Justia Public Benefits Opinion Summaries

In this discretionary appeal, we consider whether Appellant, the Pennsylvania State Police (“PSP”), is entitled to subrogation of benefits that a trooper – who was injured in a motor vehicle accident – was eligible to receive under the Workers’ Compensation Act (“WCA”) against the trooper’s recovery from a third-party tortfeasor pursuant to the Motor Vehicle Financial Responsibility Law (“MVFRL”). In 2011, Pennsylvania State Trooper Joseph Bushta (“Claimant”) was on duty when his police vehicle was hit by a tractor-trailer. As a result of the collision, Claimant suffered various cervical, thoracic, and lumbar injuries which required medical treatment and physical therapy, and which resulted in Claimant’s inability to perform his job duties for approximately 16 months. PSP, a self-insured public employer, issued a notice of compensation payable (“NCP”) indicating a weekly compensation rate of $858.08 under the WCA. The Pennsylvania Supreme Court determined that all of the benefits Claimant received were Heart and Lung benefits, not WCA benefits. Thus, pursuant to the MVFRL, PSP does not have a right of subrogation against Claimant’s settlement with the third-party tortfeasors. View "Penn. State Police v. WCAB (Bushta)" on Justia Law

The Supreme Court affirmed in part and reversed and remanded in part the decision of the Workers’ Compensation Court of Appeals (WCCA) upholding the decision of the compensation judge ordering that Atlas Staffing, Inc. and its insurer, Meadowbrook Claims Services, pay workers’ compensation benefits to Anthony Gist. The compensation judge found that Gist’s exposure to silica, a known cause of end stage renal disease (ESRD), during his employment with Atlas was a substantial contributing factor to his kidney disease.In the consolidated appeals brought by Appellants and Fresenius Medical Care, which treated Gist after Appellants denied coverage and accepted payments from Medicaid and Medicare for the costs of that treatment, the Supreme Court held (1) the compensation judge did not abuse her discretion by relying on a certain medical report to find that work-related silica exposure was a substantial contributing factor to Gist’s kidney failure; (2) under 42 C.F.R. 447.15, a provider cannot recover payment from third parties for any services billed to Medicaid after the provider has accepted payment from Medicaid for those services; and (3) the WCCA erred when it dismissed Fresenius’s cross-appeal as untimely. View "Gist v. Atlas Staffing, Inc." on Justia Law

Six judges who were elected to the superior court in mid-term elections in 2012, but who did not take office until January 7, 2013, claimed entitlement to benefits under the Judges’ Retirement System II (JRS II) as in effect at the time they were elected, rather than at the time they assumed office. On January 1, 2013, JRS II became subject to the California Public Employees’ Pension Reform Act of 2013 (PEPRA), Government Code section 75500, which amended virtually all state employee retirement systems to address the state’s enormous unfunded pension liability and return these systems to actuarially sound footing. PEPRA increases employee contributions, provides for fluctuating contribution rates based on market performance and actuarial projections, and bases the amount of monthly pension payments on an employee’s final three years of compensation, rather than on only the final year. The court of appeal held that the judges did not obtain a vested right in JRS II benefits as judges-elect, but rather obtained a vested right to retirement benefits only upon taking office after PEPRA went into effect. PEPRA’s provisions pertaining to fluctuating pension contributions do not violate the non-diminution clause of the California Constitution nor do they impermissibly delegate legislative authority over judicial compensation. View "McGlynn v. State of California" on Justia Law

