Justia Insurance Law Opinion Summaries

The Supreme Court granted certiorari in this case to consider whether La. R.S. 23:1203.1 applied to a dispute arising out of a request for medical treatment where the request for treatment was submitted after the effective date of the statute and the medical treatment schedule, but the compensable accident and injury that necessitated the request occurred prior to that date. Both the Office of Workers’ Compensation (OWC) and the court of appeal ruled that La. R.S. 23:1203.1 applied to all requests for medical treatment submitted after the statute’s effective date, regardless of the date of accident and injury. Finding no reversible error, the Supreme Court affirmed. View "Cook v. Family Care Services, Inc." on Justia Law

The issue this case presented to the Supreme Court centered on whether the Patient’s Compensation Fund (PCF) could be bound by summary judgment rendered solely against a defendant physician in the underlying malpractice proceeding on the issue of causation. Plaintiffs, Majdi Khammash and his wife and children, filed suit against various defendants, including Dr. Gray Barrow. After approving plaintiff’s settlement with Dr. Barrow for the $100,000 Medical Malpractice Act (MMA) cap, the District Court granted partial summary judgment, finding plaintiff’s injuries were caused by the fault of Dr. Barrow. The case then proceeded to jury trial against the PCF for the remaining $400,000 MMA cap. The jury returned a verdict in the PCF’s favor, finding Dr. Barrow’s malpractice did not cause plaintiff damage. The Court of Appeal reversed, finding as a result of the partial summary judgment, the issue of causation was not properly before the jury, and remanded for a new trial on damages only. The Supreme Court granted certiorari to address the extent, if any, the PCF was bound by the partial summary judgment on causation. The Court found, in accordance with La. Rev. Stat. 40:1299.44(C)(5)(a) and its holding in "Graham v. Willis-Knighton Med. Ctr.," (699 So.2d 365), the partial summary judgment against Dr. Barrow on the issue of causation was not binding on the PCF in plaintiff’s claim for damages exceeding the $100,000 MMA cap. Furthermore, the Court found no manifest error in the jury’s factual findings on causation. The Court therefore reversed the judgment of the Court of Appeal and reinstated the District Court’s judgment in its entirety. View "Khammash v. Clark" on Justia Law

This case arose out of dispute over the administration of a workers’ compensation self-insurance plan (“Plan”) administered by Herkimer County. Dozens of municipalities participated in the Plan, including the Village of Herkimer. In 2005, the County passed a resolution to terminate the plan. To ensure funding for outstanding workers’ compensation claims, the County created an Abandonment Plan that allowed municipalities to withdraw from the plan and pay a lump sum withdrawal fee. Several of the participating municipalities, including the Village, filed an action challenging the Plan and Abandonment Plan based on alleged mismanagement by the County. The County counterclaimed for breach of contract, seeking to recover the withdrawal liability. The County prevailed on summary judgment as to the liability on its counterclaim for breach of contract against the Village. After a trial on damages, the jury awarded the full amount of damages sought by the County against the Village. The Appellate Division affirmed the damages award. The Court of Appeals affirmed as modified, holding that the fee for the Village’s withdrawal from the Plan reflected benefits to be paid in the future and therefore should have been discounted to its current value as of the date it was due. View "Village of Ilion v. County of Herkimer" on Justia Law

Workforce Safety and Insurance appealed a district court judgment affirming an administrative law judge's order finding William Snook and other similarly situated welders were independent contractors. The Supreme Court affirmed, concluding the ALJ's findings of fact were supported by a preponderance of the evidence and the conclusions of law were supported by those facts. View "WSI v. Larry's On Site Welding" on Justia Law

Dennis Whedbee appealed a district court judgment affirming Workforce Safety and Insurance's ("WSI") binding dispute resolution denying Whedbee's request for a myoelectric prosthesis and approving a body-powered prosthesis. Whedbee argued the binding dispute resolution was an abuse of discretion and violated his due process rights. He argued that WSI should have selected an independent medical examiner located closer to his residence and that his treating physician's opinion should have been given controlling weight. Finding no reversible error, the Supreme Court affirmed. View "Whedbee v. WSI" on Justia Law

In 2006, Appellant injured her lower back while working for Employer, who was self-insured. Later that year, Employer discharged Appellant for violating the company’s absenteeism policy and failing to accept the light-duty work offered. The Industrial Commission denied Appellant’s request for temporary total disability (TTD) compensation, concluding that Appellant had abandoned her employment and that the abandonment barred payment of TTD compensation. Three and a half years after the denial of benefits, Appellant filed a complaint for a writ of mandamus. The appellate court denied the writ, concluding that the Commission did not abuse its discretion when it denied Appellant’s request for TTD benefits, as her conduct had amounted to a voluntary abandonment of employment. The Supreme Court affirmed, holding that the Commission did not abuse its discretion when it denied Appellant’s request for compensation, as the Commission’s order was supported by the evidence. View "State ex rel. Jacobs v. Indus. Comm'n" on Justia Law

