Justia U.S. D.C. Circuit Court of Appeals Opinion Summaries
Articles Posted in Insurance Law
TIG Insurance Company v. Republic of Argentina
In this case, a private insurance company, TIG Insurance Company, sought to enforce two judgments against the Republic of Argentina. The dispute centers on whether Argentina, as the successor to a state-owned Argentine company, Caja Nacional de Ahorro y Seguro, is liable under reinsurance contracts that Caja entered into with TIG in 1979. TIG alleged that Caja failed to pay as promised under these contracts, leading to arbitral awards and subsequent judgments in TIG's favor.The United States District Court for the District of Columbia initially ruled in favor of Argentina, finding that Argentina's property was immune from execution under the Foreign Sovereign Immunities Act (FSIA) because it was not used for commercial activity at the time the writ would issue. The court also held that the Illinois district court lacked jurisdiction over Argentina for the 2018 judgment and that TIG needed to amend the 2001 judgment in Illinois to name Argentina before seeking enforcement in D.C. TIG appealed these decisions.The United States Court of Appeals for the District of Columbia Circuit reviewed the case and concluded that two FSIA exceptions—the arbitration and waiver exceptions—might apply. The court held that an agreement could be "made by" a sovereign if it legally binds that sovereign to arbitrate, even if the sovereign was not an original signatory. The court also found that implied waiver does not require evidence of subjective intent but can be based on objective actions, such as agreeing to arbitration or a choice-of-law clause. The court vacated the district court's decisions and remanded for further analysis and factfinding on these issues.The appellate court affirmed the denial of TIG's request for jurisdictional discovery and precluded TIG from advancing an alter ego theory or arguing that Argentina failed to raise its immunity in a responsive pleading. The case was remanded for further proceedings consistent with the appellate court's instructions. View "TIG Insurance Company v. Republic of Argentina" on Justia Law
3534 East Cap Venture, LLC v. Westchester Fire Insurance Company
A real estate developer, 3534 East Cap Venture, LLC, and a construction company, McCullough Construction, LLC, were involved in a dispute with their insurers, Westchester Fire Insurance Company and Endurance American Insurance Company. The dispute centered around the coverage of two identical builders’ risk insurance policies for a residential and retail complex under construction in the District of Columbia. During construction, the absence of a vapor barrier in the architect's plans led to the condensation of vapor into water during cold weather, causing nearly $1.5 million in damages. The insurers denied the claims, arguing that the policies excluded losses caused by atmospheric dampness or temperature changes.The case was initially brought to the Superior Court of the District of Columbia, but was moved to federal district court due to diversity of citizenship. The district court ruled in favor of the insurers, holding that the exclusions for losses caused by "dampness of atmosphere" or "changes in temperature" applied. The court also held that the ensuing-loss exception to the exclusions did not apply because losses from "water damage" to the building were "inextricably intertwined" with—and indeed were "one and the same" as—losses covered by the dampness and temperature exclusions.The United States Court of Appeals for the District of Columbia Circuit reversed the district court's decision. The appellate court held that the ensuing-loss clause in the insurance policies applied to losses from water damage caused by the excluded perils of dampness and temperature changes. Therefore, the policies covered the losses at issue. The court remanded the case with instructions to enter summary judgment for the insureds on the question of liability. View "3534 East Cap Venture, LLC v. Westchester Fire Insurance Company" on Justia Law
In re: Valerie White
Plaintiffs sought class certification to pursue various claims against the Hilton Hotels Retirement Plan (“Hilton Plan”) for what they say are unlawfully denied vested retirement benefits. The district court ultimately denied certification on the ground that Plaintiffs had proposed an “impermissibly ‘fail-safe’” class—that is, a class definition for which membership can only be ascertained through “a determination of the merits of the case.”
