Missouri Insurance Lawyer Blog

In a case decided September 13, 2011, the Missouri Court of Appeals, Western District, announced a "substantial departure from prior law" in holding that employees, who suffered work-related occupational diseases, now have the option of suing their employers in civil court. The case is State ex rel. KCP&L Greater Missouri Operations Company v. Cook, 353 S.W.3d 14.

Prior to the 2005 Amendment to the Missouri Workers Compensation laws, employees were prohibited from filing lawsuits in civil court against their employers for occupational diseases. The legal remedy for recovering for an "Occupational Disease" was exclusively a Workers Compensation claim. The 2005 amendment changed the definition of "accident" to now be limited to an injury caused by a specific event during a single work shift.

Further, the 2005 amendments require the workers compensation statutes to be strictly construed. Although "occupational disease" is defined in the workers compensation amendments, the court found that the plain language of the 2005 amendments' exclusivity provisions are limited to injuries or death caused by an "accident". Now, under the 2005 "strict construction" requirement, the court found that the law's exclusivity provision no longer applies to conditions such as asbestosis and cancer. Therefore, workers are now allowed to pursue claims against their employers directly in the civil courts for diseases and medical conditions caused by their employment.

Continue reading "WORKERS WHO SUFFER WORK RELATED OCCUPATIONAL DISEASES NOW HAVE THE OPTION OF SUING THEIR EMPLOYER IN CIVIL COURT" »

An insurer is hopeful that they can use an Alabama state law governing deceptive trade practices to stop Google from prominently displaying negative websites about their company. American Income Life Insurance Company has filed suit in the Jefferson County, Alabama with charges that Google (along with several other websites) are violating state law by "intentionally disparaging the goods, services, or business of the plaintiff by false and misleading representations of fact."

At issue in the suit are several websites that appear on the first Google page of search results regarding the company which contain contents condemning the insurer's business practices. One such website, scam.com, displays a heading of "American Income Life is a Scam."

Alabama attorney Richard Baxley, in his letter to Google executives, said the sites are scams that are targeted to hurt the insurer by making anonymous charges under the guise of being "whistleblowers" performing a public service. As a result, Baxley says, the company has sustained significant financial damage. Additionally, he says that these anonymous websites have figured out how to game Google's algorithm to ensure that their sites rank high in search results.

Consistently, the courts have ruled in Google's favor in similar cases. Read more here

On August 12, 2006, James Reppy was seriously injured in a head on vehicle collision with the defendant Gary Winters. Attorneys for Reppy sent a letter to defendant's automobile insurance carrier, Farmers Insurance Group, demanding settlement and left the demand open for 90 days. The demand indicated that if it was not accepted, it would be withdrawn. The offered release would have completely immunized Winters from any further claims in exchange for the policy limits.

The reply of the insurer through counsel indicated that the policy limits offer was accepted, but imposed an additional condition that Reppy's counsel and Reppy would indemnify Winters and his insurance company and their attorney from liability for any type of medical lien.

Continue reading "INSURER'S DEMAND FOR INDEMNITY OF MEDICAL LIENS IS A COUNTER OFFER, NOT ACCEPTANCE OF SETTLEMENT DEMAND" »

In the case of Long v. Shelter Insurance Company, the Missouri Western District Court of Appeals, held that Shelter Insurance's anti-stacking language in the underinsured motorist coverage was ambiguous because of the "other insurance" clause. The court concluded that Shelter's "excess" language in the "other insurance" clause as well as it's "other insurance in the company" provision created ambiguity when read with the policy's anti-stacking language. The court further went on to strike down the policy set off provision, holding that the interplay of the policy's declaration page, limits of liability, and its promise to pay uncompensated damages created ambiguity when viewed against the policy's set-off language.

