Justia Insurance Law Opinion Summaries

The Eighth Circuit affirmed the district court's grant of summary judgment to American Family in an action alleging breach of contract, negligent misrepresentation, and violation of Minnesota's consumer fraud statutes. The court held that American Family did not breach the contract because nothing in the policy imposed on American Family a contractual obligation to make objectively reasonable or accurate replacement cost estimates; American Family did not negligently misrepresent the replacement cost of plaintiffs home where, regardless of any breach of duty, no genuine dispute existed as to justifiable reliance upon the estimates; and plaintiffs could point to any promise, misrepresentation, or false statement made by American Family, let alone one that they relied upon, justifiably or unjustifiably, in deciding to purchase or renew the policy. View "Nelson v. American Family Mutual Insurance Co." on Justia Law

The Fourth Circuit affirmed the district court's grant of summary judgment to Hartford Life in an action brought under the Employee Retirement Income Security Act (ERISA). Plaintiff filed suit seeking a continuation of the long-term disability benefits that Hartford Life had terminated based on its conclusion that plaintiff was no longer "disabled," as that term was used in the plan. The court affirmed the district court's conclusion that Hartford Life, not Hartford Fire, determined that plaintiff was no longer eligible for long-term disability benefits, and Hartford Life's decision to terminate his long-term disability benefits was not an unreasonable exercise of discretion. In this case, the record demonstrated that plaintiff received a fair and thorough consideration of his claim and Hartford Life's conclusion was reasonably supported by the available evidence where, among other things, video surveillance evidence showed plaintiff walking at a quick pace and moving without observable bracing or support. View "Griffin v. Hartford Life & Accident Insurance Co." on Justia Law

The Eighth Circuit reversed the district court's dismissal of a breach-of-contract action to recover unpaid insurance premiums. The court held that the administrative procedures available to the insurer were too informal to require exhaustion under then-applicable Missouri law. Therefore, Travelers had no obligation to exhaust its administrative remedies before filing its lawsuit. The court remanded for further proceedings. View "Travelers Property Casualty Insurance Company of America v. Jet Midwest Technik" on Justia Law

The Eighth Circuit affirmed the district court's dismissal of an action against WireCo's workers' compensation insurance carriers, Liberty, seeking damages for excess premiums that WireCo allegedly paid on three of Liberty's insurance policies. The court held that the plain language and established purpose of the Missouri vexatious refusal to pay statute indicated that it applied to claims filed under a policy that related to a covered loss and that a breach of a contract of overcharging or of failure to refund premium was not a loss contemplated by the statute. Therefore, a loss under the statute did not include excess premium payments.The court also held that only the theories of breach of contract were before the district court at summary judgment; even assuming the rating plans were incorporated into the policies, and that Liberty breached the contracts, WireCo must present evidence that Liberty's alleged breaches caused WireCo to suffer damages; and Liberty was entitled to summary judgment on WireCo's breach of contract claims because WireCo failed to present evidence that it would have paid lower premiums if Liberty had complied with the notice and documentation requirements of the Missouri and Texas schedule rating plans. View "WireCo WorldGroup, Inc. v. Liberty Mutual Fire Insurance Co." on Justia Law

The DC Circuit affirmed the district court's grant of summary judgment in favor of an insurance company in a breach of contract dispute over a homeowners insurance policy. The court held that plaintiffs could not recover under the clear terms of their insurance policy where plaintiffs were away from their beach home for ten days and failed to shut off the water supply where it entered the house. In this case, there was no question that the damage for which they sought coverage was caused by flooding from the plumbing. The court also affirmed the district court's transfer of the claims against the cleaning-and-restoration company to the district court in Delaware based on lack of personal jurisdiction. View "Katopothis v. Windsor-Mount Joy Mutual Insurance Co." on Justia Law

Appellant Jennifer Eastman sought a declaratory judgment that she was entitled to underinsured motorist insurance coverage (“UIM coverage”) under her auto insurance policy (the “Policy”) with Respondent Farmers Insurance Company (“Farmers”). Eastman was involved in a motor vehicle accident while traveling in a van operated by the Spokane Transit Authority (“STA”). Eastman sustained injuries as a result of the accident. Both the at-fault driver and STA held insurance policies. Eastman collected $50,000 from the at-fault driver’s insurance policy. Additionally, Eastman collected $48,846 in UIM coverage from STA’s insurance policy. Eastman’s special damages from the accident exceeded the amount that she collected from the two insurance policies. Eastman thereafter filed a claim with her insurer, Farmers, in an attempt to collect her own UIM coverage under the Policy. Specifically, Eastman sought her UIM coverage limit ($500,000) minus the $98,846 that she had already collected from the other insurance policies. Farmers denied Eastman’s claim based on an exclusion within the Policy which eliminated UIM coverage in situations where the insured was riding in another vehicle that had UIM coverage. The district court granted summary judgment in favor of Farmers, ruling that an exclusion contained in the Policy precluded UIM coverage for Eastman’s injuries. Finding that the clause in Eastman's policy violated Idaho's public policy, the Idaho Supreme Court vacated the district court's judgment and remanded this case with direction to invalidate the insurance exclusion at issue here. View "Eastman v. Farmers Insurance" on Justia Law

