Justia Insurance Law Opinion Summaries

The Health Care Authority for Baptist Health, an affiliate of UAB Health System ("HCA"), and The Health Care Authority for Baptist Health, an affiliate of UAB Health System d/b/a Prattville Baptist Hospital (collectively, "the HCA entities"), appealed a circuit court order denying their motion to compel arbitration in an action brought by Leonidas Dickson, II. In 2015, Dickson sustained injuries as a result of an automobile accident. Following the accident, Dickson was taken to Prattville Baptist Hospital ("PBH"), where he was treated and discharged. Dickson was partially covered by a health-insurance policy issued by Blue Cross and Blue Shield of Alabama, Inc. ("BCBS"). PBH was a party to a "Preferred Outpatient Facility Contract" ("the provider agreement") with BCBS, under which the medical care rendered to Dickson in the emergency department at PBH was reimbursable. In 2017, Dickson filed a complaint to challenge a reimbursement that PBH had received in exchange for Dickson's medical treatment. Dickson's complaint also sought to certify a class of people who were insured by BCBS and who had received care at any hospital operated by HCA's predecessor, Baptist Health, Inc. ("BHI"). After the HCA entities' motion to dismiss was denied, the HCA entities filed an answer to the lawsuit, but the answer did not raise arbitration as a defense. After a year of extensive discovery (including class certification and class-related discovery), the HCA entities moved to compel arbitration on grounds that Dickson's health-insurance policy with BCBS required all claims related to the policy to be arbitrated and that the provider agreement also provided for arbitration, contingent upon the arbitration requirements of the BCBS policy. The trial court denied the motion to compel without providing a reason for the denial. After a request for reconsideration was also denied, the HCA entities appealed. The Alabama Supreme Court concluded the HCA entities waived their right to arbitration, thus affirming the trial court order. View "The Health Care Authority for Baptist Health v. Dickson" on Justia Law

The Supreme Court reaffirmed in this case that undocumented aliens who are injured while working for a Nevada employer may be eligible for monetary disability benefits, holding that these monetary benefits, paid by the insurer, do not conflict with federal law or undermine the Legislature's intent.Respondent, an undocumented Nevadan, was severely injured while working for High Point Construction and applied for permanent total disability (PTD) status. Associated Risk Management (ARM), High Point's insurance administrator, denied the request. An appeals officer reversed and granted Respondent PTD status pursuant to the "odd-lot doctrine." ARM petitioned for judicial review, arguing that the appeals officer committed legal error by granting PTD to an undocumented alien. The Supreme Court affirmed, holding (1) undocumented aliens are not precluded from receiving disability benefits under Nevada's workers' compensation laws; (2) although federal law prohibits employers from knowingly employing an undocumented alien, it does not prohibit insurers from compensating undocumented aliens for injuries they sustain while working; and (3) the appeals officer's decision was based on substantial evidence. View "Associated Risk Management, Inc. v. Ibanez" on Justia Law

Defendant Gemini Insurance Company appealed a district court's holding La. C.C. arts. 2315.1, 2315.2 and 199 were “unconstitutional as applied to children given in adoption” and overruling the defendants’ peremptory exceptions of no right of action. At issue was whether plaintiffs Daniel Goins and David Watts, two adult children who were given in adoption as minors, had a right to bring wrongful death and survival actions stemming from the deaths of their biological father and his two minor children, who were not given in adoption, and were plaintiffs’ biological half-siblings. After a de novo review, based on the clear and unambiguous wording of La. C.C. arts. 2315.1 and 2315.2, the Louisiana Supreme Court concluded Goins and Watts were “children of the deceased” and “brothers of the deceased” who were permitted to bring wrongful death and survival actions arising from the death of their biological father and half-siblings. In view of the Court's holding that plaintiffs had a right to assert survival and wrongful death actions, the Court declined to address their argument that La. C.C. arts. 2315.1, 2315.2 and 199 were unconstitutional as applied to children given in adoption. View "Rismiller v. Gemini Insurance Co." on Justia Law

