Justia Insurance Law Opinion Summaries

The NECA-IBEW Health and Welfare Fund provides health benefits to members of a local union of electrical workers. The Fund negotiated a Local Agreement with Sav-Rx, a provider of prescription-drug benefits, under which Sav-Rx reimburses pharmacies for dispensing medication and then invoices the Fund for some of its costs. The Local Agreement does not call for arbitration. A few months later, Sav-Rx negotiated a different agreement with the national organization of the IBEW, with which the local is affiliated. The National Agreement offers locals reduced charges and more services than the Local Agreement and contains a mandatory arbitration clause. Local unions and funds could opt into the National Agreement, but the Fund's trustees never voted on the matter. Over the next eight years the Fund accepted from Sav-Rx services provided by the National Agreement. The Fund sued Sav-Rx for invoicing the Fund at rates not authorized by either the Local or National Agreement. The district court dismissed, finding that Fund had accepted the benefits of the National Agreement and was bound to it; Sav-Rx established that the Fund knew it was accepting benefits under the National Agreement. The Seventh Circuit affirmed. View "NECA-IBEW Rockford Local Union 364 Health & Welfare Fund v. A&A Drug Co." on Justia Law

In consolidated appeals, the issue before the Supreme Court was whether the manifestation of an occupational disease outside of the 300-week period prescribed by Section 301(c)(2) of the Workers’ Compensation Act removes the claim from the purview of the Act, such that the exclusivity provision of Section 303(a) does not apply. After careful consideration, the Supreme Court concluded that claims for occupational disease which manifest outside of the 300-week period prescribed by the Act do not fall within the purview of the Act, and, therefore, that the exclusivity provision of Section 303(a) does not apply to preclude an employee from filing a common law claim against an employer. Accordingly, in these cases, the Court reversed the Superior Court's decision. View "Tooey v. AK Steel" on Justia Law

The Superintendent of Insurance ordered Guarantee Trust Life Insurance Company (GTL) to pay a civil penalty of $150,000 after finding that GTL violated Me. Rev. Stat. Ann. 24-A, 1420-M(1), 1902, and 2412(1-A)(B), and that GTL was accountable, pursuant to Me. Rev. Stat. Ann. 24-A, 1445(1)(D) for violations committed by Cinergy Health, Inc., a company that acted as GTL's producer. The business and consumer docket affirmed the decision of the Superintendent. The Supreme Court affirmed, holding (1) GTL was accountable pursuant to section 1445(1)(D) for Cinergy's misconduct occurring before the date on which GTL formally appointed Cinergy as its producer; (2) the Superintendent did not err in concluding that GTL provided coverage to Maine residents and was liable under section 2412(1-A)(B); (3) the Superintendent's did not issue an untimely decision pursuant to the plain language of Me. Rev. Stat. Ann. 24-A, 235(2); (4) the Superintendent did not abuse her discretion by holding GTL liable under section 1420-M(1); and (5) the Superintendent did not abuse her discretion by penalizing GTL for violating section 1902. View "Guarantee Trust Life Ins. Co. v. Superintendent of Ins." on Justia Law

The underlying class action here was brought against Southern Financial Life Insurance Company, which sold credit life and disability insurance through lending institutions, by purchasers of Southern Financial's credit life and disability policies. During the discovery phase, the trial court entered an order compelling Southern Financial to produce certain loan information and documents regarding the putative class members and the insurance sold to them. Southern Financial did not comply with the order, arguing that the loan information was not in its "possession, custody or control" within the meaning of Ky. R. Civ. P. 34.01, but rather, the information was in the possession of the individual lenders. After applying principles of general agency law, the trial court overruled the objection. Southern Financial subsequently sought a writ of prohibition to prevent the trial court's enforcement of the discovery order. The court of appeals declined to issue a writ. The Supreme Court affirmed, holding that Southern Financial was legally in control of the information it was compelled to disclose in the trial court's order, and therefore, the trial court committed no error. View "S. Fin. Life Ins. Co. v. Pike Circuit Court" on Justia Law

While working for Employer, Employee filed notice of a workers' compensation claim related to a lower back injury he received during the course of his employment. Employee was discharged approximately four years later pursuant to a termination agreement that provided that he agreed to release Employer from any and all workers' compensation claims. Employer later brought an action against Employee, alleging civil theft, fraud, unjust enrichment, and conversion based on Defendant's admission that he never intended to release his workers' compensation claim. Employee counterclaimed, claiming that Employer's cause of action was in retaliation for Employee's decision to exercise his rights under the Workers' Compensation Act. Employer filed a motion to dismiss the counterclaim, asserting that the doctrine of absolute immunity shielded Employer from the counterclaim. The trial court denied the motion. The Supreme Court affirmed the trial court's decision denying Plaintiff's motion to dismiss, holding that an employer's right to seek redress for its alleged grievances in court does not outweigh an employee's interest in exercising his rights under the Act without fear of retaliation by his employer, and therefore, absolute immunity did not shield Employer from Employee's counterclaim. View "MacDermid, Inc. v. Leonetti" on Justia Law

