Justia Public Benefits Opinion Summaries

Plaintiff Jerry Elliott sought workers' compensation benefits from his employer, International Paper Company, Inc. (IP). He petitioned the Supreme Court for a writ of mandamus to quash a Court of Civil Appeals' writ of mandamus directed to the Conecuh Circuit Court. Plaintiff lived in Conecuh County for over 15 years and for 21 years worked as a machine operator at the plywood-manufacturing plant owned by IP located in Butler County. In 2007, he allegedly sustained an injury to his shoulder while at work. He filed an action at the Conecuh Circuit Court seeking workers' compensation benefits. IP filed motions to dismiss Plaintiff's action or, in the alternative, to transfer the case to Butler County. After a hearing, the trial court denied the motions to dismiss or to transfer. IP then filed a petition for the writ of mandamus at the Court of Civil Appeals to review the trial court's denial of its motion. The Court of Appeals granted the writ directing the Conecuh Court to transfer the case to Butler County. Upon review, the Supreme Court concluded the appellate court's decision was in error, and quashed the writ that was issued transferring venue to Butler County.

Employee-Petitioner Melenia Trotter was awarded workers' compensation benefits for a back injury by the South Carolina Workers' Compensation Commission ("Commission").  Petitioner worked at "the turb and trim station," which consisted of using an "air driver" (a screwdriver with a blade) to trim down tubes to the same length, and then "turbulating" the tubes by putting a spring into each tube. According to Petitioner, she began having spasms and some lower back pain that extended down her legs in December 2004, which she mentioned to her Team Leader and Trane's Safety Coordinator.  Petitioner continued to work with increasing discomfort in December 2004 and January 2005. An MRI revealed Petitioner had a herniated disc at L5-S1 with marked compression of the right S1 nerve root.  Following a doctor's recommendation, Petitioner underwent surgery in early 2005. In May 2005, Petitioner filed a claim alleging a job-related injury to her back. Trane denied the claim, maintaining it did not receive notice of the injury until after her surgery and that there was insufficient proof of a work-related injury. An Appellate Panel of the Commission unanimously upheld the commissioner's order finding Petitioner's injury was work related and granted her benefits.  The circuit court affirmed.  Trane appealed, and the appellate court reversed. Upon review, the Supreme Court concluded the Court of Appeals erred in finding the Commission abused its discretion in denying Trane's motions for a continuance or to keep the record open for depositions to be taken.  Consequently, the Court reversed the opinion of the Court of Appeals and reinstated the order of the Commission. 

In this case, the court construed Labor Code section 4659(c), which provided for the annual indexing of two categories of workers' compensation benefits, total permanent disability and life pension payments, to yearly increases in the state's average weekly wage (SAWW), so that lifetime disability payments made to the most seriously injured workers would keep pace with inflation. The indexing procedure was sometimes referred to as an "escalator," or one providing for "cost of living adjustments" (COLA's). At issue was whether the operative language of section 4659(c) required the annual COLA's for total permanent disability and life pension payments to be calculated (1) prospectively from the January 1 following the year in which the worker became "entitled to receive a life pension or total disability indemnity," (when the payments actually commenced); (2) retroactively to January 1 following the year in which the worker sustained the industrial injury; or (3) retroactively to January 2004, in every case involving a qualifying industrial injury, regardless of the date of injury or the date the first benefit payment became due. Applying fundamental rules of statutory construction, the court held that the Legislature intended that COLA's be calculated and applied prospectively commencing on the January 1 following the date on which the injured worker first became entitled to receive, and actually began receiving, such benefits payments, i.e., the permanent and stationary date in the case of total permanent disability benefits, and the date on which partial permanent disability benefits became exhausted in the case of life pension payments.

Linda Thompson appealed from a Superior Court judgment reversing the determination of the Unemployment Appeals Board (UIAB) that good cause existed for Thompson's voluntary resignation and granting her unemployment benefits. Thompson contended that good cause existed for voluntarily terminating her employment, that she exhausted her administrative remedies, and that substantial evidence in the record supported the UIAB's decision. The court affirmed the judgment of the Superior Court and held that substantial evidence did not support the UIAB's decision and the UIAB erred as a matter of law by concluding that Thompson was entitled to benefits pursuant to 19 Del. C. 3314(1).

