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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

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. MISSING
Regular Panel Decision
Mar 04, 1988

In re Nurse Care Registry, Inc.

Nurse Care Registry, Inc., an agency providing health care personnel, appealed a decision by the Unemployment Insurance Appeal Board that classified its workers as employees rather than independent contractors, making Nurse Care liable for unemployment insurance contributions. The court affirmed the Board's decision, finding substantial evidence of Nurse Care's control over key aspects of the services provided by the workers. This control included client contact, worker wages, and billing/collection, which were deemed indicative of an employer-employee relationship. The court relied on precedent establishing that such control warrants an employment finding, despite workers having full-time positions elsewhere and the agency not directly supervising daily work.

unemployment insuranceemployer-employee relationshipindependent contractoradministrative lawappellate reviewlabor lawagency staffingcontrol testsubstantial evidencehealth care industry
References
4
Case No. 04-06-00417-CV
Regular Panel Decision
Jun 25, 2008

Sylvia Casas, Ind. Substantively Consolidated Bankruptcy Estates of Fountain View, Inc. as Successor to Summit Care Corporation, Summit Care Texas, L.P. D/B/A Comanche Trail Nursing Center and Summit Care Management Texas and Robert Gundling, Ind. v. Rosamarie Paradez, as the Administrator and Heir at Law of the Estate of Tranquilino Mendoza

This case involves a medical malpractice survival action initiated by Rosamarie Paradez, daughter of the deceased Tranquilino Mendoza, against Sylvia Casas, Robert Gundling, and the consolidated bankruptcy estates of Fountain View, Inc. (successor to Summit Care Corp. and Summit Care Texas, L.P., operators of Comanche Trail Nursing Center). Mendoza, an 81-year-old nursing home resident, suffered severe injuries after being beaten by a violent roommate, allegedly due to the appellants' negligence. The appellants challenged various aspects of the trial court's judgment, including the denial of new trial motions, sufficiency of damages, excessive awards, and the application of damages caps. The appellate court affirmed the trial court's judgment, upholding the damages awarded for pain, mental anguish, and physical impairment, and finding no error in the application of the damages cap or the finding of negligence against Gundling.

Medical MalpracticeNursing Home NegligencePersonal InjurySurvival ActionAppellate ReviewJury ArgumentDamages CapFactual SufficiencyMental AnguishPhysical Impairment
References
35
Case No. NO. 01-13-00108-CV
Regular Panel Decision
Sep 23, 2014

Iris Gonzalez v. Diversicare Leasing Corp D/B/A Afton Oaks Nursing Care Center A/K/A Afton Oaks Nursing and Rehab Center Diversicare Afton Oaks, LLC.

Iris Gonzalez, an employee at a nursing home, sued her employer, Afton Oaks, for personal injuries sustained after tripping over crates on an employee pathway. The trial court dismissed her lawsuit for failure to file an expert report under the Texas Medical Liability Act, categorizing it as a health care liability claim. Gonzalez appealed, arguing it was an ordinary negligence claim unrelated to health care. The Court of Appeals, relying on a recent decision in Williams v. Riverside General Hospital, Inc., held that a 'garden-variety slip-and-fall claim that is completely untethered from the provision of health care' does not constitute a health care liability safety claim. Therefore, the appellate court reversed the trial court's judgment and remanded the case for further proceedings.

Slip and FallOrdinary NegligenceTexas Medical Liability ActHealth Care Liability ClaimEmployer LiabilityNursing HomePremises LiabilityWorkers' CompensationExpert ReportAppellate Procedure
References
4
Case No. 2021 NY Slip Op 06800
Regular Panel Decision
Dec 07, 2021

Harris v. Pelham Parkway Nursing Care & Rehabilitation Facility LLC

Plaintiff Mariantha Harris appealed an order from Supreme Court, Bronx County, denying her cross motion for summary judgment dismissing an affirmative defense based on the exclusivity provision of the Workers' Compensation Law. The Appellate Division, First Department, reversed the order, granting Harris's cross motion. Harris successfully established prima facie that she was not an employee of Pelham Parkway Nursing Care and Rehabilitation Facility LLC at the time of her accident, but rather was solely employed by nonparty Clear Choice, P.C. The defendant failed to provide sufficient evidence to support its claim that Harris was its special employee, with its reliance solely on the plaintiff performing duties at its nursing home being insufficient. Additionally, the court found the doctrine of judicial estoppel inapplicable because plaintiff had not secured a judgment in her favor in the prior proceeding, and the defendant's prematurity argument was improperly raised for the first time on appeal.

Summary JudgmentExclusive RemedyEmployment StatusSpecial EmployeeSlip and FallJudicial EstoppelAppellate ProcedureCross MotionAffirmative DefenseClear Choice P.C.
References
6
Case No. 01-11-00882-CV
Regular Panel Decision
May 09, 2013

Concierge Nursing Centers, Inc. and Houston Concierge Care, L.P. v. Antex Roofing, Inc., Nevco Waterproofing, Inc., Conex Constructors, Inc., and Mitchell Chuoke Plumbing, Inc.

