Justia Insurance Law Opinion Summaries

Plaintiff Town of Ira brought this action to recover from its insurer, Vermont League of Cities and Towns Property and Casualty Intermunicipal Fund, Inc. (PACIF), certain losses related to the embezzlement of town funds by the Town's former treasurer. On summary judgment, the trial court found that the Town was entitled to interest on the embezzled amount up to the policy limit and that this amount mooted the Town's claim for audit and attorney's fees, as well as insurer's counterclaims to recoup certain sums already paid. It also granted judgment to insurer on the Town's claim that insurer acted in bad faith by not paying for all of the items it claimed. After review of the trial court record, the Supreme Court affirmed that judgment.View "Town of Ira v. Vermont League of Cities and Towns" on Justia Law

Roger Brock was passenger in a vehicle driven by Brian Mason, which was involved in an accident with a logging truck, driven by Ryan Stevens. At the time of the accident, Stevens was insured through the owner of the logging truck, Malachi Sanders' policy issued by Aequicap Insurance Company. Brock sustained severe injuries as a result of the wreck and filed suit. Soon after the litigation began, Brock settled his claim against Stevens and Sanders with Aequicap for $185,000 for the release of all claims. Shortly after the settlement was reached but before Brock received any payment, Aequicap was declared insolvent. Because Aequicap was an insurer licensed to do business in the State of South Carolina and the insured was a resident of South Carolina, the claim was referred to South Carolina Property and Casualty Insurance Guaranty Association (Guaranty). As a result, Brock made demand on Guaranty for payment of the full settlement amount of $185,000. The issue this case presented for the Supreme Court's review centered on the construction and application of the South Carolina Property and Casualty Insurance Guaranty Association Act (the Act), S.C. Code Ann. Secs. 38-31-10 to -170 (2002 and Supp. 2013), and specifically the exhaustion/non-duplication provision in section 38-31-100(1). Guaranty and Brock moved for summary judgment on the issue whether Guaranty may offset payments from solvent insurance carriers against Brock's settlement under section 38-31-100. The circuit court found section 38-31-100 was ambiguous and granted partial summary judgment to both parties, holding that Guaranty may offset some but not all of the benefits received by Brock from solvent insurance carriers. The Supreme Court disagreed that section 38-31-100 was ambiguous and hold that the unambiguous language of section 38-31-100 provides that Guaranty may offset all payments from all solvent insurers made to Brock as a result of this wreck.View "SC Property v. Brock" on Justia Law

In 2010, Idaho Power entered into two Firm Energy Sales Agreements, one with New Energy Two, LLC, and the other with New Energy Three, LLC, under which Idaho Power agreed to purchase electricity from them that was to be generated by the use of biogas. The agreement with New Energy Two stated that the project would be operational on October 1, 2012, and the agreement with New Energy Three stated that the project would be operational on December 1, 2012. Both contracts were submitted for approval to the Idaho Public Utilities Commission, and were both approved on July 1, 2010. Each of the agreements contained a force majeure clause. By written notice, New Energy Two and New Energy Three informed Idaho Power that they were claiming the occurrence of a force majeure event, which was ongoing proceedings before the Public Utilities Commission. New Energy asserted that until those proceedings were finally resolved "the entire circumstance of continued viability of all renewable energy projects in Idaho is undecided"and that as a consequence "renewable energy project lenders are unwilling to lend in Idaho pending the outcome of these proceedings."Idaho Power filed petitions with the Commission against New Energy Two and New Energy Three seeking declaratory judgments that no force majeure event, as that term was defined in the agreements, had occurred and that Idaho Power could terminate both agreements for the failure of the projects to be operational by the specified dates. New Energy filed a motion to dismiss both petitions on the ground that the Commission lacked subject matter jurisdiction to interpret or enforce contracts. After briefing from both parties, the Commission denied New Energy's motion to dismiss. The Commission's order was an interlocutory order that is not appealable as a matter of right. New Energy filed a motion with the Supreme Court requesting a permissive appeal pursuant to Idaho Appellate Rule 12, and the Court granted the motion. New Energy then appealed. Finding no reversible error, the Supreme Court affirmed the Commission's order.View "Idaho Power v. New Energy Two" on Justia Law

Dick McClary submitted an application for health insurance to Golden Rule Insurance Company that failed to disclose proposed insured Patti Denney’s preexisting condition. Golden Rule issued a policy covering Denney, but later denied coverage for a proposed surgery based on the fact that the conditions documented in Denney’s medical records were not disclosed in her insurance application. The Kansas Insurance Department imposed sanctions on Golden Rule for unfair claim settlement practices, concluding that Golden Rule had wrongfully denied Denney coverage for a medically necessary procedure. The district court affirmed. The court of appeals reversed, concluding that McClary was not acting as Golden Rule’s soliciting agent when he submitted Denney’s health insurance application. The Supreme Court (1) reversed the court of appeals’ decision on the agency question, as substantial evidence supported the conclusion that McClary had the actual authority to solicit and submit applications directly to Golden Rule; and (2) reversed the Department and the district court on their ruling that Golden Rule violated Kan. Stat. Ann. 40-2404(9)(f) but affirmed the finding of a violation of subsection (d); and (3) affirmed the Department’s remedy.View "Golden Rule Ins. Co. v. Tomlinson" on Justia Law

An Employer appealed from a decision of the Workers’ Compensation Commission (Commission) ordering Employer to pay additional temporary total disability benefits to Employee, who was injured during his employment. After a jury trial, the trial court granted Employee’s motion for judgment and affirmed the award, concluding that the Commission decision was a piece of evidence that needed to be considered by the jury and that Employer was required to introduce the Commission decision into evidence. The court of special appeals reversed, concluding that Appellant was not required to move the award into evidence. The Court of Appeals affirmed, holding that, in a de novo workers’ compensation jury trial, the appellant is not required to move the Commission decision into evidence.View "Gales v. Sunoco & Amer. Zurich Ins." on Justia Law

