Justia Insurance Law Opinion Summaries

Several family members were injured in a car accident and divided the benefits paid by the tortfeasor's insurer. One family member, Hannah Lakes, also sought to recover under the underinsured motorist (UIM) endorsement of an insurance policy provided by Grange Mutual Casualty Company that applied to all the family members involved in the accident. The trial court granted Grange's motion for summary judgment, holding that the tortfeasor's vehicle was not underinsured because the per-accident limit of his policy was equal to the UIM coverage under the family members' policy. The Supreme Court reversed after reaffirming its decision in Corr v. American Family Insurance, holding that the tortfeasor's vehicle was underinsured because the amount actually paid to Lakes was less than the per-person limit of liability of the under-insurance endorsement.

The predecessor insurance companies to Plaintiff, Arrowood Indemnity Company, brought a declaratory judgment action in the U.S. district court claiming they did not have a duty to defend or to indemnify Defendants, the King family, for liability arising out of injuries sustained by a third party while the King's child was driving his parents' ATV on a private road in a private residential community, claiming that the accident had not occurred on an insured location and the Kings' notice of a claim was untimely. The district court rendered summary judgment in favor of Plaintiff. The Supreme Court accepted certification to answer questions of unresolved state law and concluded (1) with respect to a claim for negligent entrustment under a liability policy that provides coverage for accidents involving ATVs that occur on insured locations, the relevant location is the site of the accident; (2) the private road in this case did not fall under the coverage provision; and (3) social interactions between the insured and the claimant making no reference to an accident do not justify delayed notice, but an insurer must prove prejudice to disclaim its obligation to provide coverage based on untimely notice.

An insurer appealed from a decision related to an employee's injury in a metal rolling machine accident. The court concluded that the board was not arbitrary or capricious in deciding that there was insufficient evidence to find that the employee was entitled under G.L.c. 152, section 51 to compensation based on an amount greater than his average weekly wage. But the court concluded that the board erred in finding that the employee's compensation should be based on the average weekly wage he earned when injured in 1980 rather than the out-of-state average weekly wage he earned when that injury recurred in 2003. The court also affirmed the board's decision to vacate the denial of recoupment for the insurer's overpayment of temporary total disability benefits between 1985 and 1988, but noted that, should the insurer decide to renew its claim for recoupment in a separate complaint filed with the department, its claim could prevail only if recoupment was equitable in the circumstances.

Plaintiff-Appellant Allen Perius appealed a district court judgment following a jury verdict in favor of Appellee Nodak Mutual Insurance Company. In 2004, Plaintiff was involved in a motor vehicle accident with an uninsured driver, Jacob Kessler. Plaintiff insured his vehicle with Nodak for basic no-fault benefits and uninsured motorist benefits. Nodak paid Plaintiff no-fault benefits as a result of the accident. Plaintiff did not seek further medical treatment until March 2005, when he saw a chiropractor. Plaintiff submitted the bills to Nodak for payment as no-fault benefits. After Plaintiff submitted to an independent medical examination, Nodak denied him payment for any medical treatment after December 31, 2004, concluding such treatment was unrelated to the accident. In 2007, Plaintiff brought suit against Kessler, alleging he negligently operated his motor vehicle and caused Plaintiff's injuries. Plaintiff also sued Nodak, alleging the company breached its insurance contract with him. Nodak denied liability, and asserted a cross-claim against Kessler regarding Plaintiff's uninsured motorist claim. Kessler did not answer the claims against him. In 2009, Nodak moved for summary judgment, arguing no competent, admissible evidence established his claimed injuries were caused by the accident. Plaintiff resisted the motion, and submitted the affidavits of two of his treatment providers who stated their belief that Plaintiff's injuries and treatment were due to the accident. The district court granted Nodak's motion for summary judgment, and this Court reversed and remanded, finding disputed issues of material fact existed. A trial was set on remand. Shortly after, Plaintiff sent Nodak amended responses to Nodak's interrogatories. Prior to trial, Nodak was informed of Plaintiff's intent to call a chiropractor, as an expert witness. Nodak filed a motion in limine seeking to exclude the expert witness, alleging the expert was not properly disclosed.The district court granted Nodak's motion, but ordered the doctor would still be allowed to testify as a fact witness. The jury returned a verdict in Nodak's favor. The Supreme Court concluded that Plaintiff did not properly disclose his witness and that the district court did not abuse its discretion excluding the expert's testimony as a discovery sanction.

Appellant Michael Beall received preauthorization from the Wyoming Workers' Safety and Compensation Division for an orchiectomy, a procedure to remove his left testicle, which he claimed was related to a workplace injury. Beall's employer, Sky Blue Enterprises, objected to the preauthorization and the matter was referred to the Medical Commission Hearing Panel for a contested case hearing. Beall elected to undergo the surgery prior to the scheduled hearing. The Commission denied Beall's claim for reimbursement of medical expenses on the basis that the surgery was not reasonable or necessary medical care resulting from his workplace injury. The district court affirmed. The Supreme Court affirmed, holding (1) the burden of proving that the orchiectomy was reasonable and necessary medical care as related to Beall's alleged workplace injury rested with Beall; and (2) substantial evidence supported the Commission's determination that Beall failed to meet this burden.

