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

Case No. 03-02-00429-CV
Regular Panel Decision
May 30, 2003

Hospitals and Hospital Systems v. Continental Casualty Company

Hospitals and Hospital Systems appealed a declaratory judgment favoring Continental Casualty Company and other insurers, concerning the application of a one-year statute of limitations (rule 133.305(a)) for workers' compensation medical claims. The claims arose after the 1992 Acute Care Hospital Fee Guideline was invalidated. Hospitals argued the limitations period should be tolled due to prior litigation challenging the guideline and that the Commission waived the rule through a settlement agreement. The Texas Court of Appeals, Third District, Austin, found no basis for tolling, noting hospitals were not prevented from filing claims earlier. It also ruled that the Commission's executive director lacked authority to waive the rule, and that any waiver could not revive time-barred claims. The court affirmed the trial court's judgment, upholding the applicability of rule 133.305(a) and barring the Hospitals' claims.

Workers' CompensationAdministrative LawDeclaratory JudgmentStatute of LimitationsTollingWaiverTexas Court of AppealsFee GuidelinesMedical Dispute ResolutionAgency Rules
References
10
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. MISSING
Regular Panel Decision

League of Voluntary Hospitals & Homes v. Local 1199, Drug, Hospital & Health Care Workers Union

The court addresses an application for a preliminary injunction against Local 1199, a union planning a three-day strike. The League of Voluntary Hospitals and Homes of N. Y. sought the injunction following a previous temporary restraining order concerning a one-day strike. The union argued that each planned strike required a new legal proceeding, but the court deemed the strikes "episodic and organically connected." Citing concerns about blocked ingress/egress to hospitals and the union president's threats to "shut down" facilities, the judge found a preliminary injunction necessary under Labor Law § 807 to protect public health and safety. The injunction restrains the union from unlawfully interfering with hospital operations, blocking access, and picketing within certain distances of hospital entrances and emergency rooms.

Labor DisputePreliminary InjunctionStrike ActionUnion ActivityHospital AccessPicketing RegulationsCollective BargainingCivil Disobedience ThreatPublic Health and SafetyIngress Egress Interference
References
1
Case No. MISSING
Regular Panel Decision

Washington Heights-West Harlem-Inwood Mental Health Council, Inc. v. District 1199, National Union of Hospital & Health Care Employees, RWDSU

This case involves a dispute between District 1199, National Union of Hospital and Health Care Employees, and Washington Heights-West Harlem-Inwood Mental Health Council, Inc. The union sought to enforce an arbitration award requiring the Council to rehire and provide back pay to an employee, Edward Lane. The Council cross-moved to vacate the award, arguing that no valid collective bargaining agreement with an arbitration clause existed between the parties. Although the parties had acted under the terms of a proposed agreement for a period, including processing some grievances and wage increases, no formal, signed contract had ever been executed. Citing recent appellate court decisions emphasizing contract formalism over implied intent, the District Court granted the Council's motion to vacate the arbitration award and denied the union's motion to enforce it, concluding that without a signed agreement, there was no contractual duty to arbitrate.

Arbitration AwardSummary JudgmentContract FormationCollective BargainingLabor DisputeContract FormalismVacation of AwardEnforcement of AwardMeeting of the MindsFederal Court
References
23
Case No. MISSING
Regular Panel Decision
Dec 18, 2003

Hospitals v. Continental Casualty Co.

This case involves an appeal by various hospitals and hospital systems (referred to as 'Hospitals') against several insurance companies and other entities (collectively, 'Insurers') regarding workers' compensation medical claims. The central issue is whether Texas Worker’s Compensation Commission (the 'Commission') rule 133.305(a), which mandates a one-year filing period for medical dispute resolution claims, bars the Hospitals' claims. The Hospitals argued that the time limit was tolled due to ongoing litigation that invalidated the 1992 Acute Care Hospital Fee Guideline, or that the Commission had waived the rule through a 1997 settlement agreement. The court affirmed the trial court's judgment, ruling that rule 133.305(a) was neither tolled nor waived. The court found that the Hospitals were not prevented from timely filing claims or seeking an injunction, and that the executive director of the Commission lacked the authority to waive a lawfully enacted agency rule, especially for claims that were already time-barred.

Worker's CompensationMedical ClaimsFee GuidelinesStatute of LimitationsTollingWaiverAdministrative Procedure ActDeclaratory JudgmentInsurance DisputeHospitals
References
10
Case No. 2023 NY Slip Op 01193 [214 AD3d 735]
Regular Panel Decision
Mar 08, 2023

Matter of Long Beach Professional Firefighters Assn. v. City of Long Beach

This case concerns a dispute between the Long Beach Professional Firefighters Association (union) and the City of Long Beach regarding the terms of employment for paramedics. The City had unilaterally set these terms, leading the union to file a grievance and subsequently seek arbitration. The arbitrator found that the City violated the collective bargaining agreement. The Supreme Court confirmed the arbitration award, which the City appealed. The Appellate Division affirmed the Supreme Court's order, ruling that the City failed to provide clear and convincing evidence to vacate the arbitration award on grounds of irrationality, manifest disregard of law, arbitrator misconduct, or violation of public policy.

