Articles Posted in Insurance Law

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The Fifth Circuit reversed the district court's judgment in favor of LINA, the insurer and plan administrator of a life insurance policy. Plaintiff, the beneficiary of the policy, was denied benefits because LINA determined that the insured's death was caused in part by intoxication or drug abuse. The court took into account LINA's conflict of interest, its procedural unreasonableness, its denial of a full and fair review, and the counter-balanced nature of the evidence, and held that LINA abused its discretion in denying benefits. The court remanded with instructions to enter judgment for plaintiff and for any further proceedings. View "White v. Cigna Group 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 an insurer, in an action seeking a declaratory judgment that the insurer owed no coverage under a commercial property insurance policy. The insured then counterclaimed for declaratory judgment, breach of the insurance contract, and violations of the Texas Insurance Code. The court held that the insured failed to meet its burden to offer evidence that would allow a trier of fact to segregate covered losses from non-covered losses. Therefore, because the insured failed to meet its burden to show what portion, if any, of the claimed damage occurred during the coverage period, the insurer was entitled to summary judgment on its claim seeking declaratory judgment. The insured's counterclaims failed for the same reason. View "Certain Underwriters at Lloyd's of London v. Lowen Valley View, LLC" on Justia Law

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The Fifth Circuit affirmed the district court's grant of summary judgment for Axis and grant of Axis's motion to strike an affidavit submitted in support of its motion for summary judgment as untimely. The court held that this case presented no unusual or exceptional circumstances and the district court did not abuse is discretion in striking the affidavit where Hartford did not not seek modification of the scheduling order so that it may apprise the district court of its intent to offer another witness's testimony so as to give Axis an opportunity to depose the witness, nor did Hartford provide any valid justification for its failure to secure the affidavit before all discovery deadlines had passed. The court held that the policy unambiguously provided coverage in this case because the Hartford policy provided liability coverage for any auto and because the CRB Endorsement did not conflict with the liability coverage provision of the policy. Finally, the court declined to take judicial notice of Dana Transport's "admission." View "Bennett v. Hartford Insurance Company of the West" on Justia Law

Posted in: Insurance Law

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In the Fifth Circuit's previous ruling, Aldous v. Darwin Nat'l Assurance Co., 851 F.3d 473, 485 (5th Cir. 2017), the court determined that plaintiff's claims under the Texas Insurance Code Chapter 541 were barred because she did not claim damages beyond the loss of policy benefits. Since that ruling, the Supreme Court of Texas decided USAA Texas Lloyds Co. v. Menchaca, No. 14-0721, 2018 WL 1866041, at 10 (Tex. Apr. 13, 2018), and repudiated the independent-injury rule. Therefore, the court granted plaintiff's motion for leave to file her petition out of time because the court retained jurisdiction over the appeal and because plaintiff had good cause for her late filing. View "Charla Aldous, P.C. v. Darwin National Assurance Co." on Justia Law

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