Justia Insurance Law Opinion Summaries

In 2006, plaintiff Robert Kyle Morris, a licensed insurance agent, was working for his father's independent insurance agency, the Morris Insurance Agency ("Morris Insurance"). At some point, Morris contacted one of the Farmers entities about becoming a Farmers agent. Morris testified that he initially became interested in working as a Farmers agent because Farmers had a policy whereby a Farmers agent could place insurance with a different company if a customer was not eligible for insurance issued by Farmers or if Farmers refused to underwrite a policy for the customer. He further testified that he had not been looking to disaffiliate himself from his father's insurance agency and that he had told a Farmers recruiter that he did not want to cut off the working relationship he had with his father. Morris also testified that, when he agreed to become a Farmers agent, he signed several different agreements; that nothing in any of those agreements or documents indicated that his relationship with his father's agency constituted a conflict of interest; that the documents given to him did not say anything contrary to what he had been told by any recruiter, or that any representations made to him by the agents of Farmers were false. Despite signing an agent agreement, and having been recruited, Morris' contract was ultimately terminated for conflict of interest. Morris sued Farmers, arguing that Farmers had fraudulently induced him to become a Farmers agent. The trial court ruled in Morris' favor, and Farmers appealed. The Supreme Court affirmed in part and reversed in part. The Court found Morris did not blindly rely on oral representations and ignore the terms of his contract. "The only information contrary to what Morris had been told was buried in a 200-page manual among dozens of other documents provided for training modules, and even longtime Farmers employees were not aware of the existence of the statement." Morris presented sufficient evidence of fraudulent inducement for the matter to be decided by the jury. Farmers' postjudgment motion was denied by operation of law, but the trial court did not make any findings regarding Farmers' request for a remittitur of the punitive-damages award. The Court remanded this case for the trial court to conduct a hearing on the punitive-damages award. View "Farmers Insurance Exchange v. Morris" on Justia Law

Federal Insurance Company appealed a circuit court order denying its motion to compel arbitration of the breach-of-contract claim asserted against it by Kert Reedstrom. In 2008, Reedstrom entered into a written employment agreement with Marshall-Jackson Mental Health Board, Inc., d/b/a Mountain Lakes Behavioral Healthcare ("MLBHC"), to begin serving as its executive director in Guntersville. During the course of Reedstrom's employment with MLBHC, MLBHC held an executive-liability, entity-liability, and employment-practices-liability policy issued by Federal Insurance that generally protected certain MLBHC officers and employees described as "insureds" in the policy from loss for actions committed in the course of their employment with MLBHC. It was undisputed that Reedstrom was an "insured" covered by the Federal Insurance policy. The Federal Insurance policy contained an arbitration provision. A separate endorsement to the Federal Insurance policy further highlighted the arbitration provision and explained that its effect was that any disagreement related to coverage would be resolved by arbitration and not in a court of law. In July 2010, MLBHC terminated Reedstrom's employment and, in December 2010, Reedstrom sued MLBHC alleging that his termination constituted a breach of his employment contract. MLBHC asserted various counterclaims against Reedstrom based on his alleged misconduct while serving as executive director. Thereafter, Reedstrom gave Federal Insurance notice of the claims asserted against him and requested coverage under the terms of the Federal Insurance policy. Federal Insurance ultimately denied his claim and refused to provide him with counsel to defend against MLBHC's claims. A jury returned a verdict awarding Reedstrom $150,000 on his claim against MLBHC and awarding MLBHC $60,000 on its claims against Reedstrom. Consistent with its previous denial of his request for coverage, Federal Insurance refused Reedstrom's request to satisfy the judgment entered against him. Reedstrom sued Federal Insurance, asserting one claim of breach of contract and seeking $72,000 in damages ($60,000 for the judgment entered against him and $12,000 for the attorney fees he incurred in defending those claims). The Supreme Court reversed and remanded, finding that the trial court did not articulate its rationale for denying the motion to compel arbitration. The denial was apparently based on the court's resolving at least one of the arbitrability issues raised by Reedstrom in his favor and against Federal Insurance. However, because the subject arbitration provision delegated to the arbitrators the authority to resolve such issues, the trial court erred by considering the waiver and nonsignatory issues raised by Reedstrom instead of granting the motion to compel arbitration and allowing the arbitrators to resolve those issues. View "Federal Insurance Company v. Reedstrom" 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

