Articles Posted in US Court of Appeals for the Sixth Circuit

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Heimer, one year over the legal drinking age, drank alcohol with friends and then rode motorbikes in a field. Heimer and his friend collided. Heimer suffered extensive injuries, incurring more than $197,333.50 in medical bills. Heimer’s blood alcohol level shortly after the crash was 0.152, nearly twice the limit to legally use an off-road vehicle in Michigan. Heimer was insured. As required by his plan, he submitted a medical claim form shortly after the accident. The plan administrator denied coverage based on an exclusion for “[s]ervices, supplies, care or treatment of any injury or [s]ickness which occurred as a result of a Covered Person’s illegal use of alcohol.” After exhausting administrative appeals, Heimer filed suit. The district court held that the plan exclusion did not encompass Heimer’s injuries, reasoning that there is a difference between the illegal use of alcohol—such as drinking while under 21 or drinking in defiance of a court order—and illegal post-consumption conduct, such as the illegal use of a motor vehicle. The Sixth Circuit affirmed. Reading “illegal use of alcohol” to disclaim coverage only for the illegal consumption of alcohol, and not for illegal post-consumption conduct is consistent with the ordinary meaning of “use” and best gives effect to the contract as a whole. View "Heimer v. Companion Life Insurance Co." on Justia Law

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Doe and her daughter flew aboard Etihad Airways from Abu Dhabi to Chicago. During the journey, Doe’s tray table remained open because a knob had fallen off. Doe’s daughter found the knob on the floor; Doe placed it in a seatback pocket. When a flight attendant reminded Doe to place her tray in the locked position for landing, Doe attempted to explain by reaching into the seatback pocket to retrieve the knob. She was pricked by a hypodermic needle that lay hidden within, which drew blood. Doe sought damages from Etihad for her physical injury and her “mental distress, shock, mortification, sickness and illness, outrage and embarrassment from natural sequela of possible exposure to” various diseases. Her husband claimed loss of consortium. The court granted Etihad partial summary judgment, citing the Montreal Convention of 1999, an international treaty, which imposes capped strict liability “for damage sustained in case of death or bodily injury of a passenger upon condition only that the accident which caused the death or injury took place on board the aircraft.” The Sixth Circuit reversed. The district court erred in reading an additional “caused by” requirement into the treaty and concluding that Doe’s bodily injury did not cause her emotional and mental injuries. The Convention allows Doe to recover all her “damage sustained” from the incident. View "Doe v. Etihad Airways, P.J.S.C." on Justia Law

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A tree fell on Kaitlyn and Joshua. Kaitlyn died. She was pregnant. Doctors delivered the baby, but he died an hour later. Joshua survived with serious injuries. A state jury found the Somerset Housing Authority liable and awarded $3,736,278. The Authority belonged to the Kentucky Housing Authorities Self-Insurance Fund, which provided a policy with Evanston. Evanston sought a declaratory judgment limiting its liability under the Fund’s policy to $1 million. Meanwhile, through mediation of the state court case, Evanston agreed to pay the “policy limits” in return for an agreement to dismiss the state court action and release the Authority from further liability. Evanston claimed that $1 million was the coverage cap; the defendants claimed it was $2 to $4 million. The district court determined that there was complete diversity and ruled for Evanston on the merits. The Sixth Circuit affirmed. The district court properly aligned the parties given their respective interests in the primary dispute at the time of filing, so that diversity jurisdiction was not destroyed. The policy obligates Evanston to provide a maximum of $1 million of coverage per “occurrence,” with an aggregate limit of $2 million for more than one occurrence. The contract defines “occurrence” as “an accident, including continuous or repeated exposure to substantially the same general harmful conditions.” When one tree falls at one time, that is one occurrence and one accident. View "Evanston Insurance Co. v. Housing Authority of Somerset" on Justia Law

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In 2009, Williamson, an Army veteran and U.S. postal worker, began experiencing pain in his right foot. He usually worked a walking route, walking up to eight miles per day on the job. He was also doing other physical activity, including running and CrossFit, which could have contributed to his injury. He eventually received benefits under the Federal Employees’ Compensation Act (FECA): $79,379.66 in temporary total disability net compensation from March 20, 2010 through October 25, 2012; $27,801.27 for medical expenses; and $19,974.19 as a lump-sum “schedule award.” Williamson then sought damages under the Federal Tort Claims Act (FTCA) for medical malpractice by the Department of Veterans Affairs in the treatment of his injuries, which included two unsuccessful surgeries. The district court denied the government’s motion for summary judgment. The Sixth Circuit reversed. Liability under FECA is “exclusive” of “all other liability of the United States” to the employee “under a Federal tort liability statute,” 5 U.S.C. 8116(c) (2012). Because this exclusion applies broadly even when a work-related injury has been negligently treated by an entirely non-work-related federal hospital, Williamson may not recover under the FTCA. View "Williamson v. United States" on Justia Law