Justia Insurance Law Opinion Summaries

Dakota Trailer Manufacturing, which makes radiator components for an unrelated company, performs its component work in one of Dakota Trailer’s locations that was originally classified as a “machine shop” for workers compensation insurance rating purposes. After an inspection, the National Council on Compensation Insurance changed the location’s classification to “welding or cutting.” Both the Workers’ Compensation Appeals Board and the South Dakota Department of Labor affirmed the new classification. The circuit court reversed and reinstated the machine shop code. The Supreme Court reversed, holding that the circuit court properly found that Dakota Trailer’s activities fit within the machine shop code. View "Dakota Trailer Mfg. v. United Fire & Cas. Co." on Justia Law

An employee at a boiler manufacturing plant sustained permanent hearing loss as a result of his employment. Between the time he was injured and the time he filed his workers’ compensation claim, the plant changed ownership. Twin City Fire Insurance Company insured the plant for the previous owner, and American Insurance Company insured the new owner. Counsel representing American mistakenly believed that American had insured the plant during the time of the injury, and Twin City was not given notice of the claim until after entry of an award. The new owner of the plant filed a declaratory judgment action against the previous owner and both insurers to determine who was liable for payment of the award. The district court determined that Twin City was liable for the employee’s workers’ compensation award. The Supreme Court affirmed, holding that the district court did not err in finding that Twin City was liable for the award, in rejecting Twin City’s equitable defenses, and in dismissing Twin City’s counterclaims. View "Cleaver-Brooks Inc. v. Twin City Fire Ins. Co." on Justia Law

Prentice Delon Hyler sought health care services from Action Chiropractic Clinic, LLC (Plaintiff) after she was injured in an automobile accident. Hyler executed an “Assignment of Rights” to Plaintiff for medical benefits payable to Hyler by Erie Insurance Exchange. Erie was the automobile liability insurance provider for the opposing driver involved in the accident. Erie and Hyler entered into a settlement agreement providing that Erie would pay Hyler $8,510 for claims relating to the accident. Plaintiff sued both Erie and Hyler seeking to recover the $5,010 it was owed from Hyler. The trial court granted Erie’s motion for summary judgment, concluding that the Assignment of Rights was not a valid assignment. The Supreme Court affirmed, holding that the assignment in this case was ineffective. View "Action Chiropractic Clinic, LLC v. Hyler" on Justia Law

The Court of Appeals held in Matter of State Farm Mut. Auto. Ins. Co. v. Amato that N.Y. Ins. Law 3420(f), which provides that all motor vehicle insurance policies must contain uninsured motorist coverage, has no application to police vehicles. Here, Respondent, a police officer, was injured when the driver of an underinsured vehicle struck the police car in which Respondent was a passenger and Michael Knauss was the driver. Knauss maintained an automobile liability insurance policy issued by State Farm that included a supplementary uninsured/underinsured motorist (SUM) endorsement. Respondent made a demand upon State Farm for underinsured motorist arbitration under the SUM endorsement of Knauss’s policy. State Farm refused payment, asserting that a police vehicle was not a covered “motor vehicle” within the meaning of the SUM endorsement. Supreme Court concluded that Knauss’s policy did not cover Respondent. The Appellate Division reversed, concluding that Amato was inapplicable to SUM coverage mandated by section 3420(f)(2) and defining “motor vehicle” for purposes of statutorily required SUM coverage as inclusive of police vehicles. The Court of Appeals reversed, holding (1) a police vehicle is not a “motor vehicle” covered by a SUM endorsement under section 3420(f)(2)(a); and (2) Amato remains binding precedent in this matter of statutory interpretation. View "Matter of State Farm Mut. Auto. Ins. Co. v. Fitzgerald" on Justia Law

Wheaton College, a nondenominational Illinois college, hires from a various Christian traditions and admits students of varied faiths, but requires all to sign a “Covenant” that requires them to “uphold the God-given worth of human beings, from conception to death.” The Covenant does not mention contraception, but Wheaton believes that “emergency contraception” is forbidden on religious grounds if it can destroy a fertilized ovum. Wheaton also opposes intrauterine devices (IUDs) that prevent implantation of a fertilized ovum. Wheaton excludes coverage of emergency contraception and IUDs from its health plans, but covers “traditional contraception.” Of the 20 types of FDA-approved female contraceptives, Wheaton disapproves only emergency contraceptives and certain IUDs. Wheaton challenged the Affordable Care Act as violating the Religious Freedom Restoration Act, 42 U.S.C. 2000bb-1, and the First Amendment, by making it complicit in the provision of emergency-contraception. The district court denied a preliminary injunction. The Seventh Circuit affirmed, stating: What had been Wheaton’s plan, concerning emergency contraception, the Affordable Care Act made the government’s plan when Wheaton refused to comply with the Act’s provision on contraception coverage. When notified that a health insurance provider has religious objections to providing coverage for some government-approved medical procedure, the government directs the insurer to provide the coverage itself. View "Wheaton College v. Burwell" on Justia Law

