Justia Insurance Law Opinion Summaries

In 2014, Lend Lease, the construction manager of the Chicago River Point Tower Project, hired Cives as a subcontractor. Cives hired Midwest Steel. Midwest had, years before, hired AES to supply Midwest with additional workers, who were co‐employed by Midwest and AES. Lend Lease entered into a “contractor-controlled insurance program” with Starr Liability with a $500,000 deductible. All subcontractors were to join in the policy. AES had, several years earlier, obtained workers’ compensation for its workers from TIC, so that injured AES‐Midwest workers could obtain workers’ compensation from either Starr (or Lend Lease under the deductible) or TIC. Four ironworkers, jointly employed by Midwest and AES and performing work for Midwest were injured on the job and sought workers’ compensation. The claims exceeded $500,000, so Lend Lease had to pay its full deductible. Starr paid the remaining claims. Lend Lease filed suit against TIC, AES’s insurer, and AES, seeking reimbursement of the $500,000. The district court dismissed. The Seventh Circuit affirmed. Lend Lease made a deal with Starr and is bound by it. The court rejected an argument that AES has been unjustly enriched; AES was not obligated to purchase an insurance policy that would cover Lend Lease's deductible. View "Lend Lease (US) Construction, Inc. v. Administrative Employer Services, Inc." on Justia Law

The United States District Court for the District of New Mexico certified a question of New Mexico law to the state Supreme Court. The question centered on whether a worker injured in the course of employment by a co-worker operating an employer owned motor vehicle was a person “legally entitled to recover damages” under his employer’s uninsured/underinsured motorist coverage. Andrew Vasquez was killed at the workplace after being struck by a steel beam that fell off of a forklift during the course of his employment at Coronado Wrecking and Salvage. A coworker operating the forklift had jumped off to check whether the steel beam being lifted was secure, leaving the forklift unattended as the steel beam slid off of the forks, striking and killing Vasquez. Plaintiff, Vasquez’s estate, subsequently collected workers’ compensation benefits from Coronado’s workers’ compensation carrier. Related to the forklift accident, Plaintiff also collected uninsured motorist benefits under Vasquez’s own automobile insurance policy.The certified question from the district court arose from an alleged discontinuity among the plain language of New Mexico’s Workers’ Compensation Act (WCA), the Uninsured Motorist statute, and the New Mexico Court’s case law. Because the WCA provided the exclusive remedy for an employee injured in a workplace accident by an employer or its representative, the employee was not legally entitled to recover damages from the uninsured employer tortfeasor under the Uninsured Motorist statute. The Court therefore answered the certified question in the negative. View "Vasquez v. American Cas. Co. of Reading" on Justia Law

James Mordhorst was injured while working for Fischer Furniture. Almost one year later, Dakota Truck Underwriters and Risk Administration Services (collectively, Insurers) terminated all workers’ compensation benefits. The South Dakota Department of Labor subsequently ordered Insurers to pay all past medical bills and interest as well as future medial expenses. Mordhorst then filed an action seeking punitive damages for an alleged bad-faith denial of workers’ compensation benefits. The circuit court granted Insurers’ motion to dismiss for failure to state a cause of action upon which relief could be granted. The Supreme Court reversed, holding that the circuit court erred by granting Insurers’ motion to dismiss because Mordhorst asserted facts that, if true, state a claim for bad faith denial of a workers’ compensation claim and that Insurers’ reliance on an independent medical examiner’s report to deny benefits was not per se reasonable. View "Mordhorst v. Dakota Truck Underwriters" on Justia Law

