Justia Public Benefits Opinion SummariesArticles Posted in Injury Law
Sea "B" Mining Co. v. Addison
An ALJ found that Jerry Addison was entitled to benefits under the Black Lung Benefits Act, 30 U.S.C. 901-944, because he had established the existence of clinical and legal pneumoconiosis that resulted in a total respiratory disability. Sea-B, Addison's former employer, filed a petition for review of the ALJ's decision. The court concluded that the ALJ’s decision to exclude the additional CT scan evidence was not harmless. This error affects the determination of both clinical and legal pneumoconiosis and impacts the ALJ’s consideration of the other evidence in this case. The omitted CT scan evidence is unquestionably probative of the central issue in dispute: whether Addison suffered from pneumoconiosis. Furthermore, the court could not determine from the ALJ’s sparse explanation how, or if, he weighed the x-ray readings in light of the readers’ qualifications. Finally, because the proffered explanation for elevating Dr. Forehand’s diagnosis is not supported, the ALJ must reevaluate that opinion to determine the proper weight it should be given. Accordingly, the court granted the petition for review, vacated the order, and remanded for further proceedings. View "Sea "B" Mining Co. v. Addison" on Justia Law
Arbuckle v. General Motors, LLC
Plaintiff Clifton Arbuckle sustained a work-related back injury while working for General Motors Corporation (GM), and in May 1993 began receiving a disability pension. He retired that month and was subsequently awarded workers’ compensation benefits. Later, he also received Social Security Disability Insurance (SSDI) benefits. GM and the International Union, United Automobile, Aerospace and Agricultural Implement Workers of America (UAW) had executed a letter of agreement in 1990 in which GM agreed not to coordinate workers’ compensation and disability pension benefits for its employees under MCL 418.354. This letter of agreement was incorporated into the 1990 collective-bargaining agreement (CBA) between GM and the UAW and was intended to remain in place until termination or amendment of the CBA, which expired in November 1993. When the CBA expired, however, the provision against coordination was continued in subsequent letters of agreement and incorporated into subsequent CBAs. In 2009, GM and the UAW adopted a formula (incorporated into the 2009 CBA) by which GM would coordinate benefits, using disability pension benefits to reduce the amount of workers’ compensation benefits for all workers and retirees, regardless of when they had retired. GM advised Arbuckle that effective January 1, 2010, his benefits would be reduced using the formula in the 2009 agreement. Arbuckle appealed to the Workers’ Compensation Agency, which ultimately concluded that GM was improperly using Arbuckle’s SSDI benefits to offset his workers’ compensation benefits, in violation of MCL 418.354(11). A workers’ compensation magistrate reversed the director’s ruling but nevertheless concluded that GM was prohibited from reducing Arbuckle’s workers’ compensation benefits by his disability pension benefits because Arbuckle had never agreed to coordination of benefits and no evidence established that the UAW had the authority to bargain on Arbuckle’s behalf after his retirement. The Michigan Compensation Appellate Commission (MCAC) reversed in part, holding that irrespective of the UAW’s authority to bind retirees, GM was permitted to coordinate Arbuckle’s disability pension benefits. Arbuckle sought leave to appeal, but after the Court of Appeals granted his application, he died. Robert Arbuckle, the personal representative of the estate, was substituted as plaintiff. The Court of Appeals reversed in an unpublished opinion per curiam and remanded the case for further proceedings. GM then appealed. The Supreme Court concluded after its review that the Court of Appeals erred in holding that GM lacked the authority to coordinate Arbuckle’s benefits under the 2009 CBA. The Court reversed and reinstated MCAC's order. View "Arbuckle v. General Motors, LLC" on Justia Law
Winkelman v. CVS Caremark Corp.
