Justia Insurance Law Opinion Summaries

Mercury filed suit against the City for inverse condemnation after a tree fell on the home of a couple insured by Mercury. The trial court entered judgment for Mercury, finding the tree that fell on the couple's home was a work of public improvement that supported an inverse condemnation claim. The Court of Appeal held, however, that the tree that fell on the couple's home did not constitute a work of public improvement for purposes of an inverse condemnation claim. In this case, there was no evidence that the City planted the tree as part of a construction project serving a public purpose, such as a roadway beautification project. Therefore, the court reversed the judgment and subsequent order awarding costs because the City could not be held inversely liable for the damage caused to the home. View "Mercury Casualty Co. v. Pasadena" on Justia Law

As Greg Peters and Mike Williams were attempting to position Peters’ fishing boat on its trailer, the winch handle recoiled, struck, and seriously injured Williams. Peters, who owned the truck, the trailer, and the boat, had two liability insurance policies covering bodily injury: his truck and trailer were insured by Allstate Property and Casualty Insurance Company (Allstate) and his boat was insured by Continental Casualty Company (Continental). Ultimately, the insurers settled with Williams for $460,000, each paying $230,000 toward the total settlement. Prior to settlement, however, the insurers had not agreed on apportionment. Continental sought a declaratory judgment that it was indemnified by Allstate based on its apportionment theory and also reimbursement for the defense costs it had incurred investigating the claim. Allstate moved to dismiss, seeking indemnity from Allstate based on its own apportionment theory and also sanctions against Continental for having made its defense costs and expenses claim. The circuit court treated the motion to dismiss as a motion for partial summary judgment and granted summary judgment in Allstate’s favor, but declined to award sanctions. Allstate then moved for summary judgment on Continental’s remaining indemnity claim, which the circuit court granted. Continental appealed the grant of summary judgment on its indemnity claim. Allstate cross-appealed the denial of sanctions. As to Continental’s indemnity claim, the Mississippi Supreme Court reversed summary judgment to Allstate and rendered judgment in favor of Continental. As to Continental’s claim of entitlement to defense costs, the Court affirmed summary judgment for Allstate. The Court affirmed the denial of sanctions. View "Continental Casualty Co. v. Allstate Property & Casualty Ins. Co." on Justia Law

While employed by Zing LLC, Josue Barrios (“Claimant”) was totally and permanently disabled as a result of an industrial accident when he fell about twelve feet from a ladder and hit his head face first on a concrete floor. He suffered multiple facial fractures, a frontal bone fracture, the loss of sight in his left eye, and a severe traumatic brain injury that caused a major neurocognitive disorder and speech language deficits. This case was an appeal of an Industrial Commission order requiring an employer and its surety to pay the cost of a guardian and a conservator for Barrios. Finding no reversible error in the Commission's order, the Idaho Supreme Court affirmed. View "Barrios v. Zing, LLC" on Justia Law

Roniesha Adams, her son, and her son’s father, Barry Adams (Barry), were passengers in Milton Mitchell’s car when the car was rear ended. Mitchell and his three passengers asserted claims against State Farm, seeking personal injury protection and uninsured motorist benefits. Because they allegedly gave inconsistent statements to State Farm regarding “substantive issues,” State Farm advised Mitchell, Adams, and Barry that they were required to submit to questioning under oath. Adams and Barry refused to submit to questioning under oath, and State Farm refused to pay additional benefits. Adams and Barry filed suit, and State Farm filed a counterclaim seeking a declaratory judgment that it did not have to provide coverage because Adams and Barry failed to cooperate with its investigation. The circuit court granted summary judgment for State Farm. Adams appealed. The court of appeals reversed, ruling that State Farm was required to obtain a court order before it could require Adams to submit to questioning under oath. The Supreme Court reversed, holding that the circuit court correctly found that Adams was required to submit to questioning under oath regarding issues as a condition precedent to coverage. View "State Farm Mutual Automobile Insurance Co. v. Adams" on Justia Law

KESA, the Kentucky Workers’ Compensation Fund, on behalf of its insureds, filed five separate medical fee disputes against the Injured Workers’ Pharmacy (IWP) and the insureds’ employees and former employees, all of whom had their prescriptions filled by IWP. The chief administrative law judge (CALJ) found (1) a pharmacy/pharmacist is a medical provider, which entitles an injured worker to choose where to have his or her prescriptions filled; (2) the pharmacy fee schedule is based on the amount a pharmacist pays a wholesaler for medication, and IWP is entitled to interest on any underpayment by KESA; and (3) because KESA brought its medical fee disputes without reasonable ground and without reasonable medical or factual foundation, KESA was required to pay the cost of the proceedings. The Workers’ Compensation Board reversed the award of costs but otherwise affirmed. The court of appeals affirmed. The Supreme Court affirmed in part, vacated in part, and remanded, holding (1) the court of appeals did not err regarding the assessment of interest and sanctions or in concluding that a pharmacy is a medical provider; but (2) the remainder of the court of appeals opinion is vacated and remanded because the CALJ did not make a determination regarding the actual average wholesale price paid by IWP. View "Steel Creations by and through KESA, the Kentucky Workers’ Compensation Fund v. Injured Workers’ Pharmacy" on Justia Law

