Justia Government & Administrative Law Opinion Summaries

Articles Posted in Insurance Law
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Employee, an undocumented worker, was injured while working for Employer. Employee was awarded temporary total disability benefits. Employer later petitioned the workers' compensation court to discontinue the temporary benefits. While the action was pending, Employee returned to his county of origin. The compensation court concluded (1) Employer's obligation to pay Employee temporary total disability should cease because Employee had reached maximum medical improvement; and (2) there was no credible evidence which could be used to determine Employee's loss of earning capacity in his new community, and therefore, Employee's request for benefits for his claim of permanent impairment and loss of earning capacity was denied. The Supreme Court (1) affirmed the compensation court's conclusion that Employee had reached maximum medical improvement; but (2) reversed the denial of Employee's claim of permanent impairment and loss of earning capacity because where no credible data exists for the community to which the employee has relocated, the community where the injury occurred can serve as the hub community. Remanded. View "Visoso v. Cargill Meat Solutions" on Justia Law

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This case was an appeal to challenge the administrative rule adopted by the Industrial Commission in 1994 that regulates the amount of attorney fees allowable for attorneys representing claimants in worker's compensation proceedings. Upon review of the facts of this case, the Supreme Court upheld the validity of the rule. View "Seiniger Law v. Industrial Commission" on Justia Law

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While in the course and scope of her employment, Appellant suffered and injury and incurred medical expenses. The Workers' Compensation Court ordered Appellant's employer (Employer) to pay the expenses. Employer made payments directly to Appellant's health care providers within thirty days of the court's order. Because she was not personally reimbursed for the medical expenses within thirty days, Appellant sought a waiting-time penalty, attorney fees, and interest pursuant to Neb. Rev. Stat. 48-125. The Workers' Compensation Court denied relief, and Appellant appealed. The Supreme Court affirmed, holding (1) because section 48-125 did not apply to Appellant's request for a waiting-time penalty, the compensation court did not err in overruling her motion for a waiting-time penalty; and (2) Employer in this case was not subject to liability for attorney fees, and therefore, Appellant was not entitled to an award of interest. View "VanKirk v. Cent. Cmty. Coll." on Justia Law

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The Workers Compensation Board awarded Plaintiff benefits under the Workers Compensation Act for an injury he sustained while operating a go-cart at an event sponsored by his employer (Employer). Employer and its insurance carrier (Insurer) appealed the award, claiming that Plaintiff's injuries were not compensable because they were sustained during a recreational or social event that Plaintiff was not required to attend. The court of appeals affirmed the Board. The Supreme Court reversed, holding that the Board applied the incorrect legal standard in determining whether Plaintiff's injuries arose out of and in the course of his employment, and the error was not harmless. Remanded to the Board to make the determination based on the statutory criteria of Kan. Stat. Ann. 44-508(f). View "Douglas v. Ad Astra Info. Sys., LLC" on Justia Law

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CDA Dairy Queen, Inc. and Discovery Care Centre, LLC of Salmon (collectively, Dairy Queen) filed a class action against the Idaho State Insurance Fund (SIF) seeking a declaratory judgment that SIF violated Idaho Code section 72-915 by failing to distribute premium rate readjustments on a pro rata basis. The district court granted SIF's motion for summary judgment, finding that the Idaho Legislature's retroactive repeal of section 72-915 was constitutional and that Dairy Queen's action was thereby barred. Dairy Queen appealed and argued that the retroactive repeal violated article I, section 16 of the Idaho Constitution. Dairy Queen the Supreme Court to reverse the decision of the district court and remand for further proceedings consistent with the determination that the retroactive repeal was unconstitutional. Upon review, the Supreme Court agreed with Dairy Queen and reversed. View "CDA Dairy Queen, Inc. v. State Insurance Fund" on Justia Law

