Justia Insurance Law Opinion Summaries

Piedmont Office Realty Trust, Inc. purchased two insurance policies: a primary policy issued by Liberty Surplus Insurance Company and an excess coverage policy issued by XL Specialty Insurance Company ("XL"). The excess policy provided that XL will only pay for a "loss" which Piedmont became "legally obligated to pay as a result of a securities claim." The policy also contains a "consent to settle" clause. In addition, the policy contains a "no action" clause which read: "No action shall be taken against the insurer unless, as a condition precedent thereto, there shall have been full compliance with all of the terms of this policy, and the amount of the insureds’ obligation to pay shall have been finally determined either by judgment against the insureds after actual trial, or by written agreement of the insureds, the claimant and the insurer." Piedmont was named as a defendant in a federal securities class action suit in which the plaintiffs sought damages exceeding $150 million. Relatively early in the litigation, Piedmont moved for summary judgment. The district court denied Piedmont’s motion. Thereafter, following years of discovery and litigation, Piedmont renewed its summary judgment motion. The district court granted the renewed motion and dismissed the class action suit. Plaintiffs appealed. While the plaintiffs’ appeal was pending, plaintiffs and Piedmont agreed to mediate plaintiffs’ claim. By that time, Piedmont had already exhausted its coverage limit under its primary policy and another $4 million of its excess policy simply by defending itself. Anticipating a settlement with plaintiffs, Piedmont sought XL’s consent to settle the claim for the remaining $6 million under the excess policy. XL agreed to contribute $1 million towards the settlement, but no more. Without further notice to XL and without obtaining XL’s consent, Piedmont agreed to settle the underlying lawsuit with plaintiffs for $4.9 million. The district court approved the settlement and Piedmont demanded XL provide coverage for the full settlement amount. XL refused. Piedmont filed suit against XL for breach of contract and bad faith failure to settle. XL moved to dismiss the complaint; the district court granted XL’s motion; and Piedmont appealed. The 11th Circuit certified three questions to the Georgia Supreme Court: (1) Under the facts of this case, was Piedmont "legally obligated to pay" the $4.9 million settlement amount, for purposes of qualifying for insurance coverage under the Excess Policy?; (2) In a case like this one, when an insurance contract contains a "consent-to-settle" clause that provides expressly that the insurer's consent "shall not be unreasonably withheld," can a court determine, as a matter of law, that an insured who seeks (but fails) to obtain the insurer's consent before settling is flatly barred from bringing suit for breach of contract or for bad-faith failure to settle?; and (3) In this case, under Georgia law, was Piedmont's complaint dismissed properly? The Georgia Supreme Court responded: absent XL’s consent to the settlement, under the terms of the policy, Piedmont could not sue XL for bad faith refusal to settle the underlying lawsuit in the absence of a judgment against Piedmont after an actual trial. It follows that the district court did not err in dismissing Piedmont’s complaint. View "Piedmont Realty Office Trust v. XL Specialty Insurance Co." on Justia Law

Nova is the trustee and fiduciary of the Charter Oak Benefit Plan. A participating employer took out insurance policies on its employee’s (Spencer) life, totaling $30 million, and placed them into the Plan. Spencer named Universitas as the sole, irrevocable beneficiary. After Spencer’s death, the insurer paid $30 million to the Plan. Nova denied Universitas’s claim for the proceeds. In binding arbitration, an arbitrator held Nova liable for $26,558,308. Nova declined to pay, filing suit to vacate the arbitration award. The court confirmed the award. Nova moved for reconsideration and for a stay of post‐judgment discovery, then moved to dismiss for lack of subject matter jurisdiction. All were rejected. The district court granted Nova’s application to reinstate the motion to dismiss, but warned of potential penalties. Nova’s then‐counsel withdrew the motion; new counsel filed an amended motion, arguing complete diversity was lacking because Charter Oak was a citizen of New York, as was Universitas. Charter Oak was not a party; Nova argued that it was “a real and substantial party to the controversy.” The district court dismissed the motion. Nova refused to pay or to cooperate in discovery of its assets. The Second Circuit affirmed, awarding costs. The district court then sanctioned Nova by requiring it to deposit $30,181,880, the amount of the outstanding judgment, with the court. The Second Circuit vacated, holding that the court may not collect damages owed to a party by imposition of a sanction. View "Universitas Educ. LLC v. Nova Group Inc." on Justia Law

