Justia Insurance Law Opinion Summaries

James Mickelson appealed a judgment affirming a Workforce Safety and Insurance ("WSI") decision denying his claim for workers' compensation benefits. He argued WSI erred in deciding he did not suffer a compensable injury. Upon review, the Supreme Court concluded WSI misapplied the definition of a compensable injury, and the Court reversed and remanded for further proceedings. View "Mickelson v. Workforce Safety & Ins." on Justia Law

Plaintiffs-Appellants Mark Tibert, Melvin Tibert, Sue Tibert, and William Tibert appealed a district court judgment that dismissed their declaratory judgment action against Nodak Mutual Insurance Company. Mark, Melvin, and William Tibert are brothers, and Sue Tibert is Mark's wife. The Tiberts were involved in a lengthy dispute with Minto Grain, LLC, and its owners William and Katherine Slominski. Mark and Sue Tibert and Melvin Tibert owned homes on property adjacent to a grain elevator owned and operated by Minto Grain. Minto Grain intended to expand its facility, and acquired a portion of BNSF Railway's right-of-way on a roadway abutting and providing access to the Tiberts' properties. The Tiberts had various homeowner's policies and umbrella policies, which included personal injury liability endorsements, with Nodak. In 2004, Minto Grain brought an action against the Tiberts, alleging civil conspiracy, wrongful interference with business, tortious interference with contract, nuisance, trespass, and abuse of process. The Tiberts delivered the complaint to Nodak. Nodak denied it had a duty to indemnify or defend the Tiberts under the policies. The Tiberts brought this declaratory judgment action against Nodak, seeking indemnification and recovery of their costs of defending the underlying action. Upon review, the Supreme Court concluded that the district court did not err in concluding Nodak did not have a duty to indemnify the Tiberts for the damages paid to Minto Grain, but did err in concluding Nodak did not have a duty to defend the Tiberts in the underlying action. The Court considered the remaining issues and arguments raised by the parties and found them to be either unnecessary to its decision or without merit.

Appellant Beverly Fetzer appealed a district court judgment that affirmed a Workforce Safety and Insurance (WSI) order denying her request for benefits. While walking down a hallway on her employer's premises and during work hours, Appellant thought she heard someone call her name. Turning in response, she caught her foot and fell, fracturing her left hip and wrist. No cause of the fall was apparent. Appellant filed a claim for workers' compensation benefits with WSI, and WSI denied her claim. Appellant submitted a request for reconsideration; WSI issued an order consistent with its prior decision, determining Appellant’s injury "occurred in the course of, but did not arise out of" her employment. WSI added, "Mere walking, without more, is not an activity that is sufficiently linked to Claimant's employment so that the injury can be deemed to have arisen from employment." Upon review, the Supreme Court affirmed: “If merely being at work was sufficient to show causation, the legislature need not have required the 'arising out of' test." Appellant was unable to prove a causal connection between her employment and injury.

Plaintiff-Appellant Allen Perius appealed a district court judgment following a jury verdict in favor of Appellee Nodak Mutual Insurance Company. In 2004, Plaintiff was involved in a motor vehicle accident with an uninsured driver, Jacob Kessler. Plaintiff insured his vehicle with Nodak for basic no-fault benefits and uninsured motorist benefits. Nodak paid Plaintiff no-fault benefits as a result of the accident. Plaintiff did not seek further medical treatment until March 2005, when he saw a chiropractor. Plaintiff submitted the bills to Nodak for payment as no-fault benefits. After Plaintiff submitted to an independent medical examination, Nodak denied him payment for any medical treatment after December 31, 2004, concluding such treatment was unrelated to the accident. In 2007, Plaintiff brought suit against Kessler, alleging he negligently operated his motor vehicle and caused Plaintiff's injuries. Plaintiff also sued Nodak, alleging the company breached its insurance contract with him. Nodak denied liability, and asserted a cross-claim against Kessler regarding Plaintiff's uninsured motorist claim. Kessler did not answer the claims against him. In 2009, Nodak moved for summary judgment, arguing no competent, admissible evidence established his claimed injuries were caused by the accident. Plaintiff resisted the motion, and submitted the affidavits of two of his treatment providers who stated their belief that Plaintiff's injuries and treatment were due to the accident. The district court granted Nodak's motion for summary judgment, and this Court reversed and remanded, finding disputed issues of material fact existed. A trial was set on remand. Shortly after, Plaintiff sent Nodak amended responses to Nodak's interrogatories. Prior to trial, Nodak was informed of Plaintiff's intent to call a chiropractor, as an expert witness. Nodak filed a motion in limine seeking to exclude the expert witness, alleging the expert was not properly disclosed.The district court granted Nodak's motion, but ordered the doctor would still be allowed to testify as a fact witness. The jury returned a verdict in Nodak's favor. The Supreme Court concluded that Plaintiff did not properly disclose his witness and that the district court did not abuse its discretion excluding the expert's testimony as a discovery sanction.

