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

Case No. 03-12-00293-CV
Regular Panel Decision
Jul 12, 2013

Southwest Pharmacy Solutions, Inc. D/B/A American Pharmacies v. Texas Health and Human Services Commission and Thomas Suehs, Solely in His Official Capacity as Executive Commissioner of the Texas Health and Human Services Commission

Southwest Pharmacy Solutions, Inc. d/b/a American Pharmacies appealed a trial court's judgment granting a plea to the jurisdiction filed by the Texas Health and Human Services Commission (HHSC) and its Executive Commissioner. American Pharmacies challenged HHSC's rulemaking obligations and specific rules related to pharmacy benefits under the Texas Medicaid managed care (MMC) program. They argued that HHSC failed to regulate reimbursement rates for pharmacies and did not comply with statutory requirements for analyzing the economic impact on small businesses. The appellate court affirmed the trial court's judgment, concluding that HHSC was not obligated to set reimbursement rates under the MMC model and had substantially complied with the relevant government code regarding small business impact. The court also determined that American Pharmacies lacked a justiciable interest as their economic losses stemmed from legislative changes rather than the challenged rules.

Medicaid Managed CarePharmacy BenefitsReimbursement RatesAdministrative Procedure ActDeclaratory JudgmentPlea to the JurisdictionUltra ViresStatutory ConstructionSmall Business ImpactTexas Court of Appeals
References
37
Case No. 03-15-00219-CV
Regular Panel Decision

Hallmark Specialty Underwriters, Inc. and Hallmark Specialty Insurance Company v. Texas Mutual Insurance Company

This case arises from a declaratory judgment action filed by Appellee Texas Mutual Insurance Company, seeking a determination regarding its duty to defend Absolute Oil Field Services, LLC. The trial court granted summary judgment in favor of Texas Mutual and denied Appellants Hallmark Specialty Underwriters, Inc. and Hallmark Specialty Insurance Company's cross-motion for summary judgment. Appellants contend that the trial court erred in its decision, arguing that the underlying petition contained sufficient factual allegations to trigger Appellee's duty of defense under the 'eight corners' rule, as the injured party, Jose Guzman, was an employee of Absolute and was potentially injured in the course of his employment. They argue that Texas law requires liberal interpretation of pleadings, resolving doubts in favor of coverage, and that Appellee's arguments misinterpret established legal principles regarding the duty to defend.

Insurance CoverageDuty to DefendWorkers' CompensationEight Corners RuleSummary JudgmentAppellate ReviewTexas LawEmployee InjuryCourse and Scope of EmploymentDeclaratory Judgment Action
References
38
Case No. ADJ2178733 (BAK 0154115)
Regular
May 27, 2014

LIDIA BUENO vs. RAVILA FARM LABOR SERVICES, REDWOOD FIRE AND CASUALTY INSURANCE COMPANY

This case involves a lien claimant, Biocare RX Specialty Pharmacy, whose lien was dismissed by the Workers' Compensation Appeals Board (WCAB). Biocare argued the dismissal was erroneous because it had not yet filed a lien. The WCAB granted reconsideration, rescinding the dismissal order. The Board found it lacked jurisdiction to dismiss a lien that had not been filed and that Biocare was improperly dismissed for non-appearance at a lien conference for which it received no notice.

Lien claimantPetition for ReconsiderationOrder to Dismiss LiensWCJBiocare RX Specialty PharmacyElite Lien Servicesjurisdictionfiled lienLabor Code section 4903.5industrial injury
References
0
Case No. MISSING
Regular Panel Decision

Moeckel v. Caremark RX Inc.

Plaintiff Robert E. Moeckel, a participant in the John Morrell Employee Benefits Plan, filed a putative class action against Caremark Rx Inc. and Caremark Inc., alleging breaches of fiduciary duty under ERISA. Moeckel claimed that Caremark, as the plan's pharmacy benefits manager, engaged in secret self-dealing by creating hidden pricing spreads, manipulating drug formularies, and retaining undisclosed compensation, leading to increased costs for participants. Defendants moved to dismiss or transfer the complaint. The court granted dismissal of Caremark Rx Inc. due to its lack of a direct contractual relationship with the plan but denied the motion to dismiss Caremark Inc. on grounds of standing, statutory authority, and failure to exhaust administrative remedies. The court also denied the motion to transfer venue to Alabama.

ERISA Fiduciary DutyPharmacy Benefits Manager (PBM)Self-Dealing AllegationsMotion to Dismiss Granted in PartStanding in ERISA ActionsExhaustion of Administrative RemediesEmployee Benefit Plan LitigationClass Action SuitCorporate Subsidiary LiabilityDrug Formulary Manipulation
References
54
Case No. 2024 NY Slip Op 03519
Regular Panel Decision
Jun 27, 2024

Matter of Reyes Bonilla v. XL Specialty Ins.

Claimants Jose Reyes Bonilla and Marvin Reyes Bonilla, carpenters, were involved in a motor vehicle accident while commuting to a job site in Greenpoint, Brooklyn, in an employer-provided van. They filed workers' compensation claims, which were established against XL Specialty Insurance by a Workers' Compensation Law Judge (WCLJ). XL Specialty appealed, arguing its policy did not cover commuting injuries and that it was not the proper carrier. The Workers' Compensation Board affirmed the WCLJ's decisions, finding XL Specialty failed to preserve its challenge to being the carrier and that the employer's responsibility for transportation made the injuries compensable. The Appellate Division, Third Department, affirmed, agreeing that the issue was unpreserved and that the injuries arose out of and in the course of employment due to the employer's control over the conveyance.

