Justia Government & Administrative Law Opinion Summaries

In this writ proceeding, Daniel Ramirez sought review of his independent medical review (pursuant to his workers' compensation claim) on the ground the underlying utilization review was based on an incorrect standard. In effect, he sought review of his utilization review with this the Court of Appeal. The Court concluded this was not a proper ground for appeal of a utilization review determination because "it goes to the heart of the determination of medical necessity. The independent medical reviewer is in the best position to determine whether the proper standard was used to evaluate the medical necessity of the requested treatment, and the statutory scheme requires the independent medical reviewer to use the proper standard in determining medical necessity." Ramirez made no claim that the independent medical reviewer did not use the proper statutory standard, nor did he state a proper ground for review of his independent medical review, which was appealable only for the nonsubstantive reasons. Ramirez also challenged the constitutionality of the independent medical review process, claiming it violated the state Constitution’s separation of powers clause, and state and federal principles of procedural due process. The Court concluded that the Legislature’s plenary power over the workers’ compensation system precluded any separation of powers violation, and the process afforded workers under the system afforded sufficient opportunity to present evidence and be heard. View "Ramirez v. WCAB" on Justia Law

Romo was a volunteer firefighter for Marinwood from 1989-1991 and for the San Antonio Volunteer Fire District, 2002-2006. Beginning in 2006, he was employed full time as a paid Mill Valley firefighter. While working for Mill Valley, Romo was diagnosed with prostate cancer. The Workers’ Compensation Appeals Board (WCAB) held that Romo was entitled to the benefit of the rebuttable presumption under Labor Code section 3212.11 that his cancer arose out of his employment. While Mill Valley and San Antonio stipulated that the statutory presumption that cancer suffered while employed as a firefighter arises out of the employment would apply to them if the elements set forth in section 3212.1 were proven, Marinwood appealed. The court of appeal affirmed. “While neither of the statutes at issue is a model of clarity, the WCAB’s interpretations of both are reasonable.” The court noted that Marinwood’s fire captain and training officer considers the volunteer firefighters to be employees and that Romo was within 120 months of the “last date actually worked in the specified capacity.” View "Marin Community Services v. Workers' Compensation Appeals Board" on Justia Law

Officer J.C. Clifton and Officer Jason Davis, law enforcement officers for the City of Homewood, and the City of Homewood petitioned for a writ of mandamus to direct the Jefferson Circuit Court to enter a summary judgment in their favor on the ground of immunity. In 2013, the officers were dispatched to the Babies "R" Us retail store in the Wildwood Shopping Center in response to a shoplifting incident involving Bristinia Fuller and Bria Mines. When the officers arrived, they learned that Fuller and Mines were leaving the parking lot of the store in a vehicle being driven by Fuller. Officer Clifton and Officer Davis, driving separate patrol cars, attempted to stop the vehicle. Instead of stopping, Fuller eluded the officers by speeding through the parking area and onto Lakeshore Drive. The officers pursued. Fuller continued speeding and ran through multiple red traffic lights before losing control of her vehicle. The vehicle struck a light pole and a stopped vehicleat the intersection. Fuller was killed and Mines was seriously injured. 2015, Mines sued Officer Clifton and Officer Davis, both in their official and individual capacities, Homewood, and others alleging she was injured as a result of the negligent, reckless, and/or wanton conduct of the officers and Homewood during the officers' pursuit of Fuller's vehicle. She also alleged that Homewood was vicariously liable for the officers' conduct and was negligent in hiring and supervising the officers. After review, the Supreme Court concluded the officers established they were entitled to immunity as to Mines' claims against them in both their official and individual capacities. Moreover, because the officers were entitled to immunity, Homewood was also entitled to immunity. The Court therefore granted their petition and issued the writ, directing the trial court to enter a summary judgment for Officer Clifton, Officer Davis, and Homewood. View "Ex parte City of Homewood" on Justia Law

After plaintiff was injured while riding her bicycle over a ramp at DeSoto National Forest, she filed suit against government officials under the Federal Tort Claims Act (FTCA), 28 U.S.C. 2671-2680. Plaintiff alleged that defendants failed to inspect and maintain the bicycle trails, and failed to warn her of the hazard. The district court granted defendants' motion to dismiss. The court concluded that the FTCA's discretionary function exception barred plaintiff's claim. In this case, the relevant Manual and Handbook provisions contemplate an element of choice as to how USFS employees inspect and maintain the trails, and the manner in which the USFS officials inspected and maintained the trails was susceptible to policy considerations. In regard to plaintiff's failure to warn claim, the court explained that it was difficult to conceive of a provision mandating the USFS to take specific action to warn the public about unknown hazards. Even if the court did not accept the district court's findings with respect to the USFS having no knowledge of the bridge, the court concluded that the discretionary exception would still apply. Here, plaintiff failed to identify specific provisions that mandate an approach to creating or placing closure signs in these circumstances, and the USFS's decision about how to post notice of the closed trail was based on considerations of social, economic, or political public policy. Accordingly, the court affirmed the judgment. View "Gonzalez v. United States" on Justia Law

