Justia Insurance Law Opinion Summaries

An Oklahoma worker was killed at Employer's jobsite in Texas. The employer's insurer paid the worker's Widow death benefits provided by Texas workers' compensation law. The widow also recovered damages in a wrongful death tort action in Texas. When the Insurer sought subrogation from the widow's wrongful death damages as allowed by Texas law, she filed suit in Oklahoma to prevent subrogation. She sought a declaratory judgment that the rights of Oklahoma workers and their dependents were governed by Oklahoma's Workers' Compensation Act, notwithstanding the worker's injury or death in another state, and any benefits that may be paid under another state's workers' compensation law. In particular, Widow asked the Oklahoma court to enforce the provision in Oklahoma law that forbids subrogation in cases of death benefits. The trial court granted the declaratory relief sought by the widow. On appeal by the Insurer, the Court of Civil Appeals reversed. The Court of Civil Appeals ruled that the widow had to commence a proceeding by filing a claim with Oklahoma's Workers' Compensation Court before Oklahoma could exercise jurisdiction over the benefits due the widow, including enforcement of the anti-subrogation provision in death benefit cases. Because she never filed a claim with Oklahoma's Workers' Compensation Court, the Court of Civil Appeals held subrogation was proper. Upon review, the Supreme Court affirmed the trial court's judgment and vacated the appellate court in this case. View "Holley v. ACE American Ins. Co." on Justia Law

Safeway Insurance Company of Alabama, Inc. petitioned the Supreme Court for a writ of mandamus to direct the Circuit Court to grant its Rule 12(b)(1), Ala. R. Civ. P., motion to dismiss a bad-faith claim against it for lack of subject-matter jurisdiction. Richard Kimbrough alleged that a deer ran across the road causing a truck traveling in the opposite direction to swerve into the Kimbrough's lane. According to Kimbrough, the truck struck his vehicle and ran him off the road and into a creek bed. The driver of the truck allegedly fled. Kimbrough broke his right femur, right hand, and nose. Kimbrough sued Safeway, asserting claims of breach of contract and bad faith, alleging that Safeway, without justification, had intentionally refused to pay Kimbrough's claim. Safeway moved to dismiss the case for lack of subject-matter jurisdiction, arguing that the claim for uninsured-motorist benefits was not ripe for adjudication until liability and damages were established. The trial court denied the motion to dismiss, as well as Safeway's subsequent motion to reconsider. Upon careful consideration, the Supreme Court concluded Safeway did not clearly demonstrate this case was not ripe or that the trial court lacked subject-matter jurisdiction. Therefore, Safeway did not have a clear legal right to mandamus relief. View "Kimbrough v. Safeway Insurance Company of Alabama, Inc." on Justia Law

At issue in this case was what constituted a "proof of loss" in a claim for UIM benefits and what sufficed to trigger the safe harbor provision. The insured provided notice of an injury automobile accident to her insurer, but did not submit a UIM benefits claim at that time. Nearly two years later, the insurer learned of the possible UIM claim. The insurer agreed in writing that it accepted coverage, that the only remaining issues were liability and damages, and that it was willing to submit to binding arbitration. After recovering on her UIM claim, the insured asked for attorney fees. The insurer claimed the benefit of the safe harbor provision of ORS 19 742.061(3). The Court of Appeals concluded that the insurer did not send its safe harbor letter within six months of the insured's "proof of loss." According to the Court of Appeals, the "proof of loss" was the initial report of injury two years earlier. Upon review, the Supreme Court concluded that the initial report of injury did not provide sufficient information to constitute a proof of loss for a UIM claim and that the insurer's safe harbor letter was sufficient to trigger the statutory exception to an attorney fee award. View "Zimmerman v. Allstate Property and Casualty Ins." on Justia Law

In two consolidated cases involving remediation of contaminated properties, the New Jersey Property-Liability Insurance Guaranty Association (Guaranty Association) took over the administration of the claims of an insolvent insurance carrier on the risk pursuant to the New Jersey Property-Liability Insurance Guaranty Association Act. The solvent insurance company paid the property-damage claims in each of the two cases and then sought reimbursement from the Guaranty Association under the Owens-Illinois methodology. The Guaranty Association claims that, pursuant to N.J.S.A. 17:30A-5 and -12b, it was not responsible for making any contribution until the policies of the solvent carrier were fully exhausted. The solvent carrier contended on appeal that the Guaranty Association must pay the share of the insolvent carrier in accordance with the Owens-Illinois allocation scheme, and that its position is consistent with the PLIGA Act. The trial court agreed that the Guaranty Association is subject to the Owens-Illinois allocation methodology. The Appellate Division reversed, finding that N.J.S.A. 17:30A-5 expressly carves out an exception to Owens-Illinois and requires exhaustion of the solvent carrier's policies before the Guaranty Association's reimbursement commitments are triggered. Finding no error with the appellate court's judgment, the Supreme Court affirmed. View "Farmers Mut. Fire Ins. Co. of Salem v. N.J. Property-Liability Ins. Guar. Ass'n" on Justia Law

Kennedy family members own a controlling interest in corporate entities that comprise Autocam. John Kennedy is Autocam’s CEO. The companies are for-profit manufacturers in the automotive and medical industries and have 661 employees in the U.S. The Kennedys are practicing Roman Catholics and profess to “believe that they are called to live out the teachings of Christ in their daily activity and witness to the truth of the Gospel,” which includes their business dealings. Regulations under the Patient Protection and Affordable Care Act of 2010 (ACA), 124 Stat. 119, require that Autocam’s health care plan cover, without cost-sharing, all FDA-approved contraceptive methods, sterilization, and patient education and counseling for enrolled female employees. Autocam and the Kennedys claim that compliance with the mandate will force them to violate their religious beliefs, in violation of the Religious Freedom Restoration Act, 42 U.S.C. 2000bb. The district court denied their motion for a preliminary injunction. The Sixth Circuit affirmed for lack of standing. Recognition of rights for corporations under the Free Speech Clause 20 years after RFRA’s enactment does not require the conclusion that Autocam is a “person” that can exercise religion for purposes of RFRA. View "Autocam Corp. v. Sebelius" on Justia Law

