Justia U.S. 9th Circuit Court of Appeals Opinion Summaries

Two former customers of an insurance company filed suit after their vehicles were declared total losses and the insurer paid out claims based on the vehicles’ “actual cash value” (ACV). The insurance policy defined ACV as the “market value, age, and condition of the vehicle at the time the loss occurs.” The insurer calculated market value using a system that included a “projected sold adjustment” (PSA), which reduced the list prices of comparable vehicles to reflect typical consumer negotiation. The plaintiffs alleged that the PSA always resulted in an artificially low valuation, breaching the policy’s requirement to pay true market value.The United States District Court for the District of Arizona found that the plaintiffs met the requirements of numerosity, commonality, typicality, and adequacy under Federal Rule of Civil Procedure 23(a). However, the court determined that individual questions about how each vehicle’s ACV was calculated predominated over common questions, as required by Rule 23(b)(3), and therefore denied class certification. The plaintiffs appealed this decision.The United States Court of Appeals for the Ninth Circuit reviewed the district court’s denial of class certification for abuse of discretion. The appellate court held that the PSA was not facially unlawful and that determining whether each class member was harmed would require individualized inquiries into each person’s vehicle valuation. Because liability and injury could not be established through common evidence, individual issues would predominate over common ones. The Ninth Circuit therefore affirmed the district court’s order denying class certification, holding that class certification was inappropriate under Rule 23(b)(3) due to the predominance of individualized questions. View "AMBROSIO V. PROGRESSIVE PREFERRED INSURANCE COMPANY" on Justia Law

The plaintiff purchased a life insurance policy for her son and consistently paid the required premiums. She alleges that the insurer failed to provide the statutory notices and protections mandated by California law before terminating her policy for nonpayment. After missing a payment in 2016, her policy lapsed, and following reinstatement, it was terminated again in 2018 after another missed payment. The plaintiff contends that the insurer’s failure to comply with statutory notice requirements rendered the termination ineffective and that her experience was representative of many other policyholders in California.The United States District Court for the Eastern District of California granted in part the plaintiff’s motion for class certification. The court found that the prerequisites of Federal Rule of Civil Procedure 23(a) were met and certified a class under Rule 23(b)(2) for declaratory and injunctive relief. The certified class included all policy owners or beneficiaries whose policies lapsed for nonpayment without the required statutory notice. The court appointed the plaintiff as class representative but denied, without prejudice, certification for monetary relief under Rule 23(b)(3).The United States Court of Appeals for the Ninth Circuit reviewed the district court’s class-certification order. Relying on its intervening decision in Small v. Allianz Life Insurance Co. of North America, the Ninth Circuit held that to recover for violations of the relevant California statutes, plaintiffs must show not only a statutory violation but also that the violation caused them harm. The court found that the plaintiff was not an adequate class representative for beneficiaries and that her claims were not typical of class members who intentionally allowed their policies to lapse. The Ninth Circuit reversed the district court’s class-certification order and remanded the case for further proceedings. View "Farley v. Lincoln Benefit Life Co." on Justia Law

Pamela Siino purchased a life insurance policy from Foresters Life Insurance and Annuity Company (FLIAC) in 2010. In 2014, she moved and failed to successfully update her address with FLIAC. Consequently, she did not receive notices about her premium payments and missed her payment due on January 26, 2018. FLIAC sent a notice on February 26, 2018, stating that her policy had lapsed but could be reinstated if she paid the overdue premium by March 28, 2018. Siino did not receive this notice and did not pay the premium. In 2019, she discovered her policy had lapsed and declined to reinstate it, purchasing a new policy from another provider instead.The United States District Court for the Northern District of California granted summary judgment in favor of Siino, declaring that FLIAC wrongfully terminated her policy and that it would remain valid if she tendered all unpaid premiums. The court found that FLIAC violated California Insurance Code sections 10113.71 and 10113.72 by failing to provide proper pretermination and designee notices. Siino's other claims were dismissed with prejudice.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court affirmed the district court's finding that FLIAC violated the statutory notice requirements, agreeing that FLIAC failed to provide the required pretermination and designee notices. However, the Ninth Circuit reversed the district court's declaration that Siino's policy remained valid, as Siino failed to prove that FLIAC's violations caused her injury. The court noted that even if FLIAC had sent the required notices, they would not have reached Siino due to her failure to update her address. The case was remanded to the district court solely for the purpose of entering final judgment. View "SIINO V. FORESTERS LIFE INSURANCE AND ANNUITY COMPANY" on Justia Law

