Justia Insurance Law Opinion Summaries

Alohacare, a health maintenance organization (HMO), submitted a proposal to the Department of Human Services to bid for a Quest Expanded Access contract to provide healthcare services for participants in the state's Medicaid program. The Department of Human Services awarded Quest contracts to United HealthCare Insurance (United) and WellCare Health Insurance (Ohana) but not to Alohacare. Alohacare petitioned the Insurance Commissioner of the Department of Commerce and Consumer Affairs for declaratory relief that the Quest contracts required the accident and health insurers to carry an HMO license. The Commissioner concluded that the license was not required to offer the Quest managed care product because the services required under the contracts were not services that could be provided only by an HMO. The circuit court affirmed. The Supreme Court affirmed, holding (1) AlohaCare had standing to appeal the Commissioner's decision; (2) both accident and health insurers and HMOs were authorized to offer the model of care required by the Quest contracts; and (3) this holding did not nullify the Health Maintenance Organization Act.

Plaintiffs-Appellants Randolph Farber, Scott Becker, and Critter Clinic (Farber) alleged that the Manager of the Defendant-Respondent State Insurance Fund (SIF or "the Fund") failed to comply with I.C. 72-915, which provides the means by which the SIF Manager may distribute a dividend to policyholders. The district court determined that the gravamen of Farber's claim implicated the statute and held that the three-year statute of limitation provided by I.C. 5-218(1) barred all claims that accrued prior to July 21, 2003. Farber timely appealed. Upon review, the Supreme Court held that the five-year statute of limitation in I.C. 5-216 applied to Farber's claim. Therefore, the Court reversed the trial court's decision and remanded the case for further proceedings.

The Maryland Insurance Commissioner approved a filing by Allstate Insurance Company and Allstate Indemnity Company (collectively, Allstate) giving notice of its intent to cease writing new property insurance policies in certain geographic areas of the state. The Commissioner concluded that the filing was subject to administrative review under Md. Code Ann. 19-107(a) and Md. Code Ann. Ins. 27-501(a) and that it satisfied the pertinent criteria under both statutes. The circuit court affirmed both aspects of the Commissioner's ruling. The court of special appeals affirmed but on alternative grounds, holding that section 27-501(a) did not apply to the filing and that, even if it did, the statute was not violated. The Court of Appeals affirmed but, again, on different grounds, holding (1) the Commissioner did not err in finding that section 27-501 did apply to the Allstate filing, and (2) the evidence was sufficient to support the Commissioner's decision.

Claimant Jerry Benoit worked for Turner Industries for twenty-seven years. For ten of those years he worked as a general laborer for a Lake Charles Citgo refinery, where Turner was contracted to perform general maintenance. Claimant's duties included cleaning chemical discharges and oily waste which collected in the drainage ditches, sewers, and processing units at the refinery. In the course of this work, he was exposed to any number of potentially dangerous or carcinogenic chemicals, including high levels of benzene. In July 2006, Claimant fell ill. He was diagnosed with acute myeloid leukemia (AML), known to be linked to high levels of benzene exposure. Despite the medical evidence linking Claimant's cancer to the chemicals he was exposed to at work, his claim for medical benefits was denied. The eventual medical bills totaled over $625,000. Medicaid paid for $203,124.68. The remaining $422,043.59 was "written off" by the medical care providers. Turner paid nothing. Claimant's family filed suit in 2007. The Office of Workers' Compensation (OWC) awarded Claimant total medical expenses and attorney fees. Turner appealed, and the court of appeals affirmed the OWC judgment in its entirety. Upon review of the correctness of the OWC award of medical expenses, the Supreme Court concluded the OWC erred in awarding the "written off" medical expenses: "Claimant would receive an improper windfall if he was allowed to recover for medical expenses which have been reduced by health care providers as a result of their contractual arrangements with Medicaid." The Court reversed the appellate court's decision and remanded the case for further proceedings.

James Whealon was employed by the Anaconda School District pursuant to a series of employment contracts. Upon retirement, Whealon filed a formal grievance, asserting that, under the terms of his contract, he was entitled to payment of his health insurance premiums by the District until he reached the age of sixty-five. The District denied his claim. The County Superintendent granted summary judgment to the District, holding that the language of the contract was unambiguous and that Whealon was not entitled to the claimed benefits beyond the date of his retirement. The State Superintendent of Public Instruction reversed and remanded for an evidentiary hearing, holding that the language of the contract was ambiguous. The district court reversed and reinstated the County Superintendent's ruling. The Supreme Court affirmed the district court, holding (1) the district court did not err in holding that a county superintendent has authority to grant summary judgment; and (2) the district court did not err in reinstating summary judgment in favor of the district where the language of the agreement was unambiguous and the District was entitled to judgment.

