Justia Insurance Law Opinion Summaries

In 2008, Craig Ali was a police officer for appellant, the village of Oakwood. That spring, his department assigned him to perform traffic-control duties on a highway-construction project overseen by appellee, Kokosing Construction Company, Inc. Ali was injured while performing those duties. At issue was which entity was Ali's employer for purposes of his workers' compensation claim. A district hearing officer with the Industrial Commission of Ohio found that Kokosing was Ali's employer at the time of injury. A staff hearing officer reversed, finding the correct employer was Oakwood Village. The Supreme Court affirmed, holding (1) the commission, when confronted with two potential employers, may, but is not required to, use any of the State ex rel. Lord v. Daugherty and Fisher v. Mayfield factors it believes will assist analysis; (2) therefore, the commission did not abuse its discretion by not directly discussing the three enumerated Lord/Fisher factors; and (3) the staff hearing officer's decision was supported by evidence in the record. View "State ex rel. Oakwood v. Indus. Comm'n" on Justia Law

The passenger of a car was injured in a two-car accident. The passenger brought suit against the other car's driver; the passenger's requested recovery included her insurer's subrogation claim for medical expenses. The driver made an early offer of judgment, which the passenger rejected. The driver then paid the subrogation claim, thereby removing it from the passenger's expected recovery. The driver then made a second offer of judgment, which the passenger rejected, and the case proceeded to trial. After trial the jury awarded the passenger damages and both parties claimed prevailing party status; the driver sought attorney's fees under Alaska Civil Rule 68. The superior court ruled the first offer of judgment did not entitle the driver to Rule 68 fees, but the second offer did. Both parties appealed, arguing the superior court improperly considered the subrogation claim in its Rule 68 rulings. Upon review, the Supreme Court concluded the subrogation payment had to be taken into account when evaluating the first offer of judgment, but not the second. The Court therefore affirmed the superior court's rulings. View "Dearlove v. Campbell" on Justia Law

The two plaintiffs in this case, Wisconsin Public Service Corporation (WPSC) and Associated Electric & Gas Insurance Services Limited (AEGIS), brought suit against the defendant, Arby Construction, Inc. (Arby), for indemnification of the damages that the plaintiffs paid in the settlement of a tort suit in federal court. The circuit court dismissed the AEGIS claim against Arby on the basis of claim preclusion. At issue on appeal was whether AEGIS raised, in the form of an affirmative defense, a cross-claim against Arby in the prior federal action and was therefore precluded from pursuing the same claim in this action because the claim was adjudicated in the federal judgment of dismissal. The Supreme Court affirmed the court of appeals, which affirmed the circuit court, holding that AEGIS's claim was raised, in substance, in the prior federal action and was decided. Therefore, the claim was subject to claim preclusion and was properly dismissed by the circuit court. View "Wis. Pub. Serv. Corp. v. Arby Constr., Inc." on Justia Law

In this case the Supreme Court was asked to decide whether a charitable hospital may pursue payment for medical care provided to a Medicaid-eligible patient by filing a lien against a settlement between the patient and an insurance company covering the liability of a tortfeasor responsible for the patient's injuries. To answer the question, the Court balanced the complex state and federal legal framework surrounding Medicaid with Wis. Stat. 779.80 (hospital lien statute). The Court concluded that the soundest harmonization of the two permitted the liens at issue here. In so doing, the Court reversed the court of appeals, which reversed the circuit court's reasoning that the hospital was authorized to either file the liens or bill Medicaid. View "Gister v. Am. Family Mut. Ins. Co." on Justia Law

An injured employee (Employee) sought workers' compensation benefits for a work-related injury. A claims adjuster with Employer's workers' compensation insurer's (Insurer) third party administrator denied the claim. The Division of Workers' compensation determined that Employee was entitled to medical and temporary income benefits. Employee subsequently brought a bad faith action against Insurer, its third party administrator, and the claims adjuster (Defendants). During discovery, Employee sought communications made between Insurer's lawyer and Employer during the administrative proceedings. Defendants argued that the attorney-client privilege protected the communications. The trial court held that the privilege did not apply. The court of appeals subsequently denied mandamus relief. The Supreme Court affirmed, holding that the attorney-client privilege did not protect the communications between Insurer and its insured. View "In re XL Specialty Ins. Co." on Justia Law

This suit was filed by a daughter against an organ donation charity when she discovered that the charity - contrary to an earlier representation to her - would allegedly profit from harvesting her deceased mother's tissues. The charity requested a defense from its insurer, and the insurer denied a defense. The insurer's subsequent suit against the charity resulted in two certified questions from the Fifth Circuit Court of Appeals. The Supreme Court held (1) the insurance policy provision for coverage of "personal injury" does not include coverage for mental anguish, unrelated to physical damage to or disease of the daughter's body; and (2) the insurance policy provision for coverage of "property damages," does not include coverage for the underlying plaintiff's loss of use of her deceased mother's tissues, organs, bones, and body parts. View "Evanston Ins. Co. v. Legacy of Life, Inc." on Justia Law

