Justia Insurance Law Opinion Summaries

The Supreme Court reversed the decision of the court of appeals reversing the judgment of the district court that Insured was not entitled to preaward interest from Insurer on an appraisal award based on Minn. Stat. 549.09, holding that the policy language limited interest on a loss to amounts accruing after an appraisal award is issued.After a fire damaged his home, Insured disagreed with Insurer's valuation and demanded an appraisal. The claim was submitted to appraisal, but Insurer did not pay Insured any additional amounts. Insured then demanded preaward interest on the appraisal award, arguing that interest accrued from the date of written notice of his fire claim and until the appraisal award was issued. When Insurer refused to pay, Insured brought this action. The district court concluded that Insured was not entitled to preaward interest. The court of appeals reversed, concluding that the policy language must "explicitly preclude" reward interest to avoid the obligation to pay preaward interest under section 549.09. The Supreme Court reversed, holding that a fire insurance policy provision stating that "no interest accrues on the loss until after the loss becomes payable" precludes preaward interest under section 549.09. View "Wesser v. State Farm Fire & Casualty Co." on Justia Law

Glassman prevailed in an uninsured motorist (UIM) arbitration against Safeco. The arbitration agreement was contained in a Safeco umbrella policy that provided excess UIM benefits, above those afforded by Glassman’s concurrent Safeco auto-liability policy. Glassman had sustained bystander emotional distress damages after witnessing her mother’s fatal injuries when an underinsured driver hit them both while they were in a crosswalk. The arbitrator’s award determined that Glassman’s compensable damages exceeded the required threshold to entitle her to the umbrella-policy excess UIM limits of $1 million.Before the arbitration, Glassman had issued to Safeco a Code of Civil Procedure section 998 offer of $999,999.99. Safeco did not accept the offer. Glassman sought prejudgment interest under section 3287(a) from the date of her section 998 offer. Under section 3287(a), a liquidated damage claim triggers entitlement to prejudgment interest as a form of additional compensatory damages if the defendant knew or was able to calculate from reasonably available information the amount of the plaintiff’s liquidated claim owed as of a particular day. The trial court denied Glassman’s request, concluding that the amount of her claim was not certain or capable of being made certain.The court of appeal affirmed. An insured’s prevailing section 998 offer in a UIM proceeding does not effectively liquidate the insured’s claim in the amount and as of the date of the offer under section 3287(a). The court noted the lack of evidence of Safeco’s knowledge that Glassman’s economic losses or special damages resulting from the accident already exceeded the umbrella-policy limits when her section 998 offer was made. View "Glassman v. Safeco Insurance Co. of America" on Justia Law

Plaintiff Moses Enterprises, LLC, sells cars. Moses had an insurance policy issued by defendant Lexington Insurance Company, with Defendant AIG Claims, Inc. serving as the claims administrator. Moses sued Lexington and AIG in federal district court. The complaint made four claims under West Virginia law, including—as relevant here—one for breach of the insurance contract and one for violating the State’s unfair trade practices statute. The district court granted partial summary judgment for Moses on the breach of contract claim but resolved only liability—not damages.   The Fourth Circuit vacated the district court’s judgment and remanded. The court explained that the district court’s later grant of partial summary judgment also did not obviate the need for further work to “obtain payment of the insurance proceeds.” However, at the same time the court rejected Moses’s contention that the district court committed no legal errors in concluding Moses was entitled to “the entire amount of attorney’s fees incurred until the final resolution of the case.” Thus, the court wrote because the district court committed legal error in awarding Moses the full amount of its requested fees without determining whether any of the work was properly attributed only to the Jenkins claim, the court vacated the fee award and remand for further proceedings View "Moses Enterprises, LLC v. Lexington Insurance Company" on Justia Law

