Justia Insurance Law Opinion Summaries

Plaintiff, who was injured while working in Genesee County, filed a workers’ compensation claim. While his claim was pending, defendants, in their capacity as administrators of the workers’ compensation hearing system, advised plaintiff that the Genesee County hearing site where plaintiff’s case was assigned would be closed and that all pending cases from the county, including plaintiff’s, would be transferred to the State Secondary Complex in Dimondale, which is about 70 miles away in Eaton County. Plaintiff brought a mandamus action to compel defendants to maintain the Genesee County hearing site. The trial court granted mandamus relief, and in a divided and published opinion, the Court of Appeals affirmed. The issue before the Supreme Court was whether the trial court abused its discretion by issuing a writ of mandamus compelling defendants to ensure that hearings in workers’ compensation cases were held in the county in which the alleged injury occurred. The Court disagreed with the Court of Appeals, finding that plaintiff did not have a clear legal right to a hearing in Genesee County. Defendants, accordingly, did not have a clear legal obligation to hold the hearing there either. The trial court was reversed, and direct to enter judgment denying plaintiff's complaint for mandamus. View "Younkin v. Zimmer" on Justia Law

Jose Campos was injured while working for Daisy Construction Company. While Campos was receiving total disability payments from Daisy, Daisy performed an investigation of his social security number at the request of its workers' compensation insurance carrier and discovered that Campos was an undocumented worker. When Campos could not provide a valid number, Daisy terminated his employment. Around the same time, Daisy hired a doctor to re-evaluate Campos' medical condition. The doctor concluded that although Campos remained partially disabled, he could perform "light duty" work with restrictions. Daisy then filed a petition with the Industrial Accident Board to terminate Campos' total disability benefit payments. The Board granted Daisy's petition because Campos was physically capable of working and therefore was not totally disabled. The Board also found that Campos was not eligible for partial disability benefits, reasoning that Daisy had met its burden of showing that Campos had no decrease in earning capacity by testifying that Campos would be eligible for light duty jobs at Daisy at his pre-injury wage rate if he could provide a valid social security number. The Superior Court affirmed the Board's decision. After its review, the Delaware Supreme Court concluded the Board erred when it found that Campos was not eligible for partial disability benefits: "If we were to hold that Daisy's testimony constituted sufficient proof of job availability, an employer could always hire an undocumented worker, have him suffer a workplace injury, and then avoid partial disability benefit payments by 'discovering' his immigration status, offering to re-employ him if he could fix it, and claiming that a job is available to him at no loss in wages. This outcome would be contrary to the Workers' Compensation Act and our case law interpreting it, [...] which prevents employers from depriving undocumented workers of employment benefits. [...]Accordingly, Daisy must continue to pay partial disability payments until it can demonstrate that Campos has no decrease in earning power from his workplace injury, or until the statutory period for partial disability benefit eligibility expires. Federal restrictions that prevent employers from hiring undocumented workers may make it more difficult for Daisy to prove job availability, but any difficulty is appropriately borne by it as the employer, who must take the employee, Campos, as it hired him." View "Campos v. Daisy Construction Co." on Justia Law

Plaintiffs Brett Woods and Kathleen Valdes were state employees and representatives of a class of New Mexico state and local government employees who alleged they paid for insurance coverage through payroll deductions and premiums pursuant to a policy issued by Standard Insurance Company (Standard), but did not receive the coverage for which they paid and, in some cases, were denied coverage entirely. Plaintiffs filed suit in New Mexico state court against three defendants: Standard, an Oregon company that agreed to provide the subject insurance coverage; the Risk Management Division of the New Mexico General Services Department (the Division), the state agency that contracted with Standard and was responsible for administering benefits under the policy; and Standard employee Martha Quintana, who Plaintiffs allege was responsible for managing the Division’s account with Standard and for providing account management and customer service to the Division and state employees. Plaintiffs' ninety-one-paragraph complaint, stated causes of action against Standard and the Division for breach of contract and unjust enrichment; against Standard for breach of fiduciary duty, breach of the implied duty of good faith and fair dealing, and Unfair Practices Act violations; and against Standard and Ms. Quintana for breach of the New Mexico Trade Practices and Fraud Act. The issue this appeal presented for the Tenth Circuit's review centered on whether remand to the state court pursuant to the Class Action Fairness Act (CAFA) was required under either of two CAFA provisions: the state action provision, which excludes from federal jurisdiction cases in which the primary defendants are states; or the local controversy exception, which requires federal courts to decline jurisdiction where, among other things, there is a local defendant whose alleged conduct forms a significant basis for the claims asserted by plaintiffs and from whom plaintiffs seek significant relief. The Court concluded that neither provision provided a basis for remand, and therefore reversed the decision of the magistrate judge remanding the case to state court. But because the Tenth Circuit could not determine whether Defendants have established the amount in controversy required to confer federal jurisdiction, the case was remanded to the district court for the resolution of that issue. View "Woods v. Standard Insurance Co." on Justia Law

The issue this case presented for the Supreme Court's review stemmed from a worker's compensation claim. Specifically, the issue the Court had to determine was whether a “wet floor” sign was a safety device and whether a nurse who slips on a recently mopped floor at work is entitled to a 10% increase in benefits when a “wet floor” sign was not posted near a mopped floor. The Court held that a “wet floor” sign is a safety device and that the nurse’s injury resulted from the negligence of the employer in failing to supply reasonable safety devices in general use. View "Benavides v. Eastern N.M. Med. Ctr." on Justia Law

