Justia Contracts Opinion Summaries

Petitioner Arnold Calderon was injured in a vehicle accident with an uninsured motorist. At the time, petitioner was insured with respondent American Family Mutual Insurance. American Family paid the policy limit to petitioner's medical providers; it denied payment with respect to his uninsured/underinsured (UM/UIM), disputing the amount of petitioner's damages. A jury returned an award in petitioner's favor. The trial court offset the amount of the jury award by the amount already paid to the medical providers. Petitioner argued on appeal of that offset, that the "MedPay" coverage was separate from the UM/UIM coverage, and that the MedPay amount should not have been deducted. The Supreme Court reversed, finding that the amount of UM/UIM coverage, as listed in petitioner's policy, in this case should not have been reduced by the MedPay amount. View "Calderon v. American Family Mutual Insurance Company" on Justia Law

Jon and Winifred Prime brought suit against Dawn Harlor stemming from a dispute over the Primes’ right to use a dock according to an easement Harlor had granted the the Primes. At all relevant times, Harlor was insured by Amica Mutual Insurance Company under a homeowner’s insurance policy providing that Amica would defend Harlor against claims that may result in covered damages. Amica denied Harlor’s request that Amica provide a defense in the underlying suit based on its conclusion that the suit could not result in covered damages. After Harlor settled the suit with the Primes, Harlor brought suit against Amica alleging that Amica breached the policy by failing to defend her in the underlying lawsuit. The superior court granted summary judgment for Amica, concluding that any damages that might have resulted from the underlying suit would not be covered by Harlor’s policies and, therefore, did not give rise to a duty to defend. The Supreme Court vacated the summary judgment and remanded for the entry of summary judgment in favor of Harlor, holding that Amica breached its duty to defend. Remanded for further proceedings regarding Amica’s duty to indemnify Harlor for any or all of the amount that she paid to settle the underlying action. View "Harlor v. Amica Mutual Insurance Co." on Justia Law

Appellant Greenville Country Club, through its workers’ compensation carrier, Guard Insurance (“Guard”), appealed a Superior Court Order affirming a decision of the Industrial Accident Board (the “Board”). While working for Greenville Country Club, Jordan Rash suffered injuries to his lumbar spine in two separately compensable work accidents. The first accident occurred in 2009 while the country club was insured by Guard Insurance Group. The second accident occurred in 2012 while the country club was insured by Technology Insurance (“Technology”). In 2014, Rash filed two Petitions to Determine Additional Compensation, one against Guard and one against Technology. After a hearing, the Board determined that the condition at issue was a recurrence of the 2009 work injury and not an aggravation of the 2012 work injury, and concluded that Guard was therefore wholly liable for the additional compensation to Rash. Guard appealed, arguing: (1) the Board failed to properly apply the rule for determining successive carrier liability; and (2) there was no substantial evidence to support the Board’s finding that Rash fully recovered from the 2012 accident or that his ongoing condition was solely caused by the 2009 work accident. After review, the Delaware Supreme Court found no error in the Board’s decision, and that the decision was supported by substantial evidence. Accordingly, the Court affirmed the Board's decision. View "Greenville Country Club (Guard Insurance) v. Greenville Country Club (Technology Insurance)" on Justia Law

Plaintiff-Appellee Century Surety Company (“Century”) issued a commercial lines policy to Defendant-Appellant Shayona Investment, LLC covering commercial property and business income coverage. Shayona submitted claims, Century paid them, and then Century sought a declaratory judgment in the district court as to whether the claims were fraudulent. At trial, the jury found in favor of Century, awarding it both the amount the company paid Shayona under the policy and the sum it spent investigating the claims. Shayona appealed, arguing that the standard of proof the court instructed the jury to use was wrong. Finding no reversible error, the Tenth Circuit affirmed the district court's entry of judgment on the verdict. View "Century Surety Co. v. Shayona Investment" on Justia Law

