Justia Insurance Law Opinion Summaries

At issue in this direct appeal to the Supreme Court was a statutory prerequisite to the obligation of the Insurance Department to defend certain medical professional liability actions asserted against health care providers, and to the requirement for payment of claims asserted in such actions from the Medical Care Availability and Reduction of Error Fund. Specifically, resolution of the appeal turned on when, under the governing statute, a "claim" is "made" outside a specified four-year time period. On June 4, 2007, Joanna Ziv filed a praecipe for a writ of summons naming Appellant Phillip Yussen, M.D. and other medical providers as defendants. A complaint was filed on August 2, 2007, alleging medical negligence last occurring on July 7, 2003. Appellant’s primary insurer, Pennsylvania Healthcare Providers Insurance Exchange, requested that the claim be accorded Section 715 status by the Insurance Department. The Department denied such request, however, on the basis that the claim had been made less than four years after the alleged malpractice. Appellant initially challenged this determination in the administrative setting, and a hearing ensued. Before the examiner, Appellant argued that, consistent with the policy definition of a "claim," the date on which a claim is made for purposes of Section 715 cannot precede the date on which notice is provided to the insured. Appellee, on the other hand, contended that a claim is made when it is first asserted, instituted, or comes into existence - including upon the tender of a demand or the commencement of a legal action - and that notice to the insured or insurer is not a necessary prerequisite. In this regard, Appellee Medical Care Availability & Reduction of Error Fund highlighted that Section 715 does require "notice" of the claim to trigger the provider's obligation to report the claim to the Fund within 180 days, but the statute does not contain such an express notice component in delineating the four-year requirement. The Commonwealth Court sustained exceptions to the hearing examiner's recommendation lodged by Appellee and entered judgment in its favor. In its review, the Supreme Court found "claim" and "made" as used in Section 715 ambiguous. The Court determined that for purposes of Section 715, the mere filing of a praecipe for a writ of summons does not suffice to make a claim, at least in absence of some notice or demand communicated to those from whom damages are sought. The Court remanded the case for entry of judgment in Appellant's favor.

The issue before the Supreme Court in this case centered on whether Appellant Six L's Packing Company and its claims administrator Broadspire Services, Inc. bore liability for workers' compensation benefits as a statutory employer of an injured truck driver employed as an independent contractor. Appellant owns and leases various farms and distribution and processing facilities in North America. Claimant suffered injuries in a vehicle accident on a Pennsylvania roadway while transporting Appellant’s tomatoes between a warehouse in Pennsylvania and a processing facility in Maryland. Appellant submitted evidence to establish that it did not own trucks or employ drivers, but, rather, utilized independent contractors to supply transportation services. Appellant thus took the position that it was not Claimant’s employer. The WCJ found Appellant liable for payment of workers' compensation benefits. On further appeal, the Commonwealth Court affirmed on essentially the same reasoning as that of the WCJ. In its review, the Supreme Court affirmed the Commonwealth Court, recognizing "a degree of ambiguity inherent in the overall scheme for statutory employer liability, arising out of differences in the definitions for “contractor” as used in various provisions of the Workers' Compensation Act (WCA); the idiosyncratic conception of subcontracting fashioned in Section 302(a) [of the Act]; the substantial overlap between Sections 302(a) and (b); and the apparent differences in the depiction of the concept of statutory employment as between the Act’s liability and immunity provisions. Viewing the statutory scheme as a whole, however, and employing the principle of liberal construction in furtherance of the Act’s remedial purposes, [the Court found] it to be plain enough that the Legislature meant to require persons (including entities) contracting with others to perform work which is a regular or recurrent part of their businesses to assure that the employees of those others are covered by workers’ compensation insurance, on pain of assuming secondary liability for benefits payment upon a default."

The issue before the Supreme Court was the proper method of calculating an hourly-wage claimant's average weekly wage under Section 309 of the Workers’ Compensation Act where the specific loss claimant suffered an initial incident, changed employers, and later suffered a work-related injury caused by the initial incident. Claimant Janice Weber-Brown worked for Appellant Lancaster General Hospital as a licensed practical nurse. In 1980, while cleaning the tracheotomy of a patient who was infected with the herpes simplex virus (HSV), the patient coughed, causing sputum to spray in Claimant’s left eye. Approximately two weeks after the incident, Claimant’s eye became swollen and infected, and Claimant believed she contracted HSV. Claimant left the employ of Lancaster General in 1985 for reasons unrelated to the eye incident. At that time, she earned $8 per hour and worked full-time. In the years following her departure from the hospital, Claimant’s eye became infected several more times. Each time, her symptoms subsided with treatment, and Claimant did not miss any work with her other employers due to her eye infections. In October 2006, however, Claimant’s eye again became infected and, this time, her infection did not respond to treatment. By February 2007, Claimant lost the vision in her left eye, and, in May 2007, she underwent a cornea transplant. The transplant did not improve her vision, and, as a result of her blindness, she was not able to return to work. At that time, Claimant earned $21 per hour. Lancaster General denied Claimant's allegations that she contracted HSV while working for the hospital, and challenged her claim that she be paid based on her then-current wage with her new employer. The WCJ determined Claimant suffered a work-related injury and held that the hospital pay Claimant's wage set at $21 per hour. Lancaster General appealed. Upon review, the Supreme Court concluded that the WCJ correctly held that the Claimant's weekly wage should have been based on her 2007 wages with her new employer, as those wages were earned with that employer at the time Claimant suffered her work-related injury.

