Justia Government & Administrative Law Opinion Summaries

Plaintiffs filed suit in district court against the United States, alleging negligence in record-keeping and the administration of a certain life insurance policy. Plaintiffs subsequently appealed from the district court's order granting the United States' motion to dismiss for lack of subject matter jurisdiction. The court held that plaintiffs did exhaust its administrative remedies, but its claim arose out of a misrepresentation and was barred by the Federal Tort Claims Act (FTCA), 28 U.S.C. 2671.

Plaintiffs Aviva Life & Annuity Company and American Investors Life Insurance Company (collectively, "Aviva") contended the Federal Deposit Insurance Corporation (FDIC) acted in an arbitrary and capricious manner in rendering insurance determinations concerning certain of Plaintiffsâ bank deposit accounts. They appealed a district courtâs order upholding the FDICâs determinations. In 2008, the Kansas Bank Commissioner closed Columbian Bank & Trust Company and appointed the FDIC as receiver. At that time, Plaintiffs maintained twelve deposit accounts at Columbian. The bulk of those funds were held in two accounts (the âChallenged Accountsâ). The remaining accounts bore a variety of titles. Shortly after its appointment as receiver, the FDIC determined that each Plaintiffsâ respective accounts identified as âoperatingâ accounts, which included the Challenged Accounts, would be aggregated as corporate accounts. The FDIC further determined that the accounts designated as âbenefitsâ accounts would be separately insured as annuity contract accounts. Upon review of the FDIC's determination and the applicable legal authority, the Tenth Circuit found that the FDIC ultimately concluded the deposit account records clearly and unambiguously indicated the Challenged Accounts were owned in the manner of âcorporate accounts.â Plaintiffsâ extrinsic evidence was not, therefore, ârelevant dataâ for purposes of the FDICâs final insurance determination: "[t]he absence of any discussion pertaining to this evidence in the FDICâs final determination is therefore unsurprising, and in no way arbitrary or capricious." The Court affirmed the FDIC's determination.

Employee was injured while working in Minnesota for Wisconsin-based Employer. Employee applied for Wisconsin and Minnesota workers' compensation benefits. Employer's insurance company, Travelers Insurance, covered the Wisconsin benefits but denied the claim for Minnesota benefits based on an exclusion of Minnesota coverage in Employee's policy. Employee then filed a claim for Minnesota benefits with the Minnesota Department of Labor and Industry. After settling the claim, the Department pursued a petition for reimbursement it had filed against Employer. A compensation judge found that Employer was not insured for Minnesota workers' compensation liability and ordered Employer to reimburse the Department. The Workers' Compensation Court of Appeals (WCCA) reversed, concluding that Employer was entitled to coverage from Travelers under the reasonable expectations doctrine. On review, the Supreme Court reversed and remanded for reconsideration in light of a recent Court decision clarifying that the doctrine should not be used to provide coverage in contravention of unambiguous policy terms. On remand, the WCCA again reversed the compensation judge. On review, the Supreme Court reversed, holding that the WCCA had no authority to declare unambiguous language of an insurance contract to be invalid and unenforceable because the exclusion conflicted with Wisconsin statutory provisions and public policy.

The Montana Department of Revenue (Department) issued final ad valorem assessments of Puget Sound Energy (Puget) for several tax years, after which Puget petitioned the State Tax Appeal Board (STAB) for review of the Department's assessments. STAB determined the Department inaccurately assessed Puget's value and assessed Puget's value in excess of the Department's original assessment. Puget petitioned the district court for review, and the court concluded that STAB could not adopt an assessment value exceeding the Department's original assessment. On appeal, the Supreme Court reversed, holding that the district court incorrectly concluded that STAB may not assess Puget's market value in an amount that exceeds the Department's original assessment. The Court held that STAB has the constitutional and statutory duty to hear Puget's appeal and make an independent determination of Puget's market value even if STAB's assessment exceeds the Department's original assessment. Remanded.

BancInsure, Inc. appealed a declaratory judgment in favor of Columbian Financial Corporation and a former director, Carl McCaffree (collectively the Insureds). The insurance policy at issue here was a "claims-made" policy covered any claim made to BancInsure against any Columbian officer or director for a "Wrongful Act" as defined by the policy. A disputed provision of the policy pertained to the scope of coverage if Columbian was placed in receivership or otherwise ceased to engage in active banking business. The parties interpreted the provision differently. The Insureds contended that if Columbian went into receivership, the policy covered all claims made through the end of the original policy period, although only for Wrongful Acts committed before the receivership. BancInsure contended that the policy covered only claims made before the receivership. The operation of the disputed provision became relevant in August 2008 when the Kansas State Bank Commissioner declared Columbian insolvent and appointed the FDIC as its receiver. Soon thereafter, Columbianâs management sent BancInsure a letter to notify it of potential claims by the FDIC and others. The parties disputed many of the claims against Columbian which led to Columbian filing suit to the district court to determine which claims were covered under the policy. The sole issue on appeal to the Tenth Circuit was whether the district court had jurisdiction. Though no party disputed jurisdiction, the Tenth Circuit found that there was no actual controversy between the parties when the district court below rendered its judgment. The court therefore lacked jurisdiction. The Tenth Circuit reversed the lower courtâs decision and remanded to case with instructions to the court to vacate its judgment.

