Justia Insurance Law Opinion Summaries

Draper Paving, the subcontractor for a road project, employed Richard Slone as a dump truck driver and assigned him to work on the project. Slone died from injuries he received in an accident while working on the project. At the time of the accident, Draper Paving had taken out a motor vehicle insurance policy with Selective Insurance Company of America. Karen Slone Bratton and Selective Insurance filed separate declaratory judgment actions seeking to determine whether Slone fell within the scope of the Selective Insurance policy’s coverage. The circuit court concluded that Bratton was not entitled to insurance proceeds from Selective Insurance because Slone did not fall within the scope of the policy at the time of the accident. The Supreme Court reversed, holding that Slone was occupying both a dump truck and company pickup truck - both covered autos - at the time of the accident under the Selective Insurance policy. Because the policy’s coverage limit for each covered auto applied independently to multiple covered autos involved in the same accident, Bratton was entitled to proceeds under the Selective Insurance policy for both the dump truck and the company pickup truck. Remanded. View "Bratton v. Selective Ins. Co. of Am." on Justia Law

Appellant, a self-employed delivery driver who contracted with FedEx Home Delivery for one of its delivery routes, fell and injured his shoulder while delivering packages. Under his FedEx service contract, Appellant was required to maintain workers’ compensation insurance, which he did through CorVel Corporation. Appellant received medical treatment, but with his physical restrictions, he could not complete his delivery route. Appellant hired a replacement driver until he canceled the service contract. Appellant sought temporary disability benefits, which CorVel denied. Appellant administratively appealed. The appeals officer denied both temporary total disability benefits and temporary partial disability benefits on the basis that Appellant could not establish a loss of any income without evidence of a salary. The district court denied Appellant’s petition for judicial review. The Supreme Court reversed, holding (1) for self-employed individuals, the lack of a salary associated with typical employment does not preclude an average monthly wage calculation for the purpose of determining lost income and rendering a workers’ compensation benefit decision; and (2) the appeals officer in this case should have determined the best method for calculating any loss to Appellant’s wages resulting from his industrial injury, taking into account both his business’s income and expenses. Remanded. View "Mensah v. CorVel Corp." on Justia Law

When the plant closed, plaintiffs retired under a collective bargaining agreement (CBA) that provided that the employer would continue health insurance and that coverage an employee had at the time of retirement or termination at age 65 or older (other than discharge for cause) “shall be continued thereafter provided that suitable arrangements for such continuation[] can be made… In the event… benefits … [are] not practicable … the Company in agreement with the Union will provide new benefits and/or coverages as closely related as possible and of equivalent value." In 2011 TRW (employer’s successor) stated that it would discontinue group health care coverage beginning in 2012, but would be providing “Health Reimbursement Accounts” (HRAs) and would make a one-time contribution of $15,000 for each eligible retiree and eligible spouse in 2012 and, in 2013, would provide a $4,800 credit to the HRAs for each eligible party. TRW did not commit to funding beyond 2013. Plaintiffs sued, claiming that the change violated the Labor-Management Relations Act, 29 U.S.C. 185, and the Employee Retirement Income Security Act, 29 U.S.C. 1001. The court entered summary judgment, ruling that the CBAs established a commitment to lifetime health care benefits. The Sixth Circuit affirmed, but subsequently vacated and remanded for reconsideration in light of the Supreme Court’s 2015 decision in M & G Polymers. View "United Steel v. Kelsey-Hayes Co." on Justia Law

In Sprint Commc’ns, Inc. v. Jacobs, the Supreme Court revisited the doctrine of abstention enunciated in Younger v. Harris. That doctrine requires federal courts, in the absence of extraordinary circumstances, to refrain from interfering with certain state proceedings. In this case, David Knight, an employee of Sirva Relocation, LLC, filed a charge of discrimination with the Massachusetts Commission Against Discrimination (MCAD) alleging that Sirva and Aetna Life Insurance Company (together, Appellants) had discriminated against him on the basis of disability in violation of Mass. Gen. Laws ch. 151B and the Americans with Disabilities Act (ADA). Appellants filed a federal complaint against the Commonwealth of Massachusetts, the MCAD, its commissioners, and Knight, asking the court to enjoin the MCAD proceeding on the basis that ERISA preempted the chapter 151B claim. The MCAD and Knight moved to dismiss the complaint, entreating the district court to abstain. While the case was pending, the Supreme Court decided Sprint. The district court dismissed the federal court action, concluding that Younger abstention was appropriate in this case. The First Circuit affirmed the district court’s decision to abstain and further clarified its own case law concerning the exception to the Younger doctrine for facially conclusive claims of preemption. View "Sirva Relocation, LLC v. Golar Richie" on Justia Law

While in the course and scope of his employment with Employer, Plaintiff suffered serious injuries. Plaintiff recovered workers’ compensation insurance benefits in the amount of $207,147. Plaintiff subsequently brought this action against Employer, alleging that Employer was an uninsured employer under the Workers’ Compensation Act at the time of the accident. The district court granted summary judgment in favor of Employer, concluding that Employer was an insured employer under the Act and was therefore entitled to tort immunity pursuant to Mont. Code Ann. 39-71-411. The Supreme Court affirmed, holding that the district court did not err in concluding that Employer was an insured employer under the Act and therefore was entitled to tort immunity. View "Stokes v. Golden Triangle, Inc." on Justia Law