Farmers Direct Property and Casualty Insurance Company filed a declaratory judgment action against Dennis Perez, seeking a declaration that it no longer had a duty to defend or indemnify Perez under an auto insurance policy in connection with an automobile accident involving Victor Montez. Perez had been uncooperative in his defense in the underlying state court tort action filed by the Montezes, leading Farmers Direct to claim that Perez breached the policy's cooperation clause. The Montezes intervened and moved to set aside the default judgment entered against Perez, arguing that the district court lacked subject matter jurisdiction because the amount in controversy did not meet the statutory requirement.The United States District Court for the Central District of California granted the Montezes' motion, vacating the default judgment on the grounds that the amount in controversy was limited to the policy's $25,000 face amount, which did not satisfy the jurisdictional threshold of over $75,000. Farmers Direct appealed this decision.The United States Court of Appeals for the Ninth Circuit reviewed the case and reversed the district court's order. The appellate court held that the district court erred in determining that the value of the declaratory judgment action was limited to the policy's $25,000 maximum liability. The Ninth Circuit found that there was at least an arguable basis that the amount in controversy was satisfied by considering either the potential excess liability of the underlying tort claim or Farmers Direct's anticipated future defense fees and costs, or both. The appellate court concluded that the judgment was not void for lack of subject matter jurisdiction and remanded the case for further proceedings. View "FARMERS DIRECT PROPERTY AND CASUALTY INSURANCE COMPANY V. MONTEZ" on Justia Law

50 Exchange Terrace LLC sought to collect under a property insurance policy with Mount Vernon Specialty Insurance Company for damage to its property in Rhode Island. The insurance policy required an appraisal if the parties disagreed on the amount of loss. After frozen pipes caused water damage, Mount Vernon paid its estimated value but demanded an appraisal. 50 Exchange filed a lawsuit in California state court, alleging wrongful withholding of compensation by Mount Vernon while awaiting the appraisal outcome.The case was removed to the United States District Court for the Central District of California, where Mount Vernon moved to dismiss based on forum non conveniens. The district court requested supplemental briefing on ripeness and Article III standing and subsequently dismissed the action for lack of both. 50 Exchange appealed the dismissal.The United States Court of Appeals for the Ninth Circuit reviewed the case and affirmed the district court's dismissal. The court held that the injuries asserted by 50 Exchange were not actual or imminent because the extent of any loss could not be determined until the appraisal process was completed. The court concluded that any alleged injury before the appraisal was too speculative to create an actionable claim, thus failing to meet the requirements for ripeness and Article III standing. The court did not address the parties' arguments under the doctrine of forum non conveniens. View "50 EXCHANGE TERRACE LLC V. MOUNT VERNON SPECIALTY INSURANCE CO." on Justia Law

Julian Omidi and his business, Surgery Center Management, LLC (SCM), were involved in a fraudulent scheme called "Get Thin," which promised weight loss through Lap-Band surgery and other medical procedures. Omidi and SCM defrauded insurance companies by submitting false claims for reimbursement, including fabricated patient data and misrepresented physician involvement. The scheme recruited patients through a call center, pushing them towards expensive medical tests and procedures regardless of medical necessity.A grand jury indicted Omidi and SCM for mail fraud, wire fraud, money laundering, and related charges. After extensive pretrial litigation and a lengthy jury trial, both were convicted on all charges. The district court sentenced Omidi to 84 months in prison and fined SCM over $22 million. The government sought forfeiture of nearly $100 million, arguing that all proceeds from the Get Thin scheme were derived from fraud. The district court agreed, finding that even proceeds from legitimate procedures were indirectly the result of the fraudulent scheme.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court affirmed the district court's forfeiture judgment, holding that under 18 U.S.C. § 981(a)(1)(C), all proceeds directly or indirectly derived from a health care fraud scheme must be forfeited. The court rejected the argument that only proceeds from fraudulent transactions should be forfeited, noting that the entire business was permeated with fraud. The court concluded that there is no "100% Fraud Rule" in forfeiture cases seeking proceeds of a fraud scheme, and all proceeds from the Get Thin scheme were subject to forfeiture. View "United States V. Surgery Center Management, LLC" on Justia Law

Lawanda Small, a beneficiary and additional insured of her deceased husband's Allianz life insurance policy, filed a class action lawsuit against Allianz Life Insurance Company. She alleged that Allianz violated California Insurance Code sections 10113.71 and 10113.72 by failing to comply with notice procedures required to prevent policies from lapsing due to nonpayment of premiums. Small sought to represent two subclasses: the "Living Insured Subclass" seeking equitable relief to reinstate life insurance coverage, and the "Beneficiary Subclass" seeking damages from death benefits where the insured was deceased.The United States District Court for the Central District of California certified the class, finding that both subclasses satisfied the requirements of Federal Rule of Civil Procedure 23(a) and 23(b). The court granted summary judgment for Small and the class on their breach of contract and declaratory relief claims, ruling that Allianz improperly lapsed the policies by failing to comply with the Statutes. Allianz appealed, arguing that the district court erred in certifying the class and that the summary judgment orders violated the one-way intervention prohibition.The United States Court of Appeals for the Ninth Circuit reversed the district court's order certifying the class and vacated the summary judgment orders. The appellate court held that to recover for alleged violations of the Statutes, plaintiffs must show not only that the insurer violated the notice requirements but also that the violation caused them harm. The court found that individual questions of causation and injury predominated over common questions, making class certification inappropriate. Additionally, the court determined that Small was not an adequate representative with typical questions to represent both subclasses. The case was remanded for further proceedings. View "Small v. Allianz Life Insurance Co. of North America" on Justia Law

