Justia Insurance Law Opinion SummariesArticles Posted in Alaska Supreme Court
Best v. Fairbanks North Star Borough
A minor was severely injured in an all-terrain vehicle collision in which the other driver was at fault. The minor had medical benefits coverage through a health care plan provided by her father’s employer, the Fairbanks North Star Borough. As allowed by the terms of the plan, the Borough refused to pay the minor’s medical bills until she signed an agreement that included a waiver of certain defenses to the Borough’s subrogation rights, such as the common fund and made-whole doctrines. The minor refused to sign the agreement without reservation and filed suit, seeking a declaration that the Borough could not condition payment of her medical bills on her signature. The superior court decided on summary judgment that the Borough’s health care plan was not a true insurance plan and that, regardless of whether it was interpreted as an insurance policy or an ordinary contract, the parties could lawfully reject subrogation defenses. The minor appealed. The Alaska Supreme Court held that the health care plan was a bargained-for employee benefit rather than a true insurance policy, and that the superior court’s interpretation of it was correct. The Court therefore affirmed the superior court's judgment. View "Best v. Fairbanks North Star Borough" on Justia Law
Alaska, Department of Health and Social Services v. Thomas et al.
An Alaska State Commission for Human Rights (State) employee with preexisting medical conditions was involved in a work-related motor vehicle accident in January 2017. The employee consulted with Dr. Teresa Bormann two days after the accident; Dr. Bormann referred the employee to chiropractic treatment. After several month of treatment, Dr. Bormann referred the employee to physical therapy at United Physical Therapy (UPT) for chronic neck pain and headache. After an evaluation UPT recommended eight weeks of twice weekly physical therapy. Dr. Bormann endorsed the treatment plan, and the employee’s symptoms improved enough that she reduced her physical therapy visits to once a week beginning in mid-January. She saw UPT three times in February 2018. Payment for these February visits became the main dispute before the Board. The State arranged an employer’s medical evaluation (EME) with a neurologist and an orthopedist. The EME doctors diagnosed the employee with a cervical strain caused by the accident as well as several conditions they considered preexisting or unrelated to the work injury. After the State filed a retroactive controversion of medical treatment, the employee’s healthcare provider filed a workers’ compensation claim seeking payment for services it provided before the controversion was filed. The State disputed its liability for payment, and after several prehearing conferences, the Alaska Workers’ Compensation Board set a hearing on the merits of the provider’s claim. The Board ordered the State to pay the provider approximately $510.00 for the services. The State appealed, disputing several procedural aspects of the decision, and the Alaska Workers’ Compensation Appeals Commission affirmed the Board’s decision. Finding no reversible error, the Alaska Supreme Court affirmed the Commission’s decision. View "Alaska, Department of Health and Social Services v. Thomas et al." on Justia Law
Downing v. Country Life Insurance Company
In October 2015, Amy Downing purchased a life insurance policy from Country Life Insurance Company. She purchased both an “executive whole life” policy that would pay a flat amount of $500,000 to her beneficiaries upon her death and a “Paid-Up Additions Rider” (PUAR) that provided an additional death benefit and an investment opportunity. Although Amy's father Tom worked for Country, another employee, Robert Sullivan, met with Amy and Tom to describe the terms of the policy. Amy asked Sullivan why she needed one and a half million dollars in insurance coverage because it was a larger benefit than she expected to need and it required higher yearly premiums. Sullivan explained that although she might not need the large death benefit, the structure of the PUAR provided an investment opportunity because it maximized the policy’s cash value. Sullivan later testified that he never represented to Amy that the death benefit associated with the PUAR was a flat amount. After paying the premiums for a year, Amy informed her parents that she intended to abandon the policy and withdraw its existing cash value. Her mother Kathleen decided to look into the policy as an investment. Kathleen decided to take over payment of the premiums on Amy’s life insurance policy, including the PUAR, as an investment. With Tom’s assistance, Amy assigned her policy to Kathleen. Four months later, on January 27, 2017, Amy died in an accident. Her death occurred in the second year of her policy coverage. Country paid the death benefit of $500,000 on Amy’s whole life policy. Country also paid $108,855 on Amy’s PUAR. Kathleen sued, alleging that she was entitled to $1,095,741 on Amy’s PUAR, minus the $108,855 already paid. Judgment was rendered in favor of Country, and Kathleen appealed. The Alaska Supreme Court determined the superior court did not err in its interpretation of the insurance policy at issue, and affirmed the decision. View "Downing v. Country Life Insurance Company" on Justia Law
Martinez v. Government Employees Insurance Company, et al.
