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

Case No. 2000 WL 178191
Regular Panel Decision

Selby v. Principal Mutual Life Insurance

Adrian and Jill Selby sued Principal Life Insurance Company, alleging various errors in processing their health insurance claims. They challenged Principal's interpretation of an infertility treatment exclusion and its claims review procedures under ERISA. The court considered motions for class certification for four proposed classes. Class I, addressing Principal's online claims review process for altering diagnoses, was certified. Classes II and III, concerning medically necessary infertility treatments and New York Insurance Law violations respectively, were not certified for class-wide adjudication, though individual claims were permitted. Class IV, challenging the sufficiency of claim denial letters, was not certified immediately due to the named plaintiffs' lack of standing for injunctive relief, but conditional certification was offered upon identification of a new suitable plaintiff.

ERISAClass ActionHealth InsuranceClaims DenialInfertility ExclusionOnline ReviewMedical BenefitsStandingFederal Rules of Civil Procedure Rule 23Benefit Plans
References
23
Case No. 02-23-00144-CV
Regular Panel Decision
Feb 29, 2024

Zachary Long v. R.E. Watson & Associates, Inc.

Zachary Long appealed the trial court's summary judgment in favor of R.E. Watson & Associates, Inc., following an altercation with his foreman, Chris Reyes. Long sued for damages outside the workers' compensation system, alleging Reyes was a vice principal acting within the scope of employment when he assaulted Long. The appellate court affirmed the summary judgment, finding that Reyes was not a corporate vice principal and thus the intentional-injury exception to the workers' compensation bar did not apply. The court deemed Long's declaration regarding Reyes's hiring and firing authority conclusory and insufficient to raise a fact issue on vice-principal status.

Workers' Compensation ExclusivityIntentional Tort ExceptionVice Principal StatusScope of EmploymentSummary Judgment ReviewAssault ClaimEmployer LiabilityForeman AuthorityConclusory EvidenceAppellate Review Texas
References
20
Case No. MISSING
Regular Panel Decision

Hammerly Oaks, Inc. v. Edwards

Darrell Edwards, a resident of an apartment complex owned by Hammerly Oaks, Inc., was brutally assaulted in a vacant apartment adjoining his. The assailants included Roman Gonzales, an independent contractor hired by Hammerly Oaks to clean carpets. Edwards sued Hammerly Oaks, and a jury found negligence and gross negligence, awarding compensatory and punitive damages. The trial court subsequently disregarded the findings of gross negligence and punitive damages. The court of appeals modified the trial court's judgment to award punitive damages, concluding that the leasing agent, Marilyn Montgomery, was a vice principal and grossly negligent for failing to warn Edwards of threats made by Gonzales. The Supreme Court of Texas reversed the court of appeals' judgment regarding punitive damages. The Court held that Marilyn Montgomery was not a vice principal, and the jury was not properly instructed or asked to consider nondelegable duties or premises defects concerning other employees (Rose Britton, Frank Smotek). Consequently, the Supreme Court modified the court of appeals' judgment by deleting the award of punitive damages and affirmed the judgment in all other respects.

Punitive DamagesGross NegligenceCorporate LiabilityVice PrincipalRespondeat SuperiorNondelegable DutyPremises LiabilityApartment ComplexAssaultEmployee Conduct
References
14
Case No. MISSING
Regular Panel Decision
Mar 11, 2010

Gentry v. Principal Life Insurance

The case involves Plaintiff Paul Gentry's ERISA claim against Principal Life Insurance Company, challenging its calculation of his long-term disability benefits. Gentry, the 100% owner of a C-Corporation (OTLH), had his "Owner's Monthly Earnings" calculated by Principal Life to include OTLH's revenues and expenses, resulting in negative predisability earnings and a minimum $50 monthly benefit. Gentry argued this interpretation was arbitrary and capricious, contending that only his salary should be considered, especially given OTLH's C-Corporation status. The Court, applying an arbitrary and capricious standard of review, upheld the plan administrator's decision, finding its interpretation of the policy's unambiguous terms, which differentiate between owner-insureds and non-owner insureds and explicitly include "shareholder of a corporation," to be rational. Consequently, the Court denied Plaintiff's motion for judgment and granted Defendant's motion to deny relief, upholding Principal Life's benefit determination.

ERISALong-term disability insuranceBenefit calculationArbitrary and capricious standard of reviewOwner's Monthly Earnings provisionC-Corporation shareholderPlan administrator discretionInsurance policy interpretationDisability claimFederal court order
References
15
Case No. MISSING
Regular Panel Decision

In Re McLean Industries, Inc.

This case concerns U.S. Lines, Inc. (now Janus Industries), along with Mclean Industries, Inc. and First Colony Farms, Inc. (collectively, the "Debtors"), and the Unsecured Creditors’ Committee (collectively, the "Movants"). They filed for Chapter 11 bankruptcy in 1986 and had a plan of reorganization confirmed in 1989, which relied on the preservation of net operating losses (NOLs). After the IRS announced proposed regulations in 1990 that could challenge the use of NOLs if a plan's principal purpose was tax evasion, the Movants sought a court order declaring that tax evasion was not the principal purpose of their plan. The Internal Revenue Service (IRS) opposed, arguing a lack of subject matter jurisdiction and the applicability of the Declaratory Judgment Act. The court denied the Movants' motion, holding that under 11 U.S.C. § 1129(d), only a governmental unit can initiate a tax avoidance motion, and the issue of tax liability based on proposed regulations was not a concrete controversy.

