Justia Insurance Law Opinion Summaries

Ibson and her family were insured by UHS through a policy available to her to as a member of her law firm. Due to an error, UHS began informing Ibson’s medical providers that Ibson and her family no longer had insurance coverage. Although UHS eventually paid the claims it should have paid all along, Ibson sued, raising state law claims of breach of contract, negligence, and bad faith, and seeking punitive damages. UHS responded that Ibson’s claims were preempted by the Employee Retirement Income Security Act (ERISA) and barred by the policy’s three-year contractual limitations period. The district court agreed and entered summary. The Eighth Circuit reversed and remanded, agreeing that Ibson’s state law claims are preempted under ERISA, but rejecting entry of summary judgment on the basis of the three-year contractual limitations period. View "Ibson v. United Healthcare Servs., Inc." on Justia Law

During a hail storm, all twenty of the townhome buildings managed by Cedar Bluff Townhome Condominium Association (Cedar Bluff) were damaged, with at least one siding panel on each building sustaining damage. Cedar Bluff submitted a claim to American Family Mutual Insurance Company (American Family) under its businessowners’ policy, which provided for the replacement of “damaged property with other property…[o]f comparable material and quality.” A dispute arose as to whether the policy required the replacement of all siding, including undamaged siding, in order to provide a color match. Because the parties were unable to agree on the amount of the loss, Cedar Bluff demanded an appraisal. The appraisal panel concluded that siding of comparable material and quality required a reasonable color match between the damaged and undamaged siding. American Family refused to pay the appraisal award. The court of appeals agreed with the appraisal panel, concluding that “a reasonable person could understand that ‘comparable material’ means material that is the same color as the damaged property.” The Supreme Court affirmed, holding that, under the terms of its policy with American Family, Cedar Bluff was entitled to have all of the siding panels on each of its twenty buildings replaced. View "Cedar Bluff Townhome Condo. Ass’n, Inc. v. Am. Family Mut. Ins. Co." on Justia Law

In 2010 the Georgia Department of Banking and Finance closed Community Bank & Trust. St. Paul, which provided liability coverage to the Bank’s officers and directors, sought a declaratory judgment in response to a separate lawsuit (underlying action) brought by the Federal Deposit Insurance Corporation (FDIC), as receiver for the Bank, against Miller and Fricks, former Bank officers. In that action, the FDIC alleged gross negligence and breaches of fiduciary duty related to the Bank’s Home Funding Loan Program and claimed more than $15 million in damages. Finding the policy’s an “insured-versus-insured” exclusion unambiguous, the district court held that there was no coverage. The exclusion precludes coverage only for actions brought “by or on behalf of any Insured or Company in any capacity.” Neither the exclusion nor the defined terms make any reference to the FDIC, regulators, or any liquidating entity. St. Paul argued that the FDIC “steps into the shoes” of the bank, as a receiver. The Eleventh Circuit reversed, finding the provision ambiguous. View "St. Paul Mercury Ins. Co. v. Fed. Deposit Ins. Corp." on Justia Law

This appeal stemmed from an action for auto negligence arising out of injuries sustained by Plaintiffs Rachael Montgomery and her three year old son, Noah Orcutt. Montgomery was rear-ended by Defendant Morgan Potter, who claims that her car brakes failed. As a result of Defendant's negligence, Montgomery claimed she sustained a severe back injury that required surgery. Among other damages sought Montgomery sought damages for her pain and suffering. Montgomery was an uninsured driver at the time of the accident. Citing 47 O.S. Supp. 2011, section 7-116, which prevents uninsured motorists from recovering certain non-economic damages such as pain and suffering, Defendant denied that Montgomery was entitled to damages for pain and suffering. Plaintiffs argued on appeal that section 7-116 was a special law in violation of art. 5, section 46 of the Oklahoma Constitution and filed a motion for declaratory relief declaring the statute unconstitutional. The trial court ruled in Plaintiffs' favor. The Supreme Court agreed: because 47 O.S.2011, section 7-116 impacted less than an entire class of similarly situated claimants it was under-inclusive and, therefore, the Court found it to be an unconstitutional special law prohibited by the Oklahoma Constitution. View "Montgomery v. Potter" on Justia Law

In 1999, Randall Simms was injured while on the job. Thereafter, Simms became totally disabled and, since 2006, had been receiving total disability benefits. Dr. Michael Schabacker was Simms’ workers’ compensation doctor from 2004 through 2007. In 2010, Simms filed a complaint against Schabacker and his employer, alleging that Schabacker had unlawfully disseminated his private, confidential healthcare information to a law enforcement officer without Simms' permission. The district court granted summary judgment in favor of Schabacker. The Supreme Court affirmed, holding that the district court did not err in concluding (1) Schabacker was statutorily authorized to release relevant healthcare information regarding Simms to the workers’ compensation insurer, and (2) Schabacker did not knowingly assist a law enforcement agency when he discussed Simms’ medical condition with the workers’ compensation insurer. View "Simms v. Schabacker" on Justia Law

