Justia Insurance Law Opinion Summaries

by
CMA and others filed suit against Aetna, seeking among other claims, an injunction for alleged violations of the Unfair Competition Law (UCL; Bus. & Prof. Code, section 17200). The trial court found that CMA lacked standing under the UCL because it was not directly injured by Aetna's policy.The Court of Appeal affirmed the trial court's grant of Aetna's motion for summary judgment, concluding that the body of law permitting an association to bring a nonclass representative action does not bestow standing upon CMA to seek an injunction against Aetna under the UCL, whether or not CMA individually suffered injury in fact and lost money or property. The court also concluded that CMA's evidence that it diverted substantial resources to assist its physician members who were injured by Aetna's policy did not create a material disputed fact as to whether CMA itself suffered injury in fact and lost money or property. The court explained that an association must sustain direct economic injury to itself and not just its members to bring a UCL claim. Furthermore, evidence that an association diverted resources to investigate its members' claims of injury and advocate for their interests is not enough to show standing under the UCL. In this case, the federal authorities CMA cites are neither binding on this court nor instructive. View "California Medical Ass'n v. Aetna Health of California, Inc." on Justia Law

by
After plaintiffs lost their home in a fire, they promptly submitted a claim under their homeowner’s insurance policy to their insurer, Mid-Century. Mid-Century denied the claim on the ground that the policy had been canceled for nonpayment of premium six days before the fire. Plaintiffs immediately paid the past due premium, the policy was reinstated, but Mid-Century continued to deny the claim. Plaintiffs filed suit for breach of contract and breach of the implied covenant of good faith and fair dealing. The trial court granted summary adjudication for plaintiffs on the issue of Mid-Century's duty to provide coverage and denied Mid-Century's motion for summary judgment in its entirety.The Court of Appeal concluded that the trial court properly denied Mid-Century's motion for summary judgment but improperly granted plaintiff's motion for summary adjudication. The court rejected Mid-Century's argument that the loss-in-progress rule precludes coverage. Rather, the court concluded that the law allowed Mid-Century to retroactively reinstate the policy with no lapse in coverage. However, the court concluded that there exists a triable issue of material fact regarding Mid-Century's intent when it reinstated the policy that precludes summary adjudication for either party. View "Antonopoulos v. Mid-Century Insurance Co." on Justia Law

by
The Supreme Court answered a question of law certified by the United States District Court for the Western District of Tennessee by holding that Tenn. Code Ann. 56-7-111 does not provide for a private right of action.Section 56-7-111 states that when an insured property owner's home or other structure sustains more than $1,000 in damages, the casualty or property insurance company shall name the general contractor of an uncompleted construction contract as a payee when issuing payment to the property owner. In the instant case, the insurance company issued a check to the owner but did not name the general contractor as a payee. The general contractor brought this suit alleging that the insurance company did not comply with section 56-7-111. The federal court certified to the Supreme Court the question of whether a general contractor has a private right of action against an insurance company for violating section 56-7-111. The Supreme Court held that the statute does not expressly grant such a private right of action and that the legislature did not intend to imply a private right of action. View "Affordable Construction Services, Inc. v. Auto-Owners Insurance Co." on Justia Law

by
This case involves a decade-long, three-lawsuit dispute between the insurer and the insured over who owed what when. At issue in this appeal is whether the district court properly awarded extracontractual damages to the insured under Section 155 of the Illinois Insurance Code. Section 155 permits an insured to seek extracontractual damages from an insurer in any case in which at least one of three issues remains undecided: (1) the insurer's liability under the policy, (2) the amount of the loss payable under the policy, or (3) whether there was an unreasonable delay in settling a claim.The Seventh Circuit concluded that the insured cannot pursue Section 155 damages in this action because none of these three threshold issues remains undecided. In this case, the insurer's liability under its policy with the insured was resolved by the Illinois Appellate Court in 2015; the amount of loss payable by the insurer to the insured under the policy was determined by the Illinois Appellate Court in 2017; and the insured does not seek recovery for any unreasonable delay by the insurer in settling the insured's claim. Therefore, none of the insured's extracontractual issues remain undecided. Accordingly, the court reversed the district court's decision granting relief to the insured under Section 155. View "Creation Supply, Inc. v. Selective Insurance Co. of the Southeast" on Justia Law

