Justia U.S. 8th Circuit Court of Appeals Opinion Summaries

In 1988, Brake began working at Hutchinson. She was diagnosed with multiple sclerosis (MS) in 2000, but continued to work. Brake purchased disability insurance through Hutchinson’s plan in 1988. Hutchinson, as the plan administrator, ceded discretionary authority to Hartford to construe the plan and make eligibility determinations. In 2007, Brake purchased "buy-up" coverage that excluded a disability if medical treatment for that condition was rendered within 12 months prior to the effective date. The limitation ended after a year without a claim: if Brake was treated for MS between April 1, 2006, and April 1, 2007, and then became disabled as a result of MS before April 1, 2008, the exclusion would limit her benefits to core plan coverage. Brake began experiencing problems with her MS in 2007 and received benefits from a separate short-term disability plan. On March 25, 2008, she stopped working at Hutchinson. In May, she applied for LTD benefits, stating her onset of disability as July 27, 2007. Hartford informed her that her LTD benefits were approved, but not at the buy-up plan rate. Brake claimed that doctor visits during the 12 months were for a pap smear and a yearly routine MRI. Hartford cited the same records which indicated that Brake was increasingly less able to manage her MS conditions during the 12 months before her purchase of buy-up coverage. In Brake’s suit under ERISA, 29 U.S.C. 1001, the district court found that Hartford did not abuse its discretion. The Eighth Circuit affirmed summary judgment in favor of Hartford. View "Brake v. Hutchinson Tech., Inc.," on Justia Law

Paulino suffered a spinal-cord injury in a work-related accident that left him permanently paraplegic. Employer's workers’ compensation insurer was Chartis. After medical treatment and intensive rehabilitation, Paulino moved to CCS for post-acute rehabilitation. When Paulino was capable of basic self-care, CCS set a discharge date of April 30. Paulino had workers’ compensation income of less than $400 per week and was ineligible for other assistance as an undocumented Mexican national. He required wheelchair-accessible housing, an electric hospital bed, and access to public transportation. His case manager was unable to locate suitable, affordable housing acceptable to Paulino. CCS refused to discharge Paulino to a residence not adequately adapted to Paulino’s needs. Chartis continued to pay medical bills and was prepared to pay for modifications to a permanent home, but notified Paulino that it would not pay his CCS living expenses (rent, utilities, groceries, cable television) after April 30. On May 6, Chartis withdrew those payments. Paulino continued to reside at CCS. A court affirmed the Iowa Workers’ Compensation Commissioner's conclusion (Ia Code 85.27) that special circumstances case made Paulino's continued stay at CCS appropriate and compensable. Paulino sued, alleging bad-faith denial of benefits as of May 6, seeking consequential and punitive damages. The Eighth Circuit affirmed the district court’s grant of summary judgment for Chartis. View "Paulino v. Chartis Claims, Inc." on Justia Law

Ibson and her family were insured by UHS through a policy available to her to as a member of her law firm. Due to an error, UHS began informing Ibson’s medical providers that Ibson and her family no longer had insurance coverage. Although UHS eventually paid the claims it should have paid all along, Ibson sued, raising state law claims of breach of contract, negligence, and bad faith, and seeking punitive damages. UHS responded that Ibson’s claims were preempted by the Employee Retirement Income Security Act (ERISA) and barred by the policy’s three-year contractual limitations period. The district court agreed and entered summary. The Eighth Circuit reversed and remanded, agreeing that Ibson’s state law claims are preempted under ERISA, but rejecting entry of summary judgment on the basis of the three-year contractual limitations period. View "Ibson v. United Healthcare Servs., Inc." on Justia Law

Bonnie, a Trinity Health employee, enrolled her family in a Blue Cross group health plan. Trinity served as plan administrator. Bonnie took FMLA leave and then short-term disability leave, which expired June 8, 2011. Bonnie requested long-term disability benefits from Unum, which provisionally paid medical care claims under a “Reservation of Rights.” In October 2011 Unum denied Bonnie’s request but did not seek repayment. June 8, 2011 was the last day Bonnie qualified for benefits and was considered an employee. Her termination was not processed, so the family received benefits until Trinity deemed them retroactively terminated. The Coles were first alerted to their loss of insurance on June 1, 2012 by husband’s physician. They obtained insurance through husband’s employer, retroactively effective June 1, 2012. Blue Cross did not seek a refund of claims paid between January 1, and April 30, 2012. The Coles claimed violation of the Consolidated Omnibus Budget Reconciliation Act by failing to notify them of their right to continuing health care coverage. The district court declined to award statutory damages, reasoning that unreimbursed medical bills from May 2012 were less than the COBRA premiums they would have had to pay to maintain insurance. The Eighth Circuit affirmed. View "Cole v. Trinity Health Corp." on Justia Law

