Justia Government & Administrative Law Opinion Summaries

After settling a federal lawsuit brought by plaintiffs for $13,500,000.00, the sheriff of Delaware County and the County Commissioners demanded that the Association of County Commissioners of Oklahoma Self Insurance Group indemnify Delaware County for that amount. The insurance group agreed to contribute $1,000,000.00, less the defense costs already incurred, which amount was the per occurrence limit. Delaware County filed a lawsuit for breach of contract, and subsequently moved to amend its petition to add a bad faith claim, after the lawsuit had been transferred to Rogers County. The trial court granted the motion and subsequently denied the insurance group's motion to dismiss the bad faith claim. The trial court certified for immediate interlocutory appeal the order denying that motion to dismiss to the Supreme Court. The questions that appeal presented for the Supreme Court's review were: (1) whether the Association of County Commissioners of Oklahoma Self-Insurance Group was an insurer pursuant to 36 O.S.2011, sec. 607.1; and (2) whether, pursuant to the Governmental Tort Claims Act, that organization was immune from tort liability for a breach of the duty of good faith and fair dealing. After its review, the Supreme Court held that under the statutes the organization was an insurance company for some purposes, but was a governmental entity immune from a tort claim for the breach of the duty of good faith and fair dealing.View "BD. OF CTY. COMMISSIONERS v. ASSOC. OF CTY. COMMISSIONERS OF OKLA. SELF-INSUR. GROUP" on Justia Law

The Workers’ Compensation Commission found Employee to be totally and permanently disabled under the odd-lot doctrine and denied Employer and its Insurer (collectively, Employer) certain credits for disability payments previously received by Employee from other sources. The district court affirmed the Commission’s finding that Employee was totally and permanently disabled but reversed on the credit issue. The court of appeals reversed, holding (1) substantial evidence did not support the Commission’s award of permanent total benefits, and (2) the Commission was correct in its decision concerning the credits. On further review, the Supreme Court (1) affirmed the district court’s finding that substantial evidence supported the Commission’s findings that Employee was totally and permanently disabled under the odd-lot doctrine; and (2) reversed the district court’s judgment regarding the issues concerning the credit due Employer.View "Gits Mfg. Co. v. Frank" on Justia Law

Nationwide, with 32,000 employees in 49 states, has an ERISA employee-benefits plan that provides short-term disability (STD), long-term disability (LTD), and “Your Time” benefits. An employee can receive Your Time benefits for personal reasons, such as vacation or illness. To receive STD benefits, an employee must be “STD Disabled,” which means “a substantial change in medical or physical condition due to a specific illness that prevents an Eligible Associate from working their current position.” Specific rules govern maternity leave. The first five days of paid maternity leave come out of an associate’s Your Time benefits. Thereafter, a new mother is considered STD Disabled and entitled to STD benefits for six weeks following a vaginal delivery, or eight weeks following a cesarean section. Wisconsin’s Family Medical Leave Act requires that employers allow six weeks of unpaid leave following “[t]he birth of an employee’s natural child[.]” The Act’s “substitution provision” requires employers to allow an employee to substitute “paid or unpaid leave of any other type provided by the employer” for the unpaid leave provided by the statute. A Wisconsin Nationwide employee had a baby. She received six weeks of STD benefits under Nationwide’s plan. She then requested an additional period of STD benefits pursuant to the substitution provision. The plan denied the request, finding that she was no longer short-term disabled under the plan. The Wisconsin Supreme Court had held that, ERISA did not preempt the Wisconsin Act. The district court held that, under the Supremacy Clause, the administrator was required to comply with ERISA rather than the Wisconsin Act. The Sixth Circuit affirmed.View "Sherfel v. Newson" on Justia Law

