Justia Insurance Law Opinion Summaries

In 1970, while working for Employer, Employee was injured. In 1989, Employee retired. In 2008, Employee applied for permanent total disability (PTD) compensation. The Industrial Commission of Ohio concluded that Employee was permanently and totally disabled without ruling on the credibility of the assertion that Employee retired because of his injury or determining whether his retirement was voluntary or involuntary. The court of appeals granted Employer a limited writ of mandamus that vacated the Commission's order and ordered the Commission to reconsider the matter. The Supreme Court affirmed the court of appeals, holding that because a voluntary retirement from the work force prior to asserting PTD precludes the payment of compensation for that disability, the court of appeals was correct in ordering further consideration of whether Employee retired because of his injury and whether his retirement was voluntary.

Appellees, members of the Barbee family, were involved in an automobile accident. Appellant, Nationwide Mutual Insurance Company, insured the automobile. The policy contained a provision that required an action for underinsured motorist coverage be brought against the insurer within three years of the date of the accident. After receiving a judgment against the tortfeasors and more than four years after the accident, the Barbees filed suit against Nationwide to recover the outstanding amounts on their judgments. Nationwide filed a motion for summary judgment, arguing that the Barbees' claims were barred for failure to bring the claims within the three-year period required by the policy's limitation period. The trial court denied the motion. The court of appeals affirmed. At issue on appeal was whether a conflict between Nationwide's limitation provision and other provisions in the policy, which required that proceeds from any other available insurance be exhausted, rendered the limitation provision unenforceable. The Supreme Court reversed, holding (1) the three-year limitation provision was unambiguous and enforceable, and (2) the provision did not conflict with co-existing policy provisions because exhaustion of the tortfeasor's liability limits was not a precondition to filing suit by the insured against his insurer within the limitation period.

Appellant Greg Bell requested that County Risk Sharing Authority (CORSA), a joint self-insurance pool whose members included the majority of Ohio's counties, provide him with certain CORSA records pursuant to Ohio Rev. Code 149.43 and Ohio Rev. Code 149.431. David Brooks, the managing director of property and casualty insurance for CORSA, refused to provide copies of the records, asserting that they were not public records and that CORSA was a private corporation and not a public office subject to section 149.43. Bell filed for writs of mandamus to compel Brooks to provide copies of the requested CORSA records. The court of appeals denied the requested writs. The Supreme Court (1) affirmed the judgment of the court of appeals insofar as it denied the writs relating to Bell's claim for CORSA's board meeting minutes on grounds that CORSA was not the functional equivalent of a public office for purposes of section 149.43, but (2) reversed to the extent that the court of appeals failed to consider Bell's records requests for CORSA's financial and compensation records as CORSA's status as a private, nonprofit corporation was not dispositive in regard to these claims. Remanded.

Thomas Tindira was a member of Ohio Police and Fire Pension Fund (OP&F) while working as a police officer with Lakewood Police Department. Before he resigned from the department, Tindira filed his application for disability benefits with OP&F, including in his list of disabling conditions PTSD, anxiety disorder, and major depression. The OP&F board of trustees determined that Tindira was disabled but denied his claim for disability benefits. The court of appeals denied Tindira a writ of mandamus to compel appellees, OP&F and its board of trustees, to vacate the board's denial of his claim and to award him disability benefits and attorney fees. The Supreme Court reversed and granted the writ, holding that the pension fund and its board abused their discretion in denying disability benefits as Tindira had established his entitlement to the benefits.

This case arose because the settlement of a personal-injury suit brought by a recipient of workers' compensation benefits against a third-party tortfeasor did not make any provision to repay the statutory subrogee, the Ohio Bureau of Workers' Compensation. The Bureau brought suit against both the recipient of the workers' compensation benefits and third-party tortfeasor under Ohio Rev. Code 4123.931(G) to recover the full amount of its subrogation interest. The trial court held that a two-year limitations period applied and that it had expired. The court of appeals reversed, holding that a six-year limitations period applied and that it had not yet run out. At issue on appeal was whether a claim under section 4123.931(G) brought by a statutory subrogee to recover its subrogation interest is subject to a two-year statute of limitations, the same period applicable to the injured worker's personal-injury suit against the third party, or to a six-year statute of limitations for an action on a liability created by statute. The Supreme Court affirmed the court of appeals, holding that the claim in this case was an action upon a liability created by statute and that the statute of limitations was six years.

