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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Iron Workers Locals 40, 361 & 417 Health Fund v. Dinnigan

The case involves a dispute between the Iron Workers Locals 40, 361, & 417 Health Fund and Robert Dinnigan, Amanda C. Dinnigan Supplemental Needs Irrevocable Trust, and their attorney regarding reimbursement of medical expenses. The Health Fund sought nearly $1.7 million paid for Amanda Dinnigan's severe injuries from a third-party tortfeasor settlement. Defendants argued against reimbursement, citing state anti-subrogation laws and the "made-whole" doctrine. The court ruled that the Health Fund was self-insured, thus preempting state law, and that the 2008 SPD, which rejected the made-whole doctrine, applied to most expenses. Ultimately, the court ordered judgment for the Plaintiff in the amount of $1,292,278, having reduced the claim by 25% to account for the Defendants' attorneys' fees and expenses in securing the original settlement.

ERISAEmployee BenefitsHealth Fund ReimbursementSubrogationEquitable ReliefSelf-Insured PlanMade-Whole DoctrinePersonal Injury SettlementSupplemental Needs TrustAttorneys' Fees
References
32
Case No. No. 77 Civ. 4712 (MP)
Regular Panel Decision
Mar 27, 1978

National Ben. Fund, Etc. v. Presby. H., Etc.

The National Benefit Fund for Hospital and Health Care Workers and the National Pension Fund for Hospital and Health Care Workers (the Funds) sued Presbyterian Hospital in the City of New York, Inc. (Hospital) to recover allegedly owed contributions based on collective bargaining agreements. The Hospital moved to dismiss, asserting the action was barred by a prior arbitration award between the Union (District 1199, National Union of Hospital and Health Care Employees) and the Hospital, which concerned the same contributions and was dismissed due to the Union's unreasonable delay. The District Court, treating the motion as one for summary judgment, held that the arbitration award had res judicata effect. The court determined that the Funds were either in privity with the Union or acted as third-party beneficiaries subject to the same defenses as the promisee Union. Consequently, the court granted the Hospital's motion to dismiss the complaint.

Arbitration AwardRes Judicata DoctrineEmployee Benefit FundsCollective Bargaining DisputesSummary Judgment MotionHospital Labor RelationsUnion RepresentationERISA ClaimsPreclusionFederal District Court
References
19
Case No. 03-03-00355-CV
Regular Panel Decision
Apr 08, 2004

Albert Hawkins, in His Capacity as Commissioner of Health & Human Services The Texas Health & Human Services Commission And the Texas Department of Health v. Dallas County Hospital District D/B/A Parkland Health and Hospital System

This case involves an appeal concerning the rules and formulas used to reimburse Texas teaching hospitals for graduate medical education (GME) costs from Medicaid funds. The core dispute is whether the Texas Health and Human Services Commission was legally mandated to use a specific statutory formula based on a hospital's annual actual GME costs, or if it could continue using its existing rule, which derived costs from a 1984 base-period figure adjusted for inflation, mirroring the federal Medicare approach. Dallas County Hospital District, operating Parkland Memorial Hospital, sued the department, alleging underpayment of over $72 million due to the use of the incorrect formula. The district court ruled in favor of Parkland, declaring the department's rules invalid. The appellate court affirmed this judgment, concluding that the statutory formula for reimbursement was mandatory, while the department's discretion was limited to calculating variables within that prescribed formula, not to establishing an alternative method.

Medicaid reimbursementGraduate Medical EducationTeaching HospitalsStatutory interpretationTexas Health and Human Services CommissionParkland Memorial HospitalHealthcare fundingAdministrative lawJudicial reviewHealth policy
References
13
Case No. MISSING
Regular Panel Decision

Teamsters, Chauffeurs, Warehousemen & Helpers, Local Union No. 182 v. New York State Teamsters Council Health & Hospital Fund

Plaintiff Teamsters Local Union No. 182 (Local 182) filed an action against the New York State Teamsters Council Health & Hospital Fund and the New York State Teamsters Conference Pension and Retirement Fund (the Funds) under 29 U.S.C. § 185. Local 182 sought a declaration affirming the existence of valid collective bargaining agreements between April 1992 and March 1994, which mandated grievance and arbitration procedures, and an order compelling the Funds to arbitrate layoff-related grievances. The Union contended there was a long-standing oral agreement to adhere to applicable provisions of the National Master Freight Agreement (NMFA). The Funds moved for summary judgment, asserting a lack of subject matter jurisdiction and denying the existence of any agreement with requisite definiteness. The court denied the summary judgment motion, affirming subject matter jurisdiction and finding that Local 182 presented genuine issues of material fact concerning the existence of a collective bargaining agreement.