Plaintiffs (a class of 1,593) alleged that Visteon failed to deliver timely notice to ex-employees, offering them an opportunity to continue health insurance at their own expense, under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). An employer has 44 days after the end of a person’s employment to provide notice and essential details, 29 U.S.C. 1166(a)(2). The court found that Visteon had provided untimely notice to 741 former employees, and that the notice averaged 376 days late for those persons. The court awarded $2,500 to each class member who had received untimely notice (a total of about $1.85 million), a sum that does not depend on how long the delay was for any given person. While the suit was pending, Visteon was reorganized in bankruptcy. The plan provides that debts of this kind will be paid 50¢ on the dollar, so each of the 741 will receive $1,250. The court also ordered Visteon to pay class counsel $302,780 as attorneys’ fees plus costs of about $11,000. The Seventh Circuit affirmed the award of attorneys’ fees, but otherwise dismissed plaintiffs’ challenge to the penalty as untimely, having been filed several months after the district court’s delayed entry of judgment. View "Pierce v. Visteon Corp." on Justia Law

In 2011, Wanchetta Reese, individually and as owner and beneficiary of the life-insurance policy issued on the life of her husband Lee Reese, filed a complaint in the Etowah Circuit Court against the defendants, Alfa Life Insurance Corporation, Josh Griffith and Judy Russell, two licensed Alfa insurance agents. Reese advised Defendants that she sought to obtain life insurance on her husband so that she would have funds available to bury him in the event of his death. Mr. Reese suffered from several chronic conditions, including kidney disease and diabetes. Reese contended that after being advised of Lee Reese's medical condition, Griffith stated to Reese that he needed to ask Russell for advice in completing the insurance application. In the presence of Reese, Griffith advised Russell Lee Reese's medical issues, and Russell advised Griffith, in the presence of Reese, to not put that information in the application. Lee Reese passed away unexpectedly on May 23, 2010. Mrs. Reese turned to defendants to make a claim for benefits, and Alfa denied it in a letter dated August 16, 2010. In her complaint, Mrs. Reese raised several claims including breach of contract, bad faith, fraud and the tort of outrage. Defendants moved to dismiss, and the trial court granted the motion with respect to the outrage claim, and denied as to Reese's other claims. The Supreme Court, after review, reversed the trial court's denial of defendants' motion as to the remaining claims: the undisputed evidence showed: (1) that Reese improperly relied on the agents' oral representations regarding the validity of the application without making any attempt to read the life-insurance policy application; (2) that Reese made no attempt to inquire into or to investigate any inconsistencies between the agents' oral representations and the language of the application; and (3) that no exception to the duty to read applied here. View "Alfa Life Insurance Corp. v. Reese" on Justia Law

Timothy B. Johnson, a member of the Hunt Club, unintentionally shot and injured Danny Ray Marks, Jr. Marks filed suit against Johnson and the Hunt Club. Scottsdale, the insurer of the Hunt Club under a general liability policy, denied coverage, contending that the policy does not cover the Club members for their personal recreational activities but only for liability arising from some official action of the Club or actions undertaken on behalf of the Club. The magistrate judge granted summary judgment for Scottsdale. The court concluded that the policy unambiguously covered the Club members only with respect to their vicarious liability for the activities of the Club as an entity. In this case, Scottsdale has no duty to defend or indemnify Johnson where Marks alleges only that Johnson, a member of the Club, was on land leased by the Club and regularly used by Club members when he negligently fired his gun. As Marks concedes, that is not enough to bring his claim under the policy's Endorsement’s second clause, for member activities "on [the Club's] behalf." Nor does the complaint seek to hold Johnson vicariously liable "for [the Club's] activities" so as to trigger coverage under the first clause. Accordingly, the court affirmed the judgment. View "Marks, Jr. v. Scottsdale Ins. Co." on Justia Law

TES filed suit against State Farm, seeking a declaratory judgment that State Farm owes TES a duty to defend in an underlying lawsuit with Robin Singh Education Services involving test preparation services. The court concluded that the factual allegations in Singh’s Amended Counterclaim do not potentially include a trade dress infringement claim. Instead, the Amended Counterclaim alleges trademark infringement and false advertising claims. Neither of those claims is covered under the policy. Therefore, the district court was correct to grant summary judgment in favor of State Farm and the court affirmed the judgment. View "Test Masters Educ. Svc. v. State Farm Lloyds" on Justia Law

Plaintiff, the excess insurer, and Defendant, the primary insurer, issued insurance policies to a travel service company. The company was sued for damages resulting from an accidental death. The case was settled in an amount in excess of Defendant’s policy limit. Plaintiff filed a complaint against Defendant, alleging that Defendant acted in bad faith by rejecting multiple settlement offers within the limit of its primary liability policy. Defendant moved for judgment on the pleadings, arguing that Plaintiff lacked standing to assert a claim for insurer bad faith and that Plaintiff had no claim against Defendant for equitable subrogation. The federal district court certified a question to the Hawaii Supreme Court. The Supreme Court held that an excess liability insurer can bring a cause of action under the doctrine of equitable subrogation against a primary liability insurer who, in bad faith, fails to settle a claim within the limits of the primary liability policy when the primary insurer has paid its policy limit toward settlement. View "St. Paul Fire & Marine Ins. Co. v. Liberty Mut. Ins. Co." on Justia Law