Justia Insurance Law Opinion Summaries

In 2000, Rochow sold his interest in Universico to Gallagher and became President of Gallagher. As an employee of Gallagher, Rochow was covered under a LINA disability policy. In 2001, Rochow began to experience short term memory loss, chills, sweating, and stress at work. Gallagher demoted Rochow to Sales Executive-Account Manager. Because of his inability to perform his job, Gallagher forced Rochow to resign in January, 2002. In February 2002, Rochow experienced amnesia, was hospitalized, and was diagnosed with HSV-Encephalitis, a rare, severely debilitating brain infection. LINA repeatedly denied Rochow benefits stating that Rochow’s employment ended before his disability began. In 2004, Rochow sued Cigna, LINA’s parent company, alleging breach of fiduciary duty under ERISA, 29 U.S.C.1104(a). In 2007 the Sixth Circuit affirmed a decision that denial of Rochow’s claims was arbitrary, not the result of a deliberate, principled reasoning process, and did not appear to have been made solely in the interest of the participants and beneficiaries or the exclusive purpose of providing benefits to participants and beneficiaries as required by ERISA. Rochow died in 2008. In 2009, the district court ordered an equitable accounting of profits and disgorgement of $3,797,867.92 under an equitable theory of unjust enrichment. The Sixth Circuit affirmed. View "Rochowl v. Life Ins. Co. of N. America" on Justia Law

Sherry Walker was denied disability benefits by the Public Employees’ Retirement System (PERS). The Circuit Court reversed PERS’s decision. The Court of Appeals reversed the circuit court, reinstating PERS’ denial of benefits. Upon review of the matter, the Supreme Court concluded PERS’ decision to deny Walker’s request for regular disability benefits was unsupported by substantial evidence. Accordingly, the Court reversed part of the appellate court's decision and reversed the Circuit Court's decision, and remanded the case with instructions to enter judgment in Walker’s favor on her regular disability benefits claim. View "Public Employees' Retirement System v. Walker" on Justia Law

A subcontractor on a public project filed suit against the general contractor and an insurance company that provided a payment bond seeking to recover money owed under the subcontract after the general contractor defaulted. The subcontractor asserted a payment-bond claim against the insurance company and breach of contract, unjust enrichment, and other claims against the general contractor. The insurance company filed a motion for summary judgment on the payment-bond claim because the subcontractor mailed its pre-suit notice of claim to the general contractor listed on the subcontract rather than the address listed on the payment bond. The district court denied the motion and granted judgment against the insurance company. The court of appeals reversed. The Supreme Court affirmed, holding (1) pursuant to Minn. Stat. 574.31(2)(a), a claimant must serve notice on the contractor at its address as stated in the bond as a prerequisite to filing suit; and (2) the subcontractor in this case did not comply with the statutory notice requirements. View "Safety Signs, LLC v. Niles-Wiese Constr. Co., Inc." on Justia Law

Plaintiff appealed the district court's denial of her motion for judgment on the record, affirming Liberty's termination of long-term disability benefits and dismissal of the complaint with prejudice. The policy provided that an employee was not disabled if the employee was capable of performing any occupation for which he or she was reasonably fitted. The court concluded that Liberty did not abuse its discretion in determining that plaintiff was reasonably fitted to perform the occupation of ambulance/emergency service dispatcher. Therefore, the record reflected that Liberty's decision to terminate benefits was supported by substantial evidence and thus did not constitute an abuse of discretion. Accordingly, the court affirmed the judgment of the district court. View "Gerhardt v. Liberty Life Assurance Co., et al." on Justia Law

