Justia Insurance Law Opinion Summaries

The Supreme Court affirmed the decision of the court of appeals affirming the ruling of the trial court granting summary judgment for Insurer on Plaintiff's action seeking a declaration that Insurer was obligated to prove underinsured motorist (UIM) benefits under the terms of a commercial policy, holding that Plaintiff was not covered under the terms of the commercial UIM policy in this case.Plaintiff was a member of an LLC that bought a commercial automobile insurance policy from Insurer. Insurer included UIM coverage for the LLC's vehicles. Plaintiff was walking through the parking lot of a store where she had just purchased items for the LLC and was struck by an automobile. The driver of the vehicle was an underinsured motorist. Plaintiff submitted a UIM claim to Insurer. After Insurer denied the claim Plaintiff filed this declaratory action. The trial court granted summary judgment for Insurer, and the court of appeals affirmed. The Supreme Court affirmed, holding that the trial court correctly found there were no issues as to any material fact and that Insurer was entitled to judgment as a matter of law. View "Metzger v. Auto-Owners Insurance Co." on Justia Law

The Supreme Court reversed the decision of the court of appeals to grant Dr. Robert Kleinfeld’s writ petition precluding the discovery of certain information, holding that the court of appeals did not properly apply the extraordinary writ petition standard.The case began as an insurance dispute. At issue was the insurer’s discovery request for information from Kleinfeld, individually and as corporate representative for Louisville Sports Injury Center, P.S.C. The trial court entered an order compelling LSIC, through Kleinfeld, to produce the requested discovery. Thereafter, LSIC, through Kleinfeld, filed a petition for a writ of prohibition seeking protection from the trial court’s order. The court of appeals granted the petition. The Supreme Court reversed, holding that the court of appeals abused its discretion when it concluded that the extraordinarily high writ petition standard was met in this case because the court’s decision was unsupported by sound legal principles. View "Allstate Property & Casualty Insurance Co. v. Kleinfeld" on Justia Law

The Supreme Court reversed the decision of the court of appeals affirming the trial court’s grant of summary judgment in favor of Auto-Owners Insurance Company on Lee Comley’s complaint seeking payment from Auto-Owners for the loss to his property caused by water damage, holding that the lower courts erred in concluding that the damage-causing event was excluded by the policy.Comley had homeowner’s insurance through Auto-Owners. When water inundated the basement of Comley’s home from a public water main that broke at a railroad crossing near his home, Comley filed a claim for loss to his home and its contents. Auto-Owners denied the claim based upon the application of policy exclusions relating to water damage. The trial court ruled that the policy’s exclusions applied to deny Comley’s claim, and the court of appeals agreed. The Supreme Court reversed, holding that none of the policy exclusions applied under the facts of this case to negate potential coverage, and therefore, summary judgment was improperly granted. View "Comley v. Auto-Owners Insurance Co." on Justia Law

At issue was the implications of the statutory language found in Ky. Rev. Stat. 186A.220 to the sale of a vehicle that was involved in an accident that killed both Jonathan Elmore and Craig Armstrong.Charles Armstrong sued Martin Cadillac, Inc.; The Travelers Indemnity Company, Martin’s insurer; Elmore’s estate, and other parties for the wrongful death of his son, Craig. Elmore was driving the vehicle, and Craig was a passenger when the vehicle was involved in the accident. This litigation centered around who owned, operated, or was financially responsible for the vehicle Elmore was driving. The circuit court found that Elmore was the owner of the vehicle, and therefore, that Martin and Travelers were not financially liable for the loss. The Supreme Court affirmed the circuit court’s order granting summary judgment on all claims against Martin and Travelers, holding that, pursuant to section 186A. 220, Martin was not the “owner” of the vehicle, and therefore, Martin and Travelers were not responsible for coverage of the vehicle. View "Travelers Indemnity Co. v. Armstrong" on Justia Law

The Supreme Court affirmed the decision of the court of appeals reversing the trial court’s grant of summary judgment against Plaintiffs in this insurance dispute, holding that summary judgment was improper.Plaintiffs sought chiropractic treatment for injuries sustained in an automobile accident. The bills were submitted to GEICO for payment under Plaintiffs’ basic reparations benefits (BRB). GEICO denied coverage and refused to pay for certain medical treatments Plaintiffs had already received. Plaintiffs then brought suit alleging that GEICO improperly denied coverage under their BRB based upon a medical records review and arguing that Ky. Rev. Stat. 304.39-270 requires an independent medical examination before GEICO can deny them BRB. In entering summary judgment against Plaintiffs, the trial court ruled that section 304.39-270 was permissive. The court of appeals reversed and remanded the case to the trial court for further proceedings. The Supreme Court affirmed, holding (1) section 304.39-270 fails to address when and how GEICO could deny BRB; and (2) because the trial court based its decision to grant summary judgment on the implications of section 304.39-270 rather than examining the remaining parts of the Motor Vehicle Reparations Act, Ky. Rev. Stat. 304.39-020(2), it was improper for the trial court to grant summary judgment without further review of the statutes. View "Government Employees Insurance Co. v. Sanders" on Justia Law

