Justia Insurance Law Opinion Summaries

The United States District Court for the Western District of Washington certified a question of Washington law to the Washington Supreme Court. This case concerned a class action insurance claim suit pending in federal court. Plaintiff Brett Durant was a State Farm Mutual Automobile Insurance Company insured, and carried a $35,000 personal injury protection (PIP) rider. In 2012, Durant was injured in a motor vehicle accident; he opened a PIP claim with State Farm. The "coverage letter" advised Durant that "Medical services must also be essential in achieving maximum medical improvement for the injury you sustained in the accident." Durant sought treatment with chiropractor Harold Rasmussen, DC, who diagnosed injuries including sprains to the neck, back, pelvis, and right shoulder. After a shoulder MRI showed a ligament sprain and "a possible small type I SLAP [(superior labral anteroposterior)] tear,"Durant was referred to an orthopedic surgeon who diagnosed"mild bursitis/tendinitis,"which was treated with physical therapy and cortisone injections. Durant's injuries were not resolved by a date set by his physicians; his providers billed his PIP claims, but State Farm denied them on grounds that Durant had "previously reached maximum medical improvement." The federal district court asked the Washington Supreme Court (1) whether an insurer violates WAC 284-30-395(1)(a) or (b) if that insurer denied or terminated an insured's medical benefits based on a finding of "maximum medical improvement;" and (2) whether the term "maximum medical improvement" was consistent with the definition of "reasonable" or "necessary" as those terms appeared in WAC 284-30-395(1). The Washington Court answered the first certified question "yes." With regard to the second question, the Court found that under the circumstances of this case, the term "maximum medical improvement" was not consistent with the terms "reasonable" or "necessary" as those terms appeared in WAC 284-30-395(1). View "Durant v. State Farm Mut. Auto. Ins. Co." on Justia Law

The Fifth Circuit affirmed the district court's grant of summary judgment for an insurer, in an action seeking a declaratory judgment that the insurer owed no coverage under a commercial property insurance policy. The insured then counterclaimed for declaratory judgment, breach of the insurance contract, and violations of the Texas Insurance Code. The court held that the insured failed to meet its burden to offer evidence that would allow a trier of fact to segregate covered losses from non-covered losses. Therefore, because the insured failed to meet its burden to show what portion, if any, of the claimed damage occurred during the coverage period, the insurer was entitled to summary judgment on its claim seeking declaratory judgment. The insured's counterclaims failed for the same reason. View "Certain Underwriters at Lloyd's of London v. Lowen Valley View, LLC" on Justia Law

The circuit court did not err when it ruled that Plaintiff, a retired firefighter, was not a disabled person entitled to receive health insurance benefits under the Virginia Line of Duty Death and Disability Act, Va. Code 9.1-400 et seq.Plaintiff was diagnosed with throat cancer after he retired from the fire department but did not experience any health problems while he worked as a firefighter. The circuit court concluded (1) under the plain reading of the Act, Plaintiff’s duties as a firefighter ceased as of his retirement; and (2) because Plaintiff became disabled after he retired, his claim for insurance coverage under the Act was not viable. The Supreme Court affirmed, holding that Plaintiff was not a “disabled person” under the Act because his incapacity did not prevent the “further performance” of his duties as a firefighter. Therefore, Plaintiff was not entitled to continued health insurance coverage under the Act. View "Jones v. Von Moll" on Justia Law

The United States District Court for the District of Colorado certified a question of law to the Colorado Supreme Court. The question asked for an interpretation of the meaning of the words “suicide, sane or insane,” when used in life insurance policies. The Colorado Supreme Court concluded that, under Colorado law, a life insurance policy exclusion for “suicide, sane or insane” excluded coverage only if the insured, whether sane or insane at the time, committed an act of self-destruction with the intent to kill himself. View "Renfandt v. New York Life Insurance Company" on Justia Law

This case concerned a discovery dispute arising out of an automobile accident in which Gary Griggs, a driver insured by State Farm, injured Susan Goddard and several others. State Farm sought a declaratory judgment that Griggs breached the contractual duties set forth in his insurance policy by executing a settlement agreement pursuant to Nunn v. Mid-Century Insurance Co., 244 P.3d 116 (Colo. 2010), in which he waived a jury trial, consented to arbitration, and assigned to Goddard any rights that he had against State Farm. Goddard counterclaimed, asserting, among other things, that State Farm acted in bad faith by refusing both to settle her claims against Griggs and to indemnify Griggs for the judgment entered against him after the arbitration to which Griggs had consented. The district court determined State Farm impliedly waived the attorney-client privilege protecting communications between it and its former counsel when it submitted an affidavit from that former counsel to rebut allegations of discovery misconduct. The Colorado Supreme Court concluded after review that the attorney affidavit submitted in this case did not place any privileged communications at issue. Accordingly, the district court erred in finding that State Farm impliedly waived its attorney-client privilege. View "State Farm v. Griggs" on Justia Law

