Justia Insurance Law Opinion Summaries

MASC filed an action in the district court seeking a declaration that South Carolina municipalities were entitled to assess municipal business license taxes based on, or measured by, the total flood insurance premiums collected in the particular municipality by insurance companies under an arrangement with FEMA. The district court denied the insurance companies' motion for summary judgment on grounds of preemption and sovereign immunity. The flood insurance premiums were federal property that could not be taxed and the participating private insurance companies, in their operation of and participation with the National Flood Insurance Program, were federal instrumentalities so closely connected with the federal government that they were immune from taxation. The federal government did not consent to this tax, and it was therefore invalid. Accordingly, the court reversed the district court's grant of partial summary judgment to MASC and denial of summary judgment to the insurance companies. View "Municipal Assoc. of SC v. USAA General Indemnity Co." on Justia Law

Decedent worked as a firefighter for Baltimore City. After Decedent died, his widow, Petitioner, began receiving survivorship benefits from Decedent's pension. Petitioner later filed a dependent's claim for death benefits under the Maryland Workers' Compensation Act. The dispute at the hearing concerned what provision of the Act was applicable to Petitioner's claim. The City argued that Md. Code Lab. & Empl. 9-610, which reduces compensation death benefits by the amount of pension benefits, should apply. Petitioner argued that Md. Code Lab. & Empl. 9-503(e), which allows firefighters' dependents to collect both pension and workers' compensation up to the amount of what had been the firefighter's weekly salary, should apply. Petitioner's claim was pending when section 9-503(e) was amended to include dependents in its scope of coverage. The Workers' Compensation Commission determined that section 9-503(e) governed the claim and awarded Petitioner benefits. The circuit court granted summary judgment for the City, ruling that Petitioner had no preexisting right to dual benefits prior to the statute's amendment. The Court of Appeals affirmed, holding that the amendments involved a substantive change in the law that precluded it from applying retroactively to pending cases. View "Johnson v. Baltimore" on Justia Law

Appellant Altrua HealthShare appealed the district court's decision affirming the Idaho Department of Insurance's (Department) determination that Altrua transacted insurance without a certificate of authority. Altrua argued that both the Department and the Ada County district court erred in finding that Altrua was an insurer because Altrua never assumed the risk of paying its members' medical bills. The Department found, and the district court affirmed, that when members make their predetermined monthly payments into the escrow account Altrua operates, the risk of payment shifts from the individual members to the escrow account, and in turn to Altrua. Altrua also contended that the Department's determination that it is an insurer despite the disclaimers in its membership contract to the contrary is an unconstitutional interference with Altrua's right to contract. Upon review, the Supreme Court found that the Department's conclusion that Altrua's membership contract was an insurance contract was clearly erroneous, and reversed the findings. The case was remanded for further proceedings. View "Altrua Healthshare v. Deal" on Justia Law

The Wyoming Workers' Safety and Compensation Division determined that Appellant suffered a compensable injury while employed by Employer. The lodge filed an objection to that determination and requested a hearing with the Office of Administrative Hearings (OAH). Appellant filed a motion to dismiss that objection on the grounds that the objection was invalid because Employer was not a proper party to the action. The OAH denied Appellant's motion and concluded that Appellant had not suffered a compensable injury. The district court affirmed. At issue on appeal was whether Employer properly filed an objection to the Division's final determination of compensability. The Supreme Court affirmed, holding that Employer was a proper party to the action because it was the identified employer and paid the necessary contributions under Wyoming Worker's Compensation Act. View "Heikkila v. Signal Mountain Lodge" on Justia Law

Employee injured his back while working for Employer. Employee and the Department of Labor and Workforce Development (Department) agreed upon a settlement that provided for a lump sum payment to Employer for his injuries. The settlement and SD-1 form were signed by Employee and both parties' attorneys. Two years later, Employee filed a petition to set aside the settlement. The trial court granted Employee's petition. The Special Workers' Compensation Appeals Panel vacated the trial court's judgment on a procedural issue, finding the SD-1 form was not "fully completed." The Supreme Court reversed the judgments of the Panel and of the trial court and dismissed Employee's petition, holding (1) when the Department approves a settlement, it implicitly approves the accompanying SD-1 form, and a court has no authority to set the settlement aside based on its independent finding that the SD-1 form was not "fully completed"; and (2) the evidence preponderated against the trial court's finding that Employee was not represented by counsel, and the court erred in granting relief based on Tenn. R. Civ. P. 60.02(5) as well as its inherent authority. View "Furlough v. Spherion Atlantic Workforce, LLC" on Justia Law

