Justia Government & Administrative Law Opinion Summaries

Articles Posted in Insurance Law
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Appellant, a former employee of the City of La Habra Heights (City), pled no contest to a felony that arose out of the performance of her official duties. Under the terms of Appellant’s plea agreement, the conviction was later reduced to a misdemeanor under Penal Code section 17 and then dismissed under Penal Code section 1203.4. After Respondent California Public Employees’ Retirement System (CalPERS) determined that Appellant forfeited a portion of her retirement benefits as a result of her felony conviction, she filed a petition for writ of administrative mandate. The trial court denied her petition.   The Second Appellate District affirmed. The court concluded the trial court did not err in denying the petition because, consistent with the language and purpose of section 7522.72, Appellant’s retirement benefits were subject to forfeiture upon her no-contest plea to a job-related felony, notwithstanding the subsequent reduction to a misdemeanor and dismissal of the charge. Further, the court explained that Appellant asserts that section 7522.72 is unconstitutional, but she fails to present any cognizable argument or legal authority to support her claim. View "Estrada v. Public Employees' Retirement System" on Justia Law

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Plaintiff applied for disability insurance benefits on January 30, 2020, alleging disability since March 1, 2017,due to PTSD, depression, anxiety, insomnia, headaches, and a right knee injury. His application was denied initially and upon reconsideration. A medical expert confirmed that Plaintiff would be markedly limited when interacting with others. The medical expert suggested that Plaintiff’s Residual Function Capacity (RFC) includes “some limitations in terms of his work situation.” Once the Appeals Council denied review of the ALJ’s decision, Plaintiff sought judicial review. The district court affirmed the agency’s denial of benefits. On appeal, Plaintiff only challenged the ALJ’s finding that his mental impairments were not disabling.   The Ninth Circuit affirmed. The panel held that the ALJ did not err in excluding Plaintiff's VA disability rating from her analysis. McCartey v. Massanari, 298 F.3d 1072, 1076 (9th Cir. 2002) (holding that an ALJ is required to address the Veterans Administration disability rating) is no longer good law for claims filed after March 27, 2017. The 2017 regulations removed any requirement for an ALJ to discuss another agency’s rating. The panel held that the ALJ gave specific, clear, and convincing reasons for rejecting Plaintiff's testimony about the severity of his symptoms by enumerating the objective evidence that undermined Plaintiff’s testimony. The panel rejected Plaintiff's contention that the ALJ erred by rejecting the opinions of Plaintiff’s experts. The panel held that substantial evidence supported the ALJ’s conclusion that Plaintiff’s mental impairments did not meet all of the specified medical criteria or equal the severity of a listed impairment. View "JEREMY KITCHEN V. KILOLO KIJAKAZI" on Justia Law

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Saloojas, Inc. (“Saloojas”) filed five actions against Aetna Health of California, Inc. (“Aetna”), seeking to recover the difference in cost between its posted cash price for COVID-19 testing and the amount of reimbursement it received from Aetna. Saloojas argues that Section 3202 of the CARES Act requires Aetna to reimburse out-of-network providers like Saloojas for the cash price of diagnostic tests listed on their websites. The district court dismissed this action on the ground that the CARES Act does not provide a private right of action to enforce violations of Section 3202.   The Ninth Circuit affirmed. The panel held that the CARES Act does not provide a private right of action to enforce violations of Section 3202. Saloojas correctly conceded that the CARES Act did not create an express private right of action. The panel held that there is not an implied private right of action for providers to sue insurers. The use of mandatory language requiring reimbursement at the cash price does not demonstrate Congress’s intent to create such a right. The statute does not use “rights-creating language” that places “an unmistakable focus” on the individuals protected as opposed to the party regulated. View "SALOOJAS, INC. V. AETNA HEALTH OF CALIFORNIA, INC." on Justia Law

