Justia Insurance Law Opinion Summaries

When Kent Roose was injured in an automobile crash his wife was an employee of Lincoln County, which provided health benefits via a group health plan (the Plan) that was part of Joint Powers Trust (JPT). Employee Benefit Management Services, Inc. (EBMS administered the Plan. The Plan contained an exclusion stating that medical benefits would not be paid when any automobile or third-party liability insurance was available to pay medical costs. EBMS denied Roose’s request for reimbursement for medical expenses he paid out of the liability insurance payment he received from the tortfeasors’ insurer. Roose subsequently brought suit against EBMS and JPT. The Supreme Court held that the exclusion violated Mont. Code Ann. 2- 18-902(4). Appellants subsequently reimbursed Roose the requested amount. In 2014, Roose filed a motion for partial summary judgment and class certification, arguing that Appellants violated section 2-18-902 through systematic practices that amounted to seeking subrogation against the tortfeasor’s liability carrier before Roose was made whole. Roose also sought class certification on behalf of every member of Appellants’ plans subject to Montana law that contained the coverage exclusion. The district court granted Roose’s motion. The Supreme Court affirmed, holding that the district court did not abuse its discretion in certifying the class or in defining the class. View "Roose v. Lincoln County Employee Group Health Plan" on Justia Law

Keizer Trailer Sales, Inc., which was insured by Continental Western Insurance Company (CWIC), sold three trailers to James Black. The installment purchase agreement stated that Keizer would remain the owner of the trailers under the purchase price was paid in full. Black was subsequently involved in an accident while pulling a Keizer trailer that resulted in one fatality and multiple injuries. Wrongful death and negligence claims were filed against Black and his business. CWIC filed a complaint for declaratory judgment seeking a declaration that the commercial and umbrella policies it issued to Keizer on the trailer involved in the accident did not provide coverage for the claims arising from Black’s accident. The district court ruled against CWIC, concluding that Black was insured under the policies’ omnibus clauses because he was driving a vehicle owned by Keizer with Keizer’s permission. The Supreme Court affirmed, holding that because Keizer retained ownership of the trailers, and because Black’s use of the trailers was with Keizer’s permission, coverage was available under the omnibus clauses of Keizer’s CWIC policies. View "Continental W. Ins. Co. v. James Black, JJ Bugs, Ltd." on Justia Law

In 2003, Robert Loppi purchased a life insurance policy from United Investors Life Insurance Co. in which he initially named Marilyn Loppi, his wife, as the beneficiary. In 2008, after Marilyn filed for divorce from Robert, Robert applied to United Investors to change the beneficiary on his life insurance policy to his uncle, David Loppi. In 2009, during the course of the divorce proceeding, the family court entered an interlocutory order ordering that Robert’s life insurance policies be cashed in and that the cash surrender value be divided equally between Robert and Marilyn. Before Robert complied with the interlocutory order, Robert died. Thereafter, United Investors declined to pay the life insurance death benefit to either David or Marilyn. David filed this action seeking a declaratory judgment that he alone was entitled to the life insurance policy death benefit. The hearing justice granted David’s petition for declaratory judgment stating that David was entitled to 100 percent of the policy proceeds. The Supreme Court affirmed, holding that Marilyn was not entitled to any portion of the life insurance proceeds at issue. View "Loppi v. United Investors Life Ins. Co." on Justia Law

Blue Mountain Energy appealed a Benefits Review Board decision affirming an award of black lung benefits to Terry Gunderson. An administrative law judge (ALJ) originally denied benefits under the Black Lung Benefits Act (BLBA), and Gunderson appealed to the Board and then to the Tenth Circuit Court of Appeals. The Tenth Circuit remanded for further proceedings because the ALJ did not sufficiently explain the basis for the denial. The ALJ again denied benefits, and the Board vacated and remanded the ALJ’s decision because it did not comply with the Tenth Circuit’s remand. On the second remand, the ALJ awarded benefits, and the Board affirmed. Blue Mountain petitions for review, arguing that the ALJ violated the Administrative Procedure Act (APA). Specifically, Blue Mountain contended the ALJ gave the preamble to the regulations redefining compensable pneumoconiosis in 20 C.F.R. 718.201 the force and effect of law, even though the preamble had not been subject to APA notice and comment. Blue Mountain also contended its rights under the APA were violated when the ALJ refused to reopen the proceedings to allow it to submit evidence challenging the medical literature cited in the preamble. After review, the Tenth Circuit found no reversible error as Blue Mountain argued, and affirmed. View "Blue Mountain Energy v. Director OWCP" on Justia Law

Appellant, acting in the capacity as the executor of the estate of Marion Bingham, brought this lawsuit against Supervalu, Inc., alleging that Supervalu acted as an insurer of one of its subsidiaries and violated Mass. Gen. Laws ch. 176D and Mass. Gen. Laws ch. 93A by failing to promptly and equitably resolve prior litigation between the subsidiary and the State. Supervalu removed the action to federal court, arguing that it was not in the business of insurance and was thus not subject to regulation under Chapter 176D. The district court granted summary judgment in favor of Supervalu, ruling that Supervalu was not in the business of insurance. The First Circuit affirmed, holding that the district court did not err in concluding that Supervalu was not in the business of insurance. View "Bingham v. Supervalu, Inc." on Justia Law

