NCCI’s Countrywide Court Case Update provides a look at some of the cases and decisions monitored by NCCI’s Legal Team that may impact workers compensation (WC) across the states. This July 2022 edition contains updated information on cases previously introduced and presents new cases and decisions.
To view previously reported decisions, click the case links. For more information on cases monitored by NCCI’s Legal Team, visit previous Court Case Updates, COVID-19 Court Cases, and Court Case Insights on ncci.com.
Stakeholders remain interested in COVID-19-related cases that could impact the WC system. In California and Wisconsin courts have considered issues related to employer liability for injuries suffered by the spouse of an employee who allegedly contracted COVID-19 at work and spread it to the spouse at home. In Texas, a federal court held that WC exclusive remedy bars a tort lawsuit brought against an employer by the family and estate of an employee who contracted and died from COVID-19. And in Ohio, in Yeager v. Arconic Inc., an appellate court found that an employee’s contraction of COVID-19 was not an occupational disease in WC because the employee failed to show that the employment created a risk of contracting COVID-19 in a greater degree and different manner than the general public.
For more information on other COVID-19-related state and federal cases with potential implications for WC insurance, visit COVID-19 Court Cases on ncci.com.
Developments in Marijuana
The legal status of marijuana and its implications for WC remain a hot topic. In 2022 Rhode Island legalized recreational marijuana (S 2430/H 7593), Maryland passed legislation (HB 1) allowing voters to decide on a constitutional amendment that would allow recreational use, and the Mississippi legislature enacted a bill (SB 2095) that legalizes medical marijuana. So far, 20 jurisdictions have legalized recreational marijuana and 38 allow for medical use.
In the meantime, marijuana reimbursement in WC remains a state-by-state patchwork. On June 21, 2022, the United States Supreme Court denied the petition to review the case of Musta v. Mendota Heights Dental Center, where the court was asked to resolve the question of whether the federal Controlled Substances Act (CSA) preempts a state order requiring employers and insurers to reimburse claimants for their medical marijuana use. The case was on appeal from the Supreme Court of Minnesota which, on October 13, 2021, ruled that the prohibition of marijuana possession under the CSA preempts an order made under Minnesota WC law that requires an employer to reimburse an injured employee for the cost of medical marijuana used to treat a work-related injury.
Courts have also reviewed employment-related marijuana questions. On January 14, 2022, the Supreme Court of New Hampshire, in Paine v. Ride-Away, Inc., ruled that the lawful use of therapeutic cannabis can be a reasonable accommodation for an employee with a disability under New Hampshire law.
Air Ambulance Reimbursement
Courts have continued to review cases addressing whether state WC laws limiting air ambulance billing rates are preempted by the federal Airline Deregulation Act of 1978 (ADA). The Supreme Court of Kansas, on May 13, 2022, in EagleMed, LLC v. Travelers Insurance, remanded a fee dispute between an air ambulance carrier and a WC insurer to the Workers Compensation Appeals Board for a determination of whether the billed air ambulance charges are “usual and customary” as required by the state’s 2012 WC fee schedule. And on February 3, 2022, the Court of Appeals of Texas, in PHI Air Medical, LLC v. Texas Mutual Insurance Co., on remand from the state’s supreme court, ruled that the ADA does not preempt the balance billing prohibition in Texas WC statute 413.042.
Other Federal and State Developments (by Geographic Zone)
Across the states and at the federal level, courts have addressed issues related to compensability, mental injuries, exclusive remedy, benefits calculation, and constitutional challenges, to mention a few.
- Rhode Island, Parking Lot Injuries—On May 6, 2022, the Supreme Court of Rhode Island, in Phillips v. Enterprise Rent-A-Car Co. of Rhode Island, LLC, revisited an exception to the going and coming rule, which denies WC for injuries sustained while traveling to or from work. In this case, an employee suffered fatal injuries while crossing the street that separated the workplace from an employer-leased parking lot where the employee was required to park. The court found that the employee’s fatal injuries would fall under an exception to the going and coming rule—where the employer owns and maintains an employee parking area separate from its facility grounds— even though the parking lot was leased by the employer and not owned. The court reasoned that the injuries occurred due to the parking lot’s location, a risk that was immutable and unchangeable irrespective of whether the employer owned or leased the lot.
