Justia Insurance Law Opinion Summaries

The Supreme Court affirmed the court of appeals’ decision to uphold the district court’s grant of summary judgment to Fire Insurance Exchange in this dispute over attorneys fees.In the underlying action, Fire Insurance’s action sought a declaratory judgment to determine whether the claim filed by Insured, who was named as a defendant in a personal injury case, was covered under Insured’s policy. The court of appeals ultimately held that the claim was covered. Insured filed a counterclaim seeking attorney fees for the declaratory judgment action, arguing that it was brought in bad faith. The district court concluded that Fire Insurance’s denial of Insured’s claim was reasonable because the coverage issue was “fairly debatable.” The court of appeals affirmed. The Supreme Court affirmed, holding that Insured’s claim that Fire Insurance did not fairly evaluate his claim and unreasonably rejected it failed. Therefore, summary judgment was properly granted to Fire Insurance. View "Fire Insurance Exchange v. Oltmanns" on Justia Law

The Court of Appeal affirmed the trial court's order denying defendants' petition to compel arbitration of a dispute with plaintiffs. The court held that the threshold issue of whether the Federal Arbitration Act (FAA), 9 U.S.C. 1-16, applies or is preempted by the McCarran-Ferguson Act, 15 U.S.C. 1001-1015, and section 25- 2602.01(f) of the Nebraska Uniform Arbitration Act (NUAA) was for the court, and not the arbitrator, to decide; the trial court did not err by concluding that section 25-2602.01(f) of the NUAA is a statute that regulates the business of insurance within the meaning of the McCarran-Ferguson Act; application of the FAA would operate to invalidate or impair section 25-2602.01(f) of the NUAA; the trial court did not err by concluding that the McCarran-Ferguson Act applies and reverse preempts the FAA; section 25-2602.01(f) of the NUAA applies to the Reinsurance Participation Agreement (RPA) and renders the arbitration provision contained in the RPA unenforceable; and thus the trial court did not err by denying the petition to compel arbitration. View "Citizens of Humanity v. Applied Underwriters" on Justia Law

The Pennsylvania Supreme Court granted allowance of appeal in this case to determine when the statute of limitations begins to run on an uninsured motorist (UM) claim under an insurance policy. Specifically, the issue reduced to whether the statute of limitations begins to run on an insured’s ability to initiate a court action to enforce a UM claim in a policy containing an arbitration agreement. The Superior Court held that, for the purpose of UM and underinsured motorist (UIM) claims, the statute of limitations begins to run when a claimant injured in an automobile accident first learns that the other driver is uninsured or underinsured. However, the Supreme Court determined this conclusion was not adequately grounded in the pertinent statutory text, prevailing statute of limitations doctrine, or significant public policy concerns. Accordingly, the Court held that statute of limitations principles attending contract claims apply, and that the running of the statute was commenced upon an alleged breach of a contractual duty, which in this case would be occasioned by the insurer’s denial of coverage or refusal to arbitrate. The Court therefore reversed the Superior Court’s order to the contrary. View "Erie Insurance Exchange v. Bristol" on Justia Law

The Supreme Court affirmed the State Corporation Commission’s (SCC) denial of claims filed by a group of Kentucky hospitals requesting reimbursement for legal fees and costs from Reciprocal of America (ROA), an insolvent insurer. On appeal, the Hospitals argued that certain agreements constituting an assumption reinsurance transaction provided a contractual basis for the claims requiring ROA to indemnify them for legal fees and costs incurred in certain litigation and that the SCC erred in concluding otherwise. The Supreme Court disagreed, holding that the SCC did not err in concluding that the governing contractual provisions did not obligate ROA to reimburse the Hospitals for legal fees an costs that they incurred in the legal proceedings. View "Appalachian Regional Healthcare v. Cunningham" on Justia Law

Cooper filed suit against National Union after the insurer denied a claim under a commercial-crime insurance policy. The Fifth Circuit affirmed the district court's take-nothing judgment against Cooper. Determining that Texas law governs the court's interpretation of the policy, the court held that Cooper suffered a "loss" only after it loaned the principal to Greenwood and Walsh and that Cooper did not "own" the funds when they were in the fraudsters' possession. Because these holdings were sufficient to preclude coverage, the court need not consider the parties' remaining contentions. Accordingly, the court dismissed National Union's cross-appeal. View "Cooper Industries, Ltd. v. National Union Fire Insurance Co." on Justia Law

Robert Klem sued Access Insurance Company and Access General Insurance Adjusters, LLC (collectively, "Access") after he was in a car accident and Access administered his claim. Klem alleged Access falsely notified the California Department of Motor Vehicles that his care was a total loss salvage, thereby reducing its value and resulting in a loss of use. Access filed a special motion pursuant to the anti-SLAPP (strategic lawsuit against public participation) statute. The trial court found Access' notice to the DMV was a protected communication, but that Klem met his initial burden of establishing a probability of prevailing on the merits. The trial court denied Access' motion, and Access appealed. Finding the trial court erred with respect to certain evidentiary rulings and by denying the anti-SLAPP motion, the Court of Appeal reversed and remanded for the trial court to enter a new order granting Access' motion. View "Klem v. Access Insurance Co." on Justia Law