The plaintiffs in consolidated appeals each settled a claim under their automobile-insurance policies with the defendants. But plaintiffs maintained the defendants illegally reduced their settlement offers by taking into account certain benefits they had previously paid plaintiffs. The district courts dismissed the plaintiffs’ putative class-action lawsuits after concluding the plaintiffs each waived their rights to collect further damages from the defendants on their settled claims. The Tenth Circuit reversed in part and remanded to the district court with instructions to vacate its judgment in favor of USAA Casualty Insurance Company because it lacked jurisdiction to hear the claims against that defendant. Otherwise, the Court affirmed. View "McCracken v. Progressive Direct Ins. Co." on Justia Law

Plaintiff Ali Bazzi, was injured while driving a vehicle owned by his mother, third-party defendant Hala Baydoun Bazzi, and insured by defendant Sentinel Insurance Company (Sentinel). Plaintiff sued Sentinel for mandatory personal protection insurance (PIP) benefits under Michigan’s no-fault act, and Sentinel sought and obtained a default judgment rescinding the insurance policy on the basis of fraud. The issue this case presented for the Michigan Supreme Court was whether the judicially created innocent-third-party rule, which precludes an insurer from rescinding an insurance policy procured through fraud when there is a claim involving an innocent third party, survived its decision in Titan Ins Co v. Hyten, 817 NW2d 562 (2012), which abrogated the judicially created easily-ascertainable-fraud rule. The Supreme Court held "Titan" abrogated the innocent-third-party rule but that the Court of Appeals erred when it concluded that Sentinel was automatically entitled to rescission in this instance. Accordingly, the Court affirmed in part, reversed in part, and remanded to the trial court to consider whether, in its discretion, rescission was an available remedy. View "Bazzi v. Sentinel Ins. Co." on Justia Law

The Eighth Circuit affirmed the district court's grant of summary judgment deferring to an insurance policy interpretation made by the FCIC and a determination regarding the FCIC's authority made by the RMA. The court held that the clear language of the Federal Crop Insurance Act indicated that Congress intended the Corporation to have extensive and broad authority; given the FCIA's broad grant of authority to the Corporation, and the specific authority over the provisions of insurance and insurance contracts found in 5 U.S.C. 1505 and 1506, substantial deference was given to the FCIC's interpretation of the special provision; and, considering the plain language of the insurance contract and the deference given to the RMA in its role of supervisor of the FCIC, the RMA's determination that the FCIC was required to provide an interpretation of the special provision to the arbitrating parties was not clearly erroneous. View "Bottoms Farm Partnership v. Perdue" on Justia Law

ATC, a Michigan manufacturer, outsources orders, including to YiFeng, a Chinese company. ATC pays vendors in four separate payments, based on manufacturing progress. YiFeng emails ATC invoices. On March 18, 2015, ATC’s vice-president, Gizinski, emailed YiFeng employee Chen requesting all outstanding invoices. An unidentified third party intercepted this email, and impersonating Chen, began corresponding with Gizinski. On March 27, the impersonator emailed Gizinski that, due to an audit, ATC should wire its payments to a different account from usual. YiFeng had previously, legitimately informed ATC it had changed its banking details; ATC had no process for verifying the information. Gizinski wired the money to the new account. On April 3, the impersonator emailed Gizinski, stating that “due to some new bank rules,” the previous transfer was not credited to its account so it would return the payment. The impersonator requested that Gizinski wire the money to a different bank account. Gizinski wired the money to this new account. The impersonator ran this scam twice more. Gizinski wired additional payments of $1575 and $482,640.41. When the real YiFeng demanded payment, ATC paid YiFeng approximately 50% of the outstanding debt; the remaining 50% was contingent on ATC’s insurance claim. ATC sought recovery from Travelers, under the Policy’s “Computer Fraud” provision. Travelers denied the claim. ATC sued for breach of contract. The court granted Travelers summary judgment. The Sixth Circuit reversed. Computer fraud “directly caused” ATC’s “direct loss” and no exclusion applied. View "American Tooling Center, Inc. v. Travelers Casualty & Surety Co." on Justia Law