Bibeau appealed the district court's grant of summary judgment and order directing it, as a related person to a disabled miner's former employer, to pay health insurance premiums, interest, and liquidated damages to the United Mine Workers of America 1992 Benefit Plan. The court concluded that Bibeau's laches claim was precluded under Petrella v. Metro-Goldwyn-Mayer, Inc. because each premium installment gives rise to a separate cause of action for legal relief for which Congress has enacted a statute of limitations to govern timeliness. Further, under the Coal Industry Retiree Health Benefit Act of 1992, 26 U.S.C. 9701-9722, which incorporates the Employee Retirement Income Security Act's (ERISA), 29 U.S.C. 1451(a)(1), enforcement scheme, the district court did not err in awarding interest and liquidated damages. Accordingly, the court affirmed the judgment. View "Holland v. Bibeau Construction Co." on Justia Law

In this matter, Appellants John and Kathy St. John challenged the Superior Court’s decision to affirm a declaratory judgment order finding Pennsylvania National Mutual Casualty Insurance Company (“Penn National”) liable for a judgment against its insured LPH Plumbing and Heating under a commercial general liability (CGL) insurance policy in effect from July 1, 2003 to July 1, 2004. The Supreme Court granted review to determine whether, under the facts of this case and the policy language at issue, Penn National was instead liable for the judgment against its insured under a separate policy of CGL insurance as well as a companion umbrella policy in effect from July 1, 2005 to July 1, 2006. Furthermore, the Court also considered whether the multiple trigger theory of liability insurance coverage (adopted by the Supreme Court in "J.H. France Refractories Co. v. Allstate Ins. Co.," 626 A.2d 502 (Pa. 1993)), within the context of asbestos bodily injury claims applied in this case, where property damage was continuous and progressive, to trigger coverage under all policies in effect from exposure to the harmful condition to manifestation of the injury. After review, the Supreme Court affirmed all aspects of the lower court’s decision finding that coverage was triggered under the policy in effect from July 1, 2003 to July 1, 2004, when property damage became reasonably apparent, and declining to apply the multiple trigger theory of liability insurance coverage. View "PA Natl Mut Casualty v. St. John" on Justia Law

In 2007, Jared Wolfe was injured when his vehicle was hit from behind by an automobile driven by Karl Zierle. Wolfe attributed blame to Zierle and demanded $25,000 from Zierle’s insurer carrier, Appellant Allstate Property and Casualty Insurance Company, equating to half the liability limits under the applicable policy. Allstate counteroffered $1,200, which Wolfe refused. Wolfe then instituted a personal injury action against Zierle seeking compensatory damages grounded in negligence. Allstate assumed Zierle’s defense while maintaining its additional right, under the policy, to effectuate a settlement. The Pennsylvania Supreme Court accepted certification from a federal appeals court to clarify whether, under Pennsylvania law, an insured may assign the right to recover damages from his insurance company deriving from the insurer’s bad faith toward the insured. The Court concluded that the entitlement to assert damages under Pennsylvania law may be assigned by an insured to an injured plaintiff and judgment creditor such as Wolfe. Having answered the certified question, the Court returned the matter to the federal court. View "Allstate Prop & Casualty Ins Co. v. Wolfe" on Justia Law

In an interlocutory appeal, the issues before the Supreme Court were: (1) whether a negligence claim brought against an insurer by its insureds for alleged statements made by the insurer’s adjuster and an engineer the insurer had retained (that mold the insureds discovered while performing home renovations was harmless and that they should continue their renovations) was barred by the “gist of the action” doctrine on the grounds that the true gist or gravamen of the action was an alleged breach of the insurance contract (their homeowners’ policy); and (2) whether the provisions of Pa.R.C.P. 1042.1 and 1042.3 required the insureds to obtain a certificate of merit in order for them to proceed with their negligence suit against the professional engineer employed by the insurer to evaluate the mold. After careful review, the Supreme Court held that the insureds’ negligence claim was not barred by the gist of the action doctrine, as the claim was based on an alleged breach of a social duty imposed by the law of torts, and not a breach of a duty created by the underlying contract of insurance. Furthermore, the Court concluded that the insureds were not required to obtain a certificate of merit in order to proceed with their negligence suit against the professional engineer, since they were not patients or clients of the engineering company which employed him. Consequently, the Court reversed the Superior Court and remanded for further proceedings. View "Bruno v. Erie Insurance" on Justia Law

Bonnie, a Trinity Health employee, enrolled her family in a Blue Cross group health plan. Trinity served as plan administrator. Bonnie took FMLA leave and then short-term disability leave, which expired June 8, 2011. Bonnie requested long-term disability benefits from Unum, which provisionally paid medical care claims under a “Reservation of Rights.” In October 2011 Unum denied Bonnie’s request but did not seek repayment. June 8, 2011 was the last day Bonnie qualified for benefits and was considered an employee. Her termination was not processed, so the family received benefits until Trinity deemed them retroactively terminated. The Coles were first alerted to their loss of insurance on June 1, 2012 by husband’s physician. They obtained insurance through husband’s employer, retroactively effective June 1, 2012. Blue Cross did not seek a refund of claims paid between January 1, and April 30, 2012. The Coles claimed violation of the Consolidated Omnibus Budget Reconciliation Act by failing to notify them of their right to continuing health care coverage. The district court declined to award statutory damages, reasoning that unreimbursed medical bills from May 2012 were less than the COBRA premiums they would have had to pay to maintain insurance. The Eighth Circuit affirmed. View "Cole v. Trinity Health Corp." on Justia Law