Plaintiffs, representing a class of drivers whose cars were totaled in accidents, alleged that their insurers, State Farm Mutual Automobile Insurance Company and State Farm Fire and Casualty Company, failed to pay the actual cash value of their vehicles. They contended that State Farm applied two unlawful discounts: a negotiation discount, which reduced the value based on typical buyer negotiations, and a condition discount, which adjusted for the car's condition compared to similar vehicles.The United States District Court for the Western District of Washington initially certified two classes: a negotiation class and a condition class. However, following the Ninth Circuit's decision in Lara v. First National Insurance Company of America, the district court decertified both classes and granted summary judgment in favor of State Farm, concluding that the plaintiffs failed to demonstrate injury.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court reversed the district court's decertification of the negotiation class, holding that plaintiffs could prove injury on a class-wide basis by adding back the unlawful negotiation adjustment to determine the value each class member should have received. However, the court affirmed the decertification of the condition class, as determining injury required an individualized comparison of the unlawful condition adjustment and a hypothetical lawful adjustment.The Ninth Circuit also vacated the district court's summary judgment against the named plaintiffs, remanding the case for the district court to reassess whether the plaintiffs provided sufficient evidence of injury. The court clarified that plaintiffs could rely on the Autosource reports, minus the unlawful adjustments, as relevant evidence of injury. The court rejected State Farm's argument that Article III standing was a barrier to the plaintiffs' suit, affirming that the plaintiffs' claim of receiving less than owed under their insurance policies constituted a concrete injury. View "JAMA V. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY" on Justia Law

The plaintiffs, EB Holdings II, Inc. and QXH II, Inc., sought coverage from their insurers for legal fees and expenses incurred in defending against a lawsuit alleging fraudulent inducement in the purchase of notes backed by their long-term debt. The insurers denied coverage, claiming the plaintiffs made material misrepresentations in their insurance renewal application by failing to disclose significant long-term debt.The United States District Court for the District of Nevada granted summary judgment in favor of the insurers, concluding that Nevada law governed the affirmative defense of material misrepresentation. The court found that the plaintiffs had indeed made a material misrepresentation by not disclosing their long-term debt, thus barring coverage under the insurance policies.The United States Court of Appeals for the Ninth Circuit reviewed the case and reversed the district court's decision. The appellate court held that the district court erred in its choice-of-law analysis. The Ninth Circuit determined that Texas law, not Nevada law, should govern the affirmative defense of material misrepresentation. The court reasoned that the substantial relationship test set forth in the Restatement (Second) of Conflict of Laws § 188 pointed to Texas law, given that the underwriting process largely occurred through agents based in Texas and the plaintiffs were headquartered there.Applying Texas law, the Ninth Circuit found that there were material disputes of fact regarding the elements of the affirmative defense, including the plaintiffs' intent to deceive and whether the insurers provided timely notice of their refusal to be bound by the policy. Consequently, the court reversed the summary judgment and remanded the case to the district court for further proceedings. View "EB HOLDINGS II, INC. V. ILLINOIS NATIONAL INSURANCE COMPANY" on Justia Law

The case involves a putative class action of approximately 2,000 payees who received structured settlement annuities to resolve personal injury claims. The plaintiffs, Renaldo White and Randolph Nadeau, alleged that defendants Symetra Life Insurance Company and Symetra Assigned Benefits Service Company wrongfully induced them to cash out their annuities in individualized “factoring” arrangements, whereby they gave up their rights to periodic payments in return for discounted lump sums.The district court certified two nationwide classes under Federal Rule of Civil Procedure 23. The first class consisted of all persons who were annuitants of a structured settlement annuity (SSA) issued by Symetra and who subsequently sold to a Symetra affiliate the right to receive payments from that SSA in a factoring transaction. The second class was a subclass of the first, consisting of all members of the class whose contract defining the annuity at issue included language explicitly stating that the annuitants lack the power to transfer their future SSA payments.The United States Court of Appeals for the Ninth Circuit reversed the district court’s certification of the two nationwide classes. The court held that individual issues of causation will predominate over common ones when evaluating whether defendants’ acts and omissions caused the plaintiffs to enter factoring transactions and incur their alleged injuries. The court also held that the district court erred in certifying the nationwide subclass of plaintiffs whose original settlement agreements with their personal injury tortfeasors contained structured settlement annuity (SSA) anti-assignment provisions. The record indicates that the annuitants hail from a wide array of different states, and some of the settlement agreements have choice of law provisions denoting the law of a state other than the location where the contract was executed. The apparent variations in state law on the enforceability of anti-assignment provisions in SSAs and the need to apply multiple state laws to the subclass raised a substantial question of whether individual issues predominate and how the matter can be fairly managed as a class action. View "WHITE V. SYMETRA ASSIGNED BENEFITS SERVICE COMPANY" on Justia Law