Justia Insurance Law Opinion Summaries

The Supreme Court reversed the judgment of the circuit court entering summary judgment in favor Insured in this insurance coverage dispute, holding that the circuit court erred in finding that Insured was entitled to underinsured motorist (UIM) coverage under three insurance policies Insured maintained with Insurer after the death of her daughter (Decedent).When Driver crashed the vehicle she was driving, Decedent, the passenger, sustained fatal injuries. Insured asserted a wrongful death claim against Driver, and Driver settled the claim for her insurance policy's limits. Thereafter, Insured sought UIM coverage from Insurer. Insurer provided UIM coverage pursuant to one of the insurance policies, but Insurer denied UIM coverage under the other two insurance policies. Insured then brought this suit seeking a declaration that UIM coverage existed for Decedent and alleging breach of contract. The circuit court granted summary judgment for Insured. The Supreme Court reversed, holding that under the plain language of two of the policies at issue, Decedent was not an insured entitled to UIM coverage. View "Seaton v. Shelter Mutual Insurance Co." on Justia Law

The Supreme Court affirmed the judgment of the superior court granting summary judgment in favor of Insurer and Plaintiff's claims alleging that Insurer was contractually obligated to provide insurance coverage to Plaintiff, which was listed as an additional issued on the relevant insurance policy, holding that Insurer had no duty to defend Plaintiff.Plaintiff, the general contractor for a construction project, subcontracted with Insured for structural work on the project. Insured purchased a commercial general liability insurance policy from Insurer, which named Plaintiff as an additional insured. The policy provided for defense and indemnification costs to Insured for its work on the project. Insured's employee (Employee), who sustained injuries while working on the construction project site, filed a complaint against Plaintiff, alleging that Plaintiff's negligent acts were the proximate cause of his injuries. Plaintiff sought a declaratory judgment that Insurer was contractually obligated to indemnify and defend Plaintiff as an additional insured relative to the Employee action. The superior court justice granted summary judgment for Insurer. The Supreme Court affirmed, holding that Employee's complaint was devoid of any allegations that brought the underlying case within the coverage of the policy, and therefore, Insurer had no duty to defend Plaintiff. View "Bacon Construction Co. v. Arbella Protection Insurance Co." on Justia Law

The Supreme Court affirmed in part and reversed in part the decision of the court of appeals reversing the circuit court's order that determined that Plaintiffs' claims against Defendant-insurance company were barred by the doctrine of claim preclusion, holding that claim preclusion barred the claims of certain plaintiffs, but the Court was evenly divided as to whether claim preclusion barred the claims brought by a fourth plaintiff.This case arose from a car accident in which a mother and her three daughters were seriously injured. The father was not in the car. The accident resulted in two separate lawsuits. In the first action, the mother brought a negligence claim against the driver of the other vehicle and her insurer, State Farm. The children were also named as plaintiffs. The action settled. The second lawsuit brought by the family, including the father, alleging that the driver of the car in which they were passengers was negligent. Plaintiffs sued the driver's insurer directly. The circuit court granted summary judgment for Defendant, concluding that the action was barred by claim preclusion. The court of appeals reversed. The Supreme Court held (1) claim preclusion barred the claims brought by the mother and daughters in the second action; but (2) the court of appeals properly allowed the father's claims to proceed. View "Teske v. Wilson Mutual Insurance Co." on Justia Law

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

In this declaratory relief proceeding, the Supreme Court affirmed the circuit court's denial of State Farm's motion for summary judgment and entered a judgment in favor of LeRoy James on his complaint alleging that State Farm had no right to reimbursement or subrogation for paying James's medical expenses under his policy, holding that State Farm had no contractual right to reimbursement for the $5,000 paid to James for medical expenses under the policy.State Farm insured both James and Melissa Rivers, who rear-ended James and caused him personal injury. State Farm paid a portion of James's medical expenses under his policy and then, acting on behalf of Rivers, settled with James. Once James released Rivers from liability, State Farm demanded that James use his settlement proceeds to reimburse State Farm for paying his medical expenses. James then brought this action. The circuit court entered a judgment in favor of James. The Supreme Court affirmed, holding that the text of the reimbursement provision of the policy was ambiguous, and therefore, State Farm had no contractual right to reimbursement from James. View "James v. State Farm Mutual Automobile Insurance Co." on Justia Law

On October 30, 2013, Consuelo Prieto Mariscal was driving her minivan in Pasco, Washington, with her daughter. There were vehicles, including an orange, pickup truck and a van, on the right side of the road. As Prieto passed the orange pickup truck, she heard a noise, felt her van jump a little, and saw a boy, Brayan, lying on the ground. Realizing Brayan was seriously hurt, her daughter called 911. Brayan was taken to a nearby hospital. Prieto and her daughter both told the police they did not see how the accident happened. There were no other eyewitnesses, and though the officer only spoke to Prieto and her daughter, he noted in his report the "bicyclist pulled into the roadway [and] was stuck on the left side and fell to the ground. The passenger side front tire drove over the child['s] right front leg." Brayan gave a number of statements, the most detailed of which related his right shoelace got stuck in the spokes of his bicycle and his right leg was run over when he leaned over to untangle the lace. Monica Diaz Barriga Figueroa, Brayan's mother, retained counsel, and signed a blank personal injury protection (PIP) application form. The English-speaking legal assistant completed the form for the Spanish-speaking Diaz, pulling language of the accident from the police report. The significant difference between the PIP form and Brayan's testimony became a central issue at trial. Prieto's counsel stressed the differences between Diaz's and Brayan's testimony and the PIP form; Diaz's counsel stress the PIP form was based on accounts from people who did not see the accident. At trial, and over Diaz's counsel's objection, Prieto's counsel referenced the PIP form as a statement against interest. Diaz's counsel moved to exclude the PIP form as privileged. The issue before the Washington Supreme Court was whether the form could be considered work product entitled to protection from disclosure. The Court determined that in this instance, where the insured gained the status of insured by statute, rather than contract, the form at issue was privileged. The Court affirmed the Court of Appeals and remanded this matter back to the trial court for a new trial. View "Figueroa v. Mariscal" on Justia Law

