Justia Insurance Law Opinion Summaries

Appellant was injured while working for Employer, which had an insurance policy issued by Zurich American Insurance Company. The policy included an underinsured motorist (UIM) endorsement. After settling with the tortfeasor, Appellant sought damages from the UIM coverage in the Zurich policy. After Zurich refused Appellant’s claim, Appellant sued Zurich. Ultimately, the trial court granted summary judgment in favor of Zurich on the grounds that the UIM coverage included in the policy was the result of a mutual mistake in the making of the insurance contract. The Supreme Court reversed and remanded for entry of an order granting Appellant’s motion for partial summary judgment on the issue of UIM coverage, holding that reformation of the insurance contract on the grounds of mutual mistake was improper because (1) the facts did not establish that at the time the insurance contract was formed, the minds of the contracting parties met with the common intent to execute a policy that excluded UIM coverage; and (2) Zurich did not assert the mistake or deny the existence of UIM coverage until after Appellant had released the tortfeasor. View "Nichols v. Zurich Am. Ins. Co." on Justia Law

Angela Frye filed a workers' compensation claim against her employer alleging that in 2008 she suffered a work-related injury. The administrative law judge (ALJ) awarded Frye benefits related to the injury. In 2009, after the final hearing in the 2008 claim but before the ALJ took that claim under submission or rendered an opinion, Frye allegedly suffered a second work-related injury. In 2010, Frye filed a claim related to the 2009 accident. The ALJ dismissed the 2010 claim, concluding that Frye was required by Ky. Rev. Stat. 342.270(1) to file her claim for benefits related to the 2009 accident and join it to her pending 2008 claim, which she failed to do. The Workers' Compensation Board reversed, concluding that a claim is no longer pending for section 342,270(1) purposes after the date of the final hearing. The court of appeals affirmed. The Supreme Court affirmed, holding that in this case and under these facts, Frye's first injury claim was not pending between the date of the hearing and the date the ALJ rendered his opinion regarding that claim. Remanded. View "Saint Joseph Hosp. v. Frye" on Justia Law

The underlying class action here was brought against Southern Financial Life Insurance Company, which sold credit life and disability insurance through lending institutions, by purchasers of Southern Financial's credit life and disability policies. During the discovery phase, the trial court entered an order compelling Southern Financial to produce certain loan information and documents regarding the putative class members and the insurance sold to them. Southern Financial did not comply with the order, arguing that the loan information was not in its "possession, custody or control" within the meaning of Ky. R. Civ. P. 34.01, but rather, the information was in the possession of the individual lenders. After applying principles of general agency law, the trial court overruled the objection. Southern Financial subsequently sought a writ of prohibition to prevent the trial court's enforcement of the discovery order. The court of appeals declined to issue a writ. The Supreme Court affirmed, holding that Southern Financial was legally in control of the information it was compelled to disclose in the trial court's order, and therefore, the trial court committed no error. View "S. Fin. Life Ins. Co. v. Pike Circuit Court" on Justia Law

Plaintiff was a Pennsylvania resident who was injured in Kentucky. Plaintiff's daughter, with whom Plaintiff resided, was driving the vehicle involved in the accident. Plaintiff brought suit against her insurance carrier, State Farm Mutual Automobile Insurance Company, for underinsured motorist (UIM) coverage under a policy issued in Pennsylvania and covering a vehicle that Plaintiff registered and used exclusively in Pennsylvania. The trial court and court of appeals concluded that Pennsylvania law governed the dispute between Plaintiff and State Farm, but the two courts reached different results. The trial court concluded that Plaintiff was not entitled to UIM coverage because her policy disallowed coverage when she was injured in an underinsured vehicle owned or regularly used by a "resident relative." The court of appeals found Kentucky public policy would prohibit enforcement of the policy provision and concluded Plaintiff was entitled to UIM coverage despite the plain language of her policy. The Supreme Court reversed, holding (1) Pennsylvania law applied to this dispute; and (2) there was no prohibition on the type of UIM exclusion at issue in this case. View "State Farm Mut. Ins. Co. v. Hodgkiss-Warrick" on Justia Law

Jason Morris worked for Owensboro Grain, a refinery located on the Ohio River. Morris suffered a work-related injury while performing deckhand duties, including loading items onto a barge. Morris received benefits from Owensboro Grain's Longshore and Harbor Workers' Compensation Act (LHWCA) insurance policy. Later, Morris filed a claim for Kentucky workers' compensation benefits. Owensboro Grain denied the claim on the grounds that the injury was not covered under the Kentucky Workers' Compensation Act. An ALJ dismissed Morris's claim, finding that Morris's injury fell under the LHWCA, and therefore, Kentucky had no subject matter jurisdiction over his claim. The Workers' Compensation Board and court of appeals affirmed. The Supreme Court affirmed, holding (1) because Morris was covered under the LHWCA, he was exempt from Kentucky's workers' compensation law unless Owensboro Grain provided him voluntary coverage; and (2) there was insufficient evidence to prove that Owensboro Grain provided voluntary workers' compensation coverage to Morris. View "Morris v. Owensboro Grain Co., LLC" on Justia Law

