Justia Insurance Law Opinion Summaries

Claimant-appellant Kevin Hope injured his right shoulder in 2003 while he was working for Empro Professional Services. He argued to the Industrial Commission that the Idaho Industrial Special Indemnity Fund (ISIF) was liable for part of his income benefits because he was totally and permanently disabled due to pre-existing back and shoulder injuries that combined with his 2003 shoulder injury. If Hope's total and permanent disability resulted from the combined effects of his 2003 shoulder injury and impairments that pre-existed that injury, then ISIF was liable for the portion of income benefits caused by the pre-existing injuries. Hope appealed the Commission's order that ISIF was not liable for any of Hope's benefits. The Commission found that Hope was totally and permanently disabled, but had failed to prove that his disability was a result of pre-existing back and shoulder impairments combined with his last shoulder injury. Hope argued that the Commission's decision was based on errors of law and fact. Finding no reversible error, the Supreme Court affirmed the Commission's order.View "Hope v. Industrial Special Indemnity Fund" on Justia Law

Appellee, a home health nurse who provided in-home health-care services to clients of Visiting Nurse Association of Mid-Ohio (VNA), was injured in a vehicle collision while she was traveling to the home of a patient. Appellee had decided to transport her children and two friends to a mall on her way to the patient’s home. The Industrial Commission allowed Appellee’s claim for a neck sprain. VNA appealed. The trial court granted summary judgment for VNA, concluding that Appellee was on a personal errand at the time she was injured. The court of appeals reversed, concluding that the accident and injury arose out of and occurred in the course of Appellee’s employment. Specifically, the court determined that although Appellee had intended to drop her passengers off at the mall, she had the dual intent to travel to her patient’s home, and when she was injured, she had not yet diverted from that path. The Supreme Court reversed, holding that the doctrine of dual intent or dual purpose is not recognized in Ohio for purposes of determining eligibility for workers’ compensation benefits. Remanded.View "Friebel v. Visiting Nurse Ass’n of Mid-Ohio" on Justia Law

After settling a federal lawsuit brought by plaintiffs for $13,500,000.00, the sheriff of Delaware County and the County Commissioners demanded that the Association of County Commissioners of Oklahoma Self Insurance Group indemnify Delaware County for that amount. The insurance group agreed to contribute $1,000,000.00, less the defense costs already incurred, which amount was the per occurrence limit. Delaware County filed a lawsuit for breach of contract, and subsequently moved to amend its petition to add a bad faith claim, after the lawsuit had been transferred to Rogers County. The trial court granted the motion and subsequently denied the insurance group's motion to dismiss the bad faith claim. The trial court certified for immediate interlocutory appeal the order denying that motion to dismiss to the Supreme Court. The questions that appeal presented for the Supreme Court's review were: (1) whether the Association of County Commissioners of Oklahoma Self-Insurance Group was an insurer pursuant to 36 O.S.2011, sec. 607.1; and (2) whether, pursuant to the Governmental Tort Claims Act, that organization was immune from tort liability for a breach of the duty of good faith and fair dealing. After its review, the Supreme Court held that under the statutes the organization was an insurance company for some purposes, but was a governmental entity immune from a tort claim for the breach of the duty of good faith and fair dealing.View "BD. OF CTY. COMMISSIONERS v. ASSOC. OF CTY. COMMISSIONERS OF OKLA. SELF-INSUR. GROUP" on Justia Law

