Justia Insurance Law Opinion Summaries

The Supreme Court reversed the order of the district court granting Jennifer Teeter’s motion for summary judgment in this declaratory action filed by Teeter against Mid-Century Insurance Company, Teeter's insurer, seeking payment of medical expenses and lost wages after an accident. The district court concluded that Teeter made a prima facie showing that it was reasonably clear that her medical expenses and wage losses were causally related to the accident and that the opinions of certain doctors did not create a disputed issue of material fact as to medical causation and damages. The Supreme Court disagreed and remanded the case for further proceedings, holding that there was a clear dispute of material fact regarding causation because it was not reasonably clear if Teeter’s expenses were causally related to the accident. View "Teeter v. Mid-Century Insurance Co." on Justia Law

The Supreme Court’s decision in West v. Shelby County Healthcare Corp., 459 S.W.3d 33 (Tenn. 2014), holding that “reasonable charges” for medical services under Tennessee’s Hospital Lien Act are the discounted amounts a hospital accepts as full payment from patients’ private insurer and not the full, undiscounted amounts billed to patients, does not apply in personal injury cases. Further, the collateral source rule applies in this personal injury case, in which the collateral benefit at issue is private insurance. Therefore, Plaintiffs may submit evidence of the injured party’s full, undiscounted medical bills as proof of reasonable medical expenses, and Defendants are precluded from submitting evidence of discounted rates accepted by medical providers from the insurer to rebut Plaintiffs’ proof that the full, undiscounted charges are reasonable. The Supreme Court thus affirmed in part and reversed in part the decision of the court of appeals, which concluded that West did not apply to personal injury cases but that evidence of discounted amounts accepted by the injured’s medical providers may be admissible to rebut Plaintiffs’ expert testimony on the reasonableness of the amount of the full, undiscounted bills. View "Dedmon v. Steelman" on Justia Law

United Fire & Casualty Company appealed a district court judgment awarding Carol Forsman $249,554.30 in her garnishment action against United Fire, commenced after she settled claims in the underlying suit against Blues, Brews and Bar-B-Ques, Inc., d.b.a. Muddy Rivers. Muddy Rivers was a bar in Grand Forks that was insured by United Fire under a commercial general liability ("CGL") policy. In 2010, Forsman sued Muddy Rivers and Amanda Espinoza seeking damages for injuries to her leg allegedly sustained while a guest at a February 2010 private party at Muddy Rivers. Muddy Rivers notified United Fire of the suit and requested coverage. United Fire denied defense and indemnification based on the policy's exclusions for assault and battery and liquor liability. However, after appeals and reconsideration, the court ruled in Forsman's favor, finding the settlement amount was reasonable. The North Dakota Supreme Court concluded the court erred in granting summary judgment because material fact issues existed on whether exclusions for "assault and battery" and "liquor liability" in the CGL policy excluded coverage of Forsman's negligence claim against Muddy Rivers. Furthermore, the Court concluded further conclude the court properly granted summary judgment to Forsman holding United Fire had a duty to defend Muddy Rivers under the CGL policy in the underlying suit. Therefore, the Court affirmed in part, reversed in part, and remanded for further proceedings. View "Forsman v. Blues, Brews & Bar-B-Ques Inc." on Justia Law

In this case alleging that Memorial Hospital of Sweetwater County was vicariously liable for the acts or omissions of a physician who worked at the hospital as an independent contractor, the Supreme Court reversed the judgment of the district court finding that the Hospital waived its immunity by purchasing liability insurance. The Hospital had moved for summary judgment on the ground that the physician was not a Hospital employee, and therefore, the Hospital was immune from liability for his acts or omissions. The district court denied the Hospital’s motion, finding that the Hospital waived its immunity to ostensible agency claims under the insurance exception at Wyo. Stat. Ann. 1-39-118(b). The Supreme Court reversed, holding (1) the Hospital’s liability insurance did not provide coverage for liability beyond the liability defined by the Wyoming Governmental Claims Act, and (2) the Hospital’s liability insurance therefore did not extend the Hospital’s liability to include liability for its apparent agents. View "Memorial Hospital of Sweetwater County v. Menapace" on Justia Law

