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

Case No. 2015-2418 K C
Regular Panel Decision
May 25, 2018

Remedial Med. Care, P.C. v. Park Ins. Co.

This case involves an appeal from an order of the Civil Court concerning first-party no-fault benefits. The defendant, Park Insurance Co., sought summary judgment to dismiss the complaint filed by Remedial Medical Care, P.C., as assignee of Thomas Brown. The Civil Court initially denied the motion but found that the defendant had established timely mailing of denials. The Appellate Term modified the order, granting summary judgment to the defendant for a bill of services rendered on August 23, 2012, as it was paid according to the workers' compensation fee schedule. However, for the remaining bills, the defendant failed to prove timely mailing of IME scheduling letters, thus failing to demonstrate that the IMEs were properly scheduled or that the assignor failed to appear. Therefore, the denial of summary judgment for the remaining claims was affirmed.

Summary JudgmentNo-Fault BenefitsIndependent Medical Examination (IME)Timely MailingWorkers' Compensation Fee ScheduleAppellate TermCivil CourtDenial of ClaimFirst-Party BenefitsInsurance Law
References
3
Case No. ADJ11693361
Regular
Jan 21, 2020

FARAHNAZ MIRGOLI vs. CEPHEID, INC./DANAHER CORPORATION, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Appeals Board dismissed the applicant's Petition for Reconsideration because it was taken from an interlocutory, procedural decision, not a final order that determined substantive rights or liability. The Board also denied the Petition for Removal, an extraordinary remedy, finding no showing of substantial prejudice or irreparable harm that would prevent reconsideration from being an adequate remedy. The WCJ's report, which detailed these reasons, was adopted and incorporated into the Board's decision. Consequently, the applicant's attempts to appeal the procedural decision were unsuccessful.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFinal OrderInterlocutory OrderSubstantive RightLiabilityThreshold IssueExtraordinary RemedySubstantial Prejudice
References
6
Case No. ADJ12649033
Regular
Feb 05, 2020

BARBARA JUAREZ vs. ANTHONY PITROWSKI, M.D.; NATIONAL CASUALTY COMPANYT, adjusted by ILLINOIS MIDWEST INSURANCE AGENCY, LLC

The Appeals Board dismissed a petition for reconsideration because the underlying decision was not a "final" order, as it only addressed an intermediate procedural or evidentiary issue, not substantive rights or liabilities. The Board also denied the petition for removal, finding no showing of substantial prejudice or irreparable harm necessitating this extraordinary remedy. Reconsideration was deemed an adequate remedy should a final adverse decision eventually issue. Therefore, the Board found the petition to be procedurally improper and declined to grant the requested relief.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFinal OrderSubstantive RightLiabilityThreshold IssueInterlocutoryProcedural DecisionsEvidentiary Decisions
References
6
Case No. MISSING
Regular Panel Decision

DeRosa v. Dyster

The dissenting judge, Garni, J., argues against the majority's decision in a CPLR article 78 proceeding. The case involves a petitioner who retired from the City of Niagara Falls and was subsequently denied post-employment health insurance or opt-out payments, despite a memorandum of understanding with her union. Garni, J. contends that the petitioner failed to exhaust administrative remedies available through the collective bargaining agreement's grievance procedure. The dissent asserts that the grievance procedure applied to retirees and disputes over retirement benefits, and that the petitioner was aggrieved prior to her retirement, thus being obligated to pursue a grievance. Therefore, Garni, J. concludes that the petition should have been dismissed entirely due to the failure to exhaust administrative remedies.

Administrative RemediesExhaustion DoctrineCPLR Article 78Collective Bargaining AgreementGrievance ProcedureRetiree BenefitsHealth InsuranceOpt-out PaymentsDissenting OpinionLabor Law
References
20
Case No. MISSING
Regular Panel Decision

Cupit v. Walts

Danny Cupit sued his employer, Gypsum Transport Inc., for negligence and gross negligence after an on-the-job injury, while his wife, Betty Cupit, sought damages for loss of consortium. The employment relationship was governed by a collective bargaining agreement (CBA) that established an exclusive grievance and arbitration procedure for such disputes. Mr. Cupit failed to utilize this procedure. The court interpreted the CBA, in alignment with the Texas Workers' Compensation Act, to mean that gross negligence claims are only exempt from the exclusive remedy if they result in a fatality. As Mr. Cupit's injury did not result in a fatality and he did not exhaust his contractual remedies, his claims and his wife's derivative claim were barred. Consequently, the defendant's motion for summary judgment was granted.

Collective Bargaining AgreementGrievance and ArbitrationExclusive RemedyTexas Workers' Compensation ActGross NegligenceLoss of ConsortiumSummary JudgmentLabor Management Relations ActFederal PreemptionEmployment Law
References
12
Case No. MISSING
Regular Panel Decision

Garcia-Marroquin v. Nueces County Bail Bond Board

Delma J. Garcia-Marroquin, a licensed bondsman, sued the Nueces County Bail Bond Board, alleging inaccurate accounting procedures and challenging the Board's authority to impose a title policy insurance requirement. The trial court issued temporary injunctions but later dissolved them and dismissed the entire suit for lack of jurisdiction, citing Garcia-Marroquin's failure to exhaust administrative remedies. On appeal, the court held that the trial court improperly dismissed the causes of action for damages, injunctive relief (regarding accounting procedures and the insurance requirement), and declaratory judgments, reversing and remanding those issues for further proceedings. However, the appellate court affirmed the dismissal of Garcia-Marroquin's statutory de novo appeal of the Board's decision to suspend her license for failing to maintain title policy insurance, finding that she had failed to exhaust administrative remedies for that specific claim. The court also affirmed the trial court's decision to dissolve the injunctions due to defects in form and overbreadth.

