Justia Insurance Law Opinion Summaries

Employee filed a petition for workers' compensation benefits for injuries he received during his employment with Employer. In accordance with Neb. Rev. Stat. 48-139(3), Employee entered into a lump-sump settlement with Employer and its workers' compensation insurance carrier. Pursuant to the statute, Employee filed a release in which he waived his rights under the Nebraska Workers' Compensation Act (Act) and discharged Employer from further liability arising from the injury. Employer paid the lump-sum amount forty-two days after the filing of the release. Employee subsequently sought and received a workers' compensation court order awarding a waiting-time penalty and attorney fees. The Supreme Court reversed, holding (1) a worker waives all of his rights under the Act when he files a release pursuant to the settlement procedures in section 48-139(3), including the right to penalties; and (2) therefore, a waiting-time penalty and the corresponding attorney fees cannot be imposed following a settlement reached under section 48-139(3). Remanded. View "Holdsworth v. Greenwood Famers Coop." on Justia Law

Employee was injured while in the course and scope of his employment. Employee's industrial claim was allowed for certain injuries. Fourteen years later, Employee successfully requested compensation for the total loss of the functional use of his right arm. Based on the Industrial Commission's award for loss of use, one year later Employee filed a motion for compensation for statutory permanent total disability. A staff hearing officer denied the application. The court of appeals granted Employee's writ of mandamus, concluding that the loss of use of Employee's arm could not be relitigated and that the Commission was bound by the doctrine of collateral estoppel to issue the award. The Supreme Court reversed the judgment of the court of appeals and denied the writ of mandamus, holding (1) the Commission must conduct an independent evaluation of the facts when considering an application for statutory permanent disability under Ohio Rev. Code 4123.58(C) even if a prior award for the same body parts has been given pursuant to Ohio Rev. Code 4123.57(b); and (2) the evidence in the record supported the basis for the Commission's decision. View "State ex rel. Coleman v. Indus. Comm'n of Ohio" on Justia Law

The Bunch Company filed consumer complaint, alleging that when BrickStreet Mutual Insurance Company became its insurer, BrickStreet wrongfully included a charge for the expense of an agent commission in the workers' compensation premium. The West Virginia Insurance Commissioner denied relief, upholding the previously approved rates. The circuit court reversed and vacated the Commissioner's administrative order. The Supreme Court reversed, holding (1) the Commissioner did not err in allowing BrickStreet to charge Bunch for a non-incurred agent commission; (2) the Commission properly found the insurance rates at issue were reasonable, and the trial court encroached upon a matter that has been expressly delegated to the executive branch by ignoring the deference the Commissioner was entitled to in connection with the interpretation of its own regulation; and (3) this case did not present any factual disputes requiring the Commissioner to hold a hearing. View "W. Va. Employers' Mut. Ins. Co. v. Bunch Co." on Justia Law

Employee was involved in a motor-vehilce accident while operating a one-ton dump truck within the course of his employment by Employer. Employee applied for and received benefits for his physical injuries. Employee subsequently requested an additional allowance for posttraumatic-stress disorder (PTSD) that arose contemporaneously as a result of the accident. The Bureau of Workers' Compensation (BWC) allowed Employee's additional claim. The trial court held that Employee's PTSD was not compensable because it did not arise from his physical injuries. The court of appeals affirmed. The Supreme Court affirmed, holding (1) for a claimant's PTSD to qualify as a compensable injury under Ohio Rev. Code 4123.01(C)(1), the claimant must establish his PTSD was causally related to his compensable physical injuries and not simply to his involvement in the accident; and (2) the court of appeals appropriately determined that the record contained competent, credible evidence supporting the trial court's finding that Employee's physical injuries did not cause his PTSD and that Employee's PTSD was, therefore, not a compensable injury under section 4123.01(C)(1). View "Armstrong v. John R. Jurgensen Co. " on Justia Law

Appellant filed a claim for benefits associated with an injury he received during his employment. The Arkansas Workers' Compensation Commissioned denied the claim based on a finding that Appellant tested positive for controlled substances after the injury and that he failed to rebut the statutory presumption that his injury was substantially occasioned by his drug use. Appellant appealed, arguing that the Commission's decision was not supported by substantial evidence and that the Commission lacked the authority to make credibility determinations contrary to those made by an ALJ. Currently before the Supreme Court was Defendant's motion to supplement the record with affidavits and depositions that Appellant attached to a brief he previously filed. The Supreme Court remanded to the Commission to settle the record to determine whether the documents were actually placed in the record. View "Prock v. Bull Shoals Boat Landing" on Justia Law

