Justia Insurance Law Opinion Summaries

Employee was severely injured while traveling abroad on a business trip. Employer had purchased two workers’ compensation policies from two different insurers, the Insurance Company of the State of Pennsylvania (ISOP) and Great Northern Insurance Company (Great Northern). Both policies provided primary coverage. Employee pursued a workers’ compensation claim. Employer gave notice of the claim only to ISOP. ISOP began making payments pursuant to the policy and defended the claim. When ISOP learned that Employer also had workers’ compensation coverage under its Great Northern policy, ISOP filed a complaint against Great Northern seeking a judgment declaring that the doctrine of equitable contribution required Great Northern to pay one-half of the past and future defense costs and indemnity payments related to Employer’s claim. A federal district court granted summary judgment for Great Northern. ISOP appealed, and the United States Court of Appeals for the First Circuit certified a question to the Supreme Court. The Court answered that, where two primary workers’ compensation insurance policies provide coverage for the same loss arising from an injury to an employee, the insurance company that pays that loss has a right of equitable contribution from the coinsurer, regardless of whether the insured gives notice of the injury only to one insurer. View "Ins. Co. of State of Penn. v. Great N. Ins. Co." on Justia Law

Before floodwaters destroyed plaintiffs' property, FEMA issued a flood-in-progress designation. Plaintiffs believed that the FEMA designation rendered their two Standard Flood Insurance Policies (SFIPs) worthless for the pending flood and elected to cancel them. Congress then passed the Biggert-Waters Flood Insurance Reform Act of 2012 (FIRA), Pub. L. No. 112-141, 100227(b), 126 Stat. 405, 943–44, a remedial amendment that would have extended coverage for plaintiffs but for the fact that they had canceled the SFIPs. Plaintiffs filed suit against American Bankers, the issuer of the SFIPs, seeking reinstatement of the SFIPs and payment for their flood loss. The court affirmed the district court's conclusion that plaintiffs were chargeable with knowledge of the terms of the SFIPs and that the FIRA does not reinstate the canceled SFIPs. View "Hodde v. American Bankers Ins. Co." on Justia Law

The City appealed the trial court's issuance of a writ of mandate authorizing the Board to exercise its discretion, previously delegated to it by the City in an ordinance, to set the maximum subsidy contributed by the City to police and firefighter retirees‟ insurance premiums without regard to later City ordinances “freezing” the subsidy until review and increase by the City Council and requiring payment of a voluntary contribution to join an opt-in program. The court agreed with the City's contention that the trial court's grant of a writ of mandate was in error because the City Charter grants the City Council the authority to set the amount of the subsidy and, as a consequence, the Delegation Ordinance can neither restrict the Council's authority nor create a vested right to a Board-determined subsidy as such would conflict with the Charter. Accordingly, the court reversed and remanded. View "Fry v. City of L.A." on Justia Law

Plaintiff filed suit against Standard, asserting various claims after Standard determined that plaintiff was no longer disabled and discontinued benefits. The district court granted summary judgment to plaintiff, concluding that Standard abused its discretion in discontinuing long-term disability (LTD) benefits. In this case, Standard's decision was based on its determination that the disabling cognitive impairments suffered by plaintiff in a 2011 car accident had improved to the point that she could return full-time to her Own Occupation. The court concluded that the administrative record more than adequately supports the manner in which Standard addressed the Own Occupation issue in its final decision. The court also concluded that substantial evidence supported Standard's decision to discontinue benefits. Accordingly, the court reversed and remanded. View "Whitley v. Standard Ins. Co." on Justia Law

Christina Connelly appealed the dismissal of her claim against State Farm Mutual Automobile Insurance Company. She contended that a claim accrued only when the insured suffers a judgment in excess of policy limits, and that judgment becomes final and non-appealable. Connelly's appeal raised this question as it pertained to the applicable statute of limitations on Connelly's insurance claim. State Farm contended that the claim accrued when the insurer allegedly acts in bad faith and breaches its duty to the insured. Although the Delaware Supreme Court had never addressed that precise issue, courts in other states that have considered it, and the weight of expert authority on insurance law, were in accord that a bad-faith failure-to-settle claim accrued when an excess judgment became final and non-appealable. "That approach conserves litigant and judicial resources. It also properly aligns the incentives of the insurer and its insured by allowing them to join efforts in defending the underlying third-party insurance claim without a stayed breach-of-contract claim causing a conflict of interest between them. Further, to state a claim that the insurer breached its implied duty to act in good faith, the insured must plead damages, which she cannot do before there is a final excess judgment against her." In view of these considerations, the Delaware Court found that a claim against an insurer for acting in bad faith by failing to settle a third-party insurance claim accrued when an excess judgment against an insured becomes final and non-appealable. Accordingly, it reversed the Superior Court's decision. View "Connelly v. State Farm Mutual Automobile Insurance Co." on Justia Law

