Justia Insurance Law Opinion Summaries

After a film industry worker was seriously injured on a film set, he filed suit. His employer had two primary insurance policies with Fireman’s Fund, and an excess insurance policy with Ace American. Ace American subsequently filed suit against Fireman's Fund for equitable subrogation, alleging the injured worker initially offered to settle his case within the limits of the Fireman’s Fund policies, and that Fireman’s Fund unreasonably rejected those settlement offers. Ace American alleged that as a result, it was required to contribute to the eventual settlement, which exceeded the limits of the Fireman’s Fund policies. The court found that because Ace American, the excess insurer, alleged it was required to contribute to the settlement of the underlying case due to the primary insurer’s failure to reasonably settle the case within policy limits, the lack of an excess judgment against the insured in the underlying case does not bar an action for equitable subrogation and breach of the duty of good faith and fair dealing. Accordingly, the court reversed the judgment sustaining Fireman’s Fund’s demurrer and remanded for further proceedings. View "Ace American Ins. Co. v. Fireman's Fund Ins. Co." on Justia Law

At the center of this dispute was defective rebar that was incorporated into the construction of concrete pile caps that would form support for the Pinnacle Bank Arena. Some of the pile caps had to be modified in order to provide the necessary structural support for the Arena. The general contractor paid the costs of the correction and sought reimbursement from Drake-Williams Steel, Inc. (DWS), which fabricated the rebar. DWS reimbursed the general contractor and sought coverage from its insurers. The insurers denied the claim and commenced this action to determine their obligations under the policies of insurance. The district court granted summary judgment in favor of the insurers. The Supreme Court affirmed, holding that there was no coverage under the policies. View "Drake-Williams Steel, Inc. v. Continental Cas. Co." on Justia Law

After the EPA accused LaGen of violating the Clean Air Act, 42 U.S.C. 7401, LaGen promised, among other things, to upgrade parts of its power plant pursuant to a consent decree. LaGen then asked its insurer, ILU, to pay the costs of these measures, but ILU refused. The district court entered summary judgment for LaGen. The court upheld the district court’s ruling that the Consent Decree Measures indirectly mitigate BCII’s (a coal-fired electric steam generating plant owned by LaGen) past pollution; there is no genuine issue of material fact on this point, nor would further discovery create one; it is unclear, however, whether indirect mitigation and abatement efforts qualify in the first place as “remediation,” and their costs as “remediation costs,” under the Policy; and therefore, a genuine dispute of material fact exists as to whether LaGen is entitled to indemnification for any of the costs of the Consent Decree Measures. Moreover, the court concluded that, even if indirect mitigation efforts can give rise to covered “remediation costs,” genuine disputes of material fact exist as to whether LaGen’s claimed costs are unreasonable. Specifically, it is unclear whether LaGen’s claimed costs include costs that Entergy paid; design and elevator costs properly attributable to Units 1 and 2; and unreasonable delay-related cost overruns. Accordingly, the court vacated and remanded for further proceedings. View "Louisiana Generating v. Illinois Union Ins. Co." on Justia Law

Gay St. Mary Williams and her husband, Larry Williams, filed a complaint against William Tucker and two insurance companies. The Williamses alleged that Mrs. Williams had been severely injured in a motor vehicle accident caused by Tucker. When Tucker failed to answer, the circuit clerk entered a default. The trial court denied Tucker’s motion to set aside the entry of default and his motion for reconsideration. After a hearing, the trial court awarded damages in the amount of $2,962,984.60, plus $300,000 to Larry Williams for loss of consortium, and entered a default judgment in favor of the Williamses. Tucker appealed, arguing that the trial court’s refusal to set aside the entry of default was an abuse of discretion. Alternatively, he challenged portions of the damages award. The Supreme Court found that under a liberal standard applicable to setting aside default judgments, the trial court abused its discretion by refusing to set aside the entry of default in this case. Therefore, the Court reversed the judgment of the trial court and remanded this case for further proceedings. View "Tucker v. Williams" on Justia Law

Plaintiff filed a class action against United Healthcare, alleging claims of unfair competition, unjust enrichment, and financial elder abuse. Plaintiff had enrolled in a private health plan offering benefits to persons 65 and over as well as disabled persons under the federally funded Medicare Advantage program, 42 U.S.C. 1395w-21 et seq. After he went to an urgent care center outside of the plan's network, he was forced to pay a $50 copayment instead of the $30 copayment for in-network centers. Plaintiff alleged that the plan’s marketing materials misled him (and other enrollees) as to the availability of in-network urgent care centers (and their smaller copayments) and that the absence of any in-network urgent care centers in California rendered the plan’s network inadequate. The court concluded that plaintiff’s misrepresentation and adequacy-of-network based claims was expressly preempted by the preemption clause applicable to Medicare Advantage plans, 42 U.S.C. 1395w-26(b)(3). The court also concluded that plaintiff’s claims, to the extent they challenge a denial of benefits, are subject to dismissal because plaintiff did not first exhaust his administrative remedies under the Medicare Act, 42 U.S.C. 405(g), (h) and 1395ii. Accordingly, the court affirmed the trial court's dismissal of the complaint. View "Roberts v. United Healthcare" on Justia Law

