Justia Insurance Law Opinion Summaries

Linda Hodge filed suit against State Farm Mutual Automobile Insurance Company for first-party no-fault benefits related to injuries she sustained when she was struck by a car insured by State Farm. Hodge’s complaint indicated that the amount in controversy was $25,000, which was within the district court’s jurisdiction. During discovery, State Farm came to believe that Hodge would present at trial proof of damages in excess of the district court’s $25,000 jurisdictional limit. The trial court denied State Farm’s motion in limine to prevent Hodge from presenting evidence of claims exceeding $25,000, and to prevent the jury from awarding damages in excess of $25,000. At trial, Hodge did present proof of injuries exceeding $25,000, and the jury returned a verdict of $85,957. The district court reduced the verdict to the jurisdictional limit of $25,000, and it awarded $1,769 in no-fault interest. State Farm appealed, claiming that the amount in controversy exceeded the district court’s jurisdictional limit and that capping Hodge’s damages at $25,000 could not cure the defect. The circuit court agreed and reversed the district court’s order of judgment. The Court of Appeals affirmed the circuit court’s decision that the district court was divested of jurisdiction when pretrial discovery, counsel’s arguments, and the evidence presented at trial pointed to damages in excess of $25,000. The Supreme Court held "what the jurisprudence of this state has long established:" in its subject-matter jurisdiction inquiry, a district court determines the amount in controversy using the prayer for relief set forth in the plaintiff’s pleadings, calculated exclusive of fees, costs, and interest. Hodge’s complaint prayed for money damages “not in excess of $25,000,” the jurisdictional limit of the district court. Even though her proofs exceeded that amount, the prayer for relief controlled when determining the amount in controversy, and the limit of awardable damages. Because there were no allegations, and therefore no findings, of bad faith in the pleadings, the district court had subject-matter jurisdiction over the plaintiff’s claim. View "Hodge v. State Farm Mutual Automobile Ins. Co." on Justia Law

In 2008, Feridon Pirgu sustained closed head injuries after he was struck by a car driven by an insured of defendant, United Services Automobile Association. Plaintiff, Feridon’s wife Lindita, was appointed as his guardian and conservator. Shortly thereafter, plaintiff sought various personal protection insurance (PIP) benefits for Feridon. Because Feridon was uninsured, the claim was initially assigned to the Michigan Assigned Claims Facility, which then assigned the claim to Citizens Insurance Company. Following a priority dispute between Citizens and defendant, defendant was determined to have first priority for payment of PIP benefits. Defendant began adjusting the claim in 2010, and immediately discontinued payment of the benefits. The issue this case presented for the Michigan Supreme Court's was whether the framework for calculating a reasonable attorney fee set forth in "Smith v Khouri" applied to attorney fee determinations under MCL 500.3148(1) of the no-fault insurance act. The Court of Appeals’ majority affirmed the trial court’s calculation of the attorney fee award, concluding that the Smith framework did not apply to attorney fee determinations under section 3148(1). The Supreme Court disagreed with this conclusion and instead held that the Smith framework applied to attorney fee determinations under section 3148(1). Therefore, in lieu of granting leave to appeal, the Court reversed the judgment of the Court of Appeals, vacated the fee award, and remanded to the trial court for reconsideration of its attorney fee award. View "Pirgu v. Unived Services Automobile Ass'n." on Justia Law

