Justia Insurance Law Opinion Summaries

In 2002, Employee suffered injuries in a work-related accident and was rendered a paraplegic. Employer and its insurer accepted liability for Employee's injuries and paid various workers' compensation benefits. In 2010, Employee filed a medical request seeing payment for the installation of a ceiling-mounted motorized lift system. A compensation judge (1) determined that the cost of making the structural changes was compensable under Minn. Stat. 176.135 because those changes were necessary to provide Employee with reasonable and necessary medical treatment, and (2) ordered Employer and its insurer to pay for the modifications in their entirety. The workers' compensation court of appeals reversed, concluding that the changes to Employee's home necessary to permit installation of the lift system constituted "alteration or remodeling" of Employee's home and that Employer's liability was therefore limited by Minn. Stat. 176.137. The Supreme Court affirmed, holding that the cost of the structural modifications to Employee's residence that were necessary to permit the ceiling-mounted track system to be installed were "alteration or remodeling" costs subject to section 176.137 and were not costs of medical treatment. View "Washek v. New Dimensions Home Health & State Fund Mut. Ins. Co. " on Justia Law

W.R. Allison Enterprises, Inc. was a small business operated by a sole owner. Allison hired an employee in early 2009 and secured workers' compensation and employers' liability insurance from CompSource. Allison prepaid the estimated annual premium. The employee only worked for Allison for approximately one month. Allison asked its insurance agent to cancel the workers' compensation insurance policy. CompSource acknowledged the cancellation request and advised that it would issue a ten-day notice of cancellation on a short rate basis in conformance with the insurance policy. CompSource prepared a final audit report, calculating the gross premium, short rate cancellation penalty, and a catastrophe premium. CompSource subtracted the audit amount from the estimated prepaid annual premium and refunded the remainder as the unearned premium calculated on a short rate basis. Allison took the position that the short rate penalty charge conflicted with 85 O.S.2001, section 67.1 which expressly required the insurance company to refund a pro rata share of the prepaid premium if it canceled a policy and that the policy's short rate penalty provision was changed, by operation of law, to comply with section 67.1. Allison filed suit against CompSource on behalf of itself and other similarly situated employers to recover the short rate penalties charged by CompSource, alleging CompSource's refusal to return the short rate penalty charge constituted a breach of the insurance policy as impliedly amended by law. The trial court overruled CompSource's counter motion for summary judgment. The trial court granted partial summary judgment in favor of plaintiff and certified an interlocutory order that decided that when an insured employer requests that a workers' compensation insurance policy be canceled, the insurer must refund the prepaid premium on a pro rata basis pursuant to 85 O.S.2001, 67.1. The insurer filed a petition for certiorari review arguing that the pro rata refund provisions in the statute apply only when the insurer initiates the cancellation. Upon review, the Supreme Court concluded: (1) the statute was ambiguous as to insured-initiated cancellations of workers' compensation insurance policies; (2) the state insurance department has applied the statute only to insurer-initiated cancellations; and (3) plaintiff respondent did not establish any cogent reason why the Court should not defer to the department's longstanding application. Accordingly, the Supreme Court reversed. Section 67.1 did not require CompSource to make a pro rata refund of unearned prepaid premium to Allison. View "W.R. Allison Enterprises, Inc. v. CompSource of Oklahoma" on Justia Law

Appellant Mary E. Spellman ("Spellman") petitioned the Industrial Accident Board (the "Board") for a workers' compensation award against her employer, Appellee Christiana Care Health Services ("Christiana"). The Board denied the petition and the Superior Court affirmed. Appellant worked as a home health aide, where she used her personal vehicle to attend to Christiana's clients at their homes. While Appellant was reimbursed for mileage between client appointments, she was not reimbursed for travel to the first appointment, from the last appointment, or "off the clock" when she attended to personal business. In the middle of her work day, Appellant was off the clock when her car hit a patch of ice causing Appellant to crash her car. She sustained injuries to her head and hip. In her petition, Appellant argued that her status as a traveling employee exempted her from the "going and coming" rule that precludes workers' compensation for injuries suffered while going or coming from work. Alternatively, Appellant argued her injuries were compensable because she was engaged in a "mixed purpose" trip at the time of her accident. Having "no difficulty" sustaining the judgment of the Superior Court, the Supreme Court affirmed. View "Spellman v. Christiana Care Health Services" on Justia Law

ANI, a risk retention group, filed suit seeking declaratory and injunctive relief against the Commissioner and the Division of Insurance under 42 U.S.C. 1983. ANI claimed that an order of the Commissioner violated the Liability Risk Retention Act (LRRA), 15 U.S.C. 3902(a)(1). The court held that the Commissioner's Order, which barred ANI from writing first dollar liability insurance policies in Nevada, was preempted by the LRRA. Therefore, the court affirmed the district court's entry of declaratory and injunctive relief in favor of ANI. However, the LRRA did not confer a right to be free from state law that could be enforced under 42 U.S.C. 1983, making fees under 42 U.S.C. 1988 unavailable. Thus, the court vacated the fee award. Finally, the court remanded so that the district court could enter a new summary judgment order consistent with this opinion. View "Alliance of Nonprofits for Ins. v. Kipper, et al" on Justia Law

