Justia Insurance Law Opinion Summaries

Plaintiffs filed a civil suit against an insurer based on allegations that the insurer negligently advised them that they did not need to purchase a builder's risk policy for a hotel project. The district court granted the insurer's motion for summary judgment, finding that the insurer had no duty to give advice about different coverages or to ensure that adequate coverage existed and that plaintiffs failed to show the existence of a special relationship between the agent and the insureds that would give rise to additional duties on the agent's part to ensure the insured had adequate coverage.The Eighth Circuit affirmed, finding that the trial court did not err in its resolution of the motion for summary judgment. View "I Square Management, LLC v. McGriff Insurance Services, Inc." on Justia Law

Plaintiff sued Farmers New World Life Insurance Company (Defendant or Farmers) for breach of contract, breach of the covenant of good faith and fair dealing, and punitive damages in connection with a policy insuring the life of her ex-husband. The trial court granted summary judgment for Defendant on those claims, concluding it was undisputed that the ex-husband remained the owner of the policy until he died, and that he had changed the beneficiaries on the policy, reducing his ex-wife’s interest from 100 percent to 25 percent.   The Second Appellate District reversed, finding that the trial court failed to consider the terms of a divorce decree affecting ownership of the policy, and because Defendant’s agent repeatedly assured Plaintiff, up to and after the ex-husband’s death, that Plaintiff remained the sole beneficiary. Therefore, the court concluded disputed issues of material fact prevent summary judgment. View "Randle v. Farmers New World Life Insurance Co." on Justia Law

Blue Cross Blue Shield of Vermont (Blue Cross) appealed the Green Mountain Care Board’s (GMCB) decision modifying its proposed health-insurance rates for 2022. The GMCB approved Blue Cross’s proposed rates with several exceptions, one of which was relevant here: its contribution to reserves (CTR). Blue Cross had sought a base CTR rate of 1.5%, but the GMCB ordered Blue Cross to lower it to 1.0%, thereby diminishing overall insurance rates by 0.5% and reducing health-insurance premiums. The GMCB found that a 1.5% base CTR was “excessive” because Blue Cross was expected to be above its target Risk Based Capital (RBC) range by the end of 2021, “individuals and small businesses are still struggling financially after a year-long economic slowdown,” and a 1.0% CTR would allow its “reserves to sit comfortably within the company’s RBC target range.” Blue Cross moved for reconsideration, arguing that the term “excessive” was strictly actuarial in nature, and that the GMCB misconstrued it by weighing non-actuarial evidence— testimony concerning affordability—as part of its examination of whether the proposed rate was excessive. On appeal to the Vermont Supreme Court, Blue Cross raised essentially the same issue. Because none of the actuarial experts who testified concluded that Blue Cross’s proposed CTR was excessive, Blue Cross argued, the GMCB could not properly conclude that it was. Blue Cross conceded that health-insurance rates for 2022 could not now be changed, but it urged the Supreme Court to rule on the merits, arguing that this matter was not moot because the CTR rate for this year will disadvantage Blue Cross in future rate-review proceedings. The Supreme Court determined Blue Cross did not demonstrate that this kind of case was capable of repetition yet evading review or subjected it to continuing negative collateral consequences. Therefore, Blue Cross failed to meet the exceptional thresholds necessary for the Court to reach the merits in a moot case. View "In re Blue Cross and Blue Shield 2022 Individual & Small Group Market Filing" on Justia Law

The Travelers Indemnity Company appeals the judgment entered after the superior court denied Travelers’ petition for a writ of administrative mandate challenging the Insurance Commissioner’s decision that certain agreements relating to workers’ compensation insurance policies issued to Adir International, LLC were unenforceable. Travelers contended that Adir’s lawsuit in the trial court, which included a request for a declaratory judgment the agreements were void, barred the Commissioner, under the doctrine of exclusive concurrent jurisdiction, from exercising jurisdiction while that lawsuit was pending. Travelers also appealed the post-judgment order granting Adir’s motion for attorney fees, contending attorney fees were not authorized.   The Second Appellate Division affirmed the order and judgment denying Travelers’s petition. The court explained that the exclusive concurrent jurisdiction doctrine does not apply in this context to proceedings pending before the trial court and an administrative agency; and, in any event, it was reasonable and consistent with the primary jurisdiction doctrine for the trial court to defer to the Commissioner’s determination of the validity of the agreement at issue. In addition, because Adir’s administrative claim fell within the agreement’s attorney fee provision, the court affirmed the post-judgment order awarding Adir attorney fees. View "The Travelers Indemnity Co. v. Lara" on Justia Law

Respondent Myra Windham was seriously injured while driving a rental car that was considered a temporary substitute vehicle under her State Farm policy. In this declaratory judgment action instituted by Petitioner State Farm, the issue this case presented for the South Carolina Supreme Court's determination was whether Windham could stack her underinsured motorist ("UIM") coverage pursuant to section 38-77-160 of the South Carolina Code. The circuit court agreed with State Farm that stacking was prohibited, and the court of appeals reversed. Because both parties offered reasonable interpretations of the policy language, the Supreme Court found an ambiguity existed, which it construed against the drafter. Accordingly, the Court agreed with the court of appeals that Windham could stack, and affirmed as modified. View "State Farm v. Windham" on Justia Law

