Justia Insurance Law Opinion Summaries

In 2006, Appellant injured her lower back while working for Employer, who was self-insured. Later that year, Employer discharged Appellant for violating the company’s absenteeism policy and failing to accept the light-duty work offered. The Industrial Commission denied Appellant’s request for temporary total disability (TTD) compensation, concluding that Appellant had abandoned her employment and that the abandonment barred payment of TTD compensation. Three and a half years after the denial of benefits, Appellant filed a complaint for a writ of mandamus. The appellate court denied the writ, concluding that the Commission did not abuse its discretion when it denied Appellant’s request for TTD benefits, as her conduct had amounted to a voluntary abandonment of employment. The Supreme Court affirmed, holding that the Commission did not abuse its discretion when it denied Appellant’s request for compensation, as the Commission’s order was supported by the evidence. View "State ex rel. Jacobs v. Indus. Comm'n" on Justia Law

After suffering a severe electrical shock while working as a lineman for Tippah Electric Power Association, Lonnie Smith filed a petition to controvert with the Mississippi Workers' Compensation Commission. Tippah denied that Smith's claim was compensable and raised the affirmative defense that Smith had intentionally injured himself. The administrative judge (AJ) found that Smith had intentionally injured himself and that his injury was not compensable; the Commission affirmed the AJ's denial of the claim. The Court of Appeals affirmed the Commission's decision. The Supreme Court granted certiorari because it found that the Commission's decision was not supported by substantial evidence. Accordingly, the Court reversed and remanded this case to the Commission for a determination of benefits. View "Smith v. Tippah Electric Power Association" on Justia Law

Alan Christoffersen drove a truck for United Parcel Service (UPS) until he was struck and killed by an underinsured motorist. After the accident, Christoffersen's heirs sued UPS and its automobile insurer (Liberty Mutual Insurance Group), asserting claims for underinsured motorist (UIM) benefits. All parties moved for summary judgment. The district court granted UPS's motion on the ground that Utah's Worker's Compensation Act provided the exclusive remedy. On the claim against Liberty Mutual, the court granted judgment to the heirs for $10,000. The heirs and Liberty Mutual appealed. Upon review, the Tenth Circuit concluded that Liberty Mutual did not incur liability because UPS validly rejected UIM coverage; therefore, with regard to the claim against Liberty Mutual, the Court reversed the judgment of $10,000 for the heirs and remanded the case with instructions to grant summary judgment to Liberty Mutual on the entire claim. Furthermore, the Court affirmed the grant of summary judgment to UPS because it was not considered a "self insurer" for purposes of Utah's UIM statute. View "Christoffersen v. United Parcel Service, et al" on Justia Law

A worker was left a paraplegic after a 1976 work-related motor vehicle accident. He suffered a number of medical complications related to his injuries. In 2007, his employer controverted some aspects of his medical care, and he filed a written workers’ compensation claim. Shortly before the hearing on the claim, the employer withdrew most of its controversions. The Alaska Workers’ Compensation Board decided that some of the controversions were frivolous, unfair, or in bad faith. It imposed a statutory penalty and reported its findings about frivolous or unfair controversions to the Alaska Division of Insurance. The employer appealed, and the Alaska Workers’ Compensation Appeals Commission reversed the Board in part, deciding as a matter of law that the Board could not impose a penalty for some of the controversions. The Commission decided that other appeal points were moot. The worker appeals the Commission’s decision reversing the penalties and some attorney’s fees; the employer cross-appeals the Commission’s decisions about preservation of the controversion issues and mootness. Upon review, the Supreme Court affirmed the Commission's decision that the controversion issue was properly before the Board, but reversed regarding the penalties issue. View "Harris v. M-K Rivers" on Justia Law

The general contractor of a Wisconsin construction project, hired Harsco to supply scaffolding. Krien, injured in a fall when a plank on a scaffold on which he was standing, broke, sued Harsco. The parties settled his claim for $900,000. Harsco filed a third‐party complaint against the contractor, seeking indemnification plus interest and attorneys’ fees. The district judge granted the contractor summary judgment. The Seventh Circuit reversed and remanded after examining the complex provisions of the contract between the two. The plank may or may have been supplied by Harsco and may or may not have been defective, as claimed by Krien, who could not sue Riley in tort, because against his employer his only remedy for a work‐related accident was a claim for workers’ compensation, but there has never been judicial resolution of these questions, because Krien’s suit was settled before there was any judgment. Indemnification, however, is a form of insurance, and could apply even if the party seeking indemnification was negligent. Riley’s duty to indemnify Harsco extends to legal expenses incurred by Harsco in defending against Krien’s suit and in litigating this suit. View "Krien v. Harsco Corp." on Justia Law