RB Entertainment is one of a complicated web of at least seventeen different companies that Appellant Jeffrey Cohen allegedly owns and controls. Central to this appeal was one issue: whether the delinquency proceedings for Indemnity Insurance Corporation, RRG violated the constitutional due process rights of Cohen or Co-Appellant RB Entertainment Ventures. Co-Appellant IDG Companies, LLC (Indemnity's managing general agent), was also one of the Cohen-affiliated entities. After uncovering evidence that Cohen had committed fraud in his capacity as Indemnity's CEO and that Indemnity might be insolvent, the Delaware Insurance Commissioner petitioned the Court of Chancery for a seizure order. The Delaware Uniform Insurers Liquidation Act. Based on the detailed allegations and supporting evidence presented by the Commissioner, the Court of Chancery granted that seizure order, which, among other things, prohibited anyone with notice of the proceedings from transacting the business of Indemnity, selling or destroying Indemnity’s assets, or asserting claims against Indemnity in other venues without permission from the Commissioner. The seizure order also prohibited anyone with notice of the proceedings from interfering with the Commissioner in the discharge of her duties. Cohen, who founded Indemnity and had served as its President, Chairman, and CEO, resigned from Indemnity's board during the ensuing investigation and the board removed him from his managerial positions. After his resignation, Cohen interfered with the Commissioner's efforts to operate Indemnity in various ways. The Commissioner returned to the Court of Chancery several times, first seeking an amendment to the seizure order to address Cohen's behavior and then seeking sanctions against him. The Court of Chancery entered a series of orders that increased the restrictions on Cohen's behavior and imposed stiffer sanctions upon him. Cohen argued that he was denied due process at several junctures during the Court of Chancery proceedings. Because Cohen's claims alleged violations of his right to due process, the focus of the Supreme Court's opinion was on whether Cohen was given notice of the allegations against him and a fair opportunity to present his side of the dispute. Having carefully examined the record in this case, the Court concluded that he was given that opportunity: no violation of Cohen's or the affiliated entities' due process rights occurred. View "Cohen, et al. v. State of Delaware, et al." on Justia Law

After suffering a severe electrical shock while working as a lineman for Tippah Electric Power Association, Lonnie Smith filed a petition to controvert with the Mississippi Workers' Compensation Commission. Tippah denied that Smith's claim was compensable and raised the affirmative defense that Smith had intentionally injured himself. The administrative judge (AJ) found that Smith had intentionally injured himself and that his injury was not compensable; the Commission affirmed the AJ's denial of the claim. The Court of Appeals affirmed the Commission's decision. The Supreme Court granted certiorari because it found that the Commission's decision was not supported by substantial evidence. Accordingly, the Court reversed and remanded this case to the Commission for a determination of benefits. View "Smith v. Tippah Electric Power Association" on Justia Law

Dustin Watkins suffered an in utero stroke approximately two days before he was born (in 1990), allegedly arising out of the medical malpractice of the treating obstetrician, Dr. Richard Barry, which resulted in a brain injury. This medical malpractice action followed, and a November 2003 trial resulted in multiple damage awards. At issue in this case was the extent to which the Louisiana Patient's Compensation Fund (PCF) continued to be obligated to make advance payments for custodial/attendant care for a medical malpractice victim, after receiving information indicating that such care may no longer be needed, and whether the PCF had the right to unilaterally terminate such payments, without prior court approval, when a judgment was previously rendered ordering it to make said payments. Upon review, the Supreme Court held that when the PCF denies a claim for payment of a future medical or related expense and the district court thereafter exercises its continuing jurisdiction and issues a ruling as to that matter, the PCF is obligated to comply with the district court's ruling, order, or judgment unless it modified or set aside by the court. View "Watkins v. Lake Charles Memorial Hospital" on Justia Law

The Colorado Division of Insurance initiated an investigation into Milton Trujillo's application to renew as a insurance producer license with bail bond authority. It later denied the application based on a complaint it received. The Division charged Trujillo with twelve counts of violating the insurance code, professions and occupations code, and Division regulations. The ALJ revoked the license; the Commissioner of Insurance adopted the ALJ's decision. The court of appeals affirmed the Commissioner's action, determining that Trujillo violated a fiduciary duty prescribed by 10-2-704(a). The Supreme Court reversed, finding that the court of appeals erred in applying section 10-2-704(1)(a) to this case: "[w]hile there are unappealed findings of fact upon which the Commissioner on remand could uphold the sanction it ordered, it is not clear [to the Court] whether, absent the agency's construction of 10-2-704(1)(a), the Commissioner would have exercised his authority to revoke Trujillo's license and deny his renewal application." The case was therefore remanded for redetermination by the Commissioner the appropriate sanction for Trujillo's conduct. View "Trujillo v. Colorado Division of Insurance" on Justia Law