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February 2007

February 25, 2007

Comp is comp, and PIP is PIP, and never shall the two meet

A recent nonpublished decision was a reminder that the two systems for compensating injured claimants may overlap for an injury but they do not overlap for their benefits.

For example, workers compensation and personal injury protection benefits may be available for a work-related car accident.

Most already know that workers compensation benefits are primary in this scenario, and is to be looked at for medical benefits and expenses.  Wage loss is another matter as the typcial workers compensation benefit for wages does not kick in for at least five days and then at only 66 2/3ds the wage rate.  With PIP covering up to 80 per cent of wage loss not to exceed $200 per week, then PIP can be looked at for the first week of wage loss and then the difference in wage loss thereafter (eg., 80 - 66.67 or 12.33 per cent).

Well, this nonpublished decision reminds the workers compensation attorneys that the pip benefits are not income benefits for statute of limitations purposes.  Be careful.

James Muncy v. Elmo Greer & Sons
WORKERS COMP:  KRS 342.185's income benefits does NOT include auto reparation benefits for SOL purposes in W.Comp claim
2006-CA-001742
NOT PUBLISHED:  DATE RENDERED: 2/23/2007

When dealing with the workers compensation carrier while representing a claimant injured in a car accident, here are a few suggestions:

  • Remember the statute of limitations for the claim against the adverse driver for those benefits not covered by the exclusive remedy provisions of workers compensation runs from the date of the accident or the last date PIP paid.  No pip paid, then date of accident.  Therefore, those small wage sums via pip are worth more than just wages but buy time for filing suit.
  • Workers comp is aggressive and more controlling of medical treatment monitoring, and do not forget to try submitting to PIP those workers compensation denials of benefits.  It may be a dry hole, but . . . .
  • If not representing the claimant for the workers compensation claim, then have a letter confirming that (or arrange for a workers comp attorney to handle that portion of the claim), else they may be looking to you.
  • Workers compensation carriers are difficult to deal with when you are not representing the claimant for that portion of the claim, so be aggressive and follow up with medical releases and requests for information.

February 24, 2007

SCOKY grants discretionary review in Com., Transportation Cabinet, Department of Highways v. Shannon D. Sexton regarding duty of landowners for trees

The Kentucky Supreme Court granted discretionary review in Commonwealth, Transportation Cabinet, Department of Highways v. Shannon D. Sexton, (2006-SC-0454-DG).  Click here for previous digest and link to text at this site.

This is an appeal of a decision from the Jefferson Circuit Court, Judge Ann Shake presiding.

The Court of Appeals in a published decision written by Judge Henry (with Judge Combs concurring) held "that a landowner in an urban or heavily populated area has a duty to others outside of his land to exercise reasonable care to prevent an unreasonable risk of harm arising from defective or unsound trees on the premises."

SCOKY Justice Will Schroder while sitting as a COA Judge filed a dissenting opinion in the COA decision:

Our first inquiry is whether or not the Department owed a duty of care to Sexton. We all agree that under present law, there is no duty. The majority believes it’s time to create a duty. I must dissent. The General Assembly could, and probably should consider creating such a duty, but not the courts. Also, the urban/rural distinction invites a number of questions, such as do we classify by city limits, population density, lot size, etc?

Attorney Daniel Alvarez is representing the claimant injured by the tree, and Andrew Draut the Commonwealth.

February 16, 2007

Legislation pending in Kentucky House to do away with the "contact rule" for uninsured motorist benefits

Rep. Darryl Owens of Louisville has proposed legislation whose time has come - eliminating the "contact rule" for uninsured motorist benefits when hit by an "unknown motorist".  This is sometimes referred to as the "hit and run" rule, but in that situation coverage is provided since there has been a "hit" or contact.

The contact requirement is historically an outgrowth of the insurance industry's efforts to reduce fraud.  However, the contact rule would have denied uninsured motorist benefits even if the accident had been caught on tape and witnessed by half of Louisville during Derby week!

For example, in recent news story, a young man was run off the interestate by an unknown trucker.  He crossed the center line and was struck by a police officer.  Result - no contact, no known driver, no coverage.

