Justia Insurance Law Opinion Summaries

Plaintiff, an in-home registered nurse, was injured in an automobile accident while driving her employer's vehicle to to a patient's home to perform her nursing duties. Plaintiff incurred $382,849 in medical expenses as a result of the accident. After Plaintiff's employer's workers compensation carrier (AIG) denied Plaintiff's workers compensation claim, Plaintiff filed a medical payments claim with Allstate, with whom Plaintiff had a personal automobile insurance policy that provided $100,000 in medical payments coverage. Allstate failed to provide medical payments benefits immediately to Plaintiff. Plaintiff and AIG later settled Plaintiff's worker's compensation claim for $150,000. Plaintiff then commenced this breach of contract and bad faith action against Allstate based on Allstate's failure to pay medical benefits. The circuit court granted judgment as a matter of law for $33,000 on the breach of contract claim and awarded $150,000 in compensatory damages and $1,500,000 in punitive damages on the bad faith claim. The Supreme Court reversed in part, holding that the circuit court erred in excluding Allstate's evidence of AIG's acceptance of the worker's compensation claim, and that exclusion prejudiced Allstate's ability to defend the bad faith and punitive damages claims. View "Bertelsen v. Allstate Ins. Co." on Justia Law

Doe Run commenced a declaratory action seeking to enforce Lexington's contractual duty to defend Doe Run per its Commercial General Liability (CGL) policies in two underlying lawsuits (the Briley Lawsuit and the McSpadden Lawsuit). These underlying lawsuits sought damages arising out of Doe Run's operation of a five-hundred-acre waste pile (Leadwood Pile). The court concluded that the pollution exclusions in the CGL policies precluded a duty to defend Doe Run in the Briley Lawsuit. The court concluded, however, that the McSpadden Lawsuit included allegations and claims that were not unambiguously barred from coverage by the pollution exclusions in the policies. The McSpadden Lawsuit alleged that the distribution of toxic materials harmed plaintiffs, without specifying how that harm occurred. The McSpadden complaint also alleged that Doe Run caused bodily injury or property damage when it left the Leadwood Pile open and available for use by the public without posting warning signs. Accordingly, the court affirmed in part, reversed in part, and remanded. View "Doe Run Resources Corp. v. Lexington Ins. Co." on Justia Law

Doe Run commenced a declaratory judgment action seeking to enforce Lexington's contractual duty to defend Doe Run per its Commercial General Liability (CGL) policies in an underlying lawsuit. The underlying lawsuit alleged environmental property damage resulting from Doe Run's mine and mill operations. The court affirmed the district court's conclusion that Lexington had no duty to defend because the policies' absolute pollution exclusions unambiguously barred coverage of all claims asserted in the underlying lawsuit. View "Doe Run Resources Corp. v. Lexington Ins. Co." on Justia Law

Plaintiffs appealed the district court's judgment in favor of Federal, denying plaintiffs indemnification under their insurance policy for the destruction of their barn by fire. The court concluded that the permissive adverse inference instruction with respect to a photograph that plaintiffs had not produced in discovery was appropriate; Federal was not entitled to attorney fees; Federal was not entitled to equitable relief to recover payments made to plaintiffs; and, therefore, the judgment of the district court was affirmed. View "Mali v. Federal Ins. Co," on Justia Law

In 1987, Kenseth underwent surgical gastric banding, covered by her insurer. About 18 years later Dr. Huepenbecker, advised another operation for severe acid reflux and other problems resulting from the first surgery. Her employer provided insurance through Dean, a physician-owned integrated healthcare system, specifically excluding coverage for “surgical treatment or hospitalization for the treatment of morbid obesity” and services related to a non-covered benefit or service. Plan literature refers coverage questions to the customer service department. Huepenbecker worked at a Dean-owned clinic, scheduled surgery at a Dean-affiliated hospital, and instructed Kenseth to call her insurer. Kenseth spoke with a customer service representative, who stated that Dean would cover the procedure. After the surgery, Dean declined coverage. Kenseth was readmitted for complications. Dean denied coverage for the second hospitalization. Kenseth pursued internal appeals to obtain payment of the $77,974 bill before filing suit under ERISA, 29 U.S.C. 1001, and Wisconsin law. The district court granted Dean summary judgment. The Seventh Circuit affirmed as to estoppel and pre-existing condition claims, but remanded concerning breach of fiduciary duty. After the district court again entered summary judgment for Dean, the Supreme Court decided Cigna v. Amara, clarifying relief available for a breach of fiduciary duty in an ERISA action. The Seventh Circuit remanded, stating that Kenseth has a viable claim for equitable relief. View "Kenseth v. Dean Health Plan, Inc." on Justia Law

