Articles Posted in Insurance Law

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The Eleventh Circuit Court of Appeals certified a question of Georgia law to the Georgia Supreme Court stemming from an appeal in a personal injury case arising from an automobile accident. The Eleventh Circuit asked for the proper interpretation of OCGA 9-11-67.1, which governed the formation of settlement agreements pursuant to a pre-suit “offer to settle a tort claim for personal injury, bodily injury, or death arising from the use of a motor vehicle and prepared by or with the assistance of an attorney on behalf of a claimant or claimants” (a “Pre-Suit Offer”). The Supreme Court responded that OCGA 9-11-67.1 did not prohibit a claimant from conditioning acceptance of a Pre-Suit Offer upon the performance of some act, including a timely payment. The Court left it to the Eleventh Circuit to apply this principle to the facts of this case. View "Grange Mutual Casualty Co. v. Woodard" on Justia Law

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Adrian Burdette was seriously injured when he fell while attempting a controlled descent from a cell-phone tower in contravention of instructions by his employer, Chandler Telecom, LLC (“Chandler”), that technicians must climb down from towers. This case presented the question of whether an employee could, in deliberate disobedience of his employer’s explicit prohibition, act in a knowingly dangerous fashion with disregard for the probable consequences of that act, and still recover workers’ compensation when injured by that disobedient act. The Supreme Court concluded that OCGA 34-9-17(a) could bar recovery in such cases. View "Chandler Telecom, LLC v. Burdette" on Justia Law

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In 1993, Willie Barnes suffered an amputation of his left leg below the knee in an industrial accident at the Georgia-Pacific (GP) wood processing plant where he worked. GP, its insurer Georgia Conversion Primary Ins. Co. and its workers’ compensation servicing agent CCMSI, accepted the claim as catastrophic and began paying temporary total disability (TTD) benefits. Barnes was fitted with a prosthetic leg and returned to lighter duty work in January 1994. On January 30, 1994, GP stopped paying TTD benefits to Barnes, and the TTD benefits were replaced with permanent partial disability (PPD) benefits. The PPD benefits continued until May 1998. In 2006, the GP plant was sold to Roseburg Forest Products Company (Roseburg). Barnes continued working for Roseburg, but was laid off on September 11, 2009. On November 13, 2009, Barnes consulted a doctor regarding chronic knee pain. Two years later, he was fitted for a new prosthetic leg, which was paid for by CCMSI, the company that continued as the workers’ compensation servicing agent for Roseburg and Roseburg’s insurer, ACE American Insurance Co. (ACE American). On August 30, 2012, Barnes filed a claim to resume TTD benefits, asserting the date of his original workplace accident August 13, 1993 as the date of injury. On November 30, 2012, Barnes filed a separate notice of claim, alleging a fictional new injury based on the date that he was terminated from his employment, September 11, 2009. The Administrative Law Judge denied the claims as barred by the applicable statutes of limitation set out in OCGA 34-9-104 (b) and 34-9-82. The State Board of Workers’ Compensation (Board) affirmed, as did the trial court. However, the Court of Appeals reversed, finding that both of Barnes’ claims were not barred by the applicable statutes of limitation. The Supreme Court concluded the appellate court erred in its interpretation of the applicable statutes of limitations in these cases, and reversed. View "Roseburg Forest Products Co. v. Barnes" on Justia Law

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Amy Smith, individually and as next friend of her daughter Tyasia Brown, sued her landlord, Bobby Chupp for injuries Brown allegedly sustained as the result of ingesting lead from deteriorating lead-based paint at the house Smith rented from Chupp. The house was insured by Chupp under a commercial general liability (CGL) policy issued by Georgia Farm Bureau Mutual Insurance Company (GFB). After Chupp tendered Smith’s claims to GFB under the provisions of the policy, GFB filed a declaratory judgment action against Smith and Chupp seeking a determination that Brown’s injuries were not covered under the policy and that it had no duty to defend Chupp against Smith’s claims. The Georgia Supreme Court granted a petition for certiorari to the Court of Appeals to determine whether the Court of Appeals erred in holding, as a matter of first impression, that personal injury claims arising from lead poisoning due to lead-based paint ingestion were not excluded from coverage pursuant to an absolute pollution exclusion in CGL insurance policy covering residential rental property. Because the Supreme Court disagreed with the Court of Appeals’ conclusion that lead-based paint was not clearly a “pollutant” as defined by the policy, it reversed the Court of Appeals' decision in this case. View "Georgia Farm Bureau Mut. Ins. Co. v. Smith" on Justia Law

