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

Case No. 01-42217-REG
Regular Panel Decision

Ames Department Stores, Inc. v. Lumbermens Mutual Casualty Co. (In re Ames Department Stores, Inc.)

This document is a report and recommendation from Judge Robert E. Gerber concerning Ames Department Stores, Inc.'s motion to confirm exclusive jurisdiction in an adversary proceeding against Lumbermens Mutual Casualty Company. The proceeding, occurring under Ames' Chapter 11 bankruptcy, addresses the ownership of an $8 million trust account and alleged interference with the debtor's property. Judge Gerber recommends that the court possesses subject matter jurisdiction over all claims, asserting exclusive jurisdiction over specific claims involving automatic stay violations, marshaling, and equitable subordination. Furthermore, he advises that the McCarran-Ferguson Act does not mandate deferral to an Illinois state court for these issues, and the First Assuming Jurisdiction Doctrine is applicable to certain in rem claims.

Bankruptcy LawJurisdictional DisputeExclusive JurisdictionAutomatic Stay ViolationMcCarran-Ferguson ActIn Rem JurisdictionAdversary ProceedingChapter 11 BankruptcySurety BondsCash Collateral
References
65
Case No. MISSING
Regular Panel Decision

Texas Mutual Insurance Co. v. Texas Department of Insurance

Texas Mutual Insurance Company appealed a district court's decision that granted a plea to the jurisdiction by the Texas Department of Insurance, Division of Workers’ Compensation. The core issues were whether the Division had exclusive jurisdiction over disputes concerning employers liability insurance coverage periods and if Texas Mutual's challenge to Division rule 110.1 was ripe for adjudication. The appellate court found that the Division does not hold exclusive jurisdiction over employers liability coverage disputes, especially when no workers' compensation benefits claim is pending. Furthermore, the court determined that Texas Mutual's challenge to rule 110.1 was indeed ripe for judicial review. Consequently, the appellate court reversed the district court's judgment and remanded the case for further proceedings consistent with its opinion.

JurisdictionExclusive JurisdictionEmployers Liability InsuranceWorkers' CompensationDeclaratory JudgmentAdministrative Procedure ActRule ChallengeRipenessCoverage DisputeStatutory Interpretation
References
36
Case No. MISSING
Regular Panel Decision

Graybill v. City of New York

Plaintiff Christopher Graybill, a construction worker, sued the City of New York and the Port Authority for injuries sustained while cleaning debris at the World Trade Center site after 9/11. The Port Authority removed the case to federal court, citing Section 408(b)(3) of the Air Transportation Safety and System Stabilization Act, which grants exclusive federal jurisdiction for claims 'resulting from or relating to the terrorist-related aircraft crashes' of September 11, 2001. Judge Hellerstein denied federal jurisdiction, holding that the case, involving injuries common to general construction sites and New York Labor Law claims, does not fall under the exclusive federal jurisdiction intended by Congress, as the duties and risks were not unique to the special conditions of the 9/11 site. The case was remanded to the New York Supreme Court.

Federal JurisdictionRemand9/11 LitigationWorld Trade CenterConstruction InjuryLabor LawStatutory InterpretationProximate CausationAir Transportation Safety and System Stabilization ActSouthern District of New York
References
28
Case No. MISSING
Regular Panel Decision
Oct 29, 2009

APOLLO ENTERPRISES, INC. v. ScripNet, Inc.