The Supreme Court reversed the decision of the Court of Appeals affirming the judgment of the trial court ruling in favor of Peters Farms, LLC, which sued Ikerd Mining, LLC and Ikerd’s insurer, American Mining Insurance Company (AMIC), holding that Ikerd’s unauthorized removal of coal from Peters’ property was not an accident and therefore not covered under the insurance policy.The trial court concluded that Ikerd’s removal of coal from Peters’ property were “accidents,” which meant each “mistake” was an “occurrence” that unintentionally caused “property damage” as defined by Ikerd’s commercial general liability (CGL) policy. Therefore, the court concluded that the mineral removal was covered under the CGL policy. The Supreme Court disagreed, holding that the intentional removal and conversion of coal is not an “accident” constituting an “occurrence,” regardless of whether the trespass was willful or innocent. View "American Mining Insurance Co. v. Peters Farms, LLC" on Justia Law

The Court of Appeals correctly applied the principles of Cincinnati Insurance Co. v. Motorist Mutual Insurance Co., 306 S.W.3d 69 (Ky. 2010), to hold that a contractor’s faulty workmanship on the basement and foundation of an existing structure, which resulted in extensive damage to the entire building, was not an accident triggering coverage as an occurrence under the contractor’s commercial general liability (CGL) insurance policy.The policy provided that the insurer (Insurer) would pay for property damage if it resulted from an “occurrence.” The trial court ruled that Plaintiff could recover from Insurer under the policy for the damage to the structure above the basement level because the damage was an unexpected and unintended consequence of the contractor’s faulty work on the basement. The court of appeals reversed, ruling that none of the structural damage qualified as an accident triggering coverage as an occurrence under Insurer’s CGL policy. The Supreme Court affirmed, holding that the trial court failed to focus on the proper elements from Cincinnati. View "Martin/Elias Properties, LLC v. Acuity, a Mutual Insurance Co." on Justia Law

The Supreme Court affirmed the circuit court’s order rejecting the Board of Trustees of the Kentucky Schools Boards Insurance Trust’s (KSBIT) claim of governmental immunity and thus denying its motion for summary judgment. In this complaint filed by the Deputy Rehabilitator of the Kentucky School Boards Trust Workers’ Compensation Self-Insurance Fund and of the Kentucky School Boards Insurance Trust Property and Liability Self Insurance Fund against the KSBIT Board for, inter alia, negligence, the KSBIT Board asserted a defense of governmental immunity and moved for summary judgment. The circuit court determined that the KSBIT Board was not entitled to governmental immunity because its “parent” entity was not an agency of state government that enjoyed governmental immunity and because it did not perform a function that was integral to state government. The Supreme Court affirmed, holding (1) because the KSBIT Board is not the offspring of local public school boards, it does not have the governmental immunity accorded to those governmental bodies; and (2) the KSBIT Board does not serve a function integral to state government. View "Board of Trustees of Kentucky School Boards Insurance Trust v. Pope" on Justia Law

Roniesha Adams, her son, and her son’s father, Barry Adams (Barry), were passengers in Milton Mitchell’s car when the car was rear ended. Mitchell and his three passengers asserted claims against State Farm, seeking personal injury protection and uninsured motorist benefits. Because they allegedly gave inconsistent statements to State Farm regarding “substantive issues,” State Farm advised Mitchell, Adams, and Barry that they were required to submit to questioning under oath. Adams and Barry refused to submit to questioning under oath, and State Farm refused to pay additional benefits. Adams and Barry filed suit, and State Farm filed a counterclaim seeking a declaratory judgment that it did not have to provide coverage because Adams and Barry failed to cooperate with its investigation. The circuit court granted summary judgment for State Farm. Adams appealed. The court of appeals reversed, ruling that State Farm was required to obtain a court order before it could require Adams to submit to questioning under oath. The Supreme Court reversed, holding that the circuit court correctly found that Adams was required to submit to questioning under oath regarding issues as a condition precedent to coverage. View "State Farm Mutual Automobile Insurance Co. v. Adams" on Justia Law

KESA, the Kentucky Workers’ Compensation Fund, on behalf of its insureds, filed five separate medical fee disputes against the Injured Workers’ Pharmacy (IWP) and the insureds’ employees and former employees, all of whom had their prescriptions filled by IWP. The chief administrative law judge (CALJ) found (1) a pharmacy/pharmacist is a medical provider, which entitles an injured worker to choose where to have his or her prescriptions filled; (2) the pharmacy fee schedule is based on the amount a pharmacist pays a wholesaler for medication, and IWP is entitled to interest on any underpayment by KESA; and (3) because KESA brought its medical fee disputes without reasonable ground and without reasonable medical or factual foundation, KESA was required to pay the cost of the proceedings. The Workers’ Compensation Board reversed the award of costs but otherwise affirmed. The court of appeals affirmed. The Supreme Court affirmed in part, vacated in part, and remanded, holding (1) the court of appeals did not err regarding the assessment of interest and sanctions or in concluding that a pharmacy is a medical provider; but (2) the remainder of the court of appeals opinion is vacated and remanded because the CALJ did not make a determination regarding the actual average wholesale price paid by IWP. View "Steel Creations by and through KESA, the Kentucky Workers’ Compensation Fund v. Injured Workers’ Pharmacy" on Justia Law