Justia Insurance Law Opinion Summaries

In the workers' compensation case underlying this interlocutory appeal, Employee and Employer were unable to reach a resolution. A benefit review report submitted at 10:25 a.m. on October 20, 2011 memorialized the impasse. On the same day, Employee filed a complaint seeking workers' compensation benefits in the chancery court. The time stamp affixed by the court clerk indicated the complaint was filed at 10:22 a.m. In response to Employee's complaint, Employer filed a motion to dismiss for lack of jurisdiction, arguing that Employee's complaint had been filed prematurely. After Employee filed affidavits averring he did not file the complaint until after he received the benefit review repor, the chancery court determined it had subject matter jurisdiction and denied the motion to dismiss. The Supreme Court reversed, holding (1) a complaint may not be filed until the time noted on the benefit review report; and (2) when a complaint bears an unambiguous time stamp, it shall be deemed filed t the time indicated, and the time stamp may not be impeached by extrinsic evidence. View "Word v. Metro Air Servs., Inc." on Justia Law

Miller, a Fund beneficiary, fell from a ladder and was injured. He hired attorney Darr on a contingent fee basis to sue the person who was supposed to hold the ladder. The Fund advanced $86,709.73 in medical and disability benefits on the condition that Miller repay from any recovery, without deducting attorneys’ fees. Miller and Darr, signed a subrogation agreement. The lawsuit settled for $500,000. Calculating his fee based on $413,290.27, Darr submitted $57,806.48 to the Fund, stating that he was withholding $28,903.25 as a fee. To avoid jeopardizing Miller’s benefits Darr later submitted the $28,903.25. The Fund indicated that if Darr pursued his claim, it would consider Darr and Miller in breach of Plan terms and in repudiation of the subrogation agreement and would consider terminating coverage and seeking relief under ERISA. Darr sued the Fund in Illinois state court under the common fund doctrine, which permits a party who creates a fund in which others have an interest to obtain reimbursement for litigation expenses incurred in creating that fund. The district court enjoined Darr’s lawsuit. The Seventh Circuit vacated. A federal court may not enjoin “proceedings in a State court except as expressly authorized by Act of Congress, or where necessary in aid of its jurisdiction, or to protect or effectuate its judgments,” 28 U.S.C. 2283.View "Trs. of the Carptenters' Health & Welfare Trust v. Darr" on Justia Law

Ronald Bole appealed a superior court's order that affirmed an arbitration award that denied him recovery of underinsured motorist benefits. The Supreme Court allowed the appeal to determine whether the rescue doctrine allowed a volunteer firefighter responding to a crash to recover despite finding his injuries were the result of a superseding cause. Upon review, the Supreme Court concluded that Bole could not, and did not disturb the arbitrator's determination. View "Bole v. Erie Insurance Exchange" on Justia Law

James Mickelson appealed a judgment affirming a Workforce Safety and Insurance ("WSI") decision denying his claim for workers' compensation benefits. He argued WSI erred in deciding he did not suffer a compensable injury. Upon review, the Supreme Court concluded WSI misapplied the definition of a compensable injury, and the Court reversed and remanded for further proceedings. View "Mickelson v. Workforce Safety & Ins." on Justia Law

Swanson hired ISF for steel fabrication work on an Indiana construction project. ISF hired Central to perform steel erection work. ISF and Central signed a subcontract in which Central agreed to procure insurance and to “defend, indemnify and hold harmless.” Central purchased insurance from Scottsdale: a $1 million commercial general liability policy and a $2 million umbrella insurance policy. ISF also carried $1 million in commercial general liability coverage from Amerisure and $7 million in umbrella coverage from National. Colip, a Central employee, was injured at work when he fell 30 feet through a hole in a building roof. Colip settled with ISF for $2.9 million, and the insurers paid according to an agreement that provided that Scottsdale would pay $1 million out of the CGL policy and $950,000 out of the Umbrella policy, while Amerisure would pay the remaining $950,000. Initially, National had no obligation to contribute. The agreement reserved the rights of the parties to seek reimbursement or contribution from each other. Amerisure sued Scottsdale and Central; Scottsdale filed counter- and cross-claims against Amerisure and National. The district court dismissed Central from the litigation and awarded Scottsdale $50,000 from Amerisure and the remaining $900,000 from National. The Seventh Circuit affirmed. View "Scottsdale Ins. Co. v. Nat'l Sur. Corp." on Justia Law

