Justia Insurance Law Opinion Summaries

Cincinnati Insurance issued a liability policy to Painters, which allowed the insured to add an “additional insured” by oral agreement, if that agreement preceded the occurrence and “a certificate of insurance ... has been issued.” No permission from Cincinnati is required, if the insureds have a relationship consistent with the policy. Painters was hired to paint Vita’s premises and orally agreed to add Vita as an additional insurer. Painters’ worker fell, before there was any written confirmation of the oral agreement, and remains in a coma. In a suit by the insurer, seeking a declaration that Vita was not covered based on a certificate issued to Vita the day after the accident, the court granted summary judgment in favor of Cincinnati. The Seventh Circuit reversed. Summary judgment was premature. The policy is ambiguous. A certificate could be regarded a prerequisite to coverage of the additional insured, but also could be intended merely to memorialize the oral agreement. The policy could also mean that the oral agreement must be memorialized in writing before the insured can file a claim. Oral agreements are valid contracts and the policy is explicit that an oral agreement is sufficient to add an insured. The certificate is not a contract, but “a matter of information only” that “confers no rights upon the certificate holder.” View "Cincinnati Ins. Co. v. Vita Food Prods, Inc." on Justia Law

Respondents, Angela Lennartson and Katie Foss, were involved in separate car accidents and recovered damages in their respective negligence actions. Subsequently, each respondent was awarded no-fault benefits from their insurer, State Farm, in arbitration proceedings under the Minnesota No-Fault Insurance Act (No-Fault Act). State-Farm moved to vacated the arbitration awards, arguing, inter alia, that collateral estoppel barred the no-fault arbitrations. The district court granted State Farm’s motion to vacate in Lennartson’s case and denied it in Foss’s case. The cases were consolidated on appeal. The court of appeals affirmed the decision in favor of Foss and reversed the decision against Lennartson, concluding that neither the No-Fault Act nor collateral estoppel barred the arbitrators’ awards of no-fault benefits to Respondents.The Supreme Court affirmed, holding (1) the No-Fault Act does not bar an insured from recovering no-fault benefits for medical expenses previously recovered in a negligence action; and (2) collateral estoppel does not bar an insured from seeking medical-expense or income-loss benefits in no-fault arbitration recovering damages for the same expenses or losses in a negligence action. View "State Farm Mut. Auto. Ins. Co. v. Lennartson" on Justia Law

Safeway Insurance issued Tiffany Dukes an automobile insurance policy on her car. Dukes' boyfriend, Robert Hudson, was driving Dukes' car when he was involved in an accident that injured Jeffrey Piggs. Dukes sought coverage for the accident under her policy, but Safeway disputed coverage, claiming the policy was void due to Dukes' failure to list Hudson as a regular, frequent driver on her application for insurance. The trial court granted Safeway partial summary judgment because Dukes and Hudson refused to cooperate with Safeway’s investigation; however, the trial court also found that Safeway was responsible to provide $25,000 of liability coverage, even though Hudson was not listed as a regular, frequent driver on the policy. Following the trial court’s denial of a motion for reconsideration, Safeway appealed, via petition for interlocutory appeal, to the Court. Finding that the trial court erred in its holding, the Supreme Court reversed and rendered summary judgment in Safeway's favor. View "Safeway Insurance Co. v.Dukes" on Justia Law

The issue in this case was whether the plaintiff-appellant Sandra Vilarrubias Serra was covered under the uninsured/underinsured motorist (UM) and medical payments (medical pay) coverage of the automobile insurance policy issued to Traci Robertson by Appellee State Farm Mutual Automobile Insurance Company. Serra was a foreign exchange student from Spain who was attending her senior year of high school in Pryor. She resided with Robertson in Pryor. As a passenger in the car of a friend, Andrea McNair, she sustained serious injuries when McNair's car collided with Donald Broughton, who was driving a motorcycle. Broughton was killed in the accident. Serra attempted to collect damages for her injuries by filing a claim against Robertson's automobile policy's uninsured motorist and medical payments coverage. State Farm denied coverage to Serra who then filed a lawsuit against the Personal Representative of Donald Broughton, Andrea McNair and State Farm. State Farm filed a motion for summary judgment in the trial court which was granted. The Court of Civil Appeals (COCA) affirmed the trial court. In particular, the issue this case presented for the Supreme Court's review was whether Serra was a "ward" of Robertson for purposes of coverage under the policy. The Court held that she was covered and reversed. View "Serra v. Estate of Broughton" on Justia Law

