Justia Public Benefits Opinion Summaries

The Supreme Court affirmed the district court’s grant of summary judgment in favor of Defendants, holding that Plaintiffs' claims were either moot or failed to state a claim as a matter of law.The hospital at which an injured child received medical care sought to secure payment for that care by asserting liens against the child’s interest in the tort claim against the driver of the car that struck the child. The child and his mother brought claims against the hospital owner and its payments vendor, arguing that the liens violated Medicaid law. When the liens were released, the district court granted summary judgment in favor of Defendants. The Supreme Court affirmed on the principles of mootness and Plaintiffs’ failure to state a claim as a matter of law. View "Shaffer v. IHC Health Services, Inc." 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

Johnson worked successively as a firefighter for South San Francisco (CSSF) and Pacifica. He developed nasopharyngeal cancer. Labor Code section 3212.11 establishes a presumption that cancer manifesting during and for a specified period following employment in certain public safety positions, including firefighters, arose out of and in the course of that employment. Section 5500.5(a) limits employer liability for a cumulative injury to the employer who employed the applicant during the one year preceding the earliest of the date of injury or the last date of injurious exposure to the hazards that caused the injury, so either CSSF or Pacifica would be potentially responsible for compensation for the entire injury. CSSF settled Johnson's workers’ compensation claim and sought contribution from Pacifica. An arbitrator denied the petition, ruling that evidence of the latency period for Johnson's cancer showed the injurious exposure occurred during Johnson’s earlier employment with CSSF. The Workers’ Compensation Appeals Board adopted the order. CSSF argued the Board erroneously utilized a more lenient preponderance evidentiary standard in applying section 5500.5(a), rather than the more stringent cancer presumption rebuttal standard of section 3212.1. The court of appeal affirmed; the evidence supports the award. Worker protection policies embodied in section 3212.1 are not implicated in the allocation of liability between employers. View "City of South San Francisco v. Workers' Compensation Appeals Board" on Justia Law

Johnson worked successively as a firefighter for South San Francisco (CSSF) and Pacifica. He developed nasopharyngeal cancer. Labor Code section 3212.11 establishes a presumption that cancer manifesting during and for a specified period following employment in certain public safety positions, including firefighters, arose out of and in the course of that employment. Section 5500.5(a) limits employer liability for a cumulative injury to the employer who employed the applicant during the one year preceding the earliest of the date of injury or the last date of injurious exposure to the hazards that caused the injury, so either CSSF or Pacifica would be potentially responsible for compensation for the entire injury. CSSF settled Johnson's workers’ compensation claim and sought contribution from Pacifica. An arbitrator denied the petition, ruling that evidence of the latency period for Johnson's cancer showed the injurious exposure occurred during Johnson’s earlier employment with CSSF. The Workers’ Compensation Appeals Board adopted the order. CSSF argued the Board erroneously utilized a more lenient preponderance evidentiary standard in applying section 5500.5(a), rather than the more stringent cancer presumption rebuttal standard of section 3212.1. The court of appeal affirmed; the evidence supports the award. Worker protection policies embodied in section 3212.1 are not implicated in the allocation of liability between employers. View "City of South San Francisco v. Workers' Compensation 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

In 2006, Moreno fell off scaffolding and landed on his back while working. An orthopedist found a soft tissue injury but no signs of fracture. He continued to feel significant pain. A follow-up test revealed acute lumbar radiculopathy—lower back pain caused by compression, inflammation or injury to a spinal nerve root. Moreno also is diabetic, has high blood pressure, and is obese. Moreno sought treatment from a psychologist, who reported that Moreno manifested depressed mood, irritability, memory difficulties, inability to concentrate, and an ongoing inability to sleep, sometimes for days. Moreno took several medications. In 2007, Moreno sought Supplemental Security Income and Disability Insurance Benefits. An ALJ affirmed the denial of his application. In the district court, the parties agreed to a remand to a different ALJ, who concluded that Moreno was not disabled although he was suffering from severe impairments and could not perform his past work as a drywall taper. The Seventh Circuit reversed. The ALJ improperly relied on an outdated assessment although later evidence containing new, significant medical diagnoses reasonably could have changed the reviewing physician’s opinion. Doctors’ notes set forth problems with Moreno becoming distracted, “spacing out,” and experiencing difficulties concentrating; these limitations were not included in the hypothetical question posed to the vocational expert. View "Moreno v. Berryhill" on Justia Law