The Supreme Court reversed in part the judgment of the court of appeals in this insurance dispute, holding that Tex. Ins. Code 705.051 does not displace the common-law rule that insurers may not avoid liability under an insurance policy based on a misrepresentation in an insurance application unless the insurer pleads and proves the insured intended to deceive or induce the insurer to issue the policy.At issue was whether the common-law scienter requirement was repugnant to the plain language of section 705.051, which provides that a misrepresentation in an application for an insurance policy does not defeat recovery under the policy unless the misrepresentation is of a material fact and affects the risks assumed. The court of appeals held that the common-law scienter requirement survived section 705.051's recodification, and therefore, summary judgment was not proper. The Supreme Court affirmed in part, holding (1) section 705.051 does not displace the common-law rule; and (2) as a matter of law, the insurer in this case was exempt from complying with the ninety-day notice provision in Texas Ins. Code 705.005. View "American Nat'l Insurance Co. v. Arce" on Justia Law

The Santa Ynez Band of Chumash Mission Indians of the Santa Ynez Reservation California (Chumash) appealed a judgment following the granting of a motion for summary judgment in favor of Lexington Insurance Company (Lexington) in Chumash’s lawsuit against Lexington for denial of insurance coverage.   The Second Appellate District affirmed. The court concluded that, among other things, Chumash did not present sufficient evidence to show that the COVID-19 virus caused physical property damage to its casino and resort so as to fall within the property damage coverage provisions of the Lexington insurance policy. The court explained that had the Chumash Casino and Resort sustained property damage, it was required to specify what property was damaged and to submit a claim for the dollar amount of that loss. The absence of such information supports Lexington’s decision to deny coverage. View "Santa Ynez Band of Chumash etc. v. Lexington Ins. Co." on Justia Law

Olmsted Medical Center (“Olmsted”) provides preventive, primary, and specialty healthcare in southeastern Minnesota. Olmsted purchased a business property insurance policy from Continental Casualty Company (“Continental”) for the period from January 1, 2020, to January 1, 2021. The “Coverage” section of the policy states that it “insures against risks of direct physical loss of or damage to property and/or interests described herein at” Olmsted’s premises. Olmsted submitted a claim for losses it sustained due to the COVID-19 pandemic under the insurance policy it held with Continental. Continental denied the claim two days later. Olmsted filed suit in Minnesota state court, alleging Continental breached the insurance contract when it refused to pay the claim. Olmsted requested damages and declaratory relief. After Olmsted filed its amended complaint, Continental filed a motion to dismiss. Continental argued, among other things, that Olmsted’s allegations did not implicate a “direct physical loss of or damage to” property; therefore, its claim for coverage did not fall within the policy’s language under any of the above provisions.   The Eighth Circuit affirmed. The court explained that although SARS-CoV-2 may have a “physical” element, it does not have a physical effect on real or personal property. Moreover, the business-interruption provision, however, expressly limits coverage to the “length of time as would be required . . . to rebuild, repair or replace” the affected property. Due to the fact that SARS-CoV-2 does not have an effect on the underlying property, the court did not see how to square Olmsted’s broader interpretation of the provision with the express time limitation. View "Olmsted Medical Center v. Continental Casualty Company" on Justia Law

A False Claims Act qui tam action was filed under seal against SHH and its nursing facilities, alleging that SHH provided unreasonable and unnecessary services to claim the highest possible Medicare reimbursement. Three co-relators also alleged that SHH retaliated against them for internally reporting fraudulent billing practices. SHH received a Department of Justice notification that it was the subject of a fraudulent claims investigation, requesting information about recent terminations of SHH employees, including the relators. It did not explicitly refer to the retaliation allegations.Two years later, SHH obtained liability coverage. Allied's claims-made policy applies only to claims first made during the policy period. SHH's application checked "none" when asked to “provide full details of all inquiries, investigations, administrative charges, claims, and lawsuits filed” within the last three years. SHH checked “no” to whether “[SHH], any Subsidiary, any Executive or other entity proposed for coverage kn[ew] of any act, error or omission which could give rise to a claim, suit or action.” An application exclusion, incorporated into the policy, stated that if such information existed, any inquiry, investigation, administrative charge, claim, or lawsuit arising therefrom or arising from such violation, knowledge, information, or involvement is excluded from coverage.The qui tam action was unsealed. SHH notified Allied and sought coverage for defense costs. Allied denied coverage. SHH sued. SHH later settled the relators' retaliation claim ($2.2 million) and finalized a $10 million settlement for the claims-submissions violations. The district court granted SHH partial summary judgment, awarding $2,336,786.35. The Sixth Circuit reversed. The plain language of SHH’s policy excluded coverage. View "SHH Holdings, LLC v. Allied World Specialty Ins. Co." on Justia Law