The no contact rule has also produced the bizarre situation where one insurance company was able to deny coverage to its insured's estate in a fatality caused by an unknown, but no contact, motorist, but then the insurance company was able to use the unknown motorist to shift the fault in defense of the underinsured motorist claim arising from the negligence of the third driver who actually did make contact with the insured's car killing one and seriously injuring the other!

Here's the pending legislation:

  • House Bill 271 (Expand Definition Of Personal Injury Accident):

    Introduced by Rep. Darryl Owens on February 6, 2007, to establish that physical contact is not required to recover damages in personal injury or wrongful death claims arising from certain vehicle accidents.

    Details and Comments: http://www.kentuckyvotes.org/Legislation.aspx?ID=51087

  • See,

    KENTUCKY FARM BUREAU MUT INS CO V. RYAN
    INSURANCE - Uninsured motorist; Underinsured motorist
    CIVIL PROCEDURE - Apportionment, Warning order attorney

    2003-SC-000944-DG.pdf
    Published, reversing, JOHNSTONE

    Date: 11/23/2005

    The basic holding permitted a UIM carrier to third party an unknown motorcyclist defendant for purposes of apportioning fault even though there was no personal jurisdiction over that unknown motorcyclist.  An odd twist in this case was that the UIM was also a UM carrier and was permitted to use the 'no contact' rule to defeat the plaintiff's claim for uninsured motorist benefits.

    Comment:  However for now, note the inconsistent positions permitted KFBM in talking what were essentially inconsistent positions by parsing the policy provisions and not reading the policy as a whole and ignore the intent and purpose of the 'no contact' rule to prevent fraudulent claims.  Justice Johnstone wrote for the majority and made some black letter law pronouncements that a UIM claim is not controlled by the apportionment statute since it is a contract and not a tort and its tweener status (my word not his) does not change that fact.  However, in a UIM case the damages are in tort and the third party claim for apportionment is permitted.  Of course, would a constructively served third party complaint suffice if a direct action against the tortfeasor?  Time will tell on that one, but in that scenario I would suggest a motion to dismiss by the plaintiff for failure to state a cause of action since indemnity in this situation is non-existent and apportionment is a legal conclusion and not a claim, Kevin Tucker case notwithstanding in creating the legal fiction.

    February 14, 2007

    Now, who's insurance card do you have in your wallet? Here's a statutory bad faith claim in which the insurer's investigation and delay went on and on and on.

    The duty to investigate a claim does have it's limits in behavior and in time, and in the following case, the insurer was taken to task by its insured and then the courts which finally resulted in appellate resolution of afire loss NINE years later.

    An insurance company still is obligated under the Unfair Claims Settlement Practices Act to investigate, negotiate, and attempt to settle the claim in a fair and reasonable manner. Moreover, whether a claim or the amount of a claim is fairly debatable is a question of fact for the jury, and Kntucky courts have never held that advice of counsel provided an absolute defense against allegations of an insurer’s bad faith.  In the 2006 case of Knotts v. Zurich Ins. Co., the Court held that evidence of an insurer’s settlement behavior throughout the litigation may be examined and presented in order to establish an insurer’s bad faith.

    This is a claims settlement violation appeal arising from a 1998 fire loss that the Hamilton investigated for over a year without paying, tendered the insured forms for cash value as opposed to replacement value, took four examinations under oath, multiple proofs of loss, etc. and still did not pay after a year forcing the insured to sue for his loss of nearly $58,000.  And still the insurer would not pay after the jury awarded nearly that amount.  The matter went up to the COA which affirmed; and still no payment; then Hamilton sought discretionary review which was denied; and still no payment.  Motion to forfeit supersedeas bond, and still the insurer stood firm, whereupon this claim under the Unfair Claims Settlement Practices Act was filed with a jury awarding nearly $263,000 in damages PLUS over $27k in attorney fees, and still this appeal followed.  Affirmed.

