Justia Government & Administrative Law Opinion Summaries

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

Employee suffered bilateral shoulder injuries and underwent separate surgeries on each shoulder. Employee later agreed to a voluntary buyout of his employment. Employee subsequently filed two separate suits for workers’ compensation benefits. The trial court determined that Employee’s permanent partial disability benefits were not capped at one and one-half times the impairment rating and awarded ninety percent permanent partial disability benefits. Employer appealed. A Special Workers’ Compensation Appeals Panel modified the award of permanent partial disability benefits to 37.5 percent as capped at one and one-half times the impairment rating, concluding that Employee’s decision to accept the buyout was not “reasonable” for purposes of the statutory cap. The Supreme Court reversed in part and reinstated the judgment of the trial court as to the award of ninety percent permanent partial disability benefits, holding that because Employee acted reasonably by accepting the voluntary buyout for reasons related to his work injuries, the award for permanent partial disability was not subject to the one-and-one-half-times multiplier. View "Yang v. Nissan N. Am., Inc." on Justia Law

Reva Merrill appealed a Superior Court judgment that affirmed the Board of Trustees for the Maine Public Employees Retirement System's decision to deny her request for a waiver of past-due life insurance premiums. Merrill contended on appeal that the Board erred in interpreting 5 M.R.S. 17103(6)(2008) to prohibit it from waiving past-due payments for the non-mandatory Group Life Insurance Program, and that the Board's administrative procedures violated her right to due process. Because the Supreme Court agreed with Merrill that the Board had the authority to waive back premiums, the Court vacated the Board's decision and remanded the case for the Board to decide finally whether to waive Merrill's required payments. View "Merrill v. Maine Public Employees Retirement System" on Justia Law

In 1984 and 1985, James Stevens injured both shoulders while working for S.T. Services and CNA Insurance Companies (collectively, S.T. Services). In 1994, Stevens and S.T. Services entered into a stipulation for settlement under which the parties agreed that Stevens was permanently totally disabled and would receive ongoing permanent total disability benefits. A compensation judge entered an award on the stipulation, and Stevens received benefits until 2011. Stevens began working as a plumbing specialist in 2008 and disclosed his job to S.T. Stevens but continued to receive workers’ compensation benefits. In 2011, S.T. Services filed a petition with the Workers Compensation Court of Appeals (WCCA) to discontinue paying benefits on the grounds that Stevens was no longer permanently totally disabled. A compensation judge granted S.T. Services’ petition to discontinue, and the WCCA affirmed. The Supreme Court reversed, holding that S.T. Services was not allowed by statute to file a petition to discontinue benefits under the circumstances of this case. View "Stevens v. S.T. Servs." on Justia Law

The Eastern Municipal Water District (EMWD) hired general contractor S.J. and Burkhardt, Inc. (SJB) for a public works construction project in 2006. Safeco Insurance Company (Safeco) executed performance and payment bonds for the project. Plaintiff Golden State Boring & Pipe Jacking, Inc. (GSB) was a subcontractor for the project, completing its work by September 2006, but it did not receive payment. In March 2008, SJB sent a voluntary default letter to Safeco. In July 2008, GSB sued SJB, EMWD, and Safeco for the unpaid amounts under the contract, separately seeking payment from Safeco under its payment bond. EMWD filed a cross-complaint to interplead retained sums. Safeco made a motion for summary judgment on the cause of action for payment under the bond on the ground that GSB’s claim was untimely. The trial court granted the motion, finding that there had been three cessations of labor that triggered GSB’s duty to file a stop notice in order to secure payment under Safeco's payment bond. At a subsequent court trial on the contract claims, GSB was awarded judgment against SJB, and Safeco was awarded judgment on the interpleader action. GSB appealed the summary judgment ruling, arguing: (1) the trial court erroneously overruled its objections to evidentiary matters presented in support of Safeco’s summary judgment; and (2) the court erred in finding the action was untimely. Finding no reversible error, the Court of Appeal affirmed. View "Golden State v. Eastern Municipal Water Dist." on Justia Law

The question before the Court of Appeals in these three consolidated cases was the appropriate method for crediting payments made under a workers’ compensation award when that award is increased on appeal. At issue was whether the credits should be computed on the basis of the number of weeks paid or the amount of money expended. The Court of Appeals resolved the issue in favor of the workers in each case by relying on legislation passed specifically to supersede earlier decisions of the Court, holding that, when crediting an employer/insurer for payments made under a workers’ compensation award that is subsequently amended, credit should be given for the total amount of dollars paid under the initial award. View "W.R. Grace & Co. v. Swedo" on Justia Law

