Justia Insurance Law Opinion Summaries
Articles Posted in Labor & Employment Law
Vest v. Resolute FP US Inc.
Plaintiff Mead Vest contended defendant Resolute FP US Inc. breached its fiduciary-duty obligations set forth in the Employee Retiree Income Security Act when it failed to notify her late husband of his right to convert a group life insurance policy to an individual life insurance policy after he ceased employment and began drawing long-term disability benefits. The district court ruled plaintiff did not adequately plead a breach-of-fiduciary-duty cause of action. After review, the Sixth Circuit agreed and affirmed. View "Vest v. Resolute FP US Inc." on Justia Law
Atkins v. Inlet Transportation & Taxi Service, Inc.
A taxi driver injured in an accident while working filed a report with the Alaska Workers' Compensation Board. The nature of the relationship between the taxi company and the driver was disputed. The driver retained an attorney for a lawsuit against the other driver, and settled that claim with the other driver's insurance company without his taxi company's approval. Because the taxi company did not have workers' compensation insurance, the Alaska Workers' Compensation Benefits Guaranty Fund assumed responsibility for adjusting the workers' compensation claim. The Fund asked the Board to dismiss the taxi driver's claim because of the unapproved settlement. The Board dismissed the claim, and the Workers' Compensation Appeals Commission ultimately affirmed the Board's decision. The taxi driver appealed, but finding no reversible error, the Alaska Supreme Court affirmed the Commission's decision. View "Atkins v. Inlet Transportation & Taxi Service, Inc." on Justia Law
Jackson v. Family Dollar Stores of Louisiana, Inc.
In this workers’ compensation case, the issue presented for the Louisiana Supreme Court’s review centered on whether the employer’s appeal, taken with devolutive appeal delays but outside of the suspensive appeal delays, was timely under the special provisions of La. R.S. 23:1310.5(C). While the Court acknowledged La. R.S. 23:1310.5 “is not a model of legislative clarity,” the Court broadly interpreted the statute to find nothing specified the time period in which this appeal have to be filed. The Court found the appeal should have been maintained as timely, but because the appeal was devolutive in nature, the judgment awarding benefits was subject to immediate execution. View "Jackson v. Family Dollar Stores of Louisiana, Inc." on Justia Law
Skidgel v. California Unemployment Insurance Appeals Board
The IHSS program (Welf. & Inst. Code 12300) provides in-home services to elderly or disabled persons so that they may avoid institutionalization. For purposes of the state unemployment insurance system, IHSS service recipients are considered employers of their service providers if the providers are directly paid by the program or the recipient receives IHSS funds to pay their providers (Unemp. Ins. Code 683.) Generally, an employee of a close family member (child, parent or spouse) is excluded from unemployment insurance coverage. The California Unemployment Insurance Appeals Board ruled that, because a close-family-member IHSS service provider under the Direct Payment Mode is employed by the recipient, the provider is subject to the exclusion of Unemployment Insurance Code 631 (Caldera). Skidgel, an IHSS provider for her daughter, challenged the validity of Caldera, arguing government entities were joint employers with the recipient, thereby qualifying providers for unemployment insurance coverage despite the close-family-member exclusion. The court of appeal rejected the challenge, concluding that the Legislature, in enacting Unemployment Insurance Code section 683, intended to designate the recipient as the IHSS provider’s sole employer for purposes of unemployment insurance coverage. View "Skidgel v. California Unemployment Insurance Appeals Board" on Justia Law
Jones v. Von Moll
The circuit court did not err when it ruled that Plaintiff, a retired firefighter, was not a disabled person entitled to receive health insurance benefits under the Virginia Line of Duty Death and Disability Act, Va. Code 9.1-400 et seq.Plaintiff was diagnosed with throat cancer after he retired from the fire department but did not experience any health problems while he worked as a firefighter. The circuit court concluded (1) under the plain reading of the Act, Plaintiff’s duties as a firefighter ceased as of his retirement; and (2) because Plaintiff became disabled after he retired, his claim for insurance coverage under the Act was not viable. The Supreme Court affirmed, holding that Plaintiff was not a “disabled person” under the Act because his incapacity did not prevent the “further performance” of his duties as a firefighter. Therefore, Plaintiff was not entitled to continued health insurance coverage under the Act. View "Jones v. Von Moll" on Justia Law
Brickstreet Mutual Insurance Co. v. Zurich American Insurance Co.
