Justia Insurance Law Opinion SummariesArticles Posted in Oregon Supreme Court
Batten v. State Farm Mutual Automobile Ins. Co.
Consolidated cases presented a certified question from the United States District Court for the District of Oregon. The Oregon Supreme Court was asked to determine whether Oregon law precluded an insurer from limiting its liability for uninsured/underinsured motorist (UM/UIM) benefits on the basis that another policy also covered the insured’s losses. Each plaintiff suffered injuries caused by an uninsured or underinsured motorist, and each plaintiff incurred resulting damages that qualify as covered losses under multiple motor vehicle insurance policies issued by defendant State Farm Mutual Automobile Insurance Company (State Farm). Each plaintiff alleged a loss that exceeded the declared liability limits of any single applicable policy and sought to recover the excess under additional applicable policies, up to the combined total of the limits of liability. In each case, however, State Farm refused to cover the excess loss, citing a term in the policies that allowed State Farm to limit its liability to the amount that it agreed to pay under the single policy with the highest applicable limit of liability. The Oregon Supreme Court concluded that that term made State Farm’s uninsured motorist coverage less favorable to its insureds than the model coverage that the legislature has required and, thus, was unenforceable. View "Batten v. State Farm Mutual Automobile Ins. Co." on Justia Law
Allianz Global Risks v. ACE Property & Casualty Ins. Co.
Various parties petitioned the Oregon Supreme Court for reconsideration of its decision in Allianz Global Risks v. ACE Property & Casualty Ins. Co., 483 P3d 1124 (2021). Petitioner on review Allianz Global Risks US Insurance Company and Allianz Underwriters Insurance Company (“Allianz”), together with respondent on review Certain Underwriters at Lloyd’s, London and Certain London Market Insurance Companies (“London”), petitioned on two grounds: (1) that the court in one place in the opinion incorrectly characterized its earlier cases regarding the duties of an insurer to defend or indemnify its insured; and (2) that the court in several places incorrectly identified a particular entity as the “indemnitor” in several agreements discussed in the opinion. Respondent on review Con-Way filed a petition for reconsideration asserting that the court erred in holding that certain “side” agreements between Con-Way and three of its insurers were to be considered separately from the insurance policies that those companies issued to Con-Way’s subsidiary, Freightliner. The Supreme Court considered the arguments in Con-Way’s petition, and denied it: "The purpose of a rehearing is not to raise new questions or rehash old arguments, but to allow the court to correct mistakes and consider misapprehensions." As to the Allianz/London petition: the Court allowed that petition to make changes as noted. View "Allianz Global Risks v. ACE Property & Casualty Ins. Co." on Justia Law
Wright v. Turner
Plaintiff was a passenger in a truck driven by Lorenz. The vehicles were traveling on an interstate when it began to hail and rain. A sedan ahead of the truck spun out of control and collided with the front of the truck. The passengers of the sedan required medical assistance; a third vehicle struck the back of the truck, pushing the truck into the sedan. Plaintiff was severely injured. Plaintiff filed a personal injury claim for damages, alleging the drivers of the vehicles, John Turner and Sherri Oliver, had been negligent and that the negligence of each had caused her injuries and damages. She also alleged that Turner and Oliver were underinsured and that, as a result, she was entitled to UIM benefits from her own insurance company, defendant Mutual of Enumclaw Insurance. Eventually, plaintiff settled with Turner and Oliver for a total of $175,000, and the case was dismissed as to them. This case was the second appeal in a dispute between Plaintiff and her insurance company over the limits of her Underinsured Motorist (UIM) coverage. Plaintiff’s policy included a limit of $500,000 for damages “resulting from any one automobile accident.” In the first trial in this case, the jury found that plaintiff’s injuries resulted in damages of $979,540. In the second trial, the jury found that plaintiff was injured, not in one, but in two, separate “accidents,” and that it could not “separate the cause” of plaintiff’s injuries between those two accidents. Consequently, the trial court awarded plaintiff the full measure of her damages, minus offsets. On appeal, the insurance company argued the trial court had erred in its instructions to the jury and should have required the jury to apportion plaintiff’s damages between the two accidents. The Court of Appeals agreed with the company and reversed. The Oregon Supreme Court concluded the trial correctly instructed the jury it could find, as a matter of fact, the number of accidents that occurred and whether the cause of plaintiff's injuries could be separated between them. View "Wright v. Turner" on Justia Law
Allianz Global Risks v. ACE Property & Casualty Ins. Co.