by
The Supreme Court conditionally granted mandamus relief in these actions challenging rulings on a Rule 91a motion to dismiss, holding that the the trial court abused its discretion in denying Insurer's motion to dismiss Insured's claim for negligent failure to settle.A liability insurer (Insurer) settled claims against its insured (Insured) within policy limits but obtained a release that was contingent on Insured paying a portion of the settlement. Insured paid and then brought this action seeking reimbursement, alleging claims for negligent failure to settle and for breach of contract. Insurer filed a motion to dismiss, which the trial court denied. Insurer sought mandamus relief. The court of appeals granted relief as to the breach of contract claim but concluded that the trial court properly refused to dismiss the claim for negligent failure to settle. Both parties sought mandamus relief. The Supreme Court conditionally granted mandamus relief to both parties, holding (1) the trial court abused its discretion in denying Insurer's motion to dismiss Insured's Stowers claim for negligent failure to settle; and (2) the court of appeals erred in ordering the trial court to dismiss Insured's claim for breach of the contractual obligation to indemnify. View "In re Farmers Texas County Mutual Insurance Co." on Justia Law

by
Plaintiff filed suit against USAA on behalf of himself and a putative class for declaratory judgments that USAA's method to calculate insurance payments was inconsistent with Florida law and the insurance policy.The Eleventh Circuit concluded that plaintiff does not have standing to seek prospective relief on the off chance that he might total a car again in the future. The court further concluded that plaintiff's request for supplemental relief does not change the standing analysis for a declaratory judgment claim. Therefore, the court concluded that plaintiff does not have standing to bring his declaratory judgment claims, vacated the district court's order of dismissal, and remanded to the district court with instructions that the district court remand the case back to state court. View "Mack v. USAA Casualty Insurance Co." on Justia Law

by
The Eighth Circuit reversed the district court's grant of summary judgment to Selective in an action brought by Selective, seeking a declaration that a subcontractor's policy did not require it to defend or indemnify CSC General. CSC entered into a subcontract that required it to be an "additional insured" on Glosson's general liability policy, and Glosson's policy was with Selective.In this case, Glosson damaged the parking lot through its handling of the cement (adding too much water) before it hardened. Thus, the damage was caused, at least in part, by handling of the cement, not handling of real property. Therefore, the court concluded that CSC is an additional insured for the property damage Glosson caused. The court also concluded that the district court erred in looking beyond the denial letter in focusing at length on five coverage issues not stated in Selective's coverage denial. The court explained that the district court did not properly apply North Dakota's estoppel law on insurance coverage. Finally, the court concluded that summary judgment was not appropriate on the bad faith claim. Accordingly, the court remanded for further proceedings. View "Selective Way Insurance Co. v. CSC General Contractors, Inc." on Justia Law