This case concerns an appeal by Concierge Nursing Centers, Inc. and Houston Concierge Care, L.P. (Concierge) from a summary judgment in favor of four construction subcontractors in a contract action. Concierge, acting as an assignee of its general contractor Brae Burn Construction Company, Ltd., sought indemnification from the subcontractors for water damage and mold in its facility. The Court of Appeals addressed whether Brae Burn's claims were assignable despite subrogation clauses in its insurance policies and the scope of the subcontractors' indemnity obligations. The court ruled that the claims were indeed assignable and that the indemnity provisions covered the property damage at issue, rejecting the subcontractors' narrow interpretation of 'property.' Additionally, the court found Concierge's expert affidavit on causation to be sufficient. Consequently, the appellate court reversed the trial court’s summary judgment and remanded the case for further proceedings.

Contract DisputeSummary JudgmentAppellate ReviewIndemnity AgreementSubrogation RightsProperty DamageConstruction DefectWater IntrusionMoldInsurance Policies
References
45
Case No. MISSING
Regular Panel Decision

Beth Israel Medical Center v. 1199/S.E.I.U. United Healthcare Workers East

Beth Israel Medical Center (BIMC) petitioned to vacate an arbitration award concerning a labor dispute over wage differentials for registered nurses on flex-time schedules at its Kings Highway Division. Local 1199, the nurses' union, moved to confirm the award. The dispute arose when BIMC discontinued pro-rata wage differentials for day shift nurses, arguing a 2002 Memorandum of Agreement (MOA) adopted a different plan. The arbitrator found for Local 1199, concluding the 2002 MOA did not alter the longstanding practice established in prior MOAs. BIMC argued the arbitrator exceeded his power and violated public policy; however, the court denied BIMC's petition and granted Local 1199's motion, affirming the arbitrator's decision that drew its essence from the collective bargaining agreement.

Labor DisputeArbitration AwardWage DifferentialsCollective Bargaining AgreementFlex-Time ScheduleRegistered NursesNew YorkFederal CourtLMRAContract Interpretation
References
14
Case No. MISSING
Regular Panel Decision
Apr 27, 2012

China Auto Care, LLC v. China Auto Care (Caymans)

Plaintiffs China Auto Care, LLC and China Auto Care Holdings, LLC brought an action against China Auto Care (Caymans), Digisec Corporation, and the estate of Chander Oberoi, alleging various causes of action stemming from the 2011 sale of Digisec's assets. Defendants sought to dismiss the complaint and compel arbitration, citing an arbitration clause in the parties' "Business Relationship and Shareholder Agreement." The court analyzed the scope of the arbitration clause under the Federal Arbitration Act. Finding the clause to be broad, the court concluded that the plaintiffs' claims were within its scope, as they "touch matters" governed by the Shareholder Agreement. Consequently, the court granted the defendants' motion, staying the litigation and compelling arbitration.

ArbitrationShareholder AgreementCorporate DisputeMotion to CompelFederal Arbitration ActSecond Circuit PrecedentFraudulent InducementCorporate GovernanceCayman Islands LawStay of Proceedings
References
25
Case No. MISSING
Regular Panel Decision
Mar 03, 2008

Texas Mutual Insurance Co. v. Sara Care Child Care Center, Inc.

Texas Mutual Insurance Company appealed two summary judgment orders and a final judgment in favor of its insured, Sara Care Child Care Center, Inc., and employee Martha Martinez. The core issue was whether Sara Care's workers' compensation policy was extended due to Texas Mutual's alleged failure to comply with statutory cancellation notice requirements, thus covering Ms. Martinez's injury. The Workers' Compensation Commission Appeals Panel and the trial court affirmed coverage. The appellate court affirmed the trial court's judgment regarding judicial review of the Appeals Panel decision, Sara Care's common law claims (breach of contract, promissory estoppel), and the attorney's fee award. However, the court reversed and remanded the trial court's judgment on Sara Care's statutory claims (Texas Insurance Code and Texas Deceptive Trade Practices Act) and the 'knowingly' finding, stating a fact issue remained on whether coverage liability was 'reasonably clear' for these claims.

Workers' Compensation InsurancePolicy NonrenewalStatutory Notice RequirementsSummary Judgment ReviewAppellate Court DecisionBreach of ContractTexas Insurance Code ViolationsDTPA ViolationsAttorney's FeesJudicial Review
References
30
Case No. MISSING
Regular Panel Decision

Schauer v. Memorial Care Systems

Helen Schauer, a registered nurse, brought a lawsuit against her employer, Memorial Care Systems, and Assistant Vice President Martha Koperwhats, alleging defamation and emotional distress stemming from a negative employment appraisal. The appraisal, prepared by Koperwhats, rated Schauer's overall performance as "fair" and contained several critical statements. Schauer argued these statements were libelous, constituted a lack of qualified privilege, and were made with actual malice. The trial court granted summary judgment for the defendants, leading to this appeal. The appellate court affirmed the summary judgment, concluding that the statements in the appraisal were either truthful, protected opinions, or not defamatory, and that Schauer failed to demonstrate actual malice or severe emotional distress not precluded by the Texas Workers’ Compensation Act.

DefamationEmployment AppraisalQualified PrivilegeActual MaliceSummary JudgmentEmotional DistressIntentional Infliction of Emotional DistressNegligent Infliction of Emotional DistressTexas Workers' Compensation ActAppellate Review
References
55
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