Justia Government & Administrative Law Opinion Summaries
Articles Posted in Insurance Law
Coffey v. Mid Seven Transp. Co.
Employee, who was injured while working for Employer, sought enforcement of an arbitration award he received from the workers' compensation commissioner against Employer and Employer's insurer. Employee requested the district court to determine the amount Employer and its insurer (collectively, Appellees) owed him under the arbitration award in light of Employee's claim that Appellees failed to pay all of the medical benefits, mileage reimbursements, and interest due under the arbitration decision. Appellees claimed a credit against any amount they owed Employee due to his third-party settlements. After a hearing, the district court declined to answer the issues raised by the parties and declined to determine the amount still owed to Employee under the arbitration decision, concluding that addressing the issues in Employee's petition required the district court to exceed its authority. The Supreme Court reversed and remanded to the district court for the court to remand the matter to the commissioner with directions to decide the issues Employee raised in his petition for judgment. View "Coffey v. Mid Seven Transp. Co." on Justia Law
Arrants v. Home Depot
Claimant-appellant Stephen Arrants appealed a superior court order that affirmed an Industrial Accident Board's order granting employer-appellee Home Depot's petition to terminate appellant's total disability benefits. Appellant raised two claims on appeal: (1) the Board's decision was in error because all experts agreed that his condition had not improved since the 2007 Board finding of total disability; and (2) the Board's decision was not supported by competent evidence in the record. Upon review, the Supreme Court concluded that both arguments were without merit, and affirmed the superior court.
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Smith v. Mark Chrisman Trucking, Inc.
Employee suffered an accident arising out of the course of his employment on October 23, 2007. Employee filed a workers' compensation action on February 28, 2012 against Employer, seeking relief under an amended version of Neb. Rev. Stat. 48-121(3), alleging that he was entitled to benefits calculated on the basis of the loss of earning capacity pursuant to this amendment. The Legislature specified that the operative date of the amendment to the statute was January 1, 2008. The workers' compensation court granted summary judgment for Employer, concluding that the amendment was substantive rather than procedural and that because Employee's accident and injuries occurred prior to the operative date of the amendment, Employee could not recover for a loss of earning capacity under the amendment. The Supreme Court affirmed, holding that because the amendment to section 48-121(3) did not apply to Employee's action, he could not recover for an alleged loss of earning capacity on that basis. View "Smith v. Mark Chrisman Trucking, Inc." on Justia Law
City of Las Vegas v. Evans
Respondent, a firefighter, filed a claim for workers' compensation benefits after he was diagnosed with cancer within four years from the commencement of his employment with the City. Respondent asserted that his cancer was a compensable occupational disease that resulted from his work as a firefighter. The City denied the claim for benefits. A hearing officer with the Department of Administration Hearings Division affirmed the denial of the claim because Defendant had not been employed as a firefighter for five years pursuant to Nev. Rev. Stat. 617.453. An appeals officer reversed, holding that Defendant satisfied Nev. Rev. Stat. 617.440's requirements for proving a compensable occupational disease. The district court affirmed. The Supreme Court affirmed, holding (1) the district court did not err in upholding the appeals officer's determination that a firefighter such as Evans, who fails to qualify for section 617.453's rebuttable presumption can still seek workers' compensation benefits pursuant to section 617.440 by proving that his cancer is an occupational disease that arose out of his employment; and (2) the appeals officer correctly found Respondent's cancer was a compensable occupational disease. View "City of Las Vegas v. Evans" on Justia Law
Pack v. Little Rock Convention Ctr. & Visitors Bureau
Appellant was employed by Employer when he suffered a compensable work-related brain injury. Appellant, who was permanently and totally disabled, filed a workers' compensation claim seeking benefits and also requested benefits for the nursing care services his mother was providing. The workers' compensation commission (Commission) found Appellant's injury was compensable but denied the requested nursing service benefits. Appellant subsequently made a second request for additional benefits in the form of nursing services at Timber Ridge Ranch, an assisted living facility. The Commission denied Appellant benefits, finding that the services at Timber Ridge were not nursing services as defined by the law. The court of appeals affirmed. The Supreme Court reversed, holding that the Commission's findings and conclusions were not supported by substantial evidence and that the services provided at Timber Ridge qualified as nursing services under the applicable statutes. Remanded. View "Pack v. Little Rock Convention Ctr. & Visitors Bureau" on Justia Law
State ex rel. Coleman v. Schwartz
