Justia Injury Law Opinion Summaries

Defendant Russell Blodgett appealed a superior court order granting summary judgment in favor of plaintiff Cincinnati Specialty Underwriters Insurance Company (CSU). Blodgett argued the trial court erred by concluding that the terms of a commercial general liability policy issued by CSU clearly and unambiguously excluded coverage for Blodgett’s damages in a separate personal injury action against CSU’s insured resulting from Blodgett’s fall from an alleged negligently constructed staircase. The New Hampshire Supreme Court concluded that, pursuant to the policy’s clear and unambiguous language, CSU had no duty or obligation to defend or indemnify its insured in the underlying litigation. View "Cincinnati Specialty Underwriters Insurance Company v. Best Way Homes, Inc. & a." on Justia Law

Appellant Dameron Hospital Association (Dameron) required patients or their family members sign Conditions of Admissions (COAs) when Dameron provides the patients’ medical care. The COAs at issue here contained language assigning to Dameron direct payment of uninsured and underinsured motorist (UM) benefits and medical payment (MP) benefits that would otherwise be payable to those patients under their automobile insurance policies. Dameron treated five of AAA Northern California, Nevada & Utah Insurance Exchange’s (CSAA) insureds for injuries following automobile accidents. Those patients had UM and/or MP coverage as part of their CSAA coverage, and Dameron sought to collect payment for those services from the patients’ UM and/or MP benefits at Dameron’s full rates. Instead of paying to Dameron the lesser of either all benefits due to the patients under their UM and MP coverage, or Dameron’s full charges, CSAA paid portions of those benefits directly to the patients which left balances owing on some of Dameron’s bills. Dameron sued CSAA to collect UM and MP benefits it contended CSAA owed Dameron under the assignments contained in the COAs. The trial court concluded that Dameron could not enforce any of the assignments contained in the COAs and entered summary judgment in CSAA’s favor. After its review, the Court of Appeal held Dameron could not collect payment for emergency services from the UM or MP benefits due to patients that were covered under health insurance policies. Additionally, the Court found: (1) the COA forms were contracts of adhesion; (2) it was not within the reasonable possible expectations of patients that a hospital would collect payments for emergency care directly out of their UM benefits; and (3) a trier of fact might find it is within the reasonable expectations of patients that a hospital would collect payments for emergency care directly out of their MP benefits. Accordingly, the Court concluded Dameron could not maintain causes of action to collect MP or UM benefits due to four of the five patients directly from CSAA. However, consistent with its opinion, the trial court could consider whether an enforceable assignment of MP benefits was made by one adult patient. View "Dameron Hospital Assn. v. AAA Northern Cal., Nevada etc." on Justia Law

While shopping at the Carmel Mountain Ranch location of Costco in San Diego, plaintiff Lilyan Hassaine slipped and fell on a slippery substance that she believed was liquid soap. Claiming serious injuries from the fall, she sued Costco and Club Demonstration Services (CDS), an independent contractor that operated food sample tables within the store. The trial court granted a motion for summary judgment filed by CDS, concluding that the company owed Hassaine no duty of care. In the court’s view, it was dispositive that CDS’s contract with Costco limited its maintenance obligations to a 12-foot perimeter around each sample table, and that Hassaine’s fall occurred outside that boundary. The Court of Appeal reversed, finding the trial court erred in concluding CDS’s contract with Costco delineated the scope of its duty of care to business invitees under general principles of tort law. Businesses have a common law duty of ordinary care to their customers that extends to every area of the store in which they are likely to shop. "While the CDS-Costco agreement may allocate responsibility and liability as a matter of contract between those parties, it does not limit the scope of CDS’s common law duty to customers. ... Breach and causation present triable factual issues here, precluding summary judgment on those grounds." View "Hassaine v. Club Demonstration Services, Inc." on Justia Law

Plaintiff filed 1983 against two nurses alleging that he was provided inadequate medical care during a health crisis he experienced while incarcerated. He was eventually sent a series of hospitals, where doctors told him a flesh-eating organism was damaging his internal organs.The first nurse was successfully served by the Marshals Service within Rule 4(m)’s 90-day period. The second nurse was not served because service was returned as “refused unable to forward.” The district court dismissed Plaintiff’s lawsuit on timeliness grounds after finding that Plaintiff’s amended complaint did not relate back under Rule 15(c) of the Federal Rules of Civil Procedure to his initial and timely complaint.At issue is whether the amended complaint adding Defendants is timely because it relates back to the date of the original complaint. The court found that the district court erred and the text of Rule 15(c)(1)(C) makes clear that the required “notice” and knowledge must come “within the period provided by Rule 4(m) for service.Next, the court addressed whether Defendants were provided the necessary notice within the Rule 4(m) notice period. The court ruled that Rule 15(c)’s requirements have been satisfied as to the first nurse. In regards to the second nurse, the court remanded to the district court for consideration of Plaintiff’s extension request, reasoning that the district court incorrectly believed that Plaintiff lost his chance to take advantage of Rule 15(c)’s relation-back rule. The court vacated the district court’s order granting the motion to dismiss. View "Patrick McGraw v. Theresa Gore" on Justia Law

