Justia Insurance Law Opinion Summaries

After defendant was in a serious automobile accident, a benefit plan administered by plaintiff paid $66,866 for his medical expenses. Defendant then recovered $110,000 from third parties, with the assistance of counsel. Plaintiff, which had not sought to enforce its subrogation rights, demanded reimbursement of the entire $66,866 it had paid without allowance for legal costs, which had reduced defendant's net recovery to less than the amount it demanded. Plaintiff sued for "appropriate equitable relief" pursuant to the Employee Retirement Income Security Act, 29 U.S.C. 1132(a)(3) B). The district court ordered plaintiff to pay the entire. $66,866. The Third Circuit vacated, holding that defendant may assert equitable limitations, such as unjust enrichment, on plaintiff's equitable claim.

Plaintiff John Ensey was employed by both Defendant Ozzie’s Pipeline Padder, Inc. (Ozzie’s) and Rockford Corporation when he was severely injured. He sued Ozzie’s but was denied relief on the ground that Ozzie’s was protected by the exclusive-remedy provision of the New Mexico Workers’ Compensation Act. Plaintiff appealed, contending that Ozzie’s could not invoke the exclusivity provision because it failed to show that it contributed to paying for the workers’ compensation policy obtained by co-employer Rockford. Upon review, the Tenth Circuit concluded that under New Mexico law Ozzie’s was protected by the exclusivity provision because its contract with Rockford required Rockford to obtain workers’ compensation insurance for Plaintiff, and Plaintiff failed to produce evidence to overcome the inference that Ozzie’s therefore contributed to paying the insurance premium. Accordingly, the Court affirmed the district court's judgment that denied him relief.

This appeal stemmed from an explosion that severely injured Robbie Griffin at a worksite in Stephens County, Oklahoma. At the time of the explosion, Mr. Griffin was working as an independent contractor for S&W Transports, Inc. Through a settlement agreement, S&W agreed to pay Mr. Griffin for his injuries. The issue before the Court was which of S&W’s insurers had a duty provide coverage for that payment. Mid-Continent Casualty Company covered S&W under a general commercial insurance policy. Union Insurance Company covered S&W under a commercial umbrella insurance policy. Mid-Continent and Union agreed that if Mr. Griffin caused, in whole or in part, his injuries, Mid-Continent must provide coverage. If not, Union provided coverage. Both companies moved for summary judgment in the district court. The court held that Mr. Griffin caused his injuries under Oklahoma insurance law and granted summary judgment for Union. Mid-Continent appealed. Because, after its review, the Tenth Circuit agreed that Mr. Griffin caused, at least in part, his injuries, the Court affirmed the district court's judgment in favor of Union.

The executor of the estates of a family who were killed in an accident filed a wrongful death action against an individual and trucking company. The trucking company was bankrupt, but insurance coverage for the accident was available through a policy issued to the company by Converium. Converium subsequently entered into an agreement with National Indemnity Company, which agreed to purchase all or certain portions of Converium. No representation of National Indemnity appeared at the court-ordered mediation. National Indemnity's vice president and legal counsel, Joseph Casaccio, failed to appear at the second mediation but appeared at the third mediation. The case was eventually settled. The circuit court subsequently imposed monetary sanctions against Petitioners, National Indemnity and Casaccio, for failing, without good cause, to appear at the mediation. The Supreme Court reversed the order imposing sanctions, holding (1) W.V. Trial Ct. R. 25.10 did authorize a trial court to sanction Petitioners, but (2) no sanctionable conduct occurred in this case.

Plaintiffs brought a declaratory judgment action seeking a determination that certain medical malpractice claims that they had asserted in an action against a medical association were covered under an insurance policy issued to the facility by Insurer. Due to Insurer's insolvency during the pendency of the action, Connecticut Insurance Guaranty Association assumed liability for Insurer's obligations to the extent that claims were covered under the Connecticut Insurance Guaranty Act. The Association filed a counterclaim, contending that the claims against the medical association were not covered because they were subject to a policy provision that excluded them from corporate coverage liability. The trial rendered rendered judgment in Plaintiffs' favor. The Supreme Court affirmed, holding that that the policy exclusion was inapplicable to the medical association's coverage for claims brought against it predicated solely on liability that it may have occurred through the acts of one of its nurse practitioners.

