Justia Insurance Law Opinion SummariesArticles Posted in Supreme Court of Illinois
Prate Roofing and Installations, LLC v. Liberty Mutual Insurance Corp.
Prate, a construction contractor, sought coverage through the Illinois Assigned Risk Plan, which provides workers’ compensation insurance coverage through a risk pool administered by the National Council on Compensation Insurance (NCCI). Liberty was assigned as Prate’s carrier. After determining that Prate’s subcontractor, ARW, did not have workers’ compensation insurance, Liberty assessed Prate an additional premium of $127,305. The Illinois Workers’ Compensation Appeals Board, which provides dispute resolution services for NCCI, declined to rule on the dispute, citing insufficient information. Prate appealed to the Department of Insurance (DOI) under Insurance Code section 462. One of Prate’s arguments was that ARW had no employees and that all work on Prate projects was performed by RTS, which had workers’ compensation insurance. The DOI’s hearing officer agreed with Liberty on all issues. The circuit court affirmed. While an appeal was pending, the appellate court issued its ruling in a dispute between Liberty and a trucking company, finding that DOI did not have the authority to resolve a dispute concerning employment status.The Illinois Supreme Court reinstated the trial court decision. The DOI had the authority to resolve the dispute under 215 ILCS 5/462. While section 462 does not apply to all insurance premium disputes but only to those involving the application of a rating system to a party’s insurance, the existence of a single factual dispute does not preclude review under section 462. View "Prate Roofing and Installations, LLC v. Liberty Mutual Insurance Corp." on Justia Law
Munoz v. Bulley & Andrews, LLC
Munoz sued general contractor, Bulley & Andrews, for injuries he sustained while an employee of its subcontractor, Bulley Concrete. Bulley & Andrews had paid workers’ compensation insurance premiums and benefits for the subcontractor and its employees. Each company has its own distinct federal tax identification number and files separate federal and state income tax returns. The companies have different presidents and employ different workers.The circuit court dismissed, finding that the genderal contractor was immune from the lawsuit under the exclusive remedy provisions of the Workers’ Compensation Act (820 ILCS 305/5(a). The appellate court affirmed.The Illinois Supreme Court reversed. The exclusive remedy provisions do not extend to a general contractor who is not the employee’s immediate employer. Immunity does not hinge on the payment of benefits. Bulley & Andrews had no legal obligation to provide workers’ compensation insurance for Bulley Concrete employees. The fact that Bulley Concrete was a subsidiary of Bulley & Andrews is of no import. If a parent company and its subsidiary are operated as separate entities, only the entity that was the immediate employer of the injured worker is entitled to immunity. The Act bars an employee from bringing a civil suit directly against his employer but does not limit the employee’s recovery from a third-party general contractor. View "Munoz v. Bulley & Andrews, LLC" on Justia Law
Haage v. Zavala
In each of two automobile personal injury actions, plaintiffs moved for entry of a qualified protective order (QPO) pursuant to the Health Insurance Portability and Accountability Act (HIPAA), 110 Stat. 1936, and its implementing regulations (45 C.F.R. 160, 164) (Privacy Rule). Plaintiffs’ proposed QPOs would allow protected health information (PHI) to be released, subject to restrictions that nonlitigation use or disclosure of PHI is prohibited and PHI must be returned or destroyed at the conclusion of the litigation. State Farm, the liability insurer for the named defendants, intervened in each lawsuit and sought entry of its own protective order, which expressly allowed insurance companies to use, disclose, and maintain PHI for purposes beyond the litigation and expressly exempted insurers from the “return or destroy” requirement.In both cases the circuit court granted the plaintiffs’ motions. The appellate court and Illinois Supreme Court affirmed, rejecting State Farm’s argument that property and casualty insurers fall outside HIPAA. Rejecting arguments concerning the requirements of the Illinois Insurance Code, the court stated that no Illinois law requires State Farm to use or disclose plaintiffs’ PHI after the conclusion of the litigation. The Cook County standard protective order is preempted by the Privacy Rule and the McCarran-Ferguson Act, 15 U.S.C. 1011, does not apply to shield that order from traditional preemption. View "Haage v. Zavala" on Justia Law
Sproull v. State Farm Fire and Casualty Co.
