Justia Contracts Opinion Summaries

Appellant Mildred Powell filed an insurance claim with respondent Liberty Mutual Fire Insurance Company to cover damage to her house. Liberty Mutual denied the claim, stating that the damage was excluded under the âearth movement exclusionâ in Appellantâs insurance policy. Appellant took Liberty Mutual to the district court. The court eventually granted Liberty Mutualâs motion for partial summary judgment, concluding that the âearth movement exclusionâ of the policy excluded coverage of the damage. Appellant challenged the district courtâs review of the policy, arguing that it was contrary to state law on a similar âearth movement exclusion.â The Supreme Court concluded that Liberty Mutualâs policy was ambiguous held in light of the applicable state law. The Court held that the district court erred in granting the company summary judgment, and reversed its holding. The Court remanded the case for further proceedings.

An insurance policyholder, TD Banknorth Insurance Agency, Inc., appealed from a declaratory judgment awarding to its insurer, Fireman's Fund Insurance Company, all funds in escrow as proceeds from settlement of the policyholder's claims against third parties. The policyholder challenged the allocation of the escrowed funds on the ground that Connecticut's common law "make whole" doctrine entitled it to recover its deductible before its insurer could collect as subrogee. The court held that this issue was undecided under Connecticut law and certified the following question to the Supreme Court of Connecticut: "Are insurance policy deductibles subject to Connecticut's make whole doctrine?"

ConAgra Foods, Inc. ("ConAgra") sued Lexington Insurance, Co. ("Lexington") alleging breach of contract and breach of the implied duty of good faith and fair dealing. ConAgra's claims arose from the alleged 2007 contamination of certain Peter Pan and Great Value peanut butter products that ConAgra manufactured. ConAgra subsequently sought coverage under its insurance policy with Lexington for personal injury claims arising from its contaminated products and Lexington denied coverage. At issue was whether the provision in the insurance policy provided coverage in light of the "lot or batch" provision in the policy. The court held that the "lot or batch" provision was ambiguous where, under one of the two reasonable interpretations, Lexington's duties to defend and indemnify were triggered. The court also held that, because the policy arguably provided coverage to ConAgra, Lexington's duty to defend was thereby triggered when ConAgra satisfied the applicable "retained limit" for a single "occurrence." Accordingly, the court reversed and remanded to ascertain the intent underlying the ambiguous policy language for purposes of determining whether there was ultimate policy coverage.

Claimant filed a claim against Government Insurance Company ("GEICO") for uninsured/underinsured motorist coverage after sustaining serious injuries as a result of a car accident. At issue was whether the coverage provisions of the GEICO policy entitled claimant to underinsured motorist benefits under the policy. The court held that claimant was not entitled to uninsured/underinsured coverage where Exclusion number 4 in the GEICO insurance policy was authorized by section 19-509(f)(1) of the Insurance Article, Maryland Code, 1997, 2006 Repl.Vol., and was applicable to the facts of this case.

Phoenix Insurance Company ("Phoenix") filed a complaint in circuit court rejecting the arbitration award given to appellee when she requested coverage under the underinsured-motorist provisions of her policy with Phoenix after she was injured in a car accident and the other driver's vehicle was underinsured. At issue was whether a provision allowing either party to an insurance contract to demand a trial de novo following arbitration was unenforceable when it appeared in an underinsured-motorist policy. The court held that the provision in appellee's underinsured-motorist policy allowing either party to reject an award over the statutory minimum for liability coverage did not violate public policy and was not unconscionable.

Plaintiff sued defendants, United Healthcare Insurance Company and the American Association of Retired Persons, alleging breach of contract, fraud under the D.C. Consumer Protection Procedures Act, and unjust enrichment when plaintiff had to pay nearly $40,000 in uninsured medical bills. At issue was whether the district court properly dismissed plaintiff's claim under Federal Rule of Civil Procedure 12(b)(6) for failure to state a claim when plaintiff tried to recover the uninsured amount by alleging that the contract between plaintiff and defendants was ambiguous. The court held that the district court properly dismissed plaintiff's claim under Rule 12(b)(6) where the contract was not ambiguous when it included sections on what services were and were not covered and included notations limiting coverage that was directly relevant to plaintiff's circumstances.

A non-profit hospital ("plaintiff") that provided medical services to beneficiaries of Local 272 Welfare Fund ("Fund"), an employee benefit plan governed by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. 1101, filed a complaint against defendants seeking payment for over $1 million in medical services provided to beneficiaries that the Fund had allegedly failed to reimburse. At issue was whether a healthcare provider's breach of contract and quasi-contract claims against an ERISA benefit plan were completely preempted by federal law under the two-pronged test for ERISA preemption established in Aetna Health Inc. v. Davila. The court held that an "in-network" healthcare provider may receive a valid assignment of rights from an ERISA plan beneficiary pursuant to ERISA section 502(a)(1)(B); where a provider's claims involved the right to payment and not simply the amount or execution of payment when the claim implicated coverage and benefit determinations as set forth by the terms of the ERISA benefit plan, that claim constituted a colorable claim for benefits pursuant to ERISA section 502(a)(1)(B); and in the instant case, at least some of plaintiff's claims for reimbursement were completely preempted by federal law. The court also held that the remaining state law claims were properly subject to the district court's supplemental jurisdiction.

The company purchased a disability benefits plan, regulated by the Employee Retirement Income Security Act. A part-owner and employee of the company received benefits for about four years before the insurer terminated benefits because her non-salary income was higher than her salary income had been. The plan defines "pre-disability earnings" as: "your monthly rate of earnings from the employer in effect just prior to the date disability begins" and "basic annual earnings" as the amount reported by the policyholder on a W-2, excluding commissions. The company argued that a provision allowing termination of benefits when "current earnings" reach a percentage of pre-disability earnings referred to earnings from all sources. The district court held that the employee was not entitled to benefits but denied the insurer reimbursement. The First Circuit reversed, in favor of the employee, finding that the insurer's interpretation of the plan was unreasonable.

Plaintiffs sued Atlas Van Lines, Inc. ("Atlas") and Pickens Kane Moving & Storage Co. ("Pickens") for carrier liability under the Carmack Amendment to recover damages plaintiff paid to its insureds after the insureds' shipment of household goods were destroyed by a fire while in transit. Pickens was the receiving carrier and the goods were destroyed in the custody of Atlas. At issue was whether the district court properly interpreted sections 14706(f) and 14706(b) of the Carmack Amendment when apportioning the replacement value of household goods and apportioning costs. The court held that the district court properly apportioned the damages as it did under section 14706(f)(2), (3) to limit Atlas' liability to the tariff amount of $5.00 per pound in the absence of a declared value. The court also held that the district court did not abuse its discretion in apportioning costs where Atlas had custody of the shipment when it was destroyed and was liable to Pickens.

The insured was treated as an outpatient for "mental or nervous disorder" in 2005-2007, allegedly incurring expenses of more than $125,000. In 2006 the company informed her that it had already paid $8,506 and would pay only $1,494 more toward the lifetime cap of $10,000. The district court held that the contract was not ambiguous and that the limit was not prohibited by New Hampshire law. The First Circuit affirmed. The policy limit for mental health benefits, stated as "the amount shown on page 3" is not ambiguous simply because that page refers to both the "Mental and Nervous Disorder Limit" of $10,000, and the "Maximum Benefit Limit Per Covered Person" of $1 million. A state law prohibiting unfair trade practices, including discrimination in insurance does not provide a private right of action until after the claimant obtains a favorable ruling from the insurance commissioner.