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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
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

Hand v. Stevens Transport, Inc. Employee Benefit Plan

Jean and Howard Hand appealed the trial court's grant of summary judgment which dismissed their claims for health care benefits against the Stevens Transport, Inc. Employee Benefit Plan as time-barred. The Hands argued that the Plan's failure to comply with ERISA's notification requirements should invalidate or toll the contractual limitations period. The appellate court found that while the Plan's notice was non-compliant, it still provided reasonable notice of partial denial, and the Hands failed to exercise due diligence. The court concluded that the twenty-seven month contractual limitations period was reasonable and was not tolled by the Plan's ERISA non-compliance or the pursuit of administrative remedies. Therefore, the Hands' claims were barred, and the trial court's judgment was affirmed.

ERISAHealth Insurance BenefitsContractual Limitations PeriodStatute of LimitationsSummary JudgmentDenial of BenefitsEquitable TollingAdministrative RemediesNotice RequirementsEmployee Benefit Plan
References
19
Case No. MISSING
Regular Panel Decision

Travelers Indemnity Co. of Rhode Island v. Starkey

The Travelers Indemnity Company of Rhode Island appealed a trial court's judgment that awarded death benefits to Lynn Edward Starkey and Hazel Dean Starkey under the Texas Workers’ Compensation Act. The case stemmed from Jonathan Starkey's work-related injuries in 1984, for which Travelers paid indemnity benefits until his death in 2001. His parents subsequently sought death benefits, which Travelers disputed, asserting a right to deduct previously paid benefits. The trial court found that Travelers had waived this credit in a third-party settlement agreement. The appellate court affirmed, concluding that the contractual language constituted a waiver of Travelers' rights to an offset and upheld the award of benefits, attorneys' fees, interest, and costs to the Starkeys.

Workers' CompensationDeath BenefitsIndemnity BenefitsThird-Party SettlementContractual WaiverCredit OffsetWage Rate DisputeAppellate CourtTexas LawEvidentiary Sufficiency
References
22
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. 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

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

LTV Steel Co. v. Connors (In Re Chateaugay Corp.)

This case is an appeal of two orders issued by the United States Bankruptcy Court for the Southern District of New York. The first order granted partial summary judgment to the Mining Companies and LTV Steel Corporation, holding they were not legally obligated to pay retiree health benefits. The second order granted the United Mine Workers of America's cross-motion for summary judgment, determining that the United Mine Workers of America 1974 Benefit Plan and Trust was liable to pay these benefits. The Plan & Trust appealed both orders to the District Court, arguing violations of the Retiree Benefits Bankruptcy Protection Act, lack of subject matter jurisdiction, denial of due process, and misinterpretation of its obligations under the Wage Agreement's 'no longer in business' clause. The District Court affirmed the Bankruptcy Court's orders, finding the Act inapplicable, subject matter jurisdiction proper as a core proceeding, sufficient opportunity to litigate, and the Plan & Trust liable due to contractual interpretation and collateral estoppel from prior litigations.

Bankruptcy LawChapter 11 ReorganizationRetiree Health BenefitsCollective Bargaining AgreementUMWAEmployee BenefitsSummary JudgmentSubject Matter JurisdictionCore ProceedingCollateral Estoppel
References
13
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
Case No. MISSING
Regular Panel Decision

Liberty Mutual v. Kinser

The case addresses whether a workers' compensation carrier has a subrogation right to benefits paid to an employee under their personal uninsured/underinsured motorist (UIM) insurance coverage. Michael Kinser, injured in an automobile accident during employment, received workers' compensation benefits from Liberty Mutual. After receiving payment from the at-fault driver's insurer, Liberty Mutual sought subrogation from Kinser's personal UIM policy with State Farm. The trial court denied Liberty Mutual's claims, and the appellate court affirmed. The court held that the Texas Labor Code's subrogation provision applies to 'damages' from a third party liable in tort or contract, not to contractual UIM benefits, especially when the employee paid the premiums. Consequently, Kinser was not liable for conversion.

Workers' CompensationSubrogation RightsUninsured/Underinsured Motorist (UIM)Insurance LawTexas Labor CodeContractual BenefitsTortious ActSummary JudgmentAppellate AffirmationPersonal Insurance Policy
References
33
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