William Googins committed an intentional assault of Eric Benson, which resulted in Benson’s death. Benson’s estate sued Googins in tort. Googins consented to a judgment in favor of the Estate and assigned to the Estate all rights he may have had against Metropolitan Property and Casualty Insurance Company, whose potential liability stemmed from a homeowner’s policy it issued to Goggins’s grandmother that was active at the time of the assault. Pursuant to the agreement, the superior court entered a judgment against Googins, after which the Estate filed a reach-and-apply action against Metropolitan. Metropolitan filed a complaint for declaratory judgment seeking a determination as to its obligation to indemnify Googins. The superior court granted summary judgment in favor of Metropolitan, declaring that it had no contractual obligation to indemnify Googins. Specifically, the court found that the claim was precluded by an intentional loss exclusion because Googins intentionally assaulted Benson. The Supreme Judicial Court affirmed, holding that the superior court did not err in determining that Googins’s conduct was within the scope of the intentional loss exclusion. View "Metro. Prop. & Cas. Ins. Co. v. Estate of Benson" on Justia Law

Lee Stenseth was injured at work many years ago. He and his employer, the Municipality of Anchorage, entered into a compromise and release agreement (C&R) in August 1996 in which Stenseth waived all future benefits except medical benefits in exchange for $37,000. Stenseth retired from the Municipality in 1996, but he continued to receive medical benefits for his work-related injury, including narcotic pain medication. Ten years later, Stenseth was charged with multiple felonies related to selling or delivering narcotics that he had acquired, some from forged prescriptions modeled on the prescriptions for his work-related injury. Stenseth pleaded guilty to a number of felonies and served time in jail. He was released in June 2010. The Municipality sought to terminate future workers’ compensation benefits and be reimbursed for the benefits it paid out, alleging that Stenseth obtained those benefits by making a false statement or misrepresentation. The Alaska Workers’ Compensation Board dismissed the Municipality’s fraud petition after deciding that the parties had reached an enforceable settlement. The Municipality appealed the dismissal, arguing that any settlement of its fraud petition was void because the settlement did not meet the requirements set out in the Alaska Workers’ Compensation Act and the Board’s regulations. The Alaska Workers’ Compensation Appeals Commission affirmed the Board’s decision. The Municipality appealed to the Alaska Supreme Court, arguing that the Commission’s interpretation of the statute was incorrect and that the Commission incorrectly interpreted our decisions about estoppel. Finding no reversible error, the Supreme Court affirmed the Commission’s decision. View "Municipality of Anchorage v. Stenseth" on Justia Law

Joseph Parker was allegedly injured on the job. It was undisputed that Global Health Initiative (GHI), which at one time employed Parker, did not have workers' compensation insurance. Parker filed a workers' compensation claim in the Workers' Compensation Court. That court awarded Parker, by default judgment against GHI, $17,595.60 plus interest. Parker filed the judgment in the district court of Tulsa County in an attempt to collect the money awarded by the Workers' Compensation Court. After futile efforts to garnish the GHI bank accounts, Parker filed a motion to pierce the corporate veil and to proceed against individual GHI shareholders in an attempt to collect his compensation awards. The trial judge denied Parker's request due to lack of evidence. Thereafter, GHI filed notice of bankruptcy. By August of 2004, Parker had filed an appeal in which the Court of Civil Appeals reversed the trial court's determination that stockholders could not be held liable for the workers' compensation award and remanded the case to the trial court. GHI did not defend or participate in the case on appeal. Parker did not pursue collection against individual shareholders but, instead, returned to the Workers' Compensation Court seeking permanent partial and permanent total awards and an increase in his original award. GHI was not served notice of this proceeding and the cause was consequently undefended. The Workers' Compensation Court entered another award in favor of Parker and against GHI totaling $236,476.20. In June of 2009, Parker, through his counsel, sent letters to some of the GHI shareholders, seeking collection of the shareholders' pro rata share for payment of workers' compensation awards. However, for unexplained reasons, not all shareholders were asked to pay "their portion" of the judgment. The plaintiffs-appellants, doctors Thomas Kenkel and Robert Gold were two of the doctor stockholders, and they appealed seeking a declaration that: (1) Parker had no valid judgment against them; (2) Parker was not entitled to proceed against them for the injuries he sustained; (3) Parker was not entitled to collect the workers' compensation judgment; (4) they had the right to defend against any of Parker's claims ab initio; (5) they were not shareholders of GHI at all but if they were, they were merely minority shareholders; and (6) they were not liable for the debts Parker is attempting to collect. The trial court agreed and sustained the doctors' motion for summary judgment. Parker appealed and the Court of Civil Appeals reversed the trial court and remanded with directions for the trial court to enter judgment in the appellant's favor. The Oklahoma Supreme Court granted certiorari to address the issue of whether a business' failure to secure workers' compensation insurance rendered its shareholders personally liable for a workers' compensation award to an employee. The Court held that it did not. View "Kenkel v. Parker" on Justia Law

