Justia Insurance Law Opinion Summaries

Kara Sidebottom was injured during the course of her employment. Sidebottom filed a workers’ compensation claim in connection with the work-related injury. In determining Sidebottom’s weekly compensation benefit, the administrative law judge (ALJ) applied Ky. Rev. Stat. 342.140(1)(d). The ALJ determined that Sidebottom was a variable wage employee working on a “wage plus tips” arrangement at the time of her injury. The Uninsured Employers’ Fund appealed, arguing that, at the time of her injury, Sidebottom was a salaried, or fixed wage, employee whose average weekly wage should have been determined in accordance with Ky. Rev. Stat. 342.140(1)(a). The Workers’ Compensation Board disagreed and affirmed the ALJ’s decision. The court of appeals affirmed. The Supreme Court affirmed, holding that the ALJ, and hence the Board, applied the correct statute to the facts in determining Sidebottom’s average weekly wage. Remanded. View "Commonwealth, Uninsured Employers’ Fund v. Sidebottom" on Justia Law

This appeal stemmed from an application Mercury Casualty Co. (Mercury) filed in 2009 to increase its homeowners’ insurance rates. In denying the increase Mercury requested, the California Insurance Commissioner (the commissioner) made two decisions at issue on appeal. The commissioner determined: (1) under subdivision (f) of section 2644.10 of title 10 of the California Code of Regulations, Mercury’s entire advertising budget had to be excluded from the calculation of the maximum permitted earned premium because “Mercury[] aims its entire advertising budget at promoting the Mercury Group as whole” rather than “seek[ing] to obtain business for a specific insurer and also provid[ing] customers with pertinent information” about that specific insurer; (2) Mercury did not qualify for a variance from the maximum permitted earned premium under subdivision (f)(9) of section 2644.27 because “Mercury failed to demonstrate the rate decrease [that resulted from application of the regulatory formula] results in deep financial hardship.” Mercury and certain insurance trade organizations ("the Trades") unsuccessfully sought to challenge the commissioner’s decision in the superior court. On appeal, Mercury and the Trades raised three main issues: (1) the commissioner and the superior court erred in interpreting and applying section 2644.10(f) with regard to what constitutes institutional advertising expenses; (2) the Trades contended section 2644.10(f) violated the First Amendment to the United States Constitution because the regulation imposed a content-based financial penalty on speech; and (3) Mercury and the Trades contended the commissioner and the superior court erred in determining that Mercury did not qualify for the constitutional variance because the commissioner and the court wrongfully applied a “deep financial hardship” standard instead of a “fair return” standard. Finding no merit in these arguments, or any of the other arguments offered to overturn the judgment, the Court of Appeal affirmed. View "Mercury Casulaty Co. v. Jones" on Justia Law

This dispute centered on subrogation claims Victoria Insurance Company and Nationwide Insurance Company asserted against the City of Wilmington. This appeal presented a question of first impression before the Supreme Court: whether, under Delaware's motor vehicle insurance statute governing subrogation disputes among insurers and self-insurers, the losing party may appeal de novo to the Superior Court from an adverse arbitration award. In considering consolidated motions to dismiss two such appeals filed by the City against the insurers, the Superior Court determined that 21 Del. C. 2118(g)(3), which mandated arbitration for subrogation disputes arising between insurers and self-insurers, did not provide a right to appeal. Because the statute unambiguously provided for appeals from mandatory arbitration of subrogation disputes between insurers and self-insurers, the Supreme Court reversed. View "City of Wilmington v. Nationwide Insurance Co." on Justia Law

Plaintiffs brought a purported class action to recover damages resulting from an alleged scheme to inflate the interest rate delinquent property taxpayers in Madison County, Illinois, were compelled to pay to those who purchased delinquent taxpayer debt. Former Madison County Treasurer and Collector (Bathon) had purportedly agreed with certain defendants to manipulate the delinquent tax purchasing system, so that delinquent taxpayers were required to pay the maximum allowable interest to the purchasers of their tax debt to discharge the liens and redeem their properties. The purchasers of the tax debt allegedly provided financial support to Bathon. Plaintiffs brought suit against those involved in the scheme, Madison County, and RLI, the entity acting as surety on Bathon’s statutory public official bond under 55 ILCS 5/3-10003 and 35 ILCS 200/19-40. The bond identified “Madison County Government” as the named obligee. The court dismissed, finding that plaintiffs were not proper claimants under the terms of the public official bond or under the statutes. The appellate court affirmed. The Illinois Supreme Court affirmed. Private citizens are precluded from making claims on the statutorily mandated public official bond at issue. View "Bueker v. Madison County" on Justia Law

