Justia Insurance Law Opinion Summaries

This case involved the interpretation of two contractual provisions under Minnesota law: an indemnification clause in a contract between PDSI and Miller and an insurance contract between Harleysville and PDSI which extended insurance coverage to PDSI's indemnification of third parties for tort liability caused, in whole or in part, by PDSI or by those acting on its behalf. The court agreed with the district court's finding that a PDSI employee's suit fell squarely within the indemnity provision of the 1989 Agreement between PDSI and Miller. The court also agreed with the district court's interpretation of the insurance agreements as requiring Harleysville to cover Miller's settlement of the employee's claims. Further, the court concluded that the undisputed facts established as a matter of law that PDSI or those acting on its behalf at least partly caused the employee's bodily injury within the terms of the Harleysville policy. Accordingly, the court affirmed the judgment. View "Harleysville Ins. Co. v. Physical Distrib. Serv., et al" on Justia Law

Appellant was injured during the course and scope of his employment. Appellant filed a motion for temporary total disability compensation, which a hearing officer granted. The Industrial Commission later terminated temporary total disability compensation based on the report of doctor who stated that the allowed conditions in Appellant's workers' compensation claim had reached maximum medical improvement. Appellant filed a complaint in mandamus, alleging that the Commission acted contrary to law when it relied on the report of the doctor. The court of appeals denied the writ, concluding that the doctor's report constituted some evidence upon which the Commission could rely. The Supreme Court affirmed, holding that the doctor's report was sufficiently reliable to constitute some evidence to support the Commission's decision. View "State ex rel. Coleman v. Schwartz" on Justia Law

Veteran filed a claim for workers' compensation benefits alleging that he sustained an injury during the course of his employment with Employer. Veteran received care and treatment for that injury at a United States Department of Veterans Affairs (VA) medical facility, which Employer did not authorize. The VA petitioned for a writ to compel the chief ALJ to allow the VA's intervention in the proceeding, claiming entitlement to intervene as a matter of right under 38 U.S.C. 1729 and the U.S. Constitution's supremacy clause. The circuit court denied the VA's petition. The Supreme Court reversed and issued a permanent writ of mandamus, holding that section 1729 and the supremacy clause gave the VA the right to intervene in Veteran's workers' compensation claim to assert its claim for recovery of health care provided to him. View "U.S. Dep't of Veterans Affairs v. Boresi" on Justia Law

Appellant Matthew Mazzone appealed an Idaho Industrial Commission's order that denied him workers' compensation for psychological injuries allegedly arising as a result of an industrial accident wherein appellant tripped and fell into a deep fat fryer while employed at Texas Roadhouse. Appellant contended the Commission’s order was not based on substantial and competent evidence. During his time at a Burn Center, appellant was twice noted in medical records to be exhibiting exaggerated pain behaviors. At one point during his treatment, appellant stayed at a hotel in Salt Lake City so as to receive follow-up care. In a follow-up at the Burn Center, appellant had quit "cold turkey" his opioid medication, at which point he began to experience nightmares and flashbacks. Appellant was referred to an Idaho psychiatrist. The Idaho psychiatrist clarified that appellant's nightmares and anxiety were related to returning to work; appellant was assessed a GAF score of 55/85, the same assessment he had before the industrial accident. Three months after accident, appellant returned to work, but he was allegedly so overwhelmed that he asked to transfer to another Texas Roadhouse location in Massachusetts because he was nervous, sick, worried, and nauseous working at the site of the accident. Subsequent years following the accident, appellant sought additional counseling and medical treatment. He was eventually diagnosed with post-traumatic stress disorder (PTSD) and general anxiety and memory loss. Appellant then filed a complaint against Texas Roadhouse and its insurer. Upon review, the Supreme Court concluded that appellant did not suffer a compensable psychological injury, and that the evidence presented was substantial enough to support the Industrial Commission's order. View "Mazzone v. Texas Roadhouse" on Justia Law

Employee sustained injuries in the course of his employment with Four Star Transportation. Despite being hired by Four Star, Employee was initially considered an employee of Better Integrated Services. Better Integrated leased Employee to Beacon Enterprises, which then leased Employee to Four Star. Beacon had an insurance policy with Kentucky Employers' Mutual Insurance (KEMI). An ALJ determined (1) Employee's injury entitled him to benefits and a permanent partial disability award, and (2) KEMI's policy covered Employee's injury. The Workers' Compensation Board reversed, finding Employee was not covered under the KEMI policy due to the fact he was unaware that Four Star was leasing him from different entities, including Beacon. The court of appeals affirmed. The Uninsured Employers' Fund appealed. The Supreme Court affirmed, holding (1) Employee could not be considered Beacon's employee because he did not enter into a contract for hire with Beacon; (2) the Board did not act arbitrarily in finding that the ALJ's opinion was not supported by substantial evidence; and (3) the Board and lower court's decision was not based on Better Integrated and Beacon's failure to comply with Ky. Rev. Stat. 342.615. View "Ky. Uninsured Employers' Fund v. Hoskins" on Justia Law

