Justia Insurance Law Opinion Summaries

After Arch denied coverage to its insured, Jon Davler, Inc., based on an employment-related practices exclusion, Jon Davler filed suit seeking coverage. In the underlying action, employees filed suit against their employer, Jon Davler, for various employment claims, including sexual harassment, invasion of privacy, and false imprisonment. The trial court sustained Arch's demurrer to the complaint without leave to amend. The court concluded that the employment-related practices exclusion applies to the underlying claims and rejected Jon Davler's contention that the exclusion is ambiguous. The court concluded that the employment-related practices exclusion is plain and clear and "understandable to a layperson." Jon Davler is not entitled to leave to amend and the court affirmed the judgment of the trial court.View "Davler, Inc. v. Arch Ins. Co." on Justia Law

State farm Fire & Casualty Company issued a rental dwelling policy to Jerry Dantzler. The tenants of Dantzler’s rental property sued Dantzler for personal injuries allegedly sustained by a Dantzler’s tenant as a result of exposure to lead-based paint. Dantzler tendered the claim to State Farm. State Farm subsequently filed an action for declaratory judgment against Dantzler and the tenants asking for a determination of whether its policy precluded coverage for the tenants’ personal injury claim. The district court granted summary judgment for State Farm, concluding as a matter of law that the pollution exclusion barred coverage under State Farm’s policy. The court of appeals reversed, concluding that a genuine issue of material fact existed as to whether the tenant’s injuries were the result of a “discharge, dispersal, spill, release or escape of pollutants” as described in the pollution exclusion. The Supreme Court reversed, holding that all manners of exposure to lead-based paint involve discharge, dispersal, spill, release, or escape, and therefore, the manner of exposure was not a material fact that prevented summary judgment. Remanded.View "State Farm Fire & Cas. Co. v. Dantzler" on Justia Law

Petitioner, who was injured while performing her work duties, filed a workers’ compensation claim. Liberty Northwest (Liberty), the insurer for the claim, terminated Petitioner’s temporary partial disability (TPD) benefits after Petitioner revoked releases and authorizations she had previously signed allowing Liberty and its agents to have ex parte communications with her medical care providers. Petitioner filed an action asserting that the statutes relied upon by Liberty to terminate her medical benefits, Mont. Code Ann. 39-71-604 and Mont. Code Ann. 50-16-527, were unconstitutional. The Workers’ Compensation Court (WCC) determined that section 39-71-604(3), as applied in Petitioner’s case, violated Petitioner’s constitutional right of privacy. The Supreme Court affirmed, holding that the WCC did not err in concluding that section 39-71-604(3) violated Petitioner’s right of privacy set forth in the Montana Constitution.View "Malcomson v. Liberty Northwest" on Justia Law

Rose’s Bidwell, Ohio home was insured by State Farm. Rose also had a Personal Articles Policy that covered two Rolex watches. In 2009, a fire destroyed the house. Later that day, Rose made a claim of $696,373.30 for the dwelling, $512,765.57 for damage to personal property, $30,000 for living expenses, and $29,850 for one Rolex watch. State Farm’s investigator took a recorded statement from Rose and his wife and spoke with Rose’s ex-wife; gathered information by searching public records; and retained a fire investigator, who issued a report, finding that the fire originated in the kitchen, that electrical items did not appear to be the source of the fire, and that neither smoking nor cooking was suspected as a cause. The report indicated that non-reported human action could not be eliminated as a cause, but did not specify that the fire was deliberately ignited. State Farm denied Rose’s claims, alleging that Rose violated “Intentional Acts” and “Concealment or Fraud” conditions of his policies. Rose sued, alleging breach of contract and bad faith. The district court declined to grant summary judgment on the “Intentional Acts” clause, but found that some answers Rose gave, failing to identify multiple tax liens and judgments, in statements to State Farm were misleading and material, and granted summary judgment on the other claim. The Sixth Circuit reversed, finding material questions of fact concerning whether Rose misled investigators.View "Rose v. State Farm Fire & Cas. Co." on Justia Law

Annex, Stuart Lind, and Tom Janas filed suit challenging HHS' contraceptive mandate under the Religioous Freedom Restoration Act (RFRA), 42 U.S.C. 2000bb-1(a). Lind, a controlling shareholder of Annex, opposed insurance coverage of contraceptives for Annex's employees. The district court denied Annex and Lind's motion for a preliminary injunction respecting the contraceptive mandate's enforcement. The court concluded that Janas lacks standing to appeal because he did not join the preliminary injunction motion which forms the basis of the appeal; the mandate does not apply to Annex because Annex has fewer than fifty full-time employees and has no government-imposed obligation to offer health insurance of any kind; the only alleged injury is that independent third parties - private health insurance companies not involved in this case - are unable to sell Annex a health insurance plan that excludes healthcare inconsistent with Lind's religious relief; and, ultimately, it is unclear whether Annex's alleged injury is caused by the government defendants and redressable by the federal courts. Accordingly, the court vacated the district court's denial and remanded for the district court to conduct more fact-finding to determine whether subject matter jurisdiction exists. View "Annex Medical, Inc., et al. v. Sebelius, et al." on Justia Law