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A bail bond company challenged the district court's decision affirming an order of the Director of the Idaho Department of Insurance. That order, which was based on I.C. 41-1042, prohibited a bail bond company from contemporaneously writing a bail bond and contracting with a client to indemnify the company for the cost of apprehending a bail jumper. It also prohibited a bail bond company from later requiring a client to agree to such indemnification as a condition of the bond's continuing validity. While the proceedings before the district court were pending, the Director promulgated I.D.A.P.A. 18.01.04.016.02, which by rule expressed the Final Order. Upon review of the applicable statutory authority and the trial court record below, the Supreme Court concluded that: (1) the plain text of I.C. 41-1042 permits a bail bond company to contemporaneously write a bail bond and contract with a client to indemnify the company for the cost of apprehending a defendant who jumps bail; and (2) the Director's interpretation of I.C. 41-1042 prejudiced PetitionerTwo Jinn's substantial rights. The Court reversed the district court's memorandum decision and remanded the case for further review. View "Two Jinn, Inc. v. Idaho Dept of Insurance" on Justia Law

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CDA Dairy Queen, Inc. and Discovery Care Centre, LLC of Salmon (collectively, Dairy Queen) filed a class action against the Idaho State Insurance Fund (SIF) seeking a declaratory judgment that SIF violated Idaho Code section 72-915 by failing to distribute premium rate readjustments on a pro rata basis. The district court granted SIF's motion for summary judgment, finding that the Idaho Legislature's retroactive repeal of section 72-915 was constitutional and that Dairy Queen's action was thereby barred. Dairy Queen appealed and argued that the retroactive repeal violated article I, section 16 of the Idaho Constitution. Dairy Queen the Supreme Court to reverse the decision of the district court and remand for further proceedings consistent with the determination that the retroactive repeal was unconstitutional. Upon review, the Supreme Court agreed with Dairy Queen and reversed. View "CDA Dairy Queen, Inc. v. State Insurance Fund" on Justia Law

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In a dispute over insurance coverage between the plaintiff-appellee City of Choctaw, and its insurer defendant-appellant Oklahoma Municipal Assurance Group (OMAG), the trial court granted a motion for summary judgment for Choctaw. Both in the trial court and on appeal, the city argued that OMAG should cover an inverse condemnation judgment entered against the city in a suit brought by a landowner, even though the city admitted it obtained coverage from OMAG for liability imposed under the Governmental Tort Claims Act (GTCA). The OMAG appealed summary judgment granted in favor of the Choctaw on a claim which had been denied. Upon review, the Supreme Court concluded that the summary judgment record disclosed neither a legal nor factual basis for applying any theory of estoppel to make OMAG liable for the inverse condemnation judgment. Accordingly, the Court reversed the summary judgment in favor of the city, and remanded the case with directions to enter summary judgment in favor of OMAG. View "City of Choctaw v. Oklahoma Municipal Assurance Group " on Justia Law

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Law Firm represented Employee in a workers' compensation action against Employee's Employer. After a trial, Employee was awarded compensation, including medical expenses incurred by Employee with Medical Clinic. Employer paid sums owed to Medical Clinic pursuant to the award. Law Firm subsequently filed a complaint against Medical Clinic, seeking attorney fees under the common fund doctrine. Following a hearing, the district court dismissed Law Firm's complaint, concluding that Law Firm was not permitted to recover attorney fees from Medical Clinic under the doctrine. The Supreme Court affirmed, holding (1) the plain language of Neb. Rev. Stat. 48-125(2)(a) prohibits the charging of attorney fees against medical providers in workers' compensation court; and (2) the common fund doctrine may not be applied in this case to allow Law Firm a fee from Medical Clinic from the district court when it would not be entitled to such a fee from the workers' compensation court. View "Walentine, O'Toole, McQuillan & Gordon, LLP v. Midwest Neurosurgery, PC" on Justia Law

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Plaintiff was a partner in a medical practice where she served as a staff anesthesiologist. When Plaintiff's dependence on opioids came to light, her employer had in force a group employee benefit plan, underwritten and administered by Union Security Insurance Company & Management Company for Merrimack Anesthesia Associates Long Term Disability Plan (USIC), which included long-term disability (LTD) benefits. When Plaintiff applied for those benefits, USIC refused to pay benefits past the point when Plaintiff was discharged from a treatment center, finding that Plaintiff's risk for relapse was not the same as a current disability. Plaintiff brought suit in the federal district court. The district court ultimately awarded Plaintiff LTD benefits for the maximum time available under the plan, concluding that categorically excluding the risk of drug abuse relapse was an unreasonable interpretation of the plan. The First Circuit Court of Appeals affirmed, holding that, in an addiction context, a risk of relapse can be so significant as to constitute a current disability. View "Colby v. Union Sec. Ins. Co." on Justia Law