Justia Government & Administrative Law Opinion Summaries

A highly paid worker suffered a debilitating stroke while traveling for his employer. The employer did not think the stroke was work related, but it later accepted the claim and paid workers' compensation benefits. The statutory maximum compensation rate at the time of the injury was $700 a week. A little more than five months after the employee's stroke, an amended version of the Alaska Workers' Compensation Act took effect. Instead of an absolute maximum compensation rate, the amended statute set a variable rate indexed to the statewide average weekly wage. The employee asked for an increased rate of compensation, arguing that the law in effect at the time he was recognized as being permanently and totally disabled should govern his benefit amount. The Alaska Workers' Compensation Board, with one panel member dissenting, decided that the version of the statute in effect at the time of the injury was the applicable statute and consequently capped the employee's benefits at $700 a week for life. The dissenting panel member would have construed the statute as permitting increased benefits. The Alaska Workers' Compensation Appeals Commission affirmed the Board's decision. The employee appealed, arguing that the amount of his benefits did not fairly compensate him for lost wages during the period of his disability so that the date of his disability, rather than the date of his injury, should have been used to determine the version of the statute governing his claim. Finding no reversible error, the Supreme Court affirmed the Commission's decision.View "Louie v. BP Exploration (Alaska), Inc." on Justia Law

Plaintiff injured his shoulder while working for Employer. Plaintiff was terminated later that year for “reduction of staff due to lack of work.” Employer accepted Plaintiff’s injury as compensable. In January 2009, Plaintiff began to receive unemployment benefits from Employer and Insurer (together, Defendants). In December 2010, Defendants sought to terminate payment of compensation, alleging that Plaintiff could no longer show he was disabled. The Industrial Commission concluded that Plaintiff was not entitled to disability payments made after December 2010 and that Defendants were entitled to a credit for any payments they had made after that date, finding that Plaintiff’s inability to find work was not due to his injury but to large-scale economic factors. The Supreme Court affirmed, holding that the Commission properly concluded that Plaintiff failed to prove that his inability to earn the same wages as before his injury resulted from his work-related injury. View "Medlin v. Weaver Cooke Constr., LLC" on Justia Law

While working for Vista Care (Employer), appellant Sherrie Fowler suffered a back injury. Appellant began receiving TTD and subsequently underwent back surgery. Several years later, a physician determined that appellant reached maximum medical improvement (MMI). This case began when appellant filed a complaint with the Workers' Compensation Act (WCA) in 2010, for reinstatement of her TTD benefits and for an increase in her PPD rating. The Court of Appeals held that the Act limited appellant's eligibility for TTD benefits to 700 weeks of benefits and reversed a contrary decision of the Workers’ Compensation Administration judge. Upon review of the matter, the Supreme Court concluded that the Act imposed no such limitation; TTD benefits are payable during any period of total disability for the remainder of a worker’s life. View "Fowler v. Vista Care" on Justia Law

Paul Lightner filed a consumer complaint on behalf of himself and other policyholders before the Insurance Commissioner against CitiFinancial and Triton Insurance Company challenging the rates for certain insurance products. Following the Commissioner’s investigation and consideration of Lightner’s complaint, the Commissioner denied Lightner’s request for a hearing and found the challenged rates were reasonable. Lightner filed a petition appealing the Commissioner’s order denying his request for a hearing. The circuit court affirmed. The Supreme Court affirmed, holding that the circuit court (1) did not err in upholding the Commissioner’s order denying a hearing because this case did not present any factual disputes warranting a hearing in this case; and (2) properly concluded that the Commissioner’s handling of the rate issues raised in Lightner’s complaint met statutory, regulatory, and constitutional standards. View "Lightner v. Riley" on Justia Law

Appellant, an over-the-road truck driver, filed a claim for workers’ compensation benefits, alleging that he sustained injuries in the form of deep vein thrombosis and pulmonary embolism in an accident that occurred during the course and scope of his employment. The compensation court applied a split test of causation used in heart attack cases, which requires proof of both legal and medical causation. The court then dismissed Appellant’s claim for failure to establish the medical cause prong. The Supreme Court affirmed the dismissal of Appellant’s claim, holding (1) the split test was properly applied to Appellant’s injuries in this case, as deep vein thrombosis and pulmonary embolism present the same difficulties in attributing the cause of a heart attack to a claimant’s work and are similar in origin to a heart attack; and (2) the compensation court’s finding as to causation was not clearly wrong. View "Wingfield v. Hill Bros. Transp., Inc." on Justia Law