Collective Bargaining AgreementSummary Judgment MotionLabor DisputeUnion RightsGrievance ProcedureArbitrationSeniority RightsLayoffsNational Master Freight AgreementPension Benefits
References
24
Case No. MISSING
Regular Panel Decision

New York State Teamsters Council Health & Hospital Fund v. Estate of DePerno

This memorandum-decision and order, issued on remand, addresses the damages in a case where Rocco F. DePerno and Rocco A. DePerno violated ERISA by hiring employees of Rocco A. DePerno's business (Sea Shell Inn cooks) as maintenance workers for the New York State Teamsters Council Health & Hospital Fund. While liability for fiduciary breach was established, the court previously awarded only nominal damages, which was reversed on appeal. On remand, the court found that the defendants successfully proved the hired workers' services were "reasonably necessary" to the Fund, primarily to replace a fired worker and reduce overtime for existing staff. Despite the breach of fiduciary duty due to self-dealing, the Fund suffered no actual loss as the cooks performed legitimate tasks and were paid reasonable wages. Consequently, the plaintiffs were again awarded only one dollar in nominal damages.

ERISAFiduciary Duty BreachNominal DamagesRemand OrderEmployee BenefitsSelf-dealingTrust Law PrinciplesMaintenance StaffingOvertime ReductionNorthern District of New York
References
2
Case No. MISSING
Regular Panel Decision
Jun 20, 1996

Trustees of the Health & Welfare & the Pension Funds of the Four Joint Boards v. Schlesinger Bros.

Plaintiffs, Trustees of the Health and Welfare and Pension Funds of the Four Joint Boards and Esther Maiese, filed an action against Schlesinger Brothers, Inc. and the International Leather Goods, Plastics, Novelty and Service Workers Union, alleging violations of ERISA and LMRA. Specifically, plaintiffs claimed that defendants breached ERISA's 'sole benefit rule' by diverting contributions from the FJBC Funds to the International's Funds. They also alleged that Schlesinger violated the collective bargaining agreement under LMRA. The court determined that Schlesinger did not act as a fiduciary under ERISA and that the plaintiffs lacked standing to bring the LMRA claim against the employer. Similarly, the court found that the International union was not subject to fiduciary duties under ERISA when engaged in collective bargaining. Consequently, the court granted Schlesinger's motion to dismiss the entire complaint and the International's motion to dismiss the ERISA claim, leaving only the LMRA claim against the International viable.

ERISALMRAFiduciary DutyCollective Bargaining AgreementMotion to DismissPension FundsHealth and Welfare FundsUnionEmployer LiabilityStanding
References
31
Case No. 15-24-00114-CV
Regular Panel Decision
Oct 04, 2024

Cecile Erwin Young, in Her Official Capacity as the Executive Commissioner of the Texas Health and Human Services Commission; Molina Healthcare of Texas, Inc.; And Aetna Better Health of Texas, Inc. v. Cook Children's Health Plan, Texas Children's Health Plan, Superior Health Plan, Inc., and Wellpoint Insurance Company

This case involves an appeal concerning a temporary injunction and the denial of a plea to the jurisdiction issued by the 353rd Judicial District of Travis County. The appellants, including Cecile Erwin Young (Executive Commissioner of HHSC), Molina Healthcare of Texas, Inc., and Aetna Better Health of Texas, Inc., are challenging the lower court's decision. The appellees (Cook Children's Health Plan, Texas Children's Health Plan, Superior Health Plan, Inc., and Wellpoint Insurance Company) had sought to enjoin the Texas Health and Human Services Commission (HHSC) from proceeding with STAR & CHIP and STAR Kids managed care procurements. The core legal arguments revolve around whether HHSC's procurement processes violated Texas law, thereby rendering the intended contract awards unlawful ultra vires acts, and whether the appellees' claims are barred by sovereign immunity or failure to exhaust administrative remedies. The appellants contend that the district court abused its discretion by granting the injunction and denying the plea.

