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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. MISSING
Regular Panel Decision

Vogel v. Wells Fargo Guard Services

Walter Vogel, a 73-year-old security guard, sustained a work-related shoulder and back injury, leading to a trial court finding of 100% permanent and total disability. The trial court declared Tennessee Code Annotated Section 50-6-207(4)(A)(i) unconstitutional for its age-related benefit caps and awarded Vogel lifetime benefits. On appeal, the Supreme Court reversed, upholding the constitutionality of the statute's age-based distinctions for permanent total disability benefits under the Equal Protection Clause and the Age Discrimination in Employment Act, finding them rationally related to the state's interest in tying workers' compensation to Social Security benefits. However, the Court found the statute's disparate treatment of permanent total versus permanent partial disability benefits for workers over sixty to be irrational, modifying the award to 260 weeks of benefits for the plaintiff.

Workers' CompensationAge DiscriminationEqual ProtectionConstitutional LawPermanent Total DisabilityPermanent Partial DisabilitySocial Security BenefitsWage LossJudicial ReviewStatutory Interpretation
References
19
Case No. MISSING
Regular Panel Decision
Sep 09, 1998

In re the Claim of Peabody

The claimant appealed a decision by the Unemployment Insurance Appeal Board, filed on September 9, 1998, which ruled that the claimant was not entitled to receive unemployment insurance benefits. This denial was based on Labor Law § 591 (5), a 1996 amendment that limits unemployment benefits when a claimant also receives workers' compensation benefits exceeding their average weekly wage. The claimant contended that the statutory limitation should consider the pre-injury weekly wage used for workers' compensation. However, the Board, and subsequently the court, found no textual basis to interpret 'average weekly wage' in Labor Law § 591 (5) differently from its definition in Labor Law former § 590 (2). Consequently, the Board's conclusion was affirmed.

Unemployment benefitsWorkers' compensation offsetStatutory interpretationAverage weekly wage calculationBenefit eligibilityLabor Law § 591(5)Appeal Board decisionJudicial reviewAffirmed decision
References
2
Case No. 03-05-00309-CV
Regular Panel Decision
May 12, 2006

TPCIGA, for Reliance National Indemnity Company v. Magdalena Ford Morrison A/N/F of Eric Ford

This case addresses the duration of workers' compensation death benefits for a deceased employee's minor, dependent stepchild in Texas. TPCIGA, representing Reliance National Indemnity Company, argued that benefits for Eric Ford should be limited to 364 weeks due to his dependent status. Magdalena Ford Morrison, on behalf of Eric, contended that as a minor, Eric was entitled to benefits until age 18, or up to age 25 if enrolled as a full-time student, under the Texas Workers' Compensation Act. The Texas Workers' Compensation Commission initially limited benefits, but the Travis County court reversed this, granting summary judgment for Morrison. The appellate court affirmed, interpreting the Act's sections 408.182 and 408.183 to mean a minor child's eligibility for benefits is based on minority, not solely dependency, entitling Eric to benefits until age 18 or 25 under student provisions.

Death BenefitsMinor DependencyStepchild EligibilityBenefit DurationStatutory InterpretationTexas Labor Code §408.183Appellate ReviewSummary Judgment RulingAdministrative LawTexas Courts of Appeals
References
32
Case No. MISSING
Regular Panel Decision

Hand v. Stevens Transport, Inc. Employee Benefit Plan

Jean and Howard Hand appealed the trial court's grant of summary judgment which dismissed their claims for health care benefits against the Stevens Transport, Inc. Employee Benefit Plan as time-barred. The Hands argued that the Plan's failure to comply with ERISA's notification requirements should invalidate or toll the contractual limitations period. The appellate court found that while the Plan's notice was non-compliant, it still provided reasonable notice of partial denial, and the Hands failed to exercise due diligence. The court concluded that the twenty-seven month contractual limitations period was reasonable and was not tolled by the Plan's ERISA non-compliance or the pursuit of administrative remedies. Therefore, the Hands' claims were barred, and the trial court's judgment was affirmed.

ERISAHealth Insurance BenefitsContractual Limitations PeriodStatute of LimitationsSummary JudgmentDenial of BenefitsEquitable TollingAdministrative RemediesNotice RequirementsEmployee Benefit Plan
References
19
Case No. MISSING
Regular Panel Decision

Claim of Kowalchyk v. Wade Lupe Construction Co.

The claimant, a carpenter over 60 with an 11th-grade education, fractured his back and wrist in August 1985 while on a construction jobsite. Initially, his physician, Dr. James Slavin, considered him totally disabled, and he received total disability benefits from his employer's carrier. However, in December 1985, the employer reduced benefits to a partial disability rate, relying on a report from their consultant, Dr. Edward Pasquarella. The claimant subsequently filed for compensation, leading to a determination by the Workers’ Compensation Law Judge and ultimately the Workers’ Compensation Board that he had a total industrial disability. The employer appealed this decision, arguing it lacked substantial evidence. The court affirmed the Board's decision, considering the claimant’s physical limitations, age, work experience, and limited education, concluding he had no marketable skills outside carpentry.

