Justia Insurance Law Opinion Summaries

In an interlocutory appeal from the trial court's denial of defendant Vaughn Bowden, PA's motion to dismiss for failure to state a claim upon which relief could be granted. Plaintiffs Cherie Blackmore and Diane Young sued their former employer, Vaughn Bowden, regarding the presence of toxic mold in two of the firm's offices in which they worked. They also argued they were exposed to sewer gas and a natural gas leak. Plaintiffs also sued Lowry Development and its owner who owned a second building in which Blackmore and Young claimed they were injured. Upon review, the Supreme Court concluded that plaintiffs failed to allege any facts by defendants' which rose to the level of intent that would remove their claims from the exclusivity of the Mississippi Workers' Compensation Act. Plaintiffs' only avenue for relief against the firm was in workers' compensation. Accordingly, the Supreme Court affirmed the trial court in dismissing plaintiffs' complaint. View "Vaughn & Bowden, PA v. Young" on Justia Law

Claimant suffered a compensable injury to his right ankle in 1991 and developed reflex sympathetic dystrophy in the injured ankle. In 1997, the appeals panel determined Claimant was entitled to Lifetime Income Benefits (LIBs). The workers' compensation carrier for Claimant's employer (Insurer) did not seek judicial review of that decision. More than a decade later, Insurer sought a new contested case hearing on Claimant's continuing eligibility for LIBs. A hearing officer found that Insurer could re-open the previous LIB determination but that Claimant remained entitled to LIBs. The appeals panel affirmed. Both parties sought judicial review. The trial court granted Claimant's motion for summary judgment, concluding that the hearing officer lacked jurisdiction to re-open the previous LIB determination. The court of appeals affirmed. The Supreme Court affirmed, holding that the Legislature does not allow permanent benefit determinations like LIBs to be re-opened. View "Liberty Mut. Ins. Co. v. Adcock" on Justia Law

Claimant Rubio Izaguirre settled with a third-party tortfeasor following a work-related automobile accident. His employer and surety asserted a right of subrogation against the entirety of that settlement. On appeal, claimant argued that subrogation rights should have extended only to damages that workers’ compensation typically insures and not to pain and suffering. The Commission found in favor of the employer and surety, holding that all of the settlement proceeds were subject to subrogation. Finding no error, the Supreme Court affirmed. View "Izaguirre v. R&L Carriers" on Justia Law

Jason Morris worked for Owensboro Grain, a refinery located on the Ohio River. Morris suffered a work-related injury while performing deckhand duties, including loading items onto a barge. Morris received benefits from Owensboro Grain's Longshore and Harbor Workers' Compensation Act (LHWCA) insurance policy. Later, Morris filed a claim for Kentucky workers' compensation benefits. Owensboro Grain denied the claim on the grounds that the injury was not covered under the Kentucky Workers' Compensation Act. An ALJ dismissed Morris's claim, finding that Morris's injury fell under the LHWCA, and therefore, Kentucky had no subject matter jurisdiction over his claim. The Workers' Compensation Board and court of appeals affirmed. The Supreme Court affirmed, holding (1) because Morris was covered under the LHWCA, he was exempt from Kentucky's workers' compensation law unless Owensboro Grain provided him voluntary coverage; and (2) there was insufficient evidence to prove that Owensboro Grain provided voluntary workers' compensation coverage to Morris. View "Morris v. Owensboro Grain Co., LLC" on Justia Law

Sarah Crossett was employed by Jackson Purchase Medical Associate (JPMA), which leased space within a medical pavilion. Crossett was injured when she slipped and fell in snow that had accumulated outside of the building. Crossett filed for workers' compensation. JPMA disputed Crossett's claim, asserting that the injury did not occur on its operating premises under the going and coming rule, which provides that injuries that occur while an employee is on the way to or from a worksite are not compensable. An ALJ concluded that Crossett's injury was compensable, finding that Crossett fell within the operating premises of JPMA. The court of appeals affirmed. The Supreme Court affirmed, holding that because JPMA could assert control over the parking area and because Crossett was not taking an unreasonable path between her car and her office, she was entitled to workers' compensation benefits for her injury. View "Jackson Purchase Med. Assocs. v. Crossett" on Justia Law

Kenneth Poch and Kevin Key were temporary workers contracted through Personnel Resources of Georgia, Inc. and Carolina Staffing, Inc. d/b/a Job Place of Conway, to work for Bayshore Concrete Products/South Carolina, Inc. to clean up a concrete casting worksite and dismantle equipment used to produce concrete forms. As a result of a tragic, work-related accident, Poch was killed and Key was injured. Poch's estate and Key received workers' compensation benefits through Job Place. Subsequently, Key and his wife and the estate of Poch filed suit against Bayshore SC and its parent company, Bayshore Concrete Products Corporation. The circuit court granted the company's motion to dismiss the actions on the ground that workers' compensation was Petitioners' exclusive remedy and, therefore, the company was immune from liability in a tort action. The Court of Appeals affirmed the circuit court's order. Though the Supreme Court agreed with the result reached by the Court of Appeals, it found the court incorrectly analyzed Petitioners' arguments. Accordingly, the Court affirmed as modified. View "Poch v. Bayshore Concrete" on Justia Law

