Justia Insurance Law Opinion Summaries

The appeals before the Tenth Circuit in this opinion concerned the regulations (as a part of the Affordable Care Act ("ACA")) that required group health plans to cover contraceptive services for women as a form of preventive care ("Mandate"). In response to religious concerns, the Departments implementing the ACA (Health and Human Services ("HHS"), Labor, and Treasury) adopted a regulation that exempted religious employers (churches and their integrated auxiliaries) from covering contraceptives. When religious non-profit organizations complained about their omission from this exemption, the Departments adopted a regulation that allowed them to opt out of providing, paying for, or facilitating contraceptive coverage. Under this regulation, a religious non-profit organization could opt out by delivering a form to their group health plan’s health insurance issuer or third-party administrator or by sending a notification to HHS. The Plaintiffs in the cases here were religious non-profit organizations. They argued that complying with the Mandate or the accommodation scheme imposed a substantial burden on their religious exercise. The Plaintiffs argued the Mandate and the accommodation scheme violated the Religious Freedom Restoration Act (“RFRA”) and the Religion and Speech Clauses of the First Amendment. While Tenth Circuit recognized the sincerity of Plaintiffs’ beliefs and arguments, it concluded the accommodation scheme relieved Plaintiffs of their obligations under the Mandate and did not substantially burden their religious exercise under RFRA or infringe upon their First Amendment rights. The Court affirmed the district court’s denial of a preliminary injunction to the plaintiffs in Little Sisters of the Poor Home for the Aged v. Sebelius, (6 F.Supp. 3d 1225 (D. Colo. 2013)), and reversed the district courts’ grants of a preliminary injunction to the plaintiffs in "Southern Nazarene University v. Sebelius," (No. CIV-13-1015-F, 2013 WL 6804265 (W.D. Okla. Dec. 23, 2013)), and "Reaching Souls International, Inc. v. Burwell," (No. CIV-13-1092-D, 2013 WL 6804259 (W.D. Okla. Dec. 20, 2013)). View "Little Sisters of the Poor v. Burwell" on Justia Law

While in the course and scope of his employment with Employer, Plaintiff suffered serious injuries. Plaintiff recovered workers’ compensation insurance benefits in the amount of $207,147. Plaintiff subsequently brought this action against Employer, alleging that Employer was an uninsured employer under the Workers’ Compensation Act at the time of the accident. The district court granted summary judgment in favor of Employer, concluding that Employer was an insured employer under the Act and was therefore entitled to tort immunity pursuant to Mont. Code Ann. 39-71-411. The Supreme Court affirmed, holding that the district court did not err in concluding that Employer was an insured employer under the Act and therefore was entitled to tort immunity. View "Stokes v. Golden Triangle, Inc." on Justia Law

Plaintiffs filed a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729 et seq., claiming that State Farm submitted false claims to the government for payment on flood policies arising out of damage caused by Hurricane Katrina. On appeal, plaintiffs primarily challenged the district court's discovery ruling and State Farm principally challenged the jury verdict. The court concluded that the district court's denial of plaintiffs' request for additional discovery after the verdict in their favor was an abuse of discretion because it affected plaintiffs' substantial rights and therefore, the court reversed the district court’s decision. However, the court affirmed the district court’s decisions with respect to the seal violations, subject matter jurisdiction, and State Farm’s motion for judgment as a matter of law. The court remanded for further proceedings. View "Rigsby v. State Farm Fire & Casualty Co." on Justia Law

This case involved a lease agreement between Greyhound Lines, Inc., the lessee, and Utah Transit Authority (UTA), the lessor, for a section of UTA’s intermodal transportation facility (intermodal hub). The insurance procurement provision of the lease agreement required Greyhound to purchase commercial general liability insurance covering UTA. At issue was whether the provision required that this insurance cover UTA’s negligent acts. This litigation resulted from a Greyhound passenger’s fall from a concrete pedestrian ramp during a layover at the intermodal hub. UTA admitted negligence in not installing a handrail on the pedestrian ramp. UTA settled the injured passenger’s claim and requested that Greyhound reimburse it for the cost of the claim under the lease agreement. Greyhound refused. The district court entered judgment against Greyhound. The Supreme Court affirmed, holding (1) under Utah law, an agreement to procure insurance for the benefit of another is not subject to strict construction; (2) the district court did not err when it concluded that the injured passenger’s claim triggered Greyhound’s duty to procure insurance that covered UTA’s negligent acts; and (3) the district court did not abuse its discretion in awarding UTA’s attorney fees. View "Utah Transit Auth. v. Greyhound Lines, Inc." on Justia Law

Procaccio purchased its workers' compensation insurance from West Bend. This litigation concerns three policy years: 2006, 2007, and 2010. Procaccio contends that West Bend’s offset procedure effectively nullified its Illinois Contracting Classification Premium Adjustment Program (ICC) credit for these policy years, resulting in substantial overcharges. The district court agreed and awarded a large sum in damages. The court concluded that the insurance policy contained no agreement to adjust the Schedule Modification credit after the ICC credit became due; West Bend needs parol evidence to prove its version of the parties’ agreement, but the insurance contract was fully integrated so any evidence of an oral understanding with Procaccio’s president is inadmissible; and while West Bend had the unilateral right to issue endorsements, that authority is cabined by contractual and statutory restrictions on its ability to alter its rates. The court further concluded that, even if the Schedule Modification credit was artificially inflated for these policy years, West Bend was not permitted to reduce it based on Procaccio’s ICC credit. Accordingly, the court affirmed the district court's judgment. View "West Bend Mut. Ins. Co. v. Procaccio Painting & Drywall" on Justia Law

