Justia Insurance Law Opinion Summaries

A hospital provided medical services to twenty-nine insureds who were injured in motor vehicle accidents. After paying the hospital, the insurer requested certain documentation relating to the reasonableness of the charges pursuant to Fla. Stat. 627.736(6)(b). The hospital provided the insurer with various documents but refused to furnish copies of third-party contracts containing negotiated discount rates between the hospital and other insurers and payers, arguing that the information was not covered by subsection (6)(b). The insurer filed a petition pursuant to Fla. Stat. 627.736(6)(c) asking the trial court to compel discovery of the withheld information. The trial court ordered the hospital to produce the requested discovery. The court of appeal reversed, concluding that the trial court’s order exceeded the scope of discovery permissible under sections 627.736(6)(b) and (c). Specifically, the court ruled that discovery of facts under section 627.736(6)(c) is limited to the production of the documents described in section 627.736(6)(b). The Supreme Court approved the court of appeal’s interpretation of the scope of discovery under section 627.736(6)(c), holding that the scope of permissible discovery under subsection (6)(c) is limited to the production of documents described in subsection (6)(b). View "State Farm Mutual Automobile Insurance Co. v. Shands Jacksonville Medical Center, Inc." on Justia Law

Plaintiff had an Oregon auto insurance policy issued by defendant. In 2008, plaintiff was injured in a motor vehicle accident. Among other expenses, plaintiff incurred $430.67 in transportation costs to attend medical appointments and to obtain medication. She then applied for PIP medical benefits under her insurance policy. Defendant paid for plaintiff’s medical care, but it declined to pay for her transportation expenses to obtain her medical care. Plaintiff then filed a complaint for breach of contract, both for herself and on behalf of others similarly situated. She alleged that her claim for medical expenses under ORS 742.524(1)(a) included her transportation costs. Defendant moved for summary judgment, arguing ORS 742.524(1)(a) did not require it to pay for transportation costs. After a hearing, the trial court granted defendant’s motion and entered a judgment in defendant’s favor. The question on review was whether the PIP medical benefit in ORS 742.524(1)(a) included the insured plaintiff’s transportation costs to receive medical care. The Supreme Court held that PIP benefits for the “expenses of medical * * * services” do not include an insured’s transportation costs for traveling to receive medical care. Therefore, the Court affirmed the grant of summary judgment in favor of defendant. View "Dowell v. Oregon Mutual Ins. Co." on Justia Law

Plaintiff-appellant Malinda Falcone brought an insurance claim against defendants-appellees for payment of her emergency room medical expenses. Her claim was made pursuant to the Uninsured/Underinsured Motorist (UM) provisions of her mother's automobile insurance policy following the injuries she sustained as a passenger in her mother's car when an uninsured driver ran a stop sign and collided with them. Defendants initially questioned the decision to refer Plaintiff to the level 2 trauma center of the emergency room and refused to pay the bill Plaintiff received from the OU Medical Center trauma center. After nearly a year of offers and rejections, Plaintiff sued for breach of the implied duty of good faith and fair dealing for failing to pay her trauma room "compensatory damages" as required under the policy. The trial court granted summary judgment in favor of defendants and denied Plaintiff's motion for new trial. After review, the Supreme Court held that it was a question for the trier of fact whether defendants showed a lack of good faith in handling Plaintiff's claim for payment. The trial court erred in granting summary judgment in defendants' favor, holding as a matter of law that defendants did not commit the tort of bad faith. View "Falcone v. Liberty Mutual Ins. Co." on Justia Law

Plaintiffs commenced this action seeking a declaration of coverage under a program of builder’s risk insurance furnished by Defendants for weather-related damage to a tower crane. The Appellate Division granted summary judgment declaring that Defendants had no obligation to provide coverage for the subject loss under the policy. At issue in this case was (1) whether the crane was covered in the first instance under the insurance provided for temporary works and, if so, whether the contractor’s tools exclusion defeated that initial grant of coverage; and (2) whether the contractor’s tools exclusion was ineffective because it would render the coverage granted in the first instance for temporary works illusory. The Court of Appeals affirmed, holding (1) assuming that the policy contains coverage for the crane in the first instance, the contractor’s tools exclusion would defeat that coverage; and (2) the contractor’s tools exclusion does not render the coverage afforded under the temporary works provision of the policy illusory. View "Lend Lease (US) Construction LMB Inc. v. Zurich American Insurance Co." on Justia Law

