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Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. MISSING

Regular Panel Decision

Maryland Insurance Co. v. Head Industrial Coatings & Services, Inc.

This is an appeal in a bad faith insurance case involving Head Industrial Coatings and Services, Inc. (Head) and Maryland Insurance Company (Maryland). Head sued Maryland for denying a contractual liability claim, which was missing from its policy due to an agent's clerical error. The appellate court upheld the cause of action for bad faith, ruling that the agent's knowledge was imputable to Maryland, making the conduct knowingly wrongful. However, the court reduced Head's damage award to policy limits and reversed a statutory penalty. The case also involves a third-party action by Maryland against Gans & Smith Insurance Agency, which was remanded for a new trial due to issues with the jury's finding on breach of fiduciary duty.

Bad Faith InsuranceInsurance Code ViolationsContractual LiabilityAgent ErrorClerical ErrorIndemnity AgreementUnfair Claims Settlement PracticesDuty of Good Faith and Fair DealingImputed KnowledgeDamages Calculation

References

Case No. MISSING

Regular Panel Decision

Universe Life Insurance v. Giles

Justice Hecht's concurring opinion addresses the complex issues surrounding insurance bad-faith liability in Texas. He critiques the existing 'no reasonable basis' standard for its difficulty in appellate review, particularly due to the limitations of no-evidence review which prevents weighing conflicting evidence. He advocates for defining bad faith as 'unscrupulous, arbitrary conduct' and for treating the 'reasonably clear' liability standard as a legal question rather than a factual one. This approach, he argues, would provide clearer guidelines for insurers and enable meaningful judicial review, preventing juries from arbitrarily defining bad faith. Furthermore, he emphasizes that the requisite mental state for bad-faith liability should involve intentional or reckless conduct, not mere negligence. He concurs with the judgment that Universe Life wrongfully delayed Giles' claim (thus implying the claim for benefits was granted) but finds no evidence for punitive damages.

Insurance bad faithTexas lawtort liabilitycontractual disputesappellate reviewevidentiary standardsjudicial roleinsurer conductdamagespunitive damages

References

152

Case No. MISSING

Regular Panel Decision

Chandler v. Prudential Insurance Co.

Plaintiff Dorothy G. Chandler sued Prudential Insurance Company of America after the termination of her long-term disability benefits. She alleged bad faith, outrageous conduct, and violations of the Tennessee Consumer Protection Act. The trial court granted partial summary judgment to Prudential on the outrageous conduct, tort of bad faith, and Consumer Protection Act claims. Plaintiff later nonsuited her claim for the statutory bad-faith penalty. The appellate court affirmed the trial court's decision, ruling that the statutory bad-faith penalty (T.C.A. § 56-7-105) provides the exclusive remedy for bad faith actions against insurers in Tennessee. The court also found that the plaintiff failed to state a cause of action for outrageous conduct and that the Tennessee Consumer Protection Act was not applicable based on the facts presented.

Disability BenefitsInsurance PolicyBad Faith ClaimOutrageous ConductConsumer Protection ActSummary JudgmentExclusive RemedyAppellate ReviewInsurance LawTort Law

References

Case No. 2021 NY Slip Op 01050 [191 AD3d 884]

Regular Panel Decision

Feb 17, 2021

Matter of Faith A. M. (Faith M.)

The mother, Faith M., appealed an order from the Family Court, Kings County, which found her to have derivatively neglected her child, Faith A.M. This finding stemmed from a prior neglect determination in May 2014 concerning her other children due to excessive corporal punishment, which the court deemed proximate in time to the current proceeding. The evidence presented, including statements from siblings, testimony from a school counselor, and observations of injuries, corroborated the ongoing use of excessive corporal punishment. The Family Court's assessment of the mother's credibility, finding her denials incredible, was supported by the record, reinforced by her guilty plea to disorderly conduct related to similar allegations. The Appellate Division affirmed the Family Court's order, as the mother failed to provide evidence that the circumstances leading to the neglect finding no longer existed.

Child NeglectDerivative NeglectCorporal PunishmentFamily Court ActAppellate ReviewParental JudgmentPreponderance of EvidenceCredibilityPrior FindingsRisk of Harm

References

Case No. MISSING

Regular Panel Decision

Rangel v. Hartford Accident & Indemnity Co.