Appellate CourtTemporary InjunctionPlea to the JurisdictionSovereign ImmunityUltra Vires ClaimsProcurement DisputeManaged Care ContractsMedicaidCHIPTexas Health and Human Services Commission
References
95
Case No. MISSING
Regular Panel Decision
Apr 16, 1986

New York State Teamsters Council Health & Hospital Fund v. City of Utica

The New York State Teamsters Council Health and Hospital Fund and its trustees (plaintiffs) sued the City of Utica (defendant) under ERISA for failing to make required contributions to an employee benefit plan. An audit revealed significant deficiencies related to bargaining unit work by non-Union CETA employees and bookkeeping errors. The defendant challenged the agreements' enforceability and the mayor's authority, also disputing the audit's accuracy. The District Court found in favor of the plaintiffs, ruling that the agreements were valid and enforceable. The court ordered the defendant to pay $121,254.66 in unpaid contributions, $12,125.47 in liquidated damages, auditor's fees of $6,787.00, interest, and plaintiffs' costs and reasonable attorney's fees.

ERISAEmployee Benefit PlanUnpaid ContributionsCollective Bargaining AgreementAuditLiquidated DamagesAttorney's FeesFederal Rules of Civil ProcedureDistrict CourtBench Trial
References
5
Case No. 03-01-00631-CV
Regular Panel Decision
Jun 21, 2002

Everest National Insurance Company v. Texas Workers' Compensation Commission Subsequent Injury Fund Leonard W. Riley, Jr., in His Official Capacity as Director of Texas Workers' Compensation Commission And John Casseb, in His Official Capacity as Administrator of Subsequent Injury Fund

Everest National Insurance Company (Everest) sought reimbursement from the Subsequent Injury Fund for overpaid workers' compensation benefits after district court judgments reversed prior agency decisions. The Fund denied a portion of the requested amount, leading Everest to file a declaratory judgment suit in district court. The district court dismissed the suit, citing lack of subject-matter jurisdiction due to Everest's alleged failure to exhaust administrative remedies. The Texas Court of Appeals reversed this decision, holding that Everest was not required to exhaust administrative remedies because the Fund had previously stated no such remedies existed. The appellate court found Everest was authorized to bring a direct suit for declaratory relief under the Uniform Declaratory Judgments Act to enforce the Fund's statutory obligation, remanding the case for a decision on the merits.

Workers' CompensationInsurance ReimbursementSubsequent Injury FundAdministrative Procedure ActDeclaratory JudgmentExhaustion of Administrative RemediesSubject-Matter JurisdictionStatutory InterpretationTexas Court of AppealsJudicial Review
References
8
Case No. MISSING
Regular Panel Decision

Ames v. Group Health Inc.

Plaintiffs, including trustees John Ames and Michael Pantony of the United Welfare Fund-Welfare Division (UWF) and participant Fred Tremarcke, sued Group Health Incorporated (GHI) under ERISA and HIPAA. They alleged GHI illegally discriminated against Tremarcke by denying his health coverage after he went on disability leave, arguing it violated HIPAA's anti-discrimination provisions and breached the insurance policy. Tremarcke's employer, Classic Chevrolet, continued making health contributions on his behalf, and a 'Side Letter of Understanding' with his union attempted to maintain his 'active employee' status. The court ultimately ruled in favor of GHI, finding that Tremarcke did not meet the eligibility requirements of the UWF-GHI plan, which required working over 20 hours per week, and that the 'Side Letter' could not unilaterally alter GHI's contractual obligations. Consequently, the plaintiffs' motion for partial summary judgment was denied, and the defendant's motion for partial summary judgment was granted, dismissing the second and third causes of action.

ERISAHIPAACOBRAHealth InsuranceDisability BenefitsSummary JudgmentFiduciary DutyBreach of ContractMulti-employer FundCollective Bargaining Agreement
References
6
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