Insureds, who owned a policy from Insurer, alleged that Insurer failed to pay them for damage to their home from sinkhole loss, thus breaching the terms of the insurance policy. When Insurer became insolvent, Florida Insurance Guaranty Association (FIGA) was activated to handle the “covered claims.” The circuit court ordered appraisal, and the appraisers determined the amount of loss to be $130,600. FIGA objected to the confirmation of the appraisal award, arguing that the statutory definition of “covered claim” in effect when Insurer was adjudicated insolvent should govern any payments made on the claim, thus prohibiting any direct payment to Insureds for their sinkhole loss. The circuit court confirmed the appraisal award and entered judgment in favor of Insureds in the amount of $130,600, concluding that Insureds’ rights to recover against FIGA for sinkhole loss were established when Insurer issued the insurance policy. The Second District Court of Appeal reversed. The Supreme Court affirmed, holding (1) the definition of “covered claim” in effect on the date that Insurer was adjudicated to be insolvent governed the scope of FIGA’s liability to Insureds for the sinkhole loss at their property; and (2) Insureds were precluded from obtaining an appraisal award for their sinkhole loss directly from FIGA under the terms of the policy. View "de la Fuente v. Florida Insurance Guaranty Ass’n" on Justia Law

In 2008, the workers’ compensation insurance policy for South Jersey (SJ), a trash-removal business, neared expiration, SJ, through its insurance agent, entered into a three-year Reinsurance Participation Agreement (RPA) with Applied Underwriters. The RPA stated that any disputes would be arbitrated in Tortola or in an agreed location and indicated that it would be governed by Nebraska law. The RPA and its attachments total 10 pages. SJ claims that it believed the RPA was a workers’ compensation insurance policy; that Applied fraudulently presented it as such; that the RPA is actually a retrospective rating insurance policy under which premiums would be based on claims paid during the previous period; and that it was promised possible huge rebates. SJ acknowledged that Applied is not an insurer and cannot issue workers’ compensation insurance. Applied represented that SJ purchased a primary workers’ compensation policy from Continental, which entered into a pooling agreement with California; all are Berskshire Hathaway companies. The pooling agreement was a reinsurance treaty. According to Applied, the RPA was not insurance, but an investment instrument. For 34 months, SJ paid monthly premiums of $40,000-$50,000, expecting a rebate. Claims paid on its behalf were $355,000 over three years. After the RPA expired, Applied declared that SJ owed $300,632.94. SJ did not pay. Applied filed a demand for arbitration. SJ sought declaratory relief as to the arbitration provision and rescission of the RPA. The district court denied the motion to compel arbitration. The Third Circuit reversed. SJ’s challenges to the arbitration agreement apply to the contract as a whole, rather than to the arbitration agreement alone; the parties’ dispute is arbitrable. View "South Jersey Sanitation Co., Inc v. Applied Underwriters Captive Risk Assurance Co., Inc." on Justia Law

Richard Tryon was injured by an underinsured motorist while driving his motorcycle. At the time of the accident, Tryon owed two automobiles insured with Encompass Indemnity Co. and Philadelphia Indemnity Insurance Co. (together, the Companies). Both policies included Underinsured Motorist Insurance (UIM) coverage provisions. The Companies denied UIM coverage for Tryon on the basis of their respective insurance policies, which had owned-but-not-scheduled-for-coverage exclusions. Tryon filed suit against the Companies. The trial court granted summary judgment for Encompass and Philadelphia, ruling that the language in the policies issued by the Companies clearly excluded coverage of Tryon’s motorcycle. The court of appeals reversed, concluding that the unpublished Court of Appeals opinion in Motorists Mutual Insurance Co. v. Hartley and the Supreme Court’s holding in Chaffin v. Kentucky Farm Bureau Insurance Cos. mandated coverage. The Supreme Court affirmed in part and reversed in part, holding (1) owned-but-not-scheduled provisions for UIM coverage are enforceable so long as they expressly and plainly apprise insureds of the exclusion; and (2) the Philadelphia policy failed to plainly exclude coverage under the circumstances, but the terms of the Encompass policy plainly excluded coverage. View "Philadelphia Indemnity Insurance Co. v. Tryon" on Justia Law

