Justia U.S. 11th Circuit Court of Appeals Opinion SummariesArticles Posted in Insurance Law
MSPA Claims 1, LLC v. Kingsway Amigo Insurance Company
Of two people injured in a car wreck in April 2012, one was a Medicare beneficiary who received her benefits from an MAO-Florida Healthcare Plus, which later assigned its claims to appellant MSPA Claims 1, LLC. The other party involved in the accident was insured by appellee Kingsway Amigo Insurance. The Medicare beneficiary obtained medical treatment for her accident-related injuries between April 29, 2012 and July 26, 2012, and Florida Healthcare made $21,965 in payments on her behalf. On March 28, 2013, the beneficiary settled a personal-injury claim with Kingsway and received a $6,667 settlement payment. The issue this case presented for the Eleventh Circuit’s review centered on the timeliness requirement with which the government had to comply as a prerequisite to filing suit to seek reimbursements that it made on behalf of the Medicare beneficiary, and whether filing suit beyond a statutory three-year period beginning on the date on which medical services were rendered was fatal to the government’s claim. The district court held that MSPA’s claim was stale because it didn’t comply with what the court (somewhat confusingly) called “the three-year limitation requirement.” The Eleventh Circuit disagreed and reversed. “The Medicare Secondary Payer Act’s private cause of action, and our cases interpreting it lead us to conclude that the Act’s claims-filing provision, doesn’t erect a separate bar that private plaintiffs must overcome in order to sue. A closer look at the claims-filing provision’s text and the Act’s structure confirms that conclusion. Accordingly, the district court erred in granting Kingsway’s motion for judgment on the pleadings.” View "MSPA Claims 1, LLC v. Kingsway Amigo Insurance Company" on Justia Law
Crawford’s Auto Center, Inc. v. State Farm Mutual Automobile Insurance Co.
Two auto body collision repair shops filed a class action against dozens of insurance defendants, alleging claims under the Racketeer Influenced and Corrupt Organizations Act (RICO) and state law fraud and unjust enrichment theories. The Eleventh Circuit affirmed the district court's grant of defendants' motion to dismiss each of plaintiffs' claims. The court held that plaintiffs failed to allege at least two predicate acts of racketeering activity, fraud or extortion. The court also held that plaintiffs have not sufficiently pleaded their state law fraud and unjust enrichment claims; the district court did not err by excluding exhibits E1-E7; and the district court did not err by dismissing the complaint with prejudice. View "Crawford's Auto Center, Inc. v. State Farm Mutual Automobile Insurance Co." on Justia Law
Hallums v. Infinity Insurance Co.
The Eleventh Circuit affirmed the district court's grant of summary judgment to defendants in a putative class action seeking damages and a declaration that vehicle insurance purchased by plaintiffs was not valid. Plaintiffs alleged that the endorsement in the policy was illusory because it only provides coverage for vicarious liability against lessors, and that liability was foreclosed by the Graves Amendment. Determining that plaintiffs had Article III standing, the court held that the endorsement was not illusory because it imposed on defendants a duty to defend lessors from claims of vicarious liability. View "Hallums v. Infinity Insurance Co." on Justia Law
Geico Marine Insurance Co. v. Shackleford
Geico Marine filed suit seeking a declaration that a navigational limit in the policy with defendant that required the vessel to be north of Cape Hatteras, North Carolina, during hurricane season barred coverage. The district court ruled against Geico Marine and declared that the policy covered the loss. The Eleventh Circuit reversed and remanded, holding that the navigational limit barred coverage. In this case, the policy was not ambiguous about whether it contained a navigational limit when the loss occurred, and the plain language of the policy contained a navigational limit. Because the navigational limit was dispositive where the vessel suffered damage while outside the covered navigational area, the court need not address the breach of a duty of uberrimae fidei. View "Geico Marine Insurance Co. v. Shackleford" on Justia Law
Principle Solutions Group, LLC v. Ironshore Indemnity, Inc.
After a scammer posing as an executive of Principle Solutions persuaded an employee to wire money to a foreign bank account, Principle Solutions sought coverage under the "fraudulent instruction" provision of its insurance policy with Ironshore. Ironshore denied Principle Solution's claim, asserting that the scammer's communications with the employee did not meet the conditions for a fraudulent instruction. The Eleventh Circuit affirmed the district court's grant of summary judgment. The court held that the policy unambiguously covered Principle Solutions' claim, because the loss involved a fraudulent instruction directing a financial institution to transfer funds and the loss resulted directly from the fraudulent instruction. View "Principle Solutions Group, LLC v. Ironshore Indemnity, Inc." on Justia Law
Crowley Maritime Corp. v. National Union Fire Insurance Co.