Kaiser Permanente covered three patients who received care at an emergency room operated by Dameron Hospital Association. The patients were injured due to the negligence of third party tortfeasors who had automobile liability insurance with California Automobile Association Inter-insurance Bureau (AAA) and Allstate Insurance Company. Unlike Kaiser, neither AAA nor Allstate had contracts with Dameron. In the absence of an agreement for negotiated billing rates, Dameron sought to collect from AAA and Allstate its customary billing rates by asserting liens filed under the Hospital Lien Act (HLA). AAA and Allstate ignored Dameron’s HLA liens when paying settlements to the three Kaiser patients. Upon learning of the settlements, Dameron sued AAA and Allstate to recover on its liens. The trial court granted the automobile liability insurers’ motions for summary judgment on grounds the patients’ debts had already been fully satisfied by their health care service plans. Reasoning the HLA liens were extinguished for lack of any underlying debt, the trial court dismissed the case. The trial court further found dismissal was warranted because Dameron failed to timely file some of its HLA liens against AAA. The issue this case presented for the Court of Appeal was whether a heath care service plan’s payment of a previously negotiated rate for emergency room services insulate the tortfeasor’s automobile liability insurer from having to pay the customary rate for medical care rendered? AAA and Allstate contended they were not responsible for any amount after Kaiser paid in full the bill for the emergency room services provided by Dameron. Dameron contended that it contracted with Kaiser to preserve its rights to recover the customary billing rates from tortfeasors and their automobile liability insurers. Dameron argued the tortfeasors and their liability insurers were responsible for the entire bill for medical services at the customary rate, not just the difference between the reimbursement received from Kaiser and the customary billing rate. Although Dameron claimed it should benefit from the California Supreme Court’s holding that it may avoid extinguishment of its HLA liens upon receiving payments from health insurers, the contract in this case preceded that case by 10 years. The Court of Appeal concluded that the Dameron/Kaiser contract did not preserve the right to recover the customary billing rate for emergency room services from third party tortfeasors: "[I]f Dameron wishes to preserve its right to recover its customary billing rates through an HLA lien, it is free to contract for this right. But Dameron must actually contract for this right. A history of voluntary cooperation with Kaiser does not suffice to avail Dameron of the [Supreme Court's] guidance on reservation of contractual rights under the HLA." Consequently, the trial court properly granted summary judgment in favor of AAA and Allstate. As to Dameron’s argument that it filed a timely claim relating to patient Rita H.’s HLA lien, the Court of Appeal affirmed the trial court’s dismissal based on the statute of limitations. Dameron has not made a sufficient showing of diligence to toll the claim under the discovery rule. View "Dameron Hospital Assn. v. AAA etc. Ins. Exchange" on Justia Law

In the wrongful-death action underlying this case, the trial court found a certain term in a commercial general liability policy, which was not defined in a policy, to be ambiguous and construed this language against the insurer. The court then found that the policy provided coverage in the wrongful-death action. The insurer appealed. The Supreme Court reversed, holding (1) in determining whether a policy provision is ambiguous, courts must consider the context in which the specific language of the provision is used; and (2) based on this rule, the policy provision in this case was not ambiguous and did not provide coverage. View "Sauer v. Crews" on Justia Law

Thomas Hipp was driving a semi-tractor and trailer on a two-lane road when the trailer collided with a vehicle driven by Amy Soczynski. Amy died as a result of the collision and this appeal concerns the subsequent insurance coverage dispute. The court affirmed the district court's determination that a bobtail policy issued by Hipp's Trucking provided coverage for damages arising out of the collision and that the bobtail policy provided $1 million in coverage.View "Occidental Fire & Casualty Co. v. Soczynski" on Justia Law

A firefighter developed prostate cancer when he was in his mid-fifties, after working for nearly 30 years. He filed a workers’ compensation claim under a new statute creating a presumption that certain diseases in firefighters, including prostate cancer, are work related when specific conditions are met. The employer contended that the firefighter could not attach the presumption of compensability because he had not strictly complied with statutory and regulatory medical examination requirements. The employer also wanted to present expert testimony that the cause of prostate cancer was unknown. The Alaska Workers’ Compensation Board heard the claim and refused to consider parts of the expert’s testimony, deciding that the firefighter was eligible for benefits because he had attached the presumption of compensability by substantially complying with the statutory requirements and the employer had not rebutted the presumption. On appeal, the Alaska Workers’ Compensation Appeals Commission agreed, but reversed the Board’s decision disallowing the expert testimony. The Commission decided that the employer could rebut the presumption through its expert’s testimony that the cause of prostate cancer was unknown, and remanded the case to the Board for further proceedings. Because the employer also contended that the firefighter-presumption statute violated the Alaska Constitution’s equal protection guarantee, the State of Alaska intervened on appeal. The Supreme Court affirmed the Commission’s decision that the firefighter attached the presumption by substantially complying with the applicable requirements. However, the Court reversed the Commission’s decision that the employer could rebut the presumption through expert testimony that there was no known cause of prostate cancer.View "Adamson v. Municipality of Anchorage" on Justia Law

In December 2010, Cost-U-Less Insurance assisted plaintiffs by telephone, through an InsZone Insurance Services employee, in obtaining a homeowner’s insurance policy with Fidelity. In 2011, a fire damaged plaintiffs’ home. They made a claim with Fidelity. Fidelity property claims representative Fowler sent a letter advising that Fidelity was investigating coverage for the fire incident, indicating that Fidelity had obtained information suggesting plaintiff did not live in the home and that the property had been used and operated as a residential care facility. After an investigation, Fidelity rescinded the homeowner’s policy on the grounds that plaintiffs’ insurance application contained material misrepresentations about various facts concerning plaintiffs’ and their home. The trial court entered judgment in favor of plaintiffs in the amount of $807,058.10, plus interest and costs of suit. Plaintiffs appealed the trial court’s decision to strike the jury’s $1.9 million punitive damages award. Fidelity appealed that the court committed jury instructional error. The appeals court remanded, holding that the trial court prejudicially erred in refusing to give certain jury instructions concerning whether the application formed an insurance contract.View "Douglas v. Fidelity Nat' Ins.Co." on Justia Law