Justia Insurance Law Opinion Summaries

The Court of Appeals affirmed the finding of the Workers’ Compensation Commission (WCC) that Employer and Insurer (collectively, Respondents) were entitled to offset the ordinary disability benefits already paid to Petitioner against the temporary total disability benefits paid to him by Respondents.Petitioner suffered injuries primarily to his back and neck while working for Employer. Employer received two different sets of disability benefits from Employer and Insurer, each awarded by a different state agency. Specifically, Petitioner was granted temporary total disability benefits by the WCC and ordinary disability benefits by the State Retirement Agency. The WCC found that Respondents were entitled to a credit for the ordinary disability benefits already paid to Petitioner. On judicial review, the circuit court granted summary judgment in favor of the WCC. The Court of Appeals affirmed, holding that because both sets of benefits compensated Petitioner for the same injury, pursuant to Md. Code Ann. Lab. & Empl. 9-610, the statutory offset properly applied to prevent a double recovery for the same injury. View "Reger v. Washington County Board of Education" on Justia Law

Lori Greenwood was injured while working for J.J. Hooligans, LLC. Greenwood was informed that because of nonpayment, FirstComp Insurance Company (FirstComp) was not the workers’ compensation insurance carrier on the date of the accident. Greenwood filed a petition against J.J. Hooligan’s and FirstComp seeking workers’ compensation benefits. FirstComp filed a motion to dismiss, arguing that it was not a proper party because it had timely notified J.J. Hooligan’s that it had terminated its insurance coverage for nonpayment of its premium and therefore did not provide workers’ compensation insurance on the date of the accident. The Nebraska Workers’ Compensation Court sustained the motion to dismiss. The Supreme Court reversed, holding that FirstComp failed to present sufficient competent evidence as to whether it complied with the employer notice of cancellation requirement in Neb. Rev. Stat. 48-144.03 to warrant an order of dismissal. View "Greenwood v. J.J. Hooligan’s, LLC" on Justia Law

The Supreme Court affirmed the district court’s summary judgment for the County of Lancaster in this complaint filed by the City of Lincoln seeking reimbursement of expenses paid on its employee’s behalf after a deputy sheriff with the County made contact with the employee, injuring the employee’s shoulder. The district court concluded (1) the County’s procurement of liability insurance did not constitute a waiver of its sovereign immunity for claims less than the policy’s retained insurance limit; and (2) because the amount in controversy was $63,418, the County did not waive its sovereign immunity by obtaining insurance for claims exceeding $250,000. The Supreme Court affirmed for reasons different from those stated by the district court, holding (1) the County’s procurement of insurance did not constitute a waiver of immunity as to a claim arising out of a battery; and (2) therefore, the County’s policy did not cover the underlying event, and there was no waiver of immunity regardless of the retained insurance limit. View "City of Lincoln v. County of Lancaster" on Justia Law

Ashley Palmer (Palmer) and Stephen Palmer appealed a district court’s order granting Lisa Ellefson’s motion for a new trial under Idaho Rule of Civil Procedure 59(a)(6). Ellefson was involved in an automobile accident caused by Palmer. A jury found that Ellefson was not injured in the accident. However, the district court determined that the jury verdict of “no injury” was against the clear weight of evidence and granted a new trial subject to an additur in the amount of $50,000. On appeal, Palmer argued that the district court abused its discretion in granting the new trial and in setting additur at $50,000. Finding no such error, the Idaho Supreme Court affirmed. View "Ellefson v. Palmer" on Justia Law

The Supreme Judicial Court affirmed the judgment of the superior court finding that the tortfeasor who injured Appellants in a motor vehicle accident was not an underinsured driver pursuant to Maine’s underinsured motorist (UM) statute, and therefore, there was no gap in coverage requiring State Farm Mutual Automobile Insurance Company to pay UM benefits under two policies issued to Appellants. The court held that because Appellants recovered far more from the tortfeasor’s insurers than the maximum amount of UM coverage provided by the State Farm policies, they surpassed the same recovery that would have been available had the tortfeasor been insured to the same extent. Therefore, there was no UM gap that State Farm was responsible to cover. View "Wallace v. State Farm Mutual Automobile Insurance Co." on Justia Law

The Second Circuit held that, when applied, Section 5‐335 of the New York General Obligations Law prohibited Aetna's reduction of plaintiff's disability benefits. In this case, neither the Employee Retirement Income Security Act's, 29 U.S.C. 1001 et seq., preemptive force nor the Plan's choice of law provision compelled a different conclusion; and the court rejected Aetna's forfeiture argument. Therefore, the district court erred in granting Aetna's motion for summary judgment and denying plaintiff's motion for summary judgment in regard to plaintiff's entitlement to the past and ongoing benefits that Aetna has withheld on the ground that they are duplicative of plaintiff's personal injury settlement. Accordingly, the court reversed in part and remanded. View "Arnone v. Aetna Life Ins. Co." on Justia Law

