Justia Insurance Law Opinion Summaries

Steven Pham represented the estate of a driver of a car involved in a traffic accident. He appealed (along with the driver's parents and the five passengers in the car at the time of the accident) the court of appeals' judgment which affirmed summary judgment in favor of the insurer, State Farm, on the grounds that plaintiffs' claims were bound by the statute of limitations governing underinsured motorist claims. Upon review, the Supreme Court found that plaintiffs failed to file their action or demand arbitration of their underinsured motorist claims within either three years of the accrual of their cause or within two years after receiving payment of a settlement or judgment on an underlying bodily injury liability claim preserved as prescribed by the applicable statute. Accordingly, the Supreme Court affirmed the appellate court's decision. View "Pham v. State Farm Auto Ins. Co." on Justia Law

Insured was injured in an accident. Insured's policy with Insurer included uninsured motorist (UM) bodily injury coverage and personal injury protection (PIP) coverage. Insured's Employer's third-party workers' compensation (WC) administrator asserted a subrogation right against any PIP or UM recovery by Insured. At issue in this case was the correct interpretation of Md. Code Ins. 19-513. The district court asked the Court of Appeals to determine whether section 19-513(e) requires an insurance company to deduct WC benefits payable to an insured for UM and PIP when the insured has not reimbursed its provider and the insured intends to reimburse the WC provider in the future. The Court of Appeals held (1) under the plain meaning of section 19-513(e), an insured's benefits payable under UM and PIP coverage shall be reduced to the extent that the insured recovered benefits under WC and the WC provider has not been reimbursed; and (2) if the applicable workers' compensation law treats "write-downs" of medical bills as WC benefits, and the WC benefits have not been reimbursed, then the insurer shall deduct those benefits, calculated as discounts, from its benefits payable to the insured under section 19-513(e). View "Travco Ins. Co. v. Williams" on Justia Law

Respondent Philadelphia Indemnity Insurance Company appealed a superior court order that found Petitioner Great American Dining, Inc (GAD) was an additional insured under a Philadelphia policy. The dispute arose from a slip-and-fall injury in 2008 whereby the injured party sued DW Ray Commons, LLC, who owned and leased a building to Webster Place Center, Inc. DW Ray required Webster Place to obtain an insurance policy listing DW Ray as an additional insured. The commercial general liability policy contained a provision listing as an additional insured "any person or organization with respect to their liability arising out of the ownership, maintenance or use o that part of the premises leased or rented…" When DW Ray and Webster Place were sued for damages and settled with the injured party. That party then sued GAD for contribution on the theory that GAD constructed, installed and maintained the premises under the policy. GAD then sought a declaration that it too was an additional party under the DW Ray policy. Upon review, the Supreme Court agreed GAD was an additional party and upheld the superior court's judgment. View "Great American Dining, Inc. v. Philadelphia Indemnity Insurance Company " on Justia Law

Respondents Christopher Roinestad and Gerald Fitz-Gerald were overcome by poisonous gases while cleaning a grease clog in a sewer near the Hog's Breath Saloon & Restaurant. The district court concluded that Hog's Breath caused respondents' injuries by dumping substantial amounts of cooking grease into the sewer thereby creating the clog and consequent build up of the gas. On summary judgment, the district court found the saloon liable under theories of negligence and off-premises liability and granted respondents damages. The saloon carried a commercial general liability policy issued by Petitioner Mountain States Mutual Casualty Company which sought a ruling it had no duty to indemnify Hog's Breath. The district court agreed that under the terms of the policy, the insurer had no duty under a pollution exclusion clause. The appellate court reversed the ruling in favor of the insurer, finding the pollution exclusion clause was ambiguous and that its application to cooking grease (a common waste product) could lead to absurd results and negate essential coverage. Upon review, the Supreme Court reversed, finding that the saloon released enough grease to amount to a discharge of a pollutant, and that the insurance policy pollution exclusion clause barred coverage in this case. View "Mountain States Mutual Casualty Company v. Roinestad" on Justia Law

Nationwide Mutual Fire Insurance Company and State Farm Mutual Automobile Insurance Company filed a declaratory-judgment action in the federal district court seeking, among other things, a determination of the status of a settlement agreement they had reached with D.V.G., a minor, resolving her claims for coverage stemming from injuries she received in an automobile accident, following her death in a subsequent unrelated automobile accident. The federal district court ultimately concluded that the issue presented involved a question of Alabama law for which there was no clear controlling precedent, and it certified the following question to the Alabama Supreme Court: "Under Alabama law, is an insurance company bound to a settlement agreement negotiated on behalf of an injured minor, if that minor dies before the scheduling of a pro ami hearing which was intended by both sides to obtain approval of the settlement?" The Court answered in the affirmative: "an insurance company is bound to a settlement agreement negotiated on behalf of an injured minor, even if that minor dies before the scheduling of the court hearing that all parties agreed was necessary to obtain approval of the settlement agreement. In accordance with the parties' understanding, such a hearing is still required, and the minor's death does not render that hearing impossible." View "Nationwide Mutual Insurance Company v. Wood" on Justia Law

