Justia Insurance Law Opinion Summaries

Plaintiff appealed the district court's grant of summary judgment in a class action suit alleging that Broward County's employee wellness program violated the Americans with Disabilities Act of 1990 (ADA), 42 U.S.C. 12101 et seq. Plaintiff alleged that the wellness program's biometric screening and online Health Risk Assessment questionnaire violated the ADA's prohibition on non-voluntary medical examinations and disability-related inquiries. The court held that the district court did not err in finding as a matter of law that the wellness program was a "term" of Broward County's group health insurance plan, such that the wellness program fell within the ADA's safe harbor provision. View "Seff v. Broward County, Florida" on Justia Law

James Mickelson appealed a judgment affirming a Workforce Safety and Insurance ("WSI") decision denying his claim for workers' compensation benefits. He argued WSI erred in deciding he did not suffer a compensable injury. Upon review, the Supreme Court concluded WSI misapplied the definition of a compensable injury, and the Court reversed and remanded for further proceedings. View "Mickelson v. Workforce Safety & Ins." on Justia Law

Cathy Bone filed a workers' compensation claim form (Form 50) dated August 7, 2007 alleging that she injured her back on Tuesday, June 26, 2007 while employed with U.S. Food Service. Her job consisted of power washing and cleaning the insides of truck trailers that transported food. Bone alleged that she hurt her back when she lifted two pallets inside a trailer to clean under them. She did not report the incident immediately because she needed to continue working and thought she would be okay, but thereafter she developed increasing pain. On Tuesday, July 3, 2007, Bone reported the injury to one of her supervisors shortly after she arrived at work. The same morning she reported her injury, Bone had a flat tire on her way to work, and she called in to advise her office of this fact. The employer, U.S. Food Service, and its carrier, Indemnity Insurance Co. of North America denied Bone's claim, disputing that she had injured her back on June 26 and asserting the injury occurred when her tire was changed on July 3. The employer and its carrier appealed the circuit court's order that determined the employee's claim was compensable and remanded the matter to the South Carolina Workers' Compensation Commission for further proceedings. The Court of Appeals dismissed the appeal as interlocutory. Upon review, the Supreme Court affirmed the appellate court's decision. View "Bone v. U.S. Food Service" on Justia Law

Ruth Mendenhall appealed a summary judgment in favor of Property and Casualty Insurance Company of Hartford on her equitable garnishment claim seeking insurance coverage for the death of her husband, Len Mendenhall. The trial court's judgment was premised on the conclusion that Len was an "employee" under the terms of the Hartford policy and, therefore, was excluded from coverage. The Supreme Court reversed the judgment of the trial court, holding that, given the facts of this case and the policy language, Len was not an "employee" but was instead a "temporary worker" subject to coverage under the terms of the Hartford policy. View "Mendenhall v. Prop. & Cas. Ins. Co. of Hartford" on Justia Law

Richard Ford suffered a work-related injury to his neck. He was diagnosed with a cervical strain, and Sentry Casualty Company accepted liability and paid benefits for this injury. During Ford’s treatment, he underwent an MRI which revealed a more serious cervical disc condition. Ford claimed that the workplace accident caused or aggravated this condition and that Sentry was liable for surgery to address it. Ford also claimed that Sentry was liable for ongoing temporary total disability benefits and that Sentry had unreasonably adjusted his claim. Sentry denied liability for Ford’s cervical disc condition based on the opinions of several doctors that the condition was not related to the industrial accident. Sentry also maintained that Ford reached maximum medical improvement, that he has been released to return to work without restrictions, and that it reasonably adjusted his claim. The dispute ultimately reached the Workers’ Compensation Court (WCC). Trial was held in early 2011. Ford and his wife testified, and numerous medical records were admitted into evidence. The WCC ruled in favor of Sentry as to each of the foregoing issues, and Ford appealed. Upon review of the trial court record, the Supreme Court concluded that the WCC correctly determined that he failed to carry his burden of establishing causation with regard to his disc condition and affirmed the trial court's judgment. View "Ford v. Sentry Casualty Co." on Justia Law