Kevin McGough, then a firefighter employed by the City of Birmingham ("the city"), alleges that he sustained an injury to his left knee on April 30, 2011, during the course of his employment. For approximately one year after he injured his left knee, McGough received medical treatment from numerous doctors and continued to work as much as he was able. In 2012, McGough filed a claim with the Retirement System for extraordinary-disability benefits and ordinary-disability benefit to be paid out of the City Retirement and Relief System. The Retirement System denied McGough's request for extraordinary-disability benefits and granted McGough's request for ordinary-disability benefits. It was undisputed that the Retirement System did not notify McGough by certified mail of its decision. More than one year after the Retirement System's final decision denying McGough's application for extraordinary-disability benefits, the Retirement System sent McGough a certified letter. The parties submitted to the circuit court two different certified letters sent by the Retirement System to McGough, both dated December 3, 2013. One notified him of the Retirement System's November 14, 2012, decision to approve McGough's application for ordinary-disability benefits; the other notified him of the Retirement System's November 14, 2012, decision to deny McGough's application for extraordinary-disability benefits. The latter certified letter was delivered to McGough on December 5, 2013. In 2014, McGough filed a mandamus petition in an effort to challenge the Retirement System's decision denying his application for extraordinary-disability benefits. The circuit court denied the Retirement System’s motion to dismiss. The System thereafter petitioned the Supreme Court for mandamus relief to direct the circuit court to grant its motion. After review, the Supreme Court found that McGough’s mandamus petition was untimely, and as such, reversed the circuit court’s judgment. View "City of Birmingham Retirement & Relief System v. McGough" on Justia Law

A workers’ compensation claimant sought review of a judgment from the Office of Workers’ Compensation affirming the decision of the Medical Director denying his physician’s request for trial of a spinal cord stimulator. The court of appeal affirmed the ruling of the Office of Workers’ Compensation that the claimant had failed to show the Medical Director’s decision was not in accordance with the Medical Treatment Guidelines. Because the Supreme Court found the Medical Director and the Office of Workers’ Compensation misinterpreted the language of Louisiana Administrative Code, and thus misapplied the Medical Treatment Guidelines on neurostimulation to the claimant’s case, it reversed the lower court’s ruling and found the Office of Workers’ Compensation erred in affirming the decision of the Medical Director. View "Gulley v. Hope Youth Ranch" on Justia Law

This appeal arose from an Industrial Commission (the Commission) order denying medical care benefits to Channel Rish. Rish worked as a cashier at Home Depot. While working on October 30, 2005, Rish slipped on a floor mat and injured her right knee. The injury ultimately required Rish to undergo three knee surgeries, which Dr. Casey Huntsman performed in 2005, 2006, and 2007. Roughly three months after Rish’s third surgery, Dr. Huntsman concluded Rish had achieved maximum medical improvement (MMI). Dr. Huntsman, however, further noted that Rish “definitely needs . . . continued pain management” with Dr. Holly Zoe. To that end, Rish visited Dr. Zoe for pain management treatment. Respondents remained skeptical as to Rish’s continued medical care with Dr. Zoe. Rish filed a worker’s compensation complaint to seek past and future disability benefits and medical care. Respondents answered and conceded Rish was entitled to the already-paid disability benefits and medical care, but Respondents disputed whether she was entitled to additional disability benefits and medical care. After a hearing, the Commission held in Respondents’ favor. The Commission noted that Rish did not timely raise the issue of disability benefits, but concluded Rish was nevertheless entitled to no additional disability benefits. Further, the Commission concluded Rish was entitled to no additional medical care benefits because the medical care Rish received after August 9, 2007 (the date when Dr. Huntsman deemed her at MMI) was unreasonable. Rish appealed. After review, the Supreme Court concluded the Commission erred in holding that the medical care Rish received after August 9, 2007 was unreasonable. As such, the Court vacated the Commission’s denial of medical care benefits and remanded for further proceedings. View "Rish v. Home Depot" on Justia Law

