Justia Vermont Supreme Court Opinion SummariesArticles Posted in Insurance Law
In re Blue Cross and Blue Shield 2022 Individual & Small Group Market Filing
Blue Cross Blue Shield of Vermont (Blue Cross) appealed the Green Mountain Care Board’s (GMCB) decision modifying its proposed health-insurance rates for 2022. The GMCB approved Blue Cross’s proposed rates with several exceptions, one of which was relevant here: its contribution to reserves (CTR). Blue Cross had sought a base CTR rate of 1.5%, but the GMCB ordered Blue Cross to lower it to 1.0%, thereby diminishing overall insurance rates by 0.5% and reducing health-insurance premiums. The GMCB found that a 1.5% base CTR was “excessive” because Blue Cross was expected to be above its target Risk Based Capital (RBC) range by the end of 2021, “individuals and small businesses are still struggling financially after a year-long economic slowdown,” and a 1.0% CTR would allow its “reserves to sit comfortably within the company’s RBC target range.” Blue Cross moved for reconsideration, arguing that the term “excessive” was strictly actuarial in nature, and that the GMCB misconstrued it by weighing non-actuarial evidence— testimony concerning affordability—as part of its examination of whether the proposed rate was excessive. On appeal to the Vermont Supreme Court, Blue Cross raised essentially the same issue. Because none of the actuarial experts who testified concluded that Blue Cross’s proposed CTR was excessive, Blue Cross argued, the GMCB could not properly conclude that it was. Blue Cross conceded that health-insurance rates for 2022 could not now be changed, but it urged the Supreme Court to rule on the merits, arguing that this matter was not moot because the CTR rate for this year will disadvantage Blue Cross in future rate-review proceedings. The Supreme Court determined Blue Cross did not demonstrate that this kind of case was capable of repetition yet evading review or subjected it to continuing negative collateral consequences. Therefore, Blue Cross failed to meet the exceptional thresholds necessary for the Court to reach the merits in a moot case. View "In re Blue Cross and Blue Shield 2022 Individual & Small Group Market Filing" on Justia Law
Huntington Ingalls Industries, Inc. et al. v. Ace American Insurance Company et al.
Insured Huntington Ingalls Industries, Inc. and insurer Huntington Ingalls Industries Risk Management LLC seek a declaratory judgment stating there is coverage under a property insurance policy for certain losses incurred by Huntington Ingalls Industries due to the COVID-19 pandemic. The trial court concluded that the complaint did not allege facts that would trigger coverage under the policy and granted judgment on the pleadings in favor of reinsurers. After review, the Vermont Supreme Court disagreed, reversed the trial court. and remanded for further proceedings. View "Huntington Ingalls Industries, Inc. et al. v. Ace American Insurance Company et al." on Justia Law
In re Ambassador Insurance Company (Bestwall LLC, Appellant)
In an interlocutory appeal, the issue this case presented for the Vermont Supreme Court's review was whether Vermont or Georgia law applied to a coverage dispute between claimant Bestwall LLC and insurer Ambassador Insurance Company. Bestwall contended that the trial court erred in concluding that Vermont law applied following the special master’s prediction that Georgia courts would adopt the same loss-allocation method as Vermont. But because Georgia law was unsettled on this issue, the Vermont Supreme Court concluded there was no conflict with Vermont law and accordingly, Vermont law applied. The Court therefore affirmed the trial court’s grant of partial summary judgment to Ambassador. View "In re Ambassador Insurance Company (Bestwall LLC, Appellant)" on Justia Law
Progressive Northern Insurance Company v. McGrath