Petitioner's claim for Social Security disability insurance benefits (42 U.S.C. 423(a)(1)(E)) and supplemental security income payments after suffering serious injuries in a motorcycle crash were denied by the Social Security Administration. An ALJ also denied the claim after conducting a hearing, finding that petitioner could perform a significant number of jobs. The district court the denial. The Seventh Circuit affirmed the denial as supported by substantial evidence that petitioner is qualified to work in positions that are available in substantial numbers.

Claimant Katrina Blue appealed an Employment Security Board decision that denied her claim for unemployment compensation benefits.  Claimant contended the Board erred in: (1) finding that she was disqualified from receiving benefits because she left her employment voluntarily; and (2) assigning her the burden of proof.  Claimant worked for about four years for Hickok & Boardman Realty.  In the early summer of 2010, claimant left her employment to participate in a three-month cross-country bicycle ride for multiple sclerosis. Claimant acknowledged that she did not submit a written request for leave, as required in the company's personnel policy, which stated that employees who apply for unpaid personal leave, "must apply in writing" and that, "reinstatement is not guaranteed" but rather, "at the Company's sole discretion."  While conceding that her leave arrangement "was not typical," Claimant maintained that her supervisor had agreed, "that an exception would be made in this instance." In its ruling, the ALJ's findings indicated that Claimant "requested a three-month leave of absence" but do not state whether the request was granted or, if so, on what terms.   Its key conclusion, however, was that, "[w]hile the claimant maintain[ed] that she was fired when the employer would not allow her to come back from a personal leave of absence, it was the claimant who initiated the separation from employment by requesting the leave of absence . . . thus making this a voluntary separation from employment."  Since there was no claim that the separation was for "good cause attributable" to the employer, the ALJ concluded that claimant was disqualified from receiving benefits. In a divided ruling, the Employment Security Board adopted the ALJ's findings and conclusions and sustained its decision.  The dissenting member of the Board would have found that claimant's "departure for her cross-country ride was . . . not a voluntary abandonment of her employment, but a temporary unpaid leave of absence," that claimant was let go upon her return in late August, and therefore that she was entitled to unemployment compensation benefits from that time forward.  This appeal followed. Upon review of the record, the Supreme Court reversed and remanded the case to the Department of Labor's ALJ: "[m]indful that our unemployment compensation scheme must be broadly construed so that no claimant is "excluded unless the law clearly intends" it … we direct the ALJ on remand to enter additional findings and conclusions on the material issues presented, and to award unemployment compensation benefits to claimant in the event it is determined that she  did not leave her employment voluntarily."

Employer Ethan Allen, Inc. appealed the Commissioner of the Department of Labor's decision that Claimant Robin Houle's right shoulder condition was compensable under the Workers' Compensation Act.  Claimant experienced pain and weakness in her left shoulder and arm, and her job duties as a furniture refinisher were modified to account for her medical restrictions.  Claimant was assigned to an inventory control/stockroom clerk position where she engaged in a variety of duties.  Interspersed among these duties, claimant also wrapped finished shelves to prepare them for shipping. Claimant was initially treated for the increased symptoms in her shoulder and neck by her primary care provider.  The primary care provider referred her to an orthopedist for further evaluation.  The orthopedist suspected that her left shoulder complaints were most likely due to her repetitive work for Ethan Allen.  He attributed claimant's right shoulder pain to normal wear and tear to be expected of someone claimant's age.  Claimant was dissatisfied with this evaluation and was then referred to an orthopedic surgeon for further evaluation and treatment. In view of the competing expert medical opinions, the Commission relied on a traditional five-part test to evaluate their persuasiveness. Ethan Allen raised numerous arguments on appeal to the Supreme Court. Principal among them, Ethan Allen challenged the Commissioner's use of the five-part test to evaluate competing medical opinions, both as applied in this case and in general.  According to the Employer, the use of this test improperly shifts the burden of proof from claimant to employer, unfairly places employers at a disadvantage, and erroneously employs a "winner take all" approach to evaluating a claimant's expert testimony. Upon review, the Supreme Court concluded that Ethan Allen failed to show that the Commissioner's findings were clearly erroneous or that her conclusions were unsupported by the findings. The Court affirmed the Commissioner's decision in this case.

