Justia Insurance Law Opinion Summaries

Appellant appealed from an opinion of the court of appeals which affirmed an order of the circuit court dismissing Appellant's petition for review of a decision of the Kentucky Unemployment Insurance Commission (KUIC). In addition to denying Appellant unemployment benefits, the KUIC ordered Appellant to reimburse $12,785 in benefit payments he had already received. The circuit court dismissed Appellant's petition for review because it did not comply with the verification requirement contained in Ky. Rev. Stat. 341.450(1), and thus the court concluded that its jurisdiction was not invoked within the twenty-day limitations period provided for filing such an action. The Supreme Court affirmed, holding (1) because Appellant failed to comply with the verification provision of section 341.450(1), the circuit court lacked jurisdiction over the controversy; and (2) Appellant did not comply with the verification requirement, as his attorney's signature on the petition did not constitute "certification." View "Taylor v. Ky. Unemployment Ins. Comm'n" on Justia Law

The State of North Dakota, by and through the Department of Human Services and its Child Support Enforcement Division ("the Department"), appealed a district court order denying its application for an order to enforce an administrative subpoena. In July 2010, the Department issued an administrative subpoena to the North Dakota Insurance Reserve Fund ("NDIRF") directing it to provide information on all claims submitted to the Fund. NDIRF objected to the subpoena, contending that the Department was not statutorily authorized to issue an administrative subpoena to NDIRF and that the subpoena was vague, ambiguous, and unduly burdensome. The Department filed an application for an order enforcing the administrative subpoena in district court. The district court determined that the Department was not statutorily authorized to issue an administrative subpoena to NDIRF and denied the application. The district court did not address NDIRF's arguments that the subpoena was vague, ambiguous, and unduly burdensome. Upon review, the Supreme Court concluded that the district court erred in holding the Department was not statutorily authorized to issue an administrative subpoena to NDIRF. Accordingly, the Court reversed the order denying the Department's application for an order enforcing the administrative subpoena. Because the district court did not address NDIRF's contentions that the subpoena was vague, ambiguous, and unduly burdensome, the case was remanded to the district court for further proceedings to properly consider these issues under the limited four-factor review of enforcement of an administrative subpoena. View "North Dakota v. No. Dakota Ins. Reserve Fund" on Justia Law

Employer terminated Employee's employment after receiving complaints regarding poor service and use of inappropriate language by Employee. The Department of Labor & Industry concluded Employee was not qualified for unemployment insurance benefits because she had been discharged for misconduct. A hearing officer awarded unemployment benefits to Employee, concluding that Employee had not been deliberately rude and thus had not engaged in misconduct. The Board of Labor Appeals affirmed. Employer petitioned for judicial review. The Department and Board filed a notice of non-participation indicating they would not participate in the proceeding but reserved the right to intervene if issues arose pertaining to them. The district court reversed, holding that Employee's conduct as established by the hearing officer's findings of fact constituted misconduct as a matter of law under the carelessness standard of Admin. R. M 24.11.460(1)(d). The Department appealed. The Supreme Court affirmed, holding (1) the Department did not preserve its evidentiary arguments for appeal; and (2) the district court did not err by determining that the evidence found by the Department constituted misconduct as a matter of law under the carelessness standard. View "Gary & Leo's Fresh Foods v. Dep't of Labor & Indus." on Justia Law

