Justia Insurance Law Opinion Summaries

Benjamin Morris appealed an order of the Idaho Industrial Commission that denied his motion to set aside a lump sum settlement agreement he made with his employer's surety, Liberty Northwest Insurance. Morris initiated his workers' compensation action after he suffered injuries while working construction for his employer, Hap Taylor & Sons, Inc. Morris sustained a serious head injury on when a twenty-five pound rock thrown by a piece of heavy machinery struck him in the head. Morris initiated settlement discussions with Liberty Northwest Insurance, Hap Taylor & Sons' insurer. Liberty responded with a counter-offer—a single lump sum payment which Morris accepted "with the clear understanding this is a partial settlement and does not resolve the medical side." The parties executed a Stipulation and Agreement of Partial Lump Sum Discharge (LSSA) and submitted it to the Commission for approval. Approximately eighteen months later, on July 8, 2011, a Notice of Appearance was filed with the Commission whereby Morris substituted attorney Michael Walker with his then present counsel, attorney Starr Kelso. On the same day, Morris filed a motion to review the LSSA, accompanied by an affidavit signed by Kelso. Kelso's affidavit expressed concern that Morris may not have been "competent to testify" due to his injury—though, no credible evidence of incompetence was ever offered. Liberty filed an objection to Morris' motion to review. Ultimately, the Commission denied Morris' motion. Following the Commission's refusal to review the LSSA, Morris filed a Motion to Set Aside Lump Sum Settlement Agreement, seeking to void the LSSA on grounds of illegality and constructive fraud. The Commission issued an order denying Morris' motion to set the LSSA. Morris filed a timely appeal to the Supreme Court. After its review, the Supreme Court concluded that the Commission did not err in denying Morris' request for a hearing on his fraud claim. Furthermore, the Court affirmed the Commission's decision to deny Morris' motion to set the LSSA. View "Morris v. Hap Taylor & Sons" on Justia Law

This case arose from the water loss claims Appellant Roger Daniel Rizzo made under Respondent State Farm Fire and Casualty Company's homeowners insurance policy. All of Appellant's claims were for water damage to his home's basement. The district court granted summary judgment in favor of the insurance company, effectively dismissing all of Appellant's causes of action because his homeowner's policy did not cover his water damage claims. Appellant also appealed the district court's denial of his motion to amend his complaint to include various new causes of action and the district court's grant of State Farm's motion for protective order against certain overbroad discovery requests. Finding no error in the district court's grant of summary judgment in favor of State Farm, the Supreme Court affirmed the district court's decisions. View "Rizzo v. State Farm Insurance" on Justia Law

Appellant Matthew Mazzone appealed an Idaho Industrial Commission's order that denied him workers' compensation for psychological injuries allegedly arising as a result of an industrial accident wherein appellant tripped and fell into a deep fat fryer while employed at Texas Roadhouse. Appellant contended the Commission’s order was not based on substantial and competent evidence. During his time at a Burn Center, appellant was twice noted in medical records to be exhibiting exaggerated pain behaviors. At one point during his treatment, appellant stayed at a hotel in Salt Lake City so as to receive follow-up care. In a follow-up at the Burn Center, appellant had quit "cold turkey" his opioid medication, at which point he began to experience nightmares and flashbacks. Appellant was referred to an Idaho psychiatrist. The Idaho psychiatrist clarified that appellant's nightmares and anxiety were related to returning to work; appellant was assessed a GAF score of 55/85, the same assessment he had before the industrial accident. Three months after accident, appellant returned to work, but he was allegedly so overwhelmed that he asked to transfer to another Texas Roadhouse location in Massachusetts because he was nervous, sick, worried, and nauseous working at the site of the accident. Subsequent years following the accident, appellant sought additional counseling and medical treatment. He was eventually diagnosed with post-traumatic stress disorder (PTSD) and general anxiety and memory loss. Appellant then filed a complaint against Texas Roadhouse and its insurer. Upon review, the Supreme Court concluded that appellant did not suffer a compensable psychological injury, and that the evidence presented was substantial enough to support the Industrial Commission's order. View "Mazzone v. Texas Roadhouse" on Justia Law

