Auto-Liability

Co. v. Dennison
(Hawaii Court of Appeals, Oct. 11, 2005)

Ruling: The insurer in this case filed a declaratory judgment action against its insured, alleging that it was not liable for emotional distress damages caused when the insured saw his son was being treated following an automobile accident. On appeal, the court vacated the lower court’s ruling in favor of the insured and held that because the insured was not in the vehicle with his son at the time of the accident, he could not maintain an independent claim against the insurer under the auto policy.

Auto-Uninsured/Underinsured

Motorist Coverage

Mecca v. Farmers Insurance Exchange
(Montana Court, Oct. 25, 2005)

(Unpublished)

Ruling: The lower court granted the insurer’s motion for summary judgment denying the insured’s claim for underinsured coverage. The court affirmed and held that an application of underinsured motorists (UIM) coverage was dependent on available coverage of the vehicle at issue, not the vehicle’s driver. The court noted that UIM coverage was not available because an underinsured driver who was operating a rental truck that was not underinsured caused the accident. The policy language provided that the insurer would pay insureds damages from the owner or operator of the underinsured vehicle.

Deane v. Lubow
(California Court of Appeals, 2nd District, Oct. 26, 2005) (Unpublished)

Ruling: The insured in this case appealed the dismissal of its second amended complaint that contained a cause of action for civil conspiracy. The insured contended that the insurer engaged physicians to lower, obstruct, delay and deny the payment of underinsured motorist and medical benefits. The court reversed, holding that the cause of action adequately alleged a conspiracy to defraud.

Life, Health and Disability

Pagarigan v. Aetna U.S. Healthcare
of California Inc.

(California Court of Appeals, 2nd District,

Oct. 25, 2005)

Ruling: At issue on this appeal was the liability of a health maintenance organization, which contracts out its healthcare responsibilities to various providers, when one or more of those providers denies medically necessary services or commits malpractice in the delivery of those services. The court concluded that the HMO owes a duty to avoid contracting with deficient providers or negotiating contract terms that require or duly encourage denials of service or below standard performance by its providers.

Miscellaneous

Garamendi v. Superior National

Insurance
(California Court of Appeals, 2nd District,

Oct. 26, 2005)(Unpublished)

Ruling: At issue was the trial court decision denying the insureds’ proof of claim for paid time-off benefits as a first priority claim under Insurance Code §1033(a)(1). The court held that a proof of paid time-off benefits is properly disallowed, where the claimant remanded the employee of the insurance holding company after being terminated by the Commissioner of Insurance.

Information compiled by Goldberg Segalla. Web site: www.goldbergsegalla.com.

Topics California Auto Claims