Justia Insurance Law Opinion Summaries

Tenant died in a fire that he caused on property he rented from Landlords. Insurer paid Landlords, its insureds, for the property damage caused by the fire. Plaintiff, individually and in his capacity as the administrator of Tenant’s estate, filed a wrongful death claim against Landlords. Landlords filed an answer, which included a counterclaim filed by Insurer asserting a subrogation claim against Tenant’s estate for the proceeds Insurer paid to Landlord following the fire. The estate, in turn, argued that Tenant was an additional insured under Insurer’s homeowner’s policy and that Insurer could not seek subrogation against its own insured. Insurer filed a motion for summary judgment, arguing that Tenant was not an insured under the homeowner’s policy. The circuit court concluded that Tenant was an “equitable insured” of Landlord’s insurance policy and, therefore, Insurer could not maintain a subrogation action against tenant’s estate. The Supreme Court reversed, holding that Insurer had a right of subrogation against Tenant where (1) Tenant was not a named or definitional insured of Landlord’s policy; (2) Tenant purchased his own renter’s insurance after being advised to do so by Landlord; and (3) the lease agreement stated that Tenant was solely responsible for any damage he caused to the property. View "Farmers & Mechanics Mut. Ins. v. Allen" on Justia Law

Petitioner-claimant Jeanette Ball sought permanent total disability benefits from the Multiple Injury Trust Fund. The Workers' Compensation Court held that a "Crumby" finding of preexisting disability made simultaneously with the adjudication of an on-the-job injury could be combined with the adjudicated injury to render the Claimant a physically impaired person under 85 O.S. Supp. 2005 sec. 171 and awarded Petitioner permanent total disability benefits. The Fund appealed, and a three-judge panel reversed. Claimant then appealed, and the Court of Civil Appeals reversed the panel. After its review, the Supreme Court held that an employee must be a physically impaired person as defined by the applicable statute before he or she can seek benefits from the Fund. A "Crumby" finding of preexisting disability made simultaneously with an adjudication of an on-the-job injury could not be combined with such adjudicated injury to render the Claimant a physically impaired person under 85 O.S. Supp 2005 sec. 171. The Court of Appeals' decision was vacated and the case remanded for further proceedings. View "Ball v. Multiple Injury Trust Fund" on Justia Law

A certified question of Oregon law was certified to the Oregon Supreme Court from the United States Court of Appeals for the Ninth Circuit. The question arose out of a construction contract dispute in which a homeowner's association sued a builder in state court for construction defects. The homeowner's association and the builder settled, and the settlement included an unconditional release and covenant not to execute against the builder. When the homeowner's association attempted to garnish the builder's liability insurance policy, however, the insurer claimed that it had no liability because the settlement unconditionally released its insured from any liability. The state trial court agreed, and the builder appealed. Meanwhile, in response to the state trial court's conclusion that the settlement agreement eliminated the insurer's liability, the homeowner's association and the builder amended their settlement agreement to eliminate the unconditional release and covenant not to execute. Pursuant to the new agreement, the builder initiated this action in federal court against its insurer. In the federal court action, the insurer argued that the state court already had determined that, given the terms of the original settlement, the builder could not recover under its insurance policy and that the parties lacked authority to create any new insurance coverage obligation by amending their settlement agreement. The federal district court agreed. On appeal, the Ninth Circuit certified a question on whether the homeowner's association and the builder could amend their settlement agreement in such a way as to revive the liability of the builder's insurer. After review, the Oregon Court concluded that, although the parties possessed authority to amend the terms of their settlement agreement, they could not do so in a way that retroactively revived the liability that was eliminated in their original agreement (at least not on the basis of the legal theories that they proposed). View "A&T Siding, Inc. v. Capitol Specialty Ins. Corp." on Justia Law

Haney rented a car from Enterprise. While being driven by Artley, the vehicle collided with an oncoming car operated by Nelson. Nelson sued Artley, who was uninsured, and obtained a default judgment. Nelson brought a supplementary action against Enterprise. Enterprise denied that it was in possession of any property of Artley and raised affirmative defenses to recovery: that Artley was not its customer, was not listed on its rental agreement with Haney and did not have Haney’s permission to use the vehicle. Haney had reported the vehicle as stolen. Enterprise contended in the alternative that it was self-insured, that its total financial responsibility for the liability of any authorized driver was $100,000 per occurrence, and that it had paid $50,000 to settle another claim from the same accident and had tendered $50,000 to the court to allocate between Nelson and a third injured party, exhausting its liability limits. Enterprise also argued that there was nothing in its rental agreement nor in Illinois statutes to obligate Enterprise to pay costs or post-judgment interest connected with the default judgment. The Illinois Supreme Court agreed with the trial court that, under a 2005 appellate court decision, Enterprise’s liability was limited to the minimum coverage provisions applicable to rental car companies that meet their financial responsibility obligations through the purchase of an insurance policy and not the full amount of the default judgment. View "Nelson v. Artley" on Justia Law

