotiable instrument where the payee has lost possession of the instrument. Allstate moved for summary judgment, contending section 3309 did not apply because Jozefowicz permitted Allstate to issue checks to the contractor. The trial court agreed. As did the Court of Appeals, which affirmed. View "Jozefowicz v. Allstate Ins. Co." on Justia Law

The Eighth Circuit agreed with American Family that the district court erred in holding that the matching exclusion did not apply to the insureds' policy. Reviewing the district court's interpretation of the insurance policy de novo and applying Minnesota law, the court held that even if it were to discount the matching exclusion's explicit statement that it modifies the Form, as the district court did, other circumstances unambiguously showed that the Minnesota Endorsement, and thus the matching exclusion, applied to the insureds' policy. Therefore, the district court erred in reading the matching exclusion in the policy and, after applying the explicit and unambiguous exclusion, American Family was not obligated to pay for damages attributable to matching difficulties. View "Noonan v. American Family Mutual Insurance Co." on Justia Law

After Jeffrey Odom died in a motor vehicle accident driving a pick-up truck owned by his employer and insured by Berkley, Odom's widow filed a claim with Berkley for underinsured motorist (UIM) benefits. Berkeley then filed a diversity action seeking a declaratory judgment of no UIM coverage and plaintiff counter-claimed. The Eighth Circuit affirmed the district court's grant of Berkley's motion for summary judgment and held that the other driver's vehicle was not an "underinsured motor vehicle" as defined in Berkley's policy and in the auto insurance provisions of the North Dakota Century Code. View "Berkley Regional Insurance Co. v. Bernick-Odom" on Justia Law