Justia Insurance Law Opinion Summaries

Alabama Mutual Insurance Corporation ("AMIC") appealed the trial court's order certifying a class in the action filed by the City of Vernon and a class of similarly situated entities that had purchased uninsured motorist/underinsured-motorist coverage ("UM/UIM coverage") from AMIC. Vernon was the original class representative; however, after AMIC filed its notice of appeal of the class-certification order, Vernon settled its claims against AMIC and withdrew as the class representative. Because there was no longer a representative to "fairly and adequately protect the interests of the class," the Supreme Court remanded the case back to the trial court for a new class representative to be substituted for Vernon. The City of Fairfield substituted for Vernon as the class representative. After review of the parties' arguments on appeal, the Supreme Court did not reach the merits of the underlying dispute: the Court concluded that the trial court lacked subject-matter jurisdiction over this dispute. Initial jurisdiction over this dispute was with the Alabama Department of Insurance and its commissioner. Therefore, the Supreme Court vacated the trial court's class-certification order, and remanded for dismissal. View "Alabama Mutual Insurance Corporation v. City of Fairfield" on Justia Law

Plaintiff, who worked for United Parcel Service, Inc. (UPS) for thirty-two years, was diagnosed with diabetes in 1987 and with diabetic neuropathy in 1998. The diabetic neuropathy caused impairment to his arms and hands. In 2003, Plaintiff suffered injuries to his upper arms and hands in a work-related accident. After Plaintiff retired in 2008 he filed a claim for benefits. The Workers’ Compensation Commissioner apportioned the payment so that Defendants, UPS and its insurer, paid only for the proportion of disability attributed to Plaintiff’s occupational injuries rather than pay the entirety of Plaintiff’s permanent partial disability to his upper extremities and hands. The Workers’ Compensation Board affirmed. The Appellate Court reversed. The Supreme Court affirmed, holding that a disability arising from a progressive nonoccupational condition - such as Plaintiff’s diabetes and diabetic neuropathy - that manifests prior to an occupational injury and that further disables the same body part is a compensable preexisting injury rather than a noncompensable concurrently developing disease under the apportionment rule established in Deschenes v. Transco, Inc. View "Sullins v. United Parcel Serv., Inc." on Justia Law

In 2002, Ruth McCormick slipped and fell while working at a McDonald’s restaurant. McCormick received temporary total disability (TTD) compensation until 2010, when the Industrial Commission terminated McCormick’s benefits based on a doctor’s opinion that McCormick had reached maximum medical improvement. McCormick filed a complaint for a writ of mandamus, alleging that the Commission's decision to terminate benefits was not supported by the evidence, was contrary to law, and was an abuse of discretion because the doctor’s opinion that she had reached maximum medical improvement was factually inaccurate. The court of appeals denied the writ. The Supreme Court affirmed, holding that the doctor’s report that McCormick had reached maximum level improvement was valid evidence supporting the Commission’s decision to terminate TTD compensation. View "State ex rel. McCormick v. McDonald’s" on Justia Law

Plaintiffs, insurance producers who conduct business within the state and licensees of the Department of Insurance (department), filed a declaratory judgment action against the Commissioner of Insurance seeking declaratory rulings with respect to the legality of their conduct in the sale of life insurance policies. The trial court dismissed the action, concluding (1) Plaintiffs failed to exhaust their administrative remedies before bringing this declaratory judgment action pursuant to Conn. Gen. Stat. 4-175; and (2) Plaintiffs failed to establish their standing to bring this declaratory judgment action. The Supreme Court reversed, holding (1) the trial court improperly determined that Plaintiffs were not aggrieved parties with standing to bring this declaratory judgment action; and (2) the trial court improperly dismissed this declaratory judgment action on the ground that Plaintiffs had failed to exhaust their administrative remedies. View "Fin. Consulting, LLC v. Comm’r of Ins." on Justia Law

