Justia Insurance Law Opinion Summaries

The question before the Court of Appeals in these three consolidated cases was the appropriate method for crediting payments made under a workers’ compensation award when that award is increased on appeal. At issue was whether the credits should be computed on the basis of the number of weeks paid or the amount of money expended. The Court of Appeals resolved the issue in favor of the workers in each case by relying on legislation passed specifically to supersede earlier decisions of the Court, holding that, when crediting an employer/insurer for payments made under a workers’ compensation award that is subsequently amended, credit should be given for the total amount of dollars paid under the initial award.View "W.R. Grace & Co. v. Swedo" on Justia Law

The issue this case presented for the Supreme Court's review centered on the proper allocation of the burden of proof between an employer and a workers' compensation claimant regarding the injured employee's legal eligibility under federal immigration law to obtain suitable employment whenever the employer seeks to suspend workers' compensation disability benefits. The Court held that in this case, the Commonwealth Court correctly determined that Appellant, Kennett Square Specialties bore the burden to prove that the loss of earning power of its employee, David Cruz, was due to his lack of United States citizenship or other legal work authorization in order to obtain a suspension of his workers' compensation disability benefits. Furthermore, the Court held that Claimant's invocation of his Fifth Amendment right against self-incrimination when questioned at the hearing before the Workers' Compensation Judge did not constitute substantial evidence of his alleged lack of legal authorization to be employed in the United States, and thus could not, standing alone, furnish sufficient evidence for the WCJ to suspend Claimant's benefits. View "Cruz v. Workers' Compensation Appeal Board" on Justia Law

After Elms Construction Company, owned by Richard Elms (Elms), began installing windows and doors for Renewal by Anderson (Renewal), Elms fell from a ladder and injured his right foot. Elms filed a workers’ compensation claim with the Workers’ Compensation Commission, alleging that he was Renewal’s common law employee at the time of the injury. The Commission concluded that Elms was an independent contractor, rather than a common law employee of Renewal, and was therefore not entitled to collect workers’ compensation benefits. The circuit court reversed, concluding that Elms was Renewal’s common law employee. The court of special appeals vacated the circuit court’s opinion and remanded. The Supreme Court vacated the court of appeals’ opinion and remanded with directions to affirm the circuit court’s judgment, holding (1) the Commission misconstrued the law as applied to the facts when it concluded that Elms was an independent contractor and not an employee of Renewal; (2) the court of special appeals erred when it held that a statutory employment analysis under section 9-508 of the Workers’ Compensation Act must precede a common law employment analysis; and (3) by application of the common law to the facts of this case, Elms was Renewal’s employee at the time of the accident. View "Elms v. Renewal by Anderson" on Justia Law

Interstate Fire filed suit against Greenspring and others, alleging that defendants owed a duty under a Greenspring general liability policy to provide primary insurance coverage for a nurse hired by a staffing agency and assigned to work at a hospital on a temporary basis. Greenspring had issued an insurance policy providing coverage to employees of the hospital for claims arising out of medical incidents within the scope of their employment. The court agreed with the district court that the dictionary definition and a common law test supports the conclusion that the nurse qualified as an "employee" of the hospital. The court rejected defendant's remaining arguments and concluded that Interstate Fire was entitled to reimbursement from Greenspring for the amounts paid to defend and settle the underlying action. Accordingly, the court affirmed the judgment of the district court.View "Interstate Fire & Casualty Co v. Washington Hospital Center Corp., et al." on Justia Law

Seventy-year-old James Higginbotham was employed by Industrial Contractors, Inc. ("ICI") as a welder and pipefitter in May 2010 when he sustained an injury to his left rotator cuff. The medical records demonstrated that Higginbotham's injury arose out of and in the course of his work for ICI. Prior to his injury, Higginbotham made $34.61 per hour, but only worked part time. He often traveled to work sites some distance from his home near Hazen, including a site north of Mandan. Since his injury, Higginbotham was no longer able to make the trip from Hazen to Bismarck without stopping, and he could no longer perform welding or pipefitting work. Higginbotham lived in a mobile home near Hazen, approximately 70 miles from Bismarck and 80 miles from Minot. He indicated he was having difficulty paying bills, which he did not have before the injury, and he wanted to maintain the lifestyle he had prior to his injury. Following left rotator cuff surgery, WSI referred Higginbotham to vocational rehabilitation with Kim Hornberger, a vocational rehabilitation consultant, who identified the first appropriate rehabilitation option for Higginbotham and developed a vocational consultant's report ("VCR"). The VCR concluded that it was appropriate for Higginbotham to return to an occupation in the statewide job pool suited to his education, experience, and marketable skills: cashier, telephone sales representative, gaming dealer, and greeter, and the expected income of $332 per week exceeded 90% of Higginbotham's pre-injury income of $227 per week. WSI approved the vocational plan and notified Higginbotham that it intended to discontinue his benefits. Higginbotham asked for reconsideration, and WSI issued an order affirming the rehabilitation plan and denying further disability benefits. Higginbotham appealed, and an ALJ affirmed the WSI order. Higginbotham appealed the ALJ's decision, and the district court affirmed. Higginbotham now appeals the district court judgment. Finding no reversible error, the Supreme Court affirmed. View "Higginbotham v. WSI" on Justia Law

