Justia Montana Supreme Court Opinion Summaries

In 2006, Plaintiffs sustained serious injuries in an automobile accident and incurred medical expenses in excess of $1,000,000. Plaintiffs subsequently learned that they had only $5,000 in medical payments coverage and did not have any underinsured motorist (UIM) coverage after a transfer of their Oregon State Farm policy to Montana by the Mark Olson State Farm Agency. The driver who caused the accident carried the statutory minimum automobile liability insurance limits. Plaintiffs sued State Farm and Mark Olson, requesting declaratory relief and a reformation of the contract and alleging negligence, breach of fiduciary duty, and conduct sufficient to support an award of punitive damages. The district court entered summary judgment in favor of Defendants. The Supreme Court reversed, holding that the district court erred in entered summary judgment in favor of State Farm and Olson on Plaintiffs' negligence claims. Remanded for trial. View "Bailey v. State Farm Auto. Ins. Co." on Justia Law

Plaintiff was injured in an automobile accident and received medical treatment at Benefis Health System, Inc. Plaintiff had healthcare coverage as a TRICARE beneficiary and also had medical payments coverage through his insurance carrier, Kemper. Plaintiff's medical treatment costs totaled $2,073. Benefis accepted $662 from TRICARE as payment in full satisfaction of the bill pursuant to a preferred provider agreement (PPA) between Blue Cross Blue Shield and Benefis. Benefis subsequently received $1,866 from Kemper, upon which Benefis reimbursed TRICARE's payment in full. Plaintiff filed an individual and class action complaint, claiming that he was entitled to the additional $1,204 that Benefis received from Kemper over and above the TRICARE reimbursement rate. Plaintiff filed a motion for judgment on the pleadings, asking the district court to find Benefis breached its contract with TRICARE and that Benefis was liable for Plaintiff's damages. The district court converted the motion into a motion for summary judgment and granted summary judgment to Plaintiff. The Supreme Court reversed the grant of summary judgment, holding (1) Plaintiff was not entitled to pocket the difference between the TRICARE reimbursement rate and the amount Benefis accepted from Kemper; and (2) Plaintiff failed to establish any damages that resulted from the alleged breach. View "Conway v. Benefis Health Sys., Inc." on Justia Law

Brent Anderson purchased life insurance from Insurer and named three beneficiaries under the policy: (1) his then-wife, Lucia, (2) his parents, and (3) his sister. Brent and Lucia subsequently divorced. Later that year, Mont. Code Ann. 72-2-814 became effective. The statute provides that a divorce revokes "any revocable disposition or appointment of property made by a divorced individual to the individual's former spouse in a governing instrument." Brent died several years later without having changed his designation of Lucia as primary beneficiary under the life insurance policy. Insurer filed an interpleader action to determine the rightful beneficiary under Brent's policy. The district court ruled in favor of Lucia based in part on the fact that section 72-2-814 became effective after Brent and Lucia's divorce. The Supreme Court accepted a certified question from the U.S. court of appeals and answered that section 72-2-814 applies to a divorce that pre-dates the statute's enactment. View "Thrivent Fin. for Lutherans v. Andronescu" on Justia Law

Employee was injured while working for Employer. Because Employer failed to retain current worker's compensation insurance, Employee filed a claim with the Uninsured Employer's Fund, which the Fund accepted. The Fund sought indemnity from Employer for Employee's damages, and the parties agreed to an interim payment plan. However, the Fund ultimately turned Employer over to collection. Employer responded by suing the Fund for breach of contract. The district court granted Employer's summary judgment motion on the issue of whether the Fund had breached the repayment agreement. The district court then awarded damages to Employer in the amount of $198,749. The damages awarded largely centered on the court's implicit conclusion that the Fund's actions had interfered with Employer's ability to obtain financing, which, in turn, hurt Employer's sales. The Supreme Court affirmed, holding that the district court properly (1) determined Employer was entitled to summary judgment on the question of whether the Fund had breached the payment plan agreement; (2) determined Employer could receive consequential damages for the Fund's breach of contract; (3) denied the Fund's motion for post-trial relief; (3) calculated damages; and (4) denied Employer's damage claim for ten years of lost profits. View "Elk Mountain Motor Sports, Inc. v. Dep't of Labor & Indus." on Justia Law

Employer terminated Employee's employment after receiving complaints regarding poor service and use of inappropriate language by Employee. The Department of Labor & Industry concluded Employee was not qualified for unemployment insurance benefits because she had been discharged for misconduct. A hearing officer awarded unemployment benefits to Employee, concluding that Employee had not been deliberately rude and thus had not engaged in misconduct. The Board of Labor Appeals affirmed. Employer petitioned for judicial review. The Department and Board filed a notice of non-participation indicating they would not participate in the proceeding but reserved the right to intervene if issues arose pertaining to them. The district court reversed, holding that Employee's conduct as established by the hearing officer's findings of fact constituted misconduct as a matter of law under the carelessness standard of Admin. R. M 24.11.460(1)(d). The Department appealed. The Supreme Court affirmed, holding (1) the Department did not preserve its evidentiary arguments for appeal; and (2) the district court did not err by determining that the evidence found by the Department constituted misconduct as a matter of law under the carelessness standard. View "Gary & Leo's Fresh Foods v. Dep't of Labor & Indus." on Justia Law