George Dukes and Joe Jordan sued Union Insurance Company Inc. as surety on the public official bond of Newton County Circuit Clerk Rodney Bounds. Union filed a crossclaim against Bounds for indemnity. The Circuit Court dismissed the case against Bounds, but found Union liable to Dukes and Jordan. However, it also found Bounds liable to Union for indemnity. Union appealed, and the Court of Appeals reversed, finding that Union was not liable to Dukes and Jordan, and that Bounds was not liable to Union for indemnity. The Supreme Court granted Union’s petition for certiorari. Union argued the Court of Appeals erred by finding that Bounds was not liable to Union for indemnity for its attorneys fees and costs incurred in defending the lawsuits filed on Bounds’s public official bond. The Supreme Court affirmed in part, and reversed in part. The Court of Appeals erred to the extent it found that Bounds was not obligated to indemnify Union for reasonable attorneys’ fees and costs. View "Newton County v. Mississippi" on Justia Law

Plaintiff Nicholas Bonnano appealed the superior court’s grant of summary judgment against him and in favor of his employer, Verizon, and Verizon’s third-party claims administrator, Sedgwick Claims Management. Plaintiff’s claims stemmed from an alleged breach of a settlement agreement with employer regarding his workers’ compensation claim. On appeal, plaintiff argued that the trial court erred because there was a dispute of material fact as to the voluntariness of employer’s temporary total disability (TTD) payments made to plaintiff after the TTD termination date indicated in the settlement. Finding no reversible error, the Supreme Court affirmed the superior court in all respects. View "Bonanno v. Verizon Business Network Systems" on Justia Law

Appellant appealed the Bankruptcy Appellate Panel's (BAP) judgment holding that the bankruptcy estate of her former employer, Racing Services, was entitled to the liquidation proceeds of a cash-value life insurance policy the employer purchased for her. Because the trustee had presented no evidence demonstrating that appellant could have demonstrated insurability, the court rejected the argument that the purported "equities" of this case required that the court deem appellant's failure to reinstate the policy as an act of surrender. The terms of the agreement between appellant and Racing Services granted Racing Services only the limited right to receive a repayment of policy premiums from the cash value upon surrender of the policy. Accordingly, the court reversed where appellant at no time surrendered the policy and the estate did not possess a right to control the policy or receive its liquidation proceeds. View "Kaler v. Bala" on Justia Law

Workforce Safety and Insurance ("WSI") denied Rick Brockel medical benefits and terminated his disability benefits. Upon review of Brockel's arguments on appeal, the Supreme Court concluded WSI's finding that Brockel's condition was not causally related to his work injury was supported by a preponderance of the evidence. Furthermore, the Court concluded Brockel was denied a fair hearing because he was not provided notice that one of the grounds for terminating his disability benefits would be the failure to submit medical verification of his disability. In addition, the Court concluded WSI's finding that Brockel failed to show his wage loss was the result of his compensable injury was not in accordance with the law. Therefore, the Court affirmed in part, reversed in part, and remanded the case for retroactive reinstatement of Brockel's disability benefits and for further proceedings. View "Brockel v. WSI" on Justia Law

Retired Employees and their spouses filed suit against the County, alleging that the Retired Employees have an implied vested right to the pooling of their health care premiums with those of current employees ("pooled premiums"). The court affirmed the district court's order granting the County's motion for summary judgment, concluding that Retired Employees failed to raise a genuine issue of material fact where they did not show any link to Retired Employees' claim of an implied right to an ongoing pool premium; a practice or policy extended over a period of time did not translate into an implied contract without clear legislative intent to create that right - and intent that Retired Employees has not demonstrated in this case; Retired Employees' assertions that its involvement in negotiations with the County revealed an implied contract right to the pooled premium also lacked evidentiary support; and the nature of Retired Employees' evidence underscored the absence of any definitive intent or commitment on the part of the County to provide for the pooled premium. Accordingly, the court affirmed the district court's grant of the County's motion for summary judgment. View "REAOC v. County of Orange" on Justia Law