Justia Insurance Law Opinion Summaries

Claimant Carl Wynne was a truck driver. While he was in Tennessee driving a truck for his former employer, he heard that Triad Transport, Inc. was hiring. Claimant called Triad’s headquarters in McAlester and spoke to a recruiter who had hiring authority. Claimant requested that an application be sent by fax to Odessa, Texas, where he lived. He completed the application and sent it by fax to McAlester. A week or so later, the recruiter phoned while Claimant was driving somewhere between Georgia and Arizona that his application had been approved. Claimant agreed to travel to McAlester for orientation. He returned his prior employer's truck to a terminal in Tuscon, Arizona, and a Triad employee gave him a ride to a Triad satellite terminal in Laveen, Arizona. There, he passed a drug test, was provided a fuel card, and dispatched to Rockwall, Texas with a load. In 2010, Claimant was injured in a motor vehicle accident in Colorado while he was driving Triad’s truck. He filed a Form 3 claim for benefits in the Oklahoma Workers' Compensation Court which Triad opposed. The trial tribunal conducted a hearing solely on the issue of the court's jurisdiction. Two witnesses were presented, Claimant and the President of Employer. Claimant testified concerning when and where he was actually hired, and Employer's President testified to the general hiring practices of his company. The recruiter was not called to testify. The trial tribunal made several findings of fact and concluded that it had jurisdiction to hear the case of Claimant's subsequent injury as Claimant's hiring and final assent to permanent employment relationship between claimant and respondent occurred in Oklahoma. A three-judge panel of the Workers' Compensation Court unanimously affirmed the decision. The Supreme Court’s de novo review of the record, the testimony of the witnesses, and the arguments of the parties lead to the conclusion that Claimant's final assent to employment did not occur until he attended the orientation in Oklahoma, “[t]hat process began when Claimant first made contact with [Triad’s] recruiter, but it did not end until Claimant gave his final assent to employment during the orientation in Oklahoma. The Workers' Compensation Court did not err in determining that it has jurisdiction to hear the claim.”

Plaintiff-Appellant Allen Perius appealed a district court judgment following a jury verdict in favor of Appellee Nodak Mutual Insurance Company. In 2004, Plaintiff was involved in a motor vehicle accident with an uninsured driver, Jacob Kessler. Plaintiff insured his vehicle with Nodak for basic no-fault benefits and uninsured motorist benefits. Nodak paid Plaintiff no-fault benefits as a result of the accident. Plaintiff did not seek further medical treatment until March 2005, when he saw a chiropractor. Plaintiff submitted the bills to Nodak for payment as no-fault benefits. After Plaintiff submitted to an independent medical examination, Nodak denied him payment for any medical treatment after December 31, 2004, concluding such treatment was unrelated to the accident. In 2007, Plaintiff brought suit against Kessler, alleging he negligently operated his motor vehicle and caused Plaintiff's injuries. Plaintiff also sued Nodak, alleging the company breached its insurance contract with him. Nodak denied liability, and asserted a cross-claim against Kessler regarding Plaintiff's uninsured motorist claim. Kessler did not answer the claims against him. In 2009, Nodak moved for summary judgment, arguing no competent, admissible evidence established his claimed injuries were caused by the accident. Plaintiff resisted the motion, and submitted the affidavits of two of his treatment providers who stated their belief that Plaintiff's injuries and treatment were due to the accident. The district court granted Nodak's motion for summary judgment, and this Court reversed and remanded, finding disputed issues of material fact existed. A trial was set on remand. Shortly after, Plaintiff sent Nodak amended responses to Nodak's interrogatories. Prior to trial, Nodak was informed of Plaintiff's intent to call a chiropractor, as an expert witness. Nodak filed a motion in limine seeking to exclude the expert witness, alleging the expert was not properly disclosed.The district court granted Nodak's motion, but ordered the doctor would still be allowed to testify as a fact witness. The jury returned a verdict in Nodak's favor. The Supreme Court concluded that Plaintiff did not properly disclose his witness and that the district court did not abuse its discretion excluding the expert's testimony as a discovery sanction.

