Justia Insurance Law Opinion Summaries

In 1993, the County and the Orange County Employee Retirement System (OCERS) entered into a Memorandum of Understanding (MOU), allowing the County to access surplus investment earnings controlled by OCERS and depositing a portion of the surplus into an account to pay for county retirees' health insurance. The county adopted the Retiree Medical Plan, funded by those investment earnings and mandatory employee deductions. The Plan explicitly provided that it did not create any vested rights. The labor unions then entered into MOUs, requiring the county to administer the Plan and that retirees receive a Medical Insurance Grant. In 1993-2007, retired employees received a monthly grant benefit to defray the cost of health insurance. In 2004, the county negotiated with its unions to restructure the underfunded program, reducing benefits for retirees.Plaintiffs filed suit. The Ninth Circuit affirmed summary judgment in favor of the county. The 1993 Plan explicitly provided that it did not create any vested right to benefits. The Plan was adopted by resolution and became law with respect to Grant Benefits, part of the MOUs. The MOUs expired on their own terms by a specific date. Absent express language providing that the Grant Benefits vested, the right to the benefits expired when the MOUs expired. The Plan was not unilaterally imposed on the unions and their employees without collective bargaining; the unions executed MOUs adopting the Plan. The court rejected an assertion that the Grant Benefit was deferred compensation and vested upon retirement, similar to pension benefits. View "Harris v. County of Orange" on Justia Law

In this insurance coverage dispute, at issue is who counts as an "employee" under the Texas Anti-Indemnity Act (TAIA). The Fifth Circuit certified the following question to Supreme Court of Texas: Whether the employee exception to the TAIA, Texas Insurance Code 151.103, allows additional insured coverage when an injured worker brings a personal injury claim against the additional insured (indemnitee), and the worker and the indemnitee are deemed "co-employees" of the indemnitor for purposes of the TWCA. View "Maxim Crane Works, LP v. Zurich American Insurance Co." on Justia Law

A minor was severely injured in an all-terrain vehicle collision in which the other driver was at fault. The minor had medical benefits coverage through a health care plan provided by her father’s employer, the Fairbanks North Star Borough. As allowed by the terms of the plan, the Borough refused to pay the minor’s medical bills until she signed an agreement that included a waiver of certain defenses to the Borough’s subrogation rights, such as the common fund and made-whole doctrines. The minor refused to sign the agreement without reservation and filed suit, seeking a declaration that the Borough could not condition payment of her medical bills on her signature. The superior court decided on summary judgment that the Borough’s health care plan was not a true insurance plan and that, regardless of whether it was interpreted as an insurance policy or an ordinary contract, the parties could lawfully reject subrogation defenses. The minor appealed. The Alaska Supreme Court held that the health care plan was a bargained-for employee benefit rather than a true insurance policy, and that the superior court’s interpretation of it was correct. The Court therefore affirmed the superior court's judgment. View "Best v. Fairbanks North Star Borough" on Justia Law

In this case involving the In-Home Supportive Services (IHSS) program the Supreme Court affirmed the judgment of the court of appeal concluding that sections 631 and 683 of the Unemployment Insurance Code exclude from coverage a provider who is the recipient's minor child, parent, or spouse under the state's unemployment insurance program, holding that the court of appeal did not err.The IHSS program authorized certain Californias, who were disabled or elderly, to receive in-home services from third parties or family members paid for with public funds. Under one program option, service recipients hire their own providers and the providers are paid either by a public entity or by the recipients with funds they have received from a public entity. At issue was whether such a provider qualified for unemployment benefits. The Supreme Court answered the question in the negative, holding that provider who is the recipient's minor child, parent, or spouse is not covered by the state's unemployment insurance program. View "Skidgel v. California Unemployment Insurance Appeals Board" on Justia Law

