Justia Public Benefits Opinion Summaries

A worker was involved in a fight in a logging camp bunkhouse. He did not file a report of injury related to the fight for over a year. When he finally filed a report of injury, he alleged that he had injured his hip, lower back, and ear in the fight. His employer denied the worker benefits because he did not give timely notice of the injury. The worker then alleged that he had verbally informed his supervisor of the injuries. After a hearing, the Alaska Workers’ Compensation Board determined that the worker’s claim was barred because he did not give his employer timely notice of the injury. The Board performed an alternative analysis assuming the worker had given timely notice and decided that the claim was not compensable. The Alaska Workers’ Compensation Appeals Commission affirmed the Board’s decision. Because the Commission correctly determined that substantial evidence in the record supports the Board’s decision on the compensability of the claim, the Supreme Court affirmed the Commission’s decision.

Petitioner Wanda Gottus appealed a district court judgment that affirmed a decision of Job Service North Dakota denying her unemployment benefits and concluding she was discharged for actions constituting misconduct. In January 2008, Petitioner began working as a cashier for Service Oil Inc. d/b/a Stamart. In addition to acting as a cashier, Petitioner's job duties included attending to the store's shelves, light cleaning, and other similar tasks. Petitioner's employment with Stamart ended in August 2010 when she was discharged for poor job performance. Petitioner subsequently filed for unemployment insurance benefits. Job Service initially approved Petitioner for unemployment benefits indicating she was not discharged for misconduct. Stamart appealed this decision, and a telephone hearing was held before an appeals referee. Testimony and evidence presented during the hearing revealed there were at least sixteen instances when Petitioner's job performance fell below the level expected of Stamart employees. The Job Service reviewed the record and affirmed the referee's decision. Petitioner argued on appeal her job performance was merely unsatisfactory but did not constitute misconduct. The district court rejected her argument and affirmed Job Service's decision. The Supreme Court concluded Job Service's findings of fact were supported by a preponderance of the evidence, and its conclusion that Petitioner's actions constituted disqualifying misconduct was supported by the findings.

Petitioner Theresa Freeman appealed the denial of her applications for social security disability insurance benefits and supplemental security income benefits. Petitioner applied for benefits in June 2007, alleging she was unable to work as the result of obesity and an on-the-job back injury that had occurred in February 2007. Her applications were denied at the administrative level, on reconsideration, and after a hearing before an administrative law judge (ALJ). The ALJ found that Petitioner's degenerative disk disease and obesity were severe impairments, but that none of her impairments, either alone or in combination, met or equaled one of the listings. Furthermore, the ALJ found that Petitioner had "the residual functional capacity to perform less than the full range of light work." After the Appeals Council denied her request for review, Petitioner filed her complaint in district court, and a magistrate judge affirmed the Commissioner's denial of benefits. Upon review, the Tenth Circuit concluded that Petitioner wanted the Court to "reweigh the evidence or substitute [the Court's] judgment for that of the Commissioner" which the Court declined to do. Accordingly the Court affirmed the Commissioner's decision to deny Petitioner's benefits.

This opinion consolidated two cases brought before the Supreme Court on certified appeals from the Court of Appeals. Both cases involved the Public Employees Retirement Board's (PERB or the Board) revision or reduction of benefits with respect to "Window Retirees." These cases involved the Board's efforts to recoup overpayments of benefits to retirees that were predicated on a 20 percent earnings credit for calendar year 1999 that the Board approved by order in 2000. PERB sought to recoup these overpayments to the Window Retirees through an overpayment recovery mechanism set out in ORS 238.715.2. A number of members challenged the statutory mechanism for returning the payments, and the methodology the Board used in making its individualized determinations. Upon review, the Supreme Court determined that the trial court correctly granted summary judgment to the "Arken defendants" on all four of the claims raised by the "Arken plaintiffs." Furthermore, the Court determined that the trial court erred in granting summary judgment to the "Robinson petitioners" on their claims for relief. Because the Court concluded that PERB correctly applied ORS 238.715 to recoup overpayments that were made to the Window Retirees based on the 20 percent earnings credit for 1999, the Court also determined that the trial court erred in denying PERB's cross-motion for summary judgment.

Petitioners sought judicial review of a final order of the Public Employees Retirement Board (PERB). They contested the reduction of their retirement benefits as a result of PERB's efforts to recoup benefit overpayments that Petitioners had received because of an erroneous 20 percent earnings credit for 1999. The Court of Appeals certified the matter to the Supreme Court, and upon review of the applicable legal authority, the Supreme Court affirmed PERB's final order.

