News

Case Summaries

Elder Law

[05/06] FAL-Meridian, Inc. v. US Dep't of Health & Human Serv.
A nursing home's petition to set aside a final decision by the Department of Health and Human Services, that imposed a civil penalty of $7,100 for having violated a regulation under the Medicare and Medicaid provisions of the Social Security Act, is denied as the nursing home failed to tender evidence that would show that it had done everything possible to minimize the risk of an accident to the deceased resident.

[02/05] Villano v. Waterman Convalescent Hosp., Inc.
In plaintiff's action against a convalescent hospital claiming she was admitted without her consent, judgment of the trial court is affirmed where, although a stipulated judgment is appealable, plaintiff cannot show that allegedly erroneous rulings were prejudicial.

[12/22] Massey v. Mercy Med. Center Redding
In plaintiff's negligence action against a nurse and the hospital that employed the nurse alleging that he sustained injury after falling from a walker because the nurse placed the plaintiff on the walker and left him unattended, judgment of the trial court is reversed in part where: 1) the question of nurse's alleged negligence for the fall poses a question of common knowledge, and therefore does not require expert opinion testimony; and 2) trial court's judgment that denied plaintiff's attempt to amend his complaint to add causes of action for battery, fraud and elder abuse is affirmed.

[12/21] Grace Healthcare of Benton v. US Dept. of Health & Hum. Servs.
In a petition for review of a civil monetary penalty imposed by the Secretary of the Department of Health and Human Services on petitioner nursing home for an "immediate jeopardy" violation of 42 C.F.R. section 483.13(c), which required nursing homes to thoroughly investigate all allegations of resident neglect or abuse, including injuries of unknown sources, the petition is granted where the Secretary's finding of the likely harm necessary to warrant an immediate-jeopardy-level finding was based on pure speculation and not supported by substantial evidence in the administrative record as a whole.

[12/01] Yarick v. Pacificare of California
In plaintiff-estate's suit against defendant health care providers and health care benefits providers alleging that the events resulting in decedent's death happened because of the financial pressures and incentive that arose from the care providers' contracts with the defendants, trial court's order sustaining defendants' demurrer is affirmed as: 1) federal law expressly preempts applications of state laws where standards for Medicare Advantage plans are established pursuant to the Medicare law; and 2) to the extent the plaintiff seeks to allege causes of action based on state common law concepts of duty independent of the Health and Safety Code provisions cited, those common law causes of action are preempted.

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ERISA

[06/24] Simonia v. Glendale Nissan/Infiniti Disability Plan
In plaintiff's appeal from the district court's denial of his motion for attorney's fees under the Employee Retirement Income Security Act of 1974 (ERISA), the order is affirmed where: 1) district courts must consider the Hummell factors after they have determined that a litigant has achieved "some degree of success on the merits,"; but 2) even assuming plaintiff achieved some degree of success on the merits, the Ninth Circuit agreed with the district court's conclusion that fees are nonetheless inappropriate after applying the Hummell factors.

[06/24] Edwards v. A.H. Cornell & Son, Inc.
In plaintiff's suit against her employers and supervisors, claiming that she was terminated in violation of section 510 of ERISA and state common law after complaining to management about alleged ERISA violations, district court's grant of defendants' motion to dismiss is affirmed as unsolicited internal complaints are not protected activities under the anti-retaliation provision of section 510 of ERISA.

[06/24] Durakovic v. Bldg. Serv. 32 BJ Pension Fund
In an ERISA challenge to a union disability-benefits denial, dismissal of the complaint is reversed where: 1) a fund organized pursuant to 29 U.S.C. section 186(c)(5) is conflicted within the meaning of Metropolitan Life Insurance Company v. Glenn, 128 S. Ct. 2343 (2008); 2) the district court should have accorded the conflict in this case more weight; and 3) no rational trier of fact could have failed to conclude that the benefits denial was arbitrary and capricious.

[06/22] Winnett v. Caterpillar, Inc.
In an interlocutory appeal brought by Caterpillar from the district court's decision preliminarily enjoining the company to provide a subclass of 275 plaintiffs who retired from a Caterpillar subsidiary between 1992 and 1998 with "lifetime cost-free retiree health care," the decision is reversed as the statute of limitations bars the claims of this subclass because the the claim accrued at least by 1998 when the union and the company reached a new labor agreement that altered the healthcare benefits available to retirees.

[06/21] Ringwald v. Prudential Ins. Co. of Am.
In an action seeking long-term disability benefits under a plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), summary judgment for defendant is reversed where there were no terms in the plan that allowed it to be amended by inserting into the Summary Plan Description such critical provisions as the administrator's discretionary authority to interpret the plan or to determine eligibility for benefits.

