Justia Insurance Law Opinion Summaries

The Supreme Court affirmed in part and reversed in part the judgment of the circuit court in favor of Secura Supreme Insurance Company as the underinsured motorists' (UIM) carrier for Viviane Renot, holding that the trial court erroneously permitted Dr. David Porta to testify about medical questions beyond his qualifications.Renot was allegedly injured in a vehicle collision and brought this action against Secura as her UIM carrier. During trial, Secura called Porta, a biomechanics expert, to testify regarding his biomechanics and anatomical opinions relative to the mechanism of injury in the collision. The jury returned a verdict in favor of Secura, finding that the collision had not been a substantial factor in Renot's injuries. The court of appeals affirmed. The Supreme Court reversed in part, holding that the trial court erroneously permitted Dr. Porta to invade the exclusive province of medical doctors in determining medical causation, and the error required a new trial. View "Renot v. Secura Supreme Insurance Co." on Justia Law

The Supreme Court reversed the judgment of the court of appeals affirming the decision of the trial court to utilize Ky. R. Civ. P. 37.02(3) to assess attorney's fees against a non-party after the non-party failed to obey an order to comply with a subpoena duces tecum, holding that the plain language of CR 34.07(3) applies only to parties to an action.Plaintiffs brought two actions related to an automobile collision against their insurer, Allstate Property & Casualty Insurance Company, among others. Allstate disputed the charges assessed by Dr. David Megronigle for his chiropractic treatment to Plaintiffs, alleging that they were not properly compensable. Plaintiffs later filed a notice of voluntary dismissal as to Megronigle. Thereafter, Allstate filed a motion for attorney's fees under CR 37.02(3). The court granted the motion and ordered Megronigle to pay Allstate the amount of $816. The court of appeals affirmed. The Supreme Court reversed, holding (1) the plain language of CR 37.07(3) applies only to parties to an action; and (2) Megronigle was not a party to the underlying action because he was involved solely by virtue of the subpoenas served upon him by Allstate. View "Megronigle v. Allstate Property & Casualty Insurance Co." on Justia Law

The Supreme Court reversed the judgment of the court of appeals affirming the decision of the trial court to utilize Ky. R. Civ. P. 37.02(3) to assess attorney's fees against a non-party after the non-party failed to obey an order to comply with a subpoena duces tecum, holding that the plain language of CR 34.07(3) applies only to parties to an action.Plaintiffs brought two actions related to an automobile collision against their insurer, Allstate Property & Casualty Insurance Company, among others. Allstate disputed the charges assessed by Dr. David Megronigle for his chiropractic treatment to Plaintiffs, alleging that they were not properly compensable. Plaintiffs later filed a notice of voluntary dismissal as to Megronigle. Thereafter, Allstate filed a motion for attorney's fees under CR 37.02(3). The court granted the motion and ordered Megronigle to pay Allstate the amount of $816. The court of appeals affirmed. The Supreme Court reversed, holding (1) the plain language of CR 37.07(3) applies only to parties to an action; and (2) Megronigle was not a party to the underlying action because he was involved solely by virtue of the subpoenas served upon him by Allstate. View "Megronigle v. Allstate Property & Casualty Insurance Co." on Justia Law

Dr. Robert P. Rothenberg (Rob) tragically suffered a fatal heart attack prior to paying the initial premium on his term life insurance policy issued by Principal National Life Insurance Company (Principal). Principal filed this action in the district court, seeking a declaratory judgment that Appellant— the policy’s intended beneficiary—was not owed death benefits in light of the nonpayment. Appellant filed a counterclaim, asserting claims against Principal for breach of contract, vexatious denial of proceeds, and negligence, as well as claims against Appellee, the couple’s insurance broker and financial planner, for negligence. After the parties filed cross-motions for summary judgment, the district court granted summary judgment in favor of Principal and Appellee, finding, in part, that the policy was not in effect at the time of Rob’s death. Appellant appealed, arguing that the district court erred in concluding (1) that the Policy was not in effect at the time of Rob’s death and (2) that, assuming the Policy was not in effect, neither Principal nor Appellee were negligent because neither owed a duty to Appellant.   The Eighth Circuit affirmed. The court explained that Appellant did not pay the initial premium until after Rob’s death, at which time he was not in a similar state of health as when he applied for the policy. Moreover, any “privileges and rights” Rob (or Appellant) had to retroactively effectuate the Policy were terminated at Rob’s death pursuant to the Policy’s termination provision. Second, Rob’s signature on the EFT Form alone did not render the Policy effective on April 26, 2019, or earlier. View "Principal National Life Insurance Company v. Donna Rothenberg" on Justia Law

