Justia Insurance Law Opinion Summaries

Law Firm represented Employee in a workers' compensation action against Employee's Employer. After a trial, Employee was awarded compensation, including medical expenses incurred by Employee with Medical Clinic. Employer paid sums owed to Medical Clinic pursuant to the award. Law Firm subsequently filed a complaint against Medical Clinic, seeking attorney fees under the common fund doctrine. Following a hearing, the district court dismissed Law Firm's complaint, concluding that Law Firm was not permitted to recover attorney fees from Medical Clinic under the doctrine. The Supreme Court affirmed, holding (1) the plain language of Neb. Rev. Stat. 48-125(2)(a) prohibits the charging of attorney fees against medical providers in workers' compensation court; and (2) the common fund doctrine may not be applied in this case to allow Law Firm a fee from Medical Clinic from the district court when it would not be entitled to such a fee from the workers' compensation court. View "Walentine, O'Toole, McQuillan & Gordon, LLP v. Midwest Neurosurgery, PC" on Justia Law

Employee was injured while in the course of scope of his employment through the actions of a third-party tortfeasor (Tortfeasor). Employee filed a claim for workers' compensation benefits and a lawsuit against Tortfeasor. Employer intervened in the lawsuit to protect its subrogation lien against any recovery from Tortfeasor. Employee settled the lawsuit with Tortfeasor and dismissed the case. Employer filed a motion to set the case for trial, asserting that it was entitled to a lien against the settlement proceeds for the cost of future medical benefits that may be paid on behalf of Employee. After initially setting the case for trial, the trial court dismissed for failure to state a claim. The court of appeals reversed and remanded, concluding that future medical expenses are not too speculative as a matter of law to be included in an employer's lien against the proceeds of a suit against a third-party tortfeasor. The Supreme Court reversed, holding that Employer failed to state a claim for which relief can be granted, as Employer's subrogation lien against the proceeds of the settlement did not extend to the cost of future medical benefits to which Employee may be entitled. View "Cooper v. Logistics Insight Corp." on Justia Law

Ryan Price-Williams sued Admiral Insurance Company and Gabriel Dean and Charles Baber in Circuit Court pursuant to Alabama's direct-action statute. Both Dean and Baber were alleged by Price-Williams to be covered under a commercial general-liability insurance policy Admiral had issued the national Kappa Sigma fraternity to which Dean and Baber belonged. Price-Williams alleged that Admiral was obligated to pay a judgment that had been entered in favor of Price-Williams and against Dean and Baber in a previous action. Following a bench trial, the trial court entered a judgment in favor of Price-Williams and against Admiral, holding that the Admiral policy provided coverage to Dean and Baber for the negligent and/or wanton acts that formed the basis of the underlying action. Price-Williams sued Admiral after obtaining a judgment against Dean and Baber, who he alleged were insured by Admiral under a policy Admiral had issued to Kappa Sigma, by virtue of their positions as officers of the local chapter of Kappa Sigma. Following another bench trial, the trial court entered a judgment in favor of Price-Williams, obligating Admiral to fulfill the judgment entered against Dean and Baber in the underlying action. Because the evidence presented at trial supported the trial court's conclusion that Admiral's policy with Kappa Sigma provided liability coverage to Dean and Baber with regard to the negligence and wantonness claims tried in the underlying action, the Supreme Court affirmed that judgment. View "Admiral Insurance Company v. Price-Williams " on Justia Law

Hentz is an accountant with a firm employed by pension funds to perform accounting and auditing services. The firm possessed a compact disc containing confidential and protected information, including the names, birth dates, and Social Security numbers of approximately 30,000 participants and beneficiaries of the funds. The firm agreed in writing to ensure that it would safeguard the information on the compact disc. Hentz placed the compact disc in a laptop, put the laptop in her personal vehicle, and parked in the open at her residence. The laptop and disc were stolen. The funds incurred nearly $200,000 in credit monitoring and insurance expenses and sued Hentz, who tendered the defense to Nationwide, which had written her homeowner’s insurance policy. Nationwide obtained a declaration that it had no duty to defend or indemnify Hentz because the policy does not cover damage to property rented to, occupied or used by or in the care of the insured or arising out of or in connection with a business conducted from an insured location or engaged in by an insured, whether or not the business is owned or operated by an insured or employs an insured. The Seventh Circuit affirmed. View "Nationwide Ins. Co. v. Central Laborers' Pension Fund" on Justia Law

Appellant suffered extensive injuries while riding a motorcycle that was hit by a vehicle driven by Tortfeasor. Appellanat recovered $100,000 from Tortfeasor's insurance company, which left Appellant with $1.4 million in unpaid damages. Appellant sought additional recovery under the underinsured motorist coverage endorsement of the American Family policy he had purchased for the motorcycle and under the underinsured motorist coverage endorsements of each of the additional American Family insurance policies he had purchased for his two trucks. He also sought recovery as an additional insured on the American Standard policy his father maintained for a motorcycle. Both insurers denied coverage under all of these four policies. Appellant then joined both insurers as additional defendants, claiming he was entitled to $400,000 in underinsured motorist coverage under the four policies. The trial court granted summary judgment in favor of the insurers, holding that the policies' owned-vehicle exclusions unambiguously applied to the motorcycle he was riding at the time of the accident. The Supreme Court reversed, holding (1) Tortfeasor's vehicle was an underinsured motor vehicle; (2) the insurers failed to show that the owned-vehicle exclusion applied; and (3) the "other insurance" clause permitted stacking of the underinsured motorist coverage, and offset was not permitted. View "Manner v. Schiermeier" on Justia Law