Plaintiff-appellant Kevin McGrath challenged a superior court’s decision granting summary judgment to appellee Progressive Northern Insurance Company. Specifically, he argued the court erred in concluding that he was not “occupying” a vehicle, as that term is defined in the insurance policy at issue, when he was struck and injured by an underinsured motorist. Plaintiff was driving the vehicle’s owner in the owner’s vehicle to the airport. Plaintiff stopped at a gas station/convenience store on the way; he got out to pump gas and paid for it at the pump. The owner went inside the store for coffee. As the two returned to the car, but before they got inside, a pickup truck struck both plaintiff and the owner. Plaintiff filed for underinsured motorist benefits with the owner’s insurance company, Progressive, asserting he qualified for coverage under the terms of the policy. Progressive denied the claim, contending Plaintiff was not operating or occupying the car at the time of the accident. Plaintiff sued for a declaratory judgment on stipulated facts and no discovery. Summary judgment was entered in favor of the insurer. The Vermont Supreme Court affirmed, finding that while Plaintiff intended to enter the car, he did not, thus he did not occupy it under the terms of the policy at issue. View "Progressive Northern Insurance Company v. McGrath" on Justia Law
Progressive Northern Insurance Company v. Muller
Todd and Melissa Muller appealed a superior court decision granting summary judgment to their insurer, Progressive Northern Insurance Company. The Mullers challenged the court’s conclusions on how the setoff provision of their insurance policy should have been applied when there were multiple claimants. The Vermont Supreme Court agreed with the trial court that, construing the insurance policy as a whole, the setoff provision is unambiguous: It clearly provided that Progressive was entitled to reduce “all sums . . . paid” regardless of the number of claims made. View "Progressive Northern Insurance Company v. Muller" on Justia Law
Brillman v. New England Guaranty Insurance Company, Inc.
At issue in this case before the Vermont Supreme Court was the meaning of “date of loss” for the purpose of an insurance policy’s condition that any action be commenced within one year after the “date of loss.” The trial court concluded that the insurance provision requiring that an action be brought “within one year after the date of loss” was ambiguous and had to be interpreted against insurer to mean that the one-year period began to run when insurer breached its obligations (i.e., at the time homeowner received final, allegedly insufficient, payment from insurer). The court accordingly denied insurer summary judgment and granted partial summary judgment to homeowner. After its review, the Supreme Court concluded the provision was unambiguous in requiring suit to be brought within one year of the date of the occurrence giving rise to coverage and reversed the partial summary judgment for homeowner. View "Brillman v. New England Guaranty Insurance Company, Inc." on Justia Law
Commercial Construction Endeavors, Inc. v. Ohio Security Insurance Company
On a winter night in 2014, strong winds blew through the town of Georgia, Vermont, causing a partially constructed livestock barn to collapse. Commercial Construction Endeavors, Inc. (CCE), the contractor building the barn, sought recompense for the resulting losses from its insurer, Ohio Security Insurance Company. However, insurer and insured disagreed as to policy coverage for costs incurred by CCE in removing the remains of the collapsed barn and rebuilding it to its pre-collapse state. Ultimately, CCE sued Ohio Security for breach of contract. In successive summary-judgment rulings, the trial court held that the contractor’s rebuilding expenses were covered under the policy, but the cost of debris removal was not. Ohio Security cross-appealed the first ruling and CCE appealed the second; the Vermont Supreme Court reversed the first ruling and affirmed the second. The Court determined the additional collapse coverage applied only to “Covered Property,” which was business personal property; CCE did not dispute that the barn was not business personal property and thus was not “Covered Property.” Therefore, the court’s first summary-judgment ruling was reversed. The debris removal was not a loss involving business personal property. As a result, it was not a loss to “Covered Property” at that term was defined by the policy at issue. View "Commercial Construction Endeavors, Inc. v. Ohio Security Insurance Company" on Justia Law
Integrated Technologies, Inc. v. Crum & Forster Specialty Insurance Company
