Justia Insurance Law Opinion Summaries

Nicole discovered Shawn’s body in their Ohio home. Shawn had gone out drinking the night before, while Nicole spent the night at a friend’s house. The Medical Examiner’s Office reported the cause of death as “[a]sphyxia by extreme and restricted position (positional asphyxia)” and the manner of death as “[a]cute ethanol intoxication ... ACCIDENT: Prolonged and extreme hypertension of neck and torso while intoxicated.” Shawn’s blood-alcohol level at the time of autopsy was .22%. Nicole filed a $212,000 claim for accidental-death benefits with the Plan, which covers “injury” as a result of an “accident,” defined as “an unintended or unforeseeable event or occurrence which happens suddenly and violently.” No benefits will be paid if the “Covered Person [is] deemed and presumed, under the law of the locale … to be under the influence of alcohol or intoxicating liquors.” Nationwide directed denial of Nicole’s claim, citing Exclusion 12, but quoting an earlier version that provided: “The Covered Person being deemed and presumed … to be driving or operating a motor vehicle while under the influence…” Later, based on amended Exclusion 12, Nationwide upheld the denial; its appeals panel affirmed. Nicole filed suit, asserting claims under the Employee Retirement Income Security Act and a common-law breach-of-fiduciary-duty claim. The district court entered judgment in favor of the defendants, but agreed with Nicole that the appeals panel had breached its statutory duty to provide her with Plan-related documents upon written request, and imposed a penalty of $55 per day ($8,910). The Sixth Circuit affirmed. View "Cultrona v. Nationwide Life Ins. Co." on Justia Law

Appellant Dorris Green, representing his child who was injured while a passenger in his mother's automobile, contended that as a matter of public policy the courts of South Carolina should refuse to recognize the validity of a family member exclusion in a Florida car insurance policy. Further, he contended that the circuit court erred in finding there was no uninsured motorist coverage for his minor child under his Florida policy. The Supreme Court agreed with the circuit court that enforcement of this exclusion, valid under Florida law, did not offend South Carolina public policy, and that there was no underinsured coverage for father's minor child under the father's policy. The Court therefore affirmed the grant of summary judgment to the insurance company. View "Green v. USAA" on Justia Law

After suffering a severe electrical shock while working as a lineman for Tippah Electric Power Association, Lonnie Smith filed a petition to controvert with the Mississippi Workers' Compensation Commission. Tippah denied that Smith's claim was compensable and raised the affirmative defense that Smith had intentionally injured himself. The administrative judge (AJ) found that Smith had intentionally injured himself and that his injury was not compensable; the Commission affirmed the AJ's denial of the claim. The Court of Appeals affirmed the Commission's decision. The Supreme Court granted certiorari because it found that the Commission's decision was not supported by substantial evidence. Accordingly, the Court reversed and remanded this case to the Commission for a determination of benefits. View "Smith v. Tippah Electric Power Association" on Justia Law

Plaintiffs obtained a homeowners insurance policy from American Family Mutual Insurance Company. After Plaintiffs’ home sustained substantial fire damage, a dispute arose regarding the amount of insurance claim benefits payable under the policy. Plaintiffs subsequently filed a complaint against American Family and Michael Meek, the insurance agent through whom they obtained their insurance, for negligence. The trial court granted summary judgment for Defendants, concluding that Plaintiffs failed to commence the action within the applicable statute of limitations. The court of appeals affirmed. The Supreme Court affirmed, holding that the trial court was correct to grant summary judgment on the basis of the applicable two-year statute of limitations. View "Groce v. Am. Family Mut. Ins. Co." on Justia Law

Alan Christoffersen drove a truck for United Parcel Service (UPS) until he was struck and killed by an underinsured motorist. After the accident, Christoffersen's heirs sued UPS and its automobile insurer (Liberty Mutual Insurance Group), asserting claims for underinsured motorist (UIM) benefits. All parties moved for summary judgment. The district court granted UPS's motion on the ground that Utah's Worker's Compensation Act provided the exclusive remedy. On the claim against Liberty Mutual, the court granted judgment to the heirs for $10,000. The heirs and Liberty Mutual appealed. Upon review, the Tenth Circuit concluded that Liberty Mutual did not incur liability because UPS validly rejected UIM coverage; therefore, with regard to the claim against Liberty Mutual, the Court reversed the judgment of $10,000 for the heirs and remanded the case with instructions to grant summary judgment to Liberty Mutual on the entire claim. Furthermore, the Court affirmed the grant of summary judgment to UPS because it was not considered a "self insurer" for purposes of Utah's UIM statute. View "Christoffersen v. United Parcel Service, et al" on Justia Law

