Justia Insurance Law Opinion Summaries

A putative class action was filed against West Calcasieu Cameron Hospital for alleged violations of La. R.S. 22:1874, also known as the "Balance Billing Act." This case was expanded to name several health insurance issuers as defendants. The claim under review by the Louisiana Supreme Court was asserted by plaintiff Laura Delouche against her insurer, Louisiana Health Service & Indemnity Company, d/b/a Blue Cross and Blue Shield of Louisiana (Blue Cross). The Supreme Court granted certiorari to determine whether a cause of action existed, whereby Delouche could pursue a legal remedy against Blue Cross. Finding no cause of action, and no reversible error in the trial court's decision, the Supreme Court affirmed. View "Emigh v. West Calcasieu Cameron Hospital" on Justia Law

Plaintiff injured his left knee when he stepped into his truck. Plaintiff was insured by an automobile insurance policy issued by State Farm that provided automobile medical payments (med pay) coverage. Plaintiff’s health insurer paid nearly all of Plaintiff’s medical bills, but Plaintiff sought from State Farm benefits pursuant to his med pay coverage. State Farm paid the $25.02 that was unpaid at that time and refused to pay further benefits. Plaintiff sued State Farm, alleging breach of the insurance contract for State Farm’s failure to pay the entirety of his medical expenses. The district court granted summary judgment for State Farm, concluding that State Farm was not required to pay Plaintiff’s medical expenses pursuant to his med pay coverage that were previously paid by Plaintiff’s health insurer. The Supreme Court reversed, holding that, based on the plain language of the policy, there was no limitation preventing Plaintiff from receiving a duplicate payment for medical expenses under separately purchased, uncoordinated insurance policies. View "Winter v. State Farm Mut. Auto. Ins. Co." on Justia Law

Claimant Andres Carbajal alleged he was injured when scaffolding he was on was blown over and he fell while working on a construction project in Okmulgee. He filed a claim in the Workers' Compensation Court and alleged that he was an employee of Precision Builders, Inc., and/or Mark Dickerson (Precision) when he fell. The tribunal denied the claim upon determining that claimant was an independent contractor and not an employee. The three-judge panel affirmed the trial tribunal and the panel's order was affirmed by the Court of Civil Appeals. The issue this case presented to the Oklahoma Supreme Court on certiorari was whether petitioner was an employee or independent contractor. "Considering each of the factors on which the evidence was presented leads us to the conclusion that claimant met his burden to show that he was an employee of Precision." The Court of Appeals' decision was vacated and the case remanded for further proceedings. View "Carbajal v. Precision Builders, Inc." on Justia Law

Quest Diagnostics, LLC was an independent contractor for Brown University under an agreement that obligated both parties to name the other party as an additional insured under their general liability policies. In 2006, Pauline Hall, a student at Brown University, sought treatment at the university’s health services clinic. A rapid strep test, to be performed by Quest, was ordered. The test, however, was not performed promptly, and the results were not returned to the health clinic. Hall was subsequently diagnosed with toxic shock syndrome, which resulted in permanent injuries. Hall filed suit against Brown and Quest, and Brown filed a cross-claim against Quest. Hall settled her claims with Brown and its insurers, Pinnacle Consortium of Higher Education and Genesis Insurance Company, but the cross-claim was not resolved. Quest subsequently sought a declaratory judgment that it was entitled to a defense from Pinnacle and indemnification from Pinnacle and Genesis. The superior court granted summary judgment in favor of Pinnacle and Genesis. The Supreme Court affirmed, holding that, under the facts of this case, Quest was not entitled to defense and indemnification from either insurer.View "Quest Diagnostics, LLC v. Pinnacle Consortium of Higher Educ." on Justia Law

