Justia Insurance Law Opinion Summaries

An employee of the general contractor on a construction site was allegedly injured by the negligent act of the employee of a subcontractor who carried no workers' compensation insurance. Plaintiff, the injured party, brought a common-law action against Defendants, the uninsured subcontractor and its employee, the alleged tortfeasor. The Defendants filed a plea in bar, asserting that the Virginia Workers' Compensation Act was Plaintiff's sole remedy. The circuit court held that Defendants' failure to carry workers' compensation insurance deprived them of the protections afforded by the Act because they were not participants in the statutory workers' compensation system. The court denied the plea in bar, permitting the action to go forward, but certified the case for an interlocutory appeal. The Supreme Court reversed the judgment appealed from and entered final judgment dismissing the case, holding that the circuit court erred in denying Defendants' plea in bar because Defendants were entitled to the exclusivity protection provided by the Act notwithstanding their lack of workers' compensation insurance.

Petitioner Toni Weeks appealed a district court judgment that affirmed a decision by Workforce Safety and Insurance (WSI) that reduced her disability benefits. Petitioner was injured at work after being exposed to anhydrous ammonia while employed by Dakota Gasification Company, in Beulah, North Dakota. In 2009, WSI received confirmation that on November 1, 2009, Weeks' social security disability benefits would convert to social security retirement benefits. WSI issued a notice of intention to discontinue or reduce benefits, in which Petitioner was informed that her permanent total disability benefits would end on October 31, 2009, and she would receive an "additional benefit payable" beginning November 1, 2009. Petitioner requested reconsideration. In November 2009, WSI issued an order denying Petitioner further disability benefits after October 31, 2009. Upon review, the Supreme Court found that because Petitioner failed to adequately brief her argument that WSI's reduction of her wage loss benefits violated equal protection under the federal and state constitutions, the Supreme Court declined to address her argument and otherwise affirmed the judgment.

An employee of Plaintiff, the town of Southbury, was injured in a car accident with Defendants, Patricia and Joseph Gonyea, during the course of employment. Employee applied for and received workers' compensation benefits from Plaintiff. Employee also made a claim against Defendants, which was settled for the Defendants' policy insurance limit. After Plaintiff perfected its statutory lien rights, Employee forwarded to Plaintiff the net proceeds he received from the settlement. Thereafter, Plaintiff commenced the present action to recover past and future works' compensation benefits it had paid, or would become obligated to pay, as a result of Employee's injuries. Defendants moved for summary judgment, contending that Plaintiff had assented to the settlement between Employee and Defendants and, thus, was barred from pursuing this action. The trial court granted Defendants' motion, concluding Plaintiff had assented to the settlement. The Supreme Court reversed, holding that there was a genuine issue of material fact as to whether Plaintiff assented to the settlement and voluntarily relinquished its rights to recover an outstanding balance through subsequent litigation.

This case arose because the settlement of a personal-injury suit brought by a recipient of workers' compensation benefits against a third-party tortfeasor did not make any provision to repay the statutory subrogee, the Ohio Bureau of Workers' Compensation. The Bureau brought suit against both the recipient of the workers' compensation benefits and third-party tortfeasor under Ohio Rev. Code 4123.931(G) to recover the full amount of its subrogation interest. The trial court held that a two-year limitations period applied and that it had expired. The court of appeals reversed, holding that a six-year limitations period applied and that it had not yet run out. At issue on appeal was whether a claim under section 4123.931(G) brought by a statutory subrogee to recover its subrogation interest is subject to a two-year statute of limitations, the same period applicable to the injured worker's personal-injury suit against the third party, or to a six-year statute of limitations for an action on a liability created by statute. The Supreme Court affirmed the court of appeals, holding that the claim in this case was an action upon a liability created by statute and that the statute of limitations was six years.

The State of Arizona appealed the district court's order granting a preliminary injunction to prevent a state law from taking effect that would have terminated eligibility for healthcare benefits of state employees' same-sex partners. The district court found that plaintiffs demonstrated a likelihood of success on the merits because they showed that the law adversely affected a classification of employees on the basis of sexual orientation and did not further any of the state's claimed justifiable interests. The district court also found that plaintiffs had established a likelihood of irreparable harm in the event coverage for partners ceased. The court held that the district court's findings and conclusions were supported by the record and affirmed the judgment.

