Justia Insurance Law Opinion Summaries

Fluker filed a lawsuit against Cava Toyota World on April 3, 2009, alleging that he was wrongfully terminated from his employment. The defendants reported the lawsuit to their insurance carrier, National Union, four days later, but National Union did not respond until November 11, 2009, when it sent a denial of coverage letter. The defendants defended the lawsuit without the assistance of their insurance carrier and sought to file a third-party complaint against National Union, asserting common law “bad faith” and violations of the West Virginia Unfair Trade Practices Act , arising from the denial of coverage. The third-party complaint did not seek a finding that there was coverage under the National Union policy or request that the court find coverage and order National Union to defend the lawsuit. The trial court entered summary judgment for National Union, finding that the claims contained in the third-party complaint were not derivative of the claims asserted in the underlying lawsuit. The West Virginia Supreme Court affirmed. View "Cava, v. Nat'l Union Fire Ins. Co. of Pittsburgh" on Justia Law

Petitioner Southern Farm Bureau Casualty Insurance Company petitioned for a writ of prohibition with the Supreme Court, arguing the circuit court did not have jurisdiction after ninety days to set aside its previous order in this case. This matter stemmed from a motorcycle accident in which Stuart Parsons was injured with an uninsured driver. Parsons had uninsured-motorist coverage with Farm Bureau. He made a claim against that coverage, and signed a release allowing farm bureau to obtain his medical bills, and received a personal-injury protection payment. Parsons' medical bills exceeded the policy limit. Farm Bureau them filed a complaint for interpleader, requesting the circuit court disburse its uninsured-motorist limits. At that time, no other party had filed a lien nor claimed any interest in the policy proceeds. Acting pro se, Parsons answered and requested his policy be paid to him. The circuit court ordered Farm Bureau to deposit the funds into the court's registry and to disburse the money accordingly. Then Parsons filed a counterclaim seeking a statutory penalty, interst and attorney's dees, and to dismiss Farm Bureau's interpleader. After a hearing, the circuit court vacated an earlier order thereby allowing Parsons to proceed with his counterclaims against Farm Bureau. Farm Bureau then filed for a writ of prohibition, arguing the circuit court had no jurisdiction to set aside the order after ninety days from entry of the order. The Supreme Court considered Farm Bureau's petition for a writ of prohibition as a request for a writ of certiorari, and found that Farm Bureau had another adequate remedy. As such, the Court denied Farm Bureau's petition for certiorari, and dismissed the petition for the writ of prohibition as moot. View "S. Farm Bureau Cas. Ins. Co. v. Parsons" on Justia Law

GM provides its salaried retirees with continuing life insurance benefits under an ERISA-governed plan. MetLife issued the group life insurance policy and periodically sent letters to participants advising them of the status of their benefits. The plaintiffs, participants in the plan, allege that those letters falsely stated that their continuing life insurance benefits would remain in effect for their lives, without cost to them. GM reduced their continuing life insurance benefits as part of its 2009 Chapter 11 reorganization. The plaintiffs sued MetLife under the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1132(a)(2) & (a)(3) and state law. The district court dismissed. The Sixth Circuit affirmed. MetLife did not tell participants that the benefits were fully paid up or vested upon retirement, but that their benefits would be in effect for their lifetimes, which “was undeniably true under the terms of GM’s then-existing plan.” The court rejected claims of estoppel, of breach of fiduciary duty, unjust enrichment, breach of plan terms, and restitution. View "Merrill Haviland v. Metro. Life Ins. Co." on Justia Law

The Georgia Insurance Insolvency Pool (GIIP) brought a declaratory judgment action against two insureds who purchased workers compensation insurance from the Southern United States Insurance Company (SEUS) before SEUS became a member of GIIP. SEUS insureds whose claims predated June, 2006 were not covered by GIIP, and those insureds faced exposure when SEUS was liquidated in October, 2009. In 2010, the Georgia Legislature enacted a law to expand GIIP's "covered claims" to include certain insureds who obtained insurance from a captive insurer that later became insolvent. The effect of the 2010 amendment was to retroactively cover the previously excluded claims of SEUS insureds. GIIP claimed that extension of coverage would decrease GIIP's reserves and increase the assessments levied on member insurance companies. The defendants, whose claims would be covered only because of the 2010 amendment, filed a motion to dismiss, asserting GIIP lacked standing to bring suit. The trial court granted the motion and the appellate court affirmed. Upon review, the Supreme Court concluded the legislature gave GIIP the power to sue and be sued, and as such, had no standing to challenge the 2010 statutory amendment. View "Georgia Insurer's Insolvency Pool v. Hulsey Environmental Services, Inc." on Justia Law