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Amy Smith, individually and as next friend of her daughter Tyasia Brown, sued her landlord, Bobby Chupp for injuries Brown allegedly sustained as the result of ingesting lead from deteriorating lead-based paint at the house Smith rented from Chupp. The house was insured by Chupp under a commercial general liability (CGL) policy issued by Georgia Farm Bureau Mutual Insurance Company (GFB). After Chupp tendered Smith’s claims to GFB under the provisions of the policy, GFB filed a declaratory judgment action against Smith and Chupp seeking a determination that Brown’s injuries were not covered under the policy and that it had no duty to defend Chupp against Smith’s claims. The Georgia Supreme Court granted a petition for certiorari to the Court of Appeals to determine whether the Court of Appeals erred in holding, as a matter of first impression, that personal injury claims arising from lead poisoning due to lead-based paint ingestion were not excluded from coverage pursuant to an absolute pollution exclusion in CGL insurance policy covering residential rental property. Because the Supreme Court disagreed with the Court of Appeals’ conclusion that lead-based paint was not clearly a “pollutant” as defined by the policy, it reversed the Court of Appeals' decision in this case. View "Georgia Farm Bureau Mut. Ins. Co. v. Smith" on Justia Law

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The issue this case presented for the Supreme Court's review centered on recovery under an uninsured motorist (UM) insurance policy. Specifically, the issue was whether the burden of proof on summary judgment between the insured and the UM carrier was misallocated. The UM carrier denied coverage based on a claim that the at-fault driver was not "uninsured" as defined in the UM policy at issue here because the drive's liability carrier had not "legally denied" coverage. After review, the Supreme Court concluded the Court of Appeals erred in placing the burden of proof on the UM carrier in this instance, and therefore reversed. View "Travelers Home & Marine Ins. Co. v. Castellanos" on Justia Law

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The Eleventh Circuit Court of Appeals certified a question of law to the Georgia Supreme Court. The certified question arose out of a declaratory judgment action related to underinsured motorist (“UIM”) coverage under a commercial auto insurance policy issued by FCCI Insurance Co. (“FCCI”). The litigation was the result of a 2011 collision between a McLendon Enterprises, Inc. truck driven by McLendon employee Brooks Mitchell, with passengers Elijah Profit, III and Bobby Mitchell (“Bobby”), and an Evans County school bus driven by John Haartje. Profit, Bobby, and Mitchell claimed injuries as a result of the collision. In May 2013, Mitchell filed suit in state court against Haartje and the Evans County Board of Education to recover for his alleged damages. Mitchell served FCCI as McLendon's uninsured motorist (UM) carrier. At the time of the collision, the School District had an insurance policy with GSBA Risk Management Services, under whose policy, paid out the $1,000,000 liability limits for damages related to the collision. It settled with Profit and Bobby for $350,000 combined and agreed to pay Mitchell the remaining $650,000 in exchange for a limited liability release, thereby exhausting its $1,000,000 liability limits. Mitchell filed for UM benefits from FCCI. FCCI denied liability on the basis of the at-fault driver's statutory immunity. The question certified centered on whether an insured party could recover under an uninsured-motorist insurance policy providing that the insurer will pay sums “the insured is legally entitled to recover as compensatory damages from the owner or driver of an uninsured motor vehicle” despite the partial sovereign immunity of the tortfeasor. The Georgia Supreme Court answered the question in the affirmative. View "FCCI Insurance Co. v. McLendon Enterprises, Inc." on Justia Law