Plaintiffs, husband and wife, were struck by a motor vehicle being driven by Adam Pond while they were on a walk. At the time of the accident, the Connors owned a vehicle insured by Government Employees Insurance Co. (GEICO). The terms of the policy included underinsured motorist (UIM) coverage of $300,000 per person/$300,000 per accident. Pond maintained automobile liability insurance with Allstate Insurance Co. limited to $100,000 per person/$300,000 per accident. Plaintiffs settled with Allstate. Pursuant to the settlement, Allstate paid $100,000 to each plaintiff. Plaintiffs then submitted claims for underinsured motorist coverage to GEICO under the terms of the policy, seeking $300,000 total from GEICO. GEICO paid Plaintiffs $100,000. Plaintiffs then filed a complaint for declaratory judgment against GEICO as to the $200,000 in dispute. The trial court granted summary judgment in favor of GEICO. The Court of Appeals affirmed, holding that under the unambiguous terms of the policy, the total damages due to Plaintiffs as a couple were capped at $300,000, and because Allstate already paid each Plaintiff $100,000, which amounts were deducted from the amount that GEICO would be required otherwise to pay Plaintiffs, GEICO was responsible for the remaining $100,000. View "Connors v. Gov't Employees Ins. Co." on Justia Law

Vu Vo filed a lawsuit against Christopher Bartolomucci seeking damages for injuries he sustained in a vehicle collision. Bartolomucci filed a declaratory judgment action seeking to establish that his vehicle he was driving at the time of the collision fell within the scope of the Federal Insurance Company’s insurance policy issued to Bartolomucci’s law firm. The circuit court allowed Bartolomucci’s suit to continue on the theory that he was covered by the policy. After a jury trial, the circuit court entered judgment in favor of Federal Insurance, holding that the policy did not cover Bartolomucci’s use of the vehicle at the time of the collision. At issue on appeal was the scope and application of the policy, which provided coverage for Bartolomucci’s vehicle only when that vehicle was “used in” the law firm’s business or personal affairs. The Supreme Court affirmed, holding that the policy did not cover Bartolomucci’s use of the vehicle at the time of the collision because a morning commute by a law firm partner from home to work does not constitute “use” of the partner’s vehicle “in” a law firm’s business or personal affairs. View "Bartolomucci v. Federal Ins. Co." on Justia Law

Patricia Doss filed a claim for workers' compensation with the Department of Labor and Industries after suffering chemical exposure during the course of employment with The Boeing Company. The exposure permanently aggravated her preexisting asthma, and she needed ongoing medical treatment as a result of these combined injuries. The Department determined that the combined effects of Doss's preexisting asthma and the aggravation of this condition during her Boeing employment rendered her permanently totally disabled. A right knee injury also contributed to Doss's preexisting disability. Due to her permanent total disability, the Department awarded Doss a pension. Boeing agreed to pay for the portion of the pension attributable to Doss' workplace injury but challenged the Department's order requiring it to pay for her postpension medical treatment. Boeing argued that the cost of this treatment should also be covered by the second injury fund. Boeing appealed to the Board. The issue this case presented for the Supreme Court's review centered on whether Boeing, as a self-insured employer, was entitled to second injury fund relief for a Doss' postpension medical costs. The Washington Supreme Court held that the plain language of the governing statutes did not allow a charge to the second injury fund for postpension medical treatment. Accordingly, the Court reversed the Court of Appeals. View "Boeing Co. v. Dep't of Labor & Indus." on Justia Law

