Justia Insurance Law Opinion Summaries

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The Supreme Court granted writs of prohibition and mandamus to prevent Cuyahoga County Common Pleas Court Judge John O'Donnell from exercising jurisdiction over a civil action that was transferred from the Lyndhurst Municipal Court but denied the writ of mandamus ordering Lyndhurst Municipal Court Judge Dominic Coletta to dismiss the case upon its return from the common pleas court.Plaintiff filed a complaint against State Farm Mutual Insurance Company in the small claims division of the Lyndhurst Municipal Court. Judge Coletta granted Plaintiff's subsequent motion to transfer the case to Cuyahoga County Court of Common Pleas, where it was assigned to Judge O'Donnell. State Farm filed a motion to return the case to the municipal court, but Judge O'Donnell denied the motion. State Farm then brought this action. The Supreme Court granted a writ of prohibition to prevent Judge O'Donnell from hearing the case in the Cuyahoga County Court of Common Pleas and granted a peremptory writ of mandamus ordering Judge O'Donnell to return the matter to the Lyndhurst Municipal Court, holding the peremptory writ was appropriate. View "State ex rel. State Farm Mutual Insurance Co. v. O'Donnell" on Justia Law

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In December 2015, Joseph Gill was injured in an on-the-job car accident when he was struck by a truck owned by Swift Transportation Company, LLC (“Swift”), driven by Christopher Waltz. As a result of the injuries he suffered in the accident, Gill obtained workers’ compensation benefits through Pinnacol Assurance (“Pinnacol”) to cover his medical expenses. Gill’s medical providers produced bills totaling $627,809.76 for the services he received. However, because Colorado’s workers’ compensation scheme caps the amount that medical providers can charge, Pinnacol satisfied all of Gill’s past medical expenses for significantly less. Pinnacol then pursued, and ultimately settled, its subrogation claim with Swift. Gill and his wife subsequently sued Swift and Waltz for damages resulting from the accident, and the case was removed from state court to the U.S. District Court for the District of Colorado. Swift sought partial summary judgment , relying on case law which, in applying Colorado’s workers’ compensation law, concluded that an injured employee lacked standing to pursue damages for services that were covered by workers’ compensation after the insurer had settled its subrogated claims with the third-party tortfeasor. While the federal district court was considering Swift’s motion, the Colorado Court of Appeals issued its opinion in Scholle v. Delta Air Lines, Inc., 2019 COA 81M, in which a divided court disagreed with the case law. Instead, it determined that a plaintiff-employee could seek damages for medical services covered by workers’ compensation insurance if the billed amounts were higher than the paid amounts, even after the insurer had settled its subrogation claim. The Colorado Supreme Court reversed, finding that a settlement between a workers’ compensation insurer and a third-party tortfeasor for all past medical expenses paid as a result of an on-the-job injury extinguished the plaintiff-employee’s claim to recover damages for those past medical expenses from the third-party tortfeasor. "As a result, while Joseph Gill may still pursue his claims for noneconomic damages and any economic damages not covered by his workers’ compensation insurer, he no longer has any claim to recover economic damages based on services paid for by workers’ compensation. There is consequently no reason to present evidence of either the amounts billed or the amounts paid for those services, and the collateral source rule is not implicated in this case." View "Gill v. Waltz" on Justia Law

