Justia Insurance Law Opinion Summaries

In 2009, plaintiff Craig Mulford filed a complaint against his employer Union Pacific Railroad (UP) seeking relief under the Federal Employer’s Liability Act (FELA). Plaintiff alleged he sustained injury to his knees as a result of UP's negligence. The case went to trial in 2012. The jury reached its verdict, unanimously concluding that UP was not negligent. The district court issued its final judgment and dismissed plaintiff's claims. In this appeal, plaintiff claimed that the district court erred on two separate grounds: (1) failing to disqualify a juror for cause; and (2) admitting evidence that he received disability benefits from the Railroad Retirement Board (RRB) to impeach statements made by plaintiff on direct examination. Finding no reversible error, the Supreme Court affirmed. View "Mulford v. Union Pacific Railroad" on Justia Law

This appeal stemmed from a worker’s compensation case in which Michael Vawter sought compensation from his employer, United Parcel Service (UPS), for a back injury he claimed he suffered as a result of his employment. UPS attempted to establish that Vawter did not suffer a compensable injury, but if he did the State's Industrial Special Indemnity Fund (ISIF) was liable for a portion of his benefits. Ultimately, the Idaho Industrial Commission found that Vawter was totally and permanently disabled and that UPS was solely responsible for Vawter’s disability benefits because it was estopped from arguing Vawter had a preexisting condition, a necessary element of ISIF liability. UPS appealed, arguing: (1) the accident causing Vawter’s injury did not arise out of his employment; (2) the Commission improperly applied the doctrine of quasi-estoppel to prevent it from asserting a preexisting condition; and (3) the Commission improperly awarded Vawter attorney fees. Vawter and ISIF both cross-appealed. Upon review, the Supreme Court reversed the Industrial Commission’s determination that Vawter was not entitled to recover all medical expenses incurred between the date of the accident and September 27, 2010. The Court affirmed the Industrial Commission in all other respects. View "Vawter v. United Parcel Service, Inc." on Justia Law

Respondent Helen Rodriguez injured herself after falling down a flight of stairs at work. The Supreme Court granted certiorari to consider whether an "unexplained" fall satisfied the "arising out of" employment requirement of the Workers' Compensation Act. The Court agreed with the appellate court that respondent's unexplained fall was compensable, but it disagreed with the reasoning. The Supreme Court concluded that the appellate court erred when it agreed with respondent's view that her injuries arose out of employment, and held that an unexplained fall necessarily stemmed from a "neutral" risk attributable to neither the employment nor the employee. "Under our longstanding 'but-for' test, such an unexplained fall 'arises out of' employment if the fall would not have occurred but for the fact that the conditions and obligations of employment placed the employee in a position where he or she was injured." View "City of Brighton v. Rodriguez" on Justia Law

Javery began working for Lucent as a software engineer in 1998 and participated in Lucent’s Employee Retirement Income Security Act, 29 U.S.C. 1001, qualified disability plan, administered by CIGNA. In November 2002, he reported back pain. His family doctor, Dr. Dorado, prescribed medicine and testing, and recommended some time off work. In January 2003, after Lucent transferred him from Ohio to Illinois, Javery sought treatment from another physician, Seymour. The pain worsened. In May 2005, Javery stopped working on Dr. Seymour’s advice. Lucent approved and paid short term disability benefits from until those benefits expired in November 2005. Lucent notified CIGNA that it believed Javery might be eligible for long term benefits. Javery applied, submitting extensive medical evidence of his pain and resulting cognitive impairment and of his successful application for Social Security disability benefits, but the claim was denied. In addition to claiming that Javery had not shown that he was “disabled” as that term is defined in the Plan, CIGNA claimed that Javery should be judicially estopped from pursuing his ERISA claim because Javery failed to disclose the claim in his Chapter 13 personal bankruptcy action. The district court upheld the denial. The Sixth Circuit reversed. View "Javery v. Lucent Tech., Inc. Long-Term Disability Plan" on Justia Law

The Workers' Compensation Commission dismissed applicant Matthew Ladner's petition to controvert and motion for payment of benefits because it found the statute of limitations had expired. Ladner appealed that decision to the Supreme Court. Upon review, the Supreme Court reversed the Commission's decision. View "Ladner v. Zachry Construction" on Justia Law