Lorenzo Rangel appealed a summary judgment granted in favor of Hartford Accident & Indemnity Company regarding his bad faith claim. Rangel alleged Hartford delayed workers' compensation payments following a job-related accident in May 1988, with payments ceasing in October 1988 and resuming in February 1989 after an Industrial Accident Board (IAB) conference. The underlying compensation claim was settled for $29,000, and the Compromise Settlement Agreement (CSA), approved by the IAB, noted that the carrier's liability or extent of injury was uncertain. Hartford successfully moved for summary judgment based on collateral estoppel, arguing Rangel was precluded from relitigating the issue of uncertainty. The appellate court affirmed the summary judgment, concluding that the IAB's finding of uncertainty of liability provided a reasonable basis for Hartford's delay in payments, thus defeating Rangel's bad faith claim.

Workers' CompensationBad Faith ClaimDelay in PaymentSummary JudgmentCollateral EstoppelIssue PreclusionCompromise Settlement AgreementTexas Industrial Accident BoardReasonable Basis for DelayUncertainty of Liability

References

Case No. MISSING

Regular Panel Decision

Nov 09, 2005

Plaza Restoration, Inc. v. Nationwide Mutual Insurance

The plaintiff insured brought an action seeking a declaratory judgment, alleging that the defendant insurer breached its covenant of good faith and fair dealing. This alleged breach related to a personal injury action previously commenced against the plaintiff by a construction worker. The defendant appealed an order from the Supreme Court, Nassau County, which had denied its motion to dismiss the complaint or for summary judgment, arguing the action was premature. The appellate court rejected the defendant's contention, affirming that a declaratory judgment action against an insurer is permissible even before a judgment in the underlying action. The order of the Supreme Court was affirmed, with costs.

Declaratory JudgmentBreach of CovenantGood Faith and Fair DealingInsurance LawPersonal InjuryConstruction Site InjuryRipeness DoctrineMotion to DismissSummary JudgmentAppellate Review

References

Case No. 2018 NY Slip Op 07224 [165 AD3d 1558]

Regular Panel Decision

Oct 25, 2018

Healthcare Professionals Ins. Co. v. Parentis

This case involves an appeal regarding a declaratory judgment action initiated by Healthcare Professionals Insurance Company (HPI) against Michael A. Parentis and others. The dispute arises from a prior medical malpractice verdict against Parentis totaling $8.6 million, which exceeded his combined $2.3 million primary and excess insurance policies from Medical Liability Mutual Insurance Company (MLMIC) and HPI. Parentis alleged bad faith against both insurers for failing to settle the underlying action within policy limits. The Supreme Court initially granted summary judgment to HPI and MLMIC, dismissing Parentis' bad faith claim. The Appellate Division, Third Department, reversed this decision, finding that genuine issues of material fact exist concerning whether both HPI and MLMIC acted in bad faith during settlement negotiations, especially during jury deliberations.

Insurance LawBad Faith Insurance ClaimMedical MalpracticeSummary JudgmentAppellate ReviewSettlement NegotiationsExcess InsurancePrimary InsuranceJury DeliberationsDuty to Settle

References

Case No. 07-CV-6149L

Regular Panel Decision

Feb 18, 2010

Johnson v. THE UNIVERSITY OF ROCHESTER MEDICAL CENTER

Plaintiffs Keith Johnson, M.D., and Laura Schmidt, R.N., filed a qui tam action under the False Claims Act against the University of Rochester Medical Center and Strong Memorial Hospital. They alleged defendants defrauded the government by submitting false claims for anesthesiology services under Medicare/Medicaid, claiming physician supervision when it was absent. Johnson also alleged retaliatory discharge for reporting violations, and Schmidt claimed retaliation for refusing to alter medical records. The defendants moved to dismiss, arguing failure to plead fraud with particularity under Fed. R. Civ. P. 9(b) and failure to state a claim under Rule 12(b)(6). Johnson cross-moved to amend the complaint to add claims of libel per se and prima facie tort against Dr. Lustik. The court granted the defendants' motion to dismiss, finding that the plaintiffs failed to allege that any fraudulent bills were actually presented to Medicare/Medicaid. The retaliation claims were also dismissed because the complaints were not made in furtherance of a qui tam action. Johnson's motion to amend was denied as frivolous and in bad faith. Defendants' request for sanctions was denied without prejudice.