Brown worked for BCP for 10 years. BCP had permitted Brown to wear shirts with BCP patches, rather than a uniform shirt. After discovering that it could order larger-size uniform shirts, BCP purchased such shirts for Brown in 2011. He was fired in January 2012 for wearing the wrong shirt. The Employment Development Department (EDD) denied his application for unemployment benefits. The trial court granted Brown’s writ petition, concluding that Brown had not engaged in misconduct sufficient to disqualify him from benefits because he had offered to go home and change shirts and was terminated on his first violation. In August 2013, EDD responded that EDD had paid Brown “all the benefits for which he has been found eligible,” noting that it was requiring Brown to submit certification forms and that an eligibility issue would need to be resolved before further benefits could be paid. in October 2014, Brown sought enforcement, claiming that EDD had imposed improper conditions, caused extended delays, and continued to withhold benefits. The court found EDD’s failure to comply “without good cause,” levied a $1,000 fine, awarded attorney fees, and determined that the rate of interest for wrongfully withheld unemployment benefits was seven percent, the judgment interest rate (Government Code 965.5(a), (d)). The court of appeal reversed, remanding for calculation of interest at 10 percent under Civil Code 3289(b). EDD’s statutory obligations are like contractual promises, subject to the statutory contractual rate of prejudgment interest. Brown’s right to prejudgment interest gave way to his entitlement to post-judgment interest with the trial court’s order. View "Brown v. California Unemployment Insurance Appeals Board" on Justia Law

Brown worked for BCP for 10 years. BCP had permitted Brown to wear shirts with BCP patches, rather than a uniform shirt. After discovering that it could order larger-size uniform shirts, BCP purchased such shirts for Brown in 2011. He was fired in January 2012 for wearing the wrong shirt. The Employment Development Department (EDD) denied his application for unemployment benefits. The trial court granted Brown’s writ petition, concluding that Brown had not engaged in misconduct sufficient to disqualify him from benefits because he had offered to go home and change shirts and was terminated on his first violation. In August 2013, EDD responded that EDD had paid Brown “all the benefits for which he has been found eligible,” noting that it was requiring Brown to submit certification forms and that an eligibility issue would need to be resolved before further benefits could be paid. in October 2014, Brown sought enforcement, claiming that EDD had imposed improper conditions, caused extended delays, and continued to withhold benefits. The court found EDD’s failure to comply “without good cause,” levied a $1,000 fine, awarded attorney fees, and determined that the rate of interest for wrongfully withheld unemployment benefits was seven percent, the judgment interest rate (Government Code 965.5(a), (d)). The court of appeal reversed, remanding for calculation of interest at 10 percent under Civil Code 3289(b). EDD’s statutory obligations are like contractual promises, subject to the statutory contractual rate of prejudgment interest. Brown’s right to prejudgment interest gave way to his entitlement to post-judgment interest with the trial court’s order. View "Brown v. California Unemployment Insurance Appeals Board" on Justia Law

Guzman was operating a soil compactor on a hillside with a 45-degree slope when the compactor hit a rock. The compactor rose in the air, causing Guzman to fall backward, and then fell on top of him. The workers’ compensation judge determined that Guzman sustained an injury to his back and psyche and that the psychiatric injury was caused by a “sudden and extraordinary employment condition,” Lab. Code, 3208.3(d). The workers’ compensation carrier for Guzman’s employer unsuccessfully sought reconsideration by the Workers’ Compensation Appeals Board, arguing that Guzman failed to meet his burden of proving that his psychiatric injury was caused by a “sudden and extraordinary employment condition.” The court of appeal annulled the Board’s order denying reconsideration. Guzman did not provide any evidence establishing that it is “uncommon, unusual, and totally unexpected” for a rock to be in soil, for a compactor to rise when striking a rock, or for an operator to become unbalanced and to fall when the compactor rises on a 45-degree hillside. He did not introduce any evidence regarding what regularly or routinely happens if a compactor hits a rock on a slope. Guzman admitted that he had previously worked on flat surfaces only. View "State Compensation Insurance Fund v. Workers’ Compensation Appeals Board" on Justia Law

Felton, then employed by Hewlett-Packard, sustained a minor injury to his knee while volunteering on a Douglas County search and rescue team. Felton sought insurance benefits from Douglas County and its workers' compensation insurance carrier. The third-party claims adjustor, ASC, notified Felton that it had calculated his average monthly wage (AMW) for the purpose of determining the amount of benefits based upon the statutorily deemed wage of a search and rescue volunteer as set forth in NRS 616A.157, which is $2,000 per month. ASC awarded Felton a one-percent permanent partial disability (PPD) or whole person impairment (WPI). A hearing officer affirmed the award. Felton appealed only the determination that his AMW should be set at the statutorily deemed wage of a search and rescue volunteer. The appeals officer affirmed, holding that Felton was not entitled to an AMW that aggregated his statutorily deemed wage and his earned wage from his private employment. The Nevada Supreme Court reversed. The plain language of the statutes and regulations requires the aggregation of concurrently earned wages. View "Felton v. Douglas County" on Justia Law

