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In a consolidated appeal, the New Jersey Supreme Court considered one central issue: whether the New Jersey Legislature intended to deviate from its highly regulated no-fault system of first-party self-insurance to cover medical expenses arising from automobile accidents when it amended the statutory scheme to allow an insured to elect smaller amounts of personal injury protection (PIP) under a standard policy. Each plaintiff in this appeal was injured in a car accident. Each was insured under a standard policy with insurance that provided for $15,000 in PIP coverage instead of the default amount of $250,000. Neither was able to sustain a claim for bodily injury (noneconomic loss) due to each policy’s limitation-on-lawsuit option. Each sued for outstanding medical bills in excess of their elected PIP coverage ($28,000 and $10,000, respectively). The trial courts ruled against plaintiffs in each matter and prohibited plaintiffs from admitting evidence of their medical expenses that exceeded their $15,000 PIP limits. The Appellate Division consolidated the cases on appeal, and, in a published opinion, reversed both trial court orders. After its review, the Supreme Court could not concluded there was evidence of a clear intention on the part of the Legislature to deviate from the carefully constructed no-fault first-party PIP system of regulated coverage of contained medical expenses and return to fault-based suits consisting solely of economic damages claims for medical expenses in excess of an elected lesser amount of available PIP coverage. "Unless the Legislature makes such an intent clearly known, the Court will not assume that such a change was intended by the Legislature through its amendments to the no-fault system in the Automobile Insurance Cost Reduction Act." View "Haines v. Taft" on Justia Law

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Llenos hung a noose from a basement ceiling beam, stood on a stool with the noose around his neck, and stepped off. Llenos died as a result. When Tran came home, she found her husband’s body. Though his death was initially reported as suicide, the medical examiner concluded from sexual paraphernalia on Llenos’s body that he died performing autoerotic asphyxiation, a sexual practice by which a person purposefully restricts blood flow to the brain to induce a feeling of euphoria. Llenos was covered by basic and supplemental life insurance policies, providing $517,000 in coverage, and including Accidental Death & Dismemberment (AD&D) policy riders providing an additional $60,000 in coverage. Minnesota Life paid $517,000 but denied Tran’s claim for the additional $60,000 in AD&D coverage, concluding that Llenos’s death was not “accidental” and fell under an exclusion for intentionally self-inflicted injury. Tran filed suit under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132(a)(1)(B). The district court awarded Tran judgment, reasoning that the insurer had conceded the death was accidental. The Seventh Circuit reversed, finding that autoerotic asphyxiation was the ultimate and the proximate cause of Llenos’s death. Strangling oneself to cut off oxygen to one’s brain is an injury. When that injury kills, it is “an intentionally self-inflicted injury which resulted in death,” regardless of whether it was done recreationally or with an intent to survive. View "Tran v. Minnesota Life Insurance Co." on Justia Law

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Restaurant Recycling filed suit against Employer Mutual, seeking a declaratory judgment that the insurer had a duty to defend and indemnify Restaurant Recycling. Restaurant Recycling was seeking a declaratory judgment and indemnity from an underlying lawsuit alleging that the company delivered defective shipments of recycled fat in which New Fashion Pork used as an ingredient in its swine feed. The court held that the total pollution exclusion in the insurance policy limited coverage in this case because the damage arose from dispersal of lasalocid, which Restaurant Recycling conceded was a pollutant. View "Restaurant Recycling, LLC v. Employer Mutual Casualty Co." on Justia Law

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SC, an outpatient surgical center, permits outside physicians to perform day surgery at its facility. Its insurance limited APA’s liability to $1 million per claim. In 2002, Dr. Hasson, an outside physician, performed outpatient laparoscopic surgery on Tate at SC. Hasson did not see Tate or sign her discharge instructions before SC released her; SC’s anesthesiologist discharged Tate, giving Tate's boyfriend discharge instructions. Days later, Tate checked into the hospital with a perforated bowel that rendered the previously-healthy 34‐year‐old a quadriplegic. Tate sued Hasson and SC. APA hired attorneys to defend SC. APA set the “Reserve” (money the Michigan Department of Insurance required APA to put aside to cover an adverse verdict) at $560,000. APA believed the damages could exceed the policy limit but that SC was not likely to be found liable. In 2007, APA rejected Tate's offer to settle for policy limits. Hasson’s insurer settled for his policy limit ($1 million). After the Illinois Appellate Court remanded the issue of whether SC’s nursing staff breached the standard of care, APA raised the Reserve to $1 million, stating that it still believed the case was defensible. Before the second trial, APA rejected Tate's second settlement demand for the policy limit. The jury returned a $5.17 million verdict. SC then sued APA for bad faith. The Seventh Circuit affirmed judgment as a matter of law in favor of APA. SC did not establish that anyone involved in litigating the case believed there was more than a mere possibility SC would be found liable; the mere possibility of liability is insufficient under the Illinois Supreme Court’s reasonable probability standard. View "Surgery Center at 900 North Michigan Avenue, LLC v. American Physicians Assurance Corp., Inc." on Justia Law

