Justia Insurance Law Opinion Summaries

Spirtas was hired to demolish a bridge and it hired a subcontractor for the blasting and demolition. The full demolition took more time and resources to complete. Spirtas incurred additional costs, and the general contractor withheld some payment from Spirtas. Spirtas made a claim under its commercial general liability policy with Nautilus and, after Nautilus denied the claim, Spirtas sued for declaratory judgment and vexatious refusal to pay. The court concluded that the district court correctly held that Exclusions (j)(5), (j)(6), and (m) of the policy precluded coverage. Accordingly, the court affirmed the judgment. View "Spirtas Co. v. Nautilus Ins. Co." on Justia Law

The Wyoming Workers' Safety and Compensation Division awarded benefits to Appellant after he experienced a workplace injury. The Division denied Appellant's claim for payment for prescription medication he alleged was related to his workplace injury. The Medical Commission upheld the Division's determination, and the district court affirmed. The Supreme Court affirmed, holding (1) the Commission's decision upholding the Division's denial of benefits was supported by substantial evidence; and (2) the Commission applied the proper burden of proof for a second compensable injury when it required Appellant to establish a causal connection between his abdominal pain and his ingestion of the prescription medication at issue. View "Jacobs v. State ex rel. Wyo. Workers' Safety & Comp. Div." on Justia Law

Douglas Moad was driving his truck within the course of his employment with Employer when his truck was struck by an oncoming vehicle. Douglas died from his injuries. Employer maintained workers' compensation services with Dakota Truck Underwriters (DTU), a South Dakota corporation with its principal place of business in South Dakota. Employer also maintained motorist liability coverage with Northland Insurance Company (Northland). Douglas and his wife Sharon maintained insurance coverage with Property and Casualty Insurance Company of Hartford (Hartford). Sharon filed a petition seeking damages from Northland and Hartford for uninsured motorist benefits. DTU filed a notice of subrogation lien, asserting that it was entitled to reimbursement from any proceeds obtained by Sharon as a result of the damages action. Sharon reached a settlement agreement with Northland and Hartford. The district court approved the settlement and granted Sharon's motion to extinguish DTU's lien, concluding that in the event DTU's untimely filing of notice of its lien did not bar its interest, Iowa law applied and barred DTU's recovery. The Supreme Court reversed, holding that the district court utilized the wrong standard in resolving the conflict of laws question. View "Moad v. Dakota Truck Underwriters, Risk Admin. Servs., Inc." on Justia Law

At issue in this case was whether the Iowa Insurance Commissioner's interpretation of a recently enacted law governing dental insurance plans should be upheld. Petitioner, the Iowa Dental Association (IDA), filed with the Insurance Division a request for a declaratory order clarifying the meaning of "covered services" in the statute. The Commissioner issued a declaratory order stating that an insurer may limit the maximum fees charged by dentists for services that a generally included in the insurer's dental plan, even though they are not actually reimbursed by the insurer because of a plan restriction. The district court affirmed the Commissioner's declaratory ruling. The Supreme Court reversed, holding that the services in question did not meet the statutory definition of "covered services" because they had not been reimbursed under the dental plan. Accordingly, an insurer may only impose a maximum fee on a service when a reimbursement has been provided for that service. Remanded. View "Iowa Dental Ass'n v. Iowa Ins. Div." on Justia Law

A husband and wife applied for life insurance policies from Farm Bureau Life Insurance Company and later sued Farm Bureau for its alleged negligence in failing to notify them of their HIV-positive status. Farm Bureau settled the negligence claims, sued its insurers for indemnity, and sued its insurance broker for breach of contract and negligence in failing to provide timely notice to the insurers. The district court granted summary judgment (1) in favor of the insurers on the ground that Farm Bureau had failed to give them timely notice of the applicants' liability claims, and (2) in favor of the broker after concluding that even if the insurers had been given timely notice of the applicants' tort claims against Farm Bureau, coverage for those claims would have been precluded under two separate exclusions. In this appeal, Farm Bureau challenged the judgment in favor of the broker. The Supreme Court affirmed, holding that the underwriting exclusion would have precluded coverage for the applicants' claims even if the insurers had been timely notified under the policy's notice requirement. View "Farm Bureau Life Ins. Co. v. Holmes Murphy & Assocs., Inc." on Justia Law