Magdalena Guardado, an undocumented worker, was employed as a machine manager for Roos Foods when she was involved in a work-related accident. She injured her left wrist and thereafter received total disability benefits. The employer petitioned the Industrial Accident Board (“the Board”) to terminate those benefits on the ground that the worker was no longer disabled and could return to work. The Board found: (1) the employer met its initial burden of showing that the worker was no longer totally disabled; (2) that the worker was a prima facie displaced worker based solely on her status as an undocumented worker; and (3) the employer had failed to meet its burden of showing regular employment opportunities within the worker’s capabilities. Accordingly, it denied the employer’s petition. The questions this case presented for the Delaware Supreme Court's review were: (1) whether an injured worker’s immigration status alone rendered her a prima facie displaced worker; and (2) whether the Board properly found that the employer failed to meet its burden of showing regular employment opportunities within the worker’s capabilities because its evidence failed to take into account the worker’s undocumented status. The Court concluded that an undocumented worker’s immigration status was not relevant to determining whether she was a prima facie displaced worker, but it was a relevant factor to be considered in determining whether she is an actually displaced worker. The Court also concluded that the Board correctly rejected the employer’s evidence of regular employment opportunities for the worker because that evidence failed to consider her undocumented status. View "Roos Foods v. Guardado" on Justia Law

Insured filed a complaint challenging Insurer’s termination of workers’ compensation issuance. The insurance commissioner declined to consider the merits of the complaint on the ground that the complaint raised factual issues that could not be resolved by the agency. Insurer filed a petition for judicial review seeking a declaration that the insurance commissioner should have exercised jurisdiction over the dispute. The district court granted the commissioner’s motion to dismiss, concluding that Insurer lacked standing to litigate the issues. The Supreme Court dismissed Insurer’s appeal, holding that, under the circumstances presented and applying established caselaw, the appeal was moot. View "Auto-Owners Insurance Co. v. Iowa Insurance Division" on Justia Law

Plaintiff-Appellant Federal Deposit Insurance Corporation (FDIC) sought to recover on a financial institution crime bond and appealed the district court’s grant of summary judgment in favor of Defendant-Appellee Kansas Bankers Surety Co. (KBS) and the subsequent denial of reconsideration. The district court held that the underlying bank, the New Frontier Bank of Greeley, Colorado, (Bank) had failed to submit a timely and complete proof of loss, thereby barring FDIC’s recovery on the bond. Finding no error in the district court's decision, the Tenth Circuit affirmed. View "FDIC v. Kansas Bankers Surety Company" on Justia Law

After suffering a fall at work, Linda Mitchell returned to the same position she had before her injury, and continued to work for more than seven months until she was terminated for a cause unrelated to the injury. She then sought and was awarded disability benefits from the Mississippi Workers’ Compensation Commission. But because the Administrative Law Judge (ALJ) and Commission both failed to recognize that Mitchell’s return to work created a rebuttable presumption that she suffered no loss of earning capacity, the Supreme Court reversed the award of disability benefits and remanded this case to the Commission to apply the correct legal standard. View "Hudspeth Regional Center v. Mitchell" on Justia Law

James Mordhorst was injured while working for Fischer Furniture. Almost one year later, Dakota Truck Underwriters and Risk Administration Services (collectively, Insurers) terminated all workers’ compensation benefits. The South Dakota Department of Labor subsequently ordered Insurers to pay all past medical bills and interest as well as future medial expenses. Mordhorst then filed an action seeking punitive damages for an alleged bad-faith denial of workers’ compensation benefits. The circuit court granted Insurers’ motion to dismiss for failure to state a cause of action upon which relief could be granted. The Supreme Court reversed, holding that the circuit court erred by granting Insurers’ motion to dismiss because Mordhorst asserted facts that, if true, state a claim for bad faith denial of a workers’ compensation claim and that Insurers’ reliance on an independent medical examiner’s report to deny benefits was not per se reasonable. View "Mordhorst v. Dakota Truck Underwriters" on Justia Law

This case stems from the rate filing submitted to the Green Mountain Care Board (GMCB) by MVP Health Insurance Company (MVP) with respect to the Agri-Services health insurance plan. The State of Vermont, GMCB found that the 2015 Agri-Services rate filing would not promote access to quality health care and denied it for that reason. MVP appealed, arguing: (1) that GMCB’s disapproval was an arbitrary use of discretion based on vague standards that unconstitutionally delegated authority to GMCB; (2) that GMCB’s decision was not supported by the record; and (3) that GMCB’s statutory interpretation of its authority was compelling error. After review, the Supreme Court held that 8 V.S.A. 4062 was constitutional, but found that GMCB’s conclusions were not supported by specific findings on the statutory criteria required for approval of health insurance rates and, accordingly, reversed and remanded for new findings. View "In re MVP Health Insurance Company" on Justia Law