Justia Insurance Law Opinion Summaries

Petitioner Vincent James Hogg, Sr. sought review of a Workers' Compensation Court order which denied his workers' compensation benefits based upon the court's interpretation of 85 O.S. 2011, section 312 (3). Petitioner was employed by the Oklahoma County Juvenile Detention Center when in late 2011, he sustained an injury to his right shoulder and neck while subduing an unruly and combative juvenile. Petitioner was given a post-accident drug screen and a follow-up screen the next day. Both screens showed a "positive" result for the presence of marijuana in his system. Petitioner did not dispute the test results but Petitioner denied ever smoking marijuana. The trial court ultimately found there was no evidence presented to establish Petitioner was "high," nor was there any evidence to establish the marijuana in his system was the "major cause" of the accidental injury. The trial court did, however, deny Petitioner's eligibility for workers' compensation benefits by reason of its interpretation of the newly created 85 O.S. 2011, section 312 (3). The dispositive issue presented to the Supreme Court was whether the trial court erred in its interpretation of the statute. The trial court found the last sentence of paragraph 3 expressed the legislative intent of the entire paragraph without giving any weight to the other sentences in the same paragraph. In its order, the trial court indicated this sentence created an irrebuttable presumption. Upon review, the Supreme Court disagreed. The Court concluded that Petitioner overcame the rebuttable presumption of ineligibility for workers' compensation benefits. The case was reversed and remanded for further proceedings. View "Hogg v. Oklahoma Cty. Juvenile Bureau" on Justia Law

Claimant Charles Prince filed a claim in the Workers' Compensation Court in 2009 alleging a cumulative trauma employment-related injury to his right foot, with date of last exposure in late 2008. The trial court found Claimant sustained a cumulative trauma injury to his right foot and ordered Employer, Brake Rebuilders & Friction Products, Inc., to select a physician to treat Claimant and to provide "such medical, surgical or other attendance or treatment, nurse and hospital service, medicine, diagnostic testing and referral as may be deemed necessary by the treating physician to the claimant's right foot." The court found his date of last exposure was late 2008. Claimant sought compensation for injury to his right foot, and later for his low back arising from the same injury. The trial court of the Workers' Compensation Court denied his claim for the low back, and a three judge panel affirmed. On appeal the Court of Civil Appeals (COCA) vacated the panel's order, holding the order was against the clear weight of the evidence. Upon review, the Supreme Court found that the denial of the award for Claimant's lower back was supported by competent evidence. COCA found more evidence in support of Claimant's low back injury, but Employer presented evidence from its medical expert which denied that the injury to either the low back or the right foot arose out of Claimant's employment. "The date of the injury determines the law to be used in a workers' compensation claim and applies equally to employers and claimants alike." Based on the Supreme Court's decision in "Williams Companies, Inc. v. Dunkelgod," (2012 OK 96 (2012)), and the law on the date of Claimant's injury, the opinion of the Court of Civil Appeals was vacated. View "Prince v. Brake Rebuilders & Friction Products, Inc." on Justia Law

Workers' compensation claimant Kristy Dunkelgod was injured in an employment-related accident in 2011 while working for Williams Companies, Inc. The Workers' Compensation Court entered several orders awarding claimant temporary total disability benefits. She was also awarded a "Go-Go" scooter and a lift van. On appeal by the employer, the Court of Civil Appeals vacated the awards, holding the court's finding the lift van was medically necessary was "against the clear weight of the evidence." The Court of Civil Appeals also held the claimant was limited to a maximum of 300 weeks of temporary total disability benefits and remanded for a determination of when she reached the maximum. The issues before the Supreme Court were: (1) whether the Court of Civil Appeals (COCA) err when it applied the "clear weight of the evidence" standard of review to the Workers' Compensation Court's order awarding a lift van; and (2) whether COCA erred when it held that Claimant's temporary total disability (TTD) award was limited to a maximum of 300 weeks. The Supreme Court answered both questions in the affirmative; COCA failed to apply the law in effect at the time of Claimant's injury. The Court vacated and remanded the case to the Workers' Compensation Court for further proceedings. View "Williams Companies, Inc v. Dunklegod" on Justia Law

