Justia Insurance Law Opinion Summaries

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

Hospital purchased from Assurance Company of America a "builder's risk" insurance policy and contracted with Wehr Constructors for installation of subsurfaces and floors as part its project. After installation, a portion of the floors and subsurface done by Wehr was damaged. Hospital sought recompense under the builders risk policy. Assurance denied the claim. Meanwhile, Wehr and Hospital settled on Wehr's breach of contract claim. As part of the settlement, Hospital assigned to Wehr any claim Hospital had against Assurance arising out of the policy. Wehr, as Hospital's assignee, then sued Assurance in federal district court. Assurance moved for judgment on the pleadings, invoking the policy's anti-assignment provision and arguing that it had not consented to the assignment. The district court requested certification to answer a question of Kentucky law. The Supreme Court concluded that under Kentucky law, a clause in an insurance policy that requires the insured to obtain the insurer's prior written consent before assigning a claim for an insured loss under the policy is not enforceable or applicable to the assignment of a claim under the policy where the covered loss occurs before the assignment, and that such a clause would, under those circumstances, be void as against public policy. View "Wehr Constructors, Inc. v. Assurance Co. of Am." on Justia Law

Hospital purchased from Insurer a "builders risk" insurance policy which included a provision requiring Hospital to obtain Insurer's written consent before assigning a claim for an insured loss. Hospital contracted with Constructors for floors and subsurface work, which was later damaged. Hospital claimed a loss and sought recompense under the builders risk policy, but Insurer denied the claim. Hospital later assigned Constructors any claim or rights Hospital had against Insurer arising out of the insurance policy. Constructors, as Hospital's assignee, brought suit in federal court against Insurer seeking to recover payment due under the builder's risk policy. The Supreme Court granted the certification request of the federal court to answer a question of state law and concluded that, under Kentucky law, a clause in an insurance policy that requires the insured to obtain the insurer's prior written consent before assigning a claim for an insured loss under the policy is not enforceable or applicable to the assignment of a claim under the policy where the covered loss occurs before the assignment, and that such a clause would, under those circumstances, be void as against public policy. View "Wehr Constructors, Inc. v. Assurance Co. of Am." on Justia Law

Appellant appealed from an opinion of the court of appeals which affirmed an order of the circuit court dismissing Appellant's petition for review of a decision of the Kentucky Unemployment Insurance Commission (KUIC). In addition to denying Appellant unemployment benefits, the KUIC ordered Appellant to reimburse $12,785 in benefit payments he had already received. The circuit court dismissed Appellant's petition for review because it did not comply with the verification requirement contained in Ky. Rev. Stat. 341.450(1), and thus the court concluded that its jurisdiction was not invoked within the twenty-day limitations period provided for filing such an action. The Supreme Court affirmed, holding (1) because Appellant failed to comply with the verification provision of section 341.450(1), the circuit court lacked jurisdiction over the controversy; and (2) Appellant did not comply with the verification requirement, as his attorney's signature on the petition did not constitute "certification." View "Taylor v. Ky. Unemployment Ins. Comm'n" on Justia Law

Appellee pled guilty to fraudulent insurance acts by complicity. Pursuant to a plea agreement, the circuit court sentenced Appellee to a five-year probated sentence and ordered restitution to Amica Mutual Insurance Company in the amount of $48,597 - the full amount distributed by Amica after Appellee's house burned down. The court of appeals vacated the order of restitution and remanded to the trial court to make specific findings of the monetary damages suffered as a result of the insurance fraud, without regard to the proceeds distributed as a result of the property damage or alternate housing and living expenses. The Supreme Court reversed, holding (1) a trial court is authorized to order restitution for damages not suffered as a direct result of the criminal acts for which the defendant has been convicted when, as part of a plea agreement, the defendant freely and voluntarily agrees to the restitution condition; and (2) therefore, the trial court did not abuse its discretion when it ordered Appellee to reimburse Amica for the entire $48, 597. View "Commonwealth v. Morseman" on Justia Law

Appellee was injured during the course of his employment. When his workers' compensation benefits ceased, Appellee applied for and received unemployment insurance benefits. The Kentucky Unemployment Insurance Commission determined that Kan. Rev. Stat. 341.090, which permits the use of an "extended base period" that captures earnings leading to equitable unemployment benefits, required that the extended base period may include only the four calendar quarters that immediately precede the base period. Pursuant to this extended base period, Appellee was awarded benefits of $149 per week. The circuit court reversed. The court of appeals affirmed, concluding that the extended base period need not be limited to the four quarters that immediately precede the base period. The Supreme Court reversed, holding that the Commission properly applied the statute in calculating Appellee's unemployment benefits. View "Unemployment Ins. Comm'n v. Hamilton" on Justia Law