Articles Posted in Insurance Law

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Life Insurance Company of North America’s terminated plaintiff-appellant Carl Van Steen’s long-term disability benefits under Lockheed Martin’s ERISA Plan. Life Insurance Company of North America (LINA) appealed the district court’s finding that its decision to terminate Van Steen’s benefits was arbitrary and capricious. Van Steen, in turn, appealed the district court’s denial of his attorney’s fees request. Van Steen was physically assaulted during an altercation while walking his dog. The assault resulted in a mild traumatic brain injury (mTBI) that impacted Van Steen’s cognitive abilities that prevented him from returning to full time work; Van Steen was eventually allowed to return to part-time work on a daily basis roughly six weeks later. Even on a part-time schedule, Van Steen experienced cognitive fatigue and headaches that required him to frequently rest. Due to his inability to stay organized and keep track of deadlines after the assault, Van Steen received poor feedback on his job performance. Van Steen’s claim for partial long-term disability benefits was approved on March 30, 2012. Roughly a year later, LINA reviewed Van Steen’s file, contacted his doctors, and confirmed that Van Steen’s condition and restrictions were permanent as he was “not likely to improve.” Despite this prognosis, LINA sent Van Steen a letter one week later terminating his long-term disability benefits, explaining that “the medical documentation on file does not continue to support the current restrictions and limitations to preclude you from resuming a full-time work schedule.” Having exhausted his administrative appeals under the Plan, Van Steen next sought relief before the district court. The district court reversed LINA’s decision to terminate Van Steen’s partial long-term disability benefits on the grounds that it was arbitrary and capricious, but denied Van Steen’s request for attorney’s fees. The Tenth Circuit agreed with the district court’s reversal of LINA’s decision to terminate Van Steen’s coverage. The Court also found that Van Steen was not eligible for attorney fees: “Van Steen’s arguments fail to convince us that the district court’s decision was based on a clear error of judgment or exceeded the bounds of permissible choice.” View "Van Steen v. Life Insurance Company N.A." on Justia Law

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The Tenth Circuit addressed whether the federal district court in Colorado may exercise specific personal jurisdiction over out-of-state defendant Continental Motors, Inc. based upon its contacts with Colorado through its website. Continental Motors’ website allows airplane repair businesses known as fixed- base operators (“FBOs”) to obtain unlimited access to its online service manuals in exchange for an annual fee. Arapahoe Aero, a Colorado-based FBO participating in the program, accessed and consulted the manuals in servicing an airplane that contained engine components manufactured by Continental Motors. The airplane later crashed in Idaho on a flight from Colorado. After the crash, Old Republic Insurance Company, the airplane’s insurer, paid the owner for the property loss and filed a subrogation action against Continental Motors in Colorado federal district court, seeking reimbursement. Old Republic alleged that Continental Motors’ online service manuals and bulletins contained defective information, thereby causing the crash. Continental Motors moved to dismiss the lawsuit for lack of personal jurisdiction, arguing that it did not purposely direct its activities at Colorado. Old Republic conceded that Continental Motors did not maintain sufficient contacts with Colorado to support jurisdiction for all purposes. The district court granted the motion to dismiss, ruling that it did not have specific jurisdiction over Continental Motors. On appeal, Old Republic maintains that Continental Motors was subject to specific personal jurisdiction in Colorado for purposes of this case. Finding no reversible error in dismissal, the Tenth Circuit affirmed. View "Old Republic Insurance Co. v. Continental Motors" on Justia Law

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Plaintiff Greggory Owings sustained an on-the-job injury, for which he received long-term disability benefits by defendant United of Omaha Life Insurance Company (United), under the terms of a group insurance policy issued by United to Owings’ employer. Owings disagreed with, and attempted without success to administratively challenge, the amount of his disability benefits. He then filed suit against United in Kansas state court, but United removed the action to federal district court, asserting that the federal courts had original jurisdiction over the action because the policy was governed by the Employee Retirement Income Security Act of 1974 (ERISA). The district court ultimately granted summary judgment in favor of United. Owings appealed. The Tenth Circuit concluded after review of this matter that United was arbitrary and capricious in determining the date that Owings became disabled and, in turn, in calculating the amount of his disability benefits. Consequently, the Court reversed the district court’s grant of summary judgment in favor of United and remanded with directions to enter summary judgment in favor of Owings. View "Owings v. United of Omaha Life" on Justia Law

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In 2007, undercover producers from NBC Universal, Inc., attended and surreptitiously recorded a seminar presented by plaintiff-appellant Brokers’ Choice of America, Inc. to teach insurance agents how to sell annuities to seniors. NBC used excerpts and information from the seminar in a “Dateline NBC” episode. Brokers’ Choice and its founder Tyrone Clark (collectively, “BCA”) sued for defamation. This appeal concerned the district court’s dismissal of the amended complaint after it compared the seminar recording with the episode and concluded the Dateline program was substantially true. After review, the Tenth Circuit Court of Appeals affirmed because the Dateline episode was not materially false. View "Brokers' Choice of America v. NBC Universal" on Justia Law