In 2011, Joshua Martinez was driving a pickup truck when he lost control and crashed into a cabin, injuring the cabin owner Charles Burnett, and causing damage, including a spill of heating fuel. Burnett asked Martinez's insurance company, Government Employees Insurance Company (GEICO) to pay him to do the cleanup himself, but the insurance company refused because the cabin owner did not have the qualifications required by the Alaska Department of Environmental Conservation. Cleanup stalled for over a year while the effects of the spill on the property and the owner’s health allegedly worsened. Martinez and the truck’s owner (his father) Robert Martinez, settled with the Burnett for the maximum limits of the insurance policy, but Burnett sought additional damages from the insurance company for its failure to promptly clean up the property. Following summary judgment for the insurance company and a reversal and remand by the Alaska Supreme Court, the superior court held an evidentiary hearing to decide whether the insurance company had assumed a duty to the cabin owner independent of the duty it owed its insureds. The superior court found there was no such duty. Burnett and the insureds appeal. Burnett contended the superior court erred by finding no actionable duty, and that it deprived him of due process by failing to consider his arguments before entering proposed findings of fact and conclusions of law and awarding attorney’s fees. The insureds argued the superior court erred by deciding that they were precluded from further participation in the litigation once they entered into a settlement and were voluntarily dismissed from the case. The Supreme Court concluded the superior court did not clearly err in its findings of fact about the existence of an independent duty and that it did not violate Burnett’s due process rights. The Court also concluded the insureds were no longer parties to the case at the time they sought to renew their participation in it, and their arguments that they were entitled to either joinder or intervention were waived for lack of briefing. View "Martinez v. Government Employees Insurance Company, et al." on Justia Law
Lovely, et al. v Baker Hughes, Inc., et al.
A construction contractor’s employees were injured on the job and received workers’ compensation benefits from their employer. The workers later brought a negligence suit against three other corporations: the one that had entered into the construction contract with their employer, that corporation’s parent corporation, and an affiliated corporation that operated the facility under construction. The three corporations moved for summary judgment, arguing that all three were “project owners” potentially liable for the payment of workers’ compensation benefits and therefore were protected from liability under the exclusive liability provision of the Alaska Workers’ Compensation Act. The superior court granted the motion, rejecting the workers’ argument that status as a “project owner” was limited to a corporation that had a contractual relationship with their employer. After review, the Alaska Supreme Court concluded a project owner, for purposes of the Act, "must be someone who actually contracts with a person to perform specific work and enjoys the beneficial use of that work." Furthermore, the Court found the workers raised issues of material fact about which of the three corporate defendants satisfied this definition. Judgment was therefore reversed and the matter remanded for further proceedings. View "Lovely, et al. v Baker Hughes, Inc., et al." on Justia Law
McCormick v. Chippewa, Inc.
In August 2007 Brent McCormick was injured while working aboard FV CHIPPEWA, owned by Chippewa,Inc. McCormick filed a lawsuit against Chippewa and Louis Olsen, the vessel's captain in August 2010. McCormick initiated settlement negotiations with the employer's insurance company for "policy limits." Under the insurance policy there was a per-occurrence coverage limit. During negotiations, counsel for McCormick and the insurance company discussed the terms of the settlement over a phone call; the parties provided inconsistent accounts of which issues were addressed on the call. McCormick's counsel’s affidavit asserted he raised the issue of the number of occurrences and the parties agreed to leave it unresolved. Shortly after this phone call, the parties reached a purported settlement agreement. McCormick filed suit to enforce the purported settlement agreement for policy limits based on three occurrences. The insurance company filed for summary judgment, asserting that the agreement was for policy limits of a single occurrence. The superior court granted summary judgment for the insurance company, concluding that its interpretation of the purported settlement agreement was correct. On appeal, McCormick argued the superior court abused its discretion on evidentiary and discovery issues and erred by granting the insurer’s motion for summary judgment. After review, the Alaska Supreme Court found no abuse of discretion. But the Court did find an issue of fact barring summary judgment due to the contradictory accounts of the phone call. A reasonable person could have discerned a genuine factual dispute on a material issue because this phone call could have either: (1) provided extrinsic evidence of the meaning of the settlement agreement, or (2) indicated there was no meeting of the minds on an essential term, and thus no enforceable agreement was formed. Therefore, summary judgment was inappropriate and the matter was remanded for further proceedings. View "McCormick v. Chippewa, Inc." on Justia Law
Tobar v. Remington Holdings LP
A hotel housekeeper injured her back while lifting a pile of linens. Her employer challenged her application for benefits based on an examining doctor’s opinion that she was medically stable and that the job injury was no longer the substantial cause of any disability or need for medical treatment. After a hearing, the Alaska Workers’ Compensation Board decided that the woman was medically stable as of the date of the doctor’s opinion and therefore not entitled to further disability payments or to benefits for permanent partial impairment. The Board also denied further medical care after the date of medical stability. The Alaska Workers’ Compensation Appeals Commission affirmed the Board’s decision, and the woman appealed. Because the Board’s selected date of medical stability was not supported by substantial evidence in the record, the Alaska Supreme Court vacated the Commission’s decision and remanded the case to the Commission with instructions to remand the case to the Board for further proceedings. View "Tobar v. Remington Holdings LP" on Justia Law
Buckley v. American Fast Freight, Inc.