Headwaters Resources, Inc. carried commercial liability insurance issued by two insurance companies: Illinois Union Insurance Company and ACE American Insurance Company. Headwaters sought reimbursement for its litigation costs arising from a case brought by landowners in Virginia, alleging that Headwaters had caused personal injury and property damage during the construction of a nearby golf course. The complaint alleged that fly ash used in the construction process caused air and water pollution that devalued their homes and created health risks to the homeowners. The insurance companies told Headwaters that defense costs related to Headwaters’ pollution were outside the scope of the coverage and denied the claim. Headwaters sued, and the district court eventually granted summary judgment in favor of the insurance companies, finding that the pollution exclusions in the insurance policies precluded coverage. Jurisdictions that have addressed the scope of a "total pollution exclusion" were either: (1) courts that applied the pollution exclusions as written because they find them clear and unmistakable; or (2) courts that narrowed the exclusions to "traditional environmental pollution," because they found the terms of the exclusion to be ambiguous due to their broad applicability. The Utah Supreme Court had not yet weighed in on this debate, and the federal district court did not pick a side on its behalf. Instead, the district court found that certain of the at-issue pollution exclusions unambiguously applied to bar coverage and that the remaining pollution exclusions, although possibly ambiguous, still applied because the complaints unquestionably alleged traditional environmental pollution. As a result, the complaints triggered the pollution exclusions in all of the policies, and the district court granted summary judgment in favor of the insurance companies. Upon review, the Tenth Circuit found that each of the pollution exclusions was unambiguous, and affirmed the district court’s grant of summary judgment.View "Headwaters Resources v. Illinois Union Insurance Co." on Justia Law

Schumann, as a qui tam relator under the False Claims Act (FCA), 31 U.S.C. 3729, and corresponding state laws, alleged that the drug company defendants improperly induced Medco Health, his employer, to offer certain of defendants’ drugs in its mail-order pharmacies and in health plans it managed; did not include those inducements when calculating the best price for their drugs, and thus submitted inaccurate best price reports to the government; overcharged the government based on those inaccurate best prices; and underpaid rebates owed based on those inaccurate best prices. The district court dismissed, holding that it lacked subject matter jurisdiction over Schumann’s claims because he did not have the requisite direct and independent knowledge to satisfy the original source exception to the FCA’s public disclosure bar. The Third Circuit affirmed. Schumann’s knowledge was not direct because it came from reviewing documents and discussing them with colleagues who participated in the underlying events.View "Schumann v. Astrazeneca Pharm., L.P." on Justia Law

Neumann Homes was the developer of two Antioch subdivisions. The Village entered into infrastructure agreements with Neumann to make public improvements in the subdivisions; Neumann provided four substantially identical surety bonds issued by Fidelity, totaling $18,128,827. The bonds did not contain specific “payment bond” language. A payment bond generally provides that if the contractor does not pay its subcontractors and material suppliers, the surety will pay them. In contrast, a “completion bond” or “performance bond” provides that if the contractor does not complete a project, the surety will pay for its completion. Lake County Grading (plaintiff) and Neumann entered into agreements for plaintiff to provide labor and materials for the improvements. Plaintiff completed the work, but was not paid in full. Neumann defaulted on its contract with the Village and declared bankruptcy. Plaintiff served Neumann and the Village with notices of a lien claim and ultimately filed suit, alleging breach of contract because the surety bonds did not contain language guaranteeing payment to subcontractors compliant with the first paragraph of section 1 of the Bond Act, 30 ILCS 550/1, and that it became a third-party beneficiary of the contracts between the Village and Neumann because the Act’s requirements are read into every public works contract for the benefit of subcontractors. The circuit court entered summary judgment on those counts. The appellate court affirmed. The Illinois Supreme Court reversed, holding that the bonds were sufficient and did not violate the Act, so that the Village did not breach any contractual obligation.View "Lake Cnty. Grading Co. v. Vill. of Antioch" on Justia Law

The Workers’ Compensation Commission found Employee to be totally and permanently disabled under the odd-lot doctrine and denied Employer and its Insurer (collectively, Employer) certain credits for disability payments previously received by Employee from other sources. The district court affirmed the Commission’s finding that Employee was totally and permanently disabled but reversed on the credit issue. The court of appeals reversed, holding (1) substantial evidence did not support the Commission’s award of permanent total benefits, and (2) the Commission was correct in its decision concerning the credits. On further review, the Supreme Court (1) affirmed the district court’s finding that substantial evidence supported the Commission’s findings that Employee was totally and permanently disabled under the odd-lot doctrine; and (2) reversed the district court’s judgment regarding the issues concerning the credit due Employer.View "Gits Mfg. Co. v. Frank" on Justia Law

