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

The assignees of two Medicare Advantage Organizations seek reimbursements from insurance companies that they allege qualify as primary payers of beneficiaries’ medical expenses. The insurance companies argued, and the district courts agreed, that the assignees’ claims are barred because both assignees failed to satisfy a procedural requirement: a contractual claims-filing deadline in one case and a statutory requirement of a pre-suit demand in the other. The assignees contend that the procedural requirements are preempted by the Medicare Secondary Payer Act.   The Eleventh Circuit affirmed. The court reasoned that Florida’s pre-suit demand requirement does not meet this relatively high bar. The statutory notice requirement and corresponding 30-day cure period are procedural requirements that may result in a brief delay. But the Florida law does not prevent or meaningfully impede the reimbursement of Medicare Advantage Organizations that Congress sought to facilitate. So, the provision does not create an unconstitutional obstacle to the purposes or operation of the Medicare Secondary Payer Act. View "MSP Recovery Claims, Series LLC v. United Automobile Insurance Company" on Justia Law

Life Insurance Company of North America (“LINA”) made multiple determinations that Plaintiff did not qualify for disability benefits under her long-term disability insurance policy and her life insurance policy. Plaintiff sued LINA for breach of contract and bad-faith failure to provide insurance benefits. The district court granted summary judgment for LINA on Plaintiff’s bad-faith claim based on the multiple medical opinions that supported LINA’s determinations. The district court held that, under Alabama law, Plaintiff could not recover mental anguish damages for her breach of contract claim and excluded evidence of such damages. Finally, following a jury verdict in Plaintiff’s favor on the breach of contract claim related to the long-term disability insurance policy, the district court determined that Plaintiff was entitled to simple pre-judgment interest at a rate of 1.5 percent under the policy and simple post-judgment interest at a rate of 0.08 percent pursuant to 28 U.S.C. Section 1961. In determining that the long-term disability insurance policy provided for simple rather than compound interest, the district court struck a document produced by Plaintiff because it was not properly authenticated. On appeal, Plaintiff argued that the district court erred at each of these steps.   The Eleventh Circuit affirmed. The court held that the evidence establishes that LINA had an arguable reason for determining that Plaintiff did not qualify for disability benefits under the disability policy. Further, the court wrote that the Supreme Court of Alabama has made clear that mental anguish damages are unavailable for breach of contract claims related to long-term disability insurance policies. View "Cherri Walker v. Life Insurance Company of North America" on Justia Law

Geico General Insurance Company (Geico) asserted eight claims against Glassco, Inc.: a declaratory judgment claim seeking a declaration that Glassco violated the Repair Act and that Geico had no duty to pay pending claims (count one); a federal racketeering claim (count two); a federal racketeering conspiracy claim (count three); a Florida Deceptive and Unfair Trade Practices Act claim (count four); a Florida racketeering claim (count five); a common law fraud claim (count six); an unjust enrichment claim (count seven); and a Repair Act claim (count eight). The district court denied summary judgment to the extent that Geico alleged that Glassco, Inc. made misrepresentations that amounted to fraud “independent of” Glassco’s violations of the Florida Motor Vehicle Repair Act. Geico tried to convert this nonfinal decision into a final decision by filing an amended complaint that removed the fraud allegations that were independent of the Repair Act violations.   The Eleventh Circuit dismissed the appeal explaining that because the district court denied summary judgment as to these fraud allegations, there is no final decision for Geico to appeal. The court held that it can’t exercise jurisdiction over this appeal simply because the alternative—sending this case back to the district court—may be inconvenient or inefficient. The court wrote that by dismissing this appeal today, it vindicates finality as the historic characteristic of federal appellate procedure, serves the important interests of judicial efficiency, and promotes the sensible policy of avoiding piecemeal appeals. View "Government Employees Insurance Company, et al. v. Jason Wilemon, et al." on Justia Law

