Justia Insurance Law Opinion Summaries

Viking Pump, Inc. and Warren Pumps, LLC sought to recover under insurance policies issued to a third company, Houdaille Industries, Inc. In the 1980's, Viking and Warren acquired pump manufacturing businesses from Houdaille. As a result, Viking and Warren were confronted with potential liability flowing from personal injury claims made by plaintiffs alleging damages in connection with asbestos exposure claims dating back to when the pump manufacturing businesses were owned by Houdaille. Houdaille had purchased occurrence-based primary and umbrella insurance from Liberty Mutual Insurance Company. Above the Liberty umbrella layer, Houdaille purchased layers of excess insurance. In total, Houdaille purchased 35 excess policies through 20 different carriers (the "Excess Policies"). Viking and Warren sought to fund the liabilities arising from the Houdaille-Era Claims using the comprehensive insurance program originally purchased by Houdaille. The insurance companies that issued the Excess Policies (the "Excess Insurers") contended that Viking and Warren were not entitled to use the Excess Policies to respond to the claims. The Excess Insurers also disputed the extent of any coverage available, particularly with respect to defense costs. The Supreme Court held, after careful consideration of the policies at issue: (1) the Superior Court correctly held that the 1980-1985 Liberty Primary Policies were exhausted; (2) the Superior Court held that 33 of the Excess Policies at issue in this appeal provided coverage to Viking and Warren for their defense costs, with many payments contingent on insurer consent; (3) the Court of Chancery correctly held that there were valid assignments of insurance rights to Warren and Viking under the Excess Policies; (4) the Superior Court was affirmed in part and reversed in part with respect to its determination of the Excess Policies' coverage for defense costs; and (5) the Superior Court erred with respect to the trigger of coverage under the Excess Policies. View "In Re Viking Pump, Inc. and Warren Pumps, LLC Insurance Appeals" on Justia Law

Donna Simono attended a meeting hosted by Treasure Valley Area of Narcotics Anonymous (“TVNA”) at the Turner House in Mountain Home. When leaving the meeting, she fell down the stairs and injured her ankles. Simono brought a negligence action against Turner House, Larry Rodgers, and Cheryl Baker (collectively “Turner House”). Turner House filed a third-party complaint against TVNA, alleging that TVNA was responsible for maintaining the area where Simono fell. Turner House also sought indemnification for Simono’s claims. The jury returned a verdict finding neither Turner House nor TVNA negligent, and the district court entered judgment dismissing Simono’s complaint and Turner House’s third-party complaint. TVNA filed a motion seeking attorney fees against Turner House under Idaho Code section 12-120(3). The district court denied the motion for fees, concluding that the lawsuit was not based on a commercial transaction. TVNA appealed the district court’s denial of its motion for fees. Both TVNA and Turner House sought attorney fees on appeal. Finding that the district court erred in concluding that TVNA was not entitled to attorney fees, the Supreme Court reversed. Fees and costs on appeal were awarded to TVNA. View "Turner House v. Treasure Valley Area of Narcotics Anonymous" on Justia Law

Okuno was working as an art director with a clothing company when she developed symptoms including vertigo, extreme headaches, memory loss, and abdominal pain. Though she had previously been diagnosed with fibromyalgia and degenerative disc disease, Okuno contends that these maladies had been “stable and well-controlled” for years and did not prevent her from working. After visits to multiple specialists, numerous tests, and two visits to the emergency room, Okuno was eventually diagnosed with narcolepsy, Crohn’s disease, and Sjogren’s syndrome, an autoimmune disease. After diagnosis, she struggled with negative drug interactions and the side effects associated with her many treatments. Unable to continue working, Okuno went on short-term disability and applied for benefits under her employer’s long-term disability plan, issued and administrated by Reliance. Reliance denied the application on the basis that depression and anxiety contributed to Okuno’s disabling conditions. After exhausting her administrative appeals, Okuno brought a claim under the Employee Retirement Income Security Act (ERISA). 29 U.S.C. 1132(a)(1)(B). The district court found in favor of Reliance on cross-motions for judgment on the administrative record. The Sixth Circuit reversed, reasoning that her physical ailments, including Crohn’s disease, narcolepsy, and Sjogren’s syndrome, are disabling when considered apart from any mental component. View "Okuno v. Reliance Standard Life Ins. Co." on Justia Law

