Justia Insurance Law Opinion Summaries

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

A staffing services company (Company) furnished workers for the City, including Respondent. During the course of his employment, Employee lost an arm working on a garbage truck driven by an employee of the City. Respondent sued the City and its employee (collectively, Petitioners). Petitioners filed a motion for summary judgment, asserting governmental immunity based in part on the exclusive remedy under the Texas Labor Code, which provides that recovery of workers' compensation benefits is the exclusive remedy of an employee covered by workers' compensation insurance. The trial court dismissed the case. The court of appeals reversed, holding that a fact question remained whether Respondent, who was paid by Company, was within the specific terms of the City's workers' compensation coverage. The Supreme Court reversed and dismissed the case, holding that, as a matter of law, the City provided Respondent's workers' compensation coverage, and therefore, Respondent's exclusive remedy was the compensation benefits to which he was entitled. View "City of Bellaire v. Johnson" on Justia Law

Appellant Tommie Patterson was involved in a motor vehicle accident. His insurance company paid his medical providers to the policy limit. Two years later, Appellant sued the insurance company, arguing it had shown bad faith following the accident. The company moved for summary judgment, which was granted. A month after that decision, Appellant filed a second lawsuit, alleging the company falsely advertised its services, breached his insurance contract, embezzled money from him, falsified documents and threatened to make him at fault for the accident. The company moved for summary judgment again, which was granted. After review, the Supreme Court concluded that because Appellant's embezzlement claim in the second lawsuit alleged a different cause of action than in the first, the trial court improperly granted summary judgment with regards to that claim. All other claims were barred by res judicata. Therefore the Supreme Court affirmed the trial court in all other respects. View "Patterson v. Infinity Insurance Co." on Justia Law

Appellees, the Rubins, requested that the district court issue a Writ of Garnishment against the assets of Hamas and HLF after obtaining a judgment against Hamas for damages resulting from a terrorist attack in an outdoor pedestrian mall in Jerusalem. The district court executed the writ but the Rubins could not execute against HLF's assets because those assets had been restrained under 21 U.S.C. 853 to preserve their availability for criminal forfeiture proceedings. The district court subsequently denied the government's motion to dismiss the Rubins' third-party petition under section 853(n) to assert their interests in the restrained assets and vacated the preliminary order of forfeiture. The district court held that the Terrorism Risk Insurance Act of 2002 (TRIA), Pub. L. No. 107-297, title II, 201, 116 Stat. 2337, allowed the Rubins to execute against HLF's assets not withstanding the government's forfeiture proceedings. The court reversed, holding that section 853(n) did not provide the Rubins with a basis to prevail in the ancillary proceeding; TRIA did not provide the Rubins a basis to assert their interest in the forfeited property; TRIA did not trump the criminal forfeiture statute; and the in custodia legis doctrine did not preclude the district court's in personam jurisdiction over HLF. View "United States v. Holy Land Foundation for Relief, et al." on Justia Law

Indigo and one of its employees filed suit against Advanced and Lile, alleging breach of contract, negligence, conspiracy, and violations of federal law on the theory that Advanced and Lile had intentionally delayed payments on valid insurance claims. Indigo argued on appeal that, despite receiving full reimbursement from the receiver, it suffered an injury because a monthly retention amount it had paid to Advanced was neither credited towards the employee's medical costs nor repaid by Indigo. The court agreed with the district court that Indigo failed to establish standing because Indigo failed to show how any injury had arisen, or might arise in the future, from the alleged conduct. View "Indigo LR LLC, et al. v. Advanced Ins. Brokerage, et al." on Justia Law

Defendants Pam Wood, David Wood, Justin Wood, Josh Wood and Jacob Wood filed an interlocutory appeal for the Supreme Court to determine whether the circuit court abused its discretion in denying their motion to transfer this case to another county. The underlying case involved a car accident in which a question arose over who was covered by an insurance policy. Defendant Pam Wood applied for the coverage in Covington County; the application was faxed from an insurance agent's office in Covington to Plaintiff Safeway Insurance Company's Rankin County office where it was approved. Safeway opposed the transfer of venue. Upon review, the Supreme Court concluded that Safeway could not demonstrate sufficient facts to support that venue was proper in Rankin County. Therefore the Court reversed the circuit court's order and remanded the case with instructions to transfer it to a permissible venue. View "Wood v. Safeway Insurance Co." on Justia Law

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

Plaintiff Charles Honeycutt was injured in an automobile accident involving a Mississippi state trooper. He sued the state trooper and two automobile-insurance providers, Atlanta Casualty Company and American Premier Insurance Company. The trial court granted the defendants' motions for summary judgment. On appeal, the Court of Appeals affirmed the trial court's grant of summary judgment. Plaintiff filed a writ of certiorari, seeking to appeal the grant of summary judgment for American Premier: (1) whether the trial court and the Court of Appeals erred by finding an insurance agent does not have a duty to explain uninsured-motorist coverage; (2) whether summary judgment was granted improperly. The Supreme Court found that, in order to obtain a knowing and voluntary waiver of uninsured-motorist coverage (UM coverage), an insurance agent does have a duty to explain UM coverage to the insured. The Court also found that summary judgment was not proper in this case. Thus, the Court reversed both lower courts' judgments and remanded the case back to the trial court for further proceedings. View "Honeycutt v. Coleman" on Justia Law

Plaintiff Kenneth Admire was seriously injured when the motorcycle he was riding collided with a car being operated by an insured of Defendant Auto-Owners Insurance Company. Following the accident, Kenneth required wheelchair-accessible transportation. Through his guardian Russ Admire, brought an action against Auto-Owners Insurance Company, seeking payment of personal protection insurance (PIP) benefits under the no-fault act. Auto-Owners had agreed to pay the full cost of purchasing a van modified to accommodate Kenneth’s wheelchair. Kenneth’s guardian gave Auto-Owners notice of his intent to purchase a new van. In response, Auto-Owners stated that it was not obligated to pay the base purchase price of a new van, but that it would pay for the necessary modifications if Kenneth’s guardian purchased a new vehicle for him. Kenneth’s guardian purchased the new van for Kenneth, and after the cost of the modifications was reimbursed and the trade-in value was applied, Kenneth was left with $18,388.50 in out-of-pocket expenses for the modified van. Kenneth brought suit seeking reimbursement for the out-of-pocket expenses. The Court of Appeals ruled in favor of Kenneth, but the Supreme Court reversed: Auto-Owners met its statutory obligation to pay for the transportation expenses recoverable under the statute, by paying for the van’s modifications and reimbursing him for mileage to and from his medical appointments. The Court of Appeals erred by concluding that the base price of the van was compensable. View "Admire v. Auto-Owners Ins. Co. " on Justia Law