A healthcare worker was sprayed in the eye with fluids from an HIV-positive patient. She received preventive treatment and counseling. Her employer initially paid workers' compensation benefits; it later filed a controversion based on its doctor's opinion that the employee was able to return to work. The employee asked for more benefits, but the Alaska Workers' Compensation Board denied her claim. The employee appealed, but the Alaska Workers' Compensation Appeals Commission affirmed the Board's decision. Because the Supreme Court agreed with the Commission that substantial evidence supported the Board's decision, the Court affirmed the Commission's decision. View "Runstrom v. Alaska Native Medical Center" on Justia Law

Plaintiff-Appellant Shaune Kuszmaul appealed a district court order that granted summary judgment to Sterling Life Insurance Company (Sterling) on her wrongful discharge claim. Plaintiff worked as an outside sales agent for a subsidiary of Sterling since 2000. In October 2009, Plaintiff drafted a marketing letter promoting Sterling products. She mailed out approximately 1,000 copies of the letter to current and potential customers. Plaintiff did not obtain approval from anyone at Sterling before sending the letter, nor did she clear it with the Montana Department of Insurance (DOI) or any other regulatory agency. A relative of one of the recipients of the letter anonymously notified Sterling by mail that the letter might violate the Policy. The writer sent a copy of its complaint to the Sterling Life Corporate Compliance Office, the Montana DOI, and the CMS Regional Office, exposing Sterling to possible state and federal sanctions. This prompted Sterling to begin an internal investigation. While being investigated, Plaintiff acknowledged that her marketing letter was not in conformance with company policy, but denied doing anything intentionally wrong. She was terminated for violating company policy with regard to the unapproved marketing materials. Upon review of the district court record, the Supreme Court affirmed, finding no error in the court's decision to grant the insurance company summary judgment. View "Kuszmaul v. Sterling Life" on Justia Law

Employee-Respondent Aletha Johnson hurt her back while working for Employer-Appellant Rent-A-Center, Inc. The company contended that the appellate panel of the Workers' Compensation Commission erred by awarding Respondent workers' compensation benefits. The appellate panel found Respondent was disabled and did not constructively refuse light duty work. The Supreme Court found that Respondent qualified as disabled under section 42-1-120 of the South Carolina Code, and affirmed the appellate panel's decision to award benefits. View "Johnson v. Rent-A-Center" on Justia Law

In 2008, Craig Ali was a police officer for appellant, the village of Oakwood. That spring, his department assigned him to perform traffic-control duties on a highway-construction project overseen by appellee, Kokosing Construction Company, Inc. Ali was injured while performing those duties. At issue was which entity was Ali's employer for purposes of his workers' compensation claim. A district hearing officer with the Industrial Commission of Ohio found that Kokosing was Ali's employer at the time of injury. A staff hearing officer reversed, finding the correct employer was Oakwood Village. The Supreme Court affirmed, holding (1) the commission, when confronted with two potential employers, may, but is not required to, use any of the State ex rel. Lord v. Daugherty and Fisher v. Mayfield factors it believes will assist analysis; (2) therefore, the commission did not abuse its discretion by not directly discussing the three enumerated Lord/Fisher factors; and (3) the staff hearing officer's decision was supported by evidence in the record. View "State ex rel. Oakwood v. Indus. Comm'n" on Justia Law

Maine Public Employees Retirement System (the System) appealed a superior court judgment reversing a decision of the System’s Board of Trustees that denied Petitioner Ellen Goodrich basic life insurance coverage under the group life insurance plan administered by the System. Upon review of the record, the Supreme Court vacated the Superior Court's judgment in part and remanded the case for entry of a judgment: (1) vacating the decision of the Board; and (2) remanding to the Board with instructions to provide Goodrich with prospective basic life insurance coverage after she paid back premiums accrued to date. View "Goodrich v. Maine Public Employees Retirement System" on Justia Law