Justia Insurance Law Opinion Summaries

Claimant-appellee and cross-appellant-appellant Amanda Wyatt appealed a Superior Court judgment reversing an Industrial Accident Board finding that she had a compensable, work-related injury. The employer-appellant and cross-appellee-appellee is Wyatt’s former employer, Rescare Home Care. On appeal, Wyatt argued: (1) the Superior Court erred in reversing the Board’s decision that her injury was a compensable industrial accident, since the Board’s decision was based upon substantial evidence; and (2) the Board erred in denying the medical expenses for her emergency back surgery. After careful consideration, the Supreme Court concluded the Superior Court erred in reversing the Board’s decision that the Claimant had a compensable work related injury. Furthermore, the Court concluded the Board properly determined that her back surgery was not compensable. View "Wyatt v. Rescare Home Care" on Justia Law

Claimant was employed at a secure juvenile detention facility operated by the State Office of Children & Family Services (OCFS) when she was assaulted, raped, and abducted by a resident. Claimant received workers' compensation benefits for her injuries. Claimant also filed a civil rights lawsuit in federal district court against OCFS and three supervisory OCFS employees seeking, inter alia, punitive damages. The federal lawsuit was settled. The New York State Insurance Fund (SIF), the workers' compensation carrier in this case, approved the settlement. In so doing, SIF reserved its right to take a credit against Claimant's payments of benefits until the credit was exhausted. The Workers' Compensation Law judge (WCLJ) decided that SIF was not entitled to offset the proceeds of a civil rights lawsuit that sought punitive damages. On appeal, the Workers' Compensation Board found in SIF's favor. The Appellate Division affirmed. The Court of Appeals affirmed, holding that, in light of the terms of the settlement in this case, SIF could take a credit against the settlement proceeds of Claimant's lawsuit against her employer and coemployees for injuries arising from the same incident for which Claimant received worker's compensation benefits. View "Beth V. v. State Office of Children & Family Servs." on Justia Law

Plaintiffs, victims and victims' families and estates, filed suit against Iran and others alleging their liability for the attack on the Khobar Towers apartment complex in Dhahran, Saudi Arabia. Plaintiffs obtained a default judgment and attempted to collect. Plaintiffs had writs of attachment issued to Bank of America and Wells Fargo, seeking any asset held by the banks in which Iran had interest. The banks conceded that some accounts were potentially subject to attachment and these "uncontested accounts" were the subject of an interpleader action in the district court. The remaining "contested accounts" are the subject of this appeal. The court affirmed the order of the district court denying plaintiffs' motion for a turnover of the funds because plaintiffs could not attach the contested accounts under either section 201 of the Terrorism Risk Insurance Act of 2002, Pub. L. No. 107-297, 116 Stat. 2322, 2337, or 28 U.S.C. 1610(g) without an Iranian ownership interest in the accounts and because Iran lacked an ownership interest in the accounts. View "Heiser, et al. v. Islamic Republic of Iran, et al." on Justia Law

Plaintiffs filed suit against Darwin alleging that the insurance company breached its duty to defend and its implied duties of good faith and fair dealing under the policy at issue. On appeal, plaintiffs challenged the district court's grant of summary judgment in favor of Darwin. The court concluded that Darwin owed no duty to defend plaintiffs because all of the claims at issue fell within the Customer Funds Exclusion; the district court's interpretation of the Customer Funds Exclusion did not violate the illusory coverage doctrine; and the reasonable expectations doctrine did not apply in this case. The court also concluded that the innocent insured doctrine did not obligate Darwin to defend plaintiffs and the district court did not err in granting summary judgment on plaintiffs' claim for breach of the implied contractual duties of good faith and fair dealing. Accordingly, the court affirmed the district court's judgment. View "Bethel, II, et al. v. Darwin Select Ins. Co." on Justia Law

In 2007, Appellant purchased the assets of an indoor football team owned by Omaha Beef, LLC. In 2008, Appellant applied for workers' compensation insurance under the Nebraska Workers' Compensation Plan, arguing that it was entitled to a certain experience modifier (XMod), which is used when calculating the premium owed, because it was a new entity with no claims experience. The National Council on Compensation Insurance, Inc. determined that Appellant was a successor entity to Omaha Beef, and thus, the various XMods assigned to Omaha Beef for the relevant time periods must be transferred to Appellant. The director of the Department of Insurance affirmed. The district court affirmed, reasoning that Appellant was a successor to Omaha Beef and that the change in ownership resulted in the transfer of the workers' compensation rating for Omaha Beef to Appellant. The Supreme Court affirmed, holding that the district court did not err in finding (1) Appellant had the burden of proof to show there was no "change in ownership"; and (2) a "change in ownership" existed such that the XMod of Omaha Beef should be transferred to Appellant. View "Gridiron Mgmt. Group, LLC v. Travelers Indem. Co." on Justia Law

