Justia Insurance Law Opinion Summaries

After Employee was injured in a car accident with a police officer, Employer's workers compensation carrier (Claimant) sought to bring this tort action against City. Claimant gave notice to City that it was pursuing a negligence claim against it, claiming damages in the amount of $19,590. Claimant then brought a lawsuit in the district court, requesting $19,590 in damages. Several months later, Claimant sought leave to amend its petition to raise the amount of alleged damages to $228,088. City objected, arguing that Claimant's notice did not include "a statement of the amount of monetary damages that is being requested" as required under Kan. Stat. Ann. 12-105b(d)(5). The district court granted Claimant's petition, finding that Claimant's statutory notice substantially complied with 12-105b(d). A divided court of appeals affirmed the district court's ruling that the notice was in substantial compliance with the law. The Supreme Court affirmed, holding (1) under the circumstances, Claimant's notice substantially complied with 12-105b(d), as the notice contained all the information required by the statute; and (2) when a notice conforms with section 12-105b(d), subsequent amendments to the pleadings are subject to an inquiry into a claimant's bad faith or misleading conduct. View "Cont'l W. Ins. Co. v. Shultz" on Justia Law

After Insured sustained injuries in a car accident he sought MRIs from Virtual Imaging Services. Virtual Imaging obtained an assignment of personal injury protection (PIP) benefits under Insured's policy with GEICO and billed GEICO $3600 for the MRIs. GEICO paid the bill but limited its reimbursement to eighty percent of 200 percent of the applicable Medicare fee schedule in accordance with the formula described in Fla. Stat. 627.736(5)(a). This statutory provision became effective on January 1, 2008 as part of Florida's PIP statute. Virtual Imaging subsequently sued GEICO, alleging that GEICO's reimbursement was insufficient. The county court granted Virtual Imaging's motion for summary judgment. The court of appeal affirmed then certified a question of law to the Supreme Court, which answered by holding that GEICO was required to give notice to Insured by electing the permissive Medicare fee schedules in its policy before taking advantage of the Medicare fee schedule to limit reimbursements. View "Geico Gen. Ins. Co. v. Virtual Imaging Servs., Inc." on Justia Law

In 2009, respondent Adrian Melton suffered an on-the-job accident while working for his employer, Joe Brown Company, Inc. He was awarded eleven weeks of temporary total disability, granted permanent partial disability, and a psychological overlay. The employer appealed the award, which vacated some parts and sustained others. In 2011, the employer appealed to the Court of Civil Appeals (COCA) which vacated the permanent partial impairment award because it failed to comply with the AMA Guides (5th Edition), and that an "any competent evidence" standard of review was inconsistent with 85 O.S. 2011 sec. 340, so the court used the "against the clear weight of the evidence" standard which had recently been revised. Respondent petitioned the Supreme Court for review of the COCA decision, arguing that the appellate court should have used the "any competent evidence" standard. Upon review of the matter, the Supreme Court concluded that because respondent's injury happened before the new standard went into effect, the "any competent evidence" standard should have been applied. With regard to respondent's awards of disability, the Court found that psychological overlay was not supported by appropriate expert testimony. Accordingly, the benefits as they related to the overlay were vacated. View "Joe Brown Company, Inc. v. Melton" on Justia Law

Plaintiff Fernando Rodriguez-Flores appealed the dismissal of his claims of retaliatory discharge and fraud brought against his former employer, U.S. Coatings, Inc. He worked as a painter. He stated that he suffered on the job injuries from paint-fume inhalation and other maladies. He sued the employer for workmans' compensation benefits, asserting retaliatory discharge and fraud based on his physical complaints and subsequent treatment. The trial court dismissed his complaint. Finding that the trial court did not err with regard to dismissing Plaintiff's fraud claim, the Supreme Court affirmed to that regard. However, the Court concluded the trial court erred with regard to the retaliatory-discharge claim. The case was remanded for further proceedings. View "Rodriguez-Flores v. U.S. Coatings, Inc. " on Justia Law

Plaintiff Stanford Isbell sued M&J Materials, Inc. seeking workmans' compensation benefits. He also sought compensatory and punitive damages based on his claim of a retaliatory discharge. M&J denied liability, specifically averring that Plaintiff's employment was terminated for violating a workplace prohibition of carrying firearms. The parties settled their differences with regards to the workmans' compensation claims, leaving the retaliatory discharge to be heard by the trial court. The jury found in Plaintiff's favor, but the Court of Appeals reversed. Upon review of the matter, the Supreme Court concluded the appellate court erred in its analysis of the facts in record and the applicable law. Accordingly, the appellate court's judgment was reversed and the case remanded for further proceedings. View "M & J Materials, Inc. v. Isbell" on Justia Law

