Justia Insurance Law Opinion Summaries

Following a vehicular accident, Martin Peteet entered into a release and settlement agreement with the driver of the other vehicle and her insurer. Peteet did not seek a waiver of subrogation or consent from his own automobile insurer, Mississippi Farm Bureau Casualty Insurance Company (Farm Bureau), prior to executing the release and settlement agreement. After the release and settlement agreement was executed, Peteet filed a complaint against Farm Bureau, seeking damages under the uninsured motorist (UM) provision in his auto policy with Farm Bureau. Farm Bureau moved to dismiss the complaint, and the county court denied the motion. Farm Bureau sought an interlocutory appeal, which the Mississippi Supreme Court granted. After a careful review of the law, the Supreme Court reversed the denial of the motion to dismiss and rendered judgment in favor of Farm Bureau. View "Mississippi Farm Bureau Casualty Insurance Company v. Peteet" on Justia Law

Plaintiff Union Mutual Fire Insurance Company (“Union Mutual”) appealed from a district court judgment. On March 4, 2017, a fire started at Liberty Avenue in Queens, New York, spreading to and damaging four neighboring buildings insured by Union Mutual. After an investigation, the fire marshals concluded, but could not determine with certainty, that the fire originated in the extension cords used by Ace Caribbean Market. Union Mutual paid proceeds to the damaged neighboring buildings and subrogated into their owners’ tort claims. Union Mutual then sued Ace Caribbean Market and others (collectively, “Defendants”), alleging that their negligent use of the extension cords caused the fire. The district court granted summary judgment for Defendants. At issue on appeal is whether evidence that a fire may have originated in the extension cords is sufficient to show that (a) the owners and proprietors were negligent in their use of the extension cords and (b) if they were negligent, that negligence was the cause of the fire.   The Second Circuit affirmed, holding that such evidence is not sufficient. The court held that, at most, Union Mutual produced weak circumstantial evidence that something wrong with the extension cords caused the fire. But, even assuming a reasonable jury could so conclude, Union Mutual showed no evidence of negligence whatsoever on Defendants’ part, and evidence of causation by itself is not evidence of negligence. The court concluded that there may have been negligence and that negligence may have been the cause of the fire. But no inference that it was Defendants’ negligence is permissible on the facts. View "Union Mut. Fire Ins. Co. v. Ace Caribbean Mkt." on Justia Law

Appellant Southern Orthopaedic Specialists, L.L.C. (“Southern Orthopaedic”) sued its insurer, State Farm Fire & Casualty Company (“State Farm”), to recover business interruption losses caused by covid-related shutdowns. It also claims that State Farm negligently misrepresented the scope of the policy’s coverage. The district court dismissed these claims as foreclosed by the policy and Louisiana law.   The Fifth Circuit affirmed. The court held that Southern Orthopaedic’s pleadings fall short. They do not allege that covid caused “tangible or corporeal” property damage. Nor do they allege that the presence of covid particles required physically repairing or replacing any part of Southern Orthopaedics’s property. Nor do they claim that the presence of covid necessitated lasting alterations to the property. Without allegations of this nature, Southern Orthopaedic cannot meet the requirement of pleading an “accidental direct physical loss” under the policy. View "S Orthopaedic Spclt v. State Farm Fire" on Justia Law

Plaintiffs sought class certification to pursue various claims against the Hilton Hotels Retirement Plan (“Hilton Plan”) for what they say are unlawfully denied vested retirement benefits. The district court ultimately denied certification on the ground that Plaintiffs had proposed an “impermissibly ‘fail-safe’” class—that is, a class definition for which membership can only be ascertained through “a determination of the merits of the case.”   The DC Circuit reversed and remanded the district court’s decision, finding that the district court, in this case, bypassed Rule 23’s requirements and based its denial of class certification entirely on the class’s “fail-safe” character. The court explained that the textual requirements of Rule 23 are fully capable of guarding against unwise uses of the class action mechanism. So the court rejected a rule against “fail-safe” classes as a freestanding bar to class certification ungrounded in Rule 23’s prescribed criteria. Instead, district courts should rely on the carefully calibrated requirements in Rule 23 to guide their class certification decisions and the authority the Rule gives them to deal with curable misarticulations of a proposed class definition. View "In re: Valerie White" on Justia Law

Banuelos claimed that she was unlawfully charged per-page fees for copies of her UW Hospitals medical records which were provided in an electronic format. UW Hospitals argued that section 146.83(3f) is silent as to fees for electronic copies of patient healthcare records and does not prohibit a healthcare provider from charging fees for providing such copies. Banuelos argued that because fees for electronic copies are not enumerated in the statutory list of permissible fees that a healthcare provider may charge, the fees charged here are unlawful under state law. The court of appeals agreed with Banuelos and determined that Wis. Stat. 146.83(3f) does not permit a healthcare provider to charge fees for providing copies of patient healthcare records in an electronic format.The Wisconsin Supreme Court affirmed. Although section 146.83(3f) provides for the imposition of fees for copies of medical records in certain formats, it does not permit healthcare providers to charge fees for patient records in an electronic format. Although Wisconsin statutes previously permitted a charge for the provision of electronic copies of patient health care records, that language has been repealed. View "Banuelos v. University of Wisconsin Hospitals and Clinics Authority" on Justia Law

