Justia Insurance Law Opinion Summaries

The Supreme Court granted certiorari in this case to address two issues: (1) whether a political-subdivision employer may be required to provide workers' compensation benefits to an off-duty employee injured while providing services to a private entity; and (2) whether, under the facts presented, the claimant's salaries from his full-time employment as a deputy sheriff and his part-time job as a security officer may be combined when determining the amount of benefits to which the employee is entitled. Respondent-claimant John David Waldenville was injured while acting as a security guard for petitioner Cattlemen's Steakhouse, Inc. Initially, Cattlemen's contended that Waldenville was an independent contractor but later conceded that it had workers' compensation coverage for him through their insurer. Nevertheless, the employer continued to assert that Waldenville was an employee of respondent, Oklahoma County Sheriff's Department when injured. The trial court determined that: Cattlemen's was the employing entity when the employment-related injury occurred; Oklahoma County should be dismissed pursuant to 85 O.S. 2001 sec. 2b(G); Cattlemen's was estopped to dispute employee status based on the payment of workers' compensation premiums associated with Waldenville's employment; no evidence existed indicating that the employee was acting in his official capacity as a Deputy Sheriff at the time of the incident; and because the duties that Waldenville was carrying out at the time of his injury were the same or similar to those he executed as a Deputy Sheriff, the claimant's salaries were to be combined for establishment of weekly rates. The Supreme Court held that: (1) the "plain, clear, unmistakable, unambiguous, mandatory, and unequivocal" language of 85 O.S. 2011 sec. 313(G) mandated that private employers, hiring off-duty municipal employees, alone shall be responsible for the payment of workers' compensation benefits arising from incidents occurring during the hours of actual employment by the private employer; and (2) under the facts of this case, claimant was engaged in the same, or substantially similar, employment to that of his profession as a Major with the Oklahoma County Sheriff's Department when he was injured, warranting the combination of salaries for purposes of determining workers' compensation benefits. View "Cattlemen's Steakhouse, Inc. v. Waldenville" on Justia Law

Plaintiff was injured operating his employer's truck and came to a settlement with the tortfeasors. Then plaintiff and his wife filed suit against Continental for underinsured motorist (UIM) coverage in his employer's policy. The district court granted Continental's motion for partial summary judgment, concluding that plaintiffs could not stack their claims. The court concluded that the district court erred in finding a $2 million UIM limit where there was no ambiguity in the policy's selection form because the declarations page and UIM coverage endorsement specify a $500,000 UIM limit and the selection form did not contradict this limit. The court concluded that plaintiffs' failure to timely file their cross petition did not preclude review of the stacking claim. However, the court concluded that plaintiffs' arguments lacked merit and affirmed the district court's denial of plaintiffs' stacking claim. Accordingly, the court affirmed in part, reversed in part, and remanded for further proceedings. View "Munroe, et al. v. Continental Western Ins." on Justia Law

The issue before the Supreme Court in this case centered on whether Delaware’s personal injury protection (PIP) statute requires insurers to reserve PIP benefits for lost wages when requested. The plaintiff suffered severe injuries as a passenger in a car accident. While he was in a coma, his mother signed an assignment of insurance benefits in favor of the hospital. Plaintiff did not challenge the validity of the assignment. The hospital was promptly paid by the insurance company. When plaintiff later requested the insurers to reserve his PIP benefits for his past and future lost wages, he was informed that the benefits had been exhausted by the payment to the hospital. The Superior Court held sua sponte that the unchallenged assignment to the healthcare provider was invalid. Upon review of the facts of this case, the Supreme Court concluded the Superior Court erred as a matter of law in deciding that uncontested issue. Because the assignment on behalf of the plaintiff resulted in the exhaustion of his PIP benefits before the plaintiff requested the reservation of PIP benefits for his lost wages, the legal issue of whether the insurer was required to reserve PIP benefits for lost wages is moot. View "State Farm Mutual Automobile Insurance Co. v. Davis" on Justia Law

The issue on appeal to the Supreme Court in this case centered on whether the Commonwealth Court erred by affirming the reversal by the Workers’ Compensation Appeal Board (“WCAB”) of the decision of a workers’ compensation judge (“WCJ”) that granted Appellant Philip Payes's claim application. The WCJ determined that Appellant was entitled to workers’ compensation disability benefits based on factual findings that Appellant established the existence of a mental disability that had been caused by abnormal working conditions. Upon review, the Court concluded that the Commonwealth Court erred in reversing the WCJ’s decision, and accordingly reversed the order. View "Payes v. WCAB (PA State Police)" on Justia Law

Plaintiff sought underinsured motorists (UIM) coverage from Respondent, Plaintiff's insurance carrier, after he was involved in an accident. Plaintiff and his wife eventually filed suit against Respondent seeking to recover the benefits. Plaintiff and Respondent settled the claim. Plaintiffs then amended their complaint against Respondent to allege a bad faith claim for violation of the Unfair Trade Practices Act, alleging that Respondent acted in bad faith by not paying their first-party claim for UIM. The jury returned a verdict in favor of Plaintiffs. Plaintiffs then moved for attorney fees and costs for substantially prevailing in the underlying bad faith award. The circuit court denied the costs and fees. The Supreme Court affirmed, holding that the circuit court did not abuse its discretion in concluding that there was no factual basis upon which to award fees on the bad faith claim. View "Lemasters v. Nationwide Mut. Ins. Co." on Justia Law