This appeal stemmed from an application Mercury Casualty Co. (Mercury) filed in 2009 to increase its homeowners’ insurance rates. In denying the increase Mercury requested, the California Insurance Commissioner (the commissioner) made two decisions at issue on appeal. The commissioner determined: (1) under subdivision (f) of section 2644.10 of title 10 of the California Code of Regulations, Mercury’s entire advertising budget had to be excluded from the calculation of the maximum permitted earned premium because “Mercury[] aims its entire advertising budget at promoting the Mercury Group as whole” rather than “seek[ing] to obtain business for a specific insurer and also provid[ing] customers with pertinent information” about that specific insurer; (2) Mercury did not qualify for a variance from the maximum permitted earned premium under subdivision (f)(9) of section 2644.27 because “Mercury failed to demonstrate the rate decrease [that resulted from application of the regulatory formula] results in deep financial hardship.” Mercury and certain insurance trade organizations ("the Trades") unsuccessfully sought to challenge the commissioner’s decision in the superior court. On appeal, Mercury and the Trades raised three main issues: (1) the commissioner and the superior court erred in interpreting and applying section 2644.10(f) with regard to what constitutes institutional advertising expenses; (2) the Trades contended section 2644.10(f) violated the First Amendment to the United States Constitution because the regulation imposed a content-based financial penalty on speech; and (3) Mercury and the Trades contended the commissioner and the superior court erred in determining that Mercury did not qualify for the constitutional variance because the commissioner and the court wrongfully applied a “deep financial hardship” standard instead of a “fair return” standard. Finding no merit in these arguments, or any of the other arguments offered to overturn the judgment, the Court of Appeal affirmed. View "Mercury Casulaty Co. v. Jones" on Justia Law

After Ulysses Anderson was involved in a car accident with an intoxicated driver who was driving a company vehicle with his employer's permission, a jury found the driver liable and awarded Anderson one million dollars. Great American, the employer's insurance company, filed suit for a declaration that the driver was not a permissive user – and thus not covered under the applicable insurance policies – because he broke internal company policies. The district court found that the driver was not an insured at the time of the accident, and that Great American owed no duty to cover the damages awarded at the trial of the underlying action. After the Georgia Supreme Court held that inquires into permissive use should extend only to whether a vehicle is used for an approved purpose in Strickland v. Georgia Cas. & Sur. Co., the Georgia Court of Appeals held that a company's internal rules can govern the scope of permissive use, and that violations thereof can negate an individual's status as an insured. In this case, the court found that the district court erred because it followed Barfield, and thus narrowed the scope of permissive use beyond what was permitted by Strickland. Accordingly, the court reversed and remanded. View "Anderson v. Great American Alliance Insurance Co." on Justia Law

After Leigh Anne Flores injured plaintiff in an auto accident, plaintiff filed suit against Flores and Pacific Bell, her employer, for damages. Flores was driving a van Pacific Bell had furnished to her, but that she used for both business and personal purposes. The trial court found Pacific Bell, who self-insured the van, was not vicariously liable for Flores's actions because she was not acting in the course and scope of her employment at the time of the accident. In a subsequent arbitration involving only plaintiff and Flores, plaintiff was awarded over half a million dollars by the arbitrator. Geico, Flores's personal insurer, refused to pay the judgment. Plaintiff then filed suit against Geico, alleging breach of contract, bad faith, and declaratory relief. The trial court granted summary judgment for Geico. The court concluded that, under the circumstances here, because Flores was able to use the van for both business and personal purposes, and her personal use of the van at the time of the accident was not a departure from its customary use, the van was furnished to Flores for her regular use and there is no coverage under the GEICO policy. Accordingly, the court affirmed the judgment. View "Medina v. GEICO Indemnity" on Justia Law

The United States Court of Appeals for the Ninth Circuit certified certain questions to the Supreme Court regarding what impact, if any, a lender’s full-credit bid made at an Arizona trustee’s sale has on an insurer’s liability under standard form title insurance policies. The policy provisions at issue were (1) Section 2, which provides that coverage continues in force when an insured acquires the property in a foreclosure sale but the amount of coverage is reduced by all payments made; (2) Section 9, which provides that payments of principal or the voluntary satisfaction or release of the mortgage reduce available insurance coverage, except as provided under Section 2(a); and (3) Section 7, which explains how the insurer’s liability is calculated. The Supreme Court answered the certified questions as follows: (1) Section 2 applies when a lender purchases property by full-credit bid at a trustee’s sale; (2) the full-credit bid does not constitute a “payment” under Sections 2 or 9 of the policy; and (3) accordingly, the full-credit bid neither terminates nor reduces coverage under Section 2 or Section 7. View "Equity Income Partners, LP v. Chicago Title Insurance Co." on Justia Law

After he was injured, an ARI employee filed a civil suit against ARI and was awarded over $1.5 million in damages. ARI then sought insurance coverage against Hartford. The district court granted summary judgment for Hartford. The court affirmed, concluding that ARI did not strictly comply with the policy's notification provision and forfeited any right to recover from Hartford. Furthermore, the Hartford attorney did not unambiguously deny coverage and thus Hartford is not estopped from enforcing its notice provision. View "American Railcar Industries v. Hartford Insurance Co." on Justia Law

Adam Fetzer, a delivery driver for the Papa John's restaurant chain, was killed in a car accident in the course of his employment when another driver ran a red light and struck his vehicle. Mary Hegel, the personal representative of Fetzer's estate, sought underinsured motorist (UIM) coverage under a business auto insurance policy issued by American Fire to Papa John's. After American Fire denied the claim, the district court granted summary judgment against American Fire. The court concluded that the district court erred in applying North Dakota law and thus finding American Fire was required to provide UIM coverage to Papa John's. Rather, the policy is subject to Kentucky law, which does not require such coverage. Therefore, American Fire is entitled to judgment in its favor as a matter of law. The court reversed and remanded. View "American Fire and Casualty Co. v. Hegel" on Justia Law