Appellant issued a motorcycle insurance policy to Brian McCallum that contained accident and healthcare coverage. The policy included a provision for subrogation of payments made for any injury caused by a third party. After McCallum was involved in a collision with Margarita Saldivar, Appellant paid McCallum's medical expenses. Appellant then filed a complaint alleging Saldivar's negligence and seeking to receive subrogation benefits from Saldivar. The circuit court rejected Appellant's argument that it was entitled to subrogation benefits from Saldivar and granted summary judgment in Saldivar's favor. The Supreme Court reversed and remanded, holding (1) the circuit court erred in its interpretation of the relevant statutes; and (2) Appellant properly sought general "subrogation benefits from the third party,'" as permitted by Ark. Stat. Ann. 23-79-146. View "Progressive Halcyon Ins. v. Saldivar" on Justia Law

The issue before the Supreme Court centered on the award of attorney's fees against an insurance company under the peer-review provisions of the Motor Vehicle Financial Responsibility Law (MVFRL). The MVFRL limits the amount providers may charge for treatment, products or services rendered to patients injured in automobile accidents where the injury is covered by an insurance policy. An individual obtained treatment from Appellee Herd Chiropractic Clinic for injuries sustained in a motor vehicle accident. The insurance company submitted the clinic's invoices to a Peer Review Organization (PRO) pursuant to the MVFRL. The PRO determined that certain treatments were not necessary or reasonable, and the insurance company subsequently refused to pay for such treatment The Clinic then sued for unpaid bills, plus treble damages and attorney's fees under the theory that the MVFRL authorized payment. The Common Pleas court found an award of fees proper and mandatory under the MVFRL. The Superior Court affirmed. The Supreme Court, however, reversed, finding that the MVFRL did not allow for what amounted to "fee shifting" by the lower courts' outcome: "We acknowledge [the Clinic's] concerns with the financial incentives in the peer-review industry and with the fact that litigation costs incurred by providers may discourage legitimate challenges. The fee accruals here – in the amount of $27,000 to vindicate a $1380 claim - present a stark example of the difficulty. . . . Nevertheless, fee shifting raises a host of mixed policy considerations in and of itself, which this Court has found are best left to the General Assembly, in the absence of contractual allocation or some other recognized exception to the general, American rule." View "Herd Chiropractic Clinic v. State Farm Mutual Automobile Ins. Co." on Justia Law

Dean Pepper, the owner and sole shareholder of D.F. Pepper Construction (DFP) was driving one of his trucks home in the early winter morning. An icy road caused the truck to slide into Pepper's house and crash through the foundation and west wall. The house was later condemned and demolished as a result of the damage. The house was insured by Nationwide Casualty Insurance Company. Nationwide paid the loss. As subrogee of Pepper, Nationwide then sued DFP, the registered owner of the truck, alleging vicarious liability for the negligence of its employee, Pepper. The superior court issued judgment in favor of Nationwide, finding that Pepper had been negligent and that the antisubrogation rule did not apply in this case. The Supreme Court affirmed, holding that the trial court did not err in its judgment. View "Nationwide Prop. & Cas. Ins. Co. v. D.F. Pepper Constr., Inc." on Justia Law

The Fund, a multi-employer pension plan under ERISA, has a Plan, providing for administration by a Board with authority to make benefit determinations and amend the Plan, including retroactively. No amendment may result in reduced benefits for any participant whose rights have vested, except in specified circumstances. Price began receiving Plan disability benefits under the “Total and Permanent Disability Benefit” category in 1990, after work-related injuries left him unable to work. In 2001, the Fund notified Price that he no longer qualified for benefits under this category, but that he could continue receiving benefits under provisions for “Occupational Disability Benefit.” His benefits were discontinued after 2006, according to an Amendment. Price became eligible for early retirement in 2012. The Board rejected an appeal. The district court granted Price judgment in his suit under ERISA, 29 U.S.C. 1132(a)(1)(B). On remand from the Sixth Circuit, for review determination of vesting under the arbitrary and capricious standard, the judge again ruled in favor of Price. The Sixth Circuit again reversed; the court failed to look to the terms of the plan but instead found that because the Board’s decision letter did not discuss whether the benefits vested, the Board’s decision was arbitrary and capricious. View "Price v. Bd. of Trs. of IN Laborers' Pension Fund" on Justia Law

Pro se appellant Holly Noel-Liszkiewicz appealed a superior court's decision to affirm the Industrial Accident Board's denial of her claim for worker's compensation benefits. Appellant was a customer service representative for Employer La-Z-Boy before being laid off. Almost two years after the lay off, Appellant petitioned the board seeking compensation for occupational asthma, pulmonary fibrosis, and respiratory failure allegedly caused by exposure to chemicals at La-Z-Boy’s facility. La-Z-Boy denied that Applicant suffered any illness or injury that was causally related to her work. Finding Appellant's arguments to be without merit, the Supreme Court affirmed both the Board and the superior court. View "Noel-Liszkiewicz v. La-Z-Boy" on Justia Law