The False Claims Act (FCA) forbids private parties from bringing qui tam actions on the government’s behalf alleging fraud on government programs if the complaint rests on allegations that were already publicly disclosed through certain enumerated sources. In this case, Relators brought a qui tam action under the FCA challenging certain billing practices of CVS Caremark Corp. and affiliated companies (collectively, CVS). The district court dismissed the action, concluding that previous disclosures and controversies triggered the FCA’s public disclosure bar. The First Circuit affirmed, holding that the public disclosure bar forbade Relators’ suit. View "Winkelman v. CVS Caremark Corp." on Justia Law
James Baptist v. Ford Motor Company
Baptist began working at Ford’s assembly plant, operating a forklift. Less than three months later, Baptist inadvertently hit a pillar, injuring his left wrist. He visited Ford’s medical department and submitted an injury report. An investigator and Ford’s physician doubted Baptist’s account of his injury; Baptist did not report the incident properly and refused to release medical records from a prior workers’ compensation case against another employer involving an injury to his other wrist. Ford paid for Baptist’s initial visit to an orthopedic surgeon, Dr. Heller. The parties are litigating Baptist’s workers’ compensation claim. After working two months, Baptist again sought medical attention. Dr. Heller diagnosed him with a complete ligament tear, recommended surgery, indicated that Baptist was not able to perform the essential function of his job, and cleared him to return to work if he did not lift or grip over five pounds with his left hand. Disagreeing with Ford's doctor, Baptist believed that this prevented him from operating the forklift and asked for another position. He did not work for several days. Ford suspended him for one month. When Baptist returned, he was told that the only available work was as a forklift driver. Baptist later testified that he was told that he would be fired unless he agreed to state that his injury did not happen at work. The company denied this assertion. Baptist was discharged for having three consecutive absences without justification. In a suit alleging retaliation for exercising his workers’ compensation rights, the court granted Ford summary judgment. The Seventh Circuit vacated. A triable issue exists regarding whether Baptist was put to the impracticable choice between keeping his job or giving up a key argument for workers’ compensation. View "James Baptist v. Ford Motor Company" on Justia Law
Gerdon v. Con Paulos, Inc.
In 2008, Joseph Gerdon was seriously injured in a motor vehicle accident that arose out of and in the course of his employment. He was a passenger in a vehicle being driven by a coworker, who drove off the road. The Industrial Commission awarded Gerdon benefits. Gerdon requested a hearing to determine whether he was also entitled to benefits for a compensable psychological injury. That issue was heard before a referee, who issued proposed findings of fact, conclusions of law, and a recommendation that Gerdon had failed to prove that he was entitled to additional psychological care. The Commission adopted the referee’s proposed findings of fact and conclusions of law and issued an order. Gerdon appealed to the Idaho Supreme Court. Because the Commission’s decision was based upon its constitutional right to weigh the evidence and determine the credibility of conflicting expert opinions, the Supreme Court affirmed the Commission's order. View "Gerdon v. Con Paulos, Inc." on Justia Law
Milik v. Sec’y of Health & Human Servs.