Bayer, an ironworker with Area Erectors, which was hired by Garbe to build Panduit’s warehouse facilities, fell and is now quadriplegic. Bayer filed a claim against Area under the Workers’ Compensation Act (820 ILCS 305/1). Area began making temporary total disability payments and payments for Bayer’s medical expenses. Bayer also sued Panduit, Garbe, and a structural engineering company for negligence. Panduit and Garbe sued Area under the Joint Tortfeasor Contribution Act (740 ILCS 100/0.01). Bayer's settlement with Area was approved, so Area was discharged from contribution liability. Other claims were resolved, leaving only Bayer’s action for negligence against Panduit. Judgment ($64 million) was entered in Bayer’s favor. Under the Workers’ Compensation Act (820 ILCS 305/5(b)), Area was entitled to recover out of that judgment the amount of compensation it paid or would pay to Bayer, including amounts paid or to be paid under the Act for medical expenses, vocational rehabilitation, and temporary partial disability benefits. The court suspended future workers’ compensation payments. The Act provides that where, “the services of an attorney at law of the employee . . . have . . . substantially contributed to the procurement ... of the proceeds out of which the employer is reimbursed, then, in the absence of other agreement, the employer shall pay such attorney 25% of the gross amount of such reimbursement,” 820 ILCS 305/5(b), so Bayer’s lawyers were entitled to fees equal to 25% of the amount Area had paid for lost wages, medical expenses, and other compensable items before payments were suspended. Building on its 1990 holding that the gross amount of reimbursement subject to attorney fees includes both benefits paid before the third-party recovery and the amount of such benefits the employer will be relieved from paying in the future by reason of the third-party action, the Illinois Supreme Court held that the value of future medical care should be included in this calculation. View "Bayer v. Panduit Corp." on Justia Law

John Boman appealed the grant of summary judgment in favor of the City of Gadsden. Boman worked as a Gadsden police officer from 1965 until he retired in 1991. Following his retirement, Boman elected to pay for retiree health coverage through a group plan offered by Gadsden to retired employees. This retired-employee-benefit plan was also administered by Blue Cross and provided substantially similar benefits to those Boman received as an active employee. In 2000, however, Gadsden elected to join an employee-health-insurance-benefit plan ("the plan") administered by the State Employees' Insurance Board ("the SEIB"). When Boman turned 65 in 2011, he was receiving medical care for congestive heart failure and severe osteoarthritis of the spine. After his 65th birthday, Blue Cross began denying his claims for medical treatment based on the failure to provide Blue Cross with a "record of the Medicare payment." However, Boman had no Medicare credits. Boman was hired before March 31, 1986, and, although Gadsden did begin participation in the Medicare program in 2006, Boman's employee group had not opted to obtain Medicare coverage before Boman retired. Consequently, Boman never paid Medicare taxes and did not claim to have Medicare coverage. The SEIB ultimately determined that the plan was the secondary payer to Medicare. Boman sued Gadsden, asserting that it had broken an agreement, made upon his employment, to provide him with lifetime health benefits upon his retirement. Boman also sued the members of the SEIB charged with administering the plan, challenging the SEIB's interpretation of the plan. Finding no reversible error in the grant of summary judgment to Gadsden, the Supreme Court affirmed. View "Boman v. City of Gadsden" on Justia Law

Black drove a truck for Western, one of 48 freight service providers that carry raw paper to Dixie’s Bowling Green factory. Black parked the truck, containing 41,214 pounds of pulpboard rolls, separated by 10-lb. rubber mats. Black received permission from Chinn, the Dixie forklift operator, to enter the loading dock. It was “[c]ommon practice” for the truck driver to unload the rubber mats so that the Dixie forklift operator did not “have to get off each time.” Chinn and Black got “into a rhythm” in unloading the materials until Chinn ran over Black’s foot with the forklift, leading to a below-the-knee amputation of Black’s leg. Black received workers’ compensation from Western, then filed a tort action against Dixie, seeking $1,850,000. Following a remand, the district court denied Dixie summary judgment. The Sixth Circuit reversed, holding that the Kentucky Workers’ Compensation Act barred Black’s claims, Ky. Rev. Stat. 342.610(2), .690. The work Black was doing as part and parcel of what Dixie does; a worker injured in this setting will receive compensation regardless of fault by a company in Dixie’s shoes or one in Western’s shoes. The immunity from a further lawsuit applies as well. This burden and benefit are the trade-offs built into any workers’ compensation system. View "Black v. Dixie Consumer Prods., LLC" on Justia Law

