Justia Insurance Law Opinion SummariesArticles Posted in Nevada Supreme Court
Wingco v. Gov’t Employees Ins. Co.
Appellants were injured in automobile accidents, but Geico, which insured both Appellants, denied coverage of their medical expenses. Appellants subsequently instituted a class action of behalf of themselves and others similarly situated, alleging that Geico violated Nev. Rev. Stat. 687B.145(3), which provides that a motor vehicle insurer must offer its insured the option of purchasing medical payment coverage, because, while Geico may have offered its insureds medical payment coverage, it did not obtain written rejections from them of the offered coverage. The district court granted Geico’s motion to dismiss. The Supreme Court affirmed, holding that section 687B.145(3) does not require a written rejection of medpay coverage, and therefore, Appellants’ claims failed. View "Wingco v. Gov't Employees Ins. Co." on Justia Law
Progressive Gulf Ins. Co. v. Faehnrich
Randall and Toni Faehnrich were Mississippi residents when they entered into an automobile insurance policy with Progressive Gulf Insurance Company that was negotiated, delivered, and renewed in Mississippi. The policy contained a choice-of-law provision providing that disputes about coverage shall be governed by Mississippi law. The couple subsequently divorced, and Toni moved to Nevada. While driving the Jeep that she and Randall co-owned, Toni was involved in an accident in which the couple’s two boys, who were Nevada residents when the accident occurred, suffered serious injuries. Randall presented a claim to Progressive for his sons’ injuries, but Progressive denied coverage, citing a household exclusion included in the policy that eliminated coverage for the boys’ claims against Toni. The district court held that the exclusion violated Nevada public policy, and, in accordance with Nevada choice of law rules, Mississippi law validating such exclusions did not apply. The Ninth Circuit Court of Appeals certified a question of Nevada public policy to the Supreme Court, which answered by holding that Nevada’s public policy did not preclude giving effect to the choice-of-law provision in the insurance contract, even when that effect would deny recovery to Nevada residents who were injured in Nevada. View "Progressive Gulf Ins. Co. v. Faehnrich" on Justia Law
Elizondo v. Hood Machine, Inc.
While employed by Employer, Appellant sustained an injury. Appellant filed an industrial injury claim. Employer's insurer (Insurer) partly accepted the claim but later closed Appellant's claim. After unsuccessfully filing three requests to reopen his claim, Appellant filed a fourth request, which was again denied by Insurer. A hearing officer affirmed the denial. Appellant administratively appealed. Insurer moved to dismiss, arguing that Appellant was precluded from reopening his claim under the doctrine of res judicata. The appeals officer granted Insurer's motion. The district court denied Appellant's petition for judicial review, concluding that Apellant failed to state a new cause of action that could withstand the application of res judicata. The Supreme Court reversed, holding that because the district court failed to provide any findings of fact or conclusions of law, the court could not properly review the appeals officer's determination that there was no change of circumstances warranting reopening under Nev. Rev. Stat. 616C.390. Remanded. View "Elizondo v. Hood Machine, Inc." on Justia Law
Posted in: Government & Administrative Law, Insurance Law, Labor & Employment Law, Nevada Supreme Court
Vanguard Piping v. Eighth Judicial Dist. Court
Real party in interest, a homeowner's association (HOA), filed construction defect actions against Petitioners. During discovery, Petitioners disclosed some of their primary insurance agreements to the HOA pursuant to Nev. R. Civ. P. 16.1(a)(1)(D). Petitioner refused to disclose additional undisclosed policies covering it that may have been purchased by its parent companies. A special master ordered Petitioner to disclose those agreements. Petitioner objected to the order and filed this writ petition, contending that the disclosed insurance policies were more than sufficient to satisfy any judgment that may be entered against them. The Supreme Court denied the petition, holding that section 16.1(a)(1)(D) requires disclosure of any insurance agreement that may be liable to pay a portion of a judgment. View "Vanguard Piping v. Eighth Judicial Dist. Court" on Justia Law
Bielar v. Washoe Health Sys., Inc.
Appellant received treatment at Hospital for injuries she sustained in an automobile accident. Appellant granted two statutory liens to Hospital on settlement proceeds she obtained from the tortfeasor for hospital services rendered. Appellant subsequently settled her case against the tortfeasor, and the tortfeasor's insurer (Insurer) agreed to pay Appellant $1.3 million in exchange for Appellant's agreement to indemnify Insurer from all healthcare provider liens. Hospital subsequently sued Insurer, and Appellant tendered to Hospital all money it asserted was due. Appellant then filed a complaint against Hospital, alleging that Hospital overcharged her pursuant to Nev. Rev. Stat. 439B.260(1), which provides that hospitals must reduce charges by thirty percent to inpatients who lack insurance "or other contractual provision for the payment of the charge by a third party." The district court entered judgment in favor of Hospital, finding that Appellant's settlement agreement with the tortfeasor rendered Appellant ineligible for the thirty percent statutory discount. The Supreme Court reversed in part, holding that a patient's eligibility is determined at the commencement of hospital services, and therefore, a later settlement agreement with a third party for the payment of such services does not disqualify the patient for the statutory discount. View " Bielar v. Washoe Health Sys., Inc." on Justia Law
Williams v. United Parcel Servs.
