Justia Insurance Law Opinion Summaries

The underlying dispute in this appeal revolved around the issue of who was contractually obligated to pay workers' compensation benefits to an employee of Employer. The Supreme Court found that Employer's Insurer was required to pay workers' compensation benefits for all of Employer's employees and remanded the case. The district court entered a final judgment. Instead of filing a notice of appeal within thirty days of the district court's judgment, Insurer filed an "objection to judgment." Insurer then filed its notice of appeal within thirty days of the district court's order disposing of that motion. The Supreme Court dismissed the appeal, holding that it lacked jurisdiction to address the appeal as (1) Insurer did not file its notice of appeal within thirty days of the district court's final judgment, and (2) Insurer failed to file a postjudgment motion that would toll the time for appeal or one that the Court had jurisdiction to review.

In 1970, while working for Employer, Employee was injured. In 1989, Employee retired. In 2008, Employee applied for permanent total disability (PTD) compensation. The Industrial Commission of Ohio concluded that Employee was permanently and totally disabled without ruling on the credibility of the assertion that Employee retired because of his injury or determining whether his retirement was voluntary or involuntary. The court of appeals granted Employer a limited writ of mandamus that vacated the Commission's order and ordered the Commission to reconsider the matter. The Supreme Court affirmed the court of appeals, holding that because a voluntary retirement from the work force prior to asserting PTD precludes the payment of compensation for that disability, the court of appeals was correct in ordering further consideration of whether Employee retired because of his injury and whether his retirement was voluntary.

Plaintiffs commenced a diversity action against defendant, asserting claims for breach of the insurance contract and for vexatious refusal to pay. Applying Missouri law, the district court granted defendant summary judgment, concluding that the insurance policy at issue unambiguously excluded losses caused by plaintiffs' CEO, a shareholder, and by plaintiffs' COO, a non-shareholder, acting in collusion with the CEO. The court affirmed and held that the Officer-Shareholder exclusion was consistent with Missouri public policy, and in the alternative, the Officer-Shareholder exclusion was unambiguous and excluded plaintiffs' claim.

Franklin Electric formed two new subsidiaries and started new unemployment experience accounts with a low introductory contribution rate for each one, which equaled about half the experience rating of Franklin Electric. The Department of Workforce Development later canceled the subsidiaries' experience accounts, and all experience balances and liabilities reverted to Franklin Electric. The Department also demanded back payments, interest, and a ten percent penalty. A liability administrative law judge (LALJ) affirmed the Department's determination that the three entities were a single employer but waived the penalty imposed by the Department. The court of appeals affirmed. The Supreme Court granted transfer and vacated the opinion of the court of appeals and affirmed the determination of the LALJ, holding (1) the new subsidiaries were not new employers because they were not distinct and segregable from Franklin Electric; (2) Franklin Electric's experience rating should have applied to contributions made by the subsidiaries; and (3) because there was no evidence suggesting improper conduct on the part of Franklin Electric, the penalty was not appropriate.

Appellant Thomas Pearson was struck by a forklift and was later determined to have been injured in the course of his employment with Archer-Daniels-Midland Milling Company (ADM). The workers' compensation court entered an award granting Pearson, among other benefits, certain future medical expenses. Pearson subsequently had a total knee replacement and sought reimbursement from ADM for those expenses as well as for expenses relating to a back injury. After ADM declined to pay the expenses, Pearson filed a motion to compel payment. A further award was entered (1) denying Pearson's motion with respect to the knee replacement but ordering ADM to pay expenses relating to the treatment of the back injury, and (2) applying the workers' compensation court's fee schedule to payments for the back injury, which had previously been paid by Pearson's health insurer. The workers' compensation court review panel affirmed. The Supreme Court affirmed in part and reversed in part, holding (1) the trial court incorrectly found that the original order denied knee replacement, and (2) the trial court did not err in applying the fee schedule to any reimbursement to a third party. Remanded.

Employee submitted a workers' compensation claim to his Employer after suffering a reaction that some doctors attributed to work-related exposure. Employee petitioned the Department of Labor for a hearing on his workers' compensation claim. The Department denied Employee's claim, concluding that Employee failed to demonstrate that he sustained a compensable injury arising out of and in the course of his employment. The circuit court affirmed. At issue on appeal was whether Employee's efforts to prove causation were thwarted by Employer's refusal to allow collection of samples of various materials in areas around the plant and its later destruction of potential samples. The Supreme Court reversed, holding that the Department failed to properly consider the spoliation question and Employee was entitled to a new hearing before the Department.