Interestingly, on the same day the court also issued the opinion of Stewart v. Liberty Mutual Insurance Company holding in that case that the insured could not stack and that the UIM anti-stacking language was not ambiguous. In its decision, the court distinguished between the "excess" "other insurance" language in the Liberty Mutual policy from the "other insurance" provisions considered by the Missouri Supreme Court in Ritchie v. Allied Property and Casualty Insurance Company, 307 S.W.3d 132 (Mo. banc 2009). In its decision, the Western District relied on a decision which had already been partially repudiated by the Missouri Supreme Court. That decision, Farm Bureau Town & Country Insurance Company of Missouri v. Barker, 150 S.W.3d 103 (Mo. App. W.D. 2004), was noted by the Supreme Court to have not been cited in any other underinsured motorist decision since it was handed down, and to the extent it was inconsistent with Seeck v. Geico General Insurance Company, 212 S.W.3d 129 (Mo. banc 2000), Barker should no longer be followed. In a detailed decision, the Stewart court, relying on Barker, distinguished the excess provision from other provisions addressed in Ritchie and Seeck. The Missouri Supreme Court did not accept transfer of the case. However, given Ritchie's criticism of Barker, and the Western District's reliance on Barker, this issue almost certainly will be revisited in other cases. The Seeck case, which the Supreme Court cited with approval, relied on a long line of cases including Zemelman v. Equity Mutual Insurance Company, 935 S.W.2d 673 (Mo. App. W.D. 1996); Goza v. Hartford Underwriters Insurance Company, 972 S.W.2d 371 (Mo. App. E.D. 1998); Niswonger v. Farm Bureau Town & Country Insurance Company of Missouri, 992 S.W.2d 308 (Mo. App. E.D. 1999); American Family Mutual Insurance Company v. Ragsdale, 213 S.W.2d 51 (Mo. App. W.D. 2006) and Chamness v. American Family Mutual Insurance Company, 226 S.W.3d 1999 (Mo. App. E.D. 2007), which included similar language to the policy contained in Stewart, but reached opposite conclusions of Barker. Undoubtedly, insurers seeking to avoid underinsured motorist liability will avoid the language held to be ambiguous in Long v. Shelter Insurance Company, and move towards the language held not to be ambiguous in Stewart v. Liberty Mutual Fire Insurance Company in the future. Nonetheless, given the inconsistencies between the Stewart court's reliance on the Barker decision and its stark contrast with Seeck and its cases, the underinsured motorist stacking issue will continue to spawn numerous cases, and seemingly conflicting decisions.

This grant award will help make health insurance coverage more accessible and affordable for individuals and small businesses. The state Department of Insurance and the Missouri Health Insurance Pool has plans of building an online marketplace where Missouri families and businesses can compare and purchase health insurance that specifically fits them and their needs. The online marketplace will improve competition and drive down costs because of increased transparency, comparison, and product options.

When you pay your insurance premiums, it might seem far fetched to imagine that your money may eventually end up in the hands of a prostitute, but that is exactly what happened with Munich Re, the world's largest reinsurance company.

Munich Re is an insurance company for other insurance companies, also known as reinsurance. In 2007, to reward their top 100 salesmen, board directors and executives, the company held a spa party where they provided 20 prostitutes to provide an array of sexual services. To read more about this news story, see the BBC article, "German Insurer Held Orgy for Salesmen."

Insurance companies serving the consumers in the Joplin area had already paid more than $509 million in claims in the first five weeks after the tornado. These claims were all regarding residential, personal, and commercial property damage due to the EF- 5 tornado that struck on May 22nd. John M. Huff, director of the Department of Insurance expects this number to be three to four times larger by the time all the claims are settled.

Governor Jay Nixon has extended his executive order providing emergency protections for the insurance coverage of Joplin- area residents. Under this new executive order these provisions will stay in effect:
• Insurance companies must provide copies of policies at no charge to consumers who request them;
• Public adjusters must show their state license to prospective clients;
• Public adjusters may not charge customers to pay a fee in advance; and
• After signing a contract with a public adjuster, consumers have 14 days to cancel.
John M. Huff, director of the Department of Insurance says consumers should work with their insurance companies themselves to settle claims first. If a consumer reaches a point where they cannot work with their insurance company then a consumer complaint should be filed with the department. Consumers also have the option of hiring a public adjuster to represent them.

Government officials have been warning for some time that the Second Injury Fund for injured workers was running out of funds to pay claims. With nearly 30,000 outstanding claims and 700 new claims being filed each month, this is a big problem for the attorney general. See this recent news story from the Belleville News Democrat.

A handful of U.S. states are revamping their insurance rules to become more attractive to insurance companies. Vermont, Utah, South Carolina, Delaware and Hawaii are attempting to become destinations of choice for special insurance subsidiaries called captives. See this NY Times article to read more about this unsettling development in insurance laws and regulations.

The Missouri legislature is again considering amending the current Missouri Workers' Compensation statutes. Just six years ago Missouri legislatures changed the statutes in an attempt to make it tougher to qualify for Workers' Compensation. The proposed changes, as set out in House Bill 162, make it easier for injured workers to qualify for compensation by adding occupational diseases and the acts of co-employees to the coverage designated by the statues. This alteration to the current statutes would prevent an injured employee from filing a claim against a co-employee in a Missouri Circuit Court.

On November 9, 2010, in Robinson v. Hooker, 323 S.W.3d 418, the Missouri Court of Appeals, Western District, ruled, based on the current Workers' Compensation statutes, that an injured employee who had a claim against an employer that did fall under the Workers' Compensation statutes could still recover damages against a co-employee in a subsequent tort claim. The ruling by the court in Robinson allowed an injured employee to sue a co-employee whose negligent actions resulted in injury. If House Bill 162 becomes law, injured employees will be limited to ONLY what they can recover through the Missouri Workers' Compensation statutes, no matter whether a co-employee's negligent actions were the cause of the injury.

