Justia Insurance Law Opinion Summaries

Shannon Cave suffered a work-related injury and was awarded temporary total disability (TTD) benefits during her recovery. After Cave rejected an offer of temporary light duty work from her employer, the Wyoming Workers' Safety and Compensation Division (Division) reduced Cave's TTD benefits to one-third of the previously authorized amount in accordance with Wyo. Stat. Ann. 27-14-404(j). The Office of Administrative Hearings (OAH) upheld the reduction of TTD benefits. The district court reversed the OAH decision. The Supreme Court reversed the district court's order, holding that the OAH decision was supported by substantial evidence and was not contrary to law as the hearing examiner properly determined that the offer of light duty employment tendered to Cave was bona fide, and therefore, the OAH was obligated to reduce Cave's TTD benefits.

Plaintiff appealed from the district court's grant of summary judgment to National Union with respect to his claims under the Texas Insurance Code (Insurance Code), Tex. Ins. Code Ann. 541.003, 541.051, 541.052, 541.061, and the Texas Deceptive Trade Practices Act (DTPA), Tex. Bus. & Com. Code Ann. 17.46, 17.50, asserting misrepresentation and unconscionability. At issue was the Description of Coverage documents that National Union sent to plaintiff regarding eligibility for permanent total disability benefits under two insurance policies. The court held that plaintiff's contention that he had insufficient notice of National Union's basis for seeking summary judgment on his misrepresentation claims was unsustainable. The court also held that the definition of permanent total disability in the Descriptions of Coverage was ambiguous. The court held, however, that the ambiguity did not rise to the level of a misrepresentation within the meaning of the Insurance Code or the DTPA. To the extent that the Insurance Code required additional information to clarify an ambiguity, the reference to the master policy as controlling adequately informed a reasonable person that an ambiguity in the Description of Coverage was not binding if it conflicted with the policy. The court further held that plaintiff's unconscionability claims failed where he had not offered any reasoning as to the relevance of certain evidence regarding allegations of unconscionable conduct and where the claims were premised on conduct that had occurred after his injury and well after the inception of coverage under the policies. Accordingly, the court affirmed the district court's grant of summary judgment.

An employee of the general contractor on a construction site was allegedly injured by the negligent act of the employee of a subcontractor who carried no workers' compensation insurance. Plaintiff, the injured party, brought a common-law action against Defendants, the uninsured subcontractor and its employee, the alleged tortfeasor. The Defendants filed a plea in bar, asserting that the Virginia Workers' Compensation Act was Plaintiff's sole remedy. The circuit court held that Defendants' failure to carry workers' compensation insurance deprived them of the protections afforded by the Act because they were not participants in the statutory workers' compensation system. The court denied the plea in bar, permitting the action to go forward, but certified the case for an interlocutory appeal. The Supreme Court reversed the judgment appealed from and entered final judgment dismissing the case, holding that the circuit court erred in denying Defendants' plea in bar because Defendants were entitled to the exclusivity protection provided by the Act notwithstanding their lack of workers' compensation insurance.

Kivalina, a native community located on an Alaskan barrier island, filed a lawsuit (Complaint) in a California district court against The AES Corporation, a Virginia-based energy company, and numerous other defendants for allegedly damaging the community by causing global warming through emission of greenhouse gases. Steadfast Insurance, which provided commercial general liability (CGL) to AES, provided AES a defense under a reservation of rights. Later AES filed a declaratory judgment action, claiming it did not owe AES a defense or indemnity coverage in the underlying suit. The circuit court granted Steadfast's motion for summary judgment, holding that the Complaint did not allege an "occurrence" as that term was defined in AES's contracts of insurance with Steadfast, and that Steadfast, therefore, did not owe AES a defense or liability coverage. The Supreme Court affirmed, holding that Kivalina did not allege that its property damage was the result of a fortuitous event or accident, but rather that its damages were the natural and probable consequence of AES's intentional actions, and such loss was not covered under the relevant CGL policies.

The Bank of Commerce (Bank) brought an action against SouthGroup Insurance and Financial Services, LLC (SouthGroup) and Norman White, an agent of SouthGroup, for negligent misrepresentations made by White regarding the type of liability insurance coverage they would need to purchase. The trial court granted summary judgment for SouthGroup and White on two grounds: (1) that the Bankâs claims are barred by the statute of limitations; and (2) that the damages sought by the Bank constituted a voluntary payment which may not be recovered under Mississippiâs voluntary payment doctrine. The Bank appealed the trial courtâs decision. Upon review, the Supreme Court concluded that the three-year statute of limitations began to run when the Bank first received notice that it did not have entity coverage on January 18, 2005. When the Bank filed its claim against Defendants on July 17, 2008, the statute of limitations already had run, therefore barring the Bankâs claims against them. The Court affirmed the trial court's grant of summary judgment dismissing the Bank's case.

