Justia Insurance Law Opinion Summaries

Petitioner Vincent James Hogg, Sr. sought review of a Workers' Compensation Court order which denied his workers' compensation benefits based upon the court's interpretation of 85 O.S. 2011, section 312 (3). Petitioner was employed by the Oklahoma County Juvenile Detention Center when in late 2011, he sustained an injury to his right shoulder and neck while subduing an unruly and combative juvenile. Petitioner was given a post-accident drug screen and a follow-up screen the next day. Both screens showed a "positive" result for the presence of marijuana in his system. Petitioner did not dispute the test results but Petitioner denied ever smoking marijuana. The trial court ultimately found there was no evidence presented to establish Petitioner was "high," nor was there any evidence to establish the marijuana in his system was the "major cause" of the accidental injury. The trial court did, however, deny Petitioner's eligibility for workers' compensation benefits by reason of its interpretation of the newly created 85 O.S. 2011, section 312 (3). The dispositive issue presented to the Supreme Court was whether the trial court erred in its interpretation of the statute. The trial court found the last sentence of paragraph 3 expressed the legislative intent of the entire paragraph without giving any weight to the other sentences in the same paragraph. In its order, the trial court indicated this sentence created an irrebuttable presumption. Upon review, the Supreme Court disagreed. The Court concluded that Petitioner overcame the rebuttable presumption of ineligibility for workers' compensation benefits. The case was reversed and remanded for further proceedings. View "Hogg v. Oklahoma Cty. Juvenile Bureau" on Justia Law

Brendan Muldoon appealed a district court judgment that affirmed an order from an administrative law judge ("ALJ") which: affirmed an order of Workforce Safety and Insurance ("WSI") finding Muldoon was an employer under N.D.C.C. 65-01-02(17); that Muldoon wilfully failed to secure workers' compensation coverage for his employees; and that Muldoon was personally liable for past premiums and penalties owed to WSI. Upon review of the ALJ's record, the Supreme Court affirmed, concluding the ALJ's findings were supported by a preponderance of the evidence. View "Muldoon v. WSI" on Justia Law

In this appeal, the Supreme Court was asked to determined whether Ohio Const. art. XII, 5a permits the use of motor vehicle and gas tax (MVGT) funds to pay those costs of a county's joint self-insurance pool attributable to covering the risk of liability and loss resulting from the operations of a county engineer's highway department. The Supreme Court concluded that Ohio Const. art. XII, 5a authorizes the use of MVGT funds to pay a county's cost of participating in a joint self-insurance pool attributable to covering the risk of liability and loss resulting from the operations of a county engineer's highway department. In so holding, the Court reversed the judgment of the court of appeals and remanded. View "Stockberger v. Henry" on Justia Law

Petitioner suffered an injury while in the course and scope of his employment. The employer's workers' compensation insurance carrier paid medical benefits but contested the extent of Petitioner's entitlement to impairment income benefits. The Department of Insurance's Workers' Compensation Division determined that Petitioner had an impairment rating of twenty percent. The trial court reversed the agency's decision, ruling that Petitioner had no valid impairment rating. The court of appeals affirmed. While Petitioner's appeal to the Supreme Court was pending, the Court held in American Zurich Insurance Co. v. Samudio that the absence of a valid impairment rating that had been submitted to the agency did not deprive a reviewing court of subject matter jurisdiction. In light of its decision in Samudio, the Court then reversed and remanded to the trial court with instructions that the court remand the case to the Division in light of its determination that Petitioner had no valid impairment rating. View "DeLeon v. Royal Indem. Co." on Justia Law

The Supreme Court accepted the petition of Harleysville Mutual Insurance Company (Petitioner) in its Original Jurisdiction to assess constitutional challenges to Act No. 26 of the South Carolina Acts and Joint Resolutions, which regulates coverage provided by commercial general liability (CGL) insurance policies for construction-related work. Upon review, the Supreme Court held that the retroactivity clause of Act No. 261 violated the Contract Clauses of the state and federal Constitutions, and that the statute may only apply prospectively to CGL insurance contracts executed on or after its effective date of May 17, 2011. View "Harleysville Mutual v. South Carolina" on Justia Law

