Justia Insurance Law Opinion Summaries

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

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