Justia Insurance Law Opinion Summaries

Plaintiff Charles Honeycutt was injured in an automobile accident involving a Mississippi state trooper. He sued the state trooper and two automobile-insurance providers, Atlanta Casualty Company and American Premier Insurance Company. The trial court granted the defendants' motions for summary judgment. On appeal, the Court of Appeals affirmed the trial court's grant of summary judgment. Plaintiff filed a writ of certiorari, seeking to appeal the grant of summary judgment for American Premier: (1) whether the trial court and the Court of Appeals erred by finding an insurance agent does not have a duty to explain uninsured-motorist coverage; (2) whether summary judgment was granted improperly. The Supreme Court found that, in order to obtain a knowing and voluntary waiver of uninsured-motorist coverage (UM coverage), an insurance agent does have a duty to explain UM coverage to the insured. The Court also found that summary judgment was not proper in this case. Thus, the Court reversed both lower courts' judgments and remanded the case back to the trial court for further proceedings. View "Honeycutt v. Coleman" on Justia Law

Plaintiff's young son was injured by an uninsured motorist while he was a passenger in his daycare provider's van. Plaintiff filed a petition on behalf of her son against the daycare provider's insurance company, Shelter Mutual, alleging that her child was an "insured" under the uninsured motorist provisions of the policy. The policy defined "insured" to include owners, operators, and other users who exercise physical control of the right of control of the vehicle. The trial court granted summary judgment to Shelter. Plaintiff appealed, arguing that the uninsured motorist statute requires coverage of all passengers within the definition of "user." The Supreme Court affirmed, holding that Plaintiff's child was not an insured because (1) Plaintiff's child was not included in the definition of "insured" under the policy itself; (2) the financial responsibility law implies coverage as a matter of law in a policy for owners, operators and users to the extent that liability may be imposed on them under Missouri law for damages arising out of such ownership, operation, or use; and (3) Plaintiff's child did not come within this scope of coverage. View "Steele v. Shelter Mut. Ins. Co." on Justia Law

Plaintiff, the widow of the insured, filed this action under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1132(a)(1)(B), after AUL, the insurer, refused to pay accidental death and dismemberment (AD&D) benefits. The district court affirmed the denial of benefits on the grounds that the death was not accidental because the fatal crash was an "anticipated and expected" result of driving while intoxicated. The insurance policies did not define the term "accident" despite its critical importance for determining eligibility for AD&D benefits. Because "accident" was susceptible to more than one reasonable interpretation, the court construed it against AUL, the drafting party, and concluded that a reasonable plan participant under similar circumstances would have understood the insurer's alcohol-related crash to be an "accident" under the policy language. Accordingly, the court reversed and remanded. View "Johnson v. American United Life Ins." on Justia Law

Plaintiff was injured in a motor-vehicle collision with an underinsured driver (Tortfeasor). Tortfeasor was insured by Progressive Insurance Company (Progressive). Progressive paid Plaintiff its policy limits of $25,000. Plaintiff then sought recovery for personal injuries pursuant to the uninsured/underinsured motorist provisions (UM/UIM coverage) of her policy with Encompass Insurance Company (Encompass). Arbitrators issued a total award of $172,750. Plaintiff sought confirmation of the arbitration award. Encompass objected, arguing that Plaintiff's UM/UIM policy provided $100,000 maximum coverage, that Encompass had paid the policy limits in accordance with the insurance contract, and that, under Rhode Island law, Plaintiff was not entitled to recover from Encompass in excess of her policy limits. The trial justice vacated the portion of the award in excess of the $100,000 policy limit and confirmed the remainder of the arbitration award. The Supreme Court vacated the order of the superior court and directed that the arbitration award be reinstated in its entirety, holding that the superior court was incorrect in its interpretation of the law, and no grounds for modification or vacation of the award existed. View "Wheeler v. Encompass Ins. Co." on Justia Law

In 2009, a registered nurse (Nurse) employed by Hospital commenced this action for workers' compensation benefits, alleging that as the result of three incidents with patients involving assault and sexual assault, she suffered from posttraumatic stress disorder (PTSD) and depression. The workers' compensation court found all three incidents occurred, held that Nurse suffered depression and PTSD as a result of the incidents, and that Nurse was permanently and totally disabled. The court awarded benefits accordingly. After Hospital appealed, it was discovered that the testimony of all Hospital witnesses who testified on behalf of Hospital could not be transcribed due to a failure of electronic equipment used by the court reporter. The Supreme Court vacated the judgment of the trial court and remanded for a new trial, concluding that, under the circumstances of the case, where the testimony of all Hospital witnesses had been lost due to no fault of either party, the Court could not undertake a meaningful appellate review of the assignments of error. Remanded for a new trial. View "Hynes v. Good Samaritan Hosp." on Justia Law

Landlord and Tenant signed a lease agreement for a rental property that required Tenant to obtain a liability and renter's insurance policy at his expense. Tenants obtained a renter's protection policy of insurance. The house was later damaged by fire caused by a child using a lighter. Landlord's insurer (Insurer) paid for the loss. This subrogation action was brought against Tenants in Landlord's name. The district court dismissed the action, concluding (1) the lease provision requiring Tenant to obtain renter's insurance did not permit Landlord or Insurer to bring a subrogation action against Tenants; and (2) Tenants were coinsureds under Landlord's fire insurance policy, and Insurer could not subrogate against its coinsureds. The Supreme Court affirmed, holding that because the terms of the lease did not overcome the presumption that Tenant was coinsured under Landlord's fire insurance policy, Landlord and Insurer could not bring a subrogation action against Tenants. View "Beveridge v. Savage" on Justia Law