- Arkansas, Statute of Limitations for Benefits—The Arkansas Supreme Court, on March 31, 2022, in Wynne v. Liberty Trailer, held that the one-year statute of limitations for requesting additional WC benefits begins to run on the date the claimant received the last payment for medical or indemnity benefits. In its analysis, the court interpreted Arkansas statute 11-9-702(b)(1), which provides that claims for additional compensation are barred unless filed within one year from the date of the last payment of compensation or two years from the date of the injury, whichever is greater. The court concluded that, based on the statute’s plain language, the statute of limitations on a request for additional benefits commences when the last payment, whether for disability or medical benefits, is made. The decision affirmed an appellate ruling which found that a claimant timely filed a petition for additional medical benefits made within one year of the last payment of indemnity benefits but more than one year after the last medical payment.
- Florida, Jurisdiction Over Prohibited Debt Collection Practices—On May 26, 2022, in Laboratory Corporation of America v. Davis, the Florida Supreme Court held that a trial court had jurisdiction to hear claims brought by an injured worker against medical providers for attempting to collect an illegitimate debt in violation of the Florida Consumer Collection Practices Act (FCCPA). The providers had billed the injured worker, and not the WC insurer, for the treatment of a work injury. The court rejected the providers’ argument that the trial court lacked jurisdiction pursuant to Florida statute 440.13(11)(c), which states that the Department of Financial Services (DFS) has exclusive jurisdiction to decide any matters concerning reimbursement. The court found that the statutory provision covers matters concerning payments by a carrier to a provider but does not apply to matters that involve improper billing of a worker by a provider. Thus, the court concluded that the DFS did not have exclusive jurisdiction.
- Florida, Injuries Suffered While Traveling to and From Work—Kelly Air Systems, LLC v. Kohlun (Florida First District Court of Appeals)
- Louisiana, Duty of Good Faith and Fair Dealing in WC—The Supreme Court of Louisiana, in Cox, Cox, Filo, Camel & Wilson, LLC v. Louisiana Workers’ Compensation Corp., on March 25, 2022, held that an employer established its WC insurer breached the duty of good faith and fair dealing required by Louisiana statute 22:1973. The court determined that the insurer’s failure to timely assign an attorney to defend a WC claim and the failure to communicate with the employer regarding the case, supported the lower court’s conclusion that the insurer breached its duty of good faith and fair dealing. This decision came one year after the appellate court found, as a matter of first impression, that 22:1973 applies to WC policies and provides a cause of action to insureds.
- Illinois, Applicability of Exclusive Remedy for General Contractors—Munoz v. Bulley & Andrews, LLC (Supreme Court of Illinois)
- Iowa, Compensation for Mental Injuries—Tripp v. Scott Emergency Communication Center (Supreme Court of Iowa)
- Iowa, Recovery of Benefits Paid in Error—The Iowa Supreme Court, on June 10, 2022, in American Home Assurance v. Liberty Mutual Fire Insurance Co., ruled that a WC insurer could not be reimbursed for benefits it erroneously paid to an employee whose employer was insured by a different carrier when the injury occurred. Before the benefits award was entered, the insurer did not seek a consent order under Iowa statute 85.21, reserving the right to seek indemnity or contribution from another carrier/employer. The court reasoned because the insurer failed to comply with this procedure, it was precluded from seeking reimbursement for the amounts it erroneously paid to the injured employee.
- Ohio, Calculation of the Average Weekly Wage (AWW)—The Court of Appeals of Ohio, Tenth District, on May 31, 2022, in State ex rel. Matheny v. Industrial Comm’n of Ohio, affirmed a lower tribunal finding that pension earnings and other welfare benefits are not considered wages included in the WC AWW calculation. The court relied on a case from the United States Supreme Court, Morrison-Knudsen Constr. Co. v. Dir., Office of Workers’ Comp. Programs, holding that an employer’s contributions to a union trust fund for health and welfare, pensions, and employee training were not considered wages for the purposes of calculating weekly benefits for WC in the District of Columbia.
- Idaho, Constitutional Challenge to Firefighter Presumption—On April 29, 2022, in Nelson v. City of Pocatello, the Idaho Supreme Court rejected a constitutional challenge to Idaho statute 72-438(14)(b), which generally provides that certain types of cancer suffered by firefighters are presumed to be proximately caused by the employment. In this case, an employer argued that the presumption of causation and the standard of substantial evidence to rebut the presumption violated the employer’s equal protection rights under the state and federal constitutions. The court rejected the employers’ argument concluding that the distinction between employers of firefighters with cancers and other employers whose employees may contract occupational diseases is rationally related to a legitimate government purpose of protecting firefighters by providing a presumption of causation to qualify for WC benefits.
