Justia Insurance Law Opinion Summaries

After Plaintiff was rear-ended by an underinsured motorist (UM), Plaintiff requested her $100,000 UM policy limits from State Farm. Plaintiff indicated that her damages were estimated to be $3.5 million because she suffered from reflex sympathetic dystrophy syndrome. State Farm responded that Plaintiff must schedule a compulsory medical examination (CME) pursuant to the terms of the policy. Plaintiff refused to attend a CME and instead filed suit against State Farm. The trial court entered judgment against State Farm for the UM policy limits. The court of appeal affirmed, holding (1) Plaintiff breached the contract when she failed to attend the CME; but (2) State Farm must plead and prove prejudice to avoid liability based on noncompliance with the CME clause, and State Farm failed to meet its burden in this case. The Supreme Court approved of the court of appeal’s decision, holding (1) the forfeiture of benefits under a UM policy will not automatically result upon an insured’s breach of a CME provision unless the insurer pleads and proves actual prejudice as an element of its affirmative defense; and (2) the undisputed facts demonstrate that State Farm was not prejudiced in this case. View "State Farm Mut. Auto. Ins. Co. v. Curran" on Justia Law

Truck Insurance Exchange (TIE) issued an apartment-owners insurance policy to appellant Jeanne Estates Apartments (JEA) that became effective in 1998. In 2006, Farmers Insurance Exchange (FIE) renewed the policy and continued to provide coverage. In 2008 and 2010, JEA became involved in three underlying lawsuits, which involved several appellants. JEA submitted claims for coverage to TIE/FIE in regard to those cases. TIE/FIE filed a complaint requesting that the circuit court declare that they owed no coverage to any person for any of the alleged misconduct which formed the basis of the claims in the underlying lawsuits and that they had no duty to provide a defense to any person or entity who was a defendant in the underlying lawsuits. The circuit court granted summary judgment in favor of TIE/FIE. The Supreme Court affirmed, holding that the apartment-liability contract issued by TIE/FIE did not provide an insured coverage for the type of harm alleged by the plaintiffs in the underlying suit. View "Kolbek v. Truck Ins. Exch." on Justia Law

The general contractor of a Wisconsin construction project, hired Harsco to supply scaffolding. Krien, injured in a fall when a plank on a scaffold on which he was standing, broke, sued Harsco. The parties settled his claim for $900,000. Harsco filed a third‐party complaint against the contractor, seeking indemnification plus interest and attorneys’ fees. The district judge granted the contractor summary judgment. The Seventh Circuit reversed and remanded after examining the complex provisions of the contract between the two. The plank may or may have been supplied by Harsco and may or may not have been defective, as claimed by Krien, who could not sue Riley in tort, because against his employer his only remedy for a work‐related accident was a claim for workers’ compensation, but there has never been judicial resolution of these questions, because Krien’s suit was settled before there was any judgment. Indemnification, however, is a form of insurance, and could apply even if the party seeking indemnification was negligent. Riley’s duty to indemnify Harsco extends to legal expenses incurred by Harsco in defending against Krien’s suit and in litigating this suit. View "Krien v. Harsco Corp." on Justia Law

Evan Ardente’s yacht was insured by Standard Fire Insurance Company. After Ardente purchased the yacht, it stopped navigating properly, and its top speed had decreased due to water damage to the yacht’s hull. Specifically, water was seeping into balsa wood, which is not waterproof, around installation holes and spreading throughout the hull. Ardente presented a claim to Standard Fire. Standard Fire denied coverage on the ground that the claim fell within an exclusion for manufacturing defects. Ardente sued Standard Fire for breach of contract, among other claims. The district court granted summary judgment for Standard Fire on all claims except for the breach of contract allegation. On that claim, the court granted Ardente summary judgment with respect to liability, concluding that the damage fell within an exception to the exclusion for manufacturing defects. The First Circuit Court of Appeals reversed the district court’s order granting Ardente summary judgment on his breach of contract claim, holding that the damage to the yacht did not fall within the exception to the manufacture-defect exclusion, and therefore, Standard Fire was entitled to summary judgment on the breach of contract claim. View "Ardente v. Standard Fire Ins. Co." on Justia Law

Lewis was injured in an automobile accident and her health plan paid $180,000 for her medical treatment Lewis filed a tort suit against the driver (her son-in-law), represented by Georgia lawyer Lashgari, and obtained a $500,000 settlement. Lashgari knew the plan had a subrogation lien, but split the proceeds between himself and Lewis. He claimed that the plan was owed nothing. The plan filed suit under ERISA to enforce the lien, 29 U.S.C. 1132(a)(3). The defendants argued that because the settlement funds have been dissipated, the suit was actually for damages, not authorized by ERISA. The district judge ordered the defendants to place $180,000 in Lashgari’s trust account pending judgment. The defendants did not comply. A year later, the defendants having neither placed any money in a trust account nor produced any evidence of their inability to pay, the judge held them in civil contempt, ordered them to produce records that would establish their financial situations, and ordered Lashgari to documents relating to the contempt to the General Counsel of the State Bar for possible disciplinary proceedings against him. The defendants appealed the contempt order. The Seventh Circuit dismissed, characterizing the appeal as frivolous and the defendants’ conduct as outrageous. View "Cent. States, SE & SW Areas Health & Welfare Fund v. Lewis" on Justia Law

