Justia Antitrust & Trade Regulation Opinion SummariesArticles Posted in Insurance Law
State ex rel. State Farm Mut. Auto. Ins. Co. v. Hon. Jeffrey D. Cramer
William and Sarah Bassett, who were insured by State Farm Mutual Automobile Insurance Company, alleged that State Farm engaged in unfair trade practices with regard to the Bassetts’ assertion of unfair trade practices. The Bassetts based their claim on the assertion that State Farm never properly offered additional uninsured coverage, as State Farm was statutorily required to do. The circuit court granted the Bassetts’ motion to compel answers to three interrogatories seeking the names, addresses and telephone numbers of State Farm insureds in West Virginia who may have experienced difficulties regarding their uninsured motorist coverage. State Farm filed this original proceeding in prohibition asking the Court to prohibit enforcement of its discovery order. The Supreme Court granted relief, as moulded, prohibiting enforcement of the order granting the Bassetts’ motion to compel, concluding that the circuit court erred by failing to bar the disclosure of the names, addresses and telephone numbers of State Farm’s other insureds. View "State ex rel. State Farm Mut. Auto. Ins. Co. v. Hon. Jeffrey D. Cramer" on Justia Law
Estate of Gleason v. Cent. United Life Ins. Co.
Central United Life Insurance Co. (CULI) purchased Judith Gleason’s cancer benefit insurance policy prior to Gleason’s death from breast cancer. Gleason’s Estate submitted notice of potential claims under the policy to CULI. CULI paid certain claims but denied payment for claims submitted outside the policy limit. The Estate contested the denial of the untimely-filed claims. The district court granted partial summary judgment for the Estate, ruling that CULI owed payment for the untimely-filed claims, provided it was not prejudiced by the late notice. After a trial, the jury found that CULI had violated the Montana Unfair Trade Practices Act (UTPA) but did not award damages and therefore did not consider whether CULI acted with malice. The Supreme Court affirmed in part, reversed in part, and remanded, holding (1) the district court correctly applied the notice-prejudice rule; and (2) when an insurer is found to have violated the UTPA, a jury is not required to find compensatory damages beyond those for breach of the insurance contract before considering malice and punitive damages under the UTPA, and therefore, a new trial must be held on the issue of malice and punitive damages. View "Estate of Gleason v. Cent. United Life Ins. Co." on Justia Law
Victory Ins. Co. v. Mont. State Fund
Plaintiff, a Montana corporation, sells workers’ compensation insurance to employers without the use of insurance agencies. Defendant Montana State Fund sells workers’ compensation insurance through in-house and out-of-house agents. The remaining defendants also sell workers’ compensation insurance, including State Fund policies. In 2011, Plaintiff brought this of action against Defendants, alleging violations of the Unfair Trade Practices Act (UTPA) and intentional interference with prospective economic advantage. The district court (1) dismissed Plaintiff’s UTPA claim on the grounds that the UTPA does not create a private right of action by one insurance company against another; and (2) granted Defendants’ motions for summary judgment with respect to interference with prospective economic advantage. The Supreme Court affirmed, holding that Plaintiff’s inability to establish damages was fatal to its intentional interference claim and would be fatal as well to any UTPA-related claim. View "Victory Ins. Co. v. Mont. State Fund" on Justia Law
Mueller v. Wellmark, Inc.
Wellmark, Inc., an Iowa-based health insurer that belongs to the national Blue Cross and Blue Shield (BCBS) network, contracted with health care providers in Iowa to provide services at certain reimbursement rates. Wellmark agreed to make those rates available both to self-insured Iowa plans that it administers and to out-of-state BCBS affiliates when those entities provide coverage for services provided in Iowa. Plaintiffs, a number of Iowa chiropractors, sued Wellmark, claiming that Wellmark had abused monopoly power in violation of the Iowa Competition Law. The Supreme Court affirmed the district court’s dismissal of some of the chiropractors’ antitrust claims and remanded on Plaintiffs’ remaining claims. On remand, Plaintiffs stipulated that their remaining antitrust claims regarding the agreements between Wellmark and both the self-insuring employers and the out-of-state BCBS affiliates were being asserted on a per se theory. The district court rejected Plaintiffs’ per se theories and entered summary judgment for Wellmark. The Supreme Court affirmed, holding that Wellmark’s arrangements with the self-insured employers and out-of-state BCBS licensees did not amount to per se violations of Iowa antitrust law. View "Mueller v. Wellmark, Inc." on Justia Law
Golden Rule Ins. Co. v. Tomlinson
Dick McClary submitted an application for health insurance to Golden Rule Insurance Company that failed to disclose proposed insured Patti Denney’s preexisting condition. Golden Rule issued a policy covering Denney, but later denied coverage for a proposed surgery based on the fact that the conditions documented in Denney’s medical records were not disclosed in her insurance application. The Kansas Insurance Department imposed sanctions on Golden Rule for unfair claim settlement practices, concluding that Golden Rule had wrongfully denied Denney coverage for a medically necessary procedure. The district court affirmed. The court of appeals reversed, concluding that McClary was not acting as Golden Rule’s soliciting agent when he submitted Denney’s health insurance application. The Supreme Court (1) reversed the court of appeals’ decision on the agency question, as substantial evidence supported the conclusion that McClary had the actual authority to solicit and submit applications directly to Golden Rule; and (2) reversed the Department and the district court on their ruling that Golden Rule violated Kan. Stat. Ann. 40-2404(9)(f) but affirmed the finding of a violation of subsection (d); and (3) affirmed the Department’s remedy. View "Golden Rule Ins. Co. v. Tomlinson" on Justia Law
ProMedica Health Sys., Inc. v. Fed. Trade Comm’n
Lucas County has about 440,000 residents and includes Toledo. Two-thirds of the county’s patients have government-provided health insurance, such as Medicare or Medicaid; 29 percent have private insurance, which pays significantly higher rates to hospitals than government-provided insurance. General acute-care (GAC) inpatient services include “primary services,” such as hernia surgeries, radiology services, and most inpatient obstetrical (OB) services. “Secondary services,” such as hip replacements and bariatric surgery, require more specialized resources. “Tertiary services,” such as brain surgery and treatments for severe burns, require even more specialized resources. “Quaternary services,” such as major organ transplants, require the most specialized resources. Different hospitals offer different levels of service. In Lucas County ProMedica has 46.8% of the GAC market and operates three hospitals, which together provide primary (including OB), secondary, and tertiary services. Mercy Health Partners has 28.7% of the GAC market and operates three hospitals in the county, which provide primary (including OB), secondary, and tertiary services. University of Toledo Medical Center (UTMC) has 13% of the GAC market with a single teaching and research hospital, focused on tertiary and quaternary services. It does not offer OB services. St. Luke’s Hospital had 11.5% of the GAC market and offered primary (including OB) and secondary services. In 2010 ProMedica merged with St. Luke’s, creating an entity with 50% of the market in primary and secondary services and 80% of the market for obstetrical services. The FTC challenged the merger under the Clayton Act, 15 U.S.C. 18. The Commission found that the merger would adversely affect competition and ordered ProMedica to divest St. Luke’s. The Sixth Circuit upheld the order. View "ProMedica Health Sys., Inc. v. Fed. Trade Comm'n" on Justia Law
McVey v. USAA Cas. Ins. Co.
