Justia Insurance Law Opinion Summaries

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The case concerns Brooklyn Restaurants, Inc., a company that operates a local diner in California. The company filed a lawsuit against its insurer, Sentinel Insurance Company, Limited, after the insurer declined a claim under a commercial property insurance policy following a partial shutdown of the diner during the COVID-19 pandemic. The lower court granted Sentinel’s motion for judgment on the pleadings, ruling there was no coverage under the policy for Brooklyn’s claimed business loss. However, Brooklyn appealed, asserting that its case was unique from other COVID-19 related insurance cases filed in the state, as it had alleged a direct physical loss which should trigger coverage under the policy.Brooklyn also pointed out that their insurance policy contained a unique provision specifically covering losses attributable to a virus. Therefore, they argued, physical loss should include the cleaning of an area infected by the coronavirus. The Court of Appeal, Fourth Appellate District Division One State of California, agreed that the policy was reasonably susceptible to that interpretation. They also determined that Brooklyn had adequately alleged a direct physical loss or damage under the policy, which raised the possibility of coverage.However, the policy also included certain exclusions and conditions applicable to coverage for a loss or damage resulting from a virus. Brooklyn argued that these exclusions and conditions rendered the policy illusory. The court agreed that at the pleading stage, Brooklyn had done enough to raise the issue that its policy might be illusory, which in turn raised factual questions that required further discovery and evidence collection. Therefore, the court reversed the judgment and remanded the case back to the lower court with instructions to enter an order denying Sentinel’s motion for judgment on the pleadings. View "Brooklyn Restaurants, Inc. v. Sentinel Insurance Co., Ltd." on Justia Law

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The Supreme Court of the State of Colorado reviewed a case involving an insurance dispute over uninsured/underinsured motorist ("UM/UIM") benefits in a specialty antique/classic-car policy. The plaintiff, Beverly Hughes, was injured while driving a vehicle owned by her employer. Hughes was insured by two automobile insurance policies: one standard policy issued by Travelers Insurance covering her regular-use vehicles and a specialty policy issued by Essentia Insurance Company covering her antique/classic cars. She sought to recover underinsured motorist benefits from both policies.The court held that a specialty antique/classic-car policy that requires an insured to have a regular-use vehicle and to insure it through a standard policy that provides UM/UIM coverage may properly limit its own UM/UIM coverage to the use of any antique/classic car covered under the specialty policy. The court reasoned that an adjunctive antique/classic-car policy, which excludes UM/UIM benefits with respect to situations involving a regular-use vehicle but works in tandem with a standard regular-use-vehicle policy that provides UM/UIM coverage, satisfies both the language of section 10-4-609, C.R.S. (2023), and the public policy goals underpinning the statute. Thus, the court concluded that the regular-use-vehicle exclusion in the UM/UIM provision of Essentia's specialty policy is valid and enforceable under Colorado law. As a result, the court reversed the judgment of the court of appeals and reinstated the district court’s summary judgment in favor of Essentia. View "Essentia Insurance Company, v. Hughes" on Justia Law

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In this appeal, a married couple, both visually impaired, sued Colony Insurance Company to recover for the injuries they suffered when the wife fell down a restaurant's stairs. The couple had previously sued the restaurant and its owner for negligence in a New Hampshire state court, resulting in a default judgment against the defendants.The couple then sought to collect the judgment amount from Colony, the restaurant's insurer, arguing that the insurer was obligated to pay under the restaurant's liability insurance policy. Colony denied the couple's claim, stating that it was not notified of the lawsuit against the restaurant "as soon as practicable," as required by the insurance policy. The couple contended that the insurance policy was compulsory under a City of Manchester ordinance, therefore the insurer could not deny the claim based on a breach of the notice provision in the policy.The District Court granted summary judgment to Colony, ruling that the insured had breached the insurance contract by failing to provide timely notice and that the compulsory insurance doctrine, which generally limits an insurer's defenses against an injured party's claim, did not apply. The couple appealed the decision, but the United States Court of Appeals for the First Circuit affirmed the District Court's ruling.The Appeals Court held that, as a matter of law, the lack of timely notice constituted a breach of the insurance contract, thereby releasing Colony from payment. The court also agreed with the District Court's conclusion that the compulsory insurance doctrine did not apply to the case. The court noted that the doctrine has largely been applied in the context of automobile liability insurance and found no persuasive reason to extend it to this case. View "Jespersen v. Colony Insurance Company" on Justia Law

