Articles Posted in Insurance Law

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The Supreme Court’s decision in West v. Shelby County Healthcare Corp., 459 S.W.3d 33 (Tenn. 2014), holding that “reasonable charges” for medical services under Tennessee’s Hospital Lien Act are the discounted amounts a hospital accepts as full payment from patients’ private insurer and not the full, undiscounted amounts billed to patients, does not apply in personal injury cases. Further, the collateral source rule applies in this personal injury case, in which the collateral benefit at issue is private insurance. Therefore, Plaintiffs may submit evidence of the injured party’s full, undiscounted medical bills as proof of reasonable medical expenses, and Defendants are precluded from submitting evidence of discounted rates accepted by medical providers from the insurer to rebut Plaintiffs’ proof that the full, undiscounted charges are reasonable. The Supreme Court thus affirmed in part and reversed in part the decision of the court of appeals, which concluded that West did not apply to personal injury cases but that evidence of discounted amounts accepted by the injured’s medical providers may be admissible to rebut Plaintiffs’ expert testimony on the reasonableness of the amount of the full, undiscounted bills. View "Dedmon v. Steelman" on Justia Law

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Defendant drove a car he had rented from Enterprise Rent-A-Car (Enterprise) into Plaintiff’s knee. At the time of the incident, Plaintiff was insured under a policy issued by IDS Property Casualty Insurance Company (IDS), which provided uninsured/underinsured motorist coverage. Plaintiff filed a complaint against Defendant, Defendant’s automobile liability insurer, and Enterprise. Plaintiff also served IDS with a copy of the summons and complaint for the purpose of bringing a claim under his uninsured motorist coverage policy. The trial court granted summary judgment in favor of IDS, concluding that the rental car did not qualify as an “uninsured motor vehicle” under the policy. The court of appeals affirmed. The Supreme Court reversed, holding that the rental car was an “uninsured motor vehicle” under the policy. Remanded. View "Martin v. Powers" on Justia Law

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Five separate groups of Pennsylvania-domiciled insurance companies (collectively, “Claimants”) were authorized to provide workers’ compensation coverage in Tennessee. As a result of an audit conducted by the State of Tennessee, Claimants were required, under Tennessee’s retaliatory tax statute, to recalculate their Tennessee taxes to include certain Pennsylvania workers’ compensation charges, file amended tax returns, and remit payment of the additional taxes totaling over $16 million. Claimants paid the taxes under protest. Each Claimant subsequently filed a complaint with the Tennessee Claims Commission (the “Commissioner”) seeking a refund of the retaliatory taxes paid under protest. The Commissioner issued five identical judgments, each granting summary judgment in favor of the State. The Court of Appeals affirmed. The Supreme Court reversed, holding that because the Pennsylvania workers’ compensation assessments were no longer paid by the insurance companies but were imposed on the employer-policyholders in conjunction with their premium payments, the administrative task of collecting and remitting those payments did not qualify as a burden on the insurance companies for purposes of the retaliatory tax. View "Chartis Casualty Co. v. State" on Justia Law

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Prentice Delon Hyler sought health care services from Action Chiropractic Clinic, LLC (Plaintiff) after she was injured in an automobile accident. Hyler executed an “Assignment of Rights” to Plaintiff for medical benefits payable to Hyler by Erie Insurance Exchange. Erie was the automobile liability insurance provider for the opposing driver involved in the accident. Erie and Hyler entered into a settlement agreement providing that Erie would pay Hyler $8,510 for claims relating to the accident. Plaintiff sued both Erie and Hyler seeking to recover the $5,010 it was owed from Hyler. The trial court granted Erie’s motion for summary judgment, concluding that the Assignment of Rights was not a valid assignment. The Supreme Court affirmed, holding that the assignment in this case was ineffective. View "Action Chiropractic Clinic, LLC v. Hyler" on Justia Law

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Employee worked for Employer assembling engine heads and attaching them to engine blocks. Employer ceased working after he sustained bilateral thoracic outlet syndrome, bilateral shoulder injuries, and a herniated disc in his neck. Employee filed this workers’ compensation action alleging that he received his injuries as a result of his work and that he was permanently and totally disabled by the injuries. The trial court concluded that Employee’s neck injury was not compensable and awarded eighty percent permanent partial disability for his other injuries. Both parties appealed. The Supreme Court affirmed, holding (1) the evidence did not preponderate against the trial court’s finding that Employee did not sustain a compensable neck injury; and (2) the award was not excessive. View "Watters v. Nissan N. Am., Inc." on Justia Law

