Justia Insurance Law Opinion Summaries

Plaintiff filed suit seeking declaratory relief and specific performance concerning a life insurance policy. At issue was whether any of the several notices that the insurance company sent plaintiff satisfied the requirements of Louisiana Revised Statutes 22:905, which outlined notice requirements for lapsing life insurance policies. The court concluded that the district court erred in finding that December 21, 2010, was the operative date for section 22:905 purposes, and therefore abused its discretion in denying the insurance company's motion to alter or amend the judgment. The language of section 22:905 supported the conclusion that the payment that was "due," "payable," and required to be paid was the payment at the end of the grace period, on February 11, 2011. Given the insurance company's compliance with the notice requirements, plaintiff could not claim that the company failed to provide it with fair notice. Accordingly, the court reversed and remanded for entry of judgment in the insurance company's favor. View "Johnston & Johnston v. Conseco Life Ins. Co." on Justia Law

When an insurance company authorized to transact business in Illinois becomes insolvent and unable to pay claims, the Illinois Insurance Guaranty Fund pays those claims after an order is entered liquidating the company, 215 ILCS 5/532. A cap on individual claims is inapplicable to workers compensation claims under the Workers’ Compensation Act, 820 ILCS 305/1. The plaintiff is the successor to Wells, a manufacturer. A Wells employee was seriously injured on the job in 1985, and, in 1993, the Industrial Commission ordered weekly lifetime benefits for total, permanent disability. Wells began to make the payments directly to the employee. Wells was self-insured, but had excess insurance from Home Insurance. After Wells’ payments to the injured employee reached $200,000, Home paid benefits until Home became insolvent in 2003 and was liquidated. The Illinois Insurance Guaranty Fund took over Home’s obligations, but stopped paying the employee in 2005, arguing that payments to an excess, rather than a primary, insurer were not payments of “workers’ compensation claims” exempted from the cap. Wells continued paying the employee and sought a declaration that the Fund’s payments should continue. The circuit court agreed with Wells, awarding summary judgment, and the appellate court affirmed. The Illinois Supreme Court affirmed, rejecting the distinctions made by the Fund between excess and primary coverage and between payments made directly or indirectly to employees. View "Skokie Castings, Inc. v. IL Ins. Guar. Fund" on Justia Law

Plaintiff, the owner of an apartment building, complained when Armory Plaza, the owner of the lot next to Plaintiff's building, began excavating the lot to make way for a new building. The excavation purportedly caused cracks in the walls and foundations of Plaintiff's building. After Plaintiff's insurer (Defendant) rejected Plaintiff's claims under its policy, Plaintiff brought suit. The U.S. district court granted summary judgment for Defendant, holding that the alleged conduct of Armory and its contractors was not "vandalism" within the meaning of the policy. On appeal, the Second Circuit Court of Appeals certified two questions of law to the New York Court of Appeals, which answered by holding (1) for purposes of construing a property insurance policy covering acts of vandalism, malicious damage may be found to result from an act not directed specifically at the covered property; and (2) the state of mind required to find malicious damage is a conscious and deliberate disregard of the interests of others that the conduct in question may be called willful or wanton. View "Georgitsi Realty, LLC v. Penn-Star Ins. Co." on Justia Law

Manpower, an international staffing firm, is the parent of Right Management in Paris, France. A building in which Right leased space collapsed, so that Right’s offices were inaccessible. Right relocated without having access and incurred replacement costs and lost income from the interruption of operations. A local insurance policy, issued by ISOP’s French affiliate, provided primary coverage, and a master policy, issued by ISOP and covering Manpower’s operations worldwide, provided excess coverage over the local policy’s limits. Right received $250,000 under the local policy pursuant to a provision covering losses caused by lack of access by order of a civil authority. Another $250,000 was paid under the master policy, exhausting the $500,000 sublimit under a similar lack‐of‐access provision. Manpower also claimed that, under the master policy, it was entitled to reimbursement for business interruption losses and the loss of business personal property: about $12 million. ISOP denied the claim. The district court held that Manpower was covered under the master policy for business interruption losses and loss of business personal property and improvements, but excluded Manpower’s accounting expert, without whom Manpower could not establish those damages and held that the master policy was not triggered because the losses were also covered under the local policy, which had to be fully exhausted before master policy coverage was available. The Seventh Circuit reversed exclusion of the expert and entry of judgment against Manpower on the business interruption claim, but affirmed judgment for ISOP on the property loss claim. The master policy did not provide coverage for Manpower’s property losses.View "Manpower, Inc. v. Ins. Co. of the State of PA" on Justia Law

In 2005, Patrick Richard sustained a work-related injury at the State Department of Transportation and Development ("DOTD"). After Mr. Richard's injury, DOTD began paying him workers' compensation benefits. Mr. Richard took disability retirement in 2007. Upon retiring, Mr. Richard spoke with a DOTD employee about the effect his receipt of workers' compensation benefits would have on his disability retirement benefits. Thereafter, Mr. Richard began simultaneously receiving disability retirement benefits through the Louisiana State Employees Retirement System ("LASERs"), and workers' compensation benefits through DOTD. In August 2007, DOTD informed Mr. Richard it had been overpaying him for workers' compensation benefits. In early 2011, DOTD filed a disputed claim for compensation, seeking an offset. In response, Mr. Richard filed an exception of prescription, arguing DOTD's claim for reimbursement was subject to a three-year prescriptive period. The matter proceeded to a trial before the Office of Workers' Compensation ("OWC"). The OWC denied Mr. Richard's exception of prescription. The OWC further held DOTD is entitled to an offset of $224.05 per week as of April 21, 2007, until Mr. Richard converted to regular retirement benefits at age 60. Mr. Richard appealed. The court of appeal affirmed in part and reversed in part. The court of appeal affirmed the OWC's denial of Mr. Richard's exception of prescription. However, the court found the OWC erred in holding DOTD was entitled to an offset of workers' compensation benefits. Upon review, the Supreme Court concluded the court of appeal incorrectly applied the law. Accordingly, the Court reinstated the OWC's judgment granting the employer an offset. View "Louisiana v. Richard" on Justia Law