Claimant-appellant Kevin Hope injured his right shoulder in 2003 while he was working for Empro Professional Services. He argued to the Industrial Commission that the Idaho Industrial Special Indemnity Fund (ISIF) was liable for part of his income benefits because he was totally and permanently disabled due to pre-existing back and shoulder injuries that combined with his 2003 shoulder injury. If Hope's total and permanent disability resulted from the combined effects of his 2003 shoulder injury and impairments that pre-existed that injury, then ISIF was liable for the portion of income benefits caused by the pre-existing injuries. Hope appealed the Commission's order that ISIF was not liable for any of Hope's benefits. The Commission found that Hope was totally and permanently disabled, but had failed to prove that his disability was a result of pre-existing back and shoulder impairments combined with his last shoulder injury. Hope argued that the Commission's decision was based on errors of law and fact. Finding no reversible error, the Supreme Court affirmed the Commission's order.View "Hope v. Industrial Special Indemnity Fund" on Justia Law

Appellee, a home health nurse who provided in-home health-care services to clients of Visiting Nurse Association of Mid-Ohio (VNA), was injured in a vehicle collision while she was traveling to the home of a patient. Appellee had decided to transport her children and two friends to a mall on her way to the patient’s home. The Industrial Commission allowed Appellee’s claim for a neck sprain. VNA appealed. The trial court granted summary judgment for VNA, concluding that Appellee was on a personal errand at the time she was injured. The court of appeals reversed, concluding that the accident and injury arose out of and occurred in the course of Appellee’s employment. Specifically, the court determined that although Appellee had intended to drop her passengers off at the mall, she had the dual intent to travel to her patient’s home, and when she was injured, she had not yet diverted from that path. The Supreme Court reversed, holding that the doctrine of dual intent or dual purpose is not recognized in Ohio for purposes of determining eligibility for workers’ compensation benefits. Remanded.View "Friebel v. Visiting Nurse Ass’n of Mid-Ohio" on Justia Law

After settling a federal lawsuit brought by plaintiffs for $13,500,000.00, the sheriff of Delaware County and the County Commissioners demanded that the Association of County Commissioners of Oklahoma Self Insurance Group indemnify Delaware County for that amount. The insurance group agreed to contribute $1,000,000.00, less the defense costs already incurred, which amount was the per occurrence limit. Delaware County filed a lawsuit for breach of contract, and subsequently moved to amend its petition to add a bad faith claim, after the lawsuit had been transferred to Rogers County. The trial court granted the motion and subsequently denied the insurance group's motion to dismiss the bad faith claim. The trial court certified for immediate interlocutory appeal the order denying that motion to dismiss to the Supreme Court. The questions that appeal presented for the Supreme Court's review were: (1) whether the Association of County Commissioners of Oklahoma Self-Insurance Group was an insurer pursuant to 36 O.S.2011, sec. 607.1; and (2) whether, pursuant to the Governmental Tort Claims Act, that organization was immune from tort liability for a breach of the duty of good faith and fair dealing. After its review, the Supreme Court held that under the statutes the organization was an insurance company for some purposes, but was a governmental entity immune from a tort claim for the breach of the duty of good faith and fair dealing.View "BD. OF CTY. COMMISSIONERS v. ASSOC. OF CTY. COMMISSIONERS OF OKLA. SELF-INSUR. GROUP" on Justia Law

The Workers’ Compensation Commission found Employee to be totally and permanently disabled under the odd-lot doctrine and denied Employer and its Insurer (collectively, Employer) certain credits for disability payments previously received by Employee from other sources. The district court affirmed the Commission’s finding that Employee was totally and permanently disabled but reversed on the credit issue. The court of appeals reversed, holding (1) substantial evidence did not support the Commission’s award of permanent total benefits, and (2) the Commission was correct in its decision concerning the credits. On further review, the Supreme Court (1) affirmed the district court’s finding that substantial evidence supported the Commission’s findings that Employee was totally and permanently disabled under the odd-lot doctrine; and (2) reversed the district court’s judgment regarding the issues concerning the credit due Employer.View "Gits Mfg. Co. v. Frank" on Justia Law

Nationwide, with 32,000 employees in 49 states, has an ERISA employee-benefits plan that provides short-term disability (STD), long-term disability (LTD), and “Your Time” benefits. An employee can receive Your Time benefits for personal reasons, such as vacation or illness. To receive STD benefits, an employee must be “STD Disabled,” which means “a substantial change in medical or physical condition due to a specific illness that prevents an Eligible Associate from working their current position.” Specific rules govern maternity leave. The first five days of paid maternity leave come out of an associate’s Your Time benefits. Thereafter, a new mother is considered STD Disabled and entitled to STD benefits for six weeks following a vaginal delivery, or eight weeks following a cesarean section. Wisconsin’s Family Medical Leave Act requires that employers allow six weeks of unpaid leave following “[t]he birth of an employee’s natural child[.]” The Act’s “substitution provision” requires employers to allow an employee to substitute “paid or unpaid leave of any other type provided by the employer” for the unpaid leave provided by the statute. A Wisconsin Nationwide employee had a baby. She received six weeks of STD benefits under Nationwide’s plan. She then requested an additional period of STD benefits pursuant to the substitution provision. The plan denied the request, finding that she was no longer short-term disabled under the plan. The Wisconsin Supreme Court had held that, ERISA did not preempt the Wisconsin Act. The district court held that, under the Supremacy Clause, the administrator was required to comply with ERISA rather than the Wisconsin Act. The Sixth Circuit affirmed.View "Sherfel v. Newson" on Justia Law