Plaintiff, who was injured while rendering roadside aid as a Good Samaritan, was “occupying” the insured vehicle for purposes of underinsured motorist (UM) coverage and was therefore entitled to recover under the terms of a GEICO Insurance Agency, Inc. policy.Plaintiff was a passenger in a Saab driven by Gregory Hurst when the two witnessed an automobile collision. Plaintiff exited the Saab and was attempting to render assistance when she was struck by another car. Plaintiff settled a claim against the driver of the vehicle that hit her but claimed that she was not fully compensated for her injuries. Consequently, Plaintiff filed a claim with GEICO (Defendant) seeking relief through Hurst’s GEICO policy that insured the Saab. Defendant denied the claim on the ground that Plaintiff was not “occupying” the insured vehicle at the time of her injuries. Plaintiff then filed this action. The trial justice agreed with Defendant, concluding that Plaintiff could not recover UM benefits under the terms of the GEICO policy. The Supreme Court vacated the judgment of the superior court, holding that Plaintiff was entitled to recover under the terms of the policy. View "Hudson v. GEICO Insurance Agency, Inc." on Justia Law

Where an insurance policy is restricted to liability for any bodily injury “caused, in whole or in part” by the “acts of omissions” of the named insured, the coverage applies to injury proximately caused by the named insured.The Appellate Division denied summary judgment in favor of the insurance company on the issue of coverage after interpreting this policy language as extending coverage broadly to any injury causally linked to the named insured. The court also concluded that an additional insured may collect for an injury caused solely by its own negligence even where the named insured bears no legal fault for the underlying harm. The Court of Appeals reversed, holding that the language “caused, in whole or in part” requires the insured to be the proximate cause of the injury giving rise to liability, not merely the “but for” cause. View "Burlington Insurance Co. v. New York City Transit Authority" on Justia Law

A provision of the mandatory form settlement document promulgated by the Director of the Division of Workers’ Compensation (“Director”) did not waive an injured employee’s statutory right under section 8-43-204(1), C.R.S. (2016), to reopen a settlement based on a mutual mistake of material fact. Petitioner Victor England was a truck driver for Amerigas Propane. He filed a workers’ compensation claim after sustaining a serious injury to his shoulder in December 2012 while making a delivery for Amerigas. England’s claim was governed by the Colorado Workers’ Compensation Act, which required that settlements between employer and employee must be written, signed by both sides, and approved by the Director or an administrative law judge (“ALJ”). Pursuant to section 8-43-204, the Director promulgated a form settlement agreement (“Form”), which the parties are required to use to settle all claims. In this case, the parties’ settlement agreement was consistent with the Form. England’s pain continued after the settlement agreement was signed and approved. In October 2013, he sought further medical evaluation, which revealed a previously undiagnosed stress fracture in the scapula (shoulder blade) of England’s injured shoulder. Up to this point, no one was aware that this fracture existed. England claims that if he had been aware of this fracture, he would not have settled his claim. England filed a motion to reopen the settlement on the ground that the newly discovered fracture justified reopening his workers’ compensation claim. An ALJ agreed, and the Industrial Claim Appeals Office (ICAO) affirmed. The court of appeals reversed, concluding that the Form waived England’s right to reopen. The Colorado Supreme Court held that because provisions of the form document must yield to statutory rights, the court of appeals erred in its conclusion. View "England v. Amerigas Propane" on Justia Law

Health insurers do not have a broad, unrestricted right of subrogation against third-party tortfeasors who cause injury to their insureds but, rather, are limited to reimbursement rights established by statute.In this personal injury case, the circuit court ruled that Haw. Rev. Stat. 663-10 and/or Haw. Rev. Stat. 431:13-103(a)(1) abrogated Hawai’i Medical Service Association’s (HMSA) contractual and common law rights in subrogation against a third-party tortfeasors responsible for injury to its insured. The Supreme Court affirmed, holding (1) a health insurer does not have equitable subrogation rights against a third-party tortfeasor in the context of personal injures; (2) a health insurer’s subrogation and reimbursement rights are limited by section 663-10 and section 431-13:103(a)(1); (3) any contractual provision that conflicts with section 663-10 is invalid; and (4) section 663-10 takes precedence over HMSA’s subrogation rights. View "Yukumoto v. Tawarahara" on Justia Law