Justia Insurance Law Opinion Summaries

After receiving a work-related injury during his employment by Employer, Employee applied for worker's compensation benefits. An ALJ ordered that further medical procedures were required to determine whether Employee was permanently and totally disabled, but the Labor and Industry Review Commission (LIRC) proceeded to award benefits to Employee for his permanent total disability. Employer filed a complaint seeking judicial review of LIRC's decision. The circuit court affirmed. The court of appeals reversed, concluding that the circuit court was required to dismiss Employer's complaint for lack of competency based on Employer's failure to name its insurer (Insurer) as an "adverse party" pursuant to Wis. Stat. 102.23(1)(a). The Supreme Court reversed and remanded with instructions to affirm LIRC's decision, holding (1) the circuit court had competency to adjudicate Employer's complaint notwithstanding Employer's omission of Insurer because Insurer was not an "adverse party" for purposes of section 102.23(1)(a); and (2) LIRC did not exceed its authority in awarding Employee permanent total disability benefits, and its finding that Employee was entitled to benefits on an odd-lot basis was supported by credible and substantial evidence. View "Xcel Energy Servs., Inc. v. Labor & Ind. Review Comm'n " on Justia Law

Petitioner was traveling home from work in his personal vehicle when he sustained back injuries in a car accident. Petitioner applied for workers' compensation benefits, but his application was denied under the "going and coming rule," which deems injuries occurring during a work commute outside the course of employment and thus not compensable. Petitioner appealed, arguing that in light of the benefits his employer received through various work-related uses of his vehicle, he was "in the course of employment" during the accident. The labor commission and court of appeals rejected Petitioner's claim that he qualified under the "instrumentality" exception of the going and coming rule. The Supreme Court affirmed, holding that Petitioner fell within the rule and not the exception. View "Jex v. Utah Labor Comm'n" on Justia Law

After Employee was injured in a car accident with a police officer, Employer's workers compensation carrier (Claimant) sought to bring this tort action against City. Claimant gave notice to City that it was pursuing a negligence claim against it, claiming damages in the amount of $19,590. Claimant then brought a lawsuit in the district court, requesting $19,590 in damages. Several months later, Claimant sought leave to amend its petition to raise the amount of alleged damages to $228,088. City objected, arguing that Claimant's notice did not include "a statement of the amount of monetary damages that is being requested" as required under Kan. Stat. Ann. 12-105b(d)(5). The district court granted Claimant's petition, finding that Claimant's statutory notice substantially complied with 12-105b(d). A divided court of appeals affirmed the district court's ruling that the notice was in substantial compliance with the law. The Supreme Court affirmed, holding (1) under the circumstances, Claimant's notice substantially complied with 12-105b(d), as the notice contained all the information required by the statute; and (2) when a notice conforms with section 12-105b(d), subsequent amendments to the pleadings are subject to an inquiry into a claimant's bad faith or misleading conduct. View "Cont'l W. Ins. Co. v. Shultz" on Justia Law

In 2009, respondent Adrian Melton suffered an on-the-job accident while working for his employer, Joe Brown Company, Inc. He was awarded eleven weeks of temporary total disability, granted permanent partial disability, and a psychological overlay. The employer appealed the award, which vacated some parts and sustained others. In 2011, the employer appealed to the Court of Civil Appeals (COCA) which vacated the permanent partial impairment award because it failed to comply with the AMA Guides (5th Edition), and that an "any competent evidence" standard of review was inconsistent with 85 O.S. 2011 sec. 340, so the court used the "against the clear weight of the evidence" standard which had recently been revised. Respondent petitioned the Supreme Court for review of the COCA decision, arguing that the appellate court should have used the "any competent evidence" standard. Upon review of the matter, the Supreme Court concluded that because respondent's injury happened before the new standard went into effect, the "any competent evidence" standard should have been applied. With regard to respondent's awards of disability, the Court found that psychological overlay was not supported by appropriate expert testimony. Accordingly, the benefits as they related to the overlay were vacated. View "Joe Brown Company, Inc. v. Melton" on Justia Law

Plaintiff-Appellant Cynthia Pfeifer filed suit against Defendant-Appellee Federal Express Corporation in the District of Kansas, alleging that the company fired her in retaliation for receiving workers' compensation benefits. Plaintiff filed suit fifteen months following the termination within the applicable state statute of limitations, but outside the limit of six months enumerated in her employment agreement. The district court granted Defendant's motion for summary judgment, concluding that the contract clause was reasonable and was not a violation of public policy. Because no Kansas law appeared to control the outcome of the case, the Tenth Circuit certified two questions to the Kansas Supreme Court regarding the ability of parties to shorten the applicable statute of limitations by contract, and if not, then was the six-month limitation unreasonable in this case? The Kansas Court responded that the contract clause in question here did violate public policy. Because of that answer, the Court did not respond to the Tenth Circuit's second question. In light of these answers, the federal district court was reversed and the case remanded for further proceedings. View "Pfeifer v. Federal Express Corporation" on Justia Law