Plaintiff Pamela Allen-Pentkowski appealed the Vermont Employment Security Board's (Board) determination that she was discharged from work for actions constituting misconduct, a decision which temporarily disqualified her from collecting unemployment compensation benefits.  Prior to her discharge, Plaintiff had worked for over five years at Liebert Engineering, Inc. as a computer assisted design operator. Over the course of her work for Liebert, a dispute arose when Plaintiff's work schedule changed. She claims she told her supervisor that she could make a requested change in her work hours after she had her baby, but until then, could not work an extra hour beyond 4:00 p.m. on days requested by her supervisor. In an e-mail to the company's president, Plaintiff explained she could not work the extra hour, that her supervisor would not listen to her, and that she felt harassed by his repeated insistence. Hearing an exchange between Plaintiff and the supervisor, the president came from his office and told Plaintiff that "can't is equal to refusal, refusal is reason for termination," at which point, he discharged Plaintiff. Plaintiff filed for unemployment compensation benefits but the claims adjudicator determined the nature of plaintiff's discharge from her employer was misconduct connected with her work. On appeal, plaintiff argued that her inability to work the hours requested by her employer was not misconduct within the meaning of the statute and should not disqualify her from unemployment compensation benefits.  Upon review, the Supreme Court held the employer failed to carry its burden of proof and reversed the Board's decision.

Appellant Anne Marie Morack worked for Appellee Gentex Corporation for over thirty years. In 2005, she left when swelling and pain in her hands were too overwhelming for her to continue work. She sought medical help, and notified her employer of the pain. In early 2005, Appellant applied for short-term disability, noting on her application for benefits that she did not believe her injury was work-related. After consultation with a specialist, Appellee learned that her injury was work-related. Gentex ultimately appealed the Workers' Compensation Appeal Board's decision granting Appellant's claim to the Commonwealth Court, contending that Appellant did not timely notify her supervisor of the injury nor aptly describe the injury to comply with the state workers' compensation act. The Commonwealth Court reversed, finding Appellant did not aptly describe her injury nor give Gentex adequate notice. The Supreme Court granted allocatur to determine what constitutes sufficient notice under the Act, and to "speak to" an employer's duty to conduct reasonable investigations into the circumstances surrounding a work-related injury. Under the Act, notice is a prerequisite to receive workers' compensation benefits, and the claimant bears the burden of demonstrating that proper notice was given. Upon review of the applicable case law in this instance, the Court found that, "consistent with the humanitarian purposes of the Act, [the Court] made it clear that even imperfect notice can satisfy" its strictures. The Court employed a "totality of the circumstances" approach to determining whether Appellant in this case both satisfied the notice and description of the injury in making her claim for benefits. In reversing the Commonwealth Court, the Supreme Court found that Appellant's collective communications with Gentex satisfied the notification requirements of the Act.

Claimant Kevin Ressler suffered a work-related injury in 1995. He received Workers' Compensation benefits. In 2004, Claimant submitted to an independent medical evaluation (IME). The sequence of events since the IME make up the heart of this appeal. In June 2004, Claimant had surgery related with his work-related injury. In July 2004, his employer petitioned to terminate benefits as of the date of the IME. The employer also requested a supersedeas. The Workers' Compensation Judge (WCJ) denied the superseadas in August 2004. In October of that year, the insurer received the invoice for the June surgery and paid the amount by the end of January, 2005. In June 2005, the WCJ granted the employer's petition to terminate benefits. The Workers' Compensation Appeal Bard (WCAB) affirmed that decision. The insurer then requested reimbursement for the 2004 surgery from the Supersedeas Fund. The Bureau of Workers' Compensation challenged the request because Claimant's surgery predated the supersedeas request. The WCJ found that no obligation to pay arose until the bill was submitted to the insurer in October 2004. Because the obligation to pay arose after the denial of supersedeas, reimbursement was appropriate. The WCAB affirmed. The issue of whether the Supersedeas Fund may deny reimbursement of treatment rendered before the insurer requested supersedeas came before the Supreme Court. Upon review of the trial record and the Workers' Compensation Act, the Court concluded that the lower courts appropriately ordered reimbursement to the insurer for undue payments made after the supersedeas request and in direct response to the earlier denial. The Court affirmed the lower court's decision.