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

Case No. MISSING
Regular Panel Decision

Jeffries v. Pension Trust Fund of the Pension, Hospitalization & Benefit Plan of the Electrical Industry

Plaintiff Claude Jeffries, a retired electrician, sued the Pension Trust Fund of the Electrical Industry under ERISA, seeking to include pension credits from 1969-1975 in his current benefits. He alleged the Plan should have declared a partial termination during a 1975-1979 New York recession, which would have vested his benefits. The defendant moved to dismiss the complaint, arguing lack of standing and statute of limitations, while plaintiff moved for class certification for similarly affected members. The court denied the defendant's motion to dismiss the claim for benefits, finding it timely, but granted dismissal for the breach of fiduciary duty claim as time-barred. The plaintiff's motion for class certification was denied due to insufficient evidence for numerosity, with leave to refile after discovery.

ERISAPension BenefitsClass CertificationMotion to DismissStatute of LimitationsFiduciary DutyPartial TerminationBenefit ForfeitureUnemploymentLabor Union
References
15
Case No. MISSING
Regular Panel Decision
Sep 14, 1989

Kinek v. Gulf & Western, Inc.

The Kinek plaintiffs and Pension Benefit Guaranty Corporation (PBGC) sued Gulf & Western, Inc. (G&W) and its pension plan for alleged violations of a collectively-bargained pension agreement and ERISA, stemming from a 'spin-off' where G&W transferred assets and liabilities to Horsehead Industries' pension plan. Plaintiffs argued G&W failed to fully fund vested pension benefits upon this transfer, as contractually required by the G&W Plan's sections 3.1 and 10.2. The court confirmed plaintiffs' standing and applied a de novo standard of review. It ruled that the G&W Plan's provisions, when read together, obligated G&W to provide full funding for vested benefits during an asset transfer. Consequently, the court denied G&W's motion for summary judgment and granted the Kinek plaintiffs' cross-motion for partial summary judgment, holding G&W liable.

ERISALMRAPension PlanEmployee BenefitsSummary JudgmentContract DisputePension FundingAsset TransferSpin-offVested Benefits
References
0
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
Oct 26, 1982

In re the Claim of Peat

The claimant appealed a decision by the Unemployment Insurance Appeal Board, which affirmed a reduction in her unemployment benefits. The reduction was made under Labor Law § 600(7) due to her receipt of Social Security benefits. The court, citing precedents Matter of Cullen and Rivera v Patino, ruled that Social Security benefits derived from a non-base period employer should not offset unemployment benefits from a different base period employer. As the claimant's Social Security benefits vested from prior employment, the board's decision to reduce her unemployment rate was reversed. The case was remitted to the Unemployment Insurance Appeal Board for further proceedings.

Unemployment BenefitsSocial Security OffsetLabor Law 600(7)Benefit Rate ReductionPrior EmploymentBase Period EmployerAdministrative AppealRemittitur
References
2
Case No. 01-A-01-9707-CH-00354; 96-1250-I
Regular Panel Decision
Sep 02, 1998

Edith Stromatt v. The Metropolitan Employee Benefit Board of the Metropolitan Government of Nashville and Davidson County, Tennessee

Edith Stromatt, a former employee of the Metropolitan Government of Nashville, sought an in-line-of-duty (IOD) disability pension, having already been granted a medical disability pension. She sued the Metropolitan Employee Benefit Board, claiming an erroneous denial of the IOD pension and a violation of her constitutional right to due process. The trial court upheld the Board's decision. On appeal, the Court of Appeals of Tennessee affirmed, ruling that Stromatt did not have a vested property interest in the IOD pension before it was granted and that the Board's denial was supported by material evidence, noting her disability was not from a specific incident of stress as required for an IOD pension.

Disability PensionIn-Line-of-Duty PensionMedical DisabilityDue Process ViolationProperty InterestAdministrative ReviewWrit of CertiorariStress-Related DisabilityEmployment BenefitsMetropolitan Government
References
17
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
Case No. 2:06-cv-2213
Regular Panel Decision

Kerns v. CATERPILLAR, INC.

This memorandum addresses Caterpillar Inc.'s motion to dismiss an action brought by surviving spouses of former employees seeking vested lifetime health care benefits. Plaintiffs allege Caterpillar breached collective bargaining agreements and welfare benefit plans by imposing premium co-payments and modifying benefits after 2005. The court affirmed its jurisdiction over claims under both the Labor Management Relations Act and the Employee Retirement Income Security Act, reasoning that plaintiffs assert benefits vested prior to contract expiration. While deferring a final ruling on the merits of vesting, the court found significant evidence supporting vesting, including language linking health benefits to pension eligibility. The court also clarified the proposed class definition to include only existing surviving spouses and determined that the plaintiffs' claims are not moot, despite Caterpillar's temporary waiver of premiums, due to the ongoing dispute over vested rights. Consequently, the defendant's motion to dismiss was denied.

Labor Management Relations ActEmployee Retirement Income Security ActRetiree benefitsHealth care benefitsVested benefitsCollective bargaining agreementSurviving spousesMotion to dismissSubject matter jurisdictionContract interpretation
References
31
Case No. MISSING
Regular Panel Decision

Cook v. Pension Benefit Guarantee Corp.

The Trustees of the Local 852 General Warehouseman’s Union Pension Fund sued the Pension Benefit Guarantee Corporation (PBGC) seeking reimbursement for pension benefits paid to retirees of two closed warehouses. The Fund argued for recovery based on equitable estoppel, asserting detrimental reliance on an initial PBGC determination that it would guarantee these benefits. The PBGC moved for summary judgment, contending that estoppel against a federal agency requires a showing of affirmative misconduct or manifest injustice. The Court found no evidence of affirmative misconduct by the PBGC and concluded that its change in determination, made to conform with Congressional intent, did not constitute manifest injustice. Consequently, the Court granted the PBGC's motion for summary judgment, ruling that equitable estoppel was inapplicable.

Equitable EstoppelFederal Agency EstoppelSummary JudgmentERISAPension BenefitsMulti-employer PlanPension Benefit Guarantee Corporation (PBGC)Affirmative MisconductManifest InjusticeDetrimental Reliance
References
10
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

Memorial Hermann Health System v. Coastal Drilling Co., LLC Employee Benefit Trust

Plaintiff Memorial Hermann Health System (MHHS) sued Coastal Drilling for breach of contract and recovery of benefits under the Employee Retirement Income Security Act (ERISA). MHHS claimed Coastal Drilling breached a contract to pay for healthcare services at PPOplus Contracted Rates. The Court determined that MHHS's breach of contract claim was not preempted by ERISA but could not be enforced because MHHS was a non-party to the Network Access Agreement and Coastal Drilling, also a non-party, had no direct obligation under it. Regarding the ERISA claim, the Court found that Coastal Drilling, as the plan administrator, had discretionary authority to determine benefits based on the Plan's Applicable Plan Limits (APL). The Court found substantial evidence supporting Coastal Drilling's benefits determination and no evidence of bias affecting the decision, despite a structural conflict of interest. Consequently, the Court granted Coastal Drilling's motion for summary judgment and dismissed MHHS's claims with prejudice.

ERISASummary JudgmentBreach of ContractPlan AdministratorBenefits DenialHealthcare ProviderThird-Party BeneficiaryERISA PreemptionTexas LawFiduciary Duty
References
48
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