Justia Insurance Law Opinion Summaries

A compensation judge found Respondent was barred from receiving workers' compensation benefits because his written notice of injury, given nearly two years after his last day of work, was not timely and because Respondent's employer did not have actual knowledge that Respondent's back problems were work-related. The workers' compensation court of appeals (WCCA) reversed, concluding that a reasonable person in Respondent's position would not have known his injury was compensable until Respondent's doctors provided written reports to Respondent's attorney establishing a relationship between Respondent's back problems and his job duties. The Supreme Court reversed the WCCA and affirmed the denial of benefits, holding (1) the WCCA erred in overturning the compensation judge's finding that Respondent failed to give timely notice to his employer of his work-related injury; and (2) the compensation judge did not err in finding that the employer did not have actual knowledge of such an injury. View "Anderson v. Frontier Commc'ns" on Justia Law

Respondent sustained six injuries while playing for the Washington Redskins on four separate occasions. Consequently, Respondent filed with the Maryland Workers Compensation Commission six separate claims against his employer, the Washington Redskins (Petitioner). The Commission denied five of Respondent's claims on the ground that he was not a "covered employee" because he was working for the Redskins outside of the State when he sustained the injuries underlying the claims. The circuit court affirmed. The court of special appeals reversed. The Court of Appeals affirmed, holding that a football player employed by the Washington Redskins is a "covered employee," and therefore entitled to avail himself of Maryland's workers' compensation laws, when injured while practicing and playing football outside of Maryland. View "Pro-Football, Inc. v. McCants" on Justia Law

Appellee was injured during the course of his employment. When his workers' compensation benefits ceased, Appellee applied for and received unemployment insurance benefits. The Kentucky Unemployment Insurance Commission determined that Kan. Rev. Stat. 341.090, which permits the use of an "extended base period" that captures earnings leading to equitable unemployment benefits, required that the extended base period may include only the four calendar quarters that immediately precede the base period. Pursuant to this extended base period, Appellee was awarded benefits of $149 per week. The circuit court reversed. The court of appeals affirmed, concluding that the extended base period need not be limited to the four quarters that immediately precede the base period. The Supreme Court reversed, holding that the Commission properly applied the statute in calculating Appellee's unemployment benefits. View "Unemployment Ins. Comm'n v. Hamilton" on Justia Law

This appeal concerned the method for excluding impairment from a non-compensable disability when calculating a worker's permanent disability benefit under the post-1996 version of Kan. Rev. Stat. 342.730(1)(b). The ALJ calculated a benefit based on the claimant's entire post-injury permanent impairment rating and then subtracted an amount equal to a benefit based on his pre-existing active impairment rating. The workers' compensation board reversed, determining that the present version of section 342.730(1)(b) requires the calculation of income benefits to be based only on the permanent impairment rating caused by the injury being compensated. The court of appeals affirmed. The Supreme Court affirmed, holding that pre-existing impairment must be excluded when calculating a total disability award under section 342.730(1)(b). View "Tudor v. Indus. Mold & Mach. Co." on Justia Law

Claimant sustained a work-related injury in 2003, for which he was awarded temporary total disability (TTD) benefits followed by 425 weeks of permanent partial disability benefits. In 2007 Claimant sustained another injury. After finding the effects of the 2003 injury caused Claimant's 2007 injury, an ALJ increased Claimant's partial disability benefit at reopening and tripled the entire income benefit awarded for his injury. The workers' compensation board and court of appeals affirmed. The Supreme Court affirmed, holding (1) substantial evidence supported the finding of increased impairment as well as the finding that Claimant lacked the physical capacity at reopening to perform the type of work performed at the time of his injury; and (2) the combined effects of the impairment present at the time of the initial award and the additional impairment present at reopening entitled Claimant to triple benefits based on the whole of his disability for the balance of the compensable period. View "James T. English Trucking v. Beeler" on Justia Law

An ALJ determined that Claimant sustained a work-related hearing loss and that Kan. Rev. Stat. 342.7305(4) placed the entire liability for income and medical benefits with Appellant, the last employer with whom Claimant was last injuriously exposed to hazardous noise. The workers' compensation board and court of appeals affirmed. The Supreme Court affirmed, holding (1) the record contained substantial evidence that testing revealed a pattern of hearing loss compatible with that caused by hazardous noise exposure and contained substantial evidence that Claimant sustained repetitive exposure to hazardous noise in the workplace, including his final employment with Appellant; and (2) Kan. Stat. Rev. 342.7305(4) does not permit apportioning liability among employers in such cases. View "Greg's Constr. v. Keeton" on Justia Law

