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

Richard Feingold’s mother purchased a life insurance policy from an Insurer listing her husband as the only beneficiary. Feingold's mother died in 2006. In 2012, Richard informed Insurer of his mother's death. The Insurer issued Feingold a check for death benefits but did not provide a copy of his mother's life insurance policy. Feingold filed a class action complaint against Insurer in 2013, alleging that the Insurer owed Feingold and the putative class of similarly situated beneficiaries damages based on the Insurer’s handling of unclaimed benefits under its life insurance policies. Specifically, Feingold claimed that the Insurer had an obligation, arising from a regulatory agreement (“Agreement”) between the Insurer and several states, to discover the death of its insureds and notify beneficiaries. The district court dismissed the complaint for failure to state a claim, noting that the Agreement was a contract only between Insurer and participating states. The First Circuit affirmed, holding that because Feingold was neither a party nor a third-party beneficiary of the Agreement, he had no authority to enforce the terms of the Agreement. View "Feingold v. John Hancock Life Ins. Co." on Justia Law

Plaintiff sought insurance coverage for gastric lap band surgery. Defendant, a health-care insurer that covered Plaintiff by virtue of Plaintiff’s husband’s employment with the federal government, refused to cover the full cost of the surgery. Plaintiff brought tort and breach of contract claims against Defendant in the Puerto Rico Court of First Instance. Defendant removed the action to the federal district court, asserting, inter alia, that the Federal Employees Health Benefits Act of 1959 (FEHBA) completely preempted Plaintiff’s local-law claims, thus conferring original jurisdiction on the federal court. Defendant then moved to dismiss the case, arguing that the FEHBA demanded exhaustion of administrative remedies. Plaintiff, in the meantime, requested that the district court remand the case to the Court of First Instance. The district court (1) denied Plaintiff’s motion to remand, holding that the FEHBA completely preempted Plaintiff’s claims and, thus, federal jurisdiction attached; and (2) dismissed the action for Plaintiff’s failure to exhaust administrative remedies. The First Circuit Court of Appeals reversed the district court’s judgment of dismissal and its order denying remand, holding that the court erred in concluding that the FEHBA afforded complete preemption. View "Lopez-Munoz v. Triple-S Salud, Inc. " on Justia Law

After Westernbank of Puerto Rico was ordered closed in the late 2000s and the Federal Deposit Insurance Corporation (“FDIC”) was appointed receiver, the FDIC discovered that certain bank directors and officers had breached their fiduciary duty by jeopardizing the bank’s financial soundness, causing over $176 million in damages to the bank. The directors and officers asked their insurer, Chartis Insurance Company, to confirm coverage under a directors’ and officers’ liability-insurance policy issued by Chartis to Westerbank’s owner, W Holding Company, Inc. Chartis denied coverage. The directors and officers and the FDIC sued Chartis. In this “procedurally complicated” case, a district judge eventually issued an order requiring Chartis to advance defense costs to the directors and officers. The First Circuit Court of Appeals affirmed, holding (1) the Court had jurisdiction to hear the parties; and (2) the district judge did not err in making its cost-advancement ruling. View "W Holding Co., Inc. v. AIG Ins. Co. - P.R." on Justia Law

Evan Ardente’s yacht was insured by Standard Fire Insurance Company. After Ardente purchased the yacht, it stopped navigating properly, and its top speed had decreased due to water damage to the yacht’s hull. Specifically, water was seeping into balsa wood, which is not waterproof, around installation holes and spreading throughout the hull. Ardente presented a claim to Standard Fire. Standard Fire denied coverage on the ground that the claim fell within an exclusion for manufacturing defects. Ardente sued Standard Fire for breach of contract, among other claims. The district court granted summary judgment for Standard Fire on all claims except for the breach of contract allegation. On that claim, the court granted Ardente summary judgment with respect to liability, concluding that the damage fell within an exception to the exclusion for manufacturing defects. The First Circuit Court of Appeals reversed the district court’s order granting Ardente summary judgment on his breach of contract claim, holding that the damage to the yacht did not fall within the exception to the manufacture-defect exclusion, and therefore, Standard Fire was entitled to summary judgment on the breach of contract claim. View "Ardente v. Standard Fire Ins. Co." on Justia Law

For twenty years, Defendants, various entities of OneBeacon American Insurance Company (collectively, “OneBeacon”), had a program known as Multiple Line Excess Cover (“MLEC Program”) under which OneBeacon entered into reinsurance contracts (“MLEC Agreements”) with various reinsurers. Employers Insurance Company of Wausau, National Casualty Company, and Swiss Reinsurance America Corporation (“Swiss Re”) participated as reinsurers in the MLEC Program. Some of the MLEC Agreements Wausau entered into with OneBeacon were practically identical to OneBeacon’s MLEC Agreements with Swiss Re. In 2007, OneBeacon demanded arbitration with Swiss Re seeking reinsurance recovery for losses arising out of claims against OneBeacon by policyholders. The arbitration panel decided in favor of Swiss Re. In 2012, OneBeacon demanded arbitration with Wausau and National Casualty for, according to Wausau, the same claims OneBeacon arbitrated and lost against Swiss Re. Wausau and National Casualty petitioned for a declaratory judgment that the prior arbitration award between OneBeacon and Swiss Re had preclusive effect on the arbitration pending between OneBeacon and Wausau. The district court denied the petition. The First Circuit Court of Appeals affirmed, holding that judicial confirmation of an arbitration award “does not warrant deviation from the general rule that the preclusive effect of a prior arbitration is a matter for the arbitrator to decide.” View "Nat'l Cas. Co. v. OneBeacon Am. Ins. Co." on Justia Law

