Justia Insurance Law Opinion Summaries

In purchasing a vehicle, Robin Hinkle and her former husband purchased GAP Insurance issued by Safe-Guard Products International, LLC (Safe-Guard). The Hinkles were told that the GAP Insurance would relieve them of payment owed on the vehicle if it was declared a total loss as a result of an accident and more was owed for the vehicle than the value assigned to it at the time it was totaled. Robin was later involved in an accident that resulted in her vehicle being declared a total loss. To pay off the balance owed on the vehicle, Robin submitted a claim to Safe-Guard under the GAP Insurance. Safe-Guard denied coverage. Robin subsequently filed this action against Safe-Guard, alleging breach of contract and bad faith. Robin filed a motion for partial summary judgment on the issue of whether the GAP Insurance constituted insurance under state law for purposes of this litigation. The circuit court granted the motion. Thereafter, Safe-Guard initiated the instant proceeding seeking a writ of prohibition to preclude enforcement of the partial summary judgment order. The Supreme Court denied the writ, holding that Safe-Guard’s GAP Insurance constituted insurance under the laws of West Virginia. View "State ex rel. Safe-Guard Prods. Int’l LLC v. Hon. Miki Thompson" on Justia Law

Lexon Insurance Company (“Lexon”) issued two performance bonds to DLM, LLC. Both bonds named Berkeley County as the obligee. DLM later defaulted under both bonds. Berkeley County filed this action against Lexon and DLM, seeking “specific performance of the Surety’s obligations according to the terms of the subject bonds” in addition to its costs and expenses. Berkeley County subsequently filed a motion for default judgment, pursuant to W. Va. R. Civ. P. 55(b)(1), against Lexon. The circuit court entered default judgment against Lexon for the total face value of the two bonds at issue, plus post judgment interest. The circuit court denied Lexon’s motion to set aside default judgment. The Supreme Court reversed the circuit court’s order denying Lexon’s motion to set aside default judgment, holding (1) because the damages sought in this case were not a “sum certain” as required by Rule 55(b)(1), default judgment was improperly granted under that rule; and (2) default judgment was improperly entered under the unique circumstances of this case where the parties failed to follow the Rules of Civil Procedure pertaining to the extension of the time for filing an answer. View "Lexon Ins. v. County Council of Berkeley County" on Justia Law

Client retained Attorney to handle various legal claims pertaining to the management of a trust. Attorney later came to represent Client and his wife in matters of their own estate planning and administration. Upon Attorney’s advice, Client made loans to both the Attorney’s law firm and to a business from which Attorney received a commission for the referral. Attorney did not make a written disclosure or advise Client to seek independent legal advice regarding these transactions. The loans were never repaid. Client filed a malpractice action against Attorney for breach of fiduciary duty. Judgment was entered in favor of Client. Client subsequently filed an equitable garnishment action against Attorney’s malpractice insurer (Insurer) seeking to recover the judgment under the policy. The trial court granted summary judgment for Insurer, concluding that coverage was excluded under the policy’s “legal representative of investors” exclusionary clause. The Supreme Court affirmed, holding that, under the facts of this case, the trial court was correct in holding that the exclusionary clause unambiguously excluded coverage for Attorney’s injurious acts and omissions. View "Taylor v. Bar Plan Mut. Ins. Co." on Justia Law

This action involved a dispute arising from the construction of a large house. Interstate Mechanical, Inc. initiated an arbitration action to recover payments it claimed as a result of its work on the house project. Abbey/Land LLC and Glacier Construction Partners LLC (collectively, Plaintiffs) then filed suit against Interstate in Montana District Court in Flathead County. Thereafter, Glacier asserted counterclaims in the Interstate arbitration proceeding and obtained a positive arbitration award against Interstate. Abbey/Land subsequently filed an amended complaint dismissing Glacier as a plaintiff and naming it as a defendant. Glacier tendered the Abbey/Land claims to its insurer, James River Insurance Company. James River refused to provide defense or indemnity. Glacier and Abbey/Land settled the Flathead County action as between themselves. James River moved to intervene in the Flathead County action to challenge the reasonableness of the confessed judgment against Glacier. Meanwhile, Abbey/Land and Glacier entered settlements with all other parties. The district court never ruled on James River’s motion to intervene and entered final judgment against Glacier. The Supreme Court reversed, holding that the district court erred in entering judgment without considering either its motion to intervene or the reasonableness of the confessed judgment. View "Abbey/Land LLC v. Interstate Mechanical, Inc." on Justia Law