An insured fell from a roof and became paralyzed from the waist down, never to walk again. Within months, his medical bills climbed past $400,000, and future costs were projected into the millions. Three insurance companies potentially provided coverage for the insured. This appeal is a battle between the two of them. The primary insurer was Southern Owners Insurance Company. At the time of the accident, the insured was performing subcontracting work for Beck Construction, which had a policy with American Builders Insurance Company and an excess policy with Evanston Insurance Company. American Builders investigated the accident, assessed Beck Construction’s liability, and evaluated the claim. Southern-Owners did little to nothing for months. American Builders then sued Southern-Owners for common law bad faith under Florida’s doctrine of equitable subrogation. Southern-Owners moved for summary judgment, but the district court denied the motion. A federal trial jury heard the case and found in favor of American Builders. After the entry of final judgment, Southern-Owners sought judgment matter of law or, in the alternative, a new trial. On appeal, Southern-Owners challenges the denials of its summary judgment and post-trial motions.   The Eleventh Circuit affirmed. The court held that taking the evidence in the light most favorable to American Builders, a reasonable jury could have found (as it did) both that Southern-Owners acted in bad faith and that its bad faith caused American Builders to pay its policy. Moreover, American Builders did not breach Southern-Owners’ contract and relieve Southern-Owners of its good-faith duties. The district court did not err in denying Southern-Owners’ Rule 50(b) motion. View "American Builders Insurance Company v. Southern-Owners Insurance Company" on Justia Law

This appeal arises out of an insurance dispute involving a yacht, the Serendipity, that was destroyed by Hurricane Dorian, a Category 5 storm, that slammed into Great Abaco Island in the Bahamas. Serendipity at Sea, LLC (“Serendipity, LLC”), a holding company created by M.S. and J.E. (“the Managers”) to manage the Serendipity, sued Underwriters at Lloyd’s of London Subscribing to Policy Number 187581 (“Lloyd’s”) for breach of contract after Lloyd’s denied the the Managers insurance claim for the damage Hurricane Dorian caused to the Serendipity. In denying that it had breached the contract, Lloyd’s argued that it was not liable because Serendipity, LLC did not employ a full-time licensed captain in violation of the policy’s Captain Warranty, and that the breach increased the hazard to the yacht because a licensed captain would have operated the vessel back to Florida when Hurricane Dorian formed and was forecast to hit the Bahamas.   The district court granted summary judgment in favor of Lloyd’s. It found that the Captain Warranty was unambiguous; that Serendipity, LLC breached the agreement by failing to hire a full-time licensed captain; and that the breach increased the hazard posed to the Serendipity based on the purportedly undisputed testimony of an expert hired by Lloyd’s. The Eleventh Circuit reversed the district court’s grant of summary judgment in favor of Lloyd’s and remanded. The court explained that while it agreed with the district court’s conclusion that Serendipity, LLC breached the Captain Warranty, a disputed question of material fact remains about whether the breach increased the hazard posed to the vessel. View "Serendipity at Sea, LLC v. Underwriters at Lloyd's of London Subscribing to Policy Number 187581" on Justia Law

North American issued two insurance policies for the life of J.C. On November 9, 2018, it issued a policy that named an irrevocable trust managed by the trustee as beneficiary. It issued a policy that named J.C.’s wife, as beneficiary. Each contained an essentially identical clause that excluded suicide from coverage under the policy. That clause read, “SUICIDE — If the Insured commits suicide, while sane or insane, within two years from the Policy Date, Our liability is limited to an amount equal to the total premiums paid.” In a motion for a judgment on the pleadings, the beneficiaries argued that “the entire lawsuit is predicated on [North American’s] erroneous position that the contract term ‘suicide’ is synonymous with the expression ‘suicide by cop,’ which is a term of art that actually refers to justifiable homicide.” The district court agreed that “[t]he plain meaning of the term ‘suicide’ encompasses the act of killing oneself—not the killing of a person by another” and granted the motion.   The Eleventh Circuit vacated and remanded finding that the ordinary meaning of “suicide” includes suicide-by-cop. The court explained that here, where the beneficiaries agree with the allegations in North American’s complaint due to the procedural posture of the case, no factual question exists. The ordinary meaning of “suicide” certainly covers J.C.’s specific behavior in pointing his gun at police officers to provoke them into shooting and killing him as part of his plan to end his own life. Thus, the district court erred in ruling to the contrary. View "North American Company for Life and Health Insurance v. Michelle Caldwell, et al" on Justia Law