In 1971 Milwaukee County provided its employees with health insurance under an ordinance that stated that the “county shall participate in the payment of monthly premiums” and extended coverage to retirees. In 1993, the ordinance was amended to provide that “[t]he County shall pay the full monthly cost of providing such [health insurance] coverage to retired members” as “part of an employee’s vested benefit contract.” Upon her 1991 retirement, Hussey had paid no co‐payments or deductibles for her health care. Her benefit plan booklet explained that with 15 years of service: “the retiree may participate in the health plan in which he/she is currently enrolled on the same basis as … the active employee group. The County will make the full premium contribution.” Until 2012, the plan coordinated benefits so that expenditures not covered by Medicare were paid in full by the County. In 2012 the County increased deductibles, co‐payments, and co‐insurance charges and modified coordination of benefits so that retirees over age 65 would pay the same deductibles, co‐payments, and co‐insurance charges as active employees. Hussey filed a purported class action, alleging that the failure to provide cost‐free health insurance to retirees constituted an unconstitutional taking of property. The Seventh Circuit agreed with the district court that the County only promised retirees the ability to participate in the same health insurance plan as active employees on a “premium‐free” basis.View "Hussey v. Milwaukee County" on Justia Law

Harman-Bergstedt, Inc. appealed the appellate court's decision to reverse an Industrial Claim Appeals Office decision disallowing respondent Elaine Loofbourrow's award of temporary disability benefits. The ICAO concluded that once respondent's treating physician placed her at maximum medical improvement, temporary total disability benefits could not be awarded for the injury for which she was initially treated. The appellate court concluded that under the circumstances of this case, such an independent medical exam was not a prerequisite to temporary total disability benefits. After its review of this case, the Supreme Court concluded the appellate court was correct in its decision: because a determination of maximum medical improvement has no statutory significance with regard to injuries resulting in loss of no more than three days (or shifts) of work time, respondent's award of temporary total disability benefits was not barred by her failure to first seek a division-sponsored independent medical examination. View "Harman-Bergstedt, Inc. v. Loofbourrow" on Justia Law

The issue in this case centered on a workers' compensation lump-sum award to a claimant who passed away while an appeal of her award was pending. At issue before the Supreme Court was a Court of Appeals opinion that refused to reach Respondents-Petitioners' argument that the award abated upon the beneficiary's death; granted the entire lump-sum award to beneficiary's dependent grandsons; reversed the grant of interest on the award; and affirmed the reinstatement of a ten-percent penalty. Upon review, the Supreme Court affirmed the Court of Appeals' decision with respect to the abatement issue and that court's holding that the ten-percent penalty should have been imposed in this case. The Supreme Court reversed the Court of Appeals decision requiring the entire lump-sum award be paid to the Grandsons, and reinstated the Estate's and Grandsons' settlement. The Court also reversed the Court of Appeals decision to remove the assessment of interest. The case was remanded for further proceedings on what sums were due pursuant to the Court's holding here. View "Hudson v. Lancaster Convalescent Center" on Justia Law

Plaintiff filed suit against CRST in state court alleging that CRST negligently failed to maintain his workers' compensation insurance coverage. CRST removed the case to federal court and the district court granted summary judgment to CRST. The court affirmed the district court's holding that plaintiff's action was barred by the applicable Missouri statute of limitations. View "Brown v. CRST Malone" on Justia Law

Warren Parsons appealed a judgment affirming a Workforce Safety and Insurance Fund ("WSI") decision that denied his claim for workers' compensation benefits. Parsons applied for workers' compensation benefits from WSI, alleging he sustained an injury to his left shoulder and neck while working for Ames Construction. He claimed he developed pain at the base of his neck and into his left shoulder from hitting the seat belt repeatedly while driving the dump truck on rough roads. Parsons argued his cervical spine and left shoulder injuries were "compensable injuries" by law. Upon review, the Supreme Court concluded WSI erred in determining Parsons' injury was not a compensable injury and in denying his claim for benefits. View "Parsons v. WSI" on Justia Law