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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Smith v. Bayer Corp. Long Term Disability Plan

Plaintiff Terry Smith, a former Diabetes Sales Specialist for Bayer Corporation, filed an action under ERISA to recover long-term disability benefits, claiming wrongful denial due to psychiatric impairments including depression, panic disorder, and bi-polar disorder. The Plan administrator, Bayer, upheld the denial based on reviews by non-examining physicians. However, Smith's treating psychiatrists, Dr. LeBuffe and Dr. McCool, consistently found him disabled. The court found the Plan's reliance on non-examining doctors, who 'cherry-picked' medical records and distorted findings, to be arbitrary and capricious. Consequently, the court granted Smith's motion for benefits, denying Bayer's, and also awarded partial disability benefits, ruling that Smith's failure to seek rehabilitation approval was excused by the prior wrongful denial.

ERISALong-term disabilityDisability benefits denialPsychiatric impairmentDepressionPanic disorderBi-polar disorderAttention Deficit Disorder (ADD)Treating physician ruleArbitrary and capricious standard
References
26
Case No. MISSING
Regular Panel Decision

Dean v. Tower Insurance

Plaintiffs Douglas and Joanna Dean purchased a home and obtained a homeowners' insurance policy from Tower Insurance Company of New York. Following the discovery of extensive termite damage, the plaintiffs undertook significant repairs, preventing them from immediately moving into the property. Before they could establish full residency, a fire completely destroyed the house. Tower Insurance Company disclaimed coverage, asserting the dwelling was unoccupied and thus did not qualify as a 'residence premises' under the policy's terms. The court found that the term 'residence premises,' defined only as 'where you reside' and with 'reside' undefined, was ambiguous in these circumstances, precluding summary judgment for the insurer. The decision highlighted factual issues regarding Douglas Dean's daily presence at the property and his intent to move in, citing other legal interpretations of occupancy in insurance contexts. The Appellate Division's order, which found the policy ambiguous, was affirmed.

Homeowners InsurancePolicy InterpretationContract AmbiguityResidency RequirementOccupancy ClauseFire DamageDisclaimer of CoverageSummary Judgment StandardsInsurance Contract BreachProperty Insurance
References
12
Case No. E2014-02205-COA-R3-CV
Regular Panel Decision
Sep 10, 2015

In re Estate of Warren Elrod

This case from the Tennessee Court of Appeals involves the estate of Warren Elrod and a dispute over the beneficiaries of an individual retirement account (IRA). The decedent's wife, the primary beneficiary, predeceased him, and the IRA document stipulated distribution to his "children." Warren Elrod's biological son, Gregory Lynn Elrod, argued he was the sole heir, while his two stepchildren, Sherry Diane Souder and Terry Ray Palmer, contended they should also be considered "children" for the IRA's purposes. The probate court found the term "children" to be ambiguous within the IRA agreement and, referencing Elrod's will which treated all three individuals equally, ruled that the stepchildren were intended beneficiaries. The probate court's decision, which ordered equal distribution of the IRA proceeds among Gregory, Sherry, and Terry, was subsequently appealed by Gregory. The Court of Appeals affirmed the lower court's finding, agreeing that the term was ambiguous and that the decedent's intent supported including the stepchildren as beneficiaries.

Estate LawProbateIRA BeneficiaryWill InterpretationStepchildren RightsAmbiguous ContractDecedent's IntentAppellate ReviewTennessee LawFamily Law
References
11
Case No. MISSING
Regular Panel Decision

Martin v. General Dynamics Long Term Disability Benefits Plan

Thomas E. Martin, a former General Dynamics employee, filed a lawsuit under ERISA against General Dynamics Long Term Disability Plan, General Dynamics Corporation, and Aetna Life Insurance Company. Martin claimed improper calculation of his long-term disability (LTD) benefits, arguing that the defendants wrongly deducted his workers' compensation and Social Security benefits. The central issue was the commencement date of Martin's total disability, as the Plan's terms allowed deductions if these other benefits were not received immediately prior to disability onset. The court, applying an abuse of discretion standard, determined that the defendants' decision to set Martin's disability onset date as May 10, 1990, the day he ceased working, was not arbitrary or capricious. This finding supported the defendants' deductions. Consequently, the court granted the defendants' motion for summary judgment and dismissed Martin's claims. An earlier motion by Lockheed Corporation was denied as moot.

Summary judgmentERISALong term disability benefitsBenefit calculationDisability onset dateAbuse of discretion standardFederal courtPlan interpretationEmployee benefitsDisability insurance
References
7
Case No. MISSING
Regular Panel Decision

Maddock v. Reul

This case addresses a union dispute concerning the terms of office for its officials. Defendants were elected in 1928 for three-year terms, set to expire in December 1931. A constitutional amendment in 1930 shifted election dates to June. The union's parent organization ruled that current officers would hold over until June 1932 elections, overriding an initial alternative for bye-elections. The plaintiff faction's attempt to force bye-elections in December 1931 through a special meeting and subsequent election was declared a nullity by the court. The court affirmed that the issue fell under the parent organization's authority, and their ruling was without fraud, ultimately denying the plaintiff's motion.