Most federal employees receive health benefits through the Federal Employee Health Benefits Program (FEHBP). Until the 2010 enactment of the Patient Protection and Affordable Care Act (ACA), members of the U.S. Senate and House of Representatives, and their staff members, were eligible for FEHBP insurance. The ACA limited their options to plans created under the ACA or offered through a health insurance exchange established under the ACA; they could no longer receive insurance through the FEHBP (42 U.S.C. 18032(d)(3)(D)). The Office of Personnel Management conducted notice-and-comment rulemaking and issued the final rule, 78 Fed. Reg. 60653-01. Senator Johnson and his legislative counsel sought to enjoin implementation of that rule, which, they claimed, was contrary to the ACA and other law because it allows the government to make pre-tax employer contributions to non-FEHBP plans and makes members of Congress and their staffs eligible for an ACA insurance exchange reserved for small businesses. The Seventh Circuit affirmed dismissal, finding that the plaintiffs had not identified a judicially cognizable injury that is traceable to aspects of the OPM regulation that they challenge. The court noted that the challenged regulation creates a benefit for Senator Johnson and that he is free to decline that benefit. View "Johnson v. United States Office of Pers. Mgmt." on Justia Law

From 1998 to 2012 Abbott marketed the anticonvulsant medication Depakote for applications that had not been FDA-approved (off-label uses). Physicians may prescribe drugs for off-label uses, but pharmaceutical companies are generally prohibited from marketing drugs for those same applications. Qui tam actions were filed under the False Claims Act. In 2009, Abbott disclosed in an SEC filing that the Department of Justice was investigating its marketing. Abbott pleaded guilty to illegally promoting Depakote from 2001 through 2006 and agreed to pay $1.6 billion to settle the criminal and qui tam actions. Employee benefits funds filed suit 15 months later, alleging that Abbott misrepresented Depakote’s safety and efficacy for off-label uses, paid kickbacks to physicians, established and funded intermediary entities to promote the drug for off-label uses, and concealed its role in these activities, in violation of the Racketeer Influenced and Corrupt Organizations Act. The district court dismissed, finding that the statute of limitations for the RICO claim began to run in 1998, when the funds initially reimbursed a prescription for off-label use. The court refused to toll the limitations period until the guilty plea, finding that Abbott’s concealment efforts were not designed to hinder potential lawsuits. The Seventh Circuit reversed, finding that dismissal was premature without an opportunity for discovery into when a reasonable fund should have known about its injuries from off-label marketing. View "Sidney Hillman Health Ctr. of Rochester v. Abbott Labs., Inc." on Justia Law

Defendant-appellant J. Brian O'Neill purchased the Bryemere, a sport-fishing vessel, in 2006. As he negotiated the Bryemere’s price, O’Neill incorporated a limited-liability company in the state of Rhode Island, Carolina Acquisition, LLC to take ownership of the vessel. O’Neill then applied for a preferred ship mortgage with Bank of America, N.A. (BOA) to fund the Bryemere’s cost. O’Neill signed the mortgage in his capacity as managing member of Carolina, using the ship as collateral. As a condition of the loan, BOA required proof of insurance for the Bryemere, and requested that the insurance policy contain a mortgage clause that would protect BOA’s interests as a mortgagee in the event the underlying insurance policy was found void. O’Neill’s insurance broker, Willis of Pennsylvania, Inc., sought an insurance quote for the Bryemere from AIG Centennial Insurance Company. Susan Bonner, an underwriter, handled the application process on behalf of AIG. Sharon King, a broker, was assigned to O’Neill’s case on behalf of Willis. Instead of working directly with King, O’Neill delegated the task of obtaining insurance for the Bryemere to his executive secretary, Desiree Foulds. Instead of explaining the insurance-application process to Foulds, King forwarded the application to Foulds without comment and returned the application Foulds had completed to Bonner without reviewing it for accuracy or completeness. Foulds made three mistakes on the application that were relevant to this appeal: (1) she listed O’Neill as the owner of the vessel instead of Carolina; (2) in response to a question about whether the owner or captain had ever suffered any “losses,” she disclosed one prior loss in 2003, when O’Neill lost a boat due to fire, when in fact (by his own admission at trial) O’Neill had suffered two additional losses that went undisclosed: propeller damage to his Ocean yacht and a blown engine on his sailing vessel; and (3) Foulds listed the Bryemere’s purchase price as $2.35 million, when the closing statement reflected a purchase price of $2.125 million. AIG issued the final policy. Following the Bryemere’s purchase, O’Neill invested $225,000 to pay for repairs recommended for the ship. During the voyage from Florida to Rhode Island, the crew “noticed considerable flexing in the vessel’s hull.” Upon arrival in Rhode Island, several marine experts inspected the Bryemere and concluded that it suffered from a number of structural defects rendering the vessel, in the words of one marine surveyor, “un-seaworthy, dangerous and unsafe for any use.” O’Neill then submitted a claim to AIG for coverage under his insurance policy. In response, AIG filed a declaratory judgment action with the federal district court in Florida seeking affirmation that the insurance policy was void ab initio as to both O’Neill and BOA. After an eight-day bench trial, the District Court issued an order finding that neither O’Neill nor BOA could recover under the policy. As to O’Neill, the District Court held that the misrepresentations regarding O’Neill’s prior loss history and the Bryemere’s purchase price rendered the policy void ab initio under the maritime doctrine of uberrimae fidei. As to BOA, the District Court held, among other things, that the named insured on the policy, O’Neill, was not the mortgagor on the loan and that BOA had no rights under the standard mortgage clause as a result. O’Neill and BOA appealed. But finding no reversible error, however, the Eleventh Circuit affirmed the district court. View "AIG Centennial Insurance Co. v. O'Neill" on Justia Law

