Justia Insurance Law Opinion Summaries

Employee injured his knee while climbing into his employer-provided truck as he was preparing to leave on a work-related trip. The Wyoming Workers' Safety and Compensation Division (Division) denied Employee's requested workers' compensation benefits related to his injury. The Office of Administrative Hearings (OAH) granted summary judgment in favor of the Division. The district court affirmed the OAH's decision. At issue on appeal was whether Employee's injury was sustained while he was being transported by a vehicle of the employer as the statute requires. The Supreme Court affirmed, holding (1) the statute plainly and unambiguously requires that for an injury sustained during travel to be compensable, it must occur as the employer's vehicle is carrying the employee from one place to another; and (2) because Employee here was entering the vehicle in preparation for that transportation when he was injured, the injury he sustained was not compensable.

Plaintiff appealed the district court's dismissal of her ERISA, 29 U.S.C. 1001 et seq., action against defendant as not timely filed. Plaintiff was employed by defendant as a stockbroker in 1979 and starting in 1982, plaintiff had been disabled periodically from her employment. Plaintiff applied for long-term disability benefits around January 15, 1987. The court held that plaintiff's claim did not accrue in 1990 with regard to the ERISA statute of limitations, as the district court found, but rather accrued when her claim was finally denied on January 14, 2004. Therefore, plaintiff's action, filed on February 16, 2006, commenced within the four-year statutory limitations period for ERISA claims. The court also held that the limitations provision in the policy here did not apply to disability cases in which the claimant contested the amount of benefits or claims that the benefits have been miscalculated. Accordingly, the court vacated the judgment of the district court and remanded for further proceedings.

This case stemmed from injuries Anthony Verdon Lujan sustained when his arm got caught on a luggage conveyor when he was inspecting the conveyor as an employee of Lloyd W. Aubry Co. (Aubrey), an independent contractor hired by US Airways to maintain and repair the conveyor. Aubry's workers' compensation insurer paid Verdon benefits based on the injury and subsequently sued US Airways seeking what it paid in benefits. Verdon intervened as plaintiff in the action, alleging causes of action for negligence and premises liability. At issue was whether the Privette v. Superior Court rule applied when the party that hired the contractor (the hirer) failed to comply with workplace requirements concerning the precise subject matter of the contract and the injury was alleged to have occurred as a consequence of that failure. The court held that the Privette rule did apply in that circumstance. The court concluded that, by hiring an independent contractor, the hirer implicitly delegated to the contractor any tort law duty it owed to the contractor's employees to ensure the safety of the specific workplace that was the subject of the contract. That implicit delegation included any tort law duty the hirer owed to the contractor's employees to comply with applicable statutory or regulatory safety requirements. Accordingly, plaintiffs here could not recover in tort from US Airways on a theory that Verdon's workplace injury resulted from defendant's breach of what plaintiffs described as a nondelegable duty under California Occupational Safety and Health Act of 1973 (OSHA), Cal. Code Regs., tit. 8, sections 3999, 4002, regulations to provide safety guards on the conveyor. Therefore, the court erred in reversing the trial court's grant of summary judgment for defendant.

Retirees filed suit in district court contending that their retiree health benefits were vested and that defendant's intended modification would violate both the Labor Management Relations Act, 29 U.S.C. 185, and the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132(a)(1)(B). Retirees subsequently appealed the denial of their motion for a preliminary injunction seeking continuation of certain healthcare benefits. The court held that the district court issued a thorough and well-reasoned opinion explaining in detail that the retirees failed to establish a likelihood of success on the merits. Accordingly, the court affirmed the district court's denial of the motion for preliminary injunction.

This case concerned the termination of an employee, plaintiff, in the wake of an investigation into the disappearance of approximately $58,000 from a branch of Washington Mutual Bank (defendant). Plaintiff asserted that defendant unlawfully asked him to submit to a polygraph test and unlawfully failed to notify plaintiff of his right to continue his employer-provided health insurance for a period after his termination. The court held that because defendant requested plaintiff to submit to a polygraph test in connection with an "ongoing investigation" of a specific incident in which defendant had a "reasonable suspicion" that plaintiff was involved, the district court did not err in granting summary judgment for defendant on plaintiff's Employee Polygraph Protection Act (EPPA), 29 U.S.C. 2002(1), claim. The court held, however, that the district court erred in granting summary judgment for defendant on plaintiff's improper notice claim under the Consolidated Omnibus Budget Reconciliation Act (COBRA) 29 U.S.C. 1163(2), 1166, where the court should have considered the claims on the merits because it was timely filed. Accordingly, the court affirmed in part, vacated in part, and remanded for further proceedings.