Plaintiff underwent bariatric surgery to lose weight. A few months later, Plaintiff began working for Zimmerman Transfer, Inc. and became a participant in its self-insured employee benefit plan. Zimmerman is the plan administrator, and Benefit Plan Administrators of Eau Claire, LLC (“BPA”) served as the third-party administrator until January 2020. After exhausting his administrative appeals, Plaintiff sued BPA and Zimmerman for benefits under Section 1132(a)(1)(B). He then moved for summary judgment against BPA and Zimmerman. Both Defendants filed cross-motions for summary judgment, which the district court granted.   The Eighth Circuit affirmed. The court explained that because Plaintiff’s plan specifically excludes coverage of treatment for complications of weight-reduction surgery, neither Iowa law nor the ACA requires that his treatment be covered. It is undisputed that Plaintiff’s treatment was due to a complication of his prior bariatric surgery. Thus, Iowa law and the ACA do not require that his treatment be covered. Further, the court wrote that imposing and enforcing coverage limitations, even if it results in a plan participant paying large medical bills, is not inconsistent with the plan’s goal because the plan must allocate limited resources among all plan participants. Accordingly, the court concluded that there was no abuse of discretion in denying Plaintiff’s claim for benefits because the interpretation of the plan was reasonable, and the decision to deny benefits was supported by substantial evidence. View "Darrin Shafer v. Zimmerman Transfer, Inc." on Justia Law

The Supreme Court affirmed the rulings of the Workers' Compensation Court (WCC) determining that Johnny Lee Sheldon's claim was compensable, that Contessa Bryer, Sheldon's guardian and conservator, was entitled to her attorney fees, and that a statutory penalty should be imposed against Accident Fund General Insurance Company, holding that the WCC did not err.Sheldon was rendered incapacitated and mentally incompetent after a workplace accident. Because Accident Fund General Insurance Company refused to accept liability for Sheldon's workers' compensation claim Bryer, Sheldon's guardian and conservator, petitioned the WCC for a hearing. The WCC ruled that Accident Fund was liable for Sheldon's injuries and that Bryer was entitled to attorney fees and a statutory penalty. The Supreme Court affirmed, holding that the WCC did not err when it (1) ruled that the statute of limitations was tolled during the time that Sheldon had no appointed guardian; (2) found that substantial credible evidence supported the WCC's finding that Sheldon was working with argon when the pressure relief valve burst; and (3) awarded attorney fees under Mont. Code Ann. 39-71-611 and by imposing a penalty against Accident Fund under Mont. Code Ann. 39-71-2907. View "Bryer v. Accident Fund General Insurance Co." on Justia Law

Two individuals were involved in a car accident in St. Louis, Missouri. One of the cars crashed into White Knight Diner, resulting in property damage to the restaurant. At the time, White Knight was insured by Owners Insurance Company (Owners)pursuant to a policy that provided coverage for property damage and loss of business income (the Policy). After the insurers brought several motions to dismiss, the district court dismissed all parties except for Owners and White Knight. White Knight then filed an amended complaint against Owners only, adding new causes of action, including breach of contract and breach of the implied covenant of good faith and fair dealing. Owners filed a motion for summary judgment on all claims. The district court granted Owners’ motion. White Knight appealed, arguing that disputed material facts remain as to whether Owners’ subrogation efforts were conducted in breach of the Policy.   The Eighth Circuit affirmed. The court explained that even assuming Owners’ actions were taken pursuant to the Policy, White Knight’s claim still fails because it does not establish that it suffered any damages as a result of Owners’ failure to abide by the contracted-for procedures. White Knight, as an insured party under the Policy, contracted for and paid premiums to receive insurance. And Owners settled White Knight’s claim under the Policy when Owners paid White Knight a total of $66,366.27 for property damage and business income loss. White Knight has not shown that it suffered any damages beyond the compensation it received from Owners. Without evidence of damages, a breach of contract claim fails. View "White Knight Diner, LLC v. Owners Insurance Company" on Justia Law