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Three patients, who were injured in unrelated motor vehicle accidents, were all treated at the Regional Medical Center at Memphis (Hospital). In each case, either the patient’s insurance company or TennCare paid the Hospital the full amount of the adjusted charges for their case. However, the Hospital refused to release the lien it had perfected under the Tennessee Hospital Lien Act as it awaited recovery from the third-party tortfeasors the full, unadjusted amount of the hospital lien. The patients filed suit. The trial court dismissed the suit, but the Court of Appeals reversed, determining that the hospital could not maintain its lien because each of the patients’ debts had been extinguished. The Supreme Court affirmed in part and reversed in part, holding (1) except for the unpaid co-pays and deductibles, which are a patient’s responsibility, neither the Act nor the Hospital’s contracts with the patients’ insurance companies authorized the Hospital to maintain its lien after the patients’ insurance company paid the adjusted bill; and (2) one of the patients in this case had not extinguished her debt to the Hospital and was therefore not entitled to have the lien against her extinguished. View "West v. Shelby County Healthcare Corp." on Justia Law

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While on duty, Dennis Harris, a patrolman with the Anderson County Sheriff’s Department, was struck by a pickup truck driven by Mickey Haynes. Harris received workers’ compensation benefits for his injuries. Harris and his wife (together, Plaintiffs) sued Haynes and Richard Furrow, neither of whom were insured. Plaintiffs also made a claim against Tennessee Risk Management Trust (TRMT), Anderson County’s motor vehicle liability coverage provider, for uninsured motorist coverage. The trial court granted summary judgment for TRMT. The Court of Appeals affirmed, concluding (1) TRMT was a “risk pool” and not an insurance policy, and therefore, the general statute relating to uninsured motorist coverage in liability insurance policies did not apply to the coverage document issued to Anderson County; and (2) therefore, under the terms of the coverage document, Harris was excluded from uninsured motorist coverage as an employee and a person who received workers’ compensation benefits. The Supreme Court affirmed, holding that because the coverage document TRMT issued to the County specifically excluded employees and those who receive workers’ compensation benefits from uninsured motorist coverage, and because TRMT was not otherwise required to offer such coverage, Plaintiffs could not recover from TRMT. View "Harris v. Haynes" on Justia Law

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Employee suffered bilateral shoulder injuries and underwent separate surgeries on each shoulder. Employee later agreed to a voluntary buyout of his employment. Employee subsequently filed two separate suits for workers’ compensation benefits. The trial court determined that Employee’s permanent partial disability benefits were not capped at one and one-half times the impairment rating and awarded ninety percent permanent partial disability benefits. Employer appealed. A Special Workers’ Compensation Appeals Panel modified the award of permanent partial disability benefits to 37.5 percent as capped at one and one-half times the impairment rating, concluding that Employee’s decision to accept the buyout was not “reasonable” for purposes of the statutory cap. The Supreme Court reversed in part and reinstated the judgment of the trial court as to the award of ninety percent permanent partial disability benefits, holding that because Employee acted reasonably by accepting the voluntary buyout for reasons related to his work injuries, the award for permanent partial disability was not subject to the one-and-one-half-times multiplier. View "Yang v. Nissan N. Am., Inc." on Justia Law

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Employee worked for Employer from 1977 through the date of the trial of this matter. Employee began having problems with his arms and hands in 2005. In 2009, Employee had carpal tunnel release surgery performed on his arms. Employee began having problems with his right thumb shortly after his surgeries. A surgical procedure to release the thumb was performed in 2010. In 2013, the trial court awarded permanent partial disability benefits to Employee but ruled that Employee’s injury should be apportioned to the arm, which was subject to an impairment “cap.” Employee appealed, arguing that the award should have been apportioned to the thumb, which was not subject to the cap. The Supreme Court affirmed, concluding that the trial court correctly chose to apportion Employee’s injury to the arm. View "Evans v. Fidelity & Guar. Ins. Co. " on Justia Law

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Plaintiff was the minor beneficiary of a $100,000 life insurance policy. Plaintiff filed a complaint against his financial guardian and the insurance company after the guardian misappropriated the insurance proceeds. The trial court entered judgments in favor of Plaintiff. The insurance company appealed. The court of appeals affirmed, concluding that, by entrusting the proceeds to the guardian, the insurance company breached its contractual duties. The Supreme Court reversed, holding (1) the insurance company acted in good faith when it relied upon the validity of a juvenile court order establishing a financial guardianship in making payment of the life insurance proceeds, and (2) therefore, the insurance company could not be liable for breach of contract. View "Hood v. Jenkins" on Justia Law