Justia Insurance Law Opinion Summaries

Plaintiff, Medical Mutual Insurance Company (“Med Mutual”) was the insurance carrier for numerous defendants in medical malpractice suit. Med Mutual provided the defense for the state case but, during discovery, alleged that one of the insureds had made a material modification to the Decedent’s medical records. Med Mutual brought the federal action seeking a declaratory judgment concluding that it has no obligation to provide insurance coverage for the defense of the state case. The district court declined to exercise jurisdiction over a declaratory judgment action while a parallel action was pending in state court.   The Fourth Circuit affirmed the district court’s decision. The court explained when a Section 2201 action is filed in federal court while a parallel state case is pending, the court has recognized that “courts have broad discretion to abstain from deciding declaratory judgment actions.” When deciding whether to hear such a declaratory judgment action, the court considers four factors: (1) whether the state has a strong interest in having the issues decided in its courts; (2) whether the state courts could resolve the issues more efficiently than the federal courts; (3) whether the presence of “overlapping issues of fact or law” might create unnecessary “entanglement” between the state and federal courts; and (4) whether the federal action is mere “procedural fencing”. Here, the factors favoring abstention are at least as strong, if not stronger, than those favoring retention and Med Mutual has not demonstrated an abuse by the district court of its broad discretion. View "Medical Mutual Insurance Co NC v. Rebecca Littaua" on Justia Law

The question presented for the Mississippi Supreme Court in this case “boils down to one of statutory interpretation:” whether plaintiff Crystal Bufkin was “legally entitled to recover” damages from her employer under the uninsured motorist statute, Mississippi Code Section 83-11-101(1) (Supp. 2021). The Supreme Court previously held that employees are not legally entitled to recover from their employers and thus could not make a claim under uninsured motorist coverages. Bufkin acknowledged that precedent precluded her claim, but she argued Medders v. U.S. Fid. & Guar. Co., 623 So. 2d 979 (Miss. 1993 )and its progeny were wrongly decided because the uninsured motorist law should be liberally construed in her favor. The Supreme Court concluded it already rejected the arguments Bufkin presented here, and declined to overrule Medders. View "Bufkin v. Geico Insurance Agency, Inc." on Justia Law

The Supreme Court reversed the judgment of the circuit court granting Respondents' motion for partial summary judgment in this insurance dispute, holding that the circuit court's order failed to set forth factual findings sufficient to permit meaningful appellate review.State Farm Fire and Casualty Company appealed the circuit court's partial summary judgment, arguing that the circuit court erred in finding coverage for a bat infestation under a rental dwelling policy it issued to Respondents. The Supreme Court reversed and remanded this action to the circuit court for further development, holding that the circuit court's order was not adequately set forth, leaving the Court unable to determine whether Respondents' motion for partial summary judgment was correctly granted. View "State Farm Fire & Casualty Co. v. Nathaniel Realty, LLC" on Justia Law

Two questions of law were certified to the Delaware Supreme Court by the United States Court of Appeals for the Eleventh Circuit: (1) when faced with an action brought by an estate under 18 Del. C. 2704(b), an innocent downstream investor in a stranger-originated life insurance (“STOLI”) policy, or its securities intermediary, could assert certain defenses under the Delaware Uniform Commercial Code; and (2) whether downstream investors in a STOLI policy could sue to recover any premiums they paid. The Court answered question one in the negative: in the sui generis context of STOLI schemes, these defenses are not available. The Court answered question two in the affirmative: yes, if the party being sued can prove its entitlement to those premiums under a viable legal theory. View "Wells Fargo Bank v. Estate of Phyllis M. Malkin" on Justia Law

The Supreme Court reversed the judgment of the superior court granting declaratory judgment in favor of Plaintiffs, holding that the trial justice abused his discretion by granting Plaintiffs' request for declaratory judgment.These consolidated appeals arose from two civil actions in which the trial court granted summary judgment against the Town of Johnston and its finance director. The trial justice determined that certain accounts bearing the names of the respective plaintiffs constituted deferred compensation, declared the accounts to be Plaintiffs' property, and ordered that the associated funds be remitted to Plaintiffs. The Supreme Court reversed, holding that Plaintiffs failed to establish as a factual matter that they had an agreement with the Town to defer compensation. View "Faella v. Town of Johnston" on Justia Law

Plaintiff insured a nightclub under a general liability policy, which covered “bodily injury and property damage liability.” The policy contained several restrictions on that coverage. A nightclub employee and guest were both shot during a shooting at the club.   After the shooting, Plaintiff filed a federal declaratory judgment to determine the full extent of its liability. Plaintiff claimed that because the nightclub shooting was an assault and battery, the policy limited recovery for any and all injuries to $50,000. Second, it argued that the worker’s compensation and employee-injury exclusions barred the employee’s recovery. To get around the bar, the employee’s estate argued that the nightclub’s actions triggered a statutory exception for intentional torts. It alleged that the nightclub had engaged in conduct that it “knew” was virtually certain to result in injury or death to the employee.” Relying primarily on the conflict between one of the federal claims and the state case, the district court dismissed the case. Defendant appealed.   The Eleventh Circuit vacated the district court’s dismissal held that the district court failed to consider the policy limits claim, missed the efficiency gains that it needed to balance against federalism and comity interests before deciding whether to proceed with the declaratory judgment action. A totality-of-the-circumstances analysis only works when a court considers all of the relevant details. To do otherwise leaves weights that should be balanced off the scales, or, if used more nefariously, would tip them in favor of a result chosen in advance. View "James River Insurance Company v. Rich Bon Corp, et al." on Justia Law

