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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

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

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. 01-A-01-9707-CH-00354; 96-1250-I
Regular Panel Decision
Sep 02, 1998

Edith Stromatt v. The Metropolitan Employee Benefit Board of the Metropolitan Government of Nashville and Davidson County, Tennessee

Edith Stromatt, a former employee of the Metropolitan Government of Nashville, sought an in-line-of-duty (IOD) disability pension, having already been granted a medical disability pension. She sued the Metropolitan Employee Benefit Board, claiming an erroneous denial of the IOD pension and a violation of her constitutional right to due process. The trial court upheld the Board's decision. On appeal, the Court of Appeals of Tennessee affirmed, ruling that Stromatt did not have a vested property interest in the IOD pension before it was granted and that the Board's denial was supported by material evidence, noting her disability was not from a specific incident of stress as required for an IOD pension.

Disability PensionIn-Line-of-Duty PensionMedical DisabilityDue Process ViolationProperty InterestAdministrative ReviewWrit of CertiorariStress-Related DisabilityEmployment BenefitsMetropolitan Government
References
17
Case No. 07-09-00163-CV
Regular Panel Decision
Mar 12, 2010

Potter County, Texas as Plan Administrator for the Health Benefits Plan for the Employees of Potter County, Texas v. Ronda Tuckness and Michael Tuckness

Potter County, acting as the plan administrator for its employee health benefits plan, appealed an order that denied its plea to the jurisdiction. The underlying lawsuit was filed by Ronda and Michael Tuckness, seeking health care benefits after the County denied Michael Tuckness's claim for back surgery costs due to an occupational injury exclusion. The County contended it was immune from suit. The appellate court found that the County's governmental immunity had not been waived by the requests for declaratory relief, the terms of the health plan contract, or the County's conduct. Consequently, the court reversed the trial court's order and dismissed the Tucknesses' case for lack of subject-matter jurisdiction.

Governmental ImmunityImmunity WaiverDeclaratory JudgmentContract LawHealth BenefitsPlan AdministratorOccupational Sickness/InjuryJurisdictionPlea to JurisdictionInterlocutory Appeal
References
20
Case No. MISSING
Regular Panel Decision

Stephenson v. Hotel Employees & Restaurant Employees Union Local 100

This is a dissenting opinion concerning an age discrimination lawsuit brought by Albert Stephenson and Leroy Hodge against the Hotel Employees and Restaurant Employees Union Local 100 and the Hotel Employees and Restaurant Employees International Union. The plaintiffs were fired in 1992, and a jury found in their favor, awarding substantial damages. The majority opinion reversed this verdict, but the dissenting judge, Mazzarelli, argues that the evidence presented at trial was legally sufficient to support the jury's finding of age discrimination. The dissent reviews the trial proceedings, jury instructions, evidentiary rulings, and damage awards, concluding that the jury had a rational basis for its decision. While affirming liability, the dissent suggests remanding the case for a collateral source hearing to determine potential offsets to the damages.

Age DiscriminationEmployment LawWrongful TerminationJury VerdictAppellate ReviewLegal SufficiencyBurden of ProofPretextDamagesFront Pay
References
22
Case No. MISSING
Regular Panel Decision

Klumb v. Houston Municipal Employees Pension System

The case involves a dispute over the Houston Municipal Employees Pension System (HMEPS) board's authority to define 'employee' for pension eligibility. Petitioners, former City of Houston employees transferred to a third-party entity (CCSI), sought retirement benefits or cessation of pension contributions, arguing they were no longer City employees. The pension board, however, determined these employees remained 'members' due to the City's effective control over their new employer. The trial court and court of appeals dismissed the suit for lack of subject-matter jurisdiction, citing the statutory preclusion of judicial review for HMEPS decisions. The Supreme Court of Texas affirmed, concluding that the pension board acted within its broad statutory authority and that the petitioners' ultra vires, equal protection, and due course of law claims were invalid as they lacked vested property rights in the pension benefits.

Pension LawStatutory InterpretationJudicial ReviewUltra ViresSovereign ImmunityEqual ProtectionDue Course of LawVested RightsMunicipal EmployeesOutsourcing
References
29
Case No. MISSING
Regular Panel Decision

Independent Ass'n of Publishers' Employees, Inc. v. Dow Jones & Co.

