Justia Insurance Law Opinion Summaries

Respondent-claimant, Ben Snell was employed by petitioner-employer Kentucky Fried Chicken of McAlester. He alleged that while at work he slipped and fell while carrying a tray of chicken weighing approximately 40 to 50 pounds. The trial court awarded claimant temporary total disability (TTD) and reasonable and necessary medical treatment for injuries to his neck, the second finger of his right hand, and aggravation of pre-existing conditions to his left knee and low back. All other issues were reserved. On appeal, the Court of Civil Appeals (COCA) sustained the award. In its opinion, COCA ruled the standard of review in this case was the "any competent evidence" standard because of a holding in a previous opinion by the same division, "Westoak Industries, Inc. v. DeLeon," which held 85 O.S. 2011 sec. 340(D)(4), setting out "against the clear weight of the evidence" as the appellate standard of review in workers' compensation cases, constituted a violation of the separation of powers provision of the Oklahoma Constitution. Westoak was completely at odds with another COCA opinion, "Harvey v. Auto Plus of Woodward." "Harvey" held section 340(D)(4) was not unconstitutional as a separation of powers violation. The Supreme Court granted certiorari to consider the issue as one of first impression since certiorari was not sought in either of the previous cases. The Court concluded that there was no constitutional separation of powers prohibition in in the Okla.Const., art IV, section 1 against the Legislature's adoption of the "against the clear weight of the evidence" standard of review in 85 O.S. 2011 sec. 340(D)(4). COCA's opinion was therefore vacated. Because "Westoak" and "Harvey" were totally inconsistent with the views expressed in this opinion, they were both specifically overruled. View "Kentucky Fried Chicken of McAlester v. Snell" on Justia Law

Reifer suffered a worker’s compensation injury at IU-20 where she provided special education. Her injuries prevented her from returning to work. She retained Attorney Russo. Russo carried legal malpractice insurance with Westport in compliance with the Pennsylvania Rules of Professional Conduct. When IU-20 initiated disciplinary proceedings against Reifer, Russo failed to appear at the hearing. When IU-20 terminated her, Russo failed to appeal. Russo filed suit alleging violation of Reifer’s employment rights, which he lost for failure to exhaust state remedies. When Reifer sought alternate employment, Russo advised her to answer an application question as to whether she had ever been terminated in the negative. Reifer was terminated and disciplined for the false answer. Reifer commenced a malpractice claim against Russo. Russo’s “claims-made” policy only covered losses claimed during the policy period or within 60 days of the policy’s expiration. Russo failed to inform Westport of the action until several months after the policy lapsed and he failed to secure a replacement policy. Westport refused to defend Russo. Russo admitted liability. A jury awarded Reifer $4,251,516. Russo assigned to Reifer his rights under the Westport policy. Reifer sought a declaratory judgment that Westport was required to show it was prejudiced by Russo’s failure to notify and, failing to do so, owed a duty to defend and indemnify. The federal district court, sua sponte declined to exercise jurisdiction and remanded to state court. The Third Circuit affirmed. View "Reifer v. Westport Ins. Corp." on Justia Law

After Charles Eugene Becker died from falling from a two-story home after the ladder he was climbing detached from the house, his estate filed a wrongful death suit. This appeal stems from plaintiff's claims against Anchorage Homes LLC, another contractor working on the home construction project. At the time, Anchorage held a commercial general liability insurance policy with Mid-Continent. The district court reasoned that the state court pleadings and the record evidence established that Becker was exempted from Anchorage's insurance policy with Mid-Continent under the policy's employee exclusion clause. The court concluded that the district court correctly concluded that Florida's law requires that the employee exclusion clause in Anchorage's insurance policy be construed as applying both to actual and statutory employees of Anchorage. Because Anchorage was the statutory employer of Becker, Team Fritz's employee, Anchorage was not entitled to indemnification under its general liability insurance policy for damages arising from Becker's death on the job. Therefore, plaintiff could not establish that Mid-Continent had a duty to indemnify Anchorage in the underlying suit in order to enforce the settlement agreement against Mid-Continent. There were no genuine issues of material fact and Mid-Continent was entitled to judgment as a matter of law. The court affirmed the judgment of the district court and affirmed the district court's fee and cost order. View "Stephens v. Mid-Continent Casualty Co." on Justia Law

