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

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

In re Robert Plan Corp.

Kenneth Kirschenbaum, the Chapter 7 Trustee for The Robert Plan Corporation and The Robert Plan of New York Corporation, sought court approval for fee awards for himself and his professionals for administering an ERISA plan. The U.S. Department of Labor (DOL) objected, asserting the court lacked jurisdiction to award fees from Plan assets and had specific objections to the reasonableness of the fees. The court affirmed its core jurisdiction over the Trustee's actions as Plan administrator and his professionals' compensation, regardless of whether payments came from Plan or estate assets, citing previous rulings. The court analyzed whether Bankruptcy Code §§ 326 and 330 conflicted with ERISA statutes concerning fiduciary compensation, concluding no substantive conflict existed and the Bankruptcy Code's specific compensation scheme governed. Ultimately, the court largely overruled DOL's objections and granted the fee applications for the Trustee, K & K, Witz, and Whitfield, deeming the requested amounts reasonable and compliant with the Bankruptcy Code. The awards are payable from the Plan's Pguy Account, with any shortfall covered by the Debtors' estate.

Bankruptcy LawERISAChapter 7 TrusteeFee ApplicationPlan AdministrationJurisdictionReasonable CompensationStatutory ConstructionDepartment of LaborFiduciary Duties
References
50
Case No. 07-09-00163-CV
Regular Panel Decision
Mar 12, 2010

Potter County, Texas as Plan Administrator for the Health Benefits Plan for the Employees of Potter County, Texas v. Ronda Tuckness and Michael Tuckness

Potter County, acting as the plan administrator for its employee health benefits plan, appealed an order that denied its plea to the jurisdiction. The underlying lawsuit was filed by Ronda and Michael Tuckness, seeking health care benefits after the County denied Michael Tuckness's claim for back surgery costs due to an occupational injury exclusion. The County contended it was immune from suit. The appellate court found that the County's governmental immunity had not been waived by the requests for declaratory relief, the terms of the health plan contract, or the County's conduct. Consequently, the court reversed the trial court's order and dismissed the Tucknesses' case for lack of subject-matter jurisdiction.

Governmental ImmunityImmunity WaiverDeclaratory JudgmentContract LawHealth BenefitsPlan AdministratorOccupational Sickness/InjuryJurisdictionPlea to JurisdictionInterlocutory Appeal
References
20
Case No. MISSING
Regular Panel Decision

Pig Newton, Inc. v. Boards of Directors of the Motion Picture Industry Pension Plan

Plaintiff Pig Newton, Inc. commenced an action against the Boards of Directors of the Motion Picture Industry Pension Plan, Health Plan, and Individual Account Plan, seeking a declaration that certain provisions of the Plans’ Trust Agreements were invalid and unenforceable. The Defendants counterclaimed for delinquent contributions under ERISA. The core dispute revolved around "Controlling Employee Provisions" in the Trust Agreements, which obligated employers to contribute for Controlling Employees for a specified number of hours and weeks regardless of actual hours worked. Pig Newton argued these provisions were invalid, not properly incorporated, or conflicted with collective bargaining agreements (CBAs). The Court, applying federal common law and an arbitrary and capricious standard of review for the Directors' interpretation, found the provisions valid, properly incorporated, and not in conflict with the CBAs, concluding that Szekely (Pig Newton's sole owner) qualified as a Controlling Employee. Consequently, the Court denied Plaintiff's motion for summary judgment and granted Defendants' cross-motion for summary judgment, dismissing Plaintiff's complaint and awarding Defendants the sought-after contributions, interest, auditors’ fees, and liquidated damages.

ERISAMultiemployer PlanPension PlanHealth PlanDeclaratory JudgmentSummary JudgmentTrust AgreementsCollective Bargaining AgreementsControlling Employee ProvisionsDelinquent Contributions
References
44
Case No. MISSING
Regular Panel Decision

Murphy v. Wal-Mart Associates' Group Health Plan

Hazel and Charlie Murphy sued Wal-Mart Associates’ Group Health Plan and Prudential Health Care Plan after the Plan denied coverage for Mr. Murphy's high-dose chemotherapy and autologous bone marrow transplant for Non-Hodgkin’s Lymphoma. The Murphys alleged the Wal-Mart Plan acted arbitrarily and capriciously in denying benefits and their subsequent appeal, and brought state law claims against Prudential. The court found that Wal-Mart Plan's decision was based on medical expert opinions and was not arbitrary and capricious. Furthermore, it determined that ERISA preempted all state law claims against Prudential. Consequently, the court granted summary judgment for both defendants, dismissing the plaintiffs' claims.

