Justia U.S. 1st Circuit Court of Appeals Opinion Summaries

In this appeal, a married couple, both visually impaired, sued Colony Insurance Company to recover for the injuries they suffered when the wife fell down a restaurant's stairs. The couple had previously sued the restaurant and its owner for negligence in a New Hampshire state court, resulting in a default judgment against the defendants.The couple then sought to collect the judgment amount from Colony, the restaurant's insurer, arguing that the insurer was obligated to pay under the restaurant's liability insurance policy. Colony denied the couple's claim, stating that it was not notified of the lawsuit against the restaurant "as soon as practicable," as required by the insurance policy. The couple contended that the insurance policy was compulsory under a City of Manchester ordinance, therefore the insurer could not deny the claim based on a breach of the notice provision in the policy.The District Court granted summary judgment to Colony, ruling that the insured had breached the insurance contract by failing to provide timely notice and that the compulsory insurance doctrine, which generally limits an insurer's defenses against an injured party's claim, did not apply. The couple appealed the decision, but the United States Court of Appeals for the First Circuit affirmed the District Court's ruling.The Appeals Court held that, as a matter of law, the lack of timely notice constituted a breach of the insurance contract, thereby releasing Colony from payment. The court also agreed with the District Court's conclusion that the compulsory insurance doctrine did not apply to the case. The court noted that the doctrine has largely been applied in the context of automobile liability insurance and found no persuasive reason to extend it to this case. View "Jespersen v. Colony Insurance Company" on Justia Law

In this case, the Plaintiff, Barbara M. Parmenter, had subscribed to a long-term care insurance policy offered by her employer, Tufts University, and underwritten by The Prudential Insurance Company of America. The policy was governed by the Employee Retirement Income Security Act of 1974. After Prudential twice increased Parmenter's premium rate payments for her policy, she sued Tufts and Prudential, alleging each breached their respective fiduciary duties owed to her when Prudential increased those rates. The defendants responded with motions to dismiss for failure to state a plausible claim. The district court granted each of their motions and Parmenter appealed.The United States Court of Appeals For the First Circuit found that the language in the policy stating that premium increases would be "subject to the approval of the Massachusetts Commissioner of Insurance" was ambiguous, and could not be definitively interpreted based solely on the pleadings and contract documents currently available. Therefore, the court reversed the district court's decision to dismiss the case against Prudential and remanded it for further proceedings.However, the court affirmed the dismissal of the case against Tufts, as Parmenter's allegations that Tufts failed to prevent the premium rate increases or monitor Prudential did not fall into one of the categories of co-fiduciary liability set forth in section 1105(a) of the Employee Retirement Income Security Act. View "Parmenter v. Prudential Ins. Co. of America" on Justia Law

The case involved an appellant, Jonathan Martins, who filed a lawsuit against Vermont Mutual Insurance Company. Martins' vehicle was involved in an accident with a vehicle insured by Vermont Mutual. He claimed that the insurance company failed to compensate him for the inherent diminished value (IDV) of his vehicle after the accident. The case was first heard in a district court that ruled in favor of Vermont Mutual, stating the standard Massachusetts automobile insurance policy did not provide coverage for IDV damages. Martins appealed this decision to the United States Court of Appeals for the First Circuit.The Court of Appeals reviewed the district court's decision and maintained that the district court correctly ruled in favor of Vermont Mutual. The court held that under Massachusetts law, a third-party claimant such as Martins could not maintain a direct cause of action against an insurer without first obtaining a final judgment against the insured party involved in the accident. The court also rejected Martins' argument that Vermont Mutual was estopped from denying liability for IDV damages because it had paid for other damages related to the accident. The court concluded that the insurer's obligation to make a reasonable settlement offer did not equate to admitting liability. Therefore, the court affirmed the district court's ruling in favor of Vermont Mutual. View "Martins v. Vermont Mutual Insurance Company" on Justia Law

