Justia U.S. D.C. Circuit Court of Appeals Opinion Summaries

Articles Posted in Insurance Law

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The Authority faced a funding shortfall for at least the period immediately after its opening in 2014. To cover the shortfall, the Authority, with emergency authorization from the District’s Council, levied a charge on all insurance policies above a certain premium threshold sold by health carriers in the District. American Council raised statutory and constitutional challenges to that charge and the district court rejected Council's arguments, dismissing the complaint for failure to state a claim. The court agreed with the District that the district court lacked jurisdiction to hear this case because the charge levied by the Authority was a tax rather than a fee. Therefore, the court vacated the district court's judgment for lack of jurisdiction and remanded with instructions to dismiss the case for lack of jurisdiction because the assessment is a tax. View "American Council of Life Ins. v. District of Columbia Health" on Justia Law

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Cincinnati filed suit seeking a declaratory judgment that it does not owe a duty to defendant or indemnify claims brought against its insured, All Plumbing, for sending unsolicited faxed advertisements alleged to be in violation of the Telephone Consumer Protection Act (TCPA), 47 U.S.C. 227. The district court ruled that Cincinnati could not assert any of its defenses to coverage under the primary liability provision of the policy because it had failed to reserve its rights, but could assert such defenses under the excess liability provision. However, the district court did not address the asserted defenses under that provision. The court dismissed the appeal for lack of a final decision as to all requested relief where the district court's decision did not resolve all of Cincinnati’s rights and liabilities under the excess liability provision of the policy. View "Cincinnati Ins. Co. v. All Plumbing, Inc." on Justia Law

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In 2004 the law firm was engaged to bring a medical malpractice action on behalf of a 14-year-old girl who had become paralyzed after surgery. The firm filed two complaints in Virginia state court. Each was dismissed: the first without prejudice for failure to correctly caption a pleading; the second with prejudice for filing outside the statute of limitations. Shortly thereafter, the firm applied for and obtained a new professional liability insurance policy. Asked whether there were “any circumstances which may result in a claim being made,” the firm responded “no.” The firm informed the insurer of the incident in 2009, but represented that it had occurred in 2008. In 2011, the insurance company noticed that the firm had made the caption error in 2006, before the policy period. In 2012, it notified the firm that it reserved its rights to deny coverage under the known risk exclusion. The girl filed a legal malpractice action in 2012, and was awarded $1,750,000 in 2013. The court found, as a matter of law and without expert testimony, that the firm was on notice of the potential malpractice claim and rejected arguments that the insurer had forfeited or waived its right to deny coverage. The D.C. Circuit affirmed. View "Chicago Ins. Co. v. Paulson & Nace, PLLC" on Justia Law

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Bibeau appealed the district court's grant of summary judgment and order directing it, as a related person to a disabled miner's former employer, to pay health insurance premiums, interest, and liquidated damages to the United Mine Workers of America 1992 Benefit Plan. The court concluded that Bibeau's laches claim was precluded under Petrella v. Metro-Goldwyn-Mayer, Inc. because each premium installment gives rise to a separate cause of action for legal relief for which Congress has enacted a statute of limitations to govern timeliness. Further, under the Coal Industry Retiree Health Benefit Act of 1992, 26 U.S.C. 9701-9722, which incorporates the Employee Retirement Income Security Act's (ERISA), 29 U.S.C. 1451(a)(1), enforcement scheme, the district court did not err in awarding interest and liquidated damages. Accordingly, the court affirmed the judgment. View "Holland v. Bibeau Construction Co." on Justia Law

