Justia Insurance Law Opinion Summaries

Central States, a multi-employer trust fund governed by ERISA, provides health and welfare benefits to participants in the teamster industry. Student Assurance processed claims for student accident policies. Central States claimed that it paid medical expenses of $137, 204 for 13 junior high, high school, and college student-athletes who were covered dependents under its plan and who sustained athletic injuries. Central States sought reimbursement from Student Assurance, which refused to pay. Central States alleged that according to the coordination of benefits provision of its plan, the student accident policies supply primary coverage for the students’ covered medical expenses. Student Assurance claimed that the student accident policies are excess policies, and that they are not obligated to pay until Central States has reached the maximum contribution under its plan. Central States sued, citing federal common law and section 502(a)(3) of ERISA, seeking declaratory relief, restitution, and the imposition of an equitable lien and constructive trust to secure reimbursement for the benefits paid on behalf of the common insureds. The district court dismissed, and the Eighth Circuit affirmed, holding that the claims, while ostensibly seeking equitable remedies, were actually for legal relief that is unavailable under section 502(a)(3). View "Cent. States, SE & SW Areas Health & Welfare Fund v. Student Assurance Servs., Inc." on Justia Law

Defendant-Appellants Carl McCaffree, Jimmy Helvey, and Sam McCaffree (director-defendants) and the Federal Deposit Insurance Corporation (FDIC) appealed the district court's grant of summary judgment to BancInsure, Inc. BancInsure issued a Directors and Officers Liability Insurance Policy to Columbian and its parent Columbian Financial Corporation (CFC). the Kansas State Bank Commissioner declared Columbian insolvent and appointed the FDIC as receiver. By operation of law, the FDIC-R succeeded to "all rights, titles, powers, and privileges of [Columbian], and of any stockholder, member, accountholder, depositor, officer, or director" of Columbian. BancInsure received notice of potential claims the FDIC-R intended to file against the bank's officers and directors. In anticipation of such a suit, CFC and director-defendant Carl McCaffree brought suit against BancInsure seeking a declaratory judgment that the policy covered claims made after the date Columbian was declared insolvent, but before the expiration of the policy. The district court ultimately held that the policy remained in effect until May 11, 2010, relying in part on its finding that a regulatory endorsement in the policy "provide[d] coverage for actions brought by deposit insurance organizations as receivers during the policy year," which would have been meaningless if the policy terminated upon appointment of a receiver. On appeal, the Tenth Circuit sua sponte determined that no case or controversy existed at the time of the district court's judgment and remanded with instructions to vacate the judgment for lack of jurisdiction. BancInsure filed the instant action against the director-defendants in Kansas state court seeking a declaratory judgment that it owed no duty of coverage to the director-defendants for claims brought against them by the FDIC-R. The FDIC-R joined and removed the action to the federal district court in Kansas. At approximately the same time, the FDIC-R brought claims against several of Columbian's former directors and officers alleging negligence, gross negligence, and breach of fiduciary duty. The district court held that claims by the FDIC-R were unambiguously excluded by the policy's "insured v. insured" exclusion and that BancInsure was not judicially estopped from denying coverage. Finding no reversible error in that judgment, the Tenth Circuit affirmed. View "BancInsure v. FDIC" on Justia Law

Vandenberg, attending a cruise on a chartered yacht, was injured when he fell from the upper deck because the bench on which he was sitting tipped over, while the boat was anchored in Lake Michigan. The bench was not secured to the deck, nor did the upper deck have a railing. The fall left Vandenberg paralyzed from the chest down. The yacht was owned by a closely held corporation. Vandenberg alleged that Rose Paving, a company run by Rose, one of three owners of the corporation, was a booking agent that maintained a marketing relationship for the chartering of the yacht. He filed suit, alleging negligence, and settled with the defendants. The defendants agreed to pay $25 million through the assignment of their claims against their insurers. Westfield was the insurance provider for defendant Rose Paving. Westfield disputed that its insurance policies with Rose Paving covered the yacht accident and sought a declaratory judgment. The district court granted Westfield’s motion for judgment on the pleadings. The Seventh Circuit affirmed, finding that injuries came under the policies’ watercraft exclusion. View "Westfield Ins. Co. v. Vandenberg" on Justia Law

