Justia Insurance Law Opinion Summaries

Employee was injured in an automobile accident during the course of his employment with Employer. Employer and its Insurer paid workers’ compensation benefits. Employee subsequently settled a claim against the other driver involved in the accident. From that settlement, Employee reimbursed Insurer for the workers’ compensation benefits already paid out at the time of the settlement. The remaining amount of the settlement was determined to be “like damages” for which Employer and Insurer would receive an offset against future medical expenses related to the work injury. Thereafter, Employee submitted bills for ongoing care related to the work injury to his insurers, which paid the bills. Employee then filed a petition requesting workers’ compensation benefits. Employer and Insurer denied benefits, asserting that the amounts paid by other insurers could not be used to reduce the offset against future medical expenses. An administrative law judge and the circuit court concluded that medical expenses paid by Employee’s insurance were properly used to reduce the offset. The Supreme Court affirmed, holding that although Employee’s insurance paid medical bills resulting from his compensable injury, those payments were properly considered to reduce the offset because Employee would otherwise be entitled to receive compensation for those expenses. View "Milbrandt v. Bibb’s, Inc." on Justia Law

Employee worked for Employer assembling engine heads and attaching them to engine blocks. Employer ceased working after he sustained bilateral thoracic outlet syndrome, bilateral shoulder injuries, and a herniated disc in his neck. Employee filed this workers’ compensation action alleging that he received his injuries as a result of his work and that he was permanently and totally disabled by the injuries. The trial court concluded that Employee’s neck injury was not compensable and awarded eighty percent permanent partial disability for his other injuries. Both parties appealed. The Supreme Court affirmed, holding (1) the evidence did not preponderate against the trial court’s finding that Employee did not sustain a compensable neck injury; and (2) the award was not excessive. View "Watters v. Nissan N. Am., Inc." on Justia Law

Claimant worked at the Vermont State Hospital as a psychiatric technician and ward aide. His duties involved lifting and dealing with patients who could be combative. Claimant suffered work-related injuries on three separate occasions in 1987, 1992, and 1997. All of these claims related to low back pain. Claimant underwent surgery after each of these injuries and returned to work. After the 1992 injury, claimant's surgeon rated him with a 10% permanent impairment to his spine, and the State began paying permanent partial disability benefits. There was no new rating for the 1997 injury. This appeal came after a dispute over an order based on a worker's compensation agreement. Claimant injured his back again in 2002. Claimant received an 8% whole-person impairment rating, with 6% of that rating referable to a previous injury. Based on this rating, claimant executed an Agreement for Permanent Partial Disability Compensation (Form 22) with the State, which the Commissioner of the Department of Labor then approved. Six years after the commissioner ordered the award, claimant underwent two more permanency evaluations with different doctors who both used a method that the first doctor had not used. Each of the subsequent evaluations resulted in higher whole-person impairment ratings before consideration of the portion attributable to any pre-existing impairment. Based on the higher ratings, claimant made a claim for additional benefits related to the 2002 injury. Claimant asserted that the award should be modified because his medical condition had worsened, or, alternatively, that the parties had based their Form 22 agreement upon a material mistake of fact. The commissioner ruled in the State's favor. Claimant then appealed to the superior court, which reversed the decision of the commissioner and awarded claimant additional benefits after a bench trial. After review, the Supreme Court concluded that the differences between the doctors' impairment ratings in 2010 and an impairment rating from 2003 were insufficient to serve as grounds for reopening the original order for compensation. The Court therefore concluded as a matter of law that failed to meet his burden of demonstrating a mistake of fact sufficient to require reformation of the approved Form 22. The Court vacated the decision of the superior court as to the issues on appeal. View "Marshall v. Vermont State Hospital" on Justia Law

LuAnn Shubert fell and injured her lower back while working at a Macy’s store. She appealed the Idaho Industrial Commission’s order holding that she was: (1) medically stable on November 21, 2007; (2) not entitled to medical benefits beyond that date; (3) not entitled to temporary disability benefits; (4) entitled to a permanent partial impairment rating of 5% of the whole person; and (5) entitled to a 10% permanent partial disability rating. Shubert argued that she was entitled to ongoing medical care, temporary disability benefits, and total permanent disability benefits over 10%. Macy’s West (Macy’s) and Liberty Insurance Corporation argued that Shubert was rearguing the facts. Finding no reversible error in the Commission's decision, the Idaho Supreme Court affirmed. View "Shubert v. Macy's West, Inc." on Justia Law

Plaintiff, who worked for United Parcel Service, Inc. (UPS) for thirty-two years, was diagnosed with diabetes in 1987 and with diabetic neuropathy in 1998. The diabetic neuropathy caused impairment to his arms and hands. In 2003, Plaintiff suffered injuries to his upper arms and hands in a work-related accident. After Plaintiff retired in 2008 he filed a claim for benefits. The Workers’ Compensation Commissioner apportioned the payment so that Defendants, UPS and its insurer, paid only for the proportion of disability attributed to Plaintiff’s occupational injuries rather than pay the entirety of Plaintiff’s permanent partial disability to his upper extremities and hands. The Workers’ Compensation Board affirmed. The Appellate Court reversed. The Supreme Court affirmed, holding that a disability arising from a progressive nonoccupational condition - such as Plaintiff’s diabetes and diabetic neuropathy - that manifests prior to an occupational injury and that further disables the same body part is a compensable preexisting injury rather than a noncompensable concurrently developing disease under the apportionment rule established in Deschenes v. Transco, Inc. View "Sullins v. United Parcel Serv., Inc." on Justia Law