The Supreme Court answered two certified questions from the United States Court of Appeals for the Fourth Circuit in this dispute between two insurance companies as follows: (1) The Workers’ Compensation Office of Judges does not have jurisdiction over a declaratory judgment action involving a dispute between insurance carriers regarding whether one or both carriers are responsible for contributing toward payment of an employee’s workers’ compensation benefits; and (2) Pursuant to W. Va. Code 33-46A-7(a), parties to a professional employer agreement must designate either the professional employer organization (PEO) or the client-employer as the responsible party for obtaining workers’ compensation insurance coverage for covered employees. Further, when parties to a professional employer agreement designate the PEO as the responsible party for obtaining workers’ compensation insurance coverage for covered employees, the policy obtained by the PEO is primary over a policy obtained by a client-employer. Thus, coverage under a workers’ compensation policy purchased by the client-employer is triggered only if the PEO or its carrier default on their obligation to provide workers’ compensation coverage. View "Brickstreet Mutual Insurance Co. v. Zurich American Insurance Co." on Justia Law
Triplett v. Southern Hens, Inc.
Stacy Triplett filed three lawsuits against her former employer, Southern Hens, all stemming from an incident in which Triplett, while working, witnessed the gruesome death of a coworker. This incident caused Triplett mental anguish leading to an award of workers’ compensation benefits. After Triplett allegedly incurred some trouble in collecting her award of workers’ compensation benefits, she sued Southern Hens and Southern Hens’s carrier, Liberty Mutual. Triplett’s first lawsuit against Southern Hens, for failure to pay, ultimately was dismissed. Triplett then filed a second lawsuit against Southern Hens for failure to report; Triplett failed to serve Southern Hens within 120 days, as required under Mississippi Rule of Civil Procedure 4(h). With no official court action on her second suit, and admittedly knowing that she could not show good cause for failure to serve in the second suit, Triplett filed a third suit against Southern Hens , like the second, was for failure to report. Aware of the second suit, the circuit court dismissed Triplett’s third suit as an impermissible duplicative suit. Triplett appealed. Finding no error, the Mississippi Supreme Court affirmed. View "Triplett v. Southern Hens, Inc." on Justia Law
Triplett v. Southern Hens, Inc.
Stacy Triplett filed three lawsuits against her former employer, Southern Hens, all stemming from an incident in which Triplett, while working, witnessed the gruesome death of a coworker. This incident caused Triplett mental anguish leading to an award of workers’ compensation benefits. After Triplett allegedly incurred some trouble in collecting her award of workers’ compensation benefits, she sued Southern Hens and Southern Hens’s carrier, Liberty Mutual. Triplett’s first lawsuit against Southern Hens, for failure to pay, ultimately was dismissed. Triplett then filed a second lawsuit against Southern Hens for failure to report; Triplett failed to serve Southern Hens within 120 days, as required under Mississippi Rule of Civil Procedure 4(h). With no official court action on her second suit, and admittedly knowing that she could not show good cause for failure to serve in the second suit, Triplett filed a third suit against Southern Hens , like the second, was for failure to report. Aware of the second suit, the circuit court dismissed Triplett’s third suit as an impermissible duplicative suit. Triplett appealed. Finding no error, the Mississippi Supreme Court affirmed. View "Triplett v. Southern Hens, Inc." on Justia Law
Moreau v. Transportation Ins.
