Justia Insurance Law Opinion Summaries

Phillips was beneficiary of a life insurance policy purchased by her fiancé, Strang, issued by Prudential. When Strang died, Prudential informed Phillips that the default method of payment was the “Alliance Account settlement option,” under which the insurer, instead of paying a lump-sum benefit, creates an interest-bearing account for the beneficiary and sends her checks that can be used to draw the funds, in part or in whole, at any time. The funds are held in Prudential’s general investment account, which allows Prudential to profit from the spread between its investment returns and interest paid to the beneficiary, in Phillips’s case, three percent. In a putative class action, Phillips claimed that establishment of the Alliance Account as the default payment method and her enrollment in it breached the insurance policy and unreasonably delayed payment of benefits in violation of the Illinois Insurance Code and that Prudential breached a fiduciary duty by not disclosing information regarding investments made with her funds and by keeping investment profits. The district court dismissed. The Seventh Circuit affirmed. “Whether this practice is disreputable is open to debate,” but It did not breach the policy, did not effect an unreasonable delay, and did not breach any fiduciary duty. View "Phillips v. Prudential Ins. Co." on Justia Law

Employee suffered an accident arising out of the course of his employment on October 23, 2007. Employee filed a workers' compensation action on February 28, 2012 against Employer, seeking relief under an amended version of Neb. Rev. Stat. 48-121(3), alleging that he was entitled to benefits calculated on the basis of the loss of earning capacity pursuant to this amendment. The Legislature specified that the operative date of the amendment to the statute was January 1, 2008. The workers' compensation court granted summary judgment for Employer, concluding that the amendment was substantive rather than procedural and that because Employee's accident and injuries occurred prior to the operative date of the amendment, Employee could not recover for a loss of earning capacity under the amendment. The Supreme Court affirmed, holding that because the amendment to section 48-121(3) did not apply to Employee's action, he could not recover for an alleged loss of earning capacity on that basis. View "Smith v. Mark Chrisman Trucking, Inc." on Justia Law

Shane Traylor Cabinetmaker, L.L.C. ("STC"), and Michael Shane Traylor sued American Resources Insurance Company, Inc., alleging breach of contract and bad faith, based on American Resources' refusal to defend or to indemnify STC and Traylor on counterclaims filed against them by Robert Barbee and R.L. Barbee Builders, Inc. in a separate action. The circuit court entered a summary judgment in favor of American Resources, and STC and Traylor appealed. Finding no error, the Supreme Court affirmed. View "Shane Traylor Cabinetmaker, L.L.C. v. American Resources Insurance Company, Inc. " on Justia Law

Respondent, a firefighter, filed a claim for workers' compensation benefits after he was diagnosed with cancer within four years from the commencement of his employment with the City. Respondent asserted that his cancer was a compensable occupational disease that resulted from his work as a firefighter. The City denied the claim for benefits. A hearing officer with the Department of Administration Hearings Division affirmed the denial of the claim because Defendant had not been employed as a firefighter for five years pursuant to Nev. Rev. Stat. 617.453. An appeals officer reversed, holding that Defendant satisfied Nev. Rev. Stat. 617.440's requirements for proving a compensable occupational disease. The district court affirmed. The Supreme Court affirmed, holding (1) the district court did not err in upholding the appeals officer's determination that a firefighter such as Evans, who fails to qualify for section 617.453's rebuttable presumption can still seek workers' compensation benefits pursuant to section 617.440 by proving that his cancer is an occupational disease that arose out of his employment; and (2) the appeals officer correctly found Respondent's cancer was a compensable occupational disease. View "City of Las Vegas v. Evans" on Justia Law

In 2006, Plaintiffs sustained serious injuries in an automobile accident and incurred medical expenses in excess of $1,000,000. Plaintiffs subsequently learned that they had only $5,000 in medical payments coverage and did not have any underinsured motorist (UIM) coverage after a transfer of their Oregon State Farm policy to Montana by the Mark Olson State Farm Agency. The driver who caused the accident carried the statutory minimum automobile liability insurance limits. Plaintiffs sued State Farm and Mark Olson, requesting declaratory relief and a reformation of the contract and alleging negligence, breach of fiduciary duty, and conduct sufficient to support an award of punitive damages. The district court entered summary judgment in favor of Defendants. The Supreme Court reversed, holding that the district court erred in entered summary judgment in favor of State Farm and Olson on Plaintiffs' negligence claims. Remanded for trial. View "Bailey v. State Farm Auto. Ins. Co." on Justia Law