Plaintiff, a school, was sued by two of the school's donors who sought a return of a monetary gift to the school, claiming that the gift had been induced by misrepresentations. The case settled, and Plaintiff sought defense costs and indemnity under a directors and officers liability insurance policy issued by Defendant. The district court granted summary judgment for Defendant based on a provision in the policy excluding from coverage any losses involving any matter disclosed in connection with "Note 8" of the school's financial statement. Note 8 set forth a description of the gift. Plaintiff appealed. The First Circuit Court of Appeals affirmed, holding that because the language of the policy clearly excluded coverage "in any way involving" the disputed gift, Plaintiff had no reasonable expectation of coverage. View "Clark Sch. for Creative Learning, Inc. v. Philadelphia Indem. Ins. Co." on Justia Law

Defendant was insured under three homeowners' policies issued to his parents (the Zamskys) by Plaintiff. Each policy covered a separate parcel of residential real estate owned by the Zamskys and required Plaintiff to defend and indemnify the insureds against claims stemming from bodily injury caused by a covered occurrence. One exclusion to the policy, the UL exclusion, pretermitted coverage for injuries arising out of a premises owned by an insured but not itself an "insured location." This case involved an fire that occurred on a piece of real estate owned by the Zamskys that was not insured by Plaintiff. An individual injured in the fire sued Defendant for bodily injuries. Plaintiff subsequently brought this declaratory judgment action seeking a declaration that the UL exclusions pretermitted its obligation to defend Defendant in the negligence suit or to indemnify him against any damage award. The district court held that the UL exclusion did not apply and that Plaintiff owed Defendant a duty to defend. The First Circuit Court of Appeals affirmed, holding that because the occurrence at issue here did not arise out of a condition of the premises, the district court did not err in determining that the UL exclusion did not apply. View "Vt. Mut. Ins. Co. v. Zamsky" on Justia Law

Plaintiff sued the servicer of his loan (Bank) in a putative class action, asserting that the Bank's requirement that he maintain flood insurance coverage in an amount sufficient to cover the replacement value of his home breached the terms of his mortgage contract. The mortgage was insured by the Federal Housing Administration (FHA). Specifically, Defendant contended that the Bank, under a covenant of the mortgage contract, could not require more than the federally mandated minimum flood insurance. The covenant was a standard uniform covenant prescribed by the FHA pursuant to federal law. The district court dismissed the complaint for failure to state a claim. The judgment of dismissal was affirmed by an equally divided en banc First Circuit Court of Appeals, holding that Plaintiff failed to state a claim for breach of contract, as (1) the Bank's reading of the contract was correct and Plaintiff's was incorrect; (2) Plaintiff could not avoid dismissal on the grounds that his specific understanding or the actions of the parties created an ambiguity; and (3) the United States' position articulated in its amicus brief, which stated that Plaintiff's interpretation of the contract was incorrect, reinforced the Court's conclusion. View "Kolbe v. BAC Home Loans Servicing, LP" on Justia Law

Plaintiff's property was insured by a standard flood insurance policy (SFIP) issued by Allstate Insurance Company, a private insurer participating in the National Flood Insurance Program (NFIP). Allstate issued Plaintiff's SFIP on behalf of FEMA, the federal agency that administers the NFIP. After Plaintiff's property was damaged by a flood, Allstate paid him for some but not all claims. Plaintiff sued Allstate for the alleged remaining unpaid covered losses, and the district court entered judgment in favor of Plaintiff. The First Circuit Court of Appeals reversed and remanded with directions to enter summary judgment in favor of Allstate, holding that Plaintiff's failure to comply with the SFIP's requirement that he file a proof of loss as to all damages sought barred recovery under his policy for those damages and required dismissal. View "DeCosta v. Allstate Ins. Co." on Justia Law

Appellant was placed on disability leave from work. Appellant was covered under a long term disability (LTD) policy that her employer obtained from Medical Group Insurance Services (MGIS). The policy was written by Sun Life Assurance Company (Sun Life). After leaving her job, Appellant filed a claim with MGIS seeing long term disability benefits. Sun Life denied Appellant's request for benefits. Appellant filed an action against Sun Life, asserting various state law claims. The federal district court dismissed the action based on ERISA preemption. Appellant then amended her complaint to add ERISA claims and asked the district court to apply de novo review in its evaluation of her ERISA claims. The court denied the motion and granted summary judgment for Sun Life, concluding that Sun Life's decision to deny benefits was not arbitrary and capricious, and thus complied with ERISA's requirements. The First Circuit Court of Appeals vacated the judgment, holding (1) the safe harbor exception to ERISA did not apply to the policy covering Appellant, and therefore, Appellant's state law claims were preempted; but (2) the benefits denial was subject to a de novo review, rather than the highly deferential "arbitrary and capricious" review prescribed for certain ERISA benefits decisions. Remanded. View "Gross v. Sun Life Assurance Co. of Canada" on Justia Law