Claimant Gary Davis, employer Hammack Management, Inc., surety the Idaho State Insurance Fund, and the Idaho Industrial Special Indemnity Fund (“ISIF”) entered into a compensation agreement (“Stipulation”). The parties agreed that Claimant became totally and permanently disabled based on the combined effects of preexisting impairments and a workplace injury that occurred in 2004. The Stipulation outlined each party’s financial obligations to Claimant, including a credit to Employer for permanent partial impairment benefits previously paid. The Idaho Industrial Commission (“Commission”) approved the Stipulation. Subsequently, the Idaho Supreme Court issued its decision in “Corgatelli v. Steel West, Inc.,” (335 P.3d 1150 (2014)), prohibiting such a credit. Claimant then sought a declaratory ruling that the credit in the Stipulation was void. The Commission issued an order stating that the Stipulation was binding as written and subsequently denied Claimant’s motion for reconsideration. Claimant appealed. The Supreme Court concluded the credit in the Stipulation was invalid and the Commission’s order approving the Stipulation was void. The Court affirmed the Industrial Commission’s holding that it had subject matter jurisdiction over the Claimant’s petition for declaratory ruling but reversed its order upholding the Stipulation and the credit. View "Davis v. Hammack Mgmt." on Justia Law

Teachers Becky Ingram and Nancy Wilkinson petitioned for a writ of mandamus to direct the Tuscaloosa Circuit Court to vacate its order denying their motion for a summary judgment based on State-agent immunity as to all claims asserted against them in an action filed by a female student, L.L., by and through her mother, and to enter a summary judgment in their favor. At the time of the incident at issue, L.L. was an 11-year-old eighth-grade student, suffering from spina bifida, and paralyzed from the waist down. She is confined to a wheelchair; she does not have full use of her arms and hands; she requires a urinary catheter; and she wears a diaper. L.L. also has significant mental impairment. The other eighth-grade student involved in the incident was described as having mental retardation. In 2007 when the incident underlying this case occurred, Ingram was the eighth-grade science teacher and Wilkinson was a teacher's aide assigned to Ingram's class. M.M. had a history of aggressive behavior toward teachers and other students. The incident in question happened when the teachers assisted L.L. in going to the bathroom. In a moment after lunch when students returned to classes, a moment passed when M.M. was unaccounted for, and L.L. was in the bathroom by herself. L.L. was discovered partially undressed and exposed, because M.M. had “messed with her.” L.L., by and through her mother, originally filed an action in the United States District Court for the Northern District of Alabama against the Tuscaloosa City Board of Education, Sterling, and Ingram, alleging violations of her civil rights under 42 U.S.C. 1983; Title IX; Section 504 of the Rehabilitation Act of 1973; and the Americans with Disabilities Act. She also brought several Alabama state-law claims. The federal district court entered a summary judgment in favor of all defendants on L.L.'s federal claims. After review, the Alabama Supreme Court found that by the written policy requiring that students be escorted back to their classrooms by teachers, Ingram reportedly did escort the students back to their classroom, and the Court found no basis for holding Wilkinson, who served merely as an aide to the classroom teacher, liable to the same degree as Ingram. Therefore the Court overturned the circuit court’s judgment with respect to Wilkinson, but declined to overturn the circuit court's decision to deny with respect to Ingram. View "Ex parte Ingram" on Justia Law

Petitioner Rodney Stanley Brown was employed by Respondent Claims Management Resources (CMR) as a claims adjuster. Brown suffered personal injury to his left knee. At the time Brown was injured, he finished his workday, clocked out, was leaving the office for the day when he fell while descending an interior stairwell. Brown's work area was on the second floor of the building where he worked, and CMR occupied the entire floor. Brown was unable to conclusively identify any factor that might have caused his fall. While admitting an injury occurred, CMR asserted Brown's injury was not compensable within the meaning of the Administrative Workers' Compensation Act (AWCA). A hearing on the matter was held before the Administrative Law Judge, and after considering the parties' stipulations, evidence, and arguments, the Administrative Law Judge concluded that Brown had failed to meet his burden of proving by a preponderance of the evidence that he suffered a compensable injury within the meaning of the AWCA. The Supreme Court concluded after its review that Brown was acting in the course and scope of his employment, and his injury was a compensable injury. The Workers' Compensation Commission’s interpretation of 85A O.S. Supp. 2013 sections 2(9) & (13) was legally incorrect and its order denying compensability was clearly erroneous in view of the competent evidence presented. Because relief was available on alternative grounds, the Court did not reach the constitutional issues presented. View "Brown v. Claims Management Resources, Inc." on Justia Law