The issue this case presented for the Louisiana Supreme Court's review was whether the duty to defend in long latency disease cases could be prorated between an insurer and its insured when occurrence-based policies provide coverage for only a portion of the time during which exposure occurred. In the underlying Arceneaux suit, plaintiffs alleged that they suffered hearing loss from exposure to unreasonably loud noise in the course of their work at American Sugar’s refinery in Arabi, Louisiana. Two sets of plaintiffs, the Barbe plaintiffs and the Waguespack plaintiffs, filed suit against American Sugar in 2006. These suits were consolidated with the Arceneaux action, which was filed in 1999 against American Sugar’s predecessor, Tate & Lyle North American Sugars, Inc. This opinion concerned only the Barbe and Waguespack plaintiffs, and not the Arceneaux plaintiffs whose claims had been litigated extensively in the trial court, the court of appeal, and the Louisiana Supreme Court. Continental Casualty Company argued that defense costs should have been prorated among insurers and the insured if there were periods of non-coverage. American Sugar Refining, Inc. claimed that the duty to defend as agreed upon in the policy provided for a complete defense so long as the duty to defend attached, even if some claims fell outside of coverage. The Supreme Court held that the duty to defend should have been prorated in this case based upon policy language. View "Arceneaux v Amstar Corp." on Justia Law

American Family and Liberty Mutual (Appellants) filed suit against the City after a water-main break in the City flooded the basement condominiums and street-level window wells in the the nearby Sexton building. On appeal, Appellants challenge the district court’s decision on their Equal Protection Clause claim, federal takings claim, and state takings claim. The court concluded that the insurance companies are not similarly situated to the uninsured property owners for purposes of an Equal Protection Clause claim. Even if Appellants could demonstrate that they are similarly situated to the uninsured claimants, the court is satisfied that the reasons proffered by the City, including protecting the welfare of its citizens by minimizing the time claimants were without housing and suffering uncompensated damages, as well as minimizing its own costs and litigation risks, demonstrate that its settlement decisions were rationally related to legitimate, government interests. The court also concluded that because Appellants failed to pursue the available mandamus action in state court, both the state and federal takings claims are not ripe for review by the federal district court. Accordingly, the court affirmed the judgment. View "American Family Ins. v. City of Minneapolis" on Justia Law

John Boman appealed the grant of summary judgment in favor of the City of Gadsden. Boman worked as a Gadsden police officer from 1965 until he retired in 1991. Following his retirement, Boman elected to pay for retiree health coverage through a group plan offered by Gadsden to retired employees. This retired-employee-benefit plan was also administered by Blue Cross and provided substantially similar benefits to those Boman received as an active employee. In 2000, however, Gadsden elected to join an employee-health-insurance-benefit plan ("the plan") administered by the State Employees' Insurance Board ("the SEIB"). When Boman turned 65 in 2011, he was receiving medical care for congestive heart failure and severe osteoarthritis of the spine. After his 65th birthday, Blue Cross began denying his claims for medical treatment based on the failure to provide Blue Cross with a "record of the Medicare payment." However, Boman had no Medicare credits. Boman was hired before March 31, 1986, and, although Gadsden did begin participation in the Medicare program in 2006, Boman's employee group had not opted to obtain Medicare coverage before Boman retired. Consequently, Boman never paid Medicare taxes and did not claim to have Medicare coverage. The SEIB ultimately determined that the plan was the secondary payer to Medicare. Boman sued Gadsden, asserting that it had broken an agreement, made upon his employment, to provide him with lifetime health benefits upon his retirement. Boman also sued the members of the SEIB charged with administering the plan, challenging the SEIB's interpretation of the plan. Finding no reversible error in the grant of summary judgment to Gadsden, the Supreme Court affirmed. View "Boman v. City of Gadsden" on Justia Law