Daimler-Benz AG acquired Freightliner Corporation (Freightliner) from Consolidated Freightways (now Con-Way) in 1981. As part of the transaction, it liquidated Freightliner’s assets and liabilities into a subsidiary, Daimler Trucks North America LLC (Daimler). Between 1952 and 1982, Freightliner and then Daimler had engaged in business activities, primarily the manufacture of trucks, that subsequently led to several environmental remediation proceedings, including claims related to the Portland Harbor Superfund cleanup, and to some 1,500 asbestos personal injury claims. Plaintiffs Allianz Global Risk US Insurance and Allianz Underwriters Insurance Company (Allianz) insured Freightliner in 1981 and Daimler from 1981 to 1986 through a general commercial liability insurance policy. Daimler also purchased from Allianz another policy to provide coverage for future claims that might be made against Freightliner based on its past operations that were “incurred but not yet reported.” By the time it filed the operative complaint in this action in 2014, Allianz had spent more than $24 million defending and paying environmental and asbestos claims against Daimler and the now-dissolved Freightliner arising from Freightliner’s business operations between 1952 and 1982. In this litigation, Allianz sought contribution for the payments it has made and will make in the future based on those environmental and asbestos claims from insurance companies that insured Freightliner -- either directly or through its parent, Con-Way -- from 1976 to 1982. The Oregon Supreme Court reversed the Court of Appeals' holding that Daimler did not assume the contingent liabilities of Freightliner (including the liabilities at issue here) and affirmed the jury verdict on that issue. On Allianz's appeal, the Supreme Court agreed that the trial court erred in submitting to the jury the question of whether, because of side agreements between Con-Way/Freightliner and the insurers, those insurers had a "duty to defend or indemnify Freightliner" -- that question was to be decided by the trial court as a matter of law based on the relevant policies. As to the "London pollution exclusion", the Supreme Court agreed with Allianz that it was error for the trial court not to provide a legal interpretation of a key provision in the policy as part of the jury instructions. The Court also concluded that the jury instructions regarding the London pollution exclusion should be similar to those regarding the Domestic exclusion. The decision of the Court of Appeals was reversed. The limited judgments of the trial court were affirmed in part and reversed in part, and the case was remanded to the trial court for further proceedings. View "Allianz Global Risks v. ACE Property & Casualty Ins. Co." on Justia Law
Arvidson v. Liberty Northwest Ins. Corp.
After claimant Danny Arvidson received an award of permanent total disability, insurer Liberty Northwest Insurance Corporation requested a hearing before an administrative law judge (ALJ) to review the award. The ALJ dismissed insurer’s hearing request as time-barred. The question on review before the Oregon Supreme Court was whether that dismissal entitled claimant to attorney fees under ORS 656.382(2), which provided that, if an insurer initiates review of a compensation award and the reviewing body “finds that ... all or part of the compensation awarded ... should not be reduced or disallowed,” the insurer shall pay the claimant’s attorney a “reasonable attorney fee.” The ALJ determined that the statute applied to the dismissal of insurer’s claim and awarded fees to claimant. The Workers’ Compensation Board reached a different conclusion and reversed that decision. The Court of Appeals affirmed without opinion. The Oregon Supreme Court reversed, finding the ALJ correctly determined that his dismissal of insurer’s request for hearing entitled claimant to attorney fees. The board erred in concluding otherwise. View "Arvidson v. Liberty Northwest Ins. Corp." on Justia Law
Pilling v. Travelers Ins. Co.
Claimant Mark Pilling filed a claim for workers' compensation benefits which insurer Travelers Insurance denied. An administrative law judge (ALJ) reversed insurer’s denial, but the Workers’ Compensation Board reversed the ALJ’s order and reinstated insurer’s denial on the ground that claimant was a nonsubject worker because he was a partner in the business for which he worked and he had not applied for coverage as a nonsubject worker. The Court of Appeals affirmed the board’s order. On claimant’s petition, the Oregon Supreme Court granted certiorari review and concluded that, even assuming claimant was a nonsubject worker, he was entitled to coverage because the business for which he worked made a specific written application for workers’ compensation coverage for him, which insurer accepted. Therefore, the Court reversed the decisions of the Court of Appeals and the Workers’ Compensation Board and remanded to the board for further proceedings. View "Pilling v. Travelers Ins. Co." on Justia Law
Garcia-Solis v. Farmers Ins. Co.
Claimant Elvia Garcia-Solis was injured in a work-related accident. Farmers Insurance Company and Yeaun Corporation (collectively, “Insurer”) accepted a workers’ compensation claim and certain specified medical conditions associated with the accident. Because claimant also showed psychological symptoms, her doctor recommended a psychological referral to diagnose her for possible post-traumatic stress disorder (PTSD). Insurer argued, and the Court of Appeals agreed, that the cost of the psychological referral was not covered by workers’ compensation because claimant had failed to prove that it was related to any of the medical conditions that insurer had accepted. The Oregon Supreme Court reversed both the Court of Appeals and the Workers’ Compensation Board: “’injury’ means work accident is context-specific to exactly two uses in the first and second sentences of ORS 656.245(1)(a). It does not apply to the second use in the first sentence of ORS 656.245(1)(a). We do not decide or suggest that it applies to any other statute in the workers’ compensation system.” View "Garcia-Solis v. Farmers Ins. Co." on Justia Law
Bates v. Bankers Life and Casualty Co.
