Articles Posted in Insurance Law

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Plaintiff-petitioner Charissa Schultz was injured in a 2015 car accident in which the other driver failed to stop at a stop sign. The other driver’s insurance company settled for its $25,000 policy limit, and Schultz made a demand on her own uninsured/underinsured motorist benefits under her GEICO policy, which also had a $25,000 limit. In April 2017, after months of correspondence and apparent review of an MRI performed on Schultz in April 2015, GEICO offered Schultz its full policy limit, and it did so without requesting that she undergo an independent medical examination (“IME”). Indeed, GEICO’s claim logs reveal that at the time GEICO decided to offer Schultz its policy limits, it “concede[d] peer review wouldn’t be necessary,” indicating an affirmative decision not to request an IME. A few months later, Schultz filed the present lawsuit asserting claims for bad faith breach of an insurance contract and unreasonable delay in the payment of covered benefits. GEICO denied liability, disputing the extent and cause of Schultz’s claimed injuries and asserting that causation surrounding the knee replacement surgeries was “fairly debatable” because Schultz had preexisting arthritis, which GEICO claimed may independently have necessitated her surgeries. To establish its defense, GEICO ordered the IME and the district court granted that request. The Colorado Supreme Court concluded GEICO’s conduct had to be evaluated based on the evidence before it when it made its coverage decision and that, therefore, GEICO was not entitled to create new evidence in order to try to support its earlier coverage decision. The Court also concluded the district court abused its discretion when it ordered Schultz to undergo an IME over three years after the original accident that precipitated this case and a year and a half after GEICO had made the coverage decision at issue. View "Schultz v. GEICO Casualty Company" on Justia Law

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At issue before the Colorado Supreme Court in this matter was the issue of whether an insured was entitled to collect prejudgment interest when he settles an uninsured motorist claim (“UM claim”) with his insurer in lieu of filing a lawsuit and proceeding to judgment. The Court held that under the plain language of the prejudgment interest statute, 13-21-101, C.R.S (2017), an insured is entitled to prejudgment interest only after: (1) an action is brought; (2) the plaintiff claims damages and interest in the complaint; (3) there is a finding of damages by a jury or court; and (4) judgment is entered. Because the plaintiff in this case did not meet all of these conditions, he was not entitled to prejudgment interest. View "Munoz v. Am. Fam. Ins. Co." on Justia Law

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This case concerned a discovery dispute arising out of an automobile accident in which Gary Griggs, a driver insured by State Farm, injured Susan Goddard and several others. State Farm sought a declaratory judgment that Griggs breached the contractual duties set forth in his insurance policy by executing a settlement agreement pursuant to Nunn v. Mid-Century Insurance Co., 244 P.3d 116 (Colo. 2010), in which he waived a jury trial, consented to arbitration, and assigned to Goddard any rights that he had against State Farm. Goddard counterclaimed, asserting, among other things, that State Farm acted in bad faith by refusing both to settle her claims against Griggs and to indemnify Griggs for the judgment entered against him after the arbitration to which Griggs had consented. The district court determined State Farm impliedly waived the attorney-client privilege protecting communications between it and its former counsel when it submitted an affidavit from that former counsel to rebut allegations of discovery misconduct. The Colorado Supreme Court concluded after review that the attorney affidavit submitted in this case did not place any privileged communications at issue. Accordingly, the district court erred in finding that State Farm impliedly waived its attorney-client privilege. View "State Farm v. Griggs" on Justia Law

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The United States District Court for the District of Colorado certified a question of law to the Colorado Supreme Court. The question asked for an interpretation of the meaning of the words “suicide, sane or insane,” when used in life insurance policies. The Colorado Supreme Court concluded that, under Colorado law, a life insurance policy exclusion for “suicide, sane or insane” excluded coverage only if the insured, whether sane or insane at the time, committed an act of self-destruction with the intent to kill himself. View "Renfandt v. New York Life Insurance Company" on Justia Law

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The U.S. District Court for the District of Colorado certified a question of Colorado law to the Colorado Supreme Court regarding the statute of limitations applicable to section 10-3-1116, C.R.S. (2017), which governed claims for unreasonable delay or denial of insurance benefits. Specifically, the question centered on whether a claim brought pursuant to Colorado Revised Statutes section 10-3-1116 was subject to the one-year statute of limitations found in Colorado Revised Statutes section 13-80-103(1)(d) and applicable to “[a]ll actions for any penalty or forfeiture of any penal statutes.” The Supreme Court held the one-year statute of limitations found in section 13-80-103(1)(d), C.R.S. (2017), did not apply to an action brought under section 10-3-1116(1) because section 10-3-1116(1) was not an “action[] for any penalty or forfeiture of any penal statute[]” within the meaning of section 13-80-103(1)(d). Therefore, the Court answered the certified question in the negative. View "Rooftop Restoration, Inc. v. Am. Family Mut. Ins. Co." on Justia Law

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Nine days after the jury returned its verdict, but before the trial court reduced that verdict to a written and signed judgment, Michael Casper died. Consequently, the defendant, Guarantee Trust Life Insurance Company (“GTL”), moved to substantially reduce the verdict, arguing that the survival statute barred certain damages under the policy that insured Casper. The trial court denied the motion, and the court of appeals affirmed. The Colorado Supreme Court granted GTL’s petition to review the court of appeals’ decision, and concluded that the survival statute did not limit the jury’s verdict in favor of Casper. The Court also concluded that an award of attorney fees and costs under section 10-3-1116(1) was a component of the “actual damages” of a successful claim under that section. Finally, the Court concluded that although the survival statute did not limit the damages awarded by the jury, the trial court abused its discretion by entering a final judgment on October 30, 2014, nunc pro tunc to July 15, 2014. View "Guarantee Trust Life Ins. Co. v. Estate of Casper" on Justia Law

