Justia U.S. 11th Circuit Court of Appeals Opinion Summaries

Bernard Perez, an ophthalmologist, entered into a disability insurance contract with MONY Life Insurance Company in 1988. After being diagnosed with throat cancer in 2011, Perez began receiving monthly disability benefits. MONY later suspected Perez of dishonesty in his disability claims and financial information, leading to the discontinuation of payments in February 2018. MONY sued Perez for unjust enrichment, and Perez counterclaimed for breach of contract.The Middle District of Florida held a nine-day trial where evidence showed Perez's deceitful conduct, including misrepresenting his ownership in his medical practice and overstating his physical ailments. The jury found in favor of MONY on the unjust enrichment claim, awarding $388,000, and rejected Perez's breach of contract counterclaim.The United States Court of Appeals for the Eleventh Circuit reviewed the case. The court held that under Florida law, an unjust enrichment claim cannot proceed when an express contract covers the same subject matter. Therefore, the district court erred in allowing the unjust enrichment claim to go to the jury. The Eleventh Circuit set aside the jury's verdict on this claim and directed the district court to vacate the judgment awarding MONY $448,930.06.Regarding Perez's breach of contract counterclaim, the Eleventh Circuit found that the district court erred in failing to interpret the ambiguous term "acceptable proof of loss" in the insurance contract. However, this error was deemed harmless because the evidence overwhelmingly showed Perez's dishonesty in his proofs of loss. Thus, the jury's verdict against Perez on his breach of contract counterclaim was affirmed. The court also affirmed the district court's evidentiary rulings and denial of sanctions. View "MONY Life Insurance Co. v. Perez" on Justia Law

A property insurance dispute arose between a church in Albany, Georgia, and its insurer following storm damage in 2014. The church's property, which included asbestos tile roofs, was insured under an all-risks policy. After the storm, the insurer's adjuster estimated repair costs at $2,300, but the church's contractor estimated over $1.3 million for full roof replacement. The church sued for breach of contract and bad faith. In 2018, Hurricane Michael caused further damage, and the church filed a claim with a different insurer, obtaining a lower repair estimate. The original insurer argued that the church's failure to disclose this second claim constituted a material misrepresentation.The United States District Court for the Middle District of Georgia excluded evidence of the alleged misrepresentation, finding it irrelevant. The jury awarded the church $1.75 million in damages, and the insurer's motion for a new trial was denied. The insurer appealed, arguing that the exclusion of misrepresentation evidence was erroneous and that the damages award was speculative and contrary to the policy terms.The United States Court of Appeals for the Eleventh Circuit reviewed the case. It found that the insurer had waived its misrepresentation defense by not objecting during trial and by explicitly withdrawing the defense. The court also held that the jury's award, which included increased construction costs due to delays, was supported by sufficient evidence and did not constitute double recovery when combined with prejudgment interest. The court affirmed the district court's rulings and the jury's verdict. View "Central Baptist Church of Albany Georgia Inc v. Church Mutual Insurance Co." on Justia Law

Kepali Group procured insurance for its fleet of vehicles through an agent at Brown & Brown of Florida, with Prime Property & Casualty Insurance Company issuing a commercial automobile policy for the period from January 23, 2019, to January 23, 2020. The policy included a provision for after-acquired vehicles, requiring notification within 30 days of acquisition for coverage. On December 6, 2019, a 2009 Toyota Sienna owned by Kepali was involved in an accident. Kepali had acquired the vehicle on September 30, 2019, and notified Brown to add it to the Prime policy. Prime issued a quote for the additional premium, but Kepali did not pay it, and Prime did not issue an endorsement for the vehicle.The United States District Court for the Southern District of Florida ruled that Brown was acting as Kepali’s agent, not Prime’s, when attempting to procure insurance for the 3985 Toyota. However, the court concluded that the vehicle was covered under the policy’s after-acquired auto provision because Kepali met the two conditions: Prime covered all of Kepali’s vehicles, and Kepali notified Prime within 30 days of acquiring the vehicle. The court ruled that Prime had a duty to defend Kepali and Mr. Rodriguez but deferred ruling on the duty to indemnify until the underlying suit was resolved. The court granted summary judgment against Kepali and Mr. Rodriguez on their reformation and promissory estoppel claims and dismissed the remaining claims as moot.The United States Court of Appeals for the Eleventh Circuit affirmed the district court’s ruling. The court held that the after-acquired auto provision did not require payment of an additional premium within 30 days for coverage to continue. The court also found that the premium audit provision allowed Prime to compute the final premium and bill Kepali, and that Prime failed to perform this audit or send a bill. Therefore, Prime could not terminate coverage for non-payment without following the policy’s cancellation procedures. The court concluded that Prime had a duty to defend Kepali and Mr. Rodriguez in the underlying state court action. View "Prime Property and Casualty Insurance Company v. Kepali Group, Inc." on Justia Law

