Justia Insurance Law Opinion Summaries

Caroline Burton and Brenda Olivar submitted claims for long-term disability benefits to insurance companies under employee-benefits plans set up by their employers (“the Plans”). The insurance companies denied Burton’s and Olivar’s claims. Burton and Olivar sued the Plans under the Employee Retirement Income Security Act (“ERISA”) for benefits due to them under the insurance policies. But neither served the Plans. Rather, they each served complaints on the United States Department of Labor Secretary, relying on an ERISA provision allowing such service when a plan hasn’t designated “an individual” as an agent for service of process. In both cases, the Labor Secretary never forwarded the complaint to the Plans’ designated agents for service of process, the Plans failed to answer, and Burton and Olivar obtained default judgments in their favor. Eventually, the Plans moved to set aside the default judgments for improper service, which the trial courts granted in both cases. Later, the Plans moved for summary judgment, arguing the insurers, which were obligated to make all eligibility determinations and payments under the Plans’ terms, were the only proper party defendants. The trial courts agreed, granting the Plans summary judgment. A division of the court of appeals affirmed. The issue presented to the Colorado Supreme Court for resolution centered on whether ERISA’s use of the term “individual” provided that service on the Labor Secretary was sufficient when a plan designates a corporation (instead of a natural person) as its administrator and agent for service of process. Finding no reversible error in the district court’s judgment, the Supreme Court affirmed. View "Burton v. Colorado Access & No." on Justia Law

Arizona equitable indemnity law does not incorporate the Restatement (First) of Restitution section 78 because it conflicts with Arizona’s general equitable indemnity principles.Michael Bovre rented a vehicle from Payless Car Rental System Inc. Payless offered Bovre supplemental liability insurance (SLI) under a policy provided by KnightBrook Insurance Co. Bovre caused an accident while driving the rental vehicle that injured Lorraine and Robert McGill. The McGills sued Bovre. The parties settled. Bovre assigned to the McGills his claims against KnightBrook and Payless for their alleged failure to provide supplemental liability insurance (SLI) and agreed to an adverse judgment. Thereafter, the McGills sued Payless and KnightBrook seeking to recover the judgment. The McGills and KnightBrook entered into a settlement in which the McGills’ claims against Payless were assigned to KnightBrook, which paid the McGills the $970,000 SLI policy limit. KnightBrook then filed an action in federal court against Payless, asserting an equitable indemnification claim for the $970,000 it paid McGills. Relying on the First Restatement section 78, the district court ruled that KnightBrook was entitled to equitable indemnification from Payless for the $970,000 SLI policy limits. On appeal, the Ninth Circuit certified two questions to the Supreme Court. The court answered the first question as set forth above, which rendered moot the second question. View "KnightBrook Insurance Co. v. Payless Car Rental System Inc." on Justia Law

In this action challenging an insurance company’s doubling of Plaintiff’s insurance premium, the Seventh Circuit reversed the district court’s dismissal of Plaintiff’s complaint for failure to state a claim, holding that Plaintiff was entitled to relief on her contract claim and that the allegations Plaintiff raised were enough to permit her to go forward on her other theories.When Plaintiff was sixty-seven years old, she discovered that Metropolitan Life Insurance Company (MetLife) more than doubled her insurance premium. Plaintiff brought this lawsuit against MetLife on behalf of herself and a proposed class, alleging breach of contract, deceptive and unfair business practices, and common-law fraud. The district court granted MetLife’s motion to dismiss for failure to state a claim, concluding that the insurance policy unambiguously permitted MetLife to raise Plaintiff’s premium. The First Circuit disagreed, holding that the allegations raised in the complaint were enough to entitle Plaintiff to prevail on the liability phase of her contract claim and to go forward on her remaining claims. View "Newman v. Metropolitan Life Insurance Co." on Justia Law

Migliaro purchased a Standard Flood Insurance Policy (SFIP) under the National Flood Insurance Program, 42 U.S.C. 4011(a), from Fidelity for his property, which sustained flood damage in October 2012's Hurricane Sandy. Fidelity’s adjuster recommended a payment of $90,499.11, which Fidelity paid. Five months later, Migliaro submitted a proof of loss, claiming an additional $236,702.57. On July 15, 2013, Fidelity sent Migliaro a letter titled “Rejection of Proof of Loss,” stating: This is not a denial of your claim. Your field adjuster provided you with an estimate and Proof of Loss regarding covered damages. If there are additional covered damages identified, please forward documentation and they will be considered. Migliaro did not provide additional documentation or submit a second proof of loss but filed suit. Migliaro's July 2015 complaint was dismissed as untimely. Because SFIP claims are ultimately paid by the government, SFIPs are identical and state: You may not sue ... unless you have complied with all the requirements of the policy. If you do sue, you must start the suit within one year after the date of the written denial of all or part of the claim. The Third Circuit affirmed. Although the rejection of a proof of loss is not per se a denial of the claim, it does constitute a denial if the policyholder treats it as such by filing suit against the carrier. View "Migliaro v. Fidelity National Indemnity Insurance Co." on Justia Law

