Justia Insurance Law Opinion Summaries

Defendants, Nancy and Thomas Bernheim, appealed the trial court’s summary judgment decision granting plaintiff GEICO Insurance Company’s claim against them for reimbursement of $10,000 that GEICO had paid defendants under the medical-payments provision of their automobile insurance policy. Although the Supreme Court agreed with the trial court that defendants should have reimbursed GEICO, it reversed and remanded for a determination of the proper reimbursement amount. View "GEICO Insurance Co. v. Bernheim" on Justia Law

Defendant City of Burlington Retirement System appealed a superior court judgment that reversed its decision to terminate the disability retirement of plaintiff, a former City firefighter. Upon review, the Supreme Court concluded the record fully supported the superior court's conclusion that there was no reasonable basis for the Board's decision to terminate plaintiff's disability retirement. View "Preston v. Burlington City Reitrement System" on Justia Law

Claimant Deborah Lydy was a traveling licensed practical nurse employed by defendant Trustaff, Inc. While on duty, a patient attacked her causing her to suffer (among other things) an acute cervical sprain. The issue before the Supreme Court in this case centered on whether employer-health insurance premiums should have been included when calculating claimant's average weekly wages under the state workers' compensation laws. The Department of Labor concluded that such premiums were not "wages" and should not have been included. Concluding that the Vermont Legislature did not intend for wages to include payments made on behalf of employees for the purpose of acquiring health insurance. Accordingly, the Court affirmed the Commissioner's judgment. View "Lydy v. Trustaff, Inc." on Justia Law

In 2006, Claimant Robert Brown tore the rotator cuff in his right shoulder while at work. The issue on appeal before the Supreme Court in this case centered on whether the workers' compensation laws precluded a certain impairment rating and associated award of permanent partial disability benefits for Complex Regional Pain Syndrome (CRPS) when the claimant was not diagnosed with CRPS, but an expert confirmed he had it. The Commissioner of the Department of Labor and the trial court both concluded that the applicable law denied the Commissioner discretion to assign the impairment rating and award benefits associated with CRPS when the diagnosis did not meet the diagnostic standards. Upon review of the matter, the Supreme Court concluded the Commissioner erred in his conclusion, and reversed and remanded for reconsideration. View "Brown v. W.T. Martin Plumbing & Heating, Inc." on Justia Law

The issue before the Supreme Court in this case centered on whether a workers' compensation insurer was entitled to reimbursement of death benefits it paid when a claimant's beneficiary also received proceeds from a life-insurance policy. Upon review, the Court held that under 21 V.S.A. 624(e) a workers' compensation carrier cannot seek reimbursement from life-insurance payments because such proceeds are not "damages," as contemplated by the statute and paid because of a third party's tortious actions. The Court therefore affirmed the Commissioner of Labor's grant of summary judgment to the estate of the claimant. View "Estate of Dunn v. Windham Northeast Supervisory Union" on Justia Law

James Bennett, the father of Brooke Bennett and the administrator of her estate, appealed a trial court's declaration of no coverage for the claims made in the lawsuit filed against homeowner Denise Woodward for negligent supervision and damages arising out of the abduction, assault, and death of his daughter, Brooke. Woodward was formerly married to Brooke’s uncle, Michael Jacques, who was alleged to have kidnapped, sexually assaulted, and murdered Brooke. Woodward's insurer brought a declaratory judgment action asking the trial court to hold that its policy does not cover these claims. The trial court decided the case on summary judgment, holding that the insurance policy excluded coverage and Bennett appealed. The trial court granted summary judgment for the insurer, concluding that insurer owed no duty of defense or indemnification in the underlying suit in part because the policy barred coverage for intentional acts by "an insured" that are not "occurrences." The court rejected Bennett's argument that the separate insureds, or severability clause provided coverage for homeowner because the complaint alleged that the uncle committed intentional acts. On appeal, father reiterated his argument that Jacques' alleged intentional acts did not preclude coverage for homeowner because the policy contained a severability clause. Upon review, the Supreme Court found that the plain meaning of the terms in the insurance policy at issue did not include intentional tortious acts nor allowed for severability under the facts of this case.

Medicaid recipient John Doe and the State appealed a trial court's decision allowing the State to partially recover the amount of its lien against Doe's settlement with a third party. In 1992 when Doe was nine years old, he was catastrophically injured and paralyzed in an automobile accident.  Due to Doe's injuries, his mother applied for Medicaid on his behalf in 1994.  Doe later brought suit in New York Supreme Court against the alleged third-party tortfeasors.  He also sued New York State Transit Authority (NYSTA) in the New York Court of Claims.  The State of Vermont notified Doe in January 2001 that it claimed a lien against any award, judgment, or settlement stemming from the accident.  In 2001, Doe settled the lawsuit against the third parties for $8.75 million. Doe's suit against NYSTA went to trial, and in 2004, the Court of Claims awarded Doe approximately $42 million and allocated approximately $2.9 million to Doe's past medical expenses from the date of injury to the date of trial. Between the 2001 and 2006 settlements, the State paid approximately $771,111 in medical expenses for Doe's care, in addition to the medical expenses paid up to the date of the first settlement.  The State claimed a lien on the 2006 settlement for $506,810, which was the difference between the amount the State paid for Doe's medical care under Medicaid and the State's share of litigation expenses. Doe sued the State of Vermont, seeking a declaratory judgment that he satisfied the State's lien by partial payment.  On summary judgment, the court concluded that it would not undo the 2001 settlement because it was an accord and satisfaction of all claims paid for medical expenses incurred to that point in time. The State argued on appeal to the Supreme Court that the trial court should have reduced the Court of Claims' findings of future economic damages to present value before making its lien allocation. Upon review, the Supreme Court concluded the parties' agreement resolved the issues surrounding the State's lien on Doe's first settlement, while leaving open the possibility that Doe would obtain a judgment against or settlement with the NYSTA.. On these facts, the Court agreed with the trial court that there was an accord and satisfaction, and that the State accepted $594,209.03. The case was reversed and remanded to recalculate the State's lien against $771,111 in medical expenses and reasonable attorney's fees, but affirmed in all other respects. 