Danny O'Neall was injured while working for Sadler Line Construction, a subcontractor of Alliance Construction. Sadler had commercial general liability (CGL) coverage with Federated Service Inusrance Company. In the underlying personal injury action, O'Neall sued Alliance and Sadler for negligence. In the instant action, Federated filed a declaratory judgment action against Alliance, alleging that it had no duty to defend or indemnify Alliance against O'Neall's personal injury action. The district court granted summary judgment for Federated. The Supreme Court reversed, holding (1) the parties, by requiring Sadler to name Alliance as an additional insured on its CGL policy, intended that Sadler would insure against loss caused by Alliance's negligence; and (2) Sadler's additional insured endorsement, which provided coverage for liability arising out of Sadler's operations, was broad enough to include coverage for Alliance's negligence even if Sadler was not negligent. Remanded.

Terry Richerson died after being backed over by a truck owned by United Materials. Richerson's estate requested medical payments under the policy the Cincinnati Insurance Company issued to United Materials for the truck involved in the accident. Cincinnati denied the claim because the policy provided coverage for injuries suffered by a claimant while "occupying" a covered auto. The district court concluded that Richerson was not occupying the auto as defined in the policy and, accordingly, granted summary judgment in favor of Cincinnati. Richerson's estate appealed, arguing that because Richerson was caught in and transported by the truck, he was "upon" it, and therefore he was "occupying" the truck. the Supreme Court affirmed the district court's grant of summary judgment in favor of Cincinnati, holding that Richerson's contact with the truck was insufficient to trigger coverage under the definition of "occupying" in the policy.

Plaintiff Darlene Howsden was injured on premises that were leased to her employer by a legally distinct entity that was owned and operated by the same shareholders as her employer. Plaintiff sued Defendant, the entity that owned the premises, for negligence. The district court granted summary judgment to Defendant, concluding that Plaintiff's exclusive remedy was under the Nebraska Workers' Compensation Act. The Supreme Court reversed, holding that the district court erred in concluding that the exclusive remedy rule extended to Defendant because (1) Defendant was a legally separate entity from Plaintiff's employer, despite their corporate kinship, and there was no equitable basis to justify piercing the corporate veil between the two entities; and (2) therefore, Defendant was a third party to the employment relationship between Plaintiff and her employer, so Plaintiff's third-party claim against Defendant was not barred by the exclusive remedy provisions of the Act.

Daughter was injured in an automobile accident caused by an uninsured motorist. Father and Daughter were insured by two Farmers Insurance Exchange automobile insurance policies, each providing uninsured motorist protection of $25,000. After the accident, in exchange for a full release signed by Daughter, Farmers paid $25,000 in uninsured motorist coverage under Father's policy insuring the vehicle involved in the accident. Later, Daughter and Father (Plaintiffs) sued Farmers, seeking uninsured motorist benefits under Father's second policy. The district court entered summary judgment in favor of Farmers. The Supreme Court affirmed, holding that the district court did not err in (1) dismissing Plaintiffs' claim for stacking of uninsured motorist coverage; (2) ruling that neither Plaintiff had standing to bring a claim for medical pay coverage; and (3) declining to certify a putative class for claims of unjust enrichment and disgorgement of premiums.

Claimant David Tarbet worked for Employer J.R. Simplot Company for thirty-six years until an accident in 2007 left him totally and permanently disabled. The issue before the Industrial Commission (Commission) was whether Employer was liable for all or only a part of Claimant’s income benefits. If Claimant’s total disability resulted solely from the last accident, Employer would be liable for all of the income benefits. If his total disability resulted from the combined effects of both that injury and impairments that pre-existed that injury, then Employer was liable only for that portion of the income benefits for the disability caused by the accident, and the Industrial Special Indemnity Fund (ISIF) would be liable for the remainder. The Industrial Commission found that the April 2007 accident was Claimant’s final industrial accident, that he was totally and permanently disabled as a result of the final accident, and that the impairments that existed prior to that accident did not contribute to his total disability. It found that ISIF was not liable for Claimant’s benefits and dismissed the complaint against it. Employer then appealed. Upon review of the Commission's record, the Supreme Court affirmed the Industrial Commission's order.