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The Supreme Court reversed the judgment of the district court determining that a stipulated settlement entered into by the parties was reasonable, holding that a stipulated settlement entered without the consent of an insurer to resolve litigation between the insured and a third-party claimant will not be presumed reasonable against the insurer when the insurer has been defending the insured throughout the litigation. The liability insurer in this case provided the insured a defense throughout the relevant proceedings but did not confirm coverage under the policy. The insurer declined to settle with Plaintiffs for policy limits and misrepresented the policy limits. Eventually, Plaintiffs entered into a stipulated settlement with the insured. The insurer intervened to challenge the reasonableness of the settlement. The district court found that the settlement agreement was reasonable, determining that the insurer had effectively abandoned its insured. The Supreme Court reversed, holding (1) a court may approve a stipulated judgment as between a third-party claimant and the insured in the underlying liability case, but the agreement will not be presumed reasonable as to the insurer if the insurer did not participate in the settlement and was providing a defense; and (2) the district court's reasonableness determination was based in part on its conclusion that a presumption of reasonableness applied, requiring reversal. View "Draggin'y Cattle Co. v. Junkermier, Clark, Campanella, Stevens, P.C." on Justia Law

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The Eleventh Circuit dismissed this insurance dispute case, holding that Gerber, as assignee of the insured, did not have standing to bring a declaratory judgment class action against GEICO. In this case, the action did not assert any claims for money damages and there was no substantial likelihood that the insured would suffer a future injury. Accordingly, the court reversed and remanded with instructions to dismiss the complaint for lack of standing. View "A&M Gerber Chiropractic LLC v. Geico General Insurance Co." on Justia Law

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The Supreme Court affirmed the judgment of the district court upholding the order of the Nebraska Department of Insurance determining that Mark Diamond, a licensed insurance producer, had violated three provisions of the Insurance Producers Licensing Act, Neb. Rev. Stat. 44-4047 to 44-4069, and imposing an administrative fine, holding that the district court's decision conformed to the law, was supported by competent evidence, and was neither arbitrary, capricious, nor unreasonable. On appeal, Diamond argued that his confession of liability in the consent judgment did not "admit" to "fraud" within the meaning of Neb. Rev. Stat. 44-4059(1)(g). The Supreme Court disagreed after applying settled rules of statutory interpretation, holding (1) because Diamond did not report the consent judgment taken against him in another jurisdiction within thirty days of the final disposition of the civil action, he violated section 44-4065(1), and the Department had the authority to levy an administrative fine; and (2) within the meaning of section 44-4059(1)(g), Diamond's confession of liability in the consent judgment constituted an admission of fraud. View "Diamond v. State" on Justia Law

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James Allen Insurance Brokers (JAIB) and Certain Underwriters at Lloyd’s, London, Subscribing to Certificate No. FRO-100944 (Lloyd’s) petitioned the Mississippi Supreme Court for interlocutory review of the Simpson County, Mississippi Circuit Court’s order granting partial summary judgment in favor of First Financial Bank (FFB). The trial court held that FFB was entitled to insurance proceeds from a fire loss that occurred at Luther and Freda Feazell’s poultry farm, because JAIB and Lloyd’s failed to comply with Mississippi law requiring notice of cancellation of property insurance. JAIM and Lloyd's claimed the Feazells' premium was not received on time; the effective date of the policy at issue here was reset to the date premium was paid. The Supreme Court determined coverage was effective December 13, 2013, and under the terms of the binder, and FFB having been listed in the binder as a mortgagee/loss payee, triggered Miss. Code Ann. Section 83-5-28(1)’s notification requirements. JAIB and Lloyd’s failed to comply with those statutory notification requirements; therefore, they were liable to FFB for its loss. Accordingly, the Supreme Court determined the trial court correctly granted partial summary judgment in favor of FFB. View "James Allen Insurance Brokers and Certain Underwriters at Lloyd's, London, Subscribing to Certificate NO. FRO-100944 v. First Financial Bank" on Justia Law

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Underwriters filed suit against FloaTEC, claiming that they were subrogated to Chevron's right to sue FloaTEC for damages caused by tendon failures of a floating oil-drilling platform. The Fifth Circuit affirmed the district court's dismissal of Underwriters' claims with prejudice, holding that the district court correctly ruled on FloaTEC's motion to dismiss before addressing any issue concerning the arbitrability of Underwriters' claims. The court also held that the district court correctly found that FloaTEC was an "Other Assured" under the policy and could thus invoke the subrogation waiver. View "Lloyd's Syndicate 457 v. FloaTEC, LLC" on Justia Law

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In this negligence case, the Supreme Court answered a question certified to it by a federal district court by concluding that the trial evidence was not legally sufficient to support the jury's finding that a continuing course of conduct tolled the statute of limitations. Plaintiff insurer brought this untimely filed action against Defendant claims adjuster alleging that Defendant caused Plaintiff to incur liability to a mortgagee. Plaintiff argued that the limitation period for commencing an action was tolled until Defendant produced a document in its files that reflected the mortgagee's interest during the course of litigation between the mortgagee and Plaintiff. The jury rendered a verdict in favor of Plaintiff. The court, however, set aside the jury's verdict on the ground that there was insufficient evidence to support the jury's finding that a continuing course of conduct tolled the action. The Supreme Court concluded that the evidence was not legally sufficient to toll the statute of limitations. View "Essex Insurance Co. v. William Kramer & Associates, LLC" on Justia Law