Justia Insurance Law Opinion Summaries

Southern Farm Bureau Life Insurance Company (“Farm Bureau”) issued a term life insurance policy to S.M. S.M.’s husband, Plaintiff, who was the policy’s primary beneficiary. Farm Bureau received a notification from the Post Office indicating that S.M.’s address had changed. Farm Bureau sent its semiannual bill to S.M. at her South Carolina address, informing her that her payment was due on November 23, 2016. S.M. did not pay the bill. Plaintiff sued Farm Bureau in federal district court, seeking the policy’s coverage amount as well as excess damages for alleged unfair and deceptive trade practices on the part of Farm Bureau. He argued that Farm Bureau had not complied with a statutory notice requirement prior to canceling the insurance policy for nonpayment and he was therefore entitled to the policy’s benefits. The parties filed cross-motions for summary judgment, and the district court granted summary judgment to Farm Bureau.   The Fourth Circuit affirmed finding that Farm Bureau complied with the statute’s notice requirement. The court wrote that a literal interpretation of the statute’s language—referring to a notice being sent to the “last known post-office address in this State”—would not put S.M. on notice at all. Rather it would have Farm Bureau send “notice” to an address where it knows she no longer resides. Additionally, there is substance in Farm Bureau’s argument that a rigidly literal reading of the words “in this State” would require insurers to implement burdensome and nonsensical notice policies. View "Robert Whitmire v. Southern Farm Bureau Life Insurance Company" on Justia Law

Plaintiff Aetna Life Insurance Company brought suit against Big Y Foods, Inc., for reimbursement of Aetna's payments for medical services on behalf of a woman after she was injured at a Big Y Foods, Inc. supermarket store. Aetna moved for partial summary judgment, arguing that the Medicare Secondary Payer Act gave Medicare Advantage organizations such as Aetna a private cause of action to seek reimbursement of conditional payments for medical services from tortfeasors such as Big Y and that no genuine issue of material fact remained. The district court granted Aetna's motion, and Defendant appealed.
The Second Circuit affirmed concluding that the Medicare Secondary Payer Act grants a private cause of action to Medicare Advantage organizations such as Aetna and that no genuine issue of material fact remains. Big Y argued that even if Aetna has a private cause of action under the MSP Act, there are genuine issues of material fact remaining as to whether Big Y has the responsibility to reimburse Aetna for the medical expenses Aetna incurred. The court wrote that Big Y's argument is directly contradicted by the statute. Further, Big Y does not dispute that the victim filed a claim against Big Y seeking compensation for the personal injuries that she sustained; that Big Y settled that claim with the victim paying her $30,000; and that Big Y knew that Aetna was asserting a lien against Big Y for Aetna’s payment of the woman’s medical expenses. Thus, Big Y is responsible for payment as a matter of law. View "Aetna Life Insurance Company v. Big Y Foods, Inc." on Justia Law

The United States Court of Appeals for the Eleventh Circuit certified questions of Georgia law to the Georgia Supreme Court about life-insurance law. The basic question for the Supreme Court was whether a person could legally take out an insurance policy on his own life with the intent to turn around and sell that policy to a third party who had no “insurable interest” in the policyholder’s life. The person seeking to recover on the life-insurance policy in this case said that such a policy was legal if a third party was not involved in causing the policy to be procured. The insurance company says that with or without such third-party involvement, such a policy was an illegal wagering contract and therefore void, relying on some Georgia case law. But as it turned out, that case law was interpreting and applying old statutes. In 1960, the Georgia General Assembly repealed those statutes and replaced them with new statutory language that codified some, but not all, of the old decisional law, and the new language did not even hint at the unilateral-intent-based limitation that the insurance company advanced. So the Supreme Court answered the certified questions: under Georgia law, a life-insurance policy taken out by the insured on his own life with the intent to sell the policy to a third party with no insurable interest, but without a third party’s involvement when the policy was procured, was not void as an illegal wagering contract. View "Crum v. Jackson National Life Ins. Co." on Justia Law

