Four Reasons to Avoid the CMS Approval Process for MSAs

By Teddy Snyder, Esq., Ringler Associates - Beverly Hills, CA 1. MMSEA reporting makes approval unnecessary for Medicare beneficiaries. Reporting under the Medicare, Medicaid and S-Chip Extension Act, aka “section 111 reporting”, started January 1, 2010 for workers compensation claims...

Four Reasons to Avoid the CMS Approval Process for MSAs

By Teddy Snyder, Esq., Ringler Associates - Beverly Hills, CA 1. MMSEA reporting makes approval unnecessary for Medicare beneficiaries. Reporting under the Medicare, Medicaid and S-Chip Extension Act, aka “section 111 reporting”, started January 1, 2010 for workers compensation claims...

Insurer Entitled to Credit for Third Party Recovery in Porta-Potty Injury Case: Cal. Comp. Cases May Advanced Postings (5/12/12)

Here’s the next batch of advanced postings for the May 2012 issue of Cal. Comp. Cases. Lexis.com subscribers can link to the cases to read the complete headnotes and summaries. © Copyright 2012 LexisNexis. All rights reserved. Pedro Gonzalez, Petitioner v. Workers' Compensation Appeals...

California Workers' Comp Case Roundup (6/9/2012)

CALIFORNIA COMPENSATION CASES Vol. 77 No. 5 May 2012 A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions Denied Judicial Review CONTENTS OF THIS ISSUE © Copyright 2012 LexisNexis. All rights reserved...

Larson’s Spotlight on Recent Cases: Contribution/Indemnity Defense in Third Party Suit When Employer Hires Illegal Alien

Larson's Spotlight on Contribution, Firefighter's Rule, Safety Device, and Credit. Larson's surveys the latest case developments that you need to know about. Thomas A. Robinson, the staff writer for Larson's Workers' Compensation Law , has compiled the list below. NY: Employer...

SNR Denton LLP on Great American Excess & Surplus Insurance Co. v. Quintairos, Prieto, Wood & Boyer, P.A.: Excess Insurer Can Sue Appointed Defense Counsel for Malpractice

By William T. Barker, Partner, SNR Denton LLP In Great American Excess & Surplus Insurance Co. v. Quintairos, Prieto, Wood & Boyer, P.A., the Mississippi Supreme Court adopted the opinion of a divided Mississippi Court of Appeals holding (on an issue that has divided other jurisdictions...

Homeowner’s Insurance – New Appleman on Insurance Law Library Edition, Chapter 53

By Joseph D. Jean and Gregory D. Miller Section 53.01 introduces homeowner's insurance generally and discusses the types, processes and coverages available in homeowner's policies. Section 53.01[1] discusses the general organization and scope of homeowner's policies and tracks the unique...

U.S. Airways, Inc. v. McCutchen: SCOTUS Says Enforcement of ERISA Plan Terms Is Not “Inequitable”

by Sara E. Hauptfuehrer Employer-sponsored group heath plans typically allow reimbursement to the plan for benefits paid in connection with injuries sustained as a result the tortious conduct of a third party. That right of reimbursement arises when the injured plan participant obtains a recovery...

Larson’s Spotlight on Recent Cases: Employee Sustained Psychic Injury When Told She Owed Tax on $100,000 of Travel Reimbursements

Larson's Spotlight on Psychic Injury, AMA Guides, Traveling Employee, and Subrogation. Larson's surveys the latest case developments that you need to know about. Thomas A. Robinson, the staff writer for Larson's Workers' Compensation Law , has compiled the list below. LexisNexis...

Ohio: $15,000 Settlement of Third-Party Claim Costs Injured Employee $61,500

Applying Ohio Rev. Code 4123.931(G), which provides in relevant part that if the injured employee settles with the third party without giving such notice, the employee and the third party are jointly and severally liable to pay the employer or carrier the full amount of the subrogation interest, an Ohio...

Washington Court of Appeals Clarifies an Insurer's Subrogation Rights

By Daniel R. Bentson , Jerret E. Sale The Washington Court of Appeals recently clarified that primary insurers cannot sue other primary insurers on equitable subrogation grounds to recover extra-contractual damages or reasonable attorney fees. Trinity Universal Ins. Co. of Kan. v. Ohio Cas. Ins...