In this case, an insurance agency had a contract with an insurance company that allowed the agency to commingle collected insurance premiums with its other funds in its general operating account. The government contended that the premiums collected by the agency were the property of the insurance company and held "in trust" by the agency; it alleged that when the funds were not remitted but used for other purposes, they were embezzled by the agency's treasurer, defendant. Defendant was charged with ten counts of embezzlement of insurance premiums in violation of 18 U.S.C. 1033(b)(1) and one count of conspiracy to commit embezzlement. The court held that under long-standing Arizona law, the contract between the agency and the company, which permitted agency commingling, required monthly agency payments whether premiums were collected or not, and created a right of interest on late payments, created a creditor-debtor relationship, not a trust. The agency had contractual and fiduciary duties to the company, but was not a trustee. Because the funds in question were not held "in trust" by the agency as a matter of law, an essential element of embezzlement was lacking. Therefore, the court reversed the denial of defendant's motion for judgment of acquittal.

Judy Maretta, as the named beneficiary of a Federal Employees' Group Life Insurance (FEGLI) policy, received FEGLI benefits upon the death of her ex-husband. Jacqueline Hillman, the widow of the deceased, filed an action against Maretta, claiming that pursuant to Va. Code Ann. 20-111.1(D), Maretta was liable to her for the death benefits received. Maretta claimed that the state law was preempted by 5 U.S.C. 8705 and 8705 because the state statutes granted FEGLI benefits to someone other than the named beneficiary in violation of FEGLIA's terms. The circuit court concluded that section 20-111.1(D) was not preempted by FEGLIA and entered judgment against Maretta. The Supreme Court reversed and entered judgment for Maretta, holding that because Congress intended for FEGLI benefits to be paid and to belong to a designated beneficiary, FEGLIA preempts section 20-111.1(D).

This case involved Commonwealth Care, a state-initiated program that provided structured premium assistance for low-income Massachusetts residents. In 2009, the Legislature made certain changes to the eligibility requirements of Commonwealth Care, enacted in a two-part supplemental appropriation for fiscal year 2010. Section 31(a) of the appropriation excluded all aliens who were federally ineligible under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), 8 U.S.C. 1601-1646, from participation in Commonwealth Care. Plaintiffs were individuals who either have been terminated from Commonwealth Care or have been denied eligibility solely as a result of their alienage. The court held that section 31(a) could not pass strict scrutiny and that the discrimination against legal immigrants that its limiting language embodied violated their rights to equal protection under the Massachusetts Constitution.

In 2000, a fire destroyed a business location of Stone Flood and Fire Restoration Inc., spurring years of litigation with its insurer, Safeco Insurance Company of America. After Stone Flood and its two shareholders, James and Patrice Stone, sued Safeco in 2007, the district court dismissed all claims against Safeco. The court concluded (1) Stone Flood's claims on the insurance policy were filed three days beyond the applicable statute of limitations and were therefore barred; (2) the Stones were not insureds and lacked standing to bring individual claims under the policy; and (3) the Stones lacked standing to bring a claim of intentional infliction of emotional distress (IIED) because their alleged injuries were merely derivative of the corporation's. The Supreme Court reversed in part and affirmed in part, holding (1) the district court's calculation of the tolling of the limitations period was incorrect and a correct calculation saved Stone Flood's claims under the insurance policy; and (2) the district court properly concluded the Stones were not insureds and lacked standing to sue under the policy, and their claim of IIED failed for lack of a distinct, non-derivative injury. Remanded.

