Justia Insurance Law Opinion Summaries

Defendants, Nancy and Thomas Bernheim, appealed the trial court’s summary judgment decision granting plaintiff GEICO Insurance Company’s claim against them for reimbursement of $10,000 that GEICO had paid defendants under the medical-payments provision of their automobile insurance policy. Although the Supreme Court agreed with the trial court that defendants should have reimbursed GEICO, it reversed and remanded for a determination of the proper reimbursement amount. View "GEICO Insurance Co. v. Bernheim" on Justia Law

Kenneth Poch and Kevin Key were temporary workers contracted through Personnel Resources of Georgia, Inc. and Carolina Staffing, Inc. d/b/a Job Place of Conway, to work for Bayshore Concrete Products/South Carolina, Inc. to clean up a concrete casting worksite and dismantle equipment used to produce concrete forms. As a result of a tragic, work-related accident, Poch was killed and Key was injured. Poch's estate and Key received workers' compensation benefits through Job Place. Subsequently, Key and his wife and the estate of Poch filed suit against Bayshore SC and its parent company, Bayshore Concrete Products Corporation. The circuit court granted the company's motion to dismiss the actions on the ground that workers' compensation was Petitioners' exclusive remedy and, therefore, the company was immune from liability in a tort action. The Court of Appeals affirmed the circuit court's order. Though the Supreme Court agreed with the result reached by the Court of Appeals, it found the court incorrectly analyzed Petitioners' arguments. Accordingly, the Court affirmed as modified. View "Poch v. Bayshore Concrete" on Justia Law

National contracted to produce “Kids Fun Day” events before 2010 Cleveland Indians games, including a collapsible inflatable slide. National purchased a required comprehensive liability insurance policy naming the Indians as additional insureds, from NHIC through an independent broker, CSI. On the application a box was checked, indicating use of a “bounce houses or inflatables.” A “Certificate of Liability Insurance” issued six weeks before the slide collapsed, causing a death. Neither National nor the Indians had received the full policy at the time of the accident. After the accident, National learned that, despite its specific application request, CSI had failed to procure a policy that expressly covered inflatables. In an email exchange, an employee of CSI stated, “Oh, ok. Sorry, I guess I missed it.” Later CSI stated: “inflatable’s [sic] are excluded on the policy you purchase[d] from us. Whoever own the inflatable’s [sic] are [sic] to carry insurance on them and name you … I don’t believe I’ve ever seen you indicate on your applications that inflatable’s [sic] are at your events, but please note, the exclusion is listed on the quotes we sent over to you.” The district court found NHIC not liable to the Indians and that CSI could not be liable in negligence. The Sixth Circuit reversed as to CSI and remanded the negligence and negligent misrepresentation claims. View "Cleveland Indians Baseball Co. v. NH Ins. Co." on Justia Law

Safety National sold an excess liability insurance policy to TKK, to cover excess losses resulting from liability imposed “by the Workers’ Compensation or Employers’ Liability Laws” of Illinois. The widow of a former TKK employee sued, alleging that TKK’s negligence caused the employee to become ill with and die from mesothelioma. The claim was subject to an affirmative defense: the Illinois Workers’ Occupational Diseases Act bars common law claims by or on behalf of an employee against a covered employer “on account of damage, disability or death caused or contributed to by any disease contracted or sustained in the course of the employment.” After Safety National denied coverage, TKK filed suit. The district court granted TKK summary judgment for its costs in defending and settling the widow’s suit, reasoning that the reference to “Employers’ Liability Laws” included the common law negligence claim even if the claim ultimately must fail because of the statutory bar. The court denied TKK’s claim for attorney fees and costs in the coverage lawsuit itself, except a modest award for what the court considered a vexatious motion to reconsider. The Seventh Circuit affirmed. The key policy term, “Employers’ Liability Laws,” is broad enough to include claims under the common law, including “groundless” claims. View "TKK USA, Inc. v. Safety Nat'l Cas. Corp." on Justia Law

The issue before the Supreme Court in this case centered on the statutory interpretation concerning Section 413(a) of the Workers' Compensation Act, specifically whether the claimant/appellant should have been permitted to proceed on a post-500-week petition for reinstatement of total disability benefits where he filed that petition within three years of his most recent payment of compensation, a payment which was made pursuant to a post-500-week supplemental agreement, notwithstanding a prior suspension of payments due to his return to work without a loss in earning capacity. Resolving the question, involved first determining whether expiration of the 500-week period set forth within the Act operated as a bar to the assertion of total disability claims by employees who have experienced a suspension of benefits. Also affecting the Court's decision was the effect of payments made pursuant to supplemental agreements upon an otherwise expired workers' compensation claim. The Commonwealth Court below affirmed the Workers' Compensation Appeal Board's ("WCAB") reversal of a Workers' Compensation Judge's ("WCJ") decision granting appellant's reinstatement and penalty petitions. Upon review, the Supreme Court held that appellant's reinstatement petition was not timely filed. Accordingly, it affirmed the Commonwealth Court. View "Cozzone, Aplt v. WCAB (Pa Municipal/E. Goshen Twp)" on Justia Law