Buckminster Fuller, “Bucky,” a designer, author, and inventor, well known for popularizing the geodesic dome, died in 1983. Beginning around 2009, Maxfield manufactured and distributed products under the Buckyball and related trademarks. According to its press release, Buckyballs, “the world’s best-selling desktoy,” were “inspired and named after famous … inventor, R. Buckminster Fuller.” Buckyballs are round magnets packaged in a cube shape, which can be formed into various shapes. The Big Book of Bucky, which provides instructions, states: Buckyballs were named for Buckminster Fuller. Fuller’s Estate sued, alleging: unfair competition, 15 U.S.C. 1125(a) (Lanham Act); invasion of privacy (appropriation of name and likeness); unauthorized use of name and likeness, Cal. Civil Code 3344.1; and violation of Cal. Business & Professions Code 17200. Alterra had issued an insurance policy to Maxfield, effective June 2010. Alterra agreed to defend under a reservation of rights, then sought a declaration that Alterra’s policy did not provide coverage. The Estate agreed to be bound by the outcome in return for being dismissed. Because of Maxfield’s stipulation to the allegations in the coverage action and acting without leave, the Estate later responded to Alterra’s complaint. The court of appeal affirmed a holding that Alterra had no duty to defend and no duty to indemnify, based on the “intellectual property” exclusion. View "Alterra Excess & Surplus Ins. Co. v. Estate of Buckminster Fuller" on Justia Law

Defendant-Appellant First Health Settlement Class appealed a superior court order that granted partial summary judgment in favor of plaintiff-appellee Chartis Specialty Insurance Company. This was one of a number of class action cases filed against First Health and others in the State of Louisiana. In those actions, medical service providers alleged that First Health violated notice provisions contained in a Louisiana statute known as the Preferred Provider Organizations Act. First Health ultimately entered into a settlement in which it resolved all of the Louisiana litigation. Chartis was First Health's errors and omissions insurance insurer. The policy had a number of exclusions, one of which was an exclusion for "penalties." The issue this case presented for the Delaware Supreme Court's review was whether the amount that First Health paid to settle the Louisiana litigation was a "penalty," and, therefore, not a covered loss under the insurance policy. The superior court concluded that the amount paid was a "penalty." The Delaware court disagreed, concluding that it was not a "penalty," and that the policy's exclusion for "penalties" did not apply. View "The First Health Settlement Class v. Chartis Speciality Insurance Co." on Justia Law

Defendant-Appellant CorVel Corporation appealed a superior court order that granted partial summary judgment in favor of plaintiff-appellee Homeland Insurance Company of New York. This was one of a number of class action cases filed against CorVel and others in the State of Louisiana. In those actions, medical service providers alleged that CorVel violated notice provisions contained in a Louisiana statute known as the Preferred Provider Organizations Act. CorVel ultimately entered into a settlement in which it resolved all of the Louisiana litigation. Homeland was CorVel's errors and omissions insurance insurer. The policy had a number of exclusions, one of which was an exclusion for "penalties." The issue this case presented for the Delaware Supreme Court's review was whether the amount that CorVel paid to settle the Louisiana litigation was a "penalty," and, therefore, not a covered loss under the insurance policy. The superior court concluded that the amount paid was a "penalty." The Delaware court disagreed, concluding that it was not a "penalty," and that the policy's exclusion for "penalties" did not apply. View "Corvel Corporation v. Homeland Insurance Company of New York" on Justia Law

