Justia Government & Administrative Law Opinion Summaries

In 2000, while working at Homestake Mining Company, Michael Martz injured his shoulder. Martz was paid workers’ compensation benefits. In 2002, while working for McLaughlin Sawmill (Hills Materials), Martz injured the same shoulder. Hills Materials began paying benefits but, several years later, denied liability for further benefits. Martz petitioned the Department of Labor, contending that both employers were liable for benefits. Homestake was granted summary judgment on statute of limitations grounds. In regards Hills Materials, the Department rejected Martz’s argument that promissory estoppel precluded Hills Materials from denying liability and concluded that Martz failed to satisfy his burden of showing that the 2002 injury was a “major contributing cause” of his current condition. The circuit court affirmed. The Supreme Court affirmed, holding (1) Hills Materials was not estopped from denying liability for Martz’s current condition and need for treatment; and (2) Martz failed to establish that Hills Materials was liable for benefits where he did not prove a sufficient causal relationship between his 2002 injury and his current condition and need for treatment.View "Martz v. Hills Materials" on Justia Law

Minn. Stat. 176.081(1)(a) requires employers and insurers to pay attorney fees calculated by a statutory formula not subject to judicial review. In this case, Respondent injured his back while working for Employer. Employer and its insurer (together, Relators) settled with Respondent. Respondent’s attorney then sought an award of contingent attorney fees in an amount that was calculated by applying the statutory formula in section 176.081 but which disregarded the upper limit set by the formula. Relators objected, arguing that, in the absence of judicial review to ensure a fee award is not excessive, application of the statutory formula violates separation of powers principles. The compensation judge applied the statutory formula and concluded that $13,000 would adequately compensate Respondent’s attorney but refused to consider whether the statutory fee was reasonable. The Workers’ Compensation Court of Appeals affirmed the compensation judge’s fee award. The Supreme Court affirmed, holding (1) the Court will recognize the Legislature’s statutory formula as presumptively reasonable, and, absent exceptional circumstances, further judicial review of an award based on the statutory formula is unnecessary; and (2) Relators failed to present any exceptional circumstances to challenge this presumption.View "David v. Bartel Enters." on Justia Law

WTS Acquisition Corporation purchased Ameritemps, Inc. and then transferred the assets to its wholly owned subsidiary, RFFG, LLC. RFFG continued operating the business under the Ameritemps name. The Ohio Bureau of Workers’ Compensation notified RFFG that it had determined that RFFG was a successor employer for workers’ compensation purposes and that it intended to calculate RFFG’s workers’ compensation premium rate based on Ameritemps’ experience rating. RFFG filed a complaint for a writ of mandamus alleging that the Bureau had abused its discretion when it determined RFFG to be the successor in interest to Ameritemps. The court of appeals denied the writ. The Supreme Court affirmed, holding that the court of appeals did not err in concluding that the decision of the Bureau was supported by the evidence and was not an abuse of discretion.View "State ex rel. RFFG, LLC v. Ohio Bureau of Workers' Comp." on Justia Law

An action was initiated by certain former members and the board of Mississippi Comp Choice Self-Insurers Fund. Comp Choice was a workers’ compensation group self-insurer operating under a certificate of authority granted by the Mississippi Workers’ Compensation Commission. Defendant Mississippi Workers’ Compensation Group Self-Insurer Guaranty Association (“GGA”) ordered a review of Comp Choice. Based on information revealed in the review, the Commission required Comp Choice to execute a Memorandum of Understanding outlining a plan to “strengthen the financial and operational aspects of the [Comp Choice] Fund under the control and guidance of the Commission.” Six months later, the Commission decided not to approve Comp Choice for future operation. Comp Choice voluntarily surrendered its certificate of authority to operate as a group self-insurer in January 2009. GGA stepped into the shoes of Comp Choice to protect claimants. Comp Choice a complaint against GGA, alleging, inter alia, gross negligence, breach of fiduciary duty, bad faith, conversion, and a demand for an accounting. GGA filed a motion to dismiss and claimed immunity under the Mississippi Tort Claims Act (MTCA) and the Mississippi Workers’ Compensation Self-Insurer Guaranty Association Law. The trial court granted the motion, finding that GGA was “covered” by the MTCA, sub silentio ruling that Plaintiffs could not pursue a “cause of action” as referenced in Mississippi Code Section 71-3-179. The trial court held that only the MTCA applied to suits against the Mississippi Workers’ Compensation Group Self Insurer Guaranty Association. The trial court dismissed all other claims, granting leave to amend the complaint for an MTCA action only. Comp argued on appeal to the Supreme Court: (1) the trial court erred in granting defendant's motion to dismiss based on whether GGA as an unincorporated legal entity, was covered by the Mississippi Tort Claims Act, and therefore, entitled to its various protections, immunities and exceptions pursuant to Miss. Code Ann. 11-46-7; and (2) the trial court erred in dismissing based on the determination that GGA as an unincorporated legal entity, was covered by the Mississippi Tort Claims Act, even where the immunity created in GGA in Miss. Code Ann. 71-3-179 abrogated the immunity afforded under the Mississippi Tort Claims Act in Miss. Code Ann. In the case sub judice, the Supreme Court determined that facts were still undeveloped, precluding the trial court and itself from determining whether Plaintiff’s claims, as alleged in its complaint, could be pursued only under the MTCA, as ordered by the trial court, and Plaintiff could not pursue a cause of action as contemplated by Section 71-3-151, et seq, or otherwise. "Absent factual development, no court at this stage of the proceedings could accurately discern whether GGA is an instrumentality of the Commission, vel non, as argued by GGA."View "The Former Board of Trustees and Members of Mississippi Comp Choice Self-Insurers Fund v. Mississippi Workers' Compensation Group Self-Insurer Guaranty Association" on Justia Law

