Justia Government & Administrative Law Opinion Summaries

Marshall Parker sought an award of benefits for a back injury he received during the course of his employment with Webster County Coal. An administrative law judge (ALJ) awarded benefits for the back injury. However, the ALJ found that, pursuant to Ky. Rev. Stat. 342.730(4), Webster County Coal did not have liability for payment of income benefits in addition to the two years of temporary total disability income benefits Parker had already received. The Workers’ Compensation Board and Court of Appeals affirmed. Parker appealed, arguing that section 342.730(4) is unconstitutional because, under the statute, injured older workers who qualify for normal old-age Social Security retirement benefits are treated differently from injured older workers who do not qualify. The Supreme Court reversed in part, holding that section 342.730(4) is constitutionally infirm on equal protection grounds because there is no rational basis or substantial and justifiable reason for the disparate treatment of two groups of workers. View "Parker v. Webster County Coal, LLC" on Justia Law

The Court of Appeal granted the writ application of the employer, City of Jackson (City), after the Workers’ Compensation Appeals Board (Board) disregarded the apportionment determination of the qualified medical evaluator (QME) on the ground the determination was not substantial medical evidence and directed the workers’ compensation administrative law judge (ALJ) to make an award of unapportioned disability. The QME concluded that the employee’s disability - neck, shoulder, arm, and hand pain - was caused by cervical degenerative disc disease, and that the disease, in turn, was caused in large part by heredity or genetics. The QME thus assigned causation 49 percent to the employee’s personal history, which included, but was not limited to, the genetic cause of the degenerative disease. The ALJ agreed with the QME’s apportionment, but the Board did not. The Board concluded the QME could not assign causation to genetics because that is an “impermissible immutable factor[].” The Board also concluded that by relying on the employee’s genetic makeup, the QME apportioned the causation of the injury rather than the extent of his disability. Finally, the Board concluded the QME’s determination was not substantial medical evidence. After review, the Court of Appeal disagreed with each of the Board’s conclusions, annulled its order, and remanded with directions to deny reconsideration. View "City of Jackson v. WCAB" on Justia Law

Defendant Carus Corp. (Carus) was an international company that developed and sold chemical products for municipal and industrial applications. Defendant's products included a chemical called Totalox, which essentially, was designed as a deodorizer for sewer systems. The Town of Lexington (Town) used Totalox in its sewer treatment plants. In 2010, Plaintiff John Machin, a Town employee, was exposed to Totalox when a storage container valve broke during the delivery of Totalox to one of the Town's wastewater stations. Plaintiff suffered reactive airways syndrome, which was also known as chemically induced asthma or obstructive lung disease. As a result of his injuries, Plaintiff filed a workers' compensation claim and was awarded workers' compensation benefits. The South Carolina Supreme Court accepted four certified questions from the United States District Court for the District of South Carolina: (1) Under South Carolina law, when a Plaintiff seeks recovery from a person, other than his employer, for an injury sustained on the job, may the jury hear an explanation of why the employer is not part of the instant action?; (2) when a Plaintiff seeks recovery from a person, other than his employer, for an injury sustained on the job, may a defendant argue the empty chair defense and suggest that Plaintiff's employer is the wrongdoer?; (3) In connection with Question 2, if a defendant retains the right to argue the empty chair defense against Plaintiff's employer, may a court instruct the jury that an employer's legal responsibility has been determined by another forum, specifically, the South Carolina Workers' Compensation Commission?; and (4) when a Plaintiff seeks recovery from a person, other than his employer, for an injury sustained on the job, may the Court allow the jury to apportion fault against the nonparty employer by placing the name of the employer on the verdict form? The South Carolina Supreme Court answered these questions in the abstract, without any suggestion as to the resolution of the post-trial motion before the federal court: Questions 1, 2, and 3 "yes," provided a defense seeks to assign fault to the plaintiff's employer. The Court answered Question 4, "no." View "Machin v. Carus Corporation" on Justia Law