Dane Shattuck died from injuries after being hit by an automobile. Dane received medical care at Hospital for his injuries. Dane was enrolled in a children's health insurance program (CHIP), administered by the department of public health and human services (DPHHS). Hospital submitted the bill for Dane's care to Blue Cross and Blue Shield (BCBS), which served as third-party administrator of the CHIP program for DPHHS. Hospital then asserted a lien for the full bill amount against recoveries Gail Shattuck, as personal representative of Dane's estate, may obtain against third parties. Shattuck sued Hospital, BCBS, DPHHS, and the State, asserting that Defendants unlawfully acted to avoid application of "made whole" rules and that Hospital could not foreclose the lien because Shattuck had not been made whole. The district court granted partial summary judgment to Shattuck. The Supreme Court reversed in part and affirmed in part, holding (1) the district court erred by determining that CHIP constitutes insurance and was governed by the made whole doctrine, and (2) the district court did not err by determining that BCBS was not an insurer in its role here and, therefore, was not subject to the made whole statute. Remanded.

An employee of Plaintiff, the town of Southbury, was injured in a car accident with Defendants, Patricia and Joseph Gonyea, during the course of employment. Employee applied for and received workers' compensation benefits from Plaintiff. Employee also made a claim against Defendants, which was settled for the Defendants' policy insurance limit. After Plaintiff perfected its statutory lien rights, Employee forwarded to Plaintiff the net proceeds he received from the settlement. Thereafter, Plaintiff commenced the present action to recover past and future works' compensation benefits it had paid, or would become obligated to pay, as a result of Employee's injuries. Defendants moved for summary judgment, contending that Plaintiff had assented to the settlement between Employee and Defendants and, thus, was barred from pursuing this action. The trial court granted Defendants' motion, concluding Plaintiff had assented to the settlement. The Supreme Court reversed, holding that there was a genuine issue of material fact as to whether Plaintiff assented to the settlement and voluntarily relinquished its rights to recover an outstanding balance through subsequent litigation.

Plaintiff, Metropolitan Property and Casualty Insurance Company, brought a product liability action against Defendant, Deere and Company, claiming that a lawn tractor manufactured by Defendant contained a manufacturing defect in its electrical system that caused a fire resulting in the destruction of the home of Plaintiff's insureds. Following a jury trial, the trial court rendered judgment in favor of Plaintiff. The Supreme Court reversed, holding (1) a plaintiff may base a product liability action on the "malfunction theory," which allows a jury to rely on circumstantial evidence to infer that a product that malfunctioned was defective at the time it left the manufacturer's or seller's control if the plaintiff establishes certain elements; and (2) the trial court erred in denying Defendant's motion for a directed verdict because Plaintiff's evidence in the present case was insufficient to establish its products liability claim.

Plaintiffs, John and Colm Farrell, were allegedly involved in a motor vehicle accident with an insured of Defendant, Twenty-First Century Insurance Company. Plaintiffs filed an action against Defendant, seeking damages for personal injuries arising out of the accident. During a pretrial conference, the parties agreed to settle Plaintiffs' claims and, allegedly, further agreed to arbitrate Plaintiffs' claims. Subsequently, Plaintiffs filed an action against Defendant seeking a court order to compel arbitration. The trial court rendered summary judgment in favor of Defendant, concluding that there was no clear manifestation of an agreement to arbitrate. The appellate court affirmed. The Supreme Court affirmed the judgment of the appellate court, holding that, after drawing all inferences in favor of Plaintiffs, no genuine issue of material fact existed with regard to whether the parties had an enforceable agreement to arbitrate.

This case concerned the proper application of stare decisis and required the Supreme Court to decide whether "Collins v. Farmers Ins. Co." was still good law. In "Collins," the Court held that an exclusion in a motor vehicle liability insurance policy that purported to eliminate all coverage for a claim by one insured against another insured under the same policy was unenforceable to the extent that it failed to provide the minimum coverage required by the Financial Responsibility Law (FRL). The exclusion, however, was enforceable as to any coverage beyond that statutory minimum. In this case, Plaintiff Farmers Insurance Company issued an insurance policy to Defendant Tosha Mowry that contained an exclusion identical to the exclusion in "Collins". Defendant was injured in an accident in which her friend -- a permissive user and thus an insured person under the policy -- was driving. Plaintiff brought this action seeking a declaration that Defendant had $25,000 available in coverage under her policy -- the minimum coverage required by the FRL for bodily injury to one person in any one accident. Defendant argued that her coverage was $100,000, the insurance amount stated on the declarations page of her policy. The parties filed cross-motions for summary judgment, and the trial court granted Plaintiff's motion and denied Defendant's. The Court of Appeals affirmed in a per curiam opinion that cited "Collins." The Supreme Court concluded that Defendant "advanced no argument that this court has not previously considered for reaching a different result from that in 'Collins.' Defendant failed to carry the burden for overturning a fully considered precedent of this court."