Justia Insurance Law Opinion Summaries

Kenneth Poch and Kevin Key were temporary workers contracted through Personnel Resources of Georgia, Inc. and Carolina Staffing, Inc. d/b/a Job Place of Conway, to work for Bayshore Concrete Products/South Carolina, Inc. to clean up a concrete casting worksite and dismantle equipment used to produce concrete forms. As a result of a tragic, work-related accident, Poch was killed and Key was injured. Poch's estate and Key received workers' compensation benefits through Job Place. Subsequently, Key and his wife and the estate of Poch filed suit against Bayshore SC and its parent company, Bayshore Concrete Products Corporation. The circuit court granted the company's motion to dismiss the actions on the ground that workers' compensation was Petitioners' exclusive remedy and, therefore, the company was immune from liability in a tort action. The Court of Appeals affirmed the circuit court's order. Though the Supreme Court agreed with the result reached by the Court of Appeals, it found the court incorrectly analyzed Petitioners' arguments. Accordingly, the Court affirmed as modified. View "Poch v. Bayshore Concrete" on Justia Law

Homes built with an exterior insulation and finish system (EIFS) suffer serious water damage that worsens over time. Homebuilder began a remediation program in which it offered to homeowners to remove exterior EIFS from the homes it had built and to replace it with conventional stucco. Almost all the homeowners accepted Homebuilder's offer of remediation. Homebuilder sought indemnification for the costs from its insurers (Insurers). Insurers denied coverage, preferring instead to wait until the homeowners sued. This litigation ensued. Now, only one insurer remained. The court of appeals reversed the trial court's judgment in favor of Homebuilder, finding (1) Homebuilder failed to establish its legal liability to the homeowners to trigger Insurer's coverage; and (2) Homebuilder failed to offer evidence of damages covered by the policy. The Supreme Court reversed, holding (1) Homebuilder's settlements with the homeowners established both Insurer's legal liability for the property damages and the basis for determining the amount of loss; and (2) Insurer's policy covered Homebuilder's entire remediation costs for damaged homes. View "Lennar Corp. v. Markel Am. Ins. Co." on Justia Law

Petitioner Jennifer Mau was convicted of making false insurance claims. She challenged the sufficiency of the evidence presented against her at trial. Upon review, the Supreme Court found that the State failed to prove the existence of any "contract of insurance" underlying Petitioner's claim. Therefore the Court reversed her conviction. View "Washington v. Mau" on Justia Law

National contracted to produce “Kids Fun Day” events before 2010 Cleveland Indians games, including a collapsible inflatable slide. National purchased a required comprehensive liability insurance policy naming the Indians as additional insureds, from NHIC through an independent broker, CSI. On the application a box was checked, indicating use of a “bounce houses or inflatables.” A “Certificate of Liability Insurance” issued six weeks before the slide collapsed, causing a death. Neither National nor the Indians had received the full policy at the time of the accident. After the accident, National learned that, despite its specific application request, CSI had failed to procure a policy that expressly covered inflatables. In an email exchange, an employee of CSI stated, “Oh, ok. Sorry, I guess I missed it.” Later CSI stated: “inflatable’s [sic] are excluded on the policy you purchase[d] from us. Whoever own the inflatable’s [sic] are [sic] to carry insurance on them and name you … I don’t believe I’ve ever seen you indicate on your applications that inflatable’s [sic] are at your events, but please note, the exclusion is listed on the quotes we sent over to you.” The district court found NHIC not liable to the Indians and that CSI could not be liable in negligence. The Sixth Circuit reversed as to CSI and remanded the negligence and negligent misrepresentation claims. View "Cleveland Indians Baseball Co. v. NH Ins. Co." on Justia Law

The day after Julie served her husband Steven with a summons and complaint for divorce, Steven shot and killed Julie near her car in Julie's employer's parking lot. The personal representative of Julie's estate sought worker's compensation benefits for her death, asserting that Julie's death arose out of her employment. Julie's employer (Employer) denied benefits, as did the South Dakota Department of Labor and Regulation. The circuit court affirmed. The Supreme Court also affirmed, holding that even though the assault occurred on Employer's premises, the assault could not be attributed to Julie's employment, and therefore, Julie's death did not "arise out of" her employment. View "Voeller v. HSBC Card Servs., Inc." on Justia Law

Defendant applied for homeowner's insurance with Insurer, and his application was approved. Several years later, after discovering a misrepresentation in Defendant's application, Insurer rescinded the homeowner's insurance policy issued to Defendant. Insurer then initiated this action against Defendant, alleging that it lawfully rescinded the insurance contract with Defendant. Insurer also sought recovery of all monies paid to Defendant under the insurance contract. The circuit court entered summary judgment in favor of Insurer, determining, as a matter of law, that Defendant made a misrepresentation on his homeowner's insurance application and that the misrepresentation was material. The Supreme Court affirmed, holding that because no material question of fact existed regarding whether Defendant made a material misrepresentation on his application for homeowner's insurance, the circuit court did not err in granting summary judgment for Insurer. View "De Smet Farm Mut. Ins. Co. of S.D. v. Busskohl" on Justia Law