A pharmaceutical distributor/repackager sought review of an appellate court decision that reversed a decision of the Louisiana Office of Workers' Compensation Administration. The Office awarded certain unpaid invoices for physician-dispensed medications (subject to a statutory limit) in favor of the distributor/repackager. The appellate court reversed based on a finding that the distributor/repackager did not have a right of action. After considering the applicable law, the Supreme Court found the anti-assignment language of La. R.S. 23:1205(A) did not prohibit the assignment of a health care provider's claims to a third party, an express contractual novation was effective, and an agent could statutorily be considered a health care provider based on the definition contained in La. R.S. 23:1021(6). Accordingly, the Court reversed the court of appeal's decision and remanded the case back to that court for further proceedings. View "Rebel Distributors Corp., Inc. v. Luba Workers' Comp." on Justia Law

Appellants purchased property that was subject to a Master Plan that restricted the use and development of the property. Appellants obtained title insurance from Insurer, but the policy did not mention the Master Plan. Appellants only later learned of the Master Plan when they were informed they were in violation of the Master Plan and faced substantial penalties if they failed to comply with the Plan. Appellants sued Insurer, claiming a breach of the terms of the title insurance policy, negligence, and bad faith. The district court granted summary judgment in favor of Insurer on all claims brought in Appellants' complaint. The Supreme Court affirmed, holding that the district court did not err in entering judgment in favor of Insurer. View "Sonnett v. First Am. Title Ins. Co." on Justia Law

Heath and Vail Freyer, the parents of Alicia Freyer, were all riding in their vehicle, which was insured by State Farm, when the vehicle rolled over, causing Health's death. In Freyer I, the Court held that the subject policy provided coverage for Alicia's claim for derivative damages stemming from Health's death. After remand, State Farm paid the disputed coverage amounts. The Freyers then brought claims against State Farm for the wrongful denial of coverage for Alicia's derivative claims. The district court granted summary judgment to State Farm. The Supreme Court reversed in part and affirmed in part, holding that the district court (1) erred in concluding that State Farm had not breached the insurance contract when it failed to indemnify Vail for Alicia's derivative claims based on State Farm's "reasonable basis in law" defense; (2) properly granted summary judgment to State Farm on the common-law bad faith and breach of the covenant of good faith and fair dealing claims; and (3) did not err in granting summary judgment to State Farm on the Unfair Trade Practices Act claims. View "State Farm Mut. Auto. Ins. Co. v. Freyer" on Justia Law

YA, a nonprofit corporation serving at-risk youth, transported young people to an event using vans that it owned. After the event four people were unable to board because a van was full. A YA employee requested that 16-year-old Lee, a YA participant who had driven to the event in a separate vehicle, drive them home. Lee agreed. Lee did not possess a valid driver’s license and the car that he was driving had been stolen during a carjacking. Police saw Lee driving erratically, ran a license plate check, and gave chase. Lee lost control and hit a tree. Lee survived, but all four passengers were killed. Their estates filed suit. YA requested defense and indemnification under policies issued by Indemnity: a commercial general liability policy with a $1 million limit and a commercial excess liability policy with a $2 million limit. Indemnity provided a defense, but disputed coverage and sought a federal declaratory judgment. YA counterclaimed that Indemnity breached its duty of good faith and violated the Kentucky Unfair Claims Settlement Practices Act, by misrepresenting coverage and failing to affirm liability within a reasonable time. The district court held that Indemnity was obligated under the CGL policy but not under the excess policy. The state court action settled with Indemnity’s payment of the $1 million limit of the CGL policy, plus $800,000 of the excess policy. The federal court dismissed the bad-faith counterclaims, reasoning that, as a matter of law, Indemnity’s coverage position had not been taken in bad faith. The Sixth Circuit affirmed. View "Philadelphia Indem. Ins. Co. v. Youth Alive, Inc." on Justia Law

Defendant was insured under three homeowners' policies issued to his parents (the Zamskys) by Plaintiff. Each policy covered a separate parcel of residential real estate owned by the Zamskys and required Plaintiff to defend and indemnify the insureds against claims stemming from bodily injury caused by a covered occurrence. One exclusion to the policy, the UL exclusion, pretermitted coverage for injuries arising out of a premises owned by an insured but not itself an "insured location." This case involved an fire that occurred on a piece of real estate owned by the Zamskys that was not insured by Plaintiff. An individual injured in the fire sued Defendant for bodily injuries. Plaintiff subsequently brought this declaratory judgment action seeking a declaration that the UL exclusions pretermitted its obligation to defend Defendant in the negligence suit or to indemnify him against any damage award. The district court held that the UL exclusion did not apply and that Plaintiff owed Defendant a duty to defend. The First Circuit Court of Appeals affirmed, holding that because the occurrence at issue here did not arise out of a condition of the premises, the district court did not err in determining that the UL exclusion did not apply. View "Vt. Mut. Ins. Co. v. Zamsky" on Justia Law