Justia U.S. 4th Circuit Court of Appeals Opinion Summaries

Articles Posted in Insurance Law
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First Baptist retained Skyline to provide emergency remediation services to address wind damage to First Baptist’s real estate. Skyline then received the right to collect any proceeds from First Baptist's insurance policy with Church Mutual. Church Mutual subsequently disputed coverage in part and Skyline filed suit to recover the value of services provided to First Baptist but not paid by Church Mutual.The Fourth Circuit affirmed the district court's dismissal of Skyline's claims because they were barred by the applicable North Carolina statute of limitations. The court found that the applicable statute of limitations is three years from the date of loss, and agreed that Skyline's claims for declaratory judgment and breach of contract are time barred because Skyline brought this action in November 2019, more than three years after the time of loss; October 2016. The court denied as moot Church Mutual's motion to strike part of Skyline's reply brief. View "Skyline Restoration, Inc. v. Church Mutual Insurance Co." on Justia Law

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In 2003, Shupe was an Executive Sous Chef for Hyatt when he began experiencing symptoms of osteomyelitis, an infection in his spinal cord. He was 37 years old. After rounds of antibiotics and surgery, he was unable to maintain his employment and left his position in July 2004 due to pain from chronic osteomyelitis, degenerative disc disease in the lumbar spine, and spinal stenosis that was so severe that he could not stand for an extended period of time. Hyatt’s long-term disability plan, a “qualified” plan under the Employee Retirement Income Security Act of 1974, paid Shupe disability benefit for 11 years. Hartford then terminated his benefits, finding that there were alternative occupations that Shupe could physically perform, was qualified for, and pay greater than 60% of his prior salary, so that he did not meet the plan’s definition of “disabled.”The district court rejected Shupe’s 29 U.S.C. 1132(a)(1)(B) suit on summary judgment. The Fourth Circuit reversed, in favor of Shupe. His post-termination evaluations, coupled with Shupe’s contemporaneous medical history, all uniformly conclude that Shupe was incapable of full-time sedentary employment. Hartford’s assessment was an “outlier.” View "Shupe v. Hartford Life & Accident Insurance Co." on Justia Law

Posted in: ERISA, Insurance Law
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At issue in this appeal is whether the district court had subject matter jurisdiction over an interpleader action commenced by a liability insurance company, whose policy was exposed to conflicting and excess claims. In this case, AmGuard, a Pennsylvania corporation with its principal place of business in Pennsylvania, commenced this action in the nature of an interpleader and for a declaratory judgment against its insured and the claimants to the proceeds of its policy, all of whom were South Carolina citizens.The Fourth Circuit reversed the district court's dismissal of the action based on lack of subject matter jurisdiction. The court explained that, because AmGuard disputed the amount that the claimants maintained was available under AmGuard's policy, having acknowledged coverage for only a lesser amount, it was a "claimant" adverse to the other claimants to the proceeds of the policy. Therefore, the diverse citizenship between AmGuard and the South Carolina claimants provided the district court with the minimal diversity needed for jurisdiction under 28 U.S.C. 1335. Furthermore, 28 U.S.C. 1332 also provided the district court with jurisdiction to resolve AmGuard's declaratory judgment claim, yet the district court dismissed the entire action without addressing why it did not have jurisdiction under section 1332. The court concluded that this error also required reversal. The court remanded for further proceedings. View "AmGuard Insurance Co. v. SG Patel and Sons II LLC" on Justia Law

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In 2012, Bishop Lawrence sought to disaffiliate his South Carolina-based diocese from the Episcopal “Mother Church”. Some parishes followed suit. The Mother Church purported to remove Lawrence and selected a new bishop. The Disassociated Diocese and Parishes sued the Mother Church to clarify their property rights in diocesan. The Mother Church filed counterclaims and separately filed trademark and false-advertising claims. Both cases are ongoing.The Church Insurance Company, wholly owned by the Church Pension Fund, is a freestanding nonprofit affiliated with the Mother Church. Captive insurance companies may only cover the risks of their parent companies and related entities. Before the schism, the Company issued a Diocesan Program Master Policy, listing as “named insured” the Episcopal diocese and listing 56 participant parishes, including the now-Disassociated Parishes, in its declarations. Each parish has a separate, individualized insurance policy and paid premiums directly to the Company. The policies provide liability coverage for injuries arising out of “infringement of copyright, title, slogan, trademark, or trade name” and include a broad duty to defend. The Company has reimbursed the Disassociated Parishes’ defense costs in connection with both lawsuits.The Associated Diocese sued the Company, alleging breach of contract, bad faith, breach of fiduciary duty, and aiding and abetting breach of fiduciary duty. The Fourth Circuit affirmed the dismissal of that suit for lack of standing. The Company has not strayed beyond its limitations as a captive insurer or breached its obligations under the policies, so there is no injury traceable to such conduct. View "Episcopal Church in South Carolina v. Church Insurance Company of Vermont" on Justia Law

