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

Case No. Sumner Circuit No. 15078-C, C.A. No. 01A01-9709-CV-00492
Regular Panel Decision
Jul 29, 1998

Benny Blankenship v. Estate of Joshua Bain

The central issue in this case is whether the Tennessee TennCare Program's statutory subrogation and/or assignment provisions are subject to the common law 'made whole' doctrine. Plaintiffs Benny and Sheila Blankenship, TennCare enrollees, were involved in an automobile accident, incurring substantial medical expenses, partially paid by TennCare. After settling with the at-fault party's insurer for less than their total damages, the Blankenships successfully argued in the trial court that TennCare's subrogation claim was barred by the 'made whole' doctrine. However, the Court of Appeals reversed this decision, asserting that statutory subrogation, unlike contractual subrogation, does not implicitly incorporate the 'made whole' doctrine unless explicitly stated in the statute. The court further clarified that while the state's right of subrogation is not subject to the 'made whole' doctrine, it is subject to the ordinary and reasonable attorney's fees incurred by the recipients.

SubrogationTennCareMade Whole DoctrineStatutory InterpretationMedicaidWorkers' CompensationAutomobile AccidentMedical ExpensesAttorney FeesEquitable Principles
References
7
Case No. MISSING
Regular Panel Decision

Blankenship v. Estate of Bain

The Tennessee Supreme Court addressed whether TennCare, administered by Blue Cross/Blue Shield, has subrogation rights for medical expenses paid on behalf of a recipient without the recipient first being 'made whole' for their loss. Benny and Sheila Blankenship, TennCare enrollees, were injured in a car accident and settled their claim for less than their total damages. Blue Cross/Blue Shield sought to intervene for subrogation. The trial court denied this, citing the 'made whole' doctrine, but the Court of Appeals reversed. The Supreme Court reversed the Court of Appeals, holding that TennCare's subrogation rights under Tenn.Code Ann. § 71-5-117(a) are subject to the equitable 'made whole' doctrine, as the statute does not explicitly waive this requirement. It also clarified that federal law does not mandate full subrogation regardless of the 'made whole' doctrine.

SubrogationMade Whole DoctrineTennCareMedical Assistance ProgramEquitable PrinciplesStatutory InterpretationHealth InsuranceThird-Party LiabilityWorkers' CompensationMedicaid
References
23
Case No. E2017-02288-COA-R3-CV
Regular Panel Decision
Dec 19, 2018

Shawn T. Slaughter v. Grover T. Mills

Shawn T. Slaughter, an EMT for Hamilton County, was injured in a motor-vehicle collision while working. Hamilton County, operating a self-funded on-the-job injury program, paid benefits for Mr. Slaughter and later attempted to assert a lien against his settlement with a defendant driver. The trial court denied the County's lien, citing no contractual or statutory basis and determining that Mr. Slaughter was not 'made whole' by his settlement, thus precluding subrogation. On appeal, Hamilton County argued against the application of the 'made whole' doctrine and asserted a constitutional right to recovery. The Court of Appeals affirmed the trial court's decision, ruling that the constitutional provision was inapplicable and declining to exempt counties from the 'made whole' doctrine.

Subrogation LawMade Whole DoctrineLien DisputeGovernmental Self-InsuranceWorkers' Compensation ExemptionMotor Vehicle AccidentSettlement RecoveryAppellate ReviewTennessee ConstitutionTrial Court Affirmation
References
3
Case No. 15-CV-681-LY
Regular Panel Decision
Aug 25, 2017

Markman v. Whole Foods Market, Inc.

This is a securities-fraud class action brought by the Lead Plaintiff, Employees’ Retirement System of the State of Hawaii, against Whole Foods Market, Inc. and its executives. The plaintiff alleged violations of federal securities laws, specifically Section 10(b) of the Exchange Act and Rule 10b-5, claiming Whole Foods made false and misleading statements about its pricing and financial performance due to systematic overcharging. Defendants moved to dismiss the Second Amended Class Action Complaint, arguing the plaintiff failed to adequately plead material misrepresentation, scienter (wrongful state of mind), and loss causation. The court found that the new allegations did not remedy the deficiencies of the previous complaint, specifically lacking particularity for false statements, a strong inference of scienter for the defendants, and a plausible link for loss causation. Consequently, the court granted the motion to dismiss the second amended complaint with prejudice, concluding that further amendments would be futile.

Securities FraudClass ActionMotion to DismissWhole Foods MarketFinancial MisrepresentationOverchargingPleading StandardsScienterLoss CausationFederal Rules of Civil Procedure
References
18
Case No. MISSING
Regular Panel Decision
Jun 16, 2006

Fortis Benefits v. Cantu

Vanessa Cantu suffered severe injuries in a car accident and sued multiple parties. Her medical insurer, Fortis Benefits, intervened, seeking subrogation for medical benefits paid under the policy. After Cantu settled with the defendants, Fortis pursued recovery from Cantu. Cantu argued that the equitable "made whole" doctrine barred Fortis's claim because her total losses exceeded the settlement amount plus the benefits Fortis paid. The trial court and court of appeals sided with Cantu. The Texas Supreme Court reversed, holding that the "made whole" doctrine does not override an insurer's clear contractual subrogation rights. The Court affirmed the dismissal of Fortis's claims against Ford due to a pretrial agreement.