The First Circuit reversed the judgment of the district court ruling that Insured's claim of unfair claim settlement practices in violation of Mass. Gen. Laws ch. 176D and 93A was barred by the choice-of-law provision of the marine insurance policy he purchased from Great Lakes Insurance SE (GLI), holding that the district court erred.Insurer, the insurer of Insured's forty-seven-foot catamaran sailing vessel, brought a declaratory judgment action to determine whether the "constructive total loss" of Insured's vessel was covered under the relevant policy. Insured brought a counterclaim alleging violations of Mass. Gen. Laws ch. 176D, 3(9) and ch. 93A, 9(3A). The district court ruled that pursuant to the policy's choice-of-law provision, New York law barred Insured's Massachusetts counterclaim because New York law does not provide for a chapters 176D and 93A claim. The First Circuit reversed, holding (1) Insured's statutorily-based counterclaim was extra-contractual; (2) the plain language of the choice-of-law provision was not broad enough to unambiguously encompass an extra-contractual claim; and (3) any ambiguity in the policy must be construed in favor of Insured. View "Great Lakes Insurance SE v. Andersson" on Justia Law

The Supreme Court affirmed the decision of the superior court granting summary judgment and final judgment in favor of third-party defendants, Western Surety Company and the Insurance Company of the State of Pennsylvania (collectively, the Sureties) in this case concerning the scope of the sureties' liability under a performance and payment bond issued in conjunction with a public works project, holding that there was no error.The Rhode Island Department of Transportation (RIDOT) was sued by Apex Development Company in this action alleging that RIDOT and its contractors trespassed and damaged Apex's private property. RIDOT filed a third-party complaint against the Sureties and others, seeking full indemnity and contribution. A hearing justice granted summary judgment for the Sureties, and a final judgment was entered. The Supreme Court affirmed, holding that RIDOT was not entitled to relief on its allegations of error on appeal. View "Apex Development Co., LLC v. State of R.I. Dep't of Transportation" on Justia Law

Appellants Robert and Kelly Franks sought automobile insurance from Appellee, State Farm Mutual Automobile Insurance Company in 2013 for their two vehicles. Appellants included underinsured motorist coverage (“UIM”) in their policy but completed a form rejecting stacked UIM coverage in compliance with Section 1738(d)(2) of the Motor Vehicle Financial Responsibility Law (“MVFRL”). Absent such waiver, stacked coverage would be the default. Appellants removed one of the original vehicles and added a third vehicle to the policy effective 2014, and again rejected stacked UIM coverage. They made another change to the policy in 2015, removing the other of the original insured vehicles with a different car. No additional form rejecting stacked UIM coverage was offered or sought to be completed on the occasion of the removal of the last vehicle, and the ongoing premiums paid by Appellants reflected the lower rate for non-stacked UIM overage on two vehicles. Robert was injured in an accident caused by the negligence of a third party. That party had insufficient liability coverage to cover Robert's injuries. Appellants initiated a claim for UIM benefits under their policy with State Farm, but the parties disagreed on the limit to their benefits. Appellants contended with the last change to the policy, there was no valid waiver of stacked UIM coverage, resulting in a default stacked coverage mandated by statute. The issue presented for the Pennsylvania Supreme Court's review in this matter was whether the Superior Court erred as a matter of law by holding that removal of a vehicle from a multiple motor vehicle insurance policy, in which stacked coverage had previously been waived, did not require a renewed express waiver of stacked coverage pursuant to Section 1738(c). The Supreme Court concluded the Superior Court did not err and affirmed its judgment. View "Franks, et al. v. State Farm Mutual" on Justia Law