U.S. Silica Company has been named as a defendant in numerous silica claims seeking damages for injuries allegedly caused by exposure to silica sand. When three policies of comprehensive general liability insurance purchased by U.S. Silica’s predecessor from the Travelers Indemnity Company were discovered, U.S. Silica informed Travelers of the silica claims and requested coverage and reimbursement under these Travelers policies. When it failed to receive a response, U.S. Silica filed a declaratory judgment against Travelers. The jury found that Travelers breached its insurance policies when it refused to pay U.S. Silica’s claims for insurance coverage for the silica lawsuits and that Travelers owed U.S. Silica $8 million as a result. The circuit court denied Travelers’ post-trial motions for judgment as a matter of law or for a new trial and awarded U.S. Silica attorney’s fees and prejudgment interest. The Supreme Court reversed, holding that U.S. Silica failed to demonstrate that its explanation for its significant delay in notifying Travelers of the silica claims was reasonable, and therefore, U.S. Silica was not entitled to coverage under the subject Travelers policies. Remanded with directions to enter an order granting Travelers’ post-trial motion for judgment as a matter of law. View "Travelers Indem. Co. v. U.S. Silica Co." on Justia Law

Erie Insurance Property and Casualty Company submitted to the Virginia Insurance Commissioner a rate, form, and product filing seeking approval for a new product endorsement entitled Rate Protection Endorsement (RPE). The Commissioner approved the Erie filing, as amended. Respondent, an Erie insured, filed an administrative complaint against Erie seeking a determination as to whether the Commissioner’s approval of Erie’s RPE should be withdrawn. The Commissioner denied Respondent relief. The circuit court reversed, concluding that the Commissioner was statutorily required to withdraw approval of Erie’s RPE. The Supreme Court reversed, holding that the circuit court engaged in an improper re-examination of Erie’s rate and form policy filing for its RPE that was approved by the Commissioner, and therefore, the circuit court erred in reversing the decision of the Commissioner. View "Erie Ins. Prop. & Cas. Co. v. King" on Justia Law

Plaintiffs filed suit seeking additional coverage under their flood insurance policy after their home was damaged during Hurricane Ike. The district court denied plaintiffs' claim for additional building coverage on the ground that the total recovery they had already received from insurers exceeded their total loss. As for contents coverage, the district court awarded $2,500 for some car parts damaged in the storm. Both parties appealed. The court concluded that federal common law governing the National Flood Insurance Program recognizes the rule against double recovery and affirmed the ruling that plaintiffs' are not entitled to additional building coverage. However, the court vacated the personal property award to plaintiffs because they concede it was in error. View "Pye v. Fidelity Nat'l Prop. & Cas. Ins." on Justia Law

USF&G filed suit in the Court of Federal Claims under the Tucker Act, 28 U.S.C. 1491(a)(1), seeking reimbursement from the government for legal expenses and settlement costs it allegedly incurred in its capacity as general liability insurer for Gibbs Construction, a government contractor. USF&G alleged that, in a contract for renovation work at the New Orleans main post office, the U.S. Postal Service agreed to indemnify Gibbs and its agents against any liability incurred as a result of asbestos removal work under the contract. USF&G alleged that the Postal Service failed to indemnify Gibbs in connection with a lawsuit filed against Gibbs by a former Postal Service police officer, in which the officer claimed that he contracted mesothelioma as a result of asbestos removal during performance of the contract, and that, as Gibbs’s general liability insurer, it was required to litigate and settle the officer’s claim. The Federal Circuit affirmed dismissal. The Claims Court lacked jurisdiction under a theory of equitable subrogation. View "Fid. & Guar. Ins. Underwriters, Inc. v. United States" on Justia Law

Wife was a passenger on a motorcycle operated by Husband when she was injured in an accident. At the time, Wife and Husband were named insureds on a motorcycle insurance policy from Insurer. Wife filed a complaint against Husband alleging negligence in connection with the accident. A jury found Husband negligent and awarded Wife $50,000 in damages. Husband moved to amend the judgment to obtain a credit for the amount in prejudgment payments that the Insurer had made to Wife. The superior court granted Husband’s motion to amend the judgment. Wife appealed, arguing that the court erred in interpreting Me. Rev. Stat. 24-A, 2426 to allow Husband a credit against the judgment for the medical payments maximum coverage of what Insurer had already paid to Wife’s medical providers before this action was commenced. The Supreme Judicial Court vacated the order amending judgment, as the court did not determine whether the payments Insurer paid Wife’s medical providers were medical or liability payments. Remanded for a factual determination of the type of prepayments Insurer made, whether liability payments pursuant to Husband’s policy, medical payments pursuant to Wife’s policy, or some other type of payment. View "Wood v. Wood" on Justia Law