The Georgia Department of Corrections (GDOC) entered into a construction contract with Lewis Walker Roofing (Walker Roofing) to re-roof several buildings at Valdosta State Prison. The Contract contained two “no assignment” clauses, and as a prerequisite to contracting with GDOC, Walker Roofing was required to obtain payment and performance bonds. It obtained such payment and performance bonds from Developers Surety and Indemnity Company. Walker Roofing did not complete its work within the time frame required by the Contract, and GDOC declared Walker Roofing in default. Developers Surety did not notify GDOC within 25 days of receipt of GDOC's notice of default regarding whether it would remedy the default or perform the contract. However, approximately three months after the declaration of default, Developers Surety gave GDOC the option of entering into a contract with another company for the completion of the work. GDOC then contracted with that company to finish the project. Under the payment and performance bonds and prior to Walker Roofing's default, Developers Surety had provided financial assistance to Walker Roofing. Developers Surety filed suit against GDOC for breach of contract and for a declaratory judgment that it had no obligation under the payment and performance bond it issued to Walker Roofing on behalf of GDOC. GDOC filed a counterclaim for breach of contract. The parties filed cross-motions for summary judgment, and the trial court determined that Developers Surety's claims were not barred by sovereign immunity and that GDOC had breached the construction contract as a matter of law. It concluded that GDOC waived its sovereign immunity by entering into the contract with Walker Roofing, and that the doctrine of equitable subrogation gave Developers Surety the ability to file suit against GDOC once it incurred liability and paid the obligations of its principal under the bond. Consequently, the trial court granted summary judgment to Developers Surety and denied it to GDOC; in the same order, the trial court entered judgment in favor of Developers Surety in the amount equal to the "financial assistance" Developers Surety provided to Walker Roofing. The Supreme Court granted certiorari to the Court of Appeals to consider whether the State’s sovereign immunity was waived for the claim Developers Surety made on its contract with the State. The Supreme Court found that immunity was indeed waived in this instance, and accordingly, it affirmed the judgment of the Court of Appeals. View "Georgia Dept. of Corrections v. Developers Surety & Indemnity Co." on Justia Law

Kentucky Employers’ Mutual Insurance (KEMI) was the workers’ compensation carrier for Beacon Enterprises, Inc. at the time that Julian Hoskins was injured during the course of his employment with Four Star Transportation, Inc. (Four Star). Four Star had configured its workforce pursuant to an employee leasing arrangement with a company affiliated with Beacon Enterprises, an employee leasing company. The Workers’ Compensation Board determined that Hoskins was not covered by Beacon Enterprises’ policy with KEMI because Hoskins was not an employee of Beacon Enterprises at the time of the injury. The court of appeals upheld the Board’s decision. The Supreme Court reversed, holding (1) Ky. Rev. Stat. 342.615 does not require an employee to have knowledge of his status as a leased employee or of the nature of his relationship with the employee leasing company; and (2) because the court of appeals grounded its opinion upon Hoskins’s lack of knowledge, the matter must be remanded for the court to address other issues raised by KEMI in support of the Board’s decision.View "Ky. Ininsured Employers’ Fund v. Hoskins" on Justia Law

Plaintiff sought compensation for injuries he sustained while employed with his employer. The employer’s insurer at the time Plaintiff filed his claim entered into a voluntary agreement on the claim and subsequently sought apportionment against Employer’s prior insurers, including Republic-Franklin Insurance Company. Republic-Franklin did not agree to its apportionment liability until just before the close of evidence. Thereafter, the Workers’ Compensation Commissioner ordered Republic-Franklin to pay interest pursuant to Conn. Gen. Stat. 31-299b. The Workers’ Compensation Commission affirmed. The Supreme Court affirmed the decision of the Board, holding that the Commissioner’s order of interest was proper because (1) the Commissioner satisfied the statutory prerequisites of section 31-299b; and (2) Republic-Franklin failed to preserve its claim that the Commissioner’s order of interest was not made within a reasonable period of time as required by section 31-299b.View "Ferraro v. Ridgefield European Motors, Inc." on Justia Law

