Justia Insurance Law Opinion Summaries

The issue before the Supreme Court in this case centered on whether a Workers' Compensation employer's insurance carrier should be reimbursed from the Supersedeas Fund for specific payments made to a claimant prior to the ultimate grant of supersedeas. The question turned on whether the relevant payments constituted payments of "compensation" within the meaning of Section 443 of the Workers' Compensation Act (WCA), 77 P.S. 999(a), or, as argued by Appellant Bureau of Workers' Compensation, whether the payments are not reimbursable because they constitute payment of legal costs associated with obtaining a claimant's third-party tort settlement under Section 319 of the WCA, 77 P.S. 671. After review, the Court found no language in either Section 443 or Section 319 that would transform the relevant payments into something other than compensation merely because the amounts of the payments were calculated to compensate the claimant for the costs of recovering the third-party settlement. Accordingly, the Court affirmed the decision of the Commonwealth Court. View "Bureau of Workers' Comp, Aplt v. WCAB(Excelsior Ins.)" on Justia Law

The Supreme Court granted allowance of appeal in this case to determine whether the immunity provisions of Section 23 of the Workers' Compensation Act (Act 44) applied to "subrogation and/or reimbursement claims sought against an employee who has entered into a third[-]party settlement with a Commonwealth [p]arty such as Southeastern Pennsylvania Transportation Authority ('SEPTA')." Upon review of this matter, the Supreme Court held that the portion of Act 44 at issue in this case barred any claim made by the employer for the recoupment of workers' compensation benefits it paid. View "Fraizer v. W.C.A.B." on Justia Law

Ronald Bole appealed a superior court's order that affirmed an arbitration award that denied him recovery of underinsured motorist benefits. The Supreme Court allowed the appeal to determine whether the rescue doctrine allowed a volunteer firefighter responding to a crash to recover despite finding his injuries were the result of a superseding cause. Upon review, the Supreme Court concluded that Bole could not, and did not disturb the arbitrator's determination. View "Bole v. Erie Insurance Exchange" on Justia Law

Alleging that Appellant Conestoga Title Insurance Company charged more for title insurance than its filed rates permitted, Appellee Nancy A. White asserted three claims against Conestoga in a class action complaint. The Supreme Court granted review to consider whether White was precluded from pursuing all of her claims because Article VII of the Insurance Department Act of 1921 provided her with an exclusive administrative remedy under Section 1504 of the Statutory Construction Act of 1972. Upon review, the Supreme Court reversed in part and affirm in part. Specifically, the Court reversed the Superior Court's order reversing the trial court's dismissal of White's common law claims for money had and received and for unjust enrichment, and the Court affirmed (albeit on different grounds) the Superior Court's order reversing the trial court's dismissal of White's statutory claim brought under Pennsylvania's Unfair Trade Practices and Consumer Protection Law. View "White v. Conestoga Title Insurance Co." on Justia Law

At issue in this direct appeal to the Supreme Court was a statutory prerequisite to the obligation of the Insurance Department to defend certain medical professional liability actions asserted against health care providers, and to the requirement for payment of claims asserted in such actions from the Medical Care Availability and Reduction of Error Fund. Specifically, resolution of the appeal turned on when, under the governing statute, a "claim" is "made" outside a specified four-year time period. On June 4, 2007, Joanna Ziv filed a praecipe for a writ of summons naming Appellant Phillip Yussen, M.D. and other medical providers as defendants. A complaint was filed on August 2, 2007, alleging medical negligence last occurring on July 7, 2003. Appellant’s primary insurer, Pennsylvania Healthcare Providers Insurance Exchange, requested that the claim be accorded Section 715 status by the Insurance Department. The Department denied such request, however, on the basis that the claim had been made less than four years after the alleged malpractice. Appellant initially challenged this determination in the administrative setting, and a hearing ensued. Before the examiner, Appellant argued that, consistent with the policy definition of a "claim," the date on which a claim is made for purposes of Section 715 cannot precede the date on which notice is provided to the insured. Appellee, on the other hand, contended that a claim is made when it is first asserted, instituted, or comes into existence - including upon the tender of a demand or the commencement of a legal action - and that notice to the insured or insurer is not a necessary prerequisite. In this regard, Appellee Medical Care Availability & Reduction of Error Fund highlighted that Section 715 does require "notice" of the claim to trigger the provider's obligation to report the claim to the Fund within 180 days, but the statute does not contain such an express notice component in delineating the four-year requirement. The Commonwealth Court sustained exceptions to the hearing examiner's recommendation lodged by Appellee and entered judgment in its favor. In its review, the Supreme Court found "claim" and "made" as used in Section 715 ambiguous. The Court determined that for purposes of Section 715, the mere filing of a praecipe for a writ of summons does not suffice to make a claim, at least in absence of some notice or demand communicated to those from whom damages are sought. The Court remanded the case for entry of judgment in Appellant's favor.