Zaloudek Grain Company held a workers' compensation policy with CompSource Oklahoma for approximately ten years prior to 2011. Zaloudek was required each year to provide payroll audit information to CompSource. The audit information was used to determine the proper premium for each year. CompSource sent a notice in late 2010 to Zaloudek requesting audit information. In January, 2011, Zaloudek's policy was renewed for all of 2011 through January 1, 2012. On January 18, 2011, CompSource sent another letter requesting Zaloudek provide the necessary payroll audit information, but Zaloudek was unresponsive. Subsequently, CompSource sent Zaloudek a notification to inform the company that the process of canceling its policy would begin if CompSource did not receive the audit information. The audit information was not provided; CompSource ultimately canceled the policy when Zaloudek ignored several subsequent requests. CompSource issued a refund for payments made under the policy. Later that summer, two teenage workers were seriously injured in the grain auger at Zaloudek's facility. CompSource did not accept the company's new insurance application because it was incomplete and was not signed by an owner of Zaloudek. Zaloudek sued a few weeks following the rejection of its application, asking for a judgment against CompSource for breach of contract and bad faith and further requested declaratory relief in the form of an order requiring CompSource to provide workers' compensation coverage. Zaloudek filed a motion for summary judgment claiming CompSource lacked legal justification for terminating its policy and requested orders to establish there was no lapse in coverage and requiring CompSource to provide coverage for its two injured employees. Zaloudek further requested a finding that CompSource was in breach of contract. CompSource moved for summary judgment, arguing Zaloudek was not covered at the time of the incident and its policy was properly canceled. Zaloudek filed a counter-motion for summary judgment asserting CompSource should be estopped from denying coverage because it retained premiums and acted in a manner toward Zaloudek consistent with continued coverage. The trial court issued an order dismissing Zaloudek's bad faith claim but left pending its claims for breach of contract and declaratory relief. CompSource appealed. After its review, the Supreme Court concluded that CompSource was authorized to cancel a policy for an insured's failure to participate in the audit. The Court remanded the case for further proceedings on the other contract issues raised. View "Zaloudek Grain Co. v. CompSource Oklahoma" on Justia Law

An employee of a tribal enterprise sought to invoke the jurisdiction of the Oklahoma Workers' Compensation Court. Petitioner John A. Waltrip fell on a patch of ice while working as a surveillance supervisor at a casino and injured primarily his right shoulder. Petitioner initially obtained treatment from his personal physician but Tribal First, the employer Osage Million Dollar Elm Casino's claim administrator, sent him to an orthopedic specialist who recommended surgery in 2009. Petitioner filed a claim in the Oklahoma Workers' Compensation Court on July 17, 2009, seeking medical treatment and temporary total disability. The Casino and Insurer Hudson Insurance Company asserted that court lacked jurisdiction based on the tribe's sovereign immunity. A hearing was held solely on the jurisdictional issue; the Workers' Compensation Court denied jurisdiction and dismissed the claim holding that the tribe enjoyed sovereign immunity and that the provisions of the tribe's workers' compensation policy did not subject the insurance company to liability for claims in state court. The Court of Civil Appeals affirmed and the Supreme Court granted certiorari review. Upon review, the Supreme Court held that: (1) the tribe enjoyed sovereign immunity and was not therefore subject to the jurisdiction of the Oklahoma Workers' Compensation Court; and (2) the workers' compensation insurer did not enjoy the tribe's immunity and was estopped to deny coverage under a policy for which it accepted premiums computed in part on the employee's earnings. View "Waltrip v. Osage Million Dollar Elm Casino" on Justia Law

