Justia Insurance Law Opinion Summaries

Harman-Bergstedt, Inc. appealed the appellate court's decision to reverse an Industrial Claim Appeals Office decision disallowing respondent Elaine Loofbourrow's award of temporary disability benefits. The ICAO concluded that once respondent's treating physician placed her at maximum medical improvement, temporary total disability benefits could not be awarded for the injury for which she was initially treated. The appellate court concluded that under the circumstances of this case, such an independent medical exam was not a prerequisite to temporary total disability benefits. After its review of this case, the Supreme Court concluded the appellate court was correct in its decision: because a determination of maximum medical improvement has no statutory significance with regard to injuries resulting in loss of no more than three days (or shifts) of work time, respondent's award of temporary total disability benefits was not barred by her failure to first seek a division-sponsored independent medical examination. View "Harman-Bergstedt, Inc. v. Loofbourrow" on Justia Law

Rick Wheeler had two liability insurance policies with American Family Mutual Insurance Company. Both Rick and his son Ryan were insureds under the policies. Both policies provided personal liability coverage and included exclusions for abuse and intentional injury. Both policies also contained a severability clause, which required that the insurance be applied separately to each insured. Joshua and Maren McCrary sued Rick and Ryan for Ryan’s alleged sexual assault of the McCrarys’ minor daughter. American Family filed a complaint for declaratory judgment seeking a judgment that its policies did not provide liability coverage to Rick. The district court granted summary judgment to American Family. At issue on appeal was whether the severability clause changed the effect of, or rendered ambiguous, the exclusions that would otherwise bar coverage for Rick. The Supreme Court affirmed, holding that the severability clause did not affect the unambiguous language of the policies’ exclusions, which barred coverage for Rick. View "Am. Family Mut. Ins. Co. v. Wheeler" on Justia Law

While driving a vehicle owned by her employer (Employer), Appellant was injured in an accident caused by an underinsured motorist. Appellant claimed underinsured motorist (UIM) benefits under Employer’s commercial insurance package policy, which Appellant believed had been insured by Insurer, the same carrier that insured the tortfeasor. Insurer denied Appellant’s claim. A jury awarded Appellant damages, finding the tortfeasor at fault. The district court denied Insurer’s posttrial motion for judgment based upon its claim that it did not issue Employer’s insurance policy and granted Insurer’s motion for credit against the verdict in part, declining, however, to give Insurer credit for future medical expenses. The Supreme Court (1) affirmed the trial court’s denial of Insurer’s motion for judgment as a matter of law on Insurer’s claim that Appellant named the wrong insurance company as the defendant; (2) reversed the district court’s decision on Insurer’s motion for partial summary judgment on future medical expenses and vacated the jury’s award of future medical expenses; and (3) reversed the district court’s denial of Appellant’s motion for attorney fees. Remanded. View "Bussman v. Safeco Ins. Co. of Am. " on Justia Law

This case involved copper sheeting owned by BMI that was stolen while MTS stored it in its warehouse. Aon had issued an insurance policy to BMI which covered the stolen copper. Defendant MTS and Intervenor Defendants KDP and SMA appealed from the district court's grant of summary judgment in favor of UNIC in a declaratory judgment insurance coverage dispute. The district court held that UNIC's first-party insurance policy issued to MTS was excess to BMI's own insurance policy and, therefore, no coverage existed under UNIC's policy. The court affirmed the district court's grant of summary judgment, holding, inter alia, that the Aon policy constituted "other insurance" with respect to the UNIC policy. Pursuant to Exclusion K, no coverage existed under the UNIC policy for the thefts of BMI's copper. The court also concluded that the district court did not abuse its discretion in denying KDP's Rule 59 motion where there was no conflict between the district court's final judgment and its memorandum opinion. View "United National Ins. Co. v. Mundell Terminal Servs., et al." on Justia Law

As an assembler with Eaton Corporation, McClain purchased the highest level of long-term disability insurance, which was “designed to replace ... 70 percent of [her] monthly base pay.” She stopped working in January 2008, due to a back injury she suffered on the job in June 2007. She received benefits during the first 24 months under the First Tier of the Plan’s coverage, which defined disability as being “totally and continuously unable to perform the essential duties of your regular position with the Company, or the duties of any suitable alternative position with the Company.” After 24 months, the Plan to an “any occupation” standard, providing Second Tier coverage if “you are totally and continuously unable to engage in any occupation or perform any work for compensation or profit for which you are, or may become, reasonably well fit by reason of education, training or experience--at Eaton or elsewhere.” The Plan denied her claim for benefits because her treating physician opined McClain could work part-time, and a market study identified various part-time positions in the area for which she was qualified. The district court rejected her suit under the Employee Retirement Income Security Act, 29 U.S.C. 1001. The Seventh Circuit affirmed, finding that the determination was not arbitrary.View "McClain v. Eaton Corp. Disability Plan" on Justia Law