    HAMILTON MUT. INS. CO. V. CINCINNATI INS. CO.
    INSURANCE:  Unfair Claims Settlement Practices; duty to investigate
    2005-CA-000233
    PUBLISHED: AFFIRMING; COMBS
    DATE RENDERED: 1/26/2007

    case digest below the fold.

    Continue reading "Now, who's insurance card do you have in your wallet? Here's a statutory bad faith claim in which the insurer's investigation and delay went on and on and on. " »

    February 11, 2007

    SCOKY Oral Argument on 2/16/07 re: insurance defense lawyer's impeachment of plaintiff's testifying doctor with evidence of loss of medical licensure

    From SCOKYBLOG is the following update on oral argument with SCOKY set for 2/16/2007 on a underinsured motorist case with two twists. First twist is the insurance defense lawyer's impeachment of plaintiff's testifying expert by the fact that the doctor's license was revoked just prior to trial.  Second issue of note involves trial court granted directed verdict against plaintiff on permanent impairment of power to labor and earn money.

    Note this is SCOKY so a decision last Oct 2006 at COA which was unpublished and which reversed on the question of asking about an expert doctor's loss of medical license is not that helpful.

    10:00 a.m. REECE V. NATIONWIDE MUTUAL INSURANCE, CO. (2005-SC-79-DG) “Personal Injury. Auto Insurance. Evidence. Instructions. Issues include whether plaintiff seeking recovery on under-insured-motorist policy was entitled to jury instruction on damages for permanent injury or permanent impairment of ability to labor and earn money; whether plaintiff was entitled to exclusion of evidence that her treating physician’s medical license had been suspended prior to trial; and whether trial court improperly limited plaintiffs questioning of prospective jurors during voir dire.”

    Discretionary review granted 2/15/2006
    Jefferson Circuit Court, Judge Ann Shake
    For Movant: John K. Carter
    For Respondent: Michael E. Krauser and Edward Alan Brutscher

    Appellant’s Brief

    Appellee’s Brief

    Appellant’s Reply Brief

    February 09, 2007

    Continuing treatment tolling statute of limitations continues to be followed per COA decision in medical negligence appeal

    February 08, 2007

    Another car dealer sale and no insurance on buyer case puts strong burden on dealer to shore up insurance at sale

    GAINSCO COMPANIES  V. GENTRY
    INSURANCE - Owner of vehicle upon transfer for liability insurance purposes
    2004-SC-000276-DG.pdf
    PUBLISHED
    AFFIRMING (JOHNSTONE)
    DATE:  3/23/2006

    Gainsco, H&H Auto and David Holder appeal Barren Circuit Court's entry of Summary Judgment for Gentry, Booth and Ky Farm Bureau. COA affirmed the TC's ruling, and the Supreme Court granted review.

    The case involves the sale of an auto on 4/15/00 by H&H Auto to Joe Booth. The auto in question had been purchased just 9 days prior from Philip Duke Motors in Alabama, although Duke was unable to immediately transfer the auto's certificate of title. Holder, president of H&H Auto, personally negotiated the sale to Booth, but was unable to immediately assign title to Booth. Booth nevertheless took possession of the auto on 4/15/00 without title. Booth's son lost control of the vehicle and caused an accident on 4/20/00 that resulted in his passenger Gentry sustaining permanent, disabling injuries. Gentry initiated suit against Booth, KFB, H&H Auto, Holder and Gainsco (Holder's insurer). Gentry filed a MSJ asserting that H&H Auto was the owner of the auto on the accident date for purposes of insurance coverage, which the TC granted. Gainsco was therefore deemed to have primary coverage while KFB (Booth's insurer) was held secondarily liable. This appeal followed.

