Articles Posted in Insurance Law

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Plaintiff filed suit claiming accidental death benefits under a policy with Minnesota Life after her husband was bitten by a mosquito carrying West Nile Virus and passed away. The Fifth Circuit reversed the district court's dismissal of the complaint based on summary judgment, holding that there were genuine disputes of material fact as to whether the husband's death was accidental and thus an exclusion under the policy, and whether there were other causes of his death. Accordingly, the court remanded for a factfinder to decide determinative facts of plaintiff's breach-of-contract claim. However, the court affirmed the district court's dismissal of the bad-faith tort claim because Minnesota Life had a reasonable basis for denying the claim. View "Wells v. Minnesota Life Insurance Co." on Justia Law

Posted in: Insurance Law

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The Fifth Circuit affirmed the district court's dismissal of plaintiffs' suit based on forum non conveniens. The court held that Louisiana Revised Statute 22:868 does not evince a public policy against forum-selection clauses in insurance contracts. Therefore, the court found that the parties' insurance policy contained an enforceable forum-selection clause requiring litigation in New York state court. Furthermore, the public interest factors did not weigh in favor of keeping this case in Louisiana. View "Al Copeland Investments, LLC v. First Specialty Insurance Corp." on Justia Law

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This case arose when one assisting tug allided with a bridge fender system and sank. The Fifth Circuit held that "tow" as used in Atlantic Specialty's policy was defined by its plain, ordinary meaning: a vessel that is provided auxiliary motive power by being pushed or pulled. A tug remains a tug when it is tugging (i.e., pushing or pulling), and a tow is a tow only when it is being towed (i.e., being pushed or pulled). In this case, because the MISS DOROTHY was not provided any extra motive power, it was not a tow. Therefore, Atlantic Specialty's policy did not apply. The court reversed the district court's application of the tort principle known as the "dominant mind" doctrine and rendered judgment in favor of Atlantic Specialty. View "Continental Insurance Co. v. L&L Marine Transportation, Inc." on Justia Law

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Plaintiff appealed the district court's grant of summary judgment for Provident on breach-of-contract and tortious-breach-of-contract claims stemming from two disability insurance policies that Provident issued to plaintiff. The Fifth Circuit held that plaintiff presented sufficient evidence to raise a genuine dispute of material fact as to whether his disability resulted from injury and arthritis, in which case he would be entitled to lifelong benefits. Therefore, the court reversed the grant of summary judgment as to the breach-of-contract claim. Even if plaintiff had not waived his claim for punitive damages based on the theory that Provident tortiously breached the contract, he failed to offer evidence showing that Provident lacked an arguable reason for administering his claim under the sickness provisions. Accordingly, the court affirmed as to this issue. View "Cox v. Provident Life & Accident Insurance Co." on Justia Law

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Cigna filed suit against Humble seeking overpayments and Humble counterclaimed under the Employee Retirement Income Security Act (ERISA) and Texas state common law. The district court concluded that Cigna's claims and defenses failed as a matter of law, and awarded Humble damages and penalties. The Fifth Circuit held that the district court failed to apply the required abuse of discretion analysis; other courts have upheld Cigna's interpretation of its insurance plans; and there was substantial evidence supporting Cigna's interpretation. Therefore, the court reversed the district court's judgment. The court also held that Cigna was not a named plan administrator and reversed the district court's award of ERISA penalties against Cigna. The court vacated in part the district court's dismissal of Cigna's claims against Humble and vacated the district court's award of attorneys' fees, remanding for further consideration. View "Connecticut General Life Insurance Co. v. Humble Surgical Hospital, LLC" on Justia Law

Posted in: ERISA, Insurance Law

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OSC filed suit challenging the district court's grant of summary judgment in favor of LSB on OSC's duty to defend, OSC's breach of that duty, and OSC's liability under the Texas Prompt Payment of Claims Act (PPCA). OSC also appealed the denial of its partial motion for summary judgment based on the anti-stacking rule. The Fifth Circuit held that there were no genuine issues of material fact and LSB was entitled to judgment as a matter of law. Therefore, the court affirmed the district court's grant of summary judgment in LSB's favor on the duty to defend and OSC's breach of that duty. The court also affirmed the district court's denial of OSC's motion for partial summary judgment based on the anti-stacking rule. Likewise, the court also rejected OSC's challenge to the district court's grant of summary judgment in favor of LSB under the PPCA. The court reversed the district court's judgment with respect to LSB's Chapter 541 of the PPCA claim and remanded for further proceedings in light of this opinion and USAA Texas Lloyds Co. v. Menchaca. Finally, the court affirmed the district court's damages determinations. View "Lyda Swinerton Builders, Inc. v. Oklahoma Surety Co." on Justia Law

Posted in: Insurance Law

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Cooper filed suit against National Union after the insurer denied a claim under a commercial-crime insurance policy. The Fifth Circuit affirmed the district court's take-nothing judgment against Cooper. Determining that Texas law governs the court's interpretation of the policy, the court held that Cooper suffered a "loss" only after it loaned the principal to Greenwood and Walsh and that Cooper did not "own" the funds when they were in the fraudsters' possession. Because these holdings were sufficient to preclude coverage, the court need not consider the parties' remaining contentions. Accordingly, the court dismissed National Union's cross-appeal. View "Cooper Industries, Ltd. v. National Union Fire Insurance Co." on Justia Law

Posted in: Insurance Law

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The Fifth Circuit affirmed the district court's grant of summary judgment for United in plaintiff's action seeking benefits under an accidental death and dismemberment and life insurance policy provided by his employer. The court held that plaintiff's eye infection was not an "Accident" within the meaning of the policy. Furthermore, plaintiff's loss of sight from a fungal infection was not "independent of Sickness," and was not covered by the policy. The court reasoned that the policy's extension of coverage did not turn on whether the death or loss was caused by a condition that arose after the inception of the policy. Rather, the nature and cause of the loss determine whether there was coverage. In this case, the contra proferentem rule did not apply because the policy terms were not unambiguous and the court need not construe the policy against United. View "Ramirez v. United of Omaha Life Insurance Co." on Justia Law

Posted in: Insurance Law

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Mainali filed suit against Covington for breach of contract, breach of the duty of good faith and fair dealing, fraud, and violations of the Texas Insurance Code and Texas Deceptive Trade Practices Act. The Fifth Circuit affirmed the district court's grant of summary judgment for Covington on all of Mainali's claims. The court rejected Mainali's contention that the appraisal award was incomplete because it excluded damage to items covered by the policy where Mainali cited nothing in the record to show that these items were not included. The court also held that Covington did not violate the Prompt Payment of Claims Act where Covington was not trying to avoid payment of the claim; it was invoking a contractually agreed to mechanism for assessing the amount it owed. View "Mainali Corp. v. Covington Specialty Insurance Co." on Justia Law

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After Exxon settled the underlying personal injury lawsuit, it sought reimbursement from ERS and ORIC, contending that ERS's contractual obligation to insure Exxon as an additional insured and the insurance policy issued by ORIC required ERS and ORIC to pay for the settlement of the suit and the cost of litigation. The Fifth Circuit affirmed the district court's judgment as to ERS's duty to pay the deductible; reversed the portion of the judgment pertaining to the interest award and remanded for calculation of a new interest award; vacated the portion of the judgment that held ORIC jointly and severally liable with ERS for the entire judgment and remanded for modification; reversed the denial of Exxon's attorney's fees for the initial appeal and remanded for determination of amounts; and affirmed the denial of Exxon's previously unrequested attorney's fees. View "ExxonMobil Corp. v. Electrical Reliability Services, Inc." on Justia Law