Justia Insurance Law Opinion Summaries

The U.S. District Court for the District of Colorado certified a question of Colorado law to the Colorado Supreme Court regarding the statute of limitations applicable to section 10-3-1116, C.R.S. (2017), which governed claims for unreasonable delay or denial of insurance benefits. Specifically, the question centered on whether a claim brought pursuant to Colorado Revised Statutes section 10-3-1116 was subject to the one-year statute of limitations found in Colorado Revised Statutes section 13-80-103(1)(d) and applicable to “[a]ll actions for any penalty or forfeiture of any penal statutes.” The Supreme Court held the one-year statute of limitations found in section 13-80-103(1)(d), C.R.S. (2017), did not apply to an action brought under section 10-3-1116(1) because section 10-3-1116(1) was not an “action[] for any penalty or forfeiture of any penal statute[]” within the meaning of section 13-80-103(1)(d). Therefore, the Court answered the certified question in the negative. View "Rooftop Restoration, Inc. v. Am. Family Mut. Ins. Co." on Justia Law

In 2009, a fire started in an apartment building owned by respondents Guillermo and Evelia Barriga and insured by petitioner American Family Mutual Insurance Company (“American Family”). American Family made various payments to the and on behalf of the Barrigas, totaling $209,816.43. However, after a substantial amount of repair work had been completed, the contractor revised its estimate for the cost of the repairs. The revised estimate was higher than American Family’s initial estimate, primarily because of the need for additional repairs and asbestos remediation. In response, American Family initiated a third-party appraisal process outlined in the insurance policy intended to provide an impartial assessment of the needed repair costs. The appraiser fixed the award at $322,141.79. American Family then paid that award, less the $209,816.43 that had been previously paid to the Barrigas, resulting in a payment of $122,325.36. American Family also made an additional payment of $5435.44 for emergency board-up services. The Barrigas sued American Family for breach of contract, common law bad-faith breach of insurance contract, and unreasonable delay and denial of insurance benefits under section 10-3-1116(1), C.R.S. (2017). The jury found for the Barrigas on all claims, awarding damages, as relevant here, of $9270 for breach of contract and $136,930.80 for benefits unreasonably delayed or denied. The issue raised on appeal for the Colorado Supreme Court's review centered on whether an award of damages under section 10-3-1116(1), C.R.S. (2017), had to be reduced by an insurance benefit unreasonably delayed but ultimately recovered by an insured outside of a lawsuit. The Court held that an award under section 10-3-1116(1) must not be reduced by an amount unreasonably delayed but eventually paid by an insurer because the plain text of the statute provided no basis for such a reduction. The Court also concluded that a general rule against double recovery for a single harm did not prohibit a litigant from recovering under claims for both a violation of section 10-3- 1116(1) and breach of contract. View "Am. Family Mut. Ins. Co. v. Barriga" on Justia Law

Nine days after the jury returned its verdict, but before the trial court reduced that verdict to a written and signed judgment, Michael Casper died. Consequently, the defendant, Guarantee Trust Life Insurance Company (“GTL”), moved to substantially reduce the verdict, arguing that the survival statute barred certain damages under the policy that insured Casper. The trial court denied the motion, and the court of appeals affirmed. The Colorado Supreme Court granted GTL’s petition to review the court of appeals’ decision, and concluded that the survival statute did not limit the jury’s verdict in favor of Casper. The Court also concluded that an award of attorney fees and costs under section 10-3-1116(1) was a component of the “actual damages” of a successful claim under that section. Finally, the Court concluded that although the survival statute did not limit the damages awarded by the jury, the trial court abused its discretion by entering a final judgment on October 30, 2014, nunc pro tunc to July 15, 2014. View "Guarantee Trust Life Ins. Co. v. Estate of Casper" on Justia Law

Welspun filed suit against its insurer, Liberty Mutual, arguing that its unpaid mitigation costs were "necessary expenses" included in the policy's loss of business income coverage. The Eighth Circuit affirmed the district court's grant of summary judgment for Liberty Mutual. The court held that the district court did not err in limiting necessary expenses covered in Paragraph C.2. of the policy to expenses incurred to avoid or reduce a loss of business income; reading the loss of business income policy provisions together, in light of their historical roots and obvious purpose, the court agreed with the district court that "necessary expenses" in Paragraph C.2. were limited to expenses that reduce a covered business income loss; and the incremental costs Welspun incurred in shifting some Seaway production to an affiliate in India were not "necessary expenses" within the meaning of Paragraph C.2. of the policy. View "Welspun Pipes Inc. v. Liberty Mutual Fire Insurance Co." on Justia Law

Welspun filed suit against its insurer, Liberty Mutual, arguing that its unpaid mitigation costs were "necessary expenses" included in the policy's loss of business income coverage. The Eighth Circuit affirmed the district court's grant of summary judgment for Liberty Mutual. The court held that the district court did not err in limiting necessary expenses covered in Paragraph C.2. of the policy to expenses incurred to avoid or reduce a loss of business income; reading the loss of business income policy provisions together, in light of their historical roots and obvious purpose, the court agreed with the district court that "necessary expenses" in Paragraph C.2. were limited to expenses that reduce a covered business income loss; and the incremental costs Welspun incurred in shifting some Seaway production to an affiliate in India were not "necessary expenses" within the meaning of Paragraph C.2. of the policy. View "Welspun Pipes Inc. v. Liberty Mutual Fire Insurance Co." on Justia Law

