Justia Insurance Law Opinion Summaries

In a discretionary appeal, the issue before the Supreme Court in this case was whether, under an insurance policy for underinsured motorist coverage, the amount of an insured's recovery may be offset by the amount of all damages paid in satisfaction of the underlying judgment, or by only the amount of compensation paid under the auto insurance policy of the underinsured driver/tortfeasor. Under the circumstances of this case, the Court held that the amount of damages which could be offset against recovery under a UIM policy includes damages recovered from all tortfeasors. Accordingly, the Court reversed the Superior Court. View "AAA Mid-Atlantic Ins. Co. v. Ryan" on Justia Law

In consolidated appeals, the issue before the Supreme Court was whether the manifestation of an occupational disease outside of the 300-week period prescribed by Section 301(c)(2) of the Workers’ Compensation Act removes the claim from the purview of the Act, such that the exclusivity provision of Section 303(a) does not apply. After careful consideration, the Supreme Court concluded that claims for occupational disease which manifest outside of the 300-week period prescribed by the Act do not fall within the purview of the Act, and, therefore, that the exclusivity provision of Section 303(a) does not apply to preclude an employee from filing a common law claim against an employer. Accordingly, in these cases, the Court reversed the Superior Court's decision. View "Tooey v. AK Steel" on Justia Law

Appellant Annette Shoap sustained a work-related injury in the nature of a left shoulder injury while working as an employee of Phoenixville Hospital. She began receiving temporary total disability benefits pursuant to a Notice of Compensation Payable dated 2003. The treatment for Appellant’s injury included three surgeries and physical therapy. In 2007, the employer filed a modification petition alleging both that Appellant’s physical condition had improved and that work was generally available to her within her physical restrictions in the relevant geographical area, as demonstrated by two labor market surveys. Appellant denied the material allegations of Employer’s petition, and a hearing was held before a Workers’ Compensation Judge. After the WCJ ruled in the employer's favor, Appellant unsuccessfully appealed to the Workers' Compensation Appeal Board and Commonwealth Court. On appeal to the Supreme Court, Appellant asserted that the Commonwealth Court erred by concluding that “substantial gainful employment existed” for purposes of granting a modification of her compensation benefits pursuant to Section 306(b) of the Workers' Compensation Act, despite the fact that her application for the specific jobs involved failed to result in any offers of employment. Secondarily, Appellant argued that the Commonwealth Court, even if correct in its interpretation of Section 306(b), erred by not remanding the case for further evidentiary development based on its interpretation of Section 306(b), which Appellant contended represented a change in the standard for evaluating cases under that statute. After careful review, the Supreme Court agreed with Appellant's second contention, and reversed and remanded for further proceedings. View "Phoenixville Hospital v. WCAB (Shoap, Aplt)" on Justia Law

The issue on appeal to the Supreme Court in this case centered on whether the Commonwealth Court erred by affirming the reversal by the Workers’ Compensation Appeal Board (“WCAB”) of the decision of a workers’ compensation judge (“WCJ”) that granted Appellant Philip Payes's claim application. The WCJ determined that Appellant was entitled to workers’ compensation disability benefits based on factual findings that Appellant established the existence of a mental disability that had been caused by abnormal working conditions. Upon review, the Court concluded that the Commonwealth Court erred in reversing the WCJ’s decision, and accordingly reversed the order. View "Payes v. WCAB (PA State Police)" on Justia Law

This case involved an uninsured motorist benefits claim filed in connection with injuries allegedly sustained by the appellant in a 2001 motor vehicle accident. Appellant was driving a truck insured by Harleysville Insurance Company when he rear-ended another vehicle. The police report contained no mention of a phantom vehicle being involved in the accident. Appellant later reported the accident to his employer, explaining he momentarily took his eyes off the road, and when he looked again, a vehicle was stopped in front of him; he was unable to stop and rear-ended the vehicle. Twenty days later, appellant completed a written Workers’ Compensation Employee’s Statement in which he reported the accident occurred due to the other vehicle stopping suddenly in front of him. But again, no phantom vehicle was reported. Over eight months later, appellant filed a claim for uninsured motorist benefits, alleging the accident was caused by a phantom vehicle pulling out in front of the other vehicle, causing appellant to stop suddenly. Harleysville denied appellant’s claim and sought a declaratory judgment that he was not entitled to uninsured motorist benefits. The Superior Court reversed the order of the Court of Common Pleas of Luzerne County, which held appellee Harleysville Insurance Company did not suffer prejudice as a result of appellant’s failure to report the phantom vehicle within a 30-day time requirement established by the Motor Vehicle Financial Responsibility Law (MVFRL). Upon review, the Supreme Court affirmed the Superior Court decision. View "Vanderhoff v. Harleysville Ins. Co." on Justia Law

The issue before the Supreme Court in this case centered on the statutory interpretation concerning Section 413(a) of the Workers' Compensation Act, specifically whether the claimant/appellant should have been permitted to proceed on a post-500-week petition for reinstatement of total disability benefits where he filed that petition within three years of his most recent payment of compensation, a payment which was made pursuant to a post-500-week supplemental agreement, notwithstanding a prior suspension of payments due to his return to work without a loss in earning capacity. Resolving the question, involved first determining whether expiration of the 500-week period set forth within the Act operated as a bar to the assertion of total disability claims by employees who have experienced a suspension of benefits. Also affecting the Court's decision was the effect of payments made pursuant to supplemental agreements upon an otherwise expired workers' compensation claim. The Commonwealth Court below affirmed the Workers' Compensation Appeal Board's ("WCAB") reversal of a Workers' Compensation Judge's ("WCJ") decision granting appellant's reinstatement and penalty petitions. Upon review, the Supreme Court held that appellant's reinstatement petition was not timely filed. Accordingly, it affirmed the Commonwealth Court. View "Cozzone, Aplt v. WCAB (Pa Municipal/E. Goshen Twp)" on Justia Law

