Justia Insurance Law Opinion Summaries

This appeal concerned the method for excluding impairment from a non-compensable disability when calculating a worker's permanent disability benefit under the post-1996 version of Kan. Rev. Stat. 342.730(1)(b). The ALJ calculated a benefit based on the claimant's entire post-injury permanent impairment rating and then subtracted an amount equal to a benefit based on his pre-existing active impairment rating. The workers' compensation board reversed, determining that the present version of section 342.730(1)(b) requires the calculation of income benefits to be based only on the permanent impairment rating caused by the injury being compensated. The court of appeals affirmed. The Supreme Court affirmed, holding that pre-existing impairment must be excluded when calculating a total disability award under section 342.730(1)(b). View "Tudor v. Indus. Mold & Mach. Co." on Justia Law

Appellants James Baldwin and Ronda Reynolds allegedly sustained injuries in separate highway incidents after objects came loose from unidentified vehicles and collided with their vehicles. Both Appellants sought uninsured motorist (UM) coverage for hit-and-run accidents through their automobile insurance policies. Baldwin's State Farm policy provided coverage when an uninsured motor vehicle "strikes" the insured vehicle, and Reynolds's Safeco policy covered damages when an uninsured motor vehicle "hits" the insured vehicle. The Supreme Court accepted review in these consolidated cases to focus on whether Appellants' accidents satisfied the impact requirements contained in the UM clauses of their insurance policies. The Supreme Court held that the impact requirements of the UM clauses of Baldwin's and Reynolds's insurance policies were not met, and therefore, UM coverage was not applicable to Appellants' hit-and-run accidents. View "State Farm Mut. Auto. Ins. Co. v. Baldwin" on Justia Law

Claimant sustained a work-related injury in 2003, for which he was awarded temporary total disability (TTD) benefits followed by 425 weeks of permanent partial disability benefits. In 2007 Claimant sustained another injury. After finding the effects of the 2003 injury caused Claimant's 2007 injury, an ALJ increased Claimant's partial disability benefit at reopening and tripled the entire income benefit awarded for his injury. The workers' compensation board and court of appeals affirmed. The Supreme Court affirmed, holding (1) substantial evidence supported the finding of increased impairment as well as the finding that Claimant lacked the physical capacity at reopening to perform the type of work performed at the time of his injury; and (2) the combined effects of the impairment present at the time of the initial award and the additional impairment present at reopening entitled Claimant to triple benefits based on the whole of his disability for the balance of the compensable period. View "James T. English Trucking v. Beeler" on Justia Law

An ALJ determined that Claimant sustained a work-related hearing loss and that Kan. Rev. Stat. 342.7305(4) placed the entire liability for income and medical benefits with Appellant, the last employer with whom Claimant was last injuriously exposed to hazardous noise. The workers' compensation board and court of appeals affirmed. The Supreme Court affirmed, holding (1) the record contained substantial evidence that testing revealed a pattern of hearing loss compatible with that caused by hazardous noise exposure and contained substantial evidence that Claimant sustained repetitive exposure to hazardous noise in the workplace, including his final employment with Appellant; and (2) Kan. Stat. Rev. 342.7305(4) does not permit apportioning liability among employers in such cases. View "Greg's Constr. v. Keeton" on Justia Law

This appeal concerned an ALJ's decision to award the claimant temporary total disability (TTD) benefits for his work-related shoulder injury from the date he left work, May 10, 2007, until May 8, 2009. The ALJ also awarded permanent income and medical benefits for the injury but denied claims for cervical and lumbar spine injuries. A court of appeals majority reversed, concluding that the opinion and award failed to contain findings adequate to make clear whether the ALJ considered and understood all of the evidence relevant to the date when TTD began. The Supreme Court (1) reversed to the extent that the ALJ made the finding of fact required by Kan. Rev. Stat. 342.0011(11)(a); but (2) affirmed to the extent the Court was unable to determine whether the ALJ simply misstated May 10, 2007 as being the date the claimant testified he stopped working due to the effects of his injury, misunderstood the evidence concerning his reason for missing work on May 10, 2007, or chose May 10, 2007 based on other evidence. Remanded to the ALJ to clarify that portion of the decision. View "Arnold v. Toyota Motor Mfg." on Justia Law