After obtaining an unfavorable result in an arbitration proceeding, Crowley Maritime filed suit against its insurer, National Union, seeking reimbursement in legal defense fees paid on behalf of an employee of Crowley. The district court granted National Union's converted motion for summary judgment on grounds that Crowley failed to timely report the claim at issue in this appeal to National Union as required by the relevant insurance policy. Applying Florida law, the Eleventh Circuit affirmed the district court's grant of National Union's converted motion for summary judgment, holding that the record supports the conclusion that Crowley failed to timely report the claim based on the affidavit as required by the policy. The court held that, with respect to the reporting period between April 16, 2008 and December 31, 2012, Crowley was bound by the arbitration panel's finding that Crowley had not reported a claim to National Union as required by the policy at that time; with respect to the reporting period beginning immediately after December 31, 2012 and running through the end of the discovery period on November 1, 2013, Crowley failed to report the claim based on the affidavit as required by section 7(a) of the policy; and Crowley has waived any arguments that either its February 2013 notice or its July 2015 notice should relate back to the April 2008 notice under section 7 of the policy. View "Crowley Maritime Corp. v. National Union Fire Insurance Co." on Justia Law
Ace American Insurance Co. v. The Wattles Company
In this property insurance coverage dispute, the insurer appealed the district court's grant of summary judgment and coverage award to the landlord. The Eleventh Circuit held that the district court erred in concluding the deductible was satisfied. In this case, the district court erred in determining that the Tenants and Neighbors Provision was ambiguous and concluding that it extended coverage under this property insurance policy for the landlords' attorneys' fees amount and the post-judgment interest amount. Accordingly, the court reversed and remanded with instructions to enter summary judgment -- and an order declaring that the policy did not provide coverage to the landlord -- in favor of the insurer. View "Ace American Insurance Co. v. The Wattles Company" on Justia Law
A&M Gerber Chiropractic LLC v. GEICO General Insurance Co.
The Eleventh Circuit granted Gerber's petition for panel rehearing and vacated its prior opinion, substituting the following opinion. In this insurance dispute case, the court held that Gerber, as assignee, lacked Article III standing to bring a declaratory judgment class action against GEICO in the absence of a claim for money damages or substantial likelihood that the insured would suffer a future injury. Accordingly, the court vacated the district court's judgment because it had no jurisdiction to entertain this suit. The court instructed the district court to remand the case to the circuit court. View "A&M Gerber Chiropractic LLC v. GEICO General Insurance Co." on Justia Law
A&M Gerber Chiropractic LLC v. Geico General Insurance Co.
The Eleventh Circuit dismissed this insurance dispute case, holding that Gerber, as assignee of the insured, did not have standing to bring a declaratory judgment class action against GEICO. In this case, the action did not assert any claims for money damages and there was no substantial likelihood that the insured would suffer a future injury. Accordingly, the court reversed and remanded with instructions to dismiss the complaint for lack of standing. View "A&M Gerber Chiropractic LLC v. Geico General Insurance Co." on Justia Law
Sun Life Assurance Company of Canada v. Imperial Premium Finance, LLC
These appeals relate to life insurance policies that were issued by Sun Life to non-parties and that were subsequently acquired by Imperial. The district court dismissed all claims in both cases. The Eleventh Circuit held that Sun Life waived its opportunity to rely on non-forum law to interpret the policies at issue and thus interpreted the relevant policies under Florida law. In regard to Sun Life's complaint, the court affirmed the district court's dismissal of the fraud conspiracy and declaratory judgment counts; and vacated the dismissal of the RICO, RICO conspiracy, fraud, aiding and abetting fraud, and tortious interference with contractual relations counts. In regard to Imperial's complaint, the court affirmed the breach of contract count to the extent it asserted a breach of the rights-and-privileges clause. The court vacated the district court's dismissal of the breach of contract count to the extent it asserted a breach of the incontestability clause. The court remanded for further proceedings. View "Sun Life Assurance Company of Canada v. Imperial Premium Finance, LLC" on Justia Law