Justia Insurance Law Opinion Summaries

After she was injured in a motor vehicle accident, Petitioner filed suit against Charles Serio, the tortfeasor. Petitioner’s motor vehicle insurer, GEICO, with whom Petitioner had underinsured motorist (“UM”) coverage, intervened as a defendant to protect its possible interest in the litigation. At trial, the parties stipulated that Serio was at fault for the accident, and the only issues before the jury were causation and damages. Petitioner’s counsel offered a proposed jury instruction on the nature of UM coverage, but the trial court refused the instruction, noting that insurance was not the issue at trial. The jury returned a verdict in favor of Petitioner for the amount of her medical bills but did not award damages for future medical expenses or pain and suffering. Petitioner unsuccessfully filed a motion for a new trial, arguing in not giving an instruction about the nature of UM coverage, the trial court confused the jury. The Court of Appeals affirmed, holding that the trial court did not err in declining to instruct the jury about the reason Plaintiff’s UM carrier was a party to the tort suit because the issue of UM coverage was not before the jury. View "Keller v. Serio" on Justia Law

For twenty years, Defendants, various entities of OneBeacon American Insurance Company (collectively, “OneBeacon”), had a program known as Multiple Line Excess Cover (“MLEC Program”) under which OneBeacon entered into reinsurance contracts (“MLEC Agreements”) with various reinsurers. Employers Insurance Company of Wausau, National Casualty Company, and Swiss Reinsurance America Corporation (“Swiss Re”) participated as reinsurers in the MLEC Program. Some of the MLEC Agreements Wausau entered into with OneBeacon were practically identical to OneBeacon’s MLEC Agreements with Swiss Re. In 2007, OneBeacon demanded arbitration with Swiss Re seeking reinsurance recovery for losses arising out of claims against OneBeacon by policyholders. The arbitration panel decided in favor of Swiss Re. In 2012, OneBeacon demanded arbitration with Wausau and National Casualty for, according to Wausau, the same claims OneBeacon arbitrated and lost against Swiss Re. Wausau and National Casualty petitioned for a declaratory judgment that the prior arbitration award between OneBeacon and Swiss Re had preclusive effect on the arbitration pending between OneBeacon and Wausau. The district court denied the petition. The First Circuit Court of Appeals affirmed, holding that judicial confirmation of an arbitration award “does not warrant deviation from the general rule that the preclusive effect of a prior arbitration is a matter for the arbitrator to decide.” View "Nat'l Cas. Co. v. OneBeacon Am. Ins. Co." on Justia Law

This action stemmed from property damage and the resulting business interruption sustained by Plaintiffs as a result of water damages that occurred following three separate roof breaches. Plaintiffs were Deborah Voss and three business entities owned and controlled by her. Plaintiffs sued CH Insurance Brokerage Services Co. (CHI), their insurance broker, arguing that a special relationship existed with CHI and that CHI had negligently secured inadequate levels of business interruption insurance for the three losses. Supreme Court granted summary judgment for CHI, and the Appellate Division affirmed. The Court of Appeals reversed, holding that CHI did not satisfy its initial burden of establishing the absence of a material issue of fact as to the existence of a special relationship. View "Voss v. Netherlands Ins. Co." on Justia Law

A holding company, whose subsidiaries owned power-generating facilities, filed a complaint against multiple insurers regarding the terms of liability policies the company purchased in the 1970s and 1980s. At issue in this case was whether New York or Pennsylvania law applied to the interpretation of the policies. The circuit court granted summary judgment in favor of the holding company, determining that Pennsylvania law governed the interpretation of the policies. One of the insurers, TIG Insurance Company (“TIG”), appealed. The court of special appeals affirmed, concluding that there was no genuine dispute of material fact that the insurance contracts were made in Pennsylvania, and therefore, Pennsylvania law applied to the policies at issue. The Court of Appeals affirmed and adopted the opinion of the court of special appeals with the exception of the court’s discussion addressing TIG’s argument that the place of countersigning a policy determines the applicable state law because that argument was not preserved for appeal. View "TIG Ins. Co. v. Monongahela Power Co." on Justia Law

After a fire damaged her house, Lester filed a claim with Allstate. The company asked Lester and her husband to answer questions under oath. Lester responded that they would submit to examinations only if Allstate first showed them its investigative files. Allstate refused to turn over the files, stating that doing so “could jeopardize the integrity” of its inquiry. Allstate eventually gave Lester 10 days to schedule an examination, warning that, if she did not submit to an examination, it would deny the claim. Lester never responded, but sued the company. The district court granted Allstate summary judgment. The Sixth Circuit affirmed, noting that the insurance policy requires Lester to “submit to examinations under oath” at Allstate’s request and that Tennessee law permits denial of a claim when the policyholder refuses to participate in an examination under oath. The company’s refusal to share its investigative files before examining her is reasonable and did not breach a duty of good faith. Tennessee presumes that failure to participate in an examination results in prejudice to the insurer, and makes it the policyholder’s burden to demonstrate that the company suffered no harm. Lester never introduced any evidence to rebut the presumption. View "Lester v. Allstate Prop. & Cas. Ins. Co." on Justia Law

