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

Case No. 03-02-00030-CV
Regular Panel Decision
Jun 12, 2003

Qwest Communications International, Inc. Qwest Communications Corporation And SP Construction Services, Inc./ AT&T Corp. AT&T Communications of the Southwest, Inc. CK Directional Drilling v. AT&T Corp. AT&T Communications of the Southwest, Inc./Qwest Communications International Inc. Qwest Communications Corporation SP Construction Services, Inc. C&S Directional Boring Company, Inc. CK Directional Drilling

This case involves an appeal from a judgment awarding economic and exemplary damages to AT&T for fiber-optic cable damage caused by Qwest and its subcontractors, CK Directional Drilling and C&S Directional Boring Company, Inc. The core dispute arose from three instances in 1997 where AT&T's cables were severed during Qwest's fiber-optic network construction. Qwest, CK, and AT&T all appealed the district court's final judgment, challenging various aspects, including malice findings, the validity of a Rule 11 agreement, damage calculations, and vicarious liability. The appellate court affirmed the findings of malice against Qwest and C&S, and Qwest's liability for its subcontractors' actions. However, it reversed the breach-of-contract damages awarded to AT&T due to insufficient evidence and upheld the district court's calculation of exemplary damages and prejudgment interest.

Fiber-optic cable damageTelecommunications infrastructureSubcontractor liabilityExemplary damagesMaliceRule 11 agreementBreach of contractPrejudgment interestAppellate reviewVicarious liability
References
0
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. 2015-08-0106
Regular Panel Decision
Sep 24, 2015

McIntosh, Sarah Kaye v. Randstad

Sarah Kaye Mcintosh, an employee, filed a claim alleging wrist injuries from her work at Randstad. Randstad, the employer, filed a motion to terminate benefits, arguing the claim was not compensable. The Court previously ordered Randstad to provide a panel of orthopedic surgeons and pay temporary disability benefits. Although Ms. Mcintosh selected Dr. Cannon, an orthopedic surgeon, she was instead seen by Dr. Alday, an occupational medicine physician, who opined her injury was not work-related. The Court found Dr. Alday was not an authorized treating physician as Dr. Cannon declined to treat Ms. Mcintosh directly. Therefore, Dr. Alday's opinion on causation did not carry a presumption of correctness. The Court denied Randstad's motion, ordered the continuation of temporary partial disability benefits, and mandated Randstad to provide a new panel of orthopedic surgeons to Ms. Mcintosh.

Workers' CompensationExpedited HearingBenefit TerminationOrthopedic SurgeonOccupational MedicineCausationMedical PresumptionPanel of PhysiciansTemporary Disability BenefitsCarpal Tunnel Syndrome
References
1
Case No. 2016-01-0212
Regular Panel Decision
Oct 25, 2016

Richards, Edward v. Kiewit Power Constructors Company

Edward Richards, an electrician, suffered a hernia in February 2015 while working for Kiewit Power Constructors Company, which was accepted as compensable. He underwent surgery by Dr. Claudine Siegert. In February 2016, Richards experienced a recurrence of the hernia after lifting a toolbox while working for another employer. Dr. Siegert opined that the recurrent hernia was a direct result of the original work-related hernia. The Court granted Mr. Richards' request for medical benefits, finding he is likely to prevail in proving entitlement to additional medical benefits, based on the direct and natural consequence rule. However, his request for temporary disability benefits was denied due to insufficient medical documentation of his disability post-February 2016.

Workers' CompensationHernia RecurrenceMedical BenefitsTemporary DisabilityCausationDirect and Natural Consequence RuleExpedited HearingEmployer LiabilityInsurance CarrierMedical Opinion
References
6
Case No. MISSING
Regular Panel Decision

Claim of Bowman v. Birdair, Inc.

This case involves an appeal from a Workers’ Compensation Board decision regarding death benefits. Birdair, Inc. contracted to replace a roof and was required to use union labor. They initially used Colonial Rigging and Contracting as a labor broker but later directly contacted unions for workers. The decedent, hired directly by Birdair but placed on Colonial’s payroll, died on his first day from a work-related fall. His spouse filed a claim for death benefits. The Workers’ Compensation Law Judge and subsequently the Board found that the decedent was a general employee of Colonial and a special employee of Birdair, holding Birdair 100% liable. Birdair and its carrier appealed. The Appellate Division affirmed the Board’s decision, finding substantial evidence that Birdair, by supplying tools, equipment, and directing work, had assumed control as a special employer.

Death Benefits ClaimEmployer Liability DisputeSpecial Employer DoctrineGeneral Employer DoctrineLabor BrokerageAppellate AffirmationSubstantial Evidence StandardWork-related FallConstruction IndustryUnion Labor Requirement
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. MISSING
Regular Panel Decision

Parish v. DiNapoli

Petitioner, a correction officer, was injured in April 1999 and May 2004, leading to her being placed on leave without pay. She applied for disability retirement benefits and performance of duty disability retirement benefits, both of which were denied. The Hearing Officer found the disability retirement application untimely and that the injury was not a result of a direct act of an inmate for performance of duty benefits. The Respondent adopted these findings, leading to this CPLR article 78 proceeding. The court confirmed the determination, dismissing the petition, finding the application for disability benefits untimely and agreeing that a floor waxing by an inmate does not constitute an 'act of an inmate' for performance of duty disability retirement benefits.

Disability RetirementPerformance of Duty DisabilityCorrection OfficerTimeliness of ApplicationAct of an InmateWorkers' Compensation BenefitsMedical Leave of AbsenceCPLR Article 78New York LawPublic Employees
References
2
Case No. 2018-01-0349
Regular Panel Decision
Jan 24, 2019

Rhodes, Jason v. Amazon.com, LLC

Jason Rhodes, an employee of Amazon, sustained a foot injury and sought medical care and temporary partial disability benefits. The dispute arose when Mr. Rhodes declined to see an orthopedist referred by Amazon's authorized treating physician, Dr. Natasha Ballard, citing distance, and instead saw Dr. Jesse Doty. Mr. Rhodes argued that Amazon's practice of directing referrals to a single orthopedist effectively usurped his right to choose a physician under Tennessee law. The Court found Amazon's method of compelling referrals to a specific specialist by removing the treating physician's neutrality was contrary to the spirit of the direct-referral statute. Consequently, the Court ordered Amazon to provide a new panel of orthopedists and to pay Mr. Rhodes temporary partial disability benefits for the period he was out of work.

Workers' CompensationExpedited HearingMedical BenefitsTemporary Partial DisabilityPhysician ChoiceEmployer Referral PolicyOrthopedist PanelCommunity of ResidenceMedical Treatment DisputeFoot Injury
References
4
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
May 22, 1992

Fedorczak v. Dolce

This case involves an appeal from a Supreme Court judgment that annulled determinations by the City of White Plains Commissioner of Public Safety regarding firefighter benefits. The petitioners, firefighters injured in the line of duty, were initially denied benefits under General Municipal Law § 207-a, with their time lost allocated to sick leave. The Supreme Court found that prior Workers' Compensation Board awards had already established that the injuries occurred in the performance of their duties, thus entitling them to benefits. The appellate court affirmed this decision, drawing parallels between General Municipal Law § 207-a and § 207-c, and deeming the respondents' initial determinations arbitrary and capricious. Consequently, the judgment directed the City of White Plains to provide the petitioners with the appropriate benefits under General Municipal Law § 207-a.

FirefightersGeneral Municipal Law § 207-aWorkers' Compensation BoardSick LeaveInjury in Line of DutyCPLR Article 78Appellate DivisionWestchester CountyMunicipal EmployeesPublic Safety
References
5
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