Plaintiffs Brett Woods and Kathleen Valdes were state employees and representatives of a class of New Mexico state and local government employees who alleged they paid for insurance coverage through payroll deductions and premiums pursuant to a policy issued by Standard Insurance Company (Standard), but did not receive the coverage for which they paid and, in some cases, were denied coverage entirely. Plaintiffs filed suit in New Mexico state court against three defendants: Standard, an Oregon company that agreed to provide the subject insurance coverage; the Risk Management Division of the New Mexico General Services Department (the Division), the state agency that contracted with Standard and was responsible for administering benefits under the policy; and Standard employee Martha Quintana, who Plaintiffs allege was responsible for managing the Division’s account with Standard and for providing account management and customer service to the Division and state employees. Plaintiffs' ninety-one-paragraph complaint, stated causes of action against Standard and the Division for breach of contract and unjust enrichment; against Standard for breach of fiduciary duty, breach of the implied duty of good faith and fair dealing, and Unfair Practices Act violations; and against Standard and Ms. Quintana for breach of the New Mexico Trade Practices and Fraud Act. The issue this appeal presented for the Tenth Circuit's review centered on whether remand to the state court pursuant to the Class Action Fairness Act (CAFA) was required under either of two CAFA provisions: the state action provision, which excludes from federal jurisdiction cases in which the primary defendants are states; or the local controversy exception, which requires federal courts to decline jurisdiction where, among other things, there is a local defendant whose alleged conduct forms a significant basis for the claims asserted by plaintiffs and from whom plaintiffs seek significant relief. The Court concluded that neither provision provided a basis for remand, and therefore reversed the decision of the magistrate judge remanding the case to state court. But because the Tenth Circuit could not determine whether Defendants have established the amount in controversy required to confer federal jurisdiction, the case was remanded to the district court for the resolution of that issue.View "Woods v. Standard Insurance Co." on Justia Law

Plaintiff Town of Ira brought this action to recover from its insurer, Vermont League of Cities and Towns Property and Casualty Intermunicipal Fund, Inc. (PACIF), certain losses related to the embezzlement of town funds by the Town's former treasurer. On summary judgment, the trial court found that the Town was entitled to interest on the embezzled amount up to the policy limit and that this amount mooted the Town's claim for audit and attorney's fees, as well as insurer's counterclaims to recoup certain sums already paid. It also granted judgment to insurer on the Town's claim that insurer acted in bad faith by not paying for all of the items it claimed. After review of the trial court record, the Supreme Court affirmed that judgment.View "Town of Ira v. Vermont League of Cities and Towns" on Justia Law

