Justia Connecticut Supreme Court Opinion Summaries

The case involves a billing dispute between a group of emergency room physicians (plaintiff) and an insurance company (defendant). The dispute centers on the interpretation of Connecticut’s surprise billing law, which aims to protect insured individuals from high medical bills when they receive emergency care from out-of-network providers. The plaintiff contends that the law requires the defendant to fully reimburse them for emergency services and then collect any applicable cost-sharing amounts (deductibles, copayments) from the insured. The defendant argues that it can deduct the insured’s cost-sharing amounts from the reimbursement it pays to the plaintiff.The United States District Court for the District of Connecticut dismissed the plaintiff’s stand-alone claims under the surprise billing law, concluding that the law does not create a private right of action. The court then certified three questions to the Connecticut Supreme Court: (1) whether a CUTPA claim can be maintained for conduct that violates the surprise billing law but not CUIPA, (2) whether the surprise billing law requires insurers to fully reimburse providers and then collect cost-sharing amounts from insureds, and (3) whether the defendant’s practice of deducting cost-sharing amounts from reimbursements violates the surprise billing law.The Connecticut Supreme Court held that Connecticut law does not recognize a cause of action under CUTPA for conduct that violates the surprise billing law but is not identified as an unfair insurance practice under CUIPA. The court also held that the surprise billing law does not require insurers to fully reimburse providers and then collect cost-sharing amounts from insureds. Instead, insurers can deduct the insured’s cost-sharing amounts from the reimbursement paid to the provider. Finally, the court concluded that the defendant’s practice of deducting cost-sharing amounts from reimbursements does not violate the surprise billing law. View "NEMS, PLLC v. Harvard Pilgrim Health Care of Connecticut, Inc." on Justia Law

In these actions to recover underinsured motorist benefits allegedly due under certain automobile insurance coverage provided by the State pursuant to a collective bargaining agreement the Supreme Court held that the appellate court incorrectly concluded that the trial court should have reduced one appellant's award by the sums received in settlement of a claim under Connecticut's Dram Shop Act, Conn. Gen. Stat. 30-102.The trial court found for Appellants on liability but awarded only a fraction of the damages sought, due in part to the court's rejection of Appellants' PTSD claim. The appellate court reversed in part, concluding that the trial court's failure to reduce Appellants' damages by their dram shop recovery violated the common-law rule against double recovery. The Supreme Court reversed in part, holding that the appellate court (1) properly affirmed the trial court's conclusion that Appellants were not entitled to recover underinsured motorist benefits for alleged PTSD; and (2) improperly reversed the judgments insofar as the trial court determined that the State was not entitled to a reduction in the awards for sums received by Appellants in settlement of a dram shop claim. View "Menard v. State" on Justia Law

The Supreme Court affirmed the judgment of the trial court in favor of Plaintiffs in this action for a declaratory judgment to determine whether Plaintiffs were obligated to defend and indemnify Defendant under insurance policies for damages awarded against Defendant in a separate action, holding that Defendant was not entitled to relief on his allegations of error.At issue was whether Plaintiffs, insurers, were obligated to indemnify Defendant, a business owner, under an insurance policy for liability arising from Defendant's false imprisonment of his company's employment at her workplace. The trial court concluded that Plaintiffs had a duty to indemnify Defendant, but the appellate court reversed. The Supreme Court reversed and remanded the case. After a trial de novo, the trial court concluded that coverage was barred by the policy's "business pursuits" exclusion. The Supreme Court affirmed, holding (1) the trial court properly applied the preponderance of the evidence standard at the trial de novo; and (2) Defendant's remaining claims were without merit. View "Nationwide Mutual Insurance Co. v. Pasiak" on Justia Law

The Supreme Court affirmed the decision of the trial court granting summary judgment in favor of Insurer in this action brought to determine whether business losses suffered during the COVID-19 pandemic were covered by the relevant policies, holding that Insured's losses were not covered by the two insurance policies at issue.Before the pandemic, Insurer sold two insurance policies to Insured. Insurer later initiated this action seeking a judgment declaring that Insured's business losses incurred during the COVID-19 pandemic were not covered under the policies. The trial court concluded that there was no coverage under either policy. The Supreme Court affirmed, holding that the trial court properly entered summary judgment for Insurer because Insured's losses plainly and unambiguously were not covered by either policy. View "Hartford Fire Insurance Co. v. Moda, LLC" on Justia Law

The Supreme Court affirmed the judgment of the trial court in this dispute over whether a property insurance policy providing coverage for "direct physical loss of or physical damage to" covered property provided coverage for business income losses arising from the suspension of business operations during the COVID-19 pandemic, holding that the trial court correctly granted Defendant's motion for summary judgment.Plaintiffs, who suspended their business operations during the COVID-19 pandemic and consequently lost business income and incurred other expenses, filed claims for losses with Defendants. After Defendants denied the claims Plaintiffs brought this actin seeking a judgment declaring that the relevant insurance policies covered their economic losses under the circumstances. The trial court granted summary judgment for Defendants. The Supreme Court affirmed, holding that because Plaintiffs did not suffer any "direct physical loss" of covered property, there was no genuine issue of material fact as to whether the policies did not cover Plaintiffs' claims. View "Connecticut Dermatology Group, PC v. Twin City Fire Insurance Co." on Justia Law