Petitioner Tulsa Stockyards, Inc. challenged the constitutionality of the CompSource Mutual Insurance Company Act (85 O.S.Supp.2013, secs. 375.1 et seq.). The Act required CompSource Oklahoma be restructured to do business as a domestic mutual insurer without capital stock or shares under the name of CompSource Mutual Insurance Company effective January 1, 2015. Petitioner contended that CompSource was a state agency and its money and other assets, valued at approximately $265,000,000.00, were assets of the people of Oklahoma. Converting CompSource from a department of the State to an independent, licensed mutual insurance company without provision for the State to retain ownership of CompSource's assets, petitioner argued, was contrary to the prohibition against gifts of public money, the prohibition against interference with contracts, and the prohibition against money being paid out of the State Treasury except by appropriation. Upon review of the matter, the Supreme Court concluded that CompSource's money and other assets were held in trust for the benefit of the employers and employees protected by the insurance issued by CompSource, the Court's "Moran" opinion remained sound law, and the Oklahoma Constitution did not prohibit the Legislature from placing CompSource's money and other assets in trust with a domestic mutual insurer. View "Tulsa Stockyards, Inc. v. Clark" on Justia Law

Golden purchased automobile insurance from State Farm. The mandatory liability portion of her policy provided that State Farm would defend the insured against a third-party lawsuit using attorneys chosen by State Farm. Following a collision, Golden was represented by in-house counsel. She later filed a purported class action, claiming that “historically and traditionally” State Farm and other insurers defended third-party claims against insureds by hiring private, independent attorneys. State Farm now routinely uses in-house staff attorneys to represent insureds against such claims. Golden filed a purported class action, alleging that State Farm owes its insureds a duty to explain in its policies that house counsel may be used. The district court dismissed, holding that Indiana law creates no obligation to provide advance notification to an insured that an insurer uses house counsel to defend insureds. The court denied Golden’s request to certify the question to the Indiana Supreme Court. The Seventh Circuit affirmed, noting that Golden did not allege that she received deficient representation or that she ever objected to the use of house counsel in her suit. All of her claims depended on the existence of a duty to disclose; State Farm had no duty to disclose.View "Golden v. State Farm Mut. Auto. Ins. Co." on Justia Law

Plaintiff, injured while employed by GC, filed suit against GC alleging that he was working as a seamen at the time of his accident and sought damages under the Jones Act, 46 U.S.C. 30104, for GC's negligence. Travelers, which provided coverage to GC at the time of plaintiff's accident, moved to intervene. In this appeal, the court held that an insurer who makes voluntary Longshore Harbor Workers' Compensation Act (LHWCA), 33 U.S.C. 901-950, payments to an injured employee on behalf of the employer acquires a subrogation lien on any recovery by the employee in a Jones Act suit against the employer based on the injuries for which the insurer has already compensated him. Therefore, Travelers was entitled to the disputed funds in the district court's registry, and Travelers could intervene for the purpose of collecting these funds. Accordingly, the court reversed the district court's denial of the motion to intervene filed by Travelers and remanded with instructions. View "Chenevert v. Travelers Indemnity Co." on Justia Law

Plaintiffs filed suit under 42 U.S.C. 1983, alleging that recent amendments to Minnesota's No-Fault Automobile Insurance Act, Minn. Stat. 65B.41-71, violated the First Amendment. Plaintiffs sought a preliminary injunction seeking to enjoin defendants from enforcing the new provisions. The court concluded that the "inherently misleading" standard was broad enough in application to encompass 411-Pain's references to the $40,000 in potential insurance benefits. As such, the court affirmed the district court's denial of plaintiffs' request for a preliminary injunction barring enforcement of subdivision 6(d)(5). The court concluded that plaintiffs were not likely to succeed on the merits in the ultimate litigation because the ads at issue were "inherently misleading" where 411-Pain's use of actors posing as persons of authority to sell its business extended a misleading aura of authorized approval to the services in question and where the disclaimer "PAID ACTOR" did not disclaim endorsement by the actors. Accordingly, the court affirmed the district court's denial of plaintiffs' request for a preliminary injunction barring enforcement of subdivision 6(d)(6). Finally, the court concluded that the requirements at issue in subsections 6(d)(1), 6(d)(2), and 6(d)(3) were constitutional and the court rejected plaintiffs' claims to the contrary. Therefore, the court affirmed the district court's denial of plaintiffs' request for a preliminary injunction. View "1-800-411-Pain Referral, et al. v. Leroy Otto, D.C., et al." on Justia Law

Plaintiff filed suit under the West Virginia Unfair Trade Practices Act (WVUTPA), W. Va. Code 33-11-4(9)(f), based on IOF's allegedly unlawful conduct in connection with its handling of her insurance claim. The court held that plaintiff's WVUTPA claim sounds in tort and not in contract; West Virginia governed the underlying lawsuit pursuant to the lex loci delicti approach and the Restatement choice-of-law approach; and, insofar as the Supreme Court of Appeals of West Virginia has previously entertained questions regarding an action brought under the WVUTPA against an insurer subsequent to settlement, where the cause of action was limited to unfair settlement practices, plaintiff's complaint stated a claim upon which relief could be granted. Accordingly, the court reversed the district court's dismissal of the complaint. View "Kenney v. Indep. Order of Foresters" on Justia Law