Justia Insurance Law Opinion Summaries

Petitioner was injured in an automobile accident with an underinsured motorist. Petitioner filed a claim with his insurer (Insurer) for the limits of his uninsured/underinsured motorist (UM) policy of $50,000. After Insurer refused to pay, Petitioner filed a complaint against Insurer to determine liability under the UM policy and the full extent of his damages. Prior to trial, Insurer tendered a check to Petitioner for $50,000 and filed a confession of judgment for that amount. Petitioner opposed the entry of a confessed judgment, arguing that a jury verdict would determine the upper limits of Insurer’s potential liability under a future bad faith claim. The trial court denied Insurer’s motion to confess judgment. After a trial, the jury set Petitioner’s damages at $1 million. The court of appeal vacated the jury’s verdict, concluding that after Insurer confessed judgment in the amount of $50,000, Petitioner’s UM action became moot. The Supreme Court quashed the court of appeal’s decision, holding (1) an insured is entitled to a determination of liability and the full extent of his damages in a UM action before filing a first-party bad faith action; and (2) that determination of damages is generally binding, as an element of damages, in a subsequent first-party bad faith action. Remanded. View "Fridman v. Safeco Ins. Co. of Ill." on Justia Law

Kenneth Burgraff was injured when an employee of Menard, Inc. loaded materials onto Burgraff’s trailer using a forklift. Burgraff sued Menard for damages. Burgraff’s vehicle and trailer were insured under a policy issued by Millers First Insurance Company. Millers First agreed to defend Menard under the policy as a permissive user of Burgraff’s vehicle. Menard was also insured for excess coverage under a commercial general liability policy that included a self-insured retention endorsement. Millers First eventually settled Burgraff’s claim for $40,000, after which Millers First withdrew its defense of Menard. The circuit court determined that Menard’s self-insured retention was “other applicable liability insurance” under the Millers First policy’s “other insurance” clause. The court of appeals affirmed the trial court’s determination that Menard’s self-insured retention was “other insurance” and reversed the circuit court’s determination that Menard no longer had a duty to defend. The Supreme Court affirmed, holding (1) under the terms of the policy, Millers First was required to provide a defense for Menard until it paid its $100,000 limit of liability and breached its duty to defend when it withdrew its defense of Menard; and (2) Menard’s self-insured retention is “other insurance” under the Miller’s First policy’s “other insurance” clause. View "Burgraff v. Menard, Inc." on Justia Law

This dispute arose from injuries sustained by a platform worker employed by Vertex. Continental appealed the district court's final judgment in favor of Tetra and Maritech, requiring Continental and its codefendant insured, Vertex, to indemnify them. The court concluded that the summary judgment record is inadequate to determine whether the Outer Continental Shelf Lands Act (OCSLA), 43 U.S.C. 1333(a)(1), (a)(2)(A), requires the adoption of Louisiana law as surrogate federal law where the court cannot determine whether there is an OCSLA situs, the court cannot determine whether federal maritime law applies, and the Louisiana Oilfield Indemnity Act (LOIA), La. Rev. Stat. Ann. 9:2780, is consistent with federal law. Accordingly, the court concluded that neither party is entitled to summary judgment as to whether LOIA must be adopted as surrogate federal law under OCSLA. The court remanded to the district court to determine the dispositive issue of whether Louisiana law must be adopted as surrogate federal law. View "Tetra Tech. v. Vertex Servs." on Justia Law

Plaintiffs filed suit seeking damages from American Family for their individual insurance claims, and the district court later granted American Family's motion to dismiss. The district court denied plaintiffs' motion to amend. Plaintiffs' motion to amend sought to change their theory of the case because the class action petition had challenged the contents of all American Family insurance policies in a declaratory judgment pleading while the proposed second amended petition claimed that American Family breached the contents of the insurance contract. Furthermore, the class action petition sought a class wide injunction, not individual damages, while the proposed second amended petition sought individual damages instead of a class wide injunction. Therefore, the court concluded that the district court did not abuse its discretion because plaintiffs sought to change their theory of liability after their class action petition had been dismissed. Accordingly, the court affirmed the judgment. View "Adams v. American Family Mutual Ins. Co." on Justia Law

Busch filed suit against National Union after National Union denied coverage for Busch's expenditures to remediate mold in the condominium complex that it managed. The court concluded that the district court correctly concluded that Busch's payments for mold remediation are not covered under its policy with National Union because its legal obligation to remediate the mold did not spring from "liability imposed by law." The court also concluded that the district court correctly concluded that Busch's maintenance or consent agreements do not trigger coverage under the 1994 policy because those agreements do not constitute a legal obligation to pay as damages for liability assumed by Busch under contract. Accordingly, the court affirmed the judgment. View "Busch Properties, Inc. v. National Union Fire Ins." on Justia Law

In 2010, Amy Hiltner was seriously injured when she fell off the trunk of a moving vehicle driven by Samantha Denault. Denault's insurer paid Hiltner its liability limit under a policy covering the vehicle. Owners Insurance Company provided underinsured coverage to Hiltner in an automobile policy issued to her father. In 2012, Hiltner sued Owners in state court for underinsured motorist coverage benefits under North Dakota law, alleging she was injured as a result of driver Denault's negligent operation of the motor vehicle. Owners removed the action from state court to the United States District Court in North Dakota. The United States District Court for the District of North Dakota certified then certified a question of North Dakota law to the North Dakota Supreme Court regarding the proper calculation of an offset provision to underinsured motorist coverage. The questions was "[w]hether the court should deduct no-fault benefits from the award of past economic damages before reduction for the percentage of fault attributable to plaintiff and other parties for whose conduct the defendant is not responsible." The Supreme Court answered the certified question, "No." View "Hiltner v. Owners Ins. Co." on Justia Law

