FindLaw Opinion Summaries - Insurance Law

Borden v. Allstate Ins. Co.

Mon, 23 Nov 2009 20:00:02 PDT

(U.S. 5th Cir., Civil Procedure, Contracts, Insurance Law) In an action seeking insurance proceeds related to Hurricane Katrina, summary judgment for defendants is affirmed in part where plaintiff's claims against defendant-insurance agent were barred by Louisiana's one year statute of limitations for actions against insurance agents. However, the order is vacated in part where the district court overlooked plaintiff's affidavit averring the timeliness of his notice of the claim to defendant.

Howell v. Hamilton Meats & Provisions, Inc.

Mon, 23 Nov 2009 15:00:02 PDT

(Cal. App., Civil Procedure, Injury And Tort Law, Insurance Law, Remedies) In an action arising from injuries plaintiff sustained in a vehicle accident caused by the negligent driving of defendant's employee, grant of defendant's motion to reduce by $130,286.90 a jury's special verdict award for plaintiff's past injury-related medical related expenses to $59,691.73 is reversed and remanded where in a personal injury case in which the plaintiff has private health care insurance, the negotiated rate differential is a benefit within the meaning of the collateral source rule, and thus the plaintiff may recover the amount of the differential as part her recovery of economic damages for the past medical expenses she incurred for care and treatment of her injuries.

Martco Ltd. Pshp. v. Wellons Inc.

Thu, 19 Nov 2009 20:00:02 PDT

(U.S. 5th Cir., Contracts, Insurance Law) In an action against an insurer seeking coverage for an underlying lawsuit regarding defects in a heating system installed by plaintiff, summary judgment for defendant is reversed where: 1) defendant had a duty to defend the underlying suit in light of the language of the policy and the allegations of the underlying complaint; and 2) the "work product" exclusion in the policy did not preclude recovery.

Kovach v. Zurich American Ins. Co.

Fri, 13 Nov 2009 20:00:02 PDT

(U.S. 6th Cir., Administrative Law, Contracts, ERISA, Health Law, Insurance Law, Labor & Employment Law) In plaintiff's ERISA suit against an insurance company for denying his claim for dismemberment benefits arising from a drunk-driving motorcycle accident, summary judgment for defendant-plan administrator is reversed and remanded for entry of judgment in favor of the plaintiffs where: 1) defendant's decision to deny benefits to the plaintiffs was contrary to the everyday meaning of the word "accidental" as it would be understood by a typical policyholder, and was based almost entirely on a body of largely distinguishable district court cases; 2) plaintiff's injuries were not "highly likely to occur" as a result of his intoxication, in contrast to the injuries that were highly likely to occur under the facts in Lennon; 3) defendant's interpretation of the Plan's provisions amounts to an additional, unwritten exclusion for all drunk-driving injuries, which is not permitted under even the most deferential standard of review; and 4) defendant's denial of coverage based on plaintiff's injuries being non-accidental was unreasonable, arbitrary and capricious.

Kim Seng Co. v. Great Am. Ins. Co. of New York

Fri, 13 Nov 2009 20:00:02 PDT

(Cal. App., Commercial Law, Contracts, Insurance Law, Intellectual Property, Trademark) In a dispute over whether plaintiff's insurer had a duty to defend and indemnify plaintiff in a trademark infringement action under an "advertising injury" policy, summary judgment for insurance company is affirmed as the prior publication exclusion in the policy bars coverage for trademark infringement in this case.

Berry & Murphy, P.C. v. Carolina Cas. Ins. Co.

Thu, 12 Nov 2009 20:00:02 PDT

(U.S. 10th Cir., Contracts, Ethics & Professional Responsibility, Injury And Tort Law, Insurance Law, Professional Malpractice) In an action for insurance coverage for a malpractice lawsuit, summary judgment for defendant is affirmed where: 1) the alleged acts of malpractice in a letter sent to the malpractice defendant and the lawsuit were "connected by an inevitable or predictable interrelation or sequence of events" for purposes of the policy; 2) the insurance policy treated as one claim all "related wrongful acts"; and 3) because defendant had no legally cognizable duty to defend or indemnify a claim, plaintiffs' bad faith claim could not survive.

Safety Nat'l. Cas. Corp. v. Certain Underwriters at Lloyd's

Tue, 10 Nov 2009 20:00:05 PDT

(U.S. 5th Cir., Contracts, Dispute Resolution & Arbitration, Insurance Law, International Law) In an appeal from the denial of a motion to compel arbitration of a contractual dispute among insurers, the order is reversed where the McCarran150Ferguson Act does not authorize state law to reverse-preempt the Convention on the Recognition and Enforcement of Foreign Arbitral Awards or its implementing legislation.

Payless ShoeSource, Inc. v. Travelers Cos., Inc.

