Justia Contracts Opinion Summaries

As the primary beneficiary under an insurance policy issued by Appellee Penn Mutual Life Insurance Company, Appellant Roger Goff brought a cause of action under the West Virginia Unfair Trade Practices Act, asserting that Penn Mutual had violated the statutory duty of good faith and fair dealing. After deciding that Goff did not meet the accepted definition of either a first- or a third-party bad faith claimant, the trial court dismissed Goff's complaint for failure to state a claim upon which relief could be granted. The Supreme Court reversed, holding that a primary life insurance beneficiary may assert a statutory bad faith action upon the death of the insured. Remanded.

This case presented the question of whether an automobile insurance policy's permissive user step-down provision was valid and enforceable. Specifically, the Supreme Court addressed whether the particular provision at issue was sufficiently conspicuous, plain, and clear to satisfy the doctrine of reasonable expectations. The circuit court entered summary judgment in favor of the insurance company, declaring the permissive user step-down provision enforceable. The court of appeals affirmed. The Supreme Court reversed, holding that the policy's permissive user step-down provision was insufficiently plain and clear to defeat the reasonable expectations of the insureds, and therefore, the provision violated the doctrine of reasonable expectations. Remanded.

In 1990, Pedicini purchased a LICOA supplemental cancer-insurance policy that provided for unlimited cash benefits, payable directly to Pedicini, equal to “usual and customary charges” for radiation or chemotherapy received as treatment. In 2001, Pedicini obtained assistance from an insurance agent, who negotiated a policy with LICOA that capped benefits for treatments at $25,000 per year, lowering the premium. The policy, effective October 2001, tied benefits to “actual charges” made by a person or entity furnishing services treatment or material. Unbeknownst to Pedicini, in February 2001, LICOA changed its practices. It had paid benefits tied to the amount billed by medical providers regardless of the amount accepted in payment, but began paying benefits equal to the amount accepted as full payment by providers. LICOA did not notify policyholders, but did notify its agents. In 2007, Pedicini was diagnosed with cancer. His benefits were only equal to the discounted amount accepted by his provider due to his status as a Medicare recipient. Pedicini won summary judgment on a breach of contract claim, but the court ruled in favor of LICOA on bad faith claims. The Sixth Circuit affirmed on the contract claim, but reversed with respect to bad faith claims.

Defendant appealed the district court's grant of partial summary judgment in favor of CGI in its action seeking "appropriate equitable relief" under section 502(a)(3) of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq. CGI appealed the district court's grant of partial summary judgment in favor of defendant's counsel and codefendant, dismissing the codefendant from the action. CGI also appealed the district court's grant of proportional fees and costs to the codefendant, deducted from CGI's recovery from defendant. The court affirmed the district court's grant of summary judgment in favor of the codefendant, dismissing it from the action. However, because the court saw no indication that in fashioning "appropriate equitable relief" for CGI, the district court did more than interpret the plain terms of the reimbursement provision, and no indication that the district court considered traditional equitable principles in assigning responsibility to CGI for attorneys' fees and costs, the court vacated the judgment in favor of CGI, vacated the judgment that the codefendant deducted fees and costs from CGI's entitlement, and remanded to the district court for further proceedings.

Defendant-Appellee McKinley Hyten obtained a provisional driver's license in April 2004. In January 2007, Defendant's driver's license was suspended because of multiple moving violations and two minor traffic accidents. In light of what she perceived as assurances from her probation officer, Defendant anticipated that her license would be restored at a district court hearing scheduled for later that year. Defendant's mother Anne Johnson gave Defendant a vehicle, and given the anticipated restoration of the driver's license, sought to obtain automobile insurance for Defendant. Johnson telephoned an independent insurance agent who, after being told that the license had been suspended, informed Johnson that Defendant could not be insured until her license had been restored. Nonetheless, an application for insurance from Titan Insurance Company was filled out on Defendant's behalf, postdated to August 24, 2007. August 22, 2007, Defendant signed the application for insurance. At an August 24, 2007, hearing, Defendant's driver's license was not restored. Plaintiff-Appellee Titan Insurance Company was not informed of this fact. Subsequently, in February 2008, Defendant was driving the insured vehicle and collided with the vehicle of Howard and Martha Holmes, causing injuries to both. Titan then learned Defendant did not have a valid driver's license when the policy was issued. In anticipation that the Holmeses would be filing claims against Defendant for their injuries, Titan filed suit seeking a declaratory judgment. The trial court granted Defendant's motion for summary judgment. The Court of Appeals affirmed, asserting that once an insurable event occurred and a third party (the Holmeses) possessed a claim against the insured arising out of that event, the insurer was not entitled to reform the policy to avoid paying the third party. Titan appealed, and the Supreme Court reversed the Court of Appeals: in accordance with the Supreme Court's precedent in "Keys v Pace,"(99 NW2d 547 (1959)), the Court found "nothing in the law to warrant the establishment of an 'easily ascertainable' rule." The Court overruled "State Farm Mut Auto Ins Co v Kurylowicz," (242 NW2d 530 (1976)) and its progeny, and remanded the case for further proceedings.

