Justia Government & Administrative Law Opinion Summaries

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

Robert Sheppard was injured while working for Employer. After Sheppard retired, he filed an application for permanent-total-disability (PTD) compensation, which a staff hearing officer granted. Employer filed a request for reconsideration on the basis that the staff hearing officer’s order contained mistakes of fact and law. After a hearing, the Industrial Commission issued an order confirming that the staff hearing officer’s order contained a clear mistake of law and denying the underlying request for PTD compensation. Sheppard filed a complaint for a writ of mandamus alleging that the Commission abused its discretion when it exercised continuing jurisdiction and denied PTD compensation. The court of appeals denied the writ, concluding (1) the staff hearing officer’s mistake of law was sufficient for the Commission to invoke its continuing jurisdiction; and (2) once the Commission properly invoked its continuing jurisdiction, it had authority to reconsider the issue of PTD compensation. The Supreme Court affirmed, holding (1) the staff hearing officer made a mistake of law justifying the exercise of continuing jurisdiction; and (2) the Commission’s continuing jurisdiction vested it with authority to issue a new order denying PTD compensation. View "State ex rel. Sheppard v. Indus. Comm'n" on Justia Law

Robert Corlew was an employee of Honda of America Manufacturing, Inc. when he was injured while working. Honda’s long-term-disability insurance carrier eventually determined that Corlew was not eligible for ongoing disability benefits because he was capable of gainful employment outside of Honda. Corlew subsequently retired because there was no position available at Honda. One year later, Corlew underwent surgery on his wrist. The Industrial Commission awarded temporary-total-disability (TTD) compensation to be paid during Corlew’s postsurgical recovery, concluding that Corlew had not voluntarily retired or abandoned the workforce. The court of appeals denied Honda’s request for a writ of mandamus, concluding that Corlew’s retirement was due to his industrial injury, and thus was involuntary, and that there was no evidence that Corlew had abandoned the entire workforce. The Supreme Court affirmed, holding that Corlew was eligible for TTD compensation even though he suffered no economic loss that could be directly attributed to his industrial injury. View "State ex rel. Honda of Am. Mfg., Inc. v. Indus. Comm'n" on Justia Law

The question before the Supreme Court was whether La. R.S. 23:1203.1 applied to requests for medical treatment and/or disputes arising out of requests for medical treatment in cases in which the compensable accident or injury occurred prior to the effective date of the medical treatment schedule. The Office of Workers’ Compensation (OWC) ruled that the medical treatment schedule applied to all requests for medical treatment submitted after its effective date, regardless of the date of injury or accident. The court of appeal reversed, holding that La. R.S. 23:1203.1 was substantive in nature and could not be applied retroactively to rights acquired by a claimant whose work-related accident antedated the promulgation of the medical treatment schedule. The Supreme Court disagreed with the conclusion of the court of appeal and found that La. R.S. 23:1203.1 was a procedural statute and, thus, did not operate retroactively to divest a claimant of vested rights. As a result, the statute applied to all requests for medical treatment and/or all disputes emanating from requests for medical treatment after the effective date of the medical treatment schedule, regardless of the date of the work-related injury or accident. View "Church Mutual Insurance Co. v. Dardar" on Justia Law

The Supreme Court granted certiorari in this case to consider whether La. R.S. 23:1203.1 applied to a dispute arising out of a request for medical treatment where the request for treatment was submitted after the effective date of the statute and the medical treatment schedule, but the compensable accident and injury that necessitated the request occurred prior to that date. Both the Office of Workers’ Compensation (OWC) and the court of appeal ruled that La. R.S. 23:1203.1 applied to all requests for medical treatment submitted after the statute’s effective date, regardless of the date of accident and injury. Finding no reversible error, the Supreme Court affirmed. View "Cook v. Family Care Services, Inc." on Justia Law

The issue this case presented to the Supreme Court centered on whether the Patient’s Compensation Fund (PCF) could be bound by summary judgment rendered solely against a defendant physician in the underlying malpractice proceeding on the issue of causation. Plaintiffs, Majdi Khammash and his wife and children, filed suit against various defendants, including Dr. Gray Barrow. After approving plaintiff’s settlement with Dr. Barrow for the $100,000 Medical Malpractice Act (MMA) cap, the District Court granted partial summary judgment, finding plaintiff’s injuries were caused by the fault of Dr. Barrow. The case then proceeded to jury trial against the PCF for the remaining $400,000 MMA cap. The jury returned a verdict in the PCF’s favor, finding Dr. Barrow’s malpractice did not cause plaintiff damage. The Court of Appeal reversed, finding as a result of the partial summary judgment, the issue of causation was not properly before the jury, and remanded for a new trial on damages only. The Supreme Court granted certiorari to address the extent, if any, the PCF was bound by the partial summary judgment on causation. The Court found, in accordance with La. Rev. Stat. 40:1299.44(C)(5)(a) and its holding in "Graham v. Willis-Knighton Med. Ctr.," (699 So.2d 365), the partial summary judgment against Dr. Barrow on the issue of causation was not binding on the PCF in plaintiff’s claim for damages exceeding the $100,000 MMA cap. Furthermore, the Court found no manifest error in the jury’s factual findings on causation. The Court therefore reversed the judgment of the Court of Appeal and reinstated the District Court’s judgment in its entirety. View "Khammash v. Clark" on Justia Law

This case arose out of dispute over the administration of a workers’ compensation self-insurance plan (“Plan”) administered by Herkimer County. Dozens of municipalities participated in the Plan, including the Village of Herkimer. In 2005, the County passed a resolution to terminate the plan. To ensure funding for outstanding workers’ compensation claims, the County created an Abandonment Plan that allowed municipalities to withdraw from the plan and pay a lump sum withdrawal fee. Several of the participating municipalities, including the Village, filed an action challenging the Plan and Abandonment Plan based on alleged mismanagement by the County. The County counterclaimed for breach of contract, seeking to recover the withdrawal liability. The County prevailed on summary judgment as to the liability on its counterclaim for breach of contract against the Village. After a trial on damages, the jury awarded the full amount of damages sought by the County against the Village. The Appellate Division affirmed the damages award. The Court of Appeals affirmed as modified, holding that the fee for the Village’s withdrawal from the Plan reflected benefits to be paid in the future and therefore should have been discounted to its current value as of the date it was due. View "Village of Ilion v. County of Herkimer" on Justia Law