Justia Insurance Law Opinion Summaries

Articles Posted in North Dakota Supreme Court
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Dennis Whedbee appealed a district court judgment affirming Workforce Safety and Insurance's ("WSI") binding dispute resolution denying Whedbee's request for a myoelectric prosthesis and approving a body-powered prosthesis. Whedbee argued the binding dispute resolution was an abuse of discretion and violated his due process rights. He argued that WSI should have selected an independent medical examiner located closer to his residence and that his treating physician's opinion should have been given controlling weight. Finding no reversible error, the Supreme Court affirmed. View "Whedbee v. WSI" on Justia Law

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Workforce Safety and Insurance ("WSI") denied Rick Brockel medical benefits and terminated his disability benefits. Upon review of Brockel's arguments on appeal, the Supreme Court concluded WSI's finding that Brockel's condition was not causally related to his work injury was supported by a preponderance of the evidence. Furthermore, the Court concluded Brockel was denied a fair hearing because he was not provided notice that one of the grounds for terminating his disability benefits would be the failure to submit medical verification of his disability. In addition, the Court concluded WSI's finding that Brockel failed to show his wage loss was the result of his compensable injury was not in accordance with the law. Therefore, the Court affirmed in part, reversed in part, and remanded the case for retroactive reinstatement of Brockel's disability benefits and for further proceedings. View "Brockel v. WSI" on Justia Law

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Warren Parsons appealed a judgment affirming a Workforce Safety and Insurance Fund ("WSI") decision that denied his claim for workers' compensation benefits. Parsons applied for workers' compensation benefits from WSI, alleging he sustained an injury to his left shoulder and neck while working for Ames Construction. He claimed he developed pain at the base of his neck and into his left shoulder from hitting the seat belt repeatedly while driving the dump truck on rough roads. Parsons argued his cervical spine and left shoulder injuries were "compensable injuries" by law. Upon review, the Supreme Court concluded WSI erred in determining Parsons' injury was not a compensable injury and in denying his claim for benefits. View "Parsons v. WSI" on Justia Law

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Michelle and Tony Tweten brought an action against COUNTRY Preferred Insurance Company and American National Property and Casualty Company ("ANPAC"), seeking the full amount of underinsured motorist coverage from both insurance companies. The United States District Court for the District of North Dakota certified a question to the North Dakota Supreme Court that called for an interpretation of the Twetens' policies under North Dakota law. The federal court asked whether the Twetens as a divorced couple with separate insurance policies, were foreclosed from recovering up to the full amount of underinsured motorist benefits from their respective policies under the 'other insurance' clause contained in each policy and the statutory anti-stacking provisions of NDCC Ch. 26.1-40 following the death of their son in a car accident. The North Dakota Supreme Court answered the question "Yes." View "Tweten v. COUNTRY Preferred Insurance Company" on Justia Law

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Petitioner Allen Davenport appealed a judgment affirming a Workforce Safety and Insurance ("WSI") decision to terminate benefits on his claim for treatment of his cervical spine and left shoulder and denying his claims for benefits for treatment of his anxiety and depression and lower back condition. He argued his anxiety and depression and his cervical spine, left shoulder and back conditions were "compensable injuries." Upon further review, the Supreme Court concluded Davenport failed to establish by a preponderance of the evidence that work incidents subject to this claim substantially accelerated the progression of, or substantially worsened the severity of, his existing conditions and that his physical injury caused at least 50 percent of his anxiety and depression. View "Davenport v. WSI" on Justia Law

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Workforce Safety & Insurance (WSI) appealed a district court's judgment reversing its denial of worker's compensation benefits to claimant Brenda Albright. Albright submitted her claim to WSI for a work-related back injury. Albright had a history of back problems; an independent medical records review of Albright's case showed she had "well-documented multilevel degenerative disk pathology" which contributed to the claim at issue here. The ALJ hearing Albright's case concluded her injury was not the result of a single incident, and denied her application for benefits. Finding that the evidence in the record supported the ALJ's decision to deny Albright's application for benefits, the Supreme Court reversed the district court, affirmed the ALJ and reinstated WSI's order denying benefits. View "Albright v. ND Workforce Safety & Ins" on Justia Law