Tue, 10 Nov 2009 20:00:05 PDT

(U.S. 10th Cir., Contracts, Insurance Law, Labor & Employment Law) In an action against an insurer for coverage of a settlement in a wage and hour lawsuit, summary judgment for defendant is affirmed where, by operation of the plain terms of the agreement, plaintiff had no claim for coverage against defendant.

General Star Nat. Ins. Co. v. Universal Fabricators, Inc.

Thu, 5 Nov 2009 20:00:02 PDT

(U.S. 2d Cir., Construction, Contracts, Insurance Law) In an action claiming that defendant insurer was bound by the terms of an excess insurance policy it had issued to contribute to the satisfaction of a state-court judgment of liability in a personal injury action against two entities for whom the insured had been a contractor, summary judgment for plaintiffs is reversed where the district court erred in deciding that the state-court judgment established legal liability against the insured.

World Harvest Church, Inc. v. GuideOne Mut. Ins. Co.

Fri, 30 Oct 2009 21:00:02 PDT

(U.S. 11th Cir., Contracts, Insurance Law) In an action against an insurer claiming that the insurer was estopped from contesting that a judgment against plaintiff was covered by the policy, the court of appeals certified the following questions to the Georgia Supreme Court: 1) does an insurer effectively reserve its right to deny coverage if it informs the insured that it does "not see coverage," after the insured had received a written reservation of rights from the insurer's sister company in a similar lawsuit in another jurisdiction, or is a written or more unequivocal reservation of rights required?; 2) when an insurer assumes and conducts an initial defense without notifying the insured that it is doing so with a reservation of rights, is the insurer estopped from asserting the defense of noncoverage only if the insured can show prejudice, or is prejudice conclusively presumed?; and 3) if the insured must show prejudice, do the facts and circumstances of this case show it?

Guillemaro-Ginorio v. Contreras-Gomez

Thu, 29 Oct 2009 21:00:02 PDT

(U.S. 1st Cir., Civil Rights, Constitutional Law, Government Contracts, Government Law, Injury And Tort Law, Insurance Law) In plaintiffs' case against the Office of the Insurance Commissioner of Puerto Rico and two consecutive Insurance Commissioners claiming that they were investigated and sanctioned for Insurance Code violations solely because of their political affiliations, district court's judgment in favor of the plaintiffs in the amount of $4.7 million and a permanent injunction is affirmed as all of defendants' grounds for relief are without merit.

Cox v. Standard Ins. Co.

Thu, 29 Oct 2009 21:00:02 PDT

(U.S. 6th Cir., Administrative Law, ERISA, Health Law, Insurance Law, Labor & Employment Law) In plaintiff's ERISA case, district court's judgment on the administrative record approving defendant's discontinuance of plaintiff's long-term disability benefits is affirmed as, taking the record as a whole and applying the highly deferential arbitrary and capricious standard, defendant's decision appears to have been based on a principled and deliberative reasoning process.

Zhang v. Sup. Ct.

Thu, 29 Oct 2009 21:00:02 PDT

(Cal. App., Commercial Law, Consumer Protection Law, Ethics & Professional Responsibility, Government Law, Insurance Law) In plaintiff's action against her insurer over disputes arising from a fire of her commercial premises, district court's ruling sustaining defendant's demurrer to a cause of action under the Unfair Competition Law (UCL), Business and Professions Code section 17200, is vacated and remanded with directions to reinstate the cause of action as an insurer connected with conduct that would violate Insurance Code section 790.03 can also give rise to a private civil cause of action under the UCL.

Standard Ins. Co. v. Morrison

Wed, 28 Oct 2009 20:00:02 PDT

(U.S. 9th Cir., ERISA, Insurance Law) In an action claiming that a state's practice of disapproving insurance policies with clauses vesting discretion in insurers violated the Employee Retirement Income Security Act (ERISA), summary judgment for defendant-state insurance commissioner is affirmed where: 1) the state's bar on discretionary clauses addresses an insurance-specific problem, because discretionary clauses generally do not exist outside of insurance plans; and 2) the commissioner's practice merely alters the terms by which the presence or absence of the insured contingency is determined; and 3) thus, the state regulatory scheme was saved from preemption under 29 U.S.C. section 1144(a) by the savings clause in section 1144(b).

Westchester Fire Ins. Co. v. Mendez

Wed, 28 Oct 2009 20:00:02 PDT

(U.S. 9th Cir., Civil Procedure, Contracts, Insurance Law, Sanctions) In an action by an insurer seeking a declaration that it had no obligation to defend or indemnify defendant against a certain claim because he failed to give proper notice of the claim to insurer, default judgment for plaintiffs is reversed where intervenor-Northwest Airlines should have been permitted to defend the declaratory relief action on its own.