Hall, the debtor in bankruptcy, is a former distributor of asbestos products. Tens of thousands of asbestos claims were filed against Hall, which had $10 million remaining in insurance coverage from one of its insurers, Integrity, itself bankrupt. Integrity challenged whether the policy covered the loss for which Hall was seeking indemnity. The parties agreed to settle for $4.125 million; the bankruptcy judge approved the settlement. Columbia, an excess insurer of Hall’s asbestos liabilities, with maximum coverage of $6 million, was concerned that Hall, having settled against Integrity rather than persisting in litigation, increased the likelihood of Columbia’s having to honor its secondary‐coverage obligation. Columbia filed an objection to the settlement. The bankruptcy judge refused to consider the objection, on the ground that Columbia had no right to object. The district judge affirmed. The Seventh Circuit, affirmed, stating that the matter was not a question of “standing,” but whether the Bankruptcy Code, in providing that “a party in interest, including the debtor, the trustee, a creditors’ committee, an equity security holders’ committee, a creditor, an equity security holder, or any indenture trustee, may raise and may appear and be heard on any issue in a case [arising] under” the Code, 11 U.S.C. 1109(b), conferred a right to be heard on a debtor’s insurer. View "In Re: C.P. Hall Co." on Justia Law

Claimant was injured at work as she walked out a door used by employees to exit Employer's school building. A rug outside the door slipped out from under her, causing her to fall. At the time of this accident, claimant was leaving work early due to a family medical emergency. The Workers' Compensation Court found this injury to be compensable, but the Court of Civil Appeals ruled it was not. The Court of Civil Appeals held that claimant was on a personal mission at the time of the injury and vacated the award of benefits. The dispositive question for the Supreme Court's review was whether Claimant's injury while leaving work in response to a family medical emergency arose out of her employment. The Workers' Compensation Court answered this question in the affirmative. Upon review, the Supreme Court agreed, and reversed the Court of Appeals. View "Graham Public Schools v. Priddy" on Justia Law

In 2009, Plaintiffs filed an amended complaint against, among other defendants, First American Title Insurance Company, with whom Plaintiffs had a title insurance policy for their property, for failing to defend the title to their property. As part of the settlement between Plaintiffs and defendants John and Jane Stevenson, the Stevensons paid Plaintiffs for an assignment of their rights under the title insurance policy, including any claims against First American. The Stevensons subsequently filed a cross-claim against First American for breach of contract and breach of fiduciary duty and bad faith for refusing to defend the title to Plaintiffs’ lot. After a jury trial, the jury returned a verdict in favor of the Stevensons and awarded the Stevensons compensatory damages and $1,000,000 in punitive damages to punish First American’s bad faith. The circuit court allowed the bad faith finding and the punitive damages award to stand. The court of appeals affirmed. The Supreme Court reversed, holding (1) the punitive damages award in this case was excessive and deprived First American of its right to due process, and (2) the appropriate amount of punitive damages in this case was $210,000. View "Kimble v. Land Concepts, Inc." on Justia Law

Lucas County has about 440,000 residents and includes Toledo. Two-thirds of the county’s patients have government-provided health insurance, such as Medicare or Medicaid; 29 percent have private insurance, which pays significantly higher rates to hospitals than government-provided insurance. General acute-care (GAC) inpatient services include “primary services,” such as hernia surgeries, radiology services, and most inpatient obstetrical (OB) services. “Secondary services,” such as hip replacements and bariatric surgery, require more specialized resources. “Tertiary services,” such as brain surgery and treatments for severe burns, require even more specialized resources. “Quaternary services,” such as major organ transplants, require the most specialized resources. Different hospitals offer different levels of service. In Lucas County ProMedica has 46.8% of the GAC market and operates three hospitals, which together provide primary (including OB), secondary, and tertiary services. Mercy Health Partners has 28.7% of the GAC market and operates three hospitals in the county, which provide primary (including OB), secondary, and tertiary services. University of Toledo Medical Center (UTMC) has 13% of the GAC market with a single teaching and research hospital, focused on tertiary and quaternary services. It does not offer OB services. St. Luke’s Hospital had 11.5% of the GAC market and offered primary (including OB) and secondary services. In 2010 ProMedica merged with St. Luke’s, creating an entity with 50% of the market in primary and secondary services and 80% of the market for obstetrical services. The FTC challenged the merger under the Clayton Act, 15 U.S.C. 18. The Commission found that the merger would adversely affect competition and ordered ProMedica to divest St. Luke’s. The Sixth Circuit upheld the order. View "ProMedica Health Sys., Inc. v. Fed. Trade Comm'n" on Justia Law

