Justia Government & Administrative Law Opinion Summaries

Articles Posted in Insurance Law
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Harman-Bergstedt, Inc. appealed the appellate court's decision to reverse an Industrial Claim Appeals Office decision disallowing respondent Elaine Loofbourrow's award of temporary disability benefits. The ICAO concluded that once respondent's treating physician placed her at maximum medical improvement, temporary total disability benefits could not be awarded for the injury for which she was initially treated. The appellate court concluded that under the circumstances of this case, such an independent medical exam was not a prerequisite to temporary total disability benefits. After its review of this case, the Supreme Court concluded the appellate court was correct in its decision: because a determination of maximum medical improvement has no statutory significance with regard to injuries resulting in loss of no more than three days (or shifts) of work time, respondent's award of temporary total disability benefits was not barred by her failure to first seek a division-sponsored independent medical examination. View "Harman-Bergstedt, Inc. v. Loofbourrow" on Justia Law

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Appellants are five farmers who planted corn on newly broken, non-irrigated acreage in Baca County, Colorado, in the spring of 2008. Appellee Federal Crop Insurance Corporation denied federal crop insurance coverage for corn that Appellants planted, determining that coverage should have been denied because Appellants failed to follow good farming practices by planting on this newly broken land without first allowing a fallow period. After they each received an unfavorable good farming practices determination, Appellants filed suit, arguing the agency acted arbitrarily or capriciously in denying federal crop insurance coverage. Finding that the agency did not act arbitrarily or capriciously, the Tenth Circuit affirmed the district court and agency's decision. View "Jagers v. Federal Crop Insurance Corp" on Justia Law

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Respondents The Local Government Center, Inc. (LGC), Local Government Center Real Estate, Inc., Local Government Center Health Trust, LLC, Local Government Center Property-Liability Trust, LLC, Health Trust, Inc., New Hampshire Municipal Association Property-Liability Trust, Inc., LGC-HT, LLC, and Local Government Center Workers' Compensation Trust, LLC, appealed a final order of a presiding officer of petitioner the New Hampshire Bureau of Securities Regulation (Bureau), finding that they violated RSA 5-B:5, I(c) (2013) and required, among other things, HealthTrust to return $33.2 million to its members, P-L Trust to return $3.1 million to its members, and P-L Trust to transfer $17.1 million to HealthTrust. After its review of the matter, the Supreme Court agreed with one of respondents' arguments with respect to the purchase of reinsurance: the presiding officer erred by requiring HealthTrust to purchase it. The Court affirmed the presiding officer in all other respects, and remanded the case for further proceedings on the reinsurance issue. View "Appeal of the Local Government Center, Inc." on Justia Law

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In 1997, the U.S. Department of Commerce determined, under 19 U.S.C. 1673b, that freshwater crawfish tail meat from China was being sold in the U.S. at less than fair value and directed Customs to suspend final computation of duties on such entries and to require a deposit or bond to cover estimated duties. In 2000-2001, New Phoenix made entries of the product. The exporters were subject to “new shipper” review to determine whether they were entitled to antidumping-duty rates distinct from the default rate. Each of five bonds issued by Great American to cover anticipated duties was for $1,219,458 and was signed by Davis and accepted by the government, although the power-of-attorney filed with Customs indicated a limit of $1 million on his authority. Great American later revoked his authority. In 2003, Commerce published final results, finding that the exporter was not entitled to a different rate and sought payment from New Phoenix and Great American. The amount owed is greater than the amounts of the bonds. The trial court granted the government summary judgment, without pre- and post-judgment interest, finding that the government did not timely address those issues. The Federal Circuit affirmed that the bonds were not enforceable beyond Davis’s stated authority and the denial of pre-judgment interest View "United States v. Great Am. Ins. Co" on Justia Law

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Warren Parsons appealed a judgment affirming a Workforce Safety and Insurance Fund ("WSI") decision that denied his claim for workers' compensation benefits. Parsons applied for workers' compensation benefits from WSI, alleging he sustained an injury to his left shoulder and neck while working for Ames Construction. He claimed he developed pain at the base of his neck and into his left shoulder from hitting the seat belt repeatedly while driving the dump truck on rough roads. Parsons argued his cervical spine and left shoulder injuries were "compensable injuries" by law. Upon review, the Supreme Court concluded WSI erred in determining Parsons' injury was not a compensable injury and in denying his claim for benefits. View "Parsons v. WSI" on Justia Law

