Justia Insurance Law Opinion Summaries

The Supreme Court answered in the negative a certified question regarding whether a provision in a commercial insurance policy, governed by Ohio law, providing coverage for a "direct 'loss'" to certain property covers a claim based on business shutdowns caused by COVID-19 (Covid), holding that the term "direct loss" did not include Plaintiff's Covid-related loss of the use of its offices for business purposes.Plaintiff, which owned and operated an audiology practice in northeast Ohio, held an all-risk commercial-property insurance policy issued by Defendant. Plaintiff filed suit alleging that Defendant had breached the contract by refusing to provide coverage for its Covid-related claim on the ground that there was no "direct physical loss or damage" to covered property. The federal court granted Defendant's motion for certification. The Supreme Court answered (1) the term "direct 'loss'" requires that there be some loss or damage to covered property that is physical in nature, and any potential exception to this rule did not apply in this case; and (2) therefore, the term "direct 'loss'" did not include Plaintiff's Covid-related loss of the ability to use covered property for business purposes. View "Neuro-Communication Services v. Cincinnati Insurance Co." on Justia Law

Appellants, who were maimed in a hot air balloon accident in southeastern Pennsylvania in 2015, pursued appellate challenges to the District of Maryland’s rulings against them and in favor of T.H.E. Insurance Company (the “Insurer”) in an insurance coverage dispute. In federal court proceedings initiated in Maryland, Appellants sued certain of the Insurer’s named insureds, and a business called New Horizon Balloon Team (collectively, the “Insureds”) — for the gruesome injuries Appellants’ sustained in the balloon accident (the “damages lawsuit”). While the damages lawsuit was pending, the Insurer initiated these insurance coverage proceedings in the Eastern District of Pennsylvania, naming as defendants the three Insureds, plus Appellants. The district court awarded summary judgment in favor of the Insurer’s contention with respect to a $100,000 coverage limit for each balloon passenger. The Memorandum Opinion also rejected both of Appellants’ bad faith claims. Appellants appealed those rulings.   The Fourth Circuit affirmed. Applying Maryland principles of res judicata in this dispute, the court was satisfied that the coverage issue presented by the Insurer in these proceedings is not barred by the settlement agreement in the damages lawsuit. As such, the court agreed with the district court that Appellants are not entitled to a summary judgment award on the coverage issue on res judicata grounds. Further, the district court thus did not err in ruling Appellants were inside the balloon’s basket at the time of their injuries. As such, Appellants were “passengers” under the Policy and Coverage B’s limit of $100,000 per passenger applies. View "T.H.E. Insurance Company v. Melyndia Davis" on Justia Law

This dispute over UM coverage arose from a motor vehicle accident wherein an uninsured motorist struck and killed Macy Lee Alvey, III, who was in the course and scope of his employment with Rony’s Towing & Recovery, LLC (“Rony’s Towing”). The Louisiana Supreme Court granted this writ to determine whether the failure to include the insurer’s name on an uninsured/underinsured motorist (“UM”) coverage selection form rendered it invalid. Because inclusion of the insurer’s name was an express requirement on the face of the UM form itself, the Supreme Court agreed with the court of appeal that the failure to include such information resulted in an invalid waiver of coverage. View "Berkeley Assurance Co. v. Willis, et al." on Justia Law

This consolidated matter arose from a class action for damages filed by Louisiana health care providers for alleged violations of the Preferred Provider Organizations (“PPO”) statute. La. R.S. 40:2201, et seq. The Louisiana Supreme Court granted writs to interpret the statute and to determine whether defendant, Stratacare, Inc. (“Stratacare”), was a “group purchaser” subject to penalties for violating the mandatory notice provision of the statute. After a review of the record and the law, the Supreme Court concluded that Stratacare was not a group purchaser as contemplated by the statute. Therefore, the Court reversed the court of appeal, vacated the lower court judgments, and dismissed the case. View "Williams, et al. v. Bestcomp, Inc. et al." on Justia Law

Rather than using the insurance agency’s in-house presiding officer, American Property Casualty Insurance Association (Association) requested an adjudicative hearing before an administrative law judge (ALJ) pursuant to RCW 48.04.010(5). The request was denied. The Association sought a writ of mandamus against Insurance Commissioner Mike Kreidler, requiring him to transfer the hearing. The Washington Supreme Court concluded the Association could have sought judicial review by way of the Administrative Procedure Act (APA), ch. 34.05 RCW, thus, the Association failed to demonstrate it had “no plain, speedy, and adequate remedy” at law, one of the three requirements for a writ to issue. Accordingly, the Supreme Court dismissed the petition. View "Am. Prop. Cas. Ins. Ass'n v. Kreidler" on Justia Law