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Interstate Fire filed suit against Greenspring and others, alleging that defendants owed a duty under a Greenspring general liability policy to provide primary insurance coverage for a nurse hired by a staffing agency and assigned to work at a hospital on a temporary basis. Greenspring had issued an insurance policy providing coverage to employees of the hospital for claims arising out of medical incidents within the scope of their employment. The court agreed with the district court that the dictionary definition and a common law test supports the conclusion that the nurse qualified as an "employee" of the hospital. The court rejected defendant's remaining arguments and concluded that Interstate Fire was entitled to reimbursement from Greenspring for the amounts paid to defend and settle the underlying action. Accordingly, the court affirmed the judgment of the district court. View "Interstate Fire & Casualty Co v. Washington Hospital Center Corp., et al." on Justia Law
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Plaintiffs, victims and victims' families and estates, filed suit against Iran and others alleging their liability for the attack on the Khobar Towers apartment complex in Dhahran, Saudi Arabia. Plaintiffs obtained a default judgment and attempted to collect. Plaintiffs had writs of attachment issued to Bank of America and Wells Fargo, seeking any asset held by the banks in which Iran had interest. The banks conceded that some accounts were potentially subject to attachment and these "uncontested accounts" were the subject of an interpleader action in the district court. The remaining "contested accounts" are the subject of this appeal. The court affirmed the order of the district court denying plaintiffs' motion for a turnover of the funds because plaintiffs could not attach the contested accounts under either section 201 of the Terrorism Risk Insurance Act of 2002, Pub. L. No. 107-297, 116 Stat. 2322, 2337, or 28 U.S.C. 1610(g) without an Iranian ownership interest in the accounts and because Iran lacked an ownership interest in the accounts. View "Heiser, et al. v. Islamic Republic of Iran, et al." on Justia Law

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In this case, participants in the Thunderbird Mining Company Pension Plan sought "shutdown" pension benefits. The PBGC, the government agency that administered pension termination insurance under Title IV of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001-1461, denied the participants' request. These early retirement benefits were triggered by a permanent shutdown of a plant and were payable to plan participants who met certain age and years-of-service requirements. The court held that the agency's determination was not arbitrary or capricious where the record provided sufficient support for the agency's judgment that a permanent shutdown had not occurred before Eveleth's pension plan was terminated on July 24th, 2003. Accordingly, the court affirmed the district court's grant of summary judgment in favor of the agency. View "United Steel, et al. v. Pension Benefit Guaranty Corp." on Justia Law

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After injuring her back in a car accident, plaintiff filed for and received long-term disability benefits from the insurance plan sponsored by her employer. Plaintiff brought suit pursuant to the Employee Retirement Income Security Act of 1974 (ERISA), 42 U.S. C. 29 U.S.C. 1001 et seq., against her employer and the administrators and underwriters of her employer-sponsored long-term benefit disability insurance policy after the claims administrator of that plan determined that she no longer qualified for benefits. At issue was whether the district court properly granted defendants' motion for summary judgment, finding no violation of law. The court held that because defendants acted reasonably, the court concluded that defendants' termination of plaintiff's benefits complied with federal law. The court found none of plaintiff's procedural claims persuasive and held that the district court did not err when it held that defendants did not violate plaintiff's right to a full and fair review of her adverse eligibility determination. The court also rejected plaintiff's argument that the district court violated local rule 7(h) where plaintiff failed to make this argument before the district court. Accordingly, the court affirmed the judgment of the district court.

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Plaintiffs, retired U.S. Airways pilots, each received pensions from the U.S. Airways pension plan (the plan) and each opted to receive his pension in a single lump sum rather than as an annuity. Plaintiffs subsequently sued U.S. Airways claiming that the plan owed them interest for its 45-day delay. The court reversed the judgment of the district court with respect to plaintiffs' actuarial equivalence claim where the amount of plaintiffs' lump sum benefit was equal to the actuarial present value of the annuity payments plaintiffs would have received under the plan's default payment option. Even so, U.S. Airway's 45-day delay in paying plaintiffs was unrelated to the calculation of plaintiffs' benefits and therefore, not reasonable under existing IRS regulations. The court remanded to the district court to calculate the appropriate amounts due to plaintiffs and affirmed the judgment of the district court that plaintiffs were not entitled to attorney's fees.

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Plaintiff sued defendants, United Healthcare Insurance Company and the American Association of Retired Persons, alleging breach of contract, fraud under the D.C. Consumer Protection Procedures Act, and unjust enrichment when plaintiff had to pay nearly $40,000 in uninsured medical bills. At issue was whether the district court properly dismissed plaintiff's claim under Federal Rule of Civil Procedure 12(b)(6) for failure to state a claim when plaintiff tried to recover the uninsured amount by alleging that the contract between plaintiff and defendants was ambiguous. The court held that the district court properly dismissed plaintiff's claim under Rule 12(b)(6) where the contract was not ambiguous when it included sections on what services were and were not covered and included notations limiting coverage that was directly relevant to plaintiff's circumstances.