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

A school bus owned by First Student, Inc., and insured by National Union Fire Insurance Company of Pittsburgh, PA, collided with two underinsured vehicles in Rhode Island, injuring Tiffany Briere and her minor daughter. Briere submitted a claim for underinsured motorist benefits to National Union, which was denied on the grounds that First Student had rejected such coverage. Briere then sued National Union, arguing that Rhode Island law required the policy to offer underinsured motorist coverage.The United States District Court for the District of Rhode Island granted summary judgment to National Union and First Student. The court found that the Rhode Island statute requiring underinsured motorist coverage did not apply because the insurance policy was not "delivered or issued for delivery" in Rhode Island. The policy had been issued by a New York-based broker and delivered to FirstGroup's headquarters in Ohio. Consequently, the court ruled that the policy was exempt from the statutory requirement.The United States Court of Appeals for the First Circuit reviewed the case and vacated the district court's summary judgment. The appellate court held that National Union had waived its defense based on the delivery requirement because it had not mentioned this ground in its initial denial letter to Briere. The court emphasized that insurers must notify their insureds of all grounds for denying coverage in their denial letters. Since National Union failed to do so, it could not later rely on the delivery requirement defense. The case was remanded for further proceedings to address other potential defenses and issues not considered by the district court. View "Briere v. National Union Fire Insurance Co. of Pittsburgh, PA" on Justia Law

Joan Stormo and her siblings hired attorney Peter Clark for a real estate transaction, but Clark's actions caused the deal to fall through. Stormo sued Clark for malpractice and won. Clark's insurer, State National Insurance Company, denied coverage based on a prior-knowledge exclusion and Clark's delay in reporting the lawsuit. Stormo, as Clark's assignee, then sued State National for breach of contract and unfair claim-settlement practices.The U.S. District Court for the District of Massachusetts found that factual questions necessitated a trial on the breach-of-contract claim but granted summary judgment to State National on the unfair claim-settlement practices claim. The jury found for Stormo on the breach-of-contract claim, awarding over $1 million in damages. However, the district court granted State National's motion for judgment as a matter of law, ruling that Clark's late notice of the claim voided coverage under the policy.The United States Court of Appeals for the First Circuit affirmed the district court's judgment. The court held that under Massachusetts law, a claims-made policy like Clark's does not require the insurer to show prejudice from late notice to deny coverage. Since Clark failed to provide timely notice, State National had no duty to indemnify or defend him. Consequently, Stormo's claims for breach of contract and unfair claim-settlement practices failed. View "Stormo v. State National Insurance Co." on Justia Law

Cynthia Roberge, a State of Rhode Island employee, was involved in a car accident with an underinsured motorist while driving her personal vehicle during the course of her employment. She sought uninsured/underinsured motorist (UM/UIM) coverage under the State's insurance policy issued by Travelers Property Casualty Company of America. Travelers denied her claim, stating that she was not entitled to UM/UIM coverage because she was not driving a "covered auto" as defined by the policy.Roberge filed a lawsuit in Providence County Superior Court, asserting claims for breach of contract, declaratory judgment, and bad faith. Travelers removed the case to the United States District Court for the District of Rhode Island. The district court granted summary judgment in favor of Travelers, concluding that Roberge was not entitled to UM/UIM coverage under the policy's terms and that neither the Rhode Island Supreme Court's decision in Martinelli v. Travelers Insurance Companies nor the Rhode Island Uninsured Motorist Statute required such coverage.On appeal, the United States Court of Appeals for the First Circuit reviewed the case. The court noted that the policy's language clearly excluded Roberge from UM/UIM coverage because she was not driving a "covered auto." However, the court found that the case raised unresolved questions of Rhode Island insurance law, particularly regarding the applicability of the Martinelli exception and the requirements of the Rhode Island Uninsured Motorist Statute. The First Circuit decided to certify two questions to the Rhode Island Supreme Court: whether an employee must be considered a named insured under an employer's auto insurance policy when operating a personal vehicle in the scope of employment, and whether it violates Rhode Island law and public policy for an employer's policy to provide liability but not UM/UIM coverage to employees in such circumstances. The case was stayed pending the Rhode Island Supreme Court's response. View "Roberge v. Travelers Property Casualty Co. of America" on Justia Law

B.R.S. Real Estate, Inc. owned a commercial property in West Warwick, Rhode Island, which suffered extensive water damage in 2018 due to frozen and burst pipes. B.R.S. filed an insurance claim under a policy issued by Certain Underwriters at Lloyd's, London. Disagreements arose over the amount of the loss, leading to an appraisal process involving party-appointed appraisers and a neutral umpire. The appraisal panel issued an award, which B.R.S. contested, arguing that the appraiser appointed by the insurers was biased and that the district court erred in granting summary judgment on its claim for withheld depreciation.The United States District Court for the District of Rhode Island initially denied the defendants' motion to confirm the appraisal award, citing the need for discovery. After discovery, the court granted summary judgment for the defendants, concluding that no reasonable jury could find the appraiser biased or the umpire incompetent. The court also found that B.R.S. had not met the policy conditions for receiving the withheld depreciation, as the property had not been repaired or replaced for the same use.The United States Court of Appeals for the First Circuit reviewed the case and affirmed the district court's judgment. The appellate court held that the district court correctly applied the summary judgment standard and that B.R.S. could not challenge the appraiser's impartiality post-decision based on information known before the appraisal. The court also found that the umpire was competent and that B.R.S. failed to provide evidence that the property was repaired or replaced for the same use, as required by the policy. Consequently, the court upheld the denial of the withheld depreciation and confirmed the appraisal award. View "B.R.S. Real Estate, Inc. v. Certain Underwriters at Lloyd's, London" on Justia Law

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