Sproull filed a putative class action against State Farm, alleging breach of contract. State Farm allegedly depreciated labor costs in determining “actual cash value” (ACV) of a covered loss and concealed this practice from its policyholders. The policy does not define ACV. State Farm agreed to certify a question for interlocutory review: “Where Illinois’ insurance regulations provide that the ‘actual cash value’ or ‘ACV’ of an insured, damaged structure is determined as ‘replacement cost of property at time of loss less depreciation if any,’ and the policy does not itself define actual cash value, may the insurer depreciate all components of replacement cost (including labor) in calculating ACV?”The Appellate Court reformulated the question to address solely labor costs, rather than all components of replacement cost and answered the question in the negative. The Illinois Supreme Court affirmed, finding the policy ambiguous and construing it against the insurer. Illinois’s insurance regulations provide that the ACV of an insured, damaged structure is determined as the replacement cost of the property at time of loss less depreciation if any; only the property structure and materials are subject to a reasonable deduction for depreciation, and depreciation may not be applied to the intangible labor component. View "Sproull v. State Farm Fire and Casualty Co." on Justia Law
West Bend Mutual Insurance Co. v. Krishna Schaumburg Tan, Inc.
Sekura purchased a membership from Krishna that gave her access to L.A. Tan’s salons. Her membership required Sekura to provide Krishna with her fingerprints. Sekura filed a class-action lawsuit against Krishna, alleging that Krishna violated the Biometric Information Privacy Act: because it “systematically and automatically collected, used, stored, and disclosed their [customers’] biometric identifiers or biometric information without first obtaining the written release required by 740 ILCS 14/15(b)(3) … systematically disclosed ... biometric identifiers and biometric information to SunLync, an out-of-state … vendor and … does not provide a publicly available retention schedule or guidelines for permanently destroying its customers’ biometric identifiers and biometric information as specified by the [Act].” The complaint also alleged negligence and unjust enrichment. Krishna tendered Sekura’s lawsuit to West Bend, its insurer.West Bend sought a declaratory judgment that it did not owe a duty to defend Krishna against Sekura’s lawsuit. The trial court entered a judgment for Krishna. The appellate court and Illinois Supreme Court affirmed after construing the policy terms “personal injury or advertising injury,” “publication” of material, and violation of Sekura’s “right of privacy” to conclude that the allegations in Sekura’s complaint fall within or potentially within West Bend’s policies’ coverage for personal injury or advertising injury. A “violation of statutes” exclusion in the policies does not apply to the Act. View "West Bend Mutual Insurance Co. v. Krishna Schaumburg Tan, Inc." on Justia Law
State Farm Mutual Automobile Insurance Co. v. Elmore
Kent backed up a grain truck that was owned by his father, Sheldon, to an auger that was being used to move grain to a transport truck. A tractor powered the auger by means of a power take-off shaft. Kent, attempting to open the truck’s gate, wanted to get extra leverage and stepped onto the auger. The auger’s protective shield had been removed. Kent’s foot was exposed to the turning shaft. In the ensuing accident, Kent lost his leg below the knee. Kent settled a negligence action against Sheldon and received $1.9 million from insurers.Kent reserved his right to pursue additional coverage under the auto policy that covered the truck. State Farm sought a declaratory judgment that no coverage was provided because an auger is neither a “car” nor a “trailer,” as defined in the policy but fell under the policy’s “mechanical device” exclusion for damages resulting from "THE MOVEMENT OF PROPERTY BY MEANS OF A MECHANICAL DEVICE, OTHER THAN A HAND TRUCK, THAT IS NOT ATTACHED TO THE VEHICLE.” The circuit court granted State Farm summary judgment. The appellate court construed the exclusion against State Farm.The Illinois Supreme Court reversed. The exclusion was not ambiguous. The auger is a machine or tool designed to move grain from one place to another and is a device that was “operated by a machine or tool” (a tractor) that is not a small hand-propelled truck or wheelbarrow, and was not attached to the insured vehicle. Exclusions are permissible if they do not differentiate between named insureds and permissive users. View "State Farm Mutual Automobile Insurance Co. v. Elmore" on Justia Law
Leibowitz v. Family Vision Care, LLC
Cahill was the office administrator for the Family Vision optometry practice and handled insurance billings. She left her employment and filed for bankruptcy protection. About 90% of Family’s revenue came from claims submitted to VSP, which covers claims from optometrists only if they have “majority ownership and complete control” of their medical practices. VSP disburses payments after the provider signs an agreement certifying itself as “fully controlled and majority-owned” by an optometrist. At the time Cahill was submitting Family’s claims, the practice was actually owned by a practice management company with more than 150 surgery centers and other medical practices.About a year after Cahill left Family, the trustee of Cahill’s bankruptcy estate sued under the Insurance Claims Fraud Prevention Act, 740 ILCS 92/1, which added civil penalties to existing criminal remedies for fraud against private insurance companies and allows a claim to be raised on the state’s behalf by a private person (relator), in a qui tam action. The relator becomes entitled to remuneration if the lawsuit succeeds. A relator must be an “interested person” but the Act does not define that term.The Illinois Supreme Court affirmed the reinstatement of the case. A former employee-whistleblower with personal, nonpublic information of possible wrongdoing qualifies as an “interested person” under the Act and need not allege a personal claim, status, or right related to the proceeding. The state need not suffer money damages to partially assign its claim to a relator. The Act is intended to remedy fraud against private insurers, where the only injury to the state is to its sovereignty, based on a violation of criminal law. View "Leibowitz v. Family Vision Care, LLC" on Justia Law