In this case, we deny relief on a petition for review of an award of benefits made by the Workers' Compensation Appeals Board (WCAB). In 2006, while working at Pearson Ford, Leopoldo Hernandez accidentally slammed the trunk of a car on his left hand and crushed one of his fingers. Although no bones in his hand were broken, he was unable to continue working at Pearson Ford because of continuing pain in his hand and shoulder. Hernandez applied for and received workers' compensation benefits. Pearson Ford's workers' compensation carrier retained the services of a private investigator, who conducted video surveillance of Hernandez following each of the three visits to his doctor in early 2010. Following each visit, Hernandez was observed taking off his sling, using his left hand to get in and out of his truck or a car, using his left hand to steer his truck or car, and on one occasion stopping at a grocery store and using his left hand to carry a bag of groceries. After the investigator witnessed other instances of Hernandez using his allegedly injured left hand, the carrier notified the district attorney, who in turn, commenced its own investigation. In specified circumstances, a worker who engages in criminal fraud in attempting to recover workers' compensation benefits and is convicted of doing so is thereafter barred from recovering benefits growing out of the fraud. However, in given circumstances where, independent of any fraud, a worker is able to establish his or her entitlement to benefits, benefits may be awarded. Here, the WCAB found evidence, independent of a worker's fraud, that he had suffered a compensable injury and was entitled to benefits. In doing so the WCAB relied on the determination of a medical expert. The Court of Appeal found no error in the WCAB's determination the workers' claim was not barred by the eventual misdemeanor conviction for workers' compensation fraud and in the WCAB's adoption of the expert's finding of a permanent disability. The Court denied the petitioner any relief on its petition asking that it vacate the WCAB's award. View "Pearson Ford v. Workers' Comp. Appeals Bd." on Justia Law

Douglas Ghee, as personal representative of the estate of Billy Fleming, deceased, appealed a circuit court order dismissing his wrongful-death claim against USAble Mutual Insurance Company d/b/a Blue Advantage Administrators of Arkansas ("Blue Advantage"). The Alabama Supreme Court dismissed this appeal as being from a nonfinal order. View "Ghee v. USAble Mutual Insurance Co." on Justia Law

Ron Warren, individually and on behalf of the Estate of Derek Hebert, filed a petition for damages seeking to recover for the wrongful death of his son in a recreational boating accident under general maritime law and products liability. A jury found the defendant, Teleflex, Inc. liable under the plaintiff’s failure to warn theory of the case and awarded compensatory damages of $125,000 and punitive damages of $23,000,000. The court of appeal affirmed. The Louisiana Supreme Court granted certiorari mainly to review whether the trial court properly granted the plaintiff a new trial and whether the award of punitive damages was excessive and resulted in a violation of the defendant’s right to constitutional due process. After reviewing the record and the applicable law in this case, the Supreme Court found no reversible error in the trial court’s rulings; however, the Court did find the award of punitive damages was excessive and resulted in a violation of the defendant’s right to constitutional due process. View "Warren v. Shelter Mutual Ins. Co." on Justia Law

Plaintiff Greggory Owings sustained an on-the-job injury, for which he received long-term disability benefits by defendant United of Omaha Life Insurance Company (United), under the terms of a group insurance policy issued by United to Owings’ employer. Owings disagreed with, and attempted without success to administratively challenge, the amount of his disability benefits. He then filed suit against United in Kansas state court, but United removed the action to federal district court, asserting that the federal courts had original jurisdiction over the action because the policy was governed by the Employee Retirement Income Security Act of 1974 (ERISA). The district court ultimately granted summary judgment in favor of United. Owings appealed. The Tenth Circuit concluded after review of this matter that United was arbitrary and capricious in determining the date that Owings became disabled and, in turn, in calculating the amount of his disability benefits. Consequently, the Court reversed the district court’s grant of summary judgment in favor of United and remanded with directions to enter summary judgment in favor of Owings. View "Owings v. United of Omaha Life" on Justia Law

