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

Case No. E2003-00432-WC-R3-CV
Regular Panel Decision

Bryant v. BAPTIST HEALTH SYSTEM HOME CARE

Patricia Bryant, a home-health nursing assistant, suffered two work-related back injuries in 1997 while working for Baptist Health System Home Care of East Tennessee. After leaving employment, she filed for workers' compensation benefits. During a deposition in 1998, Bryant falsely testified she had not worked since leaving Baptist. Upon discovery, Baptist filed a counterclaim under the Workers’ Compensation Fraud Act. The trial court dismissed Baptist's counterclaim, finding no prejudice or fraudulent insurance act, and awarded Bryant 22.5% permanent partial disability benefits. The Supreme Court affirmed the trial court's dismissal of the counterclaim, ruling that Baptist, as a self-insured employer, did not fit the 'insurer' definition under the Fraud Act, and affirmed the disability award, deferring to the trial court's credibility assessment of Bryant despite her false testimony.

Workers' Compensation FraudFalse TestimonyPermanent Partial Disability BenefitsMedical Impairment RatingNeurosurgeon OpinionSelf-Insured Employer LiabilityStatutory InterpretationAppellate Court ReviewCredibility AssessmentBack Injury Claim
References
13
Case No. No. 11, No. 12
Regular Panel Decision
Mar 26, 2019

Lilya Andryeyeva v. New York Health Care , Adriana Moreno v. Future Care Health Services

The New York Court of Appeals addressed a common issue in two joint appeals: whether home health care aides on 24-hour shifts must be paid for each hour. The Department of Labor (DOL) interpreted its Wage Order (12 NYCRR part 142) to allow payment for at least 13 hours if the employee receives at least 8 hours for sleep (with 5 uninterrupted) and 3 hours for meals. The Appellate Division rejected this, but the Court of Appeals reversed, deferring to DOL's interpretation as rational and consistent with the Wage Order's plain language. The cases were remitted for lower courts to evaluate class certification issues in accordance with DOL's interpretation.

Home Health Care24-Hour ShiftsMinimum Wage ActWage OrderDepartment of Labor InterpretationClass CertificationAppellate ReviewLabor Law ViolationsSleep BreaksMeal Breaks
References
49
Case No. MISSING
Regular Panel Decision

Franzese v. United Health Care/Oxford

Plaintiffs Robert and Elizabeth Franzese, parents and legal guardians of disabled adult Robert Franzese Jr. ("Bobby"), sued United Health Care/Oxford under ERISA to recover medical benefits. Bobby, suffering from chronic lung disease, requires 24/7 in-home nursing care. Oxford denied preauthorization for private duty nursing, citing it as an exclusion, and denied home health care services. The court granted Oxford's summary judgment motion regarding private duty nursing and Xopenex preauthorization, finding private duty nursing not covered. However, the court denied Oxford's motion regarding home health care services, deeming Oxford's denial arbitrary and capricious due to lack of substantial evidence. The case is remanded to Oxford for reconsideration of home health care benefits.

Employee Retirement Income Security Act (ERISA)Medical BenefitsHealth Insurance DenialSummary JudgmentArbitrary and Capricious StandardHome Health CarePrivate Duty NursingPreauthorizationMedical NecessityChronic Lung Disease
References
37
Case No. Docket No. 2015-05-0341, State File No. 69225-2015
Regular Panel Decision
Mar 16, 2016

Dugger, Paula v. Home Health Care of Middle Tennessee, LLC, et al.

Paula Dugger, a home health care nurse, was injured in a motor vehicle accident while returning home after abandoning a work trip due to inclement weather. She sought workers' compensation benefits, arguing her injuries arose from her employment. The trial court denied her claim, finding no exception to the 'going and coming' rule for injuries sustained during commutes. The Workers' Compensation Appeals Board affirmed this decision, concluding that Dugger was not a 'traveling employee' and that the employer did not control the risks of her commute, thus her journey was not a compensated part of her service or a special errand.

Going and Coming RuleMotor Vehicle AccidentHome Health Care NurseScope of EmploymentArising Out of EmploymentSpecial Errand ExceptionTraveling Employee ExceptionEmployer Furnished TransportationInclement WeatherCausal Connection
References
18
Case No. ADJ10954204
Regular
Sep 15, 2022

MARIA FLORES vs. PINNACLE HEALTH CORP., SUMMARY OF EVIDENCE INSURANCE COMPANY OF THE WEST, AFFINITY HOME HEALTH CARE SERVICES, FALLS LAKE FIRE & CASUALTY INSURANCE, SEDGWICK CMS, HOME HEALTH CARE SOLUTIONS, INC.

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by Home Health Care Solutions. The applicant, an LVN, was injured in a car accident while traveling between patients for multiple agencies. The Board adopted the WCJ's report, which found the injury arose out of and occurred in the course of employment for Home Health Care Solutions. This decision was based on the fact that the applicant was required to use her own vehicle, which extended the employer-employee relationship beyond direct service. The WCJ also found the going and coming rule did not bar the claim due to the required use of transportation between patient locations.

