Articles Posted in Insurance Law

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The Supreme Court quashed the decision of the Fifth District Court of Appeals, which held on appeal in this case that trial courts may apply a contingency fee multiplier to an award of attorney’s fees to a prevailing party only in “rare” and “exceptional” circumstances. Petitioners, the insureds in a successful dispute with their homeowners’ insurance carrier, argued before the Supreme Court that the Fifth District’s decision misapplied Supreme Court precedent from Florida Patient’s Compensation Fund v. Rowe, 472 So. 2d 1145 (Fla. 1985), and its progeny. The Supreme Court agreed with Petitioners, holding that there is no “rare” and “exceptional” circumstances requirement before a trial court may apply a contingency fee multiplier. View "Joyce v. Federated National Insurance Co." on Justia Law

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The ambiguous section of the insurance policy at issue in this case must be construed in favor of coverage for the costs and attorneys’ fees awarded against the insured pursuant to the offer of judgment statute, Fla. Stat. 768.79. Alysia Macedo sued Zackery Lombardo for damages resulting from injuries she sustained in an automobile collision.The jury returned a verdict in favor of Macedo in the amount of $243,954.55. Macedo joined to the judgment GEICO, which provided bodily injury liability coverage to Lombardo. The trial court awarded taxable fees and costs against GEICO jointly and severally with its insured pursuant to section 768.79. The First District Court of Appeal affirmed. The Supreme Court approved the First District’s decision, holding that the key provision in the insurance policy was ambiguous and must be construed in favor of coverage. View "Government Employees Insurance Co. v. Macedo" on Justia Law

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A hospital provided medical services to twenty-nine insureds who were injured in motor vehicle accidents. After paying the hospital, the insurer requested certain documentation relating to the reasonableness of the charges pursuant to Fla. Stat. 627.736(6)(b). The hospital provided the insurer with various documents but refused to furnish copies of third-party contracts containing negotiated discount rates between the hospital and other insurers and payers, arguing that the information was not covered by subsection (6)(b). The insurer filed a petition pursuant to Fla. Stat. 627.736(6)(c) asking the trial court to compel discovery of the withheld information. The trial court ordered the hospital to produce the requested discovery. The court of appeal reversed, concluding that the trial court’s order exceeded the scope of discovery permissible under sections 627.736(6)(b) and (c). Specifically, the court ruled that discovery of facts under section 627.736(6)(c) is limited to the production of the documents described in section 627.736(6)(b). The Supreme Court approved the court of appeal’s interpretation of the scope of discovery under section 627.736(6)(c), holding that the scope of permissible discovery under subsection (6)(c) is limited to the production of documents described in subsection (6)(b). View "State Farm Mutual Automobile Insurance Co. v. Shands Jacksonville Medical Center, Inc." on Justia Law

Posted in: Insurance Law

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Orthopedic Specialists and various medical service providers challenged reimbursements made by Allstate Insurance Company under personal injury protection no-fault insurance policies issued to Allstate’s insureds, arguing that Allstate’s policy was ambiguous as to whether Allstate had elected to reimburse the Providers in accordance with the Medicare fee schedules provided for in Fla. Stat. 627.736(5)(a)2. The Fourth District held that the policy language was not legally sufficient to authorize Allstate to apply the Medicare fee schedules. The Supreme Court quashed the decision of the Fourth District and approved the decision of the First District in Allstate Fire & Casualty Insurance v. Stand-Up MRI of Tallahassee, P.A., holding that Allstate’s insurance policy provides legally sufficient notice of Allstate’s election to use the permissive Medicare fee schedules identified in section 627.736(5)(a)2 to limit reimbursements. View "Allstate Insurance Co. v. Orthopedic Specialists" on Justia Law

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In 2005, John Sebo purchased a home. American Home Assurance Company (AHAC) provided homeowners insurance as of the date of the purchase. It later became clear that the house suffered from major design and construction defects when water began to intrude during rainstorms. Hurricane Wilma further damaged the residence. AHAC denied coverage for most of the claimed losses. Sebo sued AHAC seeking a declaration that the policy provided coverage for his damages. The jury found in favor of Sebo, and the trial court entered judgment against AHAC. The Second District Court of Appeal reversed and remanded for a new trial, concluding that coverage did not exist under Sebo’s all-risk policy when multiple perils combined to create a loss and at least one of the perils was excluded by the terms of the policy. The Supreme Court quashed the Second District’s opinion, holding that the plain language of the policy did not preclude recovery in this case. View "Sebo v. American Home Assurance Co." on Justia Law