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Defendant Alex Herrgott, was driving a four-seat Polaris all-terrain vehicle at night down a gravel road when he “overcorrected” trying to avoid a pothole. The ATV overturned, and Joseph MacNabb, a passenger, was severely injured. Since MacNabb was a state employee in the course and scope of his employment, he received workers’ compensation benefits from the Mississippi State Agencies Self-Insured Workers’ Compensation Trust. The Trust later initiated this litigation in an attempt to recover more than $300,000 in benefits paid for MacNabb’s injury. The circuit court ultimately granted summary judgment to Herrgott because the Trust’s Mississippi Rule of Civil Procedure 30(b)(6) representative could not articulate a legal theory entitling it to recover. The Mississippi Supreme Court found there was sufficient evidence of Herrgott’s negligence for the case to go to trial, and the deposition testimony of a lay witness should not have bound the Trust as to which legal theories it could pursue. The Supreme Court therefore reversed the summary judgment and remanded the case for trial. View "Mississippi State Agencies Self-Insured Workers' Compensation Trust v. Herrgott" on Justia Law

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The Supreme Court held that under California's Motor Carriers of Property Permit Act, Cal. Veh. Code 34600 et seq., a commercial automobile insurance policy does not continue in full force and effect until the insurer cancels a corresponding certificate of insurance on file with the Department of Motor Vehicles (DMV).Insured was driving a truck covered by his policy with Insurer when he collided with a car, killing its driver. The driver's parents sued Insured for wrongful death, and Insured tendered his defense to Insurer. Insurer settled the claim for its policy limits and then sued Insured's former insurer (Defendant) for declaratory relief, equitable contribution, and equitable subrogation. The trial court held that Defendant's policy remained in effect on the date of the collision because one of Defendant's cancellation notices was rejected by the DMV as incomplete. The Court of Appeals for the Ninth Circuit certified a question of law to the Supreme Court, which answered that the Act does not require a commercial auto insurance policy to remain in effective indefinitely until the insurer cancels the certificate of insurance on file with the DMV. View "Allied Premier Insurance v. United Financial Casualty Co." on Justia Law

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Lance Hagen filed a public records request related to a condemnation case he was a party to involving the City of Lincoln and North Dakota Insurance Reserve Fund (“NDIRF”). Hagen sought to determine how the City of Lincoln and NDIRF spent approximately $1.1 million dollars on litigation costs defending the action. NDIRF did not produce all requested records, and the parties sought relief from the district court. Hagen appealed the district court’s judgment that concluded certain documents belonging to NDIRF were exempt from release under the potential liability exception outlined in N.D.C.C. § 44-04-19.1(8). Hagen argued the court abused its discretion by finding NDIRF itself faced potential liability because its members could face potential liability, and because the court discussed the fiscal effect of a disclosure on NDIRF, which Hagen argued exceeded the scope of the North Dakota Supreme Court’s remand order in Hagen v. North Dakota Insurance Reserve Fund, 971 N.W.2d 833. Because the Supreme Court concluded the potential liability exception under N.D.C.C. § 44-04-19.1(8) did not apply to any of the documents determined by the district court to be exempt, the Court reversed. View "Hagen v. N.D. Insurance Reserve Fund" on Justia Law

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Plaintiff appealed the district court’s summary judgment of his claims against Safeco Insurance Company of Indiana (“Safeco”) for violating Section 541 and Section 542 of the Texas Insurance Code.   The Fifth Circuit explained that in 2017, the Texas legislature amended Section 542, raising an important issue of Texas insurance law as to which there is no controlling Texas Supreme Court authority, and the authority from the intermediate state appellate courts provides insufficient guidance. Thus, the court certified the following question of state law to the Supreme Court of Texas: In an action under Chapter 542A of the Texas Prompt Payment of Claims Act, does an insurer’s payment of the full appraisal award plus any possible statutory interest preclude recovery of attorney’s fees? View "Rodriguez v. Safeco" on Justia Law

