Justia Insurance Law Opinion Summaries

The plaintiff-appellants, Bruce Bermel and Pamela Jurga, as husband and wife, appealed the final judgment of the Superior Court granting the motion for summary judgment of the defendant-appellee, Liberty Mutual Fire Insurance Company. The appellants contended that the Superior Court erred by granting summary judgment in favor of Liberty. Bermel was injured in an automobile accident when his personal motorcycle was struck head-on by another driver. Bermel, then an employee of the Siemens Corporation, contended that the business policy issued to Siemens by Liberty on a company car that was assigned for his business and personal use, provided him with $100,000 in underinsured motorist coverage even when he was operating a non-work vehicle in circumstances unrelated to his employment. Bermel brought this action for underinsured benefits (“UIM”) against Liberty arguing: (1) that the Liberty Policy covering the company car he used was personal to him, even though Siemens was the named insured; (2) that he was entitled to personally access the Liberty Policy because Siemens automatically deducted a nominal fee from his paycheck for his personal use of the vehicle assigned to him that was insured by the Liberty Policy; and (3) that the Liberty Policy was ambiguously drafted and should have been construed in his favor. Upon review, the Supreme Court concluded that the Superior Court correctly found Siemens, and not Bermel, to be the named insured on the Liberty Policy, that the nominal fee charged to Bermel by Siemens for the use of the car did not make Bermel a named insured under the Liberty Policy, and that the Liberty Policy was unambiguous. Therefore, the judgments of the Superior Court were affirmed. View "Bermel v. Liberty Mutual Fire Insurance Co." on Justia Law

Plaintiff's vehicle was rear-ended by Driver's vehicle. Plaintiff sued Driver and settled with his insurer for $50,000, the maximum of Driver's automobile liability policy. Plaintiff then sought an additional $50,000 under her underinsured motorist (UIM) policy with State Farm. State Farm declined to award the requested amount. Following trial, the jury returned a verdict in favor of Plaintiff in the amount of $50,000. The trial court declined Plaintiff's motion for prejudgment interest pursuant to the Tort Prejudgment Interest Statute (TPIS). Plaintiff appealed the trial court's denial of her motion for prejudgment interest. The Supreme Court affirmed, holding (1) the TPIS does apply to UIM coverage disputes; (2) because prejudgment interest is a collateral litigation expense, it can be awarded in excess of an insured's UIM policy limits; but (3) Plaintiff was not entitled to prejudgment interest because the trial court acted within its discretion when it denied her request for prejudgment interest. View "Inman v. State Farm Mut. Auto. Ins. Co." on Justia Law

Petitioner Vincent James Hogg, Sr. sought review of a Workers' Compensation Court order which denied his workers' compensation benefits based upon the court's interpretation of 85 O.S. 2011, section 312 (3). Petitioner was employed by the Oklahoma County Juvenile Detention Center when in late 2011, he sustained an injury to his right shoulder and neck while subduing an unruly and combative juvenile. Petitioner was given a post-accident drug screen and a follow-up screen the next day. Both screens showed a "positive" result for the presence of marijuana in his system. Petitioner did not dispute the test results but Petitioner denied ever smoking marijuana. The trial court ultimately found there was no evidence presented to establish Petitioner was "high," nor was there any evidence to establish the marijuana in his system was the "major cause" of the accidental injury. The trial court did, however, deny Petitioner's eligibility for workers' compensation benefits by reason of its interpretation of the newly created 85 O.S. 2011, section 312 (3). The dispositive issue presented to the Supreme Court was whether the trial court erred in its interpretation of the statute. The trial court found the last sentence of paragraph 3 expressed the legislative intent of the entire paragraph without giving any weight to the other sentences in the same paragraph. In its order, the trial court indicated this sentence created an irrebuttable presumption. Upon review, the Supreme Court disagreed. The Court concluded that Petitioner overcame the rebuttable presumption of ineligibility for workers' compensation benefits. The case was reversed and remanded for further proceedings. View "Hogg v. Oklahoma Cty. Juvenile Bureau" on Justia Law

While driving a car owned by her divorced parents, Plaintiff was hit and injured by an uninsured drunk driver. Plaintiff's father's policy specifically covered Plaintiff's car and paid Plaintiff $100,000 in uninsured motorist benefits. This amount did not fully compensate Plaintiff for her injuries, however, and Plaintiff filed a claim under her mother's policy with Farmers Mutual Insurance Company of Nebraska (Insurer). The policy did not specifically cover Plaintiff's car but covered Plaintiff as an insured. Farmers denied Plaintiff's claim for uninsured motorist benefits under an "owned-but-not-insured" exclusion in its policy. Plaintiff subsequently filed an action seeking a declaration that the "owned-but-not-insured" exclusion was void and that she was entitled to uninsured motorist benefits from Farmers. The circuit court granted summary judgment in favor of Farmers, concluding that the exclusion was valid and enforceable in relation to uninsured motorist coverage. The Supreme Court reversed, holding (1) the circuit court incorrectly applied the law when it used the Supreme Court's statements in previous cases to conclude that the exclusion was valid and enforceable under S.D. Codified Laws 58-11-9; and (2) the "owned-but-not-insured" exclusion was void in this case. View "Wheeler v. Farmers Mut. Ins. Co. of Neb." on Justia Law

