Justia Insurance Law Opinion Summaries

Appellant was injured when she was involved in a motor vehicle accident. The other vehicle involved in the accident, a truck, was listed on two different insurance policies: an Allstate policy issued to Jeremy Lucas and a Mountain West policy issued to Wyoming Electric Company. Appellee, Mountain West, filed a complaint for declaratory judgment, requesting that the district court find Mountain West did not have to cover the truck under the policy. The district court granted summary judgment in favor of Mountain West, finding that the owner of Wyoming Electric had given the truck to Lucas and, therefore, the truck was no longer covered under the company's insurance policy. The Supreme Court affirmed, holding that although the truck was titled and registered in the name of Wyoming Electric and was still listed as a specific vehicle on the Mountain West Policy, Mountain West was not required to pay under the policy because, on the date of the accident, Wyoming electric no longer owned the truck and the truck was no longer covered under the Mountain West insurance policy.

Appellant Michael Beall received preauthorization from the Wyoming Workers' Safety and Compensation Division for an orchiectomy, a procedure to remove his left testicle, which he claimed was related to a workplace injury. Beall's employer, Sky Blue Enterprises, objected to the preauthorization and the matter was referred to the Medical Commission Hearing Panel for a contested case hearing. Beall elected to undergo the surgery prior to the scheduled hearing. The Commission denied Beall's claim for reimbursement of medical expenses on the basis that the surgery was not reasonable or necessary medical care resulting from his workplace injury. The district court affirmed. The Supreme Court affirmed, holding (1) the burden of proving that the orchiectomy was reasonable and necessary medical care as related to Beall's alleged workplace injury rested with Beall; and (2) substantial evidence supported the Commission's determination that Beall failed to meet this burden.

Appellant was physically injured as a result of an accident caused by an underinsured motorist. Prior to the accident, Appellant purchased a Dairyland Insurance Policy through his insurance agent, Jonathan Schrack. Although Appellant requested full coverage, the policy did not include underinsured motorist coverage. When the other driver's insurance did not fully cover Appellant's damages, Appellant sued Dairyland and Schrack (Defendants), raising numerous theories as to why he should recover under the Dairyland policy. The district court granted Defendants' motions for summary judgment. The Supreme Court affirmed, holding, inter alia, (1) Wyoming's uninsured motorist statutes unambiguously do not require insurers to provide underinsured motorist liability coverage; (2) Appellant's failure to read the policy was available as a defense to Defendants as to Appellant's negligence and contract claims against them and barred application of the doctrine of promissory estoppel; and (3) the doctrine of reasonable expectations was not available to alter the unambiguous terms of the policy.

Appellant Steven DeLoge, an inmate in the state penitentiary, was working in the kitchen when he was injured in an altercation with another inmate. Appellant filed a workers' compensation claim based on the injuries sustained from a head-butt from the other inmate. The Wyoming Workers' Safety and Compensation Division (Division) denied the claim. The Office of Administrative Hearings (OAH) concluded that Appellant's injuries were the result of illegal activity and were therefore not compensable under the Wyoming Worker's Compensation Act. The district court affirmed. The Supreme Court affirmed, holding that because the head-butt was a battery under the criminal statute then existing, and therefore an illegal activity, Appellant was not eligible for workers' compensation benefits.

Shannon Cave suffered a work-related injury and was awarded temporary total disability (TTD) benefits during her recovery. After Cave rejected an offer of temporary light duty work from her employer, the Wyoming Workers' Safety and Compensation Division (Division) reduced Cave's TTD benefits to one-third of the previously authorized amount in accordance with Wyo. Stat. Ann. 27-14-404(j). The Office of Administrative Hearings (OAH) upheld the reduction of TTD benefits. The district court reversed the OAH decision. The Supreme Court reversed the district court's order, holding that the OAH decision was supported by substantial evidence and was not contrary to law as the hearing examiner properly determined that the offer of light duty employment tendered to Cave was bona fide, and therefore, the OAH was obligated to reduce Cave's TTD benefits.

Kelly Shaffer received breast reduction surgery for medical purposes, after which she was hospitalized for a methicillin-resistant stophylococcus aureaus (MRSA) infection. Shaffer's insurer, WINhealth Partners (WIN), refused to pay for the treatment Shaffer received for her MRSA infection on the basis that it arose from treatment to improve appearance. Shaffer subsequently sued WIN, alleging breach of contract and bad faith contract. The trial court granted summary judgment in favor of WIN, concluding that the insurance contract language clearly and unambiguously excluded coverage for Shaffer's breast reduction surgery as well as treatment of complications arising from non-covered services. The Supreme Court reversed, holding that the district court erred in granting summary judgment to WIN because, based on the evidence in the record, the language of the insurance contract unambiguously provided coverage to Shaffer's non-cosmetic breast reduction surgery. Remanded with directions for the district court to enter summary judgment in favor of Shaffer on her claims for treatment of her MRSA infection.

Employee injured his knee while climbing into his employer-provided truck as he was preparing to leave on a work-related trip. The Wyoming Workers' Safety and Compensation Division (Division) denied Employee's requested workers' compensation benefits related to his injury. The Office of Administrative Hearings (OAH) granted summary judgment in favor of the Division. The district court affirmed the OAH's decision. At issue on appeal was whether Employee's injury was sustained while he was being transported by a vehicle of the employer as the statute requires. The Supreme Court affirmed, holding (1) the statute plainly and unambiguously requires that for an injury sustained during travel to be compensable, it must occur as the employer's vehicle is carrying the employee from one place to another; and (2) because Employee here was entering the vehicle in preparation for that transportation when he was injured, the injury he sustained was not compensable.

Anthony Smith was involved in an accident that caused extensive damage to his vehicle, which was insured by State Farm. The vehicle was taken to Lewis Auto Body for repairs, after which State Farm determined that the car was a total loss. State Farm requested that Lewis release the vehicle. In response, Lewis requested payment from State Farm amounting to $30,816 for labor and storage. Lewis then asserted a lien against the vehicle in the amount of $30,816, conducted a lien sale, and obtained title to the vehicle. Smith filed a complaint for replevin and conversion. The district court granted summary judgment to Smith, finding Lewis did not file a valid lien and did not provide proper notice of the sale. Lewis then filed a complaint for money judgment against Smith. In response, Smith filed an emergency petition to prohibit the sale or other disposition of the vehicle. The district court consolidated the actions and awarded damages to Lewis in the amount of $20,516, including $15,240 in storage fees. On appeal, the Supreme Court reversed, holding that Lewis was not entitled to accumulate storage charges after the date that a demand was made for the return of the automobile. Remanded.

Despite a divorce in 1971, appellant Christina Maycock and Bill Maycock and their children lived together as a family in a home jointly owned by the couple. In 1992, Christina, an employee of the county cemetery district, enrolled in an insurance plan that limited coverage to the district's employees, their spouses, and their dependent children. On the insurance enrollment form, Christina listed Bill as her spouse. In 2010, Christina was convicted of obtaining property by false pretenses because of her alleged misrepresentation on the insurance enrollment form. Christina appealed, challenging the legal sufficiency of the evidence supporting her conviction. The Supreme Court held that there was insufficient evidence to sustain Christina's conviction. The Court then reversed the conviction, concluding that there was no evidence on the record that Christina's misrepresentation was the determining factor in the board's decision to pay the cost of insuring Bill. Remanded.