The DC Circuit reversed and remanded the district court’s decision, finding that the district court, in this case, bypassed Rule 23’s requirements and based its denial of class certification entirely on the class’s “fail-safe” character. The court explained that the textual requirements of Rule 23 are fully capable of guarding against unwise uses of the class action mechanism. So the court rejected a rule against “fail-safe” classes as a freestanding bar to class certification ungrounded in Rule 23’s prescribed criteria. Instead, district courts should rely on the carefully calibrated requirements in Rule 23 to guide their class certification decisions and the authority the Rule gives them to deal with curable misarticulations of a proposed class definition. View "In re: Valerie White" on Justia Law
Federal Law Enforcement Officers Association v. Kiran Ahuja
The Office of Personnel Management (OPM) administers retirement benefits for civilian employees of the U.S. government. OPM typically pays retirement benefits to retirees themselves. But when a retiree’s benefits are subject to division pursuant to a divorce decree, OPM divides them between the retiree and his or her former spouse according to the terms of the decree. The Federal Law Enforcement Officers Association (Association) brought this action against OPM in district court, claiming that OPM’s method of apportioning one type of retirement benefit, the Annuity Supplement, violates the Administrative Procedure Act. OPM moved to dismiss the complaint on jurisdictional grounds.
The district court acknowledged that federal employees’ claims for retirement benefits are generally routed through that system of review, but held that the Association’s claims fell within an exception allowing pre-enforcement challenges to agency rules to proceed in district court. Exercising jurisdiction, the district court dismissed one of the Association’s counts for failure to state a legally cognizable claim and, after the administrative record was filed, granted summary judgment to OPM as to the others.
The DC Circuit vacated the district court’s orders and remanded with instructions to dismiss for lack of jurisdiction. The court held that the CSRA’s system of review—which channels disputes about FERS retirement benefits through an administrative process, subject to direct review in the Federal Circuit—precludes district court review of the Association’s claims. View "Federal Law Enforcement Officers Association v. Kiran Ahuja" on Justia Law
Ian Scott-Anderman, et al. v. Robert Martinez, et al.
Appellants– the former secretary-treasurer and president, respectively, of a District Lodge of the International Association of Machinists – appealed the district court’s denial of their motion for a preliminary injunction. They sued the international union, its president, and its general secretary-treasurer. The controversy concerns the suspensions of Appellants’ and the international union’s imposition of a trusteeship on their District Lodge. Appellants’ first amended complaint alleged one count under Title I and five counts under Title III of the Labor-Management Reporting and Disclosure Act (the “LMRDA”). They sought equitable relief along with compensatory and punitive damages. A month after they filed their first amended complaint, they filed a motion for a preliminary injunction. The district court denied the motion. It held that Appellants had not shown a likelihood of success on the merits. It also held that the other factors did not favor them.
The DC Circuit affirmed. The court held that Appellants’ request under Title III to end the trusteeship is moot. A case becomes moot when a party obtains the relief they sought. Here, the disputed trusteeship has been lifted. Further, the court explained that Appellants seek to invalidate an officer election. It is impossible to reinstate Appellant as secretary-treasurer or allow the District Lodge to elect new members to other positions unless the court invalidates the officer election that just occurred. Thus, the court rejected the Title I claim. View "Ian Scott-Anderman, et al. v. Robert Martinez, et al." on Justia Law
United Mine Workers of America v. Energy West Mining Company
The Multiemployer Pension Plan Amendments Act (“MPPAA”) requires an employer to pay “withdrawal liability” if it decides to leave a multiemployer pension plan. Calculating the amount of money the employer owes the plan requires an actuary to project the plan’s future payments to pensioners. The MPPAA requires the actuary to use “assumptions and methods which, in the aggregate, are reasonable (taking into account the experience of the plan and reasonable expectations) and which, in combination, offer the actuary’s best estimate of anticipated experience under the plan.” 29 U.S.C. Section 1393(a)(1).
The Energy West Mining Company (“Energy West”) withdrew from the United Mine Workers of America 1974 Pension Plan (“Pension Plan”). In calculating Energy West’s withdrawal liability, the actuary did not rely on the Pension Plan’s performance to determine what discount rate to use but instead adopted a risk-free discount rate. An arbitrator upheld the risk-free discount rate and the district court granted summary judgment to the Pension Plan, enforcing the arbitral award.
The Second Circuit reversed because the actuary’s choice of a risk-free rate violates the MPPAA’s command. The court explained that to calculate Energy West’s withdrawal liability from the Pension Plan, the actuary was required to base his assumptions on the Plan’s actual characteristics. Because the actuary failed to do so, the court reversed the judgment of the district court and remanded for vacatur of the arbitration award. When the actuary calculates Energy West’s withdrawal liability, the discount rate assumption must be similar, but need not be identical, to the discount rate assumption used to calculate minimum funding. View "United Mine Workers of America v. Energy West Mining Company" on Justia Law
Posted in:
Insurance Law, Labor & Employment Law
Vantage Commodities Financial Services v. Assured Risk Transfer PCC
In this insurance coverage dispute, Plaintiff, an insured company, sought to sidestep its insurer by collecting a $22 million claim from ten insurance brokers and reinsurers. The district court dismissed Plaintiff’s claims for breach of contract and declaratory judgment.