In 2010 the Georgia Department of Banking and Finance closed Community Bank & Trust. St. Paul, which provided liability coverage to the Bank’s officers and directors, sought a declaratory judgment in response to a separate lawsuit (underlying action) brought by the Federal Deposit Insurance Corporation (FDIC), as receiver for the Bank, against Miller and Fricks, former Bank officers. In that action, the FDIC alleged gross negligence and breaches of fiduciary duty related to the Bank’s Home Funding Loan Program and claimed more than $15 million in damages. Finding the policy’s an “insured-versus-insured” exclusion unambiguous, the district court held that there was no coverage. The exclusion precludes coverage only for actions brought “by or on behalf of any Insured or Company in any capacity.” Neither the exclusion nor the defined terms make any reference to the FDIC, regulators, or any liquidating entity. St. Paul argued that the FDIC “steps into the shoes” of the bank, as a receiver. The Eleventh Circuit reversed, finding the provision ambiguous. View "St. Paul Mercury Ins. Co. v. Fed. Deposit Ins. Corp." on Justia Law

In 2000, while working at Homestake Mining Company, Michael Martz injured his shoulder. Martz was paid workers’ compensation benefits. In 2002, while working for McLaughlin Sawmill (Hills Materials), Martz injured the same shoulder. Hills Materials began paying benefits but, several years later, denied liability for further benefits. Martz petitioned the Department of Labor, contending that both employers were liable for benefits. Homestake was granted summary judgment on statute of limitations grounds. In regards Hills Materials, the Department rejected Martz’s argument that promissory estoppel precluded Hills Materials from denying liability and concluded that Martz failed to satisfy his burden of showing that the 2002 injury was a “major contributing cause” of his current condition. The circuit court affirmed. The Supreme Court affirmed, holding (1) Hills Materials was not estopped from denying liability for Martz’s current condition and need for treatment; and (2) Martz failed to establish that Hills Materials was liable for benefits where he did not prove a sufficient causal relationship between his 2002 injury and his current condition and need for treatment. View "Martz v. Hills Materials" on Justia Law

Minn. Stat. 176.081(1)(a) requires employers and insurers to pay attorney fees calculated by a statutory formula not subject to judicial review. In this case, Respondent injured his back while working for Employer. Employer and its insurer (together, Relators) settled with Respondent. Respondent’s attorney then sought an award of contingent attorney fees in an amount that was calculated by applying the statutory formula in section 176.081 but which disregarded the upper limit set by the formula. Relators objected, arguing that, in the absence of judicial review to ensure a fee award is not excessive, application of the statutory formula violates separation of powers principles. The compensation judge applied the statutory formula and concluded that $13,000 would adequately compensate Respondent’s attorney but refused to consider whether the statutory fee was reasonable. The Workers’ Compensation Court of Appeals affirmed the compensation judge’s fee award. The Supreme Court affirmed, holding (1) the Court will recognize the Legislature’s statutory formula as presumptively reasonable, and, absent exceptional circumstances, further judicial review of an award based on the statutory formula is unnecessary; and (2) Relators failed to present any exceptional circumstances to challenge this presumption. View "David v. Bartel Enters." on Justia Law

WTS Acquisition Corporation purchased Ameritemps, Inc. and then transferred the assets to its wholly owned subsidiary, RFFG, LLC. RFFG continued operating the business under the Ameritemps name. The Ohio Bureau of Workers’ Compensation notified RFFG that it had determined that RFFG was a successor employer for workers’ compensation purposes and that it intended to calculate RFFG’s workers’ compensation premium rate based on Ameritemps’ experience rating. RFFG filed a complaint for a writ of mandamus alleging that the Bureau had abused its discretion when it determined RFFG to be the successor in interest to Ameritemps. The court of appeals denied the writ. The Supreme Court affirmed, holding that the court of appeals did not err in concluding that the decision of the Bureau was supported by the evidence and was not an abuse of discretion. View "State ex rel. RFFG, LLC v. Ohio Bureau of Workers' Comp." on Justia Law

