Justia Insurance Law Opinion Summaries

In 2007, Jessica Gonzalez alleged she was sexually assaulted by Rebagliati and nine other members of the De Anza College baseball team. A year later, Gonzalez filed a civil lawsuit against her purported assailants. Rebagliati sought insurance coverage for his defense through his parents’ homeowner’s and personal umbrella policies, issued by Fire and Truck. Both companies denied coverage. Eventually, Rebagliati settled with Gonzalez, assigning Gonzalez his rights against Fire and Truck. Gonzalez sued the insurers for breach of the duty of good faith and fair dealing and breach of contract and sought recovery of judgment pursuant to Insurance Code section 11580. Her underlying allegations included accidental bodily injury, false imprisonment, invasion of privacy, and slander. Fire and Truck argued they had not owed Rebagliati a duty to defend. The trial court granted the insurers summary judgment. The court of appeal reversed in part. While none of Gonzalez’s claims can be construed to allege an accidental occurrence triggering coverage under the Fire policy, Truck’s umbrella policy is broadly worded and does not require an “accident” for personal injury coverage. View "Gonzalez v. Fire Ins. Exchange" on Justia Law

Appellant Jeffrey Allen, on behalf of his daughter, appealed the Administrative Law Court's (ALC) order affirming the Appeals Committee of the South Carolina Budget and Control Board Employee Insurance Program's (EIP Appeals Committee) decision to deny Appellant's insurance claim for his daughter's diabetes educational training session. Blue Cross's Appeals Review Committee upheld the denial of benefits on the basis that diabetes educational training was excluded under the State Health Plan, and that section 38-71-46 of the South Carolina Code, did not apply to the State Health Plan. Upon review, the Supreme Court reversed the ALC's decision that section 38-71­46 of the South Carolina Code did not apply to this matter. The EIP was mandated to promptly determine and pay the benefits that were due for Appellant's daughter under the State Health Plan. View "Allen v. SC Public Employee Benefit Authority" on Justia Law

The personal injury protection (PIP) statute provides that an injured person claiming PIP benefits shall submit to physical examinations by “physicians” selected by the insurer as required to assist in determining amounts due. Plaintiff was injured in an accident while riding in a vehicle insured by Progressive Insurance Company (Progressive). Progressive engaged Examworks, Inc. to arrange an independent medical examination (IME) of Plaintiff. A licensed physical therapist, but not a licensed medical doctor under the Commonwealth’s physician statute, examined Plaintiff. Plaintiff filed this action against Examworks on behalf of himself and similarly situated persons, alleging invasion of privacy and unfair or deceptive practices. The district judge dismissed the complaint. The Supreme Court affirmed, holding (1) the word “physicians” in the PIP statute refers to both licensed medical doctors and also other appropriate licensed or registered health care practitioners; (2) the invasions of privacy associated with the examination in this case were justified; and (3) Defendant’s claim that Examworks engaged in deception by leading him to believe that the physical therapist was a licensed medical doctor as the PIP statute required failed because the PIP statute does not require an IME to be performed by a licensed medical doctor. View "Ortiz v. Examworks, Inc." on Justia Law

This appeal stems from an arbitration decision regarding Peggy Cedillo's underinsured motorist insurance policy with Farmers Insurance Company of Idaho, and damages for injuries she suffered in a motorcycle accident. After the arbitrator issued his final award, Farmers provided the arbitrator evidence that Farmers had already paid Cedillo the total amount of remaining damages. The arbitrator adjusted the award by subtracting Farmers' payment from the prejudgment interest Farmers owed Cedillo. The district court confirmed the arbitrator's amended award and awarded Cedillo attorney fees. On appeal, Farmers argued the district court should have modified the award because the arbitrator miscalculated prejudgment interest by applying Farmers' payment to the interest award. Farmers also argued numerous grounds that Cedillo was not entitled to attorney fees. Finding no reversible error, the Supreme Court affirmed. View "Cedillo v. Farmers Insurance Co of Idaho" on Justia Law

Plaintiff-appellant Windsor Food Quality Company, Ltd. manufactured Jose Ole frozen food products, using ground beef supplied by Westland/Hallmark Meat Company. In 2008, after a voluntary United States Department of Agriculture (USDA) recall of Westland beef, Windsor made a claim under its Contamination Products Insurance policy issued by defendants-respondents QBE Insurance (Europe) Limited and Underwriters of Lloyds, London. After Lloyds denied coverage on various grounds, Windsor sued for breach of contract and bad faith. The trial court granted Lloyds's summary judgment motion, finding no triable issues of material fact and no coverage. Windsor appealed. Upon review, the Court of Appeal concluded that Windsor could not claim coverage for the recall of Westland's ground beef. The Court agreed with the trial court there were no disputed material facts and no bad faith by Lloyds. View "Windsor Food Quality v. Underwriters of Lloyds etc." on Justia Law