State Farm Mutual Automobile Insurance Company and others filed a lawsuit against Michael LaRocca and his associated chiropractic clinics, alleging that the clinics submitted fraudulent insurance claims for services that were not medically necessary. The clinics, owned by LaRocca, were operating under an exemption from Florida's Health Care Clinic Act, which requires clinics to be licensed unless they are wholly owned by licensed health care practitioners who are legally responsible for compliance with all federal and state laws.The United States District Court for the Middle District of Florida denied State Farm's motion for partial summary judgment, rejecting the argument that LaRocca's failure to ensure compliance with all laws invalidated the clinics' exemption and rendered their charges noncompensable. The court found that the term "legally responsible" did not impose an affirmative duty on LaRocca to ensure compliance with all laws but rather indicated accountability for violations.The United States Court of Appeals for the Eleventh Circuit reviewed the case and determined that the interpretation of "legally responsible" within the context of Florida's Health Care Clinic Act was a matter best decided by the Florida Supreme Court. The Eleventh Circuit certified the question to the Florida Supreme Court, seeking clarification on whether the term imposes an affirmative duty on clinic owners to ensure compliance with all federal and state laws to maintain their exemption status. The Eleventh Circuit deferred its decision pending the Florida Supreme Court's interpretation. View "State Farm Mutual Automobile Insurance Company v. LaRocca" on Justia Law

The case involves a shooting incident at the Pride of St. Lucie Lodge 1189, Inc. (the "Lodge") on March 2, 2015, where Tanya Oliver was shot in the forehead and later died from her injuries. The Lodge was insured by Kinsale Insurance Company ("Kinsale"), which had a $50,000 policy sublimit for claims arising out of assault and battery. The Estate of Tanya Oliver sued the Lodge for negligent security, and a jury awarded damages exceeding $3.348 million.The Lodge and the Estate then sued Kinsale for common law bad faith under Florida law, claiming Kinsale breached its duty of good faith by failing to make a settlement offer within the policy limits before the Estate’s claim was filed. The United States District Court for the Southern District of Florida granted summary judgment to Kinsale, concluding that Kinsale had no duty to initiate settlement negotiations because no reasonable jury could find that this was a case of "clear liability."The United States Court of Appeals for the Eleventh Circuit reviewed the case and found that, viewing the evidence in the light most favorable to the Lodge and the Estate, a jury could reasonably find that Kinsale knew or should have known that liability was clear. The court noted that the Lodge's security guards had failed to prevent a second fight in the parking lot, which led to the shooting, and that Kinsale was aware of the severity of Oliver's injuries and the potential for damages far exceeding the policy limit.The Eleventh Circuit reversed the district court's grant of summary judgment and remanded the case for trial by jury, holding that a jury could reasonably find that Kinsale acted in bad faith by failing to tender its policy limit before the Estate filed suit. View "Kinsale Insurance Company v. Pride of St. Lucie Lodge 1189, Inc." on Justia Law

Kaufman Lynn Construction was hired to build a corporate campus for JM Family Enterprises in South Florida. Kaufman obtained a commercial general liability policy from Liberty Surplus Insurance to cover itself and its subcontractors. After completing several buildings, Tropical Storm Eta caused significant water damage to the completed structures. Kaufman sought indemnification from Liberty, which denied the claim based on the policy's Course of Construction Exclusion (COCE), stating that coverage did not apply until the entire project was completed. Kaufman disputed this and filed a lawsuit against its subcontractors and initiated a claims process with Liberty.The United States District Court for the Southern District of Florida granted Liberty's motion for summary judgment, concluding that the COCE excluded coverage for the water damage because the entire project was not completed. The court also dismissed Kaufman's counterclaim for declaratory relief as duplicative and ruled that Kaufman's breach of contract counterclaim was moot. Additionally, the court dismissed Kaufman's reformation counterclaim for lack of standing, reasoning that Kaufman had not demonstrated a cognizable injury.The United States Court of Appeals for the Eleventh Circuit reviewed the case and determined that Kaufman had Article III standing to seek reformation of the policy, as it suffered a cognizable injury by receiving a policy different from what was bargained for. The court affirmed the district court's ruling that the COCE precluded coverage for the water damage, as the entire project was not completed. The court also affirmed the district court's denial of Liberty's motion for attorney's fees, as Liberty's settlement proposal did not comply with the requirements of Florida's offer of judgment statute and Rule 1.442(c)(2)(B). The case was remanded for further proceedings on the reformation counterclaim. View "Liberty Surplus Insurance Corp. v. Kaufman Lynn Construction, Inc." on Justia Law

