Justia Insurance Law Opinion Summaries

Edwin Moreau worked at the W.R. Grace mine from 1963 until 1992. Edwin died of asbestos-related lung cancer in 2009. In 2013, Transportation Insurance, W.R. Grace’s workers’ compensation insurance carrier, accepted liability for Edwin’s medical expenses. Both the Libby Medical Plan, an entity established and funded by W.R. Grace to pay the medical care expenses of employees who were injured by asbestos exposure, and W.R. Grace refused to accept reimbursement from Transportation for the medical expenses the Plan had paid on Edwin’s behalf. Cristita Moreau, as personal representative of Edwin’s estate, demanded that the amount of reimbursement declined by the Plan and W.R. Grace should be paid either to Edwin’s Estate or to a charity selected by the Estate. After Transportation refused to pay the money, Moreau filed this petition to the Workers’ Compensation Court (WCC) to resolve the dispute. The WCC denied the petition, determining that it lacked jurisdiction to hear the matter because Moreau lacked standing. The Supreme Court reversed, holding that the Estate had standing and was entitled to have its petition determined on the merits. Remanded. View "Moreau v. Transp. Ins. Co." on Justia Law

Plaintiff, the administratrix of the estate of Georgette Dufresne, settled actions against two motorists whose negligence Plaintiff alleged caused Dufresne’s death. Plaintiff brought this action against Allstate Property and Casualty Insurance Company, Dufresne’s underinsured motorist carrier, alleging that she was entitled to recover underinsured motorist benefits under Dufresne’s policy. Allstate moved for summary judgment, asserting that Plaintiff was not entitled to underinsured motorist benefits because she had received payments from her settlements in an amount that exceeded Dufresne’s policy limit. The trial court agreed with Allstate and rendered judgment in its favor. The Supreme Court affirmed, holding that “an underinsured motorist carrier is entitled to judgment as a matter of law when all alleged tortfeasors settle the insured’s claims against them for the injuries giving rise to the underinsured motorist claim in an aggregate sum in excess of the policy limits.” View "Guarino v. Allstate Prop. & Cas. Ins. Co." on Justia Law

James Dickau was injured when he was struck by a vehicle driven by Irida Macomber. At the time of the accident, Dickau was covered by two insurance policies - a Dairyland Insurance Company policy and a Vermont Mutual personal umbrella policy. Dickau settled his claim against Macomber for her policy limit and also settled his claim for uninsured motorist benefits with Dairyland. Dickau then sought a declaratory judgment that his umbrella policy with Vermont Mutual provides for uninsured motorist coverage, and alternatively, that Vermont Mutual was required to provide uninsured motorist coverage under statute. The superior court granted Vermont Mutual’s motion for summary judgment. The Supreme Court affirmed, holding (1) Dickau’s umbrella policy with Vermont Mutual itself unambiguously provides no UM coverage; and (2) Maine’s UM statute does not require Vermont Mutual to provide UM coverage in the umbrella policy. View "Dickau v. Vermont Mut. Ins. Co." on Justia Law

Jonas and his wife purchased life insurance: each owned the policy on his or her life, with the other as beneficiary. When they divorced, the court reassigned ownership: Troy owned the policy on Jennifer’s life. Each policy provided that change in ownership “does not change the Beneficiary Designation.” Troy thought it unnecessary to redesignate himself as beneficiary. Jennifer died. Troy claimed the proceeds ($1 million). State Farm did not pay, concerned that the proceeds might belong to the children (named secondary beneficiaries) or to Jennifer’s estate under Tex. Family Code 9.301, which provides that if a divorce occurs after one spouse has designated the other as beneficiary of an insurance policy, the designation lapses. Texas law requires an insurer to pay within 60 days of receiving a claim and provides for “damages” at 18% a year plus reasonable attorneys’ fees. An insurer that receives “notice of an adverse, bona fide claim” may defer payment and file an interpleader action not later than the 90th day. State Farm did not receive any other claim, but filed an “interpleader” before the 60 days had run. The district court treated concerns about the potential rights of the children and Jennifer’s estate as equivalent to a claim and disbursed the money to Troy, who argued on appeal that he was entitled to attorneys’ fees and interest at 18%. The Seventh Circuit vacated for dismissal. When the litigation began, there was no justiciable controversy. View "State Farm Life Ins. Co. v. Jonas" on Justia Law

From 1995-2009, Johnson worked for CRE. In the last three years, Johnson worked from home, 8 hours a day at a computer. Johnson was covered under CRE’s United disability insurance policy. In 1999, Johnson was diagnosed with fibromyalgia. In 2004, she underwent neck surgery for nerve injuries. On the day she resigned, Johnson visited MacDonald, her primary care physician, who diagnosed anxiety, depression, fibromyalgia, and chronic pain. Johnson completed a short-term disability form. MacDonald completed an Attending Physician’s Statement. United denied the application. Based on the recommendations of its doctor, United denied Johnson’s appeal. Johnson sought long-term disability benefits. MacDonald completed a Physician’s Statement that imposed multiple limitations. United denied the claim. Johnson appealed. United referred Johnson’s file and medical records to Boscardin, an orthopedic surgeon, who determined that, although Johnson experienced chronic pain in her neck and spine, Johnson’s complaints were not supported by “conclusive, objective evidence.” McClellan, Johnson’s surgeon, responded that he “[o]verall” agreed with Boscardin. United denied the appeal. Johnson sued under ERISA. The district court granted Johnson summary judgment, finding that United failed to consider Johnson’s condition as a whole. The Eighth Circuit reversed, finding the denial supported by substantial evidence. View "Johnson v. United of Omaha Life Ins. Co." on Justia Law