Petitioner Southern Farm Bureau Casualty Insurance Company petitioned for a writ of prohibition with the Supreme Court, arguing the circuit court did not have jurisdiction after ninety days to set aside its previous order in this case. This matter stemmed from a motorcycle accident in which Stuart Parsons was injured with an uninsured driver. Parsons had uninsured-motorist coverage with Farm Bureau. He made a claim against that coverage, and signed a release allowing farm bureau to obtain his medical bills, and received a personal-injury protection payment. Parsons' medical bills exceeded the policy limit. Farm Bureau them filed a complaint for interpleader, requesting the circuit court disburse its uninsured-motorist limits. At that time, no other party had filed a lien nor claimed any interest in the policy proceeds. Acting pro se, Parsons answered and requested his policy be paid to him. The circuit court ordered Farm Bureau to deposit the funds into the court's registry and to disburse the money accordingly. Then Parsons filed a counterclaim seeking a statutory penalty, interst and attorney's dees, and to dismiss Farm Bureau's interpleader. After a hearing, the circuit court vacated an earlier order thereby allowing Parsons to proceed with his counterclaims against Farm Bureau. Farm Bureau then filed for a writ of prohibition, arguing the circuit court had no jurisdiction to set aside the order after ninety days from entry of the order. The Supreme Court considered Farm Bureau's petition for a writ of prohibition as a request for a writ of certiorari, and found that Farm Bureau had another adequate remedy. As such, the Court denied Farm Bureau's petition for certiorari, and dismissed the petition for the writ of prohibition as moot. View "S. Farm Bureau Cas. Ins. Co. v. Parsons" on Justia Law

Petitioner Jennifer Mau was convicted of making false insurance claims. She challenged the sufficiency of the evidence presented against her at trial. Upon review, the Supreme Court found that the State failed to prove the existence of any "contract of insurance" underlying Petitioner's claim. Therefore the Court reversed her conviction. View "Washington v. Mau" on Justia Law

Puerto Rico law operated to cause hundreds of thousands of motor vehicle owners to pay twice for liability insurance. Commonwealth law declared motor vehicle owners to be entitled to a refund of the excess premiums paid, but large amounts of unclaimed refunds accumulated. The Commonwealth subsequently placed the unclaimed refunds with its Treasury Secretary with the condition that, if not claimed within five years, the funds escheated to the Commonwealth without notice to the vehicle owners. In Garcia-Rubiera II, the First Circuit Court of Appeals held that the Commonwealth's failure to notify vehicle owners of their reimbursement rights violated their procedural due process rights. On remand, the district court ordered the Commonwealth to notify vehicle owners of their reimbursement rights, to publish notices in two newspapers alerting the owners of their rights, and to give owners a 120-day grace period for them to claim reimbursement. The First Circuit again remanded for the district court to craft with "the benefit of further guidance" an injunction that more fittingly remedied the Commonwealth's constitutional violations and ordered no duplicate premiums to escheat to the Commonwealth until it established and complied with a reimbursement procedure meeting the requirements of due process. View "Garcia-Rubiera v. Fortuno" on Justia Law

In 2009, respondent Adrian Melton suffered an on-the-job accident while working for his employer, Joe Brown Company, Inc. He was awarded eleven weeks of temporary total disability, granted permanent partial disability, and a psychological overlay. The employer appealed the award, which vacated some parts and sustained others. In 2011, the employer appealed to the Court of Civil Appeals (COCA) which vacated the permanent partial impairment award because it failed to comply with the AMA Guides (5th Edition), and that an "any competent evidence" standard of review was inconsistent with 85 O.S. 2011 sec. 340, so the court used the "against the clear weight of the evidence" standard which had recently been revised. Respondent petitioned the Supreme Court for review of the COCA decision, arguing that the appellate court should have used the "any competent evidence" standard. Upon review of the matter, the Supreme Court concluded that because respondent's injury happened before the new standard went into effect, the "any competent evidence" standard should have been applied. With regard to respondent's awards of disability, the Court found that psychological overlay was not supported by appropriate expert testimony. Accordingly, the benefits as they related to the overlay were vacated. View "Joe Brown Company, Inc. v. Melton" on Justia Law

Plaintiff-Appellant Cynthia Pfeifer filed suit against Defendant-Appellee Federal Express Corporation in the District of Kansas, alleging that the company fired her in retaliation for receiving workers' compensation benefits. Plaintiff filed suit fifteen months following the termination within the applicable state statute of limitations, but outside the limit of six months enumerated in her employment agreement. The district court granted Defendant's motion for summary judgment, concluding that the contract clause was reasonable and was not a violation of public policy. Because no Kansas law appeared to control the outcome of the case, the Tenth Circuit certified two questions to the Kansas Supreme Court regarding the ability of parties to shorten the applicable statute of limitations by contract, and if not, then was the six-month limitation unreasonable in this case? The Kansas Court responded that the contract clause in question here did violate public policy. Because of that answer, the Court did not respond to the Tenth Circuit's second question. In light of these answers, the federal district court was reversed and the case remanded for further proceedings. View "Pfeifer v. Federal Express Corporation" on Justia Law