Justia Insurance Law Opinion Summaries

In 1990, Employee was working for Employer when she injured her left ankle. By 2009, Employee had multiple surgeries and was taking approximately fourteen medications. That same year, a Dr. Randolph concluded Employee required no further medical treatment for her 1990 industrial injury and other allowed conditions in her claim and that her current medications were no longer necessary. Employee subsequently filed a motion with the Industrial Commission for the loss of use of her left arm. Based on Dr. Randolph's addendum to his original report, a hearing officer denied Employee's motion for compensation for the loss of use of her arm. Employee filed a complaint for a writ of mandamus, which the court of appeals denied, concluding that Dr. Randolph's second and third reports, issued as addenda to his original report, constituted some evidence upon which the Commission could rely to support its decision denying Appellant's claim. The Supreme Court affirmed, holding that because the addenda of Dr. Randolph constituted some evidence to support the Commission's decision to deny Employee's request for compensation for the loss of use of her left arm, the Commission did not abuse its discretion, and the court of appeals properly denied the writ. View "State ex rel. Kish v. Kroger Co." on Justia Law

Appellant was injured during the course and scope of his employment. Appellant filed a motion for temporary total disability compensation, which a hearing officer granted. The Industrial Commission later terminated temporary total disability compensation based on the report of doctor who stated that the allowed conditions in Appellant's workers' compensation claim had reached maximum medical improvement. Appellant filed a complaint in mandamus, alleging that the Commission acted contrary to law when it relied on the report of the doctor. The court of appeals denied the writ, concluding that the doctor's report constituted some evidence upon which the Commission could rely. The Supreme Court affirmed, holding that the doctor's report was sufficiently reliable to constitute some evidence to support the Commission's decision. View "State ex rel. Coleman v. Schwartz" on Justia Law

K&D Enterprises, through its manager, Mid-America, contracted to purchase an apartment complex. Prior to the closing, K&D Enterprises created a new company, Euclid-Richmond Gardens, and assigned its rights under the purchase agreement to that new company. Euclid-Richmond Gardens hired K&D Group, Inc., a property-management company, to manage the apartment. K&D Group hired former employees of Mid-America and assumed the operations of the complex. The Bureau of Workers' Compensation later conducted an audit and determined K&D Group was the successor in interest to the business operations of Mid-America, a determination that authorized the Bureau to base K&D Group's experience rating, in part, on Mid-America's past experience, which included a large workers' compensation claim. After K&D Group's administrative appeal was denied, K&D Group unsuccessfully filed a mandamus action in the court of appeals. The Supreme Court reversed the judgment of the court of appeals and issued the writ of mandamus, holding that K&D Group was not a successor in interest for purposes of workers' compensation law, and thus, the Bureau abused its discretion when it transferred part of Mid-America's experience rating to K&D Group. View "State ex rel. K&D Group, Inc. v. Buehrer" on Justia Law

In this appeal, the Supreme Court was asked to determined whether Ohio Const. art. XII, 5a permits the use of motor vehicle and gas tax (MVGT) funds to pay those costs of a county's joint self-insurance pool attributable to covering the risk of liability and loss resulting from the operations of a county engineer's highway department. The Supreme Court concluded that Ohio Const. art. XII, 5a authorizes the use of MVGT funds to pay a county's cost of participating in a joint self-insurance pool attributable to covering the risk of liability and loss resulting from the operations of a county engineer's highway department. In so holding, the Court reversed the judgment of the court of appeals and remanded. View "Stockberger v. Henry" on Justia Law