Defendant argued that the district court erroneously held that a life insurance policy issued by Plaintiff Jackson National Life Insurance Company (“Jackson”) to third-party K.C., and subsequently sold by K.C. to Defendant, was void and unenforceable under Georgia law as an illegal human life wagering contract. K.C. acquired the policy, which listed “K.C.” as the insured and named K.C.’s estate as the beneficiary in 1999. At the time, K.C. was HIV positive, and he had a relatively short life expectancy. A few months after he purchased the policy, K.C., with the assistance of a viatical insurance broker, sold the policy to Defendant and named Defendant as its primary beneficiary.   When Defendant learned about K.C.s death, he made a claim for the death benefit under the policy. Jackson declined to pay the benefit and initiated this action seeking a declaration that the policy was void ab initio under Georgia law as an illegal human life wagering contract. The district court concluded that the policy was void and unenforceable under Georgia law, and it entered judgment in favor of Jackson. Defendant appealed, arguing that K.C.’s unilateral intent to sell the policy to a third party without an insurable interest in his life was insufficient to declare the policy void under Georgia law.   The Eleventh Circuit reversed and vacated the judgment entered by the district court and remanded the case for further proceedings, including a determination as to whether Defendant’s claim to benefits under the policy is barred by laches. View "Jackson National Life Insurance Company v. Sterling Crum" on Justia Law

The relevant consolidated appeals constitute the latest chapter of a long-running legal battle over attempts to satisfy a 2010 default judgment of $318 million under the Anti-Terrorism Act, 18 U.S.C. Section 2333, against the Revolutionary Armed Forces of Colombia (the Fuerzas Armadas Revolucionarias de Colombia or FARC) for murder and kidnapping.   In the first appeal (Case No. 20-11736), Appellant appealed the district court’s orders directing certain garnishees to liquidate and/or distribute their assets to Plaintiffs who obtained the $318 million judgment. In the second appeal(Case No. 20-12467) Appellant appealed the denial of their motion for a preliminary injunction to stop the sale of real property located at 325 Leucadendra Drive in Coral Gables, Florida. In the third appeal(Case No. 20-12545) Appellant’s wife appealed the district court’s denial of her motion to intervene in the proceedings concerning the sale of real property located at 325 Leucadendra Drive (and owned by Leucadendra 325, one of the Appellants in Case Nos. 20-11736 and 20-12467).   In Case No. 20-11736, the Eleventh Circuit concluded that a jury must decide whether Appellant and his companies qualify as agencies or instrumentalities of the FARC such that their assets can be garnished by Plaintiffs to satisfy their $318 million judgment. The court, therefore, reversed and remanded that appeal. In Case No. 20-12467, the court dismissed the appeal as moot because 325 Leucadendra has been sold and the court lacks the ability to grant the requested relief. In Case No. 20- 12545, the court affirmed the district court’s order denying Appellant’s wife’s motion to intervene as untimely and therefore dismiss the appeal. View "Keith Stansell, et al v. UBS Financial Services, Inc., et al" on Justia Law

MSPA Claims 1 LLC—the assignee of a now-defunct Medicare Advantage Organization—sued Tower Hill Prime Insurance Company to recover a reimbursable payment. The district court granted Tower Hill’s motion for summary judgment because it determined that MSPA Claims 1’s suit was untimely.The Eleventh Circuit affirmed. The court explained that because it is at least “plausible” that the term “accrues” in Section 1658(a) incorporates an occurrence rule—in fact, and setting presumptions aside, the court wrote that it thinks that’s the best interpretation—that is how the court interprets it. Therefore, MSPA Claims 1’s cause of action accrued in 2012 when MSPA Claims 1’s assignor, Florida Healthcare, paid D.L.’s medical bills and became entitled to reimbursement through the Medicare Secondary Payer Act. Because that was more than four years before MSPA Claims 1 filed suit in 2018, its suit is not timely under 28 U.S.C. Section 1658(a). View "MSPA Claims 1, LLC. v. Tower Hill Prime Insurance Co." on Justia Law

Plaintiff sued to obtain two insurance benefits that she believes Hartford Insurance Company owes her: (1) long-term disability payments and (2) a waiver of life insurance premiums. Although it concedes that Plaintiff was covered by its policy, Hartford contends that she was ineligible for those benefits.The Eleventh Circuit affirmed the district court’s order granting Hartford summary judgment, concluding that Hartford’s determinations were permissible. The court explained that Plaintiff was not entitled to disability payments because Hartford’s interpretation of the disability exclusion was reasonable, and its conflict of interest didn’t lead it to make an arbitrary or capricious decision. Likewise, Plaintiff was not entitled to a waiver of life insurance premiums because she wasn’t disabled within the meaning of Hartford’s life insurance policy. View "Carol H. Stewart v. Hartford Life and Accident Insurance Company" on Justia Law