Todd McLaughlin was riding his bicycle on a Seattle street when the door of a parked vehicle opened right into him. McLaughlin fell, suffered injuries, and sought insurance coverage for various losses, including his medical expenses. McLaughlin’s insurance policy covered those expenses if McLaughlin was a “pedestrian” at the time of the accident. McLaughlin argued a bicyclist was a pedestrian, relying on the definition of “pedestrian” found in the Washington laws governing casualty insurance. The trial court held a bicyclist was not a pedestrian, reasoning that the plain meaning of "pedestrian" excluded bicyclists. The Court of Appeals affirmed, relying largely on its view that the Washington statute defined pedestrian for purposes of casualty insurance, excluded bicyclists. The Washington Supreme Court reversed. The Washington legislature defined “pedestrian” for purposes of casualty insurance in Washington broadly in RCW 48.22.005(11). The Supreme Court found that definition included bicyclists and applied to the insurance contract at issue here. "Even if we were to hold otherwise, at the very least, the undefined term 'pedestrian' in the insurance contract at issue must be considered ambiguous in light of the various definitions of 'pedestrian' discussed in this opinion. Being ambiguous, we must construe the insurance term favorably to the insured. Accordingly, we reverse the Court of Appeals and remand for further proceedings." View "McLaughlin v. Travelers Commercial Ins. Co." on Justia Law

In this insurance dispute arising from an employee's death, the Supreme Court remanded the determination that the employer's insurer providing underinsured motorist coverage and workers' compensation insurance was entitled to a lien on a portion of settlement proceeds received by the estate, holding that, given a lack of factual findings, there was no way to evaluate whether the court clearly erred in its assessment of the various factors impacting an equitable allocation.Charles Luze died in a work-related accident. His employer paid his wife, Jeanette Luze, workers' compensation benefits. Jeanette, as the representative of Charles's estate, then brought suit against the negligent driver and settled the claim. The estate also settled a claim against the New FB's insurer providing underinsured motorist coverage, Zurich American Insurance Company, which was also New FB's workers' compensation carrier. The circuit court determined that Zurich was entitled to a statutory workers' compensation lien on fifty percent of the settlement proceeds received by the estate and was able to subrogate against its own settlement payment of underinsured benefits. The Supreme Court remanded in part, holding (1) this Court was unable meaningfully to review the circuit court's allocation determination; and (2) the circuit court properly allowed Zurich to subrogate against the amount it paid in underinsured motorist benefits. View "Luze v. New FB Co." on Justia Law

The jury in this case was presented with two options: find the tractor driver 100 percent liable for the motorcycle riders’ injuries or not liable at all. Neither party requested a comparative-negligence instruction. And none was given. The jury found the tractor driver liable, but only awarded the motorcycle riders a fraction of their uncontested damages. Both parties filed posttrial motions: the motorcycle riders sought more damages; the tractor driver requested a new trial. The trial court granted a new trial, agreeing with the tractor driver that the jury had rendered a “compromise verdict.” At the second trial, the jury found in favor of the tractor driver. The motorcycle riders appealed, arguing the trial court erred by granting a new trial following the first verdict. The Mississippi Supreme Court determined the trial court did not abuse its discretion: the record supported the trial judge’s finding the jury had reached a compromise verdict in the first trial. Therefore, the Court affirmed the trial court's judgment. View "Richards v. Wilson" on Justia Law

After suffering two work-related injuries, Sheree Cleveland settled her workers’ compensation claims with Advance Auto Parts and its workers’ compensation insurance carrier, Indemnity Insurance Company of North America. The Workers’ Compensation Commission approved the settlement. Approximately one month later, the Employer/Carrier filed a Form B-31 indicating the last payment had been made. More than a year after that, Cleveland filed a motion asserting that the Employer/Carrier had not paid all compensation due under the settlement and that two medical bills remained outstanding. The Commission found that, because a one-year statute of limitations had expired, it lacked jurisdiction to enforce its order approving the settlement agreement. Cleveland appealed, and the Court of Appeals reversed, questioning whether the one-year statute of limitations applied to the claim. But instead of answering that question, the Court of Appeals found that the Employer/Carrier had been estopped from asserting a statute of limitations defense because it had agreed to pay the outstanding bills and had represented to the administrative law judge that it would do so. Further, the Court of Appeals also found Cleveland's contact with the Employer/Carrier within the limitations period tolled the statute of limitations, if, in fact, it applied. The Mississippi Supreme Court affirmed, but for different reasons than the appellate court. The Supreme Court determined the statute of limitations did not apply to Cleveland's motion for enforcement of the settlement order, therefore, her motion was timely filed. View "Cleveland v. Advance Auto Parts" on Justia Law