Appellant was employed by Employer when he suffered a compensable work-related brain injury. Appellant, who was permanently and totally disabled, filed a workers' compensation claim seeking benefits and also requested benefits for the nursing care services his mother was providing. The workers' compensation commission (Commission) found Appellant's injury was compensable but denied the requested nursing service benefits. Appellant subsequently made a second request for additional benefits in the form of nursing services at Timber Ridge Ranch, an assisted living facility. The Commission denied Appellant benefits, finding that the services at Timber Ridge were not nursing services as defined by the law. The court of appeals affirmed. The Supreme Court reversed, holding that the Commission's findings and conclusions were not supported by substantial evidence and that the services provided at Timber Ridge qualified as nursing services under the applicable statutes. Remanded. View "Pack v. Little Rock Convention Ctr. & Visitors Bureau" on Justia Law

The issue before the Supreme Court in this case concerned the proper procedure by which a workers' compensation insurer may enforce a subrogation claim arising under Mississippi Code Section 71-3-71. Richard Shoemake was injured in Alabama but received workers' compensation benefits from Liberty Mutual Insurance Company under Mississippi law. He brought and settled a third-party action in Alabama state court and reimbursed Liberty Mutual only the amount it was entitled to under Alabama law. Liberty Mutual, which knew of but did not join or intervene in the Alabama lawsuit, then sued Shoemake in the Circuit Court of Newton County, seeking full reimbursement as allowed under Section 71-3-71. In granting Shoemake summary judgment, the circuit court held that Alabama law applied and further concluded that res judicata and Liberty Mutual's failure to intervene in the Alabama action barred Liberty Mutual's claim. The Court of Appeals reversed, holding that Mississippi law governed the amount of Liberty Mutual's subrogation claim and that Liberty Mutual was not required to intervene in the Alabama action to become entitled to reimbursement under Mississippi law. Because the Mississippi Supreme Court found that 71-3-71 requires a workers' compensation insurer to join or intervene in a third-party action to become entitled to reimbursement, it reversed the Court of Appeals and affirmed the circuit court. View "Liberty Mutual Insurance Company v. Shoemake" on Justia Law

This case involved the interpretation of two contractual provisions under Minnesota law: an indemnification clause in a contract between PDSI and Miller and an insurance contract between Harleysville and PDSI which extended insurance coverage to PDSI's indemnification of third parties for tort liability caused, in whole or in part, by PDSI or by those acting on its behalf. The court agreed with the district court's finding that a PDSI employee's suit fell squarely within the indemnity provision of the 1989 Agreement between PDSI and Miller. The court also agreed with the district court's interpretation of the insurance agreements as requiring Harleysville to cover Miller's settlement of the employee's claims. Further, the court concluded that the undisputed facts established as a matter of law that PDSI or those acting on its behalf at least partly caused the employee's bodily injury within the terms of the Harleysville policy. Accordingly, the court affirmed the judgment. View "Harleysville Ins. Co. v. Physical Distrib. Serv., et al" on Justia Law

This case arose out of the payment of benefits pursuant to an Aflac accident insurance policy. Defendant and the decedent's siblings challenged the district court's entry of summary judgment and order compelling arbitration of defendant's claims against Aflac and its agents. At issue was whether defendant's affidavit, which included her opinion that the signature on the arbitration acknowledgment form was a forgery, was sufficient to create a genuine issue of material fact. The court concluded that defendant's affidavit was never made part of the summary judgment record before the district court and therefore failed to create a genuine issue of material fact on the authenticity of the decedent's signature. Accordingly, the court affirmed the district court's judgment. View "American Family Life Assurance Co. of Columbus v. Biles, et al" on Justia Law

Appellant was injured during the course and scope of his employment. Appellant filed a motion for temporary total disability compensation, which a hearing officer granted. The Industrial Commission later terminated temporary total disability compensation based on the report of doctor who stated that the allowed conditions in Appellant's workers' compensation claim had reached maximum medical improvement. Appellant filed a complaint in mandamus, alleging that the Commission acted contrary to law when it relied on the report of the doctor. The court of appeals denied the writ, concluding that the doctor's report constituted some evidence upon which the Commission could rely. The Supreme Court affirmed, holding that the doctor's report was sufficiently reliable to constitute some evidence to support the Commission's decision. View "State ex rel. Coleman v. Schwartz" on Justia Law