Plaintiffs filed a claim with their insurer (Insurer) for underinsured motorist benefits after a car accident. Pursuant to a provision of the insurance policy, the parties submitted the dispute to an arbitration panel. Prior to the arbitration hearing, Insurer sought broad discovery under Wis. Stat. 804. Plaintiffs refused to comply with such discovery on the grounds that Wis. Stat. 788.07 controlled and permitted only the taking of certain depositions. The arbitration panel decided that Insurer was entitled to chapter 804 discovery. The circuit court reversed and directed that arbitration discovery would proceed as allowed by section 788.07. The court of appeals reversed, holding that Plaintiffs were not allowed to seek an interlocutory appeal, and that full chapter 804 discovery was available to Insurer. The Supreme Court affirmed as modified, holding (1) because no unusual circumstances justified an interlocutory appeal, Plaintiffs' action in the circuit court was premature; and (2) because Insurer failed to include an explicit, specific, and clearly drafted arbitration clause stating otherwise, discovery in this case was limited to that provided for in section 788.07. Remanded. View "Marlowe v. IDS Prop. Cas. Ins. Co." on Justia Law

K & L Homes, Inc. ("K & L") appealed the trial court's summary judgment declaring no coverage existed under K & L's commercial general liability ("CGL") policy with American Family Mutual Insurance Company ("American Family") for damages awarded against K & L in an underlying action. Upon review of the applicable case law pertinent to this matter, the Supreme Court concluded there could be an "occurrence" under the CGL policy at issue in this case. Therefore, the Court reversed the summary judgment and remanded the case for further proceedings. View "K & L Homes, Inc. v. American Family Mutual Ins. Co." on Justia Law

Upon Marcus Degen's purchase of a home, Marcus purchased a homeowner's insurance policy with Hanson Farm Mutual Insurance Company of South Dakota (HFMIC). Marcus, Tina Sellers, and Tina's two daughters moved into the house. One evening, while Marcus was leveling dirt on the property with a skid loader, Marcus hit and killed one of the girls, Adrianna. Tina pursued a wrongful death action against Marcus a year later. HFMIC filed a declaratory judgment action asking the trial court to determine whether it had an obligation to indemnify or defend Marcus in the underlying wrongful death action. The trial court ruled in favor of HFMIC, determining that Adrianna was in Marcus's care and was therefore excluded from coverage under a household exclusion contained in the policy. Both Tina, as the personal representative of her daughter's estate, and Marcus appealed. The Supreme Court affirmed, holding (1) the trial court correctly concluded that the phrase "in your care" was unambiguous and in concluding that Adrianna was in Marcus's care; and (2) because she was in Marcus's care, Adrianna was excluded from coverage under the household exclusion contained in the policy. View "Hanson Farm Mut. Ins. Co. of S.D. v. Degen" on Justia Law

This case involved multiple litigations among three parties - Insurer, insured Mortgagee, and Homeowner - arising out of a defect in the title to Homeowner's home. Insurer brought suit in the land court on behalf of Mortgagee seeking to reform the deed to the property or to equitably subrogate Homeowner's interest in the property behind Mortgagee's mortgage. Homeowner initiated suit in the superior court against Mortgagee. Eventually, all claims in both actions became part of a federal court case, which settled. Thereafter, Mortgagee filed a complaint against Insurer in the U.S. district court seeking to recover from Insurer for the costs Mortgagee incurred in defending against Homeowner's claims. The judge determined Insurer had no obligation under its title insurance policy to pay Mortgagee's defense costs but certified two questions to the Massachusetts Supreme Court. The Court answered by holding that, under Massachusetts law (1) a title insurer does not have a duty to defend the insured in the entire lawsuit where one claim is within the scope of the title insurance coverage and other claims are not; and (2) a title insurer that initiates litigation similarly does not have a duty to defend the insured against all reasonably foreseeable counterclaims. View "GMAC Mortgage, LLC v. First Am. Title Ins. Co." on Justia Law

From 1997 through 2009 Sachdeva, the vice president for accounting at Koss, instructed Park Bank, where Koss had an account, to prepare more than 570 cashier’s checks, payable to Sachdeva’s creditors and used to satisfy personal debts. She embezzled about $17.4 million, pleaded guilty to federal crimes, and was sentenced to 11 years’ imprisonment. The SEC sued Sachdeva and an accomplice because their scheme caused Koss to misstate its financial position. Koss and Park Bank are litigating which bears the loss in Wisconsin. In this suit, Park Bank argued that Federal Insurance must defend and indemnify it under a financial-institution bond (fidelity bond) provision that promises indemnity for “Loss of Property resulting directly from . . . false pretenses, or common law or statutory larceny, committed by a natural person while on the premises of” the Bank. Sachdeva did not enter the Bank’s premises. She gave instructions by phone, then sent employees to fetch the checks. The district court entered judgment in the insurer’s favor. The Seventh Circuit affirmed; every court that has considered the subject has held that a fraud orchestrated from outside a financial institution’s premises is not covered under the provision, which is standard in the industry. View "Bankmanagers Corp. v. Fed. Ins. Co." on Justia Law

Aetna, Inc. filed a coordinated complaint with Kaiser Foundation Health Plan and Kaiser Foundation Hospitals (together, Kaiser) and Guardian Life Insurance Company (Guardian) against Pfizer, Inc. and Warner-Lambert Company (together, Pfizer). The coordinated plaintiffs asserted that they had suffered injury from the fraudulent marketing of Neurontin for off-label uses, and alleged violations of, inter alia, the Racketeer Influenced and Corrupt Organizations Act (RICO) and the Pennsylvania Insurance Fraud Statute (PIFS). The district court dismissed the claims of Guardian and Aetna but denied summary judgment as to Kaiser's claims. The court then entered judgment against Guardian and Aetna and in favor of Pfizer. The First Circuit Court of Appeals (1) reversed the dismissal of Aetna's RICO claim, as Aetna presented evidence of causation and damages sufficient to survive summary judgment; and (2) vacated the district court's dismissal of Aetna's claim under the PIFS. Remanded. View "Aetna, Inc. v. Pfizer, Inc." on Justia Law