Justia Insurance Law Opinion Summaries

Employee was injured during the course of his employment with Employer. Employer subsequently issued a notice of claim acceptance to Employee. Two years after his claim's closure, Employee unsuccessfully asked Employer to reopen his claim. An appeals officer affirmed. At issue on appeal was Nev. Rev. Stat. 616C.390, which bars an employee from applying to reopen his workers' compensation claim after a year from its closure if the employee was "not off work as a result of the injury." The appeals officer interpreted the statute as requiring that an injured employee miss at least five days of work as a result of the injury to be considered "off work." The Supreme Court reversed, holding (1) section 616.390 does not bar an employee from applying to reopen his claim after a year from its closure if the employee missed time from work as a result of his injury; (2) the appeals officer erred in reading a minimum-time-off-work requirement into the statute; and (3) because Employee missed the remainder of his shift on the day of his injury, he was "off work" as a result of his injury and was not therefore subject to the one-year limit on the reopening of his claims. View "Williams v. United Parcel Servs." on Justia Law

Employee was involved in a motor-vehilce accident while operating a one-ton dump truck within the course of his employment by Employer. Employee applied for and received benefits for his physical injuries. Employee subsequently requested an additional allowance for posttraumatic-stress disorder (PTSD) that arose contemporaneously as a result of the accident. The Bureau of Workers' Compensation (BWC) allowed Employee's additional claim. The trial court held that Employee's PTSD was not compensable because it did not arise from his physical injuries. The court of appeals affirmed. The Supreme Court affirmed, holding (1) for a claimant's PTSD to qualify as a compensable injury under Ohio Rev. Code 4123.01(C)(1), the claimant must establish his PTSD was causally related to his compensable physical injuries and not simply to his involvement in the accident; and (2) the court of appeals appropriately determined that the record contained competent, credible evidence supporting the trial court's finding that Employee's physical injuries did not cause his PTSD and that Employee's PTSD was, therefore, not a compensable injury under section 4123.01(C)(1). View "Armstrong v. John R. Jurgensen Co. " on Justia Law

The Federal Employees’ Group Life Insurance Act (FEGLIA) permits an employee to name a beneficiary of life insurance proceeds, and specifies an “order of precedence” providing that an employee’s death benefits accrue first to that beneficiary ahead of other potential recipients, 5 U.S.C. 8705(a). A Virginia statute revokes a beneficiary designation in any contract that provides a death benefit to a former spouse where there has been a change in the decedent’s marital status, Va. Code 20–111.1(A). When the provision is preempted by federal law, Section D of that law provides a cause of action rendering the former spouse liable for the proceeds to the party who would have received them were Section A not preempted. Hillman named then-spouse, Maretta, as beneficiary of his FEGLI policy. After their divorce, he married Jacqueline but never changed his named FEGLI beneficiary. After Hillman’s death, Maretta, still the named beneficiary,collected the FEGLI proceeds. A Virginia Circuit Court found Maretta liable to Jacqueline under Section D for the FEGLI policy proceeds. The Virginia Supreme Court reversed, concluding that Section D is preempted by FEGLIA because it conflicts with the purposes and objectives of Congress. The Supreme Court affirmed. FEGLIA creates a scheme that gives highest priority to an insured’s designated beneficiary and underscores that the employee’s “right” of designation “cannot be waived or restricted.” Section D interferes with this scheme, because it directs that the proceeds actually belong to someone other than the named beneficiary by creating a cause of action for their recovery by a third party. FEGLIA establishes a clear and predictable procedure for an employee to indicate who the intended beneficiary shall be and evinces Congress’ decision to accord federal employees an unfettered freedom of choice in selecting a beneficiary and to ensure the proceeds actually belong to that beneficiary. View "Hillman v. Maretta" on Justia Law

Appellant filed a claim for benefits associated with an injury he received during his employment. The Arkansas Workers' Compensation Commissioned denied the claim based on a finding that Appellant tested positive for controlled substances after the injury and that he failed to rebut the statutory presumption that his injury was substantially occasioned by his drug use. Appellant appealed, arguing that the Commission's decision was not supported by substantial evidence and that the Commission lacked the authority to make credibility determinations contrary to those made by an ALJ. Currently before the Supreme Court was Defendant's motion to supplement the record with affidavits and depositions that Appellant attached to a brief he previously filed. The Supreme Court remanded to the Commission to settle the record to determine whether the documents were actually placed in the record. View "Prock v. Bull Shoals Boat Landing" on Justia Law

In 2009, a registered nurse (Nurse) employed by Hospital commenced this action for workers' compensation benefits, alleging that as the result of three incidents with patients involving assault and sexual assault, she suffered from posttraumatic stress disorder (PTSD) and depression. The workers' compensation court found all three incidents occurred, held that Nurse suffered depression and PTSD as a result of the incidents, and that Nurse was permanently and totally disabled. The court awarded benefits accordingly. After Hospital appealed, it was discovered that the testimony of all Hospital witnesses who testified on behalf of Hospital could not be transcribed due to a failure of electronic equipment used by the court reporter. The Supreme Court vacated the judgment of the trial court and remanded for a new trial, concluding that, under the circumstances of the case, where the testimony of all Hospital witnesses had been lost due to no fault of either party, the Court could not undertake a meaningful appellate review of the assignments of error. Remanded for a new trial. View "Hynes v. Good Samaritan Hosp." on Justia Law

