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

Case No. Civ. A. No. 3:93-CV-0171-G.
Regular Panel Decision
Aug 31, 1993

Mills v. INJURY BENEFITS PLAN OF SCHEPPS-FOREMOST

Walter Mills was injured during his employment and sought benefits under his employer's Injury Benefits Plan. He subsequently filed a civil action alleging wrongful termination in retaliation for filing a workers' compensation claim under Texas law. Defendants removed the case to federal court, asserting ERISA preemption. The court granted the defendants' motion to dismiss Mills' claims against the Injury Benefits Plan, finding them preempted by ERISA. However, the court denied the dismissal of Mills' state law claims against Schepps-Foremost, Inc., d/b/a Oak Farms Dairies. Ultimately, the court remanded the remaining state law claims against Schepps-Foremost, Inc. to the County Court at Law Number 5 of Dallas County, Texas, due to a lack of federal subject matter jurisdiction.

ERISA preemptionWorkers' CompensationRetaliatory dischargeTexas lawFederal jurisdictionMotion to dismissRemandEmployee benefitsCivil procedureDallas County
References
18
Case No. MISSING
Regular Panel Decision

Walker v. Health Benefit Management Cost Containment, Inc.

Plaintiffs Thurman and Barbara Walker filed a motion to remand their workers' compensation bad-faith claim against Service Lloyds Insurance Company and Health Benefit Management Cost Containment, Inc. (HBM), which had been removed to federal court by Service Lloyds. Defendants argued for ERISA preemption and against the application of 28 U.S.C. § 1445(c), which generally prohibits removal of state workers' compensation cases. The court, presided over by Judge Means, granted the plaintiffs' motion to remand, concluding that ERISA's workers' compensation exemption applied. Furthermore, the court determined that § 1445(c) prohibited removal of bad-faith claims arising under state workers' compensation laws, deeming it an almost laughable anomaly to separate these claims. Consequently, the defendant's motion to stay was denied, as the court divested itself of jurisdiction.

Workers' CompensationERISA PreemptionMotion to RemandMotion to StayBad Faith ClaimTexas Insurance CodeFederal Question JurisdictionState Law ClaimsEmployee Benefit PlansSeparately Administered Plan
References
28
Case No. 2019-06-1008
Regular Panel Decision
Mar 23, 2021

Harris, Patricia v. Nashville Center for Rehabilatation and Healing

The Court initially awarded workers’ compensation benefits and a 20% attorney's fee for permanent and temporary disability benefits, but denied a 20% fee for unpaid medical benefits. Both parties appealed, with the employee challenging the denial of attorney's fees for medical benefits. The Appeals Board affirmed the original decision except for the attorney's fee denial and remanded the case with instructions to award the fee. This Order on Remand, therefore, grants the employee’s attorney an additional fee of $5,209.16, representing twenty percent of the unpaid medical expenses, to be paid by the employee. The prior September 28, 2020 compensation order is incorporated, with the exception of the holding denying the attorney’s fees for medical expenses.

Workers' CompensationAttorney's FeesMedical BenefitsRemandAppeals BoardCourt OrderEmployee RightsEmployer ResponsibilitiesIndemnity InsuranceWorkers' Compensation Claims
References
0
Case No. MISSING
Regular Panel Decision

Maldonado v. J.M. Petroleum Corp.

Joe Maldonado sued his former employer, J.M. Petroleum, for wrongful termination, alleging racial discrimination and retaliation for filing a worker's compensation claim. He sought reinstatement and monetary compensation for lost wages and various employee benefits. J.M. Petroleum removed the case to federal court, arguing that Maldonado's claims were preempted by ERISA because they involved employee benefits. However, the court found that Maldonado was seeking the fair market value of his lost employment, not benefits from an ERISA plan itself, and conceded his termination was not to avoid benefits. Consequently, the court determined that his claims did not "relate to" ERISA, denying preemption and remanding the case to state court.

ERISA preemptionWrongful terminationRetaliation claimWorker's compensationRacial discriminationEmployee benefitsLost value of employmentFederal jurisdictionRemandDistrict Court
References
3
Case No. MISSING
Regular Panel Decision

McMullen v. PILGRIM'S PRIDE CORPORATION

The court considered Plaintiffs’ Motion to Remand. Defendant Pilgrim’s Pride argued for federal removal jurisdiction, asserting that plaintiffs’ claims arose under ERISA, which preempts state law claims related to employee benefit plans. However, the court found that the plaintiff's petition only asserted state law causes of action for employer negligence in failing to maintain a safe workplace, not claims for benefits under the ERISA plan. Citing prior case law, the court concluded that a common law negligence suit alleging an unsafe workplace does not 'relate to' an ERISA plan merely due to a waiver inserted in the plan. Therefore, the court determined it lacked removal jurisdiction and granted the motion, remanding the case to the 217th Judicial District Court in Angelina County, Texas.