Fred and Tina Preisler operated a dairy farm and raised cattle. The Preislers hired Kuettel’s Septic to apply septage, which is primarily composed of human urine and fecal material, to their farm fields. The Preislers subsequently experienced problems with their well water. The Preislers sued Kuettel’s Septic, other defendants, and their insurers, alleging, among other claims, negligence in storing and in applying septage resulting in nuisance and trespass. The circuit court granted summary judgment for the insurers, concluding that a pollution exclusion clause precluded coverage for harm resulting from the Preislers’ water supply’s contamination. The court of appeals affirmed. The Supreme Court affirmed, holding that “a reasonable insured would understand that decomposing septage is a ‘contaminant’ and therefore a ‘pollutant’ as defined in the policies when it has decomposed and seeps into a water supply.” View "Preisler v. Kuettel's Septic Serv., LLC" on Justia Law

In 2011, Robert and Jane Falk spread liquid cow manure onto their farm fields for the purpose of fertilization. The manure leeched into and contaminated the wells of the Falks’ neighbors. Wilson Mutual Insurance Company, the Falks’ insurer, filed a declaratory judgment motion claiming it did not have a duty to defend or indemnify the Falks against allegations that they negligently spread manure on their property and thereby polluted their neighbors’ wells. The circuit court granted the motion, concluding that the Wilson Mutual policy issued to the Falks contained an exclusion for pollution and that manure is unambiguously a pollutant. The court of appeals reversed, concluding that manure is not a pollutant because, to a reasonable farmer, manure is “liquid gold.” The Supreme Court reversed, holding that the pollution exclusion in the policy unambiguously excludes coverage for well contamination caused by the seepage of cow manure. View "Wilson Mut. Ins. Co. v. Falk" on Justia Law

Plaintiff Kathryn Kipling sued State Farm Automobile Insurance Company in Colorado federal district court for breach of contract because it did not pay her benefits under four insurance policies issued in Minnesota. The court determined that she would be entitled to benefits under Colorado law but not under Minnesota law. It then applied tort conflict-of-laws principles to rule that Colorado law governed. After its review, the Tenth Circuit held that the court erred by not applying contract conflict-of-laws principles. The district court was reversed and the matter remanded for further consideration. View "Kipling v. State Farm Mutual Automobile" on Justia Law

In 1988, Brake began working at Hutchinson. She was diagnosed with multiple sclerosis (MS) in 2000, but continued to work. Brake purchased disability insurance through Hutchinson’s plan in 1988. Hutchinson, as the plan administrator, ceded discretionary authority to Hartford to construe the plan and make eligibility determinations. In 2007, Brake purchased "buy-up" coverage that excluded a disability if medical treatment for that condition was rendered within 12 months prior to the effective date. The limitation ended after a year without a claim: if Brake was treated for MS between April 1, 2006, and April 1, 2007, and then became disabled as a result of MS before April 1, 2008, the exclusion would limit her benefits to core plan coverage. Brake began experiencing problems with her MS in 2007 and received benefits from a separate short-term disability plan. On March 25, 2008, she stopped working at Hutchinson. In May, she applied for LTD benefits, stating her onset of disability as July 27, 2007. Hartford informed her that her LTD benefits were approved, but not at the buy-up plan rate. Brake claimed that doctor visits during the 12 months were for a pap smear and a yearly routine MRI. Hartford cited the same records which indicated that Brake was increasingly less able to manage her MS conditions during the 12 months before her purchase of buy-up coverage. In Brake’s suit under ERISA, 29 U.S.C. 1001, the district court found that Hartford did not abuse its discretion. The Eighth Circuit affirmed summary judgment in favor of Hartford. View "Brake v. Hutchinson Tech., Inc.," on Justia Law

Electrical problems at a plastic bag manufacturing plant led to an increased number of defective bags being produced. A dispute arose between the manufacturer and its insurer regarding what provision of the policy covered the losses associated with the defective bags and regarding what policy limit should apply to the manufacturer’s property loss. The district court submitted both issues to the jury. The jury awarded the manufacturer damages for breach of the insurance contract. The Supreme Court reversed, holding that the district court erred in sending the two questions to the jury because (1) categorizing the insured’s loss under the policy is a question of law and not a question of fact, and (2) determining which policy limit applies presents a question of law. Remanded. View "Fed. Ins. Co. v. Coast Converters, Inc." on Justia Law