In a case before the United States Court of Appeals for the First Circuit, an insurance company, Berkley National Insurance Company, sued two of its insureds, Granite Telecommunications, LLC and Atlantic-Newport Realty LLC, seeking restitution for both the payment it had made to settle a personal-injury lawsuit against the insureds and the costs it had incurred to defend them against that suit. The insurer, Berkley, also sought a declaratory judgement that it had no duty to defend or indemnify the insureds with respect to the personal-injury claims that they were facing. The District Court granted partial summary judgment in favor of Berkley, ordering the insureds to pay restitution for both the insurer's defense costs and its settlement payment. The insureds appealed the judgment.The Court of Appeals reversed the District Court's order, concluding that the rulings conflicted with Massachusetts law governing when a liability insurer who has chosen to defend its insureds may seek reimbursement from them. The Court stated that under Massachusetts law, a liability insurer can only seek reimbursement for an amount paid to settle a lawsuit if the insured has agreed that the insurer may commit its own funds to a reasonable settlement with a right to seek reimbursement, or if the insurer secures specific authority to reach a particular settlement which the insured agrees to pay. The Court found that the insurer, Berkley, did not meet any of these conditions, and as a result, it could not seek reimbursement from the insureds. Consequently, the Court vacated the grant of summary judgment to the insurer and dismissed the remainder of the appeal as moot. View "Berkley National Ins. Co. v. Atlantic-Newport Realty LLC" on Justia Law

The United States Court of Appeals for the First Circuit considered a case where Lawrence General Hospital (LGH) sued Continental Casualty Company for denying coverage for losses LGH alleges it suffered during the COVID-19 pandemic. LGH argued that its insurance policy with Continental covered the losses under two types of coverage: coverage for "direct physical loss of or damage to property" and a Health Care Endorsement covering losses and costs incurred due to compliance with government decontamination orders.Applying Massachusetts state law, the court ruled that LGH failed to state a claim that the SARS-CoV-2 virus caused "direct physical loss of or damage to its property," affirming the lower court's dismissal of this claim. However, the court found that LGH was subject to decontamination orders due to COVID-19 and thus had a valid claim for coverage under the Health Care Endorsement. As such, the court reversed the lower court's dismissal of this claim and remanded the case for further proceedings. View "Lawrence General Hospital v. Continental Casualty Co." on Justia Law

In this case, Defendant-Appellee Martin Andersson purchased an insurance policy for his vessel from Plaintiff-Appellant Great Lakes Insurance SE. The vessel ran aground off the coast of the Dominican Republic, and Great Lakes brought a declaratory judgment action to determine coverage under the policy. Andersson filed counterclaims for breach of contract and equitable estoppel. Great Lakes' motion for summary judgment was denied, and Andersson was granted partial summary judgment on his breach of contract claim. Great Lakes appealed, claiming the district court erred in refusing to apply the policy's definition of seaworthiness.The United States Court of Appeals for the First Circuit held that under the absolute implied warranty of seaworthiness, the insured vessel must be seaworthy at the policy's inception, and if not, the policy is void. The court affirmed the district court's ruling, stating that Great Lakes' argument that the absolute implied warranty required the vessel to carry up-to-date charts for all geographic areas covered by the policy in order to be considered seaworthy was unsupported by admiralty case law and was unreasonable.Additionally, the court held that Great Lakes' argument that the express terms of the policy required updated paper charts for every location that could be navigated under the entirety of the policy coverage area was unsupported by the express language of the policy itself. The court found no precedent supporting the claim that updated paper charts for every location covered by the policy were required to be onboard the vessel at the inception of the policy. As a result, the Court of Appeals affirmed the district court's decision in favor of Andersson. View "Great Lakes Insurance SE v. Andersson" on Justia Law

