Justia Insurance Law Opinion Summaries

Peter Lee and three other passengers were injured in a single vehicle accident. The driver held an insurance policy issued by USAA Casualty Insurance Company and United States Automobile Association (collectively, USAA), and all of the passengers were covered by TRICARE. TRICARE paid medical benefits for the passengers and asserted medical payment liens for the passengers’ combined medical expenses. Lee made a settlement demand on USAA for Perez’s $100,000 policy limits. USAA offered to pay the policy limits provided that Lee first secure lien releases from TRICARE. TRICARE eventually waived its liens, and USAA issued a check for the policy limits of $100,000. Lee continued his suit against Perez after receiving the policy limits payment from USAA. Perez agreed to a consent judgment and assigned his claims against USAA to Lee. Elizabeth West, acting as guardian ad litem for Lee, filed suit asserting that USAA acted in bad faith by conditioning payment on resolving the TRICARE liens. The district court granted summary judgment for West, holding USAA liable to Lee for the consent judgment. The Supreme Court reversed, holding that USAA’s grounds for conditioning its payment of policy limits upon resolution of the TRICARE liens were reasonable under existing law, and therefore, USAA was entitled to judgment as a matter of law. View "West v. United Services Automobile Ass’n" on Justia Law

Insured Kourtni Martin suffered serious injuries from an automobile collision in Oklahoma City with Nicholas Gray. At the time of the collision, Insured had UM coverage with Goodville Mutual Casualty Company. The policy was purchased by her parents while they lived in Kansas. She was, however, a listed/rated driver in the policy. Before the collision, Martin's parents notified the Kansas agent that she was moving to Oklahoma to live with her grandmother and that her vehicle would be garaged in Oklahoma. After the collision, the claim was reported to the agent in Kansas who then transmitted the claim to Insurer which was located principally in Pennsylvania. The claim was adjusted out of Pennsylvania. Martin was unable to locate Gray. Her attempts to serve Gray, or his insurer, in Oklahoma and Texas failed. Martin filed this lawsuit against Gray alleging negligence (later adding breach of contract and bad faith against her Insurer). After service by publication, Gray answered asserting a general denial. Martin sought compensation from the Insurer pursuant to her UM policy and negotiations began between Insured and Insurer regarding medical bills and projected future medical bills substantially in excess of $100,000. Insurer offered $27,000 for medical expenses under the "Kansas No Fault Benefits" and $10,000 in UM coverage. The trial court, after reviewing the policy at issue here, applied Kansas law to this case and dismissed Martin's bad faith claim against the Insurer (with prejudice). After review, however, the Oklahoma Supreme Court concluded the trial court erred in applying Kansas law, finding that the actions by Insurer related to the bad-faith claim appear to have occurred primarily in Oklahoma and Pennsylvania: (1) any injury from the alleged bad faith occurred in Oklahoma where Insured is located; (2) the alleged conduct causing injury from bad faith occurred in Oklahoma or Pennsylvania, where the claim was handled; (3) the domicile of Insurer and Insured are Pennsylvania and Oklahoma, respectively, and (4) the place where the relationship between the parties occurred had yet to be determined. However, because the trial court did not apply the "most significant relationship test," there was no evaluation of these factors according to their relative importance. Despite the parties' voluntary settlement of this case, the Supreme Court nevertheless remanded this case for the trial court to make findings with respect to the "most significant relationship test," and then to dismiss. View "Martin v. Gray" on Justia Law

Petitioner Arnold Calderon was injured in a vehicle accident with an uninsured motorist. At the time, petitioner was insured with respondent American Family Mutual Insurance. American Family paid the policy limit to petitioner's medical providers; it denied payment with respect to his uninsured/underinsured (UM/UIM), disputing the amount of petitioner's damages. A jury returned an award in petitioner's favor. The trial court offset the amount of the jury award by the amount already paid to the medical providers. Petitioner argued on appeal of that offset, that the "MedPay" coverage was separate from the UM/UIM coverage, and that the MedPay amount should not have been deducted. The Supreme Court reversed, finding that the amount of UM/UIM coverage, as listed in petitioner's policy, in this case should not have been reduced by the MedPay amount. View "Calderon v. American Family Mutual Insurance Company" on Justia Law