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Insureds, who owned a policy from Insurer, alleged that Insurer failed to pay them for damage to their home from sinkhole loss, thus breaching the terms of the insurance policy. When Insurer became insolvent, Florida Insurance Guaranty Association (FIGA) was activated to handle the “covered claims.” The circuit court ordered appraisal, and the appraisers determined the amount of loss to be $130,600. FIGA objected to the confirmation of the appraisal award, arguing that the statutory definition of “covered claim” in effect when Insurer was adjudicated insolvent should govern any payments made on the claim, thus prohibiting any direct payment to Insureds for their sinkhole loss. The circuit court confirmed the appraisal award and entered judgment in favor of Insureds in the amount of $130,600, concluding that Insureds’ rights to recover against FIGA for sinkhole loss were established when Insurer issued the insurance policy. The Second District Court of Appeal reversed. The Supreme Court affirmed, holding (1) the definition of “covered claim” in effect on the date that Insurer was adjudicated to be insolvent governed the scope of FIGA’s liability to Insureds for the sinkhole loss at their property; and (2) Insureds were precluded from obtaining an appraisal award for their sinkhole loss directly from FIGA under the terms of the policy. View "de la Fuente v. Florida Insurance Guaranty Ass’n" on Justia Law

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Johnson was covered under a homeowner’s insurance policy issued by Omega when she filed a claim to recover damages resulting from conditions which she believed to be sinkhole activity. After an initial sinkhole investigation determining that there was no sinkhole activity present on Johnson’s property, Omega denied Johnson’s claim. Johnson filed suit against Omega for breach of contract. In response, Omega hired another expert to perform an additional evaluation. The expert agreed that sinkhole activity was present on Johnson’s property. Omega accepted the evaluation report and provided payment for the damages. At issue before the trial court was whether Johnson was entitled to attorney’s fees. The trial court concluded that Omega’s agreement to pay money to Johnson amounted to a confession of judgment and awarded Johnson attorney’s fees under Fla. Stat. 627.428. The Fifth District Court of Appeal reversed, concluding that Omega did not act wrongfully or in bad faith, and therefore, section 627.428 and the confession of judgment doctrine did not apply. The Supreme Court quashed the decision below, holding that a recovery for attorney’s fees under section 627.428 requires an incorrect denial of benefits by the insurance company, not a bad faith denial. View "Johnson v. Omega Ins. Co." on Justia Law

Posted in: Insurance Law

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This case involved a dispute over the validity of three stranger-originated life insurance (STOLI) policies. The United States Court of Appeals for the Eleventh Circuit certified two questions of Florida law to the Supreme Court that were determinative of the case and for which there appeared to be no controlling precedent. The certified questions involved two Florida statutes: Fla. Stat. 627.404(1), requiring that an insurable interest exist at the inception of each life insurance policy, and Fla. Stat. 627.455, providing that an insurance policy is incontestable two years after its issuance. STOLI transactions offer an insured (often an elderly one) “free” or “risk-free” insurance in exchange for transferring the policy to the investor after the two-year incontestability period has expired. The Supreme Court answered that a party cannot challenge the validity of a life insurance policy after the two-year contestability period established by section 627.455 because it is created through a STOLI scheme. View "Wells Fargo Bank, N.A. v. Pruco Life Ins. Co." on Justia Law

Posted in: Insurance Law

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Petitioner was injured in an automobile accident with an underinsured motorist. Petitioner filed a claim with his insurer (Insurer) for the limits of his uninsured/underinsured motorist (UM) policy of $50,000. After Insurer refused to pay, Petitioner filed a complaint against Insurer to determine liability under the UM policy and the full extent of his damages. Prior to trial, Insurer tendered a check to Petitioner for $50,000 and filed a confession of judgment for that amount. Petitioner opposed the entry of a confessed judgment, arguing that a jury verdict would determine the upper limits of Insurer’s potential liability under a future bad faith claim. The trial court denied Insurer’s motion to confess judgment. After a trial, the jury set Petitioner’s damages at $1 million. The court of appeal vacated the jury’s verdict, concluding that after Insurer confessed judgment in the amount of $50,000, Petitioner’s UM action became moot. The Supreme Court quashed the court of appeal’s decision, holding (1) an insured is entitled to a determination of liability and the full extent of his damages in a UM action before filing a first-party bad faith action; and (2) that determination of damages is generally binding, as an element of damages, in a subsequent first-party bad faith action. Remanded. View "Fridman v. Safeco Ins. Co. of Ill." on Justia Law

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Luke Joerg (“Luke”) was a developmentally disabled adult who had lived with his parents his entire life and had never worked. Luke was struck by a car in 2007. John Joerg (“Joerg”), Luke’s father, filed an action against State Farm Mutual Automobile Insurance Company, Joerg’s uninsured motorist carrier. Joerg filed a motion in limine to exclude evidence of any collateral source benefits to which Luke was entitled, including discounted benefits under Medicare and Medicaid. The trial court precluded State Farm from introducing evidence of Luke’s future Medicare or Medicaid benefits. The jury awarded a total of $1,491,875 in damages, including $469,076 for future medical expenses. The Second District Court of Appeal reversed the award for future damages, concluding that Luke’s Medicare benefits should not have been excluded by the collateral source rule. The Supreme Court quashed the decision below, holding that the trial court properly excluded evidence of Luke’s eligibility for future benefits from Medicare, Medicaid, and other social legislation as collateral sources. View "Joerg v. State Farm Mut. Auto. Ins. Co." on Justia Law