Christita Moreau appealed a Workers’ Compensation Court (WCC) order denying her motion for summary judgment and granting summary judgment to Transportation Insurance Company. Moreau’s husband Edwin worked at the W.R. Grace mine near Libby. In 2009, he died from asbestos-related lung cancer. In 2010 Moreau, as personal representative of Edwin’s estate, filed a workers’ compensation claim for occupational disease benefits. Transportation Insurance Company (Transportation) was W.R. Grace’s workers’ compensation insurer, and it denied liability for the claim. Edwin’s employer, W.R. Grace, established and funded the Libby Medical Plan (LMP) to pay the medical expenses of its employees who were injured by exposure to asbestos. LMP paid approximately $95,000 of Edwin’s medical expenses. In 2012, as part of Grace’s bankruptcy, “certain rights and duties of the LMP” were transferred to the Libby Medical Plan Trust. Grace remained responsible for LMP’s “ongoing payment obligations” incurred before that time. In 2013, Transportation accepted liability for the workers’ compensation claim and entered a settlement with Moreau. Transportation agreed to reimburse Medicaid, other providers, and Moreau personally for medical expenses each had paid for Edwin’s care. The parties stipulated that Transportation paid all of Edwin’s medical bills or reimbursed the other persons or entities that had paid them. Transportation did not reimburse the LMP for the $95,846 of Edwin’s medical bills it had previously paid because the LMP refused to accept it. After the LMP refused to accept reimbursement from Transportation, Moreau demanded that Transportation pay the $95,000 either to Edwin’s Estate, to the LMP or its successor, or to a charity selected by the Estate. Transportation refused and Moreau filed a second petition with the WCC to resolve the issue. The WCC determined that all of Edwin’s medical care costs had been paid; that Edwin had no liability to any health care provider; and that he had no right to claim any further payment from Transportation. The WCC determined that if the Estate were to receive the $95,000 from Transportation it would represent a double recovery because Edwin had already received the medical benefits themselves. The Court concluded that Moreau therefore lacked standing to proceed Moreau’s petition. The WCC also found that Moreau’s attorneys also represented the LMP Trust “for purposes of recovering the disputed $95,846” for the LMP Trust. At the time of the WCC order, the LMP Trust was not a party to this action and had not advanced a claim in the WCC for reimbursement of the amount paid by its predecessor LMP. The WCC therefore granted summary judgment to Transportation. Finding no reversible error in that WCC decision, the Montana Supreme Court affirmed. View "Moreau v. Transportation Ins." on Justia Law
Van Steen v. Life Insurance Company N.A.
Life Insurance Company of North America’s terminated plaintiff-appellant Carl Van Steen’s long-term disability benefits under Lockheed Martin’s ERISA Plan. Life Insurance Company of North America (LINA) appealed the district court’s finding that its decision to terminate Van Steen’s benefits was arbitrary and capricious. Van Steen, in turn, appealed the district court’s denial of his attorney’s fees request. Van Steen was physically assaulted during an altercation while walking his dog. The assault resulted in a mild traumatic brain injury (mTBI) that impacted Van Steen’s cognitive abilities that prevented him from returning to full time work; Van Steen was eventually allowed to return to part-time work on a daily basis roughly six weeks later. Even on a part-time schedule, Van Steen experienced cognitive fatigue and headaches that required him to frequently rest. Due to his inability to stay organized and keep track of deadlines after the assault, Van Steen received poor feedback on his job performance. Van Steen’s claim for partial long-term disability benefits was approved on March 30, 2012. Roughly a year later, LINA reviewed Van Steen’s file, contacted his doctors, and confirmed that Van Steen’s condition and restrictions were permanent as he was “not likely to improve.” Despite this prognosis, LINA sent Van Steen a letter one week later terminating his long-term disability benefits, explaining that “the medical documentation on file does not continue to support the current restrictions and limitations to preclude you from resuming a full-time work schedule.” Having exhausted his administrative appeals under the Plan, Van Steen next sought relief before the district court. The district court reversed LINA’s decision to terminate Van Steen’s partial long-term disability benefits on the grounds that it was arbitrary and capricious, but denied Van Steen’s request for attorney’s fees. The Tenth Circuit agreed with the district court’s reversal of LINA’s decision to terminate Van Steen’s coverage. The Court also found that Van Steen was not eligible for attorney fees: “Van Steen’s arguments fail to convince us that the district court’s decision was based on a clear error of judgment or exceeded the bounds of permissible choice.” View "Van Steen v. Life Insurance Company N.A." on Justia Law