Justia Contracts Opinion Summaries

The issue in this case arose from a judgment which held that a "Designated Project or Premises" endorsement of a commercial general liability insurance policy purchased by a sporting goods store excluded coverage for a claim arising out of the sale of improperly reloaded ammunition. Petitioner Tom Erekson purchased a used .500 revolver from a sporting goods store, along with three boxes of handloaded ammunition, all of which the store purchased from the gun's previous owner. Erekson and his sons took the revolver to a shooting range, loaded five chambers with the reloaded ammunition, and fired. The one cartridge discharged, but two others detonated simultaneously. When the cartridge under the loading gate detonated, it sheared off the gate, a portion of the cartridge rocketed rearward, and struck Erekson in the forehead, lodging three inches into his brain. He also lost a portion of his thumb. The store held a general liability policy through Markel International Insurance Company. The store brought suit for a court order to declare Erekson's injuries were covered under the policy. The district court held that the injury was excluded; Erekson unsuccessfully moved for reconsideration. Upon review of the policy, the Supreme Court affirmed, finding coverage was excluded under the endorsement.

Patrick McGinness, driving a vehicle owned by his adult daughter, negligently struck and injured Marie DeMeo. DeMeo obtained a $350,000 state-court judgment against McGinness. McGinness's daughter's insurer, American Family Insurance Company, paid its $100,000 policy limit under an owner's liability policy that covered McGinness as a permitted driver. State Farm insured McGinness under four liability policies issued for the cars he owed. Each policy provided coverage to McGinness when operating a non-owned vehicle such as his daughter's. Invoking the policies' "anti-stacking" provisions, State Farm paid the per-person limit of one policy, $50,000. De Meo filed this action to recover an additional $150,000, the combined limits of the other three policies. The district court held that the anti-stacking provisions did not conflict with Missouri's Motor Vehicle Financial Responsibility Act (MVFRL) requirements, which mandate that motor vehicle owners and operates maintain minimum levels of financial responsibility for damages arising out of their ownership or use of a motor vehicle, and granted summary judgment in State Farm's favor. The Eighth Circuit Court of Appeals affirmed, holding that there was no basis to conclude that the MVFRL demands stacking when there are multiple policies.

South Carolina Farm Bureau Mutual Insurance Co. (Farm Bureau) brought a declaratory judgment action to determine whether Henry Kennedy was entitled to underinsured motorist (UIM) coverage for an accident. The trial court found Kennedy was entitled to UIM coverage under the terms of the policy because Kennedy was "upon" and thus "occupying" the insured vehicle at the time of the accident. The Court of Appeals reversed. The Supreme Court granted Kennedy's petition for a writ of certiorari to review the appellate court's decision. Initially, the Supreme Court concluded that the trial court's finding of actual physical contact was supported by the evidence. The trial court found Kennedy had left the engine running on his employer's vehicle; that he was in physical contact with the covered vehicle (with his hand on the truck) when the other vehicle careened towards him, forcing him to relinquish his contact in order to attempt to avoid injury; that Kennedy was "upon" and "occupying" the vehicle at the time of the accident; and he was entitled to UIM coverage under the Farm Bureau policy. Moreover, a second, resultant physical contact was established when Kennedy was pinned against the insured vehicle. The Supreme Court concluded that a requirement that an insured remain in physical contact with the insured vehicle in the face of imminent danger was unreasonable and unconscionable. Consequently, the Court reversed the decision of the Court of Appeals.

The issue before the Supreme Court in this was the denial of attorney fees under Idaho Code section 41-1839 on the ground that the insured's proof of loss was insufficient under the statute because it did not provide the insurer with the legal theory upon which coverage was later determined to exist. Upon review of the matter, the Supreme Court vacated the judgment because a proof of loss need not include an analysis of the proper theory of coverage under the insurance policy.

Plaintiffs sought to recover on behalf of themselves and similarly-situated employees and retirees of the City of Cincinnati the current value of the 870,021 shares of Anthem stock that the City received from Anthem’s demutualization. Plaintiffs asserted eight claims for breach of contract and four tort claims against Anthem and three breach of contract claims and four tort claims against the City. The district court certified the class: 2,536 people named as insureds, or former members of a group of insured persons, covered under a health care group policy from June 18 through November 2, 2001. The class included “Class A” members, who had an insurance policy with Anthem prior to its merger with Community in 1995 and “Class B” members who received a health insurance group policy after the merger. The court later dismissed. The Sixth Circuit, exercising jurisdiction under the Class Action Fairness Act of 2005, 28 U.S.C. 1332(d), affirmed. Plaintiffs cannot recover any demutualization compensation; the City was the policyholder before the merger and maintained its policyholder rights post-merger through a grandfather clause, including any rights to demutualization proceeds. The 2001 demutualization process did not disrupt the City’s membership interests or confer any equity rights to Plaintiffs.