Plaintiff, insured under two-long term disability plans, sued the Plans when Unum decided to deduct his Social Security Disability Insurance (SSDI) benefit as deductible income under each plan, resulting in what he termed a "double offset." Because the court held that Unum's decision was not an abuse of discretion, that the plain language of the Plans permitted the deduction of the SSDI benefit from each plan, and that plaintiff was not entitled to equitable estoppel, the court affirmed the district court's grant of summary judgment in favor of the Plans.

This case arose from a contract entered into by the parties where Ewing agreed to construct tennis courts for the school district. At issue was the interpretation of a Commercial General Liability (CGL) insurance policy under Texas law. The district court held that a CGL policy's contractual liability exclusion applied in this case and that no exception restored coverage. The insured construction company faced liability, if at all, because it contracted to construct usable tennis courts for the school district and it had allegedly failed to perform. The court held that the district court correctly interpreted the contractual liability exclusion and correctly applied that exclusion with respect to the insurer's duty to defend the construction company. The court held, however, that the district court was premature in applying the exclusion to the insurer's duty to indemnify.

At issue in this case was the scope of an appraisal clause in a fire and wind insurance policy, which provided that either party could demand an appraisal if the parties failed to agree on "the amount of loss." Insureds initiated a breach of contract action, arguing that the appraisal clause did not apply to their claim for damages because the parties disputed whether the damage was covered by the policy, not the cost of repairing the damage. The district court ordered the parties to participate in an appraisal process after determining that the amount of loss under the appraisal clause included a "causation element." The court of appeals reversed. The Supreme Court reversed, holding (1) the phrase "amount of loss," as it related to the authority of the appraiser under the policy, unambiguously permitted the appraiser to determine the cause of the loss; and (2) the appraiser must necessarily determine the cause of the loss as well as the amount necessary to repair the loss as an incidental step in the appraisal process in this case.

Respondents Kelly Rhoden and her daughters, Ashley Arrieta and Emerlynn Dickey, were involved in a motor vehicle accident while riding in a vehicle owned and operated by Arrieta. The parties stipulated that the Respondents are relatives residing in the same household, and that Arrieta's insurance policy with Nationwide did not provide UIM coverage. Rhoden owned two vehicles that she also insured through Nationwide under a policy that did provide UIM coverage. Rhoden's policy contained a term specifying that the insurance it provided was primary when the covered vehicle was involved in the accident but excess when the involved vehicle was not the covered vehicle but was owned by the policyholder or a resident relative. Nationwide brought a declaratory judgment action seeking a determination that UIM coverage was not available to any of the Respondents under Rhoden's policy. Nationwide contended that because Arrieta's policy had no UIM coverage, clause 3(b), a portability limitation clause, operated to prevent any Respondent from recovering under Rhoden's policy. The trial court held that UIM coverage under Rhoden's policy was available to all three Respondents because such coverage is personal and portable, and Respondents were either named insureds or resident relatives under Rhoden's policy. Nationwide appealed the decision to the court of appeals, which reversed the trial court with regard to Arrieta, and affirmed the trial court's ruling that UIM coverage was available to Rhoden and Dickey under Rhoden's policy. The issue on appeal to the Supreme Court was whether public policy was offended by the portability limitation clause preventing non-owner resident relatives from importing UIM coverage from an at-home vehicle's policy when the involved vehicle lacked UIM coverage. The Supreme Court held that South Carolina's public policy that UIM coverage is personal and portable requires UIM coverage to be provided to Rhoden and Dickey, who did not own the vehicle involved in the accident, while denied to Arrieta, who owned the vehicle involved in the accident but chose not to purchase UIM coverage. The Court affirmed the court of appeals' decision.

Plaintiff brought suit against Deerbrook for breach of the implied covenant of good faith and fair dealing. Plaintiff was injured in an accident caused by Deerbrook's insured and after plaintiff received a judgment against the insured, the insured assigned his bad faith claim to plaintiff. Plaintiff argued that Deerbrook breached the implied covenant of good faith and fair dealing owed to its insured when Deerbrook did not attempt to reach a settlement of plaintiff's claims after the insured's liability in excess of the policy limit became reasonably clear. Plaintiff subsequently appealed the district court's rejection of his request to instruct the jury that it could consider Deerbrook's failure to effectuate a settlement in determining whether Deerbrook breached the implied covenant. The court concluded that plaintiff's proposed jury instruction was consistent with the law but that there was no evidentiary basis for the instruction. Accordingly, the court affirmed the judgment.