Appellant was involved in a car accident with Kent Blough. Appellant's insurer, USAA Casualty Insurance Company, concluded that Appellant was the majority at fault for the accident and refused to honor Appellant's $300,000 UM/UIM coverage. Appellant filed suit against Blough, and in an apparent attempt to prevent Appellant from prevailing, USAA unsuccessfully tried to intervene in the lawsuit. Blough's insurer paid Appellant the limit of Blough's insurance policy. USAA's expert eventually determined that Blough, whom USAA had already paid under Appellant's policy, had been the majority at fault. USAA then tendered to Appellant its $300,000 UM/UIM policy limit. Appellant filed a complaint against USAA for, among other claims, violations of the Montana Unfair Trade Practices Act and emotional distress as a result of the mishandling of her claim. The district court entered summary judgment for USAA. The Supreme Court reversed, holding that the district court (1) erred in determining that Appellant may not pursue a claim based upon USAA's alleged failure to reasonably investigate her claim as required under Mont. Code Ann. 33-13-201(4); and (2) erred when it granted summary judgment in favor of USAA regarding Appellant's claim for damages arising from emotional distress. View " McVey v. USAA Cas. Ins. Co." on Justia Law
Dorsey v. Progressive Classic Ins. Co.
Petitioner was a guest passenger in a vehicle insured by Progressive Classic Insurance Company when the vehicle was rear-ended by a truck. Petitioner received medical payments coverage under the Progressive policy for some of the medical expenses she incurred for the treatment of her injuries. Petitioner later successfully sued the truck owner and driver and received damages. Progressive subsequently asserted a subrogation lien on the recovery for the amount it paid under the medical payments coverage. Petitioner filed this complaint against Progressive, alleging common law and statutory bad faith claims. The circuit court dismissed the action, determining that because Petitioner was not a named insured under the Progressive policy and paid no premiums for the policy, Petitioner was a third-party insured and was, therefore, precluded from pursuing her bad faith claims against Progressive. The Supreme Court reversed, holding (1) Petitioner was a first-party insured under the Progressive policy because the policy included within the definition of an insured person "any other person while occupying a covered vehicle"; and (2) therefore, Petitioner may pursue an action against Progressive for common law and statutory bad faith. View "Dorsey v. Progressive Classic Ins. Co." on Justia Law
Lemasters v. Nationwide Mut. Ins. Co.
Plaintiff sought underinsured motorists (UIM) coverage from Respondent, Plaintiff's insurance carrier, after he was involved in an accident. Plaintiff and his wife eventually filed suit against Respondent seeking to recover the benefits. Plaintiff and Respondent settled the claim. Plaintiffs then amended their complaint against Respondent to allege a bad faith claim for violation of the Unfair Trade Practices Act, alleging that Respondent acted in bad faith by not paying their first-party claim for UIM. The jury returned a verdict in favor of Plaintiffs. Plaintiffs then moved for attorney fees and costs for substantially prevailing in the underlying bad faith award. The circuit court denied the costs and fees. The Supreme Court affirmed, holding that the circuit court did not abuse its discretion in concluding that there was no factual basis upon which to award fees on the bad faith claim. View "Lemasters v. Nationwide Mut. Ins. Co." on Justia Law
AIG Domestic Claims, Inc. v. Hess Oil Co., Inc.
Hess Oil Company asserted an unfair trade practices claim against two insurance companies. The jury returned a verdict against the insurance companies and awarded punitive damages. The circuit court, however, reduced the amount of the award by means of remittitur. The insurance companies appealed, contending that the trial court erred by giving conflicting jury instructions, introducing improper evidence of future remediation costs, and awarding punitive damages. Hess also appealed, challenging the court's reduction of its punitive damages award. The Supreme Court set aside the jury verdict and remanded for a new trial, holding that the trial court committed multiple errors, and the errors affected the jury's verdict in a manner prejudicial to the insurance companies. View "AIG Domestic Claims, Inc. v. Hess Oil Co., Inc." on Justia Law