A.M. was born in1993, and was raised in a predominately Polish-speaking household. At A.M.’s 15-month routine examination, the pediatrician noted that A.M. was a “well child.” When A.M. was two years old, his pediatrician noted that A.M. used 4 to 10 words and walked independently. When A.M. was four years old, he received his second MMR vaccination. Days later, A.M. returned to the office with a sore throat. Later episodes concerned limping and limited language skills. A doctor gave A.M. a provisional diagnosis of “Ataxia/Unsteadiness and Developmental Delay.” An MRI showed “diffuse white matter demyelination which is consistent with demyelinating process most likely some form of leukodystrophy.” By 2011, A.M. was wheelchair-bound and unable to care for himself. In 2012, at age 18, A.M. saw a specialist who opined that “[t]he finding of apparently normal development followed by a sudden loss of abilities following an insult with severe demyelination is suggestive of vanishing white matter disease. This often presents during childhood with ataxia following infection or fright.” A special master denied compensation under the National Childhood Vaccine Injury Act, 42 U.S.C. 300aa, finding that the Miliks failed to prove by a preponderance of the evidence that a vaccine caused A.M.’s conditions. The Claims Court and Federal Circuit upheld the denial as not arbitrary, capricious, an abuse of discretion. View "Milik v. Sec'y of Health & Human Servs." on Justia Law
Hudgens v. McDonald
Hudgens injured his right knee while serving on active duty in the U.S. Army. In 2003, Hudgens had partial knee replacement surgery; in 2006, he sought VA benefits. The Board of Veterans’ Appeals denied him a disability rating of greater than 10 percent for degenerative joint disease in the right knee and denied him entitlement to a compensable disability rating for instability in the right knee for a prior time period. The Veterans Court vacated those decisions; held that Hudgens was not entitled to compensation for his prosthetic knee replacement under 38 C.F.R. 4.71a, Diagnostic Code 5055; and remanded for determination of whether his knee replacement could be rated by analogy to that code. The Federal Circuit reversed, holding that Hudgens may be compensated under DC 5055 based on his partial knee replacement. Hudgens’s interpretation of DC 5055 is consistent with the beneficence inherent in the veterans’ benefits scheme and with the majority of Board decisions that have interpreted the regulation. View "Hudgens v. McDonald" on Justia Law
Weible v. Dept of Labor
While claimant-appellant Judith Weible was employed by Safeway, Inc., she requested time off because she had to have surgery. Safeway granted her request and agreed to hold her job until she was able to return to work, which she intended to do. She was gone for approximately six weeks. While on leave, claimant applied for unemployment benefits. She was denied because during her leave of absence she was still employed, even though she was not working. An appeals examiner upheld the denial, and the Industrial Commission upheld the appeals examiner. Finding no reversible error, the Supreme Court affirmed the Industrial Commission. View "Weible v. Dept of Labor" on Justia Law
Travelers Cas. & Surety Co. v. Workers’ Comp. Appeals Bd.
Dreher had been a maintenance supervisor at an Alliance apartment complex for 74 days when he slipped and fell on concrete walkway in the complex in the rain. Dreher sustained a fractured pelvis and injuries to his neck, shoulder, leg, and knee. He suffered gait derangement, a sleep disorder, and headaches. Dreher required surgery to repair pelvic fractures, another surgery to repair a torn meniscus, and another surgery to address issues with his foot and ankle. Dreher sought compensation for a psychiatric injury. An evaluation concluded that Dreher suffered a psychiatric disability as a result of the accident, including depression, difficulty sleeping, and panic attacks. The ALJ found that Dreher sustained an injury arising out of and in the course of his employment but denied his claim as barred by section 3208.3(d) because Dreher was employed by Alliance for less than six months and his psychiatric injury did not result from a sudden and extraordinary employment condition. On reconsideration, the Workers’ Compensation Appeals Board found that the injury was not barred. The court of appeal annulled the decision. Dreher’s testimony that he was surprised by the slick surface because the other walkways had a rough surface, and that the walkway was later resurfaced, did not demonstrate that his injury was caused by an uncommon, unusual, or totally unexpected event. View "Travelers Cas. & Surety Co. v. Workers' Comp. Appeals Bd." on Justia Law
Taskila v. Comm’r of Social Sec.
Taskila, age 37, has several health issues. She was involved in serious car accidents in 1996, 2006, and 2010; underwent successful treatment in 2011 for a mass in her breast; and sought treatment for knee pain. She claims, the injuries have led to unremitting pain in her neck and back, to anxiety and depression, to memory problems, to incontinence, to carpal tunnel syndrome, to an inability to work. Taskila sought Social Security disability insurance and supplemental security income. An initial disability examiner denied her applications. After a hearing, an ALJ did the same. The appeals council denied review. The district court and Sixth Circuit affirmed, finding the denial supported by substantial evidence that Taskila could perform a significant number of jobs in the national economy. View "Taskila v. Comm'r of Social Sec." on Justia Law