Plaintiff Joseph Zbegner appealed a district court order dismissing without prejudice his claims against Allied Property and Casualty Insurance Co. (Allied) as not ripe for adjudication. Plaintiff was in an automobile accident in Boulder, Colorado in 2007. At that time he had an automobile insurance policy with Allied, which included underinsured motorist (UIM) coverage. In his complaint against Allied, Plaintiff alleged that he suffered severe injuries as a result of the accident and sustained damages exceeding $150,000. He claimed the driver of the other car was the person at fault in the accident, but was underinsured. Allstate paid Plaintiff $351.74 for property damage and offered him $2,145.00 to settle his injury claim. Plaintiff did not accept Allstate’s offer and did not resolve his claim against the driver. After Allied declined his claim, Plaintiff filed this action. Allied moved to dismiss Plaintiff's claim, asserting it could not know the amount due Plaintiff for UIM benefits until he had resolved his claim against Allstate, the driver's insurer. Because his claims were contingent on a future event, Allied contended they were not ripe for adjudication. The district court granted Allied’s motion, and dismissed Plaintiff's claims without prejudice. On appeal to the Tenth Circuit, Plaintiff contended the district court misconstrued Colorado law in its ripeness analysis. After careful review, the Tenth Circuit concluded the district court was correct in its analysis of Colorado law, and that Plaintiff's claim was not yet ripe for review.

Puerto Rico requires all motor vehicle owners to pay for compulsory, state-issued auto insurance when they purchase or renew their vehicle registrations, even if they have obtained equivalent private insurance, with limited exceptions P.R. Laws tit. 26, 8051. Privately-insured vehicle owners who pay twice for coverage are entitled to reimbursements of state payments. A lot of the money is not returned during the two-year period for refunds; no statute or regulation provides notice of how to obtain reimbursement and only some insurers provide their insureds with notice of how to obtain reimbursements. After the two-year period, the money is transferred into trust for five years before being transferred to the commonwealth treasury. Individuals entitled to reimbursement receive no notice. The district court entered summary judgment, rejecting challenges to the law. The First Circuit reversed in part, holding that the law violates the notice requirements of the Due Process Clause and directing entry of a declaratory judgment and injunctive relief to that effect. The court rejected substantive due process and takings claims and left claims under Puerto Rico trust law to the Puerto Rico courts.

Defendant in this case issued health care insurance policies to provide coverage for medical services and entered into contracts with practitioners of the healing arts to provide those services. Plaintiffs, three individual podiatrists and the Connecticut Podiatric Medical Association, brought an action against Defendant, alleging that Defendant's practice of reimbursing individual podiatrists at a lower rate than medical doctors for the same service constituted unfair discrimination in violation of the Connecticut Unfair Insurance Practices Act (CUIPA) and the Connecticut Unfair Trade Practices Act (CUTPA). The trial court granted summary judgment in favor of Defendant. The Supreme Court affirmed, holding that CUIPA, by prohibiting unfair discrimination, bars the denial of reimbursement on the basis of the particular license held by a practitioner of the healing arts, but does not preclude setting different reimbursement rates on the basis of the particular license held by a practitioner of the healing arts.

Defendant-Appellant Alan Tukes appealed his federal conviction for bank robbery, arguing that the government’s evidence was insufficient to prove that the bank was insured by the Federal Deposit Insurance Corporation (“FDIC”) at the time of the crime. At trial, a prosecutor asked the bank’s branch manager: “Now, the Compass Bank, is that a bank that is federally insured by the [FDIC]?” She responded: “Yes, it is.” When asked whether the bank “has” any documentation proving its insured status, she replied: “Yes. We have a certificate.” When asked whether the certificate “hangs” in the branch, the manager replied in the affirmative. The district court admitted the certificate, dated November 8, 1993, into evidence. The government offered no additional evidence of the bank’s insured status. At summation, Defendant argued that the government had not proven that the bank was FDIC insured at the time of the robbery. The jury returned a guilty verdict. Viewing the evidence in the light most favorable to the government, the Tenth Circuit concluded "it is clear that a rational juror could have concluded beyond a reasonable doubt that the bank was insured at the time of the robbery." The Court affirmed Defendant's conviction.