Relying on an advertiser’s claim that its fax advertising program complied with the Telephone Consumer Protection Act (TCPA), 47 U.S.C. 227, Stevens & Ricci allowed the advertiser to fax thousands of advertisements to potential customers on its behalf. More than six years later, Hymed filed a class action TCPA lawsuit, which settled with a $2,000,000 judgment against Stevens & Ricci. While that suit was pending, Auto-Owners sought a declaratory judgment, claiming that the terms of the insurance policy it provided Stevens & Ricci did not obligate it to indemnify or defend Stevens & Ricci in the class action. The Third Circuit affirmed summary judgment, finding that the sending of unsolicited fax advertisements in violation of the TCPA did not fall within the terms of the insurance policy. The “Businessowners Insurance Policy” obligated Auto-Owners to “pay those sums that the insured becomes legally obligated to pay as damages because of ‘bodily injury’, ‘property damage’, ‘personal injury’ or ‘advertising injury’ to which this insurance applies.” The “advertising injury” deals only with the publication of private information, View "Auto-Owners Ins. Co. v. Stevens & Ricci Inc" on Justia Law

After Blue Shield Life and Blue Shield California refused to pay or agreed to pay only a fraction of the medical bills at issue, plaintiff filed suit alleging breach of contract and quantum meruit. The trial court granted defendants' motion for summary judgment. The court concluded that plaintiff's quantum meruit claims are time-barred and affirmed the judgment. In this case, plaintiff had knowledge of the facts giving rise to its claim of quantum meruit when it received the Explanation of Benefits (EOBs) letters, with their unequivocal denial of its bills, more than two years prior to filing this lawsuit. Furthermore, plaintiff engaged in a voluntary appeals process with Blue Shield Life and Blue Shield California, which did not change or undercut the EOBs’ denials of plaintiff's claims View "Vishva Dev, M.D., Inc. v. Blue Shield of Cal." on Justia Law

A mudslide destroyed a commercial building in Boulder, Colorado, owned by Paros Properties LLC and insured under a policy issued by Colorado Casualty Insurance Company. Paros filed an insurance claim but the Insurer denied payment because damage from mudslides was excluded from policy coverage. Paros then filed a state-court suit seeking payment under the Policy and damages for bad-faith breach of the insurance contract. It argued that the mudslide caused the building to explode, bringing the incident within the scope of an explosion exception to the Policy’s mudslide exclusion. The Insurer removed the action to federal court, which granted summary judgment to the Insurer. On appeal Paros argued: (1) that the district court lacked subject-matter jurisdiction because the Insurer’s removal from state court was untimely; and (2) that the district court erred on the merits in holding that there was no coverage. After its review, the Tenth Circuit held that the notice of removal was too late. But because the district court correctly ruled on the merits and the jurisdictional requirements were satisfied at that time, the Court affirmed the judgment below rather than burden the state court and the parties by requiring relitigation. View "Paros Properties v. Colorado Casualty Ins Co" on Justia Law

Black drove a truck for Western, one of 48 freight service providers that carry raw paper to Dixie’s Bowling Green factory. Black parked the truck, containing 41,214 pounds of pulpboard rolls, separated by 10-lb. rubber mats. Black received permission from Chinn, the Dixie forklift operator, to enter the loading dock. It was “[c]ommon practice” for the truck driver to unload the rubber mats so that the Dixie forklift operator did not “have to get off each time.” Chinn and Black got “into a rhythm” in unloading the materials until Chinn ran over Black’s foot with the forklift, leading to a below-the-knee amputation of Black’s leg. Black received workers’ compensation from Western, then filed a tort action against Dixie, seeking $1,850,000. Following a remand, the district court denied Dixie summary judgment. The Sixth Circuit reversed, holding that the Kentucky Workers’ Compensation Act barred Black’s claims, Ky. Rev. Stat. 342.610(2), .690. The work Black was doing as part and parcel of what Dixie does; a worker injured in this setting will receive compensation regardless of fault by a company in Dixie’s shoes or one in Western’s shoes. The immunity from a further lawsuit applies as well. This burden and benefit are the trade-offs built into any workers’ compensation system. View "Black v. Dixie Consumer Prods., LLC" on Justia Law