Justia Insurance Law Opinion Summaries

Rafael Casados suffered a fatal, work-related injury while working for two employers that both had workers' compensation coverage. Casados' parents sued one of the employers. At issue was whether workers' compensation was the exclusive remedy to Casados' parents, which would bar their suit against Port Elevator. Because Port Elevator had a workers' compensation policy, Casados was an employee, he suffered a work-related injury, and the jury failed to find Port Elevator grossly negligent, the Texas Workers' Compensation Act (TWCA), Tex. Lab. Code 406, provided that the exclusive remedy was against the employer's insurer - not the employer. Accordingly, the claim at issue in this appeal was barred. The court reversed the judgment of the court of appeals and rendered judgment for Port Elevator.

Plaintiffs sought insurance coverage for settlement and defense costs related to thousands of asbestos-exposure products-liability lawsuits that began in 1981. Many of the underlying asbestos claims arose from exposure to products manufactured by Reardon, a corporation that sold its assets and liabilities to plaintiff and became a division of plaintiff's business in 1966. The policies did not expressly identify Reardon or its later incarnation as "Named Insureds," but provided coverage for asbestos claims related to the Reardon products, and each has paid pursuant to the policies' aggregate limits for "Products Hazard" claims. The insurance companies, collectively, have paid more than $100 millions plaintiffs sought more than $125 million in additional coverage, arguing that the Products Hazard caps did not apply to the Reardon claims. The district court granted summary judgment to the insurance companies. The Sixth Circuit affirmed, finding that the policy language supported application of the cap,

This case involved a dispute between Insured and Insurer regarding underinsured motorist benefits. The district court denied Insurer's motion for summary judgment and entered judgment in favor of Insured with interest running from the date Insured filed his action against Insurer. Insured filed a motion to modify the judgment, asking the court to amend the judgment to start the running of interest from the date Insured filed his action against the original tortfeasors. The district court granted the motion and modified the judgment. The court of appeals affirmed. The Supreme Court (1) found that the order denying Insurer's motion for summary judgment was not reviewable; (2) vacated the court of appeals; (3) affirmed the district court's judgment required Insurer to pay its underinsured motorist limit to Insured; and (4) reversed the part of the judgment awarding interest from the date Insured filed the original action against the tortfeasors, holding that Insured failed to timely file his posttrial motion and that the district court erred when it considered the motion. Remanded.

Petitioner Lachlan MacLearn and Intervenor Simon Hutchings appealed a superior court order that denied their motion for summary judgment. Petitioner was driving his 2006 Prius when he was involved in an accident with Hutchings. At the time of the accident, Petitioner also owned a 2000 Audi A6 that was insured by Respondent Commerce Insurance Company. Hutchings sued Petitioner for damages from his injuries. Hutchings made a demand upon Commerce for defense and indemnification. Commerce denied the claim, stating that coverage was barred by the terms of the policy it held on Petitioner's Audi. Petitioner petitioned for a declaratory judgment that Commerce was obligated to defend and indemnify him against Hutchings' suit. The trial court granted Commerce's motion and denied Hutchings', finding the policy barred coverage. Upon review of the policy and the arguments submitted by the parties, the Supreme Court affirmed the trial court, finding the policy did not cover Petitioner's use of the Prius, nor grant him indemnification from Commerce for the accident arising out of his use of it.

Employee was injured in an automobile accident while working for Employer. Employer had a state-certified workers' compensation plan in effect that provided coverage to Employee, and some of Employee's medical bills were paid by the workers' compensation carrier. Employee had a policy with State Farm that included no-fault medical coverage. State Farm, however, denied coverage to Employee under a policy exclusion that denied coverage for an insured if any workers' compensation law applied to the insured's bodily injury. Employee filed an action against State Farm, seeking recovery of benefits under the no-fault medical provision. The circuit court granted summary judgment in favor of State Farm. The Supreme Court affirmed, holding that Employer was entitled to judgment as a matter of law where, in accordance with previous precedent, the exclusion clearly applied in all scenarios where workers' compensation benefits either had been paid in whole or in part or could be paid in whole or in part.

A federal jury awarded Fortin $125,000 in damages against a police officer after finding that the officer negligently used force in arresting Fortin in 2007. In a post-judgment ruling, the district court reduced the award to $10,000, the maximum set by the Maine Tort Claims Act for the personal liability of government employees, Me. Rev. Stat. tit. 14, 8104-D. On appeal, Fortin argued that the MTCA cap is inapplicable here because the officer was covered by an insurance policy that triggered a higher limit under the Act. The First Circuit determined that the issues were unresolved under state law and certified two questions to the Maine Supreme Court. Whether Fortin is limited to recovery of $10,000 depends on the unexplored relationship among several provisions of the MTCA governing damage awards against government employees. Analysis may also require determining what interpretive rule should be applied to ambiguous insurance policies providing MTCA liability coverage.