After being billed by NEPT for medically necessary chiropractic services provided to the passenger of its insured, Liberty Mutual, claimed that the cost was unreasonably high and thus refused to pay the full amount invoiced. At trial, Liberty Mutual sought to introduce statistical evidence from a commercial database to show that NEPT's charges exceeded the 80th percentile of reported charges for the same procedures, pursuant to G.L. c. 233, 79B, which creates a limited exception to the hearsay rule for factual statements contained in commercial publications. The trial judge denied the motion, finding that the database was unreliable, based on a prior decision from the appellate court with respect to the database. The Massachusetts Supreme Court affirmed. Based on the explicit language of section 79B, and the gatekeeper role of a trial judge, it is within a judge's discretion to consider the reliability of evidence offered pursuant to section 79B. View "N.E. Physical Therapy Plus, Inc. v. Liberty Mut. Ins. Co." on Justia Law

Appellant Hugo Rosales suffered an injury working on a fish-processing vessel. He filed both a workers' compensation claim and a maritime lawsuit. Appellant and the employer ultimately entered into a global settlement of both cases. The state Workers' Compensation Board initially rejected the settlement. Appellant later tried to withdraw from the settlement but changed his mind. At a hearing, he testified that the though the settlement was in his best interests. The Board approved the settlement after the hearing. Several months later, appellant moved to have the agreement set aside. The Board denied this request. The Workers' Compensation Appeals Commission affirmed the Board's decision. Finding no error in the Commission's decision, the Supreme Court affirmed. View "Rosales. v. Icicle Seafoods, Inc." on Justia Law

This case concerned the struggle for control of a family business, the Pittman Nursery Corporation (PNC). The district court ruled that Hortica, insurer for PNC, had a duty to defend three of the five lawsuits at issue. Pursuant to Ark. Code. Ann. 23-79-209(a), the court reversed the district court's denial of fees and remanded for a hearing to determine the proper amount of fees Hortica must pay to PNC for its defense in the declaratory judgment suit. The court affirmed the district court's grant of Hortica's post-verdict judgment as a matter of law (JAML) motion, grant of pre-verdict JAML on PNC's breach of fiduciary duty and punitive claims, and exclusion of certain evidence. View "Hortica-Florists' Mutual Ins. v. Pittman Nursery Corp., et al." on Justia Law

In an interlocutory appeal from the trial court's denial of defendant Vaughn Bowden, PA's motion to dismiss for failure to state a claim upon which relief could be granted. Plaintiffs Cherie Blackmore and Diane Young sued their former employer, Vaughn Bowden, regarding the presence of toxic mold in two of the firm's offices in which they worked. They also argued they were exposed to sewer gas and a natural gas leak. Plaintiffs also sued Lowry Development and its owner who owned a second building in which Blackmore and Young claimed they were injured. Upon review, the Supreme Court concluded that plaintiffs failed to allege any facts by defendants' which rose to the level of intent that would remove their claims from the exclusivity of the Mississippi Workers' Compensation Act. Plaintiffs' only avenue for relief against the firm was in workers' compensation. Accordingly, the Supreme Court affirmed the trial court in dismissing plaintiffs' complaint. View "Vaughn & Bowden, PA v. Young" on Justia Law

The issue before the Court in this matter concerned interpretation of an errors-and-omissions policy. The policy excluded coverage for claims "arising out of" bankruptcy or insolvency. The dispute grew from a stop-loss policy issued by United Re to a company that had hired Plaintiff-Appellee C.L. Frates as a broker. After the policy was issued, United filed for bankruptcy protection. When Frates learned of the bankruptcy, it learned that United had been sued in Ohio, and filed for bankruptcy to stall the litigation. Ultimately, Frates recommended to its client that it move the stop-loss insurance to another insurer. The client agreed. However, Frates had to reimburse the client for what it lost through higher deductibles. Frates then sued Westchester Fire Insurance Company under its errors-and-omissions policy. In cross-motions for summary judgment, Westchester contended that Frates's claim "arose out of" United's bankruptcy or insolvency. Frates contended that the claim "arose out of" United's deception. The district court agreed with Frates and granted its motion for summary judgment. The Tenth Circuit disagreed with the district court. It held that a reasonable trier of fact could have concluded that Frates's claim arose out of United's bankruptcy or insolvency. Accordingly the Court reversed the award of summary judgment to Frates. View "CL Frates v. Westchester Fire" on Justia Law

The Federal Depository Insurance Corporation (FDIC), acting as receiver of the New Frontier Bank, used proceeds from the sale of cattle belonging to a limited liability company (LLC) to pay down a loan of one of the two LLC members. According to the complaint, the FDIC had no authority to do so because the payment was contrary to the members' agreement. Ignoring the separate entity status of an LLC, the other LLC member brought suit in its own name against the United States under the Federal Tort Claims Act (FTCA) for what it claimed to be the FDIC's wrongful disbursement of the proceeds. The LLC sued the government under the Fifth Amendment Takings Clause. The district judge dismissed the suit for failure to state a claim. The Tenth Circuit agreed dismissal was appropriate, the Appellate Court concluded dismissal should have been for lack of jurisdiction as to the member's claims and as to the LLC's claim because the United States Court of Federal Claims had exclusive jurisdiction. View "ECCO Plains, LLC., et al v. United States" on Justia Law