Williams v. Ho-Chunk Insurance Review Commission

7 Am. Tribal Law 227
CourtHo-Chunk Nation Trial Court
DecidedNovember 14, 2007
DocketCV 07-43
StatusPublished

This text of 7 Am. Tribal Law 227 (Williams v. Ho-Chunk Insurance Review Commission) is published on Counsel Stack Legal Research, covering Ho-Chunk Nation Trial Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Williams v. Ho-Chunk Insurance Review Commission, 7 Am. Tribal Law 227 (hochunkct 2007).

Opinion

[229]*229ORDER

(Reversing & Remanding)

TODD R. MATHA, Chief Judge.

INTRODUCTION

The Court must determine whether to uphold the adjudicative decision of the Ho-Chunk Insurance Review Commission (hereinafter HIRC). The Court reverses the agency final determination since not supported by substantial evidence. The analysis of the Court follows below.

PROCEDURAL HISTORY

The petitioner, Sharon L. Williams, by and through Attorney Ronald M. Fitzpatrick, filed her Petition for Administrative Review on May 24, 2007. See Ho-Chunk Ins. Review Commission Establishment & Org. Act. 1 HCC § 13.4; see also Ho-Chunk Nation Rules of Civil Proce[230]*230dure (hereinafter HCN R. Civ. P.), Rule 68(A)(1)(b). On May 30, 2007, the Court entered the Scheduling Order, setting forth the timelines and procedures to which the parties should adhere during the pendency of the appeal. In response, the respondent submitted the administrative record on June 6, 2007.1 See HCN R. Civ. P. 63(D).

The petitioner next filed a timely Initial Brief on June 21, 2007. Id., Rule 63(E). The respondent, by and through Attorney Michael P. Murphy, filed a timely Response Brief on July 23, 2007.2 Id. The petitioner filed an untimely Reply B rief on August 6, 2007, thereby precluding judicial consideration of the document. Id, Neither party requested the ability to present oral argument, prompting the Court to determine the matter on the documentary materials. Id., Rule 63(G); Scheduling Order at 3.

APPLICABLE LAW

CONSTITUTION OF THE HO-CHUNK NATION

Art. VII—Judiciary

Sec. 6. Powers of the Tribal Court.

(a) The Trial Court shall have the power to make findings of fact and conclusions of law. The Trial Court shall have the power to issue all remedies in law and in equity including injunctive and declaratory relief and all writs including attachment and mandamus.

HO-CHUNK INSURANCE REVIEW COMMISSION ESTABLISHMENT & ORGANIZATION ACT, 1 HCC § 13

Subsec. 1. Authority.

c. The Legislature established the Ho-Chunk Insurance Review Commission on April 21, 1997.

Subsec. 3. Mission. The Insurance Review Commission shall hear appeals on Ho-Chunk Nation’s employee benefit insurance plan(s) decisions relating to employment.

Subsec. 4. Powers. The Commission shall have the power to review and render a final decision on all insurance claims. Such decision shall be for the benefit of employees who have been denied benefits under Ho-Chunk Nation insurance plans. The Insurance Review Commission decisions shall be final subject to review by the Ho-Chunk Nation Trial Court. A party seeking review of a final decision by the Ho-Chunk Nation Trial Court must file a request with the Court within thirty (30) days of the issuance of the final decision.

Subsec. 5. Scope. The Commission shall hear appeals for the following insurance plans.

a. Worker’s Compensation Plan.

Subsec. 9. Commission Decisions.

a. In its review of insurance plan decisions, the Commission shall review the entire record and take into consideration the findings and conclusions of the Insurance Plan determinations.

[231]*231b. The Commission may issue an oral decision at the hearing, but shall confirm the oral decision with a written decision. The written decision shall be issued within ten (10) days and shall contain the reason(s) behind the Commission decision. All interested parties shall be notified if [sic ] the Commission decision within ten (10) days of the written decision.

WORKER’S COMPENSATION PLAN (Adopted Oct. 1998)

Sec. 1—Definitions

Subsec. 1.005. Compensation Rates.

66 2/3 percent of the Weekly Wage ..., subject to the maximum of $466.00 per week. A reduction of 25 percent of Weekly Wage will be enforced when safety equipment is required, but not used. Rate of pay determined at time of injury will be used throughout the term of loss.

Subsec. 1.007. Compensable or Compen-sable Injury.

A bodily Injury, of an Employee, caused by an Accident wfoen that injury arises out of risk of Employment, the injury occurs during a period of Employment and while performing the duties of the Employment in or on the premises of the Employer or whenever the Employer requires the Employee to perform the Employment activities.

Subsec. 1.008. Bodily Injury or Injury.

Actual physical injury to the body that arises by accident under circumstances that constitute a Compensable Injury as defined in 1.007.

Subsec. 1.009. Accidents.

A specific occurrence, neither expected nor intended, which causes Bodily Injury to an Employee and arises under circumstances constituting a Compensable Injury.

Subsec. 1.013. Primary Physician. ;

Approved Health Care Providers by the Ho-Chunk Nation within 75 miles of the employee’s home at the time of the injury and from whom the Employee receives medical treatment for a Compensable Bodily Injury.

Subsec. 1.014. Referral Physician.

A licensed medical doctor or chiropractor to w'hom the Employee is referred by the Primary Physician for further specialized treatment with the approval of the Administrator of the Nation.

Subsec. 1.015. Independent Medical Examination.

A medical examination and/or evaluation of the Employee scheduled by the Nation or Administrator, at the Nation’s expense, for the purpose of obtaining medical information or opinion.

Subsec. 1,016. Administrator.

Crawford & Co., Administrators, with whom the Nation has contracted to act on behalf of the Nation in the administration of this plan.

Sec. 2—Purpose and Scope

Subsec. 2.001. The purpose of this plan is to provide a system of compensation and medical benefits for employees of the Nation who suffer Compensable Injuries in the Employment of the Nation. Benefits under the plan are the Employee’s exclusive remedy against the Nation.

Sec. 4—Medical Benefits

Subsec. 4.001. The plan will pay the cost of all reasonable and necessary First Aid, Medical, Surgical and Hospital services incurred by the Employee as direct result of a Compensable Bodily Injury subject to the following restrictions.

Subsec. 4.003. The Plan will pay hospital and related charges only for services ordered by the Primary or Referral Physician.

[232]*232Subsec. 4.004. This Plan will pay the reasonable and necessary medical costs and the cost of medicines and supplies and equipment of a therapeutic nature to treat the Bodily Injury only if ordered by the Primary or Referral Physician.

Subsec. 4.010. When an employee has reached their end of healing, payments for medical cost [sic ] will cease.

Sec. 5—Disability Benefits

Subsec. 5.004.

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Bluebook (online)
7 Am. Tribal Law 227, Counsel Stack Legal Research, https://law.counselstack.com/opinion/williams-v-ho-chunk-insurance-review-commission-hochunkct-2007.