Justia Insurance Law Opinion SummariesArticles Posted in Government Law
Georgia Dept. of Corrections v. Developers Surety & Indemnity Co.
The Georgia Department of Corrections (GDOC) entered into a construction contract with Lewis Walker Roofing (Walker Roofing) to re-roof several buildings at Valdosta State Prison. The Contract contained two “no assignment” clauses, and as a prerequisite to contracting with GDOC, Walker Roofing was required to obtain payment and performance bonds. It obtained such payment and performance bonds from Developers Surety and Indemnity Company. Walker Roofing did not complete its work within the time frame required by the Contract, and GDOC declared Walker Roofing in default. Developers Surety did not notify GDOC within 25 days of receipt of GDOC's notice of default regarding whether it would remedy the default or perform the contract. However, approximately three months after the declaration of default, Developers Surety gave GDOC the option of entering into a contract with another company for the completion of the work. GDOC then contracted with that company to finish the project. Under the payment and performance bonds and prior to Walker Roofing's default, Developers Surety had provided financial assistance to Walker Roofing. Developers Surety filed suit against GDOC for breach of contract and for a declaratory judgment that it had no obligation under the payment and performance bond it issued to Walker Roofing on behalf of GDOC. GDOC filed a counterclaim for breach of contract. The parties filed cross-motions for summary judgment, and the trial court determined that Developers Surety's claims were not barred by sovereign immunity and that GDOC had breached the construction contract as a matter of law. It concluded that GDOC waived its sovereign immunity by entering into the contract with Walker Roofing, and that the doctrine of equitable subrogation gave Developers Surety the ability to file suit against GDOC once it incurred liability and paid the obligations of its principal under the bond. Consequently, the trial court granted summary judgment to Developers Surety and denied it to GDOC; in the same order, the trial court entered judgment in favor of Developers Surety in the amount equal to the "financial assistance" Developers Surety provided to Walker Roofing. The Supreme Court granted certiorari to the Court of Appeals to consider whether the State’s sovereign immunity was waived for the claim Developers Surety made on its contract with the State. The Supreme Court found that immunity was indeed waived in this instance, and accordingly, it affirmed the judgment of the Court of Appeals. View "Georgia Dept. of Corrections v. Developers Surety & Indemnity Co." on Justia Law
Posted in: Construction Law, Contracts, Government Contracts, Government Law, Insurance Law
Ky. Ininsured Employers’ Fund v. Hoskins
Kentucky Employers’ Mutual Insurance (KEMI) was the workers’ compensation carrier for Beacon Enterprises, Inc. at the time that Julian Hoskins was injured during the course of his employment with Four Star Transportation, Inc. (Four Star). Four Star had configured its workforce pursuant to an employee leasing arrangement with a company affiliated with Beacon Enterprises, an employee leasing company. The Workers’ Compensation Board determined that Hoskins was not covered by Beacon Enterprises’ policy with KEMI because Hoskins was not an employee of Beacon Enterprises at the time of the injury. The court of appeals upheld the Board’s decision. The Supreme Court reversed, holding (1) Ky. Rev. Stat. 342.615 does not require an employee to have knowledge of his status as a leased employee or of the nature of his relationship with the employee leasing company; and (2) because the court of appeals grounded its opinion upon Hoskins’s lack of knowledge, the matter must be remanded for the court to address other issues raised by KEMI in support of the Board’s decision.View "Ky. Ininsured Employers’ Fund v. Hoskins" on Justia Law
Ferraro v. Ridgefield European Motors, Inc.
Plaintiff sought compensation for injuries he sustained while employed with his employer. The employer’s insurer at the time Plaintiff filed his claim entered into a voluntary agreement on the claim and subsequently sought apportionment against Employer’s prior insurers, including Republic-Franklin Insurance Company. Republic-Franklin did not agree to its apportionment liability until just before the close of evidence. Thereafter, the Workers’ Compensation Commissioner ordered Republic-Franklin to pay interest pursuant to Conn. Gen. Stat. 31-299b. The Workers’ Compensation Commission affirmed. The Supreme Court affirmed the decision of the Board, holding that the Commissioner’s order of interest was proper because (1) the Commissioner satisfied the statutory prerequisites of section 31-299b; and (2) Republic-Franklin failed to preserve its claim that the Commissioner’s order of interest was not made within a reasonable period of time as required by section 31-299b.View "Ferraro v. Ridgefield European Motors, Inc." on Justia Law
Malcomson v. Liberty Northwest
Petitioner, who was injured while performing her work duties, filed a workers’ compensation claim. Liberty Northwest (Liberty), the insurer for the claim, terminated Petitioner’s temporary partial disability (TPD) benefits after Petitioner revoked releases and authorizations she had previously signed allowing Liberty and its agents to have ex parte communications with her medical care providers. Petitioner filed an action asserting that the statutes relied upon by Liberty to terminate her medical benefits, Mont. Code Ann. 39-71-604 and Mont. Code Ann. 50-16-527, were unconstitutional. The Workers’ Compensation Court (WCC) determined that section 39-71-604(3), as applied in Petitioner’s case, violated Petitioner’s constitutional right of privacy. The Supreme Court affirmed, holding that the WCC did not err in concluding that section 39-71-604(3) violated Petitioner’s right of privacy set forth in the Montana Constitution.View "Malcomson v. Liberty Northwest" on Justia Law
Adamson v. Municipality of Anchorage
A firefighter developed prostate cancer when he was in his mid-fifties, after working for nearly 30 years. He filed a workers’ compensation claim under a new statute creating a presumption that certain diseases in firefighters, including prostate cancer, are work related when specific conditions are met. The employer contended that the firefighter could not attach the presumption of compensability because he had not strictly complied with statutory and regulatory medical examination requirements. The employer also wanted to present expert testimony that the cause of prostate cancer was unknown. The Alaska Workers’ Compensation Board heard the claim and refused to consider parts of the expert’s testimony, deciding that the firefighter was eligible for benefits because he had attached the presumption of compensability by substantially complying with the statutory requirements and the employer had not rebutted the presumption. On appeal, the Alaska Workers’ Compensation Appeals Commission agreed, but reversed the Board’s decision disallowing the expert testimony. The Commission decided that the employer could rebut the presumption through its expert’s testimony that the cause of prostate cancer was unknown, and remanded the case to the Board for further proceedings. Because the employer also contended that the firefighter-presumption statute violated the Alaska Constitution’s equal protection guarantee, the State of Alaska intervened on appeal. The Supreme Court affirmed the Commission’s decision that the firefighter attached the presumption by substantially complying with the applicable requirements. However, the Court reversed the Commission’s decision that the employer could rebut the presumption through expert testimony that there was no known cause of prostate cancer.View "Adamson v. Municipality of Anchorage" on Justia Law
Hayes v. Rosenbaum Signs & Outdoor Advertising, Inc.