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Philadelphia Indemnity Insurance Company (“Philadelphia”) and Lexington Insurance Company (“Lexington”) insured the same school building that suffered fire damage. In a declaratory judgment action, they disputed their relative responsibilities to pay for the loss. The district court ordered Philadelphia to pay 54 percent and Lexington to pay 46 percent of the approximately $6 million loss. Lexington appealed, arguing it should have no obligation to pay. Philadelphia cross-appealed, arguing Lexington should have paid more. Finding no reversible error, the Tenth Circuit affirmed the district court's allocation between the insurers. View "Philadelphia Indemnity v. Lexington Insurance" on Justia Law

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This appeal arose out of a property damage claim filed by the Hayes Family Trust with its insurer, State Farm Fire & Casualty. When the parties could not agree on the amount of loss, Hayes invoked an appraisal process provided by the policy to calculate the loss incurred. After Hayes sought the district court's assistance with the appointment of an umpire, the parties participated in the appraisal process, which resulted in a unanimous award. State Farm paid the balance of that award, and Hayes accepted payment. But despite State Farm's payment, at Hayes's request, the district court confirmed the award and entered judgment in favor of Hayes. Hayes promptly moved for an award of prejudgment interest, attorney's fees, and costs under a prevailing party statute. In response, State Farm moved to vacate or amend the judgment. Finding that the parties settled any dispute over the amount of loss, the court agreed with State Farm and vacated its order confirming the appraisal award and the judgment. Hayes appealed the order vacating judgment in an attempt to recover prejudgment interest, fees, and costs. Finding no reversible error, the Tenth Circuit affirmed. View "In re: Hayes Family Trust" on Justia Law

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Terrill Graf, bought his fiancee a van for her 50th birthday. Celebrating the birthday and new purchase, Graf drank liquor and then gathered four friends in the van. Plaintiff Wendy Peden was one of those friends. She says that she expected Graf only to show off the van and to photograph the group. But Graf drove away with his friends in the van, crashing it, and causing serious injuries to Peden. She obtained $240,000 in insurance benefits. But Peden claimed more under her insurance policy for underinsured-motorist benefits. The insurer (State Farm) initially denied the claim, but ultimately paid her an additional $350,000, the maximum amount that she could receive under the underinsured-motorist coverage. Peden sued State Farm under Colorado’s common law and statutory law, claiming an unreasonable denial or delay in paying benefits. The issue this case presented for the Tenth Circuit’s review was whether a reasonable fact-finder could conclude that State Farm unreasonably denied or delayed payment of benefits. The district court answered “no.” But the Tenth Circuit disagreed after careful consideration of the facts of this case, and reversed the grant of summary judgment to State Farm. The denial of Peden’s motion for partial summary judgment was vacated, and the entire matter remanded for further proceedings. View "Peden v. State Farm Mutual Auto Ins Co" on Justia Law

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Plaintiff-Appellant Federal Deposit Insurance Corporation (FDIC) sought to recover on a financial institution crime bond and appealed the district court’s grant of summary judgment in favor of Defendant-Appellee Kansas Bankers Surety Co. (KBS) and the subsequent denial of reconsideration. The district court held that the underlying bank, the New Frontier Bank of Greeley, Colorado, (Bank) had failed to submit a timely and complete proof of loss, thereby barring FDIC’s recovery on the bond. Finding no error in the district court's decision, the Tenth Circuit affirmed. View "FDIC v. Kansas Bankers Surety Company" on Justia Law

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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

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A mudslide destroyed a commercial building in Boulder, Colorado, owned by Paros Properties LLC and insured under a policy issued by Colorado Casualty Insurance Company. Paros filed an insurance claim but the Insurer denied payment because damage from mudslides was excluded from policy coverage. Paros then filed a state-court suit seeking payment under the Policy and damages for bad-faith breach of the insurance contract. It argued that the mudslide caused the building to explode, bringing the incident within the scope of an explosion exception to the Policy’s mudslide exclusion. The Insurer removed the action to federal court, which granted summary judgment to the Insurer. On appeal Paros argued: (1) that the district court lacked subject-matter jurisdiction because the Insurer’s removal from state court was untimely; and (2) that the district court erred on the merits in holding that there was no coverage. After its review, the Tenth Circuit held that the notice of removal was too late. But because the district court correctly ruled on the merits and the jurisdictional requirements were satisfied at that time, the Court affirmed the judgment below rather than burden the state court and the parties by requiring relitigation. View "Paros Properties v. Colorado Casualty Ins Co" on Justia Law