BankruptcyChapter 11Tax AvoidanceNet Operating Losses (NOLs)IRS RegulationsPlan ConfirmationPost-Confirmation MotionDeclaratory Judgment ActSubject Matter JurisdictionGovernmental Unit
References
4
Case No. MISSING
Regular Panel Decision

Sandiford v. City of New York Department of Education

This is a dissenting opinion concerning a school aide terminated by the New York City Department of Education (DOE) for alleged inappropriate conduct with a 16-year-old student. The plaintiff, a lesbian, claimed discrimination based on sexual orientation and retaliation for complaining about the principal. The dissent argues that the plaintiff's failure to appeal the grievance decision, which substantiated her misconduct, precludes relitigation of the facts. It asserts that the principal's decision to terminate was based on legitimate, non-discriminatory reasons supported by the DOE's investigation and recommendation. Furthermore, the dissent concludes that the retaliation claim fails because the adverse employment action predated the plaintiff's complaints. The dissenting judge would therefore modify the trial court's decision to dismiss the plaintiff's discrimination claim and affirm the dismissal of retaliation and libel claims.

DiscriminationSexual OrientationRetaliationPublic SchoolEmployee TerminationMisconductGrievanceCollateral EstoppelSummary JudgmentAppellate Review
References
30
Case No. ADJ3164730 (LBO 0135441), ADJ3921082 (LBO 0100188), ADJ451512 (LBO 0100187)
Regular
Jan 03, 2011

SOMBOON INTRACHOOTO vs. COUNTY OF LOS ANGELES/RANCHO PRINCIPAL RECONSIDERATION Permissibly Self-Insured

This case involves a workers' compensation claim for permanent total disability and lifetime medical care awarded to an applicant who sustained industrial injuries as a registered nurse. The applicant's husband, also a lien claimant, provided 24-hour home health aide services after December 5, 2004. While the original award set the reasonable value of these services at $100 per day, the Appeals Board granted reconsideration. The Board increased the daily reimbursement rate to $200, finding it consistent with the evidence of actual care provided and more economical for the defendant than hiring external agencies or institutionalizing the applicant.

Workers' Compensation Appeals BoardSomboon IntrachootoCounty of Los AngelesJoint Supplemental Findings and Awardpermanent total disabilitylifetime medical carehome health aidereasonable value of servicespetition for reconsiderationAgreed Medical Examiner (AME)
References
5
Case No. MISSING
Regular Panel Decision

TOMUSHUNAS, DEBBIE v. DESIGNCRETE OF AMERICA, LLC

Plaintiff commenced an action against her former employer and its principal, alleging assault, intentional infliction of emotional distress, and prima facie tort. The Supreme Court granted the defendants' motion for summary judgment, dismissing the complaint. This decision was based on the fact that the plaintiff had previously accepted $40,000 in workers' compensation benefits for illnesses and injuries stemming from the same alleged misconduct by her employer. The court held that by accepting these benefits, the plaintiff forfeited her right to pursue an intentional tort action at law, citing established legal precedent. The ruling emphasized that the settlement nature of the workers' compensation award did not alter this forfeiture.

Workers' Compensation BenefitsSummary Judgment DismissalIntentional Tort ClaimsEmployer MisconductForfeiture of Legal RightsSettlement of ClaimAssault AllegationsEmotional Distress ClaimPrima Facie TortJudicial Precedent
References
4
Case No. MISSING
Regular Panel Decision

Volpe v. New York City Department of Education

Cheryl Volpe, a special education teacher, sued the New York City Department of Education and Principal Olivia Francis-Webber, alleging retaliation, equal protection violations, and unlawful searches stemming from her advocacy for special needs students. The defendants filed a motion to dismiss, which the court partially granted and partially denied. The court dismissed Volpe's Fourth Amendment and equal protection claims, finding no protected class or unreasonable search. However, the court allowed her Rehabilitation Act and ADA retaliation claim to proceed, specifically regarding an incident on December 18, 2013, where she was confined after attempting to speak with a student's parent.

Special Education TeacherWorkplace RetaliationDisability DiscriminationADA Title IIRehabilitation ActPublic School SystemMotion to DismissHostile Work EnvironmentFourth Amendment ViolationEqual Protection Claim
References
68
Case No. 2023 NY Slip Op 03275 [217 AD3d 1168]
Regular Panel Decision
Jun 15, 2023

Matter of Jazmyne VV.

This case involves an appeal by Jazmyne VV. from an order of the Family Court of Cortland County, which adjudicated her a Person in Need of Supervision (PINS). The principal of Randall Middle School, Juliann Quinn, filed the PINS petition due to Jazmyne's habitual truancy and disobedient behavior. Jazmyne argued that the PINS petition was jurisdictionally defective, citing the absence of a manifestation determination hearing and the Probation Department's failure to provide its case record to Family Court. The Appellate Division, Third Department, affirmed the Family Court's order, concluding that a manifestation determination hearing was not warranted as Jazmyne was not a special education student at the time, the record was made available to the court, and the petition adequately detailed diversion efforts.

PINSTruancySpecial Education Student StatusManifestation Determination HearingDiversion ServicesFamily Court Act Article 7Appellate ReviewJurisdictional DefectsCortland CountySchool Discipline
References
12
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