Articles Posted in Insurance 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

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The Fifth Circuit affirmed the district court's grant of summary judgment for Nationwide in a suit seeking insurance coverage for an underlying complaint. The court held that the underlying complaint failed to allege an advertising injury covered under the policy because it did not allege the use of another's advertising idea, a trade dress claim, nor a claim for slogan infringement. View "Laney Chiropractic and Sports Therapy v. Nationwide Mutual Insurance Co." on Justia Law

Posted in: Insurance Law

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After a commercial warehouse sustained substantial fire damage, the owner of the warehouse (Emerald), filed suit against the lessee (Sunrise), the insurance agent, and the insurer. The Fifth Circuit affirmed the district court's grant of summary judgment to the insurance defendants, holding that Emerald's claims failed under Florida and Mississippi law. In this case, no Mississippi case recognizes a duty owed by an agent to a party in Emerald's position when the agent procures insurance for its insured. Emerald's claims under Florida law failed because it had never claimed status as a third-party beneficiary to the contract to procure insurance. View "Emerald Coast Finest Produce Co. v. Alterra American Insurance Co." on Justia Law

Posted in: Insurance Law

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The rights that flow through a subrogation clause allow an insurer to seek reformation of a contract between its insured and a third party. After Associated paid the portion of the underlying settlement that was in excess of the Westfield policy, Associated sought reimbursement from Scottsdale, an insurer that issued a commercial umbrella policy to Alpha. The Fifth Circuit held that the district court erred in reading reformation’s privity requirement to necessitate a specific connection to the Alpha-Scottsdale insurance policy. Rather, privity in Texas focuses on the relationship to a party. In this case, the subrogation clause in the Associated-Alpha policy provided that connection. Accordingly, the court reversed and remanded. View "Associated International Insurance Co. v. Scottsdale Insurance Co." on Justia Law