In this appeal, accounting firm Bryan Brothers sought coverage under a professional liability insurance policy issued by Continental Casualty Company for liability arising from illegal acts of a former Bryan Brother's employee. Under the policy, it was a condition precedent to coverage that no insured had knowledge, prior to the inception of the policy, of an act that was reasonably likely to become the basis for a claim. The court held that because Bryan Brothers had such knowledge, the claims at issue were not covered. Therefore, the court affirmed the district court's grant of summary judgment to Continental Casualty Company.

Claimant Floyd Fife appealed a decision of the Industrial Commission that found he had failed to prove that his medical condition requiring back surgery was caused by an industrial accident rather than by pre-existing degenerative changes in his thoracic and lumbar spine. An evidentiary hearing was held before a hearing officer on November 5, 2009, but the hearing officer left the employment of the Industrial Commission before submitting proposed findings of fact and conclusions of law. The Commission then reviewed the record and issued its findings of fact, conclusions of law, and order on June 8, 2010. It found the testimony of Claimantâs surgeon unpersuasive, characterizing it as "unclear, to the point of opacity, as to the actual nature of the injury which he claims is responsible for the need for surgery." When the surgeon had been asked whether he could point to any objective pathological findings in any of the diagnostic studies he had performed on Claimant that related to recent trauma, the surgeon answered that he could not. The Commission found convincing the testimony of the physician who conducted the independent medical examination of Claimant. On appeal, Claimant contended that the Commission erred as a matter of law in rejecting the testimony of his surgeon. Upon review, the Supreme Court concluded that because the Commission, as the trier of fact, was not required to accept the testimony of Claimantâs treating physician, the Court affirmed its decision.

A United States District Court judge for the District of Massachusetts ruled in this case that defendant misclassified as independent contractors those plaintiffs who were Massachusetts residents. The judge certified to this court questions related to calculation of damages for one such plaintiff. The certified questions related to whether, under Massachusetts law, an employer could use a system of customer accounts receivable financing to pay its employee at the time the customer paid the employer for the employee's work rather than when the work was performed; and whether, under the Massachusetts Wage Act, G.L.c. 149, section 148, 150, an employer and an employee could agree that the employee would pay the cost of workers' compensation and other work-related insurance coverage. The court held that the accounts receivable financing system at issue improperly deferred payment of the employee's earned wages, and that an employer could not deduct the insurance costs from an employee's earned wages. In response to the judge's invitation to provide additional guidance, the court also addressed the question whether defendant could deduct "franchise fees" from such wages, and concluded that the Wage Act forbade the deductions.

Employee was diagnosed with silicosis, a condition caused by work with Employer, and filed a claim for workers' compensation benefits. During the course of Employee's employment, Employer's workers' compensation liability was covered by two insurers, first Liberty Mutual and, later, American Mutual. After Employee terminated his employment, American Mutual was declared insolvent. The Connecticut Guarantee Association subsequently became liable for certain American Mutual obligations. The workers' compensation commissioner held the association initially liable for payment of benefits as the last insurer on the risk. The workers' compensation review board affirmed. The association appealed, contending that deeming the association liable conflicted with the requirement under the Connecticut Insurance Guaranty Association Act that other insurance policies covering the same claim must be exhausted before recovery is permitted from the association. The Supreme Court affirmed, concluding that holding the association liable for an insolvent insurer's obligation as the last insurer on the risk does not conflict with the Guaranty Act.

Through its opinion in this case, the Supreme Court addressed an exception in the New Mexico Workers' Compensation Act (the Act) that permitted compensation for injuries incurred in travel by employees when those injuries "[arose] out of and in the course of employment." Eloy Doporto, Jr., Mike Lucas, Jose Turrubiates, and Pete Rodriguez (collectively, the Workers), employed by Permian Drilling Corporation (Permian) and insured by American Home Assurance, were involved in an automobile accident while traveling to their work site, resulting in the death of Doporto and injuries to the others.  Upon review, the Supreme Court concluded that the injuries suffered by the Workers arose out of and in the course of their employment because the travel was mutually beneficial to employees and employer and the Workers encountered special hazards unique to their employment while traveling, thus rendering the Workers "traveling employees" whose injuries are compensable under the Act.