Justia U.S. 7th Circuit Court of Appeals Opinion Summaries

Defendant performed occasional maintenance and repairs for a fleet of plaintiff's delivery trucks. Defendant usually provided service onsite at plaintiff's plant, but sometimes would take trucks to its shop. In 2007, defendant's employee caused a fatal traffic accident while driving plaintiff's tractor-trailer to defendant's shop for service. The district court concluded that under Illinois law only plaintiff's insurance policy provided coverage for the accident. The Seventh Circuit affirmed. Both insurers provide coverage: defendant's policy by its plain language and plaintiff's policy operation of Illinois public policy. Plaintiff and its insurer are, however, ultimately responsible for the settlement amount. Under Illinois law the vehicle owner's policy is primary over the operator's policy unless a statute provides otherwise. The Illinois tow-truck insurance statute does not apply to provide an exception.

Plaintiff insured defendants. Defendant Schilli is a freight broker that arranges freight and provides risk management services for claims against other defendants, trucking companies, but does not own tractor-trailers or employ drivers. Plaintiff advanced funds to defend or settle claims against defendants for accidents that occurred during the duration of the policy. The policy had a coverage limit of $1,000,000 for each accident and a $100,000 basket deductible per occurrence and provides that "[y]ou agree to repay us up to this deductible amount for all damages caused by any one accident, as soon as we notify you of the judgment or settlement." Schilli's name and address are included in the definition of "you;" the other companies are named as insureds. Plaintiff sought reimbursement for amounts, up to the $100,000 deductible, that it advanced in defending and settling each case. Schilli refused to pay. In granting summary judgment in favor of plaintiff, the district court stated that the policy unambiguously defines "you" as all of the corporations. The Seventh Circuit reversed, finding the policy ambiguous as to the nature of defendants' liability for the deductible.

ESBC, billing agent for the Fire Department, determined that each of the individual defendants owned a vehicle involved in a collision to which the Fire Department responded and each had insurance coverage, and billed response costs incurred for each collision. The defendants refused to pay and ESBC sought a declaration that defendants were liable under the Comprehensive Environmental Response, Compensation, and Liability Act, 42 U.S.C. 9601. Under CERCLA, the owner of a “facility” from which hazardous substances have been released is responsible for response costs that result from the release. Insurer-defendants counterclaimed for injunctive relief from ESBC’s billing practices and alleging violation of the Fair Debt Collection Practices Act, 15 U.S.C. 1692, unjust enrichment, unlawful fee collection, fraud, constructive fraud, and insurance fraud. The district court granted defendants judgment on the pleadings and dismissed counterclaims without prejudice. The Seventh Circuit affirmed. Motor vehicles for personal use fall under the "consumer product in consumer use” exception to CERCLA’s definition of facility

In 2003, the Trust sought group accident and life insurance policies as a benefit for its union members. Consistent with the Trust's request, the broker's RFP specifically sought a policy where the "Trust is the owner of the policy and also [a] beneficiary." Defendant's proposal contained only a summary of proposed terms, expressly cautioned that it was not a contract, and omitted reference to the Trust’s desired beneficiary provision. The policy drafts sent to the Trust did not contain the beneficiary provision the Trust wanted and stated that payment of the required premium after delivery of the policies would constitute acceptance. The Trust's chairman signed and paid the first premium in 2003 In May, 2004, the Trust made a claim on the group life policy. Defendant responded that the terms of the policy required it to pay the full benefit to the decedent's beneficiaries. The Trust terminated the policy, stopped paying premiums, and filed suit seeking a declaratory judgment and rescission of the contract. The district court dismissed the Trust's claims and entered judgment for defendant for $95,059.99 in unpaid premiums. The Seventh Circuit affirmed, finding that the parties had an enforceable contract.