Employee was injured while working for Employer's sheep and wool business, Cestari. Employer failed to maintain workers' compensation insurance for Cestari. Employee filed a workers' compensation claim against Employer and Cestari, as well as a complaint against Employer and Cestari, seeking damages for negligence. The workers' compensation commissioner determined that Employee was entitled to workers' compensation benefits. Finding that Employee had pursued his workers' compensation claim to a final order and that he had a remedy for collection of his workers' compensation award against Cestari and/or the Uninsured Employers' Fund, the circuit court dismissed Employee's civil complaint. The Supreme Court affirmed, holding that Employee had received the recovery he sought under the Workers' Compensation Act, and thus, the circuit court did not err in ruling that Employee could not pursue an action at law against Employer after obtaining a final collectible award of workers' compensation benefits.

This case involved Commonwealth Care, a state-initiated program that provided structured premium assistance for low-income Massachusetts residents. In 2009, the Legislature made certain changes to the eligibility requirements of Commonwealth Care, enacted in a two-part supplemental appropriation for fiscal year 2010. Section 31(a) of the appropriation excluded all aliens who were federally ineligible under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), 8 U.S.C. 1601-1646, from participation in Commonwealth Care. Plaintiffs were individuals who either have been terminated from Commonwealth Care or have been denied eligibility solely as a result of their alienage. The court held that section 31(a) could not pass strict scrutiny and that the discrimination against legal immigrants that its limiting language embodied violated their rights to equal protection under the Massachusetts Constitution.

The issue on appeal to the Tenth Circuit was whether Plaintiff Altheia Allen was disabled when her employer SouthCrest Hospital allegedly failed to accommodate her disability and terminated her employment. Because the Tenth Circuit concluded after review of the trial court record that Plaintiff failed to demonstrate a genuine issue of material fact concerning her alleged disability, the Court affirmed the district court's grant of summary judgment in favor of SouthCrest.

Petitioner, the Maryland insurance commissioner, issued a cease-and-desist order to Respondents, several premium finance companies that provided loans primarily to customers of the Maryland Automobile Insurance Fund, purporting to prevent them from charging interest on loans to consumers to pay automobile insurance premiums in excess of the statutory maximum. Respondents requested a hearing. An associate deputy insurance commissioner presided over a hearing at the Maryland Insurance Administration (MIA) and issued a final order affirming the commissioner's cease-and-desist order. The circuit court concluded that the administrative hearing violated Respondents' right to fundamental fairness and due process of law because the commissioner delegated the decision-making authority to a subordinate. The court of special appeals affirmed. The Court of Appeals vacated the court of special appeals and circuit court and affirmed for the most part the decision of the MIA, holding, inter alia, that (1) the MIA hearing was fair and without undue "command influence"; and (2) the commissioner's interpretation of Md. Code Ann. Ins. 23-304 was correct, and Respondents violated the statute when their premium finance agreements operated to assess a finance charge in excess of 1.15 percent for each of thirty days.

Petitioner Christopher Ruel, a licensed real estate appraiser, appealed a superior court order that remanded his case to the New Hampshire Real Estate Appraiser Board for a new disciplinary hearing. In the spring of 2007, Kenneth Frederick hired Petitioner to appraise his property in Kingston. The New Hampshire Department of Transportation (DOT) sought to take Frederick's property by eminent domain and Frederick used Petitioner's appraisal in negotiating a settlement with DOT. DOT performed its own appraisal and valued the property at approximately fifty thousand dollars less than did Petitioner. After finalizing the settlement, a DOT appraisal supervisor reviewed Petitioner's appraisal and filed a grievance against him with the Board. In April 2010, four members of the Board voted to order Petitioner to pay a $500 fine and attend two appraisal courses. On appeal, Petitioner argued that the superior court should have dismissed the Board proceedings against him because: (1) the DOT lacked standing to file the initial grievance and, therefore, the case should never have been heard; (2) the Board violated its governing statute by taking more than two years to dispose of his case; (3) the Board's delay materially prejudiced him; and (4) the Board's determination to continue with the hearing and render a final decision without a quorum violated his due process rights. Upon careful review of the Board's hearing record, the Supreme Court rejected Petitioner's arguments on appeal.