Starr Indemnity filed suit seeking a determination of their rights and obligations under Continental Cement's insurance policies after the Mark Twain, a cement barge owned by Continental Cement, sank in the Mississippi River. Continental Cement counterclaimed for breach of contract and vexatious refusal to pay under Missouri law. Determining that Continental Cement did not waive its appeal, the court concluded that the district court did not err by applying the federal doctrine of utmost good faith, a judicially established federal admiralty rule, instead of Missouri state law; Continental Cement waived its appeal of the denial of its motion for judgment as a matter of law on Starr Indemnity's utmost good faith defense; and, apart from the issue of waiver, the district court did not abuse its discretion in submitting the utmost good faith instruction. Accordingly, the court affirmed the judgment of the district court.View "New York Marine & General Ins., et al. v. Continental Cement Co., et al." on Justia Law

Vicki Blasing was the named insured in an automobile liability insurance policy issued by American Family Insurance Company. Blasing was injured when lumber fell on her foot that was being loaded into her pickup truck by an employee of Mernard, Inc. Blasing filed a personal injury lawsuit against Menard and Menard’s insurer. Menard, in turn, claimed its employee was an insured under the American Family policy as a permissive user of Blasing’s pickup truck. At issue in this case was whether American Family had a duty to defend and indemnify Menard when Menard’s employee was a permissive user of the injured insured’s vehicle. The court of appeals concluded that permissive user coverage was required in this case under the omnibus statute. The Supreme Court affirmed, holding that the American Family policy explicitly provided coverage in the present case.View "Blasing v. Zurich Am. Ins. Co." on Justia Law

Meadow Brook owned land that it developed into lots with covenants, conditions, and restrictions. Meadow Brook then decided to develop an undeveloped tract as an independent subdivision. The existing homeowners, however, argued that the covenants granted them exclusive use of three roads that future homeowners would need to use to access the subdivision. A court concluded that the covenants did not reserve an easement over the three roads for use by future lot owners. First American Title Insurance Company and First American Title Company of Montana (collectively, First American), which had issued Meadow Brook a title insurance policy, subsequently denied Meadow Brook’s claim for coverage and refused to further defend against the homeowners’ counterclaims. Meadow Brook settled with the homeowners in the easement litigation and then sued First American for, inter alia, breach of contract and negligence. The district court granted summary judgment to Meadow Brook as to the breach of contract claim, concluding First American had insured under the policy that the three roads would be open to public access. The Supreme Court affirmed, holding that the district court did not err in granting Meadow Brook’s motion for partial summary judgment on the breach of contract claim. View "Meadow Brook, LLP v. First Am. Title Ins. Co." on Justia Law

Plaintiff filed suit against its general-liability insurer, seeking to recover costs in defending a lawsuit brought by a former client. The client asserted that plaintiff improperly designed a building and did not adequately coordinate with the builders during its construction. The court concluded that the district court correctly concluded that the insurer owed no duty to defend plaintiff because the insurance policies unambiguously excluded coverage for professional liability. Accordingly, the court affirmed the district court's entry of judgment for the insurer.View "Wisznia Co., Inc. v. General Star Indemnity Co." on Justia Law

First American appealed the district court's judgment regarding FATTIC's liability to First American under certain vessel title insurance policies. The court concluded that the district court did not err in selecting the date of the foreclosure sales as the appropriate date of valuation; it was not error, much less clear error, to find that the Ocean Jewel's value equaled its foreclosure sale price under the circumstances; there was no reversible error in the district court's calculations; and there was no manifest error in finding that First American was not due any penalties under Louisiana law because FATTIC acted in bad faith. Accordingly, the court affirmed the judgment of the district court.View "First American Bank v. First American Trans. Title Ins." on Justia Law