Justia Insurance Law Opinion Summaries

Decedent worked as a firefighter for Baltimore City. After Decedent died, his widow, Petitioner, began receiving survivorship benefits from Decedent's pension. Petitioner later filed a dependent's claim for death benefits under the Maryland Workers' Compensation Act. The dispute at the hearing concerned what provision of the Act was applicable to Petitioner's claim. The City argued that Md. Code Lab. & Empl. 9-610, which reduces compensation death benefits by the amount of pension benefits, should apply. Petitioner argued that Md. Code Lab. & Empl. 9-503(e), which allows firefighters' dependents to collect both pension and workers' compensation up to the amount of what had been the firefighter's weekly salary, should apply. Petitioner's claim was pending when section 9-503(e) was amended to include dependents in its scope of coverage. The Workers' Compensation Commission determined that section 9-503(e) governed the claim and awarded Petitioner benefits. The circuit court granted summary judgment for the City, ruling that Petitioner had no preexisting right to dual benefits prior to the statute's amendment. The Court of Appeals affirmed, holding that the amendments involved a substantive change in the law that precluded it from applying retroactively to pending cases. View "Johnson v. Baltimore" on Justia Law

The Wyoming Workers' Safety and Compensation Division determined that Appellant suffered a compensable injury while employed by Employer. The lodge filed an objection to that determination and requested a hearing with the Office of Administrative Hearings (OAH). Appellant filed a motion to dismiss that objection on the grounds that the objection was invalid because Employer was not a proper party to the action. The OAH denied Appellant's motion and concluded that Appellant had not suffered a compensable injury. The district court affirmed. At issue on appeal was whether Employer properly filed an objection to the Division's final determination of compensability. The Supreme Court affirmed, holding that Employer was a proper party to the action because it was the identified employer and paid the necessary contributions under Wyoming Worker's Compensation Act. View "Heikkila v. Signal Mountain Lodge" on Justia Law

Employee injured his back while working for Employer. Employee and the Department of Labor and Workforce Development (Department) agreed upon a settlement that provided for a lump sum payment to Employer for his injuries. The settlement and SD-1 form were signed by Employee and both parties' attorneys. Two years later, Employee filed a petition to set aside the settlement. The trial court granted Employee's petition. The Special Workers' Compensation Appeals Panel vacated the trial court's judgment on a procedural issue, finding the SD-1 form was not "fully completed." The Supreme Court reversed the judgments of the Panel and of the trial court and dismissed Employee's petition, holding (1) when the Department approves a settlement, it implicitly approves the accompanying SD-1 form, and a court has no authority to set the settlement aside based on its independent finding that the SD-1 form was not "fully completed"; and (2) the evidence preponderated against the trial court's finding that Employee was not represented by counsel, and the court erred in granting relief based on Tenn. R. Civ. P. 60.02(5) as well as its inherent authority. View "Furlough v. Spherion Atlantic Workforce, LLC" on Justia Law

Employee, an undocumented worker, was injured while working for Employer. Employee was awarded temporary total disability benefits. Employer later petitioned the workers' compensation court to discontinue the temporary benefits. While the action was pending, Employee returned to his county of origin. The compensation court concluded (1) Employer's obligation to pay Employee temporary total disability should cease because Employee had reached maximum medical improvement; and (2) there was no credible evidence which could be used to determine Employee's loss of earning capacity in his new community, and therefore, Employee's request for benefits for his claim of permanent impairment and loss of earning capacity was denied. The Supreme Court (1) affirmed the compensation court's conclusion that Employee had reached maximum medical improvement; but (2) reversed the denial of Employee's claim of permanent impairment and loss of earning capacity because where no credible data exists for the community to which the employee has relocated, the community where the injury occurred can serve as the hub community. Remanded. View "Visoso v. Cargill Meat Solutions" on Justia Law

Dean Pepper, the owner and sole shareholder of D.F. Pepper Construction (DFP) was driving one of his trucks home in the early winter morning. An icy road caused the truck to slide into Pepper's house and crash through the foundation and west wall. The house was later condemned and demolished as a result of the damage. The house was insured by Nationwide Casualty Insurance Company. Nationwide paid the loss. As subrogee of Pepper, Nationwide then sued DFP, the registered owner of the truck, alleging vicarious liability for the negligence of its employee, Pepper. The superior court issued judgment in favor of Nationwide, finding that Pepper had been negligent and that the antisubrogation rule did not apply in this case. The Supreme Court affirmed, holding that the trial court did not err in its judgment. View "Nationwide Prop. & Cas. Ins. Co. v. D.F. Pepper Constr., Inc." on Justia Law

