Justia Insurance Law Opinion Summaries

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

Petitioners, who had a liability policy with State Farm, were involved in a motor vehicle accident. Petitioners filed an underinsured motorist claim with State Farm. Based on the absence of underinsurance coverage in Petitioners' policy, State Farm denied coverage. Petitioners filed a complaint against State Farm, asserting that a "knowing and intelligent" waiver of underinsurance coverage had not occurred. The circuit court granted Petitioners' motion for partial summary judgment, concluding (1) State Farm's underinsured motorist selection/rejection form did not precisely comply with the state Insurance Commissioner's prescribed form; and (2) State Farm's failure to use the Commissioner's prescribed forms resulted in underinsured motorists coverage being added to the policy as a matter of law. The Supreme Court answered the circuit court's certified question by holding that an insurance company's failure to use the Commissioner's prescribed forms pursuant to W. Va. Code 33-6-31(d) results in the loss of the statutory presumption that the insured provided a reasonable offer which was knowingly rejected and a reversion to the lower standards set forth in Bias v. Nationwide Mutual Insurance Co. View "Thomas v. McDermitt" on Justia Law

Plaintiffs Kylie and Michael D. Shuba appealed the Superior Court's denial of their cross-motion for summary judgment and its grant of summary judgment in favor of Defendant United Services Automobile Association's ("USAA") motion for summary judgment. The Shuba's sought to be covered persons for the wrongful death of their mother under an insurance policy issued by USAA and held by the Shubas' step-mother. It was undisputed that their mother was not a named insured under the policy or a resident of the stepmother's household as the Shubas were. The Shubas claimed the trial court erred in finding the Shubas could not recover uninsured motorist benefits under the USAA policy. In making their claim, the Shubas asked the Supreme Court to overrule two Superior Court cases, "Temple v. Travelers Indemnity Co" and "Adams-Baez v. General Accident Co.," the latter of which the Supreme Court affirmed based on the trial court opinion. The Supreme Court declined to overrule those cases as precedent, and affirmed the Superior Court's judgment. View "Shuba v. United Services Automobile Association" on Justia Law

Safeway Insurance Company of Alabama, Inc. petitioned the Supreme Court for a writ of mandamus to direct the Circuit Court to grant its Rule 12(b)(1), Ala. R. Civ. P., motion to dismiss a bad-faith claim against it for lack of subject-matter jurisdiction. Richard Kimbrough alleged that a deer ran across the road causing a truck traveling in the opposite direction to swerve into the Kimbrough's lane. According to Kimbrough, the truck struck his vehicle and ran him off the road and into a creek bed. The driver of the truck allegedly fled. Kimbrough broke his right femur, right hand, and nose. Kimbrough sued Safeway, asserting claims of breach of contract and bad faith, alleging that Safeway, without justification, had intentionally refused to pay Kimbrough's claim. Safeway moved to dismiss the case for lack of subject-matter jurisdiction, arguing that the claim for uninsured-motorist benefits was not ripe for adjudication until liability and damages were established. The trial court denied the motion to dismiss, as well as Safeway's subsequent motion to reconsider. Upon careful consideration, the Supreme Court concluded Safeway did not clearly demonstrate this case was not ripe or that the trial court lacked subject-matter jurisdiction. Therefore, Safeway did not have a clear legal right to mandamus relief. View "Kimbrough v. Safeway Insurance Company of Alabama, Inc." on Justia Law

At issue in this case was what constituted a "proof of loss" in a claim for UIM benefits and what sufficed to trigger the safe harbor provision. The insured provided notice of an injury automobile accident to her insurer, but did not submit a UIM benefits claim at that time. Nearly two years later, the insurer learned of the possible UIM claim. The insurer agreed in writing that it accepted coverage, that the only remaining issues were liability and damages, and that it was willing to submit to binding arbitration. After recovering on her UIM claim, the insured asked for attorney fees. The insurer claimed the benefit of the safe harbor provision of ORS 19 742.061(3). The Court of Appeals concluded that the insurer did not send its safe harbor letter within six months of the insured's "proof of loss." According to the Court of Appeals, the "proof of loss" was the initial report of injury two years earlier. Upon review, the Supreme Court concluded that the initial report of injury did not provide sufficient information to constitute a proof of loss for a UIM claim and that the insurer's safe harbor letter was sufficient to trigger the statutory exception to an attorney fee award. View "Zimmerman v. Allstate Property and Casualty Ins." on Justia Law

This case arose when United of Omaha denied plaintiff's claim for benefits from a life insurance policy taken out by plaintiff's daughter. The policy at issue lapsed for nonpayment of premiums and was then reinstated. On appeal, plaintiff argued that the district court failed to correctly apply Texas law governing incontestability provisions in life insurance contracts and that the district court erred by expanding the interpretation of the insurance contract. The court found it logical to conclude that Texas Insurance Code 1101.006 treated policy issuances and policy reinstatements in a uniform manner, when neither section 1101.006 nor 28 Texas Administrative Code 3.104(a) provided any reason to treat issuances and reinstatements differently. Although the court's interpretation of the relationship between sections 1101.006 and 3.104(a) differed from that of the district court, the court concluded that the district court properly denied plaintiff's motion for judgment as a matter of law on this issue. The court rejected plaintiff's remaining claim and affirmed the judgment of the district court. View "Cardenas v. United of Omaha Life Ins. Co." on Justia Law