The United States Court of Appeals for the Ninth Circuit certified a certified question of Oregon law to the Oregon Supreme Court. The question related to claims under ORS 124.110 for financial abuse of “vulnerable persons” (here, elderly persons) who purchased long-term care insurance from defendant Bankers Life & Casualty Co. (Bankers) and sought to receive insurance benefits under their policies. Specifically, the Ninth Circuit asked whether a plaintiff states a claim under ORS 124.110(1)(b) for wrongful withholding of money or property where it is alleged that an insurance company has in bad faith delayed the processing of claims and refused to pay benefits owed under an insurance contract. Plaintiffs were elderly Oregonians or their successors who purchased long-term healthcare insurance policies sold by Bankers and its parent company. Plaintiffs alleged Bankers developed onerous procedures to delay and deny insurance claims: failing to answer phone calls, losing documents, denying claims without notifying policyholders, denying claims for reasons that did not comport with Oregon law, and paying policyholders less than what they were owed under their policies. Bankers allegedly collected premium payments and, without good cause, delayed and denied insurance benefits to which Plaintiffs were entitled. The Oregon Supreme Court answered in the negative: allegations that an insurance company, in bad faith, delayed the processing of claims and refused to pay benefits owed to vulnerable persons under an insurance contract do not state a claim under ORS 124.110(1)(b) for wrongful withholding of “money or property.” View "Bates v. Bankers Life and Casualty Co." on Justia Law
Spearman v. Progressive Classic Ins. Co.
Plaintiff purchased an automobile insurance policy from Progressive. The policy included UM coverage with a limit of $25,000. Plaintiff was injured in an automobile accident with an uninsured motorist. Plaintiff filed a proof of loss for UM benefits with Progressive. ORS 742.061(1) generally provides for an award of attorney fees when an insured brings an action against his or her insurer and recovers more than the amount tendered by the insurer. Subsection (3) provides a “safe harbor” for the insurer: an insured is not entitled to attorney fees if, within six months of the filing of a proof of loss, the insurer states in writing that it has accepted coverage, that it agrees to binding arbitration, and that the only remaining issues are the liability of the uninsured motorist and the “damages due the insured.” At issue in this case was what the safe-harbor statute meant when it referred to the “damages due the insured.” The insurer, Progressive Classic Insurance Company, responded to plaintiff’s claim by agreeing that the accident was covered by the policy, but challenged the nature and extent of plaintiff’s injuries, as well as the reasonableness and necessity of his medical expenses. Plaintiff argued that, by reserving the right to challenge the nature and extent of his injuries, Progressive raised issues that went beyond the “damages due the insured.” The trial court, Court of Appeals and Oregon Supreme Court all rejected plaintiff’s construction of the safe-harbor statute. View "Spearman v. Progressive Classic Ins. Co." on Justia Law
Brown v. SAIF Corp.
The issue in this workers’ compensation case was whether claimant was entitled to benefits for his “combined condition” claim. Claimant filed- and his employer’s insurer, SAIF Corporation, initially accepted-a claim for a lumbar strain combined with preexisting lumbar disc disease and related conditions. SAIF later denied the combined condition claim on the ground that the lumbar strain had ceased to be the major contributing cause of the combined condition. Claimant objected. He did not contest that his lumbar strain had ceased to be the major contributing cause of his combined condition. Instead, he argued that the otherwise compensable injury was not limited to the lumbar strain that SAIF had accepted as part of his combined condition claim. In claimant’s view, an “otherwise compensable injury” within the meaning of ORS 656.005(7)(a)(B) referred not just to the condition that SAIF accepted, but also includes any other conditions not accepted that might have resulted from the same work-related accident that caused the lumbar strain, and that larger group of work-related conditions continued to be the major contributing cause of his combined condition. As a result, claimant contended that an employer could not close a combined condition claim if any of those non accepted conditions remained the major cause of the combined condition claim. The Workers’ Compensation Board rejected claimant’s argument and upheld SAIF’s denial of claimant’s combined condition claim, concluding that existing precedent defined the “otherwise compensable injury” component of combined conditions to consist of the condition or conditions that the employer has accepted as compensable. The Court of Appeals reversed, acknowledging that its holding was “potentially at odds” with existing precedents from both that court and the Oregon Supreme Court. It nevertheless concluded that those precedents were either distinguishable or should be reconsidered. The Supreme Court concluded that the Court of Appeals erred and that the Workers’ Compensation Board was correct. View "Brown v. SAIF Corp." on Justia Law