A boiler exploded in a home owned by a nonprofit regional housing authority, severely injuring a man who lived there. He sued the housing authority in both contract and tort, claiming that his lease-purchase contract included a promise that the authority would inspect the boiler, which it failed to do with reasonable care. After the man dismissed his contract claim, the housing authority asked the court to decide as a matter of law that a breach of a contractual promise could not give rise to a tort claim. But the superior court allowed the man to proceed to trial on his tort claim, and the jury awarded over $3 million in damages, including over $1.5 million in noneconomic damages and separate awards to several of his family members for negligent infliction of emotional distress. The court reduced the man’s noneconomic damages award to $1 million because of a statutory damages cap, but it excluded the family members’ awards from the amount subject to the cap. The housing authority appealed, maintaining it should have been granted a judgment notwithstanding the verdict because the contract did not create a continuing legal duty to inspect the boiler with reasonable care. It also argued it should have been granted a new trial because it had established that the boiler explosion was caused by a product defect rather than negligent inspection. Finally, the authority argued the family members’ damages for negligent infliction of emotional distress should have been included in the amount subject to the statutory damages cap. The man cross-appealed, arguing that the damages cap violated due process because it failed to account for inflation or the severe nature of his physical injuries. After review, the Alaska Supreme Court found no reversible error and affirmed the superior court's judgment on all issues. View "Association of Village Council Presidents Regional Housing Authority v. Mael, et al." on Justia Law

Following Susanne Burgaz’s suicide in a County Detention Facility, her children and estate sued two individual Sheriff’s deputies on duty the night she died, and various other County officials. They argued the deputies were deliberately indifferent to her serious medical needs and the County and sheriff negligently operated the jail. The defendants moved to dismiss the complaint, and the district court granted the motion. The Tenth Circuit agreed with the district court that both individual deputies were entitled to qualified immunity because the Estate failed to allege either deputy violated Ms. Burgaz’s constitutional rights. The "Monell" claim against the sheriff was also properly dismissed. And because all the claims arising under federal law were properly dismissed, the district court correctly dismissed the remaining state-law claims. View "Estate of Susanne Burgaz, et al. v. Board of County Commissioners, et al." on Justia Law

Plaintiff sued Defendant Cable News Network, Inc. (“CNN”) for defamation and civil conspiracy in the United States District Court for the Eastern District of Virginia. The case was transferred to the Southern District of New York. Plaintiff argues that the Virginia Supreme Court would determine that New York is the “place of the wrong.” Alternatively, that he was primarily injured in either the District of Columbia or Virginia or at least that the choice-of-law determination cannot be made without discovery. Second, he argues that even if California law does apply, section 48a does not apply under Virginia’s choice-of-law rules; and that even if section 48a does apply, he should have been granted leave to further amend his complaint so he could plead special damages. Plaintiff also requests that the court certifies to the Virginia Supreme Court the question of how lex loci delicti applies to multistate defamation cases like Plaintiff’s.The court concluded that the Virginia Supreme Court would apply California law, including its retraction statute, to Plaintiff’s multistate defamation claim. The court reasoned that the Virginia Supreme Court would apply the substantive law of the state where the plaintiff incurred the greatest reputational injury, with a presumption that absent countervailing circumstances, a plaintiff suffers the most harm in his state of domicile. Further, the court did not err in failing to sua sponte grant Plainitff’s leave to amend. Thus, the court affirmed the judgment of the district court dismissing the complaint with prejudice. View "Nunes v. Cable News Network, Inc." on Justia Law

