Justia Insurance Law Opinion Summaries

Frank Papotto was playing golf with co-workers and drank about four to five beers. Papotto dropped his cell phone and fell out of the golf cart while reaching for it. He suffered a head injury and died five hours later. A toxicology screen conducted posthumously revealed a blood-alcohol level of 0.115 %. The New Jersey state standard for intoxication is 0.08, putting Papotto over the legal limit for operating a motor vehicle. His widow sought payment of benefits from Hartford under Papotto’s accidental death and dismemberment policy. The policy explicitly excludes losses “sustained while Intoxicated.” Hartford’s Plan Administrator denied payment of benefits because the deceased had consumed alcohol prior to his death. The district court concluded that the policy implicitly required a causal connection between intoxication and the loss, and remanded to the Plan Administrator. The Third Circuit dismissed an appeal for lack of jurisdiction, finding that the remand order is not immediately appealable as a final judgment. View "Papotto v. Hartford Life & Accident Ins. Co." on Justia Law

In two consolidated cases involving remediation of contaminated properties, the New Jersey Property-Liability Insurance Guaranty Association (Guaranty Association) took over the administration of the claims of an insolvent insurance carrier on the risk pursuant to the New Jersey Property-Liability Insurance Guaranty Association Act. The solvent insurance company paid the property-damage claims in each of the two cases and then sought reimbursement from the Guaranty Association under the Owens-Illinois methodology. The Guaranty Association claims that, pursuant to N.J.S.A. 17:30A-5 and -12b, it was not responsible for making any contribution until the policies of the solvent carrier were fully exhausted. The solvent carrier contended on appeal that the Guaranty Association must pay the share of the insolvent carrier in accordance with the Owens-Illinois allocation scheme, and that its position is consistent with the PLIGA Act. The trial court agreed that the Guaranty Association is subject to the Owens-Illinois allocation methodology. The Appellate Division reversed, finding that N.J.S.A. 17:30A-5 expressly carves out an exception to Owens-Illinois and requires exhaustion of the solvent carrier's policies before the Guaranty Association's reimbursement commitments are triggered. Finding no error with the appellate court's judgment, the Supreme Court affirmed. View "Farmers Mut. Fire Ins. Co. of Salem v. N.J. Property-Liability Ins. Guar. Ass'n" on Justia Law

This case arose when six employees of the Baltimore Washington Conference of the United Methodist Church filed workers' compensation claims, claiming they had sustained physical injury as a result of exposure to mold in the Conference's office. The employees profferred Dr. Ritchie Shoemaker as their expert to prove causation. Defendant moved to exclude Shoemaker under Frye-Reed on the grounds that his methodology to determine causation was not generally accepted in the relevant scientific community. On remand, after a Frye-Reed hearing, the circuit court determined that Shoemaker's methodology was generally accepted by the relevant scientific community and satisfied the Frye-Reed test. The court of special appeals reversed. The Court of Appeals affirmed, holding that Shoemaker's technique and theory were not shown to be generally accepted in the relevant scientific community. View "Chesson v. Montgomery Mut. Ins. Co." on Justia Law

At issue in this case was whether the omnibus clause in a automobile insurance policy provided coverage to a permittee to whom the insured owner loans the car when that first permittee was subject to a negligent entrustment claim for loaning the car to a second permittee. A vehicle owner gave her car keys to defendant, who in turned passed them to another driver. The driver was involved in a fatal, single-car accident and the driver's estate sued defendant for negligent entrustment. Defendant sought coverage under the vehicle owner's automobile insurance policy. Defendant appealed the trial court's order granting summary judgment in favor of the insurer and finding that, as a matter of law, defendant did not qualify for coverage under the policy. Upon review of the trial court record, the Supreme Court concluded that defendant’s entrustment of the vehicle to the driver constituted "use" under the omnibus clause of the policy and that the undisputed evidence supported the conclusion that the insured did not consent to defendant's allowing the driver to drive the car, but that a material issue of fact existed with respect to whether defendant entrusted the car keys to driver reasonably believing that driver would not drive the car. Accordingly, the Court reversed and remanded the case for further proceedings. View "State Farm Mutual Automobile Co. v. Colby" on Justia Law

Garold Charles was in an accident while riding as a passenger in a vehicle belonging to Tara and Anthony Stout. He brought negligence claims against the Stouts and Credit Union 1, the lienholder of the Stouts’ vehicle. Credit Union 1 moved for summary judgment. Charles opposed the motion, relying on testimony from Tara’s deposition and contending in part that he was a third-party beneficiary of an alleged contract between Credit Union 1 and the Stouts by which the credit union agreed to provide liability insurance. The superior court struck Tara’s testimony and granted summary judgment to Credit Union 1. Charles appealed. Finding no error in the trial court's decision, the Supreme Court affirmed. View "Charles v. Stout" on Justia Law

