Articles Posted in Insurance Law

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Plaintiffs, operators of a gas purification plant, filed suit against its insurer, Ace, after the insurer denied coverage for damage caused by broken metal brackets that secured crucial components. The Ninth Circuit affirmed the district court's application of Washington law and its discovery sanctions against plaintiffs. However, the panel reversed the district court's grant of summary judgment in favor of the insurer and held that there was a triable issue of fact as to whether the insurer was prejudiced by plaintiffs' remedial actions, whether plaintiffs' loss was fortuitous, whether the policy's Boiler and Machinery endorsement applied to independently confer coverage for plaintiffs' losses, whether the Endorsement's "accident" coverage applied, and whether a 16 month shutdown was consistent with the exercise of due diligence and dispatch. View "Ingenco Holdings, LLC v. ACE American Insurance Co." on Justia Law

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The Ninth Circuit affirmed the district court's dismissal of plaintiffs' claim that their insurer, Blue Shield, violated the Medical Loss Ratio (MLR) provision of the Patient Protection and Affordable Care Act (ACA). The MLR is the ratio between what an insurer pays out in claims for medical services and the revenue it takes in. The panel held that there was no basis in the language, history, intent or spirit of the ACA to narrow the MLR by excluding payments for services rendered by out-of-network physicians. In this case, the MLR was properly calculated under federal law by including the settlement reimbursements for medical services by nonnetwork providers. Therefore, the district court correctly recognized the services were covered by the plan and the payments were made. View "Morris v. California Physicians' Service" on Justia Law

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The Ninth Circuit affirmed the district court's denial of plaintiffs' motion to remand to state court. The panel joined the Fourth Circuit in holding that receipt of an initial pleading by a statutorily designated agent does not begin the thirty-day removal clock under 28 U.S.C. 1446(b)(1), and that it was instead actual receipt by State Farm that started the removal clock. The panel applied this rule and held that State Farm timely removed the case where removal was calculated from when the forwarded copy of the complaint reached State Farm's designated recipient. View "Anderson v. State Farm Mutual Automobile Insurance Co." on Justia Law

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The Ninth Circuit affirmed the judgment of the district court in this dispute between two insurance companies that arose after the settlement of certain claims brought against their insureds, holding that Cal. Gov’t Code 825.4 did not preclude Westport Insurance Corporation’s lawsuit against California Casualty Management Company and that the district court did not err in its judgment on all the remaining issues raised on appeal. This diversity insurance coverage action concerned claims for $15.8 million brought by three former students against a school district and three of its school administrators. Westport defended and settled the claims for $15.8 million and sought repayment from California Casualty, the administrators’ insurer. The district court found California Casualty liable for $2.6 million plus prejudgment interest. The Ninth Circuit affirmed, holding (1) section 825.4 did not preclude Westport’s claim; (2) California Casualty’s claim that it was not obligated to contribute to the settlements under its policy was contrary to the plain test of its policy; (3) California Casualty’s challenge to the apportionment of liability with Westport was unavailing; and (4) the district court did not abuse its discretion in awarding prejudgment interest at ten percent from the dates Westport paid the settlements. View "Westport Insurance Corp. v. California Casualty Management Co." on Justia Law

Posted in: Insurance Law

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The Ninth Circuit certified to the California Supreme Court the following question: Does a commercial liability policy that covers "personal injury," defined as "injury . . . arising out of . . . [o]ral or written publication . . . of material that violates a person's right of privacy," trigger the insurer's duty to defend the insured against a claim that the insured violated the Telephone Consumer Protection Act by sending unsolicited text message advertisements that did not reveal any private information? View "Yahoo! Inc. v. National Union Fire Insurance Co." on Justia Law

Posted in: Insurance Law

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The panel certified the following question to the Washington Supreme Court: Under Washington law, is an insurer bound by representations made by its authorized agent in a certificate of insurance with respect to a party's status as an additional insured under a policy issued by the insurer, when the certificate includes language disclaiming its authority and ability to expand coverage? View "T-Mobile USA Inc. v. Selective Insurance Company of America" on Justia Law

Posted in: Insurance Law

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The Ninth Circuit affirmed the district court's grant of summary judgment for Lincoln Benefit in a declaratory judgment action over an insurance policy. Considering sua sponte whether the district court had subject matter jurisdiction, the panel held that the district court properly exercised jurisdiction; the district court did not abuse its discretion in deciding to strike plaintiff's expert report and plaintiff has not shown how an expert opinion could have been helpful in this case; there was no genuine dispute about whether plaintiff needed to pay certain sums to keep his policy from lapsing or whether Lincoln Benefit mailed the required notice at least 30 days before the policy lapsed; the policy was unambiguous and the district court's reading of the policy was proper; and because there was nothing to gain by deposing the Lincoln Benefit official most knowledgeable on policy lapses, the district court did not abuse its discretion in denying plaintiff's request to delay consideration of the motion. View "Elhouty v. Lincoln Benefit Life Co." on Justia Law

Posted in: Insurance Law

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The Ninth Circuit certified the following questions of state law to the California Supreme Court: 1. Are the lenders identified in Article XV of the California Constitution, see Cal. Const. art. XV, 1, as being exempt from the restrictions otherwise imposed by that article, nevertheless subject to the requirement in section 1916-2 of the California Civil Code that a lender may not compound interest "unless an agreement to that effect is clearly expressed in writing and signed by the party to be charged therewith"? 2. Does an agreement meet the requirement of section 1916-2 if it is comprised of: (1) an application for insurance signed by the borrower, and (2) a policy of insurance containing an agreement for compound interest that is subsequently attached to the application, thus constituting the entire contract between the parties pursuant to section 10113 of the California Insurance Code? View "Wishnev v. Northwestern Mutual Life Insurance Co." on Justia Law

Posted in: Insurance Law

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The Ninth Circuit certified the following question of law to the Nevada Supreme Court: Under Nevada law, if a plaintiff has filed suit against an insurer seeking damages based on a separate judgment against its insured, does the insurer's liability expire when the statute of limitations on the judgment runs, notwithstanding that the suit was filed within the six-year life of the judgment? View "Nalder v. United Automobile Insurance Co." on Justia Law

Posted in: Insurance Law

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The panel certified the following questions of state law to the Oregon Supreme Court: 1. If the Director of the Department of Consumer and Business Services approves a contractual limitations provision in an insurance policy under Oregon Revised Statutes 742.021, does the language of the policy always control or do the standard provisions of the Oregon Insurance Code apply if the standard provisions are more favorable than the approved insurance policy provision? 2. If the Oregon standard provisions do apply, when does "the period for which the insurer was liable" under Oregon Revised Statutes section 743.429 end? View "Raynor v. United of Omaha Life Insurance" on Justia Law

Posted in: Insurance Law