Defendant Travelers Indemnity Company of Connecticut ("Travelers") appealed a circuit court’s denial of its post-judgment motion seeking to set aside judgment entered on a jury verdict in favor of plaintiff Angela Worthington. Worthington was a passenger in a vehicle being driven by her husband. A friend of the Worthingtons and the Worthingtons' two minor children were also passengers in the vehicle. While the Worthingtons' vehicle was stopped at a nonfunctioning traffic light, it was struck in the rear by a vehicle being operated by Camille Thomas. Worthington and the other occupants in her vehicle were injured as a result of the accident. At the time of the accident, the company Worthington's husband owned had a comprehensive insurance policy with Travelers that included uninsured-motorist ("UM") and underinsured-motorist ("UIM") coverage. The Worthingtons sued Thomas and Travelers; the complaint included a UM/UIM claim against Travelers. After review of the claims Travelers made on appeal, the Alabama Supreme Court determined Travelers did not establish that the trial court erred in denying the post-judgment motion, and affirmed. View "Travelers Indemnity Company of Connecticut v. Worthington" on Justia Law

This case arose from a motor vehicle accident in 2012. William Taylor was driving a vehicle owned and insured by Guy's Seed Company (Guy's Seed); Appellant Mark Raymond was a passenger in the vehicle driven by Taylor. Both Raymond and Taylor were employees of Guy's Seed. Appellee American Mercury Insurance Company (Mercury) issued a commercial automobile insurance policy to Guy's Seed which provided uninsured/under-insured motorist (UM) coverage of $1,000,000 per accident. Larry Bedell was an employee of BlueKnight Energy Partners (BlueKnight); BlueKnight carried a $1,000,000 primary automobile liability policy and a $40,000,000 excess liability policy. Bedell was driving an oil tanker truck, owned by BlueKnight, and attempted to turn in front of the Guy's Seed vehicle causing a collision. The collision caused an immediate explosion, which resulted in Taylor's death and Raymond suffering significant permanent injuries. Raymond qualified as insured under Mercury's UM coverage. Raymond filed suit against Defendants, Bedell and BlueKnight. Mercury investigated and offered the UM policy limits to Raymond's and Taylor's representatives, paying $500,000 to each. Mercury then intervened in Raymond’s court case seeking subrogation from Defendants for the $500,000 payment made to Raymond under the UM policy. Raymond disputed Mercury's right to subrogation, but Defendants refused to settle unless the settlement amount was inclusive of Mercury's disputed subrogation claim. An agreement was reached where Raymond settled with Defendants for a confidential amount greater than the primary insurance liability limits but less than the excess policy; Defendants paid Raymond the amount of the settlement minus the $500,000 claimed by Mercury. The disputed $500,000 was to be held until there was an agreement or court order as to who was entitled to the funds. The question presented for the Oklahoma Supreme Court’s review centered on whether Mercury was entitled to subrogation for the $500,000 paid. The Supreme Court determined that contrary to Mercury's claims, Raymond was not receiving a windfall here. “Mercury was paid a premium for UM protection and Raymond recovered an amount not covering all of his damages within the limits of the primary liability policy and the UM policy. Raymond has also recovered an amount from the tort-feasor's other assets that, combined with the liability and UM funds, covered his damages. It would be unjust to permit Mercury to avoid its liability with its claim that the tort-feasor's other assets, that happened to be an excess liability policy, removed Mercury's liability thus denying Raymond from receiving that for which Mercury was paid a premium.” View "Raymond v. Taylor" on Justia Law