Case Summaries

Insurance Law

[11/19] Shady Grove Orthopedic Assoc. v. Allstate Ins. Co.
In a class action claim for statutory penalties under section 5106(a) of New York insurance law against defendant-Allstate Insurance Company, grant of motion to dismiss is affirmed where: 1) section 901(b) of the New York Civil Practice Law and Rules may be applied in a federal court sitting in diversity jurisdiction and adjudicating claims under state law; and 2) section 5016(a) did not fall within the exception clause of section 901(b).

[11/18] Redmon v. Sud-Chemie Inc. Ret. Plan for Union Employees
In a claim for failure to pay plaintiff-wife survivor benefits due under her husband's retirement plan and for failing to provide her with plan information she requested, dismissal of plaintiff's claims where: 1) plaintiff did not submit a claim to defendant-retirement plan until 6.5 years after her claim accrued and 1.5 years after the applicable statute of limitations had expired; and 2) accordingly, plaintiff's claim was time-barred.

[11/18] Gagliano v. Reliance Standard Life Ins. Co.
In an action for disability benefits, a judgment that plaintiff-insured was entitled to benefits under a policy issued by defendant is affirmed in part, reversed in part, and remanded where: 1) defendant-insurance company violated Employee Retirement Income Security Act of 1974 (ERISA); however 2) the proper remedy was to remand the case to the plan administrator for a full and fair review.

[11/17] The Ohio Casualty Ins. Co. v. Holcim (US), Inc.
In a claim for contractual indemnification related to settlement of a tort claim, the court certified the following questions: 1) whether, under Alabama law, an indemnitee may enforce an indemnification provision and recover damages from an indemnitor resulting from the combined or concurrent fault or negligence of the indemnitee and indemnitor; and 2) whether, under Alabama law, a court may look behind (or beyond) the pleadings (in particular, the complaint) of an underlying tort action in determining the application of an indemnification provision between an indemnitor and indemnitee.

[11/14] H&R Block, Inc. v. Am. Int'l Specialty Lines Ins. Co.
Class actions filed against nationwide tax preparer H&R Block asserting a variety of statutory and common law claims arising out of H&R's Refund Anticipation Loan (RAL) program are excluded from "prior acts" coverage under professional liability "claims made" insurance policies because other class actions asserting similar claims were filed prior to the policy periods.

[11/14] Island View Resident Treatment Ctr. v. Blue Cross Blue Shield of Massachusetts, Inc.
In an appeal by plaintiff-treatment center to recover from defendant-insurance company the cost of in-patient care furnished to a patient, summary judgment in favor of defendant is affirmed over claim that the district court erred in transferring the case to another state's district court.

[11/13] Nat'l Union Fire Ins. Co. of Pittsburgh, Pennsylvania v. West Lake Acad.
In a claim against insureds for declaratory judgment limiting plaintiff-insurance company's exposure under the policy, judgment in favor of plaintiff-insurer is affirmed where the district court properly held that: 1) the claim arose from sexual abuse; 2) the claim was excluded from the commercial general liability provisions of plaintiff's policy; and 3) the claim was covered only under the Sexual Abuse Endorsement, thus making it subject to the limitations of coverage provided in the Endorsement.

[11/12] James v. Richman
In a suit seeking Medicaid benefits, an injunction preventing defendant-Department of Public Welfare from denying benefits is affirmed where: 1) equitable relief was appropriate where plaintiff would be barred by the Eleventh Amendment from seeking monetary damages from the state; 2) plaintiff was not required to exhaust his state-level administrative remedies before seeking federal relief; and 3) a non-revocable, non-transferable annuity purchased by plaintiff's wife did not fit the statutory definition of an "available resource" for purposes of calculating Medicaid eligibility.

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