Highland Bank made a loan to FPC, an equipment lease finance company, based on an assignment of leases. The underlying leases, guaranteed by individuals, were ultimately discovered to be a Ponzi scheme. A guarantor claimed her signature was a forgery. Highland lost more than a million dollars. BancInsure denied Highland’s claim under a Financial Institution Bond that covered “Loss resulting directly from the Insured having . . . acquired, sold or delivered, given value, extended credit or assumed liability on the faith of any original . . . personal Guarantee . . . which bears a signature of any . . . guarantor . . . which is a Forgery.” BancInsure sought a declaratory judgment that Highland's claim was not covered. The district court granted summary judgment to BancInsure, finding that the loss did not “result directly from” a forged personal guaranty because the guaranty was worthless to the bank when it entered into the transactions. While appeal was pending, BancInsure was placed into receivership with the Oklahoma Insurance Commissioner as Receiver under a final order of liquidation. The Eighth Circuit affirmed. Highland failed to show the “direct relation between the injury asserted and the injurious conduct alleged” that the doctrine of proximate cause demands. View "BancInsure, Inc. v. Highland Bank" on Justia Law

Brooks was riding her bicycle when Lawrence negligently struck her with his car. Lawrence later died of unrelated causes. Brooks sued Lawrence’s estate, which settled for the $50,000 limit of Lawrence’s auto insurance policy. Brooks agreed not to seek additional recovery from Lawrence’s estate, heirs, or insurer, but retained the right to seek recovery from the Brookses’ auto insurance policy (Midwestern), which provides underinsured motorist (UIM) bodily injury coverage. On the declarations page for the UIM endorsement, the policy states, “Insurance is provided where a premium entry is shown for the coverage.” This page lists “Underinsured Motorist Bodily Injury” with liability limits of $100,000 per-person and $300,000 per-accident. A premium amount appears for each of five vehicles, indicating the Brookses pay a premium for UIM coverage for each vehicle. Midwestern paid $100,000, declaring this per-person limit the maximum amount for a single application of the policy’s UIM coverage, then sought declaratory judgment that its UIM coverage limits for multiple vehicles do not stack to multiply the per-person limit. Granting Midwestern summary judgment, the district court determined the plain language of the policy makes it “quite clear” intra-policy stacking is prohibited and the per-person limit for one accident is $100,000. The Eighth Circuit affirmed. View "Midwestern Indem. Co. v. Brooks" on Justia Law

In 1994, Investors Equity Life Insurance Company of Hawaii, Ltd. (IEL) was liquidated. The State Insurance Commission was appointed as IEL’s liquidator (Liquidator). In 1996, Investors Equity Life Holding Company (IELHC), the former parent company and sole shareholder of IEL, surrendered all of its shares in IEL to the Commissioner as part of a settlement agreement to resolve claims relating to IEL’s insolvency. The Liquidator proceeded to administer IEL’s estate. In 2008, IELHC wrote to the Liquidator claiming that it held legal or equitable title to all of IEL’s stock and demanding that the Liquidator turn over to IELHC all shares and assets remaining in IEL’s estate. The Liquidator denied the claim. The circuit court affirmed. The Supreme Court affirmed, holding (1) the circuit court did not err in concluding that IELHC asserted a claim against IEL’s estate and that the claim was time barred; (2) the circuit court had subject matter jurisdiction over IELHC’s claim and personal jurisdiction over IELHC; (3) there were no grounds for abating the adjudication of IELHC’s claim; and (4) the circuit court’s procedures met due process requirements. View "Ito v. Investors Equity Life Holding Co." on Justia Law

LuAnn Shubert fell and injured her lower back while working at a Macy’s store. She appealed the Idaho Industrial Commission’s order holding that she was: (1) medically stable on November 21, 2007; (2) not entitled to medical benefits beyond that date; (3) not entitled to temporary disability benefits; (4) entitled to a permanent partial impairment rating of 5% of the whole person; and (5) entitled to a 10% permanent partial disability rating. Shubert argued that she was entitled to ongoing medical care, temporary disability benefits, and total permanent disability benefits over 10%. Macy’s West (Macy’s) and Liberty Insurance Corporation argued that Shubert was rearguing the facts. Finding no reversible error in the Commission's decision, the Idaho Supreme Court affirmed. View "Shubert v. Macy's West, Inc." on Justia Law

The Eleventh Circuit Court of Appeals certified a question of Florida law to the Florida Supreme Court. Two cases before the Eleventh Circuit involved three Stranger-Originated Life Insurance (STOLI policies). Wells Fargo, N.A., the present owner of a STOLI policy on the life of Arlene Berger, appealed a district court's final judgment, entered in favor of Pruco Life Insurance Company, invalidating this policy. Regarding the second appeal, Pruco appealed a different district court's order dismissing its claim seeking the invalidation of two STOLI policies issued on the life of Rosalind Guild. The insurance company contended that, as with most STOLI policies, there was no such interest when these policies were issued, which the company says entitled it to have the policies declared void. Undermining the insurance company's argument, however, was another Florida statute requiring all insurance policies to include a clause providing that the policy is incontestable after it has been "in force" for two years. The policies at issue here contained such a clause, and the insurance company clearly failed to contest the policies within that two-year window. Thus, the question before the Eleventh Circuit was which statute controlled. Federal district courts have disagreed when asked how to interpret Florida law in this regard. View "Pruco Life Insurance Company v. Wells Fargo Bank, N.A." on Justia Law