Me. Rev. Stat. 39-A, 221 entitles an employer to a credit for workers’ compensation benefits previously paid for the same liability period when the employee was also receiving Social Security retirement benefits.Plaintiff was paid total incapacity workers’ compensation benefits by his employer, Interstate Brands International, after he sustained injuries in an initial workplace accident. For three years, Plaintiff collected Social Security retirement benefits while receiving the full amount of the workers’ compensation benefits. When Interstate learned that Plaintiff was receiving Social Security benefits, it sought a credit against the ongoing incapacity payments pursuant to section 221. A hearing officer determined that Interstate was entitled to a credit of nearly $25,000. The Workers’ Compensation Appellate Division vacated the decree, concluding that section 221 does not allow a reduction based on incapacity overpayments made in the past. The Supreme Judicial Court vacated the Appellate Division’s decision, holding that Interstate was entitled to a credit for incapacity benefit overpayments made to Plaintiff during the same period when he received Social Security retirement benefits. View "Urrutia v. Interstate Brands International" on Justia Law

An employee continued to work for over ten years after a job-related knee injury but had multiple surgeries on her injured knee. Over time, her employer made several permanent partial impairment payments, and she was eventually determined to be permanently and totally disabled because of the work injury. She began to receive Social Security disability at about the same time she was classified as permanently and totally disabled for workers’ compensation. Her employer asked the Alaska Workers’ Compensation Board to allow two offsets to its payment of permanent total disability (PTD) compensation: one related to Social Security disability benefits and one related to the earlier permanent partial impairment (PPI) payments. The Board established a Social Security offset and permitted the employer to deduct the amount of previously paid PPI. The employee appealed to the Alaska Workers’ Compensation Appeals Commission, arguing that the Board had improperly applied one of its regulations in allowing the PPI offset and had incorrectly calculated the amount of the Social Security offset. She also brought a civil suit against the State challenging the validity of the regulation. The State intervened in the Commission appeal; the lawsuit was dismissed. The Commission reversed the Board’s calculation of the Social Security offset and affirmed the Board’s order permitting the PPI offset. The employer appealed the Commission’s Social Security offset decision to the Alaska Supreme Court, and the employee cross- appealed the PPI offset. The Court affirmed that part of the Commission’s decision reversing the Board’s calculation of the Social Security disability offset and reversed that part of the Commission’s decision permitting an offset for permanent partial impairment benefits. The case was remanded back to the Commission for further proceedings. View "Alaska Airlines, Inc. v. Darrow" on Justia Law

Guerrero applied for workers’ compensation benefits after he was injured in the course of his employment as a construction laborer. He received temporary disability benefits: November 18–December 4, 2005, and January 17–June 15, 2006. His entitlement to permanent disability benefits was contested but settled in December 2014. The resulting agreement provided that Guerrero would receive a lump sum in satisfaction of his employer’s obligation to pay permanent disability benefits, less the amount of permanent disability payments his employer had advanced. Guerrero also applied for benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF), the state fund that pays workers’ compensation benefits to certain permanently disabled workers. A Workers’ Compensation ALJ ordered the SIBTF to pay, finding that Guerrero’s preexisting condition combined with the subsequent injury left him totally and permanently disabled. The ALJ fixed the beginning date for SIBTF payments as June 16, 2006, the day after temporary disability payments ceased, rejecting SIBTF’s argument that its obligation should not begin until January 26, 2011 (when Guerrero’s injuries were deemed permanent and stationary). The Workers’ Compensation Appeals Board denied a petition for review. The court of appeal affirmed, finding that under the controlling statutes, SIBTF benefits commence at the time the employer’s obligation to pay permanent disability benefits begins. View "Baker v. Workers Compensation Appeals Board" on Justia Law