In 1994, while en route to the scene of a fire, volunteer fireman James Hingle collided with a vehicle occupied by Sam and Ruby Anderson. Hingle was driving his personal vehicle at the time of the accident. The Andersons filed suit against Hingle, Marshall County, the volunteer fire department, and the Marshall County Board of Supervisors. The Andersons claimed that their injuries and damages amounted to $4,150,000. At the time of the accident, Hingle had two insurance policies with Guidant: personal automobile liability policy with limits of $250,000 per person and $500,000 per accident, and an umbrella protection policy with a $1,000,000 limit. Marshall County had a business automobile liability policy with a $300,000 limit through INA, which covered non-owned automobiles and provided coverage to the volunteer fire department. A dispute arose regarding which insurance company should defend the litigation and which provided primary coverage. INA filed a declaratory-judgment action against Guidant in the Circuit Court of Marshall County. INA asked for a judgment declaring, inter alia, that Guidant had a duty to defend all the defendants and INA did not have any duty to defend, and that Guidant's policies afforded primary coverage for all defendants, while INA provided excess coverage only. INA moved for summary judgment in the declaratory-judgment action, but the trial court held the motion in abeyance pending a final determination on the merits of the underlying lawsuit. Following that ruling, INA provided defense counsel to Marshall County and the fire department in the Anderson lawsuit. Guidant defended Hingle. INA appealed the trial court's decision on remand. Upon review, the Supreme Court affirmed in part, reversed in part, and remanded the case back to the trial court. The Court affirmed the trial court's denial of INA's Rule 56(f) motion for continuance and the denial of INA's request for prejudgment interest. The Court found that INA's claims of procedural errors warranting reversal were without merit. While the Court agreed with the trial court's finding that INA was required to contribute to the settlement, the Court reversed the trial court's determination that INA was required to contribute its policy limit. The Court held that Guidant was required to exhaust its $500,000 per-accident limit before INA's insurance was to be applied. View "Indemnity Insurance Company of North America v. Guidant Mutual Insurance Company" on Justia Law

Merwin Carlson appealed a judgment affirming a Workforce Safety and Insurance ("WSI") decision that denied his claim for workers' compensation benefits after remand. Under the law of the underlying case, the Supreme Court held that the administrative law judge ("ALJ") erred in concluding WSI properly exercised its continuing jurisdiction under N.D.C.C.65-05-04 to deny Carlson benefits on remand. The Court reversed and remanded for WSI to award Carlson benefits based on the ALJ's calculation that Carlson's average weekly wage was $722. View "Carlson v. Workforce Safety & Ins." on Justia Law

The Supreme Court granted allowance of appeal in this case to determine whether the immunity provisions of Section 23 of the Workers' Compensation Act (Act 44) applied to "subrogation and/or reimbursement claims sought against an employee who has entered into a third[-]party settlement with a Commonwealth [p]arty such as Southeastern Pennsylvania Transportation Authority ('SEPTA')." Upon review of this matter, the Supreme Court held that the portion of Act 44 at issue in this case barred any claim made by the employer for the recoupment of workers' compensation benefits it paid. View "Fraizer v. W.C.A.B." on Justia Law

Frank Hutson was working as a crane operator for the State Ports Authority when he suffered an injury to his lower back and legs while attempting to remove a container from a ship. He was diagnosed with a disc bulge for which he was treated with steroid injections, physical therapy, and used a back brace. After reaching maximum medical improvement, he filed a Form 50 with the workers' compensation commission for continued benefits alleging permanent and total disability pursuant to Sections 42-9-10 and 42-9-30 South Carolina Code (1976 & Supp. 2011) or, alternatively, a wage loss under Section 42-9-20. He also asked to receive the award in lump sum. Although the Ports Authority and its insurance carrier, the State Accident Fund (collectively, Respondents), admitted the accident and the back injury, they disputed the claims to his legs and argued he should receive only permanent partial disability benefits. They also objected to Hutson's request that his benefits be paid in a lump sum. The issue before the Supreme Court centered on whether speculative testimony by the claimant concerning his possible future work as a restaurateur qualified as substantial evidence to establish he did not sustain a wage loss pursuant to Section 42-9-20 of the South Carolina Code (1976). The Court held it did not, and therefore reversed and remanded the case for further proceedings. View "Hutson v. SC State Ports Authority" on Justia Law