Employee filed a claim for workers' compensation, alleging that he sustained injuries while working for Restaurant. Employee gained employment with Restaurant through a staff leasing company (Company). Employee agreed to a settlement of his claim. Later, Employee moved to re-open the workers' compensation award and to join the Uninsured Employers' Fund (UEF) as a party, asserting that Restaurant and Company were no longer available to pay for his continuing medical expenses. The ALJ subsequently joined the UEF. The ALJ found Employee's condition to have worsened so he was totally disabled and that the UEF was responsible for all benefits for which Employee was entitled. The Workers' Compensation Board vacated the portion of the ALJ's opinion regarding the amount of benefits Employee would receive and otherwise affirmed. The Supreme Court affirmed, holding (1) Employee's claim was properly reopened and the UEF joined as a party; (2) Employee presented sufficient evidence to show that his condition had worsened since the entry of his original workers' compensation award; and (3) although the original settlement agreement only listed Employee's lower back injury as compensable, Employee was not barred from raising a claim for his thoracic spine injury upon reopening. View "Commonwealth v. Allen" on Justia Law

Booker T. Washington, Jr. filed a claim against Porocel Corporation with the Workers' Compensation Commission, alleging exposure to asbestos and silica dust resulting in lung disease and silicosis. An ALJ found Washington's claim was barred by the statute of limitations. Washington subsequently filed suit against Porocel, alleging, inter alia, negligence and breach of implied warranty. Porocel moved to dismiss the complaint, contending that the Commission had exclusive jurisdiction of the claims alleged and that the Arkansas Workers Compensation Act (Act) was Washington's exclusive remedy. The circuit court denied Porocel's motion to dismiss, concluding that Washington's occupational disease was not one for which the Act provided coverage. Porocel then filed a petition for a writ of prohibition to prevent the circuit court from exercising jurisdiction over Washington's complaint. The Supreme Court granted the petition, holding that Washington's claim was covered by the Act. View "Porocel Corp. v. Circuit Court" on Justia Law

Central States is a multiemployer pension plan for members of the Teamsters union in the eastern half of the U.S. Ready Mix employed Teamsters labor and participated in the Central States plan. In 2007 Ready Mix ceased employing covered workers and incurred $3.6 million in withdrawal liability to fully fund its pension obligations. Two affiliated companies under common control by Nagy, the owner of Ready Mix, conceded liability for the shortfall under the Employee Retirement Income Security Act, as amended by the Multiemployer Pension Plan Amendments Act of 1980, 29 U.S.C. 1301(b)(1). The district court concluded that Nagy held and leased property to Ready Mix as a passive investment, not a trade or business, so the leasing activity did not trigger personal liability, but that Nagy’s work as a manager for a country club was as an independent contractor, not an employee, and this activity qualified as a trade or business under section 1301(b)(1), which was enough for personal liability. The Seventh Circuit affirmed, holding that Nagy’s leasing activity is categorically a trade or business for purposes of personal liability under 1301(b)(1). View "Cent. States SE & SW Areas Pension Fund v. Nagy" on Justia Law

Plaintiff, on behalf of herself and the Estate, challenged the district court's grant of summary judgment to Zenith on the Estate's breach of the insurance contract claim. After review and oral argument, the court certified questions to the Florida Supreme Court: (1) Does the estate have standing to bring its breach of contract claim against Zenith under the employer liability policy? (2) If so, does the provision in the employer liability policy which excludes from coverage "any obligation imposed by workers' compensation . . . law" operate to exclude coverage of the estate's claim against Zenith for the tort judgment? (3) If the estate's claim was not barred by the workers' compensation exclusion, does the release in the workers' compensation settlement agreement otherwise prohibit the estate's collection of the tort judgment? View "Morales v. Zenith Ins. Co." on Justia Law

Petitioner was severely injured when he was assaulted by a stranger in the West End of the City of Providence. Petitioner had been sent to that location by his employer, Verizon New England. Petitioner subsequently filed a claim for workers' compensation benefits. The trial judge denied Petitioner's request, concluding that Petitioner's injuries were noncompensable under Rhode Island's actual-risk test, which requires that there be some causal connection between the injury suffered by the employee and the employment or the conditions of employment. The appellate division affirmed. The Supreme Court quashed the decree of the appellate division and remanded, holding that Petitioner's injuries were compensable under the street-peril doctrine. View "Ellis v. Verizon New England, Inc." on Justia Law