7/22/2020 | This week in Business Insurance Workers Compensation… – Editor
WC Magazine
Pie secures financing for continued comp expansion
By Angela Childers
Pie Insurance Holdings Inc. has secured $127 million in new financing to continue to expand its small business workers compensation line, the three-year-old insurtech firm announced in a statement Thursday.
Pie has received a $100 million equity capital commitment for the creation of its affiliated company, Pie Carrier Holdings, and to purchase licensed insurers to enable it to issue a portion of its own policies, as well as $27 million in financing to support continued growth and expansion of the insurtech’s current workers compensation products.
Gallatin Point Capital LLC was the lead investor in this new financing commitment. Other investors included Greycroft LLC, SVB Capital (the venture arm of SVB Financial Group), Aspect Ventures LP, Elefund Management Co. LLC and Sirius International Insurance Group Ltd.
Pie, with headquarters in Washington and Denver, currently offers workers compensation to small businesses in 34 states and the District of Columbia.
Widow not bound by claims release signed by husband
By Angela Childers
A firefighter’s widow can pursue death benefits despite her husband’s earlier workers compensation settlement agreement releasing the insurer from all future claims made by his dependents.
In the case, In the Matter of Collins, the Maryland Court of Appeals in Annapolis unanimously held Tuesday that the firefighter’s dependents were not bound by the contract that he — not his dependents — signed.
Bernard Collins worked for the Huntingtown Volunteer Fire Department. In 2012, he filed a claim for disability benefits for heart disease and hypertension that was presumed to be compensable under Maryland law. The insurers, Chesapeake Employers Insurance Co. and Selective Insurance Co. of America, contested the claim, but eventually agreed to a settlement in 2015. The settlement agreement provided Mr. Collins with a lump sum payment of $150,000, a Medicare set-aside annuity and annual payments of about $4,000, with the stipulation that Mr. Collins and his dependents would release the insurers from any and all future claims that may arise under the Maryland Workers Compensation Act. The settlement was approved by the Maryland Workers Compensation Commission. His wife was not party to the settlement.
In 2017, Mr. Collins died from cardiac arrest and his widow, Peggy Collins, filed a dependent’s claim for death befits under the Act. The commission denied her claim based on the terms of the settlement agreement, and she appealed to the Calvert County Circuit Court, which upheld the denial.
The Maryland Court of Special Appeals, however, reversed the decision and remanded the case back to the commission, holding that Mrs. Collins was not a party to the settlement and therefore her husband’s settlement “does not extinguish the independent claim for death benefits that a surviving dependent may bring if the employee dies of the same compensable injury or disease.”
The insurers appealed, but the appellate court affirmed the Court of Special Appeals decision that Mr. Collins’ settlement did not bar his widow from asserting her independent claim for death benefits under the Act.
The insurers argued that Mr. Collins “unambiguously” agreed to release the insurers from future claims, but the appellate court found that the release was ambiguous and devoid of language specific to death benefits, and that the settlement agreement is unenforceable against any person who is not party to the agreement.
The court held that the Act permits dependents to release their current or future death benefit claims, but that employees do not have the power to release their dependents’ independent claims for them.
Although the insurers argued that a decision in Mrs. Collins’ favor would “largely end” the settlement for workers compensation cases by removing “any finality,” the court said insures may choose to provide payments to dependents in exchange for their death benefits release in future settlements.
Insurer failed to prove cause of guard’s fall unexplained
By Louise Escola
A workers compensation insurer failed to prove that a security guard’s fall that resulted in a hospital treatment for a brain injury was “idiopathic,” or unexplained, the Workers’ Compensation Court of Montana ruled Tuesday in denying a summary judgment to the insurer.
Margie Dargin fell during her shift as an Allied Universal employee providing security for an oil refinery in Billings, Montana. She has no recollection of how she fell or what happened after her fall, which caused her to be hospitalized for a week, according to documents in Margie Dargin v. XL Insurance of America, filed in Helena.
Ms. Dargin suffered a head injury along with a seizure in the time following her fall. A doctor “stated that it was her opinion that Dargin did not fall as a result of a seizure” and “opined that Dargin ‘somehow had a head injury’ and that she was suffering from post-concussive syndrome,” court documents state.
A second doctor commented that Ms. Dargin’s history is “incomplete” and was therefore unable to state whether she had a pre-existing condition that could cause her to have a seizure and fall, or whether a head injury caused the brain condition leading to the seizure post-fall, according to documents.
XL Insurance, which denied her claim on the basis that she fell on a level surface, moved for summary judgment before the state Workers’ Compensation Court, arguing that the cause of the fall was not “arising out of” her employment in accordance with state law, according to documents.
The court ruled that the insurer, meanwhile, failed to prove the fall was idiopathic, writing that XL Insurance “did not meet its burden of establishing that there are no issues of material fact as to whether Dargin suffered an idiopathic fall onto a level surface” and that “it is not entitled to summary judgment on those grounds.”