Kenneth Crum, who was horseback riding at the time, was struck and severely injured by a vehicle driven by Raymond Ousley. At the time, Ousley was test-driving the vehicle, an uninsured car titled to Rhonda Ward. Crum sued Ousley for personal injuries and later joined Ousley's auto liability insurer, Kentucky Farm Bureau, for no-fault benefits. Kentucky Farm and Crum settled the negligence claims against Ousley for $25,000. Later, the trial court declared by final order that Kentucky Farm was also required to pay basic reparation benefits (BRBs) to Crum for the motor vehicle accident. The trial court then entered a final order declaring coverage for Crum and ordering Kentucky Farm also to pay Crum the no-fault benefits. The court of appeals reversed, holding that Kentucky law did not allow Crum to recover and Ousley's policy excluded Crum. The Supreme Court reversed, holding (1) a pedestrian struck by an uninsured vehicle being driven by an ininsured driver can recover no-fault benefits from the driver's insurance company; and (2) therefore, Crum was entitled to receive BRBs from Kentucky Farm. View "Samons v. Ky. Farm Bureau Mut. Ins. Co." on Justia Law

While working for Employer, Appellant became trapped in a stalled elevator. Employer's security staff attempt to rescue Appellant, but as a result of their attempt, Appellant fell several stories down the elevator shaft, causing serious injuries. Appellant filed for workers' compensation. The ALJ enhanced Appellant's workers' compensation award based on Ky. Rev. Stat. 342.165(1), which provides that if an accident is caused by the intentional failure of an employer to comply with a statute or regulation relative to the maintenance of safety appliance, the claimant's benefits shall be increased, and Ky. Rev. Stat. 338.031, which states that an employer must provide his employees a place to work free from dangerous hazards. The workers' compensation board affirmed. The court of appeals reversed. The Supreme Court reversed, holding that the ALJ correctly applied the four-part test set forth in Lexington-Fayette Urban County Government v. Offutt to determine that Employer violated section 338.031, and accordingly, the ALJ properly applied the enhancement to Appellant's weekly benefit because of Employer's violation of section 342.165. View "Hornback v. Hardin Memorial Hosp." on Justia Law

Plaintiff Kenneth Admire was seriously injured when the motorcycle he was riding collided with a car being operated by an insured of Defendant Auto-Owners Insurance Company. Following the accident, Kenneth required wheelchair-accessible transportation. Through his guardian Russ Admire, brought an action against Auto-Owners Insurance Company, seeking payment of personal protection insurance (PIP) benefits under the no-fault act. Auto-Owners had agreed to pay the full cost of purchasing a van modified to accommodate Kenneth’s wheelchair. Kenneth’s guardian gave Auto-Owners notice of his intent to purchase a new van. In response, Auto-Owners stated that it was not obligated to pay the base purchase price of a new van, but that it would pay for the necessary modifications if Kenneth’s guardian purchased a new vehicle for him. Kenneth’s guardian purchased the new van for Kenneth, and after the cost of the modifications was reimbursed and the trade-in value was applied, Kenneth was left with $18,388.50 in out-of-pocket expenses for the modified van. Kenneth brought suit seeking reimbursement for the out-of-pocket expenses. The Court of Appeals ruled in favor of Kenneth, but the Supreme Court reversed: Auto-Owners met its statutory obligation to pay for the transportation expenses recoverable under the statute, by paying for the van’s modifications and reimbursing him for mileage to and from his medical appointments. The Court of Appeals erred by concluding that the base price of the van was compensable. View "Admire v. Auto-Owners Ins. Co. " on Justia Law

Benjamin Morris appealed an order of the Idaho Industrial Commission that denied his motion to set aside a lump sum settlement agreement he made with his employer's surety, Liberty Northwest Insurance. Morris initiated his workers' compensation action after he suffered injuries while working construction for his employer, Hap Taylor & Sons, Inc. Morris sustained a serious head injury on when a twenty-five pound rock thrown by a piece of heavy machinery struck him in the head. Morris initiated settlement discussions with Liberty Northwest Insurance, Hap Taylor & Sons' insurer. Liberty responded with a counter-offer—a single lump sum payment which Morris accepted "with the clear understanding this is a partial settlement and does not resolve the medical side." The parties executed a Stipulation and Agreement of Partial Lump Sum Discharge (LSSA) and submitted it to the Commission for approval. Approximately eighteen months later, on July 8, 2011, a Notice of Appearance was filed with the Commission whereby Morris substituted attorney Michael Walker with his then present counsel, attorney Starr Kelso. On the same day, Morris filed a motion to review the LSSA, accompanied by an affidavit signed by Kelso. Kelso's affidavit expressed concern that Morris may not have been "competent to testify" due to his injury—though, no credible evidence of incompetence was ever offered. Liberty filed an objection to Morris' motion to review. Ultimately, the Commission denied Morris' motion. Following the Commission's refusal to review the LSSA, Morris filed a Motion to Set Aside Lump Sum Settlement Agreement, seeking to void the LSSA on grounds of illegality and constructive fraud. The Commission issued an order denying Morris' motion to set the LSSA. Morris filed a timely appeal to the Supreme Court. After its review, the Supreme Court concluded that the Commission did not err in denying Morris' request for a hearing on his fraud claim. Furthermore, the Court affirmed the Commission's decision to deny Morris' motion to set the LSSA. View "Morris v. Hap Taylor & Sons" on Justia Law