In 2006, Moreno fell off scaffolding and landed on his back while working. An orthopedist found a soft tissue injury but no signs of fracture. He continued to feel significant pain. A follow-up test revealed acute lumbar radiculopathy—lower back pain caused by compression, inflammation or injury to a spinal nerve root. Moreno also is diabetic, has high blood pressure, and is obese. Moreno sought treatment from a psychologist, who reported that Moreno manifested depressed mood, irritability, memory difficulties, inability to concentrate, and an ongoing inability to sleep, sometimes for days. Moreno took several medications. In 2007, Moreno sought Supplemental Security Income and Disability Insurance Benefits. An ALJ affirmed the denial of his application. In the district court, the parties agreed to a remand to a different ALJ, who concluded that Moreno was not disabled although he was suffering from severe impairments and could not perform his past work as a drywall taper. The Seventh Circuit reversed. The ALJ improperly relied on an outdated assessment although later evidence containing new, significant medical diagnoses reasonably could have changed the reviewing physician’s opinion. Doctors’ notes set forth problems with Moreno becoming distracted, “spacing out,” and experiencing difficulties concentrating; these limitations were not included in the hypothetical question posed to the vocational expert. View "Moreno v. Berryhill" 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

Claimant sought permanent total disability benefits from the Multiple Injury Trust Fund. The Workers' Compensation Court of Existing Claims held that the claimant's combined injuries rendered the claimant permanently totally disabled and awarded benefits. The Multiple Injury Trust Fund appealed. On appeal, the Court of Civil Appeals reversed, finding claimant ineligible to claim benefits against the Multiple Injury Trust Fund as the claimant was not a "physically impaired person" at the time of the claimant's second on-the-job injury. The dispositive issue presented for the Oklahoma Supreme Court’s review was whether claimant met the statutory definition of a "physically impaired person" at the time of the claimant's second on-the-job injury for purposes of determining eligibility for Multiple Injury Trust Fund benefits. As a corollary, the Court considered whether a duly-executed settlement agreement (memorialized on a form prescribed by the Workers' Compensation Court) constituted an adjudication of the claimant's disabilities. The Court answered both questions in the affirmative. View "Multiple Injury Trust Fund v. Garrett" on Justia Law

In 2003, following a physical examination, Contreras, 13 years old, received the Tetanus-Diphtheria and Hepatitis B vaccines. About 24 hours later, he was diagnosed with atypical Guillain-Barre Syndrome (GBS), a peripheral nervous system disease that causes descending paralysis. Three months later, Contreras was discharged from the hospital with a diagnosis of Transverse Myelitis (TM), an inflammatory disease of the spinal cord. His petition for compensation under the Vaccine Act, accompanied by an expert report indicating that he developed both conditions as a result of the vaccines, was denied, on the basis that the time interval between the administration of Contreras’s vaccines and the onset of TM was too short to establish causation. Contreras submitted the expert report of pediatric neurologist concerning his rapid adverse immunological response. In 2012, a Special Master concluded that Contreras failed to establish that the TM arose within a “medically appropriate” timeframe. Following a remand from the Claims Court, the government disclosed that the medical license of its expert (Sladsky) was suspended during the time that he had provided witness services in this case. The Special Master again denied compensation, stating that Sladky’s opinion “retain[ed] some value” and that Contreras did not suffer from GBS—a violation of the court’s instruction to refrain from diagnosing Contreras. The Claims Court again remanded, with instructions to address Sladky’s credibility in light of his misrepresentations and to issue an alternative ruling that disregards Sladky’s testimony. The Special Master denied compensation. The Claims Court denied review based on the time interval. The Federal Circuit vacated. The Special Master improperly diagnosed Contreras and failed to consider evidence relevant to his GBS. View "Contreras v. Secretary of Health & Human Services" on Justia Law