Bliss Sequoia Insurance and Risk Advisors held an insurance policy from Allied Property and Casualty Insurance (Allied Property) covering any liability that Bliss Sequoia might incur for “damages because of ‘bodily injury.’” One of Bliss Sequoia’s clients was a water park, and after a park guest was injured, the park sued Bliss Sequoia for professional negligence, alleging that the coverage limits on the park’s liability insurance were too low. This appeal presents the question whether that negligence claim arose “because of” the guest’s “bodily injury” and is therefore covered by Bliss Sequoia’s policy. We agree with the district court that the answer is no.   The panel affirmed the district court’s summary judgment in favor of Allied Property. Allied’s policy provided that it covered any sums Bliss Sequoia was “legally obligated to pay as damages because of ‘bodily injury’ or ‘property damage.’” Bliss Sequoia alleged that the bodily injury at issue was a “but-for” cause of Bliss Sequoia’s professional-negligence liability. The panel held that pure but-for causation would result in infinite liability for all wrongful acts, and therefore, the law almost never employs that standard without limiting it in some way. The law cuts off remote chains of causation by applying common law principles of proximate causation. Further, the personal-injury lawsuit against the water park arose “because of bodily injury,” but the claims of professional negligence did not. Because Bliss Sequoia’s policy did not cover those claims, Allied had no duty to defend or indemnify Bliss Sequoia against them. View "BLISS SEQUOIA INSURANCE, ET AL V. ALLIED PROPERTY & CASUALTY INS" on Justia Law

The Multiemployer Pension Plan Amendments Act of 1980 imposes liability on employers who withdraw—partially or completely—from multiemployer pension funds. After a complete withdrawal, GCIU-Employer Retirement Fund’s (GCIU) actuary calculated MNG Enterprise’s (MNG) withdrawal liability using an interest rate published by the Pension Benefit Guaranty Corporation. On MNG’s challenge, an arbitrator found (1) that MNG could not be assessed partial withdrawal liability following a complete withdrawal, (2) that it had shown the interest rate used was not the best estimate of the plan’s experience, and (3) that GCIU properly included the newspapers’ contribution histories. The district court affirmed the arbitrator’s award, vacating and correcting only a typographical error on the interest rate.   The Ninth Circuit affirmed in part and vacated in part the district court’s order affirming, except for a typographical error, an arbitrator’s award regarding the withdrawal liability. The panel held that the MPPAA directs the plan actuary to determine withdrawal liability based on “actuarial assumptions and methods which, in the aggregate, are reasonable (taking into account the experience of the plan and reasonable expectations) and which, in combination, offer the actuary’s best estimate of anticipated experience under the plan.” The panel held that the GCIU actuary’s use of the PBGC rate, without considering the “experience of the plan and reasonable expectations,” did not satisfy the “best estimate” standard. View "GCIU-EMPLOYER RETIREMENT FUND, ET AL V. MNG ENTERPRISES, INC." on Justia Law

The Supreme Court reversed the judgment of the circuit court in favor of Liberty Mutual Fire Insurance Company in this insurance dispute, holding that the circuit court improperly dismissed the complaint for failure to state a claim upon which relief can be granted.An agent of Kaiser Trucking was in an automobile accident with Liberty Mutual's insured. The circuit court granted default judgment for Kaiser Trucking and its agent. After the judgments were returned unsatisfied, Kaiser and its agent brought this action against Liberty Mutual seeking indemnification of the judgments against its insured. Liberty Mutual filed a motion to dismiss under S.D. Codified Laws 15-6-12(b)(5), arguing that Plaintiffs failed to plead a condition precedent to coverage under the policy. The circuit court agreed and dismissed the complaint. The Supreme Court reversed, holding that Kaiser Trucking, Inc. was not required to plea satisfaction of conditions precedent in the relevant insurance policy sufficiently to state a claim upon which relief could be granted and avoid a Rule 12(b)(5) dismissal of its complaint. View "Kaiser Trucking, Inc. v. Liberty Mutual Fire Insurance Co." on Justia Law

The Supreme Court affirmed the judgment of the district court concluding that Bonner County, an Idaho political subdivision, had failed to demonstrate to Western Insurance Company's Liquidator that Pend Oreille Bonner Development LLC's failure to complete several municipal projects had cost it anything, holding that the court's finding were not against the clear weight of the evidence.Bonner County contracted with Pend Oreille to construct the projects at issue and required Pend Oreille to obtain multiple surety bonds, which Pend Oreille purchased through Western. Pend Oreille defaulted on the projects. Bonner County filed a claim with the Liquidator of Western, which had been placed in liquidation, to recover the surety bonds. The district court entered judgment against Bonner County. The Supreme Court affirmed across the Board, holding that the district court did not err when it (1) admitted extrinsic evidence to determine the parties' intent; (2) read the statute to provide that a liquidator can amend a determination of claims in response to charged circumstances; and (3) made its findings. View "Bonner County v. Western Insurance Co." on Justia Law

The Court of Appeals held that Plaintiffs' original complaint alleging that Defendant breached the parties' written insurance policy and that Plaintiffs had fully complied with the requirements contained in the policy failed to give Defendant the requisite notice of the "transactions, occurrences, or series of transactions or occurrences, to be proved" in support of Plaintiff's reformation claim, as required under N.Y. C.P.L.R. 203(f).Defendant, an insurance company, issued Plaintiffs, two limited liability companies, a multi-million dollar, written insurance policy covering many of Plaintiffs' vacant commercial properties. Plaintiffs later brought this action for breach of contract seeking damages based on Defendant's failure to cover damages incurred after a fire on the premises. A jury returned a verdict in favor of Plaintiffs on the reformation claim, and the appellate division affirmed. The Court of Appeals reversed, holding that Plaintiffs' complaint failed to give notice to Defendant of the transactions or occurrences on which Plaintiffs based their reformation claim. View "34-06 73, LLC v. Seneca Insurance Co." on Justia Law