Justia Insurance Law Opinion Summaries

In November 2021, David Goyco was struck and injured by an automobile while operating a low-speed electric scooter (LSES). Goyco filed a claim for personal injury protection (PIP) benefits under his personal automobile policy with Progressive Insurance Company. Progressive denied the claim, arguing that Goyco's LSES did not meet the definition of an "automobile" and that Goyco could not be considered a "pedestrian" under the New Jersey Automobile Reparation Reform Act, commonly known as the No-Fault Act. Goyco filed a complaint, asserting that LSES riders should be considered "pedestrians" entitled to PIP benefits under the No-Fault Act. The trial court denied relief to Goyco, and the Appellate Division affirmed.The Supreme Court of New Jersey affirmed the lower courts' decisions. The court held that an LSES rider does not fall within the definition of "pedestrian" for purposes of the No-Fault Act. The court found that Goyco's LSES was a "vehicle" that used a rechargeable electric motor and was therefore "propelled by other than muscular power" and was "designed for use on highways, rails and tracks." The court also rejected Goyco's reliance on a 2019 statute that provides that an LSES should be considered equivalent to a bicycle, stating that the statute was not intended to have any effect on the No-Fault Act. The court concluded that Goyco was not a pedestrian entitled to PIP benefits under Progressive's No-Fault insurance policy. View "Goyco v. Progressive Insurance Company" on Justia Law

The case involves an employee, Braden Nanez, who was injured in an auto accident while off work and away from his job at a remote fire base camp. His employer, 3 Stonedeggs, Inc., expected employees not to leave the job site and to notify a manager if they did. Nanez did not notify a manager he was leaving camp. The Workers’ Compensation Appeals Board (the Board) determined that under the commercial traveler rule, workers’ compensation coverage applied to Nanez's injuries. The Board found that Nanez’s use of his own car while off work to drive approximately 70 miles away from camp purportedly to obtain cellular service was conduct reasonably expected by his employer to be incident to its requirement that Nanez spend time away from home where cellular service was not adequately provided at the camp.The employer, 3 Stonedeggs, Inc., and its insurer, Technology Insurance Company, Inc., administered by Amtrust North America, petitioned for a writ of review, arguing that the Board acted in excess of its authority and that substantial evidence does not support the Board’s findings. They argued that Nanez was injured during a material deviation from his employment; he left the camp without employer approval on a personal activity that, under the unique circumstances of working at this remote fire camp, was not contemplated by the employer.The Court of Appeal of the State of California Third Appellate District denied the petition, finding that substantial evidence supports the Board’s findings. The court concluded that under the circumstances of Nanez’s age, his having his personal vehicle with him, the structure of his shifts, the remoteness of the camp, and his not being prohibited from using his vehicle during his off hours, it was reasonable for the employer to expect that Nanez would leave camp in his car during his off time as incident to being employed away from home. View "3 Stonedeggs, Inc. v. Workers' Compensation Appeals Board" on Justia Law

This case involves a three-car consecutive rear-end collision. The plaintiffs, Scott Eastman and his wife, filed a lawsuit against Jillian Peterson and her insurer, State Farm Mutual Automobile Insurance Company, alleging that Peterson was solely liable for the accident because she negligently rear-ended Eastman's vehicle. Peterson and State Farm denied the allegations, contending that Eastman was comparatively at fault for the accident because he impacted the vehicle in front of him prior to being rear-ended by Peterson. They also disputed the severity of Eastman's injuries caused by the accident and argued that a majority of his alleged injuries and damages were due to a pre-existing condition.The case was tried before a jury, which found both Peterson and Eastman comparatively liable for the accident, assigning fifty-percent fault to each. The jury also found that Eastman had been injured in the accident and awarded him damages. Eastman then filed a motion for judgment notwithstanding the verdict (JNOV), arguing that the jury erred as the evidence strongly and overwhelmingly favored a finding of sole liability on the part of Peterson. The trial court granted the JNOV, finding Peterson solely liable for the accident and increasing the damages awarded to Eastman. The court of appeal affirmed the trial court's judgment.The Supreme Court of Louisiana granted certiorari to review the lower courts' judgments. The court found that the trial court erred in granting the JNOV as to both liability and damages. The court noted that there was conflicting, credible testimony as to whether Eastman collided with the vehicle ahead of him prior to being impacted from behind by Peterson. The court also found that the evidence did not so strongly and overwhelmingly favor Eastman that reasonable jurors could not reach different conclusions. Therefore, the court reversed the court of appeal, vacated the judgment of the trial court, and reinstated the jury's verdict. View "EASTMAN VS. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY" on Justia Law

