Justia Insurance Law Opinion Summaries

Mallory Warburton was working for the City of North Las Vegas when she was involved in a car accident and suffered numerous injuries. The City started paying workers' compensation benefits to Warburton at a rate of $10 an hour. At the time of the accident, Warburton was expected to make $12 an hour because of a promotion to manager of one of the City's pools. After an administrative appeal, a hearing officer instructed the City to redetermine Warburton's benefits using the $12-an-hour rate of pay for a pool manager. An appeals officer reversed, concluding Warburton's benefits should be based on the $10-an-hour rate of pay she was actually receiving at the time of the accident. The district court reversed the appeals officer's decision. The Supreme Court affirmed, holding that the appeals officer's conclusion was not supported by substantial evidence and that substantial evidence supported the district court's determination that (1) Warburton's primary job at the time of the accident was that of pool manager, and (2) Warburton's workers' compensation benefits must be determined using an average monthly wage calculation at the $12-an-hour rate of pay.

The underlying dispute in this appeal revolved around the issue of who was contractually obligated to pay workers' compensation benefits to an employee of Employer. The Supreme Court found that Employer's Insurer was required to pay workers' compensation benefits for all of Employer's employees and remanded the case. The district court entered a final judgment. Instead of filing a notice of appeal within thirty days of the district court's judgment, Insurer filed an "objection to judgment." Insurer then filed its notice of appeal within thirty days of the district court's order disposing of that motion. The Supreme Court dismissed the appeal, holding that it lacked jurisdiction to address the appeal as (1) Insurer did not file its notice of appeal within thirty days of the district court's final judgment, and (2) Insurer failed to file a postjudgment motion that would toll the time for appeal or one that the Court had jurisdiction to review.

In 1970, while working for Employer, Employee was injured. In 1989, Employee retired. In 2008, Employee applied for permanent total disability (PTD) compensation. The Industrial Commission of Ohio concluded that Employee was permanently and totally disabled without ruling on the credibility of the assertion that Employee retired because of his injury or determining whether his retirement was voluntary or involuntary. The court of appeals granted Employer a limited writ of mandamus that vacated the Commission's order and ordered the Commission to reconsider the matter. The Supreme Court affirmed the court of appeals, holding that because a voluntary retirement from the work force prior to asserting PTD precludes the payment of compensation for that disability, the court of appeals was correct in ordering further consideration of whether Employee retired because of his injury and whether his retirement was voluntary.

Ronald Bacon was injured while working at a construction site. Bacon sued the general contractor, the general contractor's commercial liability insurer, the subcontractor, and the parent company of the subcontractor. Bacon settled with the insurer, which together with the general contractor's separate liability insurer, made payments to Bacon pursuant to the settlement agreement. After Bacon settled with the subcontractor's parent company, the general contractor's two insurers filed a breach of contract action because Bacon received the proceeds of his second settlement but refused to make payment to the insurers under the terms of the first settlement agreement. The district court granted summary judgment for the insurers, finding Bacon, his lawyer, and the lawyer's law firm liable in the amount of $437,500. The Supreme Court reversed the district court's finding that lawyer and law firm were personally liable on the contract, holding that an attorney and/or law firm is not liable on a contract negotiated on behalf of a client when the contract provides that both the client and the attorney "agree to and will pay" a certain sum of money and the attorney signs the contract under the legend "Agreed to in Form & Substance". The Court otherwise affirmed.

Plaintiff brought a personal injury action arising out of an automobile accident then voluntarily dismissed the action eleven days prior to trial in order to further develop expert testimony on the extent of permanent injuries caused by the accident. Two months later, Plaintiff refiled the action. The district court granted summary judgment to Defendant, holding that Iowa's savings statute was inapplicable under the facts of the case. The court of appeals affirmed. The issue on appeal was whether the voluntary dismissal of Plaintiff's claim under the circumstances met the savings statute requirement that the claim "fails" without "negligence in its prosecution." The Supreme Court affirmed, holding that Plaintiff's claim did not meet the requirements of the savings statute and that the district court properly granted summary judgment for Defendant.

Appellees, members of the Barbee family, were involved in an automobile accident. Appellant, Nationwide Mutual Insurance Company, insured the automobile. The policy contained a provision that required an action for underinsured motorist coverage be brought against the insurer within three years of the date of the accident. After receiving a judgment against the tortfeasors and more than four years after the accident, the Barbees filed suit against Nationwide to recover the outstanding amounts on their judgments. Nationwide filed a motion for summary judgment, arguing that the Barbees' claims were barred for failure to bring the claims within the three-year period required by the policy's limitation period. The trial court denied the motion. The court of appeals affirmed. At issue on appeal was whether a conflict between Nationwide's limitation provision and other provisions in the policy, which required that proceeds from any other available insurance be exhausted, rendered the limitation provision unenforceable. The Supreme Court reversed, holding (1) the three-year limitation provision was unambiguous and enforceable, and (2) the provision did not conflict with co-existing policy provisions because exhaustion of the tortfeasor's liability limits was not a precondition to filing suit by the insured against his insurer within the limitation period.