In 2007, Employers Mutual Casualty Company (EMC) brought a declaratory judgment action against the Donnellys and Rimar Construction, Inc. (RMI) to establish that under its policy of insurance with RCI, EMC had no duty or responsibility to pay damages claimed by the Donnellys in litigation between the Donnellys and RCI. The declaratory judgment action was stayed until a verdict was reached in the underlying action. In the underlying action, the Donnellys were awarded damages, costs and attorney fees against RCI. Subsequently the district court entered summary judgment in the declaratory action, finding that there was no insurance coverage for the damages the Donnellys incurred, but that there was coverage for costs and attorney fees. On appeal, EMC argued that the district court erred in its determination that it had a duty to pay attorney fees and costs when there were no damages awarded to the plaintiff subject to the policy coverage. The Donnellys cross appealed, arguing the district court erred in its conclusion that EMC did not have a duty to cover the damages in this case, and that the Donnellys were entitled to attorney fees. Upon review, the Supreme Court affirmed the district court's decision. View "Employers Mutual Casualty Co v. Donnelly" on Justia Law

Appellant Altrua HealthShare appealed the district court's decision affirming the Idaho Department of Insurance's (Department) determination that Altrua transacted insurance without a certificate of authority. Altrua argued that both the Department and the Ada County district court erred in finding that Altrua was an insurer because Altrua never assumed the risk of paying its members' medical bills. The Department found, and the district court affirmed, that when members make their predetermined monthly payments into the escrow account Altrua operates, the risk of payment shifts from the individual members to the escrow account, and in turn to Altrua. Altrua also contended that the Department's determination that it is an insurer despite the disclaimers in its membership contract to the contrary is an unconstitutional interference with Altrua's right to contract. Upon review, the Supreme Court found that the Department's conclusion that Altrua's membership contract was an insurance contract was clearly erroneous, and reversed the findings. The case was remanded for further proceedings. View "Altrua Healthshare v. Deal" on Justia Law

This case was an appeal to challenge the administrative rule adopted by the Industrial Commission in 1994 that regulates the amount of attorney fees allowable for attorneys representing claimants in worker's compensation proceedings. Upon review of the facts of this case, the Supreme Court upheld the validity of the rule. View "Seiniger Law v. Industrial Commission" on Justia Law

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

A bail bond company challenged the district court's decision affirming an order of the Director of the Idaho Department of Insurance. That order, which was based on I.C. 41-1042, prohibited a bail bond company from contemporaneously writing a bail bond and contracting with a client to indemnify the company for the cost of apprehending a bail jumper. It also prohibited a bail bond company from later requiring a client to agree to such indemnification as a condition of the bond's continuing validity. While the proceedings before the district court were pending, the Director promulgated I.D.A.P.A. 18.01.04.016.02, which by rule expressed the Final Order. Upon review of the applicable statutory authority and the trial court record below, the Supreme Court concluded that: (1) the plain text of I.C. 41-1042 permits a bail bond company to contemporaneously write a bail bond and contract with a client to indemnify the company for the cost of apprehending a defendant who jumps bail; and (2) the Director's interpretation of I.C. 41-1042 prejudiced PetitionerTwo Jinn's substantial rights. The Court reversed the district court's memorandum decision and remanded the case for further review. View "Two Jinn, Inc. v. Idaho Dept of Insurance" on Justia Law

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

The issue before the Supreme Court in this case stemmed from the grant of summary judgment in favor of an insurance company. The insureds contended that the liability coverage provision in their homeowner's policy required the insurer to defend a lawsuit brought by a contractor they hired to repair fire damage to their home and to remodel the home, and that the insurer was required to indemnify against any recovery by the contractor. Upon review of the policy underlying this case, the Supreme Court found no such duties as the insureds contended and affirmed the district court's judgment. View "Linford v. State Farm Fire & Casualty" on Justia Law