Jane held a minority stake in Du-Kane and Crush-Crete, companies owned by her husband, Paul, and other family members. The couple divorced in 2009. Jane died in 2017. Paul died months later. In 2017 Jane’s estate sued, alleging that Jane’s ownership interest was wrongfully diluted after the divorce. The complaint named only Du-Kane as the defendant, though the allegations concerned the actions of the couple's four sons as officers, directors, and shareholders. An amended complaint filed in 2018 added Crush-Crete and the Dunteman brothers as codefendants. The codefendants were insured under “claims made” liability policies issued in 2017 and 2018 by Hanover. With “claims made” insurance, the insured must notify the insurer of a “claim” in the policy period in which it is first “made.” If a claim goes unreported in the relevant policy period, the insurer owes no duty to defend or indemnify. The defendants notified Hanover and sought coverage under the 2018 policy. Hanover denied the request because the claim was first made in 2017 and had not been timely reported during that policy period.Hanover sought a declaration that it owed no defense or indemnity. The insureds counter-claimed breach of contract. The Seventh Circuit affirmed judgment for Hanover. The original complaint triggered a reportable claim during the 2017 policy period. Subsequent amendments to that complaint did not commence a new, distinct claim first made in 2018. View "Hanover Insurance Co. v. R.W. Dunteman Co." on Justia Law

The Supreme Court reversed the opinion of the court of appeals determining that the prior notice of events exclusion (Exclusion 15) contained in the insurance policies applied to deny the coverage sought by King's Daughters Medical Center (KDMC) for claims made against it and that Insurers were entitled to recoupment of expenses, holding that the court of appeals erred as to both issues.Multiple medical malpractice claims were asserted against KDMC alleging unnecessary cardiac operations and lack of informed consent, among other allegations. Insurers subsequently filed a declaratory action in circuit court to determine their rights and coverage under the relevant policies. The circuit court granted summary judgment in favor of KDMC. The court of appeals reversed, ruling that Exclusion 15 applied to bar professional liability and excess coverage for the underlying litigation and that Insurers were entitled to recoupment of their expenses thus far in defending the litigation. The Supreme Court reversed, holding (1) Exclusion 15 did not bar coverage; and (2) the court of appeals lacked jurisdiction to rule on recoupment. View "Ashland Hospital Corp. v. Darwin Select Insurance Co." on Justia Law

Bernacchi was a passenger in a taxicab insured by First Chicago when an uninsured driver struck the cab. In February 2021, an Illinois court concluded that Bernacchi was covered under the First Chicago policy up to $350,000. On February 11, 2021, Bernacchi sent First Chicago documentation, requesting $350,000, though she valued her entire loss at $680,000. On May 11, 2021, Bernacchi filed suit in federal court, alleging that First Chicago had still not done anything to adjust her claim.The district dismissed, reasoning that Bernacchi’s complaint failed to cite any contract language creating an obligation to adjust her claim or to do so within a certain timeframe; Bernacchi’s claim relied upon the Illinois Insurance Code, which does not provide a private right of action. The Seventh Circuit affirmed. The district court did not violate the party presentation rule. The parties squarely argued about Illinois insurance statutes and administrative regulations; 215 ILCS 5/215 ILCS 5/154.6 enumerates a list of acts that constitute improper claims practice, but neither it nor its surrounding statutes provide a private right of action. View "Bernacchi v. First Chicago Insurance Co." on Justia Law

The Supreme Court vacated the opinion of the court of appeals affirming the judgment of the trial court, after a jury trial, in this tort action for first-party insurance bad faith, holding that the trial court erred in instructing the jury on waiver and mitigation of damages.Plaintiff sued Defendant for insurance bad faith. Defendant denied liability and asked the trial court to instruct the jury on waiver, in the form of a contract waiver instruction, and mitigation of damages. The trial court granted Defendant's request for both jury instructions, and the jury returned a verdict for Defendant. The court of appeals affirmed. The Supreme Court reversed, holding that the waiver jury instruction was misleading and prejudicial to Plaintiff, requiring a remand for a new trial. View "Cavallo v. Phoenix Health Plans, Inc." on Justia Law