Defendant is a captive insurer owned by plaintiff plans across the nation. In 2003 healthcare providers filed class action suits in Florida against all of those plans. Twelve plans, which had errors-and-omissions insurance from defendant, asked it to assume the defense and indemnify. Defendant declined, and the plans demanded arbitration. Acting under the Federal Arbitration Act, 9 U.S.C. 5, the district court held that the arbitrators could determine whether arbitration of a class action or consolidated arbitration were authorized by contract and appointed a third arbitrator. The court dismissed the appeal of the court's first ruling for lack of jurisdiction and affirmed the appointment. If defendant wanted a judge to decide whether the plans' demands should be arbitrated jointly or separately, it should have refused to appoint an arbitrator. Both sides appointed arbitrators, however, and the proceeding got under way. Nothing in the Federal Arbitration Act authorizes anticipatory review of the arbitrators' anticipated decisions on procedural questions.

On June 17, 2006, wife applied for a $500,000 life insurance policy. She paid $100 and signed a conditional receipt agreement for immediate coverage, subject to conditions that "on the Effective Date the Proposed Insured(s) is (are) insurable exactly as applied for under the Company’s printed underwriting rules for the plan, amount and premium rate class applied for; ... (C) the Proposed Insured(s) has/have completed all examinations and/or tests requested by the Company." On June 28, wife was examined and submitted specimens. Her cholesterol level and urine sample raised concerns. The company sought medical records from her physician and a second urine specimen. On July 22, 2006, wife was diagnosed with a brain tumor. On August 9, the company declared wife uninsurable based on her brain surgery. About a year later, she died. Husband claimed that the request for the second urine specimen was communicated in a untimely and ineffective fashion. The district court entered summary judgment for the insurance company on claims of breach of contract, estoppel, bad faith, and negligence. The Seventh Circuit affirmed, finding no evidence of purposeful misconduct; if there was no contract, any duty of good faith did not come into play.

Plaintiffs' insurance policy indemnifies them against liability under several federal environmental protection laws or the state-law equivalents. They attempted to invoke their policy for up to $10 million in coverage following an explosion on one of their vessels that resulted in an oil spill in the Chicago Sanitary and Ship Canal. The district court granted the insurer judgment on the pleadings that: it owed $5,000,000 per vessel, per incident and had fully honored the policy with respect to one vessel; it owed no coverage for either two others for in rem liability. It granted the insureds summary judgment on their breach of contract claim, finding that the insurer owed $5,000,000 in coverage for a vessel, was obligated to pay defense costs up to that amount, and had breached its contract by not doing so. It denied summary judgment on a claim of breach of the duty of good faith and fair dealing. The Seventh Circuit affirmed.

The company, an egg producer, was charged in class action suits with conspiring to fix the price of eggs, in violation of section 1 of the Sherman Act. and requested that its liability insurers defend. The company argued that the complaints sought damages for what its policies call "personal and advertising injury," defined as injury. arising out of a list of torts that includes use of another's advertising idea in your advertisement. The insurer refused and the district court granted summary judgment in favor of the insurer. The Seventh Circuit affirmed, noting that the antitrust complaints make no mention of the company's theory that consumers might believe that advertised "free-roaming" chicken management policies are an attempt to justify prices.

The class action alleges that the company committed fraud by charging for uninsured or underinsured motorist coverage that is worthless in light of policy restrictions. The district court remanded to state court based on the representative plaintiff's argument that the amount in controversy was less than $5,000,000. The Seventh Circuit reversed, calculating the cost if the company were to stop charging a premium or change the terms so that policyholders receive indemnity more frequently, and the availability of punitive damages in Illinois, and concluding that it is not "legally impossible" that policyholders would recover the jurisdictional amount.

After being diagnosed with fibromyalgia, chronic pain, anxiety, and depression, plaintiff was awarded long-term disability benefits under an employee benefit plan issued and administered by defendant. Benefits were discontinued a little more than 24 months later, when defendant determined that plaintiff had received all to which she was entitled under the plan’s self-reported symptoms limitation. Because plaintiff had retroactively received social security benefits, defendant also sought to recoup equivalent overpayments as provided by the plan. On rehearing, the Seventh Circuit reversed the district court ruling in favor of defendant. The application of the self-reported symptoms clause was unreasonable under ERISA, 29 U.S.C. 1001; the disabling illness, fibromyalgia, is not primarily based on self-reported symptoms, but rather can be based on the verifiable evidence of its manifestations. The Social Security Act, 42 U.S.C. 407(a), does not preclude recovery of any overpayment that resulted from receipt of social security benefits.