While working for Employer, Appellant became trapped in a stalled elevator. Employer's security staff attempt to rescue Appellant, but as a result of their attempt, Appellant fell several stories down the elevator shaft, causing serious injuries. Appellant filed for workers' compensation. The ALJ enhanced Appellant's workers' compensation award based on Ky. Rev. Stat. 342.165(1), which provides that if an accident is caused by the intentional failure of an employer to comply with a statute or regulation relative to the maintenance of safety appliance, the claimant's benefits shall be increased, and Ky. Rev. Stat. 338.031, which states that an employer must provide his employees a place to work free from dangerous hazards. The workers' compensation board affirmed. The court of appeals reversed. The Supreme Court reversed, holding that the ALJ correctly applied the four-part test set forth in Lexington-Fayette Urban County Government v. Offutt to determine that Employer violated section 338.031, and accordingly, the ALJ properly applied the enhancement to Appellant's weekly benefit because of Employer's violation of section 342.165. View "Hornback v. Hardin Memorial Hosp." on Justia Law

Benjamin Morris appealed an order of the Idaho Industrial Commission that denied his motion to set aside a lump sum settlement agreement he made with his employer's surety, Liberty Northwest Insurance. Morris initiated his workers' compensation action after he suffered injuries while working construction for his employer, Hap Taylor & Sons, Inc. Morris sustained a serious head injury on when a twenty-five pound rock thrown by a piece of heavy machinery struck him in the head. Morris initiated settlement discussions with Liberty Northwest Insurance, Hap Taylor & Sons' insurer. Liberty responded with a counter-offer—a single lump sum payment which Morris accepted "with the clear understanding this is a partial settlement and does not resolve the medical side." The parties executed a Stipulation and Agreement of Partial Lump Sum Discharge (LSSA) and submitted it to the Commission for approval. Approximately eighteen months later, on July 8, 2011, a Notice of Appearance was filed with the Commission whereby Morris substituted attorney Michael Walker with his then present counsel, attorney Starr Kelso. On the same day, Morris filed a motion to review the LSSA, accompanied by an affidavit signed by Kelso. Kelso's affidavit expressed concern that Morris may not have been "competent to testify" due to his injury—though, no credible evidence of incompetence was ever offered. Liberty filed an objection to Morris' motion to review. Ultimately, the Commission denied Morris' motion. Following the Commission's refusal to review the LSSA, Morris filed a Motion to Set Aside Lump Sum Settlement Agreement, seeking to void the LSSA on grounds of illegality and constructive fraud. The Commission issued an order denying Morris' motion to set the LSSA. Morris filed a timely appeal to the Supreme Court. After its review, the Supreme Court concluded that the Commission did not err in denying Morris' request for a hearing on his fraud claim. Furthermore, the Court affirmed the Commission's decision to deny Morris' motion to set the LSSA. View "Morris v. Hap Taylor & Sons" on Justia Law

Palmetto Hardwood, Inc., employed Petitioner Clifton Sparks as a saw operator. Petitioner suffered three work-related injuries during this employment, the first two of which injured Petitioner's lower back. In the third incident, Petitioner was required to remove a piece of metal from under a gang saw. In the process, the metal exploded and a three- to four-inch cubic piece struck him in the head. Petitioner subsequently sought workers' compensation for his injuries. At the hearing, Petitioner testified to substantial head pain, loss of cognitive ability, and other brain-function-related symptoms, including inability to read without severe headache, loss of his mathematical abilities, inability to balance while standing or to walk without a cane, hand tremors, anxiety, and more. Petitioner argued on appeal to the Supreme Court that the Court of Appeals erred when it applied an improper definition of "physical brain damage" within the meaning of section 42-9-10(C). The Supreme Court disagreed. Because "physical brain damage" as contemplated in S.C. Code Ann. 42-9-10 required "severe and permanent physical brain damage as a result of a compensable injury" and the Workers' Compensation Commission's finding that Petitioner did not suffer such brain damage was supported by substantial evidence in the record, the Court affirmed the Court of Appeals. View "Sparks v. Palmetto Hardwood" on Justia Law

The Wyoming Workers' Safety and Compensation Division awarded benefits to Appellant after he experienced a workplace injury. The Division denied Appellant's claim for payment for prescription medication he alleged was related to his workplace injury. The Medical Commission upheld the Division's determination, and the district court affirmed. The Supreme Court affirmed, holding (1) the Commission's decision upholding the Division's denial of benefits was supported by substantial evidence; and (2) the Commission applied the proper burden of proof for a second compensable injury when it required Appellant to establish a causal connection between his abdominal pain and his ingestion of the prescription medication at issue. View "Jacobs v. State ex rel. Wyo. Workers' Safety & Comp. Div." on Justia Law

Douglas Moad was driving his truck within the course of his employment with Employer when his truck was struck by an oncoming vehicle. Douglas died from his injuries. Employer maintained workers' compensation services with Dakota Truck Underwriters (DTU), a South Dakota corporation with its principal place of business in South Dakota. Employer also maintained motorist liability coverage with Northland Insurance Company (Northland). Douglas and his wife Sharon maintained insurance coverage with Property and Casualty Insurance Company of Hartford (Hartford). Sharon filed a petition seeking damages from Northland and Hartford for uninsured motorist benefits. DTU filed a notice of subrogation lien, asserting that it was entitled to reimbursement from any proceeds obtained by Sharon as a result of the damages action. Sharon reached a settlement agreement with Northland and Hartford. The district court approved the settlement and granted Sharon's motion to extinguish DTU's lien, concluding that in the event DTU's untimely filing of notice of its lien did not bar its interest, Iowa law applied and barred DTU's recovery. The Supreme Court reversed, holding that the district court utilized the wrong standard in resolving the conflict of laws question. View "Moad v. Dakota Truck Underwriters, Risk Admin. Servs., Inc." on Justia Law