Zaloudek Grain Company held a workers' compensation policy with CompSource Oklahoma for approximately ten years prior to 2011. Zaloudek was required each year to provide payroll audit information to CompSource. The audit information was used to determine the proper premium for each year. CompSource sent a notice in late 2010 to Zaloudek requesting audit information. In January, 2011, Zaloudek's policy was renewed for all of 2011 through January 1, 2012. On January 18, 2011, CompSource sent another letter requesting Zaloudek provide the necessary payroll audit information, but Zaloudek was unresponsive. Subsequently, CompSource sent Zaloudek a notification to inform the company that the process of canceling its policy would begin if CompSource did not receive the audit information. The audit information was not provided; CompSource ultimately canceled the policy when Zaloudek ignored several subsequent requests. CompSource issued a refund for payments made under the policy. Later that summer, two teenage workers were seriously injured in the grain auger at Zaloudek's facility. CompSource did not accept the company's new insurance application because it was incomplete and was not signed by an owner of Zaloudek. Zaloudek sued a few weeks following the rejection of its application, asking for a judgment against CompSource for breach of contract and bad faith and further requested declaratory relief in the form of an order requiring CompSource to provide workers' compensation coverage. Zaloudek filed a motion for summary judgment claiming CompSource lacked legal justification for terminating its policy and requested orders to establish there was no lapse in coverage and requiring CompSource to provide coverage for its two injured employees. Zaloudek further requested a finding that CompSource was in breach of contract. CompSource moved for summary judgment, arguing Zaloudek was not covered at the time of the incident and its policy was properly canceled. Zaloudek filed a counter-motion for summary judgment asserting CompSource should be estopped from denying coverage because it retained premiums and acted in a manner toward Zaloudek consistent with continued coverage. The trial court issued an order dismissing Zaloudek's bad faith claim but left pending its claims for breach of contract and declaratory relief. CompSource appealed. After its review, the Supreme Court concluded that CompSource was authorized to cancel a policy for an insured's failure to participate in the audit. The Court remanded the case for further proceedings on the other contract issues raised. View "Zaloudek Grain Co. v. CompSource Oklahoma" on Justia Law

The issue before the Supreme Court was whether an employee who filed an injury claim against his employer under the State Workers' Compensation Act and receives compensation in exchange for a "no liability" settlement with his employer that is approved by the State Board of Workers' Compensation may then turn around and sue the co-employee who caused the injury in a tort action. Ten years ago, the Court of Appeals answered this question no, holding that the Act's exclusive remedy provision bars such a lawsuit based on the same injury for which the employee has already received a remedy. In this appeal, however, the Court of Appeals was equally divided as to whether the underlying case law should be overruled, and the case was sent to the Supreme Court for resolution. Upon review, the Supreme Court held that "Ridley" was correctly decided. Thus, appellant Joseph Smith, having previously entered a Board-approved settlement with his employer in exchange for compensation, would be barred from suing appellee John Ellis for the same injury in tort if Ellis qualified as an "employee of the same employer" as Smith, rather than a "third-party tort-feasor," as those phrases are used in the applicable statutory authority. However, the evidence did not establish that Ellis was acting as "an employee of the same employer" in the course of his employment, at the time he injured Smith. The trial court therefore erred in granting summary judgment to Ellis, and that judgment was reversed. View "Smith v. Ellis" on Justia Law

At issue in this case was whether the workers' compensation courts had the authority to hear a petition filed by Insured to determine whether Insurer had a duty to defend and indemnify Insured under a policy for workers' compensation insurance. Insurer moved to dismiss Insured's petition, arguing that the compensation judge did not have subject matter jurisdiction to hear the petition because it asserted a breach of contract claim rather than one arising under the workers' compensation laws. The compensation judge disagreed and denied Insurer's motion to dismiss. The workers' compensation court of appeals (WCCA) affirmed, concluding that Insured was seeking a declaration that its insurance coverage with Insurer was still "in effect," a question within the compensation judge's authority to decide. The Supreme Court affirmed, holding that the workers' compensation courts had jurisdiction to decide the issues presented in Insured's petition for declaration of insurance coverage, as the real nature of the claim was whether Insured's insurance coverage was in effect, a question that was within the authority of the compensation judge to answer. View "Giersdorf v. A & M Constr., Inc." on Justia Law