Petitioners had a homeowners' insurance policy with Respondent that covered Petitioners' dwelling. The policy stated that any covered loss would be paid based on actual cash value, rather than replacement value, but the policy did not define the term "actual cash value." After Petitioners' dwelling was damaged by a tornado, Respondent valued Petitioners' loss at $48,647 after calculating the repair costs and the depreciation of the items requiring repair. Petitioners brought a class action in federal district court against Respondent, alleging that Respondent breached the insurance policy, and those policies of the putative class members, when it improperly applied a depreciation factor to the labor portion of repairs required at their respective dwellings. Specifically, Petitioners contend that their policy's failure to address depreciation of labor rendered the policy's term "actual cash value" ambiguous. The federal district court certified a question of law to the Supreme Court, which answered by holding that an insurer, in determining the "actual cash value" of a covered loss under an indemnity insurance policy, may not depreciate the costs of labor when the term "actual cash value" is not defined in the policy. View "Adams v. Cameron Mut. Ins. Co." on Justia Law

In an insurance coverage dispute between Macheca and Philadelphia, Macheca contended on appeal for a third time that damages were erroneously reduced by amounts it recovered from a separate insurance carrier, and that the district court erred in denying its request for prejudgment interest. The court affirmed the district court's judgment with respect to all of Macheca's challenges on the issue of the Travelers payment because Macheca was barred from raising the issue in this appeal under the law-of-the-case doctrine; affirmed the district court's denial of prejudgment interest on the claims for lost business income and necessary expenses; and reversed the denial of prejudgment interest on the claim for property damage where the award was reasonably ascertainable. View "Macheca Transport Co., et al. v. Philadelphia Indemnity Ins." on Justia Law

Plaintiff filed suit against Farmers and American, insurance companies, for breach of contract and various state law violations, seeking recovery for additional loss. The court concluded that plaintiffs' claims for specific performance, unjust enrichment, and bad faith were expressly preempted by federal law; the court affirmed the district court's grant of Farmers' motion to dismiss plaintiffs' extracontractual claims because they were preempted under federal law; and the court affirmed the district court's grant of summary judgment to Farmers on the ground that plaintiffs failed to file a supplemental proof of loss, a strictly construed requirement, and thus did not satisfy the prerequisites for suing on their additional claims, rejecting plaintiffs' estoppel, duress, repudiation, and due process arguments. Further, the court affirmed the district court's grant of summary judgment for American, concluding that the American policy was supplemental and plaintiffs could not recover from American for flood damage because they had not exhausted their primary policy with Farmers. View "Gunter, et al. v. Farmers Ins. Co., et al." on Justia Law

Appellant Annette Shoap sustained a work-related injury in the nature of a left shoulder injury while working as an employee of Phoenixville Hospital. She began receiving temporary total disability benefits pursuant to a Notice of Compensation Payable dated 2003. The treatment for Appellant’s injury included three surgeries and physical therapy. In 2007, the employer filed a modification petition alleging both that Appellant’s physical condition had improved and that work was generally available to her within her physical restrictions in the relevant geographical area, as demonstrated by two labor market surveys. Appellant denied the material allegations of Employer’s petition, and a hearing was held before a Workers’ Compensation Judge. After the WCJ ruled in the employer's favor, Appellant unsuccessfully appealed to the Workers' Compensation Appeal Board and Commonwealth Court. On appeal to the Supreme Court, Appellant asserted that the Commonwealth Court erred by concluding that “substantial gainful employment existed” for purposes of granting a modification of her compensation benefits pursuant to Section 306(b) of the Workers' Compensation Act, despite the fact that her application for the specific jobs involved failed to result in any offers of employment. Secondarily, Appellant argued that the Commonwealth Court, even if correct in its interpretation of Section 306(b), erred by not remanding the case for further evidentiary development based on its interpretation of Section 306(b), which Appellant contended represented a change in the standard for evaluating cases under that statute. After careful review, the Supreme Court agreed with Appellant's second contention, and reversed and remanded for further proceedings. View "Phoenixville Hospital v. WCAB (Shoap, Aplt)" on Justia Law

A 2009 collision on a rural Effingham County highway resulted in the death of a man, 18 years old and not intoxicated. The other driver was a 60-year-old man who was intoxicated and had been drinking in Johnny’s Bar and Grill. The decedent’s parents, who had already obtained $106,550 in insurance recoveries, sued under the Dramshop Act, which has a statutory cap on recovery of $130,338.51. The bar owner had insurance for that amount, but his insurer became insolvent and was liquidated. The Illinois Insurance Guaranty Fund assumed his defense. The Fund statute provides that the Fund’s obligation shall be reduced by a plaintiff’s other insurance recoveries. The plaintiffs argued that, if the jury award were far in excess of the statutory cap, the setoff could first be applied to the award, and the award could then be brought down to allow them to recover the full amount of the statutory cap itself. The appellate court ruled that the reduction should be applied to the jury’s verdict. The Illinois Supreme Court reversed. The Fund is liable only up $130,338.51. The setoff for insurance proceeds should be applied against that maximum liability. The availability of a jury trial is not relevant and the amount of a verdict cannot expand the Fund’s obligation. View "Rogers v. Imeri" on Justia Law