Justia Insurance Law Opinion Summaries

After a foreclosure case, Davis filed various claims against an entity that he calls “Wells Fargo U.S. Bank National Association as Trustee for the Structured Asset Investment Loan Trust, 2005-11” as the purported holder of Davis’s mortgage. Davis also sued Assurant, believing it to be the provider of insurance on his home. His claims arise from damage that occurred to his house after Wells Fargo locked him out of it, which went unrepaired and worsened into severe structural problems. The district court dismissed Davis’s claims against Wells Fargo, on the grounds that claim preclusion and a statute of limitations barred recovery, and claims against Assurant for lack of subject matter jurisdiction. The Court reasoned that Davis lacked standing to bring those claims because he sued the wrong corporate entity, namely Assurant, when he should have sued Assurant’s wholly-owned subsidiary, ASIC. The Third Circuit affirmed dismissal of Wells Fargo, but vacated as to Assurant. Standing is a jurisdictional predicate, but generally focuses on whether the plaintiff is the right party to bring particular claims, not on whether the plaintiff has sued the right party. View "Davis v. Wells Fargo" on Justia Law

Plaintiffs filed suit against the Archdiocese for damages after plaintiffs were molested as two teenage boys by a monsignor in the Catholic church. Insurance Code section 11583 tolls the statute of limitations period once a “person” makes an “advance payment or partial payment of damages” unless he notifies the recipient of the applicable statute of limitations period or until the recipient hires a lawyer. The court concluded that the monsignor's contemporaneous gifts did not amount to such an “advance payment or partial payment of damages” to the extent those gifts were not solely to compensate for past sexual abuse but were also to facilitate criminal conduct such as “grooming” the boys for further sexual abuse or encouraging the boys not to report the past abuse they suffered. Because the victims’ civil complaint alleges that the monsignor’s contemporaneous gifts were for criminal as well as compensatory purposes, the trial court properly sustained the demurrer. Nevertheless, the court remanded to give plaintiffs the opportunity to amend their complaint to allege whether there were any solely compensatory payments made while the statute of limitations period had yet to expire. View "Doe v. Roman Catholic Archbishop etc." on Justia Law

After plaintiff was injured in a motor vehicle accident, the Plan paid medical benefits on plaintiff's behalf. Plaintiff also received a payment from a different carrier that insured the party who was allegedly responsible for plaintiff’s injury. The Blue Cross carriers contend that under the terms of plaintiff's benefit plan, she must use any monies obtained from the alleged tortfeasor’s insurer to reimburse the Plan for medical benefits paid by Blue Cross. Blue Cross’s position is that a provision of the Federal Employees Health Benefits Act, 5 U.S.C. 8902(m)(1), expressly preempts plaintiff’s state-law defense, and that the Plan governs the question of reimbursement. The court concluded that federal law preempts the Arkansas state-law defense, and that plaintiff must reimburse the Plan. Accordingly, the court affirmed the judgment of the district court. View "Bell v. Blue Cross & Blue Shield of OK" on Justia Law

In this insurance dispute over the adjusted value of hail-damaged crops in northwest Iowa, Bruhn challenged the district court's grant of summary judgment for Fireman's. The court concluded that there is a factual dispute about whether Fireman's breached its obligations to its insured in this case. Bruhn contends that Fireman's breached the agreement by tendering payment for the loss without first reaching agreement with Bruhn, without entry of a final judgment, and without the filing of any appraisal award. Fireman's contends that the provision merely provides a payment deadline, not a condition precedent to payment issuance. Because there is an issue of fact as to whether Fireman's breached the insurance contract and because the factual issues in the breach claim are relevant to the bad-faith claim, this claim survives summary judgment as well. Accordingly, the court reversed and remanded for further proceedings. View "Bruhn Farms Joint Venture v. Fireman's Fund Ins. Co." on Justia Law

Plaintiff, an insured under a commercial-property insurance policy issued by Country Mutual, was awarded $76,065.50 by the jury for covered hail and wind damage to her property. However, the jury found that the policy did not cover water damage to the interiors of the property. Plaintiff appealed. The court concluded that the district court applied the law correctly under the federal rules and acted within the scope of its discretion in excluding certain portions from the supplemental expert reports; plaintiff was not prejudiced by the exclusion of this evidence to an extent resulting in fundamental unfairness; and the jury instructions fairly and adequately presented the issues in the case to the jury. Accordingly, the court affirmed the district court's denial of plaintiff's motion for new trial and entry of judgment. View "Amplatz v. Country Mutual Ins. Co." on Justia Law

This case arose out of claims asserted by multiple people against Blue Cross and Blue Shield of Montana, now known as Caring for Montanans, Inc. (CFM) and Montana Comprehensive Health Association (MCHA). The claimants asserted that while they were insured by CFM or MCHA, they submitted claims that the insurers denied based upon exclusions contained in their health insurance policies. These exclusions generally provided that the insurer would not pay for health care costs of the injured insureds if the insureds received, or were entitled to receive, benefits from any automobile liability policy. These exclusions were subsequently disapproved by the Montana Commissioner of Insurance, and the insureds sought the previously-denied benefits. The district court certified a class of claimants for settlement purposes only. The court then held a fairness hearing on a proposed settlement agreement and approved the settlement. Several class members objected to the settlement and appealed to the Montana Supreme Court, arguing they should have been allowed to conduct further discovery to ascertain the fairness of the settlement agreement. The Supreme Court agreed with the objectors and remanded the case to the district court for further discovery and a second fairness hearing. The district court allowed further discovery, held a second fairness hearing, and determined that the same settlement agreement was fair, reasonable, and adequate. The Objectors again appealed. Finding no reversible error, the Supreme Court affirmed. View "Pallister v. BCBS" on Justia Law

