Justia Insurance Law Opinion Summaries

Plaintiff, through his guardian, sought to recover from an insurance policy of ACE. Plaintiff is developmentally disabled and requires a personal care assistant. Plaintiff, while supervised by an assistant, was blinded in one eye by a BB gun given to him by the assistant. On appeal, plaintiff challenged the district court's grant of summary judgment to ACE, finding that plaintiff's claim was excluded from the policy's general-liability coverage. Plaintiff argued that his injury was within the general-liability coverage because he was not a "patient" within the meaning of the patient exclusion in the policy. The court affirmed the judgment of the district court, concluding that the district court correctly found that the term "patient" was unambiguous. View "Volk v. Ace American Ins. Co." on Justia Law

Petitioner was injured in a car accident while riding as a passenger in a vehicle driven by a co-employee. The liability limits of the at-fault driver were tendered, and there was no underinsured motorist (UIM) coverage on the vehicle in which he was riding. Therefore, Petitioner submitted a claim for UIM benefits under a Progressive insurance policy, issued to Sarah Severn. At the time of the accident, Petitioner resided with Severn and their child. He described Severn as "his on again off again fiancé." Both Petitioner's and Severn's names appear on the Declarations Page of the Policy under the heading "Drivers and household residents." Under the heading "Additional information," Severn is listed as the "Named insured." Progressive denied UIM coverage to Petitioner under Part III of the Policy. According to the affidavit filed by Progressive's Claims Injury Operations Manager, "[t]he claim was denied because [Petitioner] did not fall within the terms, provisions and conditions of [the Policy] to qualify for benefits under the [UIM] provisions," as Petitioner "was only listed as a 'driver' on the policy and not a named insured, nor was he a resident relative of the named insured." The Supreme Court granted Bell's petition for review of the court of appeals' decision affirming the circuit court's grant of summary judgment in favor of Progressive Direct Insurance Company. Finding no reversible error, the Supreme Court affirmed. View "Bell v. Progressive Direct Insurance" on Justia Law

A contract for reinsurance between National and Meadowbrook required both parties to submit any reinsurance disputes to a three-member arbitration panel to be comprised of “two arbitrators and an umpire” who were “active or retired disinterested officials of the insurance or reinsurance companies, or Underwriters at Lloyd’s, London, not under the control of either party.” After Meadowbrook initiated arbitration, National named Rosen and Meadowbrook named Schlaybaugh as arbitrators. They deadlocked in selecting an umpire, exchanged slates of candidates, and chose Greene, who disclosed that he was a personal friend of Rosen and that both were members of the reinsurance industry group The panel adopted orders that, “Ex parte communications with any member of the Panel shall cease upon the filing of the parties’ initial pre-hearing briefs.” The panel issued a unanimous Interim Final Award, resolving issues of liability in favor of National, but did not calculate a final damages award at that time. Rosen resumed ex parte communications and National disclosed those communications. After the panel rejected Meadowbrook’s submissions concerning damages, Meadowbrook claimed that it had disenfranchised Schlaybaugh. National claimed that a swift decision was needed, that Schlaybaugh was on vacation and could not be reached, and that his participation would have made no difference. The district court enjoined proceedings. The Sixth Circuit reversed, noting that judicial review of arbitral decisions is narrow and deferential. View "Savers Prop. & Cas. Ins. Co. v. Nat'l Union Fire Ins. Co." on Justia Law

Nicole discovered Shawn’s body in their Ohio home. Shawn had gone out drinking the night before, while Nicole spent the night at a friend’s house. The Medical Examiner’s Office reported the cause of death as “[a]sphyxia by extreme and restricted position (positional asphyxia)” and the manner of death as “[a]cute ethanol intoxication ... ACCIDENT: Prolonged and extreme hypertension of neck and torso while intoxicated.” Shawn’s blood-alcohol level at the time of autopsy was .22%. Nicole filed a $212,000 claim for accidental-death benefits with the Plan, which covers “injury” as a result of an “accident,” defined as “an unintended or unforeseeable event or occurrence which happens suddenly and violently.” No benefits will be paid if the “Covered Person [is] deemed and presumed, under the law of the locale … to be under the influence of alcohol or intoxicating liquors.” Nationwide directed denial of Nicole’s claim, citing Exclusion 12, but quoting an earlier version that provided: “The Covered Person being deemed and presumed … to be driving or operating a motor vehicle while under the influence…” Later, based on amended Exclusion 12, Nationwide upheld the denial; its appeals panel affirmed. Nicole filed suit, asserting claims under the Employee Retirement Income Security Act and a common-law breach-of-fiduciary-duty claim. The district court entered judgment in favor of the defendants, but agreed with Nicole that the appeals panel had breached its statutory duty to provide her with Plan-related documents upon written request, and imposed a penalty of $55 per day ($8,910). The Sixth Circuit affirmed. View "Cultrona v. Nationwide Life Ins. Co." on Justia Law

