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

Case No. No. 14-CV-6449 (E.D.N.Y.)
Regular Panel Decision

AEI Life, LLC v. Lincoln Benefit Life Co.

This memorandum addresses whether a pending appeal in another circuit concerning a jurisdictional dismissal precludes the Eastern District of New York from exercising jurisdiction. The New Jersey District Court had previously dismissed an action by Lincoln Benefit Life Company (LBL) against AEI Life, LLC (AEI) for lack of subject matter jurisdiction, which LBL appealed. Subsequently, AEI initiated the current lawsuit in New York, seeking a declaration of policy validity and damages for alleged breach. The court concluded that the first-to-file rule is inapplicable here because the New Jersey court never secured jurisdiction. Additionally, a balance of convenience analysis favored New York as the appropriate venue, citing AEI's home forum, witness locations, and the locus of operative facts. Consequently, LBL's motion to dismiss or stay the action is denied, allowing the case to proceed in the Eastern District of New York.

JurisdictionSubject Matter JurisdictionPersonal JurisdictionFirst-to-File RuleFinal Judgment RuleChoice of LawVenueDiversity JurisdictionInsurance PolicySTOLI Scheme
References
36
Case No. 14-07-00880-CV
Regular Panel Decision
Apr 21, 2009

Symetra National Life Insurance Company and Symetra Life Insurance Company v. Rapid Settlements, LTD

Symetra National Life Insurance Co. and Symetra Life Insurance Co. appealed a trial court's confirmation of an arbitration award that directed them to make structured settlement payments to Rapid Settlements, Ltd., instead of the original payee, Paul Patterson. Symetra argued that the transfer lacked the required court approval under the Texas Structured Settlement Protection Act (SSPA) and violated public policy, while Rapid Settlements asserted it was not a 'transfer' under SSPA, federal law preempted SSPA, and Symetra lacked standing. The court rejected Rapid's arguments, emphasizing that the SSPA mandates court preapproval for structured settlement payment transfers to protect payees and their dependents. Consequently, the court held that the arbitration award violated Texas public policy by effectuating an unapproved transfer. The trial court's judgment was reversed, and the arbitration award was vacated.

Structured Settlement Protection Act (SSPA)Arbitration AwardPublic PolicyFederal Arbitration Act (FAA)PreemptionStandingGarnishmentTransfer of PaymentsAnnuity IssuerTexas Law
References
20
Case No. 03-07-00429-CV
Regular Panel Decision
Dec 12, 2008

Texas Health Insurance Risk Pool v. Southwest Service Life Insurance Company and Regal Life of America Insurance Company

Southwest Service Life Insurance Company and Regal Life of America Insurance Company (Appellees) brought a declaratory-judgment action against the Texas Health Insurance Risk Pool (Appellant) to challenge assessments levied against them, arguing their policies qualified as 'other limited benefit coverage' under the Texas Insurance Code. The trial court granted summary judgment in favor of the Appellees and awarded attorney's fees. The Pool appealed, contending the summary judgment was erroneous and the attorney's fee award should be reversed. The appellate court affirmed the trial court's judgment, holding that the policies issued by Southwest and Regal were indeed covered by the 'limited benefit coverage' exception, and thus the summary judgment and attorney's fee award were proper.

Insurance LawHealth InsuranceStatutory ConstructionDeclaratory JudgmentSummary JudgmentAttorney's FeesTexas Insurance CodeLimited Benefit CoverageHIPAAAdministrative Law
References
15
Case No. MISSING
Regular Panel Decision

Olivier v. Life & Casualty Insurance Co. of Tennessee

Olues V. Olivier sued Life and Casualty Insurance Company of Tennessee and Texas Lathing Plastering Contractors Association for medical and surgical expenses incurred from an injury on November 18, 1964. Olivier asserted entitlement to benefits under a group insurance policy. The trial court granted an instructed verdict for both defendants, leading to Olivier appealing solely against Life and Casualty Insurance Company of Tennessee. The appeals court affirmed the trial court's judgment, finding that Olivier, as an employer actively working in his own business for compensation, was not covered under the policy's exclusion for injuries arising out of employment for compensation or profit. The court also noted a waiver of other grounds for appeal.

Workers' CompensationInsurance PolicyGroup BenefitsEmployment ExclusionAccidental InjuryDirected VerdictAppellate ReviewMedical CoverageTexas LawContract Interpretation
References
3
Case No. MISSING
Regular Panel Decision

Spear, Leeds & Kellogg v. Central Life Assurance Co.

Plaintiff Spear, Leeds & Kellogg (SLK), a registered futures commission merchant and a member of the New York Stock Exchange, sought a preliminary injunction against three life insurance companies (Defendants) to prevent compulsory arbitration. Defendants had filed an arbitration demand with the NYSE, seeking recovery of monies they paid out on life insurance policies of a customer named Marvin Goodman. Defendants alleged that SLK either falsified account documents or knew of their falsification by Goodman, leading to their losses. SLK argued it had no transactional nexus with Defendants and thus no obligation to arbitrate under NYSE Constitution and Rules. The court found no valid arbitration agreement between the parties and granted SLK's motion for a preliminary injunction, enjoining Defendants from compelling arbitration. The court emphasized that arbitration is a creature of contract, and no such contract existed between SLK and the Defendant insurance companies.

ArbitrationPreliminary InjunctionNYSE RulesContract LawSecuritiesInsuranceDispute ResolutionNon-Member ArbitrationFinancial FraudFalsified Documents
References
9
Case No. MISSING
Regular Panel Decision

Veryzer v. American International Life Assurance Co.

