Insurance Law Case Summaries
[09/03] Conseco Life Ins. Co. v. Williams
In an interpleader action to determine the rights to life insurance proceeds, district court's grant of decedent's sister's motion for summary judgment is affirmed where: 1) the district court properly admitted the affidavits as, under Primerica Life Ins. Co. v. Watson, 207 S.W. 3d 442 (Ark. 2005), a deceased insured's oral statements to several people concerning that insured's future intentions to change the beneficiary in an insurance contract in favor of another are admissible to resolve disputes as to who is the proper beneficiary; and 2) the decedent's sister rebutted the presumption of undue influence with the affidavits in support of her motion for summary judgment.
[09/02] Travelers Prop. Cas. Ins. Co. of Am. v. Nat'l. Union Ins. Co.
In an action by one insurer against another seeking $10 million in subrogation proceeds, summary judgment for defendants is affirmed in part where plaintiff waived certain rights by refusing repeated invitations to participate in subrogation discussions. However, the judgment is reversed in part where, as the excess insurer, plaintiff was entitled to a priority interest in the subrogation proceeds representing insured losses.
[09/02] Atlantic Nat'l Trust LLC v. Mt. Hawley Ins. Co.
In an action seeking insurance proceeds arising from a fire, defendants' appeal from the grant of plaintiff's motion to remand is dismissed where the court lacked appellate jurisdiction to review a federal district court order remanding a case to state court based on a ground colorably characterized as a "defect" for purposes of 28 U.S.C. section 1447(c).
[09/01] Sprinkles v. Associated Indem. Corp.
In plaintiffs' bad faith action against Fireman's Fund Insurance Company, arising from an underlying suit against defendant and his employer for causing the death of plaintiffs' father in an automobile accident, trial court's judgment sustaining the insurer's demurrer is affirmed as, under the complaint and matters judicially noticed, the defendant-employee was an insured, rendering the automobile exclusion in the GCL policy applicable, and Fireman's Fund had no duty to defend the employer.
[08/31] Hayes Lemmerz Int'l, Inc. v. ACE Am. Ins. Co.
In an employer's suit against its insurer for refusing to tender defense in an underlying suit under its workers' compensation and employer liability policy, judgment of the district court in favor of the insurer is affirmed as, because defendant was, by virtue of Indiana law, a joint employer, insurer was contractually obligated to reimburse the reasonable expense of defendant's getting itself dismissed from the tort suit. However, because the defendant is not claiming that insurer refused to pay that amount, but rather, it is complaining that the insurer breached its duty to defend by failing to advise defendant that it's law firm was not defending the suit properly, the insurer had no duty to provide its insured's lawyers with legal advice.
[08/30] Uhm v. Humana, Inc.
In an action against an insurer for nonpayment of Medicare benefits, the dismissal of the action is affirmed where 1) the district court lacked jurisdiction to consider plaintiffs' breach of contract and unjust enrichment claims because they were not properly exhausted under the Medicare Prescription Drug Improvement and Modernization Act; and 2) plaintiffs' fraud and consumer protection act claims, while not subject to the Act’s exhaustion provisions, were expressly preempted.
[08/30] Vill. Northridge Homeowners Ass'n v. State Farm Fire & Cas. Co.
In homeowners association's suit against an insurance company, claiming that the insurer fraudulently induced it to settle a Northridge earthquake-related claim for less than it was worth under the policy, judgment of the court of appeals is reversed as a release of a disputed claim does not permit a party to elect the remedy of a suit for damages when the release itself bars that option. Instead, the insured party to the release must follow the rules governing rescission of the release before suing the insurer for damages.
[08/30] First Nat'l Bank & Trust Co. v. Stonebridge Life Ins. Co.
