Justia Insurance Law Opinion Summaries

Candelario Lopez, who was hired by Interstate Treating to work on the installation of a gas processing plant, was transporting two other Interstate Treating employees to the job site when he died in an automobile accident. Lopez’s wife, Maximina Lopez, sought death benefits from Interstate Treating’s workers’ compensation insurance carrier, SeaBright Insurance Co. SeaBright denied coverage, concluding that Lopez was not acting in the course and scope of his employment at the time of the accident. A hearing officer, however, determined that Lopez was acting in the course and scope of his employment and ordered SeaBright to pay death benefits. The trial court affirmed the administrative decision. The court of appeals affirmed the trial court’s judgment. The Supreme Court affirmed, holding that Lopez was acting in the course and scope of his employment when he died, and Maximina was entitled to benefits. View "Seabright Ins. Co. v. Lopez" on Justia Law

In 2010, two miners died in a mining accident while employed by Webster County Coal, LLC. That same year, another miner died in a mining accident while employed by River View Coal, LLC. Both River View and Webster County were wholly owned subsidiaries of Alliance Coal LLC, the parent company. Alliance, which had obtained a self-insurance contract, guaranteed payment of benefits under the Workers’ Compensation Act in the event its subsidiaries failed to pay benefits. Webster County and River View accepted the workers’ compensation claims made on behalf of the surviving widows and children of the deceased miners, and Alliance paid the benefits. Appellants filed lawsuits against Alliance alleging that it had liability for the miners’ deaths. The trial court granted summary judgment for Alliance, concluding that it had immunity under the Act. The court of appeals affirmed. The Supreme Court affirmed, holding that a parent company that completely self-insures the liability of its subsidiary is a carrier and immune from tort liability. View "Falk v. Alliance Coal, LLC" on Justia Law

Employee was injured when he ran from a co-worker on the job site after tricking that co-worker. Employee sought workers’ compensation benefits. Employer and Insurer denied workers’ compensation benefits, asserting that Employee’s injury did not “arise out of” or “in the course of” his employment because Employer specifically prohibited horseplay by its employees. Employee petitioned for a hearing. The Department of Labor concluded that Employee’s injury arose “out of” his employment because, but for his work with Employer” he would not have been at the job site where he was injured, but that the injury did not occur “in the course of” the employment. The circuit court affirmed. The Supreme Court reversed in part, affirmed in part, and remanded for an award of benefits, holding that the Department (1) correctly concluded that Employee’s injury arose “out of” the employment; and (2) erred when it did not consider the effect of the mandatory lull in Employee’s work when it determined that the injury did not occur “in the course of” his employment. Because Employee’s act of horseplay was not a substantial deviation from his employment, it occurred “in the course of the employment.” View "Petrik v. JJ Concrete, Inc." on Justia Law

At the time that Claimant suffered a compensable work-related injury to his left knee, Liberty Mutual Insurance Group (Liberty Mutual) was the workers’ compensation insurance carrier for Claimant’s employer (Employer). Claimant subsequently suffered a compensable work-related injury to his right knee. At the time, Chubb & Son (Chubb) was the workers’ compensation insurance carrier for Employer. Claimant was scheduled to have bilateral knee replacement surgery, but the two insurance carriers disagreed about who would pay for Claimant’s temporary total disability benefits. After a hearing, the Workers’ Compensation Commissioner required Liberty Mutual to reimburse Chubb for one half of Claimant’s temporary total disability benefits. The Workers’ Compensation Review Board and the Appellate Court affirmed. Liberty Mutual appealed, claiming that the Commissioner lacked the statutory authority to order the reimbursement to Chubb. The Supreme Court affirmed, holding that, given the unique factual circumstances of this case, the Commissioner had the authority to order the reimbursement pursuant to the relapse statute, Conn. Gen. Stat. 31-307b. View "Gill v. Brescome Barton, Inc." on Justia Law

A man working at a concrete-pouring job was assaulted by another worker at the job site. The injured man filed a lawsuit against the assailant and both the concrete-pouring company and its owner. Although the company’s commercial general liability insurer initially provided a defense attorney in the negligence action, the insurer later brought a declaratory judgment action alleging that the incident fell within the policy’s employee-exclusion clause. The superior court granted summary judgment to the insurance company. The Supreme Court affirmed. "[B]ecause courts look to workers’ compensation law to give meaning to the phrase 'arising out of and in the course of employment' in workers’ compensation/employers’ liability policies, and because commercial general liability policies are designed to avoid the existence of an overlap or a gap between workers’ compensation/employers’ liability and commercial general liability policies, sister jurisdictions interpret the same phrase in employee-exclusion clauses in commercial general liability policies in light of the identical language in workers’ compensation statutes. We have found no case law holding that the contractual phrase 'arising out of and in the course of employment' in commercial general liability exclusions should be interpreted differently from the identical phrase in workers’ compensation statutes. For purposes of this appeal, we will use workers’ compensation case law to interpret the meaning of the commercial general liability policy’s exclusion of coverage for bodily injury "arising out of and in the course of employment.'" The employer did not purchase workers' compensation coverage. And in reading the general liability policy in question, the Supreme Court concluded the superior court did not err in determining that the incident here fell within the employee-exclusion claim. View "Devine v. Great Divide Insurance Company" on Justia Law