John Buckley started working for Labor Ready, Inc., a temporary employment service, in 2009. He was injured on assignment for a shipping company. At the time of injury he was performing a task prohibited by the contract between the temporary employment service and the shipping company. The injury resulted in loss of the worker’s hand and part of his arm. After getting workers’ compensation benefits from the temporary employment service, the worker brought a negligence action against the shipping company and one shipping company employee. The superior court decided on cross-motions for summary judgment that the exclusive liability provision of the Alaska Workers’ Compensation Act (Act) barred the action. The Alaska Supreme Court reverse, finding material issues of fact precluded disposition by summary judgment. View "Buckley v. American Fast Freight, Inc." on Justia Law
Morrison v. Alaska Interstate Construction Inc.
Petitioner Theodore Morrison had surgery on his right knee in 2004 after injuring it at work. He returned to work after the surgery and did not consult a doctor about that knee for almost ten years, until he again injured it in 2014 while working for a different employer. Following the 2014 injury he sought to have arthroscopic surgery as his doctor recommended. His 2014 employer disputed its liability for continued medical care, and the worker filed a written claim against the 2014 employer. The Alaska Workers’ Compensation Board joined the earlier employer to the claim and decided, after a hearing, that the 2014 work injury was the substantial cause of the worker’s current need for medical care, requiring the 2014 employer to pay the cost of treatment for the right knee. The 2014 employer appealed to the Alaska Workers’ Compensation Appeals Commission, which decided the Board misapplied the new compensability standard and remanded the case to the Board for further proceedings. Morrison petitioned the Alaska Supreme Court for review of the Commission’s decision, and the Supreme Court reversed the Commission’s decision and reinstated the Board’s award. Based on the medical testimony, the Court found the Board identified two possible causes of Morrison’s need for medical treatment at the time of the hearing. It then considered the extent to which the two causes contributed to that need and decided the 2014 injury was the more important cause of the need for treatment then. "The legislature gave the Board discretion to assign a cause based on the evidence before it. The Board did here what the statute directs." View "Morrison v. Alaska Interstate Construction Inc." on Justia Law
Warnke-Green v. Pro-West Contractors, LLC
The Alaska Workers’ Compensation Board denied a Bryce Warnke-Green's request that his employer pay for a van modified to accommodate his work-related disability. On appeal, the Alaska Workers’ Compensation Appeals Commission decided that a modifiable van was a compensable medical benefit. Warnke-Green moved for attorney’s fees. The Commission reduced the attorney’s hourly rate, deducted a few time entries, and awarded him less than half of what was requested. Warnke-Green asked the Commission to reconsider its award, but the Commission declined to do so because of its view that the Alaska Workers’ Compensation Act (the Act) allowed it to reconsider only the final decision on the merits of an appeal. The Alaska Supreme Court granted Warnke-Green's petition for review, and held that the Commission had the necessarily incidental authority to reconsider its non-final decisions. The Court also reversed the Commission’s award of attorney’s fees and remanded for an award that was fully compensable and reasonable. View "Warnke-Green v. Pro-West Contractors, LLC" on Justia Law