An action was initiated by certain former members and the board of Mississippi Comp Choice Self-Insurers Fund. Comp Choice was a workers’ compensation group self-insurer operating under a certificate of authority granted by the Mississippi Workers’ Compensation Commission. Defendant Mississippi Workers’ Compensation Group Self-Insurer Guaranty Association (“GGA”) ordered a review of Comp Choice. Based on information revealed in the review, the Commission required Comp Choice to execute a Memorandum of Understanding outlining a plan to “strengthen the financial and operational aspects of the [Comp Choice] Fund under the control and guidance of the Commission.” Six months later, the Commission decided not to approve Comp Choice for future operation. Comp Choice voluntarily surrendered its certificate of authority to operate as a group self-insurer in January 2009. GGA stepped into the shoes of Comp Choice to protect claimants. Comp Choice a complaint against GGA, alleging, inter alia, gross negligence, breach of fiduciary duty, bad faith, conversion, and a demand for an accounting. GGA filed a motion to dismiss and claimed immunity under the Mississippi Tort Claims Act (MTCA) and the Mississippi Workers’ Compensation Self-Insurer Guaranty Association Law. The trial court granted the motion, finding that GGA was “covered” by the MTCA, sub silentio ruling that Plaintiffs could not pursue a “cause of action” as referenced in Mississippi Code Section 71-3-179. The trial court held that only the MTCA applied to suits against the Mississippi Workers’ Compensation Group Self Insurer Guaranty Association. The trial court dismissed all other claims, granting leave to amend the complaint for an MTCA action only. Comp argued on appeal to the Supreme Court: (1) the trial court erred in granting defendant's motion to dismiss based on whether GGA as an unincorporated legal entity, was covered by the Mississippi Tort Claims Act, and therefore, entitled to its various protections, immunities and exceptions pursuant to Miss. Code Ann. 11-46-7; and (2) the trial court erred in dismissing based on the determination that GGA as an unincorporated legal entity, was covered by the Mississippi Tort Claims Act, even where the immunity created in GGA in Miss. Code Ann. 71-3-179 abrogated the immunity afforded under the Mississippi Tort Claims Act in Miss. Code Ann. In the case sub judice, the Supreme Court determined that facts were still undeveloped, precluding the trial court and itself from determining whether Plaintiff’s claims, as alleged in its complaint, could be pursued only under the MTCA, as ordered by the trial court, and Plaintiff could not pursue a cause of action as contemplated by Section 71-3-151, et seq, or otherwise. "Absent factual development, no court at this stage of the proceedings could accurately discern whether GGA is an instrumentality of the Commission, vel non, as argued by GGA." View "The Former Board of Trustees and Members of Mississippi Comp Choice Self-Insurers Fund v. Mississippi Workers' Compensation Group Self-Insurer Guaranty Association" on Justia Law

Plaintiffs Brett Woods and Kathleen Valdes were state employees and representatives of a class of New Mexico state and local government employees who alleged they paid for insurance coverage through payroll deductions and premiums pursuant to a policy issued by Standard Insurance Company (Standard), but did not receive the coverage for which they paid and, in some cases, were denied coverage entirely. Plaintiffs filed suit in New Mexico state court against three defendants: Standard, an Oregon company that agreed to provide the subject insurance coverage; the Risk Management Division of the New Mexico General Services Department (the Division), the state agency that contracted with Standard and was responsible for administering benefits under the policy; and Standard employee Martha Quintana, who Plaintiffs allege was responsible for managing the Division’s account with Standard and for providing account management and customer service to the Division and state employees. Plaintiffs' ninety-one-paragraph complaint, stated causes of action against Standard and the Division for breach of contract and unjust enrichment; against Standard for breach of fiduciary duty, breach of the implied duty of good faith and fair dealing, and Unfair Practices Act violations; and against Standard and Ms. Quintana for breach of the New Mexico Trade Practices and Fraud Act. The issue this appeal presented for the Tenth Circuit's review centered on whether remand to the state court pursuant to the Class Action Fairness Act (CAFA) was required under either of two CAFA provisions: the state action provision, which excludes from federal jurisdiction cases in which the primary defendants are states; or the local controversy exception, which requires federal courts to decline jurisdiction where, among other things, there is a local defendant whose alleged conduct forms a significant basis for the claims asserted by plaintiffs and from whom plaintiffs seek significant relief. The Court concluded that neither provision provided a basis for remand, and therefore reversed the decision of the magistrate judge remanding the case to state court. But because the Tenth Circuit could not determine whether Defendants have established the amount in controversy required to confer federal jurisdiction, the case was remanded to the district court for the resolution of that issue. View "Woods v. Standard Insurance Co." on Justia Law