In 2014, Lend Lease, the construction manager of the Chicago River Point Tower Project, hired Cives as a subcontractor. Cives hired Midwest Steel. Midwest had, years before, hired AES to supply Midwest with additional workers, who were co‐employed by Midwest and AES. Lend Lease entered into a “contractor-controlled insurance program” with Starr Liability with a $500,000 deductible. All subcontractors were to join in the policy. AES had, several years earlier, obtained workers’ compensation for its workers from TIC, so that injured AES‐Midwest workers could obtain workers’ compensation from either Starr (or Lend Lease under the deductible) or TIC. Four ironworkers, jointly employed by Midwest and AES and performing work for Midwest were injured on the job and sought workers’ compensation. The claims exceeded $500,000, so Lend Lease had to pay its full deductible. Starr paid the remaining claims. Lend Lease filed suit against TIC, AES’s insurer, and AES, seeking reimbursement of the $500,000. The district court dismissed. The Seventh Circuit affirmed. Lend Lease made a deal with Starr and is bound by it. The court rejected an argument that AES has been unjustly enriched; AES was not obligated to purchase an insurance policy that would cover Lend Lease's deductible. View "Lend Lease (US) Construction, Inc. v. Administrative Employer Services, Inc." on Justia Law

When Ultramar sold the Golden Eagle Refinery to Tesoro Refining, the purchase and sale agreement specified that Ultramar was to assign the Tosco indemnities, and to either secure an endorsement to the Chartis policy adding the new company as an additional insured or assign the Chartis policy directly. This litigation concerns the transfer of the Chartis policy from Ultamar. In this appeal, Tesoro Refining challenged the district court's grant of summary judgment for Chartis. The court agreed with the district court that Tesoro Refining cannot assert third-party judgment on the breach of contract claim premised upon a third-party beneficiary argument where the instant policy's language does not evince any intent to benefit a third party. The court also concluded that the Tesoro Parties were unable to point to any basis for concluding that the injury in this case—the alleged mistake over which entity was covered—is “inherently undiscoverable.” The court explained that Texas cases since 1996 have determined the discovery rule does not apply to delay the accrual of the cause of action in such situations. Therefore, the Tesoro Parties’ reformation claim is time-barred. The court affirmed the judgment. View "AIG Specialty Ins. Co. v. Tesoro Corp." on Justia Law

Samantha Gillespie and her mother, Tina Taylor, appealed the grant of summary judgment dismissing their lawsuit against Taylor's motor vehicle insurer, National Farmers Union, for underinsured motor vehicle coverage. Gillespie and Taylor sued Farmers Union for underinsured motor vehicle coverage, alleging Gillespie was insured under her mother's motor vehicle policy with Farmers Union and was driving a motor vehicle owned by another person when Gillespie lost control of the vehicle and it overturned, resulting in significant injuries to her. According to Gillespie and Taylor, the motor vehicle was owned by Angela Ayers, Gillespie's aunt, and insured by GEICO. Ayers died as a result of the accident and another passenger in the motor vehicle sustained significant injuries. Gillespie and Taylor asserted GEICO paid Gillespie $25,000 in no-fault benefits, but denied her request for liability coverage based on a claim that Ayers negligently entrusted the vehicle to Gillespie, an alleged inexperienced driver who received her learner's permit two days before the accident. After review, the Supreme Court concluded Gillespie and Taylor failed to raise a genuine issue of material fact about whether Gillespie was legally entitled to collect for bodily injury from the owner or operator of an underinsured motor vehicle, and affirmed. View "Gillespie v. National Farmers Union Property & Casualty Co." on Justia Law