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The Supreme Court of North Carolina reversed a decision by the Court of Appeals regarding the interpretation of a clause in the Financial Responsibility Act (FRA) about underinsured motorist (UIM) coverage. The defendant, Mr. Hebert, was in a vehicle accident where multiple parties were injured, and he sought to claim UIM coverage under his policy and his parents' policy. The Court of Appeals had allowed him to "stack" or add together the UIM limits from both policies to qualify his vehicle as underinsured. However, the Supreme Court disagreed with this interpretation.The court held that the FRA's plain language only permits the claimant’s UIM coverages that pertain to the vehicle involved in the accident, not all UIM policies for which the UIM claimant is personally eligible. Therefore, the defendant could not stack his policy’s UIM limits with his parents’ policy’s UIM limits to qualify his vehicle as underinsured. The court concluded that the defendant's vehicle did not qualify as an underinsured highway vehicle under the FRA, and he could not activate his policy’s UIM coverage. Consequently, the Supreme Court reversed the Court of Appeals' decision and remanded the case to the trial court for entry of judgment on the pleadings in favor of the plaintiff, North Carolina Farm Bureau Mutual Insurance Company. View "N.C. Farm Bureau Mut. Ins. Co. v. Hebert" on Justia Law

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The appellant, Demitri Gee, was convicted for driving under the influence resulting in substantial bodily harm. He appealed the judgment of conviction, challenging the restitution amount of $9,940 that was awarded to the State of Nevada Victims of Crime Program. On appeal, the Supreme Court of the State of Nevada found two main issues: whether an order of restitution must be based on competent evidence and whether a defendant’s restitution obligation should be offset by the amount the defendant’s insurance provider paid to the victim for the same losses.Gee had been driving while intoxicated when he lost control of his vehicle and collided with another car, severely injuring the occupants. He subsequently fled the scene. As a result of the collision, Gee was charged with two counts of driving under the influence resulting in substantial bodily harm among other charges. A civil settlement agreement was reached with the victims, and they received compensation through Gee's insurance.The court found that the restitution amount of $9,940 was not supported by competent evidence as the state failed to present evidence to support it. The court also found that the district court had not evaluated whether the restitution should be offset by the insurance payment made by Gee to the victims. Therefore, the Supreme Court of Nevada concluded that the district court had abused its discretion by ordering restitution not supported by competent evidence and by failing to evaluate whether the award needed to be offset by the compensation provided to the victim through Gee’s insurance. The court then vacated the $9,940 in restitution, affirmed the rest of the conviction, and remanded the case for further proceedings regarding the restitution amount. View "Gee v. State" on Justia Law

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The case pertains to a marital dissolution dispute in Indiana where the husband's police pension constituted the majority of the couple's marital estate. The husband was reluctant to share his pension with his wife, expressing his intention to disregard any court order mandating him to do so. As a response, the trial court ordered the husband to secure and subsidize a life insurance policy to ensure the wife received her share of the marital estate. The husband challenged the trial court's authority, arguing that the court did not consider the tax implications of his future pension payments.The Indiana Supreme Court upheld the trial court's decision. It ruled that the trial court had broad statutory authority to order a security or other guarantee, such as a life insurance policy, when necessary, to secure the division of property. The court also held that the husband had waived his challenge regarding the tax consequences of his future pension payments.The facts of the case reveal that the husband and wife had been married for nearly twenty-six years. The husband's police pension had a market value of over $1.1 million, constituting over 85% of the marital estate. The husband was unwilling to share his pension with his wife, and the wife expressed concern that she might not receive anything. The trial court ordered the husband to make monthly payments and obtain a life insurance policy that named her as owner and beneficiary. The husband contested this order, leading to the appeal. The Indiana Supreme Court affirmed the trial court's decision, maintaining that the court had the authority to secure the wife's share of the marital estate through a life insurance policy. View "Cooley v. Cooley" on Justia Law

