Justia U.S. 10th Circuit Court of Appeals Opinion Summaries

Plaintiff James Bannister was injured in a motorcycle accident on the freeway near Oklahoma City in 2009. According to Bannister, he was forced to lay down and slide his motorcycle at a high speed when a car in front of him braked suddenly, that car having been cut off by another car. Bannister slammed into the wall of the freeway and suffered substantial injuries. He did not collide with any other vehicle; neither of the aforementioned cars remained at the scene of the accident; and no witnesses besides Bannister ever gave an account of the crash. Bannister filed an insurance claim with his insurer, defendant State Farm Automobile Insurance Company (State Farm). State Farm denied Bannister’s claim, finding him to be majority at fault in the accident. Bannister subsequently filed suit in Oklahoma state court, and State Farm removed the case to the Western District of Oklahoma. By the time the case went to trial, Bannister sought relief solely on a tort theory: that State Farm violated its duty of good faith and fair dealing in denying his claim. The jury found in favor of Bannister, but the district court granted State Farm’s renewed motion for judgment as a matter of law (“JMOL”), ruling essentially that the evidence showed that State Farm’s denial of Bannister’s claim was based on a reasonable dispute regarding whether Bannister was majority at fault, and that no evidence suggested that further investigation would have undermined the reasonableness of that dispute. Bannister failed to “make a showing that material facts were overlooked or that a more thorough investigation would have produced relevant information” that would have delegitimized the insurer’s dispute of the claim. As such, the Tenth Circuit concluded his inadequate-investigation theory of bad faith was without merit, and JMOL in favor of State Farm was appropriate. View "Bannister v. State Farm Mutual Auto Ins Co" on Justia Law

Plaintiff-Appellee Larry Frederick brought a putative class action suit against Hartford Underwriters Insurance Company (Hartford) in Colorado state court; Hartford removed the case to federal court. Looking to the face of Plaintiff’s complaint, the district court concluded that the amount in controversy did not exceed $5,000,000 (which was required for federal jurisdiction under the Class Action Fairness Act (CAFA)). Accordingly, the district court remanded the case to state court. In reaching its decision, the district court acknowledged that the Tenth Circuit had not defined the burden a defendant must carry to prevent a remand in a CAFA suit. Faced with this question, the Tenth Circuit held that a defendant in these circumstances is entitled to present his own estimate of the amount at stake and must show by a preponderance of the evidence that the amount in controversy exceeds the amount in 28 U.S.C. 1332(d)(2) (currently $5,000,000). The Court emphasized that the preponderance standard applies to punitive damages as well, and that such damages cannot be assumed when calculating the amount in controversy. Accordingly, the Court reversed the district court and remanded the case for further proceedings. View "Frederick v. Hartford" on Justia Law

The district court overturned an employee benefit plan's denial of a former employee's claim for permanent and total disability life insurance benefits. On appeal, Defendant Owens-Illinois Hourly Employees Welfare Benefit Plan contended the district court erred in rejecting Defendant’s argument that the employee was not eligible for this benefit under the Plan’s life insurance coverage provisions because his PTD life insurance claim was not filed until after he retired. Upon review, the Tenth Circuit concluded that the district court should have entered judgment in favor of Plaintiff on the administrative record rather than remanding for further administrative proceedings. The Tenth Circuit therefore remanded the case with directions for the district court to modify its order and enter judgment in favor of Plaintiff. View "Spradley v. Owens-Illinois Hourly Employees Welfare Benefit Plan" on Justia Law