Bail Bond ActAdministrative RemediesJurisdictionInjunctionsDeclaratory JudgmentExhaustion DoctrineStatutory InterpretationTexas LawAppellate ReviewTemporary Injunction
References
44
Case No. MISSING
Regular Panel Decision

Kuzel v. Aetna Insurance Co.

This appeal concerns a lawsuit where an appellant sought disability benefits under an employment contract. The appellant, employed by Atlantic International Marketing Corporation to work in Saudi Arabia, subsequently included Aetna, the appellee, in the lawsuit. The central issue was whether the employment contract, particularly its worker's compensation provisions, was formed in Houston, Texas, or Baltimore, Maryland, as the contract specified Maryland law as the exclusive remedy for work-related injuries. The trial court granted Aetna's plea to the jurisdiction, dismissing the case due to the appellant's failure to exhaust Maryland's administrative remedies. The appellate court affirmed, concluding that the critical terms regarding the exclusive remedy were agreed upon in Baltimore when the written contract was signed, thus subjecting the appellant to Maryland's administrative procedures.

Disability BenefitsEmployment ContractWorkers' CompensationMaryland LawTexas LawExclusive RemedyAdministrative RemediesJurisdictionContract FormationChoice of Law
References
4
Case No. MISSING
Regular Panel Decision

Jones v. Dallas Independent School District

Sharon Garner Jones, a special education teacher, sued the Dallas Independent School District (DISD) after being denied teacher certification and new placement, alleging retaliation for filing a workers' compensation claim. The trial court granted DISD's plea to the jurisdiction and dismissed Jones's suit, ruling she failed to exhaust administrative remedies. The appellate court affirmed, holding that exhaustion of administrative remedies is a prerequisite to district court jurisdiction in matters concerning school laws and factual disputes, and none of the recognized exceptions applied to Jones's case. The court emphasized that administrative remedies provide an orderly procedure for aggrieved parties to enforce their rights within the school administration system. This decision reinforces the requirement for individuals to pursue available administrative processes before seeking judicial intervention in school-related employment disputes.

Administrative RemediesExhaustion DoctrineTeacher CertificationWorkers' Compensation ClaimRetaliatory DischargePlea to JurisdictionSchool LawTexas LawEmployment LawJudicial Review
References
13
Case No. MISSING
Regular Panel Decision

Brewer v. United States

The plaintiff, Boyd Richard Brewer, Sr., a self-proclaimed tax protestor, initiated litigation against the Internal Revenue Service (IRS) to regain properties seized and sold due to his failure to file tax returns from 1980-1982 and 1984-1987. Rather than challenging his tax liability, Brewer focused on alleged procedural defects in the IRS's assessment and collection methods. The court denied Brewer's motion for a preliminary injunction, citing the Anti-Injunction Act and the availability of other legal remedies. Furthermore, the court largely granted the government's motions for summary judgment, dismissing most of Brewer's procedural challenges, including those related to notices, statute of limitations, and delegation of authority. However, the court reserved its decision on specific claims regarding the IRS's compliance with assessment procedures and the precise dates of title transfer for certain properties, ordering the government to provide further documentation.

Tax Protestor LitigationIRS Collection ProceduresAnti-Injunction ActQuiet Title ActionNotice of DeficiencyTax Assessment ValiditySummary Judgment StandardProcedural IrregularitiesStatute of Limitations (Tax)Paperwork Reduction Act
References
24
Case No. MISSING
Regular Panel Decision
Dec 14, 2000

Cash America International Inc. v. Bennett

Justice Owen, joined by Justice Hecht, dissents from the Court's holding that Bennett is not required to exhaust administrative remedies under the Texas Pawnshop Act before filing suit. Owen argues that the Act, prior to its September 1999 amendment, clearly mandated exhaustion and that the legislative intent of a later amendment should not infer the intent of an earlier one. The dissent also addresses Bennett's constitutional challenges, finding that limiting recovery to like-kind replacement does not violate the open courts provision given the nature of pawnshop transactions and the reasonable substitution of remedies. However, Justice Owen agrees that the Act, as interpreted by the Texas Administrative Procedure Act (imposing substantial evidence review), would violate the right to a jury trial under the Texas Constitution. Owen proposes severing the unconstitutional aspect of substantial evidence review, allowing for de novo review with a jury determination of factual issues. The dissent concludes that Bennett failed to exhaust administrative remedies and therefore her claim should be dismissed or abated.

Exhaustion of Administrative RemediesTexas Pawnshop ActStatutory InterpretationRight to Jury TrialOpen Courts ProvisionConstitutional LawSubstantial Evidence ReviewDe Novo ReviewSeverabilityAdministrative Procedure Act
References
17
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