Appellant Greenville Country Club, through its workers’ compensation carrier, Guard Insurance (“Guard”), appealed a Superior Court Order affirming a decision of the Industrial Accident Board (the “Board”). While working for Greenville Country Club, Jordan Rash suffered injuries to his lumbar spine in two separately compensable work accidents. The first accident occurred in 2009 while the country club was insured by Guard Insurance Group. The second accident occurred in 2012 while the country club was insured by Technology Insurance (“Technology”). In 2014, Rash filed two Petitions to Determine Additional Compensation, one against Guard and one against Technology. After a hearing, the Board determined that the condition at issue was a recurrence of the 2009 work injury and not an aggravation of the 2012 work injury, and concluded that Guard was therefore wholly liable for the additional compensation to Rash. Guard appealed, arguing: (1) the Board failed to properly apply the rule for determining successive carrier liability; and (2) there was no substantial evidence to support the Board’s finding that Rash fully recovered from the 2012 accident or that his ongoing condition was solely caused by the 2009 work accident. After review, the Delaware Supreme Court found no error in the Board’s decision, and that the decision was supported by substantial evidence. Accordingly, the Court affirmed the Board's decision. View "Greenville Country Club (Guard Insurance) v. Greenville Country Club (Technology Insurance)" on Justia Law

Barbara Bagley and Vom Baur, her common law husband, were traveling in a Range Rover when Bagley lost control of the vehicle and flipped it. Ten days later, Baur died from the injuries he sustained in the accident. Bagley, in her capacity as sole heir and personal representative of her deceased husband’s estate, brought suit against herself as an individual, alleging that she negligently caused her husband’s death. Bagley, who sued under Utah’s wrongful death and survival action statutes, brought suit to compel State Farm Insurance Company, with whom she maintained a motor vehicle insurance policy, to indemnify her. The district court dismissed the complaint, concluded that a person cannot simultaneously act as plaintiff and defendant in a wrongful death or survival action suit. The court of appeals reversed. The Supreme Court affirmed, holding that the court of appeals did not err when it concluded that the wrongful death and survival action statutes permit a person acting in the legal capacity of an heir or personal representative to sue herself in an individual capacity for negligently causing a decedent’s death or injury. View "Bagley v. Bagley" on Justia Law

Defendant drove a car he had rented from Enterprise Rent-A-Car (Enterprise) into Plaintiff’s knee. At the time of the incident, Plaintiff was insured under a policy issued by IDS Property Casualty Insurance Company (IDS), which provided uninsured/underinsured motorist coverage. Plaintiff filed a complaint against Defendant, Defendant’s automobile liability insurer, and Enterprise. Plaintiff also served IDS with a copy of the summons and complaint for the purpose of bringing a claim under his uninsured motorist coverage policy. The trial court granted summary judgment in favor of IDS, concluding that the rental car did not qualify as an “uninsured motor vehicle” under the policy. The court of appeals affirmed. The Supreme Court reversed, holding that the rental car was an “uninsured motor vehicle” under the policy. Remanded. View "Martin v. Powers" on Justia Law

After suffering a fall at work, Linda Mitchell returned to the same position she had before her injury, and continued to work for more than seven months until she was terminated for a cause unrelated to the injury. She then sought and was awarded disability benefits from the Mississippi Workers’ Compensation Commission. But because the Administrative Law Judge (ALJ) and Commission both failed to recognize that Mitchell’s return to work created a rebuttable presumption that she suffered no loss of earning capacity, the Supreme Court reversed the award of disability benefits and remanded this case to the Commission to apply the correct legal standard. View "Hudspeth Regional Center v. Mitchell" on Justia Law