Randy Ellington owned and operated R&J Cabinets as a sole proprietorship. When Ellington received a work-related injury, R&J had no employees. Kentucky Employers’ Mutual Insurance (KEMI) had previously issued a workers’ compensation policy to Ellington and R&J as “insureds.” At the same time, the policy included a specific exclusion from coverage of Ellington as the sole proprietor. KEMI denied Ellington’s claim for benefits, arguing that it was not covered because of the sole-proprietor exclusion endorsement. An administrative law judge concluded that Ellington was not covered by the policy. The Court of Appeals reversed, finding the policy was ambiguous and construing it in Ellington’s favor to provide coverage for his injuries. The Supreme Court reversed, holding that the policy, as issued, is not a personal policy but rather a business policy purchased by a sole proprietor, and Ellington, as the sole proprietor, was not entitled to benefits under the policy. View "Ky. Employers Mut. Ins. v. Ellington" on Justia Law

In 2005, Plaintiff suffered a compensable, work-related injury to his neck and back while employed by Ridco, Inc. Twin City Fire Insurance Company, which insured Ridco for purposes of workers’ compensation, paid temporary disability benefits. Plaintiff subsequently sought additional workers’ compensation benefits, which the administrative law judge granted. In 2010, Plaintiff filed suit against Twin City and Ridco, alleging bad faith handling of his workers’ compensation claim. During the discovery stage, Plaintiff filed a motion to compel Twin City to produce wholly unredacted claim files, personnel files, and privilege logs. The circuit court ordered Twin City to produce the disputed documents in in unredacted form, concluding that Twin City impliedly waived the attorney-client privilege. The Supreme Court reversed, holding that the circuit court erred in concluding that Twin City implied the attorney-client privilege without conducting an in camera inspection of the documents. Remanded for findings as to whether Twin City injected its reliance upon the advice of counsel into the bad faith litigations, thereby making the disputed communications relevant to the case such that would constitute an implied waiver of the attorney-client privilege. View "Andrews v. Ridco, Inc." on Justia Law

In 2009, George Lawrence, while employed by Schneider National Inc., suffered a work-related injury when he slipped and fell in a parking lot leased by Domtar Paper Company, and allegedly owned and maintained by Commercial Net Lease Realty Services, Inc., Commercial Net Lease Realty Trust, Commercial Net Lease Realty, Inc., National Retail Properties, Inc., and National Retail Properties Trust. As a result of this injury, Schneider's workers' compensation carrier, Liberty Mutual Insurance Company, paid Lawrence $33,929.23 in workers' compensation benefits. The issue this case presented for the Supreme Court's review centered on whether section 319 of the Pennsylvania Workers' Compensation Act (WCA) conferred on employers or their workers' compensation insurers a right to pursue a subrogation claim directly against a third-party tortfeasor when the injured employee took no action against the tortfeasor. Based on established precedent, the Superior Court held that Section 319 did not permit employers/insurers to commence an action directly against the third-party tortfeasor, and affirmed the trial court's grant of preliminary objections in favor of the tortfeasors. Agreeing with that reasoning, the Supreme Court affirmed. View "Liberty Mutual Ins. Co. v. Domtar Paper Co." on Justia Law

Patricia Doss filed a claim for workers' compensation with the Department of Labor and Industries after suffering chemical exposure during the course of employment with The Boeing Company. The exposure permanently aggravated her preexisting asthma, and she needed ongoing medical treatment as a result of these combined injuries. The Department determined that the combined effects of Doss's preexisting asthma and the aggravation of this condition during her Boeing employment rendered her permanently totally disabled. A right knee injury also contributed to Doss's preexisting disability. Due to her permanent total disability, the Department awarded Doss a pension. Boeing agreed to pay for the portion of the pension attributable to Doss' workplace injury but challenged the Department's order requiring it to pay for her postpension medical treatment. Boeing argued that the cost of this treatment should also be covered by the second injury fund. Boeing appealed to the Board. The issue this case presented for the Supreme Court's review centered on whether Boeing, as a self-insured employer, was entitled to second injury fund relief for a Doss' postpension medical costs. The Washington Supreme Court held that the plain language of the governing statutes did not allow a charge to the second injury fund for postpension medical treatment. Accordingly, the Court reversed the Court of Appeals. View "Boeing Co. v. Dep't of Labor & Indus." on Justia Law

In 2009, claimant sought workers' compensation benefits for a work-related injury. Claimant had preexisting multilevel degenerative disc disease and a history of intermittent low back pain with some bilateral radiation to his legs. SAIF, the employer's workers' compensation insurer, accepted a claim for a lumbar strain. Claimant subsequently sought acceptance of a combined condition, which SAIF ultimately denied on the ground that the accepted injury was no longer the major contributing cause of the combined condition. The Workers' Compensation Board upheld SAIF's denial, and claimant sought judicial review in the Court of Appeals. On appeal to that court, claimant contended that, in determining the compensability of his claim, the board erroneously had framed the inquiry in terms of whether the accepted condition continued to be the major contributing cause of his disability or need for treatment. In claimant's view, the proper inquiry was whether his accidental injury continued to be the major contributing cause of his combined condition. Claimant contended that there was no evidence that that injury was no longer the major contributing cause of his disability or need for treatment. While judicial review was pending before the Court of Appeals, claimant died of causes unrelated to his workplace injury, without a surviving spouse or other beneficiary entitled to a death benefit. The Court of Appeals held that claimant's estate, through his personal representative, was not authorized to pursue the claim to final determination under ORS 656.218(3) on the grounds that: (1) the estate was not one of the "persons" described in 656.218(5); and (2) the phrase "unpaid balance of the award" in the second sentence of subsection (5) restricted an estate's entitlement to permanent partial disability benefits that were awarded before a worker's death. The Supreme Court reversed the appellate court: in the absence of persons who would have been entitled to receive death benefits if the injury causing a deceased worker's disability had been fatal, an award of permanent partial disability benefits that is finally determined after the worker's death pursuant to ORS 656.218(3) is payable to the worker's estate under ORS 656.218(5). The case was remanded for further proceedings. View "Sather v. SAIF" on Justia Law