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

Petitioner-claimant Jeanette Ball sought permanent total disability benefits from the Multiple Injury Trust Fund. The Workers' Compensation Court held that a "Crumby" finding of preexisting disability made simultaneously with the adjudication of an on-the-job injury could be combined with the adjudicated injury to render the Claimant a physically impaired person under 85 O.S. Supp. 2005 sec. 171 and awarded Petitioner permanent total disability benefits. The Fund appealed, and a three-judge panel reversed. Claimant then appealed, and the Court of Civil Appeals reversed the panel. After its review, the Supreme Court held that an employee must be a physically impaired person as defined by the applicable statute before he or she can seek benefits from the Fund. A "Crumby" finding of preexisting disability made simultaneously with an adjudication of an on-the-job injury could not be combined with such adjudicated injury to render the Claimant a physically impaired person under 85 O.S. Supp 2005 sec. 171. The Court of Appeals' decision was vacated and the case remanded for further proceedings. View "Ball v. Multiple Injury Trust Fund" on Justia Law

Waskiewicsz suffers from type-1 diabetes, major depression, and gender identity disorder She worked as a product design engineer for Ford from 1990 until October, 2010, when she suffered “a debilitating emotional breakdown.” In December, after her father found her barricaded in her house, she sought long-term disability benefits under Ford’s Plan, governed by the Employment Retirement Income Security Act, 29 U.S.C. 1001. Under the plan: An Active Employee whose employment is terminated . . . shall cease to be eligible for Benefits as of the earlier of: (a) the date the Employee has been notified; or (b) the day prior to the date of such termination (in the case of retroactive terminations) . .... An employee is required to notify the Claim Processor ... if the employee is absent for more than five (5) consecutive Workdays.” She did not give notice within the five-day period and was, apparently, terminated in the interim. UniCare concluded that she did not qualify for benefits. The Sixth Circuit reversed. On remand, Waskiewicz must be given the opportunity to show that her alleged failure to comply with the requirements of the Plan was due to the very disability for which she seeks benefits. View "Waskiewicz v. UniCare Life & Health Ins. Co." on Justia Law

In December, 2009, Heelan, a Vernon Hills police officer for approximately 20 years, responded to an emergency call, slipped on ice, and fell. He was ultimately diagnosed with significant osteoarthritis in both hips, aggravated by the fall, and had two hip replacement surgeries. He did not return to work. The Village Police Pension Board awarded a line-of-duty disability pension, 40 ILCS 5/3-114.1. The Village sought a declaration that it was not obligated to pay Heelan’s health insurance premium under the Public Safety Employee Benefits Act (the Act), 820 ILCS 320/10. The circuit court entered judgment in favor of Heelan. The appellate court and Illinois Supreme Court affirmed, Proof of a line-of-duty disability pension establishes a catastrophic injury under section 10(a) of the Act as a matter of law; a public safety officer’s employer-sponsored health insurance coverage expires upon the termination of the officer’s employment by the award of the line-of-duty disability pension. The Act lengthens such health insurance coverage beyond the termination of the officer’s employment. View "Village of Vernon Hills v. Heelan" on Justia Law

Max Trucking transports freight throughout the United States, maintaining a staff of six dispatchers at its Michigan headquarters. The dispatchers find jobs on websites and contact one of 76 truck drivers, including about 20 drivers based in Michigan, to offer the load to that driver. The Michigan Worker’s Disability Compensation Act (WDCA) requires employers to maintain worker’s compensation insurance coverage for their employees. Liberty Mutual issued Max a policy, which it renewed annually for several years. In 2011, Liberty audited Max and determined that 16–18 Michigan-based drivers, who leased trucks from Max through a lease-to-buy program, were employees, not independent contractors, and increased Max’s policy premium. Max has not paid the premium increase and sought a declaratory judgment that drivers operating under the lease-to-buy program are not employees but are independent contractors under the WDCA. Liberty filed a counterclaim, seeking unpaid premiums totaling $101,592. The Sixth Circuit affirmed judgment in favor of Liberty Mutual, agreeing that the truckers are employees, despite evidence that that they may decline to work, can incur a financial loss, made a significant financial investment in the vehicle purchase, and receive all tax deductions and depreciation of the vehicles on their personal tax returns. View "Max Trucking, LLC v. Liberty Mut. Ins. Corp." on Justia Law