Justia U.S. 5th Circuit Court of Appeals Opinion Summaries

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

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

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

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

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

This case involved an allision causing significant damage to a submerged moor line for a mobile offshore drilling unit used by Shell. Tesla, an offshore survey company, contracted with International to provide and operate the tow vessel. On appeal, International and Tesla challenged the district court's grant of summary judgment dismissing their indemnity and insurance claims. The Fifth Circuit held that a warning to Tesla's party chief that the tow vessel was moving too close to the moor line was a gratuitous act that had no effect on the outcome of the litigation. The court also held that none of the insurance policies were in the record nor was there any other evidence from which the policy language could be definitively discerned. Accordingly, the court vacated the district court's judgment as to Tesla's and International's insurance claims and remanded. View "International Marine, LLC v. Integrity Fisheries, Inc." on Justia Law

Plaintiffs filed suit alleging that defendants unlawfully used WCTL to calculate the base value of total loss vehicles. Plaintiffs alleged that using WCTL, instead of lawful sources such as the National Automobile Dealers Association (NADA) Guidebook or the Kelly Blue Book (KBB), resulted in their vehicles being assigned a lower base value and accordingly resulted in plaintiffs receiving lower payouts on their insurance claims. Plaintiffs contended that damages can be calculated by replacing defendants' allegedly unlawful WCTL base value with a lawful base value, derived from either NADA or KBB, and then adjusting that new base value using defendants' current system for condition adjustment. The Fifth Circuit found that plaintiffs' damages methodology was sound and did not preclude class treatment. The Fifth Circuit reversed the district court's certification of a fraud class where plaintiff failed to show that class issues will predominate. Defendant argued for the first time on appeal that by accepting defendants' condition score calculation as is, plaintiffs may have impermissibly waived unnamed class members' ability to assert a future claim contesting defendants' computation of the condition factor. Because this argument was not expressly raised to the district court, and may present important certification questions, the Fifth Circuit remanded the certification order as to the contract and statutory claims. View "Slade v. Progressive Security Insurance" on Justia Law

State Farm filed suit seeking a declaratory judgment that a homeowner's insurance policy issued by State Farm to Cedric Flowers was void ab initio as a result of material misrepresentations made by him in his application for the policy. The district court granted State Farm's motion for summary judgment. In this case, the district court noted that, in both his answer to State Farm's complaint and his response to State Farm's request for admission, Cedric Flowers admitted to telling the agent who took his insurance application that he was the owner of the property and to stating as much in his application. Because there was no actual controversy over whether Cedric Flowers made a material misstatement on his insurance application, the court affirmed the judgment. View "State Farm Fire & Casualty Co. v. Flowers" on Justia Law

Plaintiff, a dependent eligible for benefits under the Eyesys Vision Inc. group health plan, filed suit challenging Humana's denial of benefits. The district court ultimately granted summary judgment for Humana. The court found that Texas's anti-discretionary clause does not change the court's normal abuse of discretion deference pursuant to Pierre v. Connecticut General Life Insurance Co./Life Insurance Co. of North America. The court concluded that the district court did not err in finding that Humana's consideration of the Mihalik criteria was proper because the record supported a finding that the Mihalik criteria are in line with national standards. Finally, the court concluded that it was not unreasonable on this record to conclude that plaintiff could be treated with a less costly, equally effective outpatient treatment. Therefore, substantial evidence supported Humana's finding that further treatment for plaintiff at the Avalon Hills facility was not medically necessary. The court found plaintiff's remaining arguments were without merit and affirmed the judgment. View "Ariana M. v. Humana Health Plan of Texas" on Justia Law

Wise Regional, a Texas municipal hospital authority, filed suit against Aetna, an insurance plan administrator, in state court over a dispute regarding medical insurance claims Wise Regional submitted on behalf of its patients. Aetna removed to federal court under 28 U.S.C. 1442, but the district court remanded to state court, awarding attorneys' fees. The court concluded that it had appellate jurisdiction over the remand order because Aetna relied upon the federal officer removal statute in its notice of removal; remand was proper because Aetna's notice of removal was untimely; and the district court did not abuse its discretion in awarding attorneys' fees where Aetna lacked an objectively reasonable basis for seeking removal of this action almost five months after expiration of the thirty-day deadline for removal. Accordingly, the court affirmed the judgment. View "Decatur Hospital Authority v. Aetna Health, Inc." on Justia Law