Thomas Warner filed a complaint against Robert and Rebecca Hanke for conversion and negligence after Robert Hanke asserted ownership over some personal property Warner was storing on the Hanke's property. At the time the action was filed, Robert and Rebecca Hankes maintained home insurance coverage from a subsidiary of Horace Mann Insurance Company. The Hankes filed a claim with Horace Mann to request a defense against Warner's suit. Horace Mann filed a declaratory judgment action requesting a determination whether the insurance policy required Horace Mann to defend the Hankes. The district court concluded that Horace Mann did not owe coverage to the Hankes for the Warner dispute. The Supreme Court affirmed in part, reversed in part, and remanded, holding that the district court (1) properly determined that the Hankes' insurance policy failed to cover the Warner dispute; (2) correctly determined that Horace Mann's decisions to provide a defense and to pay the settlement of Warner's claims nevertheless allowed Horace Mann to pursue reimbursement for the Hankes' share of the settlement; and (3) abused its discretion in awarding attorney's fees to Horace Mann. View "Horace Mann Ins. Co. v. Hanke" on Justia Law

Mead Johnson, purchased a primary Commercial General Liability policy from National Union, with a limit of $2 million for liability for “personal and advertising injury” and an excess liability policy from Lexington, with a limit of $25 million. Mead’s main product, Enfamil infant formula, is sold worldwide. Mead’s competitor, PBM, sued Mead for false advertising and consumer fraud and Mead sued PBM for trade dress infringement. PBM claimed that Mead had falsely asserted that PBM’s generic formula lacked key fats that promote brain and eye development. The suit sought $500 million in damages for product disparagement, a tort that the policies cover as a form of “advertising injury.” Mead did not notify the insurers of the suit until December 2009, after the suit ended in the $13.5 million verdict against Mead. Mead wanted its insurers to pay that judgment, plus a $15 million settlement that it made to resolve the class action suit. The insurers obtained declaratory judgments that they were not required to pay. The Seventh Circuit reversed the summary judgment in favor of the insurers in the suit relating to the PBM litigation, but affirmed the judgment in favor of National Union in the suit arising from the class action against Mead. View "Nat'l Union Fire Ins. Co. v. Mead Johnson & Co., LLC" on Justia Law

After Mr. Greenfield unsuccessfully filed criminal charges against Petitioner, Petitioner filed a complaint against Mr. and Mrs. Greenfield (Respondents) alleging, inter alia, defamation and false light/invasion of privacy. The circuit court granted summary judgment to Respondents as to all claims. Respondents subsequently moved for an award of attorney's fees and costs while acknowledging that their attorney's fees and costs had been paid by their insurance carrier (Insurer). The circuit court denied the motion as to Mr. Greenfield but granted it as to Mrs. Greenfield, finding that she had been joined in the action without substantial justification and that she had "incurred" the costs of her defense within the meaning of Maryland Rule 1-341, even though Insurer had paid the costs of litigation on her behalf. The court of special appeals affirmed. The Court of Appeals affirmed, holding that a party compelled to defend him or herself against abusive litigation may recover the costs associated with that litigation under Rule 1-341, regardless of the individual or entity that actually pays such expenses. View "Worsham v. Greenfield" on Justia Law

An Oklahoma worker was killed at Employer's jobsite in Texas. The employer's insurer paid the worker's Widow death benefits provided by Texas workers' compensation law. The widow also recovered damages in a wrongful death tort action in Texas. When the Insurer sought subrogation from the widow's wrongful death damages as allowed by Texas law, she filed suit in Oklahoma to prevent subrogation. She sought a declaratory judgment that the rights of Oklahoma workers and their dependents were governed by Oklahoma's Workers' Compensation Act, notwithstanding the worker's injury or death in another state, and any benefits that may be paid under another state's workers' compensation law. In particular, Widow asked the Oklahoma court to enforce the provision in Oklahoma law that forbids subrogation in cases of death benefits. The trial court granted the declaratory relief sought by the widow. On appeal by the Insurer, the Court of Civil Appeals reversed. The Court of Civil Appeals ruled that the widow had to commence a proceeding by filing a claim with Oklahoma's Workers' Compensation Court before Oklahoma could exercise jurisdiction over the benefits due the widow, including enforcement of the anti-subrogation provision in death benefit cases. Because she never filed a claim with Oklahoma's Workers' Compensation Court, the Court of Civil Appeals held subrogation was proper. Upon review, the Supreme Court affirmed the trial court's judgment and vacated the appellate court in this case. View "Holley v. ACE American Ins. Co." on Justia Law

After Larry Sewell fell into a service pit at Xpress Lube, Sewell filed suit against Xpress Lube. A process server left copies of the summons and complaint with an Xpress Lube employee. Bruce Anderson, the sole proprietor of Xpress Lube, later found the summons and complaint and sent them to his insurance agent, who, in turn, attempted to fax the complaint to Travelers Insurance, Anderson's insurance carrier. Travelers, however, never received the fax. Sewell later filed a motion for default judgment. The district court granted the motion and entered judgment against Xpress Lube. The Supreme Court vacated the default judgment, holding (1) there was no proper service on Xpress Lube because the sole proprietor was not served in this case, and therefore, the default judgment was void for lack of jurisdiction; (2) the district court erred in failing to vacate the default judgment due to mistake, inadvertence, or excusable neglect; and (3) the district court erred when it failed to hold an evidentiary hearing on unliquidated damages. View "Sewell v. Xpress Lube" on Justia Law