Petitioner, who was injured while performing her work duties, filed a workers’ compensation claim. Liberty Northwest (Liberty), the insurer for the claim, terminated Petitioner’s temporary partial disability (TPD) benefits after Petitioner revoked releases and authorizations she had previously signed allowing Liberty and its agents to have ex parte communications with her medical care providers. Petitioner filed an action asserting that the statutes relied upon by Liberty to terminate her medical benefits, Mont. Code Ann. 39-71-604 and Mont. Code Ann. 50-16-527, were unconstitutional. The Workers’ Compensation Court (WCC) determined that section 39-71-604(3), as applied in Petitioner’s case, violated Petitioner’s constitutional right of privacy. The Supreme Court affirmed, holding that the WCC did not err in concluding that section 39-71-604(3) violated Petitioner’s right of privacy set forth in the Montana Constitution.View "Malcomson v. Liberty Northwest" on Justia Law

A firefighter developed prostate cancer when he was in his mid-fifties, after working for nearly 30 years. He filed a workers’ compensation claim under a new statute creating a presumption that certain diseases in firefighters, including prostate cancer, are work related when specific conditions are met. The employer contended that the firefighter could not attach the presumption of compensability because he had not strictly complied with statutory and regulatory medical examination requirements. The employer also wanted to present expert testimony that the cause of prostate cancer was unknown. The Alaska Workers’ Compensation Board heard the claim and refused to consider parts of the expert’s testimony, deciding that the firefighter was eligible for benefits because he had attached the presumption of compensability by substantially complying with the statutory requirements and the employer had not rebutted the presumption. On appeal, the Alaska Workers’ Compensation Appeals Commission agreed, but reversed the Board’s decision disallowing the expert testimony. The Commission decided that the employer could rebut the presumption through its expert’s testimony that the cause of prostate cancer was unknown, and remanded the case to the Board for further proceedings. Because the employer also contended that the firefighter-presumption statute violated the Alaska Constitution’s equal protection guarantee, the State of Alaska intervened on appeal. The Supreme Court affirmed the Commission’s decision that the firefighter attached the presumption by substantially complying with the applicable requirements. However, the Court reversed the Commission’s decision that the employer could rebut the presumption through expert testimony that there was no known cause of prostate cancer.View "Adamson v. Municipality of Anchorage" on Justia Law

Appellant injured his lower back in 2007 while working for Employer. Employer denied further treatment that same year. Appellant filed a petition for hearing in 2009, alleging that he was entitled to medical benefits. Based on a deposition of Dr. Dale Anderson, Employer filed an amended answer admitting that Appellant’s work activities were a major contributing cause to his need for medical treatment. The Department of Labor dismissed the case in 2010. In 2011, Employer denied further medical treatment based upon a recent independent medical evaluation by another doctor. Appellant petitioned for a hearing, arguing that res judicata applied to prevent Employer from changing its position from its previous admittance. The Department found res judicata inapplicable and that Appellant failed to meet his burden of proof on causation. The circuit court affirmed. The Supreme Court reversed, holding that because Dr. Anderson’s opinion was adopted by Employer and judicially accepted by the Department through its 2010 order of dismissal, Employer was judicially estopped from taking an inconsistent position; and (2) Appellant met his burden of proving that his work-related activities as of 2010 were a major contributing cause of his disability. Remanded.View "Hayes v. Rosenbaum Signs & Outdoor Advertising, Inc. " on Justia Law

In this class action lawsuit, the trial court found that the State wrongfully denied health benefits to a number of its part-time employees. The issue this case presented for the Supreme Court's review was how to value the damages suffered by that group of employees when they were denied health benefits. The State argued that the only damages to the employees were immediate medical expenses paid by employees during the time they were denied health benefits. But evidence showed that people denied health care benefits suffer additional damage. They often avoid going to the doctor for preventive care, and they defer care for medical problems. This results in increased long-term medical costs and a lower quality of life. Based on this evidence, the trial court correctly rejected the State's limited definition of damages because it would significantly understate the damages suffered by the employees. The Supreme Court affirmed.View "Moore v. Health Care Auth." on Justia Law