The Supreme Court affirmed the order of the circuit court granting summary judgment in favor of Municipal Health Benefit Fund and dismissing this class action complaint challenging the Fund's decision to deny payment for portions of Plaintiff's daughter's medical bills based on its interpretation of the uniform, customary, and reasonable charges (UCR) exclusion in the Fund's policy booklet, holding that there was no error.Through his employment with a municipal police department, Plaintiff obtained health benefits coverage through the Fund. After Plaintiff's daughter was injured in a car accident the Fund denied payment for portions of her medical bills based on its interpretation of the UCR exclusion. Plaintiff then brought this class action against the Fund challenging the enforcement of the UCR term. The circuit court granted class certification and later granted summary judgment in favor of the Fund. The Supreme Court affirmed, holding that the circuit court did not err in granting summary judgment in favor of the Fund. View "Hendrix v. Municipal Health Benefit Fund" on Justia Law

The Supreme Court affirmed the judgment of the circuit court granting a "First Amended Complaint in Interpleader with Accompanying Prayer for Declaratory Relief" filed by Allstate Insurance Company and apportioning the interpleaded funds, holding that there was no error.Hartford Underwriters Insurance Company and The Shoe Department brought this appeal, arguing that the circuit court erred in its construction and application of Va. Code 65.2-309 and 65.2-311 and Williams v. Capital Hospice & Property & Casualty Insurance Co., 66 Va. App. 161 (2016) to this case. The Supreme Court affirmed, holding (1) the circuit court did not err by failing to award the available Allstate coverage "to Hartford in full" or, alternatively, by failing to "permit [the requested] intracompany arbitration to proceed because there was no issue to be resolved in the requested arbitration; and (2) the circuit court provided the requisite "verdict or settlement" from which competing claims could be satisfied, and there was no error in the circuit court's apportionment of the funds. View "Hartford Underwriters Insurance Co. v. Allstate Insurance Co." on Justia Law

Wade Chapman (“Wade”) and his six siblings (“Siblings”) were the children of Wilford (“Bill”) Chapman. Bill had a life insurance policy for $7,000,000 that named the Chapman Family Multiple Power Liquidity Trust (“Trust”) as its owner. Wade, along with Siblings, were named as the Trust’s beneficiaries. Wade was also named a trustee. After Bill passed away, Wade learned that he was listed as the sole beneficiary of the life insurance policy and retained the entirety of the death benefit for himself. Siblings sued Wade for breach of fiduciary duty, among other causes of action, arguing that the policy was a Trust asset, and its proceeds should have been distributed equally among them. The district court agreed and granted summary judgment in favor of Siblings. It also awarded prejudgment interest against Wade under Idaho Code section 28-22-104 and attorney fees under Idaho Code section 15-8-201, a provision of the Trust and Estate Dispute Resolution Act (“TEDRA”). The Idaho Supreme Court affirmed the district court’s grant of summary judgment to Siblings, affirmed in part and reversed in part the award of prejudgment interest, and reversed the grant of attorney fees to Siblings under TEDRA. View "Vouk v. Chapman" on Justia Law

GWG DLP Funding V, LLC was the policy owner and beneficiary of a life insurance policy issued by PHL Variable Insurance Company. After GWG transferred beneficiary rights and ownership to Wells Fargo, PHL terminated the policy. GWG and Wells Fargo disputed the termination, and the parties attempted to settle the dispute. After some negotiations, the insured died, and PHL refused to honor the alleged agreement the parties had reached. GWG and Wells Fargo sued PHL for breach of contract and breach of the covenant of good faith and fair dealing and sought a declaratory judgment that prevents PHL from terminating the policy. Plaintiffs appealed the district court’s dismissal of their claims.   The Eighth Circuit affirmed. The court concluded that the alleged agreement in early February was incomplete and that Plaintiffs have failed to state a claim for breach of contract. Further, the court wrote that Plaintiffs have failed to state a claim for breach of the covenant of good faith and fair dealing. First, there is no enforceable agreement based on the email exchange. Thus, there was no contract under which PHL could have breached the duty of good faith. Second, even if the parties were bound by the early February communications, Plaintiffs alleged no dishonest motive on PHL’s part. View "GWG DLP Funding V, LLC v. PHL Variable Insurance Co." on Justia Law

The Supreme Court reversed the judgment of the circuit court granting summary judgment to Liosha Miles on the issue of whether each of the two insurance policies in this case provided separate tranches of insurance of uninsured motorist (UM) coverage and underinsured motorist (UIM) coverage, holding that the circuit court erred.Given her disagreement with GEICO Advantage Insurance Company and GEICO Choice Insurance Company (collectively, GEICO), Miles filed this action seeking a declaration that each policy at issue contained separate $50,000 limits for UM and UIM coverage and that GEICO owed her addition amounts for her UIM claims related to a single automobile accident caused by the negligence of two different drivers other than herself. The circuit court granted summary judgment in favor of Miles. The Supreme Court reversed, holding (1) UIM coverage is a constituent part of UM coverage; and (2) consequently, the circuit court erred in concluding that Va. Code 38.2-2206(A) required each policy to provide Miles with separate UM and UIM coverage limits for injuries arising from a single accident. View "GEICO Advantage Insurance Co. v. Miles" on Justia Law