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William Scholle worked for United Airlines, Inc., driving luggage tugs from the terminal to waiting planes, loading or unloading the bags, and returning to the terminal. In June 2012, Scholle was stopped at a stop sign on a return trip to the terminal when he was rear-ended by Daniel Moody, an employee of Delta Air Lines, Inc. Scholle applied for and received workers’ compensation insurance benefits from United, a self-insured employer. United covered all medical expenses resulting from Scholle’s on-the-job injuries, as well as a portion of his lost wages. Scholle’s medical providers produced bills for the services he received that reflected costs in excess of what is permitted by the workers’ compensation fee schedule, though they never tried to collect amounts beyond those permitted by statute. United exercised its subrogation right and sued Delta and Moody to recover the payments it made to and on behalf of Scholle. Scholle separately sued Delta and Moody for negligence, seeking to recover compensation for damages as a result of the collision. Eventually, Delta settled United’s subrogation claim; Scholle’s claims against Moody were later dismissed, leaving only Scholle and Delta as parties. Delta admitted liability for the accident, and the case went to trial on damages. In pretrial motions in limine, Scholle argued that the collateral source rule should preclude Delta from admitting evidence of the amount paid by Scholle’s workers’ compensation insurance to cover the medical expenses arising from his injuries. Instead, Scholle contended, the higher amounts billed by his medical providers reflected the true reasonable value of the medical services provided to him and should have been admissible at trial. The trial court disagreed, reasoning that when Delta settled with United, it effectively paid Scholle’s medical expenses, such that amounts paid for those expenses were no longer payments by a collateral source. The court further noted that, under the workers’ compensation statute, any amount billed for medical treatment in excess of the statutory fee schedule was “unlawful,” “void,” and “unenforceable.” The Colorado Supreme Court concluded that when, as here, a workers’ compensation insurer settles its subrogation claim for reimbursement of medical expenses with a third-party tortfeasor, the injured employee’s claim for past medical expenses is extinguished completely. "Because the injured employee need not present evidence of either billed or paid medical expenses in the absence of a viable claim for such expenses, the collateral source rule is not implicated under these circumstances. The court of appeals therefore erred in remanding for a new trial on medical expenses based on a perceived misapplication of that rule." View "Delta Air Lines, Inc. v. Scholle" on Justia Law

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In this long-running class action suit, the Supreme Court reversed in part and affirmed in part the decision of the court of appeals affirming the district court's grant of summary judgment in favor of Insureds but reversing the portion of the judgment ordering Insurer to issue the disputed insurance policies at a determined premium, holding that Insurer correctly interpreted the subject policy.At issue was how to interpret a homeowners insurance policy that had been out of use for almost twenty years. Insurer sent a notice of non-renewal to its insurers that it had decided to stop offering broad "all-risk" policies. Plaintiff, on behalf of herself and a class of similarly situated people, brought this suit seeking a declaratory judgment that the non-renewal was effective and that class members were entitled to renew their all-risk policies. The trial court granted summary judgment to Plaintiff and the class. The court of appeals affirmed in part and reversed in part. The Supreme Court reversed in part, holding that Insurer was entitled to summary judgment on the breach of contract claim for non-renewal of the policies and that remand was required for the trial court to address any remaining matters. View "Farmers Group, Inc. v. Geter" on Justia Law

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Basic underinsured motorist (UIM) coverage is equal to the policy's bodily injury limits; Pennsylvania insureds can reduce costs by making a “request in writing” for lower UIM coverage. Gibson signed a State Farm (SF) insurance application for bodily injury coverage of $250,000 with $100,000 in stacked UIM coverage; for the Gibsons' three cars, the total UIM coverage described was $300,000. The application's signature block attested that “the limits and coverages ... were selected by me”; the last page referenced other “required” documents, including an acknowledgment of UIM coverage selection. SF did not provide those additional forms. Gibson was seriously injured in an accident. Weeks later, Gibson returned to SF and signed the form, stating that UIM benefits “are available with limits up to the Liability Coverage limits for bodily injury” and that she had selected “lower limits of $100,000 (per person)/$300,000 (per accident).”Gibson sued for UIM coverage, breach of contract, and bad faith, demanding “the maximum amount of UIM coverage,” of “$300,000.” A Magistrate granted SF summary judgment on the bad faith claim. A jury awarded Gibson $1,750,000. SF moved to mold the verdict to the UIM policy limit, $300,000, listed on the application and in the complaint. Gibson successfully cross-moved to mold the verdict to $750,000 (the $250,000 bodily injury limit stacked for three cars), arguing that the application to elect a lower UIM policy limit did not comply with Pennsylvania’s Motor Vehicle Financial Responsibility Law. The Third Circuit reversed. The statute’s minimal requirement of a “request in writing” for the lower optional UIM coverage was met. The court affirmed the dismissal of the bad faith claim. View "Gibson v. State Farm Mutual Automobile Insurance Co." on Justia Law

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The Supreme Court issued a permanent writ in prohibition directing Respondent, the Honorable Brian H. May, to vacate his orders in the case entered after Insurer filed its application for change of judge and to sustain the application for change of judge, holding that Insurer was entitled to the writ.In the underlying wrongful death suit Insurer filed a motion to intervene and stay proceedings while its contractual obligation to provide coverage was determined in a pending declaratory judgment action. Judge David Lee Vincent sustained the motion to intervene but overruled the motion to stay the proceedings. Thereafter, Judge Vincent entered an order of recusal, and the case was reassigned to Respondent. Insurer then filed this petition for writ of prohibition. The Supreme Court issued the writ and directed Respondent to vacate his order overruling Insurer's application for change of judge and the order sustaining a motion to quash Insurer's notice of deposition, holding that Insurer was entitled to a change of judge. View "State ex rel. COUNTRY Mutual Insurance Co. v. Honorable Brian H. May" on Justia Law