Petitioner Shannon Hutchinson was the beneficiary of a mortgage life insurance policy. She sued Liberty Life Insurance Company after it denied her benefits under a policy exclusion for injury resulting from the insured's being intoxicated. The insured-decedent was under the influence of methamphetamine at the time of his accidental death. The circuit court granted Petitioner summary judgment, finding methamphetamine was not a narcotic under the policy. The appellate court reversed, finding the plain meaning of "narcotic" was enough to qualify as a narcotic. Petitioner petitioned the Supreme Court; the Supreme Court reversed the appellate court, finding the appellate court ready the policy exclusion to deny coverage for injuries from unlawful use of intoxicating substances: "this reading rewrites rather than interprets the insurance policy's exclusionary clause." View "Hutchinson v. Liberty Life Insurance" on Justia Law

Alea London Limited (insurer) appealed a circuit court's denial of its motion to set aside an order of a special referee that granted Respondent Elisa Narruhn an assignment of rights in supplemental proceedings held in conjunction with another lawsuit. The underlying suit was filed after Respondent was shot while attending a nightclub in Myrtle Beach. A special referee was appointed to conduct supplemental proceedings to determine whether the club had any assets to satisfy Respondent's judgment. The referee granted Respondent an assignment of any and all rights, including any claims, the club might have had against the Insurer (which issued the club a liability insurance policy). Respondent subsequently sued the Insurer seeking damages for failing to pay or defend a claim. Upon review, the Supreme Court modified the circuit court's order, but affirmed. View "Narruhn v. Alea London Limited" on Justia Law

Employee was injured while in the course and scope of his employment. Employee's industrial claim was allowed for certain injuries. Fourteen years later, Employee successfully requested compensation for the total loss of the functional use of his right arm. Based on the Industrial Commission's award for loss of use, one year later Employee filed a motion for compensation for statutory permanent total disability. A staff hearing officer denied the application. The court of appeals granted Employee's writ of mandamus, concluding that the loss of use of Employee's arm could not be relitigated and that the Commission was bound by the doctrine of collateral estoppel to issue the award. The Supreme Court reversed the judgment of the court of appeals and denied the writ of mandamus, holding (1) the Commission must conduct an independent evaluation of the facts when considering an application for statutory permanent disability under Ohio Rev. Code 4123.58(C) even if a prior award for the same body parts has been given pursuant to Ohio Rev. Code 4123.57(b); and (2) the evidence in the record supported the basis for the Commission's decision. View "State ex rel. Coleman v. Indus. Comm'n of Ohio" on Justia Law

Plaintiffs were two limited liability companies that made loans to Goldan, LLC. Goldan failed to repay the loans. Plaintiffs later discovered that their mortgages had not been recorded as agreed upon. Plaintiffs sued Goldan and its two principals, Mark Goldman and Jeffrey Daniels, alleging a number of claims. One claim was asserted against Daniels, a lawyer, for legal malpractice for failing to record the mortgages. Daniels' malpractice carrier, American Guarantee and Liability Insurance Company (American) refused to provide defense or indemnity coverage. Daniels defaulted in Plaintiffs' action against him. Daniels assigned to Plaintiffs his rights against American. Plaintiffs subsequently brought an action against American for breach of contract and bad faith failure to settle the underlying lawsuit. Supreme Court granted Plaintiffs' motions as to the breach of contract claims and dismissed the bad faith claims. The Appellate Division affirmed. The Court of Appeals affirmed, holding (1) by breaching its duty to defend Daniels, American lost its right to rely on policy exclusions to escape its duty to indemnify; and (2) the lower courts properly dismissed Plaintiffs' bad faith claims. View "K2 Inv. Group, LLC v. Am. Guar. & Liab. Ins. Co." on Justia Law

In 2003, the Securities and Exchange Commission (SEC) notified Bear Stearns & Co. and Bear Stearns Securities Corp. of its intention to charge Bear Stearns with violations of federal securities laws. Bear Stearns agreed to pay $160 million as a disgorgement and $90 million as a civil penalty. Bear Stearns then sought indemnification from its insurers (Insurers), requesting indemnity for the $160 million SEC disgorgement payment. Insurers denied coverage. Bear Stearns subsequently brought this breach of contract and declaratory judgment action against Insurers. Insurers unsuccessfully moved to dismiss the complaint. The Appellate Division reversed and dismissed the complaint, holding that, as a matter of public policy, Bear Stearns could not seek coverage under its policies for any of the SEC disgorgement payment. Bear Stearns appealed, arguing that, while it was reasonable to preclude an insured from obtaining indemnity for the disgorgement of its own illegal gains, Bear Stearns was not unjustly enriched by at least $140 million of the disgorgement payment, the sum attributable to the profits of its customers. The Court of Appeals reversed, holding that Insurers did not meet their burden of establishing, as a matter of law, that Bear Stearns was barred from pursuing insurance coverage under its policies. View "J.P. Morgan Sec. Inc. v. Vigilant Ins. Co." on Justia Law