State employee Shirley Shea suffered from chronic pain and has been unable to work. She applied for occupational disability benefits, claiming that prolonged sitting at work aggravated a preexisting medical condition. The Division of Retirement and Benefits denied the claim. An administrative law judge affirmed that decision, determining that employment was not a substantial factor in causing Shea's disability. On appeal, the superior court reversed the administrative law judge’s decision. Because the administrative law judge’s decision was supported by substantial evidence, the Alaska Supreme Court reversed the superior court’s decision and affirmed the administrative law judge. View "Alaska Dept. of Administration, Division of Retirement & Benefits v. Shea" on Justia Law

Laura Miller appeals from a summary judgment entered by the Jefferson Circuit Court ("the circuit court") in favor of the City of Birmingham ("the City"), Sandy Roberts, and Alice Crutchfield (collectively, "the City defendants"). Robert Miller, Laura's husband, was employed by the City as a firefighter. Unum Life Insurance Company of America ("Unum") issued a group life and accidental death and dismemberment policy. According to the summary of benefits, the policy included different life-insurance benefits for active employees and for retired employees. Under the policy, as an active employee, the City paid Robert's insurance premiums, thereby entitling him to a life-insurance benefit of $151,000. However, if Robert were to retire, he would be required to pay his life-insurance premiums and would be entitled to only a $50,000 life-insurance benefit. The summary of benefits specified that, in order to be eligible for a waiver of the life-insurance premiums, the insured had to "be disabled through your elimination period," which was nine months. In 2012, Robert was diagnosed with brain cancer and soon became unable to perform the duties of his job. Laura contended once the Millers learned of Robert's condition, they "sought to obtain information about [Mr. Miller's] life insurance benefit and all other benefits that might be available." The Millers did not have a copy of the policy or the summary of benefits at that time. The Millers and Ed Bluemly, Mrs. Miller's brother-in-law, met with Sandy Roberts, the assistant benefit administrator and the pension coordinator for the Jefferson County Personnel Board, and Alice Crutchfield, a personnel technician for the Jefferson County Personnel Board, to learn about the available benefits. The Millers asked for a copy of the policy, and there was a dispute over whether the Crutchfield gave the Millers a copy. The Millers ultimately sued the City for negligence with respect to the policy and collection of the benefits to which Robert was entitled. After review of this matter, the Supreme Court affirmed the circuit court's summary judgment in favor of the City insofar as the circuit court based its summary judgment in favor of the City on the City defendants' argument that the City was entitled to immunity from Laura's claim alleging wanton and reckless misrepresentation. However, the Court reversed the circuit court's summary judgment in favor of the City defendants in all other respects. The Case was remanded for further proceedings. View "Miller v. City of Birmingham et al." on Justia Law

While assigned to fight a wildfire, plaintiff and appellant Rebecca Megan Quigley was severely injured when a water truck ran over her as she slept at the fire base camp. She sued, inter alia, defendants-respondents Garden Valley Fire Protection District, Chester Fire Protection District, and their employees Frank DelCarlo, Mike Jellison, and Jeff Barnhart for damages, claiming she was injured as a result of their negligence, a dangerous condition of public property, and defendants’ failure to warn. The trial court granted nonsuit against plaintiff’s complaint on the bases that defendants were statutorily immune from liability and the firefighter’s rule prevented plaintiff from recovering. Because the Court of Appeal agreed defendants were immune from liability for plaintiff’s injuries, it affirmed the judgment. View "Quigley v. Garden Valley" on Justia Law

Petitioner LeAndra Lewis sought workers' compensation benefits for injuries she suffered following a shooting in a night club operated by L.B. Dynasty. In a previous opinion, the South Carolina Supreme Court held Lewis was an employee of L.B. Dynasty, entitling her to workers' compensation benefits. The Court remanded the matter to the court of appeals to review the commission's order awarding benefits to Lewis. Ultimately, the court of appeals affirmed the commission's award of $75 per week. Lewis appealed, arguing the court of appeals erred in holding the commission's findings were supported by substantial evidence. The Supreme Court agreed, and remanded this case back to the commission for a de novo hearing to determine the amount of benefits to which Lewis is entitled. View "Lewis v. L.B. Dynasty" on Justia Law

