Justia Insurance Law Opinion Summaries

An industrial accident occurred while Employer was insured under two separate workers compensation insurance policies, one with the Workers Compensation Fund (WCF) and one with the Utah Business Insurance Company (UBIC). WCF paid all of Employee's medical expenses and weekly compensation benefits, but when WCF became aware of the overlapping coverage, WCF filed a complaint against UBIC, alleging that UBIC was either solely or jointly liable for Employee's insurance benefits. The district court granted WCF's motion for partial summary judgment. The Supreme Court affirmed, holding that both insurers were liable for Employee's claim, and therefore, WCF was entitled to equitable contribution from UBIC for reasonable past and future costs associated with the claim. Remanded for resolution for the remaining claims. View "Workers Comp. Fund v. Utah Bus. Ins. Co." on Justia Law

Law Firm represented Employee in a workers' compensation action against Employee's Employer. After a trial, Employee was awarded compensation, including medical expenses incurred by Employee with Medical Clinic. Employer paid sums owed to Medical Clinic pursuant to the award. Law Firm subsequently filed a complaint against Medical Clinic, seeking attorney fees under the common fund doctrine. Following a hearing, the district court dismissed Law Firm's complaint, concluding that Law Firm was not permitted to recover attorney fees from Medical Clinic under the doctrine. The Supreme Court affirmed, holding (1) the plain language of Neb. Rev. Stat. 48-125(2)(a) prohibits the charging of attorney fees against medical providers in workers' compensation court; and (2) the common fund doctrine may not be applied in this case to allow Law Firm a fee from Medical Clinic from the district court when it would not be entitled to such a fee from the workers' compensation court. View "Walentine, O'Toole, McQuillan & Gordon, LLP v. Midwest Neurosurgery, PC" on Justia Law

Plaintiff was a partner in a medical practice where she served as a staff anesthesiologist. When Plaintiff's dependence on opioids came to light, her employer had in force a group employee benefit plan, underwritten and administered by Union Security Insurance Company & Management Company for Merrimack Anesthesia Associates Long Term Disability Plan (USIC), which included long-term disability (LTD) benefits. When Plaintiff applied for those benefits, USIC refused to pay benefits past the point when Plaintiff was discharged from a treatment center, finding that Plaintiff's risk for relapse was not the same as a current disability. Plaintiff brought suit in the federal district court. The district court ultimately awarded Plaintiff LTD benefits for the maximum time available under the plan, concluding that categorically excluding the risk of drug abuse relapse was an unreasonable interpretation of the plan. The First Circuit Court of Appeals affirmed, holding that, in an addiction context, a risk of relapse can be so significant as to constitute a current disability. View "Colby v. Union Sec. Ins. Co." on Justia Law

Employee was injured while in the course of scope of his employment through the actions of a third-party tortfeasor (Tortfeasor). Employee filed a claim for workers' compensation benefits and a lawsuit against Tortfeasor. Employer intervened in the lawsuit to protect its subrogation lien against any recovery from Tortfeasor. Employee settled the lawsuit with Tortfeasor and dismissed the case. Employer filed a motion to set the case for trial, asserting that it was entitled to a lien against the settlement proceeds for the cost of future medical benefits that may be paid on behalf of Employee. After initially setting the case for trial, the trial court dismissed for failure to state a claim. The court of appeals reversed and remanded, concluding that future medical expenses are not too speculative as a matter of law to be included in an employer's lien against the proceeds of a suit against a third-party tortfeasor. The Supreme Court reversed, holding that Employer failed to state a claim for which relief can be granted, as Employer's subrogation lien against the proceeds of the settlement did not extend to the cost of future medical benefits to which Employee may be entitled. View "Cooper v. Logistics Insight Corp." on Justia Law

In this case, participants in the Thunderbird Mining Company Pension Plan sought "shutdown" pension benefits. The PBGC, the government agency that administered pension termination insurance under Title IV of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001-1461, denied the participants' request. These early retirement benefits were triggered by a permanent shutdown of a plant and were payable to plan participants who met certain age and years-of-service requirements. The court held that the agency's determination was not arbitrary or capricious where the record provided sufficient support for the agency's judgment that a permanent shutdown had not occurred before Eveleth's pension plan was terminated on July 24th, 2003. Accordingly, the court affirmed the district court's grant of summary judgment in favor of the agency. View "United Steel, et al. v. Pension Benefit Guaranty Corp." on Justia Law

Plaintiff, a former software developer for Lockheed Martin Corporation, brought this action for judicial review after Connecticut General terminated his disability benefits in 2007. The court held that the district court properly applied an abuse of discretion standard; on the record, it was not an abuse of discretion to terminate plaintiff's benefits; and the district court did not err in denying plaintiff an opportunity to depose the expert at issue. Accordingly, the court affirmed the judgment. View "Siegel v. Connecticut General Life Ins., et al" on Justia Law

Gallagher provided insurance-related services throughout the country. Its subsidiary, GBSI, handled Gallagher's employee-benefit insurance programs. In November 2003, GBSI purchased Babcock Consulting, a business owned by Clayton L. Babcock. In this diversity suit, Gallagher and GBSI (collectively, "plaintiffs") sought money damages for breach of restrictive employment agreements under Louisiana law. The court affirmed the district court's directed verdict on the breach of competition agreement, but set aside the damages. The court concluded that the district court abused its discretion in admitting certain evidence on the issue of damages. The court vacated the award of attorneys' fees, leaving the ultimate award to be decided on remand. View "Arthur J. Gallagher & Co., et al v. Babcock, et al" on Justia Law

This case involved an insurance coverage dispute arising from charges of sexual harassment brought by a former employee (Employee) against the one-time president (President) of Jasmine Company, Inc. After President filed an action against Jasmine's liability insurance provider (Insurer), seeking defense and indemnification for the harassment charges, Insurer filed a third-party complaint against Jasmine itself, requesting a declaratory judgment that it had not duty to defend or indemnify Jasmine for the harassment claims. The district court granted summary judgment on the third-party claims for Jasmine, holding that Insurer had to defend and indemnify Jasmine. At issue on appeal was whether a finder of fact must conclude that the conduct underlying the sexual harassment charges did or did not begin before Jasmine's insurance policy took effect. The First Circuit Court of Appeals vacated the judgment and remanded, holding that neither party was entitled to summary judgment, as the question of when the harassing conduct that gave rise to Employee's claims began was a quintessential question for a factfinder. View "Manganella v. Evanston Ins. Co." on Justia Law

In 1992 Navistar attempted to reduce its costs for retired employee health and life insurance benefits. Navistar’s retirement benefit plan is a registered employee health benefit plan under the Employee Retirement Income Security Act, 29 U.S.C. § 1001 and Navistar is both plan administrator and fiduciary. In 1993, the district court entered judgment in a class action challenging the change, adopting an agreement between the parties and retaining jurisdiction. The Agreement established the Retiree Health Benefit and Life Insurance Plan. The Plan established the Health Benefit Program Summary Plan Description, which contains a description of the health benefits and is furnished to all beneficiaries. The Agreement divides health benefits into two plans: Plan 2 for those eligible for Medicare and Plan 1 for those who are not eligible. A prescription drug benefit was provided under the Agreement, identical for both Plan 1 and Plan 2. When Navistar moved to substitute Medicare Part D into the Plan, class members claimed violation of the Agreement. The district court ordered Navistar to reinstate, retroactively, the prescription drug benefit that was in effect before Navistar made the unilateral substitution. The Sixth Circuit affirmed,View "Shy v. Navistar Int'l Corp." on Justia Law

The plaintiff-appellants, Bruce Bermel and Pamela Jurga, as husband and wife, appealed the final judgment of the Superior Court granting the motion for summary judgment of the defendant-appellee, Liberty Mutual Fire Insurance Company. The appellants contended that the Superior Court erred by granting summary judgment in favor of Liberty. Bermel was injured in an automobile accident when his personal motorcycle was struck head-on by another driver. Bermel, then an employee of the Siemens Corporation, contended that the business policy issued to Siemens by Liberty on a company car that was assigned for his business and personal use, provided him with $100,000 in underinsured motorist coverage even when he was operating a non-work vehicle in circumstances unrelated to his employment. Bermel brought this action for underinsured benefits (“UIM”) against Liberty arguing: (1) that the Liberty Policy covering the company car he used was personal to him, even though Siemens was the named insured; (2) that he was entitled to personally access the Liberty Policy because Siemens automatically deducted a nominal fee from his paycheck for his personal use of the vehicle assigned to him that was insured by the Liberty Policy; and (3) that the Liberty Policy was ambiguously drafted and should have been construed in his favor. Upon review, the Supreme Court concluded that the Superior Court correctly found Siemens, and not Bermel, to be the named insured on the Liberty Policy, that the nominal fee charged to Bermel by Siemens for the use of the car did not make Bermel a named insured under the Liberty Policy, and that the Liberty Policy was unambiguous. Therefore, the judgments of the Superior Court were affirmed. View "Bermel v. Liberty Mutual Fire Insurance Co." on Justia Law