by
The Court of Appeal affirmed the trial court's order denying Federal's special motion to strike a civil complaint for fraud as a strategic lawsuit against public participation under Code of Civil Procedure section 425.16, as well as the trial court's order overruling its evidentiary objections. In the underlying action, plaintiffs filed lawsuits against Moldex, alleging Moldex manufactured defective air respirators and masks that failed to protect them. This litigation ensued between Truck, Federal, and First State over coverage and the extent to which Truck was obligated to reimburse Federal and First State for payments made for Moldex's defense and indemnity, plus interest. Federal argued that Truck's complaint for fraud is based on Federal's "acts in furtherance of its right to petition" and are thus protected speech pursuant to section 425.16, subdivisions (e)(1) and (e)(2).The court affirmed the trial court's rulings on Federal's evidentiary objections and concluded that the first amended complaint is not relevant to the court's review of the anti-SLAPP motion. The court also affirmed Federal's special motion to strike Truck's complaint for fraud, concluding that Federal met its burden of showing that Truck's complaint for fraud arises from Federal's protected activity, and that the trial court correctly found that Truck met its burden to establish a probability of success on the merits of its fraud cause of action.In this case, a factfinder considering all the circumstances could reasonably conclude that when Truck signed the July 2013 settlement agreeing to pay nearly $5 million to Federal and to dismiss its pending appeal of the February 2013 judgment, it did so in reasonable reliance on Federal's course of conduct and Federal's stated position that it had a duty to defend Moldex pursuant to its policy. Furthermore, Truck agreed to file a request for dismissal of its pending appeal, with prejudice, when it entered the settlement agreement, which further supports a finding of extrinsic fraud by Federal. Finally, Federal is mistaken in its belief that Truck "released the claim for which it now seeks damages" by signing the July 2013 settlement agreement. View "Truck Insurance Exchange v. Federal Insurance Co." on Justia Law

by
Mesa sent faxes promoting its services. Some recipients had not consented to receive such faxes, and the faxed materials did not include an opt‐out notice as required by the Telephone Consumer Protection Act (TCPA), 47 U.S.C. 227(b)(1)(C). Orrington filed a class‐action lawsuit under the TCPA and the Illinois Consumer Fraud and Deceptive Business Practices Act and alleged that Mesa’s conduct constituted common‐law conversion, nuisance, and trespass to chattels for Mesa’s appropriation of the recipients’ fax equipment, paper, ink, and toner. Mesa notified its insurer, Federal, of the Orrington action. Federal declined to provide a defense. After Mesa and Orrington reached a settlement, Mesa sued Federal, alleging breach of contract, bad faith, and improper delay and denial of claims under Colorado statutes.The Seventh Circuit affirmed summary judgment in favor of Federal. The policy’s “Information Laws Exclusion” provides that the policy “does not apply to any damages, loss, cost or expense arising out of any actual or alleged or threatened violation of “ TCPA “or any similar regulatory or statutory law in any other jurisdiction.” The exclusion barred all of the claims because the common-law claims arose out of the same conduct underlying the statutory claims. View "Mesa Laboratories, Inc. v. Federal Insurance Co." on Justia Law

by
MAO-MSO acquired rights to collect conditional payments that Medicare Advantage Organizations (MAOs) made if a primary insurer (such as automobile insurance carriers) has not promptly paid medical expenses. MAO-MSO sued those primary payers. The district court proof of required actual injury. Specifically, MAO-MSO needed to identify an “illustrative beneficiary”— a concrete example of a conditional payment that State Farm, the relevant primary payer, failed to reimburse to the pertinent MAO. MAO-MSO alleged that “O.D.” suffered injuries in a car accident and that State Farm “failed to adequately pay or reimburse” the appropriate MAO. The district court determined that these allegations sufficed for pleading purposes to establish standing.As limited discovery progressed, MAO-MSO struggled to identify evidence supporting the complaint. One dispute centered on whether O.D.’s MAO made payments related to medical care stemming from a car accident before State Farm reached its limit under O.D.’s auto policy so that State Farm should have reimbursed the MAO. The payment in question was to a physical therapist. State Farm argued that the physical therapy services had no connection to O.D.’s car accident and related only to her prior knee surgery.The district court determined no reasonable jury could find that the payment related to O.D.’s car accident, meaning that MAO-MSO lacked standing. The Seventh Circuit affirmed the dismissal. The Medicare Act may authorize the lawsuit but MAO-MSO fail to establish subject matter jurisdiction by establishing an injury in fact. View "MAO-MSO Recovery II, LLC v. State Farm Mutual Automobile Ins. Co." on Justia Law