False Claims ActQui TamMedicare FraudMedicaid FraudRetaliatory DischargePleading StandardsRule 9(b)Motion to DismissLeave to AmendLibel

References

Case No. MISSING

Regular Panel Decision

Raff v. Maggio

David Raff, an arbitrator, initiated an action against Maggio, an employer, to recover unpaid arbitration fees. Maggio had refused to pay his half of the fees stemming from a labor dispute arbitration, despite previous court affirmations of the arbitration award and advice from his own counsel to pay. Raff sought the arbitration fee, interest, and attorney's fees, contending that Maggio's prolonged refusal constituted bad faith. While Maggio eventually conceded his liability for the arbitration fee, interest, and court costs after his appeal to the Supreme Court was denied, he continued to dispute the payment of attorney's fees. The court determined that Maggio's initial and persistent refusal to pay the arbitration fee, based on a meritless defense, amounted to bad faith conduct. Consequently, the court partially granted Raff's motion for summary judgment, awarding him the arbitration fee, interest, court filing costs, and attorney's fees incurred up to the point Maggio filed his answer, marking the cessation of his bad faith actions concerning the fee itself. Maggio's cross-motion for summary judgment was denied.

Arbitrator FeesLabor DisputeSummary JudgmentAttorneys' FeesBad Faith LitigationAmerican Rule (Attorneys' Fees)Collective Bargaining AgreementArbitration Award EnforcementFederal Rules of Civil Procedure Rule 56Contractual Obligation

References

Case No. MISSING

Regular Panel Decision

Columbia Universal Life Insurance Co. v. Miles

Columbia Universal Life Insurance Company appealed a jury finding that it canceled Carl David Miles' health insurance policy in bad faith. Miles, the appellee, suffered from chronic immune deficiency conditions (IGA and agammaglobulinemia) that he claimed were disclosed during the application process but not recorded by the agent. Columbia rescinded the policy after discovering these undisclosed pre-existing conditions, which made Miles uninsurable per their underwriting guidelines, prompting Miles to file a bad faith claim. The court, applying established legal sufficiency standards for bad faith, found that Columbia had a reasonable basis for its actions due to the undisputed omission of critical medical history and Miles' previous denial of coverage by another insurer. Consequently, the appellate court reversed the trial court's judgment, ruling that Miles should take nothing on his bad faith claim.

Insurance LawBad Faith ClaimPolicy CancellationMisrepresentation in ApplicationPre-existing ConditionImmune DeficiencyDeclaratory JudgmentLegal Sufficiency ReviewDuty to InvestigateContractual Dispute

References

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Updated Daily

Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. MISSING

Regular Panel Decision

Maryland Insurance Co. v. Head Industrial Coatings & Services, Inc.

References

Case No. MISSING

Regular Panel Decision

Universe Life Insurance v. Giles

Insurance bad faithTexas lawtort liabilitycontractual disputesappellate reviewevidentiary standardsjudicial roleinsurer conductdamagespunitive damages

References

152

Case No. MISSING

Regular Panel Decision

Chandler v. Prudential Insurance Co.

Disability BenefitsInsurance PolicyBad Faith ClaimOutrageous ConductConsumer Protection ActSummary JudgmentExclusive RemedyAppellate ReviewInsurance LawTort Law

References

Case No. 2021 NY Slip Op 01050 [191 AD3d 884]

Regular Panel Decision

Feb 17, 2021

Matter of Faith A. M. (Faith M.)

Child NeglectDerivative NeglectCorporal PunishmentFamily Court ActAppellate ReviewParental JudgmentPreponderance of EvidenceCredibilityPrior FindingsRisk of Harm

References

Case No. MISSING

Regular Panel Decision

Rangel v. Hartford Accident & Indemnity Co.

References

Case No. MISSING

Regular Panel Decision

Nov 09, 2005

Plaza Restoration, Inc. v. Nationwide Mutual Insurance

Declaratory JudgmentBreach of CovenantGood Faith and Fair DealingInsurance LawPersonal InjuryConstruction Site InjuryRipeness DoctrineMotion to DismissSummary JudgmentAppellate Review

References

Case No. 2018 NY Slip Op 07224 [165 AD3d 1558]

Regular Panel Decision

Oct 25, 2018

Healthcare Professionals Ins. Co. v. Parentis

Insurance LawBad Faith Insurance ClaimMedical MalpracticeSummary JudgmentAppellate ReviewSettlement NegotiationsExcess InsurancePrimary InsuranceJury DeliberationsDuty to Settle

References

Case No. 07-CV-6149L

Regular Panel Decision

Feb 18, 2010

Johnson v. THE UNIVERSITY OF ROCHESTER MEDICAL CENTER

False Claims ActQui TamMedicare FraudMedicaid FraudRetaliatory DischargePleading StandardsRule 9(b)Motion to DismissLeave to AmendLibel

References

Case No. MISSING

Regular Panel Decision

Raff v. Maggio

References

Case No. MISSING

Regular Panel Decision

Columbia Universal Life Insurance Co. v. Miles

References

Showing 1-10 of 11,046 results

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