Employee was allegedly involved in a work-related accident on property owned by Corporation. Insurer was Employer's insurance carrier. While paying Employee's workers' compensation benefits, Insurer filed suit against Corporation, asserting its right of subrogation. After the statute of limitations period had elapsed, Employee sought to intervene in Insurer's suit, and the circuit court granted Employee's request. Corporation subsequently moved for summary judgment on the ground that Haw. Rev. Stat. 386-8, which governs the right of an employee to intervene in an employer's third party liability lawsuit under workers' compensation law, did not allow an employee to intervene after the statute of limitations had expired. The circuit court granted Corporation's motion and entered judgment against Employee. The Supreme Court vacated the circuit court's judgment and remanded, holding that Employee could intervene in Insurer's action against Corporation because section 386-8 did not limit Employee's right to intervene in Insurer's timely filed lawsuit.

The Supreme Court granted certiorari to determine whether a "statement made or action taken" language in La. R.S. 17:439(A) precludes a cause of action against school employees for negligent acts of omission and to ascertain whether an action may be filed pursuant to La. R.S. 17:439(D) directly against a school employee for the negligent operation of a motor vehicle to the extent his or her liability is covered by insurance or self-insurance. Nakisha Credit, mother of Adrianne Breana Howard (Breana), sued on behalf of Breana's half-siblings and herself stemming from a fight Breana had on school grounds. Breana was involved in "an ongoing feud" with Courtney McClain. Breana was dropped off in the rear of Rayville High School after school had been dismissed for the day at Richland Career Center and began to walk home. Plaintiffs contend LeBaron Sledge instigated a fight between Breana and Courtney whereby the two girls began fighting on the sidewalk in the rear of the school. During the altercation, Breana was either pushed by Courtney or fell off the sidewalk, and was struck by an oncoming Richland Parish school bus. Breana died as a result of her injuries. Among other allegations, Plaintiffs' petition alleged Defendants the School District, State Farm Mutual Automobile Insurance Company, the school board's insurer, the school superintendent and the bus driver were negligent in a variety of ways by failing to supervise the children, failing to timely respond to the fight, and failing to adequately staff the bus area with teachers or school employees. Upon review, the Supreme Court reversed the appellate court's decision to hold that La. R.S. 17:439(A) precludes a cause of action against school employees for certain negligent acts, including acts of commission and acts of omission. The Court otherwise affirmed the court of appeal's ruling that La. R.S. 17:439(D) permits an action directly against a school bus driver for the negligent operation of a school bus to the extent the driver’s liability is covered by insurance or self-insurance.

Employee filed a workers' compensation claim against Employer. Employer's Insurer accepted liability for Employee's claim. Insurer contracted with third-party Adjuster to provide services for Employee's claim. Employee and Insurer disagreed over elements of the claim, and Attorney advised Insurer on various legal matters. The claim was eventually resolved. Employee then filed the present action for unfair claims settlement practices, naming Insurer and an employee of Adjuster as defendants. Employee served Employer with a subpoena requesting, inter alia, a letter Attorney wrote to Adjuster's employee concerning the underlying case. Employer and Insurer objected to the subpoena, citing attorney-client privilege and the work-product doctrine. The court denied the motions. Insurer then petitioned the Supreme Court for a writ of supervisory control. The Court dismissed the petition, holding that the district court correctly applied the law of attorney-client privilege but incorrectly analyzed the work product doctrine. However, because the court reached the proper conclusion, supervisory control was unnecessary.

Insurers sought a declaration that they had no duty to defend or indemnify in tort suits brought against the insured village, concerning discovery of "perc," a carcinogenic common dry cleaning solvent, in one of its wells and the village's continued use of the well without disclosure. The district court, relying on a pollution exclusion in the policies, granted summary judgment for the insurers. The exclusion refers to "actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of 'pollutants'" and excludes from coverage expenses for "cleaning up ... or in any way responding to, or assessing the effects of pollutants." After exploring the reasons for the exclusion, the Seventh Circuit affirmed. The court rejected an argument that this was not a pollution case, because the amount of perc in the water was below the maximum level permitted by environmental regulations. The complaints actually filed "describe in copious detail the conduct giving rise to the tort suits, and in doing so inadvertently but unmistakably acknowledge the applicability of the pollution exclusion."

Insured, who was injured, submitted a claim to Insurer under her underinsured motorist (UIM) coverage after exhausting the policy limits of the underinsured motorist. An arbitration panel concluded that the court of appeals decision in Heritage Mutual v. Graser precluded Insured from recovering under her UIM coverage the value of medical expenses that were written off by her medical provider. The circuit court modified the arbitration award to include the reasonable value of the written-off medical expenses. The Supreme Court affirmed, holding that the arbitration panel's decision in this case was properly modified by the circuit court because the arbitrators exceeded their authority by failing to fully review the Court's decisions on the collateral source rule and the law of damages. The Court overruled Graser to the extent that it held that the collateral source rule had no application in cases involving UIM coverage, because according to precedent, an injured party is entitled to recover the reasonable value of medical services, which, under the operation of the collateral source rule, includes written-off medical expenses.