Appellant was injured during the course and scope of his employment. Appellant filed a motion for temporary total disability compensation, which a hearing officer granted. The Industrial Commission later terminated temporary total disability compensation based on the report of doctor who stated that the allowed conditions in Appellant's workers' compensation claim had reached maximum medical improvement. Appellant filed a complaint in mandamus, alleging that the Commission acted contrary to law when it relied on the report of the doctor. The court of appeals denied the writ, concluding that the doctor's report constituted some evidence upon which the Commission could rely. The Supreme Court affirmed, holding that the doctor's report was sufficiently reliable to constitute some evidence to support the Commission's decision. View "State ex rel. Coleman v. Schwartz" on Justia Law
U.S. Dep’t of Veterans Affairs v. Boresi
Veteran filed a claim for workers' compensation benefits alleging that he sustained an injury during the course of his employment with Employer. Veteran received care and treatment for that injury at a United States Department of Veterans Affairs (VA) medical facility, which Employer did not authorize. The VA petitioned for a writ to compel the chief ALJ to allow the VA's intervention in the proceeding, claiming entitlement to intervene as a matter of right under 38 U.S.C. 1729 and the U.S. Constitution's supremacy clause. The circuit court denied the VA's petition. The Supreme Court reversed and issued a permanent writ of mandamus, holding that section 1729 and the supremacy clause gave the VA the right to intervene in Veteran's workers' compensation claim to assert its claim for recovery of health care provided to him. View "U.S. Dep't of Veterans Affairs v. Boresi" on Justia Law
Mazzone v. Texas Roadhouse
Appellant Matthew Mazzone appealed an Idaho Industrial Commission's order that denied him workers' compensation for psychological injuries allegedly arising as a result of an industrial accident wherein appellant tripped and fell into a deep fat fryer while employed at Texas Roadhouse. Appellant contended the Commission’s order was not based on substantial and competent evidence. During his time at a Burn Center, appellant was twice noted in medical records to be exhibiting exaggerated pain behaviors. At one point during his treatment, appellant stayed at a hotel in Salt Lake City so as to receive follow-up care. In a follow-up at the Burn Center, appellant had quit "cold turkey" his opioid medication, at which point he began to experience nightmares and flashbacks. Appellant was referred to an Idaho psychiatrist. The Idaho psychiatrist clarified that appellant's nightmares and anxiety were related to returning to work; appellant was assessed a GAF score of 55/85, the same assessment he had before the industrial accident. Three months after accident, appellant returned to work, but he was allegedly so overwhelmed that he asked to transfer to another Texas Roadhouse location in Massachusetts because he was nervous, sick, worried, and nauseous working at the site of the accident. Subsequent years following the accident, appellant sought additional counseling and medical treatment. He was eventually diagnosed with post-traumatic stress disorder (PTSD) and general anxiety and memory loss. Appellant then filed a complaint against Texas Roadhouse and its insurer. Upon review, the Supreme Court concluded that appellant did not suffer a compensable psychological injury, and that the evidence presented was substantial enough to support the Industrial Commission's order.
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Ky. Uninsured Employers’ Fund v. Hoskins
Employee sustained injuries in the course of his employment with Four Star Transportation. Despite being hired by Four Star, Employee was initially considered an employee of Better Integrated Services. Better Integrated leased Employee to Beacon Enterprises, which then leased Employee to Four Star. Beacon had an insurance policy with Kentucky Employers' Mutual Insurance (KEMI). An ALJ determined (1) Employee's injury entitled him to benefits and a permanent partial disability award, and (2) KEMI's policy covered Employee's injury. The Workers' Compensation Board reversed, finding Employee was not covered under the KEMI policy due to the fact he was unaware that Four Star was leasing him from different entities, including Beacon. The court of appeals affirmed. The Uninsured Employers' Fund appealed. The Supreme Court affirmed, holding (1) Employee could not be considered Beacon's employee because he did not enter into a contract for hire with Beacon; (2) the Board did not act arbitrarily in finding that the ALJ's opinion was not supported by substantial evidence; and (3) the Board and lower court's decision was not based on Better Integrated and Beacon's failure to comply with Ky. Rev. Stat. 342.615. View "Ky. Uninsured Employers' Fund v. Hoskins" on Justia Law
Commonwealth v. Allen
Employee filed a claim for workers' compensation, alleging that he sustained injuries while working for Restaurant. Employee gained employment with Restaurant through a staff leasing company (Company). Employee agreed to a settlement of his claim. Later, Employee moved to re-open the workers' compensation award and to join the Uninsured Employers' Fund (UEF) as a party, asserting that Restaurant and Company were no longer available to pay for his continuing medical expenses. The ALJ subsequently joined the UEF. The ALJ found Employee's condition to have worsened so he was totally disabled and that the UEF was responsible for all benefits for which Employee was entitled. The Workers' Compensation Board vacated the portion of the ALJ's opinion regarding the amount of benefits Employee would receive and otherwise affirmed. The Supreme Court affirmed, holding (1) Employee's claim was properly reopened and the UEF joined as a party; (2) Employee presented sufficient evidence to show that his condition had worsened since the entry of his original workers' compensation award; and (3) although the original settlement agreement only listed Employee's lower back injury as compensable, Employee was not barred from raising a claim for his thoracic spine injury upon reopening. View "Commonwealth v. Allen" on Justia Law