Justia Government & Administrative Law Opinion Summaries

James Whealon was employed by the Anaconda School District pursuant to a series of employment contracts. Upon retirement, Whealon filed a formal grievance, asserting that, under the terms of his contract, he was entitled to payment of his health insurance premiums by the District until he reached the age of sixty-five. The District denied his claim. The County Superintendent granted summary judgment to the District, holding that the language of the contract was unambiguous and that Whealon was not entitled to the claimed benefits beyond the date of his retirement. The State Superintendent of Public Instruction reversed and remanded for an evidentiary hearing, holding that the language of the contract was ambiguous. The district court reversed and reinstated the County Superintendent's ruling. The Supreme Court affirmed the district court, holding (1) the district court did not err in holding that a county superintendent has authority to grant summary judgment; and (2) the district court did not err in reinstating summary judgment in favor of the district where the language of the agreement was unambiguous and the District was entitled to judgment.

Employee was injured while working for Employer's sheep and wool business, Cestari. Employer failed to maintain workers' compensation insurance for Cestari. Employee filed a workers' compensation claim against Employer and Cestari, as well as a complaint against Employer and Cestari, seeking damages for negligence. The workers' compensation commissioner determined that Employee was entitled to workers' compensation benefits. Finding that Employee had pursued his workers' compensation claim to a final order and that he had a remedy for collection of his workers' compensation award against Cestari and/or the Uninsured Employers' Fund, the circuit court dismissed Employee's civil complaint. The Supreme Court affirmed, holding that Employee had received the recovery he sought under the Workers' Compensation Act, and thus, the circuit court did not err in ruling that Employee could not pursue an action at law against Employer after obtaining a final collectible award of workers' compensation benefits.

This case involved Commonwealth Care, a state-initiated program that provided structured premium assistance for low-income Massachusetts residents. In 2009, the Legislature made certain changes to the eligibility requirements of Commonwealth Care, enacted in a two-part supplemental appropriation for fiscal year 2010. Section 31(a) of the appropriation excluded all aliens who were federally ineligible under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), 8 U.S.C. 1601-1646, from participation in Commonwealth Care. Plaintiffs were individuals who either have been terminated from Commonwealth Care or have been denied eligibility solely as a result of their alienage. The court held that section 31(a) could not pass strict scrutiny and that the discrimination against legal immigrants that its limiting language embodied violated their rights to equal protection under the Massachusetts Constitution.

This case arose from an automobile collision in which a police officer employed by the City of Newman was driving a City police car when it was struck by a motor vehicle owned and operated by the insured, who had $25,000 of motor vehicle liability coverage. The City had a Member Coverage Agreement (Agreement) with the Georgia Interlocal Risk Management Agency (GIRMA), established under OCGA 36-85-1 et seq. The officer subsequently sued the insured in tort and served a copy of the complaint on GIRMA to notify GIRMA that it might be held responsible as an uninsured motorist carrier pursuant to OCGA 33-7-11. The court subsequently granted a writ of certiorari to the court of appeals to consider whether that court properly determined that a municipality's motor vehicle liability coverage secured through an interlocal risk management agency was not statutorily obligated to satisfy the requirements for uninsured and underinsured motorist coverage that were applied to commercial insurance policies and private self-insurance plans. The court held that the district court reached the correct conclusion when it determined that there was no authority for the conclusion that an interlocal risk management program such as that offered by GIRMA must include uninsured motorist coverage pursuant to OCGA 33-7-11. Therefore, the Agreement was limited to its express terms and did not include the underinsured motorist protection that the police officer sought. Accordingly, the judgment was affirmed.

In two consolidated cases, Liberty Mutual Fire Insurance Company denied personal injury protection (PIP) benefits to Chung Ahn and Kee Kim (collectively, Insureds) for treatments after motor vehicle accidents. Insureds each sought administrative reviews with the Insurance Division of the Department of Commerce and Consumer Affairs (DCCA). The DCCA granted summary judgment to Liberty Mutual based on the holding in Wilson v. AIG Hawaii Insurance Company, which stated that unless an insurer's non-payment of PIP benefits jeopardizes an insured's ability to reach the minimum amount of medical expenses required to file a tort lawsuit, insureds are not real parties in interest allowed to pursue lawsuits seeking payment of PIP benefits to providers. The circuit court reversed, concluding that Act 198 of 2006 had legislatively overruled Wilson. The intermediate court of appeals (ICA) upheld the circuit court. On appeal, the Supreme Court (1) overruled Wilson, holding that insureds are real parties in interest in actions against insurers regarding PIP benefits; and (2) vacated the ICA and circuit court judgments because at the time of judgment, Act 198 of 2006 was not retrospective, and the real party in interest holding of Wilson was still in effect. Remanded.

