Case Summaries

Workers' Comp

[09/22] American Int'l. Specialty Lines Ins. Co. v. Rentech Steel LLC
In an action by an insurer seeking a declaration that plaintiff had no duty to either defend defendant in an underlying state-court personal injury lawsuit or to indemnify defendant for the judgment, summary judgment for defendants is affirmed where the Texas Workers' Compensation Act imposed no obligation on a nonsubscriber to compensate an employee for injuries sustained due to the employer's own negligence, and thus the exclusion was not applicable.

[08/31] Hayes Lemmerz Int'l, Inc. v. ACE Am. Ins. Co.
In an employer's suit against its insurer for refusing to tender defense in an underlying suit under its workers' compensation and employer liability policy, judgment of the district court in favor of the insurer is affirmed as, because defendant was, by virtue of Indiana law, a joint employer, insurer was contractually obligated to reimburse the reasonable expense of defendant's getting itself dismissed from the tort suit. However, because the defendant is not claiming that insurer refused to pay that amount, but rather, it is complaining that the insurer breached its duty to defend by failing to advise defendant that it's law firm was not defending the suit properly, the insurer had no duty to provide its insured's lawyers with legal advice.

[08/27] Transcon. Ins. Co. v. Crump
In plaintiff's suit against her deceased husband's insurer for workers' compensation death benefits, the judgment of the court of appeals is reversed and remanded where: 1) the treating physician's opinion was based on a reliable foundation and, therefore, legally sufficient evidence supports the jury's verdict; 2) the trial court's omission of the but-for component in the jury charge constitutes reversible error; and 3) an insurance carrier is entitled to have a jury determine the disputed amount of reasonable and necessary attorney's fees for which it is liable.

[08/19] Milpitas Unified Sch. Dist. v. Workers' Comp. Appeals Bd.
In a School District employee's suit for workers' compensation claims, the decision of the Workers' Compensation Appeals Board is affirmed as, the language of section 4660 permits reliance on the entire American Medical Association's Guides to the Evaluation of Permanent Impairment, including the instructions on the use of clinical judgment, in deriving an impairment rating in a particular case.

[08/12] Alvarez v. Workers' Comp. Appeals Bd.
In a claimant's objection to a panel qualified medical evaluator's ex parte communication with defense counsel, and a request for a new panel qualified medical evaluator under section 4062.3(f), in a workers' compensation proceeding for death benefits, the Workers' Compensation Appeals Board's (WCAB) denial of the petition is annulled and remanded as section 4062.3 expressly prohibits ex parte communications with a panel qualified evaluator, with no exception based on the initiator of the communication or for "administrative" matters. However, because a certain degree of informality in workers' compensation procedures has been recognized, not every conceivable ex parte communication permits a party to obtain a new evaluation from another panel qualified medical evaluator.

[08/05] Casanova v. Am. Airlines, Inc.
In a former baggage handler's suit against American Airlines, claiming he was terminated in retaliation for claiming workers' compensation benefits, jury verdict for plaintiff of more than $1 million, $112,000 for lost wages, $250,000 for emotional injury, and $724,000 for punitive damages, and district court's denial of defendant's post-judgment motions are reversed as defendant is entitled to judgment as a matter of law under Rule 50 as plaintiff's dissembling and insubordination was sufficient cause for his discharge.

[07/15] Gacek v. Am. Airlines, Inc.
In a former baggage handler's suit against an airline for retaliatory discharge in violation of the Illinois Workers' Compensation Act, district court's grant of summary judgment for the airline is affirmed as no reasonable jury could find that the airline had fired plaintiff because its claims administrator had opened a file on an injury rather than because it believed that he had lied about having the flu and had disobeyed the doctor's orders to wear a splint on an injured finger and not lift anything with that hand.