Workers' Compensation Appeals BoardPetition for ReconsiderationGoing and Coming RuleAOE/COELVNCar AccidentAutomobile ExceptionTransitEmployment RelationshipRequired Vehicle Use
References
6
Case No. 2025 NY Slip Op 06107 [243 AD3d 986]
Regular Panel Decision
Nov 06, 2025

Matter of Dunkez Private Home Care, Inc. v. McDonald

The case involves Dunkez Private Home Care, Inc., a licensed home care services agency, challenging the Commissioner of Health's determination to revoke its license and impose a monetary penalty. The revocation stemmed from multiple deficiencies found during DOH surveys in 2019 and 2021, a substantiated patient complaint, and the agency's failure to comply with a temporary suspension order. The Appellate Division, Third Department, confirmed the Commissioner's determination, finding it supported by substantial evidence. The Court also found the penalty, license revocation and a monetary fine, was not disproportionate or shocking to one's sense of fairness, considering the serious danger posed to vulnerable patients.

Home Care Services AgencyLicense RevocationAdministrative LawJudicial ReviewSubstantial EvidenceDepartment of HealthCPLR Article 78Monetary PenaltyTemporary Suspension OrderPatient Care Deficiencies
References
12
Case No. 03A01-9709-CH-00395
Regular Panel Decision
Nov 10, 1998

Deborah H. Steele v. Superior Home Health Care of Chattanooga, Inc., and David Twombley - Concurring

Deborah H. Steele sued her former employer and supervisor, Superior Home Health Care of Chattanooga, Inc. and David Twombley, for sexual harassment under the Tennessee Human Rights Act (THRA), and for outrageous conduct and intentional infliction of emotional distress. A jury awarded Steele $1.2 million in compensatory and $60,000 in punitive damages, later remitted to $850,000 compensatory. On appeal, the Court affirmed the jury's finding of hostile environment sexual harassment against both defendants, concluding that Twombley was individually liable as an aider and abetter, and upheld the outrageous conduct claim against Twombley. However, the Court reversed the finding of quid pro quo sexual harassment against Superior due to a lack of evidence of tangible job detriment. The Court found no reversible error in the admission of evidence or jury instructions, and upheld the attorney's fees awarded against Twombley.

Sexual HarassmentHostile Work EnvironmentIntentional Infliction of Emotional DistressOutrageous ConductTennessee Human Rights ActEmployer Vicarious LiabilitySupervisor Individual LiabilityAiding and Abetting HarassmentCompensatory DamagesRemittitur of Damages
References
23
Case No. MISSING
Regular Panel Decision

Concerned Home Care Providers, Inc. v. State

The case concerns a challenge by home care service agencies and a trade association (petitioners) to New York's Wage Parity Law (Public Health Law § 3614-c). This law conditions Medicaid reimbursement for home health care services in the metropolitan New York area on agencies paying home care aides a minimum wage, determined by reference to New York City's Living Wage Law. Petitioners argued the law was unconstitutional due to improper delegation of legislative authority, violation of the "incorporation by reference" clause, and violation of home rule provisions. They also challenged the Department of Health's (DOH) interpretation of "total compensation." The Supreme Court granted summary judgment to the respondents (DOH), and the appellate court affirmed, finding no improper delegation, no violation of the incorporation by reference clause, home rule provisions inapplicable as Medicaid is a state concern, and DOH's interpretation of "total compensation" to be rational.

Wage Parity LawHome Health Care ServicesMedicaid ReimbursementConstitutional LawLegislative AuthorityNew York City Living Wage LawHome RuleDue ProcessDepartment of HealthStatutory Interpretation
References
27
Case No. 2022 NY Slip Op 00289
Regular Panel Decision
Jan 18, 2022

Matter of Personal-Touch Home Care of N.Y., Inc. v. City of N.Y. Human Resources Admin.

The Appellate Division affirmed the Supreme Court's judgment, which denied a petition to overturn a decision by the Office of Administrative Trials and Hearings Contract Dispute Resolution Board (CDRB). The CDRB had found that Personal-Touch Home Care's claim to use unspent Medicaid funds for fiscal year 2007 to offset workers' compensation assessment expenses from 2009-2010 was foreclosed. The court agreed that the State Department of Health (DOH) rationally interpreted its regulations, concluding that these retroactive assessments, levied due to financial mismanagement of a self-insurance trust, were not

Workers' CompensationMedicaid FundsSelf-Insurance TrustFiscal YearRetroactive AssessmentAdministrative LawAgency DeferenceContract DisputeHealth Care AgenciesFinancial Mismanagement
References
4
Case No. MISSING
Regular Panel Decision

Texas Health Care Information Council v. Seton Health Plan, Inc.

Seton Health Plan, Inc., a licensed health maintenance organization (HMO), failed to file its annual Health Plan Employer Data Information Set (HEDIS) reports for 1999 and 2000 with the Texas Health Care Information Council, leading to a dispute over civil penalties. The State, through the Attorney General, initially demanded $153,000, interpreting 'each act of violation' as each day of non-compliance, while Seton contended the maximum penalty was $10,000 per unfiled report. Seton filed a declaratory judgment action to construe the statute, and the district court sided with Seton, assessing a minimum penalty of $1,000 for each report. The State appealed, raising issues of mootness, sovereign immunity, the penalty amount, denial of injunctive relief, and attorney's fees. The appellate court affirmed the district court's interpretation of the penalty, the assessed penalties, and the denial of injunctive relief, but remanded the issue of the State's attorney's fees.

Declaratory JudgmentStatutory ConstructionCivil PenaltiesSovereign ImmunityInjunctive ReliefAttorney's FeesHEDIS ReportHealth Maintenance OrganizationTexas Health and Safety CodeAdministrative Procedure Act
References
43
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