A railroad employee sued his employer, DM&E, after he was injured while working as the employee-in-charge of a construction site. DM&E then brought a third-party complaint against Corman, contending that Corman was required to indemnify and defend it against the employee's Federal Employers' Liability Act (FELA), 45 U.S.C. 51-60, claim pursuant to a contract between the parties. Nothing in the Contract Work Agreement (CWA) indicated that it extended to claims which were unrelated to Corman's common-law negligence. The indemnity clause in the CWA did not mention the FELA. Therefore, the court held that DM&E had not shown any issues of material fact existed and therefore no negligence could be attributed to Corman. The court also held that the indemnification provision in the CWA did not trigger the insured contract exception to the general exclusion provision contained in the Lexington Insurance policy, and, as a result, no obligation existed based on the terms of the policy. View "Dakota, MN & Eastern R. R. v. R. J. Corman R. R. Construction" on Justia Law

The Supreme Court granted allowance of appeal in this consolidated case to consider whether a plaintiff may recover delay damages on the full amount of a jury verdict in his favor, or whether delay damages are limited to the amount of the legally-recoverable molded verdict, as it was adjusted by the trial court to reflect insurance policy limits. This case stemmed from a 2002 accident in which the vehicle operated by Richard and Marleen Marlette, stopped in traffic, was hit when vehicle operated by Herman Jordan crossed the center line and sideswiped them. Mr. Marlette sustained serious physical injuries, as well as lost wages and impairment of his earning capacity. The Marlettes filed suit against Jordan, who was uninsured, and their own insurer, State Farm Mutual Automobile Insurance Company ("State Farm"), for uninsured motorist ("UM") coverage. Liability was uncontested, and the case proceeded to trial on damages. Upon review of the matter, the Supreme Court concluded that a plaintiff may recover delay damages only on the amount of legally-recoverable damages to which he is entitled pursuant to the molded verdict. The Court remanded the case to the Superior Court for remand to the trial court for reinstatement of its original award of delay damages. View "Marlette v. State Farm Mutual Automobile Ins. Co. " on Justia Law

The issue before the Supreme Court in this case stemmed from the grant of summary judgment in favor of an insurance company. The insureds contended that the liability coverage provision in their homeowner's policy required the insurer to defend a lawsuit brought by a contractor they hired to repair fire damage to their home and to remodel the home, and that the insurer was required to indemnify against any recovery by the contractor. Upon review of the policy underlying this case, the Supreme Court found no such duties as the insureds contended and affirmed the district court's judgment. View "Linford v. State Farm Fire & Casualty" on Justia Law

In 2005, Applicant Michael Benson made an application to Leader Life for a life insurance policy, naming his wife Shannon, as Beneficiary. The application asked if the applicant had ever been treated for liver disease, had any medical or surgical treatment in the last five years or any departure from good health and whether or not the applicant had ever had an alcohol or drug problem. Applicant answered yes to the departure from good health question and told the insurance company that he had a blood clot in his leg 2003. Applicant answered no to the Liver disease question and no to the alcohol question. Leaders Life accepted his answers and issued the underlying policy in this action. In 2006, Applicant was on foot, pushing a stalled car out of the street when he was struck by another vehicle which eventually resulted in his death. His wife filed for benefits under the policy. Leaders investigated the claim. They received the hospital records pertaining to his death, which also noted his blood alcohol at his time of death, although the owner of the car testified that he smelled no alcohol on the applicant. After reviewing the records, Leaders Life's underwriter concluded that Applicant falsified his answers on his application and rescinded the policy due to Applicant's alcoholism. Certiorari was granted to review the Court of Civil Appeals opinion that reversed and remanding the case following a jury verdict in Applicant's favor. Leaders Life appealed the trial court and won on appellate review. After its review, the Supreme Court found that at trial, Leaders Life made clear that they believed there were material misrepresentations made by Applicant, and that he attempted to deceive them. However, the trier of fact, the jury did not find that such a misrepresentation had been made. They decided in favor of the beneficiary, and awarded her actual and in punitive damages. The Supreme Court declined substitute its judgment for that of the jury under the case law presented by this suit. Accordingly, the Court reinstated the trial court's judgment and vacated the appellate court's opinion. View "Benson v. Leaders Life Insurance Co." on Justia Law

When Cody Metheny underwent brain surgery, the physician (Doctor) mistakenly operated on the wrong side of his brain. Fifteen months later, Cody's parents (the Methenys) learned tissue had been removed from the wrong side of Cody's brain. The Methenys filed a direct-action suit, alleging medical negligence on the part of Hospital where Doctor practiced and against Hospital's liability-insurance carrier (Insurer). The jury returned a verdict in favor of the Methenys. Insurer appealed, arguing that the circuit court erred in (1) failing to instruct the jury in a manner that would allow it to apportion liability among it and certain physicians who were sued in a prior case but ultimately settled; (2) refusing to allow Insurer to present evidence of fault attributable to the settling physicians; and (3) denying Insurer's motion for judgment notwithstanding the verdict where the evidence supporting Cody's future damages was based on improperly bundled calculations. The Methenys cross-appealed the circuit court's order reducing the jury's verdict from $20 million to $11 million. The Supreme Court affirmed on direct appeal and cross-appeal, holding that the circuit court did not err in its judgment. View "ProAssurance Indem. Co. v. Metheny" on Justia Law