Justia Insurance Law Opinion Summaries

Petitioner appealed an order of the West Virginia Workers' Compensation Board of Review through which Petitioner's permanent total disability (PTD) award previously granted was suspended and vacated. Petitioner challenged the Board's determination, upon a reopening of his PTD claim, that he was capable of gainful employment. Petitioner argued that his former employer, Lowe's, violated the statute that authorized the claim reopening because Lowe's was involved in the reevaluation process, and therefore, the order vacating his PTD award was invalid. The Supreme Court affirmed, holding that notwithstanding statutory language that suggests otherwise, an order issued by the Board that modifies or vacates a previous award of PTD is not subject to challenge based on the involvement of a self-insured former employer in the reevaluation process, given that the participation of the self-insured former employer is clearly anticipated and authorized by the provisions of W. Va. Cod 23-4-16(d). View "Justice v. W. Va. Office Ins. Comm'n" on Justia Law

Under the terms of a collective-bargaining agreement, the City of Newport provided health insurance benefits to its retired firefighters. After the City decided to modify those benefits, Local 1080, International Association of Firefighters, ALF-CIO (Union) filed grievances and sought arbitration. The City responded by seeking relief in the superior court to determine the arbitrability of disputes over changes to these benefits. The superior court determined that this dispute was not arbitrable. The Union disagreed and petitioned the Supreme Court for a writ of certiorari. The Court affirmed the judgment of the superior court, holding that the parties did not intend to arbitrate disputes regarding retiree healthcare, and therefore, such disputes must be resolved, if at all, judicially rather than through arbitration. View "City of Newport v. Local 1080, Int'l Ass'n of Firefighters, AFL-CIO" on Justia Law

The Supreme Court granted certiorari in this appeal to consider whether OCGA section 34-9-207 required an employee who files a claim under the Georgia Workers' Compensation Act (OCGA 34-9-1 et seq.), to authorize her treating physician to engage in ex parte communications with her employer or an employer representative in exchange for receiving benefits for a compensable injury. Because the Court of Appeals erroneously held an employee is not required to authorize such communications, the Supreme Court reversed. View "Arby's Restaurant Group, Inc. v. McRae" on Justia Law

Employee was severely injured while working for Employer. Employer and its Insurer began paying lifetime workers' compensation benefits. Employee brought a separate negligence action against Employer's parent company (Ridgetop) and joined Employer and Insurer for workers' compensation subrogation purposes. Employee reached a settlement agreement with Ridgetop, after which the trial court granted Employer and Insurer's motion, pursuant to Neb. Rev. Stat. 48-118, for a future credit in the amount of Employee's settlement with Ridgetop against its continuing workers' compensation obligations. The Supreme Court affirmed in part and reversed in part the order granting the future credit, holding (1) the trial court did not err in granting the motion for credit against the settlement proceeds Employee received from Employer; (2) Insurer did not waive its right to a future credit through a waiver clause in the policy or statements during settlement negotiations; but (3) the trial court erred in granting the credit for the entire amount of the settlement. Remanded for the limited purpose of deducting $437,500 - the amount paid to Insurer and an indemnity company - out of the settlement and for determining the amount of attorney fees to additionally be deducted from the amount of the credit. View "Bacon v. DBI/SALA" on Justia Law

Respondent injured his back while working, and his employer's workers' compensation insurer, Texas Mutual Insurance Company (TMIC), accepted the injury as compensable. Three years later when it was discovered that Respondent had herniated lumbar intervertebral discs, TMIC disputed whether they were causally related to the original injury. The Texas Department of Insurance Division of Workers' Compensation determined that the disc herniations were related to the original injury and ordered TMIC to pay medical benefits, which it did. Respondent later sued TMIC for damages caused by its delay in paying benefits. The trial court rendered judgment for Respondent, and the court of appeals affirmed. Based on the Court's recent decision in Texas Mutual Insurance Co. v. Ruttiger, the Supreme Court reversed and rendered judgment for TMIC. View "Tex. Mut. Ins. Co. v. Morris" on Justia Law

The issue before the Supreme Court in this case centered on whether a workers' compensation insurer was entitled to reimbursement of death benefits it paid when a claimant's beneficiary also received proceeds from a life-insurance policy. Upon review, the Court held that under 21 V.S.A. 624(e) a workers' compensation carrier cannot seek reimbursement from life-insurance payments because such proceeds are not "damages," as contemplated by the statute and paid because of a third party's tortious actions. The Court therefore affirmed the Commissioner of Labor's grant of summary judgment to the estate of the claimant. View "Estate of Dunn v. Windham Northeast Supervisory Union" on Justia Law

Appellant appealed from an opinion of the court of appeals which affirmed an order of the circuit court dismissing Appellant's petition for review of a decision of the Kentucky Unemployment Insurance Commission (KUIC). In addition to denying Appellant unemployment benefits, the KUIC ordered Appellant to reimburse $12,785 in benefit payments he had already received. The circuit court dismissed Appellant's petition for review because it did not comply with the verification requirement contained in Ky. Rev. Stat. 341.450(1), and thus the court concluded that its jurisdiction was not invoked within the twenty-day limitations period provided for filing such an action. The Supreme Court affirmed, holding (1) because Appellant failed to comply with the verification provision of section 341.450(1), the circuit court lacked jurisdiction over the controversy; and (2) Appellant did not comply with the verification requirement, as his attorney's signature on the petition did not constitute "certification." View "Taylor v. Ky. Unemployment Ins. Comm'n" on Justia Law

Employer terminated Employee's employment after receiving complaints regarding poor service and use of inappropriate language by Employee. The Department of Labor & Industry concluded Employee was not qualified for unemployment insurance benefits because she had been discharged for misconduct. A hearing officer awarded unemployment benefits to Employee, concluding that Employee had not been deliberately rude and thus had not engaged in misconduct. The Board of Labor Appeals affirmed. Employer petitioned for judicial review. The Department and Board filed a notice of non-participation indicating they would not participate in the proceeding but reserved the right to intervene if issues arose pertaining to them. The district court reversed, holding that Employee's conduct as established by the hearing officer's findings of fact constituted misconduct as a matter of law under the carelessness standard of Admin. R. M 24.11.460(1)(d). The Department appealed. The Supreme Court affirmed, holding (1) the Department did not preserve its evidentiary arguments for appeal; and (2) the district court did not err by determining that the evidence found by the Department constituted misconduct as a matter of law under the carelessness standard. View "Gary & Leo's Fresh Foods v. Dep't of Labor & Indus." on Justia Law

Merwin Carlson appealed a judgment affirming a Workforce Safety and Insurance ("WSI") decision that denied his claim for workers' compensation benefits after remand. Under the law of the underlying case, the Supreme Court held that the administrative law judge ("ALJ") erred in concluding WSI properly exercised its continuing jurisdiction under N.D.C.C.65-05-04 to deny Carlson benefits on remand. The Court reversed and remanded for WSI to award Carlson benefits based on the ALJ's calculation that Carlson's average weekly wage was $722. View "Carlson v. Workforce Safety & Ins." on Justia Law

The Supreme Court granted allowance of appeal in this case to determine whether the immunity provisions of Section 23 of the Workers' Compensation Act (Act 44) applied to "subrogation and/or reimbursement claims sought against an employee who has entered into a third[-]party settlement with a Commonwealth [p]arty such as Southeastern Pennsylvania Transportation Authority ('SEPTA')." Upon review of this matter, the Supreme Court held that the portion of Act 44 at issue in this case barred any claim made by the employer for the recoupment of workers' compensation benefits it paid. View "Fraizer v. W.C.A.B." on Justia Law