Employee was injured during the course of his employment with Employer. Employer subsequently issued a notice of claim acceptance to Employee. Two years after his claim's closure, Employee unsuccessfully asked Employer to reopen his claim. An appeals officer affirmed. At issue on appeal was Nev. Rev. Stat. 616C.390, which bars an employee from applying to reopen his workers' compensation claim after a year from its closure if the employee was "not off work as a result of the injury." The appeals officer interpreted the statute as requiring that an injured employee miss at least five days of work as a result of the injury to be considered "off work." The Supreme Court reversed, holding (1) section 616.390 does not bar an employee from applying to reopen his claim after a year from its closure if the employee missed time from work as a result of his injury; (2) the appeals officer erred in reading a minimum-time-off-work requirement into the statute; and (3) because Employee missed the remainder of his shift on the day of his injury, he was "off work" as a result of his injury and was not therefore subject to the one-year limit on the reopening of his claims. View "Williams v. United Parcel Servs." on Justia Law
City of Las Vegas v. Evans
Respondent, a firefighter, filed a claim for workers' compensation benefits after he was diagnosed with cancer within four years from the commencement of his employment with the City. Respondent asserted that his cancer was a compensable occupational disease that resulted from his work as a firefighter. The City denied the claim for benefits. A hearing officer with the Department of Administration Hearings Division affirmed the denial of the claim because Defendant had not been employed as a firefighter for five years pursuant to Nev. Rev. Stat. 617.453. An appeals officer reversed, holding that Defendant satisfied Nev. Rev. Stat. 617.440's requirements for proving a compensable occupational disease. The district court affirmed. The Supreme Court affirmed, holding (1) the district court did not err in upholding the appeals officer's determination that a firefighter such as Evans, who fails to qualify for section 617.453's rebuttable presumption can still seek workers' compensation benefits pursuant to section 617.440 by proving that his cancer is an occupational disease that arose out of his employment; and (2) the appeals officer correctly found Respondent's cancer was a compensable occupational disease. View "City of Las Vegas v. Evans" on Justia Law
Posted in: Government & Administrative Law, Insurance Law, Labor & Employment Law, Nevada Supreme Court
Garcia v. Prudential Ins. Co. of Am.
Appellant was the beneficiary of three life insurance policies insuring her husband. After the death of Appellant's husband, Appellant and one of the insurers (Insurer) disputed how the policy proceeds would be paid to Appellant. Appellant, a Nevada domiciliary, filed a complaint against Insurer on behalf of herself and a nationwide class of similarly situated persons in federal court in New Jersey, asserting claims for breach of contract, breach of fiduciary duty, and unjust enrichment. Sitting in diversity, the U.S. district court granted Insurer's motion to dismiss without prejudice. Appellant subsequently filed this action against Insurer in a Nevada state court, asserting claims for breach of fiduciary duty, breach of duties arising from a confidential relationship, and breach of the covenant of good faith and fair dealing. The district court dismissed all of Appellant's claims on issue preclusion grounds. The Supreme Court affirmed, holding (1) here, New Jersey preclusion law applies under the U.S. Supreme Court's decision in Semtek International Inc. v. Lockheed Martin Corp.; and (2) under New Jersey law, Appellant would be precluded from relitigating her claims in Nevada. View "Garcia v. Prudential Ins. Co. of Am." on Justia Law
Sierra Nevada Administrators v. Negriev
The issue before the Supreme Court in this case centered on whether NRS 616B.227 allows an average monthly wage calculation for workers' compensation benefits to include untaxed tip income that an employee reports to his/her employer. Upon review, the Supreme Court concluded that NRS 616B.227 required an average monthly wage calculation to include the untaxed tips. The Court affirmed the district court's order in this case which denied appellant Sierra Nevada Administrators' petition for judicial review. View "Sierra Nevada Administrators v. Negriev" on Justia Law
Physicians Insurance Co. v. Williams
This appeal involved the interpretation of a claims-made professional liability insurance policy that Appellant Physicians Insurance Company of Wisconsin, Inc., d.b.a. PIC Wisconsin (PIC), issued to nonparty dentist Hamid Ahmadi, D.D.S. The policy covered dental malpractice claims made against Dr. Ahmadi and reported to PIC during the policy period. On cross-motions for summary judgment, the district court determined that PIC received constructive notice of Respondent Glenn Williams’s malpractice claim against Dr. Ahmadi while the policy was in force and held that this was enough to trigger coverage. Upon review, the Supreme Court reversed, finding that a "report" of a potential demand for damages to qualify as a "claim" required sufficient specificity to alert the insurer’s claim department to the existence of a potential demand for damages arising out of an identifiable incident, involving an identified or identifiable claimant or claimants, with actual or anticipated injuries. The Court did not find an ambiguity that would permit the PIC policy to have been triggered by the report of a default judgment against the doctor filed in public records. As such, the Court remanded the case with instructions to enter summary judgment in favor of PIC. View "Physicians Insurance Co. v. Williams" on Justia Law