Collective Bargaining AgreementArbitration AwardCPLR Article 75 ProceedingJudicial Review of ArbitrationPublic Policy ExceptionManifest Disregard of LawAppellate ReviewMunicipal EmploymentParamedicsGrievance
References
20
Case No. 2018 NY Slip Op 03356 [161 AD3d 855]
Regular Panel Decision
May 09, 2018

Matter of City of Long Beach v. Long Beach Professional Fire Fighters Assn., Local 287

The City of Long Beach (petitioner) appealed an order denying its petition to stay arbitration and granting the Long Beach Professional Fire Fighters Association, Local 287's (respondent) cross-motion to compel arbitration. The dispute arose after the City laid off firefighters and hired paramedics, setting the paramedics' terms of employment unilaterally. The union filed a grievance and demand for arbitration. The Supreme Court denied the City's petition and granted the union's cross-motion. On appeal, the Appellate Division, Second Department, held that arbitration of the claim regarding firefighter layoffs violated public policy, citing Civil Service Law § 80 (1) which grants public employers nondelegable discretion over staffing. However, the court found no public policy precluding arbitration of claims related to the paramedics' terms of employment, as permitted by the collective bargaining agreement. Therefore, the order was modified to grant the City's petition to stay arbitration of the layoff claim and deny the union's cross-motion to compel arbitration of that claim, while affirming the rest of the order.

ArbitrationCollective Bargaining AgreementPublic PolicyFirefighter LayoffsParamedics EmploymentCivil Service LawManagement PrerogativeTaylor LawAppellate ReviewLabor Dispute
References
15
Case No. 13-08-00542-CV
Regular Panel Decision
Sep 30, 2010

Rio Grande Regional Hospital, Inc. and Columbia Rio Grande Healthcare, L.P. D/B/A Rio Grande Regional Hospital v. Diana Lopez Villarreal, Individually and as Representative of the Estate of Hermes Villarreal, and as Next Friend of Sarah Villarreal, Lauren Villarreal, and Hermes Alejandro Villarreal, Minors, and Hermelinda Villarreal, Indvidually

This appeal stems from a wrongful death and survival action based on a health care liability claim against Rio Grande Regional Hospital for the suicide of Hermes Villarreal while under their care. The jury concluded the hospital was 75% responsible, and the trial court awarded damages, applying statutory caps. Appellants (hospital) argued lack of evidence for foreseeability and causation, and that Hermes's suicide was an intervening cause. Appellees (Villarreal family) cross-appealed regarding Hermes's proportionate responsibility and the application of damage caps. The Court of Appeals affirmed the judgment, finding sufficient evidence to support the jury's verdict on causation and foreseeability, and that the suicide was not a superseding cause. The court also held that both sections 74.301(b) and 74.303 of the Texas Civil Practice and Remedies Code should be applied for damage caps.

Medical MalpracticeWrongful DeathSuicideHospital NegligenceForeseeabilityCausationIntervening CauseSuperseding CauseDamage CapsComparative Negligence
References
79
Case No. MISSING
Regular Panel Decision

Smith v. Bayer Corp. Long Term Disability Plan

Plaintiff Terry Smith, a former Diabetes Sales Specialist for Bayer Corporation, filed an action under ERISA to recover long-term disability benefits, claiming wrongful denial due to psychiatric impairments including depression, panic disorder, and bi-polar disorder. The Plan administrator, Bayer, upheld the denial based on reviews by non-examining physicians. However, Smith's treating psychiatrists, Dr. LeBuffe and Dr. McCool, consistently found him disabled. The court found the Plan's reliance on non-examining doctors, who 'cherry-picked' medical records and distorted findings, to be arbitrary and capricious. Consequently, the court granted Smith's motion for benefits, denying Bayer's, and also awarded partial disability benefits, ruling that Smith's failure to seek rehabilitation approval was excused by the prior wrongful denial.

ERISALong-term disabilityDisability benefits denialPsychiatric impairmentDepressionPanic disorderBi-polar disorderAttention Deficit Disorder (ADD)Treating physician ruleArbitrary and capricious standard
References
26
Case No. MISSING
Regular Panel Decision

In re New York Methodist Hospital

New York Methodist Hospital filed an order to show cause on June 1, 2009, seeking a judgment under Public Health Law § 2801-c to compel respondent E.H. to discharge himself from the hospital and accept placement in a skilled nursing facility. The hospital also sought to seal court records. Respondent, E.H., opposed the discharge. A bedside hearing was conducted on June 2, 2009, where testimony from medical staff and family members was heard. The court found that E.H., a 32-year-old bedridden male with complex medical needs, no longer required acute hospital care and was competent to make decisions, but unreasonably refused discharge plans. Despite the hospital's diligent search, the only facility willing and able to meet his needs was Daughters of Jacob Nursing Home (DOJ), which E.H. refused. The court granted the hospital's application for an injunction to compel E.H.'s discharge and to accept appropriate placement, and also granted the request to seal the court records to protect his medical privacy.

Patient DischargeInjunctionPublic Health LawMedical CapacityNursing Home PlacementHospital Discharge PlanningPatient RightsSealing Court RecordsMedicare/Medicaid ServicesSkilled Nursing Facility
References
6
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