Claimant Barton J. Rodr was a full-time computer programmer employed by Yzer, Inc. He suffered a heart attack while doing lawn work for his employer on the employer's premises. He was not paid anything additional for the lawn work. Claimant sought workers' compensation benefits, which were denied: the employer denied that he was working as an employee at the time of injury and claimed that the injury was not incurred during the course and scope of his employment. Employer asserted that the claimant was acting as a volunteer when injured. The workers' compensation court awarded benefits, determining that Claimant was not acting as a volunteer arising out of and in the course of his employment. The three-judge panel unanimously affirmed. The employer appealed, asserting that Claimant did not meet the statutory definition of an employee under the workers' compensation act and that the accidental injury did not occur in the course and scope of employment. The Court of Civil Appeals vacated the order, finding it to be against the clear weight of the evidence and contrary to law because Claimant's performance of lawn work at the time of his injury was outside his employment and was not related to or incidental to his computer programmer job, and was therefore not compensable. Claimant timely appealed. The Supreme Court found that the test here was whether the work was necessary for the benefit of the employer: "Here, the employer specifically asked for volunteers to help with the yard work to make the grounds look nice for the grand reopening of Automobile Alley. The claimant and his thirteen-year-old son performed those duties. The employer then hired claimant's thirteen-year-old son to continue the yard work. . . . The employer's yard crew had quit and the claimant was performing that task to help out the employer, at the employer's request. The yard work was for the benefit of the employer and was not in furtherance of a personal mission. The facts reflect that the claimant was performing a special task for his employer and that his accidental injury arose out of and was within the course of his employment." The Court vacated the appellate court's decision and sustained the award entered by the workers' compensation court.

The Oklahoma Tax Commission assessed corporate income taxes against Vermont Corporation Scioto Insurance Company for 2001 through 2005, based on payments Scioto received from the use of Scioto's intellectual property by Wendy's restaurants in Oklahoma. In response, Scioto protested these assessments on the ground that it did not contract with the Wendy's restaurants in Oklahoma for use of the property in question and did not conduct any business whatsoever in Oklahoma. The Tax Commission denied Scioto's protest and the Court of Civil Appeals affirmed. The Supreme Court previously granted certiorari. Upon review, the Court vacated the Court of Civil Appeals opinion, reversed the Tax Commission's denial of Scioto's protest and remanded the case with instructions to sustain Scioto's protest.

Claimant Carl Wynne was a truck driver. While he was in Tennessee driving a truck for his former employer, he heard that Triad Transport, Inc. was hiring. Claimant called Triad’s headquarters in McAlester and spoke to a recruiter who had hiring authority. Claimant requested that an application be sent by fax to Odessa, Texas, where he lived. He completed the application and sent it by fax to McAlester. A week or so later, the recruiter phoned while Claimant was driving somewhere between Georgia and Arizona that his application had been approved. Claimant agreed to travel to McAlester for orientation. He returned his prior employer's truck to a terminal in Tuscon, Arizona, and a Triad employee gave him a ride to a Triad satellite terminal in Laveen, Arizona. There, he passed a drug test, was provided a fuel card, and dispatched to Rockwall, Texas with a load. In 2010, Claimant was injured in a motor vehicle accident in Colorado while he was driving Triad’s truck. He filed a Form 3 claim for benefits in the Oklahoma Workers' Compensation Court which Triad opposed. The trial tribunal conducted a hearing solely on the issue of the court's jurisdiction. Two witnesses were presented, Claimant and the President of Employer. Claimant testified concerning when and where he was actually hired, and Employer's President testified to the general hiring practices of his company. The recruiter was not called to testify. The trial tribunal made several findings of fact and concluded that it had jurisdiction to hear the case of Claimant's subsequent injury as Claimant's hiring and final assent to permanent employment relationship between claimant and respondent occurred in Oklahoma. A three-judge panel of the Workers' Compensation Court unanimously affirmed the decision. The Supreme Court’s de novo review of the record, the testimony of the witnesses, and the arguments of the parties lead to the conclusion that Claimant's final assent to employment did not occur until he attended the orientation in Oklahoma, “[t]hat process began when Claimant first made contact with [Triad’s] recruiter, but it did not end until Claimant gave his final assent to employment during the orientation in Oklahoma. The Workers' Compensation Court did not err in determining that it has jurisdiction to hear the claim.”

