Justia Insurance Law Opinion Summaries

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

In a dispute over insurance coverage between the plaintiff-appellee City of Choctaw, and its insurer defendant-appellant Oklahoma Municipal Assurance Group (OMAG), the trial court granted a motion for summary judgment for Choctaw. Both in the trial court and on appeal, the city argued that OMAG should cover an inverse condemnation judgment entered against the city in a suit brought by a landowner, even though the city admitted it obtained coverage from OMAG for liability imposed under the Governmental Tort Claims Act (GTCA). The OMAG appealed summary judgment granted in favor of the Choctaw on a claim which had been denied. Upon review, the Supreme Court concluded that the summary judgment record disclosed neither a legal nor factual basis for applying any theory of estoppel to make OMAG liable for the inverse condemnation judgment. Accordingly, the Court reversed the summary judgment in favor of the city, and remanded the case with directions to enter summary judgment in favor of OMAG. View "City of Choctaw v. Oklahoma Municipal Assurance Group " on Justia Law

Law Firm represented Employee in a workers' compensation action against Employee's Employer. After a trial, Employee was awarded compensation, including medical expenses incurred by Employee with Medical Clinic. Employer paid sums owed to Medical Clinic pursuant to the award. Law Firm subsequently filed a complaint against Medical Clinic, seeking attorney fees under the common fund doctrine. Following a hearing, the district court dismissed Law Firm's complaint, concluding that Law Firm was not permitted to recover attorney fees from Medical Clinic under the doctrine. The Supreme Court affirmed, holding (1) the plain language of Neb. Rev. Stat. 48-125(2)(a) prohibits the charging of attorney fees against medical providers in workers' compensation court; and (2) the common fund doctrine may not be applied in this case to allow Law Firm a fee from Medical Clinic from the district court when it would not be entitled to such a fee from the workers' compensation court. View "Walentine, O'Toole, McQuillan & Gordon, LLP v. Midwest Neurosurgery, PC" on Justia Law

Plaintiff was a partner in a medical practice where she served as a staff anesthesiologist. When Plaintiff's dependence on opioids came to light, her employer had in force a group employee benefit plan, underwritten and administered by Union Security Insurance Company & Management Company for Merrimack Anesthesia Associates Long Term Disability Plan (USIC), which included long-term disability (LTD) benefits. When Plaintiff applied for those benefits, USIC refused to pay benefits past the point when Plaintiff was discharged from a treatment center, finding that Plaintiff's risk for relapse was not the same as a current disability. Plaintiff brought suit in the federal district court. The district court ultimately awarded Plaintiff LTD benefits for the maximum time available under the plan, concluding that categorically excluding the risk of drug abuse relapse was an unreasonable interpretation of the plan. The First Circuit Court of Appeals affirmed, holding that, in an addiction context, a risk of relapse can be so significant as to constitute a current disability. View "Colby v. Union Sec. Ins. Co." on Justia Law

The issue in this case concerned a challenge to a trial court's order denying a motion to compel arbitration of an insurance coverage dispute. James River Insurance Company issued two "surplus line" insurance policies under which the Washington State Department of Transportation (WSDOT) claimed coverage. James River sought to compel arbitration of the coverage dispute pursuant to the insurance policies' arbitration clauses. WSDOT opposed arbitration and filed a motion for declaratory judgment, arguing that the arbitration clauses are unenforceable under RCW 48.18.200(1)(b), which prohibits insurance contracts from "depriving the courts of this state of the jurisdiction of action against the insurer," and under RCW 48.15.150(1), which requires that "an unauthorized insurer must be sued in the superior court of the county in which the cause of action arose." In addition, WSDOT argued that the McCarran-Ferguson Act (15 U.S.C. 1012), shields the statutes from preemption by the Federal Arbitration Act (9 U.S.C. secs. 1-14). The trial court agreed with WSDOT and denied James River's motion to compel arbitration. James River appealed and the Supreme Court granted direct review. The Court affirmed: "RCW 48.18.200(1)(b) is not merely a forum selection provision as James River maintain[ed], but rather a provision prohibiting binding arbitration agreements in insurance contracts. As such, we hold that this provision regulates the 'business of insurance' because it is aimed at protecting the performance of an insurance contract by ensuring the right of the policyholder to bring an action in state court to enforce the contract." The Court concluded that RCW 48.18.200(1)(b) was shielded from preemption by the FAA under the McCarran-Ferguson Act. View "Dep't of Transp. v. James River Ins. Co." on Justia Law