After Hot Stuff recalled mislabeled sandwiches containing MSG, Hot Stuff sought indemnification from HCC for losses sustained due to the recall. HCC denied coverage on the ground that the claim did not involve an "Accidental Product Contamination" as defined by the policy. The district court granted Hot Stuff's motion for partial summary judgment. The court disagreed with the district court's interpretation of the policy term "may likely result." The court concluded that whether the consumption of the mislabeled sandwiches "may likely result" in physical symptoms of sickness or disease is a genuine dispute of material fact that cannot be answered by a summary judgment record that consists of inconclusive government reports and scientific studies and the dueling opinions of experts far removed from the relevant marketplace. Unless the district court determines on remand that summary judgment is appropriate based on the full trial record, the coverage question must be submitted to the jury. However, as the damages issues appear to be distinct and separable from the question of coverage, damages need not be retried. Further, the court concluded that the district court did not err when it denied HCC's motion for judgment as a matter of law in regards to the loss gross profit award, and the district court did not clearly err in denying an award of attorney's fees. View "Hot Stuff Foods, LLC v. Houston Casualty Co." on Justia Law

Hudson filed suit seeking a declaratory judgment that the Hired and Non-Owned Auto Liability endorsement to an insurance policy's Commercial General Liability Coverage Form provides no coverage to any defendant in the underlying lawsuit. The district court granted summary judgment to defendants. Hudson appealed. Defendants cross-appealed an earlier ruling that Hudson is not collaterally estopped to contest coverage by the state court judgment. In appeal No. 13-1688, the court concluded that Hudson is entitled to summary judgment on the coverage issue where, at the time of the accident, defendant Tyler Roush was not acting in the course of defendant Brash Tygr's business within the meaning of the Policy's Hired and Non-Owned Auto Liability endorsement. In appeal No. 13-1742, the court affirmed the judgment and dismissed the cross-appeal, concluding that defendants' cross-appeal is an alternative argument in support of the district court's decision. On the merits, the district court correctly ruled that defendants are not entitled to summary judgment on the basis of collateral estoppel.View "Hudson Specialty Ins. Co. v. Tygr, LLC, et al." on Justia Law

Annex, Stuart Lind, and Tom Janas filed suit challenging HHS' contraceptive mandate under the Religioous Freedom Restoration Act (RFRA), 42 U.S.C. 2000bb-1(a). Lind, a controlling shareholder of Annex, opposed insurance coverage of contraceptives for Annex's employees. The district court denied Annex and Lind's motion for a preliminary injunction respecting the contraceptive mandate's enforcement. The court concluded that Janas lacks standing to appeal because he did not join the preliminary injunction motion which forms the basis of the appeal; the mandate does not apply to Annex because Annex has fewer than fifty full-time employees and has no government-imposed obligation to offer health insurance of any kind; the only alleged injury is that independent third parties - private health insurance companies not involved in this case - are unable to sell Annex a health insurance plan that excludes healthcare inconsistent with Lind's religious relief; and, ultimately, it is unclear whether Annex's alleged injury is caused by the government defendants and redressable by the federal courts. Accordingly, the court vacated the district court's denial and remanded for the district court to conduct more fact-finding to determine whether subject matter jurisdiction exists. View "Annex Medical, Inc., et al. v. Sebelius, et al." on Justia Law

Thomas Hipp was driving a semi-tractor and trailer on a two-lane road when the trailer collided with a vehicle driven by Amy Soczynski. Amy died as a result of the collision and this appeal concerns the subsequent insurance coverage dispute. The court affirmed the district court's determination that a bobtail policy issued by Hipp's Trucking provided coverage for damages arising out of the collision and that the bobtail policy provided $1 million in coverage.View "Occidental Fire & Casualty Co. v. Soczynski" on Justia Law

Plaintiff filed suit against Mid-Continent, alleging that Mid-Continent breached the insurance contract by denying coverage to plaintiff in an underlying lawsuit arising from a subcontractor's faulty workmanship during construction of a home. The court affirmed the district court's dismissal of the claim because faulty workmanship on the home was not an "occurrence" within the meaning of the policy under Essex Ins. Co. v. Holder. The district court did not err by denying plaintiff leave to amend because plaintiff seeks to extend coverage to subcontractor negligence through a claim of estoppel. Under Arkansas law, the doctrine of waiver of estoppel cannot be given the effect of enlarging or extending the coverage as defined in the contract. View "J-McDaniel Construction Co v. Mid-Continent Casualty Co., et al." on Justia Law

Plaintiff appealed the district court's grant of summary judgment in favor of Encompass in this insurance coverage dispute. Plaintiff's home was damaged from a broken drain pipe in the basement shower stall and she sought to recover repair costs for the damage. The court concluded that Encompass failed to satisfy its burden of proving the applicability of the policy's exclusion and the district court erred when it determined as a matter of law that the water damage resulted from seepage. Further, the district court erred when it determined the "seepage or leakage" exclusion for mold remediation barred all of plaintiff's claims. Accordingly, the court reversed and remanded for further proceedings. View "Syfco v. Encompass Indemnity Co." on Justia Law