Plaintiff Mary Soileau was injured while working for the Town of Mamou when a front-end loader detached from a tractor and struck her in the leg. She named the tractor manufacturer, the Town, Smith's Hardware (where the Town rented the tractor for employees' use), the hardware store's owners and their insurance company. Trial began with only the owners and their insurer as the remaining defendants in the suit. On the third day, Plaintiff moved to dismiss the owners and their company in the presence of the jury, stating that she did not seek any damages personally against them. Hearing no objections, the trial court granted the request, but made no written (and therefore signed) judgment of dismissal. On day four, the insurer moved for a directed verdict, based on contract language that it was obligated to pay only if its insureds were legally obligated to pay. The insurer's motion was denied, and ultimately over $9 million in damages were awarded to Plaintiff. Concluding that the trial court erred in denying the insurer's motion, the appellate court reversed, dismissing the insurance company. The issue before the Supreme Court centered on the effect Plaintiff's in-court dismissal of the insured parties was during her personal injury action. Upon review, the Supreme Court concluded that the appellate court erred in its analysis, reversed and remanded the case for further proceedings. View "Solieau v. Smith True Value & Rental" on Justia Law

Claimant Deborah Lydy was a traveling licensed practical nurse employed by defendant Trustaff, Inc. While on duty, a patient attacked her causing her to suffer (among other things) an acute cervical sprain. The issue before the Supreme Court in this case centered on whether employer-health insurance premiums should have been included when calculating claimant's average weekly wages under the state workers' compensation laws. The Department of Labor concluded that such premiums were not "wages" and should not have been included. Concluding that the Vermont Legislature did not intend for wages to include payments made on behalf of employees for the purpose of acquiring health insurance. Accordingly, the Court affirmed the Commissioner's judgment. View "Lydy v. Trustaff, Inc." on Justia Law

Plaintiff's automobile insurance policy with Geico included a condition that Plaintiff submit to examination under oath (EUO) before recovering personal injury protection (PIP) benefits. Geico denied Plaintiff's PIP claim due to her failure to satisfy this condition after she was injured in a car accident. Plaintiff filed a class action complaint alleging that Geico had violated Florida's PIP statute. The federal district court dismissed the case, concluding that the PIP statute did not prohibit an insured from requiring an EUO. On appeal, the Eleventh Circuit certified a question of law to the Florida Supreme Court, which answered by holding that, under Fla. Stat. 627.736, an insurer cannot require an insured to attend an EUO as a condition precedent to recovery of PIP benefits. View "Nunez v. GEICO Gen. Ins. Co." on Justia Law

Appellees, the Rubins, requested that the district court issue a Writ of Garnishment against the assets of Hamas and HLF after obtaining a judgment against Hamas for damages resulting from a terrorist attack in an outdoor pedestrian mall in Jerusalem. The district court executed the writ but the Rubins could not execute against HLF's assets because those assets had been restrained under 21 U.S.C. 853 to preserve their availability for criminal forfeiture proceedings. The district court subsequently denied the government's motion to dismiss the Rubins' third-party petition under section 853(n) to assert their interests in the restrained assets and vacated the preliminary order of forfeiture. The district court held that the Terrorism Risk Insurance Act of 2002 (TRIA), Pub. L. No. 107-297, title II, 201, 116 Stat. 2337, allowed the Rubins to execute against HLF's assets not withstanding the government's forfeiture proceedings. The court reversed, holding that section 853(n) did not provide the Rubins with a basis to prevail in the ancillary proceeding; TRIA did not provide the Rubins a basis to assert their interest in the forfeited property; TRIA did not trump the criminal forfeiture statute; and the in custodia legis doctrine did not preclude the district court's in personam jurisdiction over HLF. View "United States v. Holy Land Foundation for Relief, et al." on Justia Law

Employee-claimant Cathy Bone filed a workman's compensation claim for a work-related injury. The employer, U.S. Food Service, and its carrier Indemnity Insurance Co. of North America disputed the claim. The single commissioner and an Appellate Panel of the South Carolina Workers' Compensation Commission issued orders denying the claim. Under the procedure then in place, Bone appealed to the circuit court, which concluded the injury was compensable and remanded the matter to the Commission for further proceedings. The employer appealed the circuit court's order, and the Court of Appeals dismissed the appeal on the basis the order was not a "final judgment" and thus not immediately appealable because further proceedings were ordered before the administrative agency. The Supreme Court granted Petitioners' petition for a writ of certiorari to review the decision of the Court of Appeals, and the Supreme Court affirmed. The high court subsequently granted a petition for rehearing filed by the employer, and it additionally granted the following two motions: (1) Bone's motion to argue against precedent, and (2) the motion of the South Carolina Defense Trial Attorneys' Association to accept its Amicus Curiae Brief in support of Petitioners. After considering the record in this matter, as well as the briefs and arguments, the Court adhered to its original decision to affirm. View "Bone v. U.S. Food Service" on Justia Law