Deerfield. the general contractor, subcontracted with P.S. Demolition, which agreed to indemnify and hold Deerfield harmless from all claims caused in whole or in part by P.S. P.S. employees were working at the site when an unsecured capstone fell, killing one and injuring another. The Illinois Workers’ Compensation Act limited P.S.’s liability to $5,993.91 and $25,229.15. The state court held that P.S. had waived the Kotecki cap that would ordinarily apply those limits to a third party (Deerfield) suing for contribution for its pro-rata share of common liability for a workplace injury. A bankruptcy court determined that P.S. had no assets; the state court determined that P.S.’s liability was limited to its available insurance coverage. Deerfield settled with the plaintiffs for substantially more than $75,000 plus an assignment of Deerfield’s contribution claim against P.S.StarNet, P.S.’s employer liability insurer, entered into a settlement with the plaintiffs, reserving its defenses to insurance coverage. The plaintiffs dismissed their negligence claims against P.S. The workers’ compensation and employers' liability policy issued to P.S. provides that StarNet will pay damages for which P.S. is liable to indemnify third parties, excluding “liability assumed under a contract, including any agreement to waive your right to limit your liability for contribution to the amount of benefits payable under the Workers Compensation Act ... This exclusion does not apply to a warranty that your work will be done in a workmanlike manner.The Seventh Circuit affirmed a declaratory judgment that StarNet owes P.S. no coverage for the employees’ injuries beyond the amounts specified by the Illinois Workers’ Compensation Act and the Kotecki cap. The court rejected arguments that P.S.’s liability in the personal injury action arose in part from P.S.’s failure to conduct the demolition in a workmanlike manner so that the exception applies. View "StarNet Insurance Co. v. Ruprecht" on Justia Law

Nucor Steel Tuscaloosa, Inc. ("Nucor"), appealed the grant of summary judgment entered in favor of Zurich American Insurance Company ("Zurich") and Onin Staffing, LLC ("Onin"), on claims asserted by Nucor arising from an alleged breach of an indemnification agreement. Nucor operated a steel-manufacturing facility in Tuscaloosa. Nucor had an internship program that offered part-time work to technical-school students, who, as part of the internship program, earned both academic credit and work experience relevant to their vocational training. In 2010, Nucor entered into a "Temporary Services Agency Agreement" ("the TSA Agreement") with Onin, a personnel-staffing agency, whereby Onin was to manage the employment of the technical-school students selected by Nucor for its internship program. Korey Ryan was a student at Shelton State Community College who applied for Nucor's internship program through Shelton State. In October 2014, Ryan was killed while working in the course of his duties at the Nucor facility. Ricky Edwards, a Nucor employee, directed Ryan to stand in a certain area in front of a water filter so that he would be clear of a moving crane. Edwards stated that he then turned his attention back to the load and began moving the crane. Ryan's right boot was struck by and became caught underneath the gearbox as the crane was moving. Ryan was dragged by the crane along the concrete floor through the narrow passageway between the crane and the warehouse wall, where he was crushed to death against a building support beam. Ryan's estate brought a wrongful-death action against Nucor; OSHA cited Nucor for a "serious" safety violation and fined it. Zurich issued a letter to Nucor and Onin in which it questioned whether the general-liability policy afforded coverage for the claims asserted in the wrongful-death action. Zurich noted that neither the indemnification provision in the TSA Agreement nor the additional-insured endorsement contained in the policy applied to in instances when the alleged "bodily injury" and/or "property damage" was caused by Nucor’s sole wrongful conduct. The Alabama Supreme Court determined the particular facts and circumstances underlying the wrongful- death action did not trigger the indemnification provision and the payment of an insurance benefit; rather, the facts and circumstances voided the indemnification provision altogether. Accordingly, the Supreme Court affirmed the trial court's grant of summary judgment in favor of the insurance company. View "Nucor Steel Tuscaloosa, Inc. v. Zurich American Insurance Company et al." on Justia Law

The Supreme Court affirmed the decision of the court of appeals affirming the holding of the Workers' Compensation Board that the Administrative Law Judge properly found that Plaintiff's claim for workers' compensation benefits was barred by the applicable statute of limitations, holding that there was no error.Plaintiff received a workplace injury and filed a claim for benefits. Plaintiff never sought or received any temporary total disability benefits prior to the applicable statute of limitations expiring. The insurance adjuster for the employer's workers' compensation insurance carrier offered to settle Plaintiff's claim, but the parties never reached a settlement agreement. Plaintiff later filed an application for resolution of his claim, but the employer denied the claim on the grounds that it was time barred. The ALJ found that the claim was not timely under Ky. Rev. Stat. 342.185. The Board affirmed. The Supreme Court affirmed, holding that the ALJ properly determined that equitable principles did not warrant the tolling of the statute of limitations. View "Davis v. Blendex Co." on Justia Law