Appellant Thomas Pearson was struck by a forklift and was later determined to have been injured in the course of his employment with Archer-Daniels-Midland Milling Company (ADM). The workers' compensation court entered an award granting Pearson, among other benefits, certain future medical expenses. Pearson subsequently had a total knee replacement and sought reimbursement from ADM for those expenses as well as for expenses relating to a back injury. After ADM declined to pay the expenses, Pearson filed a motion to compel payment. A further award was entered (1) denying Pearson's motion with respect to the knee replacement but ordering ADM to pay expenses relating to the treatment of the back injury, and (2) applying the workers' compensation court's fee schedule to payments for the back injury, which had previously been paid by Pearson's health insurer. The workers' compensation court review panel affirmed. The Supreme Court affirmed in part and reversed in part, holding (1) the trial court incorrectly found that the original order denied knee replacement, and (2) the trial court did not err in applying the fee schedule to any reimbursement to a third party. Remanded.

Employee submitted a workers' compensation claim to his Employer after suffering a reaction that some doctors attributed to work-related exposure. Employee petitioned the Department of Labor for a hearing on his workers' compensation claim. The Department denied Employee's claim, concluding that Employee failed to demonstrate that he sustained a compensable injury arising out of and in the course of his employment. The circuit court affirmed. At issue on appeal was whether Employee's efforts to prove causation were thwarted by Employer's refusal to allow collection of samples of various materials in areas around the plant and its later destruction of potential samples. The Supreme Court reversed, holding that the Department failed to properly consider the spoliation question and Employee was entitled to a new hearing before the Department.

Thomas Skinner received an award of benefits from the Workers' Compensation Commission for asbestosis under the scheduled loss provisions of Section 42-9-30 of the South Carolina Code.  Westinghouse Electric Corporation, Skinner's former employer, appealed that decision, arguing Skinner could not recover for a scheduled loss and must proceed under the "general disability" statutes found in Sections 42-9-10 and 42-9-20 of the South Carolina Code. Westinghouse's arguments on appeal concerned the impact of section 42-11-60 on Skinner's right to recover for his pulmonary disease.  In particular, it argued Skinner could only recover for total or partial disability under sections 42-9-10 and 42-9-20, respectively.  The Supreme Court agreed with Westinghouse and reversed the special referee's affirmation of Skinner's award based upon the clear language of section 42-11-60: "[i]n that section, the General Assembly specified that recovery for a pulmonary disease such as Skinner's hinges upon a showing of lost wages under section 42-9-10 and 42-9-20.  Because our resolution of this issue is dispositive of the appeal, it is not necessary for us to address the remaining issues raised by the parties."

Petitioners, the Estate of June M. Day (Estate) and Byron and Stephanie Day, appealed a superior court's grant of summary judgment to Respondent Hanover Insurance Company, arguing Hanover's consent to settle a claim by Petitioners with the insurer of a third party tortfeasor did not preclude Hanover from contesting its liability to provide the Estate underinsured motorist coverage under its insurance contract with the Estate's decedent. In 2007, June Day was fatally injured in a motor vehicle accident. At the time of the accident, Day's vehicle was insured under an automobile liability policy and a personal umbrella policy issued by Hanover, and both policies provided underinsured motorist coverage. Following the accident, Petitioners made a claim against the third party's insurance company's policy. Hanover agreed that Petitioners could accept the settlement offered "while reserving [Hanover's] right to continue the investigation into liability in this matter," and noting that Hanover had "neither accepted nor denied liability." Petitioners accepted payment and executed a release to the third party and her insurance company. Thereafter Petitioners took the position that, by consenting to the settlement, Hanover was precluded from contesting that Petitioners were "legally entitled to recover" damages from the third party. Ruling on the parties' cross-motions for summary judgment, the trial court rejected Petitioners' position and dismissed the action. Petitioners filed an objection arguing that the court had "misunderstood the essence of the petition." Upon review, the Supreme Court affirmed, concluding that "the record supports the trial court's ruling regarding the litigation strategy the petitioners pursued below. . . . insofar as the petitioners complain that Hanover failed to exercise good faith in that it delayed investigating and processing their claim, we note that the petitioners at all times had it within their power under the terms of the policy to address this problem by demanding arbitration of its underinsured motorist claim against Hanover, or, alternatively, by filing a breach of contract action in court."