In 2007, Dave Peterson, while riding a motorcycle that he co-owned with Benjamin Gibson, was involved in an accident with a sport utility vehicle driven by Michael Johnson. Peterson died from the injuries he received in the accident. At the time of his death, Peterson lived with his girlfriend, Ashanti Green, and their two minor children. Green filed a wrongful death action in 2008, as tutrix for the minor children, and naming as defendants: Michael Johnson and his insurer, State Farm Mutual Automobile Insurance; Allstate Insurance Company, as the UM insurer of the plaintiff, who contended that coverage extended to Peterson under her policy provisions; and American Southern Home Insurance Company as the alleged insurer of the motorcycle. By a supplemental petition, Allstate was also named as a defendant in its capacity as Gibson's automobile insurer on grounds that UM coverage was provided to Peterson under that policy. The question this case presented for the Supreme Court's review centered on whether a motorcycle accident victim, ostensibly insured under the provisions of the motorcycle co-owner’s uninsured/underinsured motorist (UM) automobile insurance policy, was entitled to UM coverage under the policy even though there was no coverage for the accident under the policy’s liability provisions. Finding the insurer failed to demonstrate a lack of UM coverage, the Supreme Court concluded the district court erred in granting summary judgment dismissing the UM insurer, and the appellate court erred in affirming the ruling. Therefore, the Court reversed and remanded this case for further proceedings.View "Green v. Johnson" on Justia Law

Petitioner, West Virginia Mutual Insurance Company, Inc. (WVMIC), was a professional medical liability insurer that insured physicians, medical practices and others in West Virginia. The medical malpractice claims underlying the current dispute were asserted by Respondents against their surgeon’s former employer, United Health Professional, Inc. (UHP), a medical corporation insured under a medical malpractice policy issued by WVMIC for the year 2010. Under the terms of a global settlement agreement, WVMIC tendered $3 million to Respondents under an extended reporting endorsement insuring the surgeon. The settlement further provided that Respondents and WVMIC would abide by a judicial determination as to whether additional insurance limits were available for Respondents’ vicarious liability claims against UHP. The circuit court concluded that there was an additional $6 million in policy limits available for Respondents’ claims against UHP. The Supreme Court reversed, holding that UHP has a total of $3 million in separate policy limits under the 2010 policy for Respondents’ claims asserted against it, which amount was in addition to the $3 million that WVMIC previously tendered under the global settlement agreement for the claims asserted against the surgeon. Remanded.View "W. Va. Mut. Ins. Co. v. Adkins" on Justia Law

Plaintiff sued its Insurer, alleging breach of contract and seeking declaratory relief, after the Insurer refused to defend or indemnify Plaintiff in connection with an environmental dispute. A superior court allowed Plaintiff’s motion for partial summary judgment on the Insurer’s duty to defend. Plaintiff then amended its complaint to assert a claim under Mass. Gen. Laws ch. 93A, 11 arising out of the Insurer’s duty to defend. Thereafter, Plaintiff subsequently accepted reimbursement from the Insurer for its expenses in litigating and resolving the environmental matter. Insurer then sought summary judgment on the chapter 93A claim, arguing that its reimbursement of Plaintiff’s expenses precluded a finding that Plaintiff had suffered a loss of money or property, as required to establish a violation of chapter 93A section 11. The trial court denied summary judgment on the chapter 93A claim. The Supreme Judicial Court affirmed, holding (1) chapter 93A does not require a showing of uncompensated loss or a prior judgment establishing the amount of damages as a prerequisite to recovery; and (2) therefore, neither Plaintiff’s acceptance of full reimbursement of its expenses nor the absence of a judgment establishing contract damages precluded Plaintiff from pursuing a claim under chapter 93A.View "Auto Flat Car Crushers, Inc. v. Hanover Ins. Co." on Justia Law