Justia Public Benefits Opinion Summaries

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.

Petitioner Maria Willits appealed the decision of the Job Service North Dakota ("Job Service") that denied her application for unemployment benefits after Job Service found she voluntarily left her employment without showing good cause attributable to her employer. In October 2003, Petitioner began working full time as a licensed practical nurse (LPN) for Circle of Nations School, a boarding school for Native American children located on federal property in Wahpeton. According to Petitioner, she became concerned that one staff member she had trained was not proficient in English. After a different staff member committed a medications error in late October 2009, Petitioner met with the dean of students of the school and expressed concerns about training the two staff members to administer medications because she did not believe they were qualified and would pose a risk to the student population. Petitioner told the dean that she would not re-certify the two staff members but would train others. Petitioner subsequently contacted the State Board of Nursing and inquired whether she could conduct medication administration training as an LPN. She was informed that she was not authorized to train staff to administer medications and that she needed to be supervised by a registered nurse or licensed practitioner. According to Petitioner, she concluded her work at the school was outside the scope of her nursing license. Petitioner's concerns were discussed with the school's administrators. In November 2009, Petitioner informed the school through a phone message that she quit her employment. By then, the school had obtained the services of a doctor to oversee nursing activities. The Supreme Court affirmed Job Service's decision, concluding "a reasoning mind reasonably could have determined that [Petitioner] did not make a reasonable effort to preserve her employment relationship and, consequently, that she left her employment without good cause attributable to her employer."

Petitioner worked as an underground surveyor for a coal company for more than 22 years. He filed an unsuccessful claim for black lung benefits (30 U.S.C. 901) about a year after being laid off. He filed a second claim 10 years later, accompanied by medical opinions and x-ray interpretations. The DOL provided a pulmonary examination for each claim. The first diagnosed shortness of breath of unknown etiology but opined that petitioner suffered no impairment. The second resulted in diagnosis of restrictive lung disease, right mid lung density, bilateral hilar adenopathy and concluded that there was no impairment. An ALJ rejected the second claim. The Benefits Review Board affirmed. The Sixth Circuit vacated for consideration under an amendment to the Act, under which a miner who worked underground for at least 15 years and who demonstrates that he suffers from a total respiratory disability is presumed to be totally disabled due to pneumoconiosis (30 U.S.C. 921(c)(4)). Rebuttal requires an affirmative showing; it is not enough to show that medical evidence does not include a well documented opinion of pneumoconiosis. The ALJ failed to consider all evidence relevant to the issue of disability.

Plaintiff appealed the district court's grant of summary judgment dismissing claims of wrongful termination against her former employer, its president and chief executive officer, and its principal owner (collectively, defendants). At issue was whether plaintiff's claim of wrongful termination violated Iowa public policy. The court held that, in these circumstances, the district court correctly concluded that plaintiff's discharge did not undermine clearly defined public policy as a matter of law where plaintiff was discharged based on an at-will employment contract and where there was no false reimbursement claim submitted and no acts of fraud occurring on the part of defendants. Accordingly, the judgment of the district court was affirmed and the court denied as moot plaintiff's motion to strike portions of defendants' briefs.

Plaintiff appealed the district court's grant of summary judgment dismissing claims of wrongful termination against her former employer, its president and chief executive officer, and its principal owner (collectively, defendants). At issue was whether plaintiff's claim of wrongful termination violated Iowa public policy. The court held that, in these circumstances, the district court correctly concluded that plaintiff's discharge did not undermine clearly defined public policy as a matter of law where plaintiff was discharged based on an at-will employment contract and where there was no false reimbursement claim submitted and no acts of fraud occurring on the part of defendants. Accordingly, the judgment of the district court was affirmed and the court denied as moot plaintiff's motion to strike portions of defendants' briefs.

This action arose when claimant, a former customer service representative for Verizon New England, Inc. ("Verizon"), was denied unemployment benefits. At issue was whether the board of review of the division of unemployed assistance ("board") erred because Verizon took the "last step" in the termination process that entitled claimant to unemployment benefits. The court affirmed the judgment of the district court, which affirmed the decision of the board, to deny claimant benefits because the court agreed with the board's conclusion that the claimant did not meet her burden of showing that her decision to leave was involuntary, where she was not compelled to apply for the termination, did not believe her job was in jeopardy, and left in part for personal reasons.

The employee developed bilateral cubital tunnel syndrome while working at a supermarket, then worked as a greeter until she was laid off in 2003 because she was unable to perform the job. She subsequently started and left a dental hygiene, radiology technology, and electroencephalography training programs because of problems related to her hands and vision. At age 45 she had an extensive medical history, including fibromyalgia, degenerative disc disease, bilateral mild ulnar neuropathy, and multiple eye surgeries with dry eye syndrome. In 2008 an ALJ rejected her claim for social security disability benefits. The appeals council denied review and the district court affirmed. The Seventh Circuit affirmed, noting that the ALJ failed to acknowledge a physician report contrary to her conclusion and to explain the weight she gave that opinion, but stating that remand would serve no purpose in light of the overwhelming evidence supporting the denial.

The Commonwealth Court declined to issue a writ of mandamus to Appellant Crozer Chester Medical Center (Crozer) in its attempt to force the Department of Labor and Industry (Department) to reimburse it for medical fees. Claimant William Radel suffered a work-related injury while lifting a bundle of rebar for his employer. The claimant underwent surgery at Crozer, and Crozer sent claimant's records and the bill to claimant's insurance company, Zurich North American Insurance (Zurich). Zurich did not pay, nor did it deny the claim. Crozer then turned to the State for reimbursement. The Department rejected the application as "premature," because Zurich's non-payment made an "outstanding issue of liability/compensability for the alleged injury." Crozer then petitioned the Commonwealth Court to force the Department to pay. The Supreme Court agreed that Crozer's application for reimbursement was premature. The Court found that Crozer did not try to resolve Zurich's nonpayment before petitioning the State or the Commonwealth Court. The Court affirmed the decision of the Department and the lower court, and dismissed Crozer's petition for a writ of mandamus.

The Secretary of the United States Department of Labor ("DOL") petitioned the district court to enforce administrative document subpoenas after a DOL investigation into the management of respondents (collectively, "Funds"), which arose out of a $10.1 million loss of Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. 1134(a)(1), plan assets, as a result of the Funds' investments in entities related to Bernard L. Madoff. At issue was whether the attorney-client and work product privileges protected some of the materials requested by the Secretary from disclosure and whether the district court erred in applying the fiduciary exception to override these privileges. The court affirmed the district court's order granting the Secretary's petition and held that the fiduciary exception applied to the Funds' claims of attorney-client privilege and no good cause showing was required in the ERISA context. The court also held that the Funds have failed to carry their burden to demonstrate the applicability of the work product doctrine.