Virginia King was injured in an automobile accident and was treated for her injuries at Toledo Hospital. Although King informed the hospital staff that she was covered by a health-insuring corporation, the hospital billed King's automobile insurer for the services rendered. King sued the hospital and ProMedica Health System (Appellants). Each of King's causes of action was based on the claim that Appellants violated Ohio Rev. Code. 1751.60(A) by billing the automobile insurer instead of the health-insuring corporation. Section 1751.60(A) stated that every provider that contracts with a health-insuring corporation to provide health-care services to an insured shall seek payment solely from the corporation. The trial court granted Appellants' motion to dismiss, and the court of appeals reversed. At issue on appeal was whether section 1751.60(A) prohibited a provider from seeking payment for medical treatment rendered to an insured injured in an automobile accident from the insured's automobile insurance medical benefits. The Supreme Court reversed the court of appeals, holding (1) section 1751.60(A) applies only when a health-care provider seeks payment from an insured, and (2) section 1751.60(A) does not conflict with Ohio's law on the coordination of insurance benefits.

Insured submitted a claim to Insurer after his house was damaged by a storm. Insured returned the payment tendered to him by Insurer, deeming the amount insufficient to cover the damage to his home. Almost two years after the house was damaged, Insured filed suit against Insurer. Insurer argued the lawsuit was barred by a clause in the insurance contract that stated that any action must be started within one year after the date of loss or damage. The trial court granted Insurer's motion for summary judgment. The court of appeals reversed, concluding the policy language was ambiguous and that Insurer, by its actions, had waived its right to enforce the one-year limitation clause. The Supreme Court reversed the judgment of the court of appeals and reinstated the trial court's grant of summary judgment, holding that Insurer could enforce the limitation-of-action clause contained in its contract because (1) the policy language was not ambiguous, and (2) Insurer did not waive its right to enforce the clause.

Gulf Underwriters Insurance issued a general liability policy to United Foundries with an endorsement for employer's liability coverage, known as a stop-gap endorsement. David Ward filed a complaint against his employer, United, alleging claims for employer intentional tort and seeking damages. While the case was pending, United filed an action against Gulf for a declaration that Gulf had a duty to defend and indemnify United for the claims asserted by Ward. The trial court granted summary judgment to United. The court of appeals reversed. The Supreme Court affirmed the judgment of the court of appeals, holding (1) an exclusion in a stop-gap endorsement stating that the insurance does not apply to bodily injury resulting from an act that is determined to have been committed by an insured with the belief that an injury is substantially certain to occur does not require a final determination by either a judge or jury before the insurer can refuse to defend a claim alleging a substantial-certainty employer intentional tort: and (2) that the claims stated in the underlying complaint were neither potentially nor arguably covered under the terms of the policy, and thus, Gulf had no duty under the policy to defend United.

In this appeal, the Supreme Court interpreted an exclusion in a homeowner's insurance policy that denied coverage for claims "arising out of" premises that are owned by the insured, but are not an insured location under the policy. Appellee Westfield Insurance provided Appellants Michael and Marilyn Hunter's insurance on their Ohio home; the Hunters hold an additional policy for any personal liability that arises from bodily injury or property damages. The Hunters also own a farm in Indiana that is not a named insured location under the Westfield policy. The Hunters purchased liability insurance for the Indiana property from co-appellant Grinell Mutual Reinsurance Company. Children playing on the Indiana property suffered bodily injuries on the property, and brought suit against the Hunters for negligence. The Hunters applied to Westfield seeking indemnification under their personal liability policy. Westfield brought a declaratory judgment action against the Hunters and Grinell seeking a declaration that it had no duty to defend or indemnify the Hunters for claims asserted in the Indiana lawsuit. At trial, the court reasoned that the claims raised by the injured children "arose out of" premises that were not insured by Westfield, therefore Westfield had no duty to indemnify the Hunters for personal liability claims. Grinnell appealed to the Supreme Court for discretionary review, and secured an order from the appellate court certifying that its decision in this case was in conflict with that of another state appellate court. On review of the lower courts' holdings, the Supreme Court found that the Westfield policy does exclude coverage for claims arising from the Indiana property, or any claims based solely on the insured's ownership of the property on which the injury occurred.