Thomas Skinner received an award of benefits from the Workers' Compensation Commission for asbestosis under the scheduled loss provisions of Section 42-9-30 of the South Carolina Code.  Westinghouse Electric Corporation, Skinner's former employer, appealed that decision, arguing Skinner could not recover for a scheduled loss and must proceed under the "general disability" statutes found in Sections 42-9-10 and 42-9-20 of the South Carolina Code. Westinghouse's arguments on appeal concerned the impact of section 42-11-60 on Skinner's right to recover for his pulmonary disease.  In particular, it argued Skinner could only recover for total or partial disability under sections 42-9-10 and 42-9-20, respectively.  The Supreme Court agreed with Westinghouse and reversed the special referee's affirmation of Skinner's award based upon the clear language of section 42-11-60: "[i]n that section, the General Assembly specified that recovery for a pulmonary disease such as Skinner's hinges upon a showing of lost wages under section 42-9-10 and 42-9-20.  Because our resolution of this issue is dispositive of the appeal, it is not necessary for us to address the remaining issues raised by the parties."

Shannon Cave suffered a work-related injury and was awarded temporary total disability (TTD) benefits during her recovery. After Cave rejected an offer of temporary light duty work from her employer, the Wyoming Workers' Safety and Compensation Division (Division) reduced Cave's TTD benefits to one-third of the previously authorized amount in accordance with Wyo. Stat. Ann. 27-14-404(j). The Office of Administrative Hearings (OAH) upheld the reduction of TTD benefits. The district court reversed the OAH decision. The Supreme Court reversed the district court's order, holding that the OAH decision was supported by substantial evidence and was not contrary to law as the hearing examiner properly determined that the offer of light duty employment tendered to Cave was bona fide, and therefore, the OAH was obligated to reduce Cave's TTD benefits.

Thomas Tindira was a member of Ohio Police and Fire Pension Fund (OP&F) while working as a police officer with Lakewood Police Department. Before he resigned from the department, Tindira filed his application for disability benefits with OP&F, including in his list of disabling conditions PTSD, anxiety disorder, and major depression. The OP&F board of trustees determined that Tindira was disabled but denied his claim for disability benefits. The court of appeals denied Tindira a writ of mandamus to compel appellees, OP&F and its board of trustees, to vacate the board's denial of his claim and to award him disability benefits and attorney fees. The Supreme Court reversed and granted the writ, holding that the pension fund and its board abused their discretion in denying disability benefits as Tindira had established his entitlement to the benefits.

Claimant Claud Sloan appealed a district court judgment that affirmed a Workforce Safety & Insurance (WSI) order awarding him additional permanent impairment benefits. In December 1985, Sloan sustained a compensable work-related injury while employed at a coal gasification plant in Beulah, North Dakota. WSI awarded Sloan permanent impairment benefits for his injury and has issued several permanent partial impairment orders since his original injury. Effective April 1, 2009, WSI promulgated N.D. Admin. Code 92-01-02-25(4) to address pain impairment ratings. Based on the newly adopted rule, WSI reviewed Sloan's pain rating and determined he had sustained an eight percent impairment for pain which, when combined with his prior impairment ratings, totaled a whole body impairment rating of 38 percent. On June 11, 2009, WSI issued an order awarding Sloan additional permanent impairment benefits, based on his combined whole body impairment of 38 percent for his cervical spine, depression, dysphagia, and chronic pain. Sloan requested a rehearing. At a November 2009, hearing before an administrative law judge, a staff attorney for WSI appeared as the only witness and testified regarding the WSI's promulgation of N.D. Admin. Code 92-01-02-25. The ALJ subsequently issued an order affirming WSI's June 2009 order awarding Sloan additional permanent impairment benefits. Sloan appealed to the district court, which affirmed the order. Upon review, the Supreme Court concluded WSI's promulgation of administrative rules for assessing pain impairment did not conflict with its statutory authority and was not arbitrary, capricious, or unreasonable.