Plaintiff filed a breach of contract claim against Zenith after Santana Morales, Jr. was crushed to death by a palm tree while working as a landscaper for Lawns. The Florida Supreme Court answered the following certified questions in the affirmative: (1) Does the estate have standing to bring its breach of contract claim against Zenith under the employer liability policy? (2) If so, does the provision in the employer liability policy which excludes from coverage "any obligation imposed by workers' compensation... law" operate to exclude coverage of the estate's claim against Zenith for the tort judgment? and (3) If the estate's claim is not barred by the workers' compensation exclusion, does the release in the workers' compensation settlement agreement otherwise prohibit the estate's collection of the tort judgment? The court concluded that, given the Florida Supreme Court's resolution of the certified issues, the district court correctly determined that the workers' compensation exclusion in Part II of the policy barred Zenith's coverage of the tort judgment against Lawns. The court affirmed the district court's grant of summary judgment in favor of Zenith. View "Morales v. Zenith Ins. Co." on Justia Law

In 2002, Ruth McCormick slipped and fell while working at a McDonald’s restaurant. McCormick received temporary total disability (TTD) compensation until 2010, when the Industrial Commission terminated McCormick’s benefits based on a doctor’s opinion that McCormick had reached maximum medical improvement. McCormick filed a complaint for a writ of mandamus, alleging that the Commission's decision to terminate benefits was not supported by the evidence, was contrary to law, and was an abuse of discretion because the doctor’s opinion that she had reached maximum medical improvement was factually inaccurate. The court of appeals denied the writ. The Supreme Court affirmed, holding that the doctor’s report that McCormick had reached maximum level improvement was valid evidence supporting the Commission’s decision to terminate TTD compensation. View "State ex rel. McCormick v. McDonald’s" on Justia Law

Employee-petitioner Judy Barnes was employed as an administrative assistant at Charter 1 Realty. On the day of her injury, Barnes was asked to check the e-mail of one of the realtors before noon. Around 11:30 a.m., Barnes left her desk and walked toward the realtor's office. However, she stumbled, fell, and sustained serious injuries: a broken left femur, broken left humerus and a torn rotator cuff.Barnes subsequently filed a claim for workers' compensation. At the hearing, Barnes testified she was hurrying to the realtor's office to check her e-mail and that caused her to fall. Evidence was also introduced that her husband did not like the shoes she wore, and he had told her she needed to pick up her feet when she walked. The single commissioner and appellate panel found that her fall was idiopathic and therefore noncompensable. The court of appeals affirmed. The Supreme Court disagreed with the commissioner and appellate panel's findings, reversed, and remanded the case for further proceedings. View "Barnes v. Charter 1 Realty" on Justia Law

Claimant-petitioner Carolyn Nicholson, a supervisor in the investigations area of child protective services for the South Carolina Department of Social Services (DSS), was on her way to a meeting when her foot caught on the hall carpet and she fell. She received treatment for pain to her neck, left shoulder, and left side connected with her fall. Nicholson's claim for workers' compensation was denied by the single commissioner because she failed to prove a causal connection between her fall and employment. The commissioner held there was nothing specific to the floor at DSS which contributed to Nicholson's fall and that she could have fallen anywhere. The question this case presented for the Supreme Court's review was whether petitioner was entitled to workers' compensation. "Despite how straightforward this issue appears to be," both the commissioner and the court of appeals found petitioner was not entitled to recover. The Supreme Court disagreed with both, reversed, and remanded the case for further proceedings. View "Nicholson v. SC Dept. of Social Services" on Justia Law

Edwin Moreau worked at the W.R. Grace mine from 1963 until 1992. Edwin died of asbestos-related lung cancer in 2009. In 2013, Transportation Insurance, W.R. Grace’s workers’ compensation insurance carrier, accepted liability for Edwin’s medical expenses. Both the Libby Medical Plan, an entity established and funded by W.R. Grace to pay the medical care expenses of employees who were injured by asbestos exposure, and W.R. Grace refused to accept reimbursement from Transportation for the medical expenses the Plan had paid on Edwin’s behalf. Cristita Moreau, as personal representative of Edwin’s estate, demanded that the amount of reimbursement declined by the Plan and W.R. Grace should be paid either to Edwin’s Estate or to a charity selected by the Estate. After Transportation refused to pay the money, Moreau filed this petition to the Workers’ Compensation Court (WCC) to resolve the dispute. The WCC denied the petition, determining that it lacked jurisdiction to hear the matter because Moreau lacked standing. The Supreme Court reversed, holding that the Estate had standing and was entitled to have its petition determined on the merits. Remanded. View "Moreau v. Transp. Ins. Co." on Justia Law