Appellant injured his lower back in 2007 while working for Employer. Employer denied further treatment that same year. Appellant filed a petition for hearing in 2009, alleging that he was entitled to medical benefits. Based on a deposition of Dr. Dale Anderson, Employer filed an amended answer admitting that Appellant’s work activities were a major contributing cause to his need for medical treatment. The Department of Labor dismissed the case in 2010. In 2011, Employer denied further medical treatment based upon a recent independent medical evaluation by another doctor. Appellant petitioned for a hearing, arguing that res judicata applied to prevent Employer from changing its position from its previous admittance. The Department found res judicata inapplicable and that Appellant failed to meet his burden of proof on causation. The circuit court affirmed. The Supreme Court reversed, holding that because Dr. Anderson’s opinion was adopted by Employer and judicially accepted by the Department through its 2010 order of dismissal, Employer was judicially estopped from taking an inconsistent position; and (2) Appellant met his burden of proving that his work-related activities as of 2010 were a major contributing cause of his disability. Remanded.View "Hayes v. Rosenbaum Signs & Outdoor Advertising, Inc. " on Justia Law
Moore v. Health Care Auth.
In this class action lawsuit, the trial court found that the State wrongfully denied health benefits to a number of its part-time employees. The issue this case presented for the Supreme Court's review was how to value the damages suffered by that group of employees when they were denied health benefits. The State argued that the only damages to the employees were immediate medical expenses paid by employees during the time they were denied health benefits. But evidence showed that people denied health care benefits suffer additional damage. They often avoid going to the doctor for preventive care, and they defer care for medical problems. This results in increased long-term medical costs and a lower quality of life. Based on this evidence, the trial court correctly rejected the State's limited definition of damages because it would significantly understate the damages suffered by the employees. The Supreme Court affirmed.View "Moore v. Health Care Auth." on Justia Law
Posted in: Employment Law, Government Law, Health Care Law, Insurance Law
Yang v. Nissan N. Am., Inc.
Employee suffered bilateral shoulder injuries and underwent separate surgeries on each shoulder. Employee later agreed to a voluntary buyout of his employment. Employee subsequently filed two separate suits for workers’ compensation benefits. The trial court determined that Employee’s permanent partial disability benefits were not capped at one and one-half times the impairment rating and awarded ninety percent permanent partial disability benefits. Employer appealed. A Special Workers’ Compensation Appeals Panel modified the award of permanent partial disability benefits to 37.5 percent as capped at one and one-half times the impairment rating, concluding that Employee’s decision to accept the buyout was not “reasonable” for purposes of the statutory cap. The Supreme Court reversed in part and reinstated the judgment of the trial court as to the award of ninety percent permanent partial disability benefits, holding that because Employee acted reasonably by accepting the voluntary buyout for reasons related to his work injuries, the award for permanent partial disability was not subject to the one-and-one-half-times multiplier.View "Yang v. Nissan N. Am., Inc." on Justia Law
Merrill v. Maine Public Employees Retirement System
Reva Merrill appealed a Superior Court judgment that affirmed the Board of Trustees for the Maine Public Employees Retirement System's decision to deny her request for a waiver of past-due life insurance premiums. Merrill contended on appeal that the Board erred in interpreting 5 M.R.S. 17103(6)(2008) to prohibit it from waiving past-due payments for the non-mandatory Group Life Insurance Program, and that the Board's administrative procedures violated her right to due process. Because the Supreme Court agreed with Merrill that the Board had the authority to waive back premiums, the Court vacated the Board's decision and remanded the case for the Board to decide finally whether to waive Merrill's required payments. View "Merrill v. Maine Public Employees Retirement System" on Justia Law
Stevens v. S.T. Servs.
In 1984 and 1985, James Stevens injured both shoulders while working for S.T. Services and CNA Insurance Companies (collectively, S.T. Services). In 1994, Stevens and S.T. Services entered into a stipulation for settlement under which the parties agreed that Stevens was permanently totally disabled and would receive ongoing permanent total disability benefits. A compensation judge entered an award on the stipulation, and Stevens received benefits until 2011. Stevens began working as a plumbing specialist in 2008 and disclosed his job to S.T. Stevens but continued to receive workers’ compensation benefits. In 2011, S.T. Services filed a petition with the Workers Compensation Court of Appeals (WCCA) to discontinue paying benefits on the grounds that Stevens was no longer permanently totally disabled. A compensation judge granted S.T. Services’ petition to discontinue, and the WCCA affirmed. The Supreme Court reversed, holding that S.T. Services was not allowed by statute to file a petition to discontinue benefits under the circumstances of this case.View "Stevens v. S.T. Servs." on Justia Law