Addison filed a class action, alleging that Domino had sent thousands of “junk faxes” in violation of the Telephone Consumer Protection Act, 47 U.S.C. 227, and the Illinois Consumer Fraud Act, and had committed the tort of conversion. Domino’s insurers refused to defend. Domino negotiated a settlement to protect its own interests; Addison and Domino agreed that the state court should certify a class and enter a judgment of $18 million. Addison agreed that the class would not recover any money from Domino, but that Domino would assign to Addison, as class representative and for the class, whatever claims Domino might have against its insurers. The state court approved the settlement. Addison sought a state court declaratory judgment holding Hartford liable for the judgment. Hartford removed the case to federal court. Addison dismissed the case voluntarily and filed another state court suit, naming Addison as the only plaintiff. Hartford again removed the case under the Class Action Fairness Act, 28 U.S.C. 1453. The district court granted remand, finding that the suit did not fit the CAFA definition. Hartford argued that under the assignment in the underlying settlement, Addison had standing only as a class representative. The Seventh Circuit agreed, reversed, and remanded to state court. View "Addison Automatics, Inc. v. Hartford Cas. Ins. Co." on Justia Law

First American Cash Advance, owned by Valued Services, L.L.C. was robbed twice. The first robbery occurred on New Year's Eve 2008, and the second was in the spring of 2009. Respondent-Claimant Leslie Tregenza was the branch manager and the only employee on the premises during both robberies. A man wearing something covering his face and a ball cap committed the first robbery; in the second, two men stole all of the cash on hand in the office. These men did not have guns. However, one of the robbers threw an empty plastic cash drawer at respondent's head. She did not return to work for her employer after the second robbery. Claimant filed her Form 3 in October 2009, alleging an accidental injury arising out of and in the course of her employment. She alleged she sustained an injury to her head with psychological overlay in the form of post-traumatic stress disorder (PTSD) and PTSD headaches. She sought permanent total disability (PTD) as a result of her injuries, claiming she was unable to work or to be out in public. The trial the court concluded respondent was permanently totally disabled and awarded her continuing medical maintenance in the nature of four annual office visits and prescription medication. The employer appealed the trial court's holding and the appellate court reversed. After its review, the Supreme Court concluded the Workers' Compensation Court received competent evidence that Claimant was permanently totally disabled. The Court vacated the appellate court's decision and affirmed the order of the lower court. View "Valued Services, LLC v. Tregenza" on Justia Law

Defendants Leisure Life Industries a/k/a Leisure Life Industries, Inc. a/k/a Leisure Life Industries, LLC (Leisure Life) and Knothe Apparel Group, Inc. appealed a superior court order that denied their motion for summary judgment and granted the cross-motion for entry of final judgment on the issue of indemnity filed by plaintiffs, JoAnne Gray, Jeffrey Gray, Jeffrey J. Gray, and Jonathan Gray. The defendants also appealed the trial court’s order denying their motion for summary judgment on successor liability. Jeffrey Gray purchased a robe from The Orvis Company (Orvis) for his wife, JoAnne. Orvis purchased the robe from the manufacturer, Leisure Life. Mrs. Gray was wearing the robe when she added a piece of firewood to her wood stove and the robe caught fire. As result, she was severely burned and suffered extensive injuries. Plaintiffs sued the defendants and Orvis along with other parties involved either in the design and distribution of the robe or the manufacture and sale of the wood stove. Leisure Life argued that it was not liable for the plaintiffs" injuries because it was no longer the same entity that manufactured the robe, and the circumstances of the purchase did not support holding Knothe liable as a successor. The trial court denied the motion. Orvis claimed that it "had no involvement in the design and manufacturing of the robe" and that it "was simply a 'pass-through' entity." As a result, Orvis sought indemnity or contribution from the defendants for any damages it ultimately owed to the plaintiffs, including the amount of any judgment against, or settlement by, Orvis. Immediately prior to the scheduled start of the trial, all parties except Leisure Life settled with the plaintiffs. The parties involved in the sale and manufacture of the wood stove settled the claims against them for five million dollars. Orvis settled the claims against it for one million dollars and assigned to the plaintiffs "any and all rights to indemnity" that Orvis had against the defendants. The settlement did not extinguish the plaintiffs' claims against the defendants. The plaintiffs, as Orvis's assignees, subsequently moved for summary judgment against the defendants on the indemnity claim. On appeal, the defendants argue that the trial court erred in granting summary judgment for the plaintiffs on the issue of indemnity. They further contend that there is no basis for the trial court’s award of attorney’s fees and costs and that, therefore, the award must be set aside. Finally, the defendants argue that the trial court erred in finding Knothe liable as a successor to Leisure Life. Upon review, the Supreme Court concluded plaintiffs' indemnity claim failed because when Orvis settled with the plaintiffs, it extinguished its own liability, but not that of the defendants. The trial court's order addressing the settlement stated that "[t]his case has been settled as to all defendants except Leisure Life Industries." In consideration for the receipt of one million dollars and the assignment of Orvis's indemnity rights against the defendants, the plaintiffs released Orvis from all claims of liability asserted against it. In contrast, there was no release of liability running to the defendants, and the defendants remained potentially liable to the plaintiffs under the theories of direct liability asserted against them, including the strict liability claim. The Court reversed the trial court’s denial of summary judgment with respect to the plaintiffs’ indemnity claim. View "Gray v. Leisure Life Industries " on Justia Law