Justia Insurance Law Opinion Summaries

Workforce Safety and Insurance ("WSI") denied Rick Brockel medical benefits and terminated his disability benefits. Upon review of Brockel's arguments on appeal, the Supreme Court concluded WSI's finding that Brockel's condition was not causally related to his work injury was supported by a preponderance of the evidence. Furthermore, the Court concluded Brockel was denied a fair hearing because he was not provided notice that one of the grounds for terminating his disability benefits would be the failure to submit medical verification of his disability. In addition, the Court concluded WSI's finding that Brockel failed to show his wage loss was the result of his compensable injury was not in accordance with the law. Therefore, the Court affirmed in part, reversed in part, and remanded the case for retroactive reinstatement of Brockel's disability benefits and for further proceedings. View "Brockel v. WSI" on Justia Law

Machon Lyons suffered severe injuries as the result of an automobile accident. The accident occurred when a vehicle operated by Roderick Holliday left the road and collided with a tree. As a result, Lyons obtained a default judgment of $72,500 against Holliday. Holliday's mother, Daisy Lang, insured the vehicle through Direct General Insurance Company of Mississippi. Lang's policy included a provision specifically excluding Holliday from any coverage under the policy. Accordingly, Direct denied coverage for the judgment. Lyons sought a declaratory judgment, asking the Circuit Court to hold that Lang's policy covered the judgment against Holliday. Lyons acknowledged the policy exclusion, but argued that Lang's policy covered the judgment against Holliday because Mississippi law required minimum-liability coverage for all permissive drivers, and because Lang's insurance card failed to mention any permissive-driver exclusions. The circuit court granted summary judgment in favor of Direct, finding that the policy clearly and specifically excluded coverage of Holliday. The Court of Appeals reversed, finding that 63-15-4(2)(a) required liability insurance for all vehicles operated in Mississippi and that Mississippi Code Section 63-15-43 required that the liability insurance policy "pay on behalf of the named insured and any other person, as insured, using any such motor vehicle or motor vehicles with the express or implied permission of such named insured." Although the Court of Appeals reached the right result, it cited as its authority the incorrect statute, so the Supreme Court granted certiorari. The Court concluded the policy exclusion violated Mississippi law: even though Holliday was an excluded driver under the Direct General policy issued to Daisy Lang, the exclusion did not operate to eliminate liability coverage in the minimum amounts required by statute. The trial court's grant of summary judgment was reversed and the case remanded for further proceedings. View "Lyons v. Direct General Insurance Company of Mississippi " on Justia Law

In 2009, plaintiff Craig Mulford filed a complaint against his employer Union Pacific Railroad (UP) seeking relief under the Federal Employer’s Liability Act (FELA). Plaintiff alleged he sustained injury to his knees as a result of UP's negligence. The case went to trial in 2012. The jury reached its verdict, unanimously concluding that UP was not negligent. The district court issued its final judgment and dismissed plaintiff's claims. In this appeal, plaintiff claimed that the district court erred on two separate grounds: (1) failing to disqualify a juror for cause; and (2) admitting evidence that he received disability benefits from the Railroad Retirement Board (RRB) to impeach statements made by plaintiff on direct examination. Finding no reversible error, the Supreme Court affirmed. View "Mulford v. Union Pacific Railroad" on Justia Law

This appeal stemmed from a worker’s compensation case in which Michael Vawter sought compensation from his employer, United Parcel Service (UPS), for a back injury he claimed he suffered as a result of his employment. UPS attempted to establish that Vawter did not suffer a compensable injury, but if he did the State's Industrial Special Indemnity Fund (ISIF) was liable for a portion of his benefits. Ultimately, the Idaho Industrial Commission found that Vawter was totally and permanently disabled and that UPS was solely responsible for Vawter’s disability benefits because it was estopped from arguing Vawter had a preexisting condition, a necessary element of ISIF liability. UPS appealed, arguing: (1) the accident causing Vawter’s injury did not arise out of his employment; (2) the Commission improperly applied the doctrine of quasi-estoppel to prevent it from asserting a preexisting condition; and (3) the Commission improperly awarded Vawter attorney fees. Vawter and ISIF both cross-appealed. Upon review, the Supreme Court reversed the Industrial Commission’s determination that Vawter was not entitled to recover all medical expenses incurred between the date of the accident and September 27, 2010. The Court affirmed the Industrial Commission in all other respects. View "Vawter v. United Parcel Service, Inc." on Justia Law