Defendant and his spouse maintained a car insurance policy (the “Policy”) with State Farm Mutual Automobile Insurance Company. While the Policy was in force, Defendant’s wife was involved in an accident in which she was struck and injured by an uninsured driver of an electric motorized scooter. Defendants made a claim for her injuries under the Policy’s Uninsured Motor Vehicle (“UM”) coverage. State Farm denied the claim on the ground that under the Policy, the scooter was neither a “motor vehicle” nor an “uninsured motor vehicle,” which the Policy defined as a “land motor vehicle.” State Farm sued Defendants, seeking a declaratory judgment that the Policy provided no coverage. Both parties moved for summary judgment. The district court denied Defendant’s motion, granting summary judgment in part to State Farm.   Defendants argued that because the Policy defines “uninsured motor vehicle” as a “land motor vehicle,” the plain and ordinary meaning of the term “land motor vehicle” dictates the scope of the Policy, and under the plain and ordinary meaning of the term, the scooter is a covered uninsured motor vehicle. The Eleventh Circuit reversed the district court’s grant of summary judgment to State Farm. The court concluded that the Policy defines “uninsured motor vehicle” more broadly than Florida insurance law requires. Because an insurer can provide more UM coverage than the law requires, we decline to disregard the Policy’s broader definition of uninsured motor vehicle in favor of a more limited statutory definition of motor vehicle. View "State Farm Mutual Automobile Insurance Company v. Anna Bevilacqua Spangler, et al." on Justia Law

Douglas Ghee, as the personal representative of the estate of Billy Fleming, appealed a circuit court judgment dismissing Ghee's wrongful-death claim against USAble Mutual Insurance Company d/b/a Blue Cross Blue Shield of Arkansas and Blue Advantage Administrators of Arkansas ("Blue Advantage"). The circuit court correctly dismissed the aspect of Ghee's claim that, on the face of the complaint, was based on an insurance-benefits decision by Blue Advantage. The Alabama Supreme Court found the circuit court erred, however, by dismissing the aspect of Ghee's claim that was based on Blue Advantage's alleged provision of medical advice, because it was not clear from the complaint that that aspect was based on an insurance-benefits decision. Accordingly, the Supreme Court affirmed the judgment in part and reversed it in part. View "Ghee v. USAble Mutual Insurance Company d/b/a Blue Cross Blue Shield of Arkansas, et al." on Justia Law

Secura Supreme Insurance Company appealed a judgment ordering Secura to indemnify Scott Differding for damages awarded against him in a tort case. The district court, deciding cross motions for summary judgment, held Secura’s policy did not insure Differding. The court nonetheless held Secura had to indemnify Differding under theories of waiver and estoppel because it assumed his defense in the tort case without reserving the right to deny coverage. The North Dakota Supreme Court held Differding could not invoke waiver and estoppel to create personal coverage under an insurance policy to which he was not a party and had no right to enforce. The district court’s judgment was therefore reversed. View "Secura Supreme Ins. Co., et al. v. Differding, et al." on Justia Law

Santa Clara Valley Water District was insured by Century. In 2000, the District notified Century that it had been advised by the federal government of potential claims for natural resource damages resulting from mercury contamination in the Guadalupe River Watershed (NRD Claim). Century requested additional information, including the status of negotiations. Century made several similar requests to the District between 2000-2002. In 2001, Century indicated that it had no duties under the primary policies because there was no lawsuit pending, had no duty to indemnify the District under the excess policies until the underlying limits of the policies had been exhausted, and was reserving its rights under the policies. The District subsequently signed a tolling agreement, was sued in federal court, and entered a Consent Decree without notifying Century.In 2008, the District notified Century of the existence of the lawsuit and the Consent Decree and stated that it had incurred $4 million in costs to comply with the Consent Decree. Century cited a No Voluntary Payment (NVP) provision. The District did not contact Century until 2014, when it completed its required Consent Decree work. In 2015, the District sued Century.The court of appeal affirmed summary judgment for Century. The NVP provisions barred the District from seeking indemnification for the expenses it incurred under the Consent Decree, without notifying Century or obtaining its consent. Those provisions apply to the settlement even though it was achieved through a consent decree rather than a traditional settlement agreement. Because the NRD Claim was disposed of by that settlement, there was no “adjudication” that gave rise to an “ultimate net loss” that gave the District the right to pay and seek indemnification. View "Santa Clara Valley Water District v. Century Indemnity Co." on Justia Law

The federal district court for the District of South Carolina certified a question of law to the South Carolina Supreme Court. Garland Denson (the decedent) was killed in an automobile accident allegedly caused by a drunk driver. The complaint alleged the at-fault driver was overserved at Royal Lanes, a bar insured by Defendant National Casualty Company (National Casualty) under a general liability policy with no liquor liability endorsement. During probate of the decedent's estate, his personal representative, Plaintiff Anthony Denson (Denson), discovered Royal Lanes did not have the required liquor liability insurance. Specifically, Denson learned National Casualty previously provided liquor liability coverage to Royal Lanes, but at the time of the accident, the business had failed to renew the liquor liability coverage, leaving only a general liability policy. Liquor liability coverage was statutorily mandated for certain establishments that sell alcoholic beverages, and the failure to maintain this coverage constituted a violation of South Carolina law. The federal court asked whether a person could bring a dram-shop negligence action against a business whose insurer failed to notify the state Department of Revenue of the business’ lapse in liquor liability coverage, and the business did not have coverage at the time of the accident. The Supreme Court responded in the negative: S.C. Code Ann. section 61-2-145(C) did not create a private right of action in favor of an injured party against the business's insurer. View "Denson v. National Casualty" on Justia Law