Younglove Construction entered into a contract with PSD Development for the construction of a feed-manufacturing plant. When PSD withheld payment, Younglove brought this diversity suit against PSD and three other defendants. In its answer, PSD alleged it had sustained damages as a result of defects in a steel grain bin constructed by Custom Agri Systems, Inc. as a subcontractor. Younglove filed a third-party complaint against Custom Agri Systems, Inc. for contribution and indemnity. Custom turned to its insurer, Westfield Insurance Company, to defend and indemnify it in the litigation. Westfield intervened to pursue a judgment declaring it had no such duty under the terms of its commercial general liability (CGL) policy with Custom. At issue was whether the claims against Custom sought compensation for "property damage" caused by an "occurrence" under the policy. The district court granted summary judgment for Westfield. On appeal, the federal court of appeals certified questions of state law to the Supreme Court. The Court answered by holding that claims of defective construction or workmanship brought by a property owner are not claims for "property damage" caused by an "occurrence" under a CGL. View "Westfield Ins. Co. v. Custom Agri Sys., Inc." on Justia Law

Employee was injured while working for Employer. Five years later, Employee was fired for violating the company's attendance policy. Employee's termination was later the basis for the Industrial Commission of Ohio's denial of his request for temporary total disability compensation (TTC). The Commission found that Employee's discharge amounted to a voluntary abandonment because it was consequence of behavior that Employee willingly undertook. The court of appeals reversed, holding that the deliberate misconduct necessary to support a finding of voluntary abandonment could not be imputed to Employee. The Supreme Court affirmed and issued a limited writ of mandamus that vacated the Commission's order and returned the cause to it for further consideration, as the hearing officer did not carefully examine the totality of the circumstances in finding that a simple allegation of misconduct existed to preclude temporary total disability compensation. View "State ex rel. Brown v. Hoover Universal, Inc." 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

Appellant Peggy Hodge sought to compel Appellee, the administrator of the Bureau of Workers' Compensation, to pay Vicki Hulbert, a licensed practical nurse, higher wages for the in-home care that Hulbert provided to her. A staff hearing officer (SHO) determined that he had no jurisdiction to order an increase. A few months later, Hodge again moved the Commission to increase Hulbert's wages. A district hearing officer (DHO) dismissed the motion of jurisdictional grounds, citing the SHO order. Thereafter, a different SHO affirmed the DHO's order. Hodge then sought a writ of mandamus against the bureau. The court of appeals denied the writ after finding, among other things, that Hodge's failure to appeal the SHO orders constituted a failure to exhaust her available administrative remedies. The Supreme Court affirmed, holding that the court of appeals was correct in denying the writ, as Hodge's failure to exhaust her administrative remedies precluded mandamus.

Employee suffered an industrial injury and received surgery on his right shoulder, after which Employee returned to work for self-insured Employer. Employee experienced renewed shoulder complaints four years later and asked Employer to add new shoulder conditions to Employee's workers' compensation claim and authorize surgery to correct them. Employer and the Industrial Commission denied Employee's request after finding that the proposed procedure was unrelated to the conditions allowed in Employee's workers' compensation claim. At issue on appeal was a doctor's report upon which the Commission based its decision. The court of appeals granted a limited writ in mandamus that ordered the Commission to reconsider the application after finding inconsistencies within the report. The Supreme Court reversed, concluding that none of the alleged inconsistencies noted in the doctor's report affected the viability of the doctor's opinion that further surgery was not reasonably related to the allowed conditions, and therefore, the report was evidence supporting the Commission's decision.

The superintendent of insurance, in her capacity as the liquidator of an insolvent insurer, filed an action in the county court of common pleas against an independent accounting firm that provided auditing services to the insurer, alleging negligence and that the firm had received preferential or fraudulent payments. The accounting firm moved to dismiss the complaint or to stay the proceedings and compel arbitration based on an arbitration clause that was contained in an engagement letter signed by the insurer and accounting firm. The trial court denied the motion. The court of appeals affirmed, holding that because the liquidator had not signed the arbitration agreement, there was a presumption against arbitration. The Supreme Court affirmed but in part for different reasons, holding that the liquidator was not bound by the insurer's agreement when the liquidator's claims did not arise from the contract that contained the arbitration provision.