[07/15] Milan v. City of Holtville
In plaintiff's suit against her former employer, a municipal water treatment plant, under the Fair Employment and Housing Act (FEHA), claiming that the city had failed to attempt to accommodate her disability and that she was capable of performing the essential functions of her job, trial court's judgment awarding the plaintiff back pay and emotional distress damages is reversed where: 1) the city did not have to offer plaintiff any accommodation as the record shows that almost one year after she was injured, the city's workers' compensation administrator advised her that its doctor did not believe she would be able to return to her job and offered her rehabilitation and retraining benefits; 2) the record shows that plaintiff was given ample opportunity to express interest in retaining her job and for more than 18 months she failed to do so; and 3) given these circumstances, where the employee failed to express any meaningful or definitive interest in retaining her job, FEHA did not require that her employer discuss with or offer her accommodations for her disability.

[07/14] US v. Lay
Conviction of defendant for investment adviser fraud and multiple mail and wire fraud, related to a hedge fund investment by the Ohio Bureau of Workers' Compensation, is affirmed as, because a hedge fund investor can in some circumstances have a fiduciary relationship with an investor, the jury instructions were correct and sufficient evidence supports defendant's conviction. Furthermore, defendant's challenges to the district court's evidentiary rulings and its orders of restitution of $212 million and forfeiture of $590,526.23 are rejected.

[07/06] Koszdin v. State Comp. Ins. Fund
In six class action suits brought by two attorneys against employers and workers' compensation insurance carriers, claiming that they failed to pay interest owed on attorney's fee awards issued by the WCAB, dismissal of the complaint following the sustaining of a demurrer for lack of subject matter jurisdiction is affirmed where: 1) under the relevant provisions of the Workers' Compensation Act, plaintiffs have standing to seek interest on the attorney's fees awarded directly to them by the WCAB; but 2) the trial court lacks jurisdiction to entertain the claims for unpaid interest where the WCAB did not expressly order the payment of interest in its attorney's fee awards.

[07/01] Singh v. Southland Stone, U.S.A. Inc.
In plaintiff's suit against his former employers raising numerous causes of action, claiming that he was induced to come to the United States by the defendants who, within just a few months of his arrival from his home country of India, had his promised salary reduced and then pressured him to resign, judgment of the trial court in favor of plaintiff is affirmed in part, reversed in part, and remanded where: 1) plaintiff has shown no prejudicial error in either the limiting instruction or the denial of his request for leave to amend the complaint; 2) the refusal of defendants' proposed jury instruction regarding the salary reduction was error; 3) defendants are entitled to judgment in their favor on the count for breach of the implied covenant of good faith and fair dealing; 4) the special verdict findings regarding alleged misrepresentations and promises made to plaintiff are inconsistent, and such inconsistency also extends to the finding of malice, oppression, or fraud; 5) defendants have shown no error in the award of damages for unpaid wages; 6) the award of damages for intentional infliction of emotional distress is based on injuries suffered in the course and scope of employment, for which workers' compensation provides the exclusive remedy; and 7) however, the workers' compensation exclusivity rule does not preclude this entire action.

[06/22] Hawaii Stevedores, Inc. v. Ogawa
In a petition for review of a decision of the Benefits Review Board (BRB) affirming an Administrative Law Judge's (ALJ) grant of disability benefits under the Longshore and Harbor Workers' Compensation Act, the petition is granted in part where: 1) the mere fact that an expert witness talked with a party's lawyer and then altered his or her opinion language, though it might be considered relevant, did not require a factfinder to find that expert witness was other than credible; and 2) the ALJ's finding of the maximum medical improvement date was not supported by substantial evidence. However, the petition is denied in part where: 1) the ALJ's finding that petitioner did not meet its burden of demonstrating prejudice was supported by substantial evidence, and respondent's late notice was properly excused; and 2) respondent's stroke qualified as a compensable injury under the Longshore Act.

[06/04] Nat'l Union Fire Ins. Co. v. VP Bldg., Inc.
In Chapter 11 proceedings, district court's affirmance of the bankruptcy court's decision disallowing an insurer's petition for administrative expenses, on the ground that the claim was not "actual" and did not benefit the estate, is affirmed as pursuant to In re HNRC Dissolution Co., 371 B.R. 210, (E.D. Ky. 2007), the insurer's request for reimbursement is not an "actual" expense within the meaning of the bankruptcy code.