Workers' CompensationTotal Industrial DisabilityPartial DisabilityMedical Testimony ConflictEarning Capacity AssessmentAppellate ReviewVocational RehabilitationAge & Education FactorsCarpenter InjuryScaffold Accident
References
3
Case No. MISSING
Regular Panel Decision

Jeffries v. Pension Trust Fund of the Pension, Hospitalization & Benefit Plan of the Electrical Industry

Plaintiff Claude Jeffries, a retired electrician, sued the Pension Trust Fund of the Electrical Industry under ERISA, seeking to include pension credits from 1969-1975 in his current benefits. He alleged the Plan should have declared a partial termination during a 1975-1979 New York recession, which would have vested his benefits. The defendant moved to dismiss the complaint, arguing lack of standing and statute of limitations, while plaintiff moved for class certification for similarly affected members. The court denied the defendant's motion to dismiss the claim for benefits, finding it timely, but granted dismissal for the breach of fiduciary duty claim as time-barred. The plaintiff's motion for class certification was denied due to insufficient evidence for numerosity, with leave to refile after discovery.

ERISAPension BenefitsClass CertificationMotion to DismissStatute of LimitationsFiduciary DutyPartial TerminationBenefit ForfeitureUnemploymentLabor Union
References
15
Case No. MISSING
Regular Panel Decision

Memorial Hermann Health System v. Coastal Drilling Co., LLC Employee Benefit Trust

Plaintiff Memorial Hermann Health System (MHHS) sued Coastal Drilling for breach of contract and recovery of benefits under the Employee Retirement Income Security Act (ERISA). MHHS claimed Coastal Drilling breached a contract to pay for healthcare services at PPOplus Contracted Rates. The Court determined that MHHS's breach of contract claim was not preempted by ERISA but could not be enforced because MHHS was a non-party to the Network Access Agreement and Coastal Drilling, also a non-party, had no direct obligation under it. Regarding the ERISA claim, the Court found that Coastal Drilling, as the plan administrator, had discretionary authority to determine benefits based on the Plan's Applicable Plan Limits (APL). The Court found substantial evidence supporting Coastal Drilling's benefits determination and no evidence of bias affecting the decision, despite a structural conflict of interest. Consequently, the Court granted Coastal Drilling's motion for summary judgment and dismissed MHHS's claims with prejudice.

ERISASummary JudgmentBreach of ContractPlan AdministratorBenefits DenialHealthcare ProviderThird-Party BeneficiaryERISA PreemptionTexas LawFiduciary Duty
References
48
Case No. MISSING
Regular Panel Decision

Auqui v. Seven Thirty One Limited Partnership

Jose Verdugo, a food service deliveryman, was injured in December 2003 and received workers' compensation benefits. He also initiated a personal injury lawsuit against Seven Thirty One Limited Partnership. The Workers' Compensation Board (WCB) later determined that Verdugo's disability ended on January 24, 2006, leading to the termination of his benefits. Subsequently, the defendants in the personal injury action sought to preclude Verdugo from relitigating the duration of his disability, arguing collateral estoppel based on the WCB's finding. The court, affirming the WCB's decision, reversed the Appellate Division's order, granting the defendants' motion to preclude further litigation on disability beyond the WCB's determined date, finding the issue was fully and fairly litigated.

Workers' Compensation BenefitsPersonal Injury ActionCollateral EstoppelAdministrative Law JudgeWorkers' Compensation BoardDisability DurationMedical TreatmentLost EarningsMedical ExpensesGuardianship Proceeding
References
6
Case No. MISSING
Regular Panel Decision

TPCIGA Ex Rel. Reliance National Indemnity Co. v. Morrison

This case addresses the duration of workers' compensation death benefits payable to Eric Ford, a minor, dependent stepchild of the deceased employee, Wayne Darlington. The Texas Property & Casualty Insurance Guaranty Association (TPCIGA) argued that benefits should be limited to 364 weeks because Eric's eligibility stemmed from his dependency. However, Magdalena Ford Morrison, on behalf of Eric Ford, contended that as a minor, Eric was entitled to benefits until age 18, or until age 25 if he remained a full-time student. The trial court sided with Morrison, and the appellate court affirmed, holding that Eric's eligibility was based on his status as a minor child, not solely his dependency, and therefore benefits were payable until he attained age 18, or 25 if a student, in accordance with the Texas Workers' Compensation Act.

Workers' CompensationDeath BenefitsMinor DependentsStepchildrenStatutory ConstructionEligibility CriteriaInsurance GuarantyAppellate LawTexas LawSummary Judgment
References
10
Case No. 2020-08-0309
Regular Panel Decision
Jan 26, 2021

Bryant, Joshua v. Malco Theaters, Inc.

Joshua Bryant requested additional medical and temporary disability benefits for a head injury sustained while working for Malco Theaters Inc. The employer argued that Bryant filed his Petition for Benefit Determination (PBD) outside the applicable statute of limitations and had already paid all entitled benefits. Bryant received initial medical evaluations from various providers, including neurologists Dr. Alan Nadel and Dr. Mohammed Assaf. Dr. Nadel eventually placed Bryant at maximum medical improvement with no impairment and returned him to regular duty. Malco's claim handler stated the last payment of medical benefits was on March 22, 2019. Bryant filed his PBD on March 26, 2020, which was more than one year after the last payment. The Court concluded that Bryant's claim was barred by the one-year statute of limitations and consequently denied his request for benefits.

Statute of LimitationsHead Injury ClaimMedical BenefitsTemporary Disability BenefitsPetition for Benefit DeterminationMaximum Medical ImprovementNeurological EvaluationWorkers' Compensation Claims CourtClosed-Head InjuryDizziness
References
0
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