In the Robinson case, Mr. Robinson's right eye was injured when Ms. Hooker used a high pressure hose negligently. As a result of the injury, Mr. Robinson is now blind in his right eye. Mr. Robinson's employer's Workers' Compensation insurance carrier settled Mr. Robinson's claim, and Mr. Robinson brought suit against Ms. Hooker for damages resulting from her negligence. If House Bill 162 becomes law, Mr. Robinson would have been barred from bringing suit against Ms. Hooker even though she may have acted negligently and caused him to lose sight in his right eye.

Medicare enrollment is currently open through December 31st. If you want to apply for Medicare benefits for yourself or help a loved one apply but don't know where to start, call the Missouri Department of Insurance or visit their website. They're offering free assistance to anyone who needs help with the enrollment process via the CLAIM Insurance Assistance project. You can also visit the CLAIM website for more information.

It was reported on Tuesday, September 21st by the Missouri Department of Insurance that eight companies and individuals have been accused of selling fake health plans. The fines against these companies and individuals is more than one million dollars.
The companies sold plans that were disguised as medical insurance. The plans were marketed through unsolicited faxes which at least 150 Missouri Consumers bought. The faxes said things such as "Dependent Coverage" and "Group Health Plan."

$130,000 in fines were imposed by regulators. Cease and desist orders were also issued for the following individuals and buisnesses:Thomas J. Sullivan; Richard Bachman; James M. Doyle; Bart S. Posey Sr.; Christopher Ashiotes; and Obed Kirkpatrick; Smart Data Solutions; Affinity Group Benefits Association Inc. Discount- plan marketers caught violating the court orders will likely face criminal prosecution.

Individuals who have been cheated by insurance companies have the right to sue the insurance company for damages. Government agencies police business but don't get compensation for the damages the consumer suffered. If an insurance company cheated you, you should speak to an experienced attorney about your legal rights

Continue reading "Fake Medical Insurance" »

All 50 states have been affected by a Tennessee based entity called the American Trade Association (ATA) plus other affiliated firms, which was selling fake health insurance. The program was supposed to work by the ATA taking out money directly from consumer's accounts. Consumer's thought they were saving hundreds of dollars each month on premiums until an issue with their health came up and they found out they were not insured.

Some consumer's have shared their stories through Smart Data Solutions where one person stated, "I tried to get prescriptions through my card and it is not covered. They say they are getting a new plan, but did not inform anyone. Their phone goes unanswered, or it is busy. Their website; http://www.myatabenefits.com doesn't work either. This is either an incredibly poor run organization, or a scam."

After investigations were held consumers found out that their money had actually been used to pay for personal items such as cars, real estate, and loan payments. Some claims were paid, but only the small ones to maintain the appearance of legitimacy.

The state of Maine actually ordered the American Trade Association to pay a $1.2 million penalty because of the unlicensed products sold to consumers, the unlicensed agents, and for not adequately paying for consumer's medical bills.

Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services describes how this is just the beginning. There will be more scammers out there because they know people are seeking cheaper insurance coverage.

Consumers who want to research a company can check with their State Department of Insurance. If you are scammed by insurance company or a company that promises to provide insurance and does not, you have legal rights. In Missouri an insurance company that does not honor its promise can be sued for breach of contract and in some circumstances for bad faith. If a company poses as an insurance company but is a fake, you can sue for damages for breach of contract, misrepresentation and fraud. If you have been scammed you should also report the company responsible to law enforcement.

Continue reading "Health Insurance Scam Affects 26,000 People Across the U.S." »

In a case handed down August 6, 2010 by the Missouri Court of Appeals, Southern District, the court found that the proposed lien of a health insurer was an invalid attempt to require assignment of the Participant's personal injury claim and, as such, it was contrary to longstanding Missouri public policy. Scroggins v. Red Lobster, No. SD 30214.

In 2007, Pamela Scroggins was seriously injured in a trip and fall accident at a restaurant. Ms. Scroggins' medical expenses were covered by an employee contributory self-funded health plan that provided benefit coverage to her under her employer provided health care plan. As a result of her injuries, Ms. Scroggins sued the restaurant and the lawsuit resulted in a settlement.

One of the health insurance plan provisions purported to grant the health insurer a lien upon the proceeds of the Participant's tort recovery, and a right to payment from any recovery, to the extent of the sum that the Insurer paid for injuries Ms. Scroggins suffered. This is not unusual. Insurers paying benefits to insureds as a result of injuries caused by third persons often claim an interest in recovering those costs if the insured obtains a settlement or collects upon a judgment against the third party. To that end, insurers have repeatedly attempted to draft policy provisions or establish other requirements for the purposes of seeking reimbursement from the insured in such situations.

Continue reading "HEALTH INSURER CANNOT ASSERT LIEN UPON THE PROCEEDS OF THE PARTICIPANT'S TORT RECOVERY" »