Plaintiff Cheryl Hersh worked for defendant County of Morris. The County rented approximately sixty-five parking spaces for its employees in the Cattano Garage, a private parking garage containing several hundred parking spaces located approximately two blocks from Hersh’s office. Although she did not have sufficient seniority to park in a county-owned lot located adjacent to her building, the County granted Hersh permission to park in one of the rented spots, gave her a scan card so she could enter the garage, and instructed her to park on the third level. Shortly after Hersh parked her car and exited the structure, she was struck by a motor vehicle while crossing a public street between the garage and her office. Hersh suffered significant injuries. Hersh filed for workers' compensation benefits. The judge concluded Hersh's injuries were compensable, finding that under New Jersey case law, parking lots provided or designated for employee use are part of the employer's premises for purposes of workers' compensation. The Appellate Division affirmed. The County appealed. The Supreme Court reversed: because the County did not control the garage where Hersh parked, the route of ingress and egress from the parking garage to her office, or the public street where she was injured, and did not expose her to any special or additional hazards, Hersh's injury occurred outside of the employer's premises and therefore was not compensable under the Workers' Compensation Act. View "Hersh v. County of Morris" on Justia Law

Plaintiffs filed tort claims against Mine Safety Appliances Company (“MSA”). Plaintiffs settled with MSA under settlement agreements that assigned to Plaintiffs the right to recover the remainder of the settlement amount under an insurance policy that North River Insurance Company sold to MSA. MSA then amended their complaints to add claims against North River, and MSA filed cross-claims against North River. In the meantime, earlier-filed litigation between North River and MSA was pending in Pennsylvania and Delaware. North River filed a motion to dismiss or, in the alternative, motion for a stay of the proceedings, arguing that West Virginia was an inconvenient forum and the proceedings should be dismissed pending resolution of the out-of-state litigation. The circuit court denied the motions. The Supreme Court denied the writ of prohibition subsequently sought by North River, holding that the circuit court did not err in (1) denying North River’s motion to dismiss where strong deference was according to Plaintiffs’ choice of forum and considerations relevant to a forum non conveniens analysis suggest no basis for dismissal of the action; and (2) denying the motion to stay the proceedings, as it would be unfair and prejudicial to Plaintiffs to delay the trials unnecessarily. View "State ex rel. N. River Ins. Co. v. Circuit Court" on Justia Law

Appellants were injured in automobile accidents, but Geico, which insured both Appellants, denied coverage of their medical expenses. Appellants subsequently instituted a class action of behalf of themselves and others similarly situated, alleging that Geico violated Nev. Rev. Stat. 687B.145(3), which provides that a motor vehicle insurer must offer its insured the option of purchasing medical payment coverage, because, while Geico may have offered its insureds medical payment coverage, it did not obtain written rejections from them of the offered coverage. The district court granted Geico’s motion to dismiss. The Supreme Court affirmed, holding that section 687B.145(3) does not require a written rejection of medpay coverage, and therefore, Appellants’ claims failed. View "Wingco v. Gov't Employees Ins. Co." on Justia Law

Dustin Watkins suffered an in utero stroke approximately two days before he was born (in 1990), allegedly arising out of the medical malpractice of the treating obstetrician, Dr. Richard Barry, which resulted in a brain injury. This medical malpractice action followed, and a November 2003 trial resulted in multiple damage awards. At issue in this case was the extent to which the Louisiana Patient's Compensation Fund (PCF) continued to be obligated to make advance payments for custodial/attendant care for a medical malpractice victim, after receiving information indicating that such care may no longer be needed, and whether the PCF had the right to unilaterally terminate such payments, without prior court approval, when a judgment was previously rendered ordering it to make said payments. Upon review, the Supreme Court held that when the PCF denies a claim for payment of a future medical or related expense and the district court thereafter exercises its continuing jurisdiction and issues a ruling as to that matter, the PCF is obligated to comply with the district court's ruling, order, or judgment unless it modified or set aside by the court. View "Watkins v. Lake Charles Memorial Hospital" on Justia Law

A worker was left a paraplegic after a 1976 work-related motor vehicle accident. He suffered a number of medical complications related to his injuries. In 2007, his employer controverted some aspects of his medical care, and he filed a written workers’ compensation claim. Shortly before the hearing on the claim, the employer withdrew most of its controversions. The Alaska Workers’ Compensation Board decided that some of the controversions were frivolous, unfair, or in bad faith. It imposed a statutory penalty and reported its findings about frivolous or unfair controversions to the Alaska Division of Insurance. The employer appealed, and the Alaska Workers’ Compensation Appeals Commission reversed the Board in part, deciding as a matter of law that the Board could not impose a penalty for some of the controversions. The Commission decided that other appeal points were moot. The worker appeals the Commission’s decision reversing the penalties and some attorney’s fees; the employer cross-appeals the Commission’s decisions about preservation of the controversion issues and mootness. Upon review, the Supreme Court affirmed the Commission's decision that the controversion issue was properly before the Board, but reversed regarding the penalties issue. View "Harris v. M-K Rivers" on Justia Law