Justia Insurance Law Opinion Summaries

Warren Parsons appealed a judgment affirming a Workforce Safety and Insurance Fund ("WSI") decision that denied his claim for workers' compensation benefits. Parsons applied for workers' compensation benefits from WSI, alleging he sustained an injury to his left shoulder and neck while working for Ames Construction. He claimed he developed pain at the base of his neck and into his left shoulder from hitting the seat belt repeatedly while driving the dump truck on rough roads. Parsons argued his cervical spine and left shoulder injuries were "compensable injuries" by law. Upon review, the Supreme Court concluded WSI erred in determining Parsons' injury was not a compensable injury and in denying his claim for benefits. View "Parsons v. WSI" on Justia Law

Reyes was driving in Elgin when she was involved in an accident with pedestrians, a mother and her four-year-old son. The boy died. The mother and her husband sued Reyes for negligence and wrongful death. American Access Casualty sought a declaration that the policy it had issued to Reyes provided no coverage. The policy had been issued to Reyes on her 1999 Chrysler. She was identified as the titleholder of the vehicle, the named insured, and as “driver number one.” Next to her name, where her driver’s license number should be, was the language “Title Holder Exclude.” A friend, was listed as “driver number two” and identified as the primary driver. An endorsement excluded from coverage vehicle operation by Reyes. State Farm, which provided uninsured-motorist coverage to the mother and son, filed a counterclaim, seeking a declaration that American Access’ attempt to exclude Reyes under its own insurance policy violated public policy and was unlawful. The trial court granted American Access summary judgment, finding that the policy in question provided no coverage for the accident. The appellate court and Illinois Supreme Court disagreed. Section 7-601(a) of the Illinois Safety and Family Financial Responsibility Law, part of the Illinois Vehicle Code, requires liability insurance for vehicles on the road for the protection of the public. Although the exclusion of named drivers is permitted, exclusion of a vehicle owner who is also the named insured is a violation of the public policy expressed in the statute. View "Am. Access Cas. Co. v. Reyes" on Justia Law

The worker was injured in a 2006 automobile accident near Cordova, where he was working temporarily for Venture. Cordova is 200 miles from Springfield, where he lived and where his plumbers’ and pipefitters’ union was. He was living a motel 30 miles from the worksite with a coworker, also from Springfield, who was driving when the accident occurred. An arbitrator denied his workers’ compensation claim. The Workers’ Compensation Commission reversed; the trial court set aside the Commission’s finding. The Workers’ Compensation Division of the Appellate Court granted relief to the worker. The Illinois Supreme Court reversed, holding that the worker was not a “traveling employee” and could not be compensated. An injury incurred by an employee in going to or returning from the place of employment is not compensable, because it is not arising out of or in the course of employment, unless the worker can be categorized as a “traveling employee.” The employer did not direct the worker to accept the position at the Cordova location; he accepted it with full knowledge of the commute involved. His course or method of travel was not determined by the demands and exigencies of the job. He was not reimbursed for travel time or expenses or told what route to take.View "The Venture-Newberg Perini Stone v. IL Workers' Compensation Comm'n" on Justia Law

Plambeck owned two Kentucky chiropractic clinics that treated patients injured in car accidents, including some State Farm customers. All of the treating chiropractors were licensed to practice in Kentucky. Plambeck was not, although he was licensed elsewhere, and did not treat any patients in Kentucky. State Farm assumed that Plambeck had a license because Kentucky law requires chiropractic practitioners and owners of chiropractic clinics to hold one. When State Farm discovered that Plambeck lacked a state license, it stopped paying the clinics and sued Plambeck to recover all payments since 2000. The district court granted summary judgment to State Farm and awarded $557,124.78 in damages. The Sixth Circuit reversed. Kentucky common law claims for recovery of funds mistakenly paid are based on unjust enrichment. Because State Farm and the clinics never had a contractual relationship, the only applicable theory would require State Farm to show that it paid money to the clinics not due “either in law or conscience.” State Farm did not offer such proof. View "State Farm Auto. Ins. Co. v. Newburg Chiropractic" on Justia Law