    In a 4-3 decision, the Supreme Court upheld the COA's ruling that affirmed the entry of Summary Judgment. Justice Johnstone wrote the majority opinion, and identified the sole issue on appeal as whether H&H Auto was the owner of the auto for insurance purposes at the time of the accident. The opinion discusses KRS 186.010(7)(c) and the requirements placed on a licensed auto dealer in order to effectively transfer ownership of the auto in those instances where the title is not immediately transferred to the buyer at the time of purchase. Those requirements as set forth in KRS 186A.220 are two-fold: 1) the dealer must obtain the purchaser's consent to file the certificate of title on his behalf; and 2) he must verify that the purchaser has obtained insurance on the auto before relinquishing possession. The majority felt that H&H Auto failed to satisfy the second prong since Holder did not request any form of proof of insurance from Booth on 4/15/00 (a Saturday) even though he did verbally verify coverage with Booth's insurance agent on 4/17/00, the next business day. Of importance was the fact that the title documents were not signed by Booth until 4/24/00. Also of importance is the fact that KFB conceded that Booth had valid insurance coverage on 4/15/00 and 4/20/00. The majority side-stepped this fact by ruling that this alone is not enough in that the statute also requires the dealer to obtain proof of insurance. The court then proceeded to reject Holder's argument that his course of prior dealing with Booth (by having sold him vehicles in the past, most recently within a year of the subject sale) satisfies the "proof" requirement by way of his knowledge that Booth was insured with KFB in the recent past, noting that the statute requires verification beyond mere assumption or prior knowledge. Justices Lambert, Roach and Winterheimer joined Johnstone in the majority.

    Justice Graves issued the dissenting opinion during which he discusses the legislative intent behind KRS 186A.220, which is to prevent uninsured vehicles on the roadways. He felt that the majority too narrowly reviewed the proof of insurance requirement, and questioned what effect a discussion about insurance coverage at the time of sale (that the majority repeatedly noted Holder had failed to do) would have on the ultimate question of ownership at the time of the accident. He felt that almost any form of proof carries an assumption, the exception being proof obtained directly from the buyer's insurance representative. He emphasizes the difficulty dealers would face if required to obtain this form of absolute proof, especially on weekends, and felt that the statute did not require it. Graves points out that even if there was a technical deficiency at the time of sale, Holder had nevertheless cured it by obtaining verbal proof of insurance from Booth's agent on 4/17/00 - 3 days before the accident. In this regard, he declares that the harm the statute seeks to prevent - uninsured motorists - did not exist in this particular case since KFB had admitted coverage existed on all relevant dates at issue. He concludes by conceding that a prior course of dealing is certainly not a preferable means to obtain proof of insurance, but nevertheless felt that there was evidence sufficient in favor of Holder to at least survive a MSJ. Justices Cooper and Scott joined in the dissent.

    Commentary: The majority's decision appears to place a burden of strict compliance on the dealer to obtain proof of insurance pursuant to KRS 186A.220, presumably on the basis that the dealer is in the best position to prevent the harm of uninsured vehicles hitting the roadways. However, the majority doesn't go far enough by offering some guidance on what actions constitute verification of "proof" of insurance. Is verbal assurance from the buyer enough? What about obtaining a copy of the most current insurance card? Of course, as Graves notes this carries with it an assumption that the policy has not lapsed or been canceled since the date the card was printed. The majority flatly rejected Holder's argument that knowledge of coverage by Booth less than a year prior was satisfactory, so would an insurance card printed up to 6 months before the sale nevertheless be okay? Or was the majority's ruling simply a way of providing as much insurance coverage as possible to a claimant who apparently sustained significant damages and would have otherwise been limited to Booth's policy limits (though never identified, it's safe to assume that they were a fraction of the dealer's liability limits). Certainly, Holder's failure to even hint at the topic of insurance coverage during the transaction with Booth gave the majority an opportunity to issue its ruling without having to adjudge what action(s) a dealer must take in order to satisfy the proof of insurance requirement.

    The court's minority instead focuses on the big picture by weighing the benefits of requiring strict compliance against the costs placed on the dealer in doing so. Their opinion is that the latter outweighs the former, and suggests that the logistics of obtaining actual proof of insurance at the time of sale would adversely impact commerce in light of the volume of sales that occur outside the regular business hours of insurance companies and agencies. The dissenting opinion seems to suggest that the ultimate determination on liability of the dealer is not the sufficiency of proof obtained at the time of sale, but instead is whether the buyer did in fact have valid insurance coverage at the time of loss. If the dealer has a reasonable basis for assuming coverage exists at the time of sale, and the assumption turns out to be correct (as in the present case), then the court's minority would seemingly relieve the dealer of liability since the vehicle is not uninsured and the situation contemplated by the statute is therefore avoided. However, this approach ignores the fact that the statute speaks to who is deemed the legal "owner" of the vehicle and not whether the vehicle is insured at the time of loss.