Chartis Insurance issued two workers' compensation insurance policies to Action Warehouse Company. Action, in turn, contracted with two tire companies to provide employees to operate tire warehouses owned by the companies and used exclusively to store the goods manufactured by the respective employers. Originally, Chartis classified the Action employees who staffed the warehouses under the National Council on Compensation Insurance (NCCI) classification code applicable to general warehouse employees. Later, Chartis retroactively and prospectively changed the employees' classification code to the code applicable to rubber tire manufacturing, resulting in a significantly higher premium. Action appealed. The NCCI Iowa workers' compensation appeals board ruled in favor of Chartis. The Iowa Insurance Commissioner reversed, and the district court affirmed. At issue before the Supreme Court was whether the Commissioner had the authority under Iowa Code 515A.1 to consider an as-applied challenge to a workers' compensation liability insurance rating schedule approved for use in accordance with Iowa law. The Supreme Court reversed, holding that the Commissioner did not have the authority to determine that a specific application of a plan approved under Iowa Code 515A.4 violated the statute's general purpose as outlined in section 515A.1 by being excessive, inadequate, or unfairly discriminatory. View "Chartis Ins. v. Iowa Ins. Comm'r" on Justia Law

This case concerned whether ILU had a duty to defend LaGen in an underlying suit filed against it by the EPA and the LDEQ for alleged Clean Air Act (CAA), 42 U.S.C. 7401, and state environmental law violations. Reading all of the relevant provisions together and giving them their plain meaning, the underlying EPA suit included allegations and prayers for relief that could potentially result in covered remediation costs. The court rejected ILU's argument that injunctive relief was excluded from coverage by the Fines and Penalties exclusion. Because the court found that ILU had a duty to defend on other grounds, the court declined to decide on interlocutory appeal whether New York law allowed indemnification for CAA civil penalties. Accordingly, the court affirmed the district court's holding that under the policy ILU had a duty to defend LaGen in the underlying EPA and LDEQ suit. The court remanded for further proceedings and denied ILU's motion to dismiss LaGen's cross-appeal as moot. View "Louisiana Generating, L.L.C., et al v. Illinois Union Ins. Co." on Justia Law

Plaintiffs entered into a contract with DJ Construction (DJ) to build a home on their property. Construction was halted two years later after Plaintiffs discovered significant water damage in the home. Plaintiffs sued DJ, seeking to recover for the damage to their home and DJ's failure to complete the house. Auto-Owners Insurance Company, DJ's insurer, denied DJ's requests for defense and indemnity against Plaintiffs' claims, determining coverage was not provided for under the terms of the policy. Plaintiffs subsequently entered into a stipulated judgment and settlement agreement with DJ in which DJ confessed judgment and assigned its rights and claims against Owners to Plaintiffs. Plaintiffs then filed suit against Owners based on Owners' failure to defend and indemnify DJ. The circuit court granted summary judgment in favor of Owners, determining there was no coverage under the policy because multiple policy exclusions applied. The Supreme Court affirmed, holding that the circuit court did not err in granting summary judgment in favor of Owners on Plaintiffs' breach of contract and bad faith claims based upon its determination that multiple policy exclusions applied. View "Swenson v. Owners Ins. Co." on Justia Law

After an administrative judge (AJ) ruled on a claimant's petition to controvert a workers' compensation claim, the claimant had twenty days to file a notice of appeal with the full Mississippi Workers' Compensation Commission. In this case, the issue before the Supreme Court was whether an AJ's order, handed down more than twenty days after the AJ's ruling and granting a claimant thirty additional days in which to prosecute her claim, should be given legal effect by the Commission so that the claimant's notice of appeal, filed within the additional thirty days, would be considered timely. Upon review, the Court found that, under the facts and circumstances presented, such an appeal was timely. View "Felter v. Floorserv, Inc." on Justia Law

Plaintiff, the insured, appealed the district court's holding that his Hartford insurance policy prohibited plaintiff from "stacking," or combining the uninsured/underinsured motorist coverage (UM/UIM) for each insured vehicle, when the policy failed to specify any particular amount of UM/UIM coverage afforded. The court concluded that because Virginia Code 38.2-2206(A) mandated that UM/UIM coverage "shall equal" the general liability coverage, this provision by operation of law provided plaintiff an equal amount of UM/UIM coverage under the Hartford policy. Accordingly, the court held that the anti-stacking provision in plaintiff's policy unambiguously prevented the stacking of UM/UIM coverage, and affirmed the district court's award of summary judgment in favor of Hartford. View "Dooley v. Hartford Accident & Indemnity Co." on Justia Law