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In the early morning hours of April 11, 2008, Jeremy Rustad and Heidi Hanna were killed in a plane crash in McLean County. Rustad was piloting his Cessna aircraft and Hanna was a passenger when the plane crashed. The National Transportation Safety Board determined the probable causes of the accident were due to pilot error and pilot impairment due to alcohol. The estate published a notice to creditors of Rustad for three successive weeks beginning May 22, 2008, informing them they had three months to file claims. On September 24, 2008, Olson, as "co-personal representative of the estate of Heidi Hanna, deceased, caretaker of [B.H.], a minor, and temporary guardian of [B.H.], a minor," filed a claim against the estate asserting the estate was indebted to Hanna's estate and to Hanna's children. The estate "disallowed" Olson's claim. In early 2009, Olson filed this wrongful death and survival action against the estate. The estate moved for summary judgment dismissing the action. The estate argued Olson's claims were barred because she did not serve the personal representative in that capacity and the failure to present her claims in the probate action made them res judicata. The estate also argued Olson could not show Hanna was injured before Rustad died, and therefore, both the wrongful death and survivor claims were barred under the nonclaim provisions of the Probate Code. The district court rejected the estate's arguments that service of process was insufficient and that the action was barred by res judicata. The court concluded Olson presented no evidence to show Hanna died before Rustad, and dismissed the wrongful death and survival actions because they were barred by the nonclaim provisions of the Probate Code. The district court further noted Rustad had an aircraft insurance policy and the nonclaim provisions did not prevent Olson from recovering to the extent of insurance coverage available for the accident. The court ruled the language in the insurance policy unambiguously limited coverage under the circumstances to $103,000, and a judgment was entered in favor of Olson for $103,000. The Estate appealed; the Supreme Court, after review of the trial court record, affirmed. View "Olson v. Estate of Rustad" on Justia Law

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Michael Jassek appealed a district court judgment that affirmed the binding dispute resolution decision of Workforce Safety and Insurance ("WSI") that denied payment for a myoelectric prosthesis. Upon review of the matter, the Supreme Court concluded the district court did not have subject matter jurisdiction, and therefore vacated the judgment. Jassek contended that because WSI failed to explain its reasons for disregarding the medical evidence favorable to Jassek, its binding dispute resolution decision was arbitrary, and that WSI's binding dispute resolution procedure violated his right to due process because it failed to provide a formal hearing. The language of N.D.C.C. 65-02-20 unambiguously provides that "[a] dispute resolution decision under this section requested by a medical provider concerning . . . a request for . . . treatment is not reviewable by any court." The statute based appealability on the identity of the party who requests binding dispute resolution, not on who appeals the binding dispute resolution decision. Jassek’s orthotist was a "medical provider," and this dispute concernd "a request for diagnostic tests or treatment," specifically the determination of an appropriate prosthetic device. Accordingly, WSI's decision on the medical provider’s request for binding dispute resolution was not reviewable by the district court, the district court was without subject matter jurisdiction, and the judgment affirming WSI's decision was void. View "Jassek v. Workforce Safety and Insurance" on Justia Law

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K & L Homes, Inc. ("K & L") appealed the trial court's summary judgment declaring no coverage existed under K & L's commercial general liability ("CGL") policy with American Family Mutual Insurance Company ("American Family") for damages awarded against K & L in an underlying action. Upon review of the applicable case law pertinent to this matter, the Supreme Court concluded there could be an "occurrence" under the CGL policy at issue in this case. Therefore, the Court reversed the summary judgment and remanded the case for further proceedings. View "K & L Homes, Inc. v. American Family Mutual Ins. Co." on Justia Law

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In 1989, Southeastern recovered a judgment against David Herzig in a North Carolina court. In August 1998, the North Carolina judgment was transcribed and filed in North Dakota under the Uniform Enforcement of Foreign Judgments Act, and renewed in North Carolina in 2000, and was again transcribed and filed in North Dakota for enforcement purposes. In 2004, Alphild Herzig, David Herzig's mother, was joined as a party. In 2005, Southeastern moved for an order compelling Alphild Herzig to comply with Southeastern's discovery requests and requested sanctions. In June 2006, Southeastern moved to compel discovery and requested sanctions. The court granted Southeastern's motion for sanctions against Alphild Herzig contingent on submission of a checklist of items to be produced so the court could set a daily sanction for each item not provided. The court also found Alphild Herzig was in contempt and awarded attorney fees. In August 2006, Alphild Herzig moved for release from the sanctions. The court denied her motion. In 2008, Alphild Herzig moved for an order to dismiss her as a party in the original action and vacating the 2004 order joining her as a party and all subsequent orders issued against her, including the 2006 contempt orders. Southeastern opposed Alphild Herzig's motion to dismiss. However, Alphild Herzig died before the court ruled on the motion. The issue before the Supreme Court in this case was whether the daily sanctions imposed on Alphild Herzig under 2006 contempt orders abated at her death. Upon review, the Supreme Court found that the district court had not followed its instructions on whether a portion of the daily sanctions were intended to be money damages to compensate Southeastern or whether the sanctions were a forfeiture. As such, the Court reversed and remanded the district court to make that determination. View "Investors Title Ins. Co. v. Herzig" on Justia Law