Claimant worked at the Vermont State Hospital as a psychiatric technician and ward aide. His duties involved lifting and dealing with patients who could be combative. Claimant suffered work-related injuries on three separate occasions in 1987, 1992, and 1997. All of these claims related to low back pain. Claimant underwent surgery after each of these injuries and returned to work. After the 1992 injury, claimant's surgeon rated him with a 10% permanent impairment to his spine, and the State began paying permanent partial disability benefits. There was no new rating for the 1997 injury. This appeal came after a dispute over an order based on a worker's compensation agreement. Claimant injured his back again in 2002. Claimant received an 8% whole-person impairment rating, with 6% of that rating referable to a previous injury. Based on this rating, claimant executed an Agreement for Permanent Partial Disability Compensation (Form 22) with the State, which the Commissioner of the Department of Labor then approved. Six years after the commissioner ordered the award, claimant underwent two more permanency evaluations with different doctors who both used a method that the first doctor had not used. Each of the subsequent evaluations resulted in higher whole-person impairment ratings before consideration of the portion attributable to any pre-existing impairment. Based on the higher ratings, claimant made a claim for additional benefits related to the 2002 injury. Claimant asserted that the award should be modified because his medical condition had worsened, or, alternatively, that the parties had based their Form 22 agreement upon a material mistake of fact. The commissioner ruled in the State's favor. Claimant then appealed to the superior court, which reversed the decision of the commissioner and awarded claimant additional benefits after a bench trial. After review, the Supreme Court concluded that the differences between the doctors' impairment ratings in 2010 and an impairment rating from 2003 were insufficient to serve as grounds for reopening the original order for compensation. The Court therefore concluded as a matter of law that failed to meet his burden of demonstrating a mistake of fact sufficient to require reformation of the approved Form 22. The Court vacated the decision of the superior court as to the issues on appeal. View "Marshall v. Vermont State Hospital" on Justia Law

In 2000, Rochow sold his interest in Universico to Gallagher and became President of Gallagher. As Gallagher employee, Rochow was covered under a LINA disability policy. In 2001, Rochow began to experience short term memory loss, chills, sweating, and stress. Gallagher demoted Rochow and forced Rochow to resign in January, 2002. In February 2002, Rochow experienced amnesia, was hospitalized, and was diagnosed with HSV-Encephalitis, a rare, severely debilitating brain infection. LINA repeatedly denied Rochow benefits stating that Rochow’s employment ended before his disability began. Rochow sued Cigna, LINA’s parent company, alleging breach of fiduciary duty under ERISA, 29 U.S.C. 1104(a). In 2007 the Sixth Circuit affirmed a decision that denial of Rochow’s claims was arbitrary and did not appear to have been made solely in the interest of the participants and beneficiaries or the exclusive purpose of providing benefits to participants and beneficiaries as required by ERISA. Rochow died in 2008. In 2009, the district court ordered an equitable accounting of profits and disgorgement of $3,797,867 under an equitable theory of unjust enrichment. The Sixth Circuit affirmed in 2013. Following rehearing en banc, the Sixth Circuit later vacated the disgorgement award and remanded the case to determine whether Rochow is entitled to prejudgment interest. View "Rochow v. Life Ins. Co. of North Am." on Justia Law

Reverend Flesher participated in benefits plans administered by the Ministers and Missionaries Benefit Board (MMBB), a New York not‐for‐profit corporation. Flesher entered into the plans while married to Snow. Snow, also a reverend and MMBB policyholder, was listed as the primary beneficiary on both of Flesher’s plans. Snow’s father was the contingent beneficiary. When Flesher and Snow divorced in 2008 they signed a Marital Settlement Agreement; each agreed to relinquish rights to inherit from the other and was allowed to change the beneficiaries on their respective MMBB plans. Flesher, then domiciled in Colorado, died in 2011 without changing his beneficiaries. MMBB , unable to determine how to distribute the funds, and filed an interpleader suit. The district court discharged MMBB from liability, applied New York law, and held that Flesher’s estate was entitled to the funds. The Second Circuit certified to the New York Court of Appeals the question: whether a governing‐law provision that states that the contract will be governed by and construed in accordance with the laws of New York, in a contract not consummated pursuant to New York General Obligations Law 5‐1401, requires the application of New York Estates, Powers & Trusts Law 3‐5.1(b)(2), which may, in turn, require application of the law of another state. View "Ministers & Missionaries Benefit Bd. v. Snow" on Justia Law