Justia Montana Supreme Court Opinion Summaries

Plaintiffs were both insured by USAA Casualty Insurance Company under auto insurance policies that provided medical payments coverage. Plaintiffs filed a complaint against USAA arguing that USAA’s practice of sending medical claims to Auto Injury Solutions (AIS) for review was an improper cost containment scheme designed to deprive Montana consumers of their first-party medical pay benefits. Plaintiffs subsequently filed a motion to certify a proposed class. The district court issued its order certifying the class, concluding “all members of the proposed class were subject to the same claims processing procedure of outsourcing claims to AIS. USAA appealed from the certification order. The Supreme Court reversed, holding that the district court abused its discretion by certifying the class under Mont. R. Civ. P. 23(a) and under Mont. R. Civ. P. 23(b)(3). Remanded. View "Byorth v. USAA Casualty Insurance Co." on Justia Law

Peter Lee and three other passengers were injured in a single vehicle accident. The driver held an insurance policy issued by USAA Casualty Insurance Company and United States Automobile Association (collectively, USAA), and all of the passengers were covered by TRICARE. TRICARE paid medical benefits for the passengers and asserted medical payment liens for the passengers’ combined medical expenses. Lee made a settlement demand on USAA for Perez’s $100,000 policy limits. USAA offered to pay the policy limits provided that Lee first secure lien releases from TRICARE. TRICARE eventually waived its liens, and USAA issued a check for the policy limits of $100,000. Lee continued his suit against Perez after receiving the policy limits payment from USAA. Perez agreed to a consent judgment and assigned his claims against USAA to Lee. Elizabeth West, acting as guardian ad litem for Lee, filed suit asserting that USAA acted in bad faith by conditioning payment on resolving the TRICARE liens. The district court granted summary judgment for West, holding USAA liable to Lee for the consent judgment. The Supreme Court reversed, holding that USAA’s grounds for conditioning its payment of policy limits upon resolution of the TRICARE liens were reasonable under existing law, and therefore, USAA was entitled to judgment as a matter of law. View "West v. United Services Automobile Ass’n" on Justia Law

In Tidyman’s I, the Supreme Court affirmed the district court’s finding that National Union Fire Insurance breached its duty to defend its insured, David and Maxwell. The Court, however, reversed the district court’s entry of summary judgment to the extent it approved a stipulated judgment of $29 million. The Court remanded for the district court to hold a hearing to assess the reasonableness of the settlement amount. On remand, after a reasonableness hearing, the district court again approved the stipulated settlement. The Supreme Court remanded the case to the district court for a second reasonableness hearing, holding (1) the district court erred in using a “reliable evidence” test to assess the reasonableness of the stipulated judgment; and (2) the district court erred in holding that Plaintiffs were entitled to prejudgment interest. View "Tidyman’s Mgmt. Servs., Inc. v. Nat’l Union Fire Ins. Co." on Justia Law

In 2014, a large boulder dislodged from a hillside and fell into J. Russell Parker’s unoccupied vacation cabin, causing substantial damage. Parker submitted a claim to his insurer, Safeco Insurance Company. Safeco denied the claim, determining that rockfall is considered “earth movement from landslide,” which was specifically excluded under Parker’s policy. Parker sued Safeco, claiming breach of contract and seeking damages under the Unfair Trade Practices Act. The district court granted summary judgment in favor of Safeco. The Supreme Court affirmed, holding that Safeco property denied Parker’s claim based upon an express coverage exclusion in the policy. View "Parker v. Safeco Ins. Co. of America" on Justia Law

This case arose out of claims asserted by multiple people against Blue Cross and Blue Shield of Montana, now known as Caring for Montanans, Inc. (CFM) and Montana Comprehensive Health Association (MCHA). The claimants asserted that while they were insured by CFM or MCHA, they submitted claims that the insurers denied based upon exclusions contained in their health insurance policies. These exclusions generally provided that the insurer would not pay for health care costs of the injured insureds if the insureds received, or were entitled to receive, benefits from any automobile liability policy. These exclusions were subsequently disapproved by the Montana Commissioner of Insurance, and the insureds sought the previously-denied benefits. The district court certified a class of claimants for settlement purposes only. The court then held a fairness hearing on a proposed settlement agreement and approved the settlement. Several class members objected to the settlement and appealed to the Montana Supreme Court, arguing they should have been allowed to conduct further discovery to ascertain the fairness of the settlement agreement. The Supreme Court agreed with the objectors and remanded the case to the district court for further discovery and a second fairness hearing. The district court allowed further discovery, held a second fairness hearing, and determined that the same settlement agreement was fair, reasonable, and adequate. The Objectors again appealed. Finding no reversible error, the Supreme Court affirmed. View "Pallister v. BCBS" on Justia Law