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The Supreme Court reversed the judgment of the South Dakota Life and Health Guaranty Association denying the protests brought by the South Dakota Bankers Benefit Plan Trust as to the Association's assessment schedule it established to cover an insolvent insurer's obligations, holding that the Trust was not liable to pay the contested assessments.In 2017, the Association, which covers impaired and insolvent insurers' obligations to their insureds by assessing Association members, assumed liability for the insolvent insurer at issue and established a five-year assessment schedule. The Trust paid three years of the five-year schedule but protested the requirement to pay the remaining two because they were assessed after the insolvent insurer's membership in the Association ended. The Association denied the protests. The South Dakota Division of Insurance's Office of Hearing Examiners reversed, determining that the Association lacked authority to assess the Trust for the last two assessments. The circuit court reversed. The Supreme Court reversed, holding that the Trust was not liable to pay the Association's 2020 and 2021 assessments. View "S.D. Life & Health Guaranty Ass'n v. S.D. Bankers Benefit Plan Trust" on Justia Law

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Gold Coast Commodities, Inc. makes animal feed using saponified poultry and plant fats at its Rankin County, Mississippi facility. Because its production process involves, among other things, old restaurant grease and sulfuric acid, Gold Coast is left with about 6,000 gallons of oily, “highly acidic,” and “extremely hot” wastewater each week. The City of Brandon, Mississippi, told a state agency that it believed Gold Coast was “discharging” that “oily, low-pH wastewater” into the public sewers. As a result, the Mississippi Department of Environmental Quality launched an investigation. Two months before the Department’s investigation, Gold Coast purchased a pollution liability policy from Crum & Forster Specialty Insurance Company. After the City filed suit, Gold Coast—seeking coverage under the provisions of its Policy—notified the insurer of its potential liability. But Crum & Forster refused to defend Gold Coast. The insurer insisted that because the Policy only covers accidents. The district court agreed with Crum & Forster—that the City wasn’t alleging an accident.   The Fifth Circuit affirmed. The court wrote that here, the Policy is governed by Mississippi law. In Mississippi, whether an insurer has a duty to defend against a third-party lawsuit “depends upon the policy's language.” The district court found that the “overarching” theme of the City’s complaint, regardless of the accompanying “legal labels,” is that Gold Coast deliberately dumped wastewater into the public sewers. The court agreed with the district court and held that Gold Coast isn’t entitled to a defense from Crum & Forster. View "Gold Coast v. Crum & Forster Spclt" on Justia Law

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Plaintiff, MSP Recovery Claims, Series LLC (“MSP”) appealed from the district court’s judgment dismissing for lack of standing its putative class action against Defendant Hereford Insurance Company (“Hereford”) and denying leave to amend. MSP has brought several lawsuits around the country seeking to recover from insurance companies that allegedly owe payments to Medicare Advantage Organizations (“MAOs”) under the Medicare Secondary Payer Act (the “MSP Act”). In the putative class action brought here, MSP charges Hereford with “deliberate and systematic avoidance” of Hereford’s reimbursement obligations under the MSP Act.   The Second Circuit affirmed. The court concluded that MSP lacked standing because its allegations do not support an inference that it has suffered a cognizable injury or that the injury it claims is traceable to Hereford. The court also concluded that the district court did not abuse its discretion when it denied MSP leave to amend based on MSP’s repeated failures to cure. The court explained that the plain language of Section 111 provides that when a no-fault insurance provider such as Hereford reports a claim pursuant to Section 111, it does not thereby admit that it is liable for the claim. The statutory context of the section’s reporting obligation and the purpose of the reporting obligation confirms the correctness of this interpretation. Because MSP’s argument that the payments made by EmblemHealth are reimbursable by Hereford rests entirely on its proposed interpretation of Section 111, MSP has not adequately alleged a “concrete” or “actual” injury or that the injury it alleges is fairly traceable to Hereford. View "MSP v. Hereford" on Justia Law