Justia Insurance Law Opinion Summaries

A driver caused injury to the passenger of another car in a two-car accident. The passenger brought suit for damages, including her insurer's subrogated claim for medical expenses. The driver made an early offer of judgment, which the passenger did not accept. The driver's insurer then made a direct payment to the subrogated insurer, thereby removing that amount from the passenger's potential recovery. The driver then made a second offer of judgment, which the passenger did not accept. After trial both parties claimed prevailing party status; the driver sought attorney's fees. The superior court ruled that the first offer of judgment did not entitle the driver to fees, but the second offer did. Both parties appealed, arguing the superior court improperly considered the subrogation claim payment in its rulings. Upon review, the Supreme Court concluded that the subrogation claim payment had to be taken into account when evaluating the first offer of judgment and affirmed the decision that the driver was not the prevailing party based on the first offer of judgment. But because the nature of the payment on the subrogation claim was not clear, the Court vacated the decision that the second offer of judgment entitled the driver to attorney fees and remanded the case for further proceedings on this issue. View "Dearlove v. Campbell" on Justia Law

Following a car accident with an uninsured motorist, Lori McDonnell filed suit against her insurer State Farm Mutual Automobile Insurance Company on behalf of herself and her minor son, Luke. McDonnell sought a declaratory judgment that: (1) she was entitled to have her personal injury claims settled by appraisal under the mandatory appraisal statute; and (2) a provision in her State Farm insurance policies requiring her to file suit against the insurance company within two years of the accident was void as against public policy. The superior court ruled that the mandatory appraisal statute did not apply to personal injury claims. The court further ruled that the contractual two-year limitations provision was enforceable, but only if State Farm could show that it was prejudiced by an insured's delay in bringing suit, and that the appropriate accrual date for the limitations period was the date State Farm denied an insured’s claim, rather than the date of the accident. McDonnell and State Farm both appealed that decision. Finding no error in the trial court's decision, the Supreme Court affirmed. View "McDonnell v. State Farm Mutual Automobile Ins. Co." on Justia Law

The question before the Supreme Court in this appeal was whether a defendant who pled no contest to disorderly conduct in a criminal action could be collaterally estopped from relitigating the elements of that crime in a related civil declaratory judgment action regarding insurance coverage, thereby precluding coverage. Kent Bearden pled no contest to disorderly conduct for punching Paul Rasmussen. Rasmussen subsequently filed a civil complaint against Bearden, and Bearden tendered the lawsuit to State Farm Insurance Company to defend and indemnify him under his homeowners insurance policy. State Farm sought declaratory relief and moved for summary judgment on the ground that Bearden's conduct could not be considered an "accident" within the meaning of the insurance policy because his no-contest plea collaterally estopped him from relitigating the issues of mens rea and self-defense. The superior court granted the motion. Finding no error with the superior court's decision, the Supreme Court affirmed. View "Bearden v. State Farm Fire & Casualty Co." on Justia Law

An employee filed an affidavit of readiness for hearing in her workers' compensation case approximately four years after her employer filed a controversion of her written workers' compensation claim. The employer petitioned to dismiss her claim based on the statutory deadline for a hearing request. After a hearing, the Alaska Workers' Compensation Board dismissed her claim, and the Alaska Workers' Compensation Appeals Commission affirmed the Board's decision. Because the employee did not file a timely request for a hearing and was not excused from doing so, the Supreme Court affirmed the Commission's decision. View "Pruitt v. Providence Extended Care" on Justia Law

A hotel worker fell and injured her back while cleaning a room. Her employer initially paid benefits, but it filed a controversion of benefits after its doctor doubted the accident’s occurrence and said any work injury was not the substantial cause of the worker’s continuing need for medical care. The Alaska Workers’ Compensation Board decided that the fall was the substantial cause of the worker’s disability, finding the worker’s testimony about the injury credible and the employer’s doctor’s testimony not credible. Based on the testimony of the worker and her treating physician, as well as an MRI showing a herniated disc, the Board decided that the injury was compensable. The Alaska Workers’ Compensation Appeals Commission reversed the Board’s decision because, in the its view, substantial evidence did not support the decision. Because the Commission incorrectly decided the substantial evidence question, the Supreme Court reversed the Commission’s decision. View "Sosa de Rosario v. Chenega Lodging" on Justia Law