To provide relief in the aftermath of Hurricanes Katrina and Rita, Congress appropriated funds to Louisiana which distributed some of those funds through the "Road Home" program. The State required more than 150,000 Road Home grant recipients to execute a "Limited Subrogation/Assignment Agreement." The Road Home program created "perverse incentives" for insurance companies and their insured homeowners: some insurers inadequately adjusted and paid grant-eligible claims, and some grant-eligible homeowners had little motivation for file insurance claims. As a result, Road Home applications skyrocketed and created a $1 billion shortfall in the program. The State filed suit against more than 200 insurance companies, seeking to recover the funds spent and yet to be spent on claims under the Road Home program. The Insurance Companies successfully removed the case to the federal district court. The Insurance Companies then sought to dismiss the State's case, arguing that as a matter of law, anti-assignment clauses in the homeowners' policies invalidated the subrogation/assignment to the State. The federal district court denied the Companies' motion to dismiss. The Companies appealed to the Fifth Circuit. Because interpretation of the policy provisions at issue was a matter of State law, the Court certified interpretation to the Louisiana Supreme Court. The Supreme Court found that there is no public policy in Louisiana that precludes anti-assignment claims from applying to post-loss assignments. The Court commented that the language of the anti-assignment clause must clearly and unambiguously express that it applies to post-loss assignments, and as such must be evaluated on a policy-by-policy basis.

Plaintiff sought disability insurance benefits under the Social Security Act, alleging that migraine headaches, affective mood disorder, and mayofascial back pain left her unable to work. At issue was whether the administrative law judge's ("ALJ") decision was supported by substantial evidence and whether the ALJ properly weighed physicians' opinions in determining plaintiff's residual functional capacity. The court concluded that substantial evidence supported the ALJ's decision to discredit plaintiff's subjective complaints where none of her doctors reported functional or work related limitations due to her headaches and where there was no basis for her creditability. The court also held that the ALJ properly weighed the physicians' opinions in determining plaintiff's residual functional capacity.

In 1998, Appellee Stephen Heim filed a professional liability action against two doctors and their medical practices alleging that their negligent care from 1992 to 1996 caused the death of his wife. In August 2000, Mr. Heim received a jury verdict for over $1 million. The jury attributed a substantial percentage of fault to Mrs. Heim, and apportioned the remaining liability among the defendant doctors, which they bore jointly and severally. At the time of the alleged negligent acts, the doctors each maintained primary professional liability insurance coverage for $200,000 per occurrence under a policy issued by a private insurer. That insurer went bankrupt, and the policy was assumed by the Pennsylvania Property and Casualty Association (PPCIGA). Excess liability protection was provided to health care providers through a government-run contingency fund known as the Medical Professional Liability Catastrophe Loss Fund (CAT Fund). It was determined that the primary insurance policy left a $100,000 shortfall in order to satisfy Mr. Heimâs judgment. The CAT Fund determined it had no responsibility to redress the shortfall from the primary insurerâs bankruptcy. With no insurance money to protect them, Mr. Heim sued against the doctorsâ assets seeking to recover the unpaid portion of the judgment that neither the insurance company nor the CAT Fund would pay. The Commonwealth Court ruled in Mr. Heimâs favor, but in accordance with joint and several liability, applied the order to both PPCIGA and the CAT Fund. The Fund appealed to the Supreme Court. The Supreme Court found that under the statutory scheme that governs the CAT Fund, the facts of this case clearly implicated the Fundâs responsibility to the doctors to pay for the $100,000 shortfall left by their primary insurance policy. Accordingly, the Court affirmed the decision of the Commonwealth Court.

In New Mexico, title insurance is totally regulated by the state. Under its âTitle Insurance Act,â the state superintendent of insurance holds yearly public hearings to establish premium rates insurers can charge for title insurance. At the close of the hearings, a legal or âfiled rateâ is published by the agency. Once set, the filed rate is considered âper se reasonable and unassailable in judicial proceedings brought by ratepayers.â The policy behind the filed rate is to prevent price discrimination, preserve the role of agencies in approving rates and âto keep courts out of the rate-making process.â The New Mexico Insurance Code does not apply to title insurers except to the extent that the Title Insurance Act provides otherwise. Plaintiffs Coll and others brought suit alleging generally that the Title Insurance Act violates numerous New Mexico constitutional and statutory provisions precluding price fixing and creating monopolies. Plaintiffs also allege that the Insurer Defendants conspired with the insurance superintendent to establish a premium rate that is unreasonably high. Based on these theories, Plaintiffs sought declaratory and injunctive relief; compensatory, punitive and statutory damages; Defendantsâ disgorgement of their profits; and attorneysâ fees and costs. The lower court dismissed Plaintiffsâ claims with prejudice and remanded to state court all claims asserted against the state Defendants. The Tenth Circuit District Court agreed with the lower courtâs decision that the âfiled rateâ doctrine precluded Plaintiffsâ claims against the Defendants. The Court affirmed the district courtâs dismissal of Plaintiffs claims and remanded the case to the lower court for review of claims brought on state constitutional and procedural grounds.