Justia Insurance Law Opinion Summaries

Plaintiffs Joseph and Josephine Iozzi owned a home located in Cranston. On October 15, 2005, excessive rainfall overwhelmed the sewer system servicing the Iozzis's home, causing water and sewage to back up and enter their basement, resulting in extensive damage to their home and personal property. Plaintiffs filed suit seeking declaratory relief and compensatory damages from Triton Ocean State, LLC (Triton); U.S. Filter Operating Services, Inc. (Veolia); and Peerless Insurance Company (Peerless). The complaint alleged that Triton and Veolia were jointly and severally liable for negligently "operating, maintaining and repairing the sewer disposal system" in the city. As to Peerless, the complaint alleged that it was liable for breach of contract for rejecting plaintiffs' claim for damages under their homeowner's insurance policy. Peerless moved for summary judgment arguing that the language in the homeowner's policy was clear and unambiguous and excluded coverage for the claims Plaintiffs made. Triton and Veolia filed a joint motion for summary judgment arguing that neither of them had a contractual or common-law responsibility to Plaintiffs for the damage to their property because a lease service agreement with the City of Cranston relieved them of responsibility for the damage and because the flooding that caused Plaintiffs' damages was caused by an "Act of God." Agreeing with the superior court's reasoning for granting defendants' motions for summary judgment, the Supreme Court affirmed dismissal of Plaintiffs' case. View "Iozzi v. City of Cranston" on Justia Law

This appeal arose out of Ryan Dorman's petition for an extension of his worker's compensation temporary total disability (TTD) benefits and for reimbursement of travel expenses incurred in travelling from Idaho to Cheyenne to obtain medical care. In May 2006, Dorman sought treatment from an Idaho physician for treatment of his alleged work-related injury. Due to the nature of Dorman's injury, he consulted multiple physicians, first in Idaho, then in Wyoming. With each consultation, the doctors indicated that the injury was outside of their scope of expertise, and referred Doman to another specialist. During the period that Dorman was changing physicians, the Division and Dorman negotiated a stipulation concerning his TTD benefits and other benefits. This followed OAH and district court decisions that largely reversed the Division's earlier determinations concerning TTD benefits and Dorman's need for continued medical treatment. The Stipulated Order also provided that medical benefits would be paid as directed by the district court's order. After the Division paid the stipulated TTD benefits, Dorman submitted a letter to the Division requesting extended benefits The Division thereafter issued a final determination denying them, and further denied several applications for travel expense reimbursement for Dorman's trips to Idaho and Cheyenne. The matters were referred to the OAH where a combined hearing was held on the denial of TTD benefits, denial of travel reimbursement, and denial of diagnostic testing related to Dorman's injury. The OAH upheld the denial of TTD benefits on the ground that Dorman had failed to make the required showing that the Idaho and Cheyenne doctors were the closest available medical providers. Dorman appealed the portion of the OAH order denying extended TTD benefits and travel reimbursement to the district court. Upon review, the Supreme Court affirmed the OAH denial of the travel reimbursement: Dorman could not prove that reimbursement of travel expenses was not supported by substantial evidence and in accordance with law. View "Dorman v. Wyoming" on Justia Law

The Supreme Court granted certiorari to the Court of Appeals in "Glass v. Gates" to answer whether the definition of "any motor vehicle" in OCGA 33-24-51(a) continued to be the broader definition of the term provided for in prior case law, notwithstanding the 2002 passage of OCGA 36-92-1. As inmates at the Troup County Correctional facility, Jonathan Glass and Tony Smith were operating tractors when Smith's tractor got stuck in a ditch. Donrell Gates, Glass' detail supervisor, instructed the men to attach a chain to the tractors so Glass could use his tractor to pull Smith's from the ditch. As Glass did so, Smith engaged his tractor's bush hog, causing a rock to take flight and pierce Glass' throat. Glass bled profusely and died later that day. Plaintiffs, Glass' minor son and the executor of his estate, brought a wrongful death and survivor action against Troup County and Gates. The county sought summary judgment, claiming plaintiffs' claims were barred by sovereign immunity. The County asserted that by revising OCGA 33-24-51 (b) in 2002 (effective 2005), the legislature demonstrated its intent to apply the more narrow definition of "motor vehicle" found in OCGA 36-92-1 (6) in determining whether a local government waived sovereign immunity by purchasing liability insurance on a motor vehicle. The trial court agreed and granted summary judgment in favor of the County, concluding that the county did not waive sovereign immunity because neither a tractor nor a bush hog could be deemed a "motor vehicle" under OCGA 36-92-1. The Court of Appeals reversed, holding that the broader definition of "motor vehicle" should have been applied under 33-24-51, and that therefore, the County waived its sovereign immunity as long as it purchased insurance for the tractor and bush hog used by Smith. The Supreme Court agreed with the Court of Appeals' reasoning, and affirmed by answering the appellate court's original question in the affirmative. View "Gates v. Glass" on Justia Law