Plaintiff ProSelect Insurance Company filed this declaratory relief action to determine its duty to indemnify its insured in a lawsuit alleging medical malpractice and sexual assault. The trial court construed a policy exclusion to bar coverage and entered judgment in favor of ProSelect. Plaintiff Robyn Levy appealed that judgment, asserting that: (1) the malpractice claims are covered under the concurrent causation doctrine; and (2) the policy exclusion as interpreted by the trial court contravenes public policy. Plaintiff alleged she began psychiatric counseling with Defendant's insured, Dr. Peter McKenna from 2003-2005. In that time, Plaintiff alleged Dr. McKenna negligently failed to properly diagnose her psychological disorder, prescribed harmful medications, encouraged her to pursue "unhealthy lifestyle choices," failed to refer her to a community-based mental health program, and engaged in treatment "at variance with accepted professional protocols." In a separate count, Levy alleged that, "[i]n the course of . . . treatment," Dr. McKenna had committed sexual assault and battery. ProSelect filed suit seeking a declaration that its professional liability policy excluded coverage of Plaintiff's suit. The trial court reasoned that the underlying action was indisputably a "suit" that contains an allegation of sexual assault. Therefore, by its plain terms the policy barred coverage of the complaint in its entirety, "[e]ven assuming" that the medical malpractice count was—as Plaintiff claimed—"totally unrelated" to the sexual assault and therefore otherwise covered. The trial court thus granted ProSelect’s motion and entered judgment in its favor. Upon review, the Supreme Court found that Plaintiff's malpractice and assault claims could not be viewed as separate or independent causes, and coverage can not be grounded on the "concurrent causation doctrine." Furthermore, without a basis in the concurrent causation doctrine, there was no violation of public policy Accordingly, the Court affirmed the trial court's judgment.

Plaintiffs Thomas and Margaret McGoff appealed a superior court order that granted Defendant Acadia Insurance Company summary judgment with respect to Plaintiffs’ underinsured motorists (UIM) claim arising from an automobile accident in which Thomas McGoff was injured. Thomas McGoff was employed by A.R. Sandri, Inc., a Massachusetts corporation that operates gas stations and other businesses in New England and New York. At the time of the accident that led to the instant lawsuit, Sandri had supplied McGoff with a company car which he kept at his Barre, Vermont home. The Plymouth was owned by Sandri, registered in Massachusetts, and insured by Acadia. Sandri had two fleet insurance policies with Acadia—one for vehicles registered in Massachusetts and one for vehicles registered in other states. The Plymouth was covered by the policy issued for vehicles registered in Massachusetts. The policy listed the vehicles as being garaged in Massachusetts, apparently based on Sandri’s representation. McGoff made a claim against the other driver and a claim for additional UIM coverage against Acadia. Acadia denied coverage because the policy’s UIM coverage was less than the alleged tortfeasor’s liability coverage. Based on this, Acadia moved for summary judgment. In May 2010, the court granted Acadia’s motion, ruling that Vermont’s uninsured/underinsured (UM/UIM) insurance requirements do not apply to the Acadia fleet policy because the policy was not "delivered or issued for delivery in this state." Without setting forth "[a] statement of the issues presented for review," Plaintiffs generally claimed on appeal that the superior court erred by granting Acadia summary judgment. Specifically, Plaintiffs argued the court erred in ruling that Vermont’s UIM requirements do not apply to the instant policy on grounds that the policy was not delivered or issued for delivery in Vermont. Because the Plymouth was garaged in Vermont rather than in Massachusetts (as indicated in the Acadia policy), they maintained the vehicle should have been registered in Vermont rather than Massachusetts and the Vermont UIM requirements should apply. Upon review of the parties briefs and the trial record, the Supreme Court found that Plaintiffs' position was contrary to the plain language of the UIM statute as well as the nearly unanimous relevant case law, and therefore the Court decline to adopt it under the present circumstances. The Court affirmed the superior court's grant of summary judgment to the insurer.

Homeowners Kenneth and Larissa Trinder filed a declaratory judgment action to establish Defendant Connecticut Attorneys Title Insurance Companyâs (Company) obligation to defend or indemnify them regarding an encroachment of their septic system onto their neighborâs property. The Trinders purchased the land in question in 2005. In conjunction with the sale, they purchased title insurance from the Company to defend themselves against situations that might make their title unmarketable or where they would be forced to remove an existing structure on their property because it extends onto someone elseâs. The Trindersâ neighbor was the Mount Holly Community Historical Museum. The Museum called the Trinders to inform them that the Museum intended to expand its facility, and it wanted to reach a settlement with the Trinders that implicated the use of their septic system. The Trinders perceived the Museumâs call (and subsequent letter) as a threat to their title, and contacted their real estate closing attorney, who filed a claim to the Company on their behalf. The Company responded that the matter didnât impact their title. In September, 2008, the Trinders filed suit against the Company seeking to protect its right to have the septic system on the museumâs land, based on the âforced removal and marketabilityâ provisions of the title insurance. Following a bench trial, the court ordered judgment in favor of the Company. The court concluded a plain reading of the insurance policy showed there was no coverage under the forced removal clause, and that the marketability provision did not apply. The Supreme Court agreed with the lower courtâs reasoning and affirmed its order on appeal.