The day after Julie served her husband Steven with a summons and complaint for divorce, Steven shot and killed Julie near her car in Julie's employer's parking lot. The personal representative of Julie's estate sought worker's compensation benefits for her death, asserting that Julie's death arose out of her employment. Julie's employer (Employer) denied benefits, as did the South Dakota Department of Labor and Regulation. The circuit court affirmed. The Supreme Court also affirmed, holding that even though the assault occurred on Employer's premises, the assault could not be attributed to Julie's employment, and therefore, Julie's death did not "arise out of" her employment. View "Voeller v. HSBC Card Servs., Inc." on Justia Law

Petitioner Thomas Phillips appealed a New Hampshire Compensation Appeals Board (CAB) decision denying him recovery under the Workers’ Compensation Law. The CAB ruled that petitioner was not entitled to benefits because he had failed to timely notify his employers, Norman and Diane Crocker, of his claim. Furthermore, the CAB ruled that petitioner was not entitled to benefits because, unbeknownst to the Crockers, he was intoxicated at the time of his injury. In 2006, petitioner and his wife lived in a trailer that they rented from the Crockers. As part of the lease agreement, the petitioner performed yard work and minor home repairs for the Crockers in exchange for a rent reduction. Mr. Crocker asked petitioner to remove a tree branch that was growing near the Crockers’ house. The next day, petitioner fell from a ladder while cutting the branch with a chainsaw. As a result of the fall, petitioner was rendered a quadriplegic. Petitioner filed a claim for workers’ compensation benefits, identifying the Crockers as his employer. The Crockers were insured under a homeowner’s insurance policy issued by State Farm Fire and Casualty Company (State Farm) that included workers’ compensation coverage for domestic employees. State Farm denied petitioner workers’ compensation benefits. The New Hampshire Department of Labor (DOL) Hearing Officer determined that petitioner was entitled to benefits. State Farm appealed to the CAB. Upon review, the Supreme Court affirmed in part, reversed in part and remanded for further proceedings: (1) the CAB misapplied the governing New Hampshire case law to the petitioner’s claim; (2) petitioner’s claim was not time barred; and (3) a factual question remained whether petitioner's injury was caused in whole or in part by his intoxication. View "Appeal of Thomas Phillips" on Justia Law

Safety National sold an excess liability insurance policy to TKK, to cover excess losses resulting from liability imposed “by the Workers’ Compensation or Employers’ Liability Laws” of Illinois. The widow of a former TKK employee sued, alleging that TKK’s negligence caused the employee to become ill with and die from mesothelioma. The claim was subject to an affirmative defense: the Illinois Workers’ Occupational Diseases Act bars common law claims by or on behalf of an employee against a covered employer “on account of damage, disability or death caused or contributed to by any disease contracted or sustained in the course of the employment.” After Safety National denied coverage, TKK filed suit. The district court granted TKK summary judgment for its costs in defending and settling the widow’s suit, reasoning that the reference to “Employers’ Liability Laws” included the common law negligence claim even if the claim ultimately must fail because of the statutory bar. The court denied TKK’s claim for attorney fees and costs in the coverage lawsuit itself, except a modest award for what the court considered a vexatious motion to reconsider. The Seventh Circuit affirmed. The key policy term, “Employers’ Liability Laws,” is broad enough to include claims under the common law, including “groundless” claims. View "TKK USA, Inc. v. Safety Nat'l Cas. Corp." on Justia Law

The issue before the Supreme Court in this case centered on the statutory interpretation concerning Section 413(a) of the Workers' Compensation Act, specifically whether the claimant/appellant should have been permitted to proceed on a post-500-week petition for reinstatement of total disability benefits where he filed that petition within three years of his most recent payment of compensation, a payment which was made pursuant to a post-500-week supplemental agreement, notwithstanding a prior suspension of payments due to his return to work without a loss in earning capacity. Resolving the question, involved first determining whether expiration of the 500-week period set forth within the Act operated as a bar to the assertion of total disability claims by employees who have experienced a suspension of benefits. Also affecting the Court's decision was the effect of payments made pursuant to supplemental agreements upon an otherwise expired workers' compensation claim. The Commonwealth Court below affirmed the Workers' Compensation Appeal Board's ("WCAB") reversal of a Workers' Compensation Judge's ("WCJ") decision granting appellant's reinstatement and penalty petitions. Upon review, the Supreme Court held that appellant's reinstatement petition was not timely filed. Accordingly, it affirmed the Commonwealth Court. View "Cozzone, Aplt v. WCAB (Pa Municipal/E. Goshen Twp)" on Justia Law