Case Summaries

Insurance Law

[12/02] Love v. Dell Inc.
In a suit arising from the denial of health benefits under a plan subject to ERISA, summary judgment for defendants is affirmed where two separate decisions by defendant-plan administrator to deny coverage as not medically necessary were supported by substantial evidence in the record, and were therefore not abuses of discretion.

[12/02] Paul v. Landsafe Flood Determination Inc.
In a suit alleging negligence and negligent misrepresentation in an erroneous determination that plaintiffs' home was not located in a flood zone, summary judgment for defendant is reversed where, under Mississippi law, the erroneous flood-zone determination was the kind of professional opinion, developed in the course of a party's business and supplied for the guidance of others in a transaction, on which justifiable and detrimental reliance by a reasonably foreseeable person might be shown to have occurred.

[12/02] Med. Mut. of Ohio v. k. Amalia Enters. Inc.
In a group health insurer's suit against parents, as well as one parent's employer and its CFO, for failing to disclose that parents' dependent son had a preexisting medical condition (hemophilia), summary judgment for defendants is affirmed where insurer's ERISA, fraud, negligent misrepresentation, breach of contract, and unjust enrichment claims were barred by a contractual limitations provision.

[12/02] U.S. Fidelity & Guaranty Co. v. Liberty Surplus Ins. Corp.
In a per curiam decision related to a commercial general liability insurance policy taken out by a general contractor, the following question is certified to state supreme court: Does the doctrine of Lex Loci Contractus apply to a dispute about coverage that involves a policy for comprehensive general liability insurance, made outside of Florida, that insure the operations of a contractor on a project located in Florida?

[11/25] Continental Casualty Co. v. Stradford
In an action to determine whether plaintiff-insurer timely disclaimed coverage in defense of two dental malpractice actions on the basis of defendant's non-cooperation, grant of summary judgment to defendants is reversed where issues of fact remain with respect to the timeliness of plaintiff's disclaimer.

[11/25] Jordan v. Comm'r of Social Security
Denial of request to review Administrative Law Judge (ALJ) finding that plaintiff was not disabled for purpose of Social Security Benefits is vacated and remanded where the ALJ lacked sufficient evidence to make a finding regarding plaintiff's future job prospects.

More...