In an action by the administrator of the estate of a murder victim, seeking the policy proceeds of a policy in the victim's name obtained by the perpetrator, judgment for plaintiff is affirmed in part where, because the victim had an interest in the policy, payment to her estate was authorized due to the perpetrator's disqualification. However, the judgment is reversed in part where, absent its presence in the case, plaintiff was still required to establish the perpetrator's disqualification in order to recover other insurance policy proceeds.
[08/30] HCM Healthcare, Inc. v. California Ins. Guarantee Ass'n
In a residential nursing facility's suit against California Insurance Guarantee Association (CIGA) for breach of contract and for violating the Insurance Code for refusing to provide plaintiffs with defense counsel and indemnification for underlying lawsuits for elder abuse, judgment in favor of defendant is affirmed where: 1) as a creature of statute, and not of contract, in some instances CIGA may not be responsible for an insured loss to the same extent as the insolvent insurer might be under the terms of its insurance contract; and 2) Pennsylvania's liquidation order imposed a June 30, 2005 deadline for filing against an insurer and because plaintiff did not meet the deadline, CIGA may not honor their claims.
[08/27] Transcon. Ins. Co. v. Crump
In plaintiff's suit against her deceased husband's insurer for workers' compensation death benefits, the judgment of the court of appeals is reversed and remanded where: 1) the treating physician's opinion was based on a reliable foundation and, therefore, legally sufficient evidence supports the jury's verdict; 2) the trial court's omission of the but-for component in the jury charge constitutes reversible error; and 3) an insurance carrier is entitled to have a jury determine the disputed amount of reasonable and necessary attorney's fees for which it is liable.
[08/25] DPC Indus., Inc. v. Am. Int'l Specialty Lines Ins. Co.
In an action seeking additional insurance coverage against a liability insurer, summary judgment for defendant is affirmed where: 1) nothing in the policy or an additional endorsement required that an insured property be actually owned or operated by the specific entity seeking coverage related to that facility; and 2) the record contained uncontradicted evidence that defendant provided indemnity coverage to plaintiff.
[08/24] Penn-America Ins. Co. v. Lavigne
In an insurer's suit against its insured and plaintiff seeking a declaratory judgment that the insured's insurance policy excluded liability coverage for claims arising from roofing, arising from serious injuries sustained by plaintiff when a portion of a scaffolding snapped while visiting his friend, the insured, at the job-site, a grant of summary judgment in favor of the insurer is affirmed where: 1) the only language added to Endorsement A plainly expresses the intent of the parties to exclude claims arising from roofing; and 2) there is no dispute that plaintiff's injuries originated from, grew out of, flowed from, or had a connection with, roofing.
[08/24] State Farm Mut. Auto. Ins. Co. v. Fisher
In an action seeking a declaration of nonliability on defendant's claim for uninsured motorist benefits, summary judgment for plaintiff-insurer is affirmed where the perpetrator of a crime used the insured vehicle, in essence, as a means to transport himself to the scene of his assault of defendant.
[08/23] US v. Hawley
In a civil action by the U.S. against an insurance agent, and his insurance company, alleging that defendants violated the False Claims Act by committing fraud in connection with federal crop insurance, summary judgment for defendant is reversed where: 1) the government adequately preserved its argument that the insurer's reimbursement demands were the "claims" presented to the government; and 2) the evidence created a genuine issue of material fact regarding whether defendant caused his company to present claims for reimbursement to the Federal Crop Insurance Corporation.
[08/20] Capella University, Inc. v. Executive Risk Specialty Ins. Co.
In an action alleging that defendant-insurer owed a duty to defend plaintiff against a federal lawsuit brought by one of plaintiff's former students, judgment for plaintiff is affirmed in part where: 1) the lawsuit was not subject to an exclusion in the policy as based upon, arising from, or in consequence of a prior or pending formal administrative proceeding; and 2) no unfair advantage to plaintiff or detriment to defendant would result from allowing a subsequent, accurate accounting of the fees and costs to form the basis for the award in this case. However, the judgment is reversed in part where plaintiff did not waive its right to statutory prejudgment interest.