Workers' CompensationMotor Vehicle AccidentEmployment InjuriesCommuting AccidentEmployer Provided TransportationWrap-up PolicyInsurance Coverage DisputeCarrier LiabilityIssue PreservationAppellate Review
References
16
Case No. 03-15-00348-CV
Regular Panel Decision

Todd Enright v. Asclepius Panacea, LLC Asclepius Panacea GP, LLC Daily Pharmacy, LLC Daily Pharmacy GP, LLC And Toth Enterprises II, P .A. D/B/A Victory Medical Center

Todd Enright appealed a district court's denial of his special appearance in a case brought by Asclepius Panacea, LLC et al. (VMC). The dispute originated from VMC's equity purchase of Texas pharmacies from QVL. Enright, acting for QVL, allegedly made fraudulent misrepresentations during negotiations concerning drug inventory and handling of insurance receipts. Post-acquisition, Enright reportedly controlled QVL's finances, directing payments and wrongfully withholding VMC's funds. VMC's claims against Enright include common law fraud, Texas Securities Act violations, tortious interference, conversion, money had and received, and a request for an accounting, asserting his actions establish sufficient minimum contacts with Texas for personal jurisdiction.

Personal JurisdictionFraudTexas Securities ActTortious InterferenceConversionEquitable AccountingSpecial AppearanceMinimum ContactsFiduciary Shield DoctrineAppellate Procedure
References
34
Case No. 01-22-00031-CV
Regular Panel Decision
Nov 03, 2022

Turner Specialty Services, LLC v. Michaela Horn, Individually and as Next Friend of G.H. and M.M., Minors

Justin Horn died while working for Turner Specialty Services, LLC. His family, Michaela Horn and Atrelle Horn, sued Turner Specialty for gross negligence. Turner Specialty filed a special appearance, contesting personal jurisdiction in Texas. The trial court denied the special appearance, and Turner Specialty appealed. The Court of Appeals for the First District of Texas affirmed the trial court's decision, finding that Turner Specialty had sufficient minimum contacts with Texas through its recruitment, hiring, and initial safety training of Justin Horn and other employees in Texas, which was purposefully availed and related to the Horns' gross negligence claim.

personal jurisdictionspecial appearanceminimum contactspurposeful availmentgross negligencewrongful deathworkers' compensationappellate reviewforum stateinterstate federalism
References
24
Case No. MISSING
Regular Panel Decision

Claim of Smith v. Specialty Services, Inc.

Claimant, a construction foreman for Specialty Services, Inc., was injured while performing work for a church in Pennsylvania. Although Specialty filed a work-related accident report and its carrier began paying benefits, the carrier filed a notice of controversy over seven months after the Workers' Compensation Board indexed the case, exceeding the 25-day limit. The carrier argued that the late filing was due to surprise, mistake, and newly discovered evidence regarding the church's involvement, which claimant and Specialty allegedly failed to disclose. The Workers' Compensation Board refused to excuse the late filing, finding the carrier failed to demonstrate good cause. The appellate court affirmed the Board's decision, noting that the carrier had ample time to investigate and that belatedly obtained evidence is not a sufficient ground to excuse a late filing.

Workers' CompensationLate Notice of ControversyTimely FilingEmployer-Employee RelationshipInsurance CarrierGood CausePleading BarAppellate ReviewBoard DecisionStatutory Interpretation
References
2
Case No. ADJ3408070
Regular
Dec 29, 2011

CARLOS LOPEZ vs. COBBLESTONE, STATE COMPENSATION INSURANCE FUND

Here's a summary for a lawyer: Biocare RX Specialty Pharmacy sought reconsideration of a lien dismissal, arguing a representative was available by phone for trial. The Workers' Compensation Appeals Board (WCAB) dismissed the petition as untimely. The dismissal order was issued June 13, 2011, and served June 22, 2011, giving the lien claimant 25 days to file for reconsideration. The petition was filed on October 31, 2011, exceeding the jurisdictional deadline.

Lien ClaimantPetition for ReconsiderationOrder Dismissing LienUntimely FilingJurisdictional Time LimitWCJBiocare RX Specialty PharmacyLabor Code section 5903Code of Civ. Proc.section 1013
References
2
Case No. ADJ7040878
Regular
Dec 28, 2011

PATRICIA FINKS vs. EXXON MOBIL CORPORATION, PETROLEUM CASUALTY COMPANY C/O EXXON MOBIL RISK MANAGEMENT SERVICES, INC.

This case involves Biocare RX Specialty Pharmacy's untimely petition for reconsideration of an order disallowing their lien claim. The Workers' Compensation Appeals Board (WCAB) dismissed the petition because it was filed on October 31, 2011, well past the jurisdictional deadline of twenty-five days from the August 11, 2011 service of the original order. The WCAB emphasized that petitions for reconsideration are deemed filed upon receipt, not mailing, and that the time limit is jurisdictional. Therefore, the WCAB lacked the power to grant the untimely petition.

Workers Compensation Appeals BoardPetition for ReconsiderationOrder Disallowing LienLien ClaimantWCJuntimely petitionjurisdictional time limitLabor Code section 5903Code of Civil Procedure section 1013WCAB Rule 10507
References
2
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