Union DisputeOfficer TermsConstitutional InterpretationElection NullityParent Organization AuthorityHoldover OfficersMotion DeniedLabor RelationsInternal Union Conflict
References
0
Case No. MISSING
Regular Panel Decision

O'Reilly v. Executone of Albany, Inc.

Plaintiff, a former marketing executive for Executone of Albany, Inc., alleged sexual harassment by co-workers and her supervisor, Michael Mahar, creating a hostile work environment and forcing her resignation. She also claimed battery by Stanley Groggins and intentional infliction of emotional distress. Plaintiff asserted that Executone and its distributor company failed to take corrective action despite knowledge of the harassment. Following a motion by defendants to dismiss, Special Term denied the motion regarding the battery and intentional infliction of emotional distress claims. This appellate court affirmed Special Term's order, finding two viable causes of action and upholding the denial of the dismissal motion.

Sexual harassmentHostile work environmentEmployment discriminationBatteryIntentional infliction of emotional distressMotion to dismissAppellate reviewCivil procedureTortsSupervisor liability
References
4
Case No. MISSING
Regular Panel Decision

Brownv. United States Fidelity & Guaranty Co.

In this action, the plaintiffs sought to recover attorney's fees and costs from the defendant, United States Fid. and Guar. Ins. Co., incurred in defending a prior Federal court action initiated by the defendant. This Federal action was itself a consequence of the defendant's earlier breach of its duty to defend the plaintiffs in a negligence suit. Special Term denied the defendant's motion to dismiss the plaintiffs' complaint, prompting the current appeal. The appellate court affirmed Special Term's decision, reiterating that expenses incurred in defending a declaratory judgment action brought due to an insurer's breach of the duty to defend are recoverable. The court distinguished this situation from prosecuting claims to establish coverage, emphasizing that the plaintiffs were defending their interests.

Attorney's FeesDeclaratory JudgmentDuty to DefendInsurance CoverageBreach of ContractIndemnificationAppellate ReviewMotion to DismissInsurer ObligationCosts
References
5
Case No. 2005 NY Slip Op 50989(11)
Regular Panel Decision
Jun 30, 2005

Benton v. 673 First Realty Co.

Plaintiff, an office clerk at New York Hospital, suffered injuries when a file cabinet he was moving with coworkers tipped due to a defective floor. The plaintiff sued the property owners, who subsequently initiated a third-party action against New York Hospital. The Civil Court initially ruled in favor of the Hospital by granting a judgment notwithstanding the verdict, determining no negligence on its part. However, the Appellate Term reversed this decision, reinstating liability against the Hospital for potential failure to train or co-employee negligence. This higher court, in turn, reversed the Appellate Term's ruling, concluding that the evidence was legally insufficient to hold the Hospital liable, attributing the accident solely to the floor defect.

Workers' Compensation LawPremises LiabilityNegligenceJudgment Notwithstanding VerdictAppellate ReviewThird-Party ActionCo-Employee NegligenceDuty to TrainCausationDefective Premises
References
2
Case No. MISSING
Regular Panel Decision

In Re Dana Corp.

Dana Corporation, as the debtor, sought court approval for its Executive Compensation Motion, which included the assumption of employment agreements and the establishment of a long-term incentive plan (LTIP) for its CEO and Senior Executives. This was Dana’s second attempt after an earlier, less incentivizing proposal was denied. The motion faced opposition from the U.S. Trustee, unions, and a non-union retiree committee, who raised concerns under Bankruptcy Code section 503(c) regarding retention and severance payments to insiders. The Court, treating the motion de novo, determined that the revised plan was a legitimate incentive program, not primarily retentive, and generally permissible under the Debtors’ sound business judgment. However, the Court expressed concern over the potential cumulative generosity of both the annual and long-term incentive plans for 2007-2008 without a clear ceiling. Consequently, the Executive Compensation Motion was granted, but conditioned on the submission of an order establishing an appropriate annual compensation cap for the CEO and Senior Executives.

Bankruptcy LawExecutive CompensationIncentive PlansEmployment AgreementsChapter 11 ReorganizationCreditors' RightsBusiness Judgment RuleKey Employee Retention Programs (KERPs)Severance PayNon-compete Clauses
References
28
Case No. MISSING
Regular Panel Decision

Rowe v. Board of Education

Plaintiff sued Chatham Central School District Middle School for negligence after sustaining injuries from a fall in the school cafeteria, allegedly due to accumulated mud, water, and a lack of rain mats. The defendant School District subsequently impleaded the Chatham Central Teachers’ Association, claiming the Association was in control of the cafeteria and responsible for the plaintiff's injuries. Following a trial, the jury rendered a verdict of no cause for action in favor of both the School District and the Association. However, Special Term set aside this verdict and granted a new trial, based on evidence suggesting an accumulation of mud and water and the defendant's failure to provide janitorial services. On appeal, the Appellate Division reversed Special Term's order, reinstating the original jury verdict, concluding that the jury's finding was not against the weight of the evidence given the conflicting testimony presented at trial.

NegligencePremises LiabilitySlip and FallJury VerdictWeight of EvidenceAppellate ReviewNew Trial Order ReversedSchool CafeteriaChatham Central School DistrictColumbia County
References
3
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