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Case Summaries

Workers' Comp

[08/31] Hayes Lemmerz Int'l, Inc. v. ACE Am. Ins. Co.
In an employer's suit against its insurer for refusing to tender defense in an underlying suit under its workers' compensation and employer liability policy, judgment of the district court in favor of the insurer is affirmed as, because defendant was, by virtue of Indiana law, a joint employer, insurer was contractually obligated to reimburse the reasonable expense of defendant's getting itself dismissed from the tort suit. However, because the defendant is not claiming that insurer refused to pay that amount, but rather, it is complaining that the insurer breached its duty to defend by failing to advise defendant that it's law firm was not defending the suit properly, the insurer had no duty to provide its insured's lawyers with legal advice.

[08/27] Transcon. Ins. Co. v. Crump
In plaintiff's suit against her deceased husband's insurer for workers' compensation death benefits, the judgment of the court of appeals is reversed and remanded where: 1) the treating physician's opinion was based on a reliable foundation and, therefore, legally sufficient evidence supports the jury's verdict; 2) the trial court's omission of the but-for component in the jury charge constitutes reversible error; and 3) an insurance carrier is entitled to have a jury determine the disputed amount of reasonable and necessary attorney's fees for which it is liable.

[08/19] Milpitas Unified Sch. Dist. v. Workers' Comp. Appeals Bd.
In a School District employee's suit for workers' compensation claims, the decision of the Workers' Compensation Appeals Board is affirmed as, the language of section 4660 permits reliance on the entire American Medical Association's Guides to the Evaluation of Permanent Impairment, including the instructions on the use of clinical judgment, in deriving an impairment rating in a particular case.

[08/12] Alvarez v. Workers' Comp. Appeals Bd.
In a claimant's objection to a panel qualified medical evaluator's ex parte communication with defense counsel, and a request for a new panel qualified medical evaluator under section 4062.3(f), in a workers' compensation proceeding for death benefits, the Workers' Compensation Appeals Board's (WCAB) denial of the petition is annulled and remanded as section 4062.3 expressly prohibits ex parte communications with a panel qualified evaluator, with no exception based on the initiator of the communication or for "administrative" matters. However, because a certain degree of informality in workers' compensation procedures has been recognized, not every conceivable ex parte communication permits a party to obtain a new evaluation from another panel qualified medical evaluator.

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