Justia Insurance Law Opinion Summaries

Betty Lu Hughes appealed the district court's grant of summary judgment declaring Owners was not obligated to cover her claim for damages caused by an underinsured motorist. The court concluded that the Owners policy's underinsured motorist coverage did not cover Hughes's claims because the underinsured motorist's liability insurance bodily limit was not "less than" $100,000 as required by the policy's unambiguous definition of "underinsured automobile." The court need not reach the alternative argument that, even if the underinsured motorist's vehicle was "underinsured," the Owners policy set-off provision reduced the amount available under the Owners policy to zero. Accordingly, the court affirmed the judgment. View "Owners Ins. Co. v. Hughes" on Justia Law

Petitioner-Claimant Nancy Bertrand injured her right foot when she slipped on a wet floor while employed as a child care worker for Respondent Laura Dester Center (Employer). She sought certiorari review of the opinion of the Court of Civil Appeals (COCA) which sustained the Workers' Compensation Court's (WCC) denial of her request for travel costs to and from a vocational rehabilitation facility. Claimant contended that her allowance for travel expenses was effectively eliminated under the new Workers' Compensation Code, enacted August 26, 2011, which set a minimum for reimbursement of twenty miles round-trip. Claimant's total round-trip mileage was fourteen miles for which she was previously paid prior to the effective date of the Code. The trial court ordered the new law was procedural and could be applied retroactively. But after its review, the Supreme Court concluded that the WCC ordered vocational rehabilitation before August 26, 2011, and the treatment facility was outside the city limits of Claimant's hometown. As such, the Supreme Court reversed. View "Bertrand v. Laura Dester Center" on Justia Law

The law firm represented a potential buyer in the purchase of a drugstore. Buyer and Seller executed the sales contract separately. The firm misfiled the contract executed by Buyer, however, and Seller subsequently attempted to rescind the contract, which it characterized as an offer, because it had not timely received a copy of the contract executed by Buyer. When Seller’s efforts to avoid the purported contract were successful, Buyer sent a “formal notice of claim” to the firm, which sought coverage from its professional liability insurer. That insurer concluded that the firm was not entitled to coverage because it failed to properly notify the insurer of the mistake that ultimately led to the malpractice claim. The firm sought a declaratory judgment. The district court granted the insurer summary judgment. The Seventh Circuit affirmed, finding that the firm’s knowledge of the email exchange with Seller’s counsel and of an Alabama declaratory-judgment action constituted knowledge of “any circumstance, act or omission that might reasonably be expected to be the basis of” a malpractice claim. View "Koransky, Bouwer & Poracky, P. C. v. Bar Plan Mut. Ins. Co." on Justia Law

Olympus appealed the district court's dismissal of its complaint for failure to state a claim. Olympus argued that the district court erred in determining that its contract with Benfield clearly and unambiguously provided that Benfield did not owe Olympus an annual fee after Benfield was notified of Olympus's decision to replace Benfield with another reinsurance broker. The court agreed with the district court's sound reasoning that the proper reading of the contract was to define "Subject Business" as the placement and servicing of all of Olympus's reinsurance contracts and therefore, this part of the contract was not ambiguous. The court also agreed with the district court, which determined that "intent not to renew" encompassed both termination and replacement and therefore, no ambiguity existed as to that matter. When Guy Carpenter informed Benfield that it would be taking over as Olympus's reinsurance broker, this activated the forfeiture provision of the contract and released Benfield from the obligation to pay the Annual Fee to Olympus, regardless of whether it was viewed as termination, replacement, or intent not to renew. Because the court found the contract to be clear and unambiguous, Olympus's claims for equitable relief must be rejected. Accordingly, the court affirmed the judgment. View "Olympus Ins. Co. v. AON Benfield, Inc., et al" on Justia Law

An employee filed an affidavit of readiness for hearing in her workers' compensation case approximately four years after her employer filed a controversion of her written workers' compensation claim. The employer petitioned to dismiss her claim based on the statutory deadline for a hearing request. After a hearing, the Alaska Workers' Compensation Board dismissed her claim, and the Alaska Workers' Compensation Appeals Commission affirmed the Board's decision. Because the employee did not file a timely request for a hearing and was not excused from doing so, the Supreme Court affirmed the Commission's decision. View "Pruitt v. Providence Extended Care" on Justia Law

Holline and William Parsons (Plaintiffs) were enrolled in Today's Option, a Medicare Advantage Plan sponsored by the Pyramid Life Insurance Company (Pyramid). After Plaintiffs were each disenrolled from their respective plans, they brought suit against Pyramid, asserting numerous state law claims. The circuit court granted Plaintiffs' motion for summary judgment in part declaring that the Medicare Act did not provide the exclusive remedy for Plaintiffs' claims in this case. Pyramid then moved for Ark. R. Civ. P. 54(b) certification and a stay pending appeal, requesting permission to file an interlocutory appeal on the issues of whether Plaintiffs' state-law claims arose under the Medicare Act and whether their claims, to the extent they did not arise under the Act, were expressly preempted by the Act. The circuit court certified this appeal pursuant to Rule 54(b). The Supreme Court dismissed the appeal without prejudice, holding that the finding supporting Rule 54(b) certification was in error. View "Pyramid Life Ins. Co. v. Parsons" on Justia Law