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Gold Coast Commodities, Inc., a company that converts used cooking oil and vegetable by-products into animal feed ingredients, was insured under a policy by Travelers Casualty and Surety Company of America. The policy included a pollution exclusion clause. During the policy period, the City of Brandon and the City of Jackson filed suits against Gold Coast, alleging that the company dumped corrosive, high-temperature wastewater into their respective sewer systems, causing damage. Travelers denied coverage for these claims, citing the policy's pollution exclusion clause. Gold Coast appealed this decision, arguing that Travelers had a duty to defend them in these lawsuits and reimburse them for their defense costs.The United States Court of Appeals for the Fifth Circuit upheld the lower court's decision, finding that the claims against Gold Coast were clearly and unambiguously excluded from coverage based on the policy's pollution exclusion. The court noted that the pollution exclusion clause was not ambiguous in this context, as there was no reasonable interpretation of the wastewater's form or qualities that would conclude that it was not an irritant or contaminant, as defined in the policy.The court concluded that because the claims fell outside the policy's coverage, Travelers had no duty to defend or indemnify Gold Coast and its principals in relation to the lawsuits brought against them by the City of Brandon and the City of Jackson. Therefore, the court affirmed the decision of the district court, which had denied Gold Coast's motions for partial judgment on the pleadings and had granted Travelers' motion for partial summary judgment. View "Gold Coast Commodities, Inc. v. Travelers Casualty and Surety Company of America" on Justia Law

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The United States Court of Appeals for the Second Circuit heard an appeal involving Timothy Daileader, the independent director and manager of an affiliated group of companies, collectively known as "Oaktree," which were in financial distress. Daileader was seeking coverage from his insurer, Certain Underwriters at Lloyds London Syndicate 1861 (Syndicate 1861), for his defense in litigation involving Oaktree. However, Syndicate 1861 denied Daileader’s insurance claim. Daileader subsequently sought a preliminary injunction to enforce Syndicate 1861’s duty to defend. The United States District Court for the Southern District of New York denied Daileader’s motion, and Daileader appealed.The Court of Appeals affirmed the district court's decision, finding that the district court did not abuse its discretion in denying Daileader's motion for a preliminary injunction. The court held that Daileader had not shown a clear or substantial likelihood of success on the merits of his claim. The court also found that Daileader had not made a strong showing of irreparable harm. The court concluded that the Syndicate's refusal to continue paying under its policy did not disrupt the status quo of ongoing payments between the two parties. Therefore, the court determined that Daileader's desired injunction was mandatory and not prohibitory, thus subject to a more stringent standard for relief. View "Daileader v. Certain Underwriters" on Justia Law

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A dispute arose between the Gardens Condominium (a Washington nonprofit corporation) and Farmers Insurance Exchange (a California company) over the interpretation of a resulting loss exception in an all-risk insurance policy. The Gardens Condominium discovered water damage to the roof's fireboard, sheathing, and several sleepers and joists in 2019, caused by faulty construction which led to insufficient ventilation in the roof assembly. They sought coverage for the cost of repairing the damage, which was denied by Farmers Insurance Exchange, who argued that the damage was excluded under the faulty workmanship exclusion in the policy.The trial court ruled in favor of Farmers Insurance Exchange, stating that the policy intended to exclude damage where an uncovered event, such as faulty workmanship, initiated a sequence of events causing damage. The Court of Appeals disagreed, finding that the resulting loss exception preserved coverage.The case reached the Supreme Court of the State of Washington. The court, following a de novo review, sided with the Court of Appeals, stating that a resulting loss exception must have effect to preserve coverage for loss resulting from covered perils, even if the peril is the natural consequence of an excluded peril. The court concluded that a resulting loss exception to the faulty workmanship exclusion revives coverage, even if the faulty workmanship exclusion would otherwise deny it. The case was remanded to the trial court for further proceedings consistent with the Supreme Court's opinion. View "Gardens Condominium v. Farmers Insurance Exchange" on Justia Law

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The Supreme Court of the State of Montana affirmed a lower court decision that granted Dr. Gregory S. Tierney's motion to dismiss a medical malpractice lawsuit filed by Janice M. Dodds for insufficient service of process. Dodds initially filed the suit against Dr. Tierney and Benefis Health System in 2013, alleging medical malpractice related to a knee replacement surgery. She failed to serve the defendants in time. Dr. Tierney later filed for bankruptcy, which invoked an automatic stay, halting the lawsuit. After his bankruptcy discharge, Dodds attempted to serve Dr. Tierney but failed to do so within the required 30-day timeframe following the discharge.Dodds further sought to join Dr. Tierney's malpractice insurance company as the real party in interest, but the court denied the motion. Upon review, the Supreme Court found that Dodds had not proven Dr. Tierney's liability, thus the insurer had no duty to indemnify him. The court also rejected Dodds' argument that Dr. Tierney lacked standing after his Chapter 7 discharge. The court held that Dr. Tierney maintained a personal stake in demonstrating he was not liable for medical malpractice and that his insurer would only have a duty to indemnify him once Dodds proved her malpractice claims. View "Dodds v. Tierney" on Justia Law