Justia Kentucky Supreme Court Opinion Summaries

KESA, the Kentucky Workers’ Compensation Fund, on behalf of its insureds, filed five separate medical fee disputes against the Injured Workers’ Pharmacy (IWP) and the insureds’ employees and former employees, all of whom had their prescriptions filled by IWP. The chief administrative law judge (CALJ) found (1) a pharmacy/pharmacist is a medical provider, which entitles an injured worker to choose where to have his or her prescriptions filled; (2) the pharmacy fee schedule is based on the amount a pharmacist pays a wholesaler for medication, and IWP is entitled to interest on any underpayment by KESA; and (3) because KESA brought its medical fee disputes without reasonable ground and without reasonable medical or factual foundation, KESA was required to pay the cost of the proceedings. The Workers’ Compensation Board reversed the award of costs but otherwise affirmed. The court of appeals affirmed. The Supreme Court affirmed in part, vacated in part, and remanded, holding (1) the court of appeals did not err regarding the assessment of interest and sanctions or in concluding that a pharmacy is a medical provider; but (2) the remainder of the court of appeals opinion is vacated and remanded because the CALJ did not make a determination regarding the actual average wholesale price paid by IWP. View "Steel Creations by and through KESA, the Kentucky Workers’ Compensation Fund v. Injured Workers’ Pharmacy" on Justia Law

The administrative law judge (ALJ) in this case did not err in failing to give effect to a settlement agreement reached after the issuance of its order and opinion and raised in a petition to reconsider.This case arose from Appellant’s filing of a claim alleging work-related injuries against his employer. An ALJ issued an opinion and award denying Appellant permanent partial disability, permanent total disability, and future medical benefits. Appellant filed a petition for reconsideration based on a settlement reached prior to receipt of the opinion. The ALJ denied the petition. The Workers’ Compensation Board and the Court of Appeals affirmed. The Supreme Court affirmed, holding that because the alleged terms of the settlement were never properly brought before the ALJ, Appellant did not properly raise the issue, and the ALJ did not err in declining to review the agreement. View "Kidd v. Crossrock Drilling, LLC" on Justia Law

The Supreme Court affirmed the judgment of the Court of Appeals affirming the decision of the Workers’ Compensation Board in this workers’ compensation case. Appellant suffered a work-related injury in 2007. After she returned to work, Appellant suffered a second work-related injury in 2011 that resulted in Appellant being found permanently totally disabled. At issue before the Supreme Court was the proper disposition of Appellant’s claim for benefits following her first injury. The Board remanded the matter to the administrative law judge, determining that the ALJ erred in concluding that Appellant had not claimed entitlement to permanent total disability benefits following her first injury. The Board remanded this case to the ALJ with specific instructions to first determine Appellant’s entitlement to permanent total disability benefits and, if she was not entitled to such benefits, to determine her permanent partial disability benefits using a proper analysis under Fawbush v. Gwinn, 103 S.W. 3d 5 (Ky. 2005). The Court of Appeals affirmed. The Supreme Court affirmed, holding that the Court of Appeals did not err in its judgment. View "Blaine v. Downtown Redevelopment Authority, Inc." on Justia Law

Steven Baytos settled his workers’ compensation injury claim with Family Dollar Stores, his employer. The settlement amount included separate consideration in exchange for Baytos’s waiver of all future claims. Two years after Baytos died from his work-related injury, Mamie Baytos, his widow who was not a party to the settlement, filed a motion to reopen Baytos’s injury claim to assert her own claim for a workers’ compensation death benefit. The administrative law judge allowed Mamie to reopen Baytos’s claim and awarded her death benefits. The Workers’ Compensation Board reversed, concluding that claims for death benefits arising from a workers’ compensation injury are not derivative of the income benefits the injured employee recovers from the employer. The Court of Appeals reversed the Board. The Supreme Court affirmed, holding (1) Mamie has a separate and viable claim for death benefits under Ky. Rev. Stat. 342.750; and (2) it was improper for Mamie to assert her claim via reopening Baytos’s settled claim, although the court made an exception in today’s case. View "Family Dollar v. Baytos" on Justia Law

An administrative law judge (ALJ) awarded Brandon Fleming partial disability benefits based on a finding that Fleming had a combined permanent impairment rating of seventeen percent. In 2010, Fleming moved to reopen his claim, alleging that his condition had worsened. A different ALJ found that Fleming had a combined permanent impairment rating of thirty-two percent. The Workers’ Compensation Board and court of appeals affirmed. LKLP CAC Inc. appealed, arguing that the ALJ’s opinion was not supported by substantial evidence because the ALJ relied on a physician who stated that Fleming’s permanent impairment rating had not changed following the 2010 opinion and award. The Supreme Court affirmed, holding that there was no abuse of discretion in the ALJ’s finding that Fleming had an increase in his permanent impairment rating, in his impairment, and in his disability. View "LKLP CAC Inc. v. Fleming" on Justia Law

