Justia U.S. 1st Circuit Court of Appeals Opinion SummariesArticles Posted in Insurance Law
Sterngold Dental, LLC v. HDI Global Insurance Co.
The First Circuit affirmed the judgment of the district court dismissing Plaintiff's action alleging that Defendant, an insurance company, had breached its duty to defend and indemnify Plaintiff against a third-party's claim, holding that Defendant had no duty to defend or indemnify Plaintiff with respect to the third-party's claim.At issue was whether the scope of a so-called intellectual property exclusion to the personal and advertising injury coverage under a commercial general liability policy issued by Defendant to Plaintiff excluded the advertising injury in this case from coverage. The First Circuit held that the advertising injury alleged in the third-party's complaint arose out of the claimed infringement of the third-party's trademark, and therefore, the policy excluded the injury from the scope of coverage. View "Sterngold Dental, LLC v. HDI Global Insurance Co." on Justia Law
Zurich American Insurance Co. v. Electricity Maine, LLC
The First Circuit affirmed the judgment of the district court granting summary judgment for Insured on Insurer's complaint seeking a declaratory judgment that it had no duty to defend Insured against an underlying class action alleging that Insured had engaged in misconduct that resulted in customers receiving higher bills than Insured had represented that they would be, holding that summary judgment was properly granted.The complaint sought class-wide damages for a variety of Maine common law claims and for claims under the federal Rackeeter Influenced and Corrupt Organizations Act (RICO), 18 U.S.C. 1962, 1964; and the Maine Unfair Trade Practices Act, Me. Rev. Stat. Ann. tit. 5, 207. In its complaint, Insurer argued that the complaint in the underlying action failed to allege that Insurer engaged in conduct that qualified as an "occurrence" or that caused any "bodily injury" under the relevant policy. The district court entered judgment for Insured. The First Circuit affirmed, holding that there was no genuine issue of material fact in dispute and that the district court's conclusions were correct as a matter of law. View "Zurich American Insurance Co. v. Electricity Maine, LLC" on Justia Law
Ezell v. Lexington Insurance Co.
The First Circuit affirmed the district court's dismissal of Appellants' claims in this putative class action against Lexington Insurance Company and other insurers alleging fraudulent misrepresentation and violation of the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C. 1961 et seq., holding that the facts Appellants pleaded demonstrated the absence of any circumstances constituting fraud.Appellants entered into structured settlement agreements with Lexington Insurance Company pursuant to which Lexington agreed that Appellants would receive specific periodic payments from annuities that Lexington would purchase. Appellants later brought this action alleging that Lexington and other affiliated insurers misrepresented the amount Appellants would receive from the settlements. The district court dismissed Appellants' claims with prejudice. The First Circuit affirmed, holding that Appellants failed to state with particularity the circumstances constituting fraud under Fed. R. Civ. P. 9(b). View "Ezell v. Lexington Insurance Co." on Justia Law
Biochemics, Inc. v. Axis Reinsurance Co.
The First Circuit affirmed the district court's grant of summary judgment to AXIS Reinsurance Company (AXIS) on Plaintiffs' complaint seeking to enforce a directors and officers insurance policy with AXIS, holding that the district court did not err in granting summary judgment in favor of AXIS and in denying Plaintiffs' motion for partial summary judgment.Plaintiffs were BioChemics, Inc., a pharmaceutical company based in Massachusetts, and John Masiz, its president and chief executive officer. Plaintiffs sought damages for what they claimed was AXIS's breach, under the relevant policy, of its duty to defend them in connection with an investigation conducted by the Securities and Exchange Commission against BioChemics and its officers. In its motion for summary judgment, AXIS argued that it did not breach its duty to defend under the policy because Plaintiffs were seeking to enforce that duty in relation to a claim that was first made before the policy took effect and thus was not covered by the policy. The district court granted the motion. The First Circuit affirmed, holding that the district court did not err in granting summary judgment to AXIS. View "Biochemics, Inc. v. Axis Reinsurance Co." on Justia Law
Calandro v. Sedgwick Claims Management Services, Inc.
The First Circuit affirmed the judgment of the district court concluding that the actions of Defendant, a claims-management firm, did not constitute unfair claims settlement practices under Mass. Gen. Laws ch. 176D, holding that Plaintiff failed to show that the district court either misapplied applicable law or clearly erred in finding the facts.Plaintiff won a multi-million dollar jury verdict for wrongful death and conscious pain and suffering against a nursing home. Thereafter, Plaintiff brought this suit alleging that Defendant’s actions, both pre- and post-verdict, violated Chapter 176D. The district court entered a take-nothing judgment, concluding that Defendant’s actions did not constitute unfair claims settlement practices. The First Circuit affirmed, holding that the district court did not err in concluding that Defendant did not violate Chapter 176D. View "Calandro v. Sedgwick Claims Management Services, Inc." on Justia Law
Easthampton Congregational Church v. Church Mutual Insurance Co.