The Court of Appeals reversed the order of the appellate division reversing the judgment of Supreme Court concluding that Petitioners did not establish that the recently amended Insurance Regulation 187, 11 N.Y.C.R.R. part 224, which provides protections to consumers engaging in life insurance and annuity transactions, was invalid, holding that there was no basis to invalidate the regulation.Petitioners commenced this N.Y. C.P.L.R. 78 proceeding alleging that the amended regulation was unconstitutionally vague because certain terms did not satisfy the test for constitutional vagueness and that the Department of Financial Services (DFS) exceeded its authority in promulgating the amendment. Supreme Court held that the amendment was a proper exercise of the powers granted to DFS. The appellate division reversed, ruling that the amended regulation was unconstitutionally vague. The Court of Appeals reversed, holding that DFS appropriately exercised its authority "to create a carefully considered and clear regulation." View "Independent Insurance Agents & Brokers of N.Y., Inc. v. New York State Dep't of Financial Services" on Justia Law

In 2012, a competitor sued Creation for trademark violations. Creation requested that Selective Insurance provide coverage. Selective refused. Creation’s settlement with its competitor prevented Creation from selling one of its primary lines. Creation struggled financially. Selective sought a declaration in Illinois state court that it had no duty to defend. Creation countersued and also alleged breach of the insurance policy. The Illinois court entered partial summary judgment for Creation on its duty-to-defend claim, limited to fees Creation incurred before the original trademark litigation was settled.In 2014—in the middle of the state-court litigation—Creation sued Selective in federal court for breach of contract and under the Illinois Insurance Code. In 2016, Creation voluntarily dismissed its state-court breach-of-contract claim with leave to refile. The Illinois court expressly reserved Creation’s right to maintain its federal action on its contract claim. After the 2017 state court award, the federal district court awarded Creation nearly $3 million in damages on the Insurance Code claim. After remand, Creation unsuccessfully sought to amend its complaint to seek punitive damages. The district court then concluded that the doctrines of claim and issue preclusion barred Creation’s remaining contract claim.The Seventh Circuit reversed, noting that the case is an “anomaly.” The state court expressly reserved Creation’s right to file the claim in federal court, so the suit is not precluded by its earlier state-court litigation. View "Creation Supply, Inc. v. Selective Insurance Co. of the Southeast" on Justia Law

A declaratory judgment action was filed in the context of two insurance- company liquidation matters. The parties asserted they informally agreed, among themselves, and the single Commonwealth Court Judge overseeing the cases, to a procedure for a three-judge panel of the Commonwealth Court to render a decision to be reviewable via exceptions by the Commonwealth Court, en banc. However, as the agreement was not memorialized as of record, the party aggrieved by the panel opinion, the statutory liquidator, lodged an immediate appeal with the Pennsylvania Supreme Court after that opinion and order were filed, and then filed exceptions with the Commonwealth Court, en banc. After the Commonwealth Court, en banc, rendered a second opinion and order, overruling the exceptions and confirming the panel’s initial decision, the statutory liquidator filed a second appeal with the Supreme Court parallel to the first. This raised a jurisdictional question. The Supreme Court found two of four petitions filed were properly dismissed for want of jurisdiction. The other two were properly before the Court, and on the merits, the Court affirmed the Panel's July 9, 2021 order: “[t]here is simply no statutory authority for this well-intentioned proposal [or] any standard to guide the Liquidator’s establishment [of the proposal] or [the Commonwealth Court’s] evaluation thereof.” View "In Re: American Network Ins. Co." on Justia Law