Claimant Charles Prince filed a claim in the Workers' Compensation Court in 2009 alleging a cumulative trauma employment-related injury to his right foot, with date of last exposure in late 2008. The trial court found Claimant sustained a cumulative trauma injury to his right foot and ordered Employer, Brake Rebuilders & Friction Products, Inc., to select a physician to treat Claimant and to provide "such medical, surgical or other attendance or treatment, nurse and hospital service, medicine, diagnostic testing and referral as may be deemed necessary by the treating physician to the claimant's right foot." The court found his date of last exposure was late 2008. Claimant sought compensation for injury to his right foot, and later for his low back arising from the same injury. The trial court of the Workers' Compensation Court denied his claim for the low back, and a three judge panel affirmed. On appeal the Court of Civil Appeals (COCA) vacated the panel's order, holding the order was against the clear weight of the evidence. Upon review, the Supreme Court found that the denial of the award for Claimant's lower back was supported by competent evidence. COCA found more evidence in support of Claimant's low back injury, but Employer presented evidence from its medical expert which denied that the injury to either the low back or the right foot arose out of Claimant's employment. "The date of the injury determines the law to be used in a workers' compensation claim and applies equally to employers and claimants alike." Based on the Supreme Court's decision in "Williams Companies, Inc. v. Dunkelgod," (2012 OK 96 (2012)), and the law on the date of Claimant's injury, the opinion of the Court of Civil Appeals was vacated. View "Prince v. Brake Rebuilders & Friction Products, Inc." on Justia Law

Plaintiffs are five pension funds operated by the State of Ohio for public employees that invested hundreds of millions of dollars in 308 mortgage-backed securities (MBS) between 2005 and 2008, all of which received a “AAA” or equivalent credit rating from one of the three major credit-rating agencies. The value of MBS collapsed during this period, leaving the Funds with estimated losses of $457 million. The Funds sued under Ohio’s “blue sky” laws and a common-law theory of negligent misrepresentation, alleging that the Agencies’ ratings were false and misleading and that the Funds’ reasonable reliance on those ratings caused their losses. The district court dismissed. The Sixth Circuit affirmed. Even if a credit rating can serve as an actionable misrepresentation, the Agencies owed no duty to the Funds and the Funds’ allegations of bad business practices did not establish a reasonable inference of wrongdoing View "OH Police & Fire Pension Fund v. Standard & Poor's Fin. Servs., LLC" on Justia Law

The issue before the Supreme Court in this case centered on whether a Workers' Compensation employer's insurance carrier should be reimbursed from the Supersedeas Fund for specific payments made to a claimant prior to the ultimate grant of supersedeas. The question turned on whether the relevant payments constituted payments of "compensation" within the meaning of Section 443 of the Workers' Compensation Act (WCA), 77 P.S. 999(a), or, as argued by Appellant Bureau of Workers' Compensation, whether the payments are not reimbursable because they constitute payment of legal costs associated with obtaining a claimant's third-party tort settlement under Section 319 of the WCA, 77 P.S. 671. After review, the Court found no language in either Section 443 or Section 319 that would transform the relevant payments into something other than compensation merely because the amounts of the payments were calculated to compensate the claimant for the costs of recovering the third-party settlement. Accordingly, the Court affirmed the decision of the Commonwealth Court. View "Bureau of Workers' Comp, Aplt v. WCAB(Excelsior Ins.)" on Justia Law

Workers' compensation claimant Kristy Dunkelgod was injured in an employment-related accident in 2011 while working for Williams Companies, Inc. The Workers' Compensation Court entered several orders awarding claimant temporary total disability benefits. She was also awarded a "Go-Go" scooter and a lift van. On appeal by the employer, the Court of Civil Appeals vacated the awards, holding the court's finding the lift van was medically necessary was "against the clear weight of the evidence." The Court of Civil Appeals also held the claimant was limited to a maximum of 300 weeks of temporary total disability benefits and remanded for a determination of when she reached the maximum. The issues before the Supreme Court were: (1) whether the Court of Civil Appeals (COCA) err when it applied the "clear weight of the evidence" standard of review to the Workers' Compensation Court's order awarding a lift van; and (2) whether COCA erred when it held that Claimant's temporary total disability (TTD) award was limited to a maximum of 300 weeks. The Supreme Court answered both questions in the affirmative; COCA failed to apply the law in effect at the time of Claimant's injury. The Court vacated and remanded the case to the Workers' Compensation Court for further proceedings. View "Williams Companies, Inc v. Dunklegod" on Justia Law

The insurers provided law enforcement liability coverage to the city of Waukegan and its employees acting within the scope of employment. In 2009, Starks filed a civil rights suit against the city and some current and former police officers, among others, alleging that each played a role in his wrongful conviction for a 1986 crime. The insurers obtained a declaratory judgment that they have no duty to defend or indemnify. The Seventh Circuit affirmed, noting that the policies were not in effect at the time of the crime, that Starks was not exonerated during the period when the policies were in place, and that any outrageous conduct that might be grounds for a claim of intentional infliction of emotional distress also fell outside the policy dates. View "Northfield Ins.Co. v. City of Waukegan" on Justia Law

Appellant was injured in an accident that occurred during the course of her employment. After receiving a permanent partial impairment award from the Wyoming Worker's Compensation Division, Appellant sought permanent partial disability benefits. The Division denied Appellant's application, stating that she had not complied with the statutory work search requirements. After a contested case hearing, the Office of Administrative Hearings granted summary judgment for the Division, concluding that Appellant had not timely submitted documentation showing she had sought work. The district court affirmed. The Supreme Court reversed, holding (1) Appellant's work search submission was timely; and (2) Appellant was entitled to a hearing and the opportunity to present evidence showing that she actively sought work. View "Stallman v. State ex rel. Wyo. Workers' Safety & Comp. Div." on Justia Law