A staffing services company (Company) furnished workers for the City, including Respondent. During the course of his employment, Employee lost an arm working on a garbage truck driven by an employee of the City. Respondent sued the City and its employee (collectively, Petitioners). Petitioners filed a motion for summary judgment, asserting governmental immunity based in part on the exclusive remedy under the Texas Labor Code, which provides that recovery of workers' compensation benefits is the exclusive remedy of an employee covered by workers' compensation insurance. The trial court dismissed the case. The court of appeals reversed, holding that a fact question remained whether Respondent, who was paid by Company, was within the specific terms of the City's workers' compensation coverage. The Supreme Court reversed and dismissed the case, holding that, as a matter of law, the City provided Respondent's workers' compensation coverage, and therefore, Respondent's exclusive remedy was the compensation benefits to which he was entitled. View "City of Bellaire v. Johnson" on Justia Law

Plaintiff Fernando Rodriguez-Flores appealed the dismissal of his claims of retaliatory discharge and fraud brought against his former employer, U.S. Coatings, Inc. He worked as a painter. He stated that he suffered on the job injuries from paint-fume inhalation and other maladies. He sued the employer for workmans' compensation benefits, asserting retaliatory discharge and fraud based on his physical complaints and subsequent treatment. The trial court dismissed his complaint. Finding that the trial court did not err with regard to dismissing Plaintiff's fraud claim, the Supreme Court affirmed to that regard. However, the Court concluded the trial court erred with regard to the retaliatory-discharge claim. The case was remanded for further proceedings. View "Rodriguez-Flores v. U.S. Coatings, Inc. " on Justia Law

Plaintiff Stanford Isbell sued M&J Materials, Inc. seeking workmans' compensation benefits. He also sought compensatory and punitive damages based on his claim of a retaliatory discharge. M&J denied liability, specifically averring that Plaintiff's employment was terminated for violating a workplace prohibition of carrying firearms. The parties settled their differences with regards to the workmans' compensation claims, leaving the retaliatory discharge to be heard by the trial court. The jury found in Plaintiff's favor, but the Court of Appeals reversed. Upon review of the matter, the Supreme Court concluded the appellate court erred in its analysis of the facts in record and the applicable law. Accordingly, the appellate court's judgment was reversed and the case remanded for further proceedings. View "M & J Materials, Inc. v. Isbell" on Justia Law

Plaintiff Mary Soileau was injured while working for the Town of Mamou when a front-end loader detached from a tractor and struck her in the leg. She named the tractor manufacturer, the Town, Smith's Hardware (where the Town rented the tractor for employees' use), the hardware store's owners and their insurance company. Trial began with only the owners and their insurer as the remaining defendants in the suit. On the third day, Plaintiff moved to dismiss the owners and their company in the presence of the jury, stating that she did not seek any damages personally against them. Hearing no objections, the trial court granted the request, but made no written (and therefore signed) judgment of dismissal. On day four, the insurer moved for a directed verdict, based on contract language that it was obligated to pay only if its insureds were legally obligated to pay. The insurer's motion was denied, and ultimately over $9 million in damages were awarded to Plaintiff. Concluding that the trial court erred in denying the insurer's motion, the appellate court reversed, dismissing the insurance company. The issue before the Supreme Court centered on the effect Plaintiff's in-court dismissal of the insured parties was during her personal injury action. Upon review, the Supreme Court concluded that the appellate court erred in its analysis, reversed and remanded the case for further proceedings. View "Solieau v. Smith True Value & Rental" on Justia Law

Claimant Deborah Lydy was a traveling licensed practical nurse employed by defendant Trustaff, Inc. While on duty, a patient attacked her causing her to suffer (among other things) an acute cervical sprain. The issue before the Supreme Court in this case centered on whether employer-health insurance premiums should have been included when calculating claimant's average weekly wages under the state workers' compensation laws. The Department of Labor concluded that such premiums were not "wages" and should not have been included. Concluding that the Vermont Legislature did not intend for wages to include payments made on behalf of employees for the purpose of acquiring health insurance. Accordingly, the Court affirmed the Commissioner's judgment. View "Lydy v. Trustaff, Inc." on Justia Law