Justia Insurance Law Opinion Summaries

Plaintiff was injured in an automobile accident. Plaintiff filed a negligence suit against the adverse driver. Plaintiff settled the claim for the adverse driver’s automobile-liability-insurance policy limits. Before dismissing the suit, however, Plaintiff asserted a claim against his own automobile liability insurer, State Farm, for underinsured motorist benefits (UIM). Plaintiff’s insurance policy contained a limitation provision that gave Plaintiff two years from the date of the accident or date of the last basic reparation benefit payment within which to make a UIM claim. Plaintiff filed his UIM three years after the date of the accident. The trial court granted summary judgment in favor of State Farm, concluding that the explicit terms of Plaintiff’s policy rendered his UIM claim untimely. The court of appeals reversed, holding that State Farm’s time limitation on UIM claims was unreasonable and therefore void. The Supreme Court reversed, holding that the State Farm policy provision was not unreasonable. View "State Farm Mut. Auto. Ins. Co. v. Riggs" on Justia Law

Plaintiff Tenet Healthsystem Desert, Inc. (Hospital) appealed a judgment entered in favor of defendants Blue Cross of California, doing business as Anthem Blue Cross (Blue Cross), Anthem Blue Cross Life and Health Insurance Company (BC Life), and Anthem UM Services, Inc. (Anthem UM). Hospital sued Anthem, as well as Eisenhower Medical Center (Eisenhower) and Keenan & Associates (Keenan), when the defendants refused to pay approximately $1.9 million the cost of medical services that Hospital provided to an insured patient following extensive communications with Anthem over a period of approximately 50 days regarding "authorization" for the services. The defendants ultimately denied coverage for the medical services based on an exclusion in the patient's policy for injuries sustained as a result of having a blood alcohol level over the legal limit. Hospital alleged that Anthem's continuing to "authorize" medical services during the patient's stay at Hospital, even after Anthem was made aware that the patient was admitted with a blood alcohol level far exceeding the legal limit, constituted a misrepresentation as to coverage, on which Hospital relied in providing care to the patient. The trial court determined that the Hospital's third amended complaint (TAC) lacked the necessary specificity to survive a demurrer, and entered judgment for Anthem. The Court of Appeal, however, reversed, concluding the TAC alleged facts with sufficient particularity to overcome a demurrer. The Court therefore reversed and remanded the matter to the trial court for further proceedings. View "Tenet Healthsystem Desert v. Blue Cross of Cal." on Justia Law

APM, a property management company, sought a builders risk insurance policy from TCI Insurance Agency, Inc. to cover an apartment building under construction in Fargo. Jay Alsop, APM's president, discussed insurance policies with TCI's agent Devin Gaard. One policy in particular, from Philadelphia Insurance Company, covered lost rent and other "soft costs," such as interest. Alsop also received a quote from a different insurance agency for another policy from Travelers Insurance Company, which was cheaper than the Philadelphia policy. The Travelers policy did not have coverage for lost rent and soft costs. Alsop informed Gaard about the Travelers policy and requested Gaard to procure the policy as it was quoted by the other agency, without change. A fire at the construction site delayed the opening of the apartment building for five months. APM filed a claim under the insurance policy for damages caused by the fire, including lost rent and interest charges. Travelers paid part of the claim, but denied the claim for lost rent and interest because the policy did not provide coverage for those costs. APM sued TCI, alleging TCI and Gaard were negligent for failing to offer APM a policy endorsement that provided additional coverage for lost rent and soft costs. TCI denied liability and moved for summary judgment, claiming that APM did not request the additional coverage for lost rent and soft costs and that TCI and Gaard were not required to offer the additional coverage to APM. The district court granted TCI's motion, concluding APM failed to raise a genuine issue of material fact as to whether Gaard breached his duty to APM. The court also concluded Gaard's duty was not enhanced because APM failed to establish a genuine issue of material fact indicating a special relationship existed between APM and TCI. On appeal, APM argued the district court erred in deciding there were no genuine issues of material fact as to whether: (1) Gaard breached his duty to APM; and (2) a special relationship existed between APM and TCI. Finding no reversible error, the Supreme Court affirmed the grant of summary judgment to TCI. View "APM, LLP v. TCI Insurance Agency, Inc." on Justia Law