Plaintiffs, former NBA referees, filed suit alleging breach of contract and/or seeking reformation with respect to each supplemental insurance policy that plaintiff had. Plaintiffs had relied on the insurance agent's representations that when plaintiffs where injured and unable to work as NBA referees, they would receive disability payments until the age of sixty-five. The court concluded that plaintiffs' failure to read the policy did not defeat their reasonable expectations. Pennsylvania law determined plaintiffs' right to reformation; absolved the insured from not reading the policy at delivery; and allowed the contract to be interpreted (or recast) from the date the carriers acted in a manner inconsistent with the insured's reasonable expectations of coverage. The policies that underlay Pennsylvania's substantive contract law of the reasonable expectations doctrine directly contradict those that drive Connecticut's view of when a claim for non-conforming coverage accrues. Accordingly, the court reversed the district court's decision dismissing plaintiffs' breach of contract claims and remanded for further proceedings. View "Nunn v. Massachusetts Casualty Ins." on Justia Law

Forsberg Engerman Co., an insurance agency, helped Lewis Holding Co., a trucking business, purchase insurance from Lexington Insurance Co. In 2011, one of Lewis Holding’s trailers was damaged. After Lewis Holding filed an insurance claim, NTA, Inc.’s adjuster examined the trailer and determined that the damage was due to mechanical failure or wear and tear. Lexington denied the insurance claim on the grounds that the damages were not the result of an upset or collision, but rather, the result of improper welding. Lewis Holding subsequently filed suit against Lexington, NTA, and Forsberg. The district court granted summary judgment for Defendants. The Supreme Court affirmed, holding that the district court did not err in granting summary judgment for Defendants where (1) the insurance agreement plainly and unambiguously excluded coverage for damages due to mechanical failure; (2) Forsberg, who was not a party to the insurance contract, could not be held liable under the insurance policy; and (3) Defendants had reasonable bases for denying Lewis Holding’s claim. View "Lewis Holding Co., Inc. v. Forsberg Engerman Co." on Justia Law

When Appellant Todd Christianson was sued by a former employee for severe personal injuries suffered while working for appellant's landscaping business, appellant tendered his defense to his general liability insurer. It did not accept his tender - instead, it sent him a letter that told him he should defend himself, noting an exclusion for claims of employees. Appellant then began to incur defense expenses. No insurer on the policies obtained by appellant's insurance broker, Conrad-Houston Insurance (CHI), ever defended him in the lawsuit. Nearly four years after receiving the insurer’s letter, appellant sued CHI for malpractice. After conducting an evidentiary hearing, the superior court applied the discovery rule and dismissed the malpractice lawsuit because it was filed after the applicable three-year statute of limitations had run. The superior court ruled that because the insurer’s letter put appellant on notice he might have a claim against CHI, the statute of limitations had begun to run more than three years before appellant sued CHI. Finding no reversible error, the Supreme Court affirmed the superior court. View "Christianson v. Conrad-Houston Insurance" on Justia Law

The Affordable Care Act, 42 U.S.C. 300gg-13(a)(4), requires health insurance providers (including third party administrators) to cover certain preventive services without cost to the insured, including, “with respect to women … preventive care and screenings,” including all FDA-approved contraceptive methods, sterilization, and patient education for women with reproductive capacity. The University of Notre Dame self‐insures employees’ medical expenses; Meritain administers the employee health plan. For students’ medical needs, Notre Dame has a contract with Aetna. Because Catholic doctrine forbids the use of contraceptives, Notre Dame has never paid for contraceptives for employees or permitted Aetna to insure the expense of contraceptives. Because of those religious objections and the Religious Freedom Restoration Act, 42 U.S.C. 2000bb‐1(a), the government created a religious exemption, 45 C.F.R. 147.130(a)(1)(iv)). New regulations enlarged the exemption, so that Notre Dame came within its scope. To exercise its right to opt out of paying for coverage for contraceptives, the university completed a form that alerts insurers that Notre Dame is not going to pay, so they will have to pay. The government will reimburse at least 110 percent of the third‐party administrator’s costs and Aetna can expect to recoup its costs from savings on pregnancy medical care. Several months after the regulations were promulgated, the University unsuccessfully sought a preliminary injunction. The Seventh Circuit affirmed, noting that the University had not indicated exactly what it wanted enjoined at this stage. The insurance companies were not parties, and, therefore, could not be enjoined from providing the required coverage. A religious institution has no right to prevent other institutions from engaging in acts that merely offend the institution and the University has complied by completing the required form. View "Univ. of Notre Dame v. Sebelius" on Justia Law

In the underlying litigation, the attorney represented a contractor being sued for job-site injuries and was later sued by the contractor’s insurance company for signing settlement agreements without authority. Section 13-214.3 of the Code of Civil Procedure, 735 ILCS 5/13-214.3, sets forth a six-year statute of repose for “action[s] for damages based on tort, contract, or otherwise … against an attorney arising out of an act or omission in the performance of professional services.” The trial court held that the provision barred claims for breach of implied warranty of authority, fraudulent misrepresentation, and negligent misrepresentation against the attorney. The appellate court reversed, finding that the statute of repose did not apply to an action brought by a non-client of the defendant-lawyer for a cause of action other than legal malpractice. The Illinois Supreme Court reversed and reinstated the dismissal, stating that under the plain, unambiguous language of the statute, the claims “arose out of” the attorney’s actions “in the performance of professional services.” View "Evanston Ins. Co. v. Riseborough" on Justia Law