Appellant suffered work-related injuries in 2000 and received workers' compensation benefits until 2004. Appellant filed another first report of injury in 2009 based on the same injuries. Employer denied benefits. Appellant filed a petition for rehearing. The Department of Labor & Regulation, Division of Labor & Management found that S.D. Codified Laws 62-7-35.1 barred Appellant's second claim for workers' compensation benefits because more than three years had passed between the date of the last payment of benefits and the date Appellant filed a written petition for a hearing. The circuit court affirmed. Appellant appealed, arguing section 62-7-35.1 should not apply to this case because his injuries were from cumulative trauma. The Supreme Court affirmed, holding that the cumulative trauma doctrine did not change section 62-7-35.1's application to this case because the cumulative trauma doctrine applies to the date of injury, which is irrelevant to section 62-7-35.1. View "Schuelke v. Belle Fourche Irrigation Dist." on Justia Law

Employee was injured while working as a truck driver for Employer. Employee's claim was allowed for the injuries. The next year, Employee returned to work. Two days later, Employer terminated Employee for violating written work rules. A staff hearing officer later denied temporary total disability (TTD) compensation, determining that Employee's termination was a voluntary abandonment of employment that barred compensation for TTD. The court of appeals concluded that the Industrial Commission abused its discretion in determining that Employee was ineligible for TTD compensation based upon his termination from Employer and granted mandamus relief to Employee. The Supreme Court (1) reversed, holding that the Commission's order did not meet the standards of State ex rel. Noll v. Indus. Comm'n because the court did not specifically state the evidence relied upon or explain the reason behind its decision that Employee had voluntarily abandoned his employment with Employer; and (2) returned the matter to the Commission to issue a new order stating the evidence relied upon and explaining its reasoning consistent with Noll. View "State ex rel. Cline v. Abke Trucking, Inc." on Justia Law

Claimant-Appellant Dallas Clark appealed an Industrial Commission order that denied her workers' compensation benefits. Claimant worked for Shari's Management Corporation as an experienced server. During a graveyard shift, she suffered a herniated disc in her back while lifting a heavy tray onto a high shelf. She would later be diagnosed with sciatica attributed to the lifting injury from work. Shari's completed a Report of Injury, interviewing Claimant in the process. The investigator testified that Claimant attributed the injury as "standing wrong" at a salad bar, which left her unable to lift the tray. The Commission concluded after a hearing that Claimant was unable to prove an industrial accident had occurred. The Supreme Court agreed with the Commission and affirmed its order. View "Clark v. Shari's Management Corp" on Justia Law

Petitioner Albert Boogaard argued that the comprehensive marine liability insurance policy he purchased from International Marine Underwriters (IMU) for his general partnership, ABCD Marine, covered bodily injuries he suffered while working as an independent contractor for Northland Services Inc. (NSI). Specifically, petitioner claimed that even as a general partner he qualified and was covered as a third party under the "insured contract" provision of the policy. IMU contended that as a general partner and insured, Boogaard was not a third party under the insured contract provision. The Supreme Court affirmed summary judgment in favor of IMU. As a general partner, Boogaard did not qualify as a third party under the "insured contract" provision in accordance with Washington partnership law. View "Int'l Marine Underwriters v. ABCD Marine, LLC" on Justia Law

Liberty Northwest Insurance filed a product liability action against Spudnik Equipment Company to recover workers' compensation benefits paid to an employee of its insured, Grand 4-D Farms, who was injured while working on a potato conveyor. The district court granted Spudnik summary judgment, finding Liberty failed to adequately identify the equipment involved in the accident. Liberty appealed to the Supreme Court. Finding no reversible error, the Supreme Court affirmed. View "Liberty Northwest Ins. Co., v. Spudnik Equip Co.," on Justia Law

Plaintiff filed a breach of contract action against Defendant, her insurer, claiming that Defendant improperly denied her claim for homeowners' insurance coverage after a fire damaged her home. BSI Financial Services, Inc., as the holder of the note and mortgage on Plaintiff's home, sought to intervene in the underlying action. The trial court denied the motion to intervene as untimely based on the policy's one year limitation period. The Supreme Court reversed, holding (1) the trial court erred in denying the motion to intervene without first determining whether the motion related back to the original complaint; and (2) the motion to intervene did not constitute a new, separate action but, rather, related back to Plaintiff's original complaint. Remanded. View "Austin-Cesares v. Safeco Ins. Co. of Am." on Justia Law