Citizens Insurance appealed the district court's ruling that it had a duty to defend Liberty University in an underlying action. In the underlying action, Janet Jenkins filed suit against Liberty University, alleging that the school participated in a scheme to kidnap Jenkin's daughter in order to disrupt the parent-child relationship. The court concluded that the district court erroneously interpreted the Jenkins Complaint, the Separation of Insureds provision, and Virginia law. In this case, the Jenkins Complaint does not allege an "occurrence," and it triggers the policy's coverage exclusions. Accordingly, Citizens Insurance has no duty to defendant Liberty University. The court vacated and remanded. View "Liberty Univ. v. Citizens Ins. Co." on Justia Law

Under Ariz. Rev. Stat. 20-259.01, insurers must offer uninsured motorist (UM) and underinsured motorist (UIM) coverage to their insureds and may prove compliance by having their insureds sign a Department of Insurance (DOI) approved form selecting or rejecting such coverage. Plaintiff obtained car insurance from State Farm through Defendant, an insurance agent. Plaintiff requested that her policy include both UM and UIM coverage, but Defendant procured insurance that did not include UIM coverage. Plaintiff signed the DOI-approved form, which had been filled out by Defendant to reject UIM coverage. Plaintiff and her husband later sued Defendant for malpractice for failing to procure the insurance coverage they had requested. The trial court concluded that Defendant’s compliance with section 20-259.01 demonstrated that it fulfilled its duties to Plaintiff regarding the offer of UM/UIM coverage, and therefore, Defendant breached no duty owed to Plaintiffs. The court of appeals reversed, holding that section 20-259.01(B) did not abolish the common law duty of reasonable care insurance agents owe their clients. The Supreme Court affirmed, holding that compliance with section 20-259.01 does not bar a negligence claim alleging that the insurance agent failed to procure the UIM coverage requested by the insured. View "Wilks v. Manobianco" on Justia Law

Plaintiffs filed suit against Lincoln seeking to recover damages for the injuries they incurred from the insured. The court certified the following question to the Supreme Court of California: When determining whether an injury arises out of the “use” of a vehicle for purposes of determining coverage under an automobile insurance policy and an insurance company’s duty to defend, is the appropriate test whether the vehicle was a “predominating cause/substantial factor” or whether there was a “minimal causal connection” between the vehicle and the injury? View "Gradillas v. Lincoln General Ins." on Justia Law

Ray Dillard attempted to collect workers' compensation benefits from the president and majority shareholder of his employer. In 1997, The Commission held that Dillard suffered a compensable injury. After the mandate issues, one of Dillard's attorneys filed a lis pendens notice regarding several parcels of real property the company's president owned. Because none of that property belonged to the company itself, Dillard's attorney informed the president that it was asking the Commission to hold the president personally liable for Dillard's benefits because the company failed to carry workers' compensation insurance. Dillard died in 2005 while unresolved issues regarding who would ultimately be responsible for Dillard's benefits was pending before an administrative law judge. Dillard's estate filed a complaint at the circuit court against the president and company, claiming that the company was required to carry workers' compensation insurance but failed to do so. Therefore, the Estate argued the president was personally liable for Dillard's benefits. Among other things, the president argued that the Estate's claim was barred by the statute of limitations and the doctrine of res judicata. Eventually, the administrative law judge granted the Estate's renewed motion for summary judgment, and entered a judgment of approximately $223,000 against the president and the company "jointly and individually." The president appealed, and the case was assigned to the Court of Appeals. The appellate court held that Dillard's claim against the company president was barred by res judicata and the statute of limitations. The Supreme Court held the Court of Appeals erred in reaching that conclusion, reversed and reinstated the trial court's judgment in favor of Dillard. View "Jarrett v. Dillard" on Justia Law

Milton Harper, the managing partner and president of Banks, Finley, White & Company of Mississippi (“Banks”), suffered a severe stroke in August 2000, and died of another stroke in July 2001. His dependents sued Banks for workers’ compensation benefits. The administrative law judge and the Workers’ Compensation Commission held that Harper’s injuries and death arose out of the scope and course of his employment at Banks. On appeal, the circuit court agreed that substantial evidence in the record supported the Commission’s conclusion that Harper’s stroke arose out of his employment, but that court held that Harper’s dependents were barred from recovering workers’ compensation benefits because Harper had failed to obtain workers’ compensation insurance for Banks. In turn, the Court of Appeals in "Harper v. Banks, Finley, White & Co. of Mississippi," (136 So. 3d 462 (Miss. Ct. App. 2014)), held that Harper’s dependents were not barred from recovery because Section 71-3-79 of the Mississippi Code allowed members of partnerships to exempt themselves from workers’ compensation coverage by giving notice in writing. Because Harper had not opted out of coverage in writing, the Court of Appeals held that Banks was required to provide workers’ compensation benefits to Harper’s beneficiaries. On writ of certiorari, the Supreme Court affirmed in part, and reversed in part. The Court held that the Court of Appeals erred in applying Section 71-3-79 of the Mississippi Code to the facts of this case. Because Banks did not have workers’ compensation insurance coverage, there was no coverage for Harper to opt out of in writing as contemplated by Section 71-3-79. Instead, the Court held that Section 71-3-52 of the Mississippi Code controlled the analysis of this case: because Banks had more than five employees, it was required to obtain workers’ compensation insurance and provide workers’ compensation benefits to its employees. The Court affirmed the Workers’ Compensation Commission’s finding that Harper suffered a fatal injury through the course of his employment at Banks was supported by substantial evidence. View "Harper v. Banks, Finley, White & Co. of Mississippi, P.C." on Justia Law