This case arose from claims asserted by multiple persons against Blue Cross and Blue Shield of Montana (BCBSMT) and Montana Comprehensive Health Association (MCHA). Claimants asserted that while they were fully insured by BCBSMT or MCHA, they submitted claims that the insurers denied based upon exclusions contained in their insurance policies. These exclusions were subsequently disapproved by the Montana Commissioner of Insurance (Commissioner) and the insureds sought the previously-denied benefits. The matter evolved into a class action and three of the claimants, Krista Lucas, Brittany Smith, and Alice Speare, were named class representatives. Subsequently, a settlement was negotiated. Three other claimants, Tyson Pallister, Kevin Budd and Jessica Normandeau, objected to the settlement and sought review by the Second Judicial District Court. The District Court approved the settlement. Pallister, Budd and Normandeau appealed asserting numerous errors by the District Court including but not limited to the court’s error in denying Pallister’s motion to conduct discovery. Upon review, the Supreme Court reversed and remanded on a discrete issue of discovery and vacated the District Court’s approval of the Settlement Agreement. View "Pallister et al v. Blue Cross & Blue Shield of Montana" on Justia Law

Candice Brilz filed an action in Montana state court purportedly asserting statutory and common law bad-faith claims against Metropolitan General Insurance Company (Metropolitan). Metropolitan removed the action to federal court and filed a motion for summary judgment, which the federal court granted. Thereafter, Brilz commenced this suit district court seeking a determination that she may pursue her common law bad-faith claim against Metropolitan. Because the statute of limitations on that claim had since expired, Brilz requested a ruling that she may pursue the claim pursuant to 27-2-407, MCA, or the Supreme Court's doctrine of equitable tolling. The District Court dismissed the action, and Brilz appealed. The Supreme Court concluded that principles of claim preclusion barred her from filing a second action against Metropolitan arising out of the same underlying facts. Accordingly the Court affirmed the District Court's judgment. View "Brilz v. Metropolitan General Ins." on Justia Law

Richard Ford suffered a work-related injury to his neck. He was diagnosed with a cervical strain, and Sentry Casualty Company accepted liability and paid benefits for this injury. During Ford’s treatment, he underwent an MRI which revealed a more serious cervical disc condition. Ford claimed that the workplace accident caused or aggravated this condition and that Sentry was liable for surgery to address it. Ford also claimed that Sentry was liable for ongoing temporary total disability benefits and that Sentry had unreasonably adjusted his claim. Sentry denied liability for Ford’s cervical disc condition based on the opinions of several doctors that the condition was not related to the industrial accident. Sentry also maintained that Ford reached maximum medical improvement, that he has been released to return to work without restrictions, and that it reasonably adjusted his claim. The dispute ultimately reached the Workers’ Compensation Court (WCC). Trial was held in early 2011. Ford and his wife testified, and numerous medical records were admitted into evidence. The WCC ruled in favor of Sentry as to each of the foregoing issues, and Ford appealed. Upon review of the trial court record, the Supreme Court concluded that the WCC correctly determined that he failed to carry his burden of establishing causation with regard to his disc condition and affirmed the trial court's judgment. View "Ford v. Sentry Casualty Co." on Justia Law

Plaintiff-Appellant Shaune Kuszmaul appealed a district court order that granted summary judgment to Sterling Life Insurance Company (Sterling) on her wrongful discharge claim. Plaintiff worked as an outside sales agent for a subsidiary of Sterling since 2000. In October 2009, Plaintiff drafted a marketing letter promoting Sterling products. She mailed out approximately 1,000 copies of the letter to current and potential customers. Plaintiff did not obtain approval from anyone at Sterling before sending the letter, nor did she clear it with the Montana Department of Insurance (DOI) or any other regulatory agency. A relative of one of the recipients of the letter anonymously notified Sterling by mail that the letter might violate the Policy. The writer sent a copy of its complaint to the Sterling Life Corporate Compliance Office, the Montana DOI, and the CMS Regional Office, exposing Sterling to possible state and federal sanctions. This prompted Sterling to begin an internal investigation. While being investigated, Plaintiff acknowledged that her marketing letter was not in conformance with company policy, but denied doing anything intentionally wrong. She was terminated for violating company policy with regard to the unapproved marketing materials. Upon review of the district court record, the Supreme Court affirmed, finding no error in the court's decision to grant the insurance company summary judgment. View "Kuszmaul v. Sterling Life" on Justia Law

The State Department of Labor and Industry appealed a district court's order that reversed the Department's decision regarding Petitioner Sheila Callahan & Friends, Inc. (SC&F). SC&F, a radio broadcasting company entered into a one-year contract with Joni Mielke. During the term of employment, SC&F evaluated Mielke as being an excellent radio personality and announcer but as underperforming other responsibilities because she either did not want to do them or preferred announcing-related duties. Mielke elected not to renew her contract with SC&F, and on an exit interview form, Mielke indicated her reason for leaving was that she "quit." After Mielke left her employment with SC&F, she was hired by another radio station. After a brief employment with this subsequent employer, she was laid off and filed for unemployment benefits in October 2009. The Department of Labor sent a Notice of Chargeability Determination to SC&F assessing a pro rata share of the costs of Mielke’s unemployment insurance benefits to SC&F’s experience rating account. The Department administratively determined that Mielke was employed for SC&F on a contract basis during her base period of employment and that SC&F’s account was chargeable for a portion of benefits drawn by Mielke. SC&F requested a redetermination, arguing that Mielke had voluntarily left her employment. The Department issued a Redetermination affirming the initial Determination. An administrative hearing was then conducted by telephone; the hearing officer determined that Mielke neither voluntarily quit nor was discharged for misconduct and affirmed the decision to charge SC&F’s account. On appeal, the Department argued the District Court improperly failed to defer to the Board’s findings of facts. Upon review, the Supreme Court concluded that the error of the Board was primarily premised upon application of legal standards, in the nature of a conclusion of law. Given the inapplicability of the imputation rules to the situation here, the District Court properly concluded that the evidence did not support the Board’s determination that Mielke’s work separation was involuntary. View "Sheila Callahan & Friends, Inc. v. Montana" on Justia Law