Boardwalk Apartments, L.C. sued State Auto Property and Casualty Insurance Co. for breach of an insurance policy, contending that State Auto had underpaid on the policy after one of Boardwalk’s eight apartment buildings (Building 1) was destroyed in a fire. In district court, State Auto contended that Boardwalk was underinsured under the policy’s coinsurance provision. Under this provision, Boardwalk’s insurance benefits were reduced if the value of the Boardwalk apartment complex exceeded the policy limit. Before trial, the district court issued two rulings: (1) for purposes of the policy’s coinsurance provision, the value of the apartment complex did not include the cost of complying with laws and ordinances regulating the construction and repair of buildings ("law-and-ordinance costs"); and (2) the district court excluded reference at trial to either the coinsurance provision or the possibility that Boardwalk was underinsured. At trial, the jury valued the Boardwalk complex below the policy limit. Based on this valuation, the district court concluded that Boardwalk was not underinsured under the coinsurance provision. In addition to valuing the apartment complex, the jury found that State Auto had underpaid for the loss of Building 1. As a result, the court awarded damages to Boardwalk. State Auto appealed. After review, the Tenth Circuit concluded: (1) the district court abused its discretion by excluding reference to the coinsurance provision; and (2) incorrectly construed the coinsurance provision. In light of these errors, the Court reversed and remanded for a new trial. View "Boardwalk Apartments v. State Auto Property" on Justia Law

Vee’s is a Subchapter S corporation wholly owned by Vee, who reports its income on his own tax returns. Vee sought a refund of $40,000 in penalties that the IRS had assessed because he took deductions for contributions to a benefit plan from 2004-2007 but did not file a Form 8886. In a separate Tax Court suit, the government is arguing that the deductions were improper. Contributions to multi-employer benefit plan, like the Vee's, are deductible unless the plan “maintains experience-rating arrangements with respect to individual employers,” 26 U.S.C. 419A(f)(6). Experience rating means that rather than pooling the risks and contributions of all the employees of the different employer-members to determine benefits, benefits are determined separately for each employer according to that employer’s contributions. If contributions go to purchase life insurance policies that accumulate cash value, the contributions are not tax deductible; such a plan is mainly an investment vehicle rather than insurance. Vee’s plan included no medical benefits. Vee’s contribution in ithe first year was $165,000, but the cost of the term life insurance purchased was only $5,400. The difference was invested to earn interest for and is the property of Vee. The district judge denied a refund. The Seventh Circuit affirmed. Vee’s plan was enough like the plan described in the IRS notice to require lForm 8886. View "Vee's Mktg., Inc. v. United States" on Justia Law

Arthur Murdock, then a lieutenant with the Maine State Police, was injured when his cruiser was struck by another vehicle after Martin Thorne indicated that Murdock could turn in front of him into an intersection. Murdock filed a four-count complaint alleging negligence against Castigliola and Thorne and seeking uninsured motorist coverage from the Maine Department of Public Safety (DPS). The superior court granted the motions for summary judgment filed by both DPS and Thorne. Murdock appealed, and DPS cross-appealed. The Supreme Judicial Court dismissed the appeals, holding that the superior court improvidently granted Murdock’s motion to enter final judgment on Murdock’s claims against Thorne and DPS pursuant to Me. R. Civ. P. 54(b)(1). View "Murdock v. Thorne" on Justia Law

William and Sarah Bassett, who were insured by State Farm Mutual Automobile Insurance Company, alleged that State Farm engaged in unfair trade practices with regard to the Bassetts’ assertion of unfair trade practices. The Bassetts based their claim on the assertion that State Farm never properly offered additional uninsured coverage, as State Farm was statutorily required to do. The circuit court granted the Bassetts’ motion to compel answers to three interrogatories seeking the names, addresses and telephone numbers of State Farm insureds in West Virginia who may have experienced difficulties regarding their uninsured motorist coverage. State Farm filed this original proceeding in prohibition asking the Court to prohibit enforcement of its discovery order. The Supreme Court granted relief, as moulded, prohibiting enforcement of the order granting the Bassetts’ motion to compel, concluding that the circuit court erred by failing to bar the disclosure of the names, addresses and telephone numbers of State Farm’s other insureds. View "State ex rel. State Farm Mut. Auto. Ins. Co. v. Hon. Jeffrey D. Cramer" on Justia Law

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