Relator, a sales manager for Takeda, brought a qui tam action against his employer under the False Claims Act, 31 U.S.C. 3729-3733, alleging that Takeda violated the Act by causing false claims to be presented to the government for payment under Medicare and other federal health insurance programs. The district court dismissed relator's claims under Rule 12(b)(6). The court held that the district court did not err in dismissing the third amended complaint because relator failed to plausibly allege that any false claims had been presented to the government for payment. The court also held that the district court did not abuse its discretion in denying relator leave to file a fourth amended complaint. Accordingly, the court affirmed the judgment. View "US ex rel. Noah Nathan v. Takeda Pharmaceuticals" on Justia Law

The Superintendent of Insurance found that a Bankers Life and Casualty Company agent engaged in deceptive insurance sales practices in multiple transactions with an elderly woman. Bankers Life and its agents functioned as insurance producers at the relevant time. The Superintendent ordered Bankers Life to pay restitution and a civil penalty of $100,000. The business and consumer docket affirmed the Superintendent's decision. Bankers Life appealed. The Supreme Court affirmed, holding that the Superintendent did not err in her statutory interpretation or factual findings and did not abuse her discretion by imposing restitution and a penalty on Bankers Life based on the evidence presented in the administrative record. View "Bankers Life & Cas. Co. v. Superintendent of Ins." on Justia Law

The United States District Court for the Northern District of Alabama, Southern Division certified a question to the Alabama Supreme Court: "Under Alabama law, is a 'Potentially Responsible Party' ('PRP') letter from the Environmental Protection Agency ('EPA'), in accordance with the Comprehensive Environmental Response Compensation and Liability Act ('CERCLA') provisions, sufficient to satisfy the 'suit' requirement under a liability policy of insurance?" The plaintiff in the underlying action is Alabama Gas Corporation ("Alagasco"). Defendants St. Paul Fire and Marine Insurance Company, St. Paul Surplus Lines Insurance Company, and St. Paul Mercury Insurance Company are all direct and indirect subsidiaries of defendant Travelers Casualty and Surety Company. Upon review of the applicable statutory and case law authority, the Supreme Court answered the certified question in the affirmative. View "Travelers Casualty and Surety Company et al. v. Alabama Gas Corporation " on Justia Law

This appeal by Dorothy Knight arose from a 2011 circuit court order. In it, the circuit court affirmed an administrative decision by the Public Employees Retirement System (PERS) denying disability benefits. Upon review, a majority of the Supreme Court concluded that Knight met her burden, and that PERS' decision to deny her claim was not supported by substantial evidence. Accordingly, the Court reversed the appellate and circuit courts' rulings and remanded the case for further proceedings. View "Knight v. Public Employees' Retirement System of Mississippi" on Justia Law

Petitioner Vincent James Hogg, Sr. sought review of a Workers' Compensation Court order which denied his workers' compensation benefits based upon the court's interpretation of 85 O.S. 2011, section 312 (3). Petitioner was employed by the Oklahoma County Juvenile Detention Center when in late 2011, he sustained an injury to his right shoulder and neck while subduing an unruly and combative juvenile. Petitioner was given a post-accident drug screen and a follow-up screen the next day. Both screens showed a "positive" result for the presence of marijuana in his system. Petitioner did not dispute the test results but Petitioner denied ever smoking marijuana. The trial court ultimately found there was no evidence presented to establish Petitioner was "high," nor was there any evidence to establish the marijuana in his system was the "major cause" of the accidental injury. The trial court did, however, deny Petitioner's eligibility for workers' compensation benefits by reason of its interpretation of the newly created 85 O.S. 2011, section 312 (3). The dispositive issue presented to the Supreme Court was whether the trial court erred in its interpretation of the statute. The trial court found the last sentence of paragraph 3 expressed the legislative intent of the entire paragraph without giving any weight to the other sentences in the same paragraph. In its order, the trial court indicated this sentence created an irrebuttable presumption. Upon review, the Supreme Court disagreed. The Court concluded that Petitioner overcame the rebuttable presumption of ineligibility for workers' compensation benefits. The case was reversed and remanded for further proceedings. View "Hogg v. Oklahoma Cty. Juvenile Bureau" on Justia Law