The City of New York sued defendants under federal and New York State antitrust laws, seeking to prevent the companies from merging. The city appealed from a judgment of the district court granting summary judgment to defendants and dismissing the city's complaint without leave to amend. The court agreed with the district court that the alleged relevant market definition, as the "low-cost municipal health benefits market[,]" was legally deficient and concluded that the district court's denial of leave to amend was not an abuse of discretion. Accordingly, the court affirmed the judgement of the district court.

After suffering a work-related injury, Employee underwent surgery at a hospital owned by HealthEast Care System. The injury required surgical implantation of a spinal cord stimulator. Employer's worker's compensation insurance provider, State Auto Insurance, paid part but not all of the surgical expenses, asserting (1) the withheld portion of the expenses was attributable to a price markup added by HealthEast to the price paid by HealthEast for the implant hardware used in Employee's surgery, and (2) the manufacturer of the implant hardware should be required to charge directly for the implant hardware. The compensation judge found that Employer and State Auto were liable for the unpaid balance. The Workers' Compensation Court of Appeals affirmed. The Supreme Court affirmed, holding (1) HealthEast could charge for the implant hardware because when more than one health care provider is responsible for the creation of a service, article, or supply, the provider that provides the service, article, or supply in its final form is entitled to charge for it; and (2) a compensation judge does not have the authority to determine a reasonable value of a treatment, service, or supply that is lower than eighty-five percent of the provider's usual or customary charge.

The company previously gave retirees credit toward their share of health care costs, based on unused sick-leave. Union workers could take that sum in cash or put it toward the premium. Executives who quit before retirement, or decided not to participate in the plan, did not receive any other form of compensation for unused leave. It had value only as a credit toward retirement health-care costs. In 2008 the company amended the plan and stopped paying any part of retirees' health-care costs. Money for employees who could have taken their balances in cash is put in an account administered by the health-care plan. Retirees, including executives who never had an option to take balances in cash, plus one who had that option but elected to leave the money on deposit, filed suit under the Employee Retirement and Income Security Act, 29 U.S.C. 1081. The district court granted judgment on the pleadings to the company. The Seventh Circuit affirmed. The company, which did not take anything out of the plan, but simply reduced the amount it would pay in, reserved the right to amend its health-care plan. It is a business decision, not a legal question, whether to use that authority to retireesâ detriment.

Employee was injured while working in Minnesota for Wisconsin-based Employer. Employee applied for Wisconsin and Minnesota workers' compensation benefits. Employer's insurance company, Travelers Insurance, covered the Wisconsin benefits but denied the claim for Minnesota benefits based on an exclusion of Minnesota coverage in Employee's policy. Employee then filed a claim for Minnesota benefits with the Minnesota Department of Labor and Industry. After settling the claim, the Department pursued a petition for reimbursement it had filed against Employer. A compensation judge found that Employer was not insured for Minnesota workers' compensation liability and ordered Employer to reimburse the Department. The Workers' Compensation Court of Appeals (WCCA) reversed, concluding that Employer was entitled to coverage from Travelers under the reasonable expectations doctrine. On review, the Supreme Court reversed and remanded for reconsideration in light of a recent Court decision clarifying that the doctrine should not be used to provide coverage in contravention of unambiguous policy terms. On remand, the WCCA again reversed the compensation judge. On review, the Supreme Court reversed, holding that the WCCA had no authority to declare unambiguous language of an insurance contract to be invalid and unenforceable because the exclusion conflicted with Wisconsin statutory provisions and public policy.

While Timothy Allen worked as a sales associate for respondent Burnet Realty, he executed agreements to participate in respondent's legal administration program (LA Program). Under the LA Program contracts, Allen and respondent agreed to an allocation of expenses should a dispute arise related to Allen's work for respondent. In litigation commenced after he stopped working for respondent, Allen claimed that respondent violated Minn. Stat. 60K.47 because the LA Program contracts were insurance, and, as a result, respondent was required to be, but was not, authorized to engage in the business of insurance in Minnesota. Allen also claimed other relief on the basis that the contracts were insurance. The district court granted summary judgment in favor of respondent, concluding that the contracts were not contracts of insurance. The court of appeals affirmed. The Supreme Court affirmed the grant of summary judgment to respondent, holding that the LA Program was not "insurance" under statutory definitions on statute or case law.