Justia Insurance Law Opinion Summaries

Employee was employer at Employer's aluminum-processing plant from 1957 to 1989. In 2009, Employee filed an occupational-disease claim for benefits with the Arkansas Workers' Compensation Commission, alleging that he suffered from cancer caused by his exposure to asbestos while working for Employer. A law judge found Employee's complaint was time barred. Rather than appeal the decision to the full Commission, Employee filed suit against Employer in circuit court. Employer filed a motion to dismiss based on the exclusive remedy afforded by the Workers' Compensation Act. The circuit court denied the motion, concluding that, where a plaintiff's disease manifests after the statute of limitations has expired, a circuit court has authority to exercise jurisdiction over the plaintiff's claims. The Supreme Court granted Employer's requested writ of prohibition, holding that the Commission had exclusive jurisdiction to decide the issue in the first instance, and because Employee's claim was not submitted to the Commission, the circuit court lacked jurisdiction to decide the case. View "Reynolds Metal Co. v. Circuit Court" on Justia Law

Employee-claimant Cathy Bone filed a workman's compensation claim for a work-related injury. The employer, U.S. Food Service, and its carrier Indemnity Insurance Co. of North America disputed the claim. The single commissioner and an Appellate Panel of the South Carolina Workers' Compensation Commission issued orders denying the claim. Under the procedure then in place, Bone appealed to the circuit court, which concluded the injury was compensable and remanded the matter to the Commission for further proceedings. The employer appealed the circuit court's order, and the Court of Appeals dismissed the appeal on the basis the order was not a "final judgment" and thus not immediately appealable because further proceedings were ordered before the administrative agency. The Supreme Court granted Petitioners' petition for a writ of certiorari to review the decision of the Court of Appeals, and the Supreme Court affirmed. The high court subsequently granted a petition for rehearing filed by the employer, and it additionally granted the following two motions: (1) Bone's motion to argue against precedent, and (2) the motion of the South Carolina Defense Trial Attorneys' Association to accept its Amicus Curiae Brief in support of Petitioners. After considering the record in this matter, as well as the briefs and arguments, the Court adhered to its original decision to affirm. View "Bone v. U.S. Food Service" on Justia Law

In 2006, Claimant Robert Brown tore the rotator cuff in his right shoulder while at work. The issue on appeal before the Supreme Court in this case centered on whether the workers' compensation laws precluded a certain impairment rating and associated award of permanent partial disability benefits for Complex Regional Pain Syndrome (CRPS) when the claimant was not diagnosed with CRPS, but an expert confirmed he had it. The Commissioner of the Department of Labor and the trial court both concluded that the applicable law denied the Commissioner discretion to assign the impairment rating and award benefits associated with CRPS when the diagnosis did not meet the diagnostic standards. Upon review of the matter, the Supreme Court concluded the Commissioner erred in his conclusion, and reversed and remanded for reconsideration. View "Brown v. W.T. Martin Plumbing & Heating, Inc." on Justia Law

Petitioner Robert Smitter applied for workers' compensation benefits after being injured on the job working as a firefighter for Thornapple Township. At the time of his injury, Petitioner also worked for General Motors. He earned eleven percent of his income from the township and 89 from GM. The township did not reduce its workers’ compensation obligation by coordinating Petitioner's benefits with his disability benefits under MCL 418.354(1)(b). The township sought reimbursement from the Second Injury Fund under the dual-employment provisions for the entirety of Petitioner's wage-loss benefits. The fund agreed to pay the amount it would have owed if the township had coordinated Petitioner's benefits. The township filed an application for a hearing with the Worker’s Compensation Board of Magistrates, seeking reimbursement from the fund for the uncoordinated amount. The magistrate ordered the fund to reimburse the township for 89 percent of Petitioner's uncoordinated benefits. The Workers’ Compensation Appellate Commission (WCAC) affirmed. The Court of Appeals denied the fund’s application for leave to appeal. After its review, the Supreme Court concluded that when the injury employment provided less than 80 percent of the employee’s wages, the fund is required to reimburse its portion of the coordinated amount of benefits. Because the Township did not coordinate in this case, the appellate court erred in its analysis. Accordingly the appellate court was reversed and the case remanded to the magistrate for further proceedings. View "Smitter v. Thornapple Township" on Justia Law

The Providence School Board (Board) provided health insurance to active employees and retirees. In 2006, the Providence Teachers Union (Union) filed a grievance protesting a difference in the increase of premium costs for retirees compared with a more modest increase in premium costs for active employees. The Union argued that the Board's action violated three provisions of the collective bargaining agreement (CBA) between the board and the union. An arbitrator ruled in the Union's favor, concluding that the Board violated the CBA by failing to include retirees and active employees in a single group when it calculated the healthcare premium rates. The trial justice vacated the arbitration award, concluding (1) the Union did not have standing to pursue a grievance on behalf of retirees, and (2) the issue of the calculation of the group premium rate was not arbitrable. The Supreme Court affirmed, holding (1) pursuant to Arena v. City of Providence and City of Newport v. Local 1080, the Union could not pursue this grievance on behalf of the retirees; and (2) because the Union had no standing to pursue this particular grievance, the grievance was not arbitrable. View "Providence Sch. Bd. v. Providence Teachers Union, Local 958" on Justia Law