Tracy Stanfield was injured in 1992. A settlement relating to his injuries resulted in an annuity providing periodic payments to Stanfield from Metropolitan Life Insurance Company (MetLife). Stanfield assigned certain annuity payments, and the assignee in turn assigned them to J. G. Wentworth S.S.C. Limited Partnership (Wentworth). Stanfield later caused MetLife to ignore the assignments to Wentworth. Wentworth filed an action in a Pennsylvania state court and obtained a judgment against Stanfield. Wentworth then filed a motion for a judgment against MetLife for the same amount. A Pennsylvania court granted the motion. Soon thereafter, Stanfield's mother Mildred filed a petition in an Oklahoma district court to be appointed guardian of her son's estate. MetLife filed an interpleader action in a Pennsylvania federal district court and named Wentworth and Mildred in her capacity as guardian of her son's estate as defendants. Mildred asked attorney Loyde Warren to accept service of process on her behalf, and he agreed. Stanfield signed Warren's contingency fee agreement; Warren then engaged local counsel in Pennsylvania. At the settlement conference the parties agreed that Wentworth's judgment would be withdrawn; payments would be paid from Stanfield's annuity payments to Wentworth; the annuity assignment was rescinded; and future annuity payments from MetLife to Stanfield, as guardian, would be made payable in care of Warren. In 2009, Warren filed a motion in the open and continuing guardianship case before the Oklahoma district court for approval of both the 2001 contract for legal representation and the payment of legal fees made pursuant to that contract. Mildred objected and among her arguments, she maintained that a contingency fee for successfully defending a client from a judgment was improper, and that the fee agreement was unenforceable because it had not been approved by the guardianship court. The district court denied Warren's motion, "[b]ecause the application was not filed prior to payment of the fee and was not filed until nearly eight years after the contract was executed." The Court of Civil Appeals affirmed, and Warren appealed. Upon review, the Supreme Court held that (1) the district court possessed jurisdiction to adjudicate a guardianship proceeding a motion seeking court approval of a lawyer's contingent fee contract; (2) the guardian's failure to obtain court approval of a contingent fee agreement prior to payment pursuant to that agreement is not, by itself, a legally sufficient reason for a court to deny a motion to approve the agreement; and (3) the mere passage of time between creation of a contingent fee agreement and when it is presented to a court for approval in an open and continuing guardianship proceeding is not a legally sufficient reason to deny approval of that agreement.

In 2005, Plaintiff Marlene Harris purchased a car from Defendant David Stanley Chevrolet. Her purchase agreement contained an arbitration provision that applied to any "controversy, claim or dispute between the Purchaser and the Dealer arising out of, or related to this sale or transaction, including but not limited to, any and all issues or disputes arising as a result of this sale or transaction whether said issues arise prior to, during or subsequent to the sale or attempted sale of a vehicle." A few days after executing the purchase agreement, Plaintiff entered into a GAP insurance contract sold to her by an employee of the dealership (acting as an agent of the insurance company). In 2009, the car was a total loss. The GAP insurance company refused to pay the total difference between the insurance proceeds and the amount owed on the car, and Plaintiff sued to compel the GAP coverage. Plaintiff maintained that the purchase of the vehicle and the purchase of the policy were separate transactions, and that the arbitration clause of the purchase contract was inapplicable to the underpayment of coverage (GAP coverage). She argued no claim was brought against the GAP insurance company which was related to the sale or financing of the vehicle, conceding the arbitration clause would have applied to claims related to the sale or financing issues. After reviewing the motions of the parties, the trial court denied Defendant's Motion to Compel arbitration without an evidentiary hearing. Upon review, the Supreme Court concluded that the two contracts involved two separate subjects, executed on different dates, and the arbitration clause in the purchase agreement did not mention or reference GAP insurance or any relationship between the two contracts. The trial court did not abuse its discretion in denying the evidentiary hearing and ruling that the arbitration clause did not apply as a matter of law.