The First Circuit affirmed the district court’s grant of summary judgment in favor of a Church on its lawsuit seeking a declaratory judgment that its claim filed pursuant to its property insurance policy with an Insurance Company was improperly denied, holding that ambiguities in the policy resulted in coverage for the collapse of a ceiling in one section of the church.The Insurance Company denied the Church’s claim, citing the “faulty construction” exclusion in the policy. In its complaint, the church argued that the collapse was caused by hidden decay such that the “additional coverage - collapse” provision applied. The First Circuit affirmed, holding that the meaning of “decay” was ambiguous and that ambiguity must be resolved in the Church’s favor. View "Easthampton Congregational Church v. Church Mutual Insurance Co." on Justia Law
Kelly v. Liberty Insurance Corp.
The First Circuit affirmed the district court’s grant of summary judgment in favor of Liberty Mutual Insurance Corporation on Brendan Kelly’s claim that Liberty was bound to provide uninsured motorist coverage for his benefit, holding that no uninsured motorist coverage was provided under the policy.The insurance contract was an umbrella policy issued to Kelly’s employer and the named insured and was issued in New Hampshire. The named insured rejected uninsured motorist coverage in writing, but the writing was not incorporated into the policy. Kelly argued that that the lack of an explicit reference to the named insured’s written rejection rendered that rejection inoperative against an additional insured like himself, and that provision of uninsured motorist coverage was therefore required under state law. The First Circuit disagreed, holding that Kelly’s position was not implicit in the statute. View "Kelly v. Liberty Insurance Corp." on Justia Law
Scottsdale Insurance Co. v. Byrne
The First Circuit affirmed the decision of the district court ruling that Scottsdale Insurance Company (Scottsdale) breached its duty to defend the Wellesley Advisory Reality Fund, I, LLC (WARF) in a prior action and awarding damages, holding that there was no error or abuse of discretion in the proceedings below.In 2014, Appellees in the instant case brought suit against WARF, acting in their capacity as representatives of the Board of Trustees for the Plumbers and Pipefitters Local 51 Pension and Annuity Funds (the Funds). Default judgment was entered against WARF, and WARF assigned the Funds its rights in WARF’s insurance policy with Scottsdale, which had refused to defend WARF. Scottsdale later brought an action against Appellees seeking a declaration that it did not owe WARF a duty to defend or indemnify under certain exclusions in the policy. The district court ultimately concluded that the the exceptions in the insurer’s policies did not relieve Scottsdale of its duty to defend WARF in the prior action, awarding the Funds the full limits of the insurance policy plus post-judgment interest. The First Circuit affirmed, holding that there was no basis for excusing Scottsdale from its duty to defend or from which to relieve Scottsdale of its obligation to pay the policy limit. View "Scottsdale Insurance Co. v. Byrne" on Justia Law
Medical Mutual Insurance Co. of Maine v. Burka
In this declaratory judgment action filed by a professional liability insurer seeking to establish that it had no duty to defend its insured in two state court proceedings, the First Circuit affirmed the judgment of the district court granting the declaratory judgment for the insurer, holding that the district court correctly determined that the claims against the insured in both lawsuits fell outside the professional liability coverage provided by the insurance policy.The insured, a physician, was the defendant in two civil suits filed in state courts in Maine and Maryland. The insured’s ex-wife claimed that the insured used his status as a doctor to obtain her medical records during their deteriorating marriage so that he could harass and embarrass her. The district court concluded that the insurer had no duty to defend the insured in either lawsuit. The First Circuit affirmed after a close review of the policy at issue, holding that the insurer had no duty to defend the insured in either the Maryland or the Maine proceedings. View "Medical Mutual Insurance Co. of Maine v. Burka" on Justia Law
Jimenez-Castaner v. Liberty Mutual Insurance Co.
The First Circuit vacated the district court’s grant of Liberty Mutual Insurance Company’s summary judgment motion in this case alleging that Liberty breached Plaintiff’s contractual rights by wrongfully denying his request for coverage under an insurance policy, holding that the district court’s reasoning in granting Liberty’s motion for summary judgment was flawed.Plaintiff argued in his complaint that Liberty improperly denied his coverage request under the Directors and Officers insurance policy that Liberty had issued to a Puerto Rico hospital where Plaintiff served as the medical director. The district court concluded that, under the policy, the “Claim” that would give rise to the “Loss” for which Plaintiff sought coverage should be “deemed first made” before the policy took effect and, therefore, was not covered by the policy. The First Circuit vacated the district court’s order granting Liberty’s summary judgment motion, holding that the “Claim” for which Plaintiff sought coverage from Liberty was not “first made” prior to the beginning of the policy at issue, and the district court wrongly construed the policy in concluding otherwise. View "Jimenez-Castaner v. Liberty Mutual Insurance Co." on Justia Law