Plaintiffs, the Independent Association of Publishers’ Employees, Inc. (IAPE) and ten Canadian employees, sued defendant Dow Jones & Company, Inc., alleging a breach of fiduciary duty under ERISA. The plaintiffs claimed that Dow Jones violated its fiduciary obligations by changing the Profit-Sharing Retirement Plan's benefit allocation formula, which resulted in reduced benefits for Canadian employees due to currency conversion. Dow Jones argued it was not a fiduciary for this specific act or that the action was not a breach, asserting the right to amend plan contributions. The court, treating the motion as one for summary judgment, found that Dow Jones's fiduciary duties under ERISA did not extend to the method of calculating employer contributions or modifying non-accrued benefits. The court concluded that both the Plan provisions and ERISA allowed prospective changes in contributions by the employer, and therefore, Dow Jones had not breached any fiduciary duty. Defendants' motion for summary judgment was granted.

ERISAFiduciary DutyProfit-Sharing PlanBenefit AllocationSummary JudgmentNon-Accrued BenefitsPlan AmendmentEmployer ContributionsCanadian EmployeesDistrict Court
References
5
Case No. NO. 13-0515
Regular Panel Decision
Mar 20, 2015

John Klumb, Veronica McClelland, Vivian Montejano, John Gonzalez, Anita Robles, and Charmaine Pilgrim, on Behalf of Themselves and All Others Similarly Situated, and the City of Houston v. Houston Municipal Employees Pension System, Barbara Chelette, David L. Long, Lenard Polk, Roy Sanchez, and Lonnie Vara

This case concerns a dispute over the Houston Municipal Employees Pension System (HMEPS) and whether its board members violated the enabling statute by requiring petitioners' continued participation in the City of Houston's defined-benefit pension plan. The City attempted to remove a division of employees from the pension system by forming quasi-governmental entities. The pension board, however, determined these employees remained under the City's control and payroll, thus falling under the "employee" definition for HMEPS membership. Petitioners, including individual employees and the City of Houston, asserted ultra vires and constitutional claims, arguing the board unlawfully redefined "employee" and denied vested rights. The Supreme Court of Texas affirmed the lower court's judgment, finding the trial court lacked subject-matter jurisdiction because the pension board acted within its broad statutory authority in construing the term "employee" and the petitioners' constitutional claims were facially invalid as they lacked vested property rights in pension benefits or contributions.

Pension SystemEmployee DefinitionUltra ViresJudicial ReviewSovereign ImmunityTexas ConstitutionEqual ProtectionDue Course of LawVested RightsMunicipal Employees
References
30
Case No. MISSING
Regular Panel Decision
Feb 22, 1984

Barnhardt v. Hudson Valley District Council of Carpenters Benefit Funds

The plaintiff, injured in May 1978 during maintenance work, was denied workers' compensation due to the absence of an employer-employee relationship. Subsequently, he sought reimbursement for medical expenses from the Hudson Valley District Council of Carpenters Benefit Funds (Benefit Funds) through a union insurance policy. Continental Assurance Company (Continental), Benefit Funds' insurer, rejected the claim, citing an employment-related injury exclusion in the policy. The plaintiff then initiated an action against Benefit Funds, which in turn filed a third-party action against Continental seeking indemnification. Continental's motion for summary judgment, asserting the exclusion, was denied by the County Court. The appellate court affirmed this denial, ruling that the exclusionary language was ambiguous and applied only in cases where a clear employer-employee relationship existed, a fact still to be determined.

Insurance Policy InterpretationEmployment StatusWorkers' Compensation ExclusionSummary Judgment MotionContractual AmbiguityGroup Health InsuranceMedical Expense ReimbursementThird-Party ActionAppellate ReviewEmployer-Employee Relationship
References
10
Case No. MISSING
Regular Panel Decision

Trapani v. Consolidated Edison Employees' Mutual Aid Society, Inc.

This case addresses claims under the Employee Retirement Income Security Act (ERISA) against Consolidated Edison Employees’ Mutual Aid Society, Inc. (Mutual Aid) and its administrative officer, Paul R. Westerkamp. Plaintiffs, Consolidated Edison employees represented by Local 3, seek an equitable share of Mutual Aid's assets and a special emergency loan fund after their membership ceased in 1983. Building on an earlier decision, the court found that defendants retained benefit assets attributable to Local 3 for the benefit of Local 1-2, violating ERISA. The court also determined that Mr. Westerkamp breached his fiduciary duty by mismanaging assets and participating in a settlement detrimental to Local 3. Consequently, Mr. Westerkamp is barred from administering the Staten Island Relief Fund, and the parties are directed to propose methods for equitable asset distribution.

ERISAEmployee Welfare Benefit PlanFiduciary Duty BreachAsset MismanagementEquitable DistributionUnion BenefitsConsolidated EdisonMutual Aid SocietyPaul R. WesterkampLocal 3 IBEW
References
21
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