Integrated Technologies, Inc. (ITI) appealed the grant of summary judgment in favor of Crum & Forster Specialty Insurance Company (Crum). ITI alleged Crum breached its duty to defend ITI against a suit brought by the GOAD Company. The court granted summary judgment to Crum, finding no claim in the GOAD complaint that was potentially covered by the policy’s Errors & Omissions (E&O) Liability Coverage Part. ITI argued on appeal that the trial court misread the allegations in the GOAD complaint and interpreted the policy coverage too narrowly. Finding no reversible error, the Vermont Supreme Court affirmed. View "Integrated Technologies, Inc. v. Crum & Forster Specialty Insurance Company" on Justia Law
Parker’s Classic Auto Works, Ltd. v. Nationwide Mutual Insurance Company
laintiff was a car repair business in Rutland, Vermont. Defendant insured the vehicles of dozens of plaintiff’s customers (“the insureds”) who hired plaintiff to repair damage to their vehicles between 2009 and 2014. Over seventy insurance claims, which all arose under identical insurance policies, were combined in this breach-of- contract case. In each instance, defendant paid less than what plaintiff had billed to complete the repair, a "short pay." Plaintiff submitted to defendant a final invoice and a “supplemental report” itemizing each of the repairs performed. For each claim involved in this case, although defendant did not pay a portion of what the repair shop believed was owed under the policy, defendant did pay significant sums. Defendant initially paid what its claims adjuster believed to be covered by the insurance policy after having conducted a visual inspection of the damage. Defendant generally would make at least one additional payment based on information provided by plaintiff after plaintiff disassembled the damaged vehicle in preparation to repair it, a "supplemental payment." After an adjuster’s initial estimate was paid to plaintiff and any supplemental payments were made, there was still an outstanding balance for the repair bill on each claim involved in this case. Plaintiff believed these were covered by the insurance policy yet had been unpaid by the insurer. However, defendant maintained that these unpaid portions of the repair bill between plaintiff and each insured were not covered under the policy. A jury ultimately awarded plaintiff $41,737.89 in damages. After the trial, the court concluded that plaintiff could not show that his assignors were damaged by a breach of contract by defendant and granted defendant's motion for judgment as a matter of law. The Vermont Supreme Court reversed this determination, vacated the judgment that was entered in favor of defendant, and remanded with direction to the superior court to reinstate the jury’s verdict and its award of damages. View "Parker's Classic Auto Works, Ltd. v. Nationwide Mutual Insurance Company" on Justia Law
Rainforest Chocolate, LLC v. Sentinel Insurance Company, Ltd.
Appellant Rainforest Chocolate, LLC appealed the grant of summary judgment motion in favor of appellee Sentinel Insurance Company, Ltd. Rainforest was insured under a business-owner policy offered by Sentinel. In May 2016, Rainforest’s employee received an email purporting to be from his manager. The email directed the employee to transfer $19,875 to a specified outside bank account through an electronic-funds transfer. Unbeknownst to the employee, an unknown individual had gained control of the manager’s email account and sent the email. The employee electronically transferred the money. Shortly thereafter when Rainforest learned that the manager had not sent the email, it contacted its bank, which froze its account and limited the loss to $10,261.36. Rainforest reported the loss to Sentinel. In a series of letters exchanged concerning coverage for the loss, Rainforest claimed the loss should be covered under provisions of the policy covering losses due to Forgery, for Forged or Altered Instruments, and for losses resulting from Computer Fraud. Sentinel denied coverage. In a continuing attempt to obtain coverage for the loss, Rainforest also claimed coverage under a provision of the policy for the loss of Money or Securities by theft. Sentinel again denied coverage, primarily relying on an exclusion for physical loss or physical damage caused by or resulting from False Pretense that concerned “voluntary parting” of the property—the False Pretense Exclusion. Finding certain terms in the policy at issue were ambiguous, the Vermont Supreme Court reversed summary judgment and remanded for the trial court to consider in the first instance whether other provisions in the policy could provide coverage for Rainforest's loss. View "Rainforest Chocolate, LLC v. Sentinel Insurance Company, Ltd." on Justia Law