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

Plaintiff, a class representative, appealed the district court's dismissal of her complaint for failure to state a claim and its order denying her motion for reconsideration. Plaintiff argued that examinations under oath (EUOs) were impermissible conditions precedent to personal injury protection (PIP) coverage under Florida law and the Florida No-Fault automobile insurance statute based on the Florida Supreme Court's decision in Custer Med. Ctr. v. United Auto. Ins. Co. As a result of varying interpretations of Custer in the lower Florida state courts, the court concluded that Florida law was unclear in the context of statutorily mandated insurance and the Florida No-Fault Statute and certified this question to the Florida Supreme Court. View "Nunez v. GEICO General Ins. Co." on Justia Law

In an insurance coverage dispute, the court was required to determine, under Florida law, what constituted "property damage" under a post-1986 standard form commercial general liability (CGL) policy with products-completed operations hazard (PCOH) coverage. Specifically, whether such a policy issued to a general contractor for damage to the part of the completed project performed by a subcontractor, but not to any other project component, caused by a subcontractor's defective work. In light of Florida precedent addressing the scope of similar CGL policies, the court concluded that the policy provided no coverage in this case. Therefore, the court affirmed the judgment of the district court, holding that the damage at issue was not covered under the policy. View "Amerisure Mutual Ins. Co., et al. v. Amelia Island Co." on Justia Law

This case arose when plaintiff sought review of the denial of her long-term disability insurance benefits from Prudential. Upon the parties' cross motions for summary judgment, the district court entered partial summary judgment for plaintiff on some issues and remanded the case to Prudential to decide in the first instance whether plaintiff was disabled. Prudential subsequently appealed, asserting jurisdiction under 28 U.S.C. 1291. After Prudential initiated the appeal, it acted on the district court's remand order and determined that plaintiff was disabled. The court invited the parties to submit supplemental briefs and after reviewing these submissions, the court concluded that the district court's order granting plaintiff partial summary judgment and remanding the case to the plan administrator, Prudential, for further proceedings, was not a final decision under section 1291. Nor was that order appealable under the collateral order doctrine. Therefore, the court lacked jurisdiction to hear the appeal. View "Young v. The Prudential Ins. Co., et al." on Justia Law

This case involved a dispute between plaintiff and other class members (insureds) and Pioneer, which was succeeded in this action by Washington National. The controversy was over the proper interpretation of certain similar insurance contracts under Florida law. Washington National appealed the district court's grant of summary judgment for the insureds. The court agreed with the district court and held that the policies in question were ambiguous, but concluded that Florida law was unsettled on the proper way to resolve the ambiguity. To establish the proper approach to take under Florida law in interpreting ambiguity, the court certified the following question to the Supreme Court of Florida: In this case, does the Policy's "Automatic Benefit Increase Percentage" apply to the dollar values of the "Lifetime Maximum Benefit Amount" and the "Per Occurrence Maximum Benefit"? View "Ruderman, et al. v. Washington Nat'l Ins." on Justia Law

Plaintiff, suing on behalf of her husband, obtained a judgment against defendant for benefits payable under a home health care insurance policy. Defendant appealed and following a judgment, the district court awarded plaintiff attorney's fees and costs. Defendant again appealed. The court held that the district court properly granted summary judgment to plaintiff, rejecting defendant's contention that the custodial care expenses claimed were not covered expenses under the policy. Case No. 10-15115 was affirmed. Because defendant challenged the award of attorneys' fees and costs in Case No. 10-15878 on the sole ground that summary judgment was improperly granted in Case No. 10-15115, the award of attorneys' fees and costs in Case No. 10-15878 was affirmed.

Plaintiff filed a complaint against State Farm in state court alleging claims of breach of contract, bad faith, and fraud. The court must decide whether an insured's claim against his insurer for breach of contract was barred by the insurance policy's one-year limitation to suit, or whether the court must reform the insurance policy to include a two-year limitation to suit, pursuant to Ga. Comp. R. & Regs. 120-2-20-.02. In making that determination, the court must address whether Rule 120-2-20-.02, a regulation promulgated recently by the Georgia Insurance Commissioner, was valid under Georgia law. Because this appeal presented questions of state law that have not yet been addressed by the Georgia appellate courts, the court certified two questions to the Supreme Court of Georgia.

This appeal involved an insurance dispute related to plaintiff's purchase of an Allstate landlord insurance policy from Edwards, a Georgia corporation, for a property plaintiff owned in Georgia. Plaintiff, a Georgia resident, sued Allstate, an Illinois corporation, in Georgia state court alleging that Allstate breached its insurance contract with plaintiff and acted in bad faith when it denied plaintiff's claim for water damage. Plaintiff then filed a second state court suit against Allstate and Edwards alleging that Allstate again breached its insurance contract with plaintiff and acted in bad faith when it denied plaintiff's claim for fire damage, and that Edwards breached its fiduciary duty to plaintiff when it failed to procure appropriate insurance coverage for plaintiff. Allstate removed both cases to federal court based on diversity jurisdiction. The district court denied plaintiff's motion to remand the second case to Georgia state court and the two cases were subsequently consolidated. Plaintiff appealed the denial of his motion to remand the second case against Allstate and Edwards, and the adverse summary judgment in both cases. The court held that the district court erred in concluding that Edwards was fraudulently joined and the fire damage case was remanded to state court. The court affirmed summary judgment in favor of Allstate in the water damage case where the district court properly concluded that plaintiff's property was not covered under the policy.

This case stemmed from a controversy between the insured and their insurer over whether the insurer breached its obligations under a commercial general liability insurance policy that the insureds had with the insurer at the time of the accident. The coverage dispute arose out of a personal injury lawsuit filed against the insured by an injured homeowner. Because the case involved unanswered questions of Florida law that were central to the appeal and because these questions were determinative of the cause in this case and there were no controlling precedents from the Supreme Court of Florida, the court certified these questions for resolution.

This case arose when plaintiff, who was exposed to various chemicals during his employment with defendant and subsequently became legally blind in both eyes, sought workers compensation benefits under the Longshore and Harbor Workers' Compensation Act (LHWCA), 33 U.S.C. 901-950. At issue was which date - the date on which disability occurred, or the date one which the injured employee was awarded benefits for such disability - determined the maximum weekly rate of compensation for a permanently totally disabled employee who was "newly awarded compensation." The court applied long-standing principles of statutory construction and found that the maximum weekly rate of compensation was governed by the rate in effect at the time of the award. Therefore, the court reversed the decision of the district court and remanded for calculation of the sum to be paid.

This case involved a dispute over the proper interpretation under Georgia law of a real property insurance contract between plaintiff and defendant. The insurance policy provided coverage for "direct physical loss of or damage to" a building plaintiff owned in the Buckhead area of Atlanta. At issue was whether the Georgia courts would hold that the State Farm Mutual Automobile Insurance Company v. Mabry rule extended to standard insurance contracts for buildings. Because this was an important unsettled question of state law, and there was no controlling precedent from the Georgia state courts, the court certified the question to the Supreme Court of Georgia.