The Wyoming Workers' Safety and Compensation Division awarded benefits to Appellant Gary Mitcheson after he fell at work and injured his tailbone in July of 2007. Approximately two years later, the Division issued a final determination denying payment for medical care that Appellant claimed was related to his workplace injury. Appellant requested a contested case hearing, and the Office of Administrative Hearings (OAH) upheld the Division's determination. Appellant appealed to the district court, which upheld the OAH's order. On appeal, Appellant challenged the OAH order contending: (1) the order was arbitrary and unsupported by substantial evidence; (2) the OAH's denial of payment for treating Appellant's tailbone was arbitrary; and (3) the OAH order denying payment for medical care contrary to the "Rule Out" rule was contrary to law. Finding the issues Appellant raised on appeal to be without merit, the Supreme Court affirmed the OAH's decision. View "Mitcheson v. Wyoming" on Justia Law

Claimant Crystal DeLeon sought workers' compensation benefits for a work-related injury to her back, neck and one shoulder. SAIF Corporation, her insurer, accepted the claim but awarded only temporary partial disability; the insurer did not award Claimant permanent partial disability. Claimant sought reconsideration, and the Department of Consumer and Business Services awarded her an eleven percent permanent partial disability for her shoulder. The insurer appealed the Department's award; the ALJ agreed with the insurer and reduced the permanent partial disability award to zero. Claimant appealed the ALJ's decision to the Workers' Compensation Board. The board reversed the ALJ and reinstated the eleven percent disability determination, and awarded attorney's fees. The issue on appeal concerned the authority of the Workers' Compensation Board to award attorney fees. Upon review, the Supreme Court found that the Board indeed has statutory authority to award attorneys' fees. View "SAIF Corp. v. DeLeon" on Justia Law

The State Department of Labor and Industry appealed a district court's order that reversed the Department's decision regarding Petitioner Sheila Callahan & Friends, Inc. (SC&F). SC&F, a radio broadcasting company entered into a one-year contract with Joni Mielke. During the term of employment, SC&F evaluated Mielke as being an excellent radio personality and announcer but as underperforming other responsibilities because she either did not want to do them or preferred announcing-related duties. Mielke elected not to renew her contract with SC&F, and on an exit interview form, Mielke indicated her reason for leaving was that she "quit." After Mielke left her employment with SC&F, she was hired by another radio station. After a brief employment with this subsequent employer, she was laid off and filed for unemployment benefits in October 2009. The Department of Labor sent a Notice of Chargeability Determination to SC&F assessing a pro rata share of the costs of Mielke’s unemployment insurance benefits to SC&F’s experience rating account. The Department administratively determined that Mielke was employed for SC&F on a contract basis during her base period of employment and that SC&F’s account was chargeable for a portion of benefits drawn by Mielke. SC&F requested a redetermination, arguing that Mielke had voluntarily left her employment. The Department issued a Redetermination affirming the initial Determination. An administrative hearing was then conducted by telephone; the hearing officer determined that Mielke neither voluntarily quit nor was discharged for misconduct and affirmed the decision to charge SC&F’s account. On appeal, the Department argued the District Court improperly failed to defer to the Board’s findings of facts. Upon review, the Supreme Court concluded that the error of the Board was primarily premised upon application of legal standards, in the nature of a conclusion of law. Given the inapplicability of the imputation rules to the situation here, the District Court properly concluded that the evidence did not support the Board’s determination that Mielke’s work separation was involuntary. View "Sheila Callahan & Friends, Inc. v. Montana" on Justia Law