While in the course and scope of her employment, Appellant suffered and injury and incurred medical expenses. The Workers' Compensation Court ordered Appellant's employer (Employer) to pay the expenses. Employer made payments directly to Appellant's health care providers within thirty days of the court's order. Because she was not personally reimbursed for the medical expenses within thirty days, Appellant sought a waiting-time penalty, attorney fees, and interest pursuant to Neb. Rev. Stat. 48-125. The Workers' Compensation Court denied relief, and Appellant appealed. The Supreme Court affirmed, holding (1) because section 48-125 did not apply to Appellant's request for a waiting-time penalty, the compensation court did not err in overruling her motion for a waiting-time penalty; and (2) Employer in this case was not subject to liability for attorney fees, and therefore, Appellant was not entitled to an award of interest. View "VanKirk v. Cent. Cmty. Coll." on Justia Law

The Alabama Insurance Guaranty Association ("AIGA") filed an action against Mercy Medical Association, and Catholic Health East, Inc. ("CHE"), seeking to recover money it had paid on behalf of Mercy Medical and CHE on workers' compensation claims filed by employees of Mercy Medical as well as a judgment declaring its right to reimbursement of statutory benefits to be paid on the employees' claims in the future. AIGA, Mercy Medical, and CHE each moved for a summary judgment. The trial court entered a summary judgment in favor of Mercy Medical and CHE, determining: (1) that the 2000 AIGA Act applied because it was in effect at the time of the insolvency of Reliance National Insurance Company (CHE's workers' compensation insurer), and at the time the workers' compensation judgment was entered against Mercy Medical; (2) that the 2009 AIGA Act did not apply retroactively because the 2009 amendments to the AIGA Act substantively changed the law; and (3) that under the 2000 AIGA Act, Mercy Medical's net worth did not exceed $25,000,000, so AIGA could not recover any amounts it had paid on behalf of Mercy Medical. AIGA appealed. Upon review, the Supreme Court concluded that the applicable law governing the vesting of AIGA's right to reimbursement of claims paid was the law in effect on the date of the insurer's insolvency. Further, the Court also concluded that the addition of the net-worth definitions in the 2009 AIGA Act were substantive and did not apply retroactively in this case. Finally, the Court concluded that AIGA was not entitled to reimbursement from Mercy Medical or CHE because, under the 2000 AIGA Act, Mercy Medical's net worth did not exceed $25,000,000 and the payments were not made on behalf of CHE. Accordingly, the Court affirmed the trial court's judgment in favor of Mercy Medical and CHE. View "Alabama Insurance Guaranty Association v. Mercy Medical Association" on Justia Law

The Fund, a multi-employer pension plan under ERISA, has a Plan, providing for administration by a Board with authority to make benefit determinations and amend the Plan, including retroactively. No amendment may result in reduced benefits for any participant whose rights have vested, except in specified circumstances. Price began receiving Plan disability benefits under the “Total and Permanent Disability Benefit” category in 1990, after work-related injuries left him unable to work. In 2001, the Fund notified Price that he no longer qualified for benefits under this category, but that he could continue receiving benefits under provisions for “Occupational Disability Benefit.” His benefits were discontinued after 2006, according to an Amendment. Price became eligible for early retirement in 2012. The Board rejected an appeal. The district court granted Price judgment in his suit under ERISA, 29 U.S.C. 1132(a)(1)(B). On remand from the Sixth Circuit, for review determination of vesting under the arbitrary and capricious standard, the judge again ruled in favor of Price. The Sixth Circuit again reversed; the court failed to look to the terms of the plan but instead found that because the Board’s decision letter did not discuss whether the benefits vested, the Board’s decision was arbitrary and capricious. View "Price v. Bd. of Trs. of IN Laborers' Pension Fund" on Justia Law

Pro se appellant Holly Noel-Liszkiewicz appealed a superior court's decision to affirm the Industrial Accident Board's denial of her claim for worker's compensation benefits. Appellant was a customer service representative for Employer La-Z-Boy before being laid off. Almost two years after the lay off, Appellant petitioned the board seeking compensation for occupational asthma, pulmonary fibrosis, and respiratory failure allegedly caused by exposure to chemicals at La-Z-Boy’s facility. La-Z-Boy denied that Applicant suffered any illness or injury that was causally related to her work. Finding Appellant's arguments to be without merit, the Supreme Court affirmed both the Board and the superior court. View "Noel-Liszkiewicz v. La-Z-Boy" on Justia Law

The Workers Compensation Board awarded Plaintiff benefits under the Workers Compensation Act for an injury he sustained while operating a go-cart at an event sponsored by his employer (Employer). Employer and its insurance carrier (Insurer) appealed the award, claiming that Plaintiff's injuries were not compensable because they were sustained during a recreational or social event that Plaintiff was not required to attend. The court of appeals affirmed the Board. The Supreme Court reversed, holding that the Board applied the incorrect legal standard in determining whether Plaintiff's injuries arose out of and in the course of his employment, and the error was not harmless. Remanded to the Board to make the determination based on the statutory criteria of Kan. Stat. Ann. 44-508(f). View "Douglas v. Ad Astra Info. Sys., LLC" on Justia Law