Justia Insurance Law Opinion Summaries

Harleysville issued Diamondhead a commercial insurance policy where, although the parties intended for the policy to exclude coverage for law enforcement, Harleysville inadvertently omitted that exclusion from the policy itself. Harleysville subsequently filed suit against Diamondhead and two residents after a Diamondhead police officer got into an altercation with the residents. Harleysville sought a reformation of the insurance contract and a declaration that it had no duty to defend or indemnify the officer. The court concluded that the district court did not err in reforming the policy to reflect the parties' intent and the doctrine of laches was inapplicable in this instance where the officer pointed to no fact that would make it unjust for Harleysville to seek relief in this circumstance. Accordingly, the court affirmed the judgment of the district court. View "Harleysville Worchester Ins. Co. v. Ensminger" on Justia Law

A Vermont statute requires all "health insurers" to file with the State reports containing claims data and other "information relating to health care." Liberty Mutual sought a declaration that the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., preempted the Vermont statute and regulation. The district court granted summary judgment in favor of Vermont. The court held that the reporting requirements of the Vermont statute and regulation have a "connection with" ERISA plans and were therefore preempted as applied. The court's holding was supported by the principle that "reporting" is a core ERISA function shielded from potentially inconsistent and burdensome state regulation. Accordingly, the court reversed and remanded with instructions to enter judgment for Liberty Mutual. View "Liberty Mutual Ins. Co. v. Donegan" on Justia Law

Respondent Helen Rodriguez injured herself after falling down a flight of stairs at work. The Supreme Court granted certiorari to consider whether an "unexplained" fall satisfied the "arising out of" employment requirement of the Workers' Compensation Act. The Court agreed with the appellate court that respondent's unexplained fall was compensable, but it disagreed with the reasoning. The Supreme Court concluded that the appellate court erred when it agreed with respondent's view that her injuries arose out of employment, and held that an unexplained fall necessarily stemmed from a "neutral" risk attributable to neither the employment nor the employee. "Under our longstanding 'but-for' test, such an unexplained fall 'arises out of' employment if the fall would not have occurred but for the fact that the conditions and obligations of employment placed the employee in a position where he or she was injured." View "City of Brighton v. Rodriguez" on Justia Law

Javery began working for Lucent as a software engineer in 1998 and participated in Lucent’s Employee Retirement Income Security Act, 29 U.S.C. 1001, qualified disability plan, administered by CIGNA. In November 2002, he reported back pain. His family doctor, Dr. Dorado, prescribed medicine and testing, and recommended some time off work. In January 2003, after Lucent transferred him from Ohio to Illinois, Javery sought treatment from another physician, Seymour. The pain worsened. In May 2005, Javery stopped working on Dr. Seymour’s advice. Lucent approved and paid short term disability benefits from until those benefits expired in November 2005. Lucent notified CIGNA that it believed Javery might be eligible for long term benefits. Javery applied, submitting extensive medical evidence of his pain and resulting cognitive impairment and of his successful application for Social Security disability benefits, but the claim was denied. In addition to claiming that Javery had not shown that he was “disabled” as that term is defined in the Plan, CIGNA claimed that Javery should be judicially estopped from pursuing his ERISA claim because Javery failed to disclose the claim in his Chapter 13 personal bankruptcy action. The district court upheld the denial. The Sixth Circuit reversed. View "Javery v. Lucent Tech., Inc. Long-Term Disability Plan" on Justia Law

The Workers' Compensation Commission dismissed applicant Matthew Ladner's petition to controvert and motion for payment of benefits because it found the statute of limitations had expired. Ladner appealed that decision to the Supreme Court. Upon review, the Supreme Court reversed the Commission's decision. View "Ladner v. Zachry Construction" on Justia Law