Benjamin Morris appealed an order of the Idaho Industrial Commission that denied his motion to set aside a lump sum settlement agreement he made with his employer's surety, Liberty Northwest Insurance. Morris initiated his workers' compensation action after he suffered injuries while working construction for his employer, Hap Taylor & Sons, Inc. Morris sustained a serious head injury on when a twenty-five pound rock thrown by a piece of heavy machinery struck him in the head. Morris initiated settlement discussions with Liberty Northwest Insurance, Hap Taylor & Sons' insurer. Liberty responded with a counter-offer—a single lump sum payment which Morris accepted "with the clear understanding this is a partial settlement and does not resolve the medical side." The parties executed a Stipulation and Agreement of Partial Lump Sum Discharge (LSSA) and submitted it to the Commission for approval. Approximately eighteen months later, on July 8, 2011, a Notice of Appearance was filed with the Commission whereby Morris substituted attorney Michael Walker with his then present counsel, attorney Starr Kelso. On the same day, Morris filed a motion to review the LSSA, accompanied by an affidavit signed by Kelso. Kelso's affidavit expressed concern that Morris may not have been "competent to testify" due to his injury—though, no credible evidence of incompetence was ever offered. Liberty filed an objection to Morris' motion to review. Ultimately, the Commission denied Morris' motion. Following the Commission's refusal to review the LSSA, Morris filed a Motion to Set Aside Lump Sum Settlement Agreement, seeking to void the LSSA on grounds of illegality and constructive fraud. The Commission issued an order denying Morris' motion to set the LSSA. Morris filed a timely appeal to the Supreme Court. After its review, the Supreme Court concluded that the Commission did not err in denying Morris' request for a hearing on his fraud claim. Furthermore, the Court affirmed the Commission's decision to deny Morris' motion to set the LSSA. View "Morris v. Hap Taylor & Sons" on Justia Law

Palmetto Hardwood, Inc., employed Petitioner Clifton Sparks as a saw operator. Petitioner suffered three work-related injuries during this employment, the first two of which injured Petitioner's lower back. In the third incident, Petitioner was required to remove a piece of metal from under a gang saw. In the process, the metal exploded and a three- to four-inch cubic piece struck him in the head. Petitioner subsequently sought workers' compensation for his injuries. At the hearing, Petitioner testified to substantial head pain, loss of cognitive ability, and other brain-function-related symptoms, including inability to read without severe headache, loss of his mathematical abilities, inability to balance while standing or to walk without a cane, hand tremors, anxiety, and more. Petitioner argued on appeal to the Supreme Court that the Court of Appeals erred when it applied an improper definition of "physical brain damage" within the meaning of section 42-9-10(C). The Supreme Court disagreed. Because "physical brain damage" as contemplated in S.C. Code Ann. 42-9-10 required "severe and permanent physical brain damage as a result of a compensable injury" and the Workers' Compensation Commission's finding that Petitioner did not suffer such brain damage was supported by substantial evidence in the record, the Court affirmed the Court of Appeals. View "Sparks v. Palmetto Hardwood" on Justia Law

The Wyoming Workers' Safety and Compensation Division awarded benefits to Appellant after he experienced a workplace injury. The Division denied Appellant's claim for payment for prescription medication he alleged was related to his workplace injury. The Medical Commission upheld the Division's determination, and the district court affirmed. The Supreme Court affirmed, holding (1) the Commission's decision upholding the Division's denial of benefits was supported by substantial evidence; and (2) the Commission applied the proper burden of proof for a second compensable injury when it required Appellant to establish a causal connection between his abdominal pain and his ingestion of the prescription medication at issue. View "Jacobs v. State ex rel. Wyo. Workers' Safety & Comp. Div." on Justia Law

Chartis Insurance issued two workers' compensation insurance policies to Action Warehouse Company. Action, in turn, contracted with two tire companies to provide employees to operate tire warehouses owned by the companies and used exclusively to store the goods manufactured by the respective employers. Originally, Chartis classified the Action employees who staffed the warehouses under the National Council on Compensation Insurance (NCCI) classification code applicable to general warehouse employees. Later, Chartis retroactively and prospectively changed the employees' classification code to the code applicable to rubber tire manufacturing, resulting in a significantly higher premium. Action appealed. The NCCI Iowa workers' compensation appeals board ruled in favor of Chartis. The Iowa Insurance Commissioner reversed, and the district court affirmed. At issue before the Supreme Court was whether the Commissioner had the authority under Iowa Code 515A.1 to consider an as-applied challenge to a workers' compensation liability insurance rating schedule approved for use in accordance with Iowa law. The Supreme Court reversed, holding that the Commissioner did not have the authority to determine that a specific application of a plan approved under Iowa Code 515A.4 violated the statute's general purpose as outlined in section 515A.1 by being excessive, inadequate, or unfairly discriminatory. View "Chartis Ins. v. Iowa Ins. Comm'r" on Justia Law

After an administrative judge (AJ) ruled on a claimant's petition to controvert a workers' compensation claim, the claimant had twenty days to file a notice of appeal with the full Mississippi Workers' Compensation Commission. In this case, the issue before the Supreme Court was whether an AJ's order, handed down more than twenty days after the AJ's ruling and granting a claimant thirty additional days in which to prosecute her claim, should be given legal effect by the Commission so that the claimant's notice of appeal, filed within the additional thirty days, would be considered timely. Upon review, the Court found that, under the facts and circumstances presented, such an appeal was timely. View "Felter v. Floorserv, Inc." on Justia Law