The case revolves around a dispute between the Texas Windstorm Insurance Association (TWIA) and Stephen Pruski, a policyholder. TWIA is a quasi-governmental body that provides windstorm and hail insurance to property owners in the coastal region of Texas who cannot get this coverage in the regular market due to the risk of catastrophic hurricanes. Pruski filed two claims with TWIA after Hurricane Harvey and a subsequent storm, and TWIA partially accepted and partially denied coverage for both claims. Pruski then filed a lawsuit in Nueces County District Court, seeking damages for TWIA’s alleged improper denial of coverage. The case was assigned to a judge who was not appointed by the Judicial Panel on Multidistrict Litigation (MDL), as required by Texas Insurance Code Section 2210.575(e).The case was initially heard in the Nueces County District Court, where TWIA filed a motion for summary judgment, arguing that the damages for which Pruski sought recovery were not covered by his policy as a matter of law. The district court granted the motion and rendered a final, take-nothing judgment for TWIA. Pruski appealed, arguing that the trial judge was not qualified to render judgment because she had not been appointed by the MDL panel. The court of appeals reversed the district court's judgment, holding that a trial judge who is not appointed by the MDL panel is “without authority to render judgment” in a suit under Chapter 2210.The Supreme Court of Texas disagreed with the court of appeals' interpretation of the statute. The court held that while the requirement for a judge to be appointed by the MDL panel is mandatory, it is not jurisdictional. Therefore, the district court had subject matter jurisdiction over the suit, even though the presiding judge was not appointed by the MDL panel. The Supreme Court of Texas reversed the court of appeals’ judgment and remanded the case to that court for further proceedings. View "TEXAS WINDSTORM INSURANCE ASSOCIATION v. PRUSKI" on Justia Law

In October 2020, Larry Knight's residence was damaged by Hurricane Zeta. He filed an insurance claim with Foremost Insurance Company, which was denied. Knight then sued Foremost, claiming that the company had insured his residence. Over the course of the litigation, Knight amended his complaint six times, eventually adding claims related to a rental property that Foremost admitted to insuring. He also added Karen Bradford and Bradford Agency, LLC as defendants. Foremost moved to strike Knight's latest amended complaint, while Bradford and the Agency moved to quash service of process and to be dismissed from the case, arguing that service on them had been insufficient. The trial court denied these motions.Foremost, Bradford, and the Agency petitioned the Supreme Court of Alabama for a writ of mandamus, arguing that they were entitled to relief. The court agreed, finding that Knight had failed to demonstrate good cause for amending his complaint for a sixth time and that allowing the amendment would result in actual prejudice to Foremost and unduly delay the trial. The court also found that service on Bradford and the Agency was ineffective, as Knight had failed to comply with the service requirements in Rule 4 of the Alabama Rules of Civil Procedure. The court therefore granted the petition and issued the writ, directing the trial court to strike Knight's sixth amended complaint and to grant Bradford and the Agency's motions to quash service of process and to dismiss them from the lawsuit. View "Ex parte Foremost Insurance Company v. Foremost Insurance Company" on Justia Law

This case involves a dispute between Sentry Insurance and James J. Morgan, who operates a business. Morgan's properties, insured by Sentry, suffered wind and hail damage from a storm. Sentry estimated the damages at $190,768.33 and paid Morgan $61,026.93 after deductions. However, Morgan estimated his loss at $540,426.05 and demanded Sentry pay an additional $349,657.22. When the parties couldn't agree on the loss amount, they turned to an appraisal process outlined in their insurance policy. Both parties appointed an appraiser, but the appraisers couldn't agree on an umpire. Consequently, Sentry filed a petition for the district court to appoint an umpire.The district court dismissed Sentry's petition, ruling that it lacked subject matter jurisdiction because the petition didn't meet the amount-in-controversy requirement for diversity jurisdiction under 28 U.S.C. § 1332. The court reasoned that it couldn't assess the value of the parties' contractual right to have an umpire examine the difference between two appraisers' estimates and determine the loss amount because the appraisers hadn't yet made their estimates.The United States Court of Appeals for the Fifth Circuit reversed the district court's decision. The appellate court disagreed with the district court's narrow interpretation of the right to be protected. It held that in an action seeking the appointment of an umpire for appraisal, the right to be protected is the right to continue with the appraisal process, and the value of this right is the disputed amount set to be resolved through appraisal. The court found that Sentry's petition established an amount in controversy over $75,000, as Morgan had demanded an additional $349,657.22 under the policy. The case was remanded to the district court to consider Morgan's additional jurisdictional arguments. View "Sentry Insurance v. Morgan" on Justia Law

The case involves George and Sheila Byers, who filed a lawsuit against their homeowners' insurance provider, USAA General Indemnity Company (USAA), and other defendants. The Byerses alleged that USAA breached their contract and the covenant of good faith and fair dealing in relation to the installation of hardwood flooring at their home. They sought attorneys' fees as damages under the Brandt v. Superior Court (1985) principle, which allows for the recovery of attorney fees when an insurer's tortious conduct compels the insured to hire an attorney to obtain policy benefits.USAA sought to compel the Byerses to produce documents related to their attorney fees, arguing that by seeking Brandt fees, the Byerses had waived their attorney-client privilege regarding these documents. The Byerses objected, arguing that the requests were ambiguous, overbroad, and violated attorney-client privilege. The trial court granted USAA's motion to compel, allowing the Byerses to redact any references they believed reflected attorney work product.The Byerses then petitioned the Court of Appeal of the State of California, First Appellate District, Division Five, challenging the trial court's order. They argued that the trial court had forced them to waive their attorney-client privilege and had abused its discretion by ordering the production of all invoices, fee agreements, and payment history.The appellate court denied the Byerses' petition. It found that by seeking Brandt fees, the Byerses had impliedly waived their attorney-client privilege regarding the attorney fees documents. The court also found no abuse of discretion in the trial court's order allowing the Byerses to redact references they believed reflected attorney work product. The court concluded that USAA had a right to learn about the attorney fees aspect of the Byerses' alleged damages during discovery. View "Byers v. Super. Ct." on Justia Law