Appellee Young's Sales & Service submitted a claim with Appellant Underground Storage Indemnification Fund for reimbursement of remediation costs it incurred following the release of certain regulated chemicals stored in underground tanks on its property. The claim was denied, and Appellee appealed. The issue before the Supreme Court in this case was whether the Commonwealth Court correctly held that section 706(2) of the Storage Tank Spill Prevention Act applied on a per tank basis. Upon review, the Supreme Court concluded it did not. Accordingly, the Court reversed the Commonwealth Court and reinstated the Board's order denying Appellee's claim. View "Young's Sales & Service v. Underground Storage Tank Indemnification Board" on Justia Law

Claimant Dorothy Robinson was a police officer for the City of Pittsburgh. In 1997, she sustained a work-related injury, and the City placed her on light-duty. In 2001, while traveling for treatment of her injury, Claimant was involved in an automobile accident in which she sustained new injuries. After the accident, Claimant did not return to her light-duty position nor was she offered any other light-duty work. In late 2004, Claimant received a disability pension. In connection with Claimant’s claim of entitlement to a disability pension, she was examined by three physicians who certified that Claimant was unable to perform her pre-injury job as a police officer. Nearly three years later, an independent medical examiner concluded that although Claimant was not fit to perform her prior job as a police officer, she could perform modified-duty work. The City filed a Petition to Suspend Compensation Benefits, asserting that Claimant was capable of working, "but has voluntarily removed herself from the work force as she has not looked for or sought employment in the general labor market." Claimant filed a response, denying the averments of the suspension petition and asserting that she remained attached to the workforce and had registered for work with the Pennsylvania Job Center. She further claimed that she was not presently working only because of the unavailability of work and because the City had eliminated her light-duty position. The Workers' Compensation Judge denied the suspension petition, concluding that Claimant had not voluntarily removed herself from the workforce. The issue before the Supreme Court in this appeal concerned the assignment of the burden of proof when the employer sought to modify or suspend a claimant's benefits on the basis that the claimant had retired. The Commonwealth Court plurality devised a "totality of the circumstances" test and concluded that the City failed to show that the injured worker had voluntarily withdrawn from the workforce. The City appealed, but the Supreme Court concurred with the Commonwealth Court and affirmed. View "City of Pittsburgh v. WCAB (Robinson)" on Justia Law

The issue before the Supreme Court centered on the award of attorney's fees against an insurance company under the peer-review provisions of the Motor Vehicle Financial Responsibility Law (MVFRL). The MVFRL limits the amount providers may charge for treatment, products or services rendered to patients injured in automobile accidents where the injury is covered by an insurance policy. An individual obtained treatment from Appellee Herd Chiropractic Clinic for injuries sustained in a motor vehicle accident. The insurance company submitted the clinic's invoices to a Peer Review Organization (PRO) pursuant to the MVFRL. The PRO determined that certain treatments were not necessary or reasonable, and the insurance company subsequently refused to pay for such treatment The Clinic then sued for unpaid bills, plus treble damages and attorney's fees under the theory that the MVFRL authorized payment. The Common Pleas court found an award of fees proper and mandatory under the MVFRL. The Superior Court affirmed. The Supreme Court, however, reversed, finding that the MVFRL did not allow for what amounted to "fee shifting" by the lower courts' outcome: "We acknowledge [the Clinic's] concerns with the financial incentives in the peer-review industry and with the fact that litigation costs incurred by providers may discourage legitimate challenges. The fee accruals here – in the amount of $27,000 to vindicate a $1380 claim - present a stark example of the difficulty. . . . Nevertheless, fee shifting raises a host of mixed policy considerations in and of itself, which this Court has found are best left to the General Assembly, in the absence of contractual allocation or some other recognized exception to the general, American rule." View "Herd Chiropractic Clinic v. State Farm Mutual Automobile Ins. Co." on Justia Law

The Supreme Court granted allowance of appeal in this consolidated case to consider whether a plaintiff may recover delay damages on the full amount of a jury verdict in his favor, or whether delay damages are limited to the amount of the legally-recoverable molded verdict, as it was adjusted by the trial court to reflect insurance policy limits. This case stemmed from a 2002 accident in which the vehicle operated by Richard and Marleen Marlette, stopped in traffic, was hit when vehicle operated by Herman Jordan crossed the center line and sideswiped them. Mr. Marlette sustained serious physical injuries, as well as lost wages and impairment of his earning capacity. The Marlettes filed suit against Jordan, who was uninsured, and their own insurer, State Farm Mutual Automobile Insurance Company ("State Farm"), for uninsured motorist ("UM") coverage. Liability was uncontested, and the case proceeded to trial on damages. Upon review of the matter, the Supreme Court concluded that a plaintiff may recover delay damages only on the amount of legally-recoverable damages to which he is entitled pursuant to the molded verdict. The Court remanded the case to the Superior Court for remand to the trial court for reinstatement of its original award of delay damages. View "Marlette v. State Farm Mutual Automobile Ins. Co. " on Justia Law