"Haunted houses may be full of ghosts, goblins, and guillotines, but it’s their more prosaic features that pose the real danger." When the flashlight Tyler Hodges used in connection with taking tickets at an Oklahoma City haunted house began flickering and then died, he ventured inside the house in search of a replacement. To navigate, Mr. Hodges used the light of his cell phone. An actor complained that the light dampened the "otherworldly atmosphere" of the house, Mr. Hodges turned it off and made his way to the freight elevator, where the spare flashlights were stored. When he reached the elevator, Mr. Hodges lifted the wooden gate across the entrance and stepped in, not seeing that the elevator car was not there. Mr. Hodges sued Brewer Entertainment, the haunted house’s operator, for various torts. Brewer held two insurance polities, one with Western World Insurance Company, and the other with Markel American Insurance Company. Brewer quickly looked to them to defend the lawsuit and ultimately pay any award. For its part, Western World had excluded from its haunted house coverage “any claim arising from chutes, ladders, . . . naked hangman nooses, . . . trap doors . . . [or] electric shocks.” Because the policy did not specifically exclude "blind falls down elevator shafts," the company admitted coverage and proceeded to defend Mr. Hodges’s suit. Markel however, balked, refusing to defend or pay any claim. Western World sued to have Markel contribute to the costs of defending Mr. Hodges' suit. The district court agreed with Markel, and entered summary judgment in its favor. Upon review of the record, the Tenth Circuit found that Markel's escape clause was not enough for it to avoid contributing to defending Mr. Hodges' suit. The Court reversed the grant of summary judgment in Markel's favor and remanded the case for further proceedings. View "Western World Ins. Company v. Markel American Ins. Company" on Justia Law

In 2005, pursuant to the Black Lung Benefits Act's administrative provisions, an Administrative Law Judge (ALJ) awarded lifetime benefits to Merrill Lambright and survivor benefits to his widow, Delores Ashmore. Lambright's claims arose out of his employment with Petitioner Bridger Coal Company. In 2006, a three-member panel of the U.S. Department of Labor Benefits Review Board vacated the ALJ's decision and remanded to the ALJ for reconsideration. In 2008, the ALJ denied benefits on both the lifetime and survivor claims. In 2009, a three-member panel of the Board reversed this decision and reinstated the 2005 award of benefits. The issue on appeal was the characterization of Ms. Ashmore's 2002 request for a modification in her survivor benefits: "it appears the director interpreted Ashmore's motion as a motion for modification based on change in conditions, but only to the extent Ashmore alleged she was entitled to additional (survivor) benefits due to Lambright's death. To the extent the order granting modification was based on a change in conditions, the ruling only implicated the claim for survivor benefits, not Lambright's original claim for lifetime benefits." On reconsideration en banc, the full five-member Board was unable to reach a disposition in which at least three permanent members concurred. As a result, the 2009 panel decision stood. Petitioner appealed, challenging the scope of the 2009 panel's authority to review the 2008 ALJ decision, the standard used in determining whether to award benefits, and the onset-date determination. Upon review, the Tenth Circuit affirmed the 2009 panel decision. View "Bridger Coal Company v. United States Dept. of Labor" on Justia Law

The issue on appeal to the Tenth Circuit was whether Plaintiff Altheia Allen was disabled when her employer SouthCrest Hospital allegedly failed to accommodate her disability and terminated her employment. Because the Tenth Circuit concluded after review of the trial court record that Plaintiff failed to demonstrate a genuine issue of material fact concerning her alleged disability, the Court affirmed the district court's grant of summary judgment in favor of SouthCrest.

Okmulgee Inn Venture, LLC (Okmulgee) leased space to a nightclub-bar and was a named insured on a liquor liability insurance policy. Okmulgee’s insurer, Mount Vernon Fire Insurance Company (Mt. Vernon), assumed a duty to defend Okmulgee against suits seeking damages for injuries covered by the policy. In 2006, three bar patrons sustained gunshot wounds during a fight at the nightclub and sued Okmulgee, alleging, among other things, that Okmulgee failed to ensure the safety of the bar’s patrons, properly train the bar's staff, or investigate the bar’s operator. The only specific allegations pertaining to alcohol were that two of the three victims were under-age but were admitted to the bar and served alcohol. Mt. Vernon refused to defend Okmulgee in these suits. Mt. Vernon asserted there was no coverage under the policy, and thus no duty to defend or indemnify, because the allegations did not indicate the injuries were caused by the selling, serving, or furnishing of alcoholic beverages. Mt. Vernon then initiated this declaratory judgment action to determine its obligations. On cross motions for summary judgment, the district court ruled in favor of Mt. Vernon. Okmulgee insisted Mt. Vernon owed it a duty to defend because the facts showed that coverage was provided by the policy. Because the victims had yet to establish Okmulgee’s liability for any claims, the Tenth Circuit concluded after its review that the question of Mt. Vernon’s duty of indemnification was not ripe for adjudication. Mt. Vernon is obligated to defend its insured, and Okmulgee was entitled to summary judgment on the duty-of-defense issue.