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Angela Frye filed a workers' compensation claim against her employer alleging that in 2008 she suffered a work-related injury. The administrative law judge (ALJ) awarded Frye benefits related to the injury. In 2009, after the final hearing in the 2008 claim but before the ALJ took that claim under submission or rendered an opinion, Frye allegedly suffered a second work-related injury. In 2010, Frye filed a claim related to the 2009 accident. The ALJ dismissed the 2010 claim, concluding that Frye was required by Ky. Rev. Stat. 342.270(1) to file her claim for benefits related to the 2009 accident and join it to her pending 2008 claim, which she failed to do. The Workers' Compensation Board reversed, concluding that a claim is no longer pending for section 342,270(1) purposes after the date of the final hearing. The court of appeals affirmed. The Supreme Court affirmed, holding that in this case and under these facts, Frye's first injury claim was not pending between the date of the hearing and the date the ALJ rendered his opinion regarding that claim. Remanded. View "Saint Joseph Hosp. v. Frye" on Justia Law

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Plaintiff was injured during the course of his employment when he was struck by a sheet of plywood that fell from a building under construction. Plaintiff received workers' compensation benefits for his injuries and then filed this personal injury action. Thereafter, the insurance carrier for Plaintiff's employer filed a motion to discontinue Plaintiff's workers' compensation benefits. An administrative law judge found Plaintiff had no further causally-related disability and that he had no further need for treatment. The Workers' Compensation Board Panel (Board) affirmed. Subsequently, in this negligence action, Defendants moved for an order estopping Plaintiff from relitigating the issue of causally-related disability. Supreme Court granted the motion. The Appellate Division reversed, concluding that the determination of the Board was one of ultimate fact and thus did not preclude Plaintiff from litigating the issue of his ongoing disability. The Court of Appeals affirmed, holding that Defendants failed to establish that the issue decided in the workers' compensation proceeding was identical to that presented in this negligence action. View "Auqui v. Seven Thirty One Ltd. P'ship" on Justia Law

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Sherry Walker was denied disability benefits by the Public Employees’ Retirement System (PERS). The Circuit Court reversed PERS’s decision. The Court of Appeals reversed the circuit court, reinstating PERS’ denial of benefits. Upon review of the matter, the Supreme Court concluded PERS’ decision to deny Walker’s request for regular disability benefits was unsupported by substantial evidence. Accordingly, the Court reversed part of the appellate court's decision and reversed the Circuit Court's decision, and remanded the case with instructions to enter judgment in Walker’s favor on her regular disability benefits claim. View "Public Employees' Retirement System v. Walker" on Justia Law

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Appellant suffered work-related injuries in 2000 and received workers' compensation benefits until 2004. Appellant filed another first report of injury in 2009 based on the same injuries. Employer denied benefits. Appellant filed a petition for rehearing. The Department of Labor & Regulation, Division of Labor & Management found that S.D. Codified Laws 62-7-35.1 barred Appellant's second claim for workers' compensation benefits because more than three years had passed between the date of the last payment of benefits and the date Appellant filed a written petition for a hearing. The circuit court affirmed. Appellant appealed, arguing section 62-7-35.1 should not apply to this case because his injuries were from cumulative trauma. The Supreme Court affirmed, holding that the cumulative trauma doctrine did not change section 62-7-35.1's application to this case because the cumulative trauma doctrine applies to the date of injury, which is irrelevant to section 62-7-35.1. View "Schuelke v. Belle Fourche Irrigation Dist." on Justia Law

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Employee was injured while working as a truck driver for Employer. Employee's claim was allowed for the injuries. The next year, Employee returned to work. Two days later, Employer terminated Employee for violating written work rules. A staff hearing officer later denied temporary total disability (TTD) compensation, determining that Employee's termination was a voluntary abandonment of employment that barred compensation for TTD. The court of appeals concluded that the Industrial Commission abused its discretion in determining that Employee was ineligible for TTD compensation based upon his termination from Employer and granted mandamus relief to Employee. The Supreme Court (1) reversed, holding that the Commission's order did not meet the standards of State ex rel. Noll v. Indus. Comm'n because the court did not specifically state the evidence relied upon or explain the reason behind its decision that Employee had voluntarily abandoned his employment with Employer; and (2) returned the matter to the Commission to issue a new order stating the evidence relied upon and explaining its reasoning consistent with Noll. View "State ex rel. Cline v. Abke Trucking, Inc." on Justia Law