Floyd Cornelison injured his back at work in 1996 while shoveling dirt. He had back surgery later that year, but it did little to improve his condition. The Board found he was permanently and totally disabled (PTD) in 2001 under the "odd-lot doctrine." TIG Insurance, the workers’ compensation insurer for Floyd’s employer, did not contest that he was PTD; it reclassified his workers’ compensation benefits as PTD in 2000. Floyd also received Social Security disability payments, and the employer received an offset for those payments. The employer and TIG challenged Cornelison's continuing eligibility for workers’ compensation, relying on surreptitious video surveillance and a doctor’s report issued after the doctor viewed an edited surveillance video. Cornelison and his wife sued TIG and a number of others involved in the attempt to terminate benefits; they alleged several causes of action, contending that the video had been purposely edited to provide a false picture of the employee’s physical abilities and that the defendants had participated to varying degrees in a scheme to defraud the Alaska Workers’ Compensation Board. The trial court granted summary judgment or dismissal as to all of the defendants on all counts. After review of the matter, the Supreme Court affirmed in part, and reversed in part. The Court concluded the Cornelisons provided enough evidence to show that a material factual dispute existed about the accuracy of the edited videos and the manner in which the videos were created. They also presented more than generalized claims of emotional distress. Because the superior court failed to address the issues in dispute in the IIED claim against certain persons involved with the making of the videos, we reverse the grant of summary judgment on this claim and remand to the superior court. The case was remanded for further proceedings. View "Cornelison v. TIG Insurance" on Justia Law

An employee of NTC Transportation, Inc. (“NTC”) filed petitions with the Mississippi Workers’ Compensation Commission (“the Commission”), claiming he had suffered compensable work-related injuries on two occasions. AmFed National Insurance Co. (“Amfed”), believing NTC’s workers’ compensation coverage to have lapsed due to NTC’s failure to timely pay the premium, responded and denied both liability and coverage as to the latter injury. AmFed’s denial of coverage was litigated and culminated in a judgment rendered in NTC’s favor. Based on the applicable law and particular facts of this case, the Supreme Court found that NTC had no insurance coverage with AmFed in effect at the time of the relevant injury. Accordingly, the Court reversed and remanded. View "Amfed National Insurance Co. v. NTC Transportation, Inc." on Justia Law

Respondent suffered a work-related back injury. Respondent and her employer entered into a “full, final, and complete” settlement of Respondent’s claims for workers’ compensation benefits related to that injury. Respondent later filed a claim petition seeking additional benefits for the back injury, alleging a lumbar spine injury with consequential depression and anxiety. The employer moved to dismiss the petition on the ground that Respondent was first required to bring a motion to vacate the existing settlement agreement before bringing a new claim. The workers’ compensation judge denied the motion, concluding that the settlement agreement did not foreclose a later claim for consequential psychological injury. The Workers’ Compensation Court of Appeals affirmed, concluding that the settlement agreement did not foreclose claims from the same incident that were not mentioned in the agreement without evidence that those claims were contemplated by the parties at the time they entered into the agreement. The Supreme Court reversed, holding that the language of the settlement agreement was sufficient settle conditions and complications that arise out of, and are a consequence of, Respondent’s workers’ compensation injury. View "Ryan v. Potlatch Corp." on Justia Law

Both of the injured employees in these cases, Charles Morris and Charles Poole, were treated at the Lafayette Bone & Joint Clinic (“LB&J”); Morris was treated by Dr. Louis Blanda and Poole by Dr. John Cobb. Louisiana United Business SIF (“LUBA”), sent letters to LB&J and its doctors stating that LUBA would no longer pay for prescription medications directly dispensed by LB&J and directing LB&J doctors to issue future prescriptions for the instant injured employees that could be filled at local retail pharmacies. Despite these notices and subsequent denials of requests for reimbursement of dispensed prescription medications, LB&J doctors continued to dispense prescription medications to these injured employee patients throughout 2008 and to submit requests for reimbursement to LUBA. LUBA declined payment for these requests, citing its prior notice. LB&J and the treating physicians thereafter filed disputed claim forms with the Office of Workers’ Compensation (OWC), seeking to recover the cost of the medications dispensed, along with penalties and attorney fees. Following a joint trial in these two cases, the OWC judge ruled that the plaintiff/health care providers’ recovery for medications dispensed after the 2008 notice were nonemergency treatment dispensed without consent of the payor. Further, the OWC judge found that no penalties or attorney fees were warranted because LUBA had clearly advised the plaintiff/health care providers that no further reimbursement would be made for prescription medications dispensed by LB&J doctors after the date of the notice. The plaintiff/health care providers appealed, seeking an increase in the amount awarded and an award of penalties and attorney fees. The Louisiana Supreme Court granted writs to review the appellate court decisions, which awarded unreimbursed prescription medication costs beyond the $750 limitation set forth in LSA-R.S. 23:1142(B) and awarded penalties and attorney fees. The Court reversed the appellate court's modification of the amount awarded by the OWC, and affirmed in part, the decision to award penalties and attorney fees. View "LaFayette Bone & Joint Clinic v. Louisiana United Business SIF" on Justia Law