The New Mexico Supreme Court recognized a new tort called "malicious abuse of process," which subsumed causes of action for malicious prosecution and abuse of process. Nanodetex Corporation and two of its principals (the Insureds) were successfully sued for malicious abuse of process. They then sought indemnification from Carolina CasualtyInsurance Company, which covered the Insureds under a management liability policy (the Carolina Policy). Carolina denied the claim, relying on an exclusion in the policy for losses arising from claims for "malicious prosecution." It sought a declaratory judgment that it was not liable for the damages arising from the malicious-abuse-of-process judgment. On Carolina's motion for summary judgment, the district court agreed with Carolina and also rejected the Insureds' counterclaims. The Insureds appealed. Upon review, the Tenth Circuit reversed the declaratory judgment, holding that the term "malicious prosecution" in the exclusion does not encompass all claims of malicious abuse of process, but only claims whose elements are essentially those of the common-law cause of action for malicious prosecution. Because the judgment against the Insureds in the tort case was affirmed on appeal on a claim that was not substantially the same as common-law malicious prosecution, the exclusion in the Carolina Policy did not apply. View "Carolina Casualty Insurance v. Nanodetex Corporation, et al" on Justia Law

Fifteen-year-old Kevin Michaud fired a single shot from a revolver belonging to his parents, killing one friend and seriously wounding another. The parents of the two victims sued Kevin, his parents, and their insurance company, United Services Automobile Association (USAA). The Michauds' liability policy provided a $300,000 limit for "Each Occurrence" of "Personal Liability." The superior court ruled that the policy afforded $900,000 of coverage because there had been a single occurrence and Kevin and his parents were each entitled to a separate per-occurrence policy limit. USAA appealed, arguing that the policy affords a single per-occurrence policy limit of $300,000 regardless of the number of insureds. The victims' parents also appealed, arguing that not only were there three individual coverage limits, one each for Kevin and his parents, but there were also multiple occurrences. Upon review, the Supreme Court concluded that USAA's position was most in accord with the express language of the policy, the reasonable expectations of an insured, and case law, and therefore reversed the superior court's decision. View "United Services Automobile Association v. Neary" on Justia Law

In 1997, Crum, a small company near insolvency, agreed to service Martin’s light-duty vehicles. Martin was a subsidiary of Massey Coal, a publicly-traded corporation. The agreement allowed Crum to enter Martin’s property to pick up vehicles; Martin required Crum to enter into an indemnification agreement and Crum agreed to Martin’s terms. Crum obtained insurance coverage required by the agreement from Universal. Philip, a Crum employee, rode with a Martin employee to pick up a truck from Martin property. A boulder rolled down hill, hit the vehicle, severely injuring Philip. The U.S. Mine Safety and Health Administration cited Martin for having loose rock above the roadway. Philip and Crum sued Martin; Martin counterclaimed based on the indemnification. Universal declined to defend on the counterclaim. After mediation, Martin agreed, without admitting liability, to pay $3,650,000. The parties also entered an “agreed judgment” against Crum for $3,650,000, on Martin’s counterclaim. Martin agreed not to pursue Crum for that judgment and sued Universal. The Sixth Circuit agreed with the district court that Universal had no duty to indemnify Martin because there was enough evidence to show that Crum was not actually liable to Martin. The indemnification was unenforceable as against public policy; it was the product of a significant disparity in bargaining power and attempted to shift liability for compliance with at least one mining-safety statute. View "Martin Cnty. Coal Corp. v. Universal Underwriters Ins. Co." on Justia Law

Respondent Francina Bardsley's home was hit by a speeding car. The car ran through the house, struck and killed her husband, Frederic Bardsley, and caused substantial property damage. The liability coverage of the driver was exhausted in settlement of the wrongful death action, and upon review, the Supreme Court was asked to consider the impact of the collateral source rule on underinsured motorist property damage coverage where the homeowners' policy has already paid for the property damage. The Court held the collateral source rule did not apply and there was no underinsured motorist property damage coverage available. View "Bardsley v. Government Employees Insurance" on Justia Law

At issue in this case was a worker’s compensation claim stemming from an accident at an onion processing plant. Petitioner James Clark was injured when his right forearm was caught in a roller machine which resulted in significant soft-tissue damage. The Industrial Commission determined that Clark suffered a compensable injury and that he was entitled to medical treatment for approximately one year. The Commission also found that Clark had a permanent partial impairment (PPI) of 10% of the whole person and a permanent partial disability rated at 25% of the whole person. Clark appealed that determination pro se, arguing the Commission relied on fraudulent evidence because his medical records were fraudulently obtained. Finding no error, the Supreme Court affirmed. View "Clark v. State Ins Fund" on Justia Law