This case presented the question of whether an automobile insurance policy's permissive user step-down provision was valid and enforceable. Specifically, the Supreme Court addressed whether the particular provision at issue was sufficiently conspicuous, plain, and clear to satisfy the doctrine of reasonable expectations. The circuit court entered summary judgment in favor of the insurance company, declaring the permissive user step-down provision enforceable. The court of appeals affirmed. The Supreme Court reversed, holding that the policy's permissive user step-down provision was insufficiently plain and clear to defeat the reasonable expectations of the insureds, and therefore, the provision violated the doctrine of reasonable expectations. Remanded. View "Bidwell v. Shelter Mut. Ins. Co." on Justia Law

At issue in this appeal was whether Ky. Rev. Stat. 342.730(6) entitled UPS Airlines to receive credit against its liability under section 342.730(1) for the payment of loss of license benefits that were the product of a collective bargaining agreement between UPS Airlines and the Independent Pilots Association (IPA), of which Claimant was a member. Claimant, a UPS pilot, sustained a work-related injury and underwent surgery. UPS paid the entire premium for the loss of license insurance plan. UPS subsequently sought leave to credit Claimant's loss of license benefits against its liability for income benefits. Reversing an ALJ's decision, the workers' compensation board found that section 342.730(6) did not entitle UPS to a dollar-for-dollar credit against Claimant's past due and future income benefits for all benefits paid under the loss of license plan. The Supreme Court (1) affirmed to the extent that UPS was not entitled to a dollar-for-dollar credit; but (2) reversed with respect to the conclusion that loss of license benefits were not funded exclusively by the employer for the purposes of section 342.730(6) because they were bargained-for benefits, holding that section 342.730(6) does not entitle UPS to credit the overpayment of voluntary benefits against future income benefits. Remanded.

On April 1, 2005, Employee was injured during the course of his employment. Due to the injury, Employee never returned to work. Employee received workers' compensation benefits from April 2, 2005 through April 14, 2007. When the workers' compensation benefits ceased, Employee applied for unemployment insurance benefits. The Unemployment Insurance Commission based Employee's unemployment benefits on an extended base period comprised of the first three quarters of 2005 and the fourth quarter of 2006. Employee appealed, arguing that the extended base period should be based upon the four calendar quarters of the year 2004 because those were the most recent four quarters which fairly reflected the wages he earned prior to his injury. The circuit court reversed. The court of appeals affirmed. At issue on appeal was the proper interpretation of "extended base period" as defined in section 341.090(2). The Supreme Court reversed the court of appeals and reinstated the decision of the Commission, holding that the Commission properly applied the statute as written by the General Assembly in calculating Employee's unemployment benefits.

Doctors' Associates, Inc. (DAI) owns the "Subway" trademark and franchises the right to operate Subway sandwich shops nationwide. A claimant sought workers' compensation benefits for a work-related injury sustained while working for an uninsured Subway franchisee. The DAI and Uninsured Employers' Fund (UEF) were later joined as parties. The sole issue submitted for a decision by the ALJ was whether DAI was a contractor and, thus, liable to the employee of its uninsured subcontractor. The ALJ dismissed the UEF's claim against DAI, ruling that Ky. Rev. Stat. 342.610, which provides that a contractor can be liable to the employee of its uninsured subcontractor, imposed no liability on DAI because the statute did not encompass franchise relationships. The workers' compensation board affirmed. The court of appeals reversed, holding that the ALJ committed by legal error by concluding that the legislature did not intend for section 34.610 to encompass the franchisor-franchisee relationship simply because the statute failed to mention the relationship. The Supreme Court reversed, holding (1) the ALJ erroneously interpreted section 342.610, but (2) the error did not require reversal of the ALJ's ruling because the ALJ properly analyzed the facts of the case under the statute.

Travelers Insurance Company brought suit in circuit court alleging that Blackstone Mining Company had underpaid premiums under two separate workers' compensation policies issued by Travelers. Blackstone counterclaimed, alleging that it had overpaid the premiums due under the policies and was entitled to a refund. The circuit court granted summary judgment to Blackstone. The court of appeals reversed. The Supreme Court reversed the court of appeals and reinstated the judgment of the circuit court, holding (1) the court of appeals incorrectly applied well-established burden of proof principles applicable to summary judgment motions; and (2) the circuit court correctly determined that Blackstone was entitled to summary judgment.