ICI Homes, Inc. (ICI) had a general liability insurance policy with General Fidelity Insurance Company. In 2007, Katherine Ferrin, the owner of a residence constructed by ICI, was injured while using stairs installed by Custom Cutting, Inc. Ferrin filed suit against ICI. ICI, in turn, sought indemnification from Custom Cutting. The parties agreed to a $1.6 million settlement of Ferrin’s claim. ICI accepted $1 million from Custom Cutting’s insurer to settle its indemnification claim, which it paid to Ferrin. ICI and General Fidelity then claimed the other was responsible for paying Ferrin the remaining $600,000. Both parties paid $300,000 to Ferrin to settle Ferrin’s claim. ICI then filed suit against General Fidelity seeking return of the $300,000 ICI paid above the $1 million indemnification payment. General Fidelity counterclaimed seeking return of the $300,000 it had paid to Ferrin. The district court entered judgment for General Fidelity. The court of appeals certified two questions to the Supreme Court for resolution. The Supreme Court answered (1) the General Fidelity policy allowed ICI to apply indemnification payments received from Custom Cutting’s insurer towards satisfaction of its $1 million self-insured retention; and (2) the transfer of rights provision in the policy did not abrogate the made whole doctrine. View "Intervest Constr. of Jax, Inc. v Gen. Fidelity Ins. Co." on Justia Law

At issue in this case was W. Va. Code 33-6-36, which, in certain circumstances, requires insurance companies to continue motor vehicle liability coverage for a spouse after the death of, or separation or divorce from, the named insured. Francis McComas separated from and then divorced a United Service Automobile Association (USAA) named insured. USAA removed McComas from the named insured’s policy. Seven days after the divorce, McComas lost control of his vehicle and collided with Kimberly Lucas’s vehicle. McComas died in the collision. Lucas, who was seriously injured, filed a lawsuit against McComas’s estate. Plaintiff included a declaratory judgment count against USAA, contending that the USAA motor vehicle policy with McComas’s former spouse provided liability coverage for McComas’s negligence. The circuit court granted judgment for Plaintiff, determining that USAA was required by section 33-6-36 to notify McComas of his right to buy a separate liability insurance policy upon canceling McComas’s liability coverage, and because that notice was not given to McComas, USAA was required to provide liability coverage to McComas’s estate. The Supreme Court affirmed, holding that, under the circumstances, 33-6-36 required USAA to notify McComas of the termination of his coverage and his right to request a separate policy. View "United Servs. Auto. Ass'n v. Lucas" on Justia Law

Plaintiff was injured in an automobile accident. Group Health Plan, Inc. (GHP) paid Plaintiff’s medical bills. Plaintiff subsequently recovered a personal injury settlement from the tortfeasor. GHP, through its agent, ACS Recovery Services, Inc. (ACS), asserted a lien against Plaintiff’s settlement, seeking reimbursement or subrogation for its payment of Plaintiff’s medical bills. Plaintiff filed a class action petition against GHP asserting several claims based on the premise that Missouri law does not permit the subrogation of tort claims. ACS intervened. The trial court entered summary judgment for GHP and ACS, concluding that the Federal Employee Health Benefits Act (FEHBA) preempts Missouri’s anti-subrogation law. The Supreme Court reversed, holding that FEHBA does not preempt Missouri law barring subrogation of personal injury claims. Remanded. View "Nevils v. Group Health Plan, Inc." on Justia Law

Respondent Helen Rodriguez injured herself after falling down a flight of stairs at work. The Supreme Court granted certiorari to consider whether an "unexplained" fall satisfied the "arising out of" employment requirement of the Workers' Compensation Act. The Court agreed with the appellate court that respondent's unexplained fall was compensable, but it disagreed with the reasoning. The Supreme Court concluded that the appellate court erred when it agreed with respondent's view that her injuries arose out of employment, and held that an unexplained fall necessarily stemmed from a "neutral" risk attributable to neither the employment nor the employee. "Under our longstanding 'but-for' test, such an unexplained fall 'arises out of' employment if the fall would not have occurred but for the fact that the conditions and obligations of employment placed the employee in a position where he or she was injured." View "City of Brighton v. Rodriguez" on Justia Law

The Workers' Compensation Commission dismissed applicant Matthew Ladner's petition to controvert and motion for payment of benefits because it found the statute of limitations had expired. Ladner appealed that decision to the Supreme Court. Upon review, the Supreme Court reversed the Commission's decision. View "Ladner v. Zachry Construction" on Justia Law

In March 2010, Justyna Kunz was involved in a car accident with GEICO's insureds, Crystal, Joseph, and Elizabeth Kalish. Kunz received medical treatment at Athens Regional Medical Center; the Hospital Authority of Clarke County and Athens Regional Medical Center (collectively, "the Hospitals") filed three hospital liens. Kunz subsequently filed suit against the Kalishes. Kunz's attorney wrote a letter to the Kalishes' attorney accepting their $100,000 policy limit settlement offer. The settlement documents, signed in Fall 2010, expressly required Kunz to satisfy the hospital liens out of the settlement fund and constituted a "general[ ] release ... from all legal and equitable claims of every kind and nature." The liens were never satisfied. The Court of Appeals held that, under OCGA 44–14–473 (a), the Hospitals were barred by a one-year statute of limitations from filing suit against GEICO to collect on the hospital liens. The Hospitals appealed the appellate court's decision. Finding that the appellate court erred in arriving at its conclusion, the Supreme Court reversed. View "Hospital Authority of Clarke County v. GEICO General Insurance Co." on Justia Law