Employee suffered an injury during the course of his employment that was compensable under the Texas Workers' Compensation Act. Petitioner insurance company provided workers' compensation coverage to Employee's employer. Petitioner disputed the impairment rating of twenty percent assigned by the doctor in the administrative proceedings. A hearing officer issued a decision finding that Employee had an impairment rating of twenty percent. The Division of Workers' Compensation upheld the decision. Petitioner appealed. The trial court granted Employee's plea to the jurisdiction and dismissed the case. The court of appeals affirmed. At issue on appeal was whether a reviewing court lacks subject matter jurisdiction to resolve an impairment rating appeal if the only rating presented to the agency was invalid. The Supreme Court reversed, holding that the absence of a valid impairment rating does not deprive the court of jurisdiction. Remanded. View "Am. Zurich Ins. Co. v. Samudio" on Justia Law

Plaintiffs Joseph and Josephine Iozzi owned a home located in Cranston. On October 15, 2005, excessive rainfall overwhelmed the sewer system servicing the Iozzis's home, causing water and sewage to back up and enter their basement, resulting in extensive damage to their home and personal property. Plaintiffs filed suit seeking declaratory relief and compensatory damages from Triton Ocean State, LLC (Triton); U.S. Filter Operating Services, Inc. (Veolia); and Peerless Insurance Company (Peerless). The complaint alleged that Triton and Veolia were jointly and severally liable for negligently "operating, maintaining and repairing the sewer disposal system" in the city. As to Peerless, the complaint alleged that it was liable for breach of contract for rejecting plaintiffs' claim for damages under their homeowner's insurance policy. Peerless moved for summary judgment arguing that the language in the homeowner's policy was clear and unambiguous and excluded coverage for the claims Plaintiffs made. Triton and Veolia filed a joint motion for summary judgment arguing that neither of them had a contractual or common-law responsibility to Plaintiffs for the damage to their property because a lease service agreement with the City of Cranston relieved them of responsibility for the damage and because the flooding that caused Plaintiffs' damages was caused by an "Act of God." Agreeing with the superior court's reasoning for granting defendants' motions for summary judgment, the Supreme Court affirmed dismissal of Plaintiffs' case. View "Iozzi v. City of Cranston" on Justia Law

This appeal arose out of Ryan Dorman's petition for an extension of his worker's compensation temporary total disability (TTD) benefits and for reimbursement of travel expenses incurred in travelling from Idaho to Cheyenne to obtain medical care. In May 2006, Dorman sought treatment from an Idaho physician for treatment of his alleged work-related injury. Due to the nature of Dorman's injury, he consulted multiple physicians, first in Idaho, then in Wyoming. With each consultation, the doctors indicated that the injury was outside of their scope of expertise, and referred Doman to another specialist. During the period that Dorman was changing physicians, the Division and Dorman negotiated a stipulation concerning his TTD benefits and other benefits. This followed OAH and district court decisions that largely reversed the Division's earlier determinations concerning TTD benefits and Dorman's need for continued medical treatment. The Stipulated Order also provided that medical benefits would be paid as directed by the district court's order. After the Division paid the stipulated TTD benefits, Dorman submitted a letter to the Division requesting extended benefits The Division thereafter issued a final determination denying them, and further denied several applications for travel expense reimbursement for Dorman's trips to Idaho and Cheyenne. The matters were referred to the OAH where a combined hearing was held on the denial of TTD benefits, denial of travel reimbursement, and denial of diagnostic testing related to Dorman's injury. The OAH upheld the denial of TTD benefits on the ground that Dorman had failed to make the required showing that the Idaho and Cheyenne doctors were the closest available medical providers. Dorman appealed the portion of the OAH order denying extended TTD benefits and travel reimbursement to the district court. Upon review, the Supreme Court affirmed the OAH denial of the travel reimbursement: Dorman could not prove that reimbursement of travel expenses was not supported by substantial evidence and in accordance with law. View "Dorman v. Wyoming" on Justia Law

This case arose from a fatal motorcycle accident in which Steven Wadzinski was struck and killed by an uninsured motorist. Steven's wife, Michelle, sought uninsured motorist (UM) coverage under an umbrella insurance policy that Steven's company carried on him at the time of his death. At issue was the meaning of an endorsement to the executive umbrella policy, and whether that endorsement caused contextual ambiguity such that a reasonable insured would expect $2,000,000 of UM coverage under the policy. The circuit court held that the executive umbrella policy was clearly intended to provide only third-party liability coverage and granted summary judgment in favor of Auto-Owners Insurance Company. The court of appeals reversed, concluding that the executive umbrella policy was contextually ambiguous, and therefore, the policy should be construed in favor of the insured to afford coverage. The Supreme Court reversed, concluding that the policy at issue unambiguously did not afford first-party UM coverage, and therefore, the circuit court's summary judgment in favor of Auto-Owners was proper. View "Wadzinski v. Auto-Owners Ins. Co." on Justia Law