In 2011, Chase Koller and his girlfriend Stephanie Nelson were killed when Koller allegedly lost control of an all-terrain vehicle. Nelson was the mother of G.K., a child from a previous relationship. Becky Anderson, Koller's mother, was the registered owner of the vehicle. The vehicle was insured under a policy issued by Nodak Mutual Insurance Company. Todd Anderson, Koller's stepfather, was the named insured. The policy provided coverage for any "family member" of the named insured, up to $100,000 per incident. The policy defined a "family member" as "a person related to you by blood, marriage or adoption, including a ward or foster child, who is a resident of your household." The policy included a "step-down" endorsement that reduced the policy limits to $25,000 per incident if the vehicle was being driven by an insured who was not a "family member" of the named insured. After the fatal accident, Nodak retained an attorney to represent Anderson to prepare probate documents. Nodak then sued Anderson in her capacity as Personal Representative to the Estate of Chase Koller, and Chris Kemp, as guardian of G.K., and the heirs of Stephanie Nelson, seeking a declaration that it was only liable to pay the reduced step-down policy limits because Koller was not a resident of Todd Anderson's household and, therefore, was not a "family member" under the policy. Kemp filed an answer, cross-claim, and third-party complaint asserting wrongful death against Anderson in her capacity as Personal Representative, and asserting negligent entrustment against Todd and Anderson individually, claiming the family car doctrine applied. The district court severed Kemp's wrongful death claim from Nodak's declaratory judgment action. In the declaratory judgment action, Kemp moved for summary judgment. Nodak responded to Kemp's motion for summary judgment arguing that the district court should deny Kemp's motion and grant summary judgment in its favor. After a hearing, the district court entered an order granting Kemp's motion for summary judgment determining that Koller was a resident of the Andersons' household under Nodak's policy. Before the district court entered judgment, the North Dakota Supreme Court decided "Nodak Mutual Ins. Co. v. Bahr-Renner," (842 N.W.2d 912), interpreting an identical "step-down" provision. After reviewing "Bahr-Renner," the district court vacated its order granting Kemp's motion for summary judgment applied the "Bahr-Renner" factors, and found that Koller was not a resident of Todd Anderson's household and, Nodak was only required to pay the "step-down" policy limits. Kemp appealed from the district court's declaratory judgment in favor of Nodak. Finding no error with the district court's judgment, the Supreme Court affirmed. View "Nodak Mutual Ins. Co. v. Koller" on Justia Law

In appeal no. 1140870, Southern Cleaning Service, Inc. ("SCSI"), appealed the grant of summary judgment in favor of Essex Insurance Company and Genesee General Agency, Inc. on SCSI's claims stemming from Essex's refusal to provide SCSI coverage under a commercial general-liability policy ("the Essex policy") based on the alleged failure to timely notify Essex of the facts leading to the claim for coverage. In appeal no. 1140918, the insurance defendants cross-appeal the trial court's denial of their requests for costs. In August 2006, Winn-Dixie Montgomery, LLC ("Winn-Dixie"), entered into a contract with SCSI that obligated SCSI to provide floor-care and general janitorial services to multiple Winn-Dixie grocery stores in central Alabama. In 2011, a store customer allegedly slipped and fell on a wet floor, and sued. Winn-Dixie sought indemnification from SCSI. SCSI sought indemnification from Phase II, one of its cleaning subcontractors. Phase II, SCSI, and Winn-Dixie again asked Essex to provide them with a defense and indemnity under the terms of the Essex policy; however, their requests were denied. With regard to appeal no. 1140870, the Supreme Court concluded that the summary judgment entered in favor of the insurance defendants should have been reversed because there was a genuine issue of material fact as to who among the insurance defendants acted under the doctrine of apparent authority to settle the Winn Dixie customer's slip and fall claim. The Court pretermitted all discussion of the other grounds for reversal SCSI offered. Because the insurance defendants would have been entitled to the costs they seek in appeal no. 1140918 only if there was a final judgment in their favor, that appeal was dismissed as moot. View "Essex Insurance Co. v. Southern Cleaning Service, Inc." on Justia Law

Government Employees Insurance Company, GEICO General Insurance Company, GEICO Casualty Company, and GEICO Indemnity Company (collectively, GEICO), as relator, brought a qui tam action asserting statutory and common law claims for damages and civil penalties against Dr. Janice Cruz (and others) arising from her alleged involvement in an insurance fraud conspiracy. The trial court granted Cruz's motion to bind GEICO to certain interrogatory responses, then granted her summary judgment motion on the basis those responses established GEICO was unable to prove its case against Cruz. On appeal, GEICO argued the trial court erred by: (1) binding GEICO to its earlier interrogatory responses; (2) excluding additional evidence offered in opposition to the summary judgment motion; and (3) granting summary judgment on its statutory claim. The Court of Appeal concluded the trial court erred in binding GEICO to its interrogatory responses, and further, found multiple instances of issues of triable facts that should not have been disposed of through summary judgment. The Court accordingly reversed the trial court and remanded the case for further proceedings. View "California ex rel. Gov. Employees Ins. Co. v. Cruz" on Justia Law

This benefits-denial case related to some charges incurred during M.G.’s stay at a residential/educational mental healthcare facility. Stephanie C., individually and on behalf of M.G., her minor son, brought this action challenging a decision of the claims administrator, Blue Cross Blue Shield of Massachusetts, partially denying her claim for benefits. The district court upheld the partial denial. The First Circuit vacated the district court’s judgment, holding that the district court employed the wrong standard of review when considering the partial denial of benefits, and therefore, the court erred in upholding BCBS’s partial denial of benefits. Remanded. View "Stephanie C. v. Blue Cross Blue Shield of Mass." on Justia Law