In 2003, the Florida Legislature enacted Chapter 558 of the Florida Statutes, establishing a notice and repair process to resolve construction disputes between property owners and contractors, subcontractors, suppliers, or design professionals. At issue is whether Chapter 558’s statutorily prescribed notice and repair process constitutes a “suit” under a commercial general liability (CGL) insurance policy, so as to trigger the insurer’s duty to defend. The court concluded that it would be greatly benefited from the guidance of the Florida Supreme Court on the meaning of the policy language at issue here and its relationship to Chapter 558. Accordingly, the court certified the following question of law to that court: Is the notice and repair process set forth in Chapter 558 of the Florida Statutes a “suit” within the meaning of the CGL policies issued by C&F to ACI? View "Altman Contractors, Inc. v. Crum & Forster Specialty Ins. Co." on Justia Law

Plaintiff was insured under a group long-term disability policy the county obtained from Hartford. After Hartford denied plaintiff's claim for disability benefits, she filed suit in Minnesota state court for breach of contract. Hartford timely removed to federal court based on diversity jurisdiction. The district court then granted Hartford summary judgment. Under the plain meaning of the statute, the court concluded that plaintiff's suit was time-barred. The court also concluded that the legislative distinction between individual and group policies does not violate the principles of equal protection under the United States and Minnesota constitutions. Accordingly, the court affirmed the district court's conclusion that plaintiff's suit was untimely. View "Walker v. Hartford Life and Accident Ins." on Justia Law

ACE Fire Underwriters Insurance Company appeals the district court’s declaration that a policy ACE issued offered total coverage up to $2 million for an accident involving two insured vehicles: a tractor and trailer. The trailer detached from the tractor. The driver pulled off the roadway to reattach, then hoped to make a quick u-turn and continue down the road. But before he could complete the turn, another vehicle collided with the trailer, killing the vehicle's driver. As the insurer of the tractor and the trailer, ACE reached a settlement with the Estate of the vehicle's driver. But the parties conditioned the settlement upon litigating the available limits of the policy. ACE maintained that the policy provisions limited its liability to $1 million per accident, regardless of the number of covered autos involved. The Estate, on the other hand, insisted that ACE’s liability under the policy was $1 million per covered auto involved in each accident. That interpretation of the policy would cap ACE’s liability in this case at $2 million because, according to the Estate, the tractor and the trailer were both involved in the accident. Under the terms of the settlement, ACE initially paid the Estate $1 million. But it agreed to pay it an additional $550,000 if the court accepted the Estate’s interpretation of the policy. Because the Tenth Circuit agreed with ACE that the policy instead limits its liability to only $1 million, it reversed. View "ACE Fire Underwriters v. Romero" on Justia Law

This case arises out of personal injuries sustained by Raylin Richard, an Offshore employee, while working on a drillship in the Gulf of Mexico. At issue is whether Valiant, as an excess insurer on a marine insurance policy, is required to reimburse Offshore, the insured, for payments in Richard's personal injury settlement. The district court granted summary judgment for Valiant, holding that an exclusion in the insurance policy precludes coverage. The court agreed with the district court that the facts as alleged by Offshore do not show conduct which would induce a reasonable person to conclude that Valiant waived its coverage defenses under the policy at issue. Accordingly, the court affirmed the judgment and denied Valiant's motion to strike portions of the record. View "Richard v. Anadarko Petroleum Corp." on Justia Law

Plaintiffs filed suit against Scottsdale, seeking additional pay for wind-related damages to their property from Hurricane Isaac. Two months later, plaintiffs added Underwriters as defendants and alleged that they were entitled to additional payment for flood damages. At issue in this appeal is plaintiffs' mortgage lender's, First American’s, breach of contract claim against Underwriters. Underwriters sought summary judgment on the merits of that claim, arguing that First American failed to timely submit a formal proof-of-loss statement and could not prove that the approximately $232,000 Underwriters already paid was insufficient to repair the properties’ damage. Determining that the district court has jurisdiction to allow the filing of the complaint adding First American’s claim that was tried against Underwriters, the court held that First American's claim was timely; there was adequate evidence to support the jury's findings that Underwriters received satisfactory proof of loss to support First American’s claim for additional recovery; and there was sufficient evidence from which to conclude that Underwriters’ presuit payments were inadequate to repair the properties to their pre-Hurricane Isaac condition. Accordingly, the court affirmed the district court's denial of Underwriter's motion for judgment as a matter of law. View "Cotton v. Scottsdale Ins. Co." on Justia Law