In this case, the United States Court of Appeals for the First Circuit had to decide whether rainwater that accumulated on a parapet roof one or more stories above the ground is considered "surface waters" under Massachusetts law for the purposes of the insurance policies in question. This determination was crucial for deciding whether the insureds, Medical Properties Trust, Inc. (MPT) and Steward Health Care System LLC (Steward), were subject to coverage limitations on "Flood" damage in the policies issued by Zurich American Insurance Company (Zurich) and American Guarantee and Liability Insurance Company (AGLIC).The interpretation of "surface waters" posed a novel issue of Massachusetts law that had not been previously addressed by the Massachusetts Supreme Judicial Court (SJC). The court decided to certify the issue to the SJC as the existing case law did not provide a clear answer and the resolution may require policy judgments on applying Massachusetts law to this key insurance coverage issue.The case arose from a situation where Norwood Hospital Facility, a building owned by MPT and leased to Steward, suffered significant damage after severe thunderstorms. Rainwater accumulated on the hospital's roof and a second-floor courtyard, eventually seeping into the hospital's upper floors. Both Zurich and AGLIC, in their initial evaluations, determined that water damage in the hospital's basement was caused by "Flood," and would be subject to the policies' respective coverage limits. However, the insurers later characterized all the water damage, including that from the roof, as "surface water" and subject to the "Flood" coverage limits.The court concluded that whether rainwater pooled on a parapet roof constitutes "surface waters" in the policies' "Flood" definition is determinative of this interlocutory appeal. Therefore, the court certified the issue to the SJC for its consideration. View "Zurich American Insurance Co. v. Medical Properties Trust, Inc." on Justia Law

Brian Smith, a Rhode Island resident, sued Prudential Insurance Company of America for breach of fiduciary duty after the company terminated his long-term disability benefits under an insurance policy. The policy stated a three-year limitations period to file a lawsuit, which began on the date Smith was required to submit proof of his disability, not on the date Prudential allegedly breached the policy by stopping payment. Consequently, by the time Smith filed his lawsuit, the limitations period had expired. Smith appealed to the United States Court of Appeals for the First Circuit after the United States District Court for the District of Rhode Island granted summary judgment in favor of Prudential on the grounds that Smith's lawsuit was filed too late.Smith argued that enforcing the limitations scheme would violate Rhode Island public policy. While the Court of Appeals found compelling reasons to believe that the limitations scheme might indeed contravene Rhode Island public policy, they also recognized that reversing and remanding on that ground would potentially expand Rhode Island law. Consequently, the Court of Appeals decided to certify the public policy question to the Rhode Island Supreme Court. The certified question is whether, in light of specific state laws and Rhode Island public policy, Rhode Island would enforce the limitations scheme in this case to bar Smith's lawsuit against Prudential. View "Smith v. Prudential Insurance Company of America" on Justia Law

The First Circuit reversed the order of the district court dismissing this case at the pleading stage for lack of standing, holding that Malcom Wiener had Article III standing to sue Defendants, MIB Group, Inc. and its executive vice president, based on additional attorney's fees and costs Wiener insured to respond to Defendants' actions in a separate lawsuit.In 2018, Wiener sued AXA Equitable Life Insurance Company, his former life insurance company, for negligence. After the jury returned a verdict in favor of Wiener the district court granted AXA's motion to dismiss for lack of subject matter jurisdiction. The court of appeals reversed the decision granting AXA's motion to dismiss. Meanwhile, Wiener brought this suit against Defendants, alleging that he incurred out-of-pocket loss in the form of attorney's fees and costs and to respond to Defendants' actions in the related lawsuit. The district court dismissed the action, concluding that Wiener lacked Article III standing. The First Circuit reversed, holding that a past, out-of-pocket loss is a basis for Article III standing, and therefore, Wiener had standing to bring this suit. View "Wiener v. MIB Group, Inc." on Justia Law

The First Circuit vacated the judgment of the district court in favor of Philadelphia Indemnity Insurance Company in this action seeking a declaration that BAS Holding Corporation breached a condition of the parties' insurance contract, holding that the district court's findings providing grounds for summary judgment were insupportable.After an arsonist destroyed a building owned by BAS and purportedly insured against loss by Philadelphia, the insurer sought an examination under oath (EUO) of George Carney, BAS's president and owner. Philadelphia then denied coverage on the grounds that BAS refused to provide Carney for an EUO, in violation of its obligations under the relevant insurance policy. Philadelphia then brought this action. The district court granted summary judgment for Philadelphia on the ground that BAS failed to cooperate by refusing to submit to the EUO. The First Circuit vacated the judgment, holding that where the evidence unequivocally showed the BAS never willfully and inexcusably refused to provide Carney for the EUO, and therefore summary judgment was improper. View "Philadelphia Indemnity Insurance Co. v. BAS Holding Corp." on Justia Law