- Nevada, WC Lien—The Supreme Court of Nevada, on May 5, 2022, in Harper v. Copperpoint Mutual Insurance Holding Co., affirmed a lower court’s ruling that a WC insurer could assert a lien against a claimant’s medical malpractice proceeds from a settlement with a healthcare provider. The court reviewed Nevada statute 42.021, which prohibits a payer of collateral benefits, including WC benefits, from recovering any amounts against a plaintiff in a medical malpractice lawsuit when the healthcare provider/defendant elects to introduce evidence of benefits received by a plaintiff from that collateral source. The court held that the plain language of the statute prohibits a WC insurer from seeking reimbursement from a medical malpractice plaintiff only when the medical malpractice defendant introduces evidence of those payments, which does not occur when a case is settled pretrial.
- New Mexico, Constitutional Challenge to Limitation on Benefits—Cardenas v. Aztec Municipal Schools (Court of Appeals of New Mexico)
Oregon, Impairment Caused by Compensable and Noncompensable Injuries—In two cases, Johnson v. SAIF Corp. and Robinette v. SAIF Corp., the Oregon Supreme Court addressed the meaning of the word impairment, defined in Oregon statute 656.214 as the loss of use or function of a body part or system due to a compen¬sable industrial injury. In Johnson, decided on April 21, 2022, a claimant’s impairment was determined to be caused in material part by a compensable condition and in part by a denied condition. The court found that Oregon statute 656.214 entitles an injured worker to compensation for all the impairment due in material part to, and resulting in material part from, a compensable injury. Thus, the court concluded the claimant was entitled to the full value of the total impairment, including the portion of her loss of grip strength that may have been attributed to the denied conditions because the com-pensable injury was found to be a material cause of the impairment.
In Robinette, decided on June 24, 2022, the Oregon Supreme Court clarified that the definition of impairment does not include findings of loss that are not related to, or caused by, a compensable injury. In this case, a claimant was determined to have a loss of use or function to the right knee for reduced motion and decreased stability that was not related to the compensable injury, and a loss of use or function to the same knee in the form of surgical value and chronic condition that was related to the compensable injury. The court reasoned that this case, unlike Johnson, involved two distinct losses of use or function and only one of them—the loss of use or function for surgical value and chronic condition—was attributed to the workplace accident. Thus, the court held, the reduced motion and decreased stability did not qualify as impairment and were not part of the calculation of the claimant’s per¬manent partial disability award.
- Oregon, WC Coverage for Drivers Leasing From For-Hire Carriers—On March 24, 2022, the Oregon Supreme Court, in SAIF Corp. v. Ward, ruled that a truck driver who sustained injuries while driving a truck that was leased from a trucking company for the sole purpose of driving it for that company was subject to Oregon WC laws, and therefore entitled to WC benefits. The court relied on ORS 656.027(15), which exempts persons who have ownership or leasehold interests in equipment and who furnish, maintain, and operate that equipment, from WC. The court found that the lease agreement between the truck driver and the trucking company did not grant the driver sufficient authority to possess, use, and furnish the truck as he chose. Therefore, the court concluded, the ORS 656.027(15) exemption did not apply, and the truck driver was subject to Oregon WC laws.
- Texas, WC Insurer’s Entitlement to Settlement Proceeds—The Court of Appeals of Texas, Dallas, on May 13, 2022, in Stevenson v. Texas Mutual Insurance Co., ruled that a WC insurer was entitled to the first money a claimant received as part of a tort lawsuit settlement with a negligent third party that allegedly aggravated the claimant’s work-related injury through medical malpractice. The court concluded that the claimant had no right to the settlement until the WC insurer was paid in full. The court relied on WC statute 417.001, which provides that injured employees may seek damages from third-party tortfeasors for injuries compensable in WC. The court also relied on prior decisions from the Texas Supreme Court stating that an insurance carrier is entitled to recover all benefits paid to an injured worker out of the first money the worker recovers from a liable third party. The court further noted that the WC insurer must pay the claimant’s attorney reasonable fees and expenses pursuant to WC statute 417.003(a), which requires insurers to pay claimant’s attorney a reasonable fee and a proportionate share of expenses when the WC insurer’s interests are not actively represented in a third-party action.
For more information on these and other cases, visit INSIGHTS.
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