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After Affinity was sued for allegedly submitting Medicaid reimbursement claims for services that they never provided, it sought coverage for the suit under its insurance policy with StarStone. StarStone denied coverage because the lawsuit's claims did not fall within the policy's coverage for "damages resulting from a claim arising out of a medical incident." The district court agreed and granted judgment on the pleadings against Affinity on a declaratory judgment claim and breach of contract claim.The Fourth Circuit first found that it had appellate jurisdiction over the appeal, because Affinity properly appeals from a "final" decision. In this case, Affinity properly appealed the district court’s order dismissing its contractual claims after voluntarily dismissing extra-contractual claims that were necessarily precluded by the order. On the merits, the court applied North Carolina law and held that the allegations in the underlying complaint fall within the insurance policy's coverage provision. The court found that the False Claims Act action "arises out of" a medical incident as required to fall under the coverage provision of StarStone's policy. Accordingly, the court vacated the district court's order granting StarStone's motion for judgment on the pleadings and vacated the order denying Affinity's motion for partial summary judgment. View "Affinity Living Group, LLC v. Starstone Specialty Insurance Co." on Justia Law

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The Fourth Circuit vacated the district court's declaratory judgment in favor of the insurer, holding that the district court abused its discretion when it assumed jurisdiction under the Declaratory Judgment Act. In this case, without addressing the decision to exercise its discretionary jurisdiction, the district court reached the merits despite a thin and ambiguous record. The court held that the district court created both a substantial question about whether Article III jurisdiction existed and a serious potential to interfere with ongoing state proceedings. Therefore, the court remanded with instructions to dismiss the action without prejudice. View "Trustgard Insurance Co. v. Collins" on Justia Law

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Neither the Worker's Compensation exclusion or the Employee Indemnification and Employer's Liability exclusion in a standard commercial automobile insurance policy barred coverage for the liability of a third-party permissive user of an insured vehicle who caused personal injuries to an employee of a named insured. While employees of Milton Hardware were performing construction work at the home of Rodney Perry, Milton Hardware's owner authorized Perry to move one of Milton Hardware's trucks. In doing so, Perry accidentally struck a Milton Hardware employee, Greg Ball, and caused him serious injuries. Ball requested indemnification from Milton Hardware's insurer, United Financial, but United Financial denied coverage. The district court granted a declaratory judgment in favor of United Financial, holding that the policy it issued to Milton Hardware did not cover Perry's liability for Ball's injuries.The Fourth Circuit vacated and held that, because Ball's negligence claim against Perry was a claim against a third party, rather than a claim against his employer for workers' compensation, the Worker's Compensation exclusion did not apply. The court also held that the policy's broader exclusion for Employee Indemnification and Employer's Liability, which on its face would apply to exclude coverage for Perry's liability to Ball, was inoperable because its limitation of coverage contravened West Virginia Code 33-6-31. Therefore, the court remanded for further proceedings. View "United Financial Casualty Co. v. Ball" on Justia Law

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Applying North Carolina law, the Fourth Circuit reversed the district court's judgment in favor of Penn National, holding that the district court erred by applying the prior publication exclusions to eliminate Penn National's duty to defend Beach Mart in the underlying lawsuit. In this case, a prior publication exclusion, like the one here, will not bar coverage for offensive publications made during the policy period which differ in substance from those published before commencement of coverage. Furthermore, because the prior publication exclusions could not eliminate Beach Mart's duty to defend, the district court erred in dismissing Beach Mart's counterclaims. Accordingly, the court remanded with instructions. View "Pennsylvania National Mutual Casualty Insurance Co. v. Beach Mart, Inc." on Justia Law

Posted in: Insurance Law
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Gateway filed suit to collect a $900,000 judgment from a contractor's liability insurer, Illinois Union. The Fourth Circuit held that the district court had diversity jurisdiction over the case and rightly refused to remand to state court. On the merits, the court held that Gateway's argument that Illinois waived certain defenses by failing to promptly inform Gateway of its coverage denial under Virginia Code section 38.2-2226 failed, because Illinois Union had not denied coverage because of the contractor's breach. In this case, the relevant policy covered only claims reported to the insurer during the policy period, and the policy expired 19 months before Illinois Union learned about Gateway's claim. Therefore, the court affirmed the district court's grant of summary judgment for Illinois Union. View "Gateway Residences at Exchange, LLC v. Illinois Union Insurance Co." on Justia Law

Posted in: Insurance Law
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The Fourth Circuit affirmed the district court's decision to vacate an arbitration award that the Farm won against a private insurance company that sold federal crop insurance policies to the Farm. The court held that, despite the strong presumption in favor of confirming arbitration awards pursuant to the Federal Arbitration Act (FAA), the insurance company met its heavy burden to prove that the arbitrator exceeded her powers by awarding extra-contractual damages, contrary to both the policy and binding authority from the Federal Crop Insurance Corporation (FCIC). In this case, the arbitrator exceeded her powers by both interpreting the policy herself without obtaining an FCIC interpretation for the disputed policy provisions, and awarding extra-contractual damages, which the FCIC has conclusively stated in multiple Final Agency Determinations could not be awarded in arbitration and can only be sought through judicial review. View "Williamson Farm v. Diversified Crop Insurance Services" on Justia Law