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Piedmont Office Realty Trust, Inc. purchased two insurance policies: a primary policy issued by Liberty Surplus Insurance Company and an excess coverage policy issued by XL Specialty Insurance Company ("XL"). The excess policy provided that XL will only pay for a "loss" which Piedmont became "legally obligated to pay as a result of a securities claim." The policy also contains a "consent to settle" clause. In addition, the policy contains a "no action" clause which read: "No action shall be taken against the insurer unless, as a condition precedent thereto, there shall have been full compliance with all of the terms of this policy, and the amount of the insureds’ obligation to pay shall have been finally determined either by judgment against the insureds after actual trial, or by written agreement of the insureds, the claimant and the insurer." Piedmont was named as a defendant in a federal securities class action suit in which the plaintiffs sought damages exceeding $150 million. Relatively early in the litigation, Piedmont moved for summary judgment. The district court denied Piedmont’s motion. Thereafter, following years of discovery and litigation, Piedmont renewed its summary judgment motion. The district court granted the renewed motion and dismissed the class action suit. Plaintiffs appealed. While the plaintiffs’ appeal was pending, plaintiffs and Piedmont agreed to mediate plaintiffs’ claim. By that time, Piedmont had already exhausted its coverage limit under its primary policy and another $4 million of its excess policy simply by defending itself. Anticipating a settlement with plaintiffs, Piedmont sought XL’s consent to settle the claim for the remaining $6 million under the excess policy. XL agreed to contribute $1 million towards the settlement, but no more. Without further notice to XL and without obtaining XL’s consent, Piedmont agreed to settle the underlying lawsuit with plaintiffs for $4.9 million. The district court approved the settlement and Piedmont demanded XL provide coverage for the full settlement amount. XL refused. Piedmont filed suit against XL for breach of contract and bad faith failure to settle. XL moved to dismiss the complaint; the district court granted XL’s motion; and Piedmont appealed. The 11th Circuit certified three questions to the Georgia Supreme Court: (1) Under the facts of this case, was Piedmont "legally obligated to pay" the $4.9 million settlement amount, for purposes of qualifying for insurance coverage under the Excess Policy?; (2) In a case like this one, when an insurance contract contains a "consent-to-settle" clause that provides expressly that the insurer's consent "shall not be unreasonably withheld," can a court determine, as a matter of law, that an insured who seeks (but fails) to obtain the insurer's consent before settling is flatly barred from bringing suit for breach of contract or for bad-faith failure to settle?; and (3) In this case, under Georgia law, was Piedmont's complaint dismissed properly? The Georgia Supreme Court responded: absent XL’s consent to the settlement, under the terms of the policy, Piedmont could not sue XL for bad faith refusal to settle the underlying lawsuit in the absence of a judgment against Piedmont after an actual trial. It follows that the district court did not err in dismissing Piedmont’s complaint. View "Piedmont Realty Office Trust v. XL Specialty Insurance Co." on Justia Law

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Wayne Farms owned and operated a chicken processing plant in Oakwood. A fire broke out at the plant in 2003. Roughly three years later, Wayne Farms and its insurers filed suit against Crane Composites, Inc., which manufactured interior panels used in the plant, alleging Crane’s negligence caused the fire to spread extensively. In the meantime, the legislature enacted OCGA 9-11-68 (b) (1). The question for decision in this case is whether OCGA 9-11-68 (a tort reform, fee-shifting statute) could be applied to a negligence action in which the injury occurred prior to the effective date of the statute, but in which the action was filed after that date. The Supreme Court concluded that it could, and in so doing, overruled the case law set forth in "L. P. Gas Industrial Equipment Co. v. Burch," (701 SE2d 602) (2010)). View "Crane Company v. Wayne Farms, LLC" on Justia Law

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Velicia Carter was injured in an automobile collision with Jeova Oliviera. It was alleged that Oliviera was under the influence of alcohol at the time. Oliviera had an auto liability insurance policy with GEICO General Insurance Company with a $30,000 per person liability limit. Carter was insured by Progressive Mountain Insurance Company, including uninsured/underinsured motorist (UM) coverage of $25,000 per person. Carter sued Oliviera and served Progressive as her UM carrier, and entered into a settlement in which GEICO paid the $30,000 limit of Oliviera's policy, and Carter executed a limited liability release. It allocated $29,000 of GEICO's payment to punitive damages and $1,000 to compensatory damages. Progressive answered the suit as Carter's UM carrier and sought summary judgment on the UM claim, which the trial court granted, ruling that, by imposing the condition that $29,000 of the liability coverage limit be allocated to the payment of punitive damages, Carter failed to meet a prerequisite for recovery of the UM benefits. The Court of Appeals affirmed, finding that, by allocating a portion of the payment to punitive damages, rather than allocating all of the payment to compensatory damages, Carter failed to exhaust the limits of Oliviera's liability policy, and, therefore, forfeited the ability to make a claim on her UM policy. The Supreme Court granted a writ of certiorari to the Court of Appeals to determine if that Court properly applied the motor vehicle insurance limited liability release provision of OCGA 33-24-41.1. Finding that the Court of Appeals erred, the Supreme Court reversed that Court's judgment. View "Carter v. Progressive Mountain Ins." on Justia Law