Nationwide Mutual Fire Insurance Company issued a policy to Danny Ludwick insuring his home and its contents. The policy named Citizens Bank & Trust Company as the first mortgagee. The dwelling was subsequently destroyed by fire. However, based on material misrepresentations in Ludwick's application, Nationwide voided the policy back to its inception. Citizens submitted a claim to Nationwide. Nationwide denied the claim on the basis that the policy was void ab initio, allegedly extinguishing not only Ludwick’s interest but also Citizen’s interest as mortgagee. Citizens filed a complaint for wrongful denial of its claim. The circuit court granted summary judgment to Citizens. The Supreme Court affirmed, holding (1) an insurance company is entitled to rescission of its insured’s policy based on the insured’s fraud or misrepresentation, but the rescission of the policy has no effect on an independent contract with the mortgagee; and (2) because the policy at issue contained a standard mortgage cause, which operated as an independent contract between the insurance company and the named mortgagee, the rescission of Nationwide’s policy had no effect on the independent contract with Citizens. View "Nationwide Mut. Ins. Co. v. Citizensbank & Trust Co." on Justia Law

In 2003, multiple residents of Greenwood Health Center, a nursing home, died or were injured when another resident set fire to the facility. Thirteen negligence actions seeking damages for wrongful death or serious bodily injury were filed against Greenwood, the lessee of the property housing Greenwood, the owner and lessor of the property, and the operator of Greenwood. Lexington Insurance Company (Plaintiff) brought this declaratory judgment action against the lessor of the Greenwood property, which was the insured party under a policy issued by Plaintiff, the other Greenwood entities, and the victims’ personal representatives. Following the filing of cross motions for summary judgment, the trial court determined the amount of coverage available under the policy and rendered judgment accordingly. Plaintiff appealed the judgment of the trial court determining available coverage, and four of the individual defendants cross appealed. The Supreme Court reversed in part, holding (1) the trial court improperly interpreted the endorsement relating to the aggregate policy limit, thereby providing more coverage for the individual defendants’ claims than that to which they were entitled; and (2) the trial court improperly applied the self-insured retention endorsement to reduce the available coverage. Remanded. View "Lexington Ins. Co. v. Lexington Healthcare Group, Inc." on Justia Law

In a discretionary appeal, the issue before the Supreme Court in this case was whether, under an insurance policy for underinsured motorist coverage, the amount of an insured's recovery may be offset by the amount of all damages paid in satisfaction of the underlying judgment, or by only the amount of compensation paid under the auto insurance policy of the underinsured driver/tortfeasor. Under the circumstances of this case, the Court held that the amount of damages which could be offset against recovery under a UIM policy includes damages recovered from all tortfeasors. Accordingly, the Court reversed the Superior Court. View "AAA Mid-Atlantic Ins. Co. v. Ryan" on Justia Law

In November 2004, Dr. Ashard Yousuf sued Dr. George Cohlmia and Cardiovascular Surgical Specialists Corporation (CVSS) in Oklahoma state court for defamation, tortious interference with business relations/contract, intentional infliction of emotional distress/outrage, negligence, and breach of contract. Dr. Yousuf alleged that Dr. Cohlmia made a series of false statements to local media disparaging Dr. Yousuf's professional reputation. Dr. Cohlmia denied that the statements he made were false. CVSS held a professional liability policy with Physicians Liability Insurance Company (PLICO) and two identical general commercial liability policies with American National Property and Casualty Company (ANPAC, one for each business location), each of which covered Dr. Cohlmia as an additional insured. Dr. Cohlmia demanded that both insurers provide for his defense, pursuant to their respective policies. PLICO agreed to defend the lawsuit under a reservation of rights and requested ANPAC to share in the defense. ANPAC refused, contending its policy did not cover the alleged wrongdoing and that it owed no duty to defend. ANPAC further claimed that even if it erred in refusing to defend Dr. Cohlmia, PLICO had no right to indemnification or contribution for the defense costs it incurred. ANPAC appealed the district court's grant of summary judgment in favor of PLICO in a dispute regarding ANPAC's breach of its duty to defend a co-insured. PLICO cross-appealed the district court's denial of its motion for prejudgment interest. Finding no reversible error, the Tenth Circuit affirmed the district court's decision. View "Yousuf v. Cohlmia" on Justia Law

Ewing Construction Company entered into a contract with a school district to serve as general contractor on a project. The school district later filed suit against Ewing for faulty construction. Ewing tendered defense of the underlying suit to Amerisure Insurance Company, Ewing's insurer under a commercial package policy that included commercial general liability coverage. Amerisure denied coverage, and Ewing filed suit in federal district court seeking a declaration that Amerisure breached its duty to defend and indemnify Ewing for damages awarded in the underlying suit. The district court granted summary judgment for Amerisure, concluding that the policy’s contractual liability exclusion applied to exclude coverage because Ewing assumed liability for its own construction work pursuant to the contract such that it would be liable for damages arising out of its defective work. On appeal, the court of appeals certified questions to the Texas Supreme Court, which answered that “a general contractor that enters into a contract in which it agrees to perform its construction work in a good and workmanlike manner, without more specific provisions enlarging this obligation, does not ‘assume liability’ for damages arising out of the contractor’s defective work so as to trigger the contractual liability exclusion.” View "Ewing Constr. Co., Inc. v. Amerisure Ins. Co." on Justia Law