Justia Insurance Law Opinion Summaries

Harman-Bergstedt, Inc. appealed the appellate court's decision to reverse an Industrial Claim Appeals Office decision disallowing respondent Elaine Loofbourrow's award of temporary disability benefits. The ICAO concluded that once respondent's treating physician placed her at maximum medical improvement, temporary total disability benefits could not be awarded for the injury for which she was initially treated. The appellate court concluded that under the circumstances of this case, such an independent medical exam was not a prerequisite to temporary total disability benefits. After its review of this case, the Supreme Court concluded the appellate court was correct in its decision: because a determination of maximum medical improvement has no statutory significance with regard to injuries resulting in loss of no more than three days (or shifts) of work time, respondent's award of temporary total disability benefits was not barred by her failure to first seek a division-sponsored independent medical examination. View "Harman-Bergstedt, Inc. v. Loofbourrow" on Justia Law

While driving a vehicle owned by her employer (Employer), Appellant was injured in an accident caused by an underinsured motorist. Appellant claimed underinsured motorist (UIM) benefits under Employer’s commercial insurance package policy, which Appellant believed had been insured by Insurer, the same carrier that insured the tortfeasor. Insurer denied Appellant’s claim. A jury awarded Appellant damages, finding the tortfeasor at fault. The district court denied Insurer’s posttrial motion for judgment based upon its claim that it did not issue Employer’s insurance policy and granted Insurer’s motion for credit against the verdict in part, declining, however, to give Insurer credit for future medical expenses. The Supreme Court (1) affirmed the trial court’s denial of Insurer’s motion for judgment as a matter of law on Insurer’s claim that Appellant named the wrong insurance company as the defendant; (2) reversed the district court’s decision on Insurer’s motion for partial summary judgment on future medical expenses and vacated the jury’s award of future medical expenses; and (3) reversed the district court’s denial of Appellant’s motion for attorney fees. Remanded. View "Bussman v. Safeco Ins. Co. of Am. " on Justia Law

As an assembler with Eaton Corporation, McClain purchased the highest level of long-term disability insurance, which was “designed to replace ... 70 percent of [her] monthly base pay.” She stopped working in January 2008, due to a back injury she suffered on the job in June 2007. She received benefits during the first 24 months under the First Tier of the Plan’s coverage, which defined disability as being “totally and continuously unable to perform the essential duties of your regular position with the Company, or the duties of any suitable alternative position with the Company.” After 24 months, the Plan to an “any occupation” standard, providing Second Tier coverage if “you are totally and continuously unable to engage in any occupation or perform any work for compensation or profit for which you are, or may become, reasonably well fit by reason of education, training or experience--at Eaton or elsewhere.” The Plan denied her claim for benefits because her treating physician opined McClain could work part-time, and a market study identified various part-time positions in the area for which she was qualified. The district court rejected her suit under the Employee Retirement Income Security Act, 29 U.S.C. 1001. The Seventh Circuit affirmed, finding that the determination was not arbitrary.View "McClain v. Eaton Corp. Disability Plan" on Justia Law

In 2003, multiple residents of Greenwood Health Center, a nursing home, died or were injured when another resident set fire to the facility. Thirteen negligence actions seeking damages for wrongful death or serious bodily injury were filed against Greenwood, the lessee of the property housing Greenwood, the owner and lessor of the property, and the operator of Greenwood. Lexington Insurance Company (Plaintiff) brought this declaratory judgment action against the lessor of the Greenwood property, which was the insured party under a policy issued by Plaintiff, the other Greenwood entities, and the victims’ personal representatives. Following the filing of cross motions for summary judgment, the trial court determined the amount of coverage available under the policy and rendered judgment accordingly. Plaintiff appealed the judgment of the trial court determining available coverage, and four of the individual defendants cross appealed. The Supreme Court reversed in part, holding (1) the trial court improperly interpreted the endorsement relating to the aggregate policy limit, thereby providing more coverage for the individual defendants’ claims than that to which they were entitled; and (2) the trial court improperly applied the self-insured retention endorsement to reduce the available coverage. Remanded. View "Lexington Ins. Co. v. Lexington Healthcare Group, Inc." on Justia Law

In a discretionary appeal, the issue before the Supreme Court in this case was whether, under an insurance policy for underinsured motorist coverage, the amount of an insured's recovery may be offset by the amount of all damages paid in satisfaction of the underlying judgment, or by only the amount of compensation paid under the auto insurance policy of the underinsured driver/tortfeasor. Under the circumstances of this case, the Court held that the amount of damages which could be offset against recovery under a UIM policy includes damages recovered from all tortfeasors. Accordingly, the Court reversed the Superior Court. View "AAA Mid-Atlantic Ins. Co. v. Ryan" on Justia Law