Customers of a securities firm made claims against that firm based on real estate investments the firm’s broker-dealers recommended. An entity that had an interest in and operated each of the real estate investments filed for bankruptcy, and at least some of the real estate investments became debtors in that bankruptcy proceeding. The appointed examiner in the bankruptcy proceeding found that the entity was engaged in a fraudulent “Ponzi scheme.” When the securities firm applied for professional liability insurance, it disclosed one of the customer claims but not the facts that would support other potential customer claims arising out of investments through the same entity as that involved in the disclosed claim. The insurer refused to defend against undisclosed claims because the policy’s application included an exclusion for nondisclosure of facts that might lead to a claim. The court of appeal affirmed judgment in favor of the insurer: There was no insurance coverage because all of the undisclosed claims arose out of the same events as the disclosed claim. The securities firm was aware of facts and circumstances that might result in a claim or claims being made against it, which awareness it was required to disclose. View "Crown Capital Secs., L.P. v. Endurance Am. Specialty Ins. Co." on Justia Law

The Patient Protection and Affordable Care Act (ACA) creates “navigators,” to assist consumers in purchasing health insurance from exchanges, 42 U.S.C. 18031(i), and authorizes the Department of Health and Human Services to establish standards for navigators and exchanges. HHS regulations recognize: federal navigators, certified application counselors (CACs), and non-navigator assistance personnel. They conduct many of the same activities, but federal navigators have more extensive duties. Plaintiffs, federally-certified counselor designated organizations, employ CACs. The federal government established a Missouri Federally Facilitated Exchange. The Health Insurance Marketplace Innovation Act (HIMIA), Mo. Rev. Stat. 376.2000, regulates “person[s] that, for compensation, provide[] information or services in connection with eligibility, enrollment, or program specifications of any health benefit exchange.” Regulatory provisions dictate what state navigators and cannot do. Plaintiffs challenged: the definition of state navigators; three substantive provisions; and penalty provisions. The district court granted a preliminary injunction, finding that the ACA preempted HIMIA. The Eighth Circuit affirmed in part, finding likelihood of success in challenges to HIMIA requirements that: state navigators refrain from providing information about health insurance plans not offered by the exchange; that in some circumstances, the navigator must advise consultation with a licensed insurance producer regarding private coverage; and that CACs provide information about different health insurance plans and clarify the distinctions. The court vacated the preliminary injunction, holding that ACA does not entirely preempt HIMIA. View "St. Louis Effort For AIDS v. Huff" on Justia Law