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Workers' Comp

[06/24] Bifulco v. Patient Bus. & Fin. Serv., Inc.
In plaintiff's wrongful termination suit against her former employer, Fifth District's reversal of trial court's grant of defendant's motion for summary judgment is affirmed as workers' compensation retaliation claims brought against the state under section 440.205 are not subject to the presuit notice requirements of section 768.28(6)

[06/22] Hawaii Stevedores, Inc. v. Ogawa
In a petition for review of a decision of the Benefits Review Board (BRB) affirming an Administrative Law Judge's (ALJ) grant of disability benefits under the Longshore and Harbor Workers' Compensation Act, the petition is granted in part where: 1) the mere fact that an expert witness talked with a party's lawyer and then altered his or her opinion language, though it might be considered relevant, did not require a factfinder to find that expert witness was other than credible; and 2) the ALJ's finding of the maximum medical improvement date was not supported by substantial evidence. However, the petition is denied in part where: 1) the ALJ's finding that petitioner did not meet its burden of demonstrating prejudice was supported by substantial evidence, and respondent's late notice was properly excused; and 2) respondent's stroke qualified as a compensable injury under the Longshore Act.

[06/11] Zenith Ins. Co. v. Ayala
In a worker's compensation suit, the court of appeals' affirmance of trial court's holding that the insurer waived its right to contest compensability by not timely disputing the claimant's lumbar condition diagnosis is reversed and remanded as the sixty-day period for challenging compensability does not apply to a dispute over extent of injury.

[06/04] Nat'l Union Fire Ins. Co. v. VP Bldg., Inc.
In Chapter 11 proceedings, district court's affirmance of the bankruptcy court's decision disallowing an insurer's petition for administrative expenses, on the ground that the claim was not "actual" and did not benefit the estate, is affirmed as pursuant to In re HNRC Dissolution Co., 371 B.R. 210, (E.D. Ky. 2007), the insurer's request for reimbursement is not an "actual" expense within the meaning of the bankruptcy code.

[05/07] In re Odyssey Healthcare, Inc.
In plaintiff's negligence case against her employer, defendant's petition for writ of mandamus is conditionally granted as, the trial court abused its discretion by refusing to grant the defendant's motion to compel arbitration as the plaintiff failed to prove a valid defense against enforcement of her agreement to arbitrate disputes with her employer.

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Government Benefits

[06/25] Rice v. Astrue
In plaintiff's appeal from the district court's order requiring her attorney to remit a portion of her Equal Access to Justice Act (EAJA) award if she won attorney's fees at the administrative level, the order is reversed where a federal court may not condition the amount of its EAJA award of attorney's fees on a future grant of attorney's fees by the Commissioner of Social Security.

[06/22] Hawaii Stevedores, Inc. v. Ogawa
In a petition for review of a decision of the Benefits Review Board (BRB) affirming an Administrative Law Judge's (ALJ) grant of disability benefits under the Longshore and Harbor Workers' Compensation Act, the petition is granted in part where: 1) the mere fact that an expert witness talked with a party's lawyer and then altered his or her opinion language, though it might be considered relevant, did not require a factfinder to find that expert witness was other than credible; and 2) the ALJ's finding of the maximum medical improvement date was not supported by substantial evidence. However, the petition is denied in part where: 1) the ALJ's finding that petitioner did not meet its burden of demonstrating prejudice was supported by substantial evidence, and respondent's late notice was properly excused; and 2) respondent's stroke qualified as a compensable injury under the Longshore Act.

[06/18] Action Alliance of Senior Citizens v. Sebelius
In an action seeking to retain plaintiffs' mistaken refunds of their Medicare premiums, dismissal of the action is affirmed where the Social Security statute allowed waiver from recovery of overpaid Social Security benefits, not waiver from recovery of mistaken Medicare Part D premium refunds.

[06/18] Jennifer Matthew Nursing & Rehab. Ctr. v. US Dept. of Health & Hum. Servs.
In a petition for review of a ruling by the Appeals Board of the U.S. Department of Health and Human Services affirming the decision of an Administrative Law Judge that upheld the assessment of an $80,000 civil monetary penalty for regulatory violations imposed by the Centers for Medicare and Medicaid Services against a certified nursing facility formerly owned and operated by petitioner, the petition is dismissed as moot where, subsequent to the filing of the petition, the new owner-operator satisfied the civil monetary penalty assessed against the facility.

[06/17] Price v. Wolford
In the Oklahoma Health Care Authority (OHCA)'s appeal from the district court's order allotting part of a malpractice settlement to OHCA in full satisfaction of the lien, the order is reversed where the district court correctly construed Oklahoma law but erred in finding that the settling parties had proved by clear and convincing evidence that only $67,666.67 of the settlement could be attributed to medical care paid by Medicaid.

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