In the underlying litigation, the Estate of Ronny Groff filed suit against Jake Weitzel alleging that Weitzel wrongful absconded with Ronny’s property and assets, causing economic loss to the Estate. Weitzel tendered this litigation to Fire Insurance Exchange (FIE) under a homeowner’s insurance policy covering claims for personal and bodily injury and property damage. FIE accepted responsibility for the litigation under a reservation of rights. FIE then filed suit in district court seeking declaratory relief, claiming that it owed no duty to defend Weitzel against the Estate under the terms of the policy. The district court granted summary judgment in favor of Weitzel. The Supreme Court reversed, holding that the district court erred by concluding that FIE had a duty to defend Weitzel under the terms of the insurance policy. View "Fire Ins. Exchange v. Weitzel" on Justia Law

Mark Ibsen, Inc., the owner and operator of the Urgent Care Plus medical clinic in Helena, purchased health insurance coverage for its employees from Blue Cross and Blue Shield of Montana (BCBSMT) through a Chamber of Commerce program. Health Care Corporation (Health Care) subsequently acquired BCBSMT’s health insurance business and changed its name to Caring for Montanans, Inc. (Caring). Less than one year later, Ibsen filed a complaint and class action against Caring and Health Care claiming that they had violated the Unfair Trade Practices Act (UTPA). Health Care filed a motion to dismiss and Caring filed a motion for summary judgment. The district court granted the motions, concluding that the legislature did not provide private citizens with the right to bring a cause of action to enforce the UTPA. The Supreme Court affirmed, holding (1) Ibsen may not maintain a private right of action for violation of Mont. Code Ann. 33-18-208 and -212 of the UTPA; and (2) in the alternative, Ibsen’s claims cannot be sustained as common law claims. View "Mark Ibsen, Inc. v. Caring for Montanans, Inc." on Justia Law

Roger and Carrie Peters and Daggin’ Y Cattle Company (collectively, Peters) filed a complaint against Junkermier, Clark, Campanella, Stevens, P.C. and Larry Addink (collectively, Junkermeir) alleging multiple counts stemming from tax services Junkermier performed for Peters. New York Marine, which insured Junkermier under a professional liability policy, defended Junkermeir subject to a reservation of rights. Peters and Junkermeir eventually entered into a settlement agreement and stipulation for entry of judgment without New York Marine’s participation, and the district court scheduled a hearing on the stipulated settlement’s reasonableness. The district court allowed New York Marine to intervene. After a hearing, the district court found that the stipulated settlement amount was reasonable, entered judgment in Peters’s favor, and ordered that Junkermier was not liable for the stipulated settlement. New York Marine appealed, asserting for the first time that the district court judge erred by not disclosing an apparent conflict of interest. The Supreme Court dismissed the appeal without prejudice pending referral to a district judge for hearing on New York Martine’s request for disqualification for cause, holding (1) New York Marine did not waive its disqualification claim; and (2) the presiding judge should have disclosed circumstances that could potentially cause the judge’s impartiality reasonably to be questioned. View "Draggin’ Y Cattle Co. v. Addink" on Justia Law

Jerry and Karen Slack hired Jeffrey Fisher and his construction company, Fisher Builders, to build a remodeled home. During the project, the deck collapsed, and the Slacks’ construction permit was revoked. The Slacks filed a negligence action against Fisher and his company. Fisher had a commercial general liability insurance policy with Employers Mutual Casualty Company (EMC). EMC filed a declaratory action alleging that there was no coverage and that it had no duty to defend or indemnify any party in the negligence action. Fisher and Fisher Builders ultimately settled with the Slacks and assigned their rights under the EMC insurance policy to the Slacks. The district court granted summary judgment in favor of EMC, ruling that Fisher’s conduct was clearly intentional and did not fit within the meaning of “occurrence” under the policy, regardless of whether Fisher intended the consequences. The Supreme Court reversed, holding that the district court (1) erred by concluding that, in the context of general liability insurance, the term “occurrence,” defined by the policy as “an accident,” categorically precludes coverage for any intentional conduct on the part of the insured with unintended results; and (2) erred when it granted summary judgment in favor of EMC, as issues of material fact precluded summary judgment. Remanded. View "Employers Mut. Cas. Co. v. Slack" on Justia Law

Plaintiff was seriously injured while working for Employer. Plaintiff’s injury was caused by the use of her personal vehicle. Plaintiff was able to recover benefits under her auto insurance policy but also sought benefits under Employer’s commercial auto policy. Employer’s insurer (Insurer) denied coverage. Plaintiff brought a claim for coverage, arguing that she was a named insured under Employer’s policy and that she was occupying a temporary substitute for an insured vehicle at the time of her injury. The district court granted summary judgment in favor of Insurer. The Supreme Court (1) affirmed the grant of summary judgment on the issue of whether Plaintiff was a named insured under Employer’s commercial auto policy; but (2) reversed the district court’s order granting Insurer’s motion for summary judgment on the issue of whether Plaintiff’s pickup was a temporary substitute for a covered auto and directed the district court to enter judgment in favor of Plaintiff on her coverage claim, as the evidence was sufficient to establish that Plaintiff’s pickup was a temporary substitute for an insured vehicle, entitling her to judgment on her coverage claim.. View "Stonehocker v. Gulf Ins. Co." on Justia Law