Justia Insurance Law Opinion Summaries

In 2006, Claimant Robert Brown tore the rotator cuff in his right shoulder while at work. The issue on appeal before the Supreme Court in this case centered on whether the workers' compensation laws precluded a certain impairment rating and associated award of permanent partial disability benefits for Complex Regional Pain Syndrome (CRPS) when the claimant was not diagnosed with CRPS, but an expert confirmed he had it. The Commissioner of the Department of Labor and the trial court both concluded that the applicable law denied the Commissioner discretion to assign the impairment rating and award benefits associated with CRPS when the diagnosis did not meet the diagnostic standards. Upon review of the matter, the Supreme Court concluded the Commissioner erred in his conclusion, and reversed and remanded for reconsideration. View "Brown v. W.T. Martin Plumbing & Heating, Inc." on Justia Law

Petitioner Robert Smitter applied for workers' compensation benefits after being injured on the job working as a firefighter for Thornapple Township. At the time of his injury, Petitioner also worked for General Motors. He earned eleven percent of his income from the township and 89 from GM. The township did not reduce its workers’ compensation obligation by coordinating Petitioner's benefits with his disability benefits under MCL 418.354(1)(b). The township sought reimbursement from the Second Injury Fund under the dual-employment provisions for the entirety of Petitioner's wage-loss benefits. The fund agreed to pay the amount it would have owed if the township had coordinated Petitioner's benefits. The township filed an application for a hearing with the Worker’s Compensation Board of Magistrates, seeking reimbursement from the fund for the uncoordinated amount. The magistrate ordered the fund to reimburse the township for 89 percent of Petitioner's uncoordinated benefits. The Workers’ Compensation Appellate Commission (WCAC) affirmed. The Court of Appeals denied the fund’s application for leave to appeal. After its review, the Supreme Court concluded that when the injury employment provided less than 80 percent of the employee’s wages, the fund is required to reimburse its portion of the coordinated amount of benefits. Because the Township did not coordinate in this case, the appellate court erred in its analysis. Accordingly the appellate court was reversed and the case remanded to the magistrate for further proceedings. View "Smitter v. Thornapple Township" on Justia Law

Workforce Safety & Insurance (WSI) appealed a district court's judgment reversing its denial of worker's compensation benefits to claimant Brenda Albright. Albright submitted her claim to WSI for a work-related back injury. Albright had a history of back problems; an independent medical records review of Albright's case showed she had "well-documented multilevel degenerative disk pathology" which contributed to the claim at issue here. The ALJ hearing Albright's case concluded her injury was not the result of a single incident, and denied her application for benefits. Finding that the evidence in the record supported the ALJ's decision to deny Albright's application for benefits, the Supreme Court reversed the district court, affirmed the ALJ and reinstated WSI's order denying benefits. View "Albright v. ND Workforce Safety & Ins" on Justia Law

Lisbeth Cherrington entered into a contract with the Pinnacle Group for the construction of a home. Anthony Mamone worked with Cherrington during the contract and construction process. After the construction was completed, Cherrington filed this action against Pinnacle and Mamone, alleging, inter alia, negligence, misrepresentation, and breach of fiduciary duty. Pinnacle and Mamone requested Erie Insurance Property and Casualty Company, with whom they had insurance policies, to provide coverage and a defense. Because Erie denied both coverage and a duty to defend, Pinnacle and Mamone filed a third-party complaint against Erie seeking a declaration of the coverage provided by their policies. The circuit court granted Erie's motion for summary judgment, finding that the three policies issued to Pinnacle and Mamone did not provide coverage for the injuries and property damage allegedly sustained by Cherrington. The Supreme Court (1) affirmed the circuit court's finding that neither Mamone's homeowners policy nor his umbrella policy provided coverage under the facts of this case; but (2) reversed the circuit court's ruling finding no coverage to exist under Pinnacle's commercial general liability policy. Remanded. View "Cherrington v. Erie Ins. Prop. & Cas. Co." on Justia Law

The United States District Court for the Northern District of Georgia certified two questions to the Georgia Supreme Court. The questions related to the Automobile Insurance Company of Hartford Connecticut's umbrella policy issued to Louis and Betty Wilson. At the time, Georgia law required policies to have uninsured motorist coverage unless the insured rejected that coverage in writing. The Wilsons did not reject uninsured motorist coverage; their policy excluded such coverage despite being required by law. Because it was not written into the policy but required, it was implied by operation of law. In 2010, Louis Wilson was seriously injured in an accident, and gave notice of a claim for uninsured motorist benefits. The insurance company denied the claim, contending that a 2008 amendment to the Georgia law specifically excluded umbrella policies from mandatory uninsured motorist coverage. The questions from the federal court centered on whether the amendment to the applicable Georgia law applied to the Wilson's umbrella policy after 2009, and whether the notice requirements of the amended law applied to umbrella policies. After review, the Georgia Court concluded that the amendment in question here did not apply to the Wilson's umbrella policy, nor did the notice requirement. View "Wilson v. Automobile Insurance Co. of Hartford, Connecticut" on Justia Law