Appellant Valerie Joy Tronnes appealed a judgment that affirmed the Job Service of North Dakota's decision to deny her claim for unemployment benefits. In 2002, Appellant began working part-time at the Wal-Mart Vision Center. In 2010, Appellant received her paycheck (via a debit-card style card), and purchased a few items at Wal-Mart's customer service center. The amount of the purchase was mistakenly credited to Appellant's account by a different employee rather than deducted, which resulted in a substantial benefit to Appellant. Appellant met with the vision center manager about the extra money on her card, but later testified she believed the amount to be correct. The store gave Appellant the option of resigning as a result of her spending the extra money, but believed the paid time off she was given ( a "D-day"-- so named to give Appellant a day to decide whether to remain employed at Wal-Mart) meant she would be fired soon. Store management negotiated a payment plan for Appellant to repay the amount she was credited and allowed her to return to work. Ultimately the "repayment plan" took the form of the store withholding Appellant's subsequent paychecks to cover the indebtedness. Appellant did not report to work after that payday, and subsequently filed for unemployment benefits. The Job Service determined Appellant was ineligible for benefits because she voluntarily quit her job. Upon review, the Supreme Court concluded the evidence in the record supported the Job Service's denial of benefits to Appellant.

Defendant-Appellant Nodak Mutual Insurance Company appealed from a judgment awarding Plaintiff-Appellee Barry Myaer $34,933.24 plus interest in his breach of contract action against Nodak. Upon review, the Supreme Court concluded the district court did not err in ruling Plaintiff was entitled to deferred commissions payable to him in December 2009, but did err in ruling those commissions could exceed 10 percent under the terms of the parties' contract.

Petitioner-Appellant Lyle Hollingsworth, as personal representative of the Estate of Audrey Hollingsworth, appeals from a district court judgment determining the distribution of insurance proceeds. Jerry Hollingsworth, Petitioner's brother had lived in a house he shared with their mother Audrey and continued to live there after her death. The house was insured under a farm and ranch policy issued by Nodak Mutual Insurance Company (Nodak) which listed Jerry Hollingsworth as the primary insured, with Audrey Hollingsworth listed as an additional insured. After Audrey Hollingsworth's death, the Estate was listed as the additional insured. The house was destroyed by fire in 2006. Nodak issued several checks made payable to Jerry Hollingsworth and the Estate for the loss. Disputes arose over the various heirs' rights in the insurance proceeds, and Lyle Hollingsworth, as personal representative of the Estate, began proceedings in the informal probate requesting that the district court order a division of the insurance proceeds. Following an evidentiary hearing, the district court issued its findings of fact, conclusions of law, and order for judgment directing division of various components of the insurance proceeds between Jerry Hollingsworth and the Estate. The court concluded that the portion of the insurance proceeds paid for loss of the dwelling should be divided on the basis of the relative percentage value of Jerry Hollingsworth's life estate and the Estate's remainder interest, as calculated by actuarial tables. Finding that there was an "unsupervised probate" of the case, it could not be appealed without a Rule 54(b) certification. Because the district court's judgment resolved some but not all of the disputed between the parties in this case, the disbursement of the insurance proceeds was not a final, appealable judgment. The Supreme Court determined it did not have jurisdiction to hear the case further, and dismissed the appeal.