State Farm filed a complaint for negligence against Appellant, alleging that Appellant was at fault in an automobile accident with State Farm's insured. Appellant counterclaimed, alleging that State Farm was unjustly enriched as a result of having engaged in the deceptive and unlawful business practice of causing collection-style letters to be mailed in an attempt to collect unadjudicated, potential subrogation claims as debts. Appellant's counterclaim identified two putative classes. State Farm filed a motion to strike the class allegations. Rather than granting the motion to strike class allegations, the circuit court denied class certification "for the reasons stated in State Farm's motion." The Supreme Court reversed, holding that the circuit court acted without due consideration of the Court's foregoing case law on typicality, commonality, and predominance and therefore abused its discretion in prematurely denying class certification at the early pleading stage of this case. Remanded. View "Kersten v. State Farm Mut. Auto. Ins. Co." on Justia Law

Defendant-Appellant Indiana Lumbermens Mutual Insurance Company (ILM) appealed the district court's denial of its motion for judgment as a matter of law, or in the alternative, for a new trial following a $2.2 million jury verdict in favor of Plaintiff-Appellee Ryan Development Company, L.C., d/b/a Agriboard Industries (Agriboard). This case arose from a fire that destroyed a Texas manufacturing facility in April 2009. Agriboard, manufactured building panels made of compressed straw. At the time of the fire, Agriboard was insured under a fire and related losses insurance policy issued by ILM with various coverages including lost income. By May 2009, ILM had paid $450,000; Agriboard filed suit and thereafter ILM paid $1.8 million. Agriboard continued to seek recovery under the policy, but ILM refused to pay the amount requested and Agriboard re-filed suit, seeking $2.4 million in unpaid coverages. The trial court denied ILM's motion for judgment as a matter of law, or in the alternative, for a new trial. ILM timely appealed that denial to the Tenth Circuit. Upon review, the Tenth Circuit found no abuse of the trial court's discretion in denying ILM's motion and affirmed the lower court's judgment. View "Ryan Development Co. v. Indiana Lumbermens Mutual Ins. Co." on Justia Law

Brothers Thomas and Michael Tessier allegedly swindled brothers Frederick and Thaddeus Jakobiec and the estate of their mother out of millions of dollars. This lawsuit covered the Tessiers' theft of almost $100,000 in life insurance proceeds due to a trust benefitting Thaddeus. Thaddeus and various persons affiliated with the trust and estate (collectively, Plaintiffs) filed this action against Merrill Lynch, the company that issued the life insurance policy, claiming that Merrill Lynch made out the insurance proceeds check to the wrong trust entity in breach of the insurance contract, thus allowing the Tessiers to steal the money. The First Circuit Court of Appeals granted summary judgment for Merrill Lynch, concluding that even if Merrill Lynch did breach the contract, its breach was not the cause of Plaintiffs' losses because the Tessiers would have stolen the money even if the check had been made out correctly. The First Circuit Court of Appeals affirmed, holding (1) because the extensive groundwork laid by the Tessiers for their criminal scheme, they could have and would have stolen the insurance money regardless of how Merrill Lynch made out the check; and (2) therefore, the district court correctly granted summary judgment for Merrill Lynch. View "Jakobiec v. Merrill Lynch Life Ins. Co." on Justia Law

Claimant Dorothy Robinson was a police officer for the City of Pittsburgh. In 1997, she sustained a work-related injury, and the City placed her on light-duty. In 2001, while traveling for treatment of her injury, Claimant was involved in an automobile accident in which she sustained new injuries. After the accident, Claimant did not return to her light-duty position nor was she offered any other light-duty work. In late 2004, Claimant received a disability pension. In connection with Claimant’s claim of entitlement to a disability pension, she was examined by three physicians who certified that Claimant was unable to perform her pre-injury job as a police officer. Nearly three years later, an independent medical examiner concluded that although Claimant was not fit to perform her prior job as a police officer, she could perform modified-duty work. The City filed a Petition to Suspend Compensation Benefits, asserting that Claimant was capable of working, "but has voluntarily removed herself from the work force as she has not looked for or sought employment in the general labor market." Claimant filed a response, denying the averments of the suspension petition and asserting that she remained attached to the workforce and had registered for work with the Pennsylvania Job Center. She further claimed that she was not presently working only because of the unavailability of work and because the City had eliminated her light-duty position. The Workers' Compensation Judge denied the suspension petition, concluding that Claimant had not voluntarily removed herself from the workforce. The issue before the Supreme Court in this appeal concerned the assignment of the burden of proof when the employer sought to modify or suspend a claimant's benefits on the basis that the claimant had retired. The Commonwealth Court plurality devised a "totality of the circumstances" test and concluded that the City failed to show that the injured worker had voluntarily withdrawn from the workforce. The City appealed, but the Supreme Court concurred with the Commonwealth Court and affirmed. View "City of Pittsburgh v. WCAB (Robinson)" on Justia Law