Justia Insurance Law Opinion Summaries

The issue on appeal to the Supreme Court in this case centered on whether the Commonwealth Court erred by affirming the reversal by the Workers’ Compensation Appeal Board (“WCAB”) of the decision of a workers’ compensation judge (“WCJ”) that granted Appellant Philip Payes's claim application. The WCJ determined that Appellant was entitled to workers’ compensation disability benefits based on factual findings that Appellant established the existence of a mental disability that had been caused by abnormal working conditions. Upon review, the Court concluded that the Commonwealth Court erred in reversing the WCJ’s decision, and accordingly reversed the order. View "Payes v. WCAB (PA State Police)" on Justia Law

This case involved an uninsured motorist benefits claim filed in connection with injuries allegedly sustained by the appellant in a 2001 motor vehicle accident. Appellant was driving a truck insured by Harleysville Insurance Company when he rear-ended another vehicle. The police report contained no mention of a phantom vehicle being involved in the accident. Appellant later reported the accident to his employer, explaining he momentarily took his eyes off the road, and when he looked again, a vehicle was stopped in front of him; he was unable to stop and rear-ended the vehicle. Twenty days later, appellant completed a written Workers’ Compensation Employee’s Statement in which he reported the accident occurred due to the other vehicle stopping suddenly in front of him. But again, no phantom vehicle was reported. Over eight months later, appellant filed a claim for uninsured motorist benefits, alleging the accident was caused by a phantom vehicle pulling out in front of the other vehicle, causing appellant to stop suddenly. Harleysville denied appellant’s claim and sought a declaratory judgment that he was not entitled to uninsured motorist benefits. The Superior Court reversed the order of the Court of Common Pleas of Luzerne County, which held appellee Harleysville Insurance Company did not suffer prejudice as a result of appellant’s failure to report the phantom vehicle within a 30-day time requirement established by the Motor Vehicle Financial Responsibility Law (MVFRL). Upon review, the Supreme Court affirmed the Superior Court decision. View "Vanderhoff v. Harleysville Ins. Co." on Justia Law

An Oklahoma worker was killed at Employer's jobsite in Texas. The employer's insurer paid the worker's Widow death benefits provided by Texas workers' compensation law. The widow also recovered damages in a wrongful death tort action in Texas. When the Insurer sought subrogation from the widow's wrongful death damages as allowed by Texas law, she filed suit in Oklahoma to prevent subrogation. She sought a declaratory judgment that the rights of Oklahoma workers and their dependents were governed by Oklahoma's Workers' Compensation Act, notwithstanding the worker's injury or death in another state, and any benefits that may be paid under another state's workers' compensation law. In particular, Widow asked the Oklahoma court to enforce the provision in Oklahoma law that forbids subrogation in cases of death benefits. The trial court granted the declaratory relief sought by the widow. On appeal by the Insurer, the Court of Civil Appeals reversed. The Court of Civil Appeals ruled that the widow had to commence a proceeding by filing a claim with Oklahoma's Workers' Compensation Court before Oklahoma could exercise jurisdiction over the benefits due the widow, including enforcement of the anti-subrogation provision in death benefit cases. Because she never filed a claim with Oklahoma's Workers' Compensation Court, the Court of Civil Appeals held subrogation was proper. Upon review, the Supreme Court affirmed the trial court's judgment and vacated the appellate court in this case. View "Holley v. ACE American Ins. Co." on Justia Law

In 2005, Patrick Richard sustained a work-related injury at the State Department of Transportation and Development ("DOTD"). After Mr. Richard's injury, DOTD began paying him workers' compensation benefits. Mr. Richard took disability retirement in 2007. Upon retiring, Mr. Richard spoke with a DOTD employee about the effect his receipt of workers' compensation benefits would have on his disability retirement benefits. Thereafter, Mr. Richard began simultaneously receiving disability retirement benefits through the Louisiana State Employees Retirement System ("LASERs"), and workers' compensation benefits through DOTD. In August 2007, DOTD informed Mr. Richard it had been overpaying him for workers' compensation benefits. In early 2011, DOTD filed a disputed claim for compensation, seeking an offset. In response, Mr. Richard filed an exception of prescription, arguing DOTD's claim for reimbursement was subject to a three-year prescriptive period. The matter proceeded to a trial before the Office of Workers' Compensation ("OWC"). The OWC denied Mr. Richard's exception of prescription. The OWC further held DOTD is entitled to an offset of $224.05 per week as of April 21, 2007, until Mr. Richard converted to regular retirement benefits at age 60. Mr. Richard appealed. The court of appeal affirmed in part and reversed in part. The court of appeal affirmed the OWC's denial of Mr. Richard's exception of prescription. However, the court found the OWC erred in holding DOTD was entitled to an offset of workers' compensation benefits. Upon review, the Supreme Court concluded the court of appeal incorrectly applied the law. Accordingly, the Court reinstated the OWC's judgment granting the employer an offset. View "Louisiana v. Richard" on Justia Law