ERISA preemptionMotion to RemandFederal JurisdictionState Law ClaimsEmployer NegligenceUnsafe WorkplaceDenial of BenefitsCommon Law NegligenceTexas CourtJudicial District Court
References
4
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. 07-07-0039-CV
Regular Panel Decision
Oct 15, 2008

Johnny Rodriguez v. Icon Benefit Administrators, Inc.

This is a dissenting opinion challenging a summary judgment granted in favor of ICON Benefit Administrators, Inc. The appellant, Johnny Rodriguez, Jr., had his initial claims against ICON dismissed with prejudice due to a procedural misstep (failure to obtain leave of court to add ICON as a defendant), which was affirmed on appeal. Subsequently, Rodriguez filed a new lawsuit against ICON, asserting similar and new claims. ICON successfully argued for summary judgment based on the doctrine of res judicata. The dissenting justice contends that the previous dismissal was not a judgment on the merits, thus res judicata should not apply, and due process rights were denied. The dissent would reverse the summary judgment and remand the case for further proceedings.

Summary JudgmentRes JudicataClaim PreclusionIssue PreclusionCollateral EstoppelDismissal With PrejudiceProcedural DismissalDue ProcessAppellate ReviewFinal Judgment
References
16
Case No. 2014-01-0009
Regular Panel Decision
Dec 12, 2014

East, Sean v. Heritage Hosiery Mill

Sean Vance East, an employee, sought temporary disability benefits and medical benefits for a neck and left arm injury sustained while working for Heritage Hosiery Mill. The employer denied temporary disability benefits, alleging voluntary resignation. The trial court awarded medical benefits but denied temporary disability benefits. On interlocutory appeal, the Workers' Compensation Appeals Board affirmed the trial court's decision, finding the employee sustained an injury but voluntarily resigned due to pre-existing hernia concerns, thus upholding the denial of temporary disability benefits. The case was remanded for further proceedings.

Workers' CompensationNeck InjuryArm InjuryHerniaTemporary Disability BenefitsMedical BenefitsVoluntary ResignationInterlocutory AppealAppellate ReviewCausation
References
12
Case No. MISSING
Regular Panel Decision

York v. Comm'r of Soc. Sec.

The plaintiff appealed the Commissioner of Social Security's denial of disability benefits. An Administrative Law Judge (ALJ) initially found the plaintiff not disabled, a decision affirmed by the Appeals Council. The plaintiff subsequently moved for judgment on the pleadings, requesting a remand for benefits or further administrative proceedings. The court found that the ALJ erred in evaluating the plaintiff's spinal impairments under Listing 1.04 and in assessing medical opinion evidence from Dr. Harbinder Toor. Consequently, the court granted the plaintiff's motion, denied the Commissioner's cross-motion, and remanded the case for further proceedings, including a reassessment of Listing 1.04 and reconsideration of Dr. Toor's opinion.

Disability BenefitsSocial Security ActALJ Decision ReviewRemandLumbar Spinal StenosisDegenerative Disc DiseaseMedical Opinion EvidenceResidual Functional Capacity (RFC)Vocational Expert TestimonyAppeals Council
References
7
Case No. MISSING
Regular Panel Decision
Feb 22, 1984

Barnhardt v. Hudson Valley District Council of Carpenters Benefit Funds

The plaintiff, injured in May 1978 during maintenance work, was denied workers' compensation due to the absence of an employer-employee relationship. Subsequently, he sought reimbursement for medical expenses from the Hudson Valley District Council of Carpenters Benefit Funds (Benefit Funds) through a union insurance policy. Continental Assurance Company (Continental), Benefit Funds' insurer, rejected the claim, citing an employment-related injury exclusion in the policy. The plaintiff then initiated an action against Benefit Funds, which in turn filed a third-party action against Continental seeking indemnification. Continental's motion for summary judgment, asserting the exclusion, was denied by the County Court. The appellate court affirmed this denial, ruling that the exclusionary language was ambiguous and applied only in cases where a clear employer-employee relationship existed, a fact still to be determined.

Insurance Policy InterpretationEmployment StatusWorkers' Compensation ExclusionSummary Judgment MotionContractual AmbiguityGroup Health InsuranceMedical Expense ReimbursementThird-Party ActionAppellate ReviewEmployer-Employee Relationship
References
10
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