Plaintiffs were involved in a motor vehicle accident involving a vehicle operated by a USPS employee; through counsel, Plaintiffs submitted a “claim for damage, injury, or death." Subsequently, Plaintiffs retained a new law firm (Pawlowski), and provided notice to the USPS. On September 27, 2018, Plaintiffs filed a Federal Tort Claims Act action against the government and the USPS employee. On October 16, 2018, a copy of the complaint and summons in the first FTCA action was delivered to the government. Another law firm (“Youngblood”), filed the first FTCA action complaint.On October 22, 2018, the USPS mailed a certified letter denying Plaintiffs’ administrative claims to Pawlowski, indicating Plaintiffs had until April 22, 2019 to file suit against the government. Neither Pawlowski nor Youngblood provided the USPS notice of any change in representation. On August 30, 2019, Plaintiffs filed their second FTCA complaint. On March 4, 2020, the government moved for summary judgment, arguing Plaintiffs’ claims were time-barred.Plaintiffs contend that the government failed to comply with the plain language of 39 C.F.R. Sec. 912.9(a) when the USPS sent the denial letter to Pawlowski. Further that the district court erred in finding they were not entitled to equitable tolling.The court ruled that the USPS mailed the denial letter to the legal representative who Plaintiffs most recently identified, thus complying with the regulation. Further, the court held that Plaintiffs failed to demonstrate entitlement to equitable tolling. The court affirmed the district court’s order granting summary judgment for the government. View "Robert Wayne Dotson, et al. v. USA" on Justia Law

Relator Gilbert Ellinger brought a qui tam suit on behalf of the People of the State of California against Zurich American Insurance Company (Zurich), ESIS, Inc. (ESIS), and Stephanie Ann Magill, under Insurance Code section 1871.7, a provision of the Insurance Frauds Prevention Act (IFPA). In January 2016, Ellinger injured his back while working, and he immediately informed his supervisor. The following month, Ellinger reported to his employer’s human resources manager that he had sustained a work-related injury and had told his supervisor about it. The human resources manager created a “time line memorandum” summarizing the conversations she had with Ellinger about the injury. She placed the memorandum in Ellinger’s personnel file. Ellinger filed a workers’ compensation claim. Magill worked as a senior claims examiner for ESIS and was the adjuster assigned to investigate Ellinger’s claim. ESIS denied Ellinger’s claim on an unspecified date. Magill later testified that she denied the claim because of a written statement from Ellinger’s supervisor in which the supervisor claimed that Ellinger had not reported the injury to him. When the human resources manager was deposed in November 2016, she produced the time line memorandum, which Ellinger’s counsel in the workers’ compensation action did not know about until then. Nearly eight months after that disclosure, in July 2017, ESIS reversed its denial of the claim and stipulated that Ellinger was injured while working, as he had alleged. Contrary to Magill’s testimony, her email messages showed that the human resources manager had emailed Magill the time line memorandum in March and April 2016, and Magill thanked the manager for sending it. Ellinger alleged that Magill’s concealment of or failure to disclose the time line memorandum violated Penal Code section 550 (b)(1) to (3). On the basis of those alleged violations, Ellinger alleged that defendants were liable under section 1871.7. Against each defendant, Ellington sought a civil penalty and an assessment of no greater than three times the amount of his workers’ compensation claim. The trial court sustained defendants’ demurrers without leave to amend, concluding defendants could not be held liable under section 1871.7 for any failures of Magill in the claims handling or review process. Finding no reversible error in sustaining the demurrers, the Court of Appeal affirmed. View "California ex rel. Ellinger v. Magill" on Justia Law

This appeal involved a challenge to how Geico General Insurance Company (“GEICO”) processed insurance claims under 21 Del. C. 2118. Section 2118 provided that certain motor vehicle owners had to obtain personal injury protection (“PIP”) insurance. Plaintiffs, all of whose claims for medical expense reimbursement under a PIP policy were denied in whole or in part, were either GEICO PIP policyholders who were injured in automobile accidents or their treatment providers. Plaintiffs alleged GEICO used two automated processing rules that arbitrarily denied or reduced payments without consideration of the reasonableness or necessity of submitted claims and without any human involvement. Plaintiffs argued GEICO’s use of the automated rules to deny or reduce payments: (1) breached the applicable insurance contract; (2) amounted to bad faith breach of contract; and (3) violated Section 2118. Having reviewed the parties’ briefs and the record on appeal, and after oral argument, the Delaware Supreme Court affirmed the Superior Court’s ruling that the judiciary had the authority to issue a declaratory judgment that GEICO’s use of the automated rules violated Section 2118. The Supreme Court also affirmed the Superior Court’s judgment as to the breach of contract and bad faith breach of contract claims. The Court concluded, however, that the issuance of the declaratory judgment was improper. View "GEICO General Insurance Company v. Green" on Justia Law