Justia Insurance Law Opinion Summaries

Patrick Kendall suffered a work-related injury while working at John Morrell and Company, a self-insured employer. Morrell initially accepted Kendall's workers' compensation claim, but because Kendall later missed a number of physical therapy and doctor's appointments, Morrell later denied all further benefits relating to the injury. Almost three years later, Kendall filed a petition with the state Department of Labor requesting additional benefits for the injury. The Department granted summary judgment in favor of Morrell, concluding that the petition was barred by the statute of limitations. The circuit court affirmed. The Supreme Court affirmed, holding that all of Kendall's claims for benefits were procedurally barred by the statute of limitations in S.D. Codified Laws 62-7-35.

In July 2006, Respondent Paul Cook's workers' compensation claim was dismissed for failure to file a properly completed prehearing statement. In December 2006, his "Motion for an Order Re-Instating Claim" was denied for failing to "attach a properly completed prehearing statement . . . ." In August 2008, Respondent's "Amended Motion to Reinstate" was dismissed as barred under a one-year statute of limitations. The full Commission affirmed the dismissal, as did the circuit court and a unanimous Mississippi Court of Appeals. The Supreme Court granted Respondent's petition for certiorari and affirmed: "Cook's claim was properly dismissed. To hold otherwise would eviscerate the Commission's rules and rulings of their statutorily intended effect, since '[a] rule which is not enforced is no rule at all.'"

Rafael Casados suffered a fatal, work-related injury while working for two employers that both had workers' compensation coverage. Casados' parents sued one of the employers. At issue was whether workers' compensation was the exclusive remedy to Casados' parents, which would bar their suit against Port Elevator. Because Port Elevator had a workers' compensation policy, Casados was an employee, he suffered a work-related injury, and the jury failed to find Port Elevator grossly negligent, the Texas Workers' Compensation Act (TWCA), Tex. Lab. Code 406, provided that the exclusive remedy was against the employer's insurer - not the employer. Accordingly, the claim at issue in this appeal was barred. The court reversed the judgment of the court of appeals and rendered judgment for Port Elevator.

Employee was injured in an automobile accident while working for Employer. Employer had a state-certified workers' compensation plan in effect that provided coverage to Employee, and some of Employee's medical bills were paid by the workers' compensation carrier. Employee had a policy with State Farm that included no-fault medical coverage. State Farm, however, denied coverage to Employee under a policy exclusion that denied coverage for an insured if any workers' compensation law applied to the insured's bodily injury. Employee filed an action against State Farm, seeking recovery of benefits under the no-fault medical provision. The circuit court granted summary judgment in favor of State Farm. The Supreme Court affirmed, holding that Employer was entitled to judgment as a matter of law where, in accordance with previous precedent, the exclusion clearly applied in all scenarios where workers' compensation benefits either had been paid in whole or in part or could be paid in whole or in part.

Claimant Jerry Benoit worked for Turner Industries for twenty-seven years. For ten of those years he worked as a general laborer for a Lake Charles Citgo refinery, where Turner was contracted to perform general maintenance. Claimant's duties included cleaning chemical discharges and oily waste which collected in the drainage ditches, sewers, and processing units at the refinery. In the course of this work, he was exposed to any number of potentially dangerous or carcinogenic chemicals, including high levels of benzene. In July 2006, Claimant fell ill. He was diagnosed with acute myeloid leukemia (AML), known to be linked to high levels of benzene exposure. Despite the medical evidence linking Claimant's cancer to the chemicals he was exposed to at work, his claim for medical benefits was denied. The eventual medical bills totaled over $625,000. Medicaid paid for $203,124.68. The remaining $422,043.59 was "written off" by the medical care providers. Turner paid nothing. Claimant's family filed suit in 2007. The Office of Workers' Compensation (OWC) awarded Claimant total medical expenses and attorney fees. Turner appealed, and the court of appeals affirmed the OWC judgment in its entirety. Upon review of the correctness of the OWC award of medical expenses, the Supreme Court concluded the OWC erred in awarding the "written off" medical expenses: "Claimant would receive an improper windfall if he was allowed to recover for medical expenses which have been reduced by health care providers as a result of their contractual arrangements with Medicaid." The Court reversed the appellate court's decision and remanded the case for further proceedings.