An employer petitioned the Alaska Workers' Compensation Board for reimbursement from the Second Injury Fund for payments it made to a disabled worker. The Fund opposed the petition. After a hearing, the Board granted the petition. The Fund asked the Board to reconsider its decision in December 2009. The hearing officer told the parties that he would inform them in writing by the end of January 2010 about what action the Board was taking on the reconsideration request. Instead, in April 2010 the hearing officer sent a prehearing conference summary indicating that the reconsideration request had been denied by operation of statute. The next day the Fund filed a notice of appeal and a motion to accept a late-filed appeal with the Alaska Workers' Compensation Appeals Commission. The Commission denied the Fund's request to file its appeal late and dismissed the appeal. Because the Supreme Court concluded that the Fund filed a timely appeal, it reversed the Commission's decision and remand for consideration of the Fund's appeal.

Respondent Liberty Mutual Fire Insurance Company appealed a superior court order that denied its motion for summary judgment and granted summary judgment in favor of Petitioner Rebecca Rivera. The court ruled that an automobile policy (policy) issued to Rivera’s parents excluded liability coverage but afforded uninsured motorist coverage for injuries Rivera sustained in a single-vehicle accident in Dracut, Massachusetts. Upon review, the Supreme Court affirmed the grant of summary judgment in Petitioner's favor: "the terms of the owned vehicle exclusion appear to remove [Petitioner's vehicle] from the definition of uninsured motor vehicle even though, as to Rivera, there [was] no insurance available. While Liberty Mutual is free to limit the extent of its liability through the use of an exclusion it cannot do so in contravention of statutory provisions or public policy."

This appeal arose from an insurance coverage dispute where the City sought coverage from Genesis for 42 U.S.C. 1983 claims in the nature of malicious prosecution. Genesis filed suit against the City, seeking a declaratory judgment that its policies provided no coverage for the underlying actions. The district court granted summary judgment to Genesis and the City appealed, arguing that the district court erred in ruling as a matter of law that the policies did not provide the City insurance coverage for the claims. Because Genesis did not have an insurance contract with the City in 1977, when the underlying charges were filed, it did not have a duty to defendant and indemnify the city in the suits. Accordingly, the court affirmed the judgment.

The Workers' Compensation hearing officer terminated Petitioner Gloria Clay's benefits, finding her employer had sufficiently proved the availability of jobs such that Petitioner was capable of earning at least ninety percent of her pre-injury wages. The court of appeal reversed, finding the jobs identified by the vocational rehabilitation counselor were not available to Petitioner. Finding no manifest error in the hearing officer's decision, the Supreme Court reversed the court of appeal and reinstated the hearing officer's ruling terminating Petitioner's benefits.

A 2011 amendment to Section 71-3-51 provides that, "from and after July 1, 2011," decisions of the Mississippi Workers' Compensation Commission may be appealed directly to the Supreme Court, rather than to the circuit court, as required under the previous version of the statute. On July 1, 2011, the Commission denied Petitioner Joseph Dewayne Johnson’s claim for benefits, so he appealed to the Supreme Court. The ordered the parties to brief two issues: whether Section 71-3-51, as amended was constitutional; and whether the Court had appellate jurisdiction over direct appeals from the Commission. Upon review, the Court concluded that Section 71-3-51 was constitutional, and that the Court had appellate jurisdiction over direct appeals from the Commission.

The Oklahoma Tax Commission assessed corporate income taxes against Vermont Corporation Scioto Insurance Company for 2001 through 2005, based on payments Scioto received from the use of Scioto's intellectual property by Wendy's restaurants in Oklahoma. In response, Scioto protested these assessments on the ground that it did not contract with the Wendy's restaurants in Oklahoma for use of the property in question and did not conduct any business whatsoever in Oklahoma. The Tax Commission denied Scioto's protest and the Court of Civil Appeals affirmed. The Supreme Court previously granted certiorari. Upon review, the Court vacated the Court of Civil Appeals opinion, reversed the Tax Commission's denial of Scioto's protest and remanded the case with instructions to sustain Scioto's protest.

The Employment Appeal Board (Board) denied Willie Hall's application for unemployment insurance benefits. Hall filed a petition for judicial review. The district court affirmed the decision of the Board and assessed costs against Hall. The court of appeals affirmed. The Supreme Court reversed the portion of the judgment as it related to court costs, holding (1) pursuant to Iowa Code 96.15(2), any individual claiming benefits shall not be charged fees of any kind, including court costs, in a proceeding under the statute by a court or an officer of the court; and (2) therefore, the district court erred by requiring that Hall pay court costs.