The Louisiana Supreme Court granted this writ application to determine whether “collectibility” was a relevant consideration in a legal malpractice action. Specifically, the issue presented was whether plaintiff’s damages in this legal malpractice action were limited to the amount she could have actually collected on a judgment against the tortfeasor in the underlying lawsuit. Elaine Ewing was injured in an automobile accident in 2015, when her vehicle was hit by a vehicle driven by Marc Melancon. Her counsel failed to forward the original petition for damages within seven days as required by La. R.S. 13:850. The original petition was filed on April 22, 2016, after the one-year prescriptive period had passed. Ms. Ewing’s suit was dismissed on an exception of prescription. Ms. Ewing subsequently filed a legal malpractice action against her attorney and Westport Insurance Corporation, counsel's malpractice insurer. Defendants filed a motion for partial summary judgment asserting the court should apply the “collectibility rule.” Defendants alleged Ms. Ewing’s recovery could be no greater than her potential recovery in the underlying personal injury lawsuit, and recovery in this case should have been capped at Mr. Melancon’s insurance policy limits. The Supreme Court held that proof of collectibility of an underlying judgment was not an element necessary for a plaintiff to establish a claim for legal malpractice, nor could collectibility be asserted by an attorney as an affirmative defense in a legal malpractice action. View "Ewing v. Westport Ins. Co., et al." on Justia Law

Appellants ACW Corporation (a.k.a. Arby’s, (Arby’s)) and Eastern Alliance Ins. Co., as Subrogee of Shanara Devon Waters (“Waters”), appealed the grant of summary judgment in favor of Appellees, Christopher Maxwell (“Maxwell”) and Donegal Mutual Ins. Co. (a.k.a. Donegal Ins. Group). Eastern Alliance was Arby’s’ workers’ compensation carrier. It paid Waters, an Arby’s employee, a $12,500 commuted, lump-sum workers’ compensation benefit to settle her workers’ compensation claims for injuries she received in a work-related motor vehicle accident caused by Maxwell. Arby’s and Eastern Alliance then brought this suit against Maxwell and his auto insurer, Donegal, under 19 Del. C. 2363, claiming that they were entitled to recover the $12,500 lump-sum payment from them. Maxwell and Donegal denied liability, though they acknowledged that under the Workers’ Compensation Act Arby’s and Eastern Alliance could assert a claim against Maxwell for damages that Waters would be entitled to recover against Maxwell in an action in tort. They argued, however, that Maxwell was not liable for the lump-sum payment because it was a settlement of potential or future workers’ compensation claims and did not include any damages that Waters would have been entitled to recover against Maxwell in an action in tort. Arby’s and Eastern Alliance argued that 19 Del. C. 2363(e) allowed them to recover from Maxwell “any amounts paid or payable [to Waters] under the Workers’ Compensation Act” in connection with the Maxwell accident, and that the lump-sum benefit was an amount paid to Waters under the Act. The Superior Court agreed with Maxwell, and after finding that Arby’s and Eastern Alliance failed to offer evidence that any of the $12,500 lump-sum benefit was for damages which Waters would be able to recover in a tort action against Maxwell, granted summary judgment in Maxwell’s and Donegal’s favor. Finding no reversible error in that judgment, the Delaware Supreme Court affirmed. View "ACW Corporation v. Maxwell" on Justia Law

Defendants D.R.J. and his mother, Dana Sides, petitioned the Alabama Supreme Court for a writ of mandamus to direct the Circuit Court to vacate two orders holding that a pro tanto release executed in their favor was void, thus restoring them as defendants in the underlying lawsuit. Kathy and Barry King sued D.R.J. and Sides seeking damages for injuries the Kings sustained as a result of an automobile accident allegedly caused by D.R.J.'s negligence in driving Sides' vehicle. D.R.J. was a minor at the time of the accident. Defendants and their insurer, Alfa Mutual Insurance Company, offered to settle the Kings' claims for $95,000. Counsel for the Kings notified their insurer, State Farm, of the settlement offer, preserving its subrogation rights against defendants. State Farm responded by offering the Kings $25,000 to settle the UIM claim, which the Kings rejected. The Kings then accepted the $95,000 settlement offer without State Farm's consent, expressly reserving their UIM claim against State Farm. The Kings then moved to dismiss all claims against defendants, and the trial court entered an order dismissing defendants with prejudice. When State Farm learned of the pro tanto release, it moved the trial court for summary judgment, arguing the Kings forfeited their rights to UIM benefits by executing the pro tanto release without its consent. The trial court found State Farm validly objected to the Kings' settlement, made no ruling on State Farm's motion, and declared the pro tanto release void, thus restoring the "status quo" of the case. Defendants argued the trial court should have granted State Farm's motion and ended the litigation. The Supreme Court determined defendants' situation was not one in which they had a clear legal right to relief sought but the trial court refused to grant. They thus had not met their burden for the issuance of a writ of mandamus, and the Court denied their petition. View "Ex parte D.R.J." on Justia Law