This case involves a dispute between two insurance companies, Gemini and Zurich, over their respective contributions to a $2 million settlement arising from a fatal accident involving a tractor-trailer. FSR Trucking, the employer of the driver involved in the accident, was insured by Zurich for $1 million and by Gemini for $3 million. The settlement was paid with $2 million from Gemini and $1 million from Ryder’s insurer. The disagreement centers on how much each insurer should contribute to the $2 million paid by Gemini.The United States District Court for the Middle District of Florida granted summary judgment in favor of Zurich, ruling that both insurance policies were "mutually repugnant" and thus required pro rata contribution. Zurich had already tendered $500,000, which the court deemed its pro rata share. The court also awarded Gemini prejudgment interest on the $500,000 from the date of the settlement payment to the date Zurich tendered its share. Gemini appealed, seeking an additional $500,000, while Zurich cross-appealed the award of prejudgment interest.The United States Court of Appeals for the Eleventh Circuit reviewed the case de novo and reversed the district court's decision regarding the amount of contribution. The appellate court held that Gemini's policy was excess to Zurich's, based on the specific language in the "other insurance" clauses of both policies. Consequently, Zurich was required to pay an additional $500,000 to Gemini. The court affirmed the district court's award of prejudgment interest on the initial $500,000 and directed the lower court to award prejudgment interest on the additional $500,000 from the date of the settlement payment to the date of the amended final judgment. The case was remanded for entry of judgment consistent with these findings. View "Gemini Insurance Co. v. Zurich American Insurance Co." on Justia Law

A property-insurance dispute arose between a condominium association and its insurer after storms damaged the property. The association demanded an appraisal of the loss, and both parties selected appraisers who then chose an umpire. The association's appraiser disclosed, on the day of final negotiations, that he believed he had a financial stake in the award due to a contingency-fee retainer. The insurer did not object at that time, and the appraisal panel issued an award over a month later. Subsequently, the insurer moved to vacate the award, claiming the appraiser's partiality.The United States District Court for the Southern District of Florida denied the insurer's motion to vacate the award, ruling that the insurer had waived its objection by not raising it sooner. The court also confirmed the appraisal award.The United States Court of Appeals for the Eleventh Circuit reviewed the case and affirmed the district court's decision. The appellate court held that the insurer waived its objection to the appraiser's partiality by failing to object at the time of the disclosure. The court emphasized that a party must timely object to an arbitrator's or appraiser's partiality when it becomes aware of a potential conflict of interest. By waiting over two months and until after the award was issued, the insurer forfeited its right to challenge the appraiser's impartiality. The court did not address other arguments related to the choice of law or the appraiser's partiality, as the waiver issue was dispositive. View "Biscayne Beach Club Condominium Association, Inc. v. Westchester Surplus Lines Insurance Company" on Justia Law

Constantin, an accounting firm, performed an audit for Schratter Foods Incorporated, a food services company. The audit allegedly went wrong, leading to liability. Constantin had a professional services insurance policy from Chubb Insurance Company of New Jersey, which covered services directed toward expertise in banking finance, accounting, risk and systems analysis, design and implementation, asset recovery, and strategy planning for financial institutions. Constantin assigned its rights under the policy to ECB USA, Inc., Atlantic Ventures Corp., and G.I.E. C2B (collectively, the ECB parties).The ECB parties sued Chubb in the United States District Court for the Southern District of Florida, seeking to enforce Constantin’s assigned contractual rights, alleging a breach of contract based on Chubb’s duty to defend or indemnify in the earlier lawsuit. The district court granted summary judgment to Chubb, ruling that the insurance policy did not cover the audit because it was not performed for a financial institution. The court also granted reformation of the 2017–18 contract to include Constantin as a named insured.The United States Court of Appeals for the Eleventh Circuit reviewed the case. The court held that the phrase “for financial institutions” in the insurance policy modified all the terms in the list, including “accounting.” The court applied the series-qualifier canon of interpretation, which suggests that a postpositive modifier like “for financial institutions” modifies all the terms in a list of parallel items. The court found that the surrounding language of the policy supported this interpretation. The court rejected ECB’s arguments based on the last-antecedent canon and contra proferentem, concluding that the policy unambiguously required the services to be for financial institutions. Therefore, the court affirmed the district court’s grant of summary judgment to Chubb. View "ECB USA, Inc. v. Chubb Insurance Company of New Jersey" on Justia Law

The case involves two brothers, Levi and Benjamin Goldfarb, who sought payment of a $500,000 claim under an Accidental Death & Dismemberment insurance policy after their father, Dr. Alexander Goldfarb, died while mountain climbing in Pakistan. The insurer, Reliance Standard Life Insurance Company, denied the claim because the cause of Dr. Goldfarb’s death was unknown, and therefore, his beneficiaries could not show that he died by accident. The Goldfarb brothers challenged the denial in district court under the Employee Retirement Security Act.The district court ruled in favor of the Goldfarbs, stating that Dr. Goldfarb’s death was accidental and that Reliance Standard’s failure to pay the Accidental Death & Dismemberment claim was arbitrary and capricious. The court granted summary judgment to the Goldfarbs and denied Reliance Standard’s cross motion for summary judgment. Reliance Standard appealed this decision.The United States Court of Appeals for the Eleventh Circuit disagreed with the district court's decision. The appellate court found that Reliance Standard’s decision that Dr. Goldfarb’s death was not accidental under the insurance policy was supported by reasonable grounds, and the denial of the Goldfarbs’ claim for benefits was not arbitrary and capricious. Therefore, the court reversed the district court’s grant of summary judgment to the Goldfarbs and directed the court to enter judgment in Reliance Standard’s favor. View "Goldfarb v. Reliance Standard Life Insurance Co." on Justia Law