Justia Insurance Law Opinion Summaries

At issue in this appeal was whether Ky. Rev. Stat. 342.730(6) entitled UPS Airlines to receive credit against its liability under section 342.730(1) for the payment of loss of license benefits that were the product of a collective bargaining agreement between UPS Airlines and the Independent Pilots Association (IPA), of which Claimant was a member. Claimant, a UPS pilot, sustained a work-related injury and underwent surgery. UPS paid the entire premium for the loss of license insurance plan. UPS subsequently sought leave to credit Claimant's loss of license benefits against its liability for income benefits. Reversing an ALJ's decision, the workers' compensation board found that section 342.730(6) did not entitle UPS to a dollar-for-dollar credit against Claimant's past due and future income benefits for all benefits paid under the loss of license plan. The Supreme Court (1) affirmed to the extent that UPS was not entitled to a dollar-for-dollar credit; but (2) reversed with respect to the conclusion that loss of license benefits were not funded exclusively by the employer for the purposes of section 342.730(6) because they were bargained-for benefits, holding that section 342.730(6) does not entitle UPS to credit the overpayment of voluntary benefits against future income benefits. Remanded.

Plaintiffs, employees at a defense plant in Arizona, collectively bargained for the right to receive employer-provided healthcare coverage after they retired. At issue was whether those employees, now retirees, were contractually entitled to receive premium-free healthcare coverage until age 65, or whether the contracts on which the retirees relied as providing that entitlement allowed their prior employer to start charging them for their insurance. The court held that Raytheon expressly agreed to provide 100% company-paid healthcare coverage for eligible retirees; that Raytheon's obligation survived the expectation of the collective bargaining agreements (CBAs); and that Raytheon's agreed-upon obligation could not be unilaterally abrogated by Raytheon, regardless of the rights Raytheon reserved for itself in Plan documents, because the CBAs did not incorporate the Plans' reservation-of-rights provisions with respect to employer contribution issues, as opposed to issues relating to the provision of monetary or in kind benefits for particular medical services. The court further held that the district court did not err in rejecting plaintiffs' claim for punitive and extra-contractual damages.

An employer petitioned the Alaska Workers' Compensation Board for reimbursement from the Second Injury Fund for payments it made to a disabled worker. The Fund opposed the petition. After a hearing, the Board granted the petition. The Fund asked the Board to reconsider its decision in December 2009. The hearing officer told the parties that he would inform them in writing by the end of January 2010 about what action the Board was taking on the reconsideration request. Instead, in April 2010 the hearing officer sent a prehearing conference summary indicating that the reconsideration request had been denied by operation of statute. The next day the Fund filed a notice of appeal and a motion to accept a late-filed appeal with the Alaska Workers' Compensation Appeals Commission. The Commission denied the Fund's request to file its appeal late and dismissed the appeal. Because the Supreme Court concluded that the Fund filed a timely appeal, it reversed the Commission's decision and remand for consideration of the Fund's appeal.

"Haunted houses may be full of ghosts, goblins, and guillotines, but it’s their more prosaic features that pose the real danger." When the flashlight Tyler Hodges used in connection with taking tickets at an Oklahoma City haunted house began flickering and then died, he ventured inside the house in search of a replacement. To navigate, Mr. Hodges used the light of his cell phone. An actor complained that the light dampened the "otherworldly atmosphere" of the house, Mr. Hodges turned it off and made his way to the freight elevator, where the spare flashlights were stored. When he reached the elevator, Mr. Hodges lifted the wooden gate across the entrance and stepped in, not seeing that the elevator car was not there. Mr. Hodges sued Brewer Entertainment, the haunted house’s operator, for various torts. Brewer held two insurance polities, one with Western World Insurance Company, and the other with Markel American Insurance Company. Brewer quickly looked to them to defend the lawsuit and ultimately pay any award. For its part, Western World had excluded from its haunted house coverage “any claim arising from chutes, ladders, . . . naked hangman nooses, . . . trap doors . . . [or] electric shocks.” Because the policy did not specifically exclude "blind falls down elevator shafts," the company admitted coverage and proceeded to defend Mr. Hodges’s suit. Markel however, balked, refusing to defend or pay any claim. Western World sued to have Markel contribute to the costs of defending Mr. Hodges' suit. The district court agreed with Markel, and entered summary judgment in its favor. Upon review of the record, the Tenth Circuit found that Markel's escape clause was not enough for it to avoid contributing to defending Mr. Hodges' suit. The Court reversed the grant of summary judgment in Markel's favor and remanded the case for further proceedings.