Insurance SubrogationMade Whole DoctrineContractual SubrogationEquitable SubrogationERISATexas LawInsurance Policy InterpretationPersonal InjuryAutomobile AccidentSettlement Proceeds
References
28
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. MISSING
Regular Panel Decision

Graves v. Cocke County

This workers' compensation appeal involved Grey Graves, an employee who sustained severe injuries, and his employer, Cocke County and the Cocke County school system. The primary issues were whether the employer was entitled to a credit for future medical payments under Tenn. Code Ann. § 50-6-112 in a lump sum settlement, and if the made whole doctrine applied to workers' compensation cases. The trial court denied the employer's credit for future medicals due to their speculative nature and the need for finality in judgments. The Supreme Court affirmed this decision, clarifying that the statutory credit does not encompass unpredictable future medical expenses in lump sum awards. Additionally, the Court reaffirmed its stance from Castleman v. Ross Engineering, Inc. that the made whole doctrine is inapplicable to workers' compensation cases, thus affirming the trial court's decision.

Workers' Compensation LawLump Sum SettlementFuture Medical ExpensesSubrogation LienMade Whole DoctrineStatutory InterpretationJudicial EconomyFinality of JudgmentsTenn. Code Ann. § 50-6-112Third-Party Tortfeasor
References
10
Case No. 2016-01-0139
Regular Panel Decision
Mar 03, 2023

Brown, Binnie v, Whole Foods Markets, Inc.

Bonnie Brown, an employee of Whole Foods, sought psychiatric evaluation for impairment and ongoing treatment for a mental injury allegedly stemming from a 2015 spinal injury. Whole Foods opposed, arguing a lack of authorized referral and unproven work-relatedness of the mental injury. The Court acknowledged the problem of obtaining mental impairment assessments when only non-physician providers (psychologists) have been authorized, citing Tennessee law that limits impairment ratings to physicians. Consequently, the Court found no mechanism to compel Whole Foods to provide a psychiatrist panel solely for impairment assessment. However, based on Ms. Brown's credible testimony and corroborating medical records, the Court ruled that she would likely prevail in establishing her need for ongoing psychological care. The Court ordered Whole Foods to authorize Ms. Brown to return to Dr. Henriksen or provide a panel of psychologists/psychiatrists for assessment of her need for ongoing care and/or referral.

Mental injuryWorkers' CompensationPsychological evaluationChronic painDepressionAnxietyCausationImpairment ratingPsychiatric referralAuthorized treatment
References
4
Case No. MISSING
Regular Panel Decision

Incorporated Village of Freeport v. Sanders

The plaintiff appealed an order from the Supreme Court, Nassau County, which dismissed their complaint after granting the third-party defendants' motion for renewal. The appellate court found that Special Term erred in dismissing the complaint on collateral estoppel grounds, as the movants failed to demonstrate that the issue was necessarily decided in a prior Workers' Compensation Board proceeding. The Board's finding regarding a settlement without insurer consent did not require a determination of past workers' compensation payments. Furthermore, Special Term erred on equitable estoppel grounds, noting that this doctrine applies against governmental subdivisions only when manifest injustice is shown, which was not the case here. Additionally, equitable estoppel was not available to the third-party defendants as no representations were made to them by the plaintiff, and no claim was asserted against them. Consequently, the order was reversed, and the third-party defendants’ renewed motion to dismiss the complaint was denied.

Collateral EstoppelEquitable EstoppelGeneral Municipal LawWorkers' Compensation LienThird-Party ActionMotion to DismissAppealGovernmental SubdivisionCivil ProcedureAppellate Practice
References
7
Case No. MISSING
Regular Panel Decision

Texas Ass'n of School Boards, Inc. v. Ward

The Texas Association of School Boards (TASB), a self-insurance entity for school districts, sought reimbursement from Garry Ward for medical expenses paid after Ward received a third-party settlement for injuries from a car wreck. TASB argued an unqualified subrogation right under Local Government Code Section 172.015. However, the district court ruled against TASB, finding Ward was not fully compensated by the settlement. The appellate court affirmed this decision, holding that the statutory subrogation right is subject to equitable principles and the 'made whole' doctrine. Therefore, TASB was not entitled to reimbursement from Ward.

SubrogationEquitable PrinciplesLocal Government CodeEmployee BenefitsSettlementReimbursementMade Whole DoctrineCar WreckInsuranceTexas Law
References
19
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