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In 2009, a fire started in an apartment building owned by respondents Guillermo and Evelia Barriga and insured by petitioner American Family Mutual Insurance Company (“American Family”). American Family made various payments to the and on behalf of the Barrigas, totaling $209,816.43. However, after a substantial amount of repair work had been completed, the contractor revised its estimate for the cost of the repairs. The revised estimate was higher than American Family’s initial estimate, primarily because of the need for additional repairs and asbestos remediation. In response, American Family initiated a third-party appraisal process outlined in the insurance policy intended to provide an impartial assessment of the needed repair costs. The appraiser fixed the award at $322,141.79. American Family then paid that award, less the $209,816.43 that had been previously paid to the Barrigas, resulting in a payment of $122,325.36. American Family also made an additional payment of $5435.44 for emergency board-up services. The Barrigas sued American Family for breach of contract, common law bad-faith breach of insurance contract, and unreasonable delay and denial of insurance benefits under section 10-3-1116(1), C.R.S. (2017). The jury found for the Barrigas on all claims, awarding damages, as relevant here, of $9270 for breach of contract and $136,930.80 for benefits unreasonably delayed or denied. The issue raised on appeal for the Colorado Supreme Court's review centered on whether an award of damages under section 10-3-1116(1), C.R.S. (2017), had to be reduced by an insurance benefit unreasonably delayed but ultimately recovered by an insured outside of a lawsuit. The Court held that an award under section 10-3-1116(1) must not be reduced by an amount unreasonably delayed but eventually paid by an insurer because the plain text of the statute provided no basis for such a reduction. The Court also concluded that a general rule against double recovery for a single harm did not prohibit a litigant from recovering under claims for both a violation of section 10-3- 1116(1) and breach of contract. View "Am. Family Mut. Ins. Co. v. Barriga" on Justia Law

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An underinsured motorist struck a car driven by Dale Fisher, causing Fisher injuries requiring over $60,000 in medical care. Fisher was not at fault, and he was covered under multiple State Farm underinsured motorist (“UIM”) insurance policies. State Farm agreed that Fisher’s medical bills were covered under the UIM policies, but it disputed other amounts Fisher sought under the policies, including lost wages. So, State Farm refused to pay Fisher’s medical bills without first resolving his entire claim. Fisher sued, alleging State Farm had unreasonably delayed paying his medical expenses. In response, State Farm argued it had no duty to make piecemeal payments, even for Fisher’s undisputed medical expenses, when it disputed the rest of Fisher’s UIM claim. A jury returned a verdict in Fisher’s favor, finding that State Farm had violated section 10-3-1115, C.R.S. (2017), which provides that an insurer “shall not unreasonably delay or deny payment of a claim for benefits owed to or on behalf of any first-party [insured] claimant.” A division of the court of appeals affirmed. The issue this case presented for the Colorado Supreme Court's review was whether auto insurers have a duty to pay undisputed portions of a UIM claim (like the medical expenses at issue here) even though other portions of the claim remain disputed. The Court held that insurers have a duty not to unreasonably delay or deny payment of covered benefits, even though other components of an insured’s claim may still be reasonably in dispute. Thus, the Court affirmed the judgment of the court of appeals. View "State Farm v. Fisher" on Justia Law

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Caroline Burton and Brenda Olivar submitted claims for long-term disability benefits to insurance companies under employee-benefits plans set up by their employers (“the Plans”). The insurance companies denied Burton’s and Olivar’s claims. Burton and Olivar sued the Plans under the Employee Retirement Income Security Act (“ERISA”) for benefits due to them under the insurance policies. But neither served the Plans. Rather, they each served complaints on the United States Department of Labor Secretary, relying on an ERISA provision allowing such service when a plan hasn’t designated “an individual” as an agent for service of process. In both cases, the Labor Secretary never forwarded the complaint to the Plans’ designated agents for service of process, the Plans failed to answer, and Burton and Olivar obtained default judgments in their favor. Eventually, the Plans moved to set aside the default judgments for improper service, which the trial courts granted in both cases. Later, the Plans moved for summary judgment, arguing the insurers, which were obligated to make all eligibility determinations and payments under the Plans’ terms, were the only proper party defendants. The trial courts agreed, granting the Plans summary judgment. A division of the court of appeals affirmed. The issue presented to the Colorado Supreme Court for resolution centered on whether ERISA’s use of the term “individual” provided that service on the Labor Secretary was sufficient when a plan designates a corporation (instead of a natural person) as its administrator and agent for service of process. Finding no reversible error in the district court’s judgment, the Supreme Court affirmed. View "Burton v. Colorado Access & No." on Justia Law

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The Colorado Supreme Court concluded here that nothing in the language of the Colorado uninsured/underinsured motorist statute, 10-4-609 C.R.S. (2016) precluded an agent from exercising either apparent or implied authority to reject UM/UIM coverage on behalf of a principal. In line with this reasoning, the agent’s rejection of UM/UIM coverage was indeed binding on the principal. Respondent Brian Johnson tasked a friend with purchasing automobile insurance for the new car that he and the friend had purchased together. The friend did so, and in the course of that transaction, she chose to reject uninsured/underinsured motorist (UM/UIM) coverage on the new car. After an accident in that car with an underinsured motorist, Johnson contended that his friend’s rejection of UM/UIM coverage was not binding on him. View "State Farm v. Johnson" on Justia Law