In 1971 Milwaukee County provided its employees with health insurance under an ordinance that stated that the “county shall participate in the payment of monthly premiums” and extended coverage to retirees. In 1993, the ordinance was amended to provide that “[t]he County shall pay the full monthly cost of providing such [health insurance] coverage to retired members” as “part of an employee’s vested benefit contract.” Upon her 1991 retirement, Hussey had paid no co‐payments or deductibles for her health care. Her benefit plan booklet explained that with 15 years of service: “the retiree may participate in the health plan in which he/she is currently enrolled on the same basis as … the active employee group. The County will make the full premium contribution.” Until 2012, the plan coordinated benefits so that expenditures not covered by Medicare were paid in full by the County. In 2012 the County increased deductibles, co‐payments, and co‐insurance charges and modified coordination of benefits so that retirees over age 65 would pay the same deductibles, co‐payments, and co‐insurance charges as active employees. Hussey filed a purported class action, alleging that the failure to provide cost‐free health insurance to retirees constituted an unconstitutional taking of property. The Seventh Circuit agreed with the district court that the County only promised retirees the ability to participate in the same health insurance plan as active employees on a “premium‐free” basis.View "Hussey v. Milwaukee County" on Justia Law

After CIC denied the Archdiocese's demand for secondary excess carrier coverage, CIC filed suit seeking a declaration that its policy did not provide coverage for the underlying wrongful death litigation. On appeal, the Archdiocese challenged the district court's grant of summary judgment in favor of CIC. The court concluded, under Gibson v. Brewer, that the Archdiocese did not affirmatively establish that it was legally liable for the conduct alleged in the wrongful death claim and the court concluded that the Archdiocese was not entitled to indemnity coverage under CIC's policy. The court rejected the Archdiocese's remaining arguments and affirmed the judgment of the district court. View "Chicago Ins. Co. v. Archdiocese of St. Louis, et al." on Justia Law

After State Farm tendered the policy limit on its uninsured motor vehicle coverage to plaintiff nearly thirty months after she was injured, plaintiff brought a bad faith claim under Mississippi law. The district court granted State Farm's motion for summary judgment. Applying Mississippi substantive law, the court affirmed the district court's grant of summary judgment as to any breach of contract claim independent of the bad faith claim; the court held that there was a fact issue as to whether, under the totality of the circumstances, State Farm had an arguable or legitimate basis for its delay; and therefore, the court reversed and remanded the district court's grant of summary judgment as to plaintiff's bad faith claim. View "James v. State Farm Mutual Auto Ins. Co." on Justia Law

In March 2010, Justyna Kunz was involved in a car accident with GEICO's insureds, Crystal, Joseph, and Elizabeth Kalish. Kunz received medical treatment at Athens Regional Medical Center; the Hospital Authority of Clarke County and Athens Regional Medical Center (collectively, "the Hospitals") filed three hospital liens. Kunz subsequently filed suit against the Kalishes. Kunz's attorney wrote a letter to the Kalishes' attorney accepting their $100,000 policy limit settlement offer. The settlement documents, signed in Fall 2010, expressly required Kunz to satisfy the hospital liens out of the settlement fund and constituted a "general[ ] release ... from all legal and equitable claims of every kind and nature." The liens were never satisfied. The Court of Appeals held that, under OCGA 44–14–473 (a), the Hospitals were barred by a one-year statute of limitations from filing suit against GEICO to collect on the hospital liens. The Hospitals appealed the appellate court's decision. Finding that the appellate court erred in arriving at its conclusion, the Supreme Court reversed. View "Hospital Authority of Clarke County v. GEICO General Insurance Co." on Justia Law

Plaintiff and his wife sought to recover damages for plaintiff's injuries under an insurance policy Redland issued to plaintiff's employer. The district court granted summary judgment in favor of Redland, concluding that plaintiff could not avail himself of uninsured motorist (UM) benefits under Title 22, Section 1295 of the Louisiana Revised Statutes. The district court ruled that the offending uninsured machine, a forklift, was not a "motor vehicle" for purposes of that law. The court reversed and remanded, holding that a forklift was a "motor vehicle" within the contemplation of Section 1295's identification of the uninsured or underinsured vehicle. View "Boyett, et al. v. Redland Ins. Co." on Justia Law