In 1993, Willie Barnes suffered an amputation of his left leg below the knee in an industrial accident at the Georgia-Pacific (GP) wood processing plant where he worked. GP, its insurer Georgia Conversion Primary Ins. Co. and its workers’ compensation servicing agent CCMSI, accepted the claim as catastrophic and began paying temporary total disability (TTD) benefits. Barnes was fitted with a prosthetic leg and returned to lighter duty work in January 1994. On January 30, 1994, GP stopped paying TTD benefits to Barnes, and the TTD benefits were replaced with permanent partial disability (PPD) benefits. The PPD benefits continued until May 1998. In 2006, the GP plant was sold to Roseburg Forest Products Company (Roseburg). Barnes continued working for Roseburg, but was laid off on September 11, 2009. On November 13, 2009, Barnes consulted a doctor regarding chronic knee pain. Two years later, he was fitted for a new prosthetic leg, which was paid for by CCMSI, the company that continued as the workers’ compensation servicing agent for Roseburg and Roseburg’s insurer, ACE American Insurance Co. (ACE American). On August 30, 2012, Barnes filed a claim to resume TTD benefits, asserting the date of his original workplace accident August 13, 1993 as the date of injury. On November 30, 2012, Barnes filed a separate notice of claim, alleging a fictional new injury based on the date that he was terminated from his employment, September 11, 2009. The Administrative Law Judge denied the claims as barred by the applicable statutes of limitation set out in OCGA 34-9-104 (b) and 34-9-82. The State Board of Workers’ Compensation (Board) affirmed, as did the trial court. However, the Court of Appeals reversed, finding that both of Barnes’ claims were not barred by the applicable statutes of limitation. The Supreme Court concluded the appellate court erred in its interpretation of the applicable statutes of limitations in these cases, and reversed. View "Roseburg Forest Products Co. v. Barnes" on Justia Law

Har-Mar Collisions, Inc. appealed a circuit court judgment after a jury verdict of $101,054.40 in favor of Har-Mar Collisions on its breach-of-contract claim against Scottsdale Insurance Company. The trial court offset the jury verdict by the amounts Har-Mar Collisions had recovered from a settlement agreement it had entered into with Auto-Owners Insurance Company and Owners Insurance Company and from a settlement agreement it had entered into with CRC Insurance Services, Inc. ("CRC"). Because the total amount Har-Mar Collisions recovered from those two settlement agreements exceeded the amount of the jury verdict, the trial court entered a judgment awarding Har-Mar Collisions $0. Har-Mar Collisions appeals, challenging the setoff. Scottsdale cross-appealed from the judgment against it. After review, the Supreme Court reversed the judgment to the extent it applied a setoff against the jury verdict returned against Scottsdale and remanded the case for the trial court to enter a judgment reinstating the jury verdict of $101,054.40. The Court remanded for the trial court to reconsider Har-Mar Collisions' motion to tax costs. The trial court was affirmed in all other respects. View "Scottsdale Insurance Company v. Har-Mar Collisions, Inc." on Justia Law

Sweet Valley Missionary Baptist Church appealed a circuit court order denying its request for prejudgment interest against Alfa Insurance Company. This suit arose from a 2005 insurance claim Sweet Valley filed with Alfa Insurance Corporation (“Alfa”), following storm damage to its property caused by Hurricane Katrina. Sweet Valley had a commercial insurance policy with Alfa Insurance. Sweet Valley filed suit against Alfa for breach of contract and alleged that Alfa had undervalued its claim. Sweet Valley requested prejudgment interest in its complaint. It was determined that Sweet Valley was entitled to $462,761.89. Alfa remitted the full amount to Sweet Valley. Subsequently, Alfa filed a motion for summary judgment, alleging that, since an appraisal had been conducted and it already had paid Sweet Valley $462,761.89, no genuine issues remained. The trial court granted Alfa’s motion. Because there was no judgment in this instance upon which interest could accrue, the Supreme Court affirmed the trial court’s judgment. View "Sweet Valley Missionary Baptist Church v. Alfa Insurance Corporation" on Justia Law

Plaintiff filed suit against his insurer, Nationwide, for breach of contract based on Nationwide’s refusal to pay for damages caused by water that leaked from a buried pipe located beneath the garage-floor slab of plaintiff's home. The court affirmed the district court's grant of summary judgment because the exclusion in plaintiff's homeowner's policy is unambiguous on its face and the court agreed with the district court's conclusion that the exclusion's language applied to water below the surface of the ground, regardless of whether that water came from a pipe. View "Bull v. Nationwide Mutual Fire Ins.Co." on Justia Law

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