    While this decision does not resolve all potential issues that may arise when a dealer transfers possession of a vehicle to a buyer without the accompanying title, it certainly suggests that the dealer must make some affirmative inquiry into the buyer's insurance status before the buyer drives the vehicle off the lot. Needless to say, it would be wise for the dealer to have some documentation in his file supporting the existence of insurance such as a copy of the buyer's current insurance card or a letter from his insurer or agent or maybe a written ledger entry confirming verbal proof received from the insurer or agent. One thing that is clear -- obtaining proof after the date of sale but before the date of loss will not be held sufficient in light of the majority's decision.

    See, KRS 186 .010(7)(a); KRS 186A.220 .

    February 06, 2007

    Torts: Invasions of privacy versus breach of confidentiality addressed in COA decision

    JOHNS V. FIRSTAR BANK
    TORTS - Invasion of privacy and breach of confidentiality
    2004-CA-001558
    PUBLISHED   
    AFFIRMING IN PART, REVERSING IN PART, AND REMANDING (DYCHE)
    DATE:  3/24/2006

    CA affirms in part, reverses in part and remands this invasion of privacy/breach of contract case.

    Johns sought financing through Firstar to establish a juvenile detention facility. He requested complete confidentiality because his father, superintendent of the school board, had recently come under public scrutiny. Someone at the bank leaked his involvement, torpedoing the deal. He sued for invasion of privacy, breach of implied contract, breach of fiduciary duty and negligence. A jury awarded him $250,000 for lost profits. CA affirms in part, reverses in part, and remands, holding that jury award did not distinguish whether award was for invasion of privacy, which did not apply, or breach of confidentiality.

    February 03, 2007

    Release reserving claims for excess trumped by agreed order dismissing with prejudice "any and all claims"

    FORD V. RATLIFF
    CIVIL - INSURANCE (Settlement, release, assignment)

    2004-CA-000022
    PUBLISHED 
    AFFIRMING
    VANMETER
    DATE:  1/13/2006

    CA affirms TC dismissal of direct action against insurance company, citing release of tortfeasor.

    In this auto collision case, plaintiff settled with tortfeasor, signing a settlement agreement and release (in exchange for policy limits under a Kentucky Farm Bureau policy) that attempted to leave open the option to sue general liability insurer Scottsdale Insurance. An agreed order dismissing "any and all" claims against the tortfeasors, with prejudice, was entered. After, plaintiff amended complaint to include general liability carrier. Carrier moved to dismiss, arguing that, under Kentucky law, plaintiff must file against tortfeasor, not directly against his carrier. Plaintiff claimed he had an executed assignment of rights, but was unable to produce it. Plaintiff moved the court to require plaintiff to sign a new one, which it declined, citing the language of the agreement. Plaintiff cannot proceed against the insurer directly; dismissal affirmed.

    February 02, 2007

    COA decision on releasing gov't employee releases gov't in Board of Claims

    COM. V. MORRIS
    BOARD OF CLAIMS - Jurisdiction (settlement and release of employee)

    2005-CA-000370
    PUBLISHED   
    REVERSING
    BUCKINGHAM
    DATE:  1/13/2006

    A release of the tortfeasor (cabinet employees) for personal injuries constitutes a release of the government in a board of claims action.  The cabinet  was relieved of any liability in connection with the claims due to the claimants having executed releases to its employee, Lancaster. Citing Copeland v. Humana of Kentucky, Inc., 769 S.W.2d 67 (Ky.App. 1989).  The claimants’ settlements with Lancaster inured to the benefit of the employer, the Labor Cabinet, notwithstanding attempts by the claimants in their releases to reserve the right to file claims against the Labor Cabinet.