Justia Insurance Law Opinion Summaries

Petitioner Vincent James Hogg, Sr. sought review of a Workers' Compensation Court order which denied his workers' compensation benefits based upon the court's interpretation of 85 O.S. 2011, section 312 (3). Petitioner was employed by the Oklahoma County Juvenile Detention Center when in late 2011, he sustained an injury to his right shoulder and neck while subduing an unruly and combative juvenile. Petitioner was given a post-accident drug screen and a follow-up screen the next day. Both screens showed a "positive" result for the presence of marijuana in his system. Petitioner did not dispute the test results but Petitioner denied ever smoking marijuana. The trial court ultimately found there was no evidence presented to establish Petitioner was "high," nor was there any evidence to establish the marijuana in his system was the "major cause" of the accidental injury. The trial court did, however, deny Petitioner's eligibility for workers' compensation benefits by reason of its interpretation of the newly created 85 O.S. 2011, section 312 (3). The dispositive issue presented to the Supreme Court was whether the trial court erred in its interpretation of the statute. The trial court found the last sentence of paragraph 3 expressed the legislative intent of the entire paragraph without giving any weight to the other sentences in the same paragraph. In its order, the trial court indicated this sentence created an irrebuttable presumption. Upon review, the Supreme Court disagreed. The Court concluded that Petitioner overcame the rebuttable presumption of ineligibility for workers' compensation benefits. The case was reversed and remanded for further proceedings. View "Hogg v. Oklahoma Cty. Juvenile Bureau" on Justia Law

Claimant Charles Prince filed a claim in the Workers' Compensation Court in 2009 alleging a cumulative trauma employment-related injury to his right foot, with date of last exposure in late 2008. The trial court found Claimant sustained a cumulative trauma injury to his right foot and ordered Employer, Brake Rebuilders & Friction Products, Inc., to select a physician to treat Claimant and to provide "such medical, surgical or other attendance or treatment, nurse and hospital service, medicine, diagnostic testing and referral as may be deemed necessary by the treating physician to the claimant's right foot." The court found his date of last exposure was late 2008. Claimant sought compensation for injury to his right foot, and later for his low back arising from the same injury. The trial court of the Workers' Compensation Court denied his claim for the low back, and a three judge panel affirmed. On appeal the Court of Civil Appeals (COCA) vacated the panel's order, holding the order was against the clear weight of the evidence. Upon review, the Supreme Court found that the denial of the award for Claimant's lower back was supported by competent evidence. COCA found more evidence in support of Claimant's low back injury, but Employer presented evidence from its medical expert which denied that the injury to either the low back or the right foot arose out of Claimant's employment. "The date of the injury determines the law to be used in a workers' compensation claim and applies equally to employers and claimants alike." Based on the Supreme Court's decision in "Williams Companies, Inc. v. Dunkelgod," (2012 OK 96 (2012)), and the law on the date of Claimant's injury, the opinion of the Court of Civil Appeals was vacated. View "Prince v. Brake Rebuilders & Friction Products, Inc." on Justia Law

Brendan Muldoon appealed a district court judgment that affirmed an order from an administrative law judge ("ALJ") which: affirmed an order of Workforce Safety and Insurance ("WSI") finding Muldoon was an employer under N.D.C.C. 65-01-02(17); that Muldoon wilfully failed to secure workers' compensation coverage for his employees; and that Muldoon was personally liable for past premiums and penalties owed to WSI. Upon review of the ALJ's record, the Supreme Court affirmed, concluding the ALJ's findings were supported by a preponderance of the evidence. View "Muldoon v. WSI" on Justia Law

This insurance coverage dispute arose from charges of sexual harassment brought by a one-time employee against Appellant, the former president of Jasmine Company, Inc. Appellant sought a defense to and indemnity for the harassment claims from Appellee, Jasmine's liability insurance provider. The district court ruled that Appellant was not entitled to coverage from Appellee because, under the doctrine of issue preclusion, a prior arbitration between Appellant and the purchaser of his business conclusively established that Appellant's conduct fell within an exclusion to Appellee's insurance policy. The First Circuit Court of Appeals affirmed, holding (1) the arbitration presented Appellant with the full and fair opportunity for adjudication on the issue at hand; and (2) therefore, the district court was correct to bar Appellant from disputing the applicability of the exclusion based on the doctrine of issue preclusion. View "Manganella v. Evanston Ins. Co." on Justia Law

Petitioner suffered an injury while in the course and scope of his employment. The employer's workers' compensation insurance carrier paid medical benefits but contested the extent of Petitioner's entitlement to impairment income benefits. The Department of Insurance's Workers' Compensation Division determined that Petitioner had an impairment rating of twenty percent. The trial court reversed the agency's decision, ruling that Petitioner had no valid impairment rating. The court of appeals affirmed. While Petitioner's appeal to the Supreme Court was pending, the Court held in American Zurich Insurance Co. v. Samudio that the absence of a valid impairment rating that had been submitted to the agency did not deprive a reviewing court of subject matter jurisdiction. In light of its decision in Samudio, the Court then reversed and remanded to the trial court with instructions that the court remand the case to the Division in light of its determination that Petitioner had no valid impairment rating. View "DeLeon v. Royal Indem. Co." on Justia Law