Petitioner Southern Farm Bureau Casualty Insurance Company petitioned for a writ of prohibition with the Supreme Court, arguing the circuit court did not have jurisdiction after ninety days to set aside its previous order in this case. This matter stemmed from a motorcycle accident in which Stuart Parsons was injured with an uninsured driver. Parsons had uninsured-motorist coverage with Farm Bureau. He made a claim against that coverage, and signed a release allowing farm bureau to obtain his medical bills, and received a personal-injury protection payment. Parsons' medical bills exceeded the policy limit. Farm Bureau them filed a complaint for interpleader, requesting the circuit court disburse its uninsured-motorist limits. At that time, no other party had filed a lien nor claimed any interest in the policy proceeds. Acting pro se, Parsons answered and requested his policy be paid to him. The circuit court ordered Farm Bureau to deposit the funds into the court's registry and to disburse the money accordingly. Then Parsons filed a counterclaim seeking a statutory penalty, interst and attorney's dees, and to dismiss Farm Bureau's interpleader. After a hearing, the circuit court vacated an earlier order thereby allowing Parsons to proceed with his counterclaims against Farm Bureau. Farm Bureau then filed for a writ of prohibition, arguing the circuit court had no jurisdiction to set aside the order after ninety days from entry of the order. The Supreme Court considered Farm Bureau's petition for a writ of prohibition as a request for a writ of certiorari, and found that Farm Bureau had another adequate remedy. As such, the Court denied Farm Bureau's petition for certiorari, and dismissed the petition for the writ of prohibition as moot. View "S. Farm Bureau Cas. Ins. Co. v. Parsons" on Justia Law

After being billed by NEPT for medically necessary chiropractic services provided to the passenger of its insured, Liberty Mutual, claimed that the cost was unreasonably high and thus refused to pay the full amount invoiced. At trial, Liberty Mutual sought to introduce statistical evidence from a commercial database to show that NEPT's charges exceeded the 80th percentile of reported charges for the same procedures, pursuant to G.L. c. 233, 79B, which creates a limited exception to the hearsay rule for factual statements contained in commercial publications. The trial judge denied the motion, finding that the database was unreliable, based on a prior decision from the appellate court with respect to the database. The Massachusetts Supreme Court affirmed. Based on the explicit language of section 79B, and the gatekeeper role of a trial judge, it is within a judge's discretion to consider the reliability of evidence offered pursuant to section 79B. View "N.E. Physical Therapy Plus, Inc. v. Liberty Mut. Ins. Co." on Justia Law

Appellant Hugo Rosales suffered an injury working on a fish-processing vessel. He filed both a workers' compensation claim and a maritime lawsuit. Appellant and the employer ultimately entered into a global settlement of both cases. The state Workers' Compensation Board initially rejected the settlement. Appellant later tried to withdraw from the settlement but changed his mind. At a hearing, he testified that the though the settlement was in his best interests. The Board approved the settlement after the hearing. Several months later, appellant moved to have the agreement set aside. The Board denied this request. The Workers' Compensation Appeals Commission affirmed the Board's decision. Finding no error in the Commission's decision, the Supreme Court affirmed. View "Rosales. v. Icicle Seafoods, Inc." on Justia Law

In an interlocutory appeal from the trial court's denial of defendant Vaughn Bowden, PA's motion to dismiss for failure to state a claim upon which relief could be granted. Plaintiffs Cherie Blackmore and Diane Young sued their former employer, Vaughn Bowden, regarding the presence of toxic mold in two of the firm's offices in which they worked. They also argued they were exposed to sewer gas and a natural gas leak. Plaintiffs also sued Lowry Development and its owner who owned a second building in which Blackmore and Young claimed they were injured. Upon review, the Supreme Court concluded that plaintiffs failed to allege any facts by defendants' which rose to the level of intent that would remove their claims from the exclusivity of the Mississippi Workers' Compensation Act. Plaintiffs' only avenue for relief against the firm was in workers' compensation. Accordingly, the Supreme Court affirmed the trial court in dismissing plaintiffs' complaint. View "Vaughn & Bowden, PA v. Young" on Justia Law

Claimant Rubio Izaguirre settled with a third-party tortfeasor following a work-related automobile accident. His employer and surety asserted a right of subrogation against the entirety of that settlement. On appeal, claimant argued that subrogation rights should have extended only to damages that workers’ compensation typically insures and not to pain and suffering. The Commission found in favor of the employer and surety, holding that all of the settlement proceeds were subject to subrogation. Finding no error, the Supreme Court affirmed. View "Izaguirre v. R&L Carriers" on Justia Law