Essex issued a professional liability insurance policy to Galilee Medical Center, covering claims against Galilee physicians, including Angarita. Galilee’s application asked, “Do[] the Applicant’s employees or independent contractors use drugs for weight reduction for patients?” Galilee answered no. The question continued: “If yes, attach a list of drugs used and percentage of practice devoted to weight reduction.” Galilee did not identify any drugs. Galilee also answered “no” to whether its employees performed any experimental procedures and to “With the exception of surgery for obesity, does your practice include weight reduction or control by other [sic] than diet or exercise? 5.(b) Do you dispense any drugs? 5.(c) Do you use injections for weight control? 9.(a) Do you use experimental procedures, devices, drugs, or therapy in treatment or surgery?” In 2011, Ravelo, Angarita’s former patient, sued Angarita and Galilee for medical negligence based on mesotherapy treatments administered by Angarita. Mesotherapy is a non-surgical treatment involving injections into subcutaneous layers of fat, to dissolve deposits of fat and provide a more desirable body shape. Mesotherapy is not FDA-approved. Angarita admitted to providing mesotherapy treatment to more than 5,000 patients, including Ravelo. Essex denied coverage and sought a declaratory judgment rescinding the Policy. The Seventh Circuit affirmed summary judgment in favor of Essex, based on the misrepresentations in the applications. View "Essex Ins. Co. v. Angarita" on Justia Law

The court originally remanded this case to the district court for additional fact-finding to establish complete diversity of citizenship between all plaintiffs and all defendants with instructions to reenter summary judgment if federal subject-matter jurisdiction could be properly established. After dismissing a nondiverse plaintiff it found was not a real party in interest to this case, the district court reentered its earlier grant of summary judgment in favor of the insurer on all claims. The court affirmed the district court's dismissal of PMI Delaware and its grant of summary judgment to Lexington. The court concluded that the district court's dismissal of PMI Delaware pursuant to FRCP 21 as a "nominal or formal party" was proper because the district court found that though PMI Delaware was a named insured on the Insurance Policy, PMI Delaware would not be entitled to any portion of a successful judgment against Lexington because PMI Florida, not PMI Delaware, was the party against whom Blue Cross had filed suit and PMI Florida, not PMI Delaware, was the only party that made a claim for coverage to Lexington. Further, PMI Delaware was not even a party to the underlying Blue Cross contract, which provided healthcare coverage only to PMI Florida’s leased employees. Further, the court affirmed the district court's holding that Lexington owed no coverage to PMI Florida. Here, the court saw no contractual ambiguity; the Insurance Policy issued by Lexington explicitly excludes the coverage sought by PMI Florida. Therefore, the district court properly granted summary judgment to Lexington on PMI Florida’s claims for breach of contract and declaratory judgment. Finally, the district court properly granted summary judgment to Lexington on its claim of negligent misrepresentation where no jury could reasonably find that Yoohoo justifiably relied on the statement at issue as an indication that there would be coverage under the policy. View "Payroll Mgmt., Inc. v. Lexington Ins. Co." on Justia Law

The Authority faced a funding shortfall for at least the period immediately after its opening in 2014. To cover the shortfall, the Authority, with emergency authorization from the District’s Council, levied a charge on all insurance policies above a certain premium threshold sold by health carriers in the District. American Council raised statutory and constitutional challenges to that charge and the district court rejected Council's arguments, dismissing the complaint for failure to state a claim. The court agreed with the District that the district court lacked jurisdiction to hear this case because the charge levied by the Authority was a tax rather than a fee. Therefore, the court vacated the district court's judgment for lack of jurisdiction and remanded with instructions to dismiss the case for lack of jurisdiction because the assessment is a tax. View "American Council of Life Ins. v. District of Columbia Health" on Justia Law

Vermont law requires certain entities, including health insurers, to report payments and other information relating to health care claims and services for compilation in a state health care database. Liberty Mutual’s health plan, which provides benefits in all 50 states, is an “employee welfare benefit plan” under the Employee Retirement Income Security Act (ERISA); its third-party administrator, Blue Cross, is subject to the statute. Concerned that the disclosure of confidential information might violate its fiduciary duties, the Plan instructed Blue Cross not to comply and sought a declaration that ERISA preempts application of Vermont’s statute. The Second Circuit reversed summary judgment in favor of the state. The Supreme Court affirmed. ERISA expressly preempts “any and all State laws insofar as they may now or hereafter relate to any employee benefit plan,” 29 U.S.C. 1144(a) and, therefore, preempts a state law that has an impermissible “connection with” ERISA plans. ERISA mandates certain oversight systems and other standard procedures; Vermont’s law also governs plan reporting, disclosure, and recordkeeping. Preemption is necessary to prevent multiple jurisdictions from imposing differing, or even parallel, regulations, creating wasteful administrative costs and threatening to subject plans to wide-ranging liability. ERISA’s uniform rule design makes clear that the Secretary of Labor, not the states, decides whether to exempt plans from ERISA reporting requirements or to require ERISA plans to report data such as sought by Vermont. View "Gobeille v. Liberty Mut. Ins. Co." on Justia Law

Opal Lowman was injured in an automobile accident. State Farm Mutual Automobile Insurance Company provided underinsured motorist coverage to Opal and her husband. The Lowmans sued State Farm, seeking damages. The jury returned a verdict for the Lowmans in the amount of $0. The Lowmans filed a motion for a new trial, which was overruled. The Supreme Court affirmed, holding (1) the district court did not err when it entered judgment on the jury’s verdict where the jury awarded the Lowmans no money damages; and (2) the district court did not err in denying the Lowmans’ motion for new trial. View "Lowman v. State Farm Mut. Auto. Ins. Co." on Justia Law