In November 2004, Dr. Ashard Yousuf sued Dr. George Cohlmia and Cardiovascular Surgical Specialists Corporation (CVSS) in Oklahoma state court for defamation, tortious interference with business relations/contract, intentional infliction of emotional distress/outrage, negligence, and breach of contract. Dr. Yousuf alleged that Dr. Cohlmia made a series of false statements to local media disparaging Dr. Yousuf's professional reputation. Dr. Cohlmia denied that the statements he made were false. CVSS held a professional liability policy with Physicians Liability Insurance Company (PLICO) and two identical general commercial liability policies with American National Property and Casualty Company (ANPAC, one for each business location), each of which covered Dr. Cohlmia as an additional insured. Dr. Cohlmia demanded that both insurers provide for his defense, pursuant to their respective policies. PLICO agreed to defend the lawsuit under a reservation of rights and requested ANPAC to share in the defense. ANPAC refused, contending its policy did not cover the alleged wrongdoing and that it owed no duty to defend. ANPAC further claimed that even if it erred in refusing to defend Dr. Cohlmia, PLICO had no right to indemnification or contribution for the defense costs it incurred. ANPAC appealed the district court's grant of summary judgment in favor of PLICO in a dispute regarding ANPAC's breach of its duty to defend a co-insured. PLICO cross-appealed the district court's denial of its motion for prejudgment interest. Finding no reversible error, the Tenth Circuit affirmed the district court's decision. View "Yousuf v. Cohlmia" on Justia Law

The issue in this case centered on a workers' compensation lump-sum award to a claimant who passed away while an appeal of her award was pending. At issue before the Supreme Court was a Court of Appeals opinion that refused to reach Respondents-Petitioners' argument that the award abated upon the beneficiary's death; granted the entire lump-sum award to beneficiary's dependent grandsons; reversed the grant of interest on the award; and affirmed the reinstatement of a ten-percent penalty. Upon review, the Supreme Court affirmed the Court of Appeals' decision with respect to the abatement issue and that court's holding that the ten-percent penalty should have been imposed in this case. The Supreme Court reversed the Court of Appeals decision requiring the entire lump-sum award be paid to the Grandsons, and reinstated the Estate's and Grandsons' settlement. The Court also reversed the Court of Appeals decision to remove the assessment of interest. The case was remanded for further proceedings on what sums were due pursuant to the Court's holding here. View "Hudson v. Lancaster Convalescent Center" on Justia Law

Plaintiff filed suit against CRST in state court alleging that CRST negligently failed to maintain his workers' compensation insurance coverage. CRST removed the case to federal court and the district court granted summary judgment to CRST. The court affirmed the district court's holding that plaintiff's action was barred by the applicable Missouri statute of limitations. View "Brown v. CRST Malone" on Justia Law

Claimant injured his low back while at work in April 2008, and his employer accepted his subsequent claim for a lumbar strain. Claimant was taken off work after his injury and, during the next several months, received an extensive course of chiropractic care. In An examining physician declared claimant medically stationary and released him to regular work without restriction. Based on the physician's findings, the employer issued a notice of closure that did not award benefits to claimant. Claimant was unsuccessful in his request for reconsideration. The Supreme Court, after its review of this case, concluded that the Department of Consumer and Business Services (DCBS) erred in its interpretation of the rules with regard to claimant's injury and determination for benefits. Accordingly, the case was remanded to the board for further proceedings. View "Schleiss v. SAIF Corporation" on Justia Law

This action arose from a rear-end collision allegedly caused by Zabian Bailey. Plaintiff filed a complaint against Bailey for negligence and against Progressive Northern Insurance Company for underinsured motorist benefits. A jury returned a verdict in favor of Plaintiff. Progressive filed a motion to set aside the verdict and for judgment in accordance with the motion for a directed verdict, claiming that Plaintiff failed to present sufficient evidence for the jury to reasonably find or infer negligence and proximate cause. The trial court denied the motion. The appellate court reversed and remanded with direction to grant Progressive’s motion. The Supreme Court reversed, holding that the evidence in this case was sufficient for a jury reasonably to find or infer that it was more probable than not that Bailey was negligent and that his negligence caused the collision. Remanded. View "Rawls v. Progressive N. Ins. Co." on Justia Law