The issue before the Supreme Court in this case centered on whether a Workers' Compensation employer's insurance carrier should be reimbursed from the Supersedeas Fund for specific payments made to a claimant prior to the ultimate grant of supersedeas. The question turned on whether the relevant payments constituted payments of "compensation" within the meaning of Section 443 of the Workers' Compensation Act (WCA), 77 P.S. 999(a), or, as argued by Appellant Bureau of Workers' Compensation, whether the payments are not reimbursable because they constitute payment of legal costs associated with obtaining a claimant's third-party tort settlement under Section 319 of the WCA, 77 P.S. 671. After review, the Court found no language in either Section 443 or Section 319 that would transform the relevant payments into something other than compensation merely because the amounts of the payments were calculated to compensate the claimant for the costs of recovering the third-party settlement. Accordingly, the Court affirmed the decision of the Commonwealth Court. View "Bureau of Workers' Comp, Aplt v. WCAB(Excelsior Ins.)" on Justia Law

Appellant was injured in an accident that occurred during the course of her employment. After receiving a permanent partial impairment award from the Wyoming Worker's Compensation Division, Appellant sought permanent partial disability benefits. The Division denied Appellant's application, stating that she had not complied with the statutory work search requirements. After a contested case hearing, the Office of Administrative Hearings granted summary judgment for the Division, concluding that Appellant had not timely submitted documentation showing she had sought work. The district court affirmed. The Supreme Court reversed, holding (1) Appellant's work search submission was timely; and (2) Appellant was entitled to a hearing and the opportunity to present evidence showing that she actively sought work. View "Stallman v. State ex rel. Wyo. Workers' Safety & Comp. Div." on Justia Law

Following the trial court's grant of summary judgment to the Georgia Insurers Insolvency Pool (GIIP), Lumpkin County appealed, contending that following the insolvency of the County's regular insurer, GIIP was required to step in and cover the pending workers' compensation claims against the County. Specifically, the County argued that the trial court erred in finding that it was not entitled to coverage under the GIIP because the County's net worth exceeded $25 million. Alternatively, the County argued OCGA 33-36-3 unconstitutionally violated the County's due process rights. Upon review, the Supreme Court affirmed: "The County contend[ed] that this ruling was erroneous because the term 'net worth' is inapplicable to government entities, and, instead, the applicability of the twenty-five million dollar exemption under the Act should be assessed based on the County's 'net assets.' The County argue[d] that the bulk of its assets, including land, roads, bridges, and government buildings are restricted from use and are thus unavailable to meet its obligations or satisfy liabilities. Based on the County's calculation of its own net assets, it only has $5.6 million dollars with which to meet these obligations. As a result, the County maintain[ed] that it should receive coverage for its claims from the GIIP. This argument is misplaced." Therefore, the Court held that the trial court did not err in excluding the County from GIIP protection based on the net worth exemption. Furthermore, the County does not possess due process rights by which to challenge the constitutionality of the Act, and its argument premised on any such right necessarily failed. View "Lumpkin Co. v. Georgia Insurers Insolvency Pool" on Justia Law

Petitioner appealed an order of the West Virginia Workers' Compensation Board of Review through which Petitioner's permanent total disability (PTD) award previously granted was suspended and vacated. Petitioner challenged the Board's determination, upon a reopening of his PTD claim, that he was capable of gainful employment. Petitioner argued that his former employer, Lowe's, violated the statute that authorized the claim reopening because Lowe's was involved in the reevaluation process, and therefore, the order vacating his PTD award was invalid. The Supreme Court affirmed, holding that notwithstanding statutory language that suggests otherwise, an order issued by the Board that modifies or vacates a previous award of PTD is not subject to challenge based on the involvement of a self-insured former employer in the reevaluation process, given that the participation of the self-insured former employer is clearly anticipated and authorized by the provisions of W. Va. Cod 23-4-16(d). View "Justice v. W. Va. Office Ins. Comm'n" on Justia Law

Respondent injured his back while working, and his employer's workers' compensation insurer, Texas Mutual Insurance Company (TMIC), accepted the injury as compensable. Three years later when it was discovered that Respondent had herniated lumbar intervertebral discs, TMIC disputed whether they were causally related to the original injury. The Texas Department of Insurance Division of Workers' Compensation determined that the disc herniations were related to the original injury and ordered TMIC to pay medical benefits, which it did. Respondent later sued TMIC for damages caused by its delay in paying benefits. The trial court rendered judgment for Respondent, and the court of appeals affirmed. Based on the Court's recent decision in Texas Mutual Insurance Co. v. Ruttiger, the Supreme Court reversed and rendered judgment for TMIC. View "Tex. Mut. Ins. Co. v. Morris" on Justia Law