While receiving workers' compensation benefits for an injury, an employee periodically endorsed benefit checks that included a certification that she had "not worked in any employment or self-employment gainful or otherwise." Her employer obtained surveillance videos of her activities at an herb store owned by her boyfriend and filed a petition with the Workers' Compensation Board alleging that she had fraudulently misrepresented her employment status for the purpose of obtaining benefits. The Board denied the petition, finding credible the employee's testimony that she did not consider her activities to be work that needed to be reported. On appeal, the Alaska Workers' Compensation Appeals Commission concluded that the Board erred in determining that the employee had not "knowingly" misrepresented her work status, but it affirmed the Board's denial of the petition on the alternative ground that the employer had not shown the requisite causal link between the allegedly fraudulent check endorsements and the payment of benefits. Upon review of the matter, the Supreme Court concluded that the Commission erred in its interpretation of the "knowingly" element of the test for fraud. Nevertheless, the Court affirmed the Commission's decision because, based on the Board's binding credibility determination, the employee's statements were not knowingly false and therefore not fraudulent. View "ARCTEC Services v. Cummings" on Justia Law

The underlying tort action in this appeal resulted from a car accident in which the insured, while driving a rental truck, hit a person who was lying in the middle of the road. Both the driver and the person struck were intoxicated, in addition to a passenger in the truck. The person who was struck died from his injuries. The victim's estate sued. The insurance company offered to settle the case against both the driver and the passenger (who may have faced liability for his actions after the accident) for policy limits. These offers were rejected. The estate offered to settle for the release of the named insured only, but the insurer rejected that offer. The occupants of the vehicle later settled with the estate. Unable to reach settlement, the insurer filed a declaratory action to clarify its duties under the policy and resolve issues of who was driving the vehicle, the number of occurrences, and possible breaches of the insurance contract by the insureds. The insureds assigned their claims against the insurer to the estate, which answered and counterclaimed for breach of contract and bad faith. The insurer prevailed on nearly all issues. The personal representative of the estate, for herself and as assignee of the insureds, appealed that result. After review, the Supreme Court found that the insurer did not breach its duties to the insured, and accordingly the Court affirmed the superior court's decision. View "Williams v. GEICO" on Justia Law

A healthcare worker was sprayed in the eye with fluids from an HIV-positive patient. She received preventive treatment and counseling. Her employer initially paid workers' compensation benefits; it later filed a controversion based on its doctor's opinion that the employee was able to return to work. The employee asked for more benefits, but the Alaska Workers' Compensation Board denied her claim. The employee appealed, but the Alaska Workers' Compensation Appeals Commission affirmed the Board's decision. Because the Supreme Court agreed with the Commission that substantial evidence supported the Board's decision, the Court affirmed the Commission's decision. View "Runstrom v. Alaska Native Medical Center" on Justia Law

The passenger of a car was injured in a two-car accident. The passenger brought suit against the other car's driver; the passenger's requested recovery included her insurer's subrogation claim for medical expenses. The driver made an early offer of judgment, which the passenger rejected. The driver then paid the subrogation claim, thereby removing it from the passenger's expected recovery. The driver then made a second offer of judgment, which the passenger rejected, and the case proceeded to trial. After trial the jury awarded the passenger damages and both parties claimed prevailing party status; the driver sought attorney's fees under Alaska Civil Rule 68. The superior court ruled the first offer of judgment did not entitle the driver to Rule 68 fees, but the second offer did. Both parties appealed, arguing the superior court improperly considered the subrogation claim in its Rule 68 rulings. Upon review, the Supreme Court concluded the subrogation payment had to be taken into account when evaluating the first offer of judgment, but not the second. The Court therefore affirmed the superior court's rulings. View "Dearlove v. Campbell" on Justia Law

An employer petitioned the Alaska Workers' Compensation Board for reimbursement from the Second Injury Fund for payments it made to a disabled worker. The Fund opposed the petition. After a hearing, the Board granted the petition. The Fund asked the Board to reconsider its decision in December 2009. The hearing officer told the parties that he would inform them in writing by the end of January 2010 about what action the Board was taking on the reconsideration request. Instead, in April 2010 the hearing officer sent a prehearing conference summary indicating that the reconsideration request had been denied by operation of statute. The next day the Fund filed a notice of appeal and a motion to accept a late-filed appeal with the Alaska Workers' Compensation Appeals Commission. The Commission denied the Fund's request to file its appeal late and dismissed the appeal. Because the Supreme Court concluded that the Fund filed a timely appeal, it reversed the Commission's decision and remand for consideration of the Fund's appeal.