Robert and Ethel Youngs' home and personal property were insured under a policy issued by Allstate Insurance Company. The policy provided that Allstate would "not cover any loss or occurrence in which any insured person has concealed or misrepresented any material fact or circumstance." After a fire broke out in the Youngs' garage, damaging or destroying many of its contents, AllState denied the Youngs' insurance claim, asserting that the Youngs misrepresented material facts regarding their losses. The Youngs filed suit against Allstate for breach of contract and vexatious refusal to pay. The district court granted summary judgment for Allstate. The Eighth Circuit Court of Appeals reversed, holding that there were genuine issues of fact for trial.

Liberty entered into a Master Declaration and Easements, Covenants, Conditions and Restrictions for a shopping mall. PMI purchased the property and entered into a Declaration that gave Liberty the right to prior approval of future purchasers and an option to purchase. PMI borrowed $3.5 million from Nationwide, using the property as collateral. Nationwide purchased title insurance from Commonwealth, containing the ALTA 9 endorsement. PMI defaulted and conveyed the property to Nationwide, which attempted to sell to Ironwood. Liberty’s successor, Franklin, refused to approve Ironwood under its rights conferred by the Declaration, based on Ironwood’s planned use as a school. Nationwide claimed that the restrictions upon which Franklin justified refusal rendered the property unusable and unsalable. Commonwealth denied the claim. The district court dismissed. The Third Circuit remanded, holding that Commonwealth is obligated to cover the claim if the restriction causing Nationwide’s harm was covered by the ALTA 9 Endorsement and not expressly excepted on Schedule B. The district court then ruled in favor of Nationwide. The Third Circuit affirmed and remanded for determination of damages owed Nationwide, relying on the plain language of the ALTA 9 rather than deferring to industry custom and usage.

After coming home drunk, Wesley Vincent was found face-down in front of his house by his wife, Cheryl Likens. Vincent was taken to the hospital but eventually died. Likens tried to collect as the beneficiary of an accidental-death insurance policy, but the claim was denied under an alcohol exclusion because Hartford Life and Accident Insurance Company determined that the injury resulted from being legally intoxicated from alcohol. The district court granted summary judgment for Hartford based on the alcohol exclusion. The Fifth Circuit Court of Appeals affirmed, holding that a reasonable jury could not help but conclude that Vincent fell and suffered injuries as a result of his intoxication. On these facts, intoxication may not have been the only cause, but it did not have to be so to satisfy the exclusion.

Dameware Development, LLC Defined Benefit Pension Plan and Trust bought several life insurance policies from American General Life Insurance Company. After Dameware was unable to obtain the tax benefits it hoped would result from purchasing the policies, it sued American General for damages and for rescission of the contract. The district court granted summary judgment to American General. The Fifth Circuit Court of Appeals affirmed, holding that Dameware had not shown any basis for rescinding the contract nor any contractual duties breached by American General, and therefore, the district court did not err in granting summary judgment to American General.

A "discrete, narrow legal question" came before the Supreme Court: is a health care provider who has received an assignment of personal injury protection (PIP) benefits from an insured obligated upon request to furnish to the insurer broad information with respect to the provider’s ownership structure, billing practices, and regulatory compliance? Plaintiffs in this matter consist of six “Selective Insurance Company” entities. Individuals insured by Selective sought medical treatment from defendants for injuries received in automobile accidents. Those insureds assigned to defendants the benefits to which they were entitled under their PIP coverage, giving defendants the contractual right to seek PIP reimbursement under those policies. In reviewing claims submitted for payment, Selective detected what it considered to be suspicious patterns in both the treatments defendants had provided and the corporate links among the treating entities. Selective requested that defendant supply to it a variety of data with respect to their ownership, structure, billing practices, and compliance with certain regulations. In support of its request, Selective cited the provision within the insureds’ insurance policies requiring the insureds to cooperate with Selective in the investigation of any claim under the policy. When defendants refused to supply the material Selective sought, Selective sued, alleging that defendants' failure to supply the information was a breach of they duty to cooperate and a violation of the PIP discovery statute. After hearing oral argument, the trial court denied defendants’ motion to dismiss and granted Selective the relief it had requested by directing defendants to respond to Selective’s discovery requests. Defendants thereafter moved for reconsideration, but the trial court denied that motion, together with defendants’ request for a stay. Upon review of the matter, the Supreme Court held that an insured had no duty to provide information to plaintiff with respect to the ownership structure, billing practices, or referral methods of the medical providers from whom he or she sought treatment for his or her injuries. Because an insured had no obligation to supply that information to plaintiff, the assignment of benefits executed by an insured could not serve to impose that duty on the providers.