OK: Oklahoma Law Prohibiting Subrogation for Death Benefits Controls for Fatal Texas Accident

Under the provisions of 85 O.S.Supp.2005, § 44(b), applicable on the date the deceased worker, a resident of Oklahoma, was killed in a work-related accident while working in Texas, neither the employer nor the carrier had the right of subrogation to recover money paid for death claims or death benefits...

NJ: Small Dog Has Big Bite, Yet Subrogation Claim Fails Since Recovery Could Have Been Had Under State’s No-Fault Auto Law

In an unpublished decision, a New Jersey court recently held that a workers’ compensation insurer was not entitled to pursue a subrogation claim for $900 in medical bills associated with injuries a police officer sustained when he was bitten on the hand by a Chihuahua sitting in the lap of a driver...

NY: Divided High Court Awards Carrier Full Credit to Settlement Proceeds Where Worker Was Assaulted, Raped & Kidnapped

A workers' compensation carrier, who paid benefits to an aide at a juvenile detention center who was physically assaulted, raped, and kidnapped by a coworker, is entitled to take a dollar-for-dollar credit against future workers’ compensation benefits owed where the aide settled a federal civil...

Supreme Court Declines to Hear Chubb's Appeal on CERCLA Subrogation Suit

New York, NY (January 15, 2014) -- The U.S. Supreme Court declined on January 13 to review a Ninth Circuit opinion affirming the U.S. District Court for the Northern District of California’s dismissal of an insurance company’s subrogation suit under CERCLA (aka Superfund) for recovery of...

Federal: Carrier’s Subrogation Claim May Not Be Removed to Federal Court

The Fifth Circuit Court of Appeals held the issue of whether a workers’ compensation insurance carrier was entitled to subrogation following a settlement between a third party and the insurance beneficiary employee arose under the Texas Workers’ Compensation Act and, therefore, the matter...

Texas: State Supreme Court Answers Complex Question as to Credit Allowed to Carrier in Third Party Action with Multiple Beneficiaries

Under Texas law, consistent with that in the large majority of states, a workers’ compensation carrier has a subrogation interest in a third-party civil action to the extent of its prior payments for benefits and to treat the amount recovered as an advance against the carrier’s future payment...

Wisconsin: Trial Court Can Compel Injured Employee to Accept Settlement of Third-Party Civil Action

The Supreme Court of Wisconsin affirmed a decision compelling a plaintiff/injured employee to accept a settlement offered in a third-party civil action he had filed against an alleged tortfeasor. The employee, who worked for the Village of Fontana, had filed a civil action against Northland Equipment...

Delaware: Affiliation Between Insurance Companies Is Insufficient to Block Insurer’s Right to Join in Third-Party Action

A Delaware court has allowed the employer’s workers’ compensation insurer to intervene in a personal injury action filed by an injured employee against the firm that provided janitorial services to the employer, finding that the insurer has a subrogation interest in any recovery by the injured...

15 Minutes (Fifteen Seconds, Really) Could Have Saved The Gecko More Than 15% On Car Insurance

Coverage Opinions hardly ever addresses automobile or subrogation cases. Here I address both. But wait, stay with me. This is an interesting one. It also speaks to an overarching issue concerning how insurers treat policyholders in a certain claim setting. The issue before the Indiana Court of Appeals...

District Court Holds that an Insurer’s Claim for Equitable Subrogation Against an Insured’s Co-Defendant Failed Because the Insurer Did Not Claim the Co-Defendant Caused the Underlying Damage at Issue

Guidry v. U.S. Department of the Interior , 2014 U.S. Dist. LEXIS 24787 (N.D. Cal. Feb. 25, 2014), [ enhanced version available to lexis.com subscribers ]. In Guidry , the district court held that, in an action where an underlying co-defendant (the “conservancy”) breached a contract by...

Owner May Sue Negligent Tenant for Uninsured Loss: Suit Against Tenant Not Subrogation

Almost every commercial lease of multi-unit structures contain waivers of subrogation or an agreement that the building owner’s fire insurance is purchased for the benefit of both the owner and the tenants. Since it is improper for an insurer to sue its own insured courts across the country have...