Legal News

Case Summaries

Insurance Law

[01/05] State of California v. Cont'l Ins. Co.
In a lawsuit brought by the state against its insurers for recovery of amounts paid to clean up a hazardous waste site, trial court erred in: 1) admitting certain documents under the "ancient documents" hearsay exception because those documents had not "been generally acted upon as true"; and 2) holding that the state was not allowed to stack the policy limits of all applicable policies across all applicable policy periods.

[12/30] Food Pro Int'l, Inc. v. Farmers Ins. Exchange
In connection to a tort claim brought by an injured construction worker against plaintiff, judgment in favor of defendant-insurer in plaintiff-insuree's claim for breach of contract and breach of implied covenant of good faith and fair dealing is reversed where: 1) there was no merit to plaintiff's punitive damages argument; but 2) the trial court erred in finding that defendant-insurer had no duty to defend plaintiff.

[12/29] Sanders v. Unum Life Ins. Co. of Am.
Insurance company correctly deducted claimant's social security disability payments from the amount owed him under long-term disability insurance. Although his SSDI payments arose from his inability to work due to mental illness, while his long-term disability payments arose from his inability to work due to physical impairments, his inability to work constituted a single disability with both mental and physical causes.

[12/24] McCauley v. First Unum Life Ins. Co.
In a challenge to defendent-insurer's denial of plaintiff's claim for long-term disability benefits, dismissal of plaintiff's complaint is reversed and remanded where: 1) in light of the Supreme Court decision in Metropolitan Life Insurance Co. v. Glenn, the Employee Retirement Income Security Act (ERISA) plan administrator abused its discretion in denying plaintiff's claim; 2) the administrator had a conflict of interest because it had both the discretionary authority to determine the validity of the employee's claim and paid the benefits under the policy; 3) a reasonable trier of fact would conclude that defendant-insurer's denial of long-term disability was arbitrary and capricious; and 4) plaintiff was entitled to benefits and interest running from September 18, 1995, the date on which defendant-insurer rejected plaintiff's appeal.

[12/04] Mercury Ins. Co. v. Pearson
Pedestrian who was struck by an uninsured motorist while crossing an intersection with his fiancée is not entitled to coverage under his fiancée's auto insurance policy. Judgment in favor of auto insurer is affirmed where the policy unambiguously extends uninsured motorist coverage to pedestrians only if they are "named insureds" or their spouses or relatives living in the same household.

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Workers' Comp

[12/30] Bullock v. AIU Ins. Co.
In a lawsuit alleging bad-faith failure to timely pay workers' compensation benefits, summary judgment for defendants is reversed and remanded in light of a Mississippi Supreme Court determination that the suit was timely filed.

[12/19] Southwestern Bell Tel. Co., L.P. v. Mitchell
In a worker's compensation claim, grant of summary judgment in favor of respondent-decedent is reversed where: 1) the rule announced in Continental Casualty Co. v. Downs was in effect for only about one year; and 2) it was wrongly decided.

[12/18] Ioerger v. Halverson Const. Co., Inc.
The immunity afforded to an employer by the exclusive remedy provisions of the Workers' Compensation Act (820 ILCS 305/5(a), 11 (West 2000)) extends to the employer's co-venturer in a joint venture and to the joint venture itself.

[12/16] Hertz v. Workers' Compensation Appeals Bd.
In a worker's compensation claim, an award determined by respondent-Board is reversed and remanded where: 1) victim-employee's permanent disability should have been rated using the 1997 rating schedule rather than the 2005 rating schedule; 2) a finding of permanent total disability was not appropriate in this case; 3) under the revised worker's compensation system an employer is liable for only the portion of an injured worker's permanent disability that is directly caused by the industrial injury; 4) a finding of permanent total disability in employee's case was based in part on a finding that vocational rehabilitation was not feasible due in part to pre-existing nonindustrial factors; and thus, 5) company was not liable for that portion of victim-employee's permanent disability that was caused by pre-existing nonindustrial factors.

[09/25] Sanders v. City of Orlando
In a workers' compensation case, reversal of vacatur of a prior settlement agreement by a Judge of Compensation Claims (JCC) is quashed where a 2001 statutory change did not strip JCCs of jurisdiction to set aside workers' compensation agreements. (Revised opinion)

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