The issue before the Supreme Court in this case centered on whether a Workers' Compensation employer's insurance carrier should be reimbursed from the Supersedeas Fund for specific payments made to a claimant prior to the ultimate grant of supersedeas. The question turned on whether the relevant payments constituted payments of "compensation" within the meaning of Section 443 of the Workers' Compensation Act (WCA), 77 P.S. 999(a), or, as argued by Appellant Bureau of Workers' Compensation, whether the payments are not reimbursable because they constitute payment of legal costs associated with obtaining a claimant's third-party tort settlement under Section 319 of the WCA, 77 P.S. 671. After review, the Court found no language in either Section 443 or Section 319 that would transform the relevant payments into something other than compensation merely because the amounts of the payments were calculated to compensate the claimant for the costs of recovering the third-party settlement. Accordingly, the Court affirmed the decision of the Commonwealth Court. View "Bureau of Workers' Comp, Aplt v. WCAB(Excelsior Ins.)" on Justia Law

Workers' compensation claimant Kristy Dunkelgod was injured in an employment-related accident in 2011 while working for Williams Companies, Inc. The Workers' Compensation Court entered several orders awarding claimant temporary total disability benefits. She was also awarded a "Go-Go" scooter and a lift van. On appeal by the employer, the Court of Civil Appeals vacated the awards, holding the court's finding the lift van was medically necessary was "against the clear weight of the evidence." The Court of Civil Appeals also held the claimant was limited to a maximum of 300 weeks of temporary total disability benefits and remanded for a determination of when she reached the maximum. The issues before the Supreme Court were: (1) whether the Court of Civil Appeals (COCA) err when it applied the "clear weight of the evidence" standard of review to the Workers' Compensation Court's order awarding a lift van; and (2) whether COCA erred when it held that Claimant's temporary total disability (TTD) award was limited to a maximum of 300 weeks. The Supreme Court answered both questions in the affirmative; COCA failed to apply the law in effect at the time of Claimant's injury. The Court vacated and remanded the case to the Workers' Compensation Court for further proceedings. View "Williams Companies, Inc v. Dunklegod" on Justia Law

Raybourne was a quality engineer for 23 years. The employer provided a long-term disability plan that paid benefits for up to 24 months if disability prevented him from performing the duties of his regular job. After 24 months, the plan paid benefits only if he was unable to perform all material duties of any occupation for which he was reasonably qualified. Raybourne suffered degenerative joint disease in his foot, with severe pain. In 2003, he stopped working and underwent the first of the four surgeries. From December 2003 through February 2006, Cigna paid benefits, then determined that he was not disabled under the more stringent standard. Raybourne exhausted administrative remedies, then sued under 29 U.S.C. 1132(a)(1)(B). The district court ruled in favor of Cigna. On remand the court rejected Cigna’s “unconvincing” explanation for how the company determined that Raybourne was not disabled. The court found that Cigna relied on the report of a non-treating physician and on the Social Security Administration’s initial rejections of Raybourne’s claim, failing to consider the SSA’s final determination of disability. The Seventh Circuit affirmed, finding that denial of benefits was based on a conflict of interest rather than on the facts and the terms of the policy. View "Raybourne v. CIGNA Life Ins. Co. of NY" on Justia Law

Appellant was injured in an accident that occurred during the course of her employment. After receiving a permanent partial impairment award from the Wyoming Worker's Compensation Division, Appellant sought permanent partial disability benefits. The Division denied Appellant's application, stating that she had not complied with the statutory work search requirements. After a contested case hearing, the Office of Administrative Hearings granted summary judgment for the Division, concluding that Appellant had not timely submitted documentation showing she had sought work. The district court affirmed. The Supreme Court reversed, holding (1) Appellant's work search submission was timely; and (2) Appellant was entitled to a hearing and the opportunity to present evidence showing that she actively sought work. View "Stallman v. State ex rel. Wyo. Workers' Safety & Comp. Div." on Justia Law

Employee was injured while working for Employer. Because Employer failed to retain current worker's compensation insurance, Employee filed a claim with the Uninsured Employer's Fund, which the Fund accepted. The Fund sought indemnity from Employer for Employee's damages, and the parties agreed to an interim payment plan. However, the Fund ultimately turned Employer over to collection. Employer responded by suing the Fund for breach of contract. The district court granted Employer's summary judgment motion on the issue of whether the Fund had breached the repayment agreement. The district court then awarded damages to Employer in the amount of $198,749. The damages awarded largely centered on the court's implicit conclusion that the Fund's actions had interfered with Employer's ability to obtain financing, which, in turn, hurt Employer's sales. The Supreme Court affirmed, holding that the district court properly (1) determined Employer was entitled to summary judgment on the question of whether the Fund had breached the payment plan agreement; (2) determined Employer could receive consequential damages for the Fund's breach of contract; (3) denied the Fund's motion for post-trial relief; (3) calculated damages; and (4) denied Employer's damage claim for ten years of lost profits. View "Elk Mountain Motor Sports, Inc. v. Dep't of Labor & Indus." on Justia Law