When Plaintiff learned that a family occupying a residence nearby to a vacant property owned by Plaintiff was pursuing environmental claims against him, he notified his liability carrier, the Indiana Insurance Company. Indiana Insurance provided a defense and eventually settled the claims. Plaintiff later sued Indiana Insurance for bad faith arising from a breach of his insurance contract. The jury awarded Plaintiff $925,000 in emotional distress damages and $2,500,000 in punitive damages. The court of appeals affirmed. On appeal, Indiana Insurance argued that, having provided a defense and indemnification, Plaintiff had no viable bad faith claim. The Supreme Court affirmed, holding (1) Plaintiff presented sufficient evidence to support the jury’s determination that Indiana Insurance breached its contract with Plaintiff and that Indiana Insurance’s acts or omissions violated the Unfair Claims Settlement Practices Act; (2) the trial court did not err in denying Indiana Insurance’s motion for directed verdict or judgment notwithstanding the verdict on Plaintiff’s Kentucky Consumer Protection Act claim; (3) expert testimony is unnecessary to substantiate damages for emotional distress in a bad faith case; and (4) Indiana Insurance’s two remaining allegations of error were not properly before the court for review. View "Indiana Insurance Co. v. Demetre" on Justia Law

In this insurance coverage dispute, the Supreme Court affirmed the denial of summary judgment in favor of Insurer but reversed the denial of summary judgment in favor of General Contractor. Homeowners sued General Contractor and Subcontractor for damages to their home. General Contractor, which was insured under a commercial general liability policy (CGL), requested defense and indemnification from Insurer. Insurer defended General Contractor under a reservation of rights. Insurer then filed a declaratory judgment action seeking a judgment that the CGL policy did not provide coverage for General Contractor in the underlying case. General Contractor and Insurer filed cross-motions for summary judgment. The circuit court denied the motions on the ground that a genuine issue of material fact existed regarding the foreseeability of Homeowners’ damages. The Supreme Court reversed the judgment denying General Contractor’s motion and remanded for further proceedings, holding that the CGL policy required Insurer to defend General Contractor against Homeowners’ suit for damages and that factual questions regarding foreseeability were not relevant to the existence of coverage under the policy. View "Owners Insurance Co. v. Tibke Construction, Inc." on Justia Law

The Eighth Circuit affirmed the district court's grant of defendants' motion to dismiss plaintiff's suit seeking reimbursement of premiums, enhanced damages and fees, alleging claims of unjust enrichment, breach of contract, and civil conspiracy. The court held that plaintiff had standing because, if the policy was deemed void ab initio due to non-compliance with state law, then plaintiff will have suffered a compensable economic injury fairly traceable to defendants' actions. Even if the policies were not void, standing still existed because plaintiff had described a concrete and redressable economic injury properly alleged to have been caused by defendants. The court also held that plaintiff's unjust enrichment was time-barred under Arkansas' three-year statute of limitations and tolling of the statue of limitations was not applicable in this case; plaintiff's breach of contract claim was not time-barred; but the breach of contract claim failed as a matter of law because the policy unambiguously granted the insurer an unconditional right to terminate the policy on thirty-days' notice. View "Graham v. Catamaran Health Solutions LLC" on Justia Law

After Exxon settled the underlying personal injury lawsuit, it sought reimbursement from ERS and ORIC, contending that ERS's contractual obligation to insure Exxon as an additional insured and the insurance policy issued by ORIC required ERS and ORIC to pay for the settlement of the suit and the cost of litigation. The Fifth Circuit affirmed the district court's judgment as to ERS's duty to pay the deductible; reversed the portion of the judgment pertaining to the interest award and remanded for calculation of a new interest award; vacated the portion of the judgment that held ORIC jointly and severally liable with ERS for the entire judgment and remanded for modification; reversed the denial of Exxon's attorney's fees for the initial appeal and remanded for determination of amounts; and affirmed the denial of Exxon's previously unrequested attorney's fees. View "ExxonMobil Corp. v. Electrical Reliability Services, Inc." on Justia Law

Prime Hospitals provide inpatient services under the Medicare program, submitting payment claims to private contractors, who make initial reimbursement determinations. Prime alleged that many short-stay claims were subject to post-payment review and denied. Prime appealed through the Medicare appeal process. Prime alleged short-stay claims audits were part of a larger initiative that substantially increased claim denials and that the Center for Medicare & Medicaid Services (CMS) was overwhelmed by the number of appeals. CMS began offering partial payment (68 percent) in exchange for dismissal of appeals. Prime alleged that it executed CMS's administrative settlement agreement so that CMS was contractually required to pay their 5,079 Medicare appeals ($23,205,245). CMS ultimately refused to allow the Prime to participate because it was aware of ongoing False Claims Act cases or investigations involving the facilities. Prime alleged that the settlement agreement did not authorize that exclusion. The district court denied a motion to dismiss Prime’s suit but transferred it to the Court of Federal Claims. The Federal Circuit affirmed in part. The breach of contract claim is fundamentally a suit to enforce a contract and does not arise under the Medicare Act, so the Claims Court has exclusive jurisdiction under the Tucker Act, 28 U.S.C. 1491. That court does not have jurisdiction, however, over Prime’s alternative claims seeking declaratory, injunctive, and mandamus relief from an alleged secret and illegal policy to prevent and delay Prime from exhausting administrative remedies. View "Alvarado Hospital, LLC v. Cochran" on Justia Law