Ransom County appealed a grant of summary judgment that awarded Plaintiffs-Appellees Tracy and Lisa Jund the $250,000 coverage limit of Ransom County's underinsured motorist coverage. The issue in this appeal involved the meaning of language in N.D.C.C. § 26.1-40-15.4(1) that "[a]ny damages payable to or for any insured for . . . underinsured motorist coverage must be reduced by" the amounts payable under any Workforce Safety and Insurance ("WSI") law. The Junds sued Johnnie B's Bar & Grill and Ransom County, alleging Tracy Jund was injured during the course of his employment as a Ransom County Deputy Sheriff when his patrol car was involved in an accident with an underinsured motor vehicle driven by Shane Reinhardt, an individual the Junds alleged had unlawfully consumed alcoholic beverages at Johnnie B's. The Junds alleged Ransom County, as a pool member of the North Dakota Insurance Reserve Fund, provided underinsured motorist coverage for the patrol car and was liable to the Junds for $250,000 in underinsured benefits under the limits of its underinsured motorist coverage. The district court construed that language to authorize a reduction for WSI benefits payable to Tracy Jund from the Junds' total compensatory damages, not from Ransom County's underinsured motorist coverage limit. Upon review, the Supreme Court affirmed the district court for substantially the same reasons outlined in its decision.

Plaintiff Chase Wisness appealed the district court's grant of summary judgment in favor of Nodak Mutual Insurance Company (Nodak), finding its Farm and Ranch Excess Liability Policy did not provide coverage for his claim. Plaintiff argued on appeal that the district court erred by finding the insurance policy did not provide underinsured motorist coverage. In 2007, Plaintiff was a passenger in a vehicle driven by an unrelated third party. An accident occurred, and Plaintiff was injured and is now a paraplegic. At the time of the accident, Milo Wisness, Plaintiff's father, owned a Nodak Mutual automobile insurance policy with underinsured motorist limits of $500,000. Milo Wisness also owned a Farm and Ranch Excess Liability Policy issued by Nodak. Plaintiff settled with Nodak for underinsured limits on the automobile policy and reserved the right to pursue a claim under the excess liability policy. Plaintiff then sued alleging that Nodak wrongfully denied his claim under his excess liability policy because the policy provided underinsured motorist coverage, that Nodak used bad faith when denying the claim and that his father's insurance agent negligently counseled Milo Wisness about what insurance policy to buy. Nodak and the agent denied the allegations. Plaintiff moved for partial summary judgment, asking the court to declare coverage existed for his claim. Judgment was entered awarding Nodak its costs and dismissing Wisness's claim with prejudice. Upon review, the Supreme Court agreed with the district court's conclusion that the excess liability policy did not cover Plaintiff's claim, and affirmed the court's decision.

Claimant Claud Sloan appealed a district court judgment that affirmed a Workforce Safety & Insurance (WSI) order awarding him additional permanent impairment benefits. In December 1985, Sloan sustained a compensable work-related injury while employed at a coal gasification plant in Beulah, North Dakota. WSI awarded Sloan permanent impairment benefits for his injury and has issued several permanent partial impairment orders since his original injury. Effective April 1, 2009, WSI promulgated N.D. Admin. Code 92-01-02-25(4) to address pain impairment ratings. Based on the newly adopted rule, WSI reviewed Sloan's pain rating and determined he had sustained an eight percent impairment for pain which, when combined with his prior impairment ratings, totaled a whole body impairment rating of 38 percent. On June 11, 2009, WSI issued an order awarding Sloan additional permanent impairment benefits, based on his combined whole body impairment of 38 percent for his cervical spine, depression, dysphagia, and chronic pain. Sloan requested a rehearing. At a November 2009, hearing before an administrative law judge, a staff attorney for WSI appeared as the only witness and testified regarding the WSI's promulgation of N.D. Admin. Code 92-01-02-25. The ALJ subsequently issued an order affirming WSI's June 2009 order awarding Sloan additional permanent impairment benefits. Sloan appealed to the district court, which affirmed the order. Upon review, the Supreme Court concluded WSI's promulgation of administrative rules for assessing pain impairment did not conflict with its statutory authority and was not arbitrary, capricious, or unreasonable.