In 2014, Lend Lease, the construction manager of the Chicago River Point Tower Project, hired Cives as a subcontractor. Cives hired Midwest Steel. Midwest had, years before, hired AES to supply Midwest with additional workers, who were co‐employed by Midwest and AES. Lend Lease entered into a “contractor-controlled insurance program” with Starr Liability with a $500,000 deductible. All subcontractors were to join in the policy. AES had, several years earlier, obtained workers’ compensation for its workers from TIC, so that injured AES‐Midwest workers could obtain workers’ compensation from either Starr (or Lend Lease under the deductible) or TIC. Four ironworkers, jointly employed by Midwest and AES and performing work for Midwest were injured on the job and sought workers’ compensation. The claims exceeded $500,000, so Lend Lease had to pay its full deductible. Starr paid the remaining claims. Lend Lease filed suit against TIC, AES’s insurer, and AES, seeking reimbursement of the $500,000. The district court dismissed. The Seventh Circuit affirmed. Lend Lease made a deal with Starr and is bound by it. The court rejected an argument that AES has been unjustly enriched; AES was not obligated to purchase an insurance policy that would cover Lend Lease's deductible. View "Lend Lease (US) Construction, Inc. v. Administrative Employer Services, Inc." on Justia Law

The United States District Court for the District of New Mexico certified a question of New Mexico law to the state Supreme Court. The question centered on whether a worker injured in the course of employment by a co-worker operating an employer owned motor vehicle was a person “legally entitled to recover damages” under his employer’s uninsured/underinsured motorist coverage. Andrew Vasquez was killed at the workplace after being struck by a steel beam that fell off of a forklift during the course of his employment at Coronado Wrecking and Salvage. A coworker operating the forklift had jumped off to check whether the steel beam being lifted was secure, leaving the forklift unattended as the steel beam slid off of the forks, striking and killing Vasquez. Plaintiff, Vasquez’s estate, subsequently collected workers’ compensation benefits from Coronado’s workers’ compensation carrier. Related to the forklift accident, Plaintiff also collected uninsured motorist benefits under Vasquez’s own automobile insurance policy.The certified question from the district court arose from an alleged discontinuity among the plain language of New Mexico’s Workers’ Compensation Act (WCA), the Uninsured Motorist statute, and the New Mexico Court’s case law. Because the WCA provided the exclusive remedy for an employee injured in a workplace accident by an employer or its representative, the employee was not legally entitled to recover damages from the uninsured employer tortfeasor under the Uninsured Motorist statute. The Court therefore answered the certified question in the negative. View "Vasquez v. American Cas. Co. of Reading" on Justia Law

Samantha Gillespie and her mother, Tina Taylor, appealed the grant of summary judgment dismissing their lawsuit against Taylor's motor vehicle insurer, National Farmers Union, for underinsured motor vehicle coverage. Gillespie and Taylor sued Farmers Union for underinsured motor vehicle coverage, alleging Gillespie was insured under her mother's motor vehicle policy with Farmers Union and was driving a motor vehicle owned by another person when Gillespie lost control of the vehicle and it overturned, resulting in significant injuries to her. According to Gillespie and Taylor, the motor vehicle was owned by Angela Ayers, Gillespie's aunt, and insured by GEICO. Ayers died as a result of the accident and another passenger in the motor vehicle sustained significant injuries. Gillespie and Taylor asserted GEICO paid Gillespie $25,000 in no-fault benefits, but denied her request for liability coverage based on a claim that Ayers negligently entrusted the vehicle to Gillespie, an alleged inexperienced driver who received her learner's permit two days before the accident. After review, the Supreme Court concluded Gillespie and Taylor failed to raise a genuine issue of material fact about whether Gillespie was legally entitled to collect for bodily injury from the owner or operator of an underinsured motor vehicle, and affirmed. View "Gillespie v. National Farmers Union Property & Casualty Co." on Justia Law