Appellant, a self-employed delivery driver who contracted with FedEx Home Delivery for one of its delivery routes, fell and injured his shoulder while delivering packages. Under his FedEx service contract, Appellant was required to maintain workers’ compensation insurance, which he did through CorVel Corporation. Appellant received medical treatment, but with his physical restrictions, he could not complete his delivery route. Appellant hired a replacement driver until he canceled the service contract. Appellant sought temporary disability benefits, which CorVel denied. Appellant administratively appealed. The appeals officer denied both temporary total disability benefits and temporary partial disability benefits on the basis that Appellant could not establish a loss of any income without evidence of a salary. The district court denied Appellant’s petition for judicial review. The Supreme Court reversed, holding (1) for self-employed individuals, the lack of a salary associated with typical employment does not preclude an average monthly wage calculation for the purpose of determining lost income and rendering a workers’ compensation benefit decision; and (2) the appeals officer in this case should have determined the best method for calculating any loss to Appellant’s wages resulting from his industrial injury, taking into account both his business’s income and expenses. Remanded. View "Mensah v. CorVel Corp." on Justia Law

Plaintiffs filed suit against Liberty Mutual, seeking to recover flood-insurance proceeds after their house was damaged by Hurricane Isaac. Plaintiffs submitted an original signed, sworn proof of loss with the handwritten note “Will send supplement later," and later sought payment from Liberty Mutual for the supplemental amount without providing a second proof of loss.The district court granted summary judgment for Liberty Mutual. Consistent with the First and Eighth Circuits, the court held that a second proof of loss was necessary for plaintiffs to perfect their claim. Therefore, the court concluded that the district court properly granted summary judgment for Liberty Mutual. Because plaintiffs have made no argument that the evidence was indeed “newly discovered” for purposes of Rule 59(e), the court found no abuse of discretion in the district court’s denial of plaintiffs' motion for reconsideration. View "Ferraro v. Liberty Mutual Ins. Co." on Justia Law

Viktor Barengolts was driving a tractor-trailer on Route 30 in Wheatland Township, Illinois when he rear-ended the Bernals in their pickup truck, causing serious injuries and property damage. The Bernals sued Unlimited Carrier, the company whose placard appeared on the tractor at the time; Viktor Barengolts; and Michael Barengolts, who owned the tractor. Viktor contacted Artisan, his insurance provider, which denied coverage, stating that the Contingent Liability Endorsement excluded coverage because he was driving the tractor on behalf of Unlimited Carrier at the time of the accident. The policy lists Viktor as an insured and Michael as an additional insured. Michael’s tractor is covered. Counsel for Unlimited Carrier wrote to Artisan, demanding that it defend the Barengoltses. Artisan refused. Michael disclosed that he did not sign a lease with Unlimited Carrier for use of the tractor until eight days after the accident. Counsel for the Barengoltses again unsuccessfully tendered the defense and sought indemnity. NAICO, the insurer for Unimited Carrier, defended the Barengoltses under a reservation of rights and paid settlements totaling $98,750 to the Bernals. The Seventh Circuit affirmed that Artisan had a duty to defend, that it breached that duty, and that Artisan was estopped from asserting defenses under its policy, stating that Artisan gambled and lost. View "Nat'l Am. Ins. Co. v. Artisan & Truckers Cas. Co." on Justia Law

Appellant was one of nineteen individuals injured when a school bus was struck by an at-fault vehicle. Appellant sought excess underinsured motorist (UIM) coverage benefits from his family’s automobile policy with American Family Mutual Insurance Company because his damages exceeded the recovery available to him under the coverage of the school bus. American Family denied Appellant’s claim for excess UIM benefits, claiming that, pursuant to the Minnesota No-Fault Automobile Insurance Act, Appellant’s excess UIM coverage ($100,000) did not “exceed” the UIM coverage provided by the school bus’s insurance ($1,000,000). Appellant then brought this action, seeking the difference between the recovery he received and his UIM policy limits from American Family. The district court granted summary judgment in favor of American Family, and the court of appeals affirmed. The Supreme Court reversed, holding (1) the phrase “coverage available,” as used in Minn. Stat. 65B.49(3)(a)(5), in reference to the “excess insurance protection” for an injured insured, is ambiguous; and (2) the phrase “coverage available” means the benefits actually paid to the insured under the coverage provided by the occupied vehicle’s policy. View "Sleiter v. Am. Family Mut. Ins. Co." on Justia Law