After SIC refused to defend or indemnify its insured, the City, in a lawsuit brought by WRI, the City settled the underlying litigation with WRI and sued SIC to recover defense costs, indemnification, and statutory penalty interest. The court concluded that SIC was liable for the City's defense costs where WRI's constitutional and tortious interference claims could produce liability that did not arise out of WRI's inverse condemnation action; the court remanded for the district court to allow the parties to introduce evidence regarding SIC's indemnity obligation where the pleadings did not raise a possibility of municipal liability independent of any just-compensation liability arising out of WRI's inverse condemnation action; the court remanded for the district court to assess the penalty interest under section 542.058 of the Texas Insurance Code; and, because it was not yet clear whether the City would prevail on its indemnity claim, or how much of the City's attorney's fees were attributable to litigating the indemnity claim, the court concluded that the district court could determine whether there was any fee award under section 38.001 of the Texas Civil Practice and Remedies Code. Accordingly, the court reversed and remanded for further proceedings. View "City of College Station, Texas v. Star Ins. Co." on Justia Law

This action arose out of allegedly defective roofing work performed by defendant. At issue was whether defendant, an insured contractor, was a nominal party in a contribution suit between its insurers. The court affirmed the district court's holding that defendant was a nominal party for purposes of the nominal party exception to the rule of unanimity governing removal where defendant did not possess a sufficient stake in the proceeding at issue to rise above the status of a nominal party. View "Hartford Fire Ins. Co. v. Harleysville Mutual Ins." on Justia Law

Appellant was involved in a car accident with Kent Blough. Appellant's insurer, USAA Casualty Insurance Company, concluded that Appellant was the majority at fault for the accident and refused to honor Appellant's $300,000 UM/UIM coverage. Appellant filed suit against Blough, and in an apparent attempt to prevent Appellant from prevailing, USAA unsuccessfully tried to intervene in the lawsuit. Blough's insurer paid Appellant the limit of Blough's insurance policy. USAA's expert eventually determined that Blough, whom USAA had already paid under Appellant's policy, had been the majority at fault. USAA then tendered to Appellant its $300,000 UM/UIM policy limit. Appellant filed a complaint against USAA for, among other claims, violations of the Montana Unfair Trade Practices Act and emotional distress as a result of the mishandling of her claim. The district court entered summary judgment for USAA. The Supreme Court reversed, holding that the district court (1) erred in determining that Appellant may not pursue a claim based upon USAA's alleged failure to reasonably investigate her claim as required under Mont. Code Ann. 33-13-201(4); and (2) erred when it granted summary judgment in favor of USAA regarding Appellant's claim for damages arising from emotional distress. View " McVey v. USAA Cas. Ins. Co." on Justia Law

Plaintiffs are survivors of the victims who were murdered inside an apartment building owned by the landlords. A state court found that the landlords breached their landlord-tenant duty to provide security to the victims and awarded plaintiffs $4 million in total damages. Plaintiffs then filed an equitable garnishment action to recover insurance proceeds from one of the landlord's insurers to satisfy a portion of the wrongful death judgments. The district court ruled that plaintiffs were entitled to collect $1 million in insurance proceeds from the insurer. The court reversed and remanded, holding that the insurance policy unambiguously precluded coverage of the wrongful death damages where the business property exclusion unambiguously precluded coverage of the wrongful death judgments plaintiffs obtained against the landlords. View "Eichholz, et al. v. Secura Supreme Ins. Co." on Justia Law

Petitioner was a guest passenger in a vehicle insured by Progressive Classic Insurance Company when the vehicle was rear-ended by a truck. Petitioner received medical payments coverage under the Progressive policy for some of the medical expenses she incurred for the treatment of her injuries. Petitioner later successfully sued the truck owner and driver and received damages. Progressive subsequently asserted a subrogation lien on the recovery for the amount it paid under the medical payments coverage. Petitioner filed this complaint against Progressive, alleging common law and statutory bad faith claims. The circuit court dismissed the action, determining that because Petitioner was not a named insured under the Progressive policy and paid no premiums for the policy, Petitioner was a third-party insured and was, therefore, precluded from pursuing her bad faith claims against Progressive. The Supreme Court reversed, holding (1) Petitioner was a first-party insured under the Progressive policy because the policy included within the definition of an insured person "any other person while occupying a covered vehicle"; and (2) therefore, Petitioner may pursue an action against Progressive for common law and statutory bad faith. View "Dorsey v. Progressive Classic Ins. Co." on Justia Law