After Elms Construction Company, owned by Richard Elms (Elms), began installing windows and doors for Renewal by Anderson (Renewal), Elms fell from a ladder and injured his right foot. Elms filed a workers’ compensation claim with the Workers’ Compensation Commission, alleging that he was Renewal’s common law employee at the time of the injury. The Commission concluded that Elms was an independent contractor, rather than a common law employee of Renewal, and was therefore not entitled to collect workers’ compensation benefits. The circuit court reversed, concluding that Elms was Renewal’s common law employee. The court of special appeals vacated the circuit court’s opinion and remanded. The Supreme Court vacated the court of appeals’ opinion and remanded with directions to affirm the circuit court’s judgment, holding (1) the Commission misconstrued the law as applied to the facts when it concluded that Elms was an independent contractor and not an employee of Renewal; (2) the court of special appeals erred when it held that a statutory employment analysis under section 9-508 of the Workers’ Compensation Act must precede a common law employment analysis; and (3) by application of the common law to the facts of this case, Elms was Renewal’s employee at the time of the accident. View "Elms v. Renewal by Anderson" on Justia Law

Seventy-year-old James Higginbotham was employed by Industrial Contractors, Inc. ("ICI") as a welder and pipefitter in May 2010 when he sustained an injury to his left rotator cuff. The medical records demonstrated that Higginbotham's injury arose out of and in the course of his work for ICI. Prior to his injury, Higginbotham made $34.61 per hour, but only worked part time. He often traveled to work sites some distance from his home near Hazen, including a site north of Mandan. Since his injury, Higginbotham was no longer able to make the trip from Hazen to Bismarck without stopping, and he could no longer perform welding or pipefitting work. Higginbotham lived in a mobile home near Hazen, approximately 70 miles from Bismarck and 80 miles from Minot. He indicated he was having difficulty paying bills, which he did not have before the injury, and he wanted to maintain the lifestyle he had prior to his injury. Following left rotator cuff surgery, WSI referred Higginbotham to vocational rehabilitation with Kim Hornberger, a vocational rehabilitation consultant, who identified the first appropriate rehabilitation option for Higginbotham and developed a vocational consultant's report ("VCR"). The VCR concluded that it was appropriate for Higginbotham to return to an occupation in the statewide job pool suited to his education, experience, and marketable skills: cashier, telephone sales representative, gaming dealer, and greeter, and the expected income of $332 per week exceeded 90% of Higginbotham's pre-injury income of $227 per week. WSI approved the vocational plan and notified Higginbotham that it intended to discontinue his benefits. Higginbotham asked for reconsideration, and WSI issued an order affirming the rehabilitation plan and denying further disability benefits. Higginbotham appealed, and an ALJ affirmed the WSI order. Higginbotham appealed the ALJ's decision, and the district court affirmed. Higginbotham now appeals the district court judgment. Finding no reversible error, the Supreme Court affirmed. View "Higginbotham v. WSI" on Justia Law

Expedia (and several other hotel booking websites, collectively, "Petitioners") has been subject to approximately 80 underlying lawsuits by states, counties, and municipalities (collectively, taxing authorities) for purportedly failing to collect the right amount of local occupancy taxes from its hotel customers. Expedia tendered most of the suits to its insurer, Zurich, although some were tendered late. Zurich refused to defend Expedia on a number of grounds, including late tender and that the underlying suits may be excluded from the policies' coverage. The trial court declined to make a determination of Zurich's duty to defend Expedia, instead ordering discovery that Expedia claimed was prejudicial to the underlying actions. Petitioners sought adjudication of their summary judgment motion concerning their respective insurers' duty to defend them in cases brought by local taxing authorities. They further requested a stay of discovery in the coverage action that could prejudice them in the underlying litigation. Upon review of the matter, the Washington Supreme Court held that the trial court erred by delaying adjudication of Zurich's duty to defend Expedia. Accordingly, the Court vacated the trial court's order. The case was remanded to the trial court to determine Zurich's duty to defend Expedia in each of the 54 underlying cases subject to Expedia's motion. The trial court was furthermore ordered to stay discovery in the coverage action until it could make a factual determination as to which parts of discovery are potentially prejudicial to Expedia in the underlying actions. View "Expedia, Inc. v. Steadfast Ins. Co." on Justia Law