The underlying lawsuit arose out of Fred Hlad’s agreement to construct a house for Travis and Teresa Nelson. The Nelsons sued Hlad for breach of contract, various intentional tort claims, and negligence in constructing their house. Hlad had a commercial general liability (“CGL”) policy with Nationwide Mutual Insurance Company at all times relevant to this case. Nationwide provided Hlad a defense in the underlying lawsuit under a reservation of rights. Nationwide also intervened in the lawsuit and filed a complaint for declaratory relief to determine whether it had a duty to defend or indemnify Hlad. The circuit court denied Nationwide’s request for declaratory relief, finding that the CGL policy provided coverage to Hlad for any damages that may be recovered in the underlying lawsuit. Nationwide then petitioned the Supreme Court for a writ of prohibition. The Supreme Court granted Nationwide’s requested writ, holding (1) most of the claims asserted by the Nelsons did not trigger coverage under the CGL policy, and the claims that did trigger coverage were precluded by clear and unambiguous exclusions; and (2) therefore, Nationwide had no duty to provide coverage, defend, or indemnify Hlad in the underlying lawsuit. View "State ex rel. Nationwide Mut. Ins. Co. v. Hon. Ronald E. Wilson" on Justia Law

In October 2010, Eddie Hoffman was injured when his vehicle was rear-ended by a vehicle driven by Carolyn Elzy. Hoffman filed suit against Ms. Elzy and her insurer, 21st Century North America Insurance Company for damages allegedly resulting from the accident. This case presented with a question of first impression for the Louisiana Supreme Court's review as to whether a write-off from a medical provider, negotiated by plaintiff's attorney, could be considered a collateral source from which the tortfeasor receives no set-off. Applying Louisiana law and the principles set forth in our Civil Code, the Court found that such a write-off did not fall within the scope of the collateral source rule. View "Hoffman v. 21st Century North America Insurance Co." on Justia Law

Waskiewicsz suffers from type-1 diabetes, major depression, and gender identity disorder She worked as a product design engineer for Ford from 1990 until October, 2010, when she suffered “a debilitating emotional breakdown.” In December, after her father found her barricaded in her house, she sought long-term disability benefits under Ford’s Plan, governed by the Employment Retirement Income Security Act, 29 U.S.C. 1001. Under the plan: An Active Employee whose employment is terminated . . . shall cease to be eligible for Benefits as of the earlier of: (a) the date the Employee has been notified; or (b) the day prior to the date of such termination (in the case of retroactive terminations) . .... An employee is required to notify the Claim Processor ... if the employee is absent for more than five (5) consecutive Workdays.” She did not give notice within the five-day period and was, apparently, terminated in the interim. UniCare concluded that she did not qualify for benefits. The Sixth Circuit reversed. On remand, Waskiewicz must be given the opportunity to show that her alleged failure to comply with the requirements of the Plan was due to the very disability for which she seeks benefits. View "Waskiewicz v. UniCare Life & Health Ins. Co." on Justia Law

The insurer operates a preferred-provider system that offers patients better benefits, or lower co-payments, for patronizing medical providers who have agreed with the insurer to accept lower reimbursements (per procedure) in exchange for a better flow of business. The chiropractor plaintiffs signed such “participating provider” or “network” agreements. Providers bill the insurer directly regardless of whether a patient obtained coverage as part of an Employee Retirement Income Security Act (ERISA) welfare-benefit plan or through some other means, such as an affinity-group policy or an insurance exchange under the Affordable Care Act. Chiropractors sued, contending that, when determining how much to pay for services rendered to patients, the insurer failed to use the procedures required by ERISA, 29 U.S.C. 1133. The district court concluded that plaintiffs are beneficiaries under ERISA and awarded damages and injunctions requiring the insurer to follow section 1133 and Department of Labor regulations. The Seventh Circuit reversed, noting that plaintiffs concede that they are not participants under the ERISA definition and that a network contract between a medical provider and an insurer does not make that provider a “beneficiary” under ERISA. View "Pa. Chiropractic Ass'n v. Independence Hosp. Indem., Inc." on Justia Law

This case concerned a dispute regarding who was entitled to the proceeds of a retirement annuity contract. Plaintiff filed a complaint for declaratory judgment pursuant to the Uniform Declaratory Judgments Act claiming that she was entitled to the proceeds. The circuit court entered summary judgment in favor of Defendant. Plaintiff appealed. The district court did not reach the merits of the case, concluding that the circuit court lacked jurisdiction over the dispute because only a district court has jurisdiction over matters brought under the Declaratory Judgments Act, no matter the amount in controversy. The Supreme Court reversed, holding (1) a cause of action seeking declaratory relief can be within the jurisdiction of the circuit court so long as the circuit court has jurisdiction independent of the declaratory relief requested; and (2) in this case, the circuit court had jurisdiction independent of the declaratory relief sought, and therefore, the court had jurisdiction to decide the declaratory judgment claim. View "Best v. Best" on Justia Law

Witasick was covered by a disability policy and a business overhead expense policy. His claims against both policies were honored. A dispute arose concerning coverage of some claimed business expenses. After years of negotiation, the parties settled: the insurer agreed to pay more than $4 million and Witasick agreed to release known, unknown, and future claims. The settlement contained a covenant not to sue, based on “any conduct prior to the date the Parties sign this document, or which is related to, or arises out of” the policies. During negotiations, the U.S. Government notified Witasick that he was the target of a grand jury investigation related to fraud and business expense claims on his income tax returns. Witasick was indicted in 2007. To support its charge of mail fraud, the government relied on information and documents Witasick had submitted to the insurer. An employee of the insurer testified before the Grand Jury and at Witasick’s trial. Witasick was convicted on most counts, but acquitted of mail fraud, and was sentenced to 15 months’ imprisonment. In 2011, Witasick sued the insurer based on the policies and cooperation with the prosecution. The Third Circuit affirmed dismissal, finding the claims prohibited by the settlement agreement. View "Witasick v. Minn. Mut. Life Ins, Co." on Justia Law