Ray Dillard attempted to collect workers' compensation benefits from the president and majority shareholder of his employer. In 1997, The Commission held that Dillard suffered a compensable injury. After the mandate issues, one of Dillard's attorneys filed a lis pendens notice regarding several parcels of real property the company's president owned. Because none of that property belonged to the company itself, Dillard's attorney informed the president that it was asking the Commission to hold the president personally liable for Dillard's benefits because the company failed to carry workers' compensation insurance. Dillard died in 2005 while unresolved issues regarding who would ultimately be responsible for Dillard's benefits was pending before an administrative law judge. Dillard's estate filed a complaint at the circuit court against the president and company, claiming that the company was required to carry workers' compensation insurance but failed to do so. Therefore, the Estate argued the president was personally liable for Dillard's benefits. Among other things, the president argued that the Estate's claim was barred by the statute of limitations and the doctrine of res judicata. Eventually, the administrative law judge granted the Estate's renewed motion for summary judgment, and entered a judgment of approximately $223,000 against the president and the company "jointly and individually." The president appealed, and the case was assigned to the Court of Appeals. The appellate court held that Dillard's claim against the company president was barred by res judicata and the statute of limitations. The Supreme Court held the Court of Appeals erred in reaching that conclusion, reversed and reinstated the trial court's judgment in favor of Dillard. View "Jarrett v. Dillard" on Justia Law

Milton Harper, the managing partner and president of Banks, Finley, White & Company of Mississippi (“Banks”), suffered a severe stroke in August 2000, and died of another stroke in July 2001. His dependents sued Banks for workers’ compensation benefits. The administrative law judge and the Workers’ Compensation Commission held that Harper’s injuries and death arose out of the scope and course of his employment at Banks. On appeal, the circuit court agreed that substantial evidence in the record supported the Commission’s conclusion that Harper’s stroke arose out of his employment, but that court held that Harper’s dependents were barred from recovering workers’ compensation benefits because Harper had failed to obtain workers’ compensation insurance for Banks. In turn, the Court of Appeals in "Harper v. Banks, Finley, White & Co. of Mississippi," (136 So. 3d 462 (Miss. Ct. App. 2014)), held that Harper’s dependents were not barred from recovery because Section 71-3-79 of the Mississippi Code allowed members of partnerships to exempt themselves from workers’ compensation coverage by giving notice in writing. Because Harper had not opted out of coverage in writing, the Court of Appeals held that Banks was required to provide workers’ compensation benefits to Harper’s beneficiaries. On writ of certiorari, the Supreme Court affirmed in part, and reversed in part. The Court held that the Court of Appeals erred in applying Section 71-3-79 of the Mississippi Code to the facts of this case. Because Banks did not have workers’ compensation insurance coverage, there was no coverage for Harper to opt out of in writing as contemplated by Section 71-3-79. Instead, the Court held that Section 71-3-52 of the Mississippi Code controlled the analysis of this case: because Banks had more than five employees, it was required to obtain workers’ compensation insurance and provide workers’ compensation benefits to its employees. The Court affirmed the Workers’ Compensation Commission’s finding that Harper suffered a fatal injury through the course of his employment at Banks was supported by substantial evidence. View "Harper v. Banks, Finley, White & Co. of Mississippi, P.C." on Justia Law

Dakota Trailer Manufacturing, which makes radiator components for an unrelated company, performs its component work in one of Dakota Trailer’s locations that was originally classified as a “machine shop” for workers compensation insurance rating purposes. After an inspection, the National Council on Compensation Insurance changed the location’s classification to “welding or cutting.” Both the Workers’ Compensation Appeals Board and the South Dakota Department of Labor affirmed the new classification. The circuit court reversed and reinstated the machine shop code. The Supreme Court reversed, holding that the circuit court properly found that Dakota Trailer’s activities fit within the machine shop code. View "Dakota Trailer Mfg. v. United Fire & Cas. Co." on Justia Law

An employee at a boiler manufacturing plant sustained permanent hearing loss as a result of his employment. Between the time he was injured and the time he filed his workers’ compensation claim, the plant changed ownership. Twin City Fire Insurance Company insured the plant for the previous owner, and American Insurance Company insured the new owner. Counsel representing American mistakenly believed that American had insured the plant during the time of the injury, and Twin City was not given notice of the claim until after entry of an award. The new owner of the plant filed a declaratory judgment action against the previous owner and both insurers to determine who was liable for payment of the award. The district court determined that Twin City was liable for the employee’s workers’ compensation award. The Supreme Court affirmed, holding that the district court did not err in finding that Twin City was liable for the award, in rejecting Twin City’s equitable defenses, and in dismissing Twin City’s counterclaims. View "Cleaver-Brooks Inc. v. Twin City Fire Ins. Co." on Justia Law

F.H. Stoltze Land & Lumber Company and Maxum Specialty Insurance Group (collectively, “Stoltze”) and Les Schlegel Enterprises (“Schlegel”) contracted for Schlegel to log Stoltze’s property. Schlegel obtained liability insurance from American States Insurance Company (ASI). Whitney Shanks, a worker for Schlegel, injured himself during logging operations on Stoltze’s property. Shanks filed a personal injury lawsuit against both Schlegel and Stoltze. Stoltze tendered defense and indemnity of Shanks’s suit to ASI. After ASI accepted the tender, the district court dismissed the case against Schlegel on the grounds that Schlegel was immune to suit under the Workers’ Compensation Act’s exclusive remedy provision. ASI subsequently withdrew its defense of Stoltze, asserting that the policy covered Stoltze only to the extent that Schlegel was liable. Stoltze then filed a complaint against ASI, seeking declaratory judgment that ASI was required to defend and indemnify Stoltze against Shanks’s suit. The district court entered summary judgment for ASI, concluding that because the court in the underlying action determined that Schlegel was immune and not liable, ASI had no duty to defend or indemnify Stoltze. The Supreme Court affirmed, holding that ASI’s insurance policy with Schlegel did not require ASI to defend and indemnify Stoltze in an action in which Schlegel could not be held liable. View "F.H. Stoltze Land & Lumber Co. v. Am. States Ins. Co." on Justia Law