James Whealon was employed by the Anaconda School District pursuant to a series of employment contracts. Upon retirement, Whealon filed a formal grievance, asserting that, under the terms of his contract, he was entitled to payment of his health insurance premiums by the District until he reached the age of sixty-five. The District denied his claim. The County Superintendent granted summary judgment to the District, holding that the language of the contract was unambiguous and that Whealon was not entitled to the claimed benefits beyond the date of his retirement. The State Superintendent of Public Instruction reversed and remanded for an evidentiary hearing, holding that the language of the contract was ambiguous. The district court reversed and reinstated the County Superintendent's ruling. The Supreme Court affirmed the district court, holding (1) the district court did not err in holding that a county superintendent has authority to grant summary judgment; and (2) the district court did not err in reinstating summary judgment in favor of the district where the language of the agreement was unambiguous and the District was entitled to judgment.

Employee was injured while working for Employer's sheep and wool business, Cestari. Employer failed to maintain workers' compensation insurance for Cestari. Employee filed a workers' compensation claim against Employer and Cestari, as well as a complaint against Employer and Cestari, seeking damages for negligence. The workers' compensation commissioner determined that Employee was entitled to workers' compensation benefits. Finding that Employee had pursued his workers' compensation claim to a final order and that he had a remedy for collection of his workers' compensation award against Cestari and/or the Uninsured Employers' Fund, the circuit court dismissed Employee's civil complaint. The Supreme Court affirmed, holding that Employee had received the recovery he sought under the Workers' Compensation Act, and thus, the circuit court did not err in ruling that Employee could not pursue an action at law against Employer after obtaining a final collectible award of workers' compensation benefits.

Edna Banco filed a claim for workers' compensation benefits for an occupational disease (OD) in her right shoulder. Banco worked concurrently at 4B's Restaurant and the Child Development Center on Malmstrom Air Force Base (CDC). 4B's was insured by Liberty Northwest Insurance Corporation (Liberty). Liberty denied Banco's claim for workers' compensation benefits. The Workers' Compensation Court (WCC) found (1) Banco was last exposed to work of the same type and kind that gave rise to her shoulder condition while she was working at CDC; and (2) thus, since Banco was not last exposed at 4B's, Liberty was not liable under the "last injurious exposure" rule set forth in In re Mitchell. The Supreme Court affirmed, holding that the WCC had substantial credible evidence upon which to find Banco was last injuriously exposed at CDC to working conditions of the type and kind that led to her OD, and thus, Liberty was not liable for Banco's OD.

Mack Downey and his wife sued Western Community College area, which operates Western Nebraska Community College, after Downey suffered injuries from a fall that occurred while he was replacing a scoreboard at the College. Downey's employer, Ferguson Signs, was named as a plaintiff to preserve a subrogation interest for workers' compensation benefits. The trial court found that the College was liable for a portion of Downey's injuries and apportioned liability to Downey and Ferguson Signs. The Supreme Court affirmed in part and in part reversed and remanded, holding (1) the court did not err in finding the College liable; (2) the court correctly denied the College's claim for indemnity; but (3) the court erred in apportioning negligence to Ferguson Signs where Ferguson Signs was not a "released person" within the meaning of Neb. Rev. Stat. 25-21,185.11. Remanded for the court to reapportion Ferguson Signs' share of the negligence to Downey and the College.

Employee received workers' compensation benefits for a neck and back injury he suffered in 2002 while working for Employer. After his benefits were discontinued in 2004, Employee sought treatment for a low back condition and petitioned the Department of Labor for workers' compensation benefits. The Department denied the petition, ruling that Employee did not prove his low back condition was related to his original 2002 work injury. The circuit court affirmed. The Supreme Court affirmed, holding that the Department correctly denied workers' compensation benefits where Employee failed to establish by a preponderance of the evidence that the 2002 injury was a major contributing cause of his current low back condition.