This appeal concerned an ALJ's decision to award the claimant temporary total disability (TTD) benefits for his work-related shoulder injury from the date he left work, May 10, 2007, until May 8, 2009. The ALJ also awarded permanent income and medical benefits for the injury but denied claims for cervical and lumbar spine injuries. A court of appeals majority reversed, concluding that the opinion and award failed to contain findings adequate to make clear whether the ALJ considered and understood all of the evidence relevant to the date when TTD began. The Supreme Court (1) reversed to the extent that the ALJ made the finding of fact required by Kan. Rev. Stat. 342.0011(11)(a); but (2) affirmed to the extent the Court was unable to determine whether the ALJ simply misstated May 10, 2007 as being the date the claimant testified he stopped working due to the effects of his injury, misunderstood the evidence concerning his reason for missing work on May 10, 2007, or chose May 10, 2007 based on other evidence. Remanded to the ALJ to clarify that portion of the decision. View "Arnold v. Toyota Motor Mfg." on Justia Law

This case involved a claim by a former professional football player (the athlete) for benefits under the Maryland Workers' Compensation Act based on an injury during pre-game warm-up at the employer's stadium in Maryland. The employment agreement contained a forum selection clause providing, inter alia, that claims for workers' compensation benefits should be governed by Virginia law and that the Virginia Workers' Compensation Commission should have exclusive jurisdiction to resolve such claims. The Maryland Workers' Compensation Commission decided that it could properly exercise jurisdiction over the athlete's claim, that the athlete had sustained an accidental injury arising out of the course of his employment, and that the athlete's disability was causally related to his accidental injury. The circuit court upheld the decision. The court of special appeals affirmed. The Court of Appeals affirmed, holding (1) the forum selection clause in the employment contract was ineffective to divest the Commission of the ability to exercise jurisdiction; and (2) injuries occurring while playing and practicing professional football are accidental injuries and thus compensable under the Act. View "Pro-Football, Inc. v. Tupa" on Justia Law

Plaintiffs are retired unionized employees of defendant and were covered by collective bargaining agreements that addressed healthcare benefits. The parties contest whether the CBAs guaranteed employees and their spouses lifetime healthcare benefits after retirement. After retiring, the employees and spouses continued to receive healthcare insurance from defendant. Between ages 62 to 65, defendant paid 80% of the premium costs. When the retirees turned 65, defendant assumed 100% of premium costs. In 2006, defendant informed plaintiffs that the company was instituting a new healthcare plan that would no longer cover 100% of the premiums. Plaintiffs claimed violations of the Labor Management Relations Act, 29 U.S.C. 185, and the Employee Retirement Income Security Act, 29 U.S.C. 1132. The district court ruled in plaintiffs’ favor as to employee coverage, but in favor of defendant as to spouses. The Sixth Circuit reversed in part, in favor of plaintiffs. Although healthcare is a “welfare benefit,” not entitled to the same ERISA protection as pension benefits, employers are free to waive their power to alter welfare benefits. Defendant did so by offering vested healthcare coverage to retired employees and spouses, and by agreeing that CBAs could only be modified with signed, mutual consent of the parties. View "Moore v. Menasha Corp." on Justia Law

In the workers' compensation case underlying this interlocutory appeal, Employee and Employer were unable to reach a resolution. A benefit review report submitted at 10:25 a.m. on October 20, 2011 memorialized the impasse. On the same day, Employee filed a complaint seeking workers' compensation benefits in the chancery court. The time stamp affixed by the court clerk indicated the complaint was filed at 10:22 a.m. In response to Employee's complaint, Employer filed a motion to dismiss for lack of jurisdiction, arguing that Employee's complaint had been filed prematurely. After Employee filed affidavits averring he did not file the complaint until after he received the benefit review repor, the chancery court determined it had subject matter jurisdiction and denied the motion to dismiss. The Supreme Court reversed, holding (1) a complaint may not be filed until the time noted on the benefit review report; and (2) when a complaint bears an unambiguous time stamp, it shall be deemed filed t the time indicated, and the time stamp may not be impeached by extrinsic evidence. View "Word v. Metro Air Servs., Inc." on Justia Law