Petitioner Ruben Espinosa sought permanent partial disability benefits for injuries to his hands, arms, and shoulders. The Workers' Compensation Court awarded benefits, but a three-judge en banc panel reduced the award to account for Petitioner's previously awarded benefits for injuries to other parts of his body. The Court of Civil Appeals vacated the panel, determining that both the trial court and the panel misapplied the applicable statute. The Supreme Court granted certiorari to resolve a conflict between two Court of Civil Appeals' opinions with differing interpretations of the limitations provided in the applicable statute. Upon review, the Supreme Court held that when the Workers' Compensation Court awards compensation for an accidental personal injury or occupational disease, pursuant to 85 O.S. 2001 Sec. 22(7), the sum of all permanent partial disability awards is limited to a total of 100% or 520 weeks (10 years) for any individual, but awards against the Multiple Injury Trust Funds, or awards for amputations and surgeries are excluded from both limitations.

Claimant Claud Sloan appealed a district court judgment that affirmed a Workforce Safety & Insurance (WSI) order awarding him additional permanent impairment benefits. In December 1985, Sloan sustained a compensable work-related injury while employed at a coal gasification plant in Beulah, North Dakota. WSI awarded Sloan permanent impairment benefits for his injury and has issued several permanent partial impairment orders since his original injury. Effective April 1, 2009, WSI promulgated N.D. Admin. Code 92-01-02-25(4) to address pain impairment ratings. Based on the newly adopted rule, WSI reviewed Sloan's pain rating and determined he had sustained an eight percent impairment for pain which, when combined with his prior impairment ratings, totaled a whole body impairment rating of 38 percent. On June 11, 2009, WSI issued an order awarding Sloan additional permanent impairment benefits, based on his combined whole body impairment of 38 percent for his cervical spine, depression, dysphagia, and chronic pain. Sloan requested a rehearing. At a November 2009, hearing before an administrative law judge, a staff attorney for WSI appeared as the only witness and testified regarding the WSI's promulgation of N.D. Admin. Code 92-01-02-25. The ALJ subsequently issued an order affirming WSI's June 2009 order awarding Sloan additional permanent impairment benefits. Sloan appealed to the district court, which affirmed the order. Upon review, the Supreme Court concluded WSI's promulgation of administrative rules for assessing pain impairment did not conflict with its statutory authority and was not arbitrary, capricious, or unreasonable.

Petitioner Toni Weeks appealed a district court judgment that affirmed a decision by Workforce Safety and Insurance (WSI) that reduced her disability benefits. Petitioner was injured at work after being exposed to anhydrous ammonia while employed by Dakota Gasification Company, in Beulah, North Dakota. In 2009, WSI received confirmation that on November 1, 2009, Weeks' social security disability benefits would convert to social security retirement benefits. WSI issued a notice of intention to discontinue or reduce benefits, in which Petitioner was informed that her permanent total disability benefits would end on October 31, 2009, and she would receive an "additional benefit payable" beginning November 1, 2009. Petitioner requested reconsideration. In November 2009, WSI issued an order denying Petitioner further disability benefits after October 31, 2009. Upon review, the Supreme Court found that because Petitioner failed to adequately brief her argument that WSI's reduction of her wage loss benefits violated equal protection under the federal and state constitutions, the Supreme Court declined to address her argument and otherwise affirmed the judgment.

Petitioner married in 2001. Her husband had retired unmarried under the Civil Service Retirement System and elected to receive an annuity payable during his lifetime with no survivor benefits. He died in 2003, and petitioner's application for survivor annuity benefits was denied. After considering evidence about a conversation that husband purportedly had with one of its employees, the Office of Personnel Management affirmed, stating that husband could have elected to receive a reduced lifetime annuity with survivor benefits for a new wife only by notifying OPM of his intentions in a signed writing within two years of his marriage, 5 U.S.C. 8339(k)(2)(A). An administrative judge upheld the decision, stating that the decision would become final on June 21, 2004, unless a petition for review was filed. Petitioner did not file until 2010, claiming disability made her unable to attend to the matter. The Board denied her petition for review as untimely filed, finding no credible medical evidence regarding her condition. The Federal Circuit affirmed.

This case was a direct appeal in a workers' compensation matter from a master's order reversing the Full Commission and finding respondent's decedent was totally disabled as the result of an occupational disease. On appeal, Appellant W. L. Gore & Associates contended this matter should have been dismissed because Respondent's admittedly untimely appeal to the Commission deprived the Commission of jurisdiction. Upon review of the Commission's record, the Supreme Court agreed that the untimely appeal to the Commission required it to vacate both the master's order and the decision of the Full Commission.