Justia Insurance Law Opinion Summaries

Judon was injured while riding in a commercial passenger vehicle that was insured by Travelers. Judon sought first-party medical benefits of $7,636.40. Travelers paid $5,000, up to the policy’s first-party medical benefits limit. Judon filed a class-action complaint in state court, alleging that Pennsylvania law required that the policy offer up to $25,000 in first-party medical benefits. Judon alleged that “there are hundreds of members of the class” who were wrongfully denied payment of first-party benefits. Travelers removed to federal court, under the Class Action Fairness Act (CAFA), 28 U.S.C. 1332(d), 1453, arguing that the parties were minimally diverse; the proposed class consisted of at least 100 putative members; and the amount in controversy exceeded $5,000,000. The district court remanded, finding that CAFA’s numerosity and amount-in- controversy requirements were disputed and placing the burden of proof on Travelers to establish jurisdiction. The Third Circuit affirmed in part and vacated in part. Judon’s complaint unambiguously pleaded that the numerosity requirement was satisfied, so the court should have placed the burden of proof on Judon to show, to a legal certainty, that the numerosity requirement was not satisfied. The court correctly applied the preponderance of the evidence standard to the amount-in-controversy requirement. View "Judon v. Travelers Prop. Cas. Co. of Am." on Justia Law

In 2000, while working at Homestake Mining Company, Michael Martz injured his shoulder. Martz was paid workers’ compensation benefits. In 2002, while working for McLaughlin Sawmill (Hills Materials), Martz injured the same shoulder. Hills Materials began paying benefits but, several years later, denied liability for further benefits. Martz petitioned the Department of Labor, contending that both employers were liable for benefits. Homestake was granted summary judgment on statute of limitations grounds. In regards Hills Materials, the Department rejected Martz’s argument that promissory estoppel precluded Hills Materials from denying liability and concluded that Martz failed to satisfy his burden of showing that the 2002 injury was a “major contributing cause” of his current condition. The circuit court affirmed. The Supreme Court affirmed, holding (1) Hills Materials was not estopped from denying liability for Martz’s current condition and need for treatment; and (2) Martz failed to establish that Hills Materials was liable for benefits where he did not prove a sufficient causal relationship between his 2002 injury and his current condition and need for treatment. View "Martz v. Hills Materials" on Justia Law

Joey and Cyrena Hossier were residents of California when they were issued an automobile-insurance policy by Interinsurance Exchange of the Automobile Club (IEAC). The Hoosiers later moved to Texas and notified IEAC of their change in residence. After the Hoosiers were involved in an automobile accident, the Hoosiers pursued underinsured-motorist-coverage benefits under their policy with IEAC. IEAC moved for summary judgment, arguing that California law applied and that, based on California law, the Hoosiers were not entitled to recovery. The circuit court granted summary judgment for IEAC, and the court of appeals affirmed. The Supreme Court reversed, holding that, under the facts of this case, the circuit court erred in granting summary judgment to IEAC, as Texas law applied to the interpretation of the underinsured-motorist provision in the insurance policy. View "Hoosier v. Interinsurance Exch. of the Auto. Club" on Justia Law

The issue at the heart of this appeal to the Tenth Circuit centered on indemnity stemming from a promise by Martin K. Eby Construction Company’s predecessor to build a water pipeline. Eby engaged another company (the predecessor to Kellogg Brown & Root, LLC), promising to indemnify claims resulting from Eby’s work. While building the water pipeline, Eby accidentally hit a methanol pipeline, causing a leak. At the time, no one knew about the leak. It was discovered over two decades later, and the owner of the methanol pipeline had to pay for the cleanup. The owner of the methanol pipeline sued to recover the expenses from Kellogg and Eby. Kellogg and Eby prevailed, but Kellogg incurred over $2 million in attorneys’ fees and costs. Kellogg invoked Eby’s indemnity promise, suing Eby and its liability insurer, Travelers Casualty and Surety Co. The district court granted summary judgment to Eby and Travelers, leading Kellogg to appeal. To resolve the Kellogg-Eby portion of the appeal, the Tenth Circuit focused on the enforceability of Eby’s promise of indemnity: the promise was broad enough to cover the pipeline owner’s claims against Kellogg for its inaction after Eby caused the leak, but the indemnity clause was not conspicuous; thus, it was unenforceable. The Kellogg-Travelers appeal turned on Kellogg’s argument that Travelers’ insurance policy covered liabilities assumed by its insured (Eby). The Tenth Circuit concluded that because the indemnity clause was unenforceable, it is as if Eby never agreed to assume Kellogg’s liabilities. In the absence of Eby’s assumption of Kellogg’s liabilities, Travelers did not insure Kellogg. Accordingly, Kellogg was not entitled to indemnity from Eby or insurance coverage from Travelers, and Eby and Travelers were entitled to summary judgment. View "Martin K. Eby Construction v. OneBeacon Insurance" on Justia Law

When Wells Trucking, Inc.’s employee was involved in an automobile accident that resulted in the death of another motorist, Wells Trucking had a primary insurance policy with United Fire & Casualty Company and an excess insurance policy with Scottsdale Insurance Company. After the decedent’s family filed a wrongful death lawsuit against Wells Trucking, Wells Trucking and Scottsdale filed suit against United Fire for bad faith refusal to settle within its policy limits. The trial court granted summary judgment for United Fire, concluding (1) an excess insurer cannot recover from a primary insurer under a claim of bad faith refusal to settle, and (2) bad faith refusal to settle could not be proven because United Fire ultimately settled the claim for its policy limits and Wells Trucking did not suffer an excess judgment. The Supreme Court reversed, holding (1) an insurer’s ultimate settlement for its policy limits does not negate the insurer’s earlier bad faith refusal to settle, and an excess judgment is not essential to a bad faith refusal to settle action; and (2) United Fire was not entitled to judgment against either Wells Trucking or Scottsdale. View "Scottsdale Ins. Co. vs. Addison Ins. Co." on Justia Law