The plaintiffs retired from the Louisville Metropolitan police department and received free health insurance, administered by Kentucky Retirement Systems. Kentucky initially paid all of their healthcare costs. After the officers turned 65, Medicare became the primary payer, leaving Kentucky to cover secondary expenses. Each officer came out of retirement, joining county agencies different from the ones they served before retiring. They became eligible for healthcare benefits in their new positions. Kentucky notified them that federal law “mandate[d]” that it “cannot offer coverage secondary to Medicare” for retirees “eligible to be on [their] employer’s group health plan” as “active employees.” Some of the officers then paid for insurance through their new employers; others kept their retirement insurance by quitting or going part-time. The officers sued.The district court granted summary judgment to the officers, ordered Kentucky to reinstate their retirement health insurance, and awarded the officers some of the monetary damages requested. The Sixth Circuit affirmed. The officers have a cognizable breach-of-contract claim. Under Kentucky law, the Kentucky Retirement Systems formed an “inviolable contract” with the officers to provide free retirement health insurance and to refrain from reducing their benefits, then breached that contract. The Medicare Secondary Payer Act of 1980 did not bar Kentucky from providing Medicare-eligible police officers with state retirement insurance after they reentered the workforce and became eligible again for employer-based insurance coverage, 42 U.S.C. 1395y. View "River City Fraternal Order of Police v. Kentucky Retirement Systems" on Justia Law

The Supreme Court reversed the judgment of the trial court granting the state's motion to dismiss this tort action, holding that a state's waiver of sovereign immunity in Conn. Gen. Stat. 52-556 for claims arising from a state employee's negligent operation of a state-owned and -insured motor vehicle extends to litigants who are state employees.Plaintiff, a state employee, was a passenger in a motor vehicle owned and insured by the state and operated by another state employee, William Texidor, when another vehicle operated by Tyreke Brooks struck their vehicle. Brooks' vehicle was uninsured. Plaintiff, who applied for and received workers' compensation benefits, brought this action agains the state and Metropolitan Casualty Insurance Company alleging that Texidor's operation of the vehicle was negligent. The state filed a motion to dismiss for lack of subject matter jurisdiction on the ground of sovereign immunity. The trial court granted the motion to dismiss. The Supreme Court reversed, holding (1) the trial court had jurisdiction pursuant to the waiver of sovereign immunity in section 52-556; (2) Plaintiff's action against the state was barred by Conn. Gen. Stat. 31-284(a); and (3) therefore, the form of judgment was improper, and the case is remanded with direction to render judgment for the state. View "Feliciano v. State" on Justia Law

An Alaska State Commission for Human Rights (State) employee with preexisting medical conditions was involved in a work-related motor vehicle accident in January 2017. The employee consulted with Dr. Teresa Bormann two days after the accident; Dr. Bormann referred the employee to chiropractic treatment. After several month of treatment, Dr. Bormann referred the employee to physical therapy at United Physical Therapy (UPT) for chronic neck pain and headache. After an evaluation UPT recommended eight weeks of twice weekly physical therapy. Dr. Bormann endorsed the treatment plan, and the employee’s symptoms improved enough that she reduced her physical therapy visits to once a week beginning in mid-January. She saw UPT three times in February 2018. Payment for these February visits became the main dispute before the Board. The State arranged an employer’s medical evaluation (EME) with a neurologist and an orthopedist. The EME doctors diagnosed the employee with a cervical strain caused by the accident as well as several conditions they considered preexisting or unrelated to the work injury. After the State filed a retroactive controversion of medical treatment, the employee’s healthcare provider filed a workers’ compensation claim seeking payment for services it provided before the controversion was filed. The State disputed its liability for payment, and after several prehearing conferences, the Alaska Workers’ Compensation Board set a hearing on the merits of the provider’s claim. The Board ordered the State to pay the provider approximately $510.00 for the services. The State appealed, disputing several procedural aspects of the decision, and the Alaska Workers’ Compensation Appeals Commission affirmed the Board’s decision. Finding no reversible error, the Alaska Supreme Court affirmed the Commission’s decision. View "Alaska, Department of Health and Social Services v. Thomas et al." on Justia Law