Claimant Jerry Benoit worked for Turner Industries for twenty-seven years. For ten of those years he worked as a general laborer for a Lake Charles Citgo refinery, where Turner was contracted to perform general maintenance. Claimant's duties included cleaning chemical discharges and oily waste which collected in the drainage ditches, sewers, and processing units at the refinery. In the course of this work, he was exposed to any number of potentially dangerous or carcinogenic chemicals, including high levels of benzene. In July 2006, Claimant fell ill. He was diagnosed with acute myeloid leukemia (AML), known to be linked to high levels of benzene exposure. Despite the medical evidence linking Claimant's cancer to the chemicals he was exposed to at work, his claim for medical benefits was denied. The eventual medical bills totaled over $625,000. Medicaid paid for $203,124.68. The remaining $422,043.59 was "written off" by the medical care providers. Turner paid nothing. Claimant's family filed suit in 2007. The Office of Workers' Compensation (OWC) awarded Claimant total medical expenses and attorney fees. Turner appealed, and the court of appeals affirmed the OWC judgment in its entirety. Upon review of the correctness of the OWC award of medical expenses, the Supreme Court concluded the OWC erred in awarding the "written off" medical expenses: "Claimant would receive an improper windfall if he was allowed to recover for medical expenses which have been reduced by health care providers as a result of their contractual arrangements with Medicaid." The Court reversed the appellate court's decision and remanded the case for further proceedings.

Robin Everhart filed suit against the Indiana Patient's Compensation Fund (PCF) to recover excess damages after settling a wrongful death claim against an emergency room physician in whose care her husband died. The PCF asked the trial court to reduce its award of damages to account for the twenty percent change that Robin's husband would have died anyway, even in the absence of the physician's negligence. The trial court declined to do so, awarding Robin the statutory maximum of $1 million in excess damages. The Supreme Court affirmed but on slightly different grounds, holding that the PCF was required to pay the statutory maximum in excess damages and was not entitled to a set-off because of how the trial court's peculiar findings of fact interacted with the rules for calculating a set-off.

Appellant Jacob Ennen was seriously injured while he was a passenger in Gordon Shanigan's car. Shanigan's insurer, Integon Indemnity Corporation (Integon), paid $50,000 to cover Shanigan's possible liability to Appellant. Under Alaska insurance statutes, Appellant would also likely have been entitled to underinsured motorist benefits under Shanigan's policy. However, Integon's policy was inconsistent with these statutes, and Integon told Ennen that he was not entitled to any additional money. Six years later, some time after Integon learned that its underinsured motorist provision violated Alaska insurance statutes, Integon paid Appellant underinsured motorist benefits plus interest and fees. Appellant sued Integon for bad faith. Integon filed a third-party complaint against Appellant's attorney, Craig Allen. Before trial, the superior court dismissed Integon’s claims against Allen on the ground that allowing Integon to implead Appellant's attorney would violate public policy. The superior court held that because Appellant did not own the insurance policy, Integon did not owe him a duty of good faith and fair dealing. Accordingly, the superior court concluded that Appellant had no cause of action for bad faith. But, in the event this ruling were to be reversed on appeal, the superior court made an alternate finding that while Integon had committed the tort of bad faith, Appellant had suffered no damages as a result. Upon review, the Supreme Court reversed on both counts. "The superior court was justifiably cautious about extending the bad faith cause of action to a new class of plaintiffs, but we conclude that Ennen, as an insured, is eligible under our existing case law to bring a cause of action for bad faith." The Court concluded that Appellant established facts that would entitle him to damages. Furthermore, the Court affirmed the dismissal of Integon's third-party claim against Allen on the alternative ground that Allen was not a proximate cause of Appellant's harm.

Employee was injured while working for Employer's sheep and wool business, Cestari. Employer failed to maintain workers' compensation insurance for Cestari. Employee filed a workers' compensation claim against Employer and Cestari, as well as a complaint against Employer and Cestari, seeking damages for negligence. The workers' compensation commissioner determined that Employee was entitled to workers' compensation benefits. Finding that Employee had pursued his workers' compensation claim to a final order and that he had a remedy for collection of his workers' compensation award against Cestari and/or the Uninsured Employers' Fund, the circuit court dismissed Employee's civil complaint. The Supreme Court affirmed, holding that Employee had received the recovery he sought under the Workers' Compensation Act, and thus, the circuit court did not err in ruling that Employee could not pursue an action at law against Employer after obtaining a final collectible award of workers' compensation benefits.