ERISAEmployee BenefitsHealth InsuranceSummary JudgmentArbitrary and Capricious StandardMedical NecessityHigh-Dose ChemotherapyAutologous Bone Marrow TransplantNon-Hodgkin’s LymphomaPlan Administrator Discretion
References
28
Case No. MISSING
Regular Panel Decision

Laflamme v. Carpenters Local 370 Pension Plan

Plaintiff Michael LaFlamme initiated a class action against the Carpenters Local #370 Pension Plan and its Board of Trustees, alleging violations of the Employee Retirement Income Security Act (ERISA) concerning the plan's 'freezing rule' for benefit accrual after a 'break in service.' LaFlamme sought a judicial declaration that this rule contravenes ERISA's minimum accrual standards, along with a reformation of the pension plan and recalculation of benefits for all affected class members. The court, presided over by District Judge Hurd, evaluated the motion for class certification under Federal Rule of Civil Procedure 23(a) and (b), finding that the requirements of numerosity, commonality, typicality, and adequacy of representation were met. Consequently, the motion for class certification was granted, establishing a class comprised of all plan participants, active or retired, who experienced a service break resulting in frozen benefit accrual rates. The decision also outlined procedures for providing notice to the newly certified class members, while deferring detailed adjudication of defenses like statute of limitations and exhaustion of remedies to later dispositive motions.

ERISAPension BenefitsClass ActionBenefit AccrualFreezing RuleBreaks in ServiceClass CertificationRule 23(a)Rule 23(b)Federal Civil Procedure
References
49
Case No. MISSING
Regular Panel Decision
Nov 24, 1992

PINE BARRENS v. Planning Bd.

This case addresses whether the State Environmental Quality Review Act (SEQRA) mandates a cumulative impact statement for over 200 proposed development projects in the Central Pine Barrens region of Long Island. The Central Pine Barrens is a vital ecological area, serving as the sole natural source of drinking water for millions and harboring numerous endangered species, leading to various protective legislations. The Court of Appeals reversed the Appellate Division's ruling, determining that a mandatory cumulative impact study under SEQRA is not applicable here because there is no overarching governmental 'plan' for development in the region, only general protective policies. The court emphasized that comprehensive planning for this area should be conducted by the Long Island Regional Planning Board as outlined in ECL article 55, rather than through individual SEQRA assessments. It also noted the significant delay in the Regional Planning Board's action, urging legislative intervention to address this pressing environmental concern.

Environmental LawSEQRACumulative ImpactPine BarrensSuffolk CountyLong IslandAquifer ProtectionLand Use PlanningState Environmental Quality Review ActPlanning Board
References
6
Case No. 14-95-00363-CV
Regular Panel Decision
Dec 19, 1996

Operation Rescue-National v. Planned Parenthood of Houston & Southeast Texas, Inc.

Appellants, anti-abortion groups and leaders, appealed a judgment awarding damages and permanently enjoining them from interfering with appellees' clinics and homes. The judgment stemmed from jury findings of civil conspiracy, tortious interference, invasion of privacy, and property rights against Planned Parenthood and other clinics/doctors. Appellants challenged the injunction's constitutionality and evidentiary sufficiency. The Court of Appeals of Texas affirmed the trial court's decision, finding adequate evidence and upholding the injunction's constitutionality under both federal and state law, and confirmed the damage awards.

Anti-abortion protestsInjunctionCivil conspiracyTortious interferenceInvasion of privacyProperty rightsActual damagesPunitive damagesFreedom of speechFirst Amendment
References
12
Case No. CA 10-02164
Regular Panel Decision
May 06, 2011

SIEGL, SALLY v. NEW PLAN EXCEL REALTY TRUST, INC.

Sally Siegl sustained injuries after falling in a parking lot owned by New Plan Excel Realty Trust, Inc. The fall was allegedly due to a depression in the parking lot caused by settlement of crushed stones used by AALCO Septic & Sewer, Inc., which had repaired a water main two months prior. New Plan brought a third-party action against AALCO for common-law indemnification and contribution. The Supreme Court granted AALCO's motion for summary judgment, dismissing the third-party complaint. On appeal, the Appellate Division affirmed the dismissal of the common-law indemnification claim, finding New Plan also negligent. The majority also affirmed the dismissal of the contribution claim, concluding AALCO did not owe an independent duty of care or launch a force of harm. A dissenting opinion argued that there was a question of fact regarding AALCO creating the dangerous condition, thus precluding summary judgment on the contribution claim.

Personal InjuryPremises LiabilitySummary JudgmentCommon-Law IndemnificationContributionNegligenceAppellate ReviewWater Main RepairParking LotHazardous Condition
References
12
Case No. MISSING
Regular Panel Decision
Sep 10, 1999

Greenlawn CVS, Inc. v. Planning Board of the Town of Huntington

This case concerns an appeal regarding site-plan approval for a retail store in Greenlawn. Greenlawn CVS, Inc. sought to construct a 10,125 square-foot CVS pharmacy, but the Planning Board of the Town of Huntington approved only a 6,000 square-foot building, citing concerns about community character and compatibility. The Supreme Court, Suffolk County, annulled the Planning Board's determination. This court affirmed that judgment, ruling that the Planning Board's findings were arbitrary and capricious and lacked substantial evidence. A dissenting opinion argued that the Planning Board had the authority to consider aesthetic impacts and community character under SEQRA, and its decision was supported by the record.

Site-plan approvalZoningLand useEnvironmental ImpactCommunity characterArbitrary and capriciousSubstantial evidenceAppellate reviewRetail developmentPlanning Board
References
9
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