This appeal examines the exclusive jurisdiction of the Texas Division of Workers’ Compensation over disputes concerning payment amounts due from workers’ compensation insurance carriers to pharmacies. Appellants Apollo Enterprises, Inc. and WorkingRx, Inc. (collectively, WorkingRx) are companies that purchase assignments of workers’ compensation reimbursement claims from pharmacies. Appellee ScripNet, Inc. is a pharmacy benefits management company (PBM) that contracts with insurers to process and pay pharmacy reimbursement bills. WorkingRx sued ScripNet alleging tortious interference and civil conspiracy, primarily claiming that ScripNet caused carriers to underpay on reimbursement claims or diverted claims away from WorkingRx. The district court dismissed all of WorkingRx’s tort claims based on exclusive jurisdiction and exhaustion-of-remedies. The appellate court affirmed the dismissal of WorkingRx’s claims related to incorrect U&C estimates and erroneous application of ScripNet contract rates, finding these to be medical fee disputes falling under the Division’s exclusive jurisdiction. However, the court reversed and remanded the dismissal of WorkingRx’s claims that ScripNet wrongfully caused pharmacies to bind themselves to ScripNet contract rates and wrongfully “diverted” pharmacy reimbursement claims, concluding these claims do not fall within the Division's exclusive jurisdiction as they do not constitute medical fee disputes over amounts due from carriers under the workers’ compensation act and rules.

Workers' CompensationExclusive JurisdictionMedical Fee DisputesPharmacy Benefits ManagerTortious InterferenceCivil ConspiracyAdministrative RemediesStatutory InterpretationReimbursement RatesAssignment of Claims
References
33
Case No. 03-05-00776-CV
Regular Panel Decision
Dec 15, 2006

Texas Mutual Insurance Company v. Texas Department of Insurance, Division of Workers' Compensation

This interlocutory appeal addresses whether the Texas Department of Insurance, Division of Workers' Compensation, holds exclusive jurisdiction over disputes concerning employers' liability insurance coverage periods and if a challenge to a Division rule was ripe for adjudication. The case originated from a wrongful death claim against AJ Commercial, whose insurance carrier, Texas Mutual, sought a declaratory judgment that the employers' liability policy had expired. The district court had granted the Division's plea to the jurisdiction, finding exclusive jurisdiction and lack of ripeness for the rule challenge. The appellate court reversed, ruling that the Division does not have exclusive jurisdiction over employers' liability coverage disputes when no worker's compensation benefits claim is pending and that the rule challenge was indeed ripe, remanding the case for further proceedings.

Workers' Compensation LawEmployer Liability InsuranceExclusive JurisdictionRipeness DoctrineDeclaratory JudgmentAdministrative LawInsurance Coverage DisputeStatutory InterpretationAppellate ReviewTexas Court of Appeals
References
25
Case No. MISSING
Regular Panel Decision

In the Interest of G.R.M.

This appeal addresses a jurisdictional dispute concerning the modification of a parent-child relationship order. Appellant Sam J.M. challenged the subject matter jurisdiction of the 393rd District Court of Denton County, arguing that the 158th District Court retained exclusive jurisdiction over the original decree of divorce. Appellee Leticia H. A. contended that the transfer of the case to the 393rd District Court for docket equalization was permissible under the Texas Government Code. The court analyzed the apparent conflict between the exclusive transfer provisions of the Texas Family Code and the docket equalization provisions of the Texas Government Code. Applying statutory construction principles, the court found that the Government Code's section on docket equalization, enacted later and reflecting a clear legislative intent to balance judicial burdens, prevails over the Family Code's transfer restrictions in this specific context. Consequently, the appellate court affirmed the trial court's order, holding that the 393rd District Court had properly acquired continuing, exclusive jurisdiction.

Subject Matter JurisdictionDocket EqualizationParent-Child RelationshipStatutory ConstructionLegislative IntentTexas Government CodeTexas Family CodeExclusive JurisdictionIntra-county TransferAppellate Review
References
27
Case No. 04-24-00386-CV
Regular Panel Decision
Feb 26, 2025

In Re Texas Mutual Insurance Company, Judy Bond, and Allstate County Mutual Insurance v. the State of Texas

Edward Santos filed a lawsuit against Texas Mutual Insurance Company, Judy Bond, and Allstate County Mutual Insurance, alleging liability for his injuries being compensated through workers' compensation benefits, thereby limiting liability under other coverages. Texas Mutual and Bond challenged the trial court's denial of their pleas to the jurisdiction, arguing that the Texas Department of Insurance, Division of Workers' Compensation (the Division) had exclusive jurisdiction over Santos's claims. The Fourth Court of Appeals found that Santos's claims against Texas Mutual and Bond, predicated on the improper investigation, handling, or settlement of his workers' compensation claim, fell within the Division's exclusive jurisdiction, and he failed to exhaust administrative remedies. Consequently, the Court conditionally granted the petition for a writ of mandamus for Texas Mutual and Bond, directing the trial court to dismiss claims against them. However, the Court denied Allstate's petition, as Santos's claims against Allstate involved a liability claim against a non-workers' compensation carrier, which did not abrogate the Division's exclusive jurisdiction by re-litigating the course and scope of employment question.