Petitioner Thomas Phillips appealed a New Hampshire Compensation Appeals Board (CAB) decision denying him recovery under the Workers’ Compensation Law. The CAB ruled that petitioner was not entitled to benefits because he had failed to timely notify his employers, Norman and Diane Crocker, of his claim. Furthermore, the CAB ruled that petitioner was not entitled to benefits because, unbeknownst to the Crockers, he was intoxicated at the time of his injury. In 2006, petitioner and his wife lived in a trailer that they rented from the Crockers. As part of the lease agreement, the petitioner performed yard work and minor home repairs for the Crockers in exchange for a rent reduction. Mr. Crocker asked petitioner to remove a tree branch that was growing near the Crockers’ house. The next day, petitioner fell from a ladder while cutting the branch with a chainsaw. As a result of the fall, petitioner was rendered a quadriplegic. Petitioner filed a claim for workers’ compensation benefits, identifying the Crockers as his employer. The Crockers were insured under a homeowner’s insurance policy issued by State Farm Fire and Casualty Company (State Farm) that included workers’ compensation coverage for domestic employees. State Farm denied petitioner workers’ compensation benefits. The New Hampshire Department of Labor (DOL) Hearing Officer determined that petitioner was entitled to benefits. State Farm appealed to the CAB. Upon review, the Supreme Court affirmed in part, reversed in part and remanded for further proceedings: (1) the CAB misapplied the governing New Hampshire case law to the petitioner’s claim; (2) petitioner’s claim was not time barred; and (3) a factual question remained whether petitioner's injury was caused in whole or in part by his intoxication. View "Appeal of Thomas Phillips" on Justia Law

Safety National sold an excess liability insurance policy to TKK, to cover excess losses resulting from liability imposed “by the Workers’ Compensation or Employers’ Liability Laws” of Illinois. The widow of a former TKK employee sued, alleging that TKK’s negligence caused the employee to become ill with and die from mesothelioma. The claim was subject to an affirmative defense: the Illinois Workers’ Occupational Diseases Act bars common law claims by or on behalf of an employee against a covered employer “on account of damage, disability or death caused or contributed to by any disease contracted or sustained in the course of the employment.” After Safety National denied coverage, TKK filed suit. The district court granted TKK summary judgment for its costs in defending and settling the widow’s suit, reasoning that the reference to “Employers’ Liability Laws” included the common law negligence claim even if the claim ultimately must fail because of the statutory bar. The court denied TKK’s claim for attorney fees and costs in the coverage lawsuit itself, except a modest award for what the court considered a vexatious motion to reconsider. The Seventh Circuit affirmed. The key policy term, “Employers’ Liability Laws,” is broad enough to include claims under the common law, including “groundless” claims. View "TKK USA, Inc. v. Safety Nat'l Cas. Corp." on Justia Law

Defendant, an independent insurance broker, offered its clients insurance products from multiple insurance companies. Plaintiff, the State, brought this action against Defendant, alleging that Defendant's failure to disclose to its clients certain contingent commission agreements that it had entered into with the insurance companies violated the Connecticut Unfair Insurance Practices Act (CUIPA) and the Connecticut Unfair Trade Practices Act (CUTPA). The trial court rendered judgment in favor of Plaintiff. The Supreme Court reversed, holding (1) the trial court improperly concluded that Defendant violated CUIPA; and (2) in the absence of a CUIPA violation in this case, the CUTPA claim failed. View "State v. Acordia, Inc." on Justia Law

The issue before the Supreme Court in this case centered on the statutory interpretation concerning Section 413(a) of the Workers' Compensation Act, specifically whether the claimant/appellant should have been permitted to proceed on a post-500-week petition for reinstatement of total disability benefits where he filed that petition within three years of his most recent payment of compensation, a payment which was made pursuant to a post-500-week supplemental agreement, notwithstanding a prior suspension of payments due to his return to work without a loss in earning capacity. Resolving the question, involved first determining whether expiration of the 500-week period set forth within the Act operated as a bar to the assertion of total disability claims by employees who have experienced a suspension of benefits. Also affecting the Court's decision was the effect of payments made pursuant to supplemental agreements upon an otherwise expired workers' compensation claim. The Commonwealth Court below affirmed the Workers' Compensation Appeal Board's ("WCAB") reversal of a Workers' Compensation Judge's ("WCJ") decision granting appellant's reinstatement and penalty petitions. Upon review, the Supreme Court held that appellant's reinstatement petition was not timely filed. Accordingly, it affirmed the Commonwealth Court. View "Cozzone, Aplt v. WCAB (Pa Municipal/E. Goshen Twp)" on Justia Law