In 2006, Robert and Teresa James brought a lot in a rural subdivision. At the time of the purchase, Chicago Title Insurance Company issued a title insurance policy that insured against loss or damage by reason of “lack of right of access to and from the land.” In 2013, the Jameses sued Chicago Title, contending that the title insurance policy required Chicago Title to provide them “legal” access to their lot. The district court granted summary judgment to Chicago Title, concluding that the Jameses failed to establish that the title insurance policy entitled them to “legal access” to their lot. The Supreme Court affirmed, holding that the district court properly granted judgment to Chicago Title on the Jameses’ claim, under the title insurance policy, that they lacked a right of access to their real property, as the language of the policy insured against loss from not having “a right” of access, and the Jameses clearly had a right of access when they bought the lot. View "James v. Chicago Title Ins. Co." on Justia Law

A church filed a claim with its insurer for damage to its sanctuary after a severe winter storm. The insurer hired an independent insurance adjuster to adjust the claim. The church eventually filed suit against both its insurer and the independent adjuster alleging breach of contract, bad faith, and gross negligence. The church settled with its insurer, and the trial court granted summary judgment for the independent adjuster. The issues this case presented for the Supreme Court's review on appeal were: (1) whether a special relationship existed between an insured entity and an independent adjuster hired by the insurer, sufficient to subject the independent adjuster to the implied covenant of good faith and fair dealing arising under the insurance contract; and (2) whether an independent insurance adjuster owed a legal duty to the insured such that it may be liable to the insured for negligence in its adjustment of the claim. The Oklahoma Supreme Court determined the answer to both questions was no, and affirmed the trial court's judgment. View "Trinity Baptist Church v. Brotherhood Mutual Insurance Services, LLC" on Justia Law

Accretive provides cost control, revenue cycle management, and compliance services to non-profit healthcare providers. Accretive and Fairview entered into a Revenue Cycle Operations Agreement (RCA), accounting for about 12% of Accretive’s revenue during the class period, and a Quality and Total Cost of Care (QTCC) contract, promoted as the future for healthcare services. In 2012, the Minnesota Attorney General sued Accretive for noncompliance with healthcare, debt collection, and consumer protection laws. Accretive wound down its RCA contract short of its term, expecting a loss of $62 to $68 million. The AG released a damaging report on Accretive’s business practices. Fairview cancelled its QTCC contract. Accretive’s stock fell from over $24 to under $10 per share. Plaintiffs filed a class action under Sections 10(b) and 20(a) of the Securities Exchange Act of 1934, alleging that Accretive concealed its practices to artificially inflate its common stock. The parties negotiated a settlement of $14 million: $0.20 per share ($0.14 with attorneys’ fees and expenses deducted). Notice was sent to 34,200 potential class members. Only one opted out; only Hayes filed an objection. At the fairness hearing, the district court granted approval, awarding attorneys’ fees of 30% and expenses of $63,911.14. Hayes did not attend. The Seventh Circuit affirmed. View "Hayes v. Accretive Health, Inc." on Justia Law

Hoey, who owns a farmers’ market that offers hay rides, pony rides, and pumpkin picking, hired Armbruster to run the hay wagon for eight weekends. Armbruster is now a paraplegic because an accident with the wagon crushed her spine. She sued for negligence in Michigan state court. Armbruster and Hoey also sought a declaratory judgment, again in state court, that Armbruster was covered by Hoey’s General Commercial Liability insurance policy. The insurer, Western, sought a federal declaratory judgment that Armbruster was not covered by the insurance policy. The cases were consolidated in federal court. Counsel, provided by Western to Hoey, filed a workers’ compensation claim on the theory that Armbruster was an “employee” eligible for workers’ compensation. The state tort claim has been stayed until the workers’ compensation claim is resolved. The district court accepted jurisdiction and construed the policy to exclude Armbruster’s injury from coverage. The Sixth Circuit affirmed, agreeing that it would be helpful for the parties to know whether Western was liable for Hoey’s legal fees, that Western was not playing procedural games, and that the federal forum could resolve the action without interfering in Armbruster’s tort suit or taking on difficult questions of state law. View "W. World Ins. Co. v. Armbruster" on Justia Law

Santana Morales died while working for Lawns Nursery and Irrigation Designs, Inc. (Lawns). Thereafter, Lawns’ surviving spouse entered into a workers’ compensation settlement agreement with Lawns and Zenith Insurance Company (Zenith), Lawns’ workers’ compensation and employer liability insurance carrier. In a separate wrongful death lawsuit, Morales’ Estate obtained a default judgment against Lawns. Zenith refused to pay the tort judgment, and the Estate sued Zenith under Lawns’ employer liability policy. A federal district court entered summary judgment for Zenith, holding that the policy’s workers’ compensation exclusion barred the Estate’s suit. On appeal, the Eleventh Circuit certified three questions of law to the Supreme Court. The Court answered (1) the Estate had standing to bring direct action against Zenith to recover the judgment against Lawns; (2) the workers’ compensation exclusion barred coverage of the Estate’s tort judgment under the employer liability policy; and (3) a release in the workers’ compensation settlement agreement, through which Mrs. Morales elected the consideration described in the agreement as the sole remedy with respect to the insurance coverage that Zenith provided to Lawns, precluded the Estate from collecting the tort judgment from Zenith. View "Morales v. Zenith Ins. Co." on Justia Law