In December 2008, Appellee was performing his duties as an outdoor parking lot attendant when he developed frostbite. Appellee’s employer and its insurance company (Appellants) voluntarily paid for the medical treatment of Appellee’s frostbite injury and paid temporary total disability benefits through mid-2009. In September 2012, a partial amputation of the fifth metatarsal in Appellee’s right foot was performed. In January 2013, Appellee sought additional benefits for his work-related injury. The Workers’ Compensation Court awarded benefits. On appeal, Appellants argued that the Workers’ Compensation Court erred in finding that Appellee’s claim was not barred by the two-year statute of limitations. The Supreme Court affirmed, holding that the partial amputation of Appellee’s foot was a material change in condition and substantial increase in disability that would permit Appellee to seek benefits more than two years after Appellants’ last voluntary payment.View "Lenz v. Cent. Parking Sys. of Neb., Inc." on Justia Law

Charles Blackmon and Dexter Booth sued Malaco, Inc.; N.J. Pockets, Inc.; and Callop Hampton (owner of Hamp’s Place Night Club) on a premises-liability claim. Plaintiffs settled with Malaco. At trial, the jury returned a verdict in favor of Hampton. Hampton filed a post-trial motion, requesting the trial court to impose sanctions against Blackmon, Booth, and their attorney for filing a frivolous lawsuit and to award attorney fees. The motion was denied, and Hampton appealed that judgment to the Supreme Court. Finding no abuse of discretion, the Supreme Court affirmed. View "Hampton v. Blackmon" on Justia Law

This appeal involved Empire Fire and Marine Insurance Company's obligations under an "Insurance for Non-Trucking Use" policy issued to Drielick Trucking. The policy contained a business-use exclusion, which included two clauses that Empire argued precluded coverage in this case. The Court of Appeals agreed that the first clause precluded coverage when the covered vehicle was not carrying property at the time of the accident, was in this case. Thus, the Court of Appeals expressly declined to address the second clause relating to leased covered vehicles. The Supreme Court held that the Court of Appeals erred in its interpretation of the first clause. The case to the trial court for further fact-finding to determine whether Drielick Trucking and Great Lakes Carriers Corporation (GLC) entered into a leasing agreement for the use of Drielick Trucking’s semi-tractors as was contemplated under the policy's clause related to a leased covered vehicle. View "Estate of Eugene Hunt v. Drielick" on Justia Law

John McNeil owned and operated J&J McNeil, LLC. While conducting work for the LLC, McNeil damaged his personal property. McNeil made an insurance claim against the LLC’s commercial general liability insurer, Dakota Fire Insurance Company (Dakota Fire), for the damage caused to his personal property. Dakota Fire, in response, brought a declaratory judgment action seeking a determination of whether the insurance policy created a duty to pay McNeil’s insurance claim. The circuit court concluded that the policy provided coverage. The Supreme Court affirmed, holding that Dakota Fire failed to establish application of the policy’s exclusions.View "Dakota Fire Ins. Co. v. J&J McNeil, LLC" on Justia Law

The South Carolina Supreme Court answered certified two questions from the U.S. District Court for the District of South Carolina. The case concerned supplemental health insurance policies, which differ from ordinary health insurance policies in both purpose and operation. The questions were: (1) whether the definition of "actual charges" contained within S.C. Code Ann. 38-71-242 be applied to insurance contracts executed prior to the statute's effective date; and (2) whether the South Carolina Department of Insurance could mandate the application of "actual charges" to policies already inexistence on the statute's effective dates by prohibiting an insurance company from paying claims absent the application of that definition. The South Carolina Supreme Court answered both questions "no." View "Kirven v. Central States" on Justia Law

David Springer was sued by J.G. Wentworth Originations, LLC for, inter alia, engaging in false and misleading advertising, defamation, and false light. Springer was insured under an insurance policy issued by Erie Insurance Exchange. The policy contained a provision that excluded personal liability coverage arising out of “business pursuits.” Erie refused to provide Springer with a legal defense in the J.G. Wentworth lawsuit, arguing that the suit was triggered by Springer’s business interests and was thus barred under the “business pursuits” exclusion. The circuit court entered judgment in favor of Erie. The Court of Appeals vacated the judgment of the circuit court, holding that Erie and the trial court should have considered more than the face of the J.G. Wentworth complaint before establishing Springer’s alleged business interests and denying Springer’s claim.View "Springer v. Erie Ins. Exch." on Justia Law