Blue Mountain Energy appealed a Benefits Review Board decision affirming an award of black lung benefits to Terry Gunderson. An administrative law judge (ALJ) originally denied benefits under the Black Lung Benefits Act (BLBA), and Gunderson appealed to the Board and then to the Tenth Circuit Court of Appeals. The Tenth Circuit remanded for further proceedings because the ALJ did not sufficiently explain the basis for the denial. The ALJ again denied benefits, and the Board vacated and remanded the ALJ’s decision because it did not comply with the Tenth Circuit’s remand. On the second remand, the ALJ awarded benefits, and the Board affirmed. Blue Mountain petitions for review, arguing that the ALJ violated the Administrative Procedure Act (APA). Specifically, Blue Mountain contended the ALJ gave the preamble to the regulations redefining compensable pneumoconiosis in 20 C.F.R. 718.201 the force and effect of law, even though the preamble had not been subject to APA notice and comment. Blue Mountain also contended its rights under the APA were violated when the ALJ refused to reopen the proceedings to allow it to submit evidence challenging the medical literature cited in the preamble. After review, the Tenth Circuit found no reversible error as Blue Mountain argued, and affirmed. View "Blue Mountain Energy v. Director OWCP" on Justia Law

Wife was a passenger on a motorcycle operated by Husband when she was injured in an accident. At the time, Wife and Husband were named insureds on a motorcycle insurance policy from Insurer. Wife filed a complaint against Husband alleging negligence in connection with the accident. A jury found Husband negligent and awarded Wife $50,000 in damages. Husband moved to amend the judgment to obtain a credit for the amount in prejudgment payments that the Insurer had made to Wife. The superior court granted Husband’s motion to amend the judgment. Wife appealed, arguing that the court erred in interpreting Me. Rev. Stat. 24-A, 2426 to allow Husband a credit against the judgment for the medical payments maximum coverage of what Insurer had already paid to Wife’s medical providers before this action was commenced. The Supreme Judicial Court vacated the order amending judgment, as the court did not determine whether the payments Insurer paid Wife’s medical providers were medical or liability payments. Remanded for a factual determination of the type of prepayments Insurer made, whether liability payments pursuant to Husband’s policy, medical payments pursuant to Wife’s policy, or some other type of payment. View "Wood v. Wood" on Justia Law

Claimant Barbara Kelly was an employee of Blue Ribbon Linen Supply, Inc. when a cart rolled over her left foot. She filed for workers’ compensation benefits. Kelly sustained additional injuries in an automobile accident when returning home from an Independent Medical Evaluation (IME) scheduled by the Idaho State Insurance Fund (Surety) in connection with the cart incident. The Industrial Commission concluded that Kelly’s injuries from the automobile accident were not compensable because they did not arise out of and in the course of her employment with Blue Ribbon. The Supreme Court concluded after review that the causal connection between Kelly’s employment and the injuries she sustained as a result of the accident was sufficiently compelling that it held that the injuries arose out of and in the course of her employment. Accordingly, the Court reversed the Commission’s decision and remanded for further proceedings. View "Kelly v. Blue Ribbon Linen Supply, Inc." on Justia Law