Plaintiff sued her employer, Life Insurance Company of North America, and several related individuals (collectively, Employer) for discrimination, harassment and wrongful termination. In response, Employer moved to compel arbitration based on a 2014 arbitration agreement. However, Employer did not present a copy of the agreement. Instead, Employer presented an auto-generated acknowledgment indicating Plaintiff read and consented to the terms of the agreement.The trial court denied Employer's motion to compel arbitration, finding that Employer did not establish an agreement to arbitrate and, even if an agreement existed, it was both procedurally and substantively unconscionable.The Second Appellate District affirmed. The trial court had the authority to review the "gateway" issue of arbitrability because Plaintiff claimed to have never seen or agreed to the arbitration agreement. Further, the fact that Employer's system created an auto-generated acknowledgment that Plaintiff consented to the agreement did not overcome Plaintiff's claim that she was not presented with the agreement and never would have agreed to it. View "Trinity v. Life Ins. Co. of North America" on Justia Law

Plaintiff bought a home insurance policy from Allstate that covered damage from wind and hail. On June 6, 2018, a wind and hail storm hit the area where Plaintiff lived, allegedly damaging his roof. An Allstate adjuster estimated the value of the loss at less than the deductible and paid Plaintiff nothing. Allstate later moved for summary judgment on Plaintiff’s remaining claims for breach of contract and failure to conduct a reasonable investigation. The district court granted Allstate’s motion finding that Plaintiff’s losses involved concurrent causes and Plaintiff had not carried his burden of proving how much damage came from the June 6, 2018 incident.   The Fifth Circuit explained that Texas’s concurrent causation doctrine instructs leaves questions about when the doctrine applies, and what plaintiffs must prove when it does. The court certified to the Supreme Court three questions:   1. Whether the concurrent cause doctrine applies where there is any non-covered damage, including “wear and tear” to insured property, but such damage does not directly cause the particular loss eventually experienced by plaintiffs;2. If so, whether plaintiffs alleging that their loss was entirely caused by a single, covered peril bear the burden of attributing losses between that peril and other, non-covered or excluded perils that plaintiffs contend did not cause the particular loss; and3. If so, whether plaintiffs can meet that burden with evidence indicating that the covered peril caused the entirety of the loss (that is, by implicitly attributing one hundred percent of the loss to that peril). View "Overstreet v. Allstate" on Justia Law

The Court of Appeals held that when an employer pays premiums to a mutual insurance company to obtain a policy for its employee and the insurance company demutualizes, the employee is entitled to the proceeds from demutualization.Medical Liability Mutual Insurance Company (MLMIC) issued professional liability insurance policies to eight medical professionals who were litigants in the cases before the Court of Appeals on appeal. The premiums for the policies were paid by the professionals' employers. After MLMIC demutualized and was acquired by National Indemnity Company, MLMIC sought to distribute $2.502 billion in cash consideration to eligible policyholders pursuant to its plan of conversion. At issue was the employers' claim of legal entitlement to receive the demutualization proceeds. The Supreme Court held that, absent contrary terms in the contract of employment, insurance policy, or separate agreement, the employee, who is the policyholder, is entitled to the proceeds. View "Columbia Memorial Hospital v. Hinds" on Justia Law

Prate, a construction contractor, sought coverage through the Illinois Assigned Risk Plan, which provides workers’ compensation insurance coverage through a risk pool administered by the National Council on Compensation Insurance (NCCI). Liberty was assigned as Prate’s carrier. After determining that Prate’s subcontractor, ARW, did not have workers’ compensation insurance, Liberty assessed Prate an additional premium of $127,305. The Illinois Workers’ Compensation Appeals Board, which provides dispute resolution services for NCCI, declined to rule on the dispute, citing insufficient information. Prate appealed to the Department of Insurance (DOI) under Insurance Code section 462. One of Prate’s arguments was that ARW had no employees and that all work on Prate projects was performed by RTS, which had workers’ compensation insurance. The DOI’s hearing officer agreed with Liberty on all issues. The circuit court affirmed. While an appeal was pending, the appellate court issued its ruling in a dispute between Liberty and a trucking company, finding that DOI did not have the authority to resolve a dispute concerning employment status.The Illinois Supreme Court reinstated the trial court decision. The DOI had the authority to resolve the dispute under 215 ILCS 5/462. While section 462 does not apply to all insurance premium disputes but only to those involving the application of a rating system to a party’s insurance, the existence of a single factual dispute does not preclude review under section 462. View "Prate Roofing and Installations, LLC v. Liberty Mutual Insurance Corp." on Justia Law