In 2004, Appellant fell while working and strained her back. Appellant was awarded worker’s compensation benefits. In 2009, Appellant slipped and fell at work and injured her ankle. In 2010, Appellant sought temporary total disability and medical pay benefits from the Workers Compensation Division, which denied Appellant’s requests. After a contested case hearing, the Office of Administrative Hearings (OAH) upheld the Division’s denial of Appellant’s request for benefits, concluding Appellant did not meet her burden of proving that she suffered aggravation of a preexisting back condition as a result of a work related injury or that she suffered a second compensable injury. The district court affirmed. The Supreme Court affirmed, holding that the OAH did not err by failing to find a causal connection between the 2009 workplace incident and Appellant’s delayed back pain. View "Hirsch v. State ex rel. Wyo. Workers' Safety & Comp. Div." on Justia Law

In 2009, Appellant suffered injuries to both of his knees in a work-related accident. Appellant filed a request for loss of earning compensation. The Workers’ Compensation Court concluded that, notwithstanding findings of permanent impairment, because no permanent physical restrictions were specifically assigned by an expert for Appellant’s left knee, the court could not perform a loss of earning capacity calculation authorized under the third paragraph of Neb. Rev. Stat. 48-121(3) and that Appellant was thus limited to scheduled member compensation. The Supreme Court reversed, holding that the compensation court erred as a matter of law in concluding that there must be expert opinion of permanent physical restrictions as to each injured member in order to perform a loss of earning capacity calculation under section 48-121(3). Remanded. View "Rodgers v. Neb. State Fair" on Justia Law

Plaintiff sought insurance coverage for gastric lap band surgery. Defendant, a health-care insurer that covered Plaintiff by virtue of Plaintiff’s husband’s employment with the federal government, refused to cover the full cost of the surgery. Plaintiff brought tort and breach of contract claims against Defendant in the Puerto Rico Court of First Instance. Defendant removed the action to the federal district court, asserting, inter alia, that the Federal Employees Health Benefits Act of 1959 (FEHBA) completely preempted Plaintiff’s local-law claims, thus conferring original jurisdiction on the federal court. Defendant then moved to dismiss the case, arguing that the FEHBA demanded exhaustion of administrative remedies. Plaintiff, in the meantime, requested that the district court remand the case to the Court of First Instance. The district court (1) denied Plaintiff’s motion to remand, holding that the FEHBA completely preempted Plaintiff’s claims and, thus, federal jurisdiction attached; and (2) dismissed the action for Plaintiff’s failure to exhaust administrative remedies. The First Circuit Court of Appeals reversed the district court’s judgment of dismissal and its order denying remand, holding that the court erred in concluding that the FEHBA afforded complete preemption. View "Lopez-Munoz v. Triple-S Salud, Inc. " on Justia Law

This case arose from a contract between Roanoke Healthcare Authority (doing business as Randolph Medical Center) and Batson-Cook Company, a general contractor, to renovate the medical center, located in Roanoke. Batson-Cook received written notice from Roanoke Healthcare that work on the renovation project had been suspended. Batson-Cook notified one of its subcontractors, Hardy, of the suspension and stated that "[t]he contract has been suspended by [Roanoke Healthcare] through no fault of Batson-Cook ... or its subcontractors. [Roanoke Healthcare] is currently out of funding and has subsequently closed the facility while seeking a buyer." Liberty Mutual, the project's insurer, alleged in its answer that Roanoke Healthcare failed to pay Batson-Cook $241,940.51 for work performed pursuant to the contract. Batson-Cook sent Hardy a change order the change order deducted from the subcontract the $147,000 in equipment and materials another subcontractor Hardy hired, Johnson Controls, Inc. (JCI), had furnished for the renovation project and for which it has not received payment. JCI notified Liberty Mutual, Roanoke Healthcare, Batson-Cook, and Hardy by certified letters of its claim on a payment bond. The letters identified Batson-Cook as the general contractor and Hardy as the debtor. Liberty Mutual denied the claim. JCI sued Liberty Mutual, alleging JCI was entitled to payment on the payment bond Liberty Mutual had issued to Batson-Cook. Upon review, the Supreme Court concluded JCI was a proper claimant on the payment bond. Therefore, the circuit court erred in entering a summary judgment in favor of Liberty Mutual and denying JCI's summary judgment motion. View "Johnson Controls, Inc. v. Liberty Mutual Insurance Company " on Justia Law

Between 1996 and 2003, Appellant filed several workers’ compensation claims, which were allowed for certain conditions. Appellant subsequently filed two applications for permanent-total-disability compensation. The Industrial Commission denied the applications, relying in part on the report of Dr. Lee Howard, a psychologist, who determined that Appellant could perform work without significant limitations. Appellant filed a complaint for a writ of mandamus, arguing that the Commission abused its discretion when it relied on Dr. Howard’s report because the report was stale. The court of appeals denied the writ, determining that Dr. Howard’s report was relevant evidence. The Supreme Court affirmed, holding that the Commission did not abuse its discretion when it relied on Dr. Howard’s report in denying permanent-total-disability compensation. View "State ex rel. Bailey v. Indus. Comm'n" on Justia Law