Justia Government & Administrative Law Opinion Summaries

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

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

Booker T. Washington, Jr. filed a claim against Porocel Corporation with the Workers' Compensation Commission, alleging exposure to asbestos and silica dust resulting in lung disease and silicosis. An ALJ found Washington's claim was barred by the statute of limitations. Washington subsequently filed suit against Porocel, alleging, inter alia, negligence and breach of implied warranty. Porocel moved to dismiss the complaint, contending that the Commission had exclusive jurisdiction of the claims alleged and that the Arkansas Workers Compensation Act (Act) was Washington's exclusive remedy. The circuit court denied Porocel's motion to dismiss, concluding that Washington's occupational disease was not one for which the Act provided coverage. Porocel then filed a petition for a writ of prohibition to prevent the circuit court from exercising jurisdiction over Washington's complaint. The Supreme Court granted the petition, holding that Washington's claim was covered by the Act. View "Porocel Corp. v. Circuit Court" on Justia Law

"At its most basic level, this case presents a policy dispute: whose policy choice concerning health insurance premiums for State employees controls—the General Assembly's or the Budget and Control Board's?" The issue before the Supreme Court centered on "maintaining and enforcing the constitutional and statutory framework through which such issues must be resolved. " Upon review of the arguments of the parties and the applicable case law, the Supreme Court found that the General Assembly had and exercised the power to determine the contribution rates of enrollees for the State's health insurance plan in 2013. The Court held that the Budget and Control Board violated the separation of powers provision by substituting its own policy for that of the General Assembly, entered judgment for the petitioners, and directed the Board to use the appropriated funds for premium increases and return the premium increases previously collected from enrollees. View "Hampton v. Haley" on Justia Law

Appellant, a medical doctor, challenged the partial denial of personal injury protection benefits after treating a patient insured by Appellee. While Appellant's request for an administrative hearing was pending in the Insurance Division of the State Department of Commerce and Consumer Affairs, the patient's available benefits under her policy were exhausted on account of payments to Appellant and other medical providers. Because of the exhaustion, the Insurance Division dismissed Appellant's claim. The circuit court and intermediate court of appeals (ICA) affirmed. The circuit court also denied Appellant's request for attorney's fees and costs under Haw. Rev. Stat. 431:10C-211(a), which allows fees and costs to be awarded even when a party does not prevail on its claim for benefits, finding Appellant's pursuit of the benefits to be unreasonable. The ICA affirmed. Appellant appealed the denial of attorney's fees. The Supreme Court vacated the ICA's judgment and the circuit court's final judgment, holding that the circuit court and ICA erred in concluding that Appellant's claim was unreasonable due to exhaustion of benefits where Plaintiff had made his claim prior to that exhaustion. Remanded. View "Jou v. Schmidt" on Justia Law

The issue before the Supreme Court in this case concerned the scope of Clackamas County's contractual obligation to provide health insurance benefits to command officer retirees of the County Sheriff's Office. A contract between the county and command officers, including Plaintiff Neil James, required the county to use a particular fund to pay for a certain level of benefits to command officers after they retired. The contract added that the obligation to pay benefits was "contingent upon the availability of sufficient funding in said fund to pay for the same." After plaintiff retired, the cost of insurance premiums increased to the point where the fund was and would for the foreseeable future continue to be insufficient to pay for the benefits required. The county entered into a new contract with certain union employees to provide lesser benefits from a more stable fund, and plaintiff (a retired officer, not a union employee) also was provided those lesser benefits. Plaintiff brought an action against the county, asserting breach of contract. He maintained that the first contract required the county to pay him full health insurance benefits and argued that the contingency provision did not apply because of the creation of the new fund, which had sufficient money to pay for those benefits. The trial court entered judgment in favor of plaintiff, but the Court of Appeals reversed. Upon review, the Supreme Court concluded that the new fund was the product of a contract that was separate and independent from the earlier contract. Because the prior fund was insufficient to provide the agreed level of benefits, the county did not breach its contractual obligation to provide that level of benefits. Accordingly, the Court affirmed the appellate court's decision. View "James v. Clackamas County" on Justia Law