A pharmaceutical distributor/repackager sought review of an appellate court decision that reversed a decision of the Louisiana Office of Workers' Compensation Administration. The Office awarded certain unpaid invoices for physician-dispensed medications (subject to a statutory limit) in favor of the distributor/repackager. The appellate court reversed based on a finding that the distributor/repackager did not have a right of action. After considering the applicable law, the Supreme Court found the anti-assignment language of La. R.S. 23:1205(A) did not prohibit the assignment of a health care provider's claims to a third party, an express contractual novation was effective, and an agent could statutorily be considered a health care provider based on the definition contained in La. R.S. 23:1021(6). Accordingly, the Court reversed the court of appeal's decision and remanded the case back to that court for further proceedings. View "Rebel Distributors Corp., Inc. v. Luba Workers' Comp." on Justia Law

First American Cash Advance, owned by Valued Services, L.L.C. was robbed twice. The first robbery occurred on New Year's Eve 2008, and the second was in the spring of 2009. Respondent-Claimant Leslie Tregenza was the branch manager and the only employee on the premises during both robberies. A man wearing something covering his face and a ball cap committed the first robbery; in the second, two men stole all of the cash on hand in the office. These men did not have guns. However, one of the robbers threw an empty plastic cash drawer at respondent's head. She did not return to work for her employer after the second robbery. Claimant filed her Form 3 in October 2009, alleging an accidental injury arising out of and in the course of her employment. She alleged she sustained an injury to her head with psychological overlay in the form of post-traumatic stress disorder (PTSD) and PTSD headaches. She sought permanent total disability (PTD) as a result of her injuries, claiming she was unable to work or to be out in public. The trial the court concluded respondent was permanently totally disabled and awarded her continuing medical maintenance in the nature of four annual office visits and prescription medication. The employer appealed the trial court's holding and the appellate court reversed. After its review, the Supreme Court concluded the Workers' Compensation Court received competent evidence that Claimant was permanently totally disabled. The Court vacated the appellate court's decision and affirmed the order of the lower court. View "Valued Services, LLC v. Tregenza" on Justia Law

Appellant Windham County Sheriff’s Department (WCSD) appealed a decision of the Employment Security Board that held it liable for reimbursement of unemployment compensation benefits as a base-period employer of a former employee. WCSD argued that because the employee was terminated for gross misconduct, and because an amendment to the statute governing reimbursement of unemployment compensation benefits that would have removed its liability for payments for employees terminated for gross misconduct took effect before the employee became eligible to receive any benefits, it should not have been held liable for reimbursement payments. Finding no error in the Board's decision, the Supreme Court affirmed. View "Windham County Sheriffs Department v. Department of Labor" on Justia Law

This case arose when six employees of the Baltimore Washington Conference of the United Methodist Church filed workers' compensation claims, claiming they had sustained physical injury as a result of exposure to mold in the Conference's office. The employees profferred Dr. Ritchie Shoemaker as their expert to prove causation. Defendant moved to exclude Shoemaker under Frye-Reed on the grounds that his methodology to determine causation was not generally accepted in the relevant scientific community. On remand, after a Frye-Reed hearing, the circuit court determined that Shoemaker's methodology was generally accepted by the relevant scientific community and satisfied the Frye-Reed test. The court of special appeals reversed. The Court of Appeals affirmed, holding that Shoemaker's technique and theory were not shown to be generally accepted in the relevant scientific community. View "Chesson v. Montgomery Mut. Ins. Co." on Justia Law

Claimant suffered a lower back injury during the course of his employment and filed notice of a workers' compensation claim. Employer later informed Claimant he would be discharged from his employment. Claimant signed a termination agreement in order not to forfeit his severance pay. The agreement stipulated that Claimant released his previously accepted workers' compensation claim. The Workers' Compensation Commissioner refused to approve the termination agreement, finding there was no consideration offered by Employer to Claimant in exchange for Plaintiff's release of the workers' compensation clim. The Workers' Compensation Review Board affirmed. The Supreme Court affirmed, holding that the Board properly affirmed the Commissioner's decision not to approve the agreement as a "voluntary agreement" or stipulation in light of its finding that Claimant's release of his workers' compensation claim was not supported by consideration. View "Leonetti v. MacDermid, Inc." on Justia Law

Appellant Hugo Rosales suffered an injury working on a fish-processing vessel. He filed both a workers' compensation claim and a maritime lawsuit. Appellant and the employer ultimately entered into a global settlement of both cases. The state Workers' Compensation Board initially rejected the settlement. Appellant later tried to withdraw from the settlement but changed his mind. At a hearing, he testified that the though the settlement was in his best interests. The Board approved the settlement after the hearing. Several months later, appellant moved to have the agreement set aside. The Board denied this request. The Workers' Compensation Appeals Commission affirmed the Board's decision. Finding no error in the Commission's decision, the Supreme Court affirmed. View "Rosales. v. Icicle Seafoods, Inc." on Justia Law