Workforce Safety & Insurance (WSI) appealed a district court's judgment reversing its denial of worker's compensation benefits to claimant Brenda Albright. Albright submitted her claim to WSI for a work-related back injury. Albright had a history of back problems; an independent medical records review of Albright's case showed she had "well-documented multilevel degenerative disk pathology" which contributed to the claim at issue here. The ALJ hearing Albright's case concluded her injury was not the result of a single incident, and denied her application for benefits. Finding that the evidence in the record supported the ALJ's decision to deny Albright's application for benefits, the Supreme Court reversed the district court, affirmed the ALJ and reinstated WSI's order denying benefits. View "Albright v. ND Workforce Safety & Ins" on Justia Law

Appellant was employed as a laborer by County Saw & Knife. Appellant successfully sought workers' compensation after he developed respiratory problems from his exposure to metal dust. One year later, Appellant applied for an additional award, alleging that Country Saw violated specific safety requirements (VSSRs). The Industrial Commission denied Appellant's application, concluding that County Saw had not violated the VSSRs. The court of appeals denied Appellant's request for a writ of mandamus that would require the Commission to vacate its order denying Appellant's application. The Supreme Court affirmed, holding that Appellant did not present sufficient evidence to establish that he was entitled to an award for a VSSR in addition to his extant workers' compensation benefits. View "State ex rel. Scott v. Indus. Comm'n" on Justia Law

Employee filed a petition for workers' compensation benefits for injuries he received during his employment with Employer. In accordance with Neb. Rev. Stat. 48-139(3), Employee entered into a lump-sump settlement with Employer and its workers' compensation insurance carrier. Pursuant to the statute, Employee filed a release in which he waived his rights under the Nebraska Workers' Compensation Act (Act) and discharged Employer from further liability arising from the injury. Employer paid the lump-sum amount forty-two days after the filing of the release. Employee subsequently sought and received a workers' compensation court order awarding a waiting-time penalty and attorney fees. The Supreme Court reversed, holding (1) a worker waives all of his rights under the Act when he files a release pursuant to the settlement procedures in section 48-139(3), including the right to penalties; and (2) therefore, a waiting-time penalty and the corresponding attorney fees cannot be imposed following a settlement reached under section 48-139(3). Remanded. View "Holdsworth v. Greenwood Famers Coop." on Justia Law

Plaintiff, an in-home registered nurse, was injured in an automobile accident while driving her employer's vehicle to to a patient's home to perform her nursing duties. Plaintiff incurred $382,849 in medical expenses as a result of the accident. After Plaintiff's employer's workers compensation carrier (AIG) denied Plaintiff's workers compensation claim, Plaintiff filed a medical payments claim with Allstate, with whom Plaintiff had a personal automobile insurance policy that provided $100,000 in medical payments coverage. Allstate failed to provide medical payments benefits immediately to Plaintiff. Plaintiff and AIG later settled Plaintiff's worker's compensation claim for $150,000. Plaintiff then commenced this breach of contract and bad faith action against Allstate based on Allstate's failure to pay medical benefits. The circuit court granted judgment as a matter of law for $33,000 on the breach of contract claim and awarded $150,000 in compensatory damages and $1,500,000 in punitive damages on the bad faith claim. The Supreme Court reversed in part, holding that the circuit court erred in excluding Allstate's evidence of AIG's acceptance of the worker's compensation claim, and that exclusion prejudiced Allstate's ability to defend the bad faith and punitive damages claims. View "Bertelsen v. Allstate Ins. Co." on Justia Law

Employee was injured while in the course and scope of his employment. Employee's industrial claim was allowed for certain injuries. Fourteen years later, Employee successfully requested compensation for the total loss of the functional use of his right arm. Based on the Industrial Commission's award for loss of use, one year later Employee filed a motion for compensation for statutory permanent total disability. A staff hearing officer denied the application. The court of appeals granted Employee's writ of mandamus, concluding that the loss of use of Employee's arm could not be relitigated and that the Commission was bound by the doctrine of collateral estoppel to issue the award. The Supreme Court reversed the judgment of the court of appeals and denied the writ of mandamus, holding (1) the Commission must conduct an independent evaluation of the facts when considering an application for statutory permanent disability under Ohio Rev. Code 4123.58(C) even if a prior award for the same body parts has been given pursuant to Ohio Rev. Code 4123.57(b); and (2) the evidence in the record supported the basis for the Commission's decision. View "State ex rel. Coleman v. Indus. Comm'n of Ohio" on Justia Law