This appeal involved the extent of a duty to defend under a “professional services” policy of liability insurance issued to a law firm. The issue arose when the law firm was confronted with allegations of overbilling. The insurer, Evanston Insurance Company, defended the law firm, The Law Office of Michael P. Medved, P.C., under a reservation of rights but ultimately concluded that the allegations of overbilling fell outside the law firm’s coverage for professional services. The law firm disagreed with this conclusion; the district court agreed with the insurer. The Tenth Circuit concurred with the district court and affirmed summary justment in favor of Evanston on all claims and counterclaims. View "Evanston Insurance v. Law Office Michael P. Medved" on Justia Law

An underinsured motorist struck a car driven by Dale Fisher, causing Fisher injuries requiring over $60,000 in medical care. Fisher was not at fault, and he was covered under multiple State Farm underinsured motorist (“UIM”) insurance policies. State Farm agreed that Fisher’s medical bills were covered under the UIM policies, but it disputed other amounts Fisher sought under the policies, including lost wages. So, State Farm refused to pay Fisher’s medical bills without first resolving his entire claim. Fisher sued, alleging State Farm had unreasonably delayed paying his medical expenses. In response, State Farm argued it had no duty to make piecemeal payments, even for Fisher’s undisputed medical expenses, when it disputed the rest of Fisher’s UIM claim. A jury returned a verdict in Fisher’s favor, finding that State Farm had violated section 10-3-1115, C.R.S. (2017), which provides that an insurer “shall not unreasonably delay or deny payment of a claim for benefits owed to or on behalf of any first-party [insured] claimant.” A division of the court of appeals affirmed. The issue this case presented for the Colorado Supreme Court's review was whether auto insurers have a duty to pay undisputed portions of a UIM claim (like the medical expenses at issue here) even though other portions of the claim remain disputed. The Court held that insurers have a duty not to unreasonably delay or deny payment of covered benefits, even though other components of an insured’s claim may still be reasonably in dispute. Thus, the Court affirmed the judgment of the court of appeals. View "State Farm v. Fisher" on Justia Law

The Fifth Circuit affirmed the district court's grant of summary judgment for Axis and grant of Axis's motion to strike an affidavit submitted in support of its motion for summary judgment as untimely. The court held that this case presented no unusual or exceptional circumstances and the district court did not abuse is discretion in striking the affidavit where Hartford did not not seek modification of the scheduling order so that it may apprise the district court of its intent to offer another witness's testimony so as to give Axis an opportunity to depose the witness, nor did Hartford provide any valid justification for its failure to secure the affidavit before all discovery deadlines had passed. The court held that the policy unambiguously provided coverage in this case because the Hartford policy provided liability coverage for any auto and because the CRB Endorsement did not conflict with the liability coverage provision of the policy. Finally, the court declined to take judicial notice of Dana Transport's "admission." View "Bennett v. Hartford Insurance Company of the West" on Justia Law

Sports Medicine performed shoulder surgery on “Joshua,” who was covered by a health insurance plan, and charged Joshua for the procedure. Because it did not participate in the insurers’ network, Sports Medicine was not limited to the insurer’s fee schedule and charged Joshua $58,400, submitting a claim in that amount to the insurers on Joshua’s behalf. The claim form indicated that Joshua had “authorize[d] payment of medical benefits.” The insurer processed Joshua’s claim according to its out-of-network cap of $2,633, applying his deductible of $2,000 and his 50% coinsurance of $316, issuing him a reimbursement check for the remaining $316, and informing him that he would still owe Sports Medicine the remaining $58,083. Sports Medicine appealed through the insurers’ internal administrative process and had Joshua sign an “Assignment of Benefits & Ltd. Power of Attorney.” Sports Medicine later sued for violations of the Employee Retirement Income Security Act (ERISA), and breach of contract, citing public policy. The district court dismissed for lack of standing because Joshua’s insurance plan included an anti-assignment clause. The Third Circuit affirmed, holding that the anti-assignment clause is not inconsistent with ERISA and is enforceable. View "American Orthopedic & Sports Medicine v. Independence Blue Cross Blue Shield" on Justia Law

The term "invasion of the right of private occupancy" is ambiguous and may include non-physical invasions of rights in real property. The Court of Appeal reversed the trial court's grant of summary judgment for the umbrella insurer in an action alleging claims for breach of contract and breach of the implied covenant of good faith and fair dealing. In this case, the personal injury provision of plaintiff's umbrella policy potentially covered the allegations in the underlying action and the umbrella insurer breached its duty to defend by not providing plaintiff with a defense. Accordingly, the court vacated the trial court's order and directed the trial court to enter a new order granting the motion. View "Albert v. Truck Insurance Exchange" on Justia Law