Hess v. Estate of TJay Klamm
Kiselewski was driving with his two granddaughters in the backseat. Klamm's vehicle crossed the center line and struck Kiselewski’s vehicle. Kiselewski, one granddaughter, and Klamm were killed. Klamm was insured under a Meridian policy issued to his mother that provides coverage for four vehicles. The policy contains an “antistacking clause” with respect to bodily injury liability limits of $100,000 per person and $300,000 per accident. In a declaratory judgment action, the circuit court found that the policy, taken as a whole, was ambiguous and declared that Meridian had a duty under the policy to aggregate the bodily injury coverage limits for all four vehicles covered by the policy, resulting in coverage in the amount of $400,000 per person and $1.2 million per accident.The Illinois Supreme Court reversed. When the declarations are read together with the antistacking clause, there is no ambiguity. The policy provides bodily injury liability coverage of $100,000 per person and $300,000 per accident, regardless of the number of claims, insureds, covered vehicles, premiums, or vehicles involved in the accident. The policy does not list liability limits separately for each covered vehicle. It lists the limits once on the first page of the declarations, next to Autos 1, 2, and 3, and once on the second page, next to Auto 4. View "Hess v. Estate of TJay Klamm" on Justia Law
Sanders v. Illinois Union Insurance Co.
In 1994, based on doctored evidence from the City of Chicago Heights Police Department, Sanders was charged with murder, attempted murder, and armed robbery. Sanders was wrongfully convicted and imprisoned for approximately 20 years before being exonerated in 2014. From November 2011 to November 2014, Chicago Heights obtained primary liability insurance from Illinois Union and excess liability insurance from Starr. The primary insurance policy covered damages arising out of the “offense” of “malicious prosecution.” The Illinois Supreme Court held that, although the cause of action for malicious prosecution did not arise until the exoneration, the underlying event that triggered the obligation to provide coverage occurred in 1994, not during the policy period. The court noted that a typical occurrence-based policy, containing multiple references to coverage for occurrences or offenses happening during the term of the policy, reflects the intent to insure only for the insured’s acts or omissions that happen during a policy period. If exoneration were deemed to trigger for coverage of a malicious prosecution insurance claim, liability could be shifted to a policy period in which none of the acts or omissions giving rise to the claim occurred, which would violate the intent of the parties to an occurrence-based policy. View "Sanders v. Illinois Union Insurance Co." on Justia Law
Robert R. McCormick Foundation v. Arthur J. Gallagher Risk Management Services, Inc.
In 2010, the Foundations and their insurance broker, Gallagher, discussed the renewal of the Foundations’ $25 million directors and officers (D&O) insurance coverage. The Foundations wanted to obtain the same coverage with a reduced premium. Gallagher offered renewal of the existing Chubb policy or the purchase of a $25 million Chartis policy, stating that the Chartis policy provided the same coverage with a premium that was $3400 lower. Unbeknownst to the Foundations, the Chartis policy contained a broad exclusion of claims related to securities transactions; the Chubb policy contained a narrower exclusion. In 2007, the Foundations sold their Tribune stock for $2 billion during a leveraged buyout. A year later, the Tribune filed for bankruptcy. The Foundations were named in suits filed by aggrieved shareholders, alleging fraud. The Foundations tendered the litigation to Chartis, which denied coverage. The Foundations, asserting that Chubb would have defended and indemnified them, sued Gallagher for breach of contract and professional negligence. Gallagher’s defenses asserted that the Foundations’ conduct was fraudulent and uninsurable and that the Foundations knew of “an ongoing, progressive loss” before changing insurers. Gallagher subpoenaed the Foundations and their attorneys, seeking communications related to the Tribune bankruptcy and the litigation. The Foundations asserted attorney-client privilege. The circuit court applied an exception, finding that Gallagher had a “common interest” with the Foundations because it was “standing in the insurer’s shoes for the purposes of this malpractice issue and may bear the ultimate burden of payment of the underlying claims and defense costs.”The Illinois Supreme Court reversed. The common-interest exception to the attorney-client privilege does not extend to these circumstances, where there is no insured-insurer relationship between the parties and the party claiming the privilege is bringing suit based on the defendant’s negligence in failing to procure appropriate insurance as a broker. View "Robert R. McCormick Foundation v. Arthur J. Gallagher Risk Management Services, Inc." on Justia Law