Plaintiff filed suit against National Life and Penn Mutual after both companies denied his claims for disability benefits under insurance policies they had issued to him. Plaintiff was unable to practice chiropractic because his license was suspended. The court concluded that an incapacity arising from license suspension was not a sickness or injury that qualified as total disability under the policies. Once plaintiff lost his chiropractic license, the practice of chiropractic no longer was an occupation from which he could become disabled by virtue of sickness. That a sickness or illness might have prevented plaintiff from reestablishing a practice of chiropractic did not qualify him for disability benefits because the sickness did not render him unable to perform an occupation under the terms of the policies. Accordingly, the court affirmed the district court's grant of summary judgment to National Life and Penn Mutual and denied plaintiff's motion for partial summary judgment. View "Cich v. National Life Ins. Co., et al," on Justia Law

Plaintiff filed suit against APIC, a nondomiciliary risk retention group, under New York's direct action statute, N.Y. Ins. Law 3420, to recover an unsatisfied state court judgment that had been entered against APIC's insured. The insured was a chiropractor that plaintiff had sought treatment from and who had pled guilty to third-degree assault for his inappropriate touching of plaintiff. At issue was whether the Liability Risk Retention Act of 1986, 15 U.S.C. 3901 et seq., preempted the application of section 3420(a)(2) to APIC, which was domiciled in Arizona, but issued insurance policies in New York. The court held that any construction of New York law that would impose section 3420's direct action requirements on foreign risk retention groups was preempted by section 3902(a)(1) of the LRRA. View "Wadsworth v. Allied Professionals Ins." on Justia Law

Appellant Dorris Green, representing his child who was injured while a passenger in his mother's automobile, contended that as a matter of public policy the courts of South Carolina should refuse to recognize the validity of a family member exclusion in a Florida car insurance policy. Further, he contended that the circuit court erred in finding there was no uninsured motorist coverage for his minor child under his Florida policy. The Supreme Court agreed with the circuit court that enforcement of this exclusion, valid under Florida law, did not offend South Carolina public policy, and that there was no underinsured coverage for father's minor child under the father's policy. The Court therefore affirmed the grant of summary judgment to the insurance company. View "Green v. USAA" on Justia Law

After suffering a severe electrical shock while working as a lineman for Tippah Electric Power Association, Lonnie Smith filed a petition to controvert with the Mississippi Workers' Compensation Commission. Tippah denied that Smith's claim was compensable and raised the affirmative defense that Smith had intentionally injured himself. The administrative judge (AJ) found that Smith had intentionally injured himself and that his injury was not compensable; the Commission affirmed the AJ's denial of the claim. The Court of Appeals affirmed the Commission's decision. The Supreme Court granted certiorari because it found that the Commission's decision was not supported by substantial evidence. Accordingly, the Court reversed and remanded this case to the Commission for a determination of benefits. View "Smith v. Tippah Electric Power Association" on Justia Law

Continental appealed the district court's grant of summary judgment to plaintiffs. The district court determined that plaintiffs' had made more than one claim against their former financial advisor. The financial advisor was insured by Continental under a professional liability insurance policy. Therefore, the district court held that the insurance policy's coverage limit for a single claim did not apply and that plaintiffs' claims triggered the insurance policy's aggregate coverage limit. The court concluded that, although the financial advisor made different alleged misstatements, omissions, and promises on different dates to each plaintiff, there nonetheless existed a logical connection between her wrongful acts. Accordingly, the court reversed and remanded to the district court for entry of judgment in favor of Continental. View "Kilcher, et al. v. Continental Casualty Co." on Justia Law

Plaintiffs obtained a homeowners insurance policy from American Family Mutual Insurance Company. After Plaintiffs’ home sustained substantial fire damage, a dispute arose regarding the amount of insurance claim benefits payable under the policy. Plaintiffs subsequently filed a complaint against American Family and Michael Meek, the insurance agent through whom they obtained their insurance, for negligence. The trial court granted summary judgment for Defendants, concluding that Plaintiffs failed to commence the action within the applicable statute of limitations. The court of appeals affirmed. The Supreme Court affirmed, holding that the trial court was correct to grant summary judgment on the basis of the applicable two-year statute of limitations. View "Groce v. Am. Family Mut. Ins. Co." on Justia Law