Migliaro purchased a Standard Flood Insurance Policy (SFIP) under the National Flood Insurance Program, 42 U.S.C. 4011(a), from Fidelity for his property, which sustained flood damage in October 2012's Hurricane Sandy. Fidelity’s adjuster recommended a payment of $90,499.11, which Fidelity paid. Five months later, Migliaro submitted a proof of loss, claiming an additional $236,702.57. On July 15, 2013, Fidelity sent Migliaro a letter titled “Rejection of Proof of Loss,” stating: This is not a denial of your claim. Your field adjuster provided you with an estimate and Proof of Loss regarding covered damages. If there are additional covered damages identified, please forward documentation and they will be considered. Migliaro did not provide additional documentation or submit a second proof of loss but filed suit. Migliaro's July 2015 complaint was dismissed as untimely. Because SFIP claims are ultimately paid by the government, SFIPs are identical and state: You may not sue ... unless you have complied with all the requirements of the policy. If you do sue, you must start the suit within one year after the date of the written denial of all or part of the claim. The Third Circuit affirmed. Although the rejection of a proof of loss is not per se a denial of the claim, it does constitute a denial if the policyholder treats it as such by filing suit against the carrier. View "Migliaro v. Fidelity National Indemnity Insurance Co." on Justia Law

In the underlying lawsuit, A1's filed an action against Decker after the plastic bags Decker sold to A1's deteriorated in the sunlight because they were not manufactured with an ultraviolet inhibitor. In this appeal, the Eighth Circuit affirmed on remand the district court's grant of summary judgment to West Bend, Decker's insurer, holding that Decker's claims were properly dismissed because there was no property damage triggering coverage under West Bend's policies. The undisputed facts established that A1's landscaping materials were not physically injured due to the incorporation of the deteriorated packaging material. View "Decker Plastics Inc. v. West Bend Mutual Insurance Co." on Justia Law

In the underlying lawsuit, A1's filed an action against Decker after the plastic bags Decker sold to A1's deteriorated in the sunlight because they were not manufactured with an ultraviolet inhibitor. In this appeal, the Eighth Circuit affirmed on remand the district court's grant of summary judgment to West Bend, Decker's insurer, holding that Decker's claims were properly dismissed because there was no property damage triggering coverage under West Bend's policies. The undisputed facts established that A1's landscaping materials were not physically injured due to the incorporation of the deteriorated packaging material. View "Decker Plastics Inc. v. West Bend Mutual Insurance Co." on Justia Law

The Florida Supreme Court answered the Eleventh Circuit's certified question, stating that the notice and repair process set forth in Chapter 558 of the Florida Statutes is a "suit" within the meaning of the CGL policies issued by C&F to ACI. The state court explained that although the chapter 558 process did not constitute a civil proceeding, it was included in the policy's definition of suit as an alternative dispute resolution proceeding to which the insurer's consent was required to invoke the insurer's duty to defend the insured. In light of the state court's answer of the certified question, the court reversed the district court's grant of summary judgment for C&F, vacated the final judgment, and remanded to the district court for further proceedings. View "Altman Contractors, Inc. v. Crum & Forster Specialty Insurance Co." on Justia Law

The Florida Supreme Court answered the Eleventh Circuit's certified question, stating that the notice and repair process set forth in Chapter 558 of the Florida Statutes is a "suit" within the meaning of the CGL policies issued by C&F to ACI. The state court explained that although the chapter 558 process did not constitute a civil proceeding, it was included in the policy's definition of suit as an alternative dispute resolution proceeding to which the insurer's consent was required to invoke the insurer's duty to defend the insured. In light of the state court's answer of the certified question, the court reversed the district court's grant of summary judgment for C&F, vacated the final judgment, and remanded to the district court for further proceedings. View "Altman Contractors, Inc. v. Crum & Forster Specialty Insurance Co." on Justia Law

The Eighth Circuit affirmed the district court's grant of summary judgment to Zurich, holding that the district court did not err in concluding that the commercial general liability policy issued by Zurich to EPS did not provide coverage for damage EPS caused to an electrical transformer while working on it. In this case, the "particular part" exclusion applied and there was no coverage for the claimed damage, because the damage to the coil at issue was caused by EPS's incorrect performance of its work in detaching the lead cable from the bushing. View "Electric Power Systems International, Inc. v. Zurich American Insurance Co." on Justia Law