Plaintiff Joseph Zbegner appealed a district court order dismissing without prejudice his claims against Allied Property and Casualty Insurance Co. (Allied) as not ripe for adjudication. Plaintiff was in an automobile accident in Boulder, Colorado in 2007. At that time he had an automobile insurance policy with Allied, which included underinsured motorist (UIM) coverage. In his complaint against Allied, Plaintiff alleged that he suffered severe injuries as a result of the accident and sustained damages exceeding $150,000. He claimed the driver of the other car was the person at fault in the accident, but was underinsured. Allstate paid Plaintiff $351.74 for property damage and offered him $2,145.00 to settle his injury claim. Plaintiff did not accept Allstate’s offer and did not resolve his claim against the driver. After Allied declined his claim, Plaintiff filed this action. Allied moved to dismiss Plaintiff's claim, asserting it could not know the amount due Plaintiff for UIM benefits until he had resolved his claim against Allstate, the driver's insurer. Because his claims were contingent on a future event, Allied contended they were not ripe for adjudication. The district court granted Allied’s motion, and dismissed Plaintiff's claims without prejudice. On appeal to the Tenth Circuit, Plaintiff contended the district court misconstrued Colorado law in its ripeness analysis. After careful review, the Tenth Circuit concluded the district court was correct in its analysis of Colorado law, and that Plaintiff's claim was not yet ripe for review.

Plaintiff-Appellant Eugene S. appealed a district court's denial of his motion to strike and its entry of summary judgment in favor of Defendant-Appellee Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ). Plaintiff sought coverage for his son A.S.'s residential treatment costs from his employer's ERISA benefits insurer. Horizon's delegated plan administrator originally denied the claim. Having exhausted his administrative appeals, Plaintiff filed suit in district court challenging the denial of benefits. The parties filed cross-motions for summary judgment, but Horizon also filed a declaration that included the terms of Horizon's delegation of authority to the plan administrator to administer mental health claims in a Vendor Services Agreement. Plaintiff moved to strike that declaration as procedurally barred. The district court denied the motion and granted Horizon summary judgment, finding that neither Horizon nor its plan administrator acted in an arbitrary or capricious manner in denying the contested claim. Upon review, the Tenth Circuit found substantial evidence in the record that A.S. did not meet the criteria for residential treatment benefits under the plan, and as such, the plan administrator did not act in an arbitrary or capricious manner in denying Plaintiff's claim. The Court affirmed the district court's judgment.

Plaintiff John Ensey was employed by both Defendant Ozzie’s Pipeline Padder, Inc. (Ozzie’s) and Rockford Corporation when he was severely injured. He sued Ozzie’s but was denied relief on the ground that Ozzie’s was protected by the exclusive-remedy provision of the New Mexico Workers’ Compensation Act. Plaintiff appealed, contending that Ozzie’s could not invoke the exclusivity provision because it failed to show that it contributed to paying for the workers’ compensation policy obtained by co-employer Rockford. Upon review, the Tenth Circuit concluded that under New Mexico law Ozzie’s was protected by the exclusivity provision because its contract with Rockford required Rockford to obtain workers’ compensation insurance for Plaintiff, and Plaintiff failed to produce evidence to overcome the inference that Ozzie’s therefore contributed to paying the insurance premium. Accordingly, the Court affirmed the district court's judgment that denied him relief.