The case involves the Government Employees Insurance Company (GEICO) and its affiliates, who sued several medical practices in separate actions in the District of New Jersey. GEICO alleged that the practices defrauded them of more than $10 million by abusing the personal injury protection (PIP) benefits offered by its auto policies. The practices allegedly filed exaggerated claims for medical services, billed medically unnecessary care, and engaged in illegal kickback schemes. GEICO's suits against the practices each included a claim under the New Jersey’s Insurance Fraud Prevention Act (IFPA).The practices sought arbitration of GEICO’s IFPA claim, arguing that a valid arbitration agreement covered the claim and that a different New Jersey insurance law allowed them to compel arbitration. However, each District Court disagreed, ruling instead that IFPA claims cannot be arbitrated. The practices appealed to the United States Court of Appeals for the Third Circuit.The Third Circuit Court of Appeals reversed the lower courts' decisions, holding that claims under the IFPA are arbitrable. The court found that GEICO's argument that the IFPA implicitly prohibits arbitration was not persuasive. The court also concluded that GEICO’s IFPA claims must be compelled to arbitration under the Federal Arbitration Act (FAA), as the claims fell under the scope of the arbitration agreement in GEICO's Precertification and Decision Point Review Plan. The court remanded the case with instructions to compel arbitration of GEICO’s IFPA claims against the practices. View "GEICO v. Caring Pain Management PC" on Justia Law

The case involves Maria and Jose Jimenez, who were involved in an auto accident with Stephen Kiefer. After the accident, the Jimenezes requested $100,000 from Kiefer's auto insurer, Travelers Commercial Insurance Company, to settle their claim against Kiefer. Travelers refused the offer, leading the Jimenezes to sue Kiefer in Illinois court. The Jimenezes and Kiefer entered into an agreement where Kiefer stipulated to a judgment against himself and assigned his rights and claims against Travelers to the Jimenezes. In exchange, the Jimenezes agreed not to execute the judgment against Kiefer personally. The Jimenezes then initiated a citation proceeding against Travelers, seeking to discover whether it held any of Kiefer’s assets.Travelers removed the action to federal court and filed for summary judgment. The district court granted summary judgment for Travelers, finding that Kiefer and the Jimenezes (as his assignees) were entitled to nothing under the insurance policy and had no claim for breach of any duties Travelers owed Kiefer. The Jimenezes appealed this decision.The United States Court of Appeals for the Seventh Circuit affirmed the district court's decision. The court found that the citation proceeding was an independent, removable action. It also agreed with the district court that the Jimenezes, as Kiefer’s assignees, could not recover under the policy in light of the legally responsible provision. The court concluded that Travelers could hold Kiefer to the terms of the policy, and under a strict construction of those terms, Kiefer was not legally responsible for the judgment because the covenant not to execute precluded its enforcement. Therefore, the legally responsible provision bars the Jimenezes’ recovery as Kiefer’s assignees. View "Jimenez v. Travelers Commercial Insurance Company" on Justia Law

The case involves an insurance claim filed by Christine and Roy Cosme after their insurer, Erie Insurance Exchange, cancelled their automobile insurance policy. The policy listed their son, Broyce Cosme, as a driver. The cancellation was due to a misunderstanding between Broyce and the Indiana Bureau of Motor Vehicles, which led to the suspension of Broyce's license. The Cosmes were informed that their policy would be cancelled unless they submitted a coverage-exclusion form removing Broyce from the policy. However, due to conflicting advice from their insurance agent at Churilla Insurance, the Cosmes did not submit the form before the deadline. The policy was cancelled, and shortly after, the Cosmes were involved in an accident with an uninsured motorist. Erie denied their claim, stating that their policy was no longer in effect at the time of the accident.The trial court granted a directed verdict in favor of Erie and Churilla, reasoning that the Cosmes brought about their own lack-of-coverage injuries when they failed to sign the exclusion form before the deadline. The court of appeals affirmed this decision, holding that the Cosmes failed to present sufficient evidence to support their claims against Erie and Churilla.The Indiana Supreme Court reversed the trial court's directed verdict for Erie, affirming as to Churilla, and remanded for further proceedings. The court held that at the directed-verdict stage, the court can review whether inferences from the evidence are reasonable, but it cannot weigh conflicting evidence or assess witness credibility. Applying this standard, the court found that the trial court erred in directing the verdict for Erie as the Cosmes’ case-in-chief presented sufficient (though conflicting) evidence to prove Erie breached its contract and violated its duty of good faith. However, the court correctly granted judgment to Churilla because the evidence showed Churilla owed no special duty to the Cosmes to procure insurance or advise on the insurance policy. View "Cosme v. Warfield" on Justia Law