Douglas Ghee, as the personal representative of the estate of Billy Fleming, appealed a circuit court order dismissing a wrongful-death claim brought against USAble Mutual Insurance Company d/b/a Blue Advantage Administrators of Arkansas ("Blue Advantage"). Fleming presented to the emergency department complaining of constipation and abdominal pain. He would ultimately need a colectomy, but the hospital informed him Blue Advantage had decided that a lower quality of care (continued non-surgical management) was more appropriate than the higher quality of care (surgery) that Fleming's surgeon felt was appropriate. Fleming and his family had multiple conversations with agents of Blue Advantage in an unsuccessful attempt to convince the company that the higher surgery was the more appropriate course of care. Ultimately, an agent of Blue Advantage suggested to Fleming that he return to the hospital in an attempt to convince hospital personnel and physicians to perform the surgery on an emergency basis. For five days, Fleming would present to the emergency room, each time he was treated by non-surgical means, then returned home. On the evening of July 15, 2013, Fleming's condition had deteriorated such that he had to be intubated. He died after midnight of septic shock due to a perforated sigmoid colon with abundant fecal material in the peritoneal cavity. A lawsuit was filed against Blue Advantage, asserting that the combined negligence of the hospitals and clinics involved and Blue Advantage, proximately caused Fleming's death. Because the trial court determined that Ghee's allegations against Blue Advantage as stated in the original complaint were defensively preempted by ERISA, the Alabama Supreme Court found Ghee should have had the right to amend his complaint to clarify his state-law claims. Because the Court concluded that Ghee should have been afforded the right to amend his complaint, it reversed the judgment of the trial court and remanded for further proceedings. View "Ghee v. USAble Mutual Insurance Company d/b/a Blue Advantage Administrators of Arkansas" on Justia Law

In this insurance coverage dispute, the Supreme Court reversed the judgment of the circuit court ruling in favor of Doswell Truck Stop, LLC (DTS) on DTS's declaratory judgment action against James River Insurance Company and entered final judgment declaring that an auto exclusion precluded coverage of James Smith's injuries under the policy at issue, holding that the trial court erred in ruling in favor of DTS.Smith filed a personal injury lawsuit against DTS for injuries he allegedly suffered as a result of a tire explosion that occurred when DTS was repairing a tire on Smith's tractor-trailer. DTS filed an insurance claim with James River, which had issued a commercial general liability policy to DTS. James River denied coverage on the basis that DTS's claim was precluded by the auto exclusion. DTS then filed this action seeking a determination of whether the policy covered Smith's injury. The circuit court ruled in favor of DTS. The Supreme Court reversed, holding (1) the circuit court erred determining that the auto exclusion was ambiguous with respect to the meaning of "maintenance" of an auto; and (2) the circuit court erred in ruling that an independent basis existed for coverage under the policy. View "James River Insurance Co. v. Doswell Truck Stop, LLC" on Justia Law

Petitioner Theodore Morrison had surgery on his right knee in 2004 after injuring it at work. He returned to work after the surgery and did not consult a doctor about that knee for almost ten years, until he again injured it in 2014 while working for a different employer. Following the 2014 injury he sought to have arthroscopic surgery as his doctor recommended. His 2014 employer disputed its liability for continued medical care, and the worker filed a written claim against the 2014 employer. The Alaska Workers’ Compensation Board joined the earlier employer to the claim and decided, after a hearing, that the 2014 work injury was the substantial cause of the worker’s current need for medical care, requiring the 2014 employer to pay the cost of treatment for the right knee. The 2014 employer appealed to the Alaska Workers’ Compensation Appeals Commission, which decided the Board misapplied the new compensability standard and remanded the case to the Board for further proceedings. Morrison petitioned the Alaska Supreme Court for review of the Commission’s decision, and the Supreme Court reversed the Commission’s decision and reinstated the Board’s award. Based on the medical testimony, the Court found the Board identified two possible causes of Morrison’s need for medical treatment at the time of the hearing. It then considered the extent to which the two causes contributed to that need and decided the 2014 injury was the more important cause of the need for treatment then. "The legislature gave the Board discretion to assign a cause based on the evidence before it. The Board did here what the statute directs." View "Morrison v. Alaska Interstate Construction Inc." on Justia Law

The Alaska Workers’ Compensation Board denied a Bryce Warnke-Green's request that his employer pay for a van modified to accommodate his work-related disability. On appeal, the Alaska Workers’ Compensation Appeals Commission decided that a modifiable van was a compensable medical benefit. Warnke-Green moved for attorney’s fees. The Commission reduced the attorney’s hourly rate, deducted a few time entries, and awarded him less than half of what was requested. Warnke-Green asked the Commission to reconsider its award, but the Commission declined to do so because of its view that the Alaska Workers’ Compensation Act (the Act) allowed it to reconsider only the final decision on the merits of an appeal. The Alaska Supreme Court granted Warnke-Green's petition for review, and held that the Commission had the necessarily incidental authority to reconsider its non-final decisions. The Court also reversed the Commission’s award of attorney’s fees and remanded for an award that was fully compensable and reasonable. View "Warnke-Green v. Pro-West Contractors, LLC" on Justia Law