Johnson v. West Virginia Office of Insurance Commissioner

In 1989 Louis Johnson died of lung cancer. Louis was employed with Foote Mineral Company (Foote). Louis had a dependent invalid child, Charles Johnson (plaintiff), who suffered from schizophrenia and required supervision. Louis and his wife, Anna Johnson (plaintiff), provided for Charles in their wills. In 1989 Anna included Charles as a dependent son on her Social Security form. In 1990 Anna filed for dependent death benefits, arguing that Louis’s death was materially contributed to by an occupational disease. In Anna’s application, she did not include any surviving dependent children. The Office of the Insurance Commissioner (defendant) rejected the claim for death benefits, determining that Louis’s death was not related to an occupational disease. Anna passed away, leaving her daughter as executrix, directing her daughter to hold assets to provide Charles with the necessities of life. The Workers’ Compensation Board of Review (the board) reversed the commissioner’s decision and granted benefits, finding that Louis’s death was materially contributed to by an occupational disease. Foote appealed, but the appeal was refused by the court. In 2002 Anna’s daughter was appointed as Charles’s guardian. In a 2002 letter, the board was informed that Anna had died, and Charles was a dependent invalid child of Louis who suffered from schizophrenia. In October 2002, a pay order was issued to Anna’s daughter and was thereafter issued monthly for Charles’s benefit, because Charles was a substitute for Anna. Anna’s daughter filed for continuation of benefits, naming Charles as Louis’s dependent, and Charles continued to receive benefits. In March 2006, Acordia Employers Service (Acordia), Foote’s third-party administrator, terminated Charles’s benefits due to a lack of evidence of dependency and the fact that the 1990 application did not include Charles. A protest was filed, and the case was brought before an administrative-law judge (ALJ). Medical reports were presented, stating Charles was a dependent of Louis. Anna’s daughter participated in a deposition, testifying that Charles lived with his parents until their deaths, lived with her now, and received dependent benefits since 1979. In 2008 the ALJ affirmed the termination of benefits based on the 1990 application. The board affirmed the ALJ’s decision, and the case was appealed.