Defendant-Appellant Alan Tukes appealed his federal conviction for bank robbery, arguing that the governmentâs evidence was insufficient to prove that the bank was insured by the Federal Deposit Insurance Corporation (âFDICâ) at the time of the crime. At trial, a prosecutor asked the bankâs branch manager: âNow, the Compass Bank, is that a bank that is federally insured by the [FDIC]?â She responded: âYes, it is.â When asked whether the bank âhasâ any documentation proving its insured status, she replied: âYes. We have a certificate.â When asked whether the certificate âhangsâ in the branch, the manager replied in the affirmative. The district court admitted the certificate, dated November 8, 1993, into evidence. The government offered no additional evidence of the bankâs insured status. At summation, Defendant argued that the government had not proven that the bank was FDIC insured at the time of the robbery. The jury returned a guilty verdict. Viewing the evidence in the light most favorable to the government, the Tenth Circuit concluded "it is clear that a rational juror could have concluded beyond a reasonable doubt that the bank was insured at the time of the robbery." The Court affirmed Defendant's conviction.

Appellant appealed the district court's grant of summary judgment in favor of Sun Life in an Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., benefits case. At issue was whether Sun Life was entitled to offset from appellant's employer-provided long-term disability benefits the amount that appellant received in Department of Veterans Affairs (VA) benefits each month. The court held that VA benefits, for a wartime service-related disability, as a matter of statutory construction, did not derive from an act that was "similar to" the SSA or RRA, which were both federal insurance programs based upon employment and the amount of an award under their terms depended upon how much had been paid in. Accordingly, the court reversed and remanded to the district court with directions to enter judgment in favor of appellant.

Mallory Warburton was working for the City of North Las Vegas when she was involved in a car accident and suffered numerous injuries. The City started paying workers' compensation benefits to Warburton at a rate of $10 an hour. At the time of the accident, Warburton was expected to make $12 an hour because of a promotion to manager of one of the City's pools. After an administrative appeal, a hearing officer instructed the City to redetermine Warburton's benefits using the $12-an-hour rate of pay for a pool manager. An appeals officer reversed, concluding Warburton's benefits should be based on the $10-an-hour rate of pay she was actually receiving at the time of the accident. The district court reversed the appeals officer's decision. The Supreme Court affirmed, holding that the appeals officer's conclusion was not supported by substantial evidence and that substantial evidence supported the district court's determination that (1) Warburton's primary job at the time of the accident was that of pool manager, and (2) Warburton's workers' compensation benefits must be determined using an average monthly wage calculation at the $12-an-hour rate of pay.

In 1970, while working for Employer, Employee was injured. In 1989, Employee retired. In 2008, Employee applied for permanent total disability (PTD) compensation. The Industrial Commission of Ohio concluded that Employee was permanently and totally disabled without ruling on the credibility of the assertion that Employee retired because of his injury or determining whether his retirement was voluntary or involuntary. The court of appeals granted Employer a limited writ of mandamus that vacated the Commission's order and ordered the Commission to reconsider the matter. The Supreme Court affirmed the court of appeals, holding that because a voluntary retirement from the work force prior to asserting PTD precludes the payment of compensation for that disability, the court of appeals was correct in ordering further consideration of whether Employee retired because of his injury and whether his retirement was voluntary.

Franklin Electric formed two new subsidiaries and started new unemployment experience accounts with a low introductory contribution rate for each one, which equaled about half the experience rating of Franklin Electric. The Department of Workforce Development later canceled the subsidiaries' experience accounts, and all experience balances and liabilities reverted to Franklin Electric. The Department also demanded back payments, interest, and a ten percent penalty. A liability administrative law judge (LALJ) affirmed the Department's determination that the three entities were a single employer but waived the penalty imposed by the Department. The court of appeals affirmed. The Supreme Court granted transfer and vacated the opinion of the court of appeals and affirmed the determination of the LALJ, holding (1) the new subsidiaries were not new employers because they were not distinct and segregable from Franklin Electric; (2) Franklin Electric's experience rating should have applied to contributions made by the subsidiaries; and (3) because there was no evidence suggesting improper conduct on the part of Franklin Electric, the penalty was not appropriate.