The issue before the Supreme Court in this case centered on whether Appellant Six L's Packing Company and its claims administrator Broadspire Services, Inc. bore liability for workers' compensation benefits as a statutory employer of an injured truck driver employed as an independent contractor. Appellant owns and leases various farms and distribution and processing facilities in North America. Claimant suffered injuries in a vehicle accident on a Pennsylvania roadway while transporting Appellant’s tomatoes between a warehouse in Pennsylvania and a processing facility in Maryland. Appellant submitted evidence to establish that it did not own trucks or employ drivers, but, rather, utilized independent contractors to supply transportation services. Appellant thus took the position that it was not Claimant’s employer. The WCJ found Appellant liable for payment of workers' compensation benefits. On further appeal, the Commonwealth Court affirmed on essentially the same reasoning as that of the WCJ. In its review, the Supreme Court affirmed the Commonwealth Court, recognizing "a degree of ambiguity inherent in the overall scheme for statutory employer liability, arising out of differences in the definitions for “contractor” as used in various provisions of the Workers' Compensation Act (WCA); the idiosyncratic conception of subcontracting fashioned in Section 302(a) [of the Act]; the substantial overlap between Sections 302(a) and (b); and the apparent differences in the depiction of the concept of statutory employment as between the Act’s liability and immunity provisions. Viewing the statutory scheme as a whole, however, and employing the principle of liberal construction in furtherance of the Act’s remedial purposes, [the Court found] it to be plain enough that the Legislature meant to require persons (including entities) contracting with others to perform work which is a regular or recurrent part of their businesses to assure that the employees of those others are covered by workers’ compensation insurance, on pain of assuming secondary liability for benefits payment upon a default."

The issue before the Supreme Court was the proper method of calculating an hourly-wage claimant's average weekly wage under Section 309 of the Workers’ Compensation Act where the specific loss claimant suffered an initial incident, changed employers, and later suffered a work-related injury caused by the initial incident. Claimant Janice Weber-Brown worked for Appellant Lancaster General Hospital as a licensed practical nurse. In 1980, while cleaning the tracheotomy of a patient who was infected with the herpes simplex virus (HSV), the patient coughed, causing sputum to spray in Claimant’s left eye. Approximately two weeks after the incident, Claimant’s eye became swollen and infected, and Claimant believed she contracted HSV. Claimant left the employ of Lancaster General in 1985 for reasons unrelated to the eye incident. At that time, she earned $8 per hour and worked full-time. In the years following her departure from the hospital, Claimant’s eye became infected several more times. Each time, her symptoms subsided with treatment, and Claimant did not miss any work with her other employers due to her eye infections. In October 2006, however, Claimant’s eye again became infected and, this time, her infection did not respond to treatment. By February 2007, Claimant lost the vision in her left eye, and, in May 2007, she underwent a cornea transplant. The transplant did not improve her vision, and, as a result of her blindness, she was not able to return to work. At that time, Claimant earned $21 per hour. Lancaster General denied Claimant's allegations that she contracted HSV while working for the hospital, and challenged her claim that she be paid based on her then-current wage with her new employer. The WCJ determined Claimant suffered a work-related injury and held that the hospital pay Claimant's wage set at $21 per hour. Lancaster General appealed. Upon review, the Supreme Court concluded that the WCJ correctly held that the Claimant's weekly wage should have been based on her 2007 wages with her new employer, as those wages were earned with that employer at the time Claimant suffered her work-related injury.

The Department of Public Welfare (DPW) and the Office of the Budget of the Commonwealth of Pennsylvania appealed a Commonwealth Court order which granted summary judgment to Appellees the Pennsylvania Medical Society and its individual members, and the Hospital and Healthsystem Association of Pennsylvania and its individual members. The court declared that the Commonwealth had an obligation under the Health Care Provider Retention Law (the Abatement Law) to transfer monies to the Medical Care Availability and Reduction of Error Fund (MCARE Fund) in an amount necessary to fund dollar for dollar, all abatements of annual assessments granted to health care providers for the years 2003-2007. Upon review of the Commonwealth Court record, the Supreme Court held that the Abatement Law gave the Secretary of the Budget the discretion, but not the obligation, to transfer monies into the MCARE Fund in an amount up to the total amount of abatements granted. Furthermore, the Court concluded that Apellees had no statutory entitlement to the funds held in abatement, nor a vested right to them.

This case raised the question of whether an uninsured driver who was injured in a motor vehicle accident with an insured driver, may sue the insured driver in tort for economic damages. "The question highlight[ed] a tension" in the Motor Vehicle Financial Responsibility Law, (MVFRL), 75 Pa.C.S. 1701-1799, and Pennsylvania decisional precedent, as noted by the United States Court of Appeals for the Third Circuit. On the one hand, Section 1714 of the MVFRL prohibits uninsured drivers from recovering first-party benefits, which include medical and income loss benefits. On the other, Section 1705 of the MVFRL deems uninsured drivers to have chosen the limited tort alternative, which permits recovery of damages for economic loss sustained in a motor vehicle accident as the consequence of the fault of another person. Loss is commonly understood as being comprised of damages for medical expenses and wage loss. "Thus, it may appear as though the MVFRL both prohibits and permits insurance recovery to uninsured drivers for this category of damages or loss." The Supreme Court answered the question posed by the Third Circuit in the negative: Section 1714 of the MVFRL does not preclude an uninsured motorist from recovering tort damages for economic loss from an alleged third-party tortfeasor under the torfeasor’s liability coverage.

In 2001, Appellant Daniel Goodson was involved in a car accident. His insurance company paid $6,300 for the loss to the bank which still held title to the Appellant's car; Appellant received $135. Appellant, dissatisfied with his "meager" share of the insurance proceeds, presented a forged check for $6,300 to his bank with which to open a new account. The bank permitted Appellant to withdraw several thousand dollars before learning that the check was forged. The insurance company confirmed that it had not paid Appellant $6,300. Appellant paid back all the money he had withdrawn, but the State still pressed charges for forgery, insurance fraud and theft. Defendant challenged his sentence and conviction, arguing that he was not guilty of insurance fraud, and that his sentence was accordingly unreasonable. Finding that the trial court erred in convicting Appellant on insurance fraud charges, the Supreme Court remanded the case for resentencing based on forgery and theft.