Gary Corgatelli sought worker's compensation benefits from his employer Steel West and the State of Idaho's Industrial Special Indemnity Fund (ISIF) for a 2005 back injury that he incurred as a result of his employment. The Idaho Industrial Commission concluded that Corgatelli had a permanent physical impairment of 15% of the whole person, attributing 5% to an earlier injury in 1994 and 10% to the 2005 injury, and that Corgatelli was totally and permanently disabled. The Commission further concluded that ISIF was liable for disability benefits because the effects of Corgatelli's preexisting impairment from the 1994 injury combined with his 2005 injury to cause total and permanent disability. The Commission subsequently issued an order to clarify that Steel West was entitled to credit on the disability award for permanent physical impairment benefits Steel West previously paid to Corgatelli for his 2005 injury. Corgatelli appealed the Commission's order to credit Steel West. ISIF cross-appealed the Commission's determination of ISIF liability. Upon review, the Supreme Court concluded the Commission erred when it allowed Steel West to offset its liability for total and permanent disability benefits with permanent physical impairment benefits previously paid to Corgatelli. Furthermore, the Court found no substantial evidence to support the Commission's finding that ISIF was liable to Corgatelli for benefit payment. The Commission's award to Steel West of a credit for permanent physical impairment benefits previously paid to Corgatelli in 2006 and 2007 for his 2005 back injury was vacated. The Commission's finding of ISIF liability was reversed. And this case was remanded for further proceedings.View "Corgatelli v. Steel West, Inc." on Justia Law

An Employer appealed from a decision of the Workers’ Compensation Commission (Commission) ordering Employer to pay additional temporary total disability benefits to Employee, who was injured during his employment. After a jury trial, the trial court granted Employee’s motion for judgment and affirmed the award, concluding that the Commission decision was a piece of evidence that needed to be considered by the jury and that Employer was required to introduce the Commission decision into evidence. The court of special appeals reversed, concluding that Appellant was not required to move the award into evidence. The Court of Appeals affirmed, holding that, in a de novo workers’ compensation jury trial, the appellant is not required to move the Commission decision into evidence.View "Gales v. Sunoco & Amer. Zurich Ins." on Justia Law

Claimant-appellant Kevin Hope injured his right shoulder in 2003 while he was working for Empro Professional Services. He argued to the Industrial Commission that the Idaho Industrial Special Indemnity Fund (ISIF) was liable for part of his income benefits because he was totally and permanently disabled due to pre-existing back and shoulder injuries that combined with his 2003 shoulder injury. If Hope's total and permanent disability resulted from the combined effects of his 2003 shoulder injury and impairments that pre-existed that injury, then ISIF was liable for the portion of income benefits caused by the pre-existing injuries. Hope appealed the Commission's order that ISIF was not liable for any of Hope's benefits. The Commission found that Hope was totally and permanently disabled, but had failed to prove that his disability was a result of pre-existing back and shoulder impairments combined with his last shoulder injury. Hope argued that the Commission's decision was based on errors of law and fact. Finding no reversible error, the Supreme Court affirmed the Commission's order.View "Hope v. Industrial Special Indemnity Fund" on Justia Law

Appellee, a home health nurse who provided in-home health-care services to clients of Visiting Nurse Association of Mid-Ohio (VNA), was injured in a vehicle collision while she was traveling to the home of a patient. Appellee had decided to transport her children and two friends to a mall on her way to the patient’s home. The Industrial Commission allowed Appellee’s claim for a neck sprain. VNA appealed. The trial court granted summary judgment for VNA, concluding that Appellee was on a personal errand at the time she was injured. The court of appeals reversed, concluding that the accident and injury arose out of and occurred in the course of Appellee’s employment. Specifically, the court determined that although Appellee had intended to drop her passengers off at the mall, she had the dual intent to travel to her patient’s home, and when she was injured, she had not yet diverted from that path. The Supreme Court reversed, holding that the doctrine of dual intent or dual purpose is not recognized in Ohio for purposes of determining eligibility for workers’ compensation benefits. Remanded.View "Friebel v. Visiting Nurse Ass’n of Mid-Ohio" on Justia Law

The Workers’ Compensation Commission found Employee to be totally and permanently disabled under the odd-lot doctrine and denied Employer and its Insurer (collectively, Employer) certain credits for disability payments previously received by Employee from other sources. The district court affirmed the Commission’s finding that Employee was totally and permanently disabled but reversed on the credit issue. The court of appeals reversed, holding (1) substantial evidence did not support the Commission’s award of permanent total benefits, and (2) the Commission was correct in its decision concerning the credits. On further review, the Supreme Court (1) affirmed the district court’s finding that substantial evidence supported the Commission’s findings that Employee was totally and permanently disabled under the odd-lot doctrine; and (2) reversed the district court’s judgment regarding the issues concerning the credit due Employer.View "Gits Mfg. Co. v. Frank" on Justia Law

Annex, Stuart Lind, and Tom Janas filed suit challenging HHS' contraceptive mandate under the Religioous Freedom Restoration Act (RFRA), 42 U.S.C. 2000bb-1(a). Lind, a controlling shareholder of Annex, opposed insurance coverage of contraceptives for Annex's employees. The district court denied Annex and Lind's motion for a preliminary injunction respecting the contraceptive mandate's enforcement. The court concluded that Janas lacks standing to appeal because he did not join the preliminary injunction motion which forms the basis of the appeal; the mandate does not apply to Annex because Annex has fewer than fifty full-time employees and has no government-imposed obligation to offer health insurance of any kind; the only alleged injury is that independent third parties - private health insurance companies not involved in this case - are unable to sell Annex a health insurance plan that excludes healthcare inconsistent with Lind's religious relief; and, ultimately, it is unclear whether Annex's alleged injury is caused by the government defendants and redressable by the federal courts. Accordingly, the court vacated the district court's denial and remanded for the district court to conduct more fact-finding to determine whether subject matter jurisdiction exists. View "Annex Medical, Inc., et al. v. Sebelius, et al." on Justia Law