The Federal Employees Health Benefits Act (FEHBA) authorizes the Office of Personnel Management to contract with private carriers for federal employees’ health insurance; 5 U.S.C. 8902(m)(1) states that the “terms of any contract under this chapter which relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any State or local law . . . which relates to health insurance.” OPM’s regulations make a carrier’s “right to pursue and receive subrogation and reimbursement recoveries" a condition of the provision of benefits under the plan’s coverage. In 2015, OPM confirmed that subrogation and reimbursement rights and responsibilities “relate to the nature, provision, and extent of coverage or benefits” under section 8902(m)(1). Nevils, insured under a FEHBA plan offered by Coventry, was injured in an automobile accident. Coventry paid his medical expenses and asserted a lien against the settlement Nevils recovered from the driver who caused his injuries. Nevils satisfied the lien, then filed a state court class action, citing Missouri law, which does not permit subrogation or reimbursement in this context. The Missouri Supreme Court ruled in favor of Nevils. The Supreme Court reversed. Because contractual subrogation and reimbursement prescriptions plainly “relate to . . . payments with respect to benefits,” they override state laws barring subrogation and reimbursement. When a carrier exercises its right to reimbursement or subrogation, it receives from either the beneficiary or a third party “payment” respecting the benefits it previously paid. The carrier’s very provision of benefits triggers that right to payment. Strong and “distinctly federal interests are involved,” in uniform administration of the FEHBA program, free from state interference, particularly concerning coverage, benefits, and payments. The regime is compatible with the Supremacy Clause. The statute, not a contract, strips overrides state law View "Coventry Health Care of Missouri, Inc. v. Nevils" on Justia Law

Enrique Lopez appeals an order of the Idaho Industrial Commission (“Industrial Commission”) declining to award him additional workman’s compensation income benefits for binaural hearing loss he sustained as a result of a workplace accident. Lopez was injured by a bull while working on a dairy. Lopez complained to the Industrial Commission that he was entitled to additional income benefits based on his interpretation of the statutory schedule for permanent impairments in Idaho Code section 72-428. The Industrial Commission disagreed, holding that Lopez was only entitled to the 8% impairment benefits previously paid. Lopez timely appealed. Finding no error in the Commission’s calculation of Lopez’ income benefits for his partial binaural hearing loss, the Supreme Court affirmed. View "Lopez v. Vanbeek Herd Partnership" on Justia Law

The issue in this workers’ compensation case was whether claimant was entitled to benefits for his “combined condition” claim. Claimant filed- and his employer’s insurer, SAIF Corporation, initially accepted-a claim for a lumbar strain combined with preexisting lumbar disc disease and related conditions. SAIF later denied the combined condition claim on the ground that the lumbar strain had ceased to be the major contributing cause of the combined condition. Claimant objected. He did not contest that his lumbar strain had ceased to be the major contributing cause of his combined condition. Instead, he argued that the otherwise compensable injury was not limited to the lumbar strain that SAIF had accepted as part of his combined condition claim. In claimant’s view, an “otherwise compensable injury” within the meaning of ORS 656.005(7)(a)(B) referred not just to the condition that SAIF accepted, but also includes any other conditions not accepted that might have resulted from the same work-related accident that caused the lumbar strain, and that larger group of work-related conditions continued to be the major contributing cause of his combined condition. As a result, claimant contended that an employer could not close a combined condition claim if any of those non accepted conditions remained the major cause of the combined condition claim. The Workers’ Compensation Board rejected claimant’s argument and upheld SAIF’s denial of claimant’s combined condition claim, concluding that existing precedent defined the “otherwise compensable injury” component of combined conditions to consist of the condition or conditions that the employer has accepted as compensable. The Court of Appeals reversed, acknowledging that its holding was “potentially at odds” with existing precedents from both that court and the Oregon Supreme Court. It nevertheless concluded that those precedents were either distinguishable or should be reconsidered. The Supreme Court concluded that the Court of Appeals erred and that the Workers’ Compensation Board was correct. View "Brown v. SAIF Corp." on Justia Law