Employee, an undocumented worker, was injured while working for Employer. Employee was awarded temporary total disability benefits. Employer later petitioned the workers' compensation court to discontinue the temporary benefits. While the action was pending, Employee returned to his county of origin. The compensation court concluded (1) Employer's obligation to pay Employee temporary total disability should cease because Employee had reached maximum medical improvement; and (2) there was no credible evidence which could be used to determine Employee's loss of earning capacity in his new community, and therefore, Employee's request for benefits for his claim of permanent impairment and loss of earning capacity was denied. The Supreme Court (1) affirmed the compensation court's conclusion that Employee had reached maximum medical improvement; but (2) reversed the denial of Employee's claim of permanent impairment and loss of earning capacity because where no credible data exists for the community to which the employee has relocated, the community where the injury occurred can serve as the hub community. Remanded. View "Visoso v. Cargill Meat Solutions" on Justia Law

This case was an appeal to challenge the administrative rule adopted by the Industrial Commission in 1994 that regulates the amount of attorney fees allowable for attorneys representing claimants in worker's compensation proceedings. Upon review of the facts of this case, the Supreme Court upheld the validity of the rule. View "Seiniger Law v. Industrial Commission" on Justia Law

While in the course and scope of her employment, Appellant suffered and injury and incurred medical expenses. The Workers' Compensation Court ordered Appellant's employer (Employer) to pay the expenses. Employer made payments directly to Appellant's health care providers within thirty days of the court's order. Because she was not personally reimbursed for the medical expenses within thirty days, Appellant sought a waiting-time penalty, attorney fees, and interest pursuant to Neb. Rev. Stat. 48-125. The Workers' Compensation Court denied relief, and Appellant appealed. The Supreme Court affirmed, holding (1) because section 48-125 did not apply to Appellant's request for a waiting-time penalty, the compensation court did not err in overruling her motion for a waiting-time penalty; and (2) Employer in this case was not subject to liability for attorney fees, and therefore, Appellant was not entitled to an award of interest. View "VanKirk v. Cent. Cmty. Coll." on Justia Law

The Workers Compensation Board awarded Plaintiff benefits under the Workers Compensation Act for an injury he sustained while operating a go-cart at an event sponsored by his employer (Employer). Employer and its insurance carrier (Insurer) appealed the award, claiming that Plaintiff's injuries were not compensable because they were sustained during a recreational or social event that Plaintiff was not required to attend. The court of appeals affirmed the Board. The Supreme Court reversed, holding that the Board applied the incorrect legal standard in determining whether Plaintiff's injuries arose out of and in the course of his employment, and the error was not harmless. Remanded to the Board to make the determination based on the statutory criteria of Kan. Stat. Ann. 44-508(f). View "Douglas v. Ad Astra Info. Sys., LLC" on Justia Law

CDA Dairy Queen, Inc. and Discovery Care Centre, LLC of Salmon (collectively, Dairy Queen) filed a class action against the Idaho State Insurance Fund (SIF) seeking a declaratory judgment that SIF violated Idaho Code section 72-915 by failing to distribute premium rate readjustments on a pro rata basis. The district court granted SIF's motion for summary judgment, finding that the Idaho Legislature's retroactive repeal of section 72-915 was constitutional and that Dairy Queen's action was thereby barred. Dairy Queen appealed and argued that the retroactive repeal violated article I, section 16 of the Idaho Constitution. Dairy Queen the Supreme Court to reverse the decision of the district court and remand for further proceedings consistent with the determination that the retroactive repeal was unconstitutional. Upon review, the Supreme Court agreed with Dairy Queen and reversed. View "CDA Dairy Queen, Inc. v. State Insurance Fund" on Justia Law