AM Grand Court Lakes LLC and AM 280 Sierra Drive LLC (collectively “AM Grand”) owned a group of buildings that were operated as an assisted living facility. AM Grand submitted a claim to its insurer, Rockhill Insurance Company, for damage caused by Hurricane Irma. Rockhill denied the claim because it determined that the hurricane caused only minor damage to the property. AM Grand sued Rockhill for breach of the policy. The case went to trial, where a jury found that Rockhill had breached the terms of the insurance policy and that AM Grand’s covered losses amounted to $9,280,000. Based on the jury’s findings, the district court entered judgment in AM Grand’s favor. After the district court entered judgment, Rockhill filed a motion for a new trial arguing that the jury’s damages award was excessive. The district court denied the motion. Rockhill argues on appeal that the district court erred in denying its motion for a new trial because there was no evidence in the record to support the jury’s finding that AM Grand sustained a loss of $9,280,000.   The Eleventh Circuit affirmed, holding that the evidence was sufficient to sustain the verdict. The court held that Rockhill is correct that the amount of damages depended on the extent to which AM Grand’s buildings were damaged in Hurricane Irma. But the court disagreed that the jury’s options were as limited as Rockhill describes. Instead, the court concluded—based on the evidence presented at trial—that the verdict was within the range of damages that a jury reasonably could have awarded. View "AM Grand Court Lakes LLC, et al. v. Rockhill Insurance Company" on Justia Law

When the COVID-19 pandemic began, Froedtert Health faced overwhelming demand to provide lifesaving care, which required substantial investments in personal protective equipment, waste disposal mechanisms, and cleaning and sanitation supplies. Froedtert also modified its emergency room layout and adapted its facilities to provide COVID-19 testing and screening. Froedtert paused nonemergency, elective procedures. Froedtert spent $85 million on COVID-related costs and sought reimbursement under its all-risks policy with Mutual. The insurer determined that the COVID-related losses did not constitute a direct physical loss triggering the general coverage provision and $2 billion limit but paid Froedtert the maximum $1 million sub-limit under a separate, additional coverage provision for losses from communicable disease response.The Seventh Circuit affirmed the dismissal of Froedert’s subsequent lawsuit, noting the policy’s “dense detail.” The policy’s general coverage is limited by accompanying exclusions, including the broad exclusion for contamination losses. In a later section, the policy then affords certain specified Additional Coverages, including for communicable disease response costs. That additional coverage would not exist if it was not expressly delineated in the Additional Coverages section of the policy. View "Froedtert Health, Inc. v. Factory Mutual Insurance Co." on Justia Law

Adora Wilmore-Moody, individually and as next friend of her minor son, brought an action against Mohammed Zakir and Everest National Insurance Company, alleging that Zakir had negligently rear-ended her vehicle, and sought personal protection insurance benefits from Everest for the injuries she and her son incurred as a result of the collision. Everest did not pay the benefits but instead rescinded plaintiff’s policy on the ground that plaintiff had failed to disclose that she had a teenaged granddaughter living with her when she applied for the insurance policy. Everest then brought a counterclaim seeking declaratory relief and moved for summary judgment of plaintiff’s claim against it under MCR 2.116(C)(10), arguing that it was entitled to rescind plaintiff’s policy because she had made a material misrepresentation in her insurance application. The trial court granted Everest’s motion. After this ruling, Zakir also moved for summary judgment, arguing that plaintiff was barred from recovering third-party noneconomic damages from him under the Michigan no-fault act because once Everett rescinded plaintiff’s insurance policy, she did not have the security required by statute at the time the injury occurred. The trial court granted Zakir summary judgment too. The Court of Appeals affirmed the grant of summary judgment to Everest, reversed as to Zakir, and remanded the case for further proceedings. Zakir appealed. The Michigan Supreme Court affirmed the appellate court: an insurer’s decision to rescind a policy post-accident does not trigger the exclusion in MCL 500.3135(2)(c). "Rescission is an equitable remedy in contract, exercised at the discretion of the insurer, and does not alter the reality that, at the time the injury occurred, the injured motorist held the required security. Rescission by the insurer post-accident is not a defense that can be used by a third-party tortfeasor to avoid liability for noneconomic damages." View "Wilmore-Moody v. Zakir" on Justia Law