Appellee Young's Sales & Service submitted a claim with Appellant Underground Storage Indemnification Fund for reimbursement of remediation costs it incurred following the release of certain regulated chemicals stored in underground tanks on its property. The claim was denied, and Appellee appealed. The issue before the Supreme Court in this case was whether the Commonwealth Court correctly held that section 706(2) of the Storage Tank Spill Prevention Act applied on a per tank basis. Upon review, the Supreme Court concluded it did not. Accordingly, the Court reversed the Commonwealth Court and reinstated the Board's order denying Appellee's claim. View "Young's Sales & Service v. Underground Storage Tank Indemnification Board" on Justia Law

In 2003, multiple residents of a nursing home (Greenwood) died or were injured when another resident set fire to the facility. Consequently, thirteen negligence actions seeking damages for serious bodily injury or wrongful death were filed against Greenwood, the owner of the property housing Greenwood, the lessee of the property (Lexington Healthcare), and the operator of Greenwood. Plaintiff issued a general liability and professional liability insurance policy to Lexington Healthcare. At issue in this case was the amount of liability insurance coverage available for the claims. The trial court determined the amount available under the policy and rendered judgment accordingly. The Supreme Court reversed in part, holding (1) the trial court improperly interpreted a policy endorsement in the policy relating to the aggregate policy limit; and (2) the trial court improperly applied a self-insured retention endorsement to reduce the available coverage. Remanded. View "Lexington Ins. Co. v. Lexington Healthcare Group, Inc." on Justia Law

Prince was the general contractor for construction of an apartment building. Rybaltowski was an employee of a waterproofing company. His boss took Rybaltowski to the project site to perform an unpaid demonstration of the proposed caulking of windows. While Rybaltowski was at the site, a beam supporting masonry equipment fell on him. Less than an hour after the accident, Prince signed a subcontract with the waterproofing company. The insurance policy at issue was a Commercial General Liability Insurance policy with an exclusion from coverage for bodily injury to any contractor arising out of or in the course of the rendering or performing services of any kind or nature whatsoever by such contractor. “Contractor” was defined to include employees of subcontractors. The district court entered judgment in favor of the insurer, finding it had no duty to defend. The Seventh Circuit reversed and remanded, reasoning that the policy can be interpreted so that services are not provided until the contractor begins compensated work on the project. View "Atl. Cas. Ins. Co. v. Prince Contractors, Inc." on Justia Law

Defendants Pam Wood, David Wood, Justin Wood, Josh Wood and Jacob Wood filed an interlocutory appeal for the Supreme Court to determine whether the circuit court abused its discretion in denying their motion to transfer this case to another county. The underlying case involved a car accident in which a question arose over who was covered by an insurance policy. Defendant Pam Wood applied for the coverage in Covington County; the application was faxed from an insurance agent's office in Covington to Plaintiff Safeway Insurance Company's Rankin County office where it was approved. Safeway opposed the transfer of venue. Upon review, the Supreme Court concluded that Safeway could not demonstrate sufficient facts to support that venue was proper in Rankin County. Therefore the Court reversed the circuit court's order and remanded the case with instructions to transfer it to a permissible venue. View "Wood v. Safeway Insurance Co." on Justia Law

Plaintiffs purchased property from Charles Johnson. During the pendency of the sale of the property, Johnson misrepresented the condition of the property and failed to disclose its prior use as a junkyard. Plaintiffs filed a complaint against Johnson alleging various causes of action and seeking damages for loss of investment, undisclosed physical problems with the property, and emotional distress. While he owned the disputed property, Johnson maintained a homeowners insurance policy with Allstate Insurance Company. Allstate refused to defend or indemnify Johnson on Plaintiffs' complaint. Plaintiffs and Johnson subsequently reached an agreement resolving the underlying complaint, and the superior court entered a judgment against Johnson for $330,000. Plaintiffs then initiated a reach and apply action against Allstate. The trial court granted summary judgment for Johnson, determining that the policy did not cover the damages Plaintiffs suffered. The Supreme Court affirmed, holding that Plaintiffs' damages did not constitute covered "bodily injury" or "property damage" pursuant to the Allstate homeowners insurance policy. View "Langevin v. Allstate Ins. Co." on Justia Law