Appraisers may determine the factual cause of damage to insured property to ascertain the amount of the loss, but coverage questions are to be resolved by the court.In the instant case, the district court rejected an insurance appraisal award for hail damage to roofing shingles. The property insurer denied coverage for hail caused damage to the asphalt shingles based on a preexisting manufacturing defect. The insured townhome association sued the insurer for breach of contract and invoked the appraisal provision of the property insurance policy to ascertain the amount of the loss from the hailstorm. The appraisal panel valued the hail damage loss at $1.4 million. The district court found no shingle damage from hail, applied an exclusion for defective materials, and rejected the appraisal award. The Supreme Court remanded the case, holding (1) the district court erred by disregarding the appraisal award’s determination of the amount of the loss for shingles damaged by the hailstorm; and (2) the issue of the extent of preexisting shingle damage excluded from coverage must be decided by the court on remand. View "Walnut Creek Townhome Ass’n v. Depositors Insurance Co." on Justia Law

By interlocutory appeal, Central Insurers of Grenada, Inc., challenges the Warren County Circuit Court’s denial of its motion to dismiss William Greenwood’s complaint against it for insufficient service of process. Greenwood, the owner of Antique Wood Company of Mississippi, filed a complaint against Central and three other defendants, alleging breach of contract, conspiracy, and bad faith due to the defendants’ refusal to provide coverage under a commercial liability insurance policy Greenwood had purchased from them. Greenwood’s complaint acknowledged that Central was a Mississippi corporation, identified Lynn Simmons Grim as Central’s registered agent for service of process, and listed an address in Grenada County, Mississippi, where Grim could be served. However, Greenwood did not personally serve process on an officer or registered agent of Central, nor did he mail a copy of the complaint and summons directly to Central or its registered agent. Instead, Greenwood’s process server served a copy of the complaint and summons on an employee of the Mississippi Commissioner of Insurance. The Commissioner’s legal process clerk then forwarded a copy of the complaint and summons, along with a notification letter, to Central via certified mail. The Mississippi Supreme Court determined the trial court erred in finding the Mississippi Commissioner of Insurance was authorized to accept service of process on Central's behalf, so it reversed that judgment and remanded this case for further proceedings. View "Central Insurers of Grenada, Inc. v. William Greenwood d/b/a Antique Wood Company of Mississippi" on Justia Law

Sentry Select Insurance Company brought a legal malpractice lawsuit in federal district court against the lawyer it hired to defend its insured in an automobile accident case. The federal court certified two questions of South Carolina law to the South Carolina Supreme Court pertaining to: (1) whether an insurer may maintain a direct malpractice action against counsel hired to represent its insured where the insurance company has a duty to defend; and (2) whether a legal malpractice claim may be assigned to a third-party who was responsible for payment of legal fees and any judgment incurred as a result of the litigation in which the alleged malpractice arose. The South Carolina Court answered the first question "yes:" "However, we will not place an attorney in a conflict between his client's interests and the interests of the insurer. Thus, the insurer may recover only for the attorney's breach of his duty to his client, when the insurer proves the breach is the proximate cause of damages to the insurer. If the interests of the client are the slightest bit inconsistent with the insurer's interests, there can be no liability of the attorney to the insurer, for we will not permit the attorney's duty to the client to be affected by the interests of the insurance company. Whether there is any inconsistency between the client's and the insurer's interests in the circumstances of an individual case is a question of law to be answered by the trial court." As to question two, the Supreme Court declined to answer the question: "We are satisfied that our answer to question one renders the second question not 'determinative of the cause then pending in the certifying court,' and thus it is not necessary for us to answer question two." View "Sentry Select Insurance v. Maybank Law Firm" on Justia Law

The Supreme Court reversed the district court’s deemed denial of Scottsdale Insurance Company’s motion to set aside the default judgment entered against it, holding that Scottsdale satisfied its burden of establishing that doubt existed concerning whether service was properly effectuated.National Parks Reservations (NPR) filed a complaint and demand for jury trial, naming Scottsdale. Because Scottsdale was a foreign insurer, NPR was statutorily required to serve Scottsdale through the Office of the Montana State Auditor, Commissioner of Securities and Insurance (the Commissioner). The Commissioner, in turn, was statutorily required to forward the complaint and summons to Scottsdale. After Scottsdale failed to appear the district court entered a partial default judgment against Scottsdale. Scottsdale moved to set aside the default judgment, arguing that both NPR and the Commissioner had failed strictly to comply with foreign insurer service requirements under Mont. Code Ann. 33-1-603(1), and, thus, the default judgment was void. Scottsdale’s motion was deemed denied. The Supreme Court reversed, holding that Scottsdale established that doubt existed regarding whether service was properly completed by the Commissioner. View "Reservation Operations Center LLC v. Scottsdale Insurance Co." on Justia Law

The Eleventh Circuit vacated the district court's grant of summary judgment to AIG in an action filed by AGLIC claiming that AIG, acting as a primary insurer, improperly allocated settlement payments between two insurance policies on behalf of their mutual insured, Imperial. The court held that, because the interests of St. Paul and AGLIC were coextensive, there was an absence of complete diversity of citizenship, and the district court lacked the power to entertain the matter in the first place. Therefore, the court remanded with instructions to dismiss. View "National Union Fire Insurance Co. of Pittsburgh v. American Guarantee & Liability Insurance Co." on Justia Law