The Workers' Compensation hearing officer terminated Petitioner Gloria Clay's benefits, finding her employer had sufficiently proved the availability of jobs such that Petitioner was capable of earning at least ninety percent of her pre-injury wages. The court of appeal reversed, finding the jobs identified by the vocational rehabilitation counselor were not available to Petitioner. Finding no manifest error in the hearing officer's decision, the Supreme Court reversed the court of appeal and reinstated the hearing officer's ruling terminating Petitioner's benefits.

A 2011 amendment to Section 71-3-51 provides that, "from and after July 1, 2011," decisions of the Mississippi Workers' Compensation Commission may be appealed directly to the Supreme Court, rather than to the circuit court, as required under the previous version of the statute. On July 1, 2011, the Commission denied Petitioner Joseph Dewayne Johnson’s claim for benefits, so he appealed to the Supreme Court. The ordered the parties to brief two issues: whether Section 71-3-51, as amended was constitutional; and whether the Court had appellate jurisdiction over direct appeals from the Commission. Upon review, the Court concluded that Section 71-3-51 was constitutional, and that the Court had appellate jurisdiction over direct appeals from the Commission.

A class of retirees who had worked under a collective bargaining agreement and their survivors and dependents obtained monetary damages and declaratory and injunctive relief requiring that defendants provide vested lifetime healthcare benefits to the class members depending on the relevant date of retirement (Employee Retirement Income Security Act of 1974, 29 U.S.C. 1132(a)(1)(B); Labor-Management Relations Act, 29 U.S.C. 185). The Sixth Circuit affirmed, holding that defendant Newell Window is bound as a successor liable under earlier collective bargaining agreements to which it was not a party; that members of the plaintiff class had vested rights to company-paid health insurance and/or Medicare Part B premium reimbursements; and that the claims were not barred by the applicable six-year statute of limitations.

The Employment Appeal Board (Board) denied Willie Hall's application for unemployment insurance benefits. Hall filed a petition for judicial review. The district court affirmed the decision of the Board and assessed costs against Hall. The court of appeals affirmed. The Supreme Court reversed the portion of the judgment as it related to court costs, holding (1) pursuant to Iowa Code 96.15(2), any individual claiming benefits shall not be charged fees of any kind, including court costs, in a proceeding under the statute by a court or an officer of the court; and (2) therefore, the district court erred by requiring that Hall pay court costs.

James Cornelius initiated a declaratory judgment action against National Casualty Company to determine whether a policy of insurance issued by National Casualty to Cornelius's employer, Live Line Maintenance, provided uninsured motorist coverage to Cornelius for injuries he sustained while occupying a vehicle owned by Live Line. The circuit court granted National Casualty's motion for summary judgment, finding that Cornelius could not recover uninsured motorist benefits. The Supreme Court reversed, holding that the circuit court erred in granting summary judgment for National Casualty because Cornelius presented evidence to support his claim that there was a casual connection between Live Line and Live Line's proprietor's alleged negligent maintenance of the work vehicle and the accident that caused Cornelius's injuries.

After an insolvent employer's insurance company also became insolvent, the Mississippi Workers' Compensation Self-Insurers Guaranty Association (SIGA) made workers' compensation payments to an injured worker. SIGA sued the Mississippi Insurance Guaranty Association (MIGA) for reimbursement of those payments, and the trial court ordered reimbursement. The issue came before the Supreme Court who, after consideration, concluded that SIGA's claim against MIGA did not fall within the statutory definition of a "covered claim," and reversed the trial court’s reimbursement decision.