An employee of a tribal enterprise sought to invoke the jurisdiction of the Oklahoma Workers' Compensation Court. Petitioner John A. Waltrip fell on a patch of ice while working as a surveillance supervisor at a casino and injured primarily his right shoulder. Petitioner initially obtained treatment from his personal physician but Tribal First, the employer Osage Million Dollar Elm Casino's claim administrator, sent him to an orthopedic specialist who recommended surgery in 2009. Petitioner filed a claim in the Oklahoma Workers' Compensation Court on July 17, 2009, seeking medical treatment and temporary total disability. The Casino and Insurer Hudson Insurance Company asserted that court lacked jurisdiction based on the tribe's sovereign immunity. A hearing was held solely on the jurisdictional issue; the Workers' Compensation Court denied jurisdiction and dismissed the claim holding that the tribe enjoyed sovereign immunity and that the provisions of the tribe's workers' compensation policy did not subject the insurance company to liability for claims in state court. The Court of Civil Appeals affirmed and the Supreme Court granted certiorari review. Upon review, the Supreme Court held that: (1) the tribe enjoyed sovereign immunity and was not therefore subject to the jurisdiction of the Oklahoma Workers' Compensation Court; and (2) the workers' compensation insurer did not enjoy the tribe's immunity and was estopped to deny coverage under a policy for which it accepted premiums computed in part on the employee's earnings. View "Waltrip v. Osage Million Dollar Elm Casino" on Justia Law

Plaintiff-Appellee William Mohr was struck in Delaware as a pedestrian by a car insured in Delaware. He recovered the minimum $15,000 coverage limit from the carrier that insured the striking car. Plaintiff also sought to recover from Defendant-Appellant Progressive Northern Insurance Company which sold an automobile insurance policy to Plaintiff's mother. Under the policy, Plaintiff's mother was the named insured, and Plaintiff was a member of her household. The Progressive policy, by its terms, did not cover Plaintiff as a pedestrian. The superior court held nonetheless that Plaintiff was entitled to recover under Progressive's policy because insofar as it denied PIP coverage, the policy conflicted with the Delaware automobile insurance statute which mandated such coverage. Progressive appealed. The court ordered Progressive to pay the difference between the amount Plaintiff recovered from the striking-car's policy and PIP limit of his mother's policy. Finding no error in the superior court's decision, the Supreme Court affirmed. View "Progressive Northern Insurance Co. v. Mohr" on Justia Law

Title insurance purchasers, on behalf of themselves and similarly situated consumers, claimed that insurers collectively fixed title insurance rates in violation of the Sherman Act. Title insurers in Delaware are required to file their insurance rates with the state Department of Insurance, Del. Code tit. 18, 2504(a). Insurers may comply with the state’s rate filing requirements through a licensed rating organization. Defendants, title insurers, are members of and file their rates through the Delaware Title Insurance Rating Bureau, which is licensed by the DOI; the statutory scheme authorizes cooperative action. The district court dismissed, holding that the complaint is barred by the filed-rate doctrine (which precludes antitrust suits based on rates currently filed with federal or state agencies), lack of standing, and federal antitrust liability exemptions. The Third Circuit affirmed.

Title insurance purchasers, on behalf of themselves and similarly situated consumers, claimed that insurers collectively fixed title insurance rates in violation of the Sherman Act and the New Jersey Antitrust Act. In New Jersey, the Department of Banking and Insurance approves and regulates title insurance rates, N.J. Stat. Ann. 17:1C-19(a)(1). Insurers may collectively file rates for approval through a licensed rating organization, thereby authorizing cooperative action. The district court dismissed, holding that the complaint is barred by the filed-rate doctrine (which precludes antitrust suits based on rates currently filed with federal or state agencies), lack of standing, and federal and state antitrust liability exemptions. The Third Circuit affirmed.