Robert Veryzer, Ph.D. ("Plaintiff") sued American International Life Assurance Company of New York ("AI Life") under ERISA, challenging the insurer's denial of his long-term disability benefits. AI Life had limited benefits to 24 months, classifying Veryzer's disability as "Mental Illness" despite extensive medical evidence from his treating physicians and neuropsychologists attributing it to mercury poisoning from Hepatitis A and B vaccinations. The court found AI Life's decision arbitrary and capricious, unsupported by substantial evidence, citing the insurer's reliance on non-examining experts who ignored medical literature and procedural irregularities in the claims process. Highlighting AI Life's conflict of interest as both administrator and payor, the court denied AI Life's motion for summary judgment, granted Veryzer's cross-motion, reversed the denial of benefits, and ordered AI Life to provide the requested coverage.

ERISA claimsLong-term disabilitySummary judgment motionsArbitrary and capricious reviewMercury toxicityVaccination injuryCognitive impairment benefitsMedical expert testimonyInsurance bad faithClaims processing irregularities
References
26
Case No. 03-00-00427-CV
Regular Panel Decision
Aug 30, 2001

All American Life Insurance Company American General Life Insurance Company American National Insurance Company American National Life Insurance Company of Texas IDS Life Insurance Company And USLIFE Life Insurance Company v. Carole Keeton Rylander, Comptroller of Public Accounts of Texas And John Cornyn, Attorney General of Texas

Several insurance companies appealed a district court judgment affirming the Comptroller's assessment of premium and maintenance taxes on 'internal rollover' transactions, where policyholders transfer accumulation values within the same company for new policies. The Texas Court of Appeals, Third District, At Austin, reviewed the construction of Texas Insurance Code articles 4.11 and 4.17 de novo. The court determined that 'internal rollovers' do not involve funds being 'received' or 'collected' by the insurance companies, as the funds remain within the company. Therefore, these transactions are not subject to the premium and maintenance taxes. The judgment of the district court was reversed in part, and the case was remanded for a determination of the refund amounts owed to the companies.

Insurance LawTax LawPremium TaxInternal RolloversStatutory ConstructionTexas Court of AppealsInsurance CompaniesComptrollerGross PremiumsTax Refund
References
9
Case No. MISSING
Regular Panel Decision

Davis v. Tennessee Life Insurance Co.

Nancy Kway Davis, administratrix of Charles M. Davis's estate, appealed a take-nothing judgment in her suit against Tennessee Life Insurance Company. She sought to recover life insurance proceeds, contending there was no valid beneficiary designation. Charles Davis, an employee of Reading and Bates, was insured under group policies provided by Tennessee Life. Davis had designated his mother, Bessie Carr, as beneficiary in 1966. Although policy 637 was superseded by policy 1264, the jury found that Reading and Bates, authorized by Tennessee Life, issued a certificate for policy 1264 to Charles Davis, naming Bessie Carr as beneficiary. The court found no error in denying Nancy Kway Davis any interest in the proceeds, affirming the judgment that Bessie Carr was the valid beneficiary.

Life InsuranceBeneficiary DesignationGroup Insurance PolicyInsurance ProceedsAdministratrix ClaimCommunity PropertyChose in ActionAppellate ReviewInsurance CertificateEmployer-Provided Insurance
References
5
Case No. MISSING
Regular Panel Decision

Castro v. New York Life Insurance

Zoila Castro, a cleaning worker, sustained a hypodermic needle puncture wound to her right thumb while working at New York Life Insurance Co.'s offices on June 22, 1989. She subsequently developed a 'generalized anxiety disorder' and 'AIDS phobia' due to the incident, leading her and her husband, Osvaldo Castro, to file a personal injury action alleging negligence by New York Life for improper disposal of hazardous medical waste. New York Life moved to dismiss the complaint and for summary judgment, arguing that fear of AIDS without reasonable certainty is not compensable and that there was no medical evidence to support the claim. The court denied both of New York Life's motions, finding that Castro's claim for mental anguish and 'AIDS Phobia' was directly tied to the incident. It concluded that a reasonable person exposed to a discarded hypodermic needle could develop such a fear, thus guaranteeing the genuineness of her claim and necessitating a trial.

Personal InjuryNegligenceHypodermic Needle InjuryAIDS PhobiaEmotional DistressSummary Judgment MotionMotion to DismissHazardous Waste DisposalCausation of InjuryGeneralized Anxiety Disorder
References
9
Case No. MISSING
Regular Panel Decision

Majors v. Moneymaker

Elsie N. Majors and her husband, Parnick Y. Majors, sued Elizabeth Moneymaker for damages following an automobile accident. All parties were co-employees of the American National Insurance Company, and the incident occurred within the scope of their employment, bringing them under the Tennessee Workmen's Compensation Law. Moneymaker filed a plea in abatement, arguing that the Workmen's Compensation Act provided the exclusive remedy and she was not a 'third party' subject to a common law negligence suit. The trial court sustained the plea and dismissed the suits, a decision affirmed by the Supreme Court. The Supreme Court held that a co-employee is not considered 'some person other than the employer' under Code Section 6865, thereby making the workers' compensation remedy exclusive and precluding a common law action against the co-employee. The court also discussed the implications for the insurance carrier's subrogation rights.

Automobile AccidentWorkmen's CompensationExclusive RemedyFellow Employee LiabilityThird-Party SuitPlea in AbatementSubrogationCommon Law ActionTennessee Supreme CourtCo-employee Immunity
References
6
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