The legislature has affirmed that a county jailer’s salary shall at least equal the prior year’s salary level in counties that do not operate a jail.Garrard County does not operate a jail. Before the 2010 election of Garrard County’s jailer, the Garrard Fiscal Court voted to fix the amount of the jailer’s salary for the new term at an amount lower than that set for the incumbent jailer. The trial court ruled that the fiscal court had acted properly in reducing the jailer’s pay before the commencement of his term. The court of appeals reversed, concluding that fiscal courts in counties without jails are statutorily prohibited from reducing the pay of their elected jailer. The Supreme Court affirmed, holding that the unambiguous language of Ky. Rev. Stat. 441-243(3) prevents the fiscal court from decreasing the county jailer’s salary in between elected terms of service. View "Garrard County v. Middleton" on Justia Law

Marshall Parker sought an award of benefits for a back injury he received during the course of his employment with Webster County Coal. An administrative law judge (ALJ) awarded benefits for the back injury. However, the ALJ found that, pursuant to Ky. Rev. Stat. 342.730(4), Webster County Coal did not have liability for payment of income benefits in addition to the two years of temporary total disability income benefits Parker had already received. The Workers’ Compensation Board and Court of Appeals affirmed. Parker appealed, arguing that section 342.730(4) is unconstitutional because, under the statute, injured older workers who qualify for normal old-age Social Security retirement benefits are treated differently from injured older workers who do not qualify. The Supreme Court reversed in part, holding that section 342.730(4) is constitutionally infirm on equal protection grounds because there is no rational basis or substantial and justifiable reason for the disparate treatment of two groups of workers. View "Parker v. Webster County Coal, LLC" on Justia Law

Ray Ballou worked as an underground coal miner from 1982 until 2012 and was sixty-nine years old when last exposed to coal dust. An administrative law judge (ALJ) awarded Ballou retraining incentive benefits (RIB), finding that Ballou had category 1/1 coal workers’ pneumoconiosis. Due to Ballou’s advanced age, however, the ALJ determined that Ballou could only receive those benefits if he participated in an approved retraining or educational program. Ballou challenged the constitutionality of the RIB statute’s age classifications. The court of appeals concluded that those age classifications are constitutional. The Supreme Court affirmed, holding that the age classifications at issue did not violate Balou’s right to equal protection. View "Ballou v. Enterprise Mining Co., LLC" on Justia Law

Margie Mullins sustained a workplace injury during the course of her employment with Leggett and Platt. Mullins settled her workers’ compensation claim after negotiating with Leggett & Platt’s insurance carrier, CCMSI. The Chief Administrative Law Judge (CALJ) approved the award, which included weekly permanent-partial disability benefits, and Mullins’s election to accelerate the payment of her attorney’s fee to a lump-sum amount. This payment reduced Mullins’s weekly benefit amount pro-rata. But, in calculating Mullins’s weekly benefits remaining after deduction of the attorney’s fee, CCMSI applied a multiplier reflecting the future periodic payment of the attorney’s fee commuted to a present value. Mullins filed a motion for determination, disputing CCMSI’s calculation. The CALJ denied the motion, concluding that the statutory text and accompanying administrative regulations supported CCMSI’s calculation. The Workers’ Compensation Board and the Court of Appeals upheld the CALJ’s ruling. The Supreme Court affirmed, holding that Mullins failed to establish that CCMSI acted contrary to law or failed to correctly reduce her weekly benefits. View "Mullins v. Leggett & Platt" on Justia Law

Kara Sidebottom was injured during the course of her employment. Sidebottom filed a workers’ compensation claim in connection with the work-related injury. In determining Sidebottom’s weekly compensation benefit, the administrative law judge (ALJ) applied Ky. Rev. Stat. 342.140(1)(d). The ALJ determined that Sidebottom was a variable wage employee working on a “wage plus tips” arrangement at the time of her injury. The Uninsured Employers’ Fund appealed, arguing that, at the time of her injury, Sidebottom was a salaried, or fixed wage, employee whose average weekly wage should have been determined in accordance with Ky. Rev. Stat. 342.140(1)(a). The Workers’ Compensation Board disagreed and affirmed the ALJ’s decision. The court of appeals affirmed. The Supreme Court affirmed, holding that the ALJ, and hence the Board, applied the correct statute to the facts in determining Sidebottom’s average weekly wage. Remanded. View "Commonwealth, Uninsured Employers’ Fund v. Sidebottom" on Justia Law