In 2002, Employee suffered injuries in a work-related accident and was rendered a paraplegic. Employer and its insurer accepted liability for Employee's injuries and paid various workers' compensation benefits. In 2010, Employee filed a medical request seeing payment for the installation of a ceiling-mounted motorized lift system. A compensation judge (1) determined that the cost of making the structural changes was compensable under Minn. Stat. 176.135 because those changes were necessary to provide Employee with reasonable and necessary medical treatment, and (2) ordered Employer and its insurer to pay for the modifications in their entirety. The workers' compensation court of appeals reversed, concluding that the changes to Employee's home necessary to permit installation of the lift system constituted "alteration or remodeling" of Employee's home and that Employer's liability was therefore limited by Minn. Stat. 176.137. The Supreme Court affirmed, holding that the cost of the structural modifications to Employee's residence that were necessary to permit the ceiling-mounted track system to be installed were "alteration or remodeling" costs subject to section 176.137 and were not costs of medical treatment. View "Washek v. New Dimensions Home Health & State Fund Mut. Ins. Co. " on Justia Law

ANI, a risk retention group, filed suit seeking declaratory and injunctive relief against the Commissioner and the Division of Insurance under 42 U.S.C. 1983. ANI claimed that an order of the Commissioner violated the Liability Risk Retention Act (LRRA), 15 U.S.C. 3902(a)(1). The court held that the Commissioner's Order, which barred ANI from writing first dollar liability insurance policies in Nevada, was preempted by the LRRA. Therefore, the court affirmed the district court's entry of declaratory and injunctive relief in favor of ANI. However, the LRRA did not confer a right to be free from state law that could be enforced under 42 U.S.C. 1983, making fees under 42 U.S.C. 1988 unavailable. Thus, the court vacated the fee award. Finally, the court remanded so that the district court could enter a new summary judgment order consistent with this opinion. View "Alliance of Nonprofits for Ins. v. Kipper, et al" on Justia Law

An employee filed an affidavit of readiness for hearing in her workers' compensation case approximately four years after her employer filed a controversion of her written workers' compensation claim. The employer petitioned to dismiss her claim based on the statutory deadline for a hearing request. After a hearing, the Alaska Workers' Compensation Board dismissed her claim, and the Alaska Workers' Compensation Appeals Commission affirmed the Board's decision. Because the employee did not file a timely request for a hearing and was not excused from doing so, the Supreme Court affirmed the Commission's decision. View "Pruitt v. Providence Extended Care" on Justia Law

Claimant Dorothy Robinson was a police officer for the City of Pittsburgh. In 1997, she sustained a work-related injury, and the City placed her on light-duty. In 2001, while traveling for treatment of her injury, Claimant was involved in an automobile accident in which she sustained new injuries. After the accident, Claimant did not return to her light-duty position nor was she offered any other light-duty work. In late 2004, Claimant received a disability pension. In connection with Claimant’s claim of entitlement to a disability pension, she was examined by three physicians who certified that Claimant was unable to perform her pre-injury job as a police officer. Nearly three years later, an independent medical examiner concluded that although Claimant was not fit to perform her prior job as a police officer, she could perform modified-duty work. The City filed a Petition to Suspend Compensation Benefits, asserting that Claimant was capable of working, "but has voluntarily removed herself from the work force as she has not looked for or sought employment in the general labor market." Claimant filed a response, denying the averments of the suspension petition and asserting that she remained attached to the workforce and had registered for work with the Pennsylvania Job Center. She further claimed that she was not presently working only because of the unavailability of work and because the City had eliminated her light-duty position. The Workers' Compensation Judge denied the suspension petition, concluding that Claimant had not voluntarily removed herself from the workforce. The issue before the Supreme Court in this appeal concerned the assignment of the burden of proof when the employer sought to modify or suspend a claimant's benefits on the basis that the claimant had retired. The Commonwealth Court plurality devised a "totality of the circumstances" test and concluded that the City failed to show that the injured worker had voluntarily withdrawn from the workforce. The City appealed, but the Supreme Court concurred with the Commonwealth Court and affirmed. View "City of Pittsburgh v. WCAB (Robinson)" on Justia Law