Whiteside represented the County of Camden in a lawsuit brought by Anderson, which resulted in a jury award paid, in part, by the County’s excess insurer, National. According to National, the County did not notify it of the lawsuit until several months after it was filed. Whiteside initially informed National that the case was meritless and valued it at $50,000. During trial, Whiteside changed her valuation and requested the full $10 million policy limit to settle Anderson’s claims. National conducted an independent review and denied that request. The jury awarded Anderson $31 million, which was remitted to $19 million. Days later, National sought a declaratory judgment that it was not obligated to provide coverage because the County had breached the policy contract by failing to timely notify National of the case and by failing to mount an adequate investigation and defense. National also asserted claims against Whiteside for legal malpractice, breach of fiduciary duty, and breach of contract. The court dismissed those claims because National could not demonstrate that Whiteside’s actions proximately caused it to suffer any damages. The Third Circuit dismissed and appeal for lack of jurisdiction, finding National’s notice of appeal untimely under Federal Rule of Appellate Procedure 4(a)(1), View "State Nat'l Ins. Co v. County of Camden" on Justia Law

Plaintiff filed suit against Humana, alleging claims for breach of contract and unfair insurance practices. The district court granted summary judgment to Humana. Plaintiff submitted a claim with Humana to cover the cost of her husband's medical services after he overdosed on ecstasy. At issue is the application of an exclusion under the policy that excluded loss due to being intoxicated or under the influence of any narcotic unless administered on the advice of a health care practitioner. The court concluded that the term "narcotic" includes ecstasy and the husband's stroke was due to being under the influence of ecstasy. Accordingly, the court affirmed the judgment. View "Crose v. Humana Ins. Co." on Justia Law

Travelers Property Casualty Company of America (Travelers) petitioned for review of a court of appeals judgment affirming the district court’s denial of its motion for directed verdict in a lawsuit brought by its insured, Stresscon Corporation. Stresscon, a subcontracting concrete company, filed suit against Travelers, alleging, among other things, that Travelers acted in bad faith, unreasonably delaying or denying its claim for covered insurance benefits; and Stresscon sought awards of two times the covered benefits along with fees and costs, as prescribed by statute. Stresscon’s claims for relief arose from a serious construction accident in July 2007, which was caused by a crane operator employed by a company that was itself a subcontractor of Stresscon. Stresscon’s general contractor, Mortenson, sought damages from Stresscon, asserting Stresson’s contractual liability for the resulting construction delays, and Stresscon in turn sought indemnification from Travelers. Although there was much dispute over the factual and legal import of Travelers’ reservation of rights and other of its communications with both Stresscon and Mortenson concerning Mortenson’s claim, there was no dispute that by December 31, 2008, Travelers had not paid the damages asserted by Mortenson. The appellate court rejected Travelers’ contention that the no-voluntary-payments clause of their insurance contract relieved it of any obligation to indemnify Stresscon for payments Stresscon had made without its consent. Instead, the court of appeals found that the Colorato Supreme Court's opinion in "Friedland v. Travelers Indemnity Co.," (105 P.3d 639 (2005)) had effectively overruled prior “no voluntary payments” jurisprudence to the contrary and given Stresscon a similar opportunity. The Supreme Court found that its adoption of a notice-prejudice rule in "Friedland" did not overrule any existing “no voluntary payments” jurisprudence in Colorado, and because the Court declined to extend notice-prejudice reasoning in Friedland to Stresscon’s voluntary payments, made in the face of the no-voluntary-payments clause of its insurance contract with Travelers, the judgment of the court of appeals was reversed. View "Travelers Prop. Cas. Co. v. Stresscon Co." on Justia Law

Fireman’s Fund, Great American, and MSI issued insurance policies that provided various coverages for a dry dock in Port Arthur, Texas owned by Signal. After the dry dock sank in 2009, Signal and Fireman’s Fund sought contributions from Great American and MSI for the loss of the dry dock and resulting environmental cleanup costs. The district court ruled that the Great American and MSI policies were void in light of Signal’s failure to disclose when it applied for those policies that the dry dock had significantly deteriorated and that repairs recommended by a number of consultants and engineers over several years had not been made. MSI and Signal settled and now Fireman's Fund contends that it may still pursue appeal of the issues relating to the policy issued to Signal by MSI based on the court's decision in Maryland Cas. Co. v. W.R. Grace & Co. The court held that the Great American policy was a marine insurance contract subject to the doctrine of uberrimae fidei and that Signal’s nondisclosure violated its duty under that doctrine, permitting Great American to void the policy. The court also held that MSI’s policy was governed by Mississippi law; that, under that law, Signal materially misrepresented the dry dock’s condition; and that MSI was entitled to void the policy on that basis.  Accordingly, the court affirmed the district court's finding that the policies were void. View "Fireman’s Fund Ins. Co. v. Great Am. Ins. Co." on Justia Law