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The Supreme Court affirmed the decision of the Administrative Hearing Commission (AHC) finding that David and Gale Collison were not entitled to a sales tax credit following their purchase of a vehicle to replace another vehicle declared a casualty loss by their insurance company, holding that the Collisons could not prevail in this matter.In denying the requested sales tax credit the AHC found that a revocable trust, not the Collisons, owned the new vehicle and that the Collisions, and not the revocable trust, owned the replaced vehicle. On appeal, the Collisons argued that they and the revocable trust were the same owner of the separate vehicles and the same entity for purposes of the sales tax credit. The Supreme Court affirmed, holding that because Missouri law clearly considers a trust and the natural persons who create and control the trust to be separate and distinct entities, the Collisons and their revocable trust were legally separate owners. View "Collison v. Director of Revenue" on Justia Law

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Defendant Daniel Clapp plead no contest to concealing the true extent of his physical activities and abilities from his employer, the Department of the California Highway Patrol (CHP), and the State Compensation Insurance Fund (SCIF). Consistent with a resolution negotiated by the parties, the trial court granted defendant three years’ probation, and as a condition of probation, ordered him to pay restitution. Following a hearing, defendant was ordered to pay $30,095.68 to SCIF for temporary disability benefits and $81,768.01 to CHP for benefits wrongfully obtained. He was also ordered to pay $1,350 and $70,159 to SCIF and CHP respectively for investigative costs. Defendant appealed the restitution award as to investigation costs contending that, as public investigative agencies, neither SCIF nor CHP was entitled to reimbursement for the costs of investigating his claim. After review, the Court of Appeal concluded that as direct victims of defendant’s fraud, both CHP and SCIF were indeed entitled to restitution for investigative costs incurred in an effort to justify discontinuance of payments and recoup money defendant fraudulently obtained. View "California v. Clapp" on Justia Law

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After plaintiff admitted to using fentanyl at work, he was terminated from his position as a certified nurse anesthetist at Mid-Missouri. Plaintiff then submitted claims for short- and long-term disability benefits to Kansas City Life, which issued disability insurance policies to Mid-Missouri as part of its employee benefit plan.The Eighth Circuit affirmed the the district court's conclusion that Kansas City Life had abused its discretion in denying plaintiff benefits under the Employee Income Security Act of 1974 (ERISA). The court concluded that Kansas City Life's denial of benefits is not supported by substantial evidence where reasonable minds could not reconcile Kansas City Life's position that plaintiff was unable to safely administer anesthesia on October 6, 2017, with its position that he had safely administered anesthesia while under the influence of fentanyl during the time period between his relapse and termination. Therefore, the evidence that plaintiff made no medical errors and did not seek treatment until after he was terminated, as well as the fact that the record does not disclose his exact date of disability, could not support Kansas City Life's conclusion that plaintiff was not disabled before his insurance coverage ended. View "Bernard v. Kansas City Life Insurance Co." on Justia Law

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Plaintiff sought life and accidental death benefits under her brother's insurance plan after he died in a single-vehicle crash. Unum Life paid plaintiff life insurance benefits, but denied her claim for accidental death benefits. Plaintiff filed suit under the Employee Retirement Income Security Act of 1974 (ERISA).The Eighth Circuit reversed the district court's grant of summary judgment for plaintiff, concluding that the administrator's decision was supported by substantial evidence. The court explained that the evidence is sufficient to support a reasonable finding that the brother's speeding and improper passing contributed to the crash; the crime exclusion applies to "accidental losses;" and Unum Life's interpretation of the "crime" exclusion was reasonable because the brother's conduct constituted a crime under Missouri law. In this case, the brother was driving more than twice the legal speed limit and passing vehicles in a no-passing zone on a two-lane road in icy road conditions. Furthermore, Missouri's classification of improper passing and speeding as misdemeanor offenses reinforces the reasonableness of Unum Life's determination. View "Boyer v. Schneider Electric Holdings, Inc." on Justia Law