Phusion manufactures and distributes an alcoholic beverage called “Four Loko.” Its original formula contained energy stimulants, such as caffeine, guarana, taurine, and wormwood. Phusion purchased a commercial general liability insurance policy and a umbrella policy from members of the Liberty Mutual Group. The policies include identical provisions, excluding coverage for bodily injury or property damage when the insured may be held liable by reason of causing or contributing to intoxication. Plaintiffs sued Phusion in separate state court actions, alleging injuries caused by consumption of Four Loko. Two cases involved traffic accidents, one involved a shooting, another involved paranoid behavior resulting in accidental death, and a fifth claim involved a death from heart trouble. Phusion notified Liberty, which sought a declaratory judgment regarding the scope of coverage. The district court examined the underlying cases in the context of comparable automobile exclusions and ruled that four of the five cases fell within the Liquor Liability Exclusion. The Seventh Circuit affirmed. The Liquor Liability Exclusions in the policies are unambiguous and apply to Phusion. The allegations of simple negligence raised by the plaintiffs in the underlying complaints are not sufficiently independent from the allegations that Phusion caused or contributed to the intoxication of any person. View "Netherlands Ins.. Co. v. Phusion Projects, Inc." on Justia Law

Safeway Insurance Company of Alabama, Inc. petitioned for a writ of mandamus to direct the Circuit Court to grant its Rule 12(b)(1) motion to dismiss a bad-faith claim against it for lack of subject-matter jurisdiction. Richard Kimbrough submitted a claim to Safeway for uninsured-motorist coverage when he was injured in an accident. A deer ran across the road, causing a truck in the southbound lane to swerve into the northbound lane, where Kimbrough was driving. According to Kimbrough, the truck struck his vehicle and ran him off the road and into a creek bed. The driver of the truck allegedly fled and was unknown. Kimbrough contended the driver of a "phantom vehicle" was an uninsured motorist. He sought the full policy limit of $50,000 because his expenses exceeded his coverage. The parties disputed whether Safeway denied the claim. After review of the matter, the Supreme Court disagreed with Safeway's argument that the Circuit Court lacked subject matter jurisdiction over the case. As such, Safeway did not demonstrate a clear legal right to the writ of mandamus. The Court therefore denied the petition. View "Kimbrough v. Safeway Insurance Company of Alabama, Inc." on Justia Law

The Standard Fire Insurance Company appealed a court of appeals' decision that reversed the trial court's grant of summary judgment in its favor, and finding respondents Thomas, Debra, and Christopher were entitled to stack underinsured motorist (UIM) coverage despite an exclusion in Standard Fire's policy purporting to limit an insured's ability to stack such coverage when the vehicles insured under the subject policy were not involved in the accident. After review of the trial and appellate court records, the Supreme Court found no reversible error and affirmed the appellate court's decision. View "Carter v. Standard Fire Insurance" on Justia Law

Plaintiff was injured during the course of his employment when he was struck by a sheet of plywood that fell from a building under construction. Plaintiff received workers' compensation benefits for his injuries and then filed this personal injury action. Thereafter, the insurance carrier for Plaintiff's employer filed a motion to discontinue Plaintiff's workers' compensation benefits. An administrative law judge found Plaintiff had no further causally-related disability and that he had no further need for treatment. The Workers' Compensation Board Panel (Board) affirmed. Subsequently, in this negligence action, Defendants moved for an order estopping Plaintiff from relitigating the issue of causally-related disability. Supreme Court granted the motion. The Appellate Division reversed, concluding that the determination of the Board was one of ultimate fact and thus did not preclude Plaintiff from litigating the issue of his ongoing disability. The Court of Appeals affirmed, holding that Defendants failed to establish that the issue decided in the workers' compensation proceeding was identical to that presented in this negligence action. View "Auqui v. Seven Thirty One Ltd. P'ship" on Justia Law

Sherry Walker was denied disability benefits by the Public Employees’ Retirement System (PERS). The Circuit Court reversed PERS’s decision. The Court of Appeals reversed the circuit court, reinstating PERS’ denial of benefits. Upon review of the matter, the Supreme Court concluded PERS’ decision to deny Walker’s request for regular disability benefits was unsupported by substantial evidence. Accordingly, the Court reversed part of the appellate court's decision and reversed the Circuit Court's decision, and remanded the case with instructions to enter judgment in Walker’s favor on her regular disability benefits claim. View "Public Employees' Retirement System v. Walker" on Justia Law

Claimant-Appellant Dallas Clark appealed an Industrial Commission order that denied her workers' compensation benefits. Claimant worked for Shari's Management Corporation as an experienced server. During a graveyard shift, she suffered a herniated disc in her back while lifting a heavy tray onto a high shelf. She would later be diagnosed with sciatica attributed to the lifting injury from work. Shari's completed a Report of Injury, interviewing Claimant in the process. The investigator testified that Claimant attributed the injury as "standing wrong" at a salad bar, which left her unable to lift the tray. The Commission concluded after a hearing that Claimant was unable to prove an industrial accident had occurred. The Supreme Court agreed with the Commission and affirmed its order. View "Clark v. Shari's Management Corp" on Justia Law