Sarah Crossett was employed by Jackson Purchase Medical Associate (JPMA), which leased space within a medical pavilion. Crossett was injured when she slipped and fell in snow that had accumulated outside of the building. Crossett filed for workers' compensation. JPMA disputed Crossett's claim, asserting that the injury did not occur on its operating premises under the going and coming rule, which provides that injuries that occur while an employee is on the way to or from a worksite are not compensable. An ALJ concluded that Crossett's injury was compensable, finding that Crossett fell within the operating premises of JPMA. The court of appeals affirmed. The Supreme Court affirmed, holding that because JPMA could assert control over the parking area and because Crossett was not taking an unreasonable path between her car and her office, she was entitled to workers' compensation benefits for her injury. View "Jackson Purchase Med. Assocs. v. Crossett" on Justia Law

Kenneth Crum, who was horseback riding at the time, was struck and severely injured by a vehicle driven by Raymond Ousley. At the time, Ousley was test-driving the vehicle, an uninsured car titled to Rhonda Ward. Crum sued Ousley for personal injuries and later joined Ousley's auto liability insurer, Kentucky Farm Bureau, for no-fault benefits. Kentucky Farm and Crum settled the negligence claims against Ousley for $25,000. Later, the trial court declared by final order that Kentucky Farm was also required to pay basic reparation benefits (BRBs) to Crum for the motor vehicle accident. The trial court then entered a final order declaring coverage for Crum and ordering Kentucky Farm also to pay Crum the no-fault benefits. The court of appeals reversed, holding that Kentucky law did not allow Crum to recover and Ousley's policy excluded Crum. The Supreme Court reversed, holding (1) a pedestrian struck by an uninsured vehicle being driven by an ininsured driver can recover no-fault benefits from the driver's insurance company; and (2) therefore, Crum was entitled to receive BRBs from Kentucky Farm. View "Samons v. Ky. Farm Bureau Mut. Ins. Co." on Justia Law

While working for Employer, Appellant became trapped in a stalled elevator. Employer's security staff attempt to rescue Appellant, but as a result of their attempt, Appellant fell several stories down the elevator shaft, causing serious injuries. Appellant filed for workers' compensation. The ALJ enhanced Appellant's workers' compensation award based on Ky. Rev. Stat. 342.165(1), which provides that if an accident is caused by the intentional failure of an employer to comply with a statute or regulation relative to the maintenance of safety appliance, the claimant's benefits shall be increased, and Ky. Rev. Stat. 338.031, which states that an employer must provide his employees a place to work free from dangerous hazards. The workers' compensation board affirmed. The court of appeals reversed. The Supreme Court reversed, holding that the ALJ correctly applied the four-part test set forth in Lexington-Fayette Urban County Government v. Offutt to determine that Employer violated section 338.031, and accordingly, the ALJ properly applied the enhancement to Appellant's weekly benefit because of Employer's violation of section 342.165. View "Hornback v. Hardin Memorial Hosp." on Justia Law

Employee sustained injuries in the course of his employment with Four Star Transportation. Despite being hired by Four Star, Employee was initially considered an employee of Better Integrated Services. Better Integrated leased Employee to Beacon Enterprises, which then leased Employee to Four Star. Beacon had an insurance policy with Kentucky Employers' Mutual Insurance (KEMI). An ALJ determined (1) Employee's injury entitled him to benefits and a permanent partial disability award, and (2) KEMI's policy covered Employee's injury. The Workers' Compensation Board reversed, finding Employee was not covered under the KEMI policy due to the fact he was unaware that Four Star was leasing him from different entities, including Beacon. The court of appeals affirmed. The Uninsured Employers' Fund appealed. The Supreme Court affirmed, holding (1) Employee could not be considered Beacon's employee because he did not enter into a contract for hire with Beacon; (2) the Board did not act arbitrarily in finding that the ALJ's opinion was not supported by substantial evidence; and (3) the Board and lower court's decision was not based on Better Integrated and Beacon's failure to comply with Ky. Rev. Stat. 342.615. View "Ky. Uninsured Employers' Fund v. Hoskins" on Justia Law

Employee filed a claim for workers' compensation, alleging that he sustained injuries while working for Restaurant. Employee gained employment with Restaurant through a staff leasing company (Company). Employee agreed to a settlement of his claim. Later, Employee moved to re-open the workers' compensation award and to join the Uninsured Employers' Fund (UEF) as a party, asserting that Restaurant and Company were no longer available to pay for his continuing medical expenses. The ALJ subsequently joined the UEF. The ALJ found Employee's condition to have worsened so he was totally disabled and that the UEF was responsible for all benefits for which Employee was entitled. The Workers' Compensation Board vacated the portion of the ALJ's opinion regarding the amount of benefits Employee would receive and otherwise affirmed. The Supreme Court affirmed, holding (1) Employee's claim was properly reopened and the UEF joined as a party; (2) Employee presented sufficient evidence to show that his condition had worsened since the entry of his original workers' compensation award; and (3) although the original settlement agreement only listed Employee's lower back injury as compensable, Employee was not barred from raising a claim for his thoracic spine injury upon reopening. View "Commonwealth v. Allen" on Justia Law