In 2009, Carol McClue was involved in a serious car accident. At the time of the accident, Carol had underinsured motorist (UIM) insurance coverage through Safeco Insurance Company of Illinois. In 2011, Carol was diagnosed with bulbar ALS. In 2013, Carol died from the illness. After the diagnosis, Dan McClue, Carol’s husband, submitted claims to Safeco for UIM benefits for damages associated with Carol’s ALS. Safeco denied the claims. Dan subsequently filed suit against Safeco, asserting that Safeco breached the insurance contract by failing to provide UIM benefits for Carol’s ALS. Before trial, the district court granted Safeco’s motions in limine to exclude expert testimony from two doctors - Dr. John Sabow and Dr. Decontee Jimmeh-Fletcher. The district court subsequently granted summary judgment to Safeco on the grounds that, without the expert testimony, Dan did not have admissible evidence to establish that the car accident caused Carol’s ALS. The Supreme Court (1) affirmed the district court’s ruling barring Dan from using Dr. Jimmeh-Fletcher’s testimony to establish causation in this case; but (2) reversed the district court’s ruling that Dr. Sabow was not qualified to present expert testimony during trial. View "McClue v. Safeco Ins. Co. of Ill." on Justia Law

In 2011, a tornado struck and substantially damaged Midwest’s building and its contents. After the tornado, the medical practice was to relocate, which required substantial work. Until construction was complete, Midwest operated out of a temporary location, but was unable to operate at its normal capacity. Moving the repaired MRI machine to the new building required a crane; it was necessary to reinforce floors; replace exterior brick; and install pipe, specialized heating and air conditioning equipment, and copper shielding. The new location opened about a year after the tornado. Cincinnati Insurance paid Midwest the policy limit of $2,414,161.26 for the building; the policy limit of $388,000 for business personal property; and $828,081.75 for business income interruption and extra expenses. . Midwest requested “Extra Expense” reimbursement for the costs to repair and relocate the MRI machine and to replace the other specialty equipment necessary for normal operations. Cincinnati denied payment, contending the expenditures were covered under the Building or Business Personal Property provisions, for which it had paid the policy limits. The district court found the claimed expenses were recoverable under the Extra Expense provision. The Eighth Circuit affirmed, noting that the language of the Policy does not specifically exclude coverage under the Extra Expense provision if the expenses happen to fall under another coverage in the Policy. View "Midwest Reg'l Allergy Ctr., P.C. v. Cincinnati Ins. Co." on Justia Law

Cox spent millions of dollars cleaning up pollution and debris after Hurricane Katrina caused extensive damage to the oil-and-gas facilities it operated. St. Paul, Cox's liability insurer, reimbursed Cox for $1.4 million and then filed suit seeking a declaration that the remainder of Cox’s costs were not “pollution clean-up costs” covered by the policy. Cox counterclaimed. The district court entered judgment awarding Cox damages for breach of the policy and penalty interest under the Texas Prompt Payment of Claims Act, Tex. Ins. Code Ann. 542.051-.061. The court concluded that the plain language of the Act provides that a violation of any of the Act’s deadlines - including St. Paul’s violation of the section 542.055(a) deadline here - begins the accrual of statutory interest under section 542.060. Therefore, the court rejected St. Paul’s argument that, notwithstanding an insurer’s violation of section 542.055(a), interest cannot begin to accrue until 60 days after the insurer receives sufficient information which would allow the insurer to adjust the claim. Because this argument is the only argument that either party has raised against the district court’s determination of the interest-accrual period, the court found no reversible error in the district court’s award of penalty interest to Cox. Accordingly, the court affirmed the judgment. View "Cox Operating, LLC v. St. Paul Surplus Lines Ins. Co." on Justia Law