The Supreme Court affirmed the judgment of the trial court dismissing Plaintiff's claims against Liberty Mutual Fire Insurance Company, holding that there was no error.Plaintiff brought this lawsuit based on a violation of the Connecticut Unfair Insurance Practices Act (CUIPA), Conn. Gen. Stat. 38a0815 et seq., asserting breach of the implied covenant of good faith and fair dealing, negligent infliction of emotional distress, and violation of the Connecticut Unfair Trade Practices Act (CUTPA), Conn. Gen. Stat. 42-110a et seq. The trial court dismissed the claims, determining that the litigation privilege deprived the court of subject matter jurisdiction. The Supreme Court affirmed, holding that the litigation privilege barred Plaintiff's CUTPA-CUIPA claim. View "Dorfman v. Smith" on Justia Law

The Supreme Court answered a question certified to the Supreme Court by the United States District Court for the District of Connecticut in this declaratory judgment action by holding that Defendant's plea of nolo contendere could not be used to trigger a criminal acts exclusion in a homeowners insurance policy governed by Connecticut law.At issue was whether Plaintiff, Allstate Insurance Company, could use Defendant's plea of nolo contendere to the charge of assault in the first degree to trigger a criminal acts exclusion that would bar Plaintiff's coverage of Defendant in a civil action involving the same underlying incident. The district court certified the question to the Supreme Court. The Supreme Court answered that Defendant's plea of nolo contendere could not be used by Plaintiff to establish the applicability of the criminal acts exclusion of the relevant policy. View "Allstate Insurance Co. v. Tenn" on Justia Law

The Supreme Court affirmed the judgment of the trial court granting Insured's application to compel appraisal with regard to a dispute as to the extent of Insurer's replacement obligation under Con. Gen. Stat. 38a-316e(a) (matching statute), holding that there was no error.At issue was whether a dispute as to the extent of an insurer's obligation under the matching statute to replace items or items in a covered loss for real property with "material of like kind and quality so as to conform to a reasonably uniform appearance" was a question properly relegated to the appraisal arbitral process or a question of coverage to be resolved by the court in the first instance. The trial court granted Insured's application to compel arbitration in this case. The Supreme Court affirmed, holding that the parties' dispute fell within the scope of the insurance policy's appraisal clause. View "Klass v. Liberty Mutual Insurance Co." on Justia Law

In this insurance dispute, the Supreme Court reversed the judgment of the trial court granting Defendant's motion for summary judgment, holding that the trial court incorrectly determined that Defendant was relieved of its duty to defend in the underlying property dispute.Plaintiff contracted with New Beginnings Residential Renovations, LLC to renovate Plaintiff's house. The house received extensive physical damage during the renovation, and Plaintiff brought an action against New Beginnings for property damage. New Beginnings tendered defense of the case to Defendant pursuant to a commercial general liability insurance policy. Defendant declined to defend under two of the policy's "business risk" exclusions. Plaintiff was awarded a default judgment against New Beginnings. Plaintiff then brought this action against Defendant under the direct action statute seeking recovery for the judgment against New Beginnings. The trial court granted summary judgment for Defendant, concluding that the policy exclusions precluded coverage. The Supreme Court reversed and remanded the case, holding that the exclusions did not relieve Defendant of its duty to defend. View "Nash Street, LLC v. Main Street America Assurance Co." on Justia Law

The Supreme Court reversed the judgment of the trial court granting the state's motion to dismiss this tort action, holding that a state's waiver of sovereign immunity in Conn. Gen. Stat. 52-556 for claims arising from a state employee's negligent operation of a state-owned and -insured motor vehicle extends to litigants who are state employees.Plaintiff, a state employee, was a passenger in a motor vehicle owned and insured by the state and operated by another state employee, William Texidor, when another vehicle operated by Tyreke Brooks struck their vehicle. Brooks' vehicle was uninsured. Plaintiff, who applied for and received workers' compensation benefits, brought this action agains the state and Metropolitan Casualty Insurance Company alleging that Texidor's operation of the vehicle was negligent. The state filed a motion to dismiss for lack of subject matter jurisdiction on the ground of sovereign immunity. The trial court granted the motion to dismiss. The Supreme Court reversed, holding (1) the trial court had jurisdiction pursuant to the waiver of sovereign immunity in section 52-556; (2) Plaintiff's action against the state was barred by Conn. Gen. Stat. 31-284(a); and (3) therefore, the form of judgment was improper, and the case is remanded with direction to render judgment for the state. View "Feliciano v. State" on Justia Law