Plaintiffs worked until 2006, when the plant closed, and retired under a collective bargaining agreement (CBA); that provided that the employer would provide health insurance, either through a self-insured plan or under a group insurance policy and identified the employer’s contribution to the premium. The CBAs provided that the coverage an employee had at the time of retirement or termination at age 65 or older other than a discharge for cause “shall be continued thereafter provided that suitable arrangements for such continuation[] can be made… In the event… benefits … [are] not practicable … the Company in agreement with the Union will provide new benefits and/or coverages as closely related as possible and of equivalent value." In 2011 TRW (the employer’s successor) stated that it would discontinue group health care coverage beginning in 2012, but would be providing “Health Reimbursement Accounts” (HRAs) and would make a one-time contribution of $15,000 for each eligible retiree and eligible spouse in 2012, and in 2013, would provide a $4,800 credit to the HRAs for each eligible party. The HRAs shifted risk, and potentially costs, to plaintiffs. TRW did not commit to funding the HRAs beyond 2013. Plaintiffs sued, claiming that the change breached the CBAs, in violation of the Labor-Management Relations Act, 29 U.S.C. 185, and the Employee Retirement Income Security Act, 29 U.S.C. 1001. The district court certified a class and granted summary judgment, ruling that the CBAs established a commitment to lifetime health care benefits. The Sixth Circuit affirmed View "United Steel, Paper, Forestry, Rubber, Mfg. Energy, Allied Indus. & Serv. Workers Int'l Union v. Kelsey-Hayes Co." on Justia Law

Levon Flowers made a workers' compensation claim against his former employer Crown Cork & Seal USA. The Supreme Court granted Crown’s petition for certiorari to review the compensability of a foot injury Flowers sustained in 2007. The Workers’ Compensation Commission denied Flowers’s request for permanent disability benefits for this injury and awarded temporary total disability benefits for the period between the injury and the date Flowers was cleared by his doctor to return to work. The Court of Appeals reversed, finding that Flowers was entitled to receive temporary total disability benefits until he reached maximum medical improvement (MMI) for his foot injury, which had not yet been determined by his doctors. Upon review, the Supreme Court found that the Court of Appeals reached the correct result in this case, but the Supreme Court reached that conclusion based on different precedent. The record in this case reflected that Crown refused to reinstate or rehire Flowers after his doctors released him to return to work. There was also evidence that Flowers underwent an unsuccessful search for alternative employment after Crown refused to rehire him. However, the ALJ and the Commission did not determine when Flowers reached MMI for his foot injury. From the testimony of Flowers' doctor, Flowers had not yet reached MMI as of January 14, 2008. Therefore, this case was not controlled by the Court's holding in "Jordan:" "[the Court] reiterate[d] that it is a primary duty of the Commission to analyze the evidence and determine whether and when a claimant has reached MMI. [. . .] After determining when Flowers reached MMI for his foot injury, the Commission must decide from the evidence presented whether Flowers is entitled to permanent disability benefits." View "Flowers v. Crown Cork & Seal USA, Inc." on Justia Law

John Zeverino owned a semi-tractor that was leased to Taylor Truck Line. In 2009, the tractor was involved in a multi-vehicle accident that occurred while Zeverino was on his way to a maintenance facility for repairs to the tractor. Acceptance Casualty Insurance Company and Great West Casualty Company both issued liability insurance policies for the semi-tractor. Acceptance provided a non-trucking use policy, and Great West provided a commercial truckers’ policy. Each insurer filed a motion for summary judgment asserting the other was responsible for coverage for the accident. The circuit court concluded that the Acceptance policy provided coverage. The court of appeals affirmed. The Supreme Court affirmed, holding that Acceptance’s non-trucking use policy provided coverage for the accident, and neither of the two exclusions in Acceptance’s policy precluded coverage. View "Casey v. Smith" on Justia Law