Roger Brock was passenger in a vehicle driven by Brian Mason, which was involved in an accident with a logging truck, driven by Ryan Stevens. At the time of the accident, Stevens was insured through the owner of the logging truck, Malachi Sanders' policy issued by Aequicap Insurance Company. Brock sustained severe injuries as a result of the wreck and filed suit. Soon after the litigation began, Brock settled his claim against Stevens and Sanders with Aequicap for $185,000 for the release of all claims. Shortly after the settlement was reached but before Brock received any payment, Aequicap was declared insolvent. Because Aequicap was an insurer licensed to do business in the State of South Carolina and the insured was a resident of South Carolina, the claim was referred to South Carolina Property and Casualty Insurance Guaranty Association (Guaranty). As a result, Brock made demand on Guaranty for payment of the full settlement amount of $185,000. The issue this case presented for the Supreme Court's review centered on the construction and application of the South Carolina Property and Casualty Insurance Guaranty Association Act (the Act), S.C. Code Ann. Secs. 38-31-10 to -170 (2002 and Supp. 2013), and specifically the exhaustion/non-duplication provision in section 38-31-100(1). Guaranty and Brock moved for summary judgment on the issue whether Guaranty may offset payments from solvent insurance carriers against Brock's settlement under section 38-31-100. The circuit court found section 38-31-100 was ambiguous and granted partial summary judgment to both parties, holding that Guaranty may offset some but not all of the benefits received by Brock from solvent insurance carriers. The Supreme Court disagreed that section 38-31-100 was ambiguous and hold that the unambiguous language of section 38-31-100 provides that Guaranty may offset all payments from all solvent insurers made to Brock as a result of this wreck.View "SC Property v. Brock" on Justia Law

In 2010, Idaho Power entered into two Firm Energy Sales Agreements, one with New Energy Two, LLC, and the other with New Energy Three, LLC, under which Idaho Power agreed to purchase electricity from them that was to be generated by the use of biogas. The agreement with New Energy Two stated that the project would be operational on October 1, 2012, and the agreement with New Energy Three stated that the project would be operational on December 1, 2012. Both contracts were submitted for approval to the Idaho Public Utilities Commission, and were both approved on July 1, 2010. Each of the agreements contained a force majeure clause. By written notice, New Energy Two and New Energy Three informed Idaho Power that they were claiming the occurrence of a force majeure event, which was ongoing proceedings before the Public Utilities Commission. New Energy asserted that until those proceedings were finally resolved "the entire circumstance of continued viability of all renewable energy projects in Idaho is undecided"and that as a consequence "renewable energy project lenders are unwilling to lend in Idaho pending the outcome of these proceedings."Idaho Power filed petitions with the Commission against New Energy Two and New Energy Three seeking declaratory judgments that no force majeure event, as that term was defined in the agreements, had occurred and that Idaho Power could terminate both agreements for the failure of the projects to be operational by the specified dates. New Energy filed a motion to dismiss both petitions on the ground that the Commission lacked subject matter jurisdiction to interpret or enforce contracts. After briefing from both parties, the Commission denied New Energy's motion to dismiss. The Commission's order was an interlocutory order that is not appealable as a matter of right. New Energy filed a motion with the Supreme Court requesting a permissive appeal pursuant to Idaho Appellate Rule 12, and the Court granted the motion. New Energy then appealed. Finding no reversible error, the Supreme Court affirmed the Commission's order.View "Idaho Power v. New Energy Two" on Justia Law

Dick McClary submitted an application for health insurance to Golden Rule Insurance Company that failed to disclose proposed insured Patti Denney’s preexisting condition. Golden Rule issued a policy covering Denney, but later denied coverage for a proposed surgery based on the fact that the conditions documented in Denney’s medical records were not disclosed in her insurance application. The Kansas Insurance Department imposed sanctions on Golden Rule for unfair claim settlement practices, concluding that Golden Rule had wrongfully denied Denney coverage for a medically necessary procedure. The district court affirmed. The court of appeals reversed, concluding that McClary was not acting as Golden Rule’s soliciting agent when he submitted Denney’s health insurance application. The Supreme Court (1) reversed the court of appeals’ decision on the agency question, as substantial evidence supported the conclusion that McClary had the actual authority to solicit and submit applications directly to Golden Rule; and (2) reversed the Department and the district court on their ruling that Golden Rule violated Kan. Stat. Ann. 40-2404(9)(f) but affirmed the finding of a violation of subsection (d); and (3) affirmed the Department’s remedy.View "Golden Rule Ins. Co. v. Tomlinson" on Justia Law

An Employer appealed from a decision of the Workers’ Compensation Commission (Commission) ordering Employer to pay additional temporary total disability benefits to Employee, who was injured during his employment. After a jury trial, the trial court granted Employee’s motion for judgment and affirmed the award, concluding that the Commission decision was a piece of evidence that needed to be considered by the jury and that Employer was required to introduce the Commission decision into evidence. The court of special appeals reversed, concluding that Appellant was not required to move the award into evidence. The Court of Appeals affirmed, holding that, in a de novo workers’ compensation jury trial, the appellant is not required to move the Commission decision into evidence.View "Gales v. Sunoco & Amer. Zurich Ins." on Justia Law