MandamusWorkers' CompensationExclusive JurisdictionAdministrative RemediesPlea to the JurisdictionInsurance CodeDeceptive Trade Practices ActFraudConspiracyEmployer Liability
References
25
Case No. MISSING
Regular Panel Decision

JM Banks v. United States

Norris JM Banks, a federal employee, sued the United States under the Federal Tort Claims Act (FTCA) to recover legal and medical expenses. These expenses were incurred after his Federal Employees’ Compensation Act (FECA) disability benefits were initially terminated due to an OWCP procedural error involving a conflicted medical examiner. Although OWCP later reinstated his benefits, Banks sought damages for the period of suspension. The District Court granted the Government's motion to dismiss for lack of subject-matter jurisdiction. The court ruled that Banks' claims derived directly from his FECA benefits determination, making FECA the exclusive remedy and precluding judicial review under 5 U.S.C. § 8128(b). The court found no exception for constitutional claims or clear statutory violations that would allow it to exercise jurisdiction. The case was dismissed without prejudice.

FECAFTCASubject-Matter JurisdictionMotion to DismissExclusive RemedyJudicial Review BarDue ProcessAdministrative Procedure ActFederal EmployeesWorkers' Compensation
References
53
Case No. MISSING
Regular Panel Decision

Holmans v. Transource Polymers, Inc.

This case involves an appeal regarding a common-law claim for unpaid wages filed by an appellant against Transource, which was dismissed by the trial court due to a perceived lack of subject-matter jurisdiction. The central issue was whether the Texas Payday Law exclusively preempted common-law claims for wages, thereby eliminating the court's jurisdiction. The appellate court determined that the Payday Law was intended to be a cumulative, alternative remedy rather than an exclusive one. It highlighted that interpreting the statute as exclusive would unconstitutionally deny wage claimants the right to a jury trial, a right preserved for common-law actions. Consequently, the court reversed the trial court's dismissal, affirming that the trial court possessed proper jurisdiction over the appellant's claim, and remanded the case for further proceedings.

Unpaid WagesPayday LawJurisdictionCommon LawStatutory InterpretationRight to Jury TrialPreemptionAdministrative RemediesAppellate ReviewRemand
References
21
Case No. 03-07-00551-CV
Regular Panel Decision
Dec 04, 2009

Apollo Enterprises, Inc. and WorkingRx, Inc. v. ScripNet, Inc.

This appeal addresses the exclusive jurisdiction of the Texas Division of Workers' Compensation over disputes concerning payments from workers' compensation insurance carriers to pharmacies. Appellants Apollo Enterprises, Inc. and WorkingRx, Inc. (WorkingRx) challenged the dismissal of their tortious interference and civil conspiracy claims against Appellee ScripNet, Inc., a pharmacy benefits manager. The district court had dismissed all claims based on the Division's exclusive jurisdiction. The Court of Appeals affirmed the dismissal of claims directly involving incorrect U&C estimates and the erroneous application of ScripNet contract rates, classifying these as medical fee disputes. However, the court reversed and remanded claims asserting that ScripNet tortiously caused pharmacies to enter contracts with ScripNet and diverted reimbursement claims, concluding these did not constitute medical fee disputes subject to the Division's exclusive jurisdiction.

Workers' Compensation LawExclusive JurisdictionMedical Fee DisputesPharmacy Benefits ManagementTortious InterferenceCivil ConspiracyContract LawStatutory InterpretationAdministrative LawJudicial Review
References
53
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