Michael Carlson, individually and in his capacity as administrator of his deceased wife Claudia Carlson’s estate and as assignee of William Porter, brought this action pursuant to N.Y. Ins. Law 3420(a)(2) to collect on certain insurance policies. The policies were issued to DHL Worldwide Express, Inc. (DHL) by National Union Fire Insurance Co. (National Union) and American Alternative Insurance Co. (AAIC), and Plaintiff had previously obtained a judgment against MVP Delivery and Logistics, Inc. (MVP) and William Porter. At issue on appeal was whether Michael sufficiently pleaded that MVP was an “insured” under DHL’s policies and whether the policies fell within the purview of N.Y. Ins. Law 3420 as policies “issued or delivered” in New York. The Court of Appeals held (1) dismissal of Plaintiff’s first cause of action pursuant to N.Y. Ins. Law 3420(a)(2) and (b) to collect on certain insurance policies was improper as to National Union and AAIC; (2) whether MVP was an “insured” under DHL’s policies presents a question of fact to be resolved by the trier of fact; and (3) section 3420 encompasses situations where both insureds and risks are located in the state of New York. View "Carlson v. American International Group, Inc." on Justia Law

The Supreme Court’s decision in West v. Shelby County Healthcare Corp., 459 S.W.3d 33 (Tenn. 2014), holding that “reasonable charges” for medical services under Tennessee’s Hospital Lien Act are the discounted amounts a hospital accepts as full payment from patients’ private insurer and not the full, undiscounted amounts billed to patients, does not apply in personal injury cases. Further, the collateral source rule applies in this personal injury case, in which the collateral benefit at issue is private insurance. Therefore, Plaintiffs may submit evidence of the injured party’s full, undiscounted medical bills as proof of reasonable medical expenses, and Defendants are precluded from submitting evidence of discounted rates accepted by medical providers from the insurer to rebut Plaintiffs’ proof that the full, undiscounted charges are reasonable. The Supreme Court thus affirmed in part and reversed in part the decision of the court of appeals, which concluded that West did not apply to personal injury cases but that evidence of discounted amounts accepted by the injured’s medical providers may be admissible to rebut Plaintiffs’ expert testimony on the reasonableness of the amount of the full, undiscounted bills. View "Dedmon v. Steelman" on Justia Law

United Fire & Casualty Company appealed a district court judgment awarding Carol Forsman $249,554.30 in her garnishment action against United Fire, commenced after she settled claims in the underlying suit against Blues, Brews and Bar-B-Ques, Inc., d.b.a. Muddy Rivers. Muddy Rivers was a bar in Grand Forks that was insured by United Fire under a commercial general liability ("CGL") policy. In 2010, Forsman sued Muddy Rivers and Amanda Espinoza seeking damages for injuries to her leg allegedly sustained while a guest at a February 2010 private party at Muddy Rivers. Muddy Rivers notified United Fire of the suit and requested coverage. United Fire denied defense and indemnification based on the policy's exclusions for assault and battery and liquor liability. However, after appeals and reconsideration, the court ruled in Forsman's favor, finding the settlement amount was reasonable. The North Dakota Supreme Court concluded the court erred in granting summary judgment because material fact issues existed on whether exclusions for "assault and battery" and "liquor liability" in the CGL policy excluded coverage of Forsman's negligence claim against Muddy Rivers. Furthermore, the Court concluded further conclude the court properly granted summary judgment to Forsman holding United Fire had a duty to defend Muddy Rivers under the CGL policy in the underlying suit. Therefore, the Court affirmed in part, reversed in part, and remanded for further proceedings. View "Forsman v. Blues, Brews & Bar-B-Ques Inc." on Justia Law

The First Circuit affirmed the district court’s denial of Plaintiffs’ motion for reconsideration of the district court’s grant of summary judgment dismissing all of their claims against various insurance companies and certain of those companies’ employees under 42 U.S.C. 1981 and Puerto Rico law. The complaint alleged that Defendants unlawfully interfered with Plaintiffs’ right to “make or enforce” existing and prospective contracts with Defendants’ insureds or third-party claimants. The district court granted summary judgment on all claims against Defendants. The First Circuit affirmed, largely on waiver grounds, holding (1) Plaintiffs expressly waived certain issues on appeal by failing to raise them in their opening brief; and (2) Plaintiffs’ remaining claims on appeal were unavailing. View "Best Auto Repair Shop, Inc. v. Universal Insurance Group" on Justia Law