The original opinion in this case was filed on June 15, 2012. Because this Texas diversity law case involved important and determinative questions of Texas law as to which there is not controlling Texas Supreme Court precedent, the panel withdrew the previous opinion and substituted the following certified questions to the Texas Supreme Court: (1) Does a general contractor that enters into a contract in which it agrees to perform its construction work in a good and workmanlike manner, assume liability for damages arising out of the contractor's defective work so as to trigger a contractual liability exclusion in a CGL insurance policy; and (2) if the exclusion is triggered, do the allegations in the underlying lawsuit alleging that the contractor violated its common law duty to perform the contract in a careful, workmanlike, and non-negligent manner fall within the exception to the contractual liability exclusion for "liability that would exist in the absence of contract." View "Ewing Constr. Co. v. Amerisure Ins. Co." on Justia Law

Perks applied for disability insurance benefits and supplemental security income under Titles II and XVI of the Social Security Act. An ALJ denied Perks's application. On appeal to the appeals council, Perks submitted additional evidence. The appeals council noted the receipt of the additional evidence but denied further review of Perks's claim. The district court affirmed. The Eighth Circuit Court of Appeals affirmed, holding (1) substantial evidence supported the ALJ's finding that Perks was not disabled; and (2) the additional evidence submitted to the appeals council did not undermine the ALJ's determination, as the ALJ would not have reached a different result with the additional evidence and the ALJ's decision was supported by substantial evidence in the record as a whole. View "Perks v. Astrue" on Justia Law

After its property sustained wind damage during Hurricane Katrina, a real-estate developer sued its insurance provider for coverage, and, in the alternative, its insurance agent for professional negligence. The district court decided that the insurance policy covered wind damage, and a jury decided that there had been no "mutual mistake" between the agent and the provider concerning wind coverage. As a consequence, the district court dismissed with prejudice the developer's negligence claim against its agent. The insurance provider appealed, and the Fifth Circuit Court of Appeals reversed, deciding that the policy did not cover wind damage. On remand, the developer moved under Fed. R. Civ. P. 60(b) to set aside the dismissal of its professional negligence claim against the agent in light of the reversal. The district court granted the motion and resurrected the negligence claim against the agent. The Fifth Circuit affirmed, holding that the district court did not abuse its discretion in granting the developer Rule 60(b) relief. View "Lowry Dev., LLC v. Groves & Assocs. Ins., Inc." on Justia Law

The underlying personal injury case stemmed from an injury suffered by Dentist on the premises of Condominium. Condominium had general liability coverage issued by Primary Insurer and excess coverage through Excess Carrier. Dentist sued Condominium which submitted the cause to Primary Insurer to provide a defense. The jury awarded Dentist $1,654,663. Condominium demanded that Excess Carrier pay the amount in excess of the primary coverage amount. Excess Carrier contested coverage for late notice, contending it did not have notice of the personal injury action until the day of the verdict. Sister Company to Primary Insurer paid the remaining amount under its supersedeas bond after Excess Carrier denied responsibility for that amount. Sister Company allowed Primary Insurer to bring this lawsuit against Excess Carrier in Sister Company's name. At issue on appeal was whether the failure to give Excess Carrier notice prior to the jury verdict forfeited coverage it would otherwise owe. The district court granted summary judgment in favor of Sister Company. The Fifth Circuit Court of Appeals reversed and remanded, holding that, under the facts of this case, the failure to give notice to Excess Carrier until after an adverse jury verdict constituted evidence of prejudice that forfeited coverage. View "Berkley Reg. Ins. Co. v. Philadelphia Indem. Ins. Co." on Justia Law

Plaintiff Marnita Goddard was injured while riding on a trolley operated by the city of Deadwood, South Dakota. Invoking diversity jurisdiction, Goddard sued the city for negligence and the South Dakota Public Assurance Alliance (SDPAA) for uninsured motorist coverage. After Goddard settled with the city, the district court granted summary judgment in favor of SDPAA, concluding that Goddard was not covered under the uninsured motorist provision in the city's agreement with SDPAA. The Eighth Circuit Court of Appeals affirmed, holding that Goddard had not shown she was entitled to coverage under the uninsured motorist provision of the SDPAA agreement. View "Goddard v. S.D. Pub. Assurance Alliance" on Justia Law