[05/25] Los Angeles County Fire Dep't v. Workers' Comp. Appeals Bd.
WCAB's denial of a county's petition for reconsideration in its claim that the battalion chief for the county fire department was not entitled to any maintenance allowance from September 8, 2005, to September 26, 2006 for his permanent disability, is affirmed in part, reversed in part, and remanded as the battalion chief's right to pending maintenance allowance ended with repeal of former section 139.5 except for that part of the maintenance allowance that was not included in the county's petition for reconsideration and, therefore, became final before the repeal of former section 139.5.

[05/20] State Comp. Ins. Fund v. Superior Court
In plaintiff's suit to collect unpaid premiums it claimed were owed for workers' compensation insurance policies issued to defendant, plaintiff's petition for a peremptory writ of mandate seeking to set aside superior court's grant of summary judgment in favor of defendant is granted where: 1) plaintiff's filing of an amended complaint rendered defendant's motion for summary judgment moot; and 2) the FAC raised new issues of fact regarding when the statute of limitations began to run on plaintiff's fraud claim.

[05/14] Alvarez v. Workers' Comp. Appeals Bd.
In claimant's petition for worker's compensation death benefits, a decision of the Workers' Compensation Appeals Board (WCAB) denying claimant's petition for a new panel qualified medical evaluator under section 4062.3(f) is annulled and remanded as section 4062.3 expressly prohibits ex parte communications with a panel qualified medical evaluator, with the only exception being for communications by the employee or deceased employee's dependent in connection with an examination, and in the event of unauthorized ex parte communication permits the aggrieved party to obtain a new evaluation from another panel qualified medical evaluator.

[05/13] Valladolid v. Pac. Ops. Offshore, LP
In a petition for review of the denial of workers' compensation benefits under the Outer Continental Shelf Lands Act (OCSLA) and the Longshore and Harbor Workers' Compensation Act (LHWCA) based on an injury on an offshore drilling platform, the petition is granted in part where: 1) the most natural reading of the OCSLA provided coverage for any injury caused by outer continental shelf operations regardless of where the injury occurred; 2) Congress intended to provide LHWCA coverage regardless of the applicability of state law; and 3) the OCSLA claimant must establish a substantial nexus between the injury and extractive operations on the shelf. However, the petition is denied in part where petitioner was not entitled to LHWCA benefits, on the ground that the drilling platform's use as a convenient dumping ground for scrap metal did not convert it into a maritime situs.

[05/07] In re Odyssey Healthcare, Inc.
In plaintiff's negligence case against her employer, defendant's petition for writ of mandamus is conditionally granted as, the trial court abused its discretion by refusing to grant the defendant's motion to compel arbitration as the plaintiff failed to prove a valid defense against enforcement of her agreement to arbitrate disputes with her employer.

[05/07] In re Odyssey Healthcare, Inc.
In plaintiff's negligence case against her employer, defendant's petition for writ of mandamus is conditionally granted as, the trial court abused its discretion by refusing to grant the defendant's motion to compel arbitration as the plaintiff failed to prove a valid defense against enforcement of her agreement to arbitrate disputes with her employer.

[04/27] Craven v. Director, Office of Wkrs. Comp. Programs
In a petition for review of the Benefits Review Board's denial of petitioner's appeal to the Board, the petition is dismissed where, as a result of petitioner's failure to exhaust his administrative remedies, the court of appeals had no final order from the Board to review.

[04/22] Bollinger Shipyards Inc. v. Director, Office of Wkrs. Comp. Programs
In a petition for review of an order of the Benefits Review Board awarding benefits under the Longshore and Harbor Workers' Compensation Act (LHWCA) to claimant, an undocumented immigrant who fell and injured himself while employed by petitioner, the petition is denied where: 1) claimant was an employee within the intendment of the statute and was thus eligible for workers' compensation benefits; 2) awarding workers' compensation benefits under the LHWCA was a non-discretionary remedy; and 3) the LHWCA expressly provided for the award of benefits to nonresident aliens.

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