The D.C. Circuit affirmed the district court’s dismissal. The court held that Plaintiff failed to plead facts to establish a contractual relationship with reinsurers. Plaintiff’s evidence of the reinsurance binders did not create a contractual relationship between Plaintiff and reinsurers. Further, the court held that summary judgment for reinsurers was proper; finding that Plaintiff’s claims of implied contract, promissory estoppel, and unjust enrichment are wholly unsupported by record evidence. The court further held that the “economic loss doctrine” bars Plaintiff’s claims against the other defendants. The economic loss doctrine prohibits claims of negligence where, as here, a claimant seeks to recover purely economic losses. View "Vantage Commodities Financial Services v. Assured Risk Transfer PCC" on Justia Law
Posted in:
Contracts, Insurance Law
UnitedHealthcare Insurance Co v. Becerra
UnitedHealthcare Medicare Advantage insurers challenged the Overpayment Rule, promulgated by the Centers for Medicare and Medicaid Services (CMS) under 42 U.S.C. 1301-1320d-8, 1395-1395hhh, in an effort to trim costs. The Rule requires that, if an insurer learns that a diagnosis submitted to CMS for payment lacks support in the beneficiary’s medical record, the insurer must refund that payment within 60 days. UnitedHealth claims that the Overpayment Rule is subject to a principle of “actuarial equivalence,” and fails to comply. Two health plans that pay the same percentage of medical expenses are said to have benefits that are actuarially equivalent.The D.C. Circuit rejected the challenge. Actuarial equivalence does not apply to the Overpayment Rule or the statutory overpayment-refund obligation under which it was promulgated. Reference to actuarial equivalence appears in a different statutory subchapter from the requirement to refund overpayments; neither provision cross-references the other. The actuarial-equivalence requirement and the overpayment-refund obligation serve different ends. The actuarial-equivalence provision requires CMS to model a demographically and medically analogous beneficiary population in traditional Medicare to determine the prospective lump-sum payments to Medicare Advantage insurers. The Overpayment Rule, in contrast, applies after the fact to require Medicare Advantage insurers to refund any payment increment they obtained based on a diagnosis they know lacks support in their beneficiaries’ medical records. View "UnitedHealthcare Insurance Co v. Becerra" on Justia Law
Feld v. Fireman’s Fund Insurance Co.
Plaintiff filed suit against FFIC to recover disputed expenses, largely attorney fees, that he incurred in an underlying action brought by his sister. The district court granted summary judgment for FFIC. The DC Circuit reversed in part and held that there were disputes of material fact as to whether the parties entered into a binding, enforceable rate agreement. In this case, the disputed communications to which FFIC points did not unambiguously show that the parties entered a rate agreement as asserted by FFIC. However, the court affirmed the district court's denial of plaintiff's motion to compel certain communications between FFIC and its attorneys. View "Feld v. Fireman's Fund Insurance Co." on Justia Law
Posted in:
Insurance Law
Katopothis v. Windsor-Mount Joy Mutual Insurance Co.
The DC Circuit vacated its previous opinion and substituted the following opinion.Homeowners filed suit against their insurance company for breach of contract when the company refused to cover flood damage to homeowners' residence. Homeowners also filed suit against their cleaning-and-restoration company for failing to adequately remedy the damage and prevent mold. The district court granted summary judgment for the insurance company and transferred the remaining claim to the district court based on lack of personal jurisdiction. The DC Circuit held that it